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  • 1
    In: Leukemia & Lymphoma, Informa UK Limited, Vol. 61, No. 11 ( 2020-09-18), p. 2595-2604
    Type of Medium: Online Resource
    ISSN: 1042-8194 , 1029-2403
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2020
    detail.hit.zdb_id: 2030637-4
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  • 2
    In: Leukemia & Lymphoma, Informa UK Limited, Vol. 53, No. 3 ( 2012-03), p. 394-399
    Type of Medium: Online Resource
    ISSN: 1042-8194 , 1029-2403
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2012
    detail.hit.zdb_id: 2030637-4
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  • 3
    In: Blood Cancer Journal, Springer Science and Business Media LLC, Vol. 11, No. 5 ( 2021-05-21)
    Type of Medium: Online Resource
    ISSN: 2044-5385
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2600560-8
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  • 4
    In: Leukemia & Lymphoma, Informa UK Limited, Vol. 57, No. 8 ( 2016-08-02), p. 1814-1822
    Type of Medium: Online Resource
    ISSN: 1042-8194 , 1029-2403
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2016
    detail.hit.zdb_id: 2030637-4
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  • 5
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2006
    In:  Annals of Hematology Vol. 86, No. 2 ( 2006-12-14), p. 89-94
    In: Annals of Hematology, Springer Science and Business Media LLC, Vol. 86, No. 2 ( 2006-12-14), p. 89-94
    Type of Medium: Online Resource
    ISSN: 0939-5555 , 1432-0584
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2006
    detail.hit.zdb_id: 1458429-3
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  • 6
    Online Resource
    Online Resource
    S. Karger AG ; 2002
    In:  Pathophysiology of Haemostasis and Thrombosis Vol. 32, No. 2 ( 2002), p. 59-66
    In: Pathophysiology of Haemostasis and Thrombosis, S. Karger AG, Vol. 32, No. 2 ( 2002), p. 59-66
    Abstract: During a 22-month period, 555 consecutive patients at seven hospitals in the western part of Sweden with an acute deep vein thrombosis (DVT) not involving the iliac vein and not having pulmonary embolism were included in a study testing the efficacy of implementing out-patient treatment. For all patients with a confirmed diagnosis of acute DVT, a folder was used that contained two checklists with detailed instructions for further treatment, one for the doctor and one for the nurse, an information pamphlet for the patient and prepared prescriptions for low-molecular-weight heparin (LMWH) tinzaparin (Innohep 〈 sup 〉 ® 〈 /sup 〉 ) of 175 anti-Xa IU/kg body weight subcutaneously once daily and warfarin. Patients not requiring hospitalisation, according to strict guidelines, were then eligible for treatment as out-patients. Prior to release from the emergency department for home treatment, a nurse provided detailed information to the patient and administered the first tinzaparin injection. In 194 (35.0%) out of 555 patients, the DVT was localised only in the lower leg not reaching the popliteal vein. Factors predisposing to venous thromboembolism were identified in 35.0% of the patients. 332 (59.8%) out of the 555 patients studied did not require hospitalisation and were therefore treated as out-patients. 140 of these patients (42.2%) injected themselves, the injection was given by a relative in 63 (19.0%) patients and by the community nurse in 129 (38.9%). Six (1.8%) patients reported a worsening of the DVT condition during the LMWH treatment period. No major bleedings were observed during the injection treatment period. Except for local minor skin bleedings at the injection site, only 3 (0.9%) patients reported minor bleedings during the injection treatment period. Recurrences of venous thromboembolism during the first 2 months were reported in 9 patients (2.7%) out of 332 patients who were sent home from the emergency department. Five (2.2%) patients out of the 223 who were admitted to the hospital had an increased tendency to bleeding. Twelve patients (5.4%) were hospitalised because of a pronounced local status, 26 (11.7%) were senile, social factors were the reason for hospitalisation in 76 (34.1%) and lack of time of the physician in 39 (17.5%) of the patients. A pharmacoeconomic analysis found a cost reduction of 69% with the present model for home treatment compared with traditional in-hospital treatment of DVT patients. We conclude that tinzaparin can be safely used at home by patients with DVT below the inguinal region and that the model used in the present study is cost-effective.
