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Background The regimen of cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) is an efficient treatment of non-Hodgkin’s lymphoma (NHL). This study aimed to assess the efficacy and toxicity of dose-adjusted CHOP alone or in combination with rituximab (R-CHOP) by examining the stem cell mobilization in NHL patients. Factors affecting the collection of CD34+ cells were also explored. Methods Our retrospective study included 39 patients eligible for autologous stem cell transplantation: 14 patients who expressed CD20 and were financially eligible received R-CHOP for autologous peripheral blood stem cell (APBSC) mobilization; the remaining 25 patients received CHOP. Results The median CD34+ cell yield was 7.01 × 106 cells/kg body weight (range 1.49–28.39 × 106 cells/kg body weight), with only two patients failing to meet the target CD34+ cell harvest of ≥2.0 × 106 cells/kg body weight. The median number of apheresis procedures per patient was 1 (range 1–3). The APBSC mobilization yield of the CHOP group appeared to be higher than that of the R-CHOP group (P = 0.005), whereas the success rate was similar between groups. R-CHOP elevated the complete response (CR) rate in B cell lymphoma patients as compared with CHOP (P = 0.01). No significant differences in toxicity or engraftment were observed between the two groups. Conclusion The present study demonstrated that dose-adjusted CHOP chemotherapy effectively mobilized APBSCs in NHL patients and that the addition of rituximab to dose-adjusted CHOP chemotherapy elevated the CR rate for patients with B-cell lymphoma.

Chemotherapy is the current mainstay of treatment for patients with newly diagnosed metastatic nasopharyngeal carcinoma (NPC), whereas the role of locoregional radiotherapy remains to be defined. In this study, we retrospectively evaluated the outcome of systemic chemotherapy followed by locoregional definitive intensity-modulated radiation therapy (IMRT) as first-line treatment for these patients. Forty-one patients with pathologically confirmed NPC with distant metastasis at initial diagnosis seen between March 2005 and February 2014 were included. All the patients were treated with platinum-based systemic chemotherapy followed by definitive IMRT to the primary head and neck region with or without concurrent chemotherapy. In addition, local treatment to metastatic lesions was given in 19 patients. With a median follow-up time of 25 months, 24 patients had died, and the estimated median overall survival time was 31.2 months. The 1-, 2-, 3- and 5-year estimated OS rates were 89.9, 67.4, 41.1 and 22.5%, respectively. Prognostic analyses showed that serum lactate dehydrogenase level (P = 0.021) and number of metastatic sites (single vs. multiple; P = 0.016) were significant prognostic factors. Five patients are still alive without evidence of disease after 52 to >101 months. All of them had a single metastatic lesion and received local treatment to metastatic sites. These results suggest that the use of definitive IMRT to treat the locoregional tumor in combination with systemic chemotherapy may prolong survival in patients with newly diagnosed metastatic NPC, making curability a possible consideration in selected patients with single metastasis. Further prospective clinical trials are warranted.

