Rituximab plus bendamustine (BR), and rituximab, bendamustine, and cytarabine (R-BAC) are well-known induction therapies in elderly patients with mantle cell lymphoma (MCL), according to clinical guidelines. However, a direct comparison between the two regimens has never been performed.In this multicentre retrospective study, we compared the outcome of patients with newly diagnosed MCL, treated with BR or R-BAC. Primary endpoint was 2-year progression-free survival (PFS). Inclusion bias was assessed using a propensity score stratified by gender, age, MCL morphology, and MIPI score.After adjusting by propensity score, we identified 156 patients (53 BR, 103 R-BAC) with median age of 72 (53-90). Median follow-up was 46 months (range 12-133). R-BAC was administered in a 2-day schedule or with attenuated dose in 51% of patients. Patients treated with R-BAC achieved CR in 91% of cases, as compared with 60% for BR (p < 0.0001). The 2-year PFS was 87 ± 3% and 64 ± 7% for R-BAC and BR, respectively (p = 0.001). In terms of toxicity, R-BAC was associated with significantly more pronounced grade 3-4 thrombocytopenia than BR (50% vs. 17%).This study indicates that R-BAC, even when administered with judiciously attenuated doses, is associated with significantly prolonged 2-year PFS than BR in elderly patients with previously untreated MCL.
Merkel cell carcinoma (MCC) is a rare neuroendocrine carcinoma of the skin. It is highly aggressive and represents the second most common cause of skin cancer-related death. Ruxolitinib is an orally administered selective inhibitor of Janus associated kinases1 and 2, which is used in the management of patients with symptomatic myelofibrosis and polycythemia vera who are non-responders or intolerant to hydroxyurea. Herein, we report the case of a 47-year-old woman with a 14-year history of chronic myeloproliferative syndrome initially treated with hydroxyurea for 4 years. She was then enrolled in the Response trial and treated for 7 years with ruxolitinib subsequently developing an MCC. This report shows the possibility of development of MCC in patients treated with ruxolitinib. Periodic skin examination is indicated in patients who undergo ruxolitinib therapy, especially if they have a history of skin cancer; dermatologists and oncohematologists should be aware of this possibility in order to introduce appropriate preventive strategies.
Primary cutaneous anaplastic large cell lymphoma (PCALCL) is a rare CD30+ lymphoproliferative disorder characterized by the development of lesions ranging from papules to large tumors. Most cases present as localized disease, however multifocal and generalized involvement of the skin can occur. Several treatments have been proposed for PCALCL; however a highly effective standard approach to multifocal disease has not yet been elucidated. The disease expression of CD30 antigen in at least 75% of the tumor makes it an optimal target for immunotherapy. The current study presents a case of a 62‑year‑old male referred to the University of Padua Dermatology Clinic complaining about nodular and ulcerated lesions involving the frontal area and scalp that were 8 cm in diameter. Doses of 180 mg brentuximab vedotin (BV), which is an antibody drug conjugate binding CD30 antigen, were administered every 21 days. A 75% decrease in dimensions after the first infusion and a complete remission after the second was observed. Disease response appeared to be dose‑related and adverse reactions, in particular peripheral neuropathy, may be an effect of cumulative toxicity, meaning that treatment cycle reduction should be considered. Based on the present results, A high dose, short course of BV is recommended as a cost‑effective approach for PCALCL. However, further studies are required to assess the efficacy and other potential advantages of this therapeutic regimen.
Kaposi's sarcoma (KS) is a rare angioproliferative tumor classified in four different clinical-epidemiological forms. The diagnosis is based on histopathological and immunohistochemical analyses. The treatment is heterogeneous and includes several local and systemic therapeutic strategies. Methods: This is a retrospective cohort study including 86 KS patients treated between 1993 and 2022 at the University Hospital of Padua (AOPD) and at the Veneto Institute of Oncology (IOV). The data were extracted from an electronic database. Survival curves were generated using the Kaplan-Meier method, and Cox regression models were employed to explore associations with overall and disease-free survival. The male sex (89.53%), classical variant (43.02%), and cutaneous involvement (77.9%) were predominant. More than 61.6% of patients received a single treatment. Surgery, antiretroviral therapy, and chemotherapy were the mostly adopted approaches. A persistent response was observed in approximately 65% of patients, with a 22% relapse rate (at least 2 years). The overall survival ranges from 90 to 70% at 2 to 10 years after the diagnosis. Iatrogenic KS demonstrated a higher mortality (52.9%). This study reflects our experience in the management of KS. Comorbidities are very frequent, and treatments are heterogeneous. A multidisciplinary approach involving multiple referral specialists is essential for the appropriate management of this disease during diagnosis, treatment, and follow-up.