    Type of Medium: Online Resource
    ISSN: 1424-8832 , 1424-8840
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2002
    detail.hit.zdb_id: 2081182-2
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  • 7
    In: Blood, American Society of Hematology, Vol. 134, No. Supplement_1 ( 2019-11-13), p. 399-399
    Abstract: Background Diffuse large B cell lymphoma (DLBCL) is an aggressive but often curable disease. However a proportion of the patients are primary refractory or relapse (R/R DLBCL) following standard immuno-chemotherapy, which is associated with a much worse prognosis especially if the CNS is involved. Current knowledge around the incidence of R/R DLBCL is mostly derived from randomized controlled trials or specialized center cohorts presenting selected patient materials. With new available treatment options for these patients it is of great importance to accurately estimate the incidence in absolute terms. Here we investigated the incidence of R/R DLBCL overall and in the CNS in a nationwide population-based cohort accounting for the presence of competing risks. Methods Patients with a primary diagnosis of DLBCL in 2007-2014 were identified using the Swedish Lymphoma Register and followed until October 31st 2017. Primary CNS lymphomas, primary mediastinal B-cell lymphomas and transformed lymphomas were excluded. The register contains information about clinical characteristics, primary treatment, treatment response and relapse. Information regarding treatment response and progression/relapse as well as site of relapse was validated through medical chart review in all patients. Primary treatment with curative intent was defined as having started treatment with anthracycline-based chemotherapy (mostly R-CHOP). Overall (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method in the full cohort. Cumulative incidence of R/R DLBCL was estimated in the subset of patients who were treated with curative intent accounting for the competing risk of death. The net probability of CNS progression/relapse by CNS IPI was estimated in curatively treated patients who did not have CNS involvement at diagnosis. The cumulative incidence of CNS relapse was estimated non-parametrically with death and non-CNS progression/relapse as competing risks among all curatively treated patients and restricted to patients with high CNS IPI (4-6) separately. Results In the study population of 4205 patients, median age at diagnosis was 71 years (range 18 to 105). Sixteen percent of patients (n=677, median age 83 years) were not able to start treatment with curative intent, with the median OS in this group of only 2.7 months. Two-year OS for patients treated with curative intent was 88% (95% CI: 87-89) and 2-year progression free survival (PFS) was 70% (95% CI: 69-72) (fig 1a). The 5-year cumulative incidence of relapsed/refractory disease in patients treated with curative intent was 23% (95% CI: 22-24, total N=713) (fig 1b) and the majority relapsed within two years (n=646, 77%). Five percent of the patients starting primary treatment with curative intent, only received 1 or 2 treatment cycles and were not evaluated for response. The 2-year cumulative incidence of CNS relapse in curatively treated patients was 2.8% (95% CI: 2.7-3.4, total N=126) (fig 1b). For patients with high CNS IPI (4-6) the 2-year rate of CNS relapse was 12% (95% CI: 8-16) when estimated using the Kaplan-Meier method (fig 1c), but only 8% (95% CI: 6-11) in the cumulative incidence model (fig 1d) accounting for other relapses and death as competing events. Conclusion The 5-year cumulative incidence of relapsed/refractory disease in patients with DLBCL treated with curative intent is 23% in this population-based study, which is lower than in previously published reports. Overall, 16% of patients were not able to start primary curative intent treatment, representing an older group of patients with a dismal OS. An additional 5% of patients were not able to tolerate more than 1-2 cycles, defining another group of patients with unmet medical needs. The 2-year cumulative incidence of CNS relapse is & lt;10% even in high-risk patients when estimating absolute risk in the real world where patients also face risks of non-CNS relapse and death. Figure 1 A): Overall survival (OS) and progression-free survival (PFS) among 4205 patients with diffuse large B-cell lymphoma (DLBCL) diagnosed in Sweden 2007-2014 treated with curative (n=3528 ) or palliative intent (n=677). B): Cumulative incidence of CNS relapse in the presence of competing risks of death and non-CNS relapse. C): Net probability of CNS relapse by CNS IPI (N=3499). D): Cumulative incidence of CNS relapse restricted to 414 patients with high CNS IPI (4-6). Disclosures Harrysson: Janssen pharmaceuticals: Other: This project was partly funded through a private-public collaboration between KI and Janssen pharmaceuticals.; Swedish Cancer Society: Other: This project was partly funded by the Swedish Cancer Society.. Eloranta:Karolinska Institutet: Other: coordinator for a public-private real world evidence; Janssen Pharmaceuticals.: Other: project coordinator for a public-private real world evidence. Ekberg:Janssen Pharmaceuticals: Other: This project was partly funded through a private-public collaboration between KI and Janssen pharmaceuticals.; Swedish Cancer Society: Other: This project was partly funded by the Swedish Cancer Society. Enblad:Kite/Gilead: Membership on an entity's Board of Directors or advisory committees. Jerkeman:Janssen: Honoraria, Research Funding; Gilead: Honoraria, Research Funding; Acerta: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Roche: Honoraria, Research Funding. Wahlin:Roche and Gilead: Consultancy. Andersson:Gilead, Janssen and Roche: Consultancy; Gilead: Research Funding; Abbvie and Janssen: Membership on an entity's Board of Directors or advisory committees. Smedby:Janssen Pharmaceuticals: Other: This project was partly funded through a private-public collaboration between KI and Janssen pharmaceuticals.; Takeda: Research Funding; Celgene: Honoraria.