RESUMEN
Patients with mantle cell lymphoma (MCL) that fail induction treatment represent a difficult-to-treat population, where no standard therapy exists. We evaluated outcomes in patients with first relapsed-refractory (r/r) MCL after upfront high dose cytarabine including standard regimens. Overall survival (OS-2) and progression-free survival (PFS-2) were estimated from the time of salvage therapy. The previously described threshold of 24 months was used to define patients as early- or late-progressors (POD). Overall, 261 r/r MCL patients were included. Second-line regimens consisted of rituximab-bendamustine (R-B, 21%), R-B and cytarabine (R-BAC, 29%), ibrutinib (19%), and others (31%). The four groups were balanced in terms of clinicopathological features. Adjusting for age and early/late-POD, patients treated with R-BAC had significantly higher complete remission (63%) than comparators. Overall, Ibrutinib and R-BAC were associated with improved median PFS-2 [24 and 25 months, respectively], compared to R-B (13) or others (7). In patients with early-POD (n = 127), ibrutinib was associated with inferior risk of death than comparators (HR 2.41 for R-B, 2.17 for others, 2.78 for R-BAC). In patients with late-POD (n = 134), no significant differences were observed between ibrutinib and bendamustine-based treatments. Ibrutinib was associated with improved outcome in early-POD patients.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Linfoma de Células del Manto/mortalidad , Recurrencia Local de Neoplasia/mortalidad , Terapia Recuperativa , Adulto , Anciano , Resistencia a Antineoplásicos , Femenino , Estudios de Seguimiento , Humanos , Agencias Internacionales , Linfoma de Células del Manto/tratamiento farmacológico , Linfoma de Células del Manto/patología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/patología , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Adulto JovenAsunto(s)
Plaquetas/ultraestructura , Diagnóstico por Computador , Errores Diagnósticos , Eritrocitos/parasitología , Malaria/diagnóstico , Microscopía , Adulto , Plaquetas/citología , Tamaño de la Célula , Eritrocitos/ultraestructura , Humanos , Masculino , Plasmodium/aislamiento & purificación , Estudios Retrospectivos , Programas InformáticosAsunto(s)
Proteínas de Fusión bcr-abl/genética , Leucemia Mielógena Crónica BCR-ABL Positiva/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Adolescente , Adulto , Factores de Edad , Anciano , Linfocitos B/inmunología , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proteínas Proto-Oncogénicas c-abl/inmunología , Adulto JovenRESUMEN
Diagnosis and monitoring of multiple myeloma (MM) and related conditions are usually carried out by means of serum and urine protein electrophoresis and immunofixation. In the early 2000s, an assay aimed at evaluating serum free light chains (sFLCs) was made available and subsequently tested in different plasma cell disorders. Several reports have demonstrated the usefulness of the assay for the diagnosis and monitoring of oligosecretory MM, nonsecretory MM, Bence Jones MM, and amyloid light-chain amyloidosis. Furthermore, a prognostic role for an abnormal sFLC κ/λ ratio has been observed in the case of monoclonal gammopathy of unknown significance, smoldering MM, solitary plasmacytomas, and in newly diagnosed symptomatic MM secreting intact monoclonal immunoglobulins. In conclusion, according to present data, the sFLC assay can be considered reliable for the diagnosis, monitoring, and prognosis of different plasma cell disorders, and recently studies have been carried out to test a possible role of an sFLC evaluation in other B-cell lymphoproliferative malignancies.