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Lipof JJ, Barr PM. Early Progression of Follicular Lymphoma: Biology and Treatment. Hematol Oncol Clin North Am 2020; 34:757-769. [PMID: 32586579 DOI: 10.1016/j.hoc.2020.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Follicular lymphoma is the most common subtype of indolent non-Hodgkin lymphoma. Although a majority of patients have a favorable prognosis, a subset of patients experiences early treatment failure. Progression of disease within 24 months of initial chemoimmunotherapy is associated with inferior survival. The biology of early progression is the subject of ongoing study and depends on the unique genetic composition of neoplastic cells and their interaction with a complex tumor microenvironment. Clinicogenetic prognostic indices have been developed to identify high-risk patients. Several have been validated but are limited in identifying those at risk for early treatment failure.
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Affiliation(s)
- Jodi J Lipof
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
| | - Paul M Barr
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
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102
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Abstract
OPINION STATEMENT Phosphatidylinositol 3-kinase (PI3K) inhibitors represent a novel class of agents targeting the key cellular regulatory PI3K/AKT/mTOR pathway involved in crucial functions such as cellular proliferation, cell cycle regulation, protein synthesis, and cell motility. This review starts with an overview of the PI3K pathway and the rationale for its targeting in lymphoma and potential on-target side effects of PI3K inhibition. With three agents now FDA approved for the treatment of relapsed and refractory (R/R) indolent non-Hodgkin lymphoma (iNHL), idelalisib, copanlisib, and duvelisib, we aim to review the pivotal trials leading to their approval as well as their clinical applications according to lymphoma subtypes. Important treatment-related adverse events are also reviewed and a perspective on the clinical role of these agents is provided, as well as some practical guidance on how to prevent, monitor, and manage potential adverse events in the clinic. PI3K inhibitors have an established role in the management of R/R iNHL, but their use and development are hampered by adverse events, particularly when used in combination with other anti-lymphoma therapies. Finally, this review highlights areas in need of more research in order to optimally use these agents in the care of patients with lymphoma.
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103
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Shimono J, Izumiyama K, Ito S, Tsutsmi Y, Kondo T, Kakinoki Y, Teshima T. Lymphocyte-monocyte ratio (LMR) can predict bendamustine therapeutic efficacy in low-grade B-cell lymphoma. Int J Lab Hematol 2020; 42:431-438. [PMID: 32343486 DOI: 10.1111/ijlh.13216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/24/2020] [Accepted: 04/06/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Bendamustine has been reported to be effective against low-grade B-cell lymphoma. We examined the effect of bendamustine on the lymphocyte-monocyte ratio (LMR) in low-grade B-cell lymphoma patients. METHODS We retrospectively reviewed 127 cases of first line or relapse/refractory low-grade B-cell lymphoma in three individual institutions (Asahikawa Municipal Hospital, Aiiku Hospital, and Hakodate Municipal Hospital). Only patients who had received at least three courses of bendamustine therapy were selected; the LMR was evaluated at starting the initial course of bendamustine therapy. Time to next treatment (TTNT) was used to ascertain the efficacy of bendamustine therapy. RESULTS Follicular lymphoma (FL), at 68.5% (87/127), is the most common histological subtype of low-grade B-cell lymphoma. The receiver operating characteristic (ROC) curve for the LMR showed a cutoff value of 2.0, and 33 cases (26.0%) had an LMR ≤2.0. Cases with LMR ≤2.0 had a significantly earlier progression than those with LMR > 2.0, based on the TTNT (P = .0007). Additionally, LMR ≤2.0 indicates earlier progression in TTNT when comparing only FL and low-grade B-cell lymphoma cases without FL (P = .007, 0.002). For multivariate analysis, the factors associated with an LMR ≤2.0 (HR, 2.741; 95% CI, 1.4330-5.245; P = .002) were considered as early progression factors with regard to the TTNT. CONCLUSION Lymphocyte-monocyte ratio effectively predicts the efficacy of bendamustine therapy for low-grade B-cell lymphoma, particularly FL; its application may improve treatment strategies for this disease.
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Affiliation(s)
- Joji Shimono
- Department of Hematology, Asahikawa Municipal Hospital, Asahikawa, Japan.,Department of Hematology, Graduate School of Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Shinichi Ito
- Department of Hematology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Yutaka Tsutsmi
- Department of Hematology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Yasutaka Kakinoki
- Department of Hematology, Asahikawa Municipal Hospital, Asahikawa, Japan
| | - Takanori Teshima
- Department of Hematology, Graduate School of Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
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104
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van der Straten L, Kater AP, Doorduijn JK, van den Broek EC, Posthuma EFM, Dinmohamed AG, Levin MD. Possible hampered effectiveness of second-line treatment with rituximab-containing chemotherapy without signs of rituximab resistance: a population-based study among patients with chronic lymphocytic leukemia. Ann Hematol 2020; 99:1081-1091. [PMID: 32193628 DOI: 10.1007/s00277-020-03994-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 03/10/2020] [Indexed: 11/25/2022]
Abstract
Rituximab-containing chemotherapy remains a viable frontline treatment option for patients with chronic lymphocytic leukemia (CLL) in the era of novel agents. However, its effectiveness in the second-line setting-in relation to previous rituximab exposure in first-line-has hardly been evaluated in a population-based setting. Therefore, in this comprehensive, population-based study, we assessed the impact of first-line treatment with rituximab-containing chemotherapy on the effectiveness of second-line treatment with rituximab-containing chemotherapy. We selected all 1735 patients diagnosed with CLL between 2004 and 2010 from the Dutch Population-based HAematological Registry for Observational Studies (PHAROS). The primary endpoint was treatment-free survival (TFS). First- and second-line treatment was instituted in 663 (38%) and 284 (43%) patients, respectively. In first line, the median TFS was 19.7 and 67.1 months for chemotherapy without (n = 445; 67%) and with rituximab (n = 218; 33%), respectively (adjusted hazard ratio [HRadjusted], 0.83; P = 0.031). The median TFS among recipients of second-line chemotherapy without (n = 165; 57%) and with rituximab (n = 121; 42%) was 15.0 and 15.3 months, respectively (HRadjusted, 0.93; P = 0.614). Of the 121 patients who received rituximab-containing chemotherapy in second-line, 89 (74%) and 32 (26%) received first-line chemotherapy without and with rituximab, respectively. Median TFS in these two treatment groups was 18.3 and 12.1 months, respectively (HRadjusted, 1.71; P = 0.060). Collectively, in this population-based study, the effectiveness of first-line treatment with rituximab-containing chemotherapy was less pronounced in second-line treatment. The hampered effectiveness of rituximab-containing chemotherapy in second-line could not be explained by previous rituximab exposure.