To evaluate the clinicopathological features and outcomes of lymphoma in pregnancy.A total of 21 patients with lymphoma in pregnancy were diagnosed and treated at our hospital between January 1999 and January 2012. The clinicopathological data were analyzed retrospectively.There were 11 cases of Hodgkin's lymphoma (HL) and 10 cases of nodular sclerosis classical Hodgkin's lymphoma (NSCHL). And, among 10 cases of non-Hodgkin's lymphomas (NHL), there were diffuse large B cell lymphoma (n = 6),B-cell lymphoma, non-classifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma (n = 1), small lymphocytic lymphoma (n = 1), anaplastic large cell lymphoma with anaplastic lymphoma kinase (ALK) positive (n = 1) and T-cell lymphoblastic lymphoma (n = 1). The median age was 26(22-35) years.Superficial lymphadenopathy was more common in HL than in NHL (10/11 vs 3/10, P = 0.008). At diagnosis, bulky disease and extranodal involvement were more prevalent in NHL than in HL (8/10 vs 2/11, P = 0.009; 7/10 vs 2/11, P = 0.030). All patients received chemotherapy and those with early stages also had combined radiotherapy. Ten patients with HL and 6 patients with NHL achieved complete remission. During a median follow-up of 90 months for HL, the 5-year progression-free survival (PFS) and overall survival (OS) rates were 87.5% and 100% respectively. And during a median follow-up of 31 months for NHL, the 2-year PFS and OS rates were 66.7% and 77.8% respectively. The values of PFS and OS of NHL were inferior to those of HL (P = 0.073 and P = 0.066 respectively).One case of HL and 1 case of NHL received chemotherapy in the second trimester. The patients and their children experienced good outcomes.NSCHL is the most prevalent subtype of HL during pregnancy. B cell lymphoma and aggressive subtypes are most common for NHL during pregnancy. The outcomes of NHL are inferior to those of HL during pregnancy.

To analyze the clinical features, therapeutic outcome and prognostic factors of mantle cell lymphoma (MCL).Clinical data of a total of 68 patients with MCL admitted from August 2003 to June 2013 in our department were retrospectively analyzed.Of all the patients, the median age was 58.5 years, with marked male predominance (2.8:1), 59 patients (86.8%) were in Ann Arbor stage III/IV. 56 cases (82.4%) primarily showed lymph node involvement, 49 cased showed extranodal involvement and 19 cases (38.8%) had bone marrow involvement. Patients were followed up for 4 to 122 months with a median follow up time of 35 months. The 3- and 5-year overall survival (OS) rates were 78.5% and 64.1%, respectively. The 2- and 3-year progression-free survival (PFS) rates were 41.3% and 23.7%, respectively, and the median time to progression was 20.0 months. The overall response rate (ORR) of CHOP regimen was superior to that of intense regimens (P = 0.036). Univariate analysis showed that stage III/IV,IPI score of 3-5, expression of Ki-67 higher than 30%, elevated LDH, elevated β2-MG, blastic variant, more than 5 lymph nodes involved, and failure to chemotherapy were the negative factors. Multivariate analysis showed that Ki-67 index, LDH and the response to chemotherapy were independent factors affecting survival.Most patients with MCL were elderly males with advanced stage and usually had bone marrow involvement. Although ORR of CHOP regimen is superior to intense regimens, the prognosis of MCL remains poor.

The study evaluated the effectiveness of autologous hematopoietic stem cell transplantation (AHSCT) in the treatment of lymphoblastic lymphoma (LL).We retrospectively analyzed the data from 41 patients with chemotherapy-sensitive LL who underwent hematopoietic stem cell transplantation (HSCT) from December 1989 to December 2009 in a single institution.HSCT was conducted as first-line consolidation therapy and salvage therapy in 36 and 5 patients, respectively. The median follow-up was 97.1 months (range, 24.6-173.1 months). The 5-year overall survival (OS) and event-free survival (EFS) rate were 64% and 47% for the initially treated patients, respectively, and were both 20% for the relapsed ones. Bone marrow (BM) involvement and chemotherapy cycles prior to transplantation were identified as significant prognostic factors for EFS in multivariate analysis.These results confirm that AHSCT is a reasonable option for chemotherapy-sensitive LL patients in first complete remission (CR1).

