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01-01-2018 | Original Article

Incidence of interstitial pneumonitis in non-Hodgkin’s lymphoma patients receiving immunochemotherapy with pegylated liposomal doxorubicin and rituximab

Authors: Ting Zhou, Qian Shen, Hui Peng, Tengfei Chao, Lihong Zhang, Liu Huang, Kaixiang Yang, Sudip Thapa, Shiying Yu, Yongsheng Jiang

Published in: Annals of Hematology | Issue 1/2018

Abstract

Pneumonitis is a rare but severe and potentially fatal adverse effect in chemotherapy of lymphoma. This study is aimed to investigate the incidence of interstitial pneumonitis in non-Hodgkin’s lymphoma (NHL) patients receiving immunochemotherapy with pegylated liposomal doxorubicin and rituximab. Lymphoma patients were retrospectively reviewed, and eligible patients were included in this study. According to the chemotherapy regimens, patients were classified in four groups: combination of vincristine, cyclophosphamide, doxorubicin, and prednisone (CHOP group) with rituximab (RCHOP group) and combination of vincristine, cyclophosphamide, pegylated liposomal doxorubicin and prednisone (CDOP group) with rituximab (RCDOP group). Incidence and severity of interstitial pneumonitis were compared among the four groups. Among 757 patients reviewed, 207 patients were included in final analysis. Thirteen patients developed chemotherapy-induced interstitial pneumonitis, and the mean cycle of chemotherapy before the onset of pneumonitis was 4. Incidence rates of pneumonitis were 0, 1.8, 17.4, and 21.1% in CHOP, RCHOP, CDOP, and RCDOP groups, respectively (p < 0.001). The mean grades of pneumonitis were 0, 2, 2.5, and 3 in four groups, respectively (p < 0.001). After adjustment of confounders, chemotherapy regimens (OR 3.491, 95% CI 1.527–7.981, p = 0.003) and neutropenia in previous cycles (OR 2.186, 95% CI 1.281–3.731, p = 0.004) were independently associated with the incidence of pneumonitis. Interstitial pneumonitis should be highlighted in NHL patients who received more than 4 cycles of RCDOP chemotherapy regimen, especially in those who had grade 4 neutropenia in the previous cycles of chemotherapy.

Siegel RL, Miller KD, Jemal A (2017) Cancer statistics, 2017. Ca-Cancer J Clin 67(1):7–30. https://doi.org/10.3322/caac.21387 CrossRefPubMed

Chen WQ, Zheng RS, Baade PD, Zhang SW, Zeng HM, Bray F, Jemal A, Yu XQ, He J (2016) Cancer statistics in China, 2015. Ca-Cancer J Clin 66(2):115–132. https://doi.org/10.3322/caac.21338 CrossRefPubMed

Zelenetz AD, Abramson JS, Advani RH, Andreadis CB, Byrd JC, Czuczman MS, Fayad L, Forero A, Glenn MJ, Gockerman JP, Gordon LI, Harris NL, Hoppe RT, Horwitz SM, Kaminski MS, Kim YH, Lacasce AS, Mughal TI, Nademanee A, Porcu P, Press O, Prosnitz L, Reddy N, Smith MR, Sokol L, Swinnen L, Vose JM, Wierda WG, Yahalom J, Yunus F (2010) NCCN clinical practice guidelines in oncology: non-Hodgkin's lymphomas. J Natl Compr Cancer Netw : JNCCN 8(3):288–334. https://doi.org/10.6004/jnccn.2010.0021 CrossRef

Horwitz SM, Zelenetz AD, Gordon LI, Wierda WG, Abramson JS, Advani RH, Andreadis CB, Bartlett N, Byrd JC, Fayad LE, Fisher RI, Glenn MJ, Habermann TM, Lee Harris N, Hernandez-Ilizaliturri F, Hoppe RT, Kaminski MS, Kelsey CR, Kim YH, Krivacic S, LaCasce AS, Lunning M, Nademanee A, Press O, Rabinovitch R, Reddy N, Reid E, Roberts K, Saad AA, Sokol L, Swinnen LJ, Vose JM, Yahalom J, Zafar N, Dwyer M, Sundar H, Porcu P (2016) NCCN guidelines insights: non-Hodgkin's lymphomas, version 3.2016. J Natl Compr Cancer Netw : JNCCN 14(9):1067–1079. https://doi.org/10.6004/jnccn.2016.0117 CrossRef

Jiang ML, Bennani NN, Feldman AL (2017) Lymphoma classification update: B-cell non-Hodgkin lymphomas. Expert Rev Hematol 10(5):405–415. https://doi.org/10.1080/17474086.2017.1318053 CrossRefPubMed

