مستخلص: Outcomes with follicular lymphoma (FL) have improved in the modern era and median survival is now beyond 15 years. Therapeutic decisions need to consider this increased survival as well as recent clinical trial data and emerging treatments. In this context, we present here current approaches to front-line management of FL in Australia. Treatment choices depend on the disease stage, tumour burden, the patient's age, symptoms, comorbidities and preferences. Only about 10-15% of patients with FL are diagnosed with early stage disease. For patients with low-grade, early stage disease, radiotherapy (RT) is recommended. The addition of chemotherapy has been shown to increase progression-free survival (PFS) but without demonstrated overall survival advantage. For patients with low-tumour-burden, advanced-stage FL, immediate treatment may not be required and we recommend considering active monitoring. For stage III/IV disease that is symptomatic and/or with high tumour burden, established first-line treatment is chemotherapy in combination with rituximab, often followed by rituximab maintenance. The listing of bendamustine and now obinutuzumab on the Pharmaceutical Benefits Scheme has expanded the first-line treatment options in Australia to include bendamustine in combination with rituximab (without rituximab maintenance permitted) or with obinutuzumab plus 2 years obintuzumab maintenance. In the FL subgroup of the Study group indolent Lymphomas (StiL) trial, therapy with bendamustine plus rituximab significantly increased PFS compared with rituximab in combination with cyclophosphamide, doxorubicin, vincristine and prednisolone, without rituximab maintenance. Initial tolerability may be more favourable with bendamustine in combination with anti-CD20 antibody therapy than other therapies overall, but clinical vigilance is still required because of concerns of late infectious toxicities associated with prolonged T-cell depletion.Copyright © 2018 Royal Australasian College o

مصطلحات الفهرس: cancer survival, clinical outcome, comorbidity, drug efficacy, drug tolerability, follicular lymphoma/di [Diagnosis], follicular lymphoma/dt [Drug Therapy], human, immunoregulation, infection/si [Side Effect], maintenance therapy, medical decision making, nonhodgkin lymphoma/di [Diagnosis], nonhodgkin lymphoma/dt [Drug Therapy], obinutuzumab/cb [Drug Combination], patient monitoring, patient preference, priority journal, progression free survival, review, second cancer/si [Side Effect], survival time, symptom, T cell depletion, treatment duration, treatment response, tumor volume, bendamustine/ae [Adverse Drug Reaction], bendamustine/cb [Drug Combination], bendamustine/dt [Drug Therapy], CD20 antibody/cb [Drug Combination], CD20 antibody/dt [Drug Therapy], obinutuzumab/dt [Drug Therapy], prednisolone/ae [Adverse Drug Reaction], prednisolone/cb [Drug Combination], prednisolone/dt [Drug Therapy], rituximab/ae [Adverse Drug Reaction], rituximab/cb [Drug Combination], rituximab/dt [Drug Therapy], vincristine/ae [Adverse Drug Reaction], vincristine/cb [Drug Combination], vincristine/dt [Drug Therapy], overall survival, cyclophosphamide/ae [Adverse Drug Reaction], cyclophosphamide/cb [Drug Combination], cyclophosphamide/dt [Drug Therapy], doxorubicin/ae [Adverse Drug Reaction], doxorubicin/cb [Drug Combination], doxorubicin/dt [Drug Therapy], lenalidomide/dt [Drug Therapy], advanced cancer/di [Diagnosis], age, asymptomatic disease/di [Diagnosis], Australia, cancer combination chemotherapy, cancer diagnosis, cancer immunotherapy, cancer recurrence, cancer staging, Review