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Affiliation(s)
- Lina van der Straten
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
| | - Arnon P Kater
- Amsterdam UMC, Department of Hematology, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeanette K Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Eduardus F M Posthuma
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Avinash G Dinmohamed
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Amsterdam UMC, Department of Hematology, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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105
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Wang L, Qin W, Huo YJ, Li X, Shi Q, Rasko JEJ, Janin A, Zhao WL. Advances in targeted therapy for malignant lymphoma. Signal Transduct Target Ther 2020; 5:15. [PMID: 32296035 PMCID: PMC7058622 DOI: 10.1038/s41392-020-0113-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/10/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022] Open
Abstract
The incidence of lymphoma has gradually increased over previous decades, and it ranks among the ten most prevalent cancers worldwide. With the development of targeted therapeutic strategies, though a subset of lymphoma patients has become curable, the treatment of refractory and relapsed diseases remains challenging. Many efforts have been made to explore new targets and to develop corresponding therapies. In addition to novel antibodies targeting surface antigens and small molecular inhibitors targeting oncogenic signaling pathways and tumor suppressors, immune checkpoint inhibitors and chimeric antigen receptor T-cells have been rapidly developed to target the tumor microenvironment. Although these targeted agents have shown great success in treating lymphoma patients, adverse events should be noted. The selection of the most suitable candidates, optimal dosage, and effective combinations warrant further investigation. In this review, we systematically outlined the advances in targeted therapy for malignant lymphoma, providing a clinical rationale for mechanism-based lymphoma treatment in the era of precision medicine.
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Affiliation(s)
- Li Wang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, China
- Pôle de Recherches Sino-Français en Science du Vivant et Génomique, Laboratory of Molecular Pathology, Shanghai, China
| | - Wei Qin
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, China
| | - Yu-Jia Huo
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, China
| | - Xiao Li
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, China
| | - Qing Shi
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, China
| | - John E J Rasko
- Gene & Stem Cell Therapy Program Centenary Institute, Sydney Medical School, University of Sydney, Camperdown, Australia
- Cell and Molecular Therapies, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Anne Janin
- Pôle de Recherches Sino-Français en Science du Vivant et Génomique, Laboratory of Molecular Pathology, Shanghai, China
- U1165 Inserm/Université Paris 7, Hôpital Saint Louis, Paris, France
| | - Wei-Li Zhao
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, China.
- Pôle de Recherches Sino-Français en Science du Vivant et Génomique, Laboratory of Molecular Pathology, Shanghai, China.
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106
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Hilal T, Sonbol MB, Prasad V. Analysis of Control Arm Quality in Randomized Clinical Trials Leading to Anticancer Drug Approval by the US Food and Drug Administration. JAMA Oncol 2020; 5:887-892. [PMID: 31046071 DOI: 10.1001/jamaoncol.2019.0167] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance To date, an empirical evaluation of the quality of control arms in randomized clinical trials (RCTs) leading to anticancer drug approvals by the US Food and Drug Administration (FDA) has not been undertaken. Objective We sought to estimate the percentage of RCTs that used a control arm deemed suboptimal and led to FDA approval of anticancer drugs from January 1, 2013, to July 31, 2018. Design, Setting, and Participants This quality improvement study included 143 anticancer drug approvals granted by the FDA from January 1, 2013, to July 31, 2018. All approvals based on single-arm studies (48 approvals) were excluded. Approvals based on RCTs were further investigated and each trial was analyzed for design, time of patient accrual, control arm, and primary end point. Standard-of-care therapy was determined by evaluating the literature and published guidelines 1 year prior to the start of trial enrollment. The percentage of approvals based on RCTs that used suboptimal control arms was then calculated. The quality of the control arm was deemed suboptimal if the choice of control agent was restricted to exclude a recommended agent, the control arm was specified but the recommended agent was unspecified, and if prior RCT data had demonstrated that the control agent was inferior to an available alternative. Main Outcomes and Measures Estimated percentage of RCTs that used suboptimal control arms that led to FDA approval of anticancer agents between January 1, 2013, to July 31, 2018. Results A total of 145 studies that led to 143 drug approvals between January 1, 2013, and July 31, 2018, were included. Of these studies, 48 single-arm studies were excluded. The remaining 97 studies led to 95 drug approvals. Of these 95 approvals, 16 (17%) were based on RCTs with suboptimal control arms; 15 were international trials, and 1 was conducted in the United States. The type of approval was regular in 15 trials and accelerated in 1 trial. When categorized by the nature of suboptimal control, 4 (25%) trials omitted active treatment in control arm by limiting investigator's choice, 11 (63%) trials omitted active treatment in the control arm by using a control agent known to be inferior to other available agents or not allowing combinations, and 1 (13%) trial used a previously used treatment in the control arm with a known lack of benefit associated with reexposure. Conclusions and Relevance Although anticancer drug approvals are increasing, a proportion of these drugs are reaching the market without proven superiority to what is considered the standard of care at the time of patient enrollment in pivotal trials. The choice of control arm should be optimized to ensure that new anticancer agents being marketed are truly superior to what most clinicians would prescribe outside a clinical trial setting.