Al-Hamadani M, Habermann TM, Cerhan JR, Macon WR, Maurer MJ, Go RS (2015) Non-Hodgkin lymphoma subtype distribution, geodemographic patterns, and survival in the US: a longitudinal analysis of the National Cancer Data Base from 1998 to 2011. Am J Hematol 90(9):790–795. https://doi.org/10.1002/ajh.24086 CrossRefPubMed

Coiffier B, Lepage E, Briere J, Herbrecht R, Tilly H, Bouabdallah R, Morel P, Van den Neste E, Salles G, Gaulard P, Reyes F, Gisselbrecht C (2002) CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. New Engl J Med 346(4):235–242. https://doi.org/10.1056/Nejmoa011795 CrossRefPubMed

Cetiner M, Salepci T, Atesoglu EB, Gumus M, Guven A, Undar L, Tuglular TF, Bayik M (2006) Rituximab-CHOP versus CHOP alone in patients with diffuse large B cell lymphoma. Blood 108(11):259b–260b. https://doi.org/10.1089/pho.2006.24.637

Pfreundschuh M, Trumper L, Osterborg A, Pettengell R, Trneny M, Imrie K, Ma D, Gill D, Walewski J, Zinzani PL, Stahel R, Kvaloy S, Shpilberg O, Jaeger U, Hansen M, Lehtinen T, Lopez-Guillermo A, Corrado C, Scheliga A, Milpied N, Mendila M, Rashford M, Kuhnt E, Loeffler M, Grp M (2006) CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol 7(5):379–391. https://doi.org/10.1016/S1470-2045(06)70664-7 CrossRefPubMed

10.

Horwitz SM, Zelenetz AD, Gordon LI, Wierda WG, Abramson JS, Advani RH, Andreadis CB, Bartlett N, Byrd JC, Fayad LE, Fisher RI, Glenn MJ, Habermann TM, Harris NL, Hernandez-Ilizaliturri F, Hoppe RT, Kaminski MS, Kelsey CR, Kim YH, Krivacic S, LaCasce AS, Lunning M, Nademanee A, Press O, Rabinovitch R, Reddy N, Reid E, Roberts K, Saad AA, Sokol L, Swinnen LJ, Vose JM, Yahalom J, Zafar N, Dwyer M, Sundar H, Porcu P (2016) Non-Hodgkin's lymphomas, version 3.2016 featured updates to the NCCN guidelines. J Natl Compr Canc Ne 14(9):1067–1079. https://doi.org/10.6004/jnccn.2016.0117 CrossRef

11.

Delarue R, Tilly H, Mounier N, Petrella T, Salles G, Thieblemont C, Bologna S, Ghesquieres H, Hacini M, Fruchart C, Ysebaert L, Ferme C, Casasnovas O, Van Hoof A, Thyss A, Delmer A, Fitoussi O, Molina TJ, Haioun C, Bosly A (2013) Dose-dense rituximab-CHOP compared with standard rituximab-CHOP in elderly patients with diffuse large B-cell lymphoma (the LNH03-6B study): a randomised phase 3 trial. Lancet Oncol 14(6):525–533. https://doi.org/10.1016/S1470-2045(13)70122-0 CrossRefPubMed

12.

Habermann TM, Weller EA, Morrison VA, Gascoyne RD, Cassileth PA, Cohn JB, Dakhil SR, Woda B, Fisher RI, Peterson BA, Horning SJ (2006) Rituximab-CHOP versus CHOP alone or with maintenance rituximab in older patients with diffuse large B-cell lymphoma. J Clin Oncol 24(19):3121–3127. https://doi.org/10.1200/Jco.2005.05.1003 CrossRefPubMed

13.

Minotti G, Menna P, Salvatorelli E, Cairo G, Gianni L (2004) Anthracyclines: molecular advances and pharmacologic developments in antitumor activity and cardiotoxicity. Pharmacol Rev 56(2):185–229. https://doi.org/10.1124/pr.56.2.6 CrossRefPubMed

14.

Hershman DL, McBride RB, Eisenberger A, Tsai WY, Grann VR, Jacobson JS (2008) Doxorubicin, cardiac risk factors, and cardiac toxicity in elderly patients with diffuse B-cell non-Hodgkin's lymphoma. J Clin Oncol 26(19):3159–3165. https://doi.org/10.1200/Jco.2007.14.1242 CrossRefPubMed

15.

Gabizon A, Shmeeda H, Barenholz Y (2003) Pharmacokinetics of pegylated pegylated liposomal doxorubicin—review of animal and human studies. Clin Pharmacokinet 42(5):419–436. https://doi.org/10.2165/00003088-200342050-00002 CrossRefPubMed

16.

Smith LA, Cornelius VR, Plummer CJ, Levitt G, Verrill M, Canney P, Jones A (2010) Cardiotoxicity of anthracycline agents for the treatment of cancer: systematic review and meta-analysis of randomised controlled trials. BMC Cancer 10. doi: https://doi.org/10.1186/1471-2407-10-337

17.