URL: https://repository.monashhealth.org/monashhealthjspui/handle/1/35707Test
Internal Medicine Journal
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مستخلص: Background: Patients with aggressive lymphoma achieving complete remission (CR) after first-line combination chemotherapy undergo regular surveillance to detect relapse. Current international guidelines recommend routine follow-up blood tests in this context, but evidence supporting this practice is limited. Method(s): We conducted a multi-centre retrospective analysis of all patients diagnosed with aggressive lymphoma treated with curative-intent chemotherapy who achieved CR for at least 3 months between 2000 and 2015. An abnormal blood test was defined as any new and unexplained abnormality for full blood examination, lactate dehydrogenase or erythrocyte sedimentation rate. Result(s): Three hundred and forty-six patients attended a total of 3084 outpatient visits; blood tests were performed at 90% of these appointments. Fifty-six (16%) patients relapsed. Routine laboratory testing detected relapse in only three patients (5% of relapses); in the remaining patients, relapse was suspected clinically (80%) or detected by imaging (15%). The sensitivity of all blood tests was 42% and the positive predictive value was 9%. No significant difference in survival was shown in patients who underwent a routine blood test within 3 months prior to relapse versus those who did not (p = 0.88). Conclusion(s): Routine blood tests demonstrate unacceptably poor performance characteristics, have no impact on survival and thus have limited value in the detection of relapse in routine surveillance.Copyright © 2018, Cancer Research UK.

مصطلحات الفهرس: human tissue, adolescent, adult, aged, article, asymptomatic disease/di [Diagnosis], asymptomatic disease/dt [Drug Therapy], blood examination, cancer chemotherapy, cancer patient, cancer recurrence, controlled study, disease surveillance, erythrocyte sedimentation rate, female, human, intention to treat analysis, lactate dehydrogenase blood level, lymphoma/di [Diagnosis], lymphoma/dt [Drug Therapy], major clinical study, male, medical examination, multicenter study, outpatient care, predictive value, priority journal, relapse/di [Diagnosis], retrospective study, sensitivity and specificity, tumor regression, very elderly, antineoplastic agent/dt [Drug Therapy], lactate dehydrogenase/ec [Endogenous Compound], Article

URL: https://repository.monashhealth.org/monashhealthjspui/handle/1/36887Test
British Journal of Cancer
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مستخلص: Background: Patients with aggressive lymphoma achieving complete remission (CR) after first-line combination chemotherapy undergo regular surveillance to detect relapse. Current international guidelines recommend routine follow-up blood tests in this context, but evidence supporting this practice is limited. Method(s): We conducted a multi-centre retrospective analysis of all patients diagnosed with aggressive lymphoma treated with curative-intent chemotherapy who achieved CR for at least 3 months between 2000 and 2015. An abnormal blood test was defined as any new and unexplained abnormality for full blood examination, lactate dehydrogenase or erythrocyte sedimentation rate. Result(s): Three hundred and forty-six patients attended a total of 3084 outpatient visits; blood tests were performed at 90% of these appointments. Fifty-six (16%) patients relapsed. Routine laboratory testing detected relapse in only three patients (5% of relapses); in the remaining patients, relapse was suspected clinically (80%) or detected by imaging (15%). The sensitivity of all blood tests was 42% and the positive predictive value was 9%. No significant difference in survival was shown in patients who underwent a routine blood test within 3 months prior to relapse versus those who did not (p = 0.88). Conclusion(s): Routine blood tests demonstrate unacceptably poor performance characteristics, have no impact on survival and thus have limited value in the detection of relapse in routine surveillance.Copyright © 2018, Cancer Research UK.

مصطلحات الفهرس: human tissue, adolescent, adult, aged, article, asymptomatic disease/di [Diagnosis], asymptomatic disease/dt [Drug Therapy], blood examination, cancer chemotherapy, cancer patient, cancer recurrence, controlled study, disease surveillance, erythrocyte sedimentation rate, female, human, intention to treat analysis, lactate dehydrogenase blood level, lymphoma/di [Diagnosis], lymphoma/dt [Drug Therapy], major clinical study, male, medical examination, multicenter study, outpatient care, predictive value, priority journal, relapse/di [Diagnosis], retrospective study, sensitivity and specificity, tumor regression, very elderly, antineoplastic agent/dt [Drug Therapy], lactate dehydrogenase/ec [Endogenous Compound], Article

URL: https://repository.monashhealth.org/monashhealthjspui/handle/1/36887Test
British Journal of Cancer
Click here for full text options
LibKey Link