ASH Presentations on NHL Novel Therapies Highlight Expanding Options for Patients
Though much of the lymphoma research presented at the Annual Meeting of the American Society of Hematology (ASH) in December 2014 focused on the growing number of novel therapies for this disease, a subset of presentations focused on the impact of non-pharmaceutical treatment issues such as patient quality of life, maintenance scans, and the presence or absence of various risk factors. These studies, a selection of which are summarized below, demonstrate that research beyond pharmaceutical trials is a crucial component of continuing to improve survival rates in lymphoma.
Patient Reported Quality of Life at Diagnosis Correlates to Survival Rates for Aggressive Lymphomas
A study of 701 patients enrolled in the University of Iowa/Mayo Clinic SPORE Molecular Epidemiology Resource found that patients' self-assessment of their quality of life at time of their lymphoma diagnosis correlates to outcome and survival rates for a number of aggressive T- and B-cell lymphomas. Within 9 months of their diagnosis, patients completed self-assessments measuring physical, social/family, emotional, functional, and spiritual well-being, as well as overall quality of life, which were then translated to a numerical figure on a scale of 0-100. Researchers found that patients with a clinically deficient quality of life (less than 50 on the scale) had a median overall survival of 59 months, compared to 121 months for patients with a quality of life score greater than 50. In fact, all quality of life measures but emotional well-being were significantly associated with overall survival.
The study suggests that patient-reported outcomes are as important as more objective prognostic measures, and that quality of life assessments at diagnosis can be an effective prognostic factor in patients with aggressive lymphoma. Researchers on this study included Lymphoma Research Foundation (LRF) Scientific Advisory Board members Stephen M. Ansell, MD, PhD and Thomas M. Habermann, MD, both of Mayo Clinic, and Brian K. Link, MD of the University of Iowa. The abstract for this presentation is available here: https://ash.confex.com/ash/2014/webprogram/Paper68472.html.
Researchers Establish 12 Months Event-Free Survival as Clinical Endpoint for Follicular Lymphoma
The growing effectiveness of immunochemotherapy treatments in follicular lymphoma (FL) has prolonged overall survival for patients with that subtype, to the extent that many patients die not from their disease, but from other causes common to their age and gender. In another study utilizing the University of Iowa/Mayo Clinic SPORE database, researchers examined the records of 936 newly diagnosed FL patients in, measuring the patients' event free survival (time from diagnosis to progression, relapse, retreatment or death from any cause) and overall survival rates. They found that patients who achieved an event free survival of 12 months post-diagnosis had overall survival rates comparable to the general population, regardless of whether they had an event after the 12 month mark. Meanwhile, the 17 percent of patients who had an event prior to 12 months post-diagnosis had poorer overall survival. Similar rates and results were found in a replication study of a hospital registry in Lyon, France.
The researchers, including LRF Scientific Advisory Board members Stephen M. Ansell, MD, PhD, Thomas E. Witzig, MD and Thomas M. Habermann, MD of Mayo Clinic and Brian K. Link, MD of the University of Iowa, noted that their results may be useful for future recommendations for patient care and counseling, as well as for establishing endpoints in other FL clinical studies. The abstract for this study may be viewed here: https://ash.confex.com/ash/2014/webprogram/Paper69587.html.
Patients with HIV-Related Lymphoma Can Successfully Undergo Autologous Stem-Cell Transplant
HIV infection often increases the risk of developing lymphoma, however many centers do not offer autologous stem-cell transplant (ASCT) to patients with HIV-related lymphomas due to their historically poor survival rates and the risk of infection. However, the success of highly active antiretroviral therapy (HAART) for HIV positive patients has improved the prognosis for this subgroup and may mean they can receive treatment identical to uninfected lymphoma patients. Researchers compared the outcomes of a group of 40 HIV-positive patients who underwent ASCT to treat lymphoma with 151 HIV-negative patients who received the same treatment. One year post-transplant, overall survival for the HIV-positive group was estimated at 86.6 percent with progression-free survival at 82.3 percent, outcomes which were comparable to the HIV-negative cohort.
The researchers, including former LRF Scientific Advisory Board member Richard Ambinder, MD, PhD of Johns Hopkins School of Medicine, said their results showed that HIV infection should not be a bar to receiving transplant for lymphoma and that the standard of care for these patients should expand to include ASCT. The abstract for this presentation is available here: https://ash.confex.com/ash/2014/webprogram/Paper70947.html.
Gender and Body Mass Index May Effect Treatment Outcomes in Older DLBCL Patients
A study investigating the relationship between outcomes in DLBCL patients and their body mass index (BMI) and gender revealed that older men in particular have poorer outcomes at the current standard dose of rituximab (Rituxan). Researchers used the National Comprehensive Cancer Network (NCCN) non-Hodgkin lymphoma database to identify 1,386 DLBCL patients, 627 of whom were elderly (over 60), analyzing long-term outcomes such as progression free survival and overall survival at 3 years based on patient gender, age, and BMI. All patients received rituximab as part of their first-line treatment. The data revealed that, where patients had a BMI of less than 25 (not considered overweight), female patients had better outcomes than male patients, but that this advantage decreased in patients with BMI of more than 25. This discrepancy between genders was also found in the elderly patients, with elderly male patients with a BMI of less than 25 having the poorest outcomes, but not in patients younger than 60. Citing previous studies that suggested elderly men clear rituximab from their systems faster than other patient groups, the researchers noted that their reports support current ongoing trials to evaluate whether men older than 60 should receive enhanced rituximab dosing to improve their outcomes.
Researchers on this study included LRF Scientific Advisory Board members, Leo I. Gordon, MD of Northwestern University Medical Center, Ann S. LaCasce, MD of Dana-Farber Cancer Center, Myron S. Czuczman, MD of Rosewell Park Cancer Institute, Andrew D. Zelenetz, MD, PhD of Memorial Sloan Kettering Cancer Center, and Jonathan W. Friedberg, MD of the University of Rochester. The abstract of this study is available here: https://ash.confex.com/ash/2014/webprogram/Paper69604.html.
Studies Assess PET Scans as Tool for Guiding Therapy in Lymphoma
Two studies at ASH investigated the effectiveness of using positron emission tomography (PET) scans to guide treatment for lymphoma patients. Researchers on the PETAL trial in Germany initiated a randomized study, in which 107 patients (out of a group of 926) who had an unfavorable PET scan after 2 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) were randomized to either move to a more intensive therapy regimen or receive an additional 6 cycles of R-CHOP. Although the PET scan did prove to be an effective predictor of poor outcomes, the researchers found that there was no significant difference in treatment outcomes for those that switched to the more aggressive therapy midway through their treatment. The abstract on this study may be viewed here: https://ash.confex.com/ash/2014/webprogram/Paper70126.html.
A separate study examined diffuse large B-cell lymphoma (DLBCL) patients who received a PET scan after 3 cycles of R-CHOP; those with positive scans (showing continued disease progression) were moved to a more aggressive R-ICE regimen (rituximab, ifosfamide, carboplatin, and etoposide). Similar to the PETAL trial, the researchers found that, though the scans were effective at predicting poor outcomes, the switch to R-ICE did not significantly improve patient outcomes. The researchers, including LRF Scientific Advisory Board members Laurie H. Sehn, MD, MPH and Randy Gascoyne, MD, as well as former SAB member Joseph M Connors, MD all of British Columbia Cancer Agency in Vancouver, suggested that R-ICE may not be sufficient to overcome the inherent resistance to chemotherapy in the group with poorer outcomes. The abstract on this study may be viewed here: https://ash.confex.com/ash/2014/webprogram/Paper76195.html.