To evaluate the efficacy and safety of gemcitabine combined with oxaliplatin (GEMOX) in lymphoma patients after failure of multiple chemotherapy regimens.The clinical data of 27 lymphoma patients, who received GEMOX regimen after failure of two or more prior chemotherapy regimens, were retrospectively reviewed. The predictive factors related to the clinical efficacy of GEMOX regimen were explored.The efficacy could be evaluated in 24 patients. Complete response was obtained in 4 patients (16.7%), partial response in 7 patients (29.1%), stable disease in 6 patients (25.0%), and progressive disease in 7 patients (29.1%), with an overall response rate of 45.8%. Among the eleven CR and PR patients, four patients were with diffuse large B cell lymphoma, four patients with Hodgkin's lymphoma, one with peripheral T cell lymphoma, one with mantle cell lymphoma and one with gastric mucosa-associated lymphoid tissue lymphoma. The median PFS time of the whole group was 8 months (95%CI, 1.6-14.4 months). For 11 CR and PR patients who had response to the GEMOX regimen, the median PFS time was 19 months (95%CI, 11.1-26.8 months). Major adverse response was hematologic toxicity. Among them, grade III or IV neutropenia appeared in 16 patients (59.3%), and grade III or IV thrombocytopenia appeared in 11 patients (40.7%). The sensitivity to the last chemotherapy was related to the efficacy of GEMOX regimen. The response rate was 83.3% in patients who had response to the last chemotherapy, and only 31.2% in the patients who failed to the last chemotherapy (P = 0.001).GEMOX regimen can get a better response rate in lymphoma patients after failure of multiple chemotherapy regimens, and with a good tolerance and acceptable safety. Some patients can get long-term survival. Patients sensitive to the last chemotherapy are more likely to benefit from GEMOX regimen.

Acute and chronic respiratory diseases are associated with abnormal coagulation regulation and fibrolysis. However, the detailed mechanism by which coagulation regulation and fibrolysis affect the occurrence and development of lung diseases remain to be elucidated. Protease activated receptor-1 (PAR-1), a major high-affinity thrombin receptor, and nuclear factor kappa B (NF-κB), a transcription factor, are involved in cell survival, differentiation, and proliferation. We have investigated the potential mechanism of thrombin-induced fibroblast proliferation and roles of PAR-1 and NF-κB signalling in this process. The effect of thrombin on proliferation of human pulmonary fibroblasts (HPF) was assessed by 5-bromo-2-deoxyuridine (BrdU) incorporation assay. The expression of PAR1 and NF-κB subunit p65 protein was detected by Western blot. Nuclear translocation of p65 was examined by laser scanning confocal microscopy. We show that thrombin significantly increased proliferation of HPF as determined by induction of BrdU-positive incorporation ratio. Induced PAR1 protein expression was also seen in HPF cells treated with thrombin. However, thrombin had no significant effect on expression and translocation of NF-κB p65 in HPF cells. The results indicate that, by increasing protein expression and interacting with PAR1, thrombin promotes HPF proliferation. NF-κB signalling appears to play no role in this process.

Peripheral T-cell lymphoma (PTCL) carries a poor prognosis with conventional treatment. We retrospectively analyzed data from 45 patients with PTCL who received high-dose therapy and autologous stem cell transplantation (HDT/ASCT) from 1990 to 2008 in our center. Eighteen patients underwent HDT/ASCT in complete remission to induction chemotherapy (CR1), and 27 patients underwent HDT/ASCT in other disease statuses. The median follow-up was 113.5 months (range 52.6–261.0) for surviving patients. The 5-year overall survival (OS) and progression-free survival (PFS) were 64 and 60 %, respectively. The 5-year OS for patients in CR1 and in other disease statuses was 89 and 47 %, respectively (P = 0.002), and 5-year PFS was 83 and 43 % (P = 0.007). In the subgroup excluding anaplastic large cell lymphoma, patients transplanted in CR1 also had significantly better 5-year OS (82 vs. 37 %, P = 0.009) and PFS (82 vs. 33 %, P = 0.008) than those transplanted in other disease statuses. Multivariate analysis showed that CR1 status was the only significant prognostic factor for OS (P = 0.040) and PFS (P = 0.040). These results support the use of HDT/ASCT consolidation in CR1 for PTCL patients. Prospective randomized trials are necessary to confirm the efficacy of this approach.

e19021Background: About 30% of advanced HL patients will suffer relapse and some may be overtreated. More accurate methods are needed to identify patients with different prognosis. The current Inte...