Wollina U, Dummer R, Brockmeyer NH, Busch JO, Kaatz M, Knopf B, Koch HJ, Hauschild A (2003) Multicenter study of pegylated pegylated liposomal doxorubicin in patients with cutaneous T-cell lymphoma. Cancer 98(5):993–1001. https://doi.org/10.1002/cncr.11593 CrossRefPubMed

18.

Zaja F, Tomadini V, Zaccaria A, Lenoci M, Battista M, Molinari AL, Fabbri A, Battista R, Cabras MG, Gallamini A, Fanin R (2006) CHOP-rituximab with pegylated pegylated liposomal doxorubicin for the treatment of elderly patients with diffuse large B-cell lymphoma. Leuk Lymphoma 47(10):2174–2180. https://doi.org/10.1080/10428190600799946 CrossRefPubMed

19.

Luminari S, Viel E, Ferreri AJM, Zaja F, Chimienti E, Musuraca G, Tucci A, Balzarotti M, Tani M, Salvi F, Pesce EA, Ferrari A, Liberati AM, Spadea A, Marino D, Bruno-Ventre M, Volpetti S, Bottelli C, Ravaioli E, Merli F, Spina M (2017) Nonpegylated pegylated liposomal doxorubicin combination regimen in patients with diffuse large B-cell lymphoma and cardiac comorbidity. Results of the HEART01 phase II trial conducted by the Fondazione Italiana Linfomi. Hematol Oncol. https://doi.org/10.1002/hon.2425

20.

Combs S, Neil N, Aboulafia DM (2006) Pegylated liposomal doxorubicin, cyclophosphamide, and etoposide and antiretroviral therapy for patients with AIDS-related lymphoma: a pilot study. Oncologist 11(6):666–673. https://doi.org/10.1634/theoncologist.11-6-666 CrossRefPubMed

21.

Iannitto E, Luminari S, Tripodo C, Mancuso S, Cesaretti M, Marcheselli L, Merli F, Stelitano C, Carella AM, Fragasso A, Montechiarello E, Ricciuti G, Pulsoni A, Paulli M, Franco V, Federico M (2015) Rituximab with cyclophosphamide, vincristine, non-pegylated pegylated liposomal doxorubicin and prednisone as first-line treatment for splenic marginal zone lymphoma: a Fondazione Italiana Linfomi phase II study. Leuk Lymphoma 56(12):3281–3287. https://doi.org/10.3109/10428194.2015.1029925 CrossRefPubMed

22.

Katsuya H, Suzumiya J, Sasaki H, Ishitsuka K, Shibata T, Takamatsu Y, Tamura K (2009) Addition of rituximab to cyclophosphamide, doxorubicin, vincristine, and prednisolone therapy has a high risk of developing interstitial pneumonia in patients with non-Hodgkin lymphoma. Leuk Lymphoma 50(11):1818–1823. https://doi.org/10.3109/10428190903258780 CrossRefPubMed

23.

Liote H, Liote F, Seroussi B, Mayaud C, Cadranel J (2010) Rituximab-induced lung disease: a systematic literature review. Eur Respir J 35(3):681–687. https://doi.org/10.1183/09031936.00080209 CrossRefPubMed

24.

Wagner SA, Mehta AC, Laber DA (2007) Rituximab-induced interstitial lung disease. Am J Hematol 82(10):916–919. https://doi.org/10.1002/ajh.20910 CrossRefPubMed

25.

Zayen A, Rais H, Rifi H, Ouarda M, Afrit M, Cherif A, Mezline A (2011) Rituximab-induced interstitial lung disease: case report and literature review. Pharmacology 87(5–6):318–320. https://doi.org/10.1159/000327681 CrossRefPubMed

26.

Huober J, Schoch O, Templeton A, Spirig C, Thurlimann B (2010) Interstitial pneumonitis after treatment with bevacizumab and pegylated pegylated liposomal doxorubicin in a patient with metastatic breast cancer. Chemotherapy 56(1):69–70. https://doi.org/10.1159/000282286 CrossRefPubMed

27.

Inaba K, Arimoto T, Hoya M, Kawana K, Nakagawa S, Kozuma S, Taketani Y (2012) Interstitial pneumonitis induced by pegylated liposomal doxorubicin in a patient with recurrent ovarian cancer. Med Oncol 29(2):1255–1257. https://doi.org/10.1007/s12032-011-9893-0 CrossRefPubMed

28.

Mark M, Thurlimann B (2012) Fatal pneumonitis after treatment with pegylated pegylated liposomal doxorubicin in a patient with metastatic breast cancer in complete remission. Med Oncol 29(3):1477–1478. https://doi.org/10.1007/s12032-011-0002-1 CrossRefPubMed

29.

