Medicine (St Vincent's) - Research Publications

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    Diagnosis, management and follow up of peripheral T-cell lymphomas: a consensus practice statement from the Australasian Lymphoma Alliance
    Hapgood, G ; Latimer, M ; Lee, ST ; Kuss, B ; Lade, S ; Tobin, JWD ; Purtill, D ; Campbell, BA ; Prince, HM ; Hawkes, EA ; Shortt, J ; Radeski, D (WILEY, 2022-10)
    Peripheral T-cell lymphomas (PTCL) represent a heterogeneous disease group accounting for 10% of non-Hodgkin lymphomas. PTCL patients have typically poorer outcomes compared with aggressive B-cell lymphomas. However, such outcomes are heavily dependent on subtype. Although anthracycline-based regimens such as cyclophosphamide, doxorubicin, vincristine and prednisone remain the standard first-line treatment for most aggressive PTCL, there are important variations including incorporation of novel agents, use of radiotherapy and judicious consideration of stem cell transplantation. Relapsed or refractory disease represents a significant area of unmet need where chemotherapy intensification has limited efficacy and novel agents such as brentuximab vedotin and pralatrexate provide additional opportunities for attainment of remission and potential stem cell transplant. In the future, pre-therapy prognostic biomarkers including genomic characterisation, may aid in risk stratification and help guide initial patient management to improve survival. There is an urgent need to understand better the pathogenesis of PTCL to facilitate novel drug combinatorial approaches to improve survival. This position statement represents an evidence-based synthesis of the literature for application in Australian and New Zealand practice.
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    The gamma delta lymphomas: an Australian multi-centre case series
    Harrop, S ; Di Ciaccio, P ; Doo, NW ; Cochrane, T ; Campbell, BA ; Hamad, N ; Dickinson, M ; Van Der Weyden, C ; Prince, HM (AME Publishing Company, 2022-03-01)
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    A comparative analysis of histone deacetylase inhibitors for the treatment of mycosis fungoides and Sezary syndrome
    Papps, T ; McCormack, C ; Buelens, O ; Van der Weyden, C ; Twigger, R ; Campbell, BA ; Dickinson, M ; Prince, HM (WILEY, 2020-02-01)
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    Mycosis fungoides and Sezary syndrome: Australian clinical practice statement
    Bhabha, FK ; McCormack, C ; Wells, J ; Campbell, BA ; Newland, K ; Lade, S ; Buelens, O ; Joske, D ; Shortt, J ; Mapp, S ; Radeski, D ; Hertzberg, M ; Khot, A ; Van der Weyden, C ; Khoo, C ; Hawkes, E ; Prince, HM (WILEY, 2021-02)
    Primary cutaneous lymphomas represent a heterogeneous group of T- and B-cell lymphomas with distinct clinical presentations, histopathologic features, treatment approaches and outcomes. The cutaneous T-cell lymphomas, which include mycosis fungoides and Sézary syndrome, account for the majority of the cutaneous lymphomas. This Clinical Practice Statement is reflective of the current clinical practice in Australia. An expanded form of the Clinical Practice Statement (and updates), along with helpful patient resources and access to support groups, can be found at the following (http://www.australasianlymphomaalliance.org.au).
