Introduction: Primary mediastinal B cell lymphoma (PMBL) is clinically and biologically distinct from the other subtypes of diffuse large B cell lymphoma (DLBCL), typically affecting young female ...patients (pts) with a bulky mediastinal mass. Standard treatment (TRT) is a combination of anti-CD20 antibody (Ab) and anthracycline-based chemotherapy. We aimed to compare patients' outcomes after CHOP delivered every 21 days (CHOP21) or 14 days (CHOP14) or ACVBP combined with anti-CD20 Ab in real life.
Methods: All Pts treated in LYSA centers were eligible in this retrospective analysis. Inclusion criteria were as follow: age ≥18 years (yrs), newly diagnosed PMBL, TRT with CHOP or ACVBP plus anti-CD20 Ab between 2006 and 2017, and patient non-opposition statement. Primary endpoint was progression-free survival (PFS), secondary endpoints were: overall survival (OS), response rate (Lugano 2014) and total metabolic tumor volume (TMTV).
Results: 313 pts were enrolled from 25 LYSA centers in France and Belgium. In all, median age at diagnosis was 32 (18-88) yrs. Majority of pts were female pts (60.7%) and presented at diagnosis with a good performance status (0-1: 81.8%), stage I-II (57.5%), elevated LDH (85%), Bulk>10cm (58.5%) and low/low-intermediate aaIPI 0-1 (56.7%). Pts in the CHOP21 (n=57) group were older (median 40 yrs, vs 33 vs 29.5, p<0.001), had more frequent low/low-intermediate risk aaIPI (71.4%, vs 55.6% vs 52.5%, p=0.044) and displayed a lower proportion of elevated LDH (66.7%, vs 88.2% vs 83.9%, p=0.014) as compared to CHOP14 (n=76) and ACVBP (n=180), plus anti CD20 Ab (Rituximab: n=296, obinutuzumab: n=17). 229 pts (73.2%) received intrathecal prophylaxis. Median number of chemotherapy cycles for CHOP21, CHOP14 and ACVBP groups were: 6 (1-8), 7.5 (1-8) and 4 (1-4), respectively. Consolidation ASCT was performed for 1 (1.8%), 24 (31.6%) and 46 (25.6%) pts, (p<0.001) and mediastinal RT was delivered to 2 (3.5%), 11 (14.5%) and 4 (2.2%) pts, respectively (p<0.001). ASCT + RT was done for 0, 5 (6.6%) and 3 (1.7%) pts, respectively (p=0.043). Baseline TMTV assessment was available for 233 pts (74.4%).
Complete metabolic response rates at end of TRT were comparable between CHOP21, CHOP14 and ACVBP groups: 81.1%, 90.9%, and 85.5%, respectively (p=0.46).
37 (11.8%) pts progressed including 32 (10.2%) who displayed primary refractory disease and 6 (16.2%) pts who relapsed after consolidation ASCT. CNS relapse occurred in 9 (2.9%) pts. Median time between ASCT and relapse was 3 (2-58) months. Patients received the following salvage TRTs: high dose chemotherapy (HDC: R-ICE/R-DHAOX-like) (n=30) followed by second-line consolidation ASCT (n=11/30) and post-ASCT mediastinal RT (n=5/11); salvage RT without chemotherapy (n=1); other regimens (R-CHOP, R-GEMOX) (n=3); none (n=3). 2-yrs second PFS (PFS2) rates in pts who had previously received CHOP21, CHOP14 and ACVBP were: 20.5% vs 62.5% vs 18.8% (p=0.43). Only HDC + ASCT strategy granted disease control (2-yrs PFS2: 32.3%).
Median follow up was 44 (1-153) months and the CHOP21, CHOP14, ACVBP 5-yrs PFS and 5-yrs OS were: 74.7% (95%CI: 64-97.1%), 89.4% (82.7-96.6%), 89.4% (84.8-94.2%) (p=0.018, Figure A); and 81% (70-94.4%), 100% (100-100%), 92.4% (88.4-96.7%) (p=0.0036, Figure B), respectively. In a multivariate model including TRT group, consolidation ASCT and/or RT, aaIPI, Bulk>10cm and TMTV≥360cm3, CHOP14 was not associated with better PFS as compared to ACVBP and CHOP21 (p=0.1548). Baseline higher TMTV (≥ 360 cm3) was associated with lower PFS in multivariate analysis, independently of TRT (HR=0.41 0.2-0.85, p=0.02).
