Browsing by Autor "Fabiola Valvert"

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Extranodal NK/T-Cell Lymphoma in Latin America: A Retrospective Multinational Analysis of Clinical Features, Therapeutic Approaches and Outcomes from the Latin American Group of Lymphoproliferative Disorders (GELL)
(Elsevier BV, 2024) Fabiola Valvert; Omar Eduardo Fernandez Vargas; Sally Paredes; Luís Alberto de Pádua Covas Lage; Luis Mario Villela Martínez; Jose Marcial Macias Abasto; Victoria Irigoín; Cesar Camilo Carias Alvado; Juan Barrios; Brenda L. Acosta‐Maldonado
Background Extranodal NK/T-cell lymphoma (ENKTL) is a rare subtype of Epstein-Barr virus (EBV)-related non-Hodgkin lymphoma. It has a distinct geographic and ethnic predilection, being more common in East Asia and Latin America (LATAM). ENKTL is known for its poor prognosis, largely due to its aggressive nature and the frequent development of resistance to conventional chemotherapies. However, the introduction of asparaginase-based regimens combined with radiotherapy has led to improved outcomes in recent years. Despite these advances, there is no established standard of care, especially in resource-limited settings like LATAM. This study aims to fill the knowledge gap regarding ENKTL in LATAM, by analyzing the clinical features, therapeutic approaches, and outcomes of patients (pts) with ENKTL in this region. Methods A retrospective, multicenter study was conducted including pts aged ≥18 with newly diagnosed ENKTL from Guatemala (n=92), Mexico (n=87), Brazil (n=92), Peru (n=19), Bolivia (n=12) and Uruguay (n=1) from 2000 to 2023. Baseline demographics, clinical-biological disease characteristics, treatment patterns, and outcomes were collected and analyzed. Primary endpoint was overall survival (OS) defined as time from diagnosis to death from any cause. Kaplan-Meier method and Log-rank tests were used to estimate and compare survival probabilities. Results A total of 303 pts were included, with a median age at diagnosis of 44 years (18-86) and a male predominance (59.41%). Localized disease (stage I/II) was seen in 59% (n=180) and advanced (stage III/IV) in 41% of pts by TNM. Clinically, pts are commonly presented with visible ulcerative lesions (53.5%) or palate perforation (31.3%). B symptoms were seen in 57.8%, high LDH in 42.9%, bulky disease (&gt;7 cm) in 16.7% and hemophagocytic lymphohistiocytosis in 15.8%. Most pts (88.4%, n=268) received first line therapy, including concurrent or sequential radiotherapy plus chemotherapy (68%), radiotherapy alone (6%) and chemotherapy alone (26%). Among those managed with systemic chemotherapy (with or without radiation therapy), 28% (n=71/251) were treated with anthracycline- (i.e. CHOP); 13% (n=33/251) with platinum; 36% (n=90/251) with asparaginase; and 23% (n=57/251) with other regimens. Complete response rates were seen in 38.6% of pts treated anthracycline- (47.7% localized vs 22.2% advanced); 66.7% with platinum-; (66.7% localized vs 64.3% advanced) and 48.9% with asparaginase-based regimens (63.3% localized vs 34.1% advanced). Responses were significantly better for platinum- (p=0.019) and worse for anthracycline-based therapy (p=0.02) in pts with advanced stage. No differences in responses by therapy regimens were seen in pts with localized disease. Median follow up was reached at 12 months and 1-year OS of 59.4%. Worse OS was seen in pts with advanced vs early stage 6 months vs 28 months respectively; (p=0,001, HR 2,73, 95% CI 1.9-3.9), indistinctive of the type of treatment. Pts with early stage disease had a median OS of 38.6, 36.6 and 26.7 months for asparaginase-, anthracycline- and platinum-based treatments, respectively. Less favorable results were seen for advanced stages with median OS of 13.8, 9.8 and 17.6 months, respectively. The leading causes of death were progression (17%, n=52), infection (10%, n=29) and lack of access for treatment (7%, n=22). Conclusion This multicenter study represents one of the largest analyses of ENKTL in LATAM, providing valuable insights into the clinical, treatment patterns and outcome of this aggressive malignancy. Our findings highlight the poor prognosis associated with advanced-stage disease, irrespective of treatment regimen, underscoring the need for early detection and timely intervention. While asparaginase-based therapies showed promise in localized disease, outcomes for advanced stages remain suboptimal, emphasizing the limitations of current treatment strategies in resource-limited settings. The study also reveals significant barriers to care, including limited access to effective therapy, which contributes to the high mortality rate from disease progression and infections. These results underscore the urgent need for improved healthcare infrastructure and tailored therapeutic approaches to enhance outcomes for ENKTL pts in LATAM.
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.