NEW ORLEANS (Reuters Health) Feb 10 - In one of the largest-ever cohorts of patients with the deadly Sezary syndrome - the leukemic form of cutaneous T-cell lymphoma - researchers have been able to identify some predictors of a complete response to treatment.
Among them is a higher percentage of monocytes at baseline - a finding that's never been reported before, the researcher who presented the study told Reuters Health.
"Also, the nearly 75% response rate that we found in our institution was 12% higher than has been reported in the literature," Brian Raphael of the University of Pennsylvania in Philadelphia said in an interview.
At the 69th annual meeting of the American Academy of Dermatology this week, he and his colleagues said that a lower CD4:CD8 ratio, a higher percentage of monocytes, and a lower number of circulating abnormal T cells at baseline appear to be the strongest predictors of complete response.
Traditionally, only 20% of patients with Sezary syndrome respond completely. But in this retrospective study, the complete response rate was 30%, Raphael reported.
He and his colleagues treated 143 patients with extracorporeal photophoresis (ECP) over a 25-year period. The presentation focused on 97 patients with stage III or IV disease who had at least 2 months of ECP therapy combined with one or more systemic treatments with immunostimulatory agents, including interferon-alfa, interferon-gamma, sargramostim (a recombinant granulocyte macrophage colony-stimulating factor), or systemic retinoids.
Seventy-three patients (75%) had significant improvement with multimodality therapy. In addition to the 29 patients (30%) who had complete resolution of their disease, 44 patients (45%) had a partial response, which was defined as greater than 50% but less than 100% improvement in skin and blood parameters.
In comparison with the non responders, the complete responders had a lower CD4:CD8 ratio (13.2 vs 44.2, p = 0.04), a lower median percent of CD4+/CD26- (27.4 vs 57.2, p = 0.01) and CD4+/CD7- (20 vs 41.3, p < 0.01) cells.
The median monocyte percentage for patients who responded completely was 9.5%, compared with 7.3% for non-responders (p = 0.02).
Age at diagnosis, median baseline white blood cell count, and serum lactate dehydrogenase were similar between complete and non-responders.
"Unfortunately, we were unable to find a statistical trend or statistically significant variables when we compared the outcomes in the partial responders," Raphael told Reuters Health. "The partial responders had lower (serum lactate dehydrogenase) and they also had a lower mean percentage of abnormal T cells, but these were not statistically significant."
Regardless, the results also demonstrate that "multimodality therapy is superior to monotherapy, as shown by our 30% complete response rate versus the 20% that has been seen with monotherapy," he noted.
Raphael added that the good results with a high percentage of monocytes could be due to the increase in cytokines that are released when treatment is initiated. "Photophoresis and multimodality therapy could lead to a rapid apoptosis of the tumor cells," he suggested.
Among them is a higher percentage of monocytes at baseline - a finding that's never been reported before, the researcher who presented the study told Reuters Health.
"Also, the nearly 75% response rate that we found in our institution was 12% higher than has been reported in the literature," Brian Raphael of the University of Pennsylvania in Philadelphia said in an interview.
At the 69th annual meeting of the American Academy of Dermatology this week, he and his colleagues said that a lower CD4:CD8 ratio, a higher percentage of monocytes, and a lower number of circulating abnormal T cells at baseline appear to be the strongest predictors of complete response.
Traditionally, only 20% of patients with Sezary syndrome respond completely. But in this retrospective study, the complete response rate was 30%, Raphael reported.
He and his colleagues treated 143 patients with extracorporeal photophoresis (ECP) over a 25-year period. The presentation focused on 97 patients with stage III or IV disease who had at least 2 months of ECP therapy combined with one or more systemic treatments with immunostimulatory agents, including interferon-alfa, interferon-gamma, sargramostim (a recombinant granulocyte macrophage colony-stimulating factor), or systemic retinoids.
Seventy-three patients (75%) had significant improvement with multimodality therapy. In addition to the 29 patients (30%) who had complete resolution of their disease, 44 patients (45%) had a partial response, which was defined as greater than 50% but less than 100% improvement in skin and blood parameters.
In comparison with the non responders, the complete responders had a lower CD4:CD8 ratio (13.2 vs 44.2, p = 0.04), a lower median percent of CD4+/CD26- (27.4 vs 57.2, p = 0.01) and CD4+/CD7- (20 vs 41.3, p < 0.01) cells.
The median monocyte percentage for patients who responded completely was 9.5%, compared with 7.3% for non-responders (p = 0.02).
Age at diagnosis, median baseline white blood cell count, and serum lactate dehydrogenase were similar between complete and non-responders.
"Unfortunately, we were unable to find a statistical trend or statistically significant variables when we compared the outcomes in the partial responders," Raphael told Reuters Health. "The partial responders had lower (serum lactate dehydrogenase) and they also had a lower mean percentage of abnormal T cells, but these were not statistically significant."
Regardless, the results also demonstrate that "multimodality therapy is superior to monotherapy, as shown by our 30% complete response rate versus the 20% that has been seen with monotherapy," he noted.
Raphael added that the good results with a high percentage of monocytes could be due to the increase in cytokines that are released when treatment is initiated. "Photophoresis and multimodality therapy could lead to a rapid apoptosis of the tumor cells," he suggested.
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