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Affiliation(s)
- Talal Hilal
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona
| | | | - Vinay Prasad
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland.,Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland.,Senior Scholar in the Center for Health Care Ethics, Oregon Health & Science University, Portland
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107
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Batlevi CL, Sha F, Alperovich A, Ni A, Smith K, Ying Z, Gerecitano JF, Hamlin PA, Horwitz SM, Joffe E, Kumar A, Matasar MJ, Moskowitz AJ, Moskowitz CH, Noy A, Owens C, Palomba LM, Straus D, von Keudell G, Zelenetz AD, Seshan VE, Luminari S, Marcheselli L, Federico M, Younes A. Positron-emission tomography-based staging reduces the prognostic impact of early disease progression in patients with follicular lymphoma. Eur J Cancer 2020; 126:78-90. [PMID: 31927165 PMCID: PMC7331469 DOI: 10.1016/j.ejca.2019.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/14/2019] [Accepted: 12/02/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Previous studies reported that early progression of disease (POD) after initial therapy predicted poor overall survival (OS) in patients with follicular lymphoma (FL). Here, we investigated whether pre-treatment imaging modality had an impact on prognostic significance of POD. METHODS In this retrospective study, we identified 1088 patients with grade I-IIIA FL; of whom, 238 patients with stage II-IV disease were initially treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP), and 346 patients were treated with rituximab-based chemotherapy. Patients (N = 484) from the FOLL05 study served as an independent validation cohort. We risk-stratified patients based on pre-treatment radiographic imaging (positron-emission tomography [PET] versus computed tomography [CT]) and early POD status using event-defining and landmark analyses. A competing risk analysis evaluated the association between early POD and histologic transformation. RESULTS In the discovery cohort, patients with POD within 24 months (PFS24) of initiating R-CHOP therapy had a 5-year OS of 57.6% for CT-staged patients compared with 70.6% for PET-staged patients. In the validation cohort, the 5-year OS for patients with early POD was 53.9% and 100% in CT- and PET-staged patients, respectively. The risk of histologic transformation in patients whose disease progressed within one year of initiating therapy was higher in CT-staged patients than in PET-staged patients (16.7% versus 6.3%, respectively), which was associated with a 9.7-fold higher risk of death. CONCLUSION In FL, pre-treatment PET staging reduced the prognostic impact of early POD compared with CT staging. Patients with early POD and no histologic transformation have an extended OS with standard therapy.
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Affiliation(s)
- Connie L Batlevi
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Fushen Sha
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anna Alperovich
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ai Ni
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katy Smith
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zhitao Ying
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John F Gerecitano
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul A Hamlin
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steve M Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erel Joffe
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anita Kumar
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew J Matasar
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alison J Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Craig H Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ariela Noy
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Colette Owens
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lia M Palomba
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Straus
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gottfried von Keudell
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew D Zelenetz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Venkatraman E Seshan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stefano Luminari
- Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy; Hematology Unit, AUSL IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Marcheselli
- Department of Medical and Surgical Sciences, FIL Trial Office, University of Modena and Reggio Emilia, Italy
| | - Massimo Federico
- Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy
| | - Anas Younes
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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108
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Capuano C, Pighi C, Maggio R, Battella S, Morrone S, Palmieri G, Santoni A, Klein C, Galandrini R. CD16 pre-ligation by defucosylated tumor-targeting mAb sensitizes human NK cells to γ c cytokine stimulation via PI3K/mTOR axis. Cancer Immunol Immunother 2020; 69:501-512. [PMID: 31950225 PMCID: PMC7113231 DOI: 10.1007/s00262-020-02482-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/04/2020] [Indexed: 12/18/2022]
Abstract
Obinutuzumab is a glycoengineered tumor-targeting anti-CD20 mAb with a modified crystallizable fragment (Fc) domain designed to increase the affinity for the FcγRIIIA/CD16 receptor, which was recently approved for clinical use in CLL and follicular lymphoma. Here we extend our previous observation that, in human NK cells, the sustained CD16 ligation by obinutuzumab-opsonized targets leads to a markedly enhanced IFN-γ production upon a subsequent cytokine re-stimulation. The increased IFN-γ competence in response to IL-2 or IL-15 is attributable to post-transcriptional regulation, as it does not correlate with the upregulation of IFN-γ mRNA levels. Different from the reference molecule rituximab, we observe that the stimulation with obinutuzumab promotes the upregulation of microRNA (miR)-155 expression. A similar trend was also observed in NK cells from untreated CLL patients stimulated with obinutuzumab-opsonized autologous leukemia. miR-155 upregulation associates with reduced levels of SHIP-1 inositol phosphatase, which acts in constraining PI3K-dependent signals, by virtue of its ability to mediate phosphatidylinositol 3,4,5-trisphosphate (PIP3) de-phosphorylation. Downstream of PI3K, the phosphorylation status of mammalian target of rapamycin (mTOR) effector molecule, S6, results in amplified response to IL-2 or IL-15 stimulation in obinutuzumab-experienced cells. Importantly, NK cell treatment with the PI3K or mTOR inhibitors, idelalisib and rapamycin, respectively, prevents the enhanced cytokine responsiveness, thus, highlighting the relevance of the PI3K/mTOR axis in CD16-dependent priming. The enhanced IFN-γ competence may be envisaged to potentiate the immunoregulatory role of NK cells in a therapeutic setting.
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Affiliation(s)
- Cristina Capuano
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Chiara Pighi
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Roberta Maggio
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy.,Clinical Cancer Research, Imperial College London, London, UK
| | - Simone Battella
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Stefania Morrone
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Gabriella Palmieri
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Angela Santoni
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.,Laboratorio Pasteur Italia Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Christian Klein
- Roche Pharmaceutical Research and Early Development Roche Innovation Center Zurich, Schlieren, Switzerland
| | - Ricciarda Galandrini
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy.
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109
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Kiesewetter B, Cherny NI, Boissel N, Cerisoli F, Dafni U, de Vries EGE, Ghia P, Gökbuget N, González-Calle V, Huntly B, Jäger U, Latino NJ, Douillard JY, Malcovati L, Mateos MV, Ossenkoppele GJ, Porkka K, Raderer M, Ribera JM, Scarfò L, Wester R, Zygoura P, Sonneveld P. EHA evaluation of the ESMO-Magnitude of Clinical Benefit Scale version 1.1 (ESMO-MCBS v1.1) for haematological malignancies. ESMO Open 2020; 5:e000611. [PMID: 31958292 PMCID: PMC7003483 DOI: 10.1136/esmoopen-2019-000611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Value frameworks in oncology have not been validated for the assessment of treatments in haematological malignancies, but to avoid overlaps and duplications it appears reasonable to build up experience on existing value frameworks, such as the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS). METHODS Here we present the results of the first feasibility testing of the ESMO-MCBS v1.1 for haematological malignancies based on the grading of 80 contemporary studies for acute leukaemia, chronic leukaemia, lymphoma, myeloma and myelodysplastic syndromes. The aims were (1) to evaluate the scorability of data, (2) to evaluate the reasonableness of the generated grades for clinical benefit using the current version and (3) to identify shortcomings in the ESMO-MCBS v1.1 that require amendments to improve the efficacy and validity of the scale in grading new treatments in the management of haematological malignancies. RESULTS In general, the ESMO-MCBS v1.1 was found to be widely applicable to studies in haematological malignancies, generating scores that were judged as reasonable by European Hematology Association (EHA) experts. A small number of studies could either not be graded or were not appropriately graded. The reasons, related to the differences between haematological and solid tumour malignancies, are identified and described. CONCLUSIONS Based on the findings of this study, ESMO and EHA are committed to develop a version of the ESMO-MCBS that is validated for haematological malignancies. This development process will incorporate all of the usual stringencies for accountability of reasonableness that have characterised the development of the ESMO-MCBS including field testing, statistical modelling, evaluation for reasonableness and openness to appeal and revision. Applying such a scale will support future public policy decision-making regarding the value of new treatments for haematological malignancies and will provide insights that could be helpful in the design of future clinical trials.
