Browsing by Autor "Alana Von Glasenapp"

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Follicular Lymphoma in Latin America: Real-World Experience from 763 Patients
(Elsevier BV, 2020) Maria Alejandra Torres Viera; Brady Beltrán; Luis Villela Villela; Denisse A. Castro; Victoria Otero; Lorena Fiad; Camila Peña; Henry Idrobo; Myrna Candelaria; Alana Von Glasenapp
Introduction: Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma subtype seen in Western countries. However, data on FL from Latin America (LATAM) are scarce. We aimed at better understanding the clinical features, treatment patterns and outcomes of patients with FL from LATAM. Methods: This is a retrospective study that included all consecutive patients with a pathological diagnosis of FL at 18 participating centers from 12 LATAM countries. All cases were reviewed by specialized pathologists at their respective participating centers. Pertinent clinical, pathological and treatment data were collected. Responses were assessed per the Lugano criteria. Time to first treatment, progression-free survival after first treatment (PFS1) and overall survival (OS) were estimated using the Kaplan-Meier method. Results: A total of 763 patients were included in this analysis. On clinical features, 51% of patients were ≥60 years, 46% were male, 29% had extranodal involvement, 27% had bulky disease (≥6 cm in diameter), 68% had stage III/IV disease, 21% had hemoglobin &lt;12 g/dl, 12% had serum albumin &lt;3 g/dl, 34% had elevated serum LDH and 24% had B2-microglobulin ≥3,5 mg/l. Low, intermediate and high-risk FLIPI was seen in 43%, 33% and 23% of patients, respectively. Low, intermediate and high-risk FLIPI2 was seen in 18%, 64% and 17% of patients, respectively. The median time to first treatment was 0.08 years (95% CI 0.08-0.09), and 88% of patients started therapy within 1 year of diagnosis. Of the 647 treated patients, 70% received CHOP ± rituximab (R), 16% CVP ± R, 6% bendamustine ± R, 4% R alone and 4% other treatments. Response data were available in 628 patients with complete response in 72%, partial response in 21% and no response in 7%, for an overall response rate of 93%. The median PFS1 was 10.5 years (95% CI 7.3-not reached; Figure), and 74 patients (12%) had disease progression within 24 months of first treatment initiation (POD24). The median OS was 21.1 years (95% CI 13-not reached; Figure). Patients with low, intermediate and high FLIPI had median OS not reached, 21.1 and 9.5 years, respectively (p&lt;0.001). Patients with low, intermediate and high FLIPI2 had median OS not reached, 21.1 and 6.8 years, respectively (p&lt;0.001). Patients who had and did not have POD24 had median OS of 7.3 years (95% CI 4.8-not reached) and 21.1 years (95% CI 13-not reached), respectively (p&lt;0.001). Conclusion: This large, real world evidence LATAM cohort of 763 patients with FL showed a higher than expected female incidence as well as higher rates of extranodal and bulky disease than previously reported in Western cohorts. Chemoimmunotherapy is the standard approach to FL patients in LATAM, which is associated with high rates of response and highly encouraging PFS and OS rates. Our study validates the prognostic value of FLIPI, FLIPI2 and POD24. Figure Disclosures Villela: Roche: Other: advisory board, Speakers Bureau; amgen: Speakers Bureau. Peña:Amgen: Speakers Bureau; BindingSite: Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Sandoz: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees. Idrobo:Takeda: Honoraria, Speakers Bureau; Amgen: Honoraria, Speakers Bureau; Tecnofarma: Honoraria, Speakers Bureau; Janssen: Honoraria, Speakers Bureau; Abbvie: Honoraria, Speakers Bureau. Abello:Dr. Reddy's: Consultancy, Research Funding; Takeda: Honoraria, Research Funding; Novartis: Consultancy, Honoraria; Amgen: Consultancy, Research Funding; Abbvie: Consultancy, Research Funding. Perini:AbbVie, Janssen: Speakers Bureau; Janssen, Takeda: Honoraria. Castillo:Abbvie: Research Funding; Janssen: Consultancy, Research Funding; Kymera: Consultancy; TG Therapeutics: Research Funding; Beigene: Consultancy, Research Funding; Pharmacyclics: Consultancy, Research Funding.