All grades TRT-related adverse events were similar between the groups, except for an excess of febrile neutropenia (5.3% vs 5.3% vs 24.4%, p<0.001) and mucositis (1.8% vs 3.9% vs 22.8%, p<0.001) in the ACVBP group. Twenty-two pts died (CHOP21: n=8, ACVBP: n=14) mainly due to lymphoma progression (n=15; 68.2%). 2 toxic deaths were observed (CHOP21: n=1, ACVBP: n=1). Secondary malignancies appeared in 7 pts (CHOP21: n=2, ACVBP: n=5), including 3 cases of acute myeloid leukemia.
Conclusion
These results confirm the favorable outcome of PMBL pts treated with CHOP14 and ACVBP plus anti CD20 Ab. The toxicity of ACVBP was more pronounced and CHOP14 was associated with a better OS. Baseline TMTV≥360cm3 is a highly predictive factor of unfavorable outcome in PMBL pts, independently of TRT. We recommend R-CHOP14 as standard of care in PMBL.
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Camus:ROCHE: Consultancy, Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); PFIZER: Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); AMGEN: Honoraria; JANSSEN: Honoraria. Decazes:Bayer: Other: travel, accomodations, expenses. Bernard:Janssen: Other: Travel and accommodation . Gandhi Laurent:Abbevie, Pfizer, Takeda, Roche: Other: Travel; Roche, Takeda, Iqone, Accord: Consultancy; Roche, Takeda, Accord: Honoraria. Laribi:amgen: Research Funding; novartis: Honoraria, Research Funding; takeda: Research Funding; abbvie: Honoraria, Research Funding. Houot:Gilead: Honoraria; Kite: Honoraria; Roche: Honoraria; Novartis: Honoraria; Janssen: Honoraria; Celgene: Honoraria; Bristol-Myers Squibb: Honoraria; MSD: Honoraria. Tilly:BMS: Honoraria.
The ubiquitous, early‐stage expression, efficient internalization, limited off‐target effects, and high disease specificity of CD19 make it an attractive therapeutic target. Currently available ...anti‐CD19 therapies have demonstrated particular promise in patients with relapsed or refractory B‐cell non‐Hodgkin lymphoma. Selection of the most appropriate treatment strategy should be based on individual patient characteristics and the goal of therapy. However, evidence and knowledge about the sequencing of anti‐CD19 therapies are limited. Here, we review the current evidence for CD19 as a target in diffuse large B‐cell lymphoma and consider approaches to the use of anti‐CD19 therapy.
Introduction
High risk stage IIB Hodgkin lymphoma (HL) with mediastinum-to-thorax ratio of ≥0.33 or extranodal localization are defined as a poor prognosis subset according to German Hodgkin study ...group (Sieber et al., Ann. of Oncol. 2000). These patients were treated consecutively in our group as limited stage in the EORTC/LYSA/FIL H10 study (André et al, JCO 2017) or advanced stage in the AHL2011 LYSA trial (Casasnovas et al., Lancet Oncol 2019). However, the relative efficacy of each of these strategies to control disease is unknown in this uncommon subset of patients. In the present retrospective study, we compared the outcome of patients with high risk stage IIB included in the H10 and AHL2011 studies, and analyzed prognostic factors.