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Affiliation(s)
- Barbara Kiesewetter
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Nathan I Cherny
- Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Nicolas Boissel
- Department of Hematology, Hospital Saint-Louis, Paris, Île-de-France, France
- Adolescent and Young Adult Hematology Unit, Diderot University Paris Faculty of Medicine, Paris, Île-de-France, France
| | - Francesco Cerisoli
- European Hematology Association, Den Haag, Zuid-Holland, The Netherlands
| | - Urania Dafni
- Laboratory of Biostatistics, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
- Frontier Science Foundation-Hellas, Frontier Science Foundation-Hellas, Athens, Greece
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Paolo Ghia
- Strategic Research Program on CLL, Division of Experimental Oncology, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
- Universita Vita e Salute San Raffaele, Milano, Lombardia, Italy
| | - Nicola Gökbuget
- Department of Hematology/Oncology, Goethe University, Frankfurt am Main, Hessen, Germany
| | - Verónica González-Calle
- Department of Hematology and Instituto de Investigación Biomédica de Salamanca-IBSAL, University Hospital of Salamanca, Salamanca, Castilla y León, Spain
| | - Brian Huntly
- Cambridge Stem Cell Institute, Department of Haematology, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Ulrich Jäger
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | | | | | - Luca Malcovati
- Department of Molecular Medicine, University of Pavia, Pavia, Lombardia, Italy
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
| | - María-Victoria Mateos
- Department of Hematology and Instituto de Investigación Biomédica de Salamanca-IBSAL, University Hospital of Salamanca, Salamanca, Castilla y León, Spain
| | - Gert J Ossenkoppele
- Department of Hematology, VU University Medical Centre Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Kimmo Porkka
- Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Markus Raderer
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Josep-Maria Ribera
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Barcelona, Catalunya, Spain
| | - Lydia Scarfò
- Strategic Research Program on CLL, Division of Experimental Oncology, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
- Universita Vita e Salute San Raffaele, Milano, Lombardia, Italy
| | - Ruth Wester
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, The Netherlands
| | - Panagiota Zygoura
- Frontier Science Foundation-Hellas, Frontier Science Foundation-Hellas, Athens, Greece
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, The Netherlands
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, The Netherlands
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110
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Hara T, Suzuki R, Ohno A, Yamakawa K, Yamagishi Y, Sugiyama Y, Sobajima T, Yamada R, Matsumoto R, Ikeda Y, Murayama M, Tsurumi H. Safe administration of rituximab for follicular lymphoma after obinutuzumab infusion-related reaction. Int J Hematol 2019; 111:585-590. [PMID: 31848991 DOI: 10.1007/s12185-019-02793-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 01/10/2023]
Abstract
Obinutuzumab is a novel glycoengineered, type-II anti-CD20 monoclonal antibody that was recently developed to treat follicular lymphoma (FL), the most prevalent subtype of indolent B-cell lymphoma. Several intensely hypermetabolic lesions (SUVmax: 40) were identified in the post-mediastinal and paraaortic lymph nodes by 18F-FDG-PET maximum-intensity projection images of a 58-year-old man who presented with systemic lymphadenopathy. A biopsy at the time of laparotomy definitively diagnosed grade 1 FL. The patient was given the recommended standard premedication, comprising acetaminophen (1000 mg), diphenhydramine (50 mg), and dexamethasone (20 mg), and then started on six cycles of obinutuzumab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP). However, the patient developed severe hypotension and dyspnea about 15 min after starting obinutuzumab. It was difficult to differentiate between a possible allergic reaction and infusion-related reaction. A pleural effusion was drained to reduce the tumor burden, after which a single course of CHOP was started. Rituximab (R) was added 10 days later without incident, and the patient completed six cycles of the R-CHOP therapy without adverse events. We conclude that R-CHOP was safe for administration to patients who react to infused obinutuzumab. Such patients should be carefully monitored during R infusion, given the risk of cross-reactivity.
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Affiliation(s)
- Takeshi Hara
- Department of Hematology, Matsunami General Hospital, 185-1 Dendai, Kasamatsu-cho, Hashima, 501-6062, Japan
| | - Ryohei Suzuki
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Akihisa Ohno
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Kengo Yamakawa
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Yasumasa Yamagishi
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Yoshihiro Sugiyama
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Takuya Sobajima
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Rie Yamada
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Rie Matsumoto
- Department of Pharmacy, Matsunami General Hospital, Hashima, Japan
| | - Yoko Ikeda
- Department of Pathology, Matsunami General Hospital, Hashima, Japan
| | - Masanori Murayama
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Hisashi Tsurumi
- Department of Hematology, Matsunami General Hospital, 185-1 Dendai, Kasamatsu-cho, Hashima, 501-6062, Japan.
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111
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Carbone A, Roulland S, Gloghini A, Younes A, von Keudell G, López-Guillermo A, Fitzgibbon J. Follicular lymphoma. Nat Rev Dis Primers 2019; 5:83. [PMID: 31831752 DOI: 10.1038/s41572-019-0132-x] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 12/12/2022]
Abstract
Follicular lymphoma (FL) is a systemic neoplasm of the lymphoid tissue displaying germinal centre (GC) B cell differentiation. FL represents ~5% of all haematological neoplasms and ~20-25% of all new non-Hodgkin lymphoma diagnoses in western countries. Tumorigenesis starts in precursor B cells and becomes full-blown tumour when the cells reach the GC maturation step. FL is preceded by an asymptomatic preclinical phase in which premalignant B cells carrying a t(14;18) chromosomal translocation accumulate additional genetic alterations, although not all of these cells progress to the tumour phase. FL is an indolent lymphoma with largely favourable outcomes, although a fraction of patients is at risk of disease progression and adverse outcomes. Outcomes for FL in the rituximab era are encouraging, with ~80% of patients having an overall survival of >10 years. Patients with relapsed FL have a wide range of treatment options, including several chemoimmunotherapy regimens, phosphoinositide 3-kinase inhibitors, and lenalidomide plus rituximab. Promising new treatment approaches include epigenetic therapeutics and immune approaches such as chimeric antigen receptor T cell therapy. The identification of patients at high risk who require alternative therapies to the current standard of care is a growing need that will help direct clinical trial research. This Primer discusses the epidemiology of FL, its molecular and cellular pathogenesis and its diagnosis, classification and treatment.
