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CNS prophylaxis and treatment in non-Hodgkin's lymphoma: variation in practice and lessons from the literature.

https://arctichealth.org/en/permalink/ahliterature184522
Source
Leuk Lymphoma. 2003 Jun;44(6):955-62
Publication Type
Article
Date
Jun-2003
Author
Rena Buckstein
Wendy Lim
Edmee Franssen
Kevin L Imrie
Author Affiliation
Department of Medicine, University of Toronto, Toronto Sunnybrook Regional Cancer Centre, 2075 Bayview Avenue, Toronto, Ont., Canada. rena.buckstein@tsrcc.on.ca
Source
Leuk Lymphoma. 2003 Jun;44(6):955-62
Date
Jun-2003
Language
English
Publication Type
Article
Keywords
Adult
Antineoplastic Agents - therapeutic use
Central Nervous System Neoplasms - drug therapy - prevention & control - radiotherapy - secondary
HIV Infections - complications
Humans
Lymphoma, Non-Hodgkin - drug therapy - pathology
Male
Neoplasm Staging
Ontario
Physician's Practice Patterns
Prognosis
Questionnaires
Risk factors
Abstract
Practices regarding central nervous system (CNS) prophylaxis and treatment for non-"high-grade" lymphomas are not standardized. We designed a survey to address the CNS surveillance, prophylaxis and treatment (S + P + T) habits of Ontario oncologists, to compare tertiary with community care and gauge interest in a randomized controlled trial (RCT). We mailed 145 questionnaires to oncologists/hematologists registered at the Royal College of Physicians and Surgeons of Ontario between 1980 and 1999. The questionnaire posed questions of S + P + T for a variety of histologies, locations and risk factors. Results showed that 49/77 respondents treated adult NHL, (19 community, 30 tertiary care). Surveillance LP's were commonly done in testicular, orbital, sinus and epidural sites of presentation (76, 69, 71, 80%, respectively), but these were less commonly prophylaxed (45, 33, 29 and 41%). HIV associated NHL received surveillance and prophylaxis by 51 and 33% of respondents. Stage IV disease, increased LDH and extranodal-sites warranted infrequent S + P. IT chemotherapy via LP was the most commonly used form of prophylaxis (74%) or treatment (84%). Twenty percent used systemic agents that cross the blood brain barrier for prophylaxis, and 45% for treatment. A vast heterogeneity of practice within and between tertiary care and community physicians' practices was documented. Ninety percent of physicians indicated willingness to participate in a RCT. In conclusion, CNS surveillance and prophylaxis in non-"high-grade" NHL is highly variable, probably because there are poorly defined risk factors, inconclusive prophylaxis efficacy and the inconvenience/toxicity of therapy. Patients at high risk by International prognostic index criteria are at an increased risk for CNS relapse. A RCT comparing standard chemotherapy with or without CNS prophylaxis in selected patients is needed.
PubMed ID
12854893 View in PubMed
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A phase II study of bortezomib and gemcitabine in relapsed mantle cell lymphoma from the National Cancer Institute of Canada Clinical Trials Group (IND 172).