Methods
We included patients with Ann-Arbor disease stage IIB with mediastinum-to-thorax (M/T) ratio of ≥0.33 or extranodal localization enrolled in the H10 or AHL2011 trials, aged between 16 and 60 years for AHL2011 and 18-60 years for H10 with newly diagnosed Hodgkin lymphoma excluding nodular lymphocyte predominant subtype, who had baseline PET and PET2 images available in the LYSA database. In H10 trial, after 2 cycles of ABVD patients received in the standard arm 2 additional cycles of ABVD plus INRT 30 Gy, in the experimental arm 2 to 4 additional cycles of ABVD;- in PET2 negative patients 4 additional cycles of ABVD (or after the trial amendment 2 additional cycles of ABVD plus INRT 30 Gy); - in PET2 positive patients 2 cycles of escalated BEACOPP plus INRT 30Gy. PET2 were reported according to IHP criteria. In AHL2011 study, after 2 upfront escalated BEACOPP patients received either 4 additional escalated BEACOPP in the standard arm and PET2 positive patients of the PET-driven arm, or 4 cycles of ABVD in PET2 negative patients of the PET-driven arm. PET2 were reported using Deauville score (DS 1-2-3 vs 4-5), DS4 being defined positive if SUVmax of the residual lesion >140% of SUVmax of the liver background.
Baseline clinical and biological characteristics of patients enrolled in both studies were compared. Total metabolic tumor volume (TMTV) at baseline was calculated with the Beth Israel Fiji software based on a 41% SUVmax cutoff of each lesion. In this study, all PET2 response was reanalysed using Deauville score And PET positivity was defined according to the criteria used in the AHL2011 trial.
Results
148 patients were eligible for the study, including 83 and 65 patients enrolled in the AHL2011 and H10 trials respectively. The median age was 27 years (16; 59), 51.4% of patients were treated according to the experimental arm of each trial, the median size of the bulky mass was 84 mm (20-197), the index prognostic score (IPS) was 3 or higher in 29.1% of cases (38.6% in AHL2011 and 16.9% in H10 patients), the median TMTV value was 155.5 ml (8.3-782.9). Most patients had M/T ratio of ≥0.33 (98.6%) and 10.9% had an extra-nodal involvement. 62.2 % of patients had a treatment strategy including escalated BEACOPP and 31.8% received radiotherapy. PET2 was positive in 16.9% (n=14) of AHL2011 cohort and 9.2% (n=6) in H10 cohort patients. With a median follow-up of 4.2 and 4.4 years in AHL2011 and H10 trials respectively, 16 patients (10.8%) relapsed including 7 (10.7%) patients in H10 and 9 (10.8%) in AHL2011, and five deaths occurred with three due to lymphoma progression . Eleven relapses (68.8% for all, 8 for AHL2011 and 3 for H10) were localized in mediastinum.
In univariate analysis, PET2 response, baseline TMTV (155 ml cut off) and IPS (0-2 vs 3-7) significantly influenced PFS with hazard ratios of 6.26 (2.29-17.07), 3.37 (1.093-10.371), 2.89 (0.94-8.86) respectively. The strategy of treatment, either H10 or AHL2011, did not influence PFS. In multivariate analysis stratified on the study (figure 1), only the TMTV as continuous variable (HR: 1.003; 1.000-1.005) and PET2 response (HR: 5.38; 1.99-14.56) were prognostic factors. Among the thirteen patients with high TMTV and PET2 positivity, 7 relapsed (4 for AHL2011 and 3 for H10).
Conclusions
This is the first study comparing two strategies of treatment in high risk stage IIB lymphoma patients included in two large randomized clinical trials. PFS of these patients was 88.0% (95%CI = 81.2%; 92.4%) at 4 years and similar regardless the study treatment. Baseline TMTV and PET2 response were the main factors influencing the outcome of high risk stage IIB lymphoma patients.
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André:Takeda: Membership on an entity's Board of Directors or advisory committees; Bristol-Myers-Squibb: Membership on an entity's Board of Directors or advisory committees; Karyopharm: Membership on an entity's Board of Directors or advisory committees; Gilead: Membership on an entity's Board of Directors or advisory committees, Other: Travel grants; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Roche: Other: Travel grants, Research Funding; Amgen: Other: Travel grants, Research Funding; Johnson & Johnson: Research Funding; Takeda Millenium: Research Funding; Chugai: Research Funding; Celgene: Other: Travel grants, Research Funding. Brice:Takeda France: Consultancy, Honoraria; Millennium Takeda: Research Funding; BMS: Honoraria. Stamatoullas:Takeda: Consultancy; Celgene: Honoraria. Federico:Seattle Genetics: Research Funding; Allos: Research Funding; Spectrum: Consultancy, Honoraria; Medimmune: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Roche: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Teva: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Research Funding; Mundipharma: Consultancy, Honoraria. Casasnovas:Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel expenses; Merck Sharp and Dohme: Membership on an entity's Board of Directors or advisory committees, Other: Travel support, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel support; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees.