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Affiliation(s)
- Antonino Carbone
- Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy.
| | - Sandrine Roulland
- Aix Marseille University, CNRS, INSERM, Centre d'Immunologie de Marseille-Luminy, Marseille, France
| | - Annunziata Gloghini
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Anas Younes
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Jude Fitzgibbon
- Barts Cancer Institute, Queen Mary University of London, London, UK
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112
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Lai C, Kandahari AM, Ujjani C. The Evolving Role of Brentuximab Vedotin in Classical Hodgkin Lymphoma. BLOOD AND LYMPHATIC CANCER-TARGETS AND THERAPY 2019; 9:63-71. [PMID: 31849558 PMCID: PMC6910100 DOI: 10.2147/blctt.s231821] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 11/21/2019] [Indexed: 11/25/2022]
Abstract
The arrival of the CD30 directed antibody-drug conjugate, brentuximab vedotin (BV), has altered the approach to patients with classical Hodgkin lymphoma. Since initial approval in 2011, BV has been extensively studied in previously untreated and relapsed/refractory patients. Treatment indications for the antibody-drug conjugate have been expanded from the previously treated population to include maintenance therapy after autologous stem cell transplantation and recently, combination with chemotherapy in newly diagnosed advanced stage patients. This article will review the evolution of BV in classical Hodgkin lymphoma, detailing the studies that led to the approved indications and discussion of recent trials in combination with chemotherapy and immunotherapy.
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Affiliation(s)
- Catherine Lai
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Adrese Michael Kandahari
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Chaitra Ujjani
- Seattle Cancer Care Alliance, Fred Hutchinson CRC, University of Washington, Seattle, WA, USA
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113
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Sharman JP. Targeting CD20: teaching an old dog new tricks. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:273-278. [PMID: 31808844 PMCID: PMC6913507 DOI: 10.1182/hematology.2019000031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Rituximab was the first monoclonal antibody used for the treatment of a malignancy. In the 22 years since initial approval, it has become a vital component of therapy for a multitude of B-cell malignancies. Within the last several years, however, there has been a robust development of novel agents targeting CD20, including second generation anti-CD20 antibodies, biosimilar antibodies, and subcutaneous formulations that have been approved. The era of passive immunotherapy is now yielding to therapeutic approaches that actively engage the immune system. Emerging approaches leverage immunomodulatory drugs or novel checkpoint inhibitors to enhance CD20 therapy. Recent data sets on bispecific CD3/CD20 antibodies demonstrate exciting early findings, and CD20-directed chimeric antigen receptor T-cell therapies are now entering clinical trials. Anti-CD20 therapies are a vital component of the treatment of B-cell malignancies, and there is a dynamic therapeutic environment with multiple new data sets reviewed here.
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Affiliation(s)
- Jeff P Sharman
- Willamette Valley Cancer Institute/US Oncology, Eugene, OR
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114
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Sindel A, Al-Juhaishi T, Yazbeck V. Marginal Zone Lymphoma: State-of-the-Art Treatment. Curr Treat Options Oncol 2019; 20:90. [PMID: 31807935 DOI: 10.1007/s11864-019-0687-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OPINION STATEMENT Despite being the second most common indolent non-Hodgkin's lymphoma (iNHL), marginal zone lymphoma (MZL) remains largely understudied, and given its underlying disease heterogeneity, it is challenging to define a single treatment approach for these patients. For localized disease, local therapy is recommended such as triple therapy for H. pylori in gastric extranodal MZL, splenectomy for splenic MZL, and radiotherapy for nodal MZL. For disseminated disease with low tumor burden, a watch and wait or single-agent rituximab can be used. However, for symptomatic disease, a similar approach to follicular lymphoma (FL) can be used with chemoimmunotherapy approaches such as bendamustine and rituximab. High FDG uptake is not common in MZL and is not diagnostic by itself of transformation to high-grade lymphoma but informs the choice of the site to be biopsied. Transformation into a large B cell lymphoma is treated with R-CHOP-like regimens. Patients with relapsing disease after at least one CD20-based therapy have several recently approved chemotherapy-free options including B cell receptor inhibitors such ibrutinib (approved specifically in MZL) and immunomodulatory agents such as lenalidomide and rituximab (FDA approved in MZL and FL). Phosphoinositide 3-kinase (PI3K) inhibitors have shown excellent activity in iNHL, specifically in MZL, with breakthrough designation status for copanlisib and umbralisib, allowing off label use of this class of agents in clinical practice. With the availability of prospective clinical trials using chemo-free approaches, specifically those targeting abnormal signaling pathways activated in MZL tumors and its microenvironment, treating physicians are encouraged to enroll patients on these clinical trials in order to better understand the underlying biology, mechanisms of response, and resistance to current therapies and help design future rationale combination strategies.
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Affiliation(s)
- Ariel Sindel
- Department of Internal Medicine, Virginia Commonwealth University, 401 College Street, Box 980035, Richmond, VA, 23298, USA
| | - Taha Al-Juhaishi
- Department of Internal Medicine, Virginia Commonwealth University, 401 College Street, Box 980035, Richmond, VA, 23298, USA
| | - Victor Yazbeck
- Department of Internal Medicine, Virginia Commonwealth University, 401 College Street, Box 980035, Richmond, VA, 23298, USA. .,Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA.
