Il

lustration by Erin Moore

Volume 14, Number 3June 2014

Table of ContentsReviews179 Prognostic Assessment and Treatment of Primary Gastric Lymphomas: How Endoscopic Ultrasonography

Can Help in Tailoring Patient ManagementCalogero Vetro, Annalisa Chiarenza, Alessandra Romano, Irene Amico, Valeria Calafiore, Cosimo Di Raimondo,Francesco Coppolino, Francesco Di Raimondo

186 Second-Line Therapy for Patients With Chronic Myeloid Leukemia Resistant to First-Line ImatinibAnna Lau, Karen Seiter

Original Studies197 High-dose Vincristine Sulfate Liposome Injection (Marqibo) Is Not Associated With Clinically Meaningful

Hematologic ToxicityOlivia R. Deitcher, John Glaspy, Rene Gonzalez, Takami Sato, Agop Y. Bedikian, Karen Segarini,Jeffrey Silverman, Steven R. DeitcherHematologic toxicity of vincristine sulfate liposome injection (VSLI) was assessed in 54 patients with metastaticcancer not known to involve bone marrow. VSLI was not associated with clinically meaningful blood count changeswhen dosed at 2.25 mg/m2 every 14 or 7 days. VSLI could be well suited for combination drug therapy and usein patients unable to tolerate blood cytopenias.

203 Clinical Characteristics of 95 Patients With Ocular Adnexal and Uveal Lymphoma: Treatment Outcomesin Extranodal Marginal Zone SubtypeCraig A. Portell, Mary E. Aronow, Lisa A. Rybicki, Roger Macklis, Arun D. Singh, John W. SweetenhamInvolved-field radiotherapy (IFRT) is effective for unilateral ocular adnexal lymphoma (OAL) but treatment forhigher stages is unclear. We retrospectively evaluated 95 patients with OAL and report the characteristics andoutcomes. Progression was more likely with rituximab than IFRT, but systemic progression was more likely with IFRT.IFRT remains the standard for localized OAL, but rituximab might have a role in higher stage OAL.

211 Patterns of Central Nervous System Involvement in Relapsed and Refractory Multiple MyelomaAl-ola Abdallah, Shebli Atrash, Zainab Shahid, Muzaffar Jameel, Monica Grazziutti, Senu Apewokin,Naveen S. Kumar, Alejandro Restrepo, Sarah Waheed, Frits Van Rhee, Christoph J. Heuck, Donald Johann, Jr,Bart Barlogie, Saad Z. UsmaniCentral nervous system (CNS) involvement in multiple myeloma (MM) usually in advanced relapsed/refractorysetting. The current manuscript presents the largest published series of CNS MM cases with malignantcerebrospinal fluid analyses. This report highlights poor prognosis of CNS MM in the era of novel agentsand paucity of agents with good CNS penetration.

215 Cyclin D1 Amplification in Multiple Myeloma Is Associated With Multidrug Resistance ExpressionEman M. Sewify, Ola A. Afifi, Eman Mosad, Amen H. Zaki, Sahar A. El GammalIn this study, we evaluated cyclin D1 gene amplification using fluorescence in situ hybridization (FISH) andmultidrug resistance (MDR1) protein using immunohistochemistry in bone marrow biopsies of 50 patients withmultiple myeloma. Cyclin D1-positive patients had a significantly lower progression-free and overall survivaland higher levels of MDR1 compared with cyclin D1-negative patients, suggesting an association betweencyclin D1 gene amplification and MDR1 unfavorable prognosis.

223 A Phase I and Pharmacodynamic Study of AT9283, a Small-Molecule Inhibitor of Aurora Kinases in PatientsWith Relapsed/Refractory Leukemia or MyelofibrosisJames Foran, Farhad Ravandi, William Wierda, Guillermo Garcia-Manero, Srdan Verstovsek, Tapan Kadia,Jan Burger, Murray Yule, Gillian Langford, John Lyons, John Ayrton, Victoria Lock, Gautham Borthakur, Jorge Cortes,Hagop KantarjianAurora kinase (AK) inhibitors are active in a variety of leukemic models. A dose-escalation study of AK inhibitorAT9283 was performed in patients with relapsed or refractory leukemias. Dose-limiting toxicities includedmultiorgan failure, hypertension, and myocardial infarction. The maximum tolerated dose was identified as324 mg/m2/72 h. Approximately one-third of patients with acute myeloid leukemia experienced significantreduction in bone marrow blasts; no durable responses were seen.