Anaplastic large-cell lymphoma (ALCL) is characterized by frequently presenting adverse factors at diagnosis. Many groups believed aggressive treatment strategies such as autologous stem cell transplantation brought survival benefit for ALCL patients. However, few compared these approaches with conventional chemotherapy to validate their superiority. Here, we report a study comparing the efficacy of peripheral blood stem cell transplantation (PBSCT) and conventional chemotherapy on ALCL. A total of 64 patients with primary systemic ALCL were studied retrospectively. The median follow-up period was 51 months (range, 1-167 months). For 48 patients undergoing conventional chemotherapy only, the 4-year event-free survival (EFS) and overall survival (OS) rates were 70.7% and 88.3%, respectively. Altogether, 16 patients underwent PBSCT, including 11 at first remission (CR1/PR1), 3 at second remission, and 2 with disease progression during first-line chemotherapy. The 4-year EFS and OS rates for patients underwent PBSCT at first remission were 81.8% and 90.9%, respectively. Compared with conventional chemotherapy, PBSCT did not show superiority either in EFS (P = 0.240) or in OS (P = 0.580) when applied at first remission. Univariate analysis showed that patients with B symptoms (P = 0.001), stage III/IV disease (P = 0.008), bulky disease (P = 0.075), negative anaplastic lymphoma kinase (ALK) expression (P = 0.059), and age ≤ 60 years (P = 0.054) had lower EFS. Furthermore, PBSCT significantly improved EFS in patients with B symptoms (100% vs. 50.8%, P = 0.027) or bulky disease (100% vs. 52.8%, P = 0.045) when applied as an up-front strategy. Based on these results, we conclude that, for patients with specific adverse factors such as B symptoms and bulky disease, PBSCT was superior to conventional chemotherapy in terms of EFS.

Background and objective The efficacy of standard chemotherapy regimen on aggressive non-Hodgkin's lymphoma (NHL) of certain pathologic types is unsatisfied. This study was to evaluate the safety and efficacy of modified Hyper-CVAD regimen on Chinese patients with aggressive NHL. Methods Clinical records of 31 NHL patients who received modified Hyper-CVAD regimen in Cancer Hospital of Chinese Academy of Medical Sciences from June 2004 to June 2008 were analyzed in terms of toxicity and response. Results The 31 patients totally received 91 cycles of regimen A and 41 cycles of regimen B with a median of 4 cycles (ranged 1-7 cycles). The major toxicity was myelosuppresion: the occurrence rates of neutropenia of grades III-IV, thrombocytopenia and febrile neutropenia were 49.5%, 3.3% and 12.1% during treatment of regimen A, and were 80.5%, 82.9% and 46.3% during treatment of regimen B. No treatment-related death was observed. The responses were assessable in 26 patients. The total response rate was 80.8%, and 12 patients achieved complete response (46.2%). Conclusion Modified Hyper-CVAD regimen is a promising regimen for the patients with intermediate and high grade NHL.

The aim and objective of the study is to compare the efficacy of conditioning regimens with or without high-dose radiotherapy for treating aggressive non-Hodgkin's lymphoma (NHL). Eighty-nine aggressive NHL patients who underwent high-dose therapy in combination with autologous stem cell transplantation (HDT/ASCT) between 1993 and 2006 were retrospectively studied. HDT was either high-dose chemotherapy alone (CT) or high-dose chemoradiotherapy (CRT). Overall, 37 patients in CT group and 52 in CRT group. The median radiotherapy DT in CRT group was 8 Gy. The median count of reinfused CD34+ cells was 6.26 x 10(6) and 22.16 x 10(6) cells/kg, respectively (p0.001). The median time of leukocyte engraftment was 11 days in CT group and 13 days in CRT group (p = 0.003), and the median platelet engraftment time was 12 days in CT group and 11 days in CRT group (p = 0.305). The median event-free survival (EFS) was 102 and 84 months in CT and CRT groups, respectively (p = 0.783), and the median overall survival (OS) was 102 and 121 months in CT and CRT groups, respectively (p = 0.857). Prolonged hospitalization favored EFS (p = 0.013) and OS (p = 0.011). In conclusion, when compared with CT, high-dose CRT does not improve prognosis.