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115
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Shah NN, Ahn KW, Litovich C, Sureda A, Kharfan-Dabaja MA, Awan FT, Ganguly S, Gergis U, Inwards D, Karmali R, Lazaryan A, Lekakis L, Munshi P, Nathan S, Saad AA, Solh M, Steinberg A, Vij R, Wood WA, Fenske TS, Smith S, Hamadani M. Allogeneic transplantation in elderly patients ≥65 years with non-Hodgkin lymphoma: a time-trend analysis. Blood Cancer J 2019; 9:97. [PMID: 31796726 PMCID: PMC6890709 DOI: 10.1038/s41408-019-0261-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022] Open
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is a curative therapy for relapsed/refractory and high-risk non-Hodgkin lymphoma (NHL). However, no large studies have evaluated allo-HCT utilization in elderly NHL patients (≥65 years). Using the CIBMTR registry, we report a time-trend analysis of 727 NHL patients (≥65 years) undergoing the first allo-HCT from 2000 to 2015 in the United States (US). Study cohorts were divided by time period: 2000-2005 (N = 76) vs. 2006-2010 (N = 238) vs. 2011-2015 (N = 413). Primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), relapse/progression (R/P), and non-relapse mortality (NRM). Median age at transplant, use of reduced-intensity conditioning, and graft source remained stable, while use of unrelated donors increased in the most current era. The 1-year probabilities of NRM from 2000 to 2005 vs. 2006-2010 vs. 2011-2015 were 24% vs. 19% vs. 21%, respectively (p = 0.67). Four-year probability of R/P was similar among the three cohorts: 48% (2000-2005), 40% (2006-2010), and 40% (2011-2015) (p = 0.39). The 4-year probabilities of PFS and OS (2000-2005 vs. 2006-2010 vs. 2011-2015) showed significantly improved outcomes in more recent time periods: 17% vs. 31% vs. 30% (p = 0.02) and 21% vs. 42% vs. 44% (p < 0.001), respectively. Utilization of allo-HCT increased in elderly NHL patients in the US since 2000 with improving survival outcomes.
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Affiliation(s)
- Nirav N Shah
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kwang Woo Ahn
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carlos Litovich
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anna Sureda
- Hematology Department, Institut Català d'Oncologia - Hospitalet, Barcelona, Spain
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Farrukh T Awan
- Ohio Stat Medical Center, James Cancer Center, Columbus, OH, USA
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS, USA
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - David Inwards
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | - Ayman A Saad
- Division of Hematology, Ohio State University, Columbus, OH, USA
| | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA, USA
| | - Amir Steinberg
- Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY, USA
| | - Ravi Vij
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - William A Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Timothy S Fenske
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sonali Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, IL, USA
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, USA. .,CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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116
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Jiménez-Ubieto A, Grande C, Caballero D, Yáñez L, Novelli S, Hernández-Garcia MT, Manzanares M, Arranz R, Ferreiro JJ, Bobillo S, Mercadal S, Galeo A, Jiménez JL, Moraleda JM, Vallejo C, Albo C, Pérez E, Marrero C, Magnano L, Palomera L, Jarque I, Rodriguez A, Lorza L, Martín A, Coria E, López-Guillermo A, Salar A, José Lahuerta J. Autologous stem cell transplantation may be curative for patients with follicular lymphoma with early therapy failure without the need for immunotherapy. Hematol Oncol Stem Cell Ther 2019; 12:194-203. [DOI: 10.1016/j.hemonc.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/23/2019] [Indexed: 12/01/2022] Open
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117
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Leslie LA, Feldman TA, McNeill A, Timberg M, Iida H, Goy AH. Contemporary management of nodal and primary splenic marginal zone lymphoma. Expert Rev Hematol 2019; 12:1011-1022. [PMID: 31619091 DOI: 10.1080/17474086.2020.1681962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Marginal zone lymphoma (MZL) accounts for approximately 10% of all cases of non-Hodgkin lymphoma and includes 3 clinically distinct subtypes: extranodal (MALT), splenic (SMZL), and nodal (NMZL). Though commonly grouped in trials of iNHL the clinical behavior, molecular features, and response to therapy of MZL is distinct from other iNHL subtypes and varies among MZL subtypes.Areas covered: This review focuses on the contemporary management of NMZL and SMZL. Treatment with monoclonal antibodies, chemoimmunotherapy, BTK inhibitors, PI3K/mTOR inhibitors, Bcl2 inhibitors, lenalidomide, and CAR-T cell therapy will be covered.Expert opinion: In the era of targeted medicine, the need to develop MZL specific clinicogenetic models with prognostic and predictive value in both the frontline and relapsed/refractory setting is becoming increasingly apparent. Due to the relative rarity of each MZL subtype, the use of novel trial design with correlative studies is imperative to advance the field.
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Affiliation(s)
- Lori A Leslie
- Lymphoma Division, John Theurer Cancer Center, Hackensack, NJ, USA
| | | | - Ann McNeill
- Lymphoma Division, John Theurer Cancer Center, Hackensack, NJ, USA
| | - Mary Timberg
- Lymphoma Division, John Theurer Cancer Center, Hackensack, NJ, USA
| | - Hoshiyuki Iida
- Lymphoma Division, John Theurer Cancer Center, Hackensack, NJ, USA
| | - Andre H Goy
- Lymphoma Division, John Theurer Cancer Center, Hackensack, NJ, USA
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118
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Matasar MJ, Luminari S, Barr PM, Barta SK, Danilov AV, Hill BT, Phillips TJ, Jerkeman M, Magagnoli M, Nastoupil LJ, Persky DO, Okosun J. Follicular Lymphoma: Recent and Emerging Therapies, Treatment Strategies, and Remaining Unmet Needs. Oncologist 2019; 24:e1236-e1250. [PMID: 31346132 PMCID: PMC6853118 DOI: 10.1634/theoncologist.2019-0138] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/13/2019] [Indexed: 12/18/2022] Open
Abstract
Follicular lymphoma (FL) is a heterogeneous disease with varying prognosis owing to differences in clinical, laboratory, and disease parameters. Although generally considered incurable, prognosis for early- and advanced-stage disease has improved because of therapeutic advances, several of which have resulted from elucidation of the biologic and molecular basis of the disease. The choice of treatment for FL is highly dependent on patient and disease characteristics. Several tools are available for risk stratification, although limitations in their routine clinical use exist. For limited disease, treatment options include radiotherapy, rituximab monotherapy or combination regimens, and surveillance. Treatment of advanced disease is often determined by tumor burden, with surveillance or rituximab considered for low tumor burden and chemoimmunotherapy for high tumor burden disease. Treatment for relapsed or refractory disease is influenced by initial first-line therapy and the duration and quality of the response. Presently, there is no consensus for treatment of patients with early or multiply relapsed disease; however, numerous agents, combination regimens, and transplant options have demonstrated efficacy. Although the number of therapies available to treat FL has increased together with an improved understanding of the underlying biologic basis of disease, the best approach to select the most appropriate treatment strategy for an individual patient at a particular time continues to be elucidated. This review considers prognostication and the evolving treatment landscape of FL, including recent and emergent therapies as well as remaining unmet needs. IMPLICATIONS FOR PRACTICE: In follicular lymphoma, a personalized approach to management based on disease biology, patient characteristics, and other factors continues to emerge. However, application of current management requires an understanding of the available therapeutic options for first-line treatment and knowledge of current development in therapies for previously untreated and for relapsed or refractory disease. Thus, this work reviews for clinicians the contemporary data in follicular lymphoma, from advances in characterizing disease biology to current treatments and emerging novel therapies.