Background: DLBCL is an aggressive non-Hodgkin lymphoma (NHL) with poor outcomes in the R/R setting; overall survival (OS) is 28% at 1 year and 20% at 2 years in refractory patients (Crump, Blood ...2017). Outcomes are particularly poor for patients ineligible for stem cell transplant (SCT). Ibrutinib is the only once-daily inhibitor of Bruton's tyrosine kinase and is approved for the treatment of various B-cell malignancies. Based on preclinical models, ibrutinib and lenalidomide, an immunomodulator that downregulates the MYD88 pathway, may synergize when combined (Yang, Cancer Cell 2012). Rituximab, an anti-CD20 antibody, has shown activity combined with ibrutinib in NHL (Wang, Lancet Onc 2016). PCYC-1123 is a multicenter, open-label phase 1b/2 study (NCT02077166) evaluating the combination of ibrutinib, lenalidomide, and rituximab (iR2) in R/R DLBCL.
Methods: Patients ≥18 years of age with R/R non-GCB DLBCL ineligible for SCT received lenalidomide 20 or 25 mg orally on Days 1-21 of each 28-day cycle plus ibrutinib 560 mg orally once daily and rituximab 375 mg/m2 IV on Day 1 of Cycle 1-6. Treatment was continued until progressive disease (PD) or unacceptable toxicity. Immunohistochemistry (IHC) was performed by central laboratory per the Hans algorithm. The primary endpoint was overall response rate (ORR); secondary endpoints were complete response (CR), duration of response (DOR), progression-free survival (PFS), OS, and safety. Response was determined by investigator assessment per Cheson (J Clin Oncol 2014) every 3 treatment cycles for the first 24 months (mos) and then every 6 cycles thereafter.
Results: In total, 89 patients were enrolled and treated in phase 2 (n=55 and n=34 in the lenalidomide 20 mg and 25 mg cohorts, respectively). The median patient age was 64 years; 58% were male. At study entry, 53% of patients were refractory to their last therapy and 16% were primary refractory, 47% had relapsed, and 63% had stage IV disease. Median number of prior DLBCL therapies was 2 (range 1-5), with the most common being R-CHOP (73%), RICE (26%), and R-DHAP (13%). Twenty patients had prior SCT. All patients were non-GCB by IHC; for the 47 patients with tumor tissue available for nanostring testing by GEP, there was 84% concordance in non-GCB status (activated B-cell ABC or unclassified). The median time on study was 16 mos (range <1-28 mos); 20 patients (22%) and 4 patients (4%) received iR2 treatment for ≥1 and ≥2 years, respectively, with 25 patients (28%) receiving iR2 treatment at the time of the analysis. The median time to response was 2.7 mos. Of the 85 response-evaluable patients with follow-up response assessment, the ORR was 47% (95% CI 36-58), including 28% with CR and 19% with partial response; 16% had stable disease. The median DOR (n=40) was 18 mos (range <1-22 mos) overall and in the 20 mg cohort and was not reached (NR) in the 25 mg cohort. For patients with CR, the median DOR was NR. Estimated PFS was 31% (95% CI 21-41) at 18 mos, and median PFS was 5 mos (95% CI 3-6). Estimated OS was 44% (95% CI 32-56) at 18 mos, and median OS was 14 mos (95% CI 10 mos-not estimable NE) (Figure 1A). For the 40 responders, median PFS was 21 mos (95% CI 11-NE), and median OS was NR (95% CI 18 mos-NE). 14 patients (16%) were in CR for >1 year (Figure 1B). The most common adverse events (occurring in >30% of patients) were diarrhea (53%), fatigue (42%), neutropenia (40%), cough (34%), anemia (33%), peripheral edema (33%), and maculopapular rash (31%). The most common Grade 3/4 AEs were neutropenia (36%) and maculopapular rash (18%); Grade 3/4 atrial fibrillation occurred in 2% of patients. Grade 5 TEAEs occurred in 12 patients; of these, 7 were due to worsening of DLBCL, and 5 were not related to PD (pneumonia n=3, sepsis n=1, and cardiac arrest n=1). AEs led to discontinuation in 17% of patients (n=15) overall (those occurring in ≥2 patients were worsening of DLBCL n=4, pneumonia n=2, and thrombocytopenia n=2).