Background Extranodal natural killer/T-cell lymphoma, nasal type (ENKL) is a rare and distinct subtype of non-hodgkin lymphoma (NHL). The frequency was higher in Asia than in western countries and it has become the most common subtype of peripheral T-cell lymphomas in China. The majority of ENKL patients present with early stage. Optimal treatment modalities and prognostic factors for localized ENKL have not been fully defined. This study aimed to evaluate the optimal treatment strategy and prognostic factors for localized ENKL patients. Methods Between 2003 and 2013, three hundred and five patients with stage IE/IIE ENKL were comprehensively analyzed in this study. A total of 180 patients received combined chemoradiotherapy, with 111 patients received radiotherapy alone and 14 patients recieved chemotherapy alone. Chemotherapy regimens include GDP (gemcitabine, cisplatin, and dexamethasone), CHOP (epirubicin, cyclophosphamide, vincristine, and prednisolone) and other regimens. A total dose of 50 Gy to the primary tumor was considered as radical dose for ENKL, and additional 5 to 10 Gy was administered as a boost to the residual disease. Results The complete response (CR) rate for patients received chemoradiotherapy (n=175) was significantly higher than that for patients received radiotherapy alone (n=102) (89.1 % vs.77.5 %, P = 0.009) or chemotherapy alone (n=14) (89.1 % vs.21.4 %, P< 0.001). The median follow up time for all 305 patients was 38.7 (1.1 to 393) months. For 228 stage IE paranasal extension or IIE patients, 3-year overall survival (OS) in combined chemoradiotherapy (n=154), radiotherapy alone (n=60) and chemotherapy alone (n=14) groups were 85.7%, 73.3% and 57.1% respectively (chemoradiotherapy vs. radiotherapy, P=0.003; chemoradiotherapy vs. chemotherapy, P Conclusions Combined chemoradiotherapy is the most optimal therapy strategy for stage IE paranasal extension or IIE ENKL patients. GDP or combined with pegaspargase regimen shows promising efficacy, significant superior to the traditional CHOP regimen. The sequence of chemotherapy and radiotherapy for patients received novel chemotherapy regimens still needs further assessment in phase 3 clinical trials. We identified 3 risk groups based on 3 prognostic factors (stage II, LDH elevated and paranasal extension) with different survival outcomes and this novel prognostic model may better predict prognosis than previous International Prognostic Index (IPI) and Korean Prognostic Index (KPI) score for ENKL patients with limited stage. Disclosures No relevant conflicts of interest to declare.