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2019
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 8
    In: Blood, American Society of Hematology, Vol. 132, No. Supplement 1 ( 2018-11-29), p. 2975-2975
    Abstract: Background Our knowledge around the incidence of relapse and primary refractory disease in patients with diffuse large B-cell lymphoma (DLBCL) in the rituximab era is mostly derived from randomized controlled trials or specialized center cohorts presenting selected patient materials. With new therapies being evaluated and launched at diagnosis as well as in the relapsed/refractory setting there is a need for a better understanding of the response and outcome with current treatment strategies. Here we investigated the incidence of primary refractory DLBCL and first relapse as well as survival among patients with relapsed/refractory DLBCL in a population-based cohort. Methods Patients with a primary diagnosis of DLBCL in 2007-2014 were identified using the Swedish Lymphoma Register in 5 of 6 health care regions, and followed until October 31st 2017. Primary CNS lymphomas and primary mediastinal B-cell lymphomas were excluded. The register contains information about clinical characteristics, primary treatment, treatment response and relapse. Information regarding treatment response and progression/relapse was validated through medical chart review in all patients. Primary treatment with curative intent was defined as having started treatment with anthracycline-based chemotherapy (mostly R-CHOP). Early relapse was defined as having primary refractory disease (stable or progressive disease (SD/PD) at response evaluation) or relapse within a year from diagnosis. Overall and progression-free survival probabilities were estimated with the Kaplan-Meier method in the entire cohort and among relapsed/refractory patients by early/late relapse and by age +/- 70 years. Additionally, cumulative incidence of relapsed/refractory disease by follow-up time was shown graphically accounting for the presence of competing risks. Results In the study population of 3165 patients, median age at diagnosis was 71 years (range 18 to 97). In this unselected cohort, 80% of the patients started treatment with curative intent. Five-year overall survival (OS) for patients treated with curative intent was 78% (95% CI: 76-80) and 5-year progression free survival (PFS) was 60% (95% CI: 58-62). Patients who received non-curative intent or palliative therapy (20%) had a median OS of 4.7 months (95% CI: 3.4-5.7). The 10-year cumulative incidence of relapsed/refractory disease in patients treated with curative intent was 22% (95% CI: 20-24) and the majority relapsed within two years (n=315, 60%). Five percent of the patients starting primary treatment with curative intent, only received 1 or 2 treatment cycles and were not evaluated for response. Patients with relapsed/refractory disease had a poor prognosis. For patients with early relapse, median survival from the date of relapse was 4.6 months (95% CI: 4.1-5.7) and 5-year OS was 11% (95% CI; 8-15) whereas patients with late relapse had a median survival of 18.0 months (95% CI: 13.0-24.5) and a 5-year OS of 26% (95% CI: 20-33). Survival in younger patients (≤70 years) by early and late relapse was higher although still low; 5-year OS in early relapse was 17% (95% CI: 12-23) and in late relapse 37% (95% CI: 27-48). Among older patients ( 〉 70 years) with early relapse, 5-year OS was only 4% (95% CI: 2-9) and in patients with late relapse it was 16% (95% CI: 9-24). More information regarding treatment intensity among relapsed/refractory patients will be presented. Conclusion The 10-year cumulative incidence of relapsed/refractory disease in patients with DLBCL treated with curative intent is 22% in this population-based study, which is lower compared to previous reports. Outcome for patients with relapsed/refractory disease continues to be poor especially for patients with early progression/relapse, even among younger patients going on to intensive second-line chemotherapy aiming for autologous stem cell transplantation. These results underscore both the urgency of new therapies for relapsed/refractory DLBCL as well as the need for identification of high-risk patients already at diagnosis. Figure 1. Overall survival (OS) and progression-free survival (PFS) among 3165 patients with diffuse large B-cell lymphoma (DLBCL) diagnosed in Sweden 2007-2014 treated with curative or palliative intent, and cumulative incidence of relapsed/refractory