Conclusions: The iR2 combination of ibrutinib, lenalidomide, and rituximab showed an ORR of 47% in patients with follow-up response assessment, with 28% CRs, including durable CRs of up to 22 mos. The safety profile was manageable in this phase 2 study of patients with R/R non-GCB DLBCL ineligible for SCT. Further evaluation of the iR2 regimen is ongoing.
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Ramchandren:Seattle Genetics, Inc.: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sandoz-Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Merck: Research Funding; Bristol-Myers Squibb: Consultancy, Membership on an entity's Board of Directors or advisory committees; Genentech: Research Funding; Pharmacyclics LLC, an Abbvie company: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Research Funding. Johnson:Boehringer Ingelheim: Honoraria; Incyte: Honoraria; Epizyme: Honoraria, Research Funding; Takeda: Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Novartis: Honoraria; Bristol-Myers Squibb: Honoraria; Genmab: Honoraria; Celgene: Honoraria; Kite: Honoraria. Ghosh:Gilead: Consultancy, Honoraria, Speakers Bureau; Janssen: Consultancy, Honoraria, Research Funding, Speakers Bureau; Pharmacyclics LLC, an AbbVie Company: Consultancy, Honoraria, Research Funding, Speakers Bureau; SGN: Consultancy, Honoraria, Research Funding, Speakers Bureau; Genentech: Research Funding; Forty Seven Inc: Research Funding; Bristol-Myers Squibb: Honoraria, Speakers Bureau; AstraZeneca: Honoraria, Speakers Bureau; TG Therapeutics: Consultancy, Honoraria, Research Funding; Celgene: Consultancy, Research Funding. Ruan:Seattle Genetics: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria; Celgene: Consultancy, Honoraria, Research Funding; AstraZeneca: Consultancy, Honoraria; Kite: Consultancy; Pharmacyclics LLC, an AbbVie company: Research Funding; Juno: Consultancy. Ardeshna:Celgene: Consultancy, Honoraria; Gilead: Consultancy, Honoraria. Johnson:Takeda: Other: Travel, accomodations, expenses; Roche: Consultancy, Honoraria, Speakers Bureau. Cunningham:Clovis: Research Funding; Eli Lilly: Research Funding; 4SC: Research Funding; Bayer: Research Funding; MedImmune: Research Funding; Celgene: Research Funding; AstraZeneca: Research Funding; Sanofi: Research Funding; Amgen: Research Funding; Janssen: Research Funding; Merck: Research Funding; Merrimack: Research Funding. de Vos:Portola Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Verastem: Consultancy; Bayer: Consultancy. Radford:Seattle Genetics: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Research Funding; ADC Therapeutics: Consultancy, Research Funding; GSK: Equity Ownership; Novartis: Consultancy, Honoraria; AstraZeneca: Equity Ownership, Research Funding; BMS: Consultancy, Honoraria. Morgan:Biogen: Equity Ownership; Eli Lilly: Equity Ownership; Gilead: Equity Ownership; Johnson and Johnson: Equity Ownership; Merck: Equity Ownership; Novo Nordisk: Equity Ownership; Pfizer: Equity Ownership; Vertex: Equity Ownership; Zoetis: Equity Ownership. Munoz:Celgene/Juno: Consultancy, Research Funding; Genentech: Consultancy, Research Funding, Speakers Bureau; Kite/Gilead: Consultancy, Research Funding, Speakers Bureau; Bristol-Myers Squibb: Consultancy; Alexion: Consultancy; Pfizer: Consultancy; Fosunkite: Speakers Bureau; AstraZeneca: Speakers Bureau; Portola: Research Funding; Incyte: Research Funding; Kyowa: Consultancy, Honoraria, Speakers Bureau; Seattle Genetics: Consultancy, Honoraria, Research Funding, Speakers Bureau; Pharmacyclics /Janssen: Consultancy, Research Funding, Speakers Bureau; Bayer: Consultancy, Speakers Bureau; Merck: Consultancy. Ping:Pharmacyclics LLC, an AbbVie company: Employment; AbbVie: Equity Ownership. Kwei:Gilead: Equity Ownership; Pharmacyclics LLC, an AbbVie company: Employment; AbbVie: Equity Ownership. Eckert:AbbVie: Equity Ownership; Pharmacyclics LLC, an AbbVie Company: Employment, Other: Travel, Accommodations, Expenses. Neuenburg:Pharmacyclics LLC, an AbbVie company: Employment, Other: