To clarify the clinical outcome of peripheral T-cell lymphomas (PTCLs), we conducted a retrospective review comparing the outcomes of patients with PTCL (nodal peripheral T-cell lymphoma, unspecified, n=34 ; angioimmunoblastic T-cell lymphoma, n=12) to those with diffuse large B-cell lymphoma (DLBCL, n=48). All patients received CHOP-based chemotherapy without rituximab. PTCL patients presented at a more advanced clinical stage (91% vs. 65%, P<0.002) with a poorer performance status (26% vs. 17%, P<0.002) than DLBCL patients. The complete response rate among PTCL patients was significantly lower than among DLBCL patients (39% vs. 67%, P<0.008), as was the 3-year overall survival rate (26% vs. 50%, P=0.005), and Cox multivariate analysis revealed immunophenotype, performance status, and extranodal site involved to be significantly associated with shorter overall survival (P=0.045, P=0.007, and P=0.034, respectively). Our findings suggest that PTCL patients tend to have a poor prognosis associated with several initial risk factors. Moreover, the T-cell phenotype itself appears to have a significant impact on overall survival. Thus, standard CHOP chemotherapy may be inadequate for PTCLs, especially in patients with high-risk factors. The development of newly stratified therapies for the treatment of PTCLs would be highly desirable. [J Clin Exp Hematopathol 51(1) : 29-35, 2011]
In cases of hematological malignancy, patients with persistent fever and neutropenia receive antifungal empirical therapy to prevent and treat invasive fungal infections. The clinical efficacy and safety of micafungin and voriconazole were compared.In this randomized, cooperative group, open-label trial, we assessed and compared the efficacy and safety of micafungin and voriconazole as an empirical antifungal therapy in febrile neutropenic patients with hematological malignancy. Patients were classified according to invasive fungal infection risk.There were no significant differences in clinical efficacy between the two treatments, evaluated based on (i) successful treatment of baseline fungal infection (no evaluation), (ii) absence of breakthrough fungal infection (P = 0.106), (iii) survival for ≥7 days after study completion (P = 0.335), (iv) premature study discontinuation due to poor efficacy (P = 0.424), and (v) resolution of fever during neutropenia (P = 0.756). Discontinuation due to drug-related adverse events (grades 3-4) occurred less frequently in the micafungin group (P = 0.005).The clinical efficacy did not differ between micafungin and voriconazole. Micafungin was generally better tolerated than voriconazole when given as an empirical antifungal therapy in patients with persistent fever and neutropenia.
Background: Every TKI has it's unique adverse events (AEs) and AEs drive therapeutic outcome down in patient with CML-CP. Treatment completion rate(TCR), complete molecular response(MR4.5), and treatment free remission(TFR) were examined. Aims: We conducted this study aiming at improving TCR, MR4.5, and TFR by stepwise dose escalation method of nilotinib. Methods: TCR, MR4.5, and TFR (6, 12, and 18 months) were examined by stepwise dose escalation method of nilotinib (4-Stepwise method, i.e., 150mg-14day, 300mg-14day, 450mg-14day, 600mg-2years) in imatinib experienced or newly diagnosed patient with CML-CP. Results: 25 cases were enrolled in this study and all patient were received this method. Consequently, all patients achieved 600 mg, TCR was 100% by the method. 22 cases (88%) achieved MR4.5, and all of them transferred to treatment discontinuation phase. 7 cases out of 22 lost MMR in non-treatment period, and all of them remained in the CP phase and were administered nilotinib again. TFR at 6, 12, 18 months were 86%(19/22), 75%(15/20), 79%(15/19), respectively. NK cell activity at before treatment, one of important biomarker, showed a significant difference between not achieved MR4.5 group and achieved MR4.5 group(P = 0.04).Summary/Conclusion: In this study, our stepwise dose escalation method of nilotinib (4-Stepwise method, i.e., 150mg-14day, 300mg-14day, 450mg-14day, 600mg-2years) will make good use of improving therapeutic outcome. TCR was 100%. 22 out of 25 cases (88%) achieved MR4.5, and all of them were transferred to treatment discontinuation phase. 7 out of 22 cases lost MMR, TFR at 6, 12, 18 months were 86%(19/22), 75%(15/20), 79%(15/19), respectively. NK cell activity at before treatment, showed a significant difference between not achieved MR4.5 group and achieved MR4.5 group(P = 0.04).