disease and survival among 529 relapsed/refractory patients by timing of relapse (early/late) and age (+/-70 years). Figure. Figure. Disclosures Harrysson: Janssen Pharmaceuticals: Other: The Department have recieved partial funding from Janssen Pharmaceuticals. Eloranta:Janssen Pharmaceuticals: Other: S Eloranta is currently employed as a project coordinator and her salary is funded via a public-private real world evidence collaboration between Karolinska Institutet and Janssen Pharmaceuticals. Ekberg:Janssen Pharmaceuticals: Other: The department has received partial funding from Janssen Pharmaceuticals. Wahlin:Gilead: Consultancy, Honoraria, Research Funding; Roche: Research Funding. Smedby:Janssen Pharmaceuticals: Other: The Department have recieved partial funding from Janssen Pharmaceuticals.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2018
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 9
    In: Leukemia & Lymphoma, Informa UK Limited, Vol. 62, No. 10 ( 2021-08-24), p. 2360-2373
    Type of Medium: Online Resource
    ISSN: 1042-8194 , 1029-2403
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2021
    detail.hit.zdb_id: 2030637-4
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  • 10
    In: Blood, American Society of Hematology, Vol. 128, No. 22 ( 2016-12-02), p. 4121-4121
    Abstract: Introduction: Diffuse Large B-cell Lymphoma (DLBCL) patients with early relapse or refractory disease have a very poor outcome. The major prognostic tool used today is still the clinically based International Prognostic Index (IPI). Yet, IPI seems to be less useful in the identification of individual patients with high risk of failing immunochemotherapy. Despite the higher risk of treatment failure in patients with biological subtypes such as ABC-DLBCL and double-hit DLBCL, about 30-40 % are long term progression-free with current therapy. So, novel biomarkers that more accurately can identify the high-risk patients are warranted, and there is a need to further explore underlying tumor biology features causing treatment resistance. Aims: We compared the proteome in tumor tissue from two groups of DLBCL patients treated with modern immunochemotherapy, i) early relapse/refractory patients and ii) long-term progression-free patients, with the aim to determine if differences in clinical outcome could be correlated to diverse proteomic profiles. Patients and Methods: Formalin-fixed paraffin-embedded tumor tissue, collected at diagnosis, from 93 DLBCL patients, divided into two groups: A) early relapse, i.e. within 12 months, or primary refractory patients, n=44 (REF/REL), and B) cured patients, i.e. with a follow-up of at least 5 years without relapse, n=49 (CURED). Micro-dissected tissue was analyzed using TMT-based mass spectrometry (MS): equal amounts of protein solutions from each patient sample and a reference pool were trypsin-digested into peptides using the FASP-method. NanoLC-MS/MS analysis was performed using a QExactive-Easy-nLC 1,000 instrument combination. Raw data were merged during the database search for protein identification and relative quantification using Proteome Discoverer. Results: In total, we identified 1996 proteins of which 443 were found in all patient samples. Of the 443 proteins, 86 were differentially expressed between the two patient groups. Fifty-seven proteins were overexpressed in the REF/REL group, among which 36 were ribosomal proteins (RP), e.g. RPS2, S3, S5, S6, S7, S13, S15a, S23, L3, L5, L6, L7a, L10, L13a, L18, L31 and L32. In contrast, only 1 RP was overexpressed in the CURED group (RPS10) (p 〈 0.0000001). Among individual proteins overexpressed in the REF/REL group we found several proteins that previously have been described as negative prognostic factors in other malignancies, e.g. IMPDH2, MARCKS, NPM1, Prohibitin, RACKS1 and SF3B3. Interestingly, we also found that 10 of 27 overexpressed proteins in the CURED group were associated with the actin-regulating network, while no such proteins were found in the REF/REL group (p 〈 0.00001). Additionally, we performed a multivariate analysis (OPLS-DA), including the significant 87 peptides, to discriminate between the REF/REL and CURED groups: we observed a separation, and a variance analysis suggested a valid model (CV-ANOVA; p=3.7 x 10-7). Discussion: We found that a number of RP was overexpressed in DLBCL patients with early relapse or refractory disease. RP play a fundamental role not only in ribosome biogenesis and protein translation but there is also accumulating evidence that dysregulated RP could contribute to tumorigenesis, tumor progression and metastasis. Furthermore, multidrug resistance in some other cancer forms has been associated with overexpression of RP. In DLBCL, apart from overexpression of RPS6 (also found in this study), there is no previous available data on RP dysregulation. Conclusion: Overexpression of multiple ribosomal proteins appears to be associated with failure to immunochemotherapy in DLBCL, and further understanding of their role could potentially lead to new therapeutic strategies in this disease. Disclosures Andersson: Roche: Speakers Bureau.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2016
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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