Background: PTCL-NOS usually lacks B-cell associated antigens. However, rare cases of CD20 positive peripheral T cell lymphpoma have been reported[1-4], with the majority of cases being classified as PTCL-NOS[4]. So far, the vast majority of the published reports on CD20+ PTCL are from US or European countries with limited data on Chinese patients. Furthermore, the clinical and prognostic profile of this rare disease entity remains largely unknown. Aim: To explore the clinical features and prognostic impact of aberrant CD20 expression in Chinese patients with PTCL-NOS. Methods: We retrospectively reviewed patients diagnosed with PTCL-NOS at our institution from August 2002 to March 2015. Patients with aberrant expression of CD20 confirmed by immunohistochemical analyses were included in the study. We examined patients' pathological and clinical features, treatment response and survival. Results: Twelve patients with CD20+ PTCL-NOS were identified. CD20 was strongly and uniformly expressed in 6 cases and dimly expressed or present on a subgroup of neoplastic cells in the remaining cases. In 6 patients, the gene rearrangement studies for immunoglobulin and T-cell receptors were performed to determine the precise lineage for neoplastic clones. The Ki-67 proliferation index ranged from 10~85% in these cases. Among the patients, there were 10 men and 2 women. Patients' median age was 54 yr (range:16~69 yr). The majority(83%) of patients had a ECOG-PS score of 0~1. Eight (67%) patients presented with advanced stage (Ann Arbor stage 3~4) disease and the remaining 3 patients presented with localized (stage 1~2) disease. Nodal disease was present in all the patients, whereas 6 patients had extra-nodal involvement including the parotid glands, tongue, oropharynx, subcutaneous tissue, spleen, lung and breast. No patient presented with bone marrow involvement. The IPI score was 0~1 in 5 cases, 2 in one case, and 3~4 in 6 cases. All patients were initially treated with CHOP-like combination chemotherapy with a response rate of 75% (CR in 5 patients, PR in 4 patients, SD in 1 patient and PD in 2 patients). Three patients with stage 1~2 disease received consolidation radiotherapy, and no patient received autologous or allogeneic stem cell transplantation. Among CR patients, three remained disease-free at 4.5, 11.3 and 57 months, respectively. The remaining 9 patients developed disease recurrence or progression, among whom seven underwent gemcitabine-based salvage chemotherapy. No patient received rituximab in first-line or subsequent lines of treatment. At last follow-up, 6 patients have died from disease progression. The median PFS and OS for all the patients were 10.5 months (range:0.7~57 months, Figure 1) and 41.9 months (range:3.4~57 months, Figure 2), respectively. Conclusions: CD20-expressing PTCL-NOS is rare, and appears to be clinically heterogeneous with a subset of patients associated with high IPI score and more aggressive clinical course. Despite the expression of B-cell antigens, the overall treatment outcome with anthracycline-based chemotherapy remains poor, and prognosis is similar to that of CD20 negative PTCL-NOS. The aberrant expression of CD20 may warrant further exploration of the role of rituximab in these patients. The clinical and prognostic implications of CD20 positivity in PTCL-NOS patients needs to be further elucidated in large-scale case series. References: [1] J Clin Oncol. 2011;29(32):e789-91. [2] Case Rep Hematol. 2013:183134. [3] Mod Pathol. 2001;14(2):105-10. [4] Am J Surg Pathol. 2008;32(11):1593-607. Figure 1. Figure 1. Figure 2. Figure 2. Disclosures No relevant conflicts of interest to declare.

e19560 Background: The role of high-dose therapy followed by hematopoietic stem cell transplantation (HSCT) in the treatment of lymphoblastic lymphoma (LBL) has not been fully defined. Methods: Thi...

e18003 Background: The CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) regimen is an efficient treatment of non-Hodgkin’s lymphoma (NHL). This study was aimed to assess the efficacy and toxicity of high-dose (HD) CHOP ± rituximab on autologous peripheral blood stem cell (APBSC) mobilization for the patients with NHL. In the meantime, factors affecting the collection of CD34+ cells were explored. Methods: 39 patients eligible for autologous stem cell transplantation (ASCT) were included in this retrospective study, 14 patients received HD CHOP combined with rituximab for APBSC mobilization and the others received HD CHOP regimen alone. Results: For all, the median number of CD34+ cell yield was 7.01×106/kg with 37 patients achieving to meet the target CD34+ cell harvest of ≥2.0×106/kg and 27 patients (69.2%) achieved the optimal collection≥5.0×106/kg. 26 of the patients underwent only one apheresis procedure with median CD34+ cell collection of 6.93×106/kg. The mobilization yield of CHO...

e18002 Background: High-dose therapy (HDT) and autologous peripheral blood stem cell transplant (APBSCT) improve the outcome of diffuse large B cell lymphoma (DLBCL) patients. There is a lack of pr...