Central nervous system relapse of diffuse large B-cell lymphoma in the rituximab era: results of the UK NCRI R-CHOP-14 versus 21 trial.

BACKGROUND: Central nervous system (CNS) relapse of diffuse large B-cell lymphoma (DLBCL) is associated with a dismal prognosis. Here, we report an analysis of CNS relapse for patients treated within the UK NCRI phase III R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) 14 versus 21 randomised trial. PATIENTS AND METHODS: The R-CHOP 14 versus 21 trial compared R-CHOP administered two- versus three weekly in previously untreated patients aged ≥18 years with bulky stage I-IV DLBCL (n = 1080). Details of CNS prophylaxis were retrospectively collected from participating sites. The incidence and risk factors for CNS relapse including application of the CNS-IPI were evaluated. RESULTS: 177/984 patients (18.0%) received prophylaxis (intrathecal (IT) methotrexate (MTX) n = 163, intravenous (IV) MTX n = 2, prophylaxis type unknown n = 11 and IT MTX and cytarabine n = 1). At a median follow-up of 6.5 years, 21 cases of CNS relapse (isolated n = 11, with systemic relapse n = 10) were observed, with a cumulative incidence of 1.9%. For patients selected to receive prophylaxis, the incidence was 2.8%. Relapses predominantly involved the brain parenchyma (81.0%) and isolated leptomeningeal involvement was rare (14.3%). Univariable analysis demonstrated the following risk factors for CNS relapse: performance status 2, elevated lactate dehydrogenase, IPI, >1 extranodal site of disease and presence of a 'high-risk' extranodal site. Due to the low number of events no factor remained significant in multivariate analysis. Application of the CNS-IPI revealed a high-risk group (4-6 risk factors) with a 2- and 5-year incidence of CNS relapse of 5.2% and 6.8%, respectively. CONCLUSION: Despite very limited use of IV MTX as prophylaxis, the incidence of CNS relapse following R-CHOP was very low (1.9%) confirming the reduced incidence in the rituximab era. The CNS-IPI identified patients at highest risk for CNS recurrence. CLINICALTRIALS.GOV: ISCRTN number 16017947 (R-CHOP14v21); EudraCT number 2004-002197-34.

Outcome of elderly patients with diffuse large B-cell lymphoma treated with R-CHOP: results from the UK NCRI R-CHOP14v21 trial with combined analysis of molecular characteristics with the DSHNHL RICOVER-60 trial.

BACKGROUND: There is an on-going debate whether 2- or 3-weekly administration of R-CHOP is the preferred first-line treatment for elderly patients with diffuse large B-cell lymphoma (DLBCL). The UK NCRI R-CHOP14v21 randomized phase 3 trial did not demonstrate a difference in outcomes between R-CHOP-14 and R-CHOP-21 in newly diagnosed DLBCL patients aged 19-88 years, but data on elderly patients have not been reported in detail so far. Here, we provide a subgroup analysis of patients ≥60 years treated on the R-CHOP14v21 trial with extended follow-up. PATIENTS AND METHODS: Six hundred and four R-CHOP14v21 patients ≥60 years were included in this subgroup analysis, with a median follow-up of 77.7 months. To assess the impact of MYC rearrangements (MYC-R) and double-hit-lymphoma (DHL) on outcome in elderly patients, we performed a joint analysis of cases with available molecular data from the R-CHOP14v21 (N = 217) and RICOVER-60 (N = 204) trials. RESULTS: Elderly DLBCL patients received high dose intensities with median total doses of ≥98% for all agents. Toxicities were similar in both arms with the exception of more grade ≥3 neutropenia (P < 0.0001) and fewer grade ≥3 thrombocytopenia (P = 0.05) in R-CHOP-21 versus R-CHOP-14. The elderly patient population had a favorable 5-year overall survival (OS) of 69% (95% CI: 65-73). We did not identify any subgroup of patients that showed differential response to either regimen. In multivariable analysis including individual factors of the IPI, gender, bulk, B2M and albumin levels, only age and B2M were of independent prognostic significance for OS. Molecular analyses demonstrated a significant impact of MYC-R (HR = 1.96; 95% CI: 1.22-3.16; P = 0.01) and DHL (HR = 2.21; 95% CI: 1.18-4.11; P = 0.01) on OS in the combined trial cohorts, independent of other prognostic factors. CONCLUSIONS: Our data support equivalence of both R-CHOP application forms in elderly DLBCL patients. Elderly MYC-R and DHL patients have inferior prognosis and should be considered for alternative treatment approaches. TRIAL NUMBERS: ISCRTN 16017947 (R-CHOP14v21); NCT00052936 (RICOVER-60).

Determination of the glycaemic index of various staple carbohydrate-rich foods in the UK diet.

OBJECTIVE: To determine the glycaemic index (GI) of various staple carbohydrate-rich foods in the UK diet, and to consider the factors influencing the GI of foods. DESIGN: Subjects were served with 25 or 50 g portions of glucose on three occasions, followed by a selection of test foods providing an equal amount of available carbohydrate, in random order. Each test food was consumed by 10 subjects. Capillary blood glucose levels were measured in the fasted state and over the 120 min following commencement of consumption of the foods. SETTING: The study was carried out in a research institute (MRC Human Nutrition Research, Cambridge, UK). SUBJECTS: Forty-two healthy adult volunteers were studied. METHODS: The GI values of 33 foods were measured according to the WHO/FAO recommended methodology. These foods included various breads, breakfast cereals, pasta, rice and potatoes, all of which were commercially available in the UK. CONCLUSIONS: The results illustrate a number of factors which are important in influencing the GI of a food, highlighting the importance of measuring the GI of a food, rather than assuming a previously published value for a similar food. This is useful both to researchers analysing dietary surveys or planning intervention studies, and also to health professionals advising individuals on their diets.

Studies of copper ion-induced mitochondrial swelling in vitro.

1. A study of the mode and mechanism of Cu(2+)-induced mitochondrial swelling was carried out. 2. Mitochondrial swelling curves (E(520) turbidity changes) were obtained as a function of [Cu(2+)], pH, temperature and mitochondrial protein concentration. ED(50) was approx. 70mmumoles of Cu(2+). Calculation of the activation energy from the Arrhenius equation gave a value of 22900cal./mole per degree with Q(10) 4.02. 3. No lipid peroxides were formed during swelling. 4. Changes in oxygen consumption (Clark-type electrode) were dependent on the substrate used, but revealed no increased uptake in presence of Cu(2+). 5. Cu(2+)-induced swelling was inhibited by EDTA, 8-hydroxyquinoline, cyanide, citrate, bovine serum albumin, ATP, glutamate, GSH, dithiothreitol and sucrose. Azide, Amytal, antimycin A and oligomycin had no significant effect. Potentiation of swelling was seen with ascorbate, 2,4-dinitrophenol and succinate. 6. The occurrence of different types of mitochondrial swelling and the suggestion that Cu(2+)-induced swelling is mediated through a stoicheiometric interaction with a thiol-containing membrane receptor are discussed.