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Affiliation(s)
- Matthew J Matasar
- Memorial Sloan Kettering Cancer Center and New York Presbyterian, New York New York, USA
| | - Stefano Luminari
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Paul M Barr
- University of Rochester Medical Center, Rochester, New York, USA
| | - Stefan K Barta
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Brian T Hill
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | | | | | - Massimo Magagnoli
- Humanitas Cancer Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | - Jessica Okosun
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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119
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O’Nions J, Townsend W. The role of obinutuzumab in the management of follicular lymphoma. Future Oncol 2019; 15:3565-3578. [DOI: 10.2217/fon-2019-0193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The outcomes for follicular lymphoma (FL) have improved significantly in recent years. This has been driven by an improved understanding of the pathobiology of FL and the development of therapeutic anti-CD20 antibodies. Combining rituximab with chemotherapy, coupled with its use as maintenance therapy, has contributed to significant improvements in disease control and progression-free survival. However, FL remains incurable and almost all patients invariably relapse. Therefore, there remains a need to develop novel therapeutic options and optimize existing regimens. Obinutuzumab (a first-in-class, glycoengineered, humanized type 2 anti-CD20 antibody) has been evaluated in a number of clinical trials. In this review, we will summarize the evaluable results of clinical trials investigating the efficacy of obinutuzumab in the treatment of FL.
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Affiliation(s)
- Jenny O’Nions
- NIHR/UCLH Clinical Research Facility, University College London Hospitals NHS Foundation Trust, London, UK
| | - William Townsend
- NIHR/UCLH Clinical Research Facility, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Haematology, Cancer Institute, University College London, UK
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120
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Peñalver F, Márquez J, Durán S, Giraldo P, Martín A, Montalbán C, Sancho J, Ramírez M, Terol M, Capote F, Gutiérrez A, Sánchez B, López A, Salar A, Rodríguez‐Caravaca G, Canales M, Caballero M. Response-adapted treatment with rituximab, bendamustine, mitoxantrone, and dexamethasone followed by rituximab maintenance in patients with relapsed or refractory follicular lymphoma after first-line immunochemotherapy: Results of the RBMDGELTAMO08 phase II trial. Cancer Med 2019; 8:6955-6966. [PMID: 31573746 PMCID: PMC6853826 DOI: 10.1002/cam4.2555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/30/2019] [Accepted: 08/30/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Consensus is lacking regarding the optimal salvage therapy for patients with follicular lymphoma who relapse after or are refractory to immunochemotherapy. METHODS This phase II trial evaluated the efficacy and safety of response-adapted therapy with rituximab, bendamustine, mitoxantrone, and dexamethasone (RBMD) in follicular lymphoma patients who relapsed after or were refractory to first-line immunochemotherapy. Sixty patients received three treatment cycles, and depending on their response received an additional one (complete/unconfirmed complete response) or three (partial response) cycles. Patients who responded to induction received rituximab maintenance therapy for 2 years. RESULTS Thirty-three (55%) and 42 (70%) patients achieved complete/unconfirmed complete response after three cycles and on completing induction therapy (4-6 cycles), respectively (final overall response rate, 88.3%). Median progression-free survival was 56.4 months (median follow-up, 28.3 months; 95% CI, 15.6-51.2). Overall survival was not reached. Progression-free survival did not differ between patients who received four vs six cycles (P = .6665), nor between patients who did/did not receive rituximab maintenance after first-line therapy (P = .5790). Median progression-free survival in the 10 refractory patients was 25.5 months (95% CI, 0.6-N/A) and was longer in patients who had shown progression of disease after 24 months of first-line therapy (median, 56.4 months; 95% CI, 19.8-56.4) than in those who showed early progression (median, 42.31 months; 95% CI, 24.41-NA) (P = .4258). Thirty-six (60%) patients had grade 3/4 neutropenia. Grade 3/4 febrile neutropenia and infection were recorded during induction (4/60 [6.7%] and 5/60 [8.3%] patients, respectively) and maintenance (2/43 [4.5%] and 4/43 [9.1%] patients, respectively). CONCLUSIONS This response-adapted treatment with RBMD followed by rituximab maintenance is an effective and well-tolerated salvage treatment for relapsed/refractory follicular lymphoma following first-line immunochemotherapy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov # NCT01133158.
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121
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NK Cells in the Treatment of Hematological Malignancies. J Clin Med 2019; 8:jcm8101557. [PMID: 31569769 PMCID: PMC6832953 DOI: 10.3390/jcm8101557] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 02/06/2023] Open
Abstract
Natural killer (NK) cells have the innate ability to kill cancer cells, however, tumor cells may acquire the capability of evading the immune response, thereby leading to malignancies. Restoring or potentiation of this natural antitumor activity of NK cells has become a relevant therapeutic approach in cancer and, particularly, in hematological cancers. The use of tumor-specific antibodies that promote antibody-dependent cell-mediated cytotoxicity (ADCC) through the ligation of CD16 receptor on NK cells has become standard for many hematologic malignancies. Hematopoietic stem cell transplantation is another key therapeutic strategy that harnesses the alloreactivity of NK cells against cancer cells. This strategy may be refined by adoptive transfer of NK cells that may be previously expanded, activated, or redirected (chimeric antigen receptor (CAR)-NK cells) against cancer cells. The antitumor activity of NK cells can also be boosted by cytokines or immunostimulatory drugs such as lenalidomide or pomalidomide. Finally, targeting immunosubversive mechanisms developed by hematological cancers and, in particular, using antibodies that block NK cell inhibitory receptors and checkpoint proteins are novel promising therapeutic approaches in these malignant diseases.