Berenson JR, Yellin O, Kazamel T, Hilger JD, Chen CS, Cartmell A, Woliver T, Flam M, Bravin E, Nassir Y, Vescio R, Swift RA (2012) A phase 2 study of pegylated liposomal doxorubicin, bortezomib, dexamethasone and lenalidomide for patients with relapsed/refractory multiple myeloma. Leukemia 26(7):1675–1680. https://doi.org/10.1038/leu.2012.51 CrossRefPubMed

30.

Blum KA, Jung SH, Johnson JL, Lin TS, Hsi ED, Lucas DM, Byrd JC, Cheson BD, Bartlett NL, CLG B (2010) Serious pulmonary toxicity in patients with Hodgkin's lymphoma with SGN-30, gemcitabine, vinorelbine, and pegylated liposomal doxorubicin is associated with an Fc gamma RIIIa-158 V/F polymorphism. Ann Oncol 21(11):2246–2254. https://doi.org/10.1093/annonc/mdq211 CrossRefPubMedPubMedCentral

31.

Del Conte G, Sessa C, von Moos R, Vigano L, Digena T, Locatelli A, Gallerani E, Fasolo A, Tessari A, Cathomas R, Gianni L (2014) Phase I study of olaparib in combination with pegylated liposomal doxorubicin in patients with advanced solid tumours. Brit J Cancer 111(4):651–659. https://doi.org/10.1038/bjc.2014.345 CrossRefPubMedPubMedCentral

32.

Mirza MR, Lund B, Lindegaard JC, Keldsen N, Mellemgaard A, Christensen RD, Bertelsen K (2010) A phase II study of combination chemotherapy in early relapsed epithelial ovarian cancer using gemcitabine and pegylated liposomal doxorubicin. Gynecol Oncol 119(1):26–31. https://doi.org/10.1016/j.ygyno.2010.06.022 CrossRefPubMed

33.

Liu X, Hong XN, YJ G, Wang BY, Luo ZG, Cao JN (2008) Interstitial pneumonitis during rituximab-containing chemotherapy for non-Hodgkin lymphoma. Leuk Lymphoma 49(9):1778–1783. https://doi.org/10.1080/10428190802270886 CrossRefPubMed

34.

Salmasi G, Li M, Sivabalasundaram V, Panzarella T, Tsang R, Kukreti V, Crump M, Kuruvilla J (2015) Incidence of pneumonitis in patients with non-Hodgkin lymphoma receiving chemoimmunotherapy with rituximab. Leuk Lymphoma 56(6):1659–1664. https://doi.org/10.3109/10428194.2014.963075 CrossRefPubMed

35.

Huang YC, Liu CJ, Liu CY, Pai JT, Hong YC, Teng HW, Hsiao LT, Chao TC, Gau JP, Liu JH, Hsu HC, Chiou TJ, Chen PM, YB Y, Tzeng CH (2011) Low absolute lymphocyte count and addition of rituximab confer high risk for interstitial pneumonia in patients with diffuse large B-cell lymphoma. Ann Hematol 90(10):1145–1151. https://doi.org/10.1007/s00277-011-1268-2 CrossRefPubMed

36.

Fridrik MA, Jaeger U, Petzer A, Willenbacher W, Keil F, Lang A, Andel J, Burgstaller S, Krieger O, Oberaigner W, Sihorsch K, Greil R (2016) Cardiotoxicity with rituximab, cyclophosphamide, non-pegylated pegylated liposomal doxorubicin, vincristine and prednisolone compared to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone in frontline treatment of patients with diffuse large B-cell lymphoma: a randomised phase-III study from the Austrian Cancer Drug Therapy Working Group [Arbeitsgemeinschaft Medikamentose Tumortherapie AGMT](NHL-14). Eur J Cancer 58:112–121. https://doi.org/10.1016/j.ejca.2016.02.004 CrossRefPubMed

Title: Incidence of interstitial pneumonitis in non-Hodgkin’s lymphoma patients receiving immunochemotherapy with pegylated liposomal doxorubicin and rituximab
Authors: Ting Zhou
Qian Shen
Hui Peng
Tengfei Chao
Lihong Zhang
Liu Huang
Kaixiang Yang
Sudip Thapa
Shiying Yu
Yongsheng Jiang
Publication date: 01-01-2018
Publisher: Springer Berlin Heidelberg
Published in: Annals of Hematology / Issue 1/2018
Print ISSN: 0939-5555
Electronic ISSN: 1432-0584
DOI: https://doi.org/10.1007/s00277-017-3160-1

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Incidence of interstitial pneumonitis in non-Hodgkin’s lymphoma patients receiving immunochemotherapy with pegylated liposomal doxorubicin and rituximab

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