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chlorambucil +rituximab

Julia von Tresckow, Barbara Eichhorst, Jasmin Bahlo, Michael Hallek
BACKGROUND: Chronic lymphocytic leukemia (CLL) mainly affects older persons and is the commonest form of leukemia, with an incidence of 6 cases per 100 000 per- sons per year. In Germany, approximately 1000 men and 850 women die of CLL each year. METHODS: This review is based on pertinent publications retrieved by a selective literature search in PubMed and on the authors' scientific and clinical experience. RESULTS: The diagnosis of CLL requires the detection of at least 5000 B-lymphocytes per microliter in the peripheral blood...
January 25, 2019: Deutsches Ärzteblatt International
Candida Vitale, Alessandra Ferrajoli
No abstract text is available yet for this article.
January 2019: Haematologica
Nitin Jain
The treatment landscape of chronic lymphocytic leukemia (CLL) has changed dramatically in the last few years. The role of chemoimmunotherapy has declined significantly for patients with CLL. Fludarabine, cyclophosphamide, rituximab chemotherapy remains the standard frontline therapy for young fit patients with CLL, especially if IGHV mutated. For older adults, ibrutinib has been shown to be superior to chlorambucil. Hence, the role of chlorambucil monotherapy in the current era in the management of CLL is limited...
November 30, 2018: Hematology—the Education Program of the American Society of Hematology
Sandra Eketorp Sylvan, Anna Asklid, Hemming Johansson, Jenny Klintman, Jenny Bjellvi, Staffan Tolvgård, Eva Kimby, Stefan Norin, Per-Ola Andersson, Claes Karlsson, Karin Karlsson, Birgitta Lauri, Mattias Mattsson, Anna Bergendahl Sandstedt, Maria Strandberg, Anders Österborg, Lotta Hansson
The aim of this study was to investigate long-term outcome following first line therapy in consecutive chronic lymphocytic leukemia patients in a well defined geographic area (Sweden). All patients diagnosed with chronic lymphocytic leukemia (2007-2013) (n=3672) were identified from national registries, screening of patient files identified all (100%) first line treated (n=1053) and for those, depth analysis was performed. Endpoints were overall response rate, progression-free survival, overall survival and safety...
November 22, 2018: Haematologica
Othman Al-Sawaf, Jasmin Bahlo, Sandra Robrecht, Kirsten Fischer, Carmen D Herling, Manuela Hoechstetter, Anna-Maria Fink, Julia von Tresckow, Petra Langerbeins, Paula Cramer, Stephan Stilgenbauer, Clemens M Wendtner, Barbara Eichhorst, Michael Hallek, Valentin Goede
Clinical management of chronic lymphocytic leukaemia (CLL) in patients aged ≥80 years is based on limited evidence due to the lack of published information. Therefore, we analysed CLL patients aged ≥80 years using data from seven phase III clinical trials of the German CLL Study Group. Among 3552 participants, 152 were ≥80 years old at initiation of first-line study treatment. Median age was 82 years (range 80-90). Concomitant diseases were present in 99% of the patients, with a median cumulative illness rating scale score of 8 (0-18)...
December 2018: British Journal of Haematology
Anton W Langerak, Matthias Ritgen, Valentin Goede, Sandra Robrecht, Jasmin Bahlo, Kirsten Fischer, Michael Steurer, Marek Trněný, Stephen P Mulligan, Ulrich J M Mey, Kerstin Trunzer, Günter Fingerle-Rowson, Kathryn Humphrey, Stephan Stilgenbauer, Sebastian Böttcher, Monika Brüggemann, Michael Hallek, Michael Kneba, Jacques J M van Dongen
No abstract text is available yet for this article.
November 19, 2018: Blood
C Briani, A Visentin, A Salvalaggio, M Cacciavillani, L Trentin
BACKGROUND AND PURPOSE: Rituximab, a chimeric anti-CD20 monoclonal antibody, has been used in polyneuropathy associated with anti-myelin-associated glycoprotein (anti-MAG) antibody polyneuropathy with controversial results. Herein, two patients with anti-MAG antibody neuropathy and concurrent chronic lymphocytic leukemia (CLL) are reported, who dramatically responded to obinutuzumab, a novel glycoengineered humanized anti-CD20 monoclonal antibody. METHODS: Patient 1 was an 82-year-old man with severe demyelinating sensory-motor neuropathy...
February 2019: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Tadeusz Robak, Jan A Burger, Alessandra Tedeschi, Paul M Barr, Carolyn Owen, Osnat Bairey, Peter Hillmen, David Simpson, Sebastian Grosicki, Stephen Devereux, Helen McCarthy, Steven E Coutre, Hang Quach, Gianluca Gaidano, Zvenyslava Maslyak, Don A Stevens, Carol Moreno, Devinder S Gill, Ian W Flinn, John G Gribben, Ahmad Mokatrin, Mei Cheng, Lori Styles, Danelle F James, Thomas J Kipps, Paolo Ghia
Chemoimmunotherapy (CIT) and targeted therapy with single-agent ibrutinib are both recommended first-line treatments for chronic lymphocytic leukemia (CLL), although their outcomes have not been directly compared. Using ibrutinib data from the RESONATE-2 (PCYC-1115/1116) study conducted in patients ≥65 years without del(17p), we performed a cross-trial comparison with CIT data from published phase 3 studies in first-line treatment of CLL. Progression-free survival (PFS), overall survival (OS), and safety data for ibrutinib (median follow-up 35...