Abstract Since the COVID‐19 outbreak started, it has been affecting mainly older individuals. Among the most vulnerable older individuals are those with cancer. Many published guidelines and consensus papers deal with prioritizing cancer care. Given the lack of high‐quality evidence for management of cancer in older patients also in normal times, it is even more stringent to provide some resources on how to avoid both undertreatment and overtreatment in this population, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID‐19 as well as from cancer not adequately addressed and treated. We hereby discuss some general recommendations (implement triage procedures; perform geriatric assessment; carefully assess comorbidity; promote early integration of palliative care in oncology; acknowledge the role of caregivers; maintain active take in charge to avoid feeling of abandonment; mandate seasonal flu vaccination) and discuss practical suggestions for specific disease settings (early‐stage and advanced‐stage disease for solid tumors, and hematological malignancies). The manuscript provides resources on how to avoid both undertreatment and overtreatment in older patients with cancer, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID‐19 as well as from cancer not adequately addressed and treated.
Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: Peripheral T-cell lymphoma (PTCL), is a heterogeneous and rare entity (5-10% of all lymphomas). Central nervous system (CNS) involvement at diagnosis and at relapse in patients with PTCL ranged from 2-9%, with a well-known dismal prognosis. There are no clear recommendations for CNS prophylaxis in PTCL, with the exception of some entity. We retrospectively collected clinicopathologic and treatment data from 205 PTCL patients, diagnosed between 2000 and 2022, who underwent induction chemotherapy in six Italian centers. Aims: To characterize the rate and survival outcome of CNS involvement in newly diagnosed PTCL. Methods: Routine staging investigations and response was evaluated using the 2014 Lugano criteria. The diagnosis of PTCL was histologically confirmed and categorized according to the classification at the time of diagnosis. Patients with primary cutaneous T-cell lymphoma, T-cell lymphoblastic leukemia/lymphoma, T-cell prolymphocytic leukemia, adult T-cell leukemia/lymphoma and extranodal NK/T-cell lymphoma were excluded from this study. Only 6 patients received CNS prophylaxis, 3 with intrathecal therapy and 3 with high-dose methotrexate. Results: Baseline characteristics are shown in Figure 1. The median age of the entire population was 72 years (range 28-90), with a predominance of PTCL, not otherwise specified. With a median follow up of 24 months, 10 patients out of 205 had CNS disease: four patients (1.5%) had CNS involvement at initial diagnosis (1 ALCL-ALK+ and 3 ALCL-ALK-) and 6 patients (2.5%) experienced a CNS relapse (3 PTCL-NOS, 2 AITL, 1 EATL). At the end of first line treatment, ORR was 65% (with 55% CR and 10% PR) in patients without CNS involvement at diagnosis, and only one CR (25%) in patients with CNS involvement at diagnosis. Median overall survival (OS) of the entire population was 38 months; primary refractory and early relapsed were 69 (35%) and 33 (17%) patients, with a median OS of 8 and 21 months, respectively. Median OS for patients with CNS relapse were 8 months, and median OS for cases with CNS involvement at diagnosis were 13 months. As previously reported, patients relapsing to CNS were all in stage IV, had an elevated LDH, with extranodal involvement ≥ 1 site. CNS relapse had inferior survival, and it usually manifests as a terminal events in patients with refractory disease Summary/Conclusion: In this small multicenter retrospective analysys, we confirmed that patients with PTCL, developing a CNS relapse, had a higher burden of disease at baseline with a very poor prognosis. PTCL is a group of disease generally considered at low risk of CNS involvement at diagnosis and relapse; prophylaxis should be stratified according to histologic subtypes and risk factors. Further studies are needed to prevent and treat this condition, aiming to define a more individualized therapeutic approaches.Keywords: Peripheral T-cell lymphoma