Travel, accomodations, expenses. Goy:University of Nebraska: Research Funding; Pharmacyclics/Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Grants outside of the submitted work, Research Funding; Acerta: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Grants outside of the submitted work, Research Funding; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Genentech: Other: Grants outside of the submitted work, Research Funding; Hackensack University Medical Center, RCCA: Employment; Hakensackumc: Research Funding; COTA: Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Other: leadership role for profit healthcare company; Takeda: Other: Grants outside of the submitted work; Kite, a Gilead Company: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Grants outside of the submitted work; Astrazenca: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.
Ibrutinib in combination with lenalidomide and rituximab is not approved by the FDA for treatment of diffuse large B-cell lymphoma (DLBCL)
Background: Q fever is a zoonosis caused by Coxiella burnetii which is among the major agents of community-acquired pneumonia in French Guiana. Despite its relatively high incidence, its epidemiology ...in French Guiana remains unclear, and all previous studies have considered transmission from livestock unlikely, suggesting that a wild reservoir is responsible for transmission. Methods: A country-wide seroprevalence survey of 2697 participants from French Guiana was conducted. Serum samples were tested for phase II IgG antibodies by ELISA and indirect immunofluorescence assays (IFAs). Factors associated with Q fever were investigated, and a serocatalytic model was used to reconstruct the annual force of infection. Findings: The overall weighted seroprevalence was estimated at 9.6% (95% confidence interval (CI): 8.2%–11.0%). The model revealed constant, low-level circulation across French Guiana, particularly affecting middle-aged males (odds ratio (OR): 3.0, 95% credible interval (CrI): 1.7–5.8) and individuals living close to sheep farms (OR: 4, 95% CrI: 1.5–12). The overall annual number of cases was estimated at 579 (95% CrI: 492–670). In the region around Cayenne, the main urban municipality, the high seroprevalence was explained by an outbreak that may have occurred between 1996 and 2003 and that infected 10% (95% CrI: 6.9%–14%) of the population and males and females alike. Interpretation: This study reveals for the first time Q fever dynamics of transmission and the role of domestic livestock in transmission in French Guiana and highlights the urgent need to reinforce Q fever surveillance in livestocks of the entire Guianese territory. Funding: This study was supported by the “European Regional Development Fund” under EPI-ARBO grant agreement (GY0008695), the “Regional Health Agency of French Guiana” and the “National Center of Spatial Studies”. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The LyKID study is a nationwide survey in France of lymphoma patients with renal involvement based on biopsy and/or imaging, to evaluate its impact on disease outcome and renal function. A total of ...87 adult cases of B or T-cell lymphomas were retrospectively analyzed. Interstitial topography was observed in most of the kidney biopsies (54/66; 80%). Kidney failure (glomerular filtration rate <60 mL/min/1.73 m
2
) was present in 47% of patients and was associated with non-significantly different outcome. After lymphoma treatment, 44% of patients had persistent chronic kidney failure (CKF); kidney failure at diagnosis was the only parameter associated with CKF in multivariate analysis. DLBCL (diffuse large B-cell lymphomas) represented half of the series, with noticeably CNS (central neurological system) relapse in 17% patients, while fewer than one of two patients had received CNS prophylaxis. To our knowledge, the LyKID study represents the largest published non-autopsy lymphoma series with renal involvement.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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