231 Phase I and Extension Study of Clofarabine Plus Cyclophosphamide in Patients With Relapsed/RefractoryAcute Lymphoblastic LeukemiaStefan Faderl, Kumudha Balakrishnan, Deborah A. Thomas, Farhad Ravandi, Gautam Borthakur, Jan Burger,Alessandra Ferrajoli, Jorge Cortes, Susan O’Brien, Tapan Kadia, Jennie Feliu, William Plunkett, Varsha Gandhi,Hagop M. KantarjianClofarabine has activity in children with relapsed/refractory acute lymphoblastic leukemia (ALL). To evaluateits activity in adults, we performed a phase I study in 50 patients using clofarabine in combination withcyclophosphamide. Dose-limiting toxicity (DLT) included diarrhea, transaminase elevations, and skin rashes.The response rate was 14%. The combination of clofarabine and cyclophosphamide at the evaluated dosesand schedule showed only moderate clinical activity.

239 Aberrant Expression of CD13 Identifies a Subgroup of Standard-Risk Adult Acute Lymphoblastic LeukemiaWith Inferior SurvivalBakul I. Dalal, Areej Al Mugairi, Steven Pi, Soo Yeon Lee, Nikisha S. Khare, Jason Pal, Adam Bryant,Alok P. Vakil, Sally Lau, Yasser R. Abou MouradAcute lymphoblastic leukemia in adults (aALL) is divided into standard-risk (SR) and high-risk (HR) subgroups withdifferent treatment algorithms. The SR-aALL subgroup contains many patients with short survival that should be treatedas HR. The retrospective analysis of flow cytometric data of 81 patients with SR-aALL found that those with aberrantexpression of CD13 had shorter survival, and such patients should be considered for more aggressive treatment.

245 Impact of Timely Switching From Imatinib to a Second-Generation Tyrosine Kinase Inhibitor After 12-MonthComplete Cytogenetic Response Failure: A Chart Review AnalysisDaniel J. DeAngelo, Lei Chen, Annie Guerin, Amy Styles, Philippe Giguere-Duval, Eric Q. WuIn patients with chronic myelogenous leukemia in chronic phase (CML-CP), the achievement of a completecytogenetic response (CCyR) at 1 year is associated with an improved overall survival, therefore, we assessedthe outcomes of patients who switched therapy (n ¼ 306) versus those who continued imatinib treatment(n ¼ 287) after failure to achieve CCyR 1 year after imatinib initiation. We found a higher rate of CCyRamong patients who switched therapy.

Available Exclusively Online atwww.clinical-lymphoma-myeloma-leukemia.come81 Fatal Bleeding Due to Acquired Factor IX and X Deficiency: A Rare Complication of Primary Amyloidosis;

Case Report and Review of the LiteratureStephanie Ericson, Nihar Shah, Justin Liberman, David M. Aboulafia

e87 Deep Sequencing Reveals Lack of a Clonal Relationship Between a Metachronous Classical Hodgkinand Diffuse Large B-Cell LymphomaImran N. Siddiqi, Sikander Ailawadhi, Qin Huang, Renae K. Shibata, Haeyoun Kang, Darryl Shibata

e95 Lymphoma With Features Intermediate Between Aggressive T-Large Granular Lymphocytic Leukemiaand Hepatosplenic T-Cell Lymphoma: A Diagnostic Dilemma?Chi Young Ok, C. Cameron Yin, Mariko Yabe, Carlos E. Bueso-Ramos, Roberto N. Miranda, L. Jeffrey Medeiros,Sergej N. Konoplev

e101 Positron Emission Tomography With Computed TomographyeBased Diagnosis of Massive ExtramedullaryProgression in a Patient With High-Risk Multiple MyelomaElena Zamagni, Cristina Nanni, Paola Tacchetti, Lucia Pantani, Giulia Marzocchi, Beatrice Zannetti,Carolina Terragna, Katia Mancuso, Serena Rocchi, Annalisa Pezzi, Nicoletta Testoni, Stefano Fanti,Michele Cavo

e105 Lenalidomide-Induced Graft-Vs.-Leukemia Effect in a Patient With Chronic Lymphocytic LeukemiaWho Relapsed After Allogeneic Stem Cell TransplantRohtesh S. Mehta, Antonio Di Stasi, Chitra Hosing, Nina Shah, Katayoun Rezvani, Amin Alousi, Susan O’Brien,William Wierda, Michael Keating, Elizabeth J. Shpall