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    Australian and New Zealand consensus statement on the management of lymphoma, chronic lymphocytic leukaemia and myeloma during the COVID-19 pandemic
    Di Ciaccio, P ; McCaughan, G ; Trotman, J ; Ho, PJ ; Cheah, CY ; Gangatharan, S ; Wight, J ; Ku, M ; Quach, H ; Gasiorowski, R ; Polizzotto, MN ; Prince, HM ; Mulligan, S ; Tam, CS ; Gregory, G ; Hapgood, G ; Spencer, A ; Dickinson, M ; Latimer, M ; Johnston, A ; Armytage, T ; Lee, C ; Cochrane, T ; Berkhahn, L ; Weinkove, R ; Doocey, R ; Harrison, SJ ; Webber, N ; Lee, H-P ; Chapman, S ; Campbell, BA ; Gibbs, SDJ ; Hamad, N (WILEY, 2020-06)
    The COVID-19 pandemic poses a unique challenge to the care of patients with haematological malignancies. Viral pneumonia is known to cause disproportionately severe disease in patients with cancer, and patients with lymphoma, myeloma and chronic lymphocytic leukaemia are likely to be at particular risk of severe disease related to COVID-19. This statement has been developed by consensus among authors from Australia and New Zealand. We aim to provide supportive guidance to clinicians making individual patient decisions during the COVID-19 pandemic, in particular during periods that access to healthcare resources may be limited. General recommendations include those to minimise patient exposure to COVID-19, including the use of telehealth, avoidance of non-essential visits and minimisation of time spent by patients in infusion suites and other clinical areas. This statement also provides recommendations where appropriate in assessing indications for therapy, reducing therapy-associated immunosuppression and reducing healthcare utilisation in patients with specific haematological malignancies during the COVID-19 pandemic. Specific decisions regarding therapy of haematological malignancies will need to be individualised, based on disease risk, risks of immunosuppression, rates of community transmission of COVID-19 and available local healthcare resources.
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    Time to Next Treatment as a Meaningful Endpoint for Trials of Primary Cutaneous Lymphoma
    Campbell, BA ; Scarisbrick, JJ ; Kim, YH ; Wilcox, RA ; McCormack, C ; Prince, HM (MDPI, 2020-08)
    Time to next treatment (TTNT) is an emerging endpoint in clinical studies of primary cutaneous T-cell lymphomas (CTCL), with utility as a surrogate marker for the "duration of clinical benefit". TTNT provides a highly clinically meaningful endpoint that uniquely reflects not only the duration of treatment efficacy on disease and symptom control, but also incorporates the patient experience by accounting for patient compliance and tolerance to the studied therapy(s). Given the distinct challenges of pin-pointing the exact date of progression in patients with multi-compartmental CTCL, TTNT overcomes many of the shortcomings of conventional, disease-focused, clinical endpoints in primary CTCL research. Although widely accepted in clinical research for numerous other incurable malignancies, TTNT currently lacks a standardised definition. In this paper, we describe the value of TTNT as a clinical endpoint, review the applications of TTNT in primary CTCL research, and propose a standardised definition of TTNT to be applied in future clinical research of primary CTCL therapies.
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    Durable Complete Remission and Long-Term Survival in FDG-PET Staged Patients with Stage III Follicular Lymphoma, Treated with Wide-Field Radiation Therapy
    MacManus, MP ; Hicks, RJ ; Bressel, M ; Campbell, BA ; Wirth, A ; Ryan, G ; Prince, HM ; Wolf, M ; Brown, R ; Seymour, JF (MDPI, 2020-04)
    Advanced-stage follicular lymphoma (FL) is generally considered incurable with conventional systemic therapies, but historic series describe long-term disease-free survival in stage III disease treated with wide-field radiation therapy (WFRT), encompassing all known disease sites. We report outcomes for patients staged with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and treated with CT-planned WFRT, given as either comprehensive lymphatic irradiation (CLI) or total nodal irradiation (TNI). This analysis of a prospective cohort includes PET-staged patients given curative-intent WFRT as a component of initial therapy, or as sole treatment for stage III FL. Thirty-three PET-staged patients with stage III FL received WFRT to 24-30Gy between 1999 and 2017. Fifteen patients also received planned systemic therapy (containing rituximab in 11 cases) as part of their primary treatment. At 10 years, overall survival and freedom from progression (FFP) were 100% and 75%, respectively. None of the 11 rituximab-treated patients have relapsed. Nine relapses occurred; seven patients required treatment, and all responded to salvage therapies. A single death occurred at 16 years. The principal acute toxicity was transient hematologic; one patient had residual grade two toxicity at one year. With FDG-PET staging, most patients with stage III FL experience prolonged FFP after WFRT, especially when combined with rituximab.