https://arctichealth.org/en/permalink/ahliterature137022
Source
Leuk Lymphoma. 2011 Mar;52(3):394-9
Publication Type
Article
Date
Mar-2011
Author
C Tom Kouroukis
Louis A V Fernandez
Michael Crump
Randy D Gascoyne
Neil Sun Chua
Rena Buckstein
Robert Turner
Sarit Assouline
Richard J Klasa
Wendy Walsh
Jean Powers
Elizabeth Eisenhauer
Author Affiliation
Juravinski Hospital and Cancer Centre, Hamilton, Ontario, Canada. tom.kouroukis@jcc.hhsc.ca
Source
Leuk Lymphoma. 2011 Mar;52(3):394-9
Date
Mar-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols - adverse effects - therapeutic use
Boronic Acids - administration & dosage - adverse effects
Canada
Clinical Trials as Topic
Deoxycytidine - administration & dosage - adverse effects - analogs & derivatives
Disease-Free Survival
Female
Humans
Lymphoma, Mantle-Cell - drug therapy - pathology
Male
Medical Oncology - organization & administration
Middle Aged
National Health Programs
Pyrazines - administration & dosage - adverse effects
Recurrence
Societies, Medical
Abstract
Bortezomib and gemcitabine have each shown activity as single agents in mantle cell lymphoma (MCL), which is incurable. The purpose of this phase II study was to determine the efficacy and safety of the previously unstudied combination of bortezomib and gemcitabine in patients with relapsed or refractory MCL. Patients were eligible if they had relapsed MCL with 1-3 prior therapies. Patients were treated with gemcitabine 1000 mg/m(2) on days 1 and 8 and bortezomib 1.0 mg/m(2) IV on days 1, 4, 8, and 11, on a 21-day schedule. Twenty-six patients were evaluable for toxicity and 25 for response. The overall response rate was 60% and the median progression free survival was 11.4 months. The main adverse effects were hematological, with 40% and 48% of patients experiencing grade 3/4 thrombocytopenia and granulocytopenia, respectively. Bortezomib and gemcitabine is an active combination in relapsed and refractory MCL with clinically meaningful results. It offers a chemotherapy backbone to which other agents, less myelosuppressive, may be added.
Notes
Comment In: Leuk Lymphoma. 2011 Apr;52(4):545-721438822
Erratum In: Leuk Lymphoma. 2011 Jun;52(6):1160Gascoyne, Randy D [added]
PubMed ID
21323520 View in PubMed
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Physician perceptions and preferences in the treatment of acquired immunodeficiency syndrome (AIDS)-related lymphoma.

https://arctichealth.org/en/permalink/ahliterature164557
Source
Ann Hematol. 2007 Sep;86(9):631-8
Publication Type
Article
Date
Sep-2007
Author
Matthew C Cheung
Kevin R Imrie
Heather A Leitch
Laura Y Park-Wyllie
Rena Buckstein
Tony Antoniou
Mona R Loutfy
Author Affiliation
Department of Medicine, Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. matthew.cheung@utoronto.ca
Source
Ann Hematol. 2007 Sep;86(9):631-8
Date
Sep-2007
Language
English
Publication Type
Article
Keywords
Antibodies, Monoclonal - therapeutic use
Antibodies, Monoclonal, Murine-Derived
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Antiretroviral Therapy, Highly Active - utilization
Canada
Choice Behavior
Cyclophosphamide - therapeutic use
Data Collection
Disease Management
Doxorubicin - therapeutic use
Humans
Lymphoma, AIDS-Related - drug therapy
Physician's Practice Patterns - statistics & numerical data
Physicians - psychology
Prednisone - therapeutic use
Vincristine - therapeutic use
Abstract
The optimal management of acquired immunodeficiency syndrome-related lymphoma (ARL) in the era of combination antiretroviral therapy (cART) is unclear. We administered a survey to determine physician preferences and perceptions in the management of ARL and to assess the variability in treatment in Canada. Of 196 lymphoma-treating physicians, 117 (63%) responded. The majority of respondents (98%) had a positive attitude towards the treatment of ARL. Most physicians (66%) recommended the concomitant use of cART in the care of their patients with ARL, and a majority (86%) recommended CHOP-like regimens (cyclophosphamide, doxorubicin, vincristine, and prednisone) to form the backbone of chemotherapy. The addition of rituximab was preferred by 43% of physicians, while 39% and 18% would either not use rituximab or were unsure of the agent's role, respectively. In logistic regression analysis, use of rituximab was predicted only by location of practice (province); physicians from the province of British Colombia were much more likely to administer rituximab than practitioners from Ontario (odds ratio 41.8; 95% confidence interval 7.44-235.1, p
PubMed ID
17372734 View in PubMed
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