November 2018: American Journal of Hematology
Arnon P Kater, Marinus H J van Oers, Yvette van Norden, Lina van der Straten, Julia Driessen, Ward F M Posthuma, Martinus Schipperus, Martine E D Chamuleau, Marcel Nijland, Jeanette K Doorduijn, Michel Van Gelder, Mels Hoogendoorn, Francien De Croon, Shulamiet Wittebol, J Martijn Kerst, Erik W A Marijt, Reinier A P Raymakers, Martijn R Schaafsma, Johan A Dobber, Sabina A Kersting, Mark-David Levin
BACKGROUND: Lenalidomide (Len) has been proven effective both as monotherapy and in combination with rituximab for the treatment of chronic lymphocytic leukemia (CLL). Len has shown a distinct and more difficult to manage toxicity profile in the context of CLL, potentially hampering combination treatment with this drug. METHODS: In 1st-line CLL elderly and fludarabine, cyclophosphamide, rituximab (FCR) unfit patients, we conducted a phase 1-2 study to evaluate efficacy and safety of 6 cycles of chlorambucil (7mg/m2 on days 1-7), rituximab (375mg/m2 cycle 1 and 500mg/m2 cycle 2-6) and individual dosed Len (started on day 9 of cycle 1 2...
August 16, 2018: Haematologica
Jason Hew, Dat Pham, Trevanne Matthews Hew, Vinay Minocha
We report the case of a patient with B-cell prolymphocytic leukemia who was successfully treated with the novel humanized monoclonal antibody obinutuzumab. This patient was previously treated with the combination of rituximab and bendamustine and had recurrent infusion reactions. Her treatment with rituximab and bendamustine was discontinued when she developed disease progression after 3 cycles of therapy. She was then treated with obinutuzumab 1000 mg on day 1 of every cycle and chlorambucil 0.5 mg/kg on days 1 and 15 every 28 days to which she had greater tolerability...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Yvonne A Dei-Adomakoh, Leslie Quarcoopome, Afua D Abrahams, Catherine I Segbefia, Dzifa I Dey
Castleman disease is a rare cause of lymphoid hyperplasia and may result in localized symptoms or an aggressive, multisystem disorder. It can mimic other diseases like lymphoma or tuberculosis. It classically presents as a mediastinal mass that involves the lymphatic tissue primarily but can also affect extra lymphatic sites including the lungs, larynx, parotid glands, pancreas, meninges, and muscles. In HIV and HHV8-negative patients with idiopathic multi-centric Castleman disease, pathogenesis may involve autoimmune mechanisms...
March 2018: Ghana Medical Journal
R Lyu, Z J Li, H Li, S H Yi, W Liu, T Y Wang, W J Xiong, L G Qiu
Objective: To summarize and investigate the characteristics, prognosis and treatments of chronic lymphocytic leukemia (CLL) patients with trisomy 12 by using FISH (CEP12). Methods: Clinical data of 330 CLL patients were analyzed retrospectively by using FISH (CEP12) to detect trisomy 12 from May 2003 to April 2015. The clinical data and laboratory characteristics of CEP12 positive patients (70 cases) were compared with those CEP12 negative patients (260 cases). Results: Compared with CEP12 negative CLL patients, the proportion of hepatomegaly (13...
May 14, 2018: Zhonghua Xue Ye Xue za Zhi, Zhonghua Xueyexue Zazhi
Anne-Sophie Michallet, Melih Aktan, Wolfgang Hiddemann, Osman Ilhan, Peter Johansson, Kamel Laribi, Balkis Meddeb, Carol Moreno, João Raposo, Anna Schuh, Ali Ünal, Tom Widenius, Alf Bernhardt, Kerstin Kellershohn, Dimitri Messeri, Stuart Osborne, Véronique Leblond
MABLE investigated the efficacy and safety of rituximab plus bendamustine or rituximab plus chlorambucil in fludarabine-ineligible patients with chronic lymphocytic leukemia. Patients received rituximab plus bendamustine or rituximab plus chlorambucil every four weeks for six cycles. Rituximab plus chlorambucil-treated patients without a complete response after Cycle 6 received chlorambucil monotherapy for at least six additional cycles or until complete response. The primary endpoint was complete response rate (confirmed by bone marrow biopsy) after Cycle 6 in first-line patients...