Serum Albumin and Neutrophil-to-Lymphocyte Ratio, Two Independent Factor Predicting Survival in Patients with Follicular Lymphoma: A Multi-Institutional Retrospective Cohort of 741 FL, from the Latin American Lymphoproliferative Study Group (GELL)
(Elsevier BV, 2021) Marialejandra Alejandra Torres Viera; Luís Villela; Brady Beltrán; Denisse Castro; Myrna Candelaria; Henry Idrobo; Victoria Otero; Alana Von Glasenapp; Fabiola Valvert; Sally Paredes
Abstract Introduction: The neutrophil-lymphocyte ratio (NLR) is a measure of systemic inflammation that appears prognostic in different cancers. Although the exact mechanism remains to be elucidated, reduced lymphocyte intra tumor infiltration coupled with the formation of neutrophil extracellular traps (or NETosis) have been postulated as endogenous mechanisms for tissue damage and inflammation. Along this line, serum albumin has also been studied as a biomarker of inflammation and has been associated to prognosis in certain cancers. We have previously reported on the prognostic value of the NLR and serum albumin in diffuse large B-cell lymphoma (Villela, ASH meeting, 2019; Castro, ASH meeting, 2019) and peripheral T-cell lymphoma, not otherwise specified (Idrobo, ASH meeting, 2019), but nothing on follicular lymphoma (FL) yet. Therefore, we aim to investigate the role of different biomarkers on the prognosis of patients with FL diagnosed and managed in Latin America. Methods: We analyzed patients with FL diagnosed between 2010 and 2020 from 30 centers in 10 Latin American countries. The study outcomes were overall survival (OS) and progression-free survival (PFS) in relation to different biomarkers. Kaplan-Meier and log-rank test were used for survival analysis. Univariate and multivariate Cox regression analysis were used to estimate hazard ratios (HR) with a 95% confidence interval (CI) and adjusted to the Follicular Lymphoma International Prognostic Index (FLIPI) score. Outcomes with a p-value &lt;0.05 were considered statistically significant. Results: We identified 939 FL patients; 741 were included for the final analysis (median age 58 y, female 52%). There was no significant correlation between the NLR and other clinical factors such as: age, clinical stage, histological FL grading, and chemotherapy regimen used. A cutoff of 2.15 for NLR was defined as the maximum point for sensitivity and specificity based on ROC analysis. Table 1 and 2 summarizes the results from the univariate and multivariate analysis for 2 years OS and PFS, respectively. Both, serum albumin &lt;3.5 g/dL and a NLR &gt;2.15 were independently associated with worse OS (adjusted, aHR 2.48 [1.26-4.91], p=0.009; and 2.55 [1.21-5.37], p=0.014) and PFS (aHR 1.62 [1.03-2.55], p=0.038; 2.22 [1.45-3.40], p&lt;0.001), respectively. The lymphocyte:monocyte ratio (LMR) was not found to be prognostic for OS or PFS, although with a trend for worse PFS with a LMR ≤2.5. With a median follow of 43 months, (95% CI: 40-47), the survival rates in patients with FL and albumin &lt;3.5 were OS of 83% (vs. 95%) and PFS of 70% (vs. 83%); whereas in patients with NLR &gt;2.15 the survival rates were OS of 91% (vs. 96%) and PFS of 75% (vs. 88%) (Figures 1 and 2; table 3). Conclusions: In this study, serum albumin and NLR emerge as reliable predictors for survival for FL patients in Latin America. Although these markers have been associated to an increased inflammatory state in cancer patients; other factors such as poor nutritional status, and advanced disease stage due to delayed access to specialized cancer care in our region may have contributed to the observed outcome. Further studies are needed to better understand the role of these biomarkers on lymphoma care and to validate our findings. Lastly, we are currently working on evaluating these biomarkers on existing prognostic models and to improve prognostication for FL patients in Latin America. Figure 1 Figure 1. Disclosures Otero: ASTRA ZENECA: Current Employment. Ramirez-Ibarguen: Asofarma: Consultancy; MSD: Consultancy; Abbvie: Speakers Bureau; Astra Zeneca: Speakers Bureau; Janssen: Speakers Bureau; Roche: Speakers Bureau; Takeda: Consultancy, Speakers Bureau. Perini: Roche: Consultancy, Speakers Bureau; AstraZeneca: Consultancy, Speakers Bureau; MSD: Consultancy, Speakers Bureau; Janssen: Consultancy, Other: Travel/Accommodations/Expenses, Speakers Bureau; Takeda: Speakers Bureau; Abbvie: Consultancy, Other: Travel/Accommodations/Expenses, Speakers Bureau. Castillo: Abbvie: Consultancy, Research Funding; BeiGene: Consultancy, Research Funding; Pharmacyclics: Consultancy, Research Funding; Janssen: Consultancy; Roche: Consultancy; TG Therapeutics: Research Funding.