April 2018: Haematologica
Richa Sinha, William Ken Redekop
BACKGROUND: Ibrutinib shows superiority over obinutuzumab with chlorambucil (G-Clb) in untreated patients with chronic lymphocytic leukemia with comorbidities who cannot tolerate fludarabine-based therapy. However, ibrutinib is relatively more expensive than G-Clb. In this study we evaluated the cost-effectiveness of ibrutinib compared with G-Clb from the United Kingdom (UK) health care perspective. MATERIALS AND METHODS: A 3-state semi-Markov model was parameterized to estimate the lifetime costs and benefits associated with ibrutinib compared with G-Clb as first-line treatment...
February 2018: Clinical Lymphoma, Myeloma & Leukemia
Y Y Mao, X X Cao, H Cai, D B Zhou, J Li
Objective: To evaluate the clinical characteristics, diagnosis criteria, treatment and prognosis in patients with Bing-Neel Syndrome (BNS) . Methods: The clinical characteristics, lab data, treatment and outcomes of 3 Bing-Neel syndrome patients diagnosed at Peking Union Medical College Hospital were collected. Results: The clinical presentation was heterogeneous without any specific common signs or symptoms. One patient was diagnosed with BNS 42 months after diagnosis of Waldenström macroglobulinemia (WM) by cerebrospinal fluid (CSF) cytology and flow cytometry, but dead of infection during the first course of chemotherapy...
December 14, 2017: Zhonghua Xue Ye Xue za Zhi, Zhonghua Xueyexue Zazhi
Emanuele Cencini, Alberto Fabbri, Francesco Lauria, Monica Bocchia
There is no consensus about the best treatment option for patients with HP-negative gastric MALT lymphomas or persistent disease after HP eradication.We have investigated fludarabine and mitoxantrone with rituximab (R-FM) as first-line treatment. A cohort of 13 patients was analyzed. Induction treatment consisted of fludarabine (25 mg/m2 i.v. on days 2 to 4), mitoxantrone (10 mg/m2 i.v. on day 2), and rituximab (375 mg/m2 i.v. on day 1), for up to six cycles every 28 days. All patients achieved a complete remission, a median of four cycles was given...
May 2018: Annals of Hematology
Luca Arcaini, Thierry Lamy, Jan Walewski, David Belada, Jiri Mayer, John Radford, Wojciech Jurczak, Franck Morschhauser, Julia Alexeeva, Simon Rule, José Cabeçadas, Elias Campo, Stefano A Pileri, Tsvetan Biyukov, Meera Patturajan, Marie-Laure Casadebaig Bravo, Marek Trnĕný
In the mantle cell lymphoma (MCL)-002 study, lenalidomide demonstrated significantly improved median progression-free survival (PFS) compared with investigator's choice (IC) in patients with relapsed/refractory MCL. Here we present the long-term follow-up data and results of preplanned subgroup exploratory analyses from MCL-002 to evaluate the potential impact of demographic factors, baseline clinical characteristics and prior therapies on PFS. In MCL-002, patients with relapsed/refractory MCL were randomized 2:1 to receive lenalidomide (25 mg/day orally on days 1-21; 28-day cycles) or single-agent IC therapy (rituximab, gemcitabine, fludarabine, chlorambucil or cytarabine)...
January 2018: British Journal of Haematology
Soheil Tavakolpour
Systemic administration of corticosteroid (CS) remains the standard gold treatment for pemphigus. However, because of several long-term adverse effects, steroid-sparing agents are usually prescribed in combination with CSs. Despite the high number of available studies, the choice of best drugs to treat pemphigus remains controversial. Therapeutic approaches for pemphigus can be divided into traditional treatment and emerging ones. Personalized medicine, which aims to increase the efficacy as well as reduce adverse effects of treatments, could be considered as the future option...
December 2017: International Immunopharmacology
Sabina Kersting, Suzanne I M Neppelenbroek, Hein P J Visser, Michel van Gelder, Mark-David Levin, Rogier Mous, Ward Posthuma, Hanneke M van der Straaten, Arnon P Kater
INTRODUCTION: In recent years, considerable progress has been made in the treatment of patients with chronic lymphocytic leukemia (CLL), and new potent drugs have become available. Therefore, the CLL working party revised the Dutch guidelines. Not only efficacy but also quality of life and socio-economic impact were taken into account in the formulation of treatment recommendations. MATERIALS AND METHODS: The working party discussed a set of questions regarding diagnostic tests and treatment and wrote the draft guideline...
January 2018: Clinical Lymphoma, Myeloma & Leukemia
Idanna Innocenti, Francesco Autore, Raffaella Pasquale, Francesca Morelli, Dimitar G Efremov, Luca Laurenti
Elderly patients with chronic lymphocytic leukemia (CLL) or patients with comorbidities are often treated with chlorambucil (Chl) as front-line therapy despite relatively low response rates. The addition of a monoclonal anti-CD20 antibody to Chl substantially increases response rates and prolongs progression-free survival (PFS) in these patients, without increasing toxicity. As a result, the ESMO guidelines recommend that previously untreated CLL patients with relevant co-morbidity, but without TP53 deletion/mutation, should be treated with the combination of Chl plus an anti-CD20 antibody (rituximab, ofatumumab or obinutuzumab)...
December 2017: Expert Review of Hematology
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