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Parakh S, King D, Gan HK, Scott AM. Current Development of Monoclonal Antibodies in Cancer Therapy. Recent Results Cancer Res 2019; 214:1-70. [PMID: 31473848 DOI: 10.1007/978-3-030-23765-3_1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Exploiting the unique specificity of monoclonal antibodies has revolutionized the treatment and diagnosis of haematological and solid organ malignancies; bringing benefit to millions of patients over the past decades. Recent achievements include conjugating antibodies with toxic payloads resulting in superior efficacy and/or reduced toxicity, development of molecular imaging techniques targeting specific antigens for use as predictive and prognostic biomarkers, the development of novel bi- and tri-specific antibodies to enhance therapeutic benefit and abrogate resistance and the success of immunotherapy agents. In this chapter, we review an overview of antibody structure and function relevant to cancer therapy and provide an overview of pivotal clinical trials which have led to regulatory approval of monoclonal antibodies in cancer treatment. We further discuss resistance mechanisms and the unique side effects of each class of antibody and provide an overview of emerging therapeutic agents.
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Affiliation(s)
- Sagun Parakh
- Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia.,Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Heidelberg, Melbourne, Australia.,School of Cancer Medicine, La Trobe University, Melbourne, Australia
| | - Dylan King
- Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia.,School of Cancer Medicine, La Trobe University, Melbourne, Australia
| | - Hui K Gan
- Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia.,Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Heidelberg, Melbourne, Australia.,School of Cancer Medicine, La Trobe University, Melbourne, Australia
| | - Andrew M Scott
- Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia. .,School of Cancer Medicine, La Trobe University, Melbourne, Australia. .,Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia. .,Department of Medicine, University of Melbourne, Melbourne, Australia.
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Tuscano JM, Maverakis E, Groshen S, Tsao-Wei D, Luxardi G, Merleev AA, Beaven A, DiPersio JF, Popplewell L, Chen R, Kirschbaum M, Schroeder MA, Newman EM. A Phase I Study of the Combination of Rituximab and Ipilimumab in Patients with Relapsed/Refractory B-Cell Lymphoma. Clin Cancer Res 2019; 25:7004-7013. [PMID: 31481504 DOI: 10.1158/1078-0432.ccr-19-0438] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/03/2019] [Accepted: 08/28/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Based on the potential for ipilimumab (I) to augment T-cell activation, we hypothesize that ipilimumab would augment the efficacy of rituximab (R) in patients with relapsed/refractory (R/R) CD20+non-Hodgkin's lymphoma (NHL). This phase I study aimed to identify a recommended phase 2 dose, document toxicities, and preliminarily assess efficacy and potential predictive biomarkers. PATIENTS AND METHODS Thirty-three patients with R/R CD20+B-cell lymphoma received R at 375 mg/m2weekly for 4 weeks and I at 3 mg/kg on day 1 and every 3 weeks for four doses. Responding patients went on to maintenance with each agent given every 12 weeks. To facilitate correlative analysis, the expansion phase randomized patients to simultaneous R+I versus R with I delayed 2 weeks. RESULTS Toxicity was manageable; no dose-limiting toxicity was observed at the doses studied. When considering the entire cohort, efficacy was modest, with an objective response rate (ORR) of 24% and median progression-free survival (PFS) of 2.6 months. However, in follicular lymphoma patients, the ORR was 58% with a median PFS of 5.6 months. The randomized comparison of R with R+I demonstrated that R+I resulted in more effective B-cell depletion (BCD). Both B-cell depletion and the ratio of CD45RA-regulatory T cell (Treg) to Treg were associated with response at all time points. CONCLUSIONS The combination of R+I has manageable toxicity and encouraging efficacy in R/R follicular lymphoma. The ratio of CD45RA-Tregs to total Tregs, and peripheral BCD should be studied further as potential predictors of response.
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Affiliation(s)
- Joseph M Tuscano
- UC Davis Comprehensive Cancer Center, Sacramento, California. .,Veterans Administration Northern California Healthcare System, Sacramento, California
| | | | - Susan Groshen
- Biostatistics Core, University of Southern California/Norris Cancer Center, Los Angeles, California
| | - Denice Tsao-Wei
- Biostatistics Core, University of Southern California/Norris Cancer Center, Los Angeles, California
| | | | | | - Anne Beaven
- University of North Carolina Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - John F DiPersio
- Washington University School of Medicine, St. Louis, Missouri
| | - Leslie Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Robert Chen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | | | | | - Edward M Newman
- Division of Molecular Pharmacology, Department of Medical Oncology, City of Hope, Duarte, California, USA
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Kandil M, Alhashmi H, Alzahrani M, Alhejazi A, Motabi I, Dada R, Al-Mansour M, Sagheir A. Marginal Zone Lymphoma: Saudi Lymphoma Group's Clinical Practice Guidelines for Diagnosis, Management and Follow-up. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 7:202-208. [PMID: 31543745 PMCID: PMC6734739 DOI: 10.4103/sjmms.sjmms_97_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/15/2019] [Accepted: 07/24/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Magdy Kandil
- Oncology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- Clinical Oncology Department, Cairo University, Giza, Egypt
| | - Hani Alhashmi
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Musa Alzahrani
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ayman Alhejazi
- Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Central Region, Riyadh, Saudi Arabia
| | - Ibraheem Motabi
- Department of Adult Hematology and BMT, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Reyad Dada
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
- College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
| | - Mubarak Al-Mansour
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Adult Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah, Saudi Arabia
| | - Ahmed Sagheir
- Oncology Institute, John Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
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Dada R, Al-Mansour M, Alhashmi H, Kandil M, Alhejazi A, Sagheir A, Alzahrani M, Motabi I. Follicular Lymphoma: Saudi Lymphoma Group's Clinical Practice Guidelines for Diagnosis, Management and Follow-up. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 7:214-218. [PMID: 31543747 PMCID: PMC6734728 DOI: 10.4103/sjmms.sjmms_101_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/06/2019] [Accepted: 07/24/2019] [Indexed: 12/04/2022]
Affiliation(s)
- Reyad Dada
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
- College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
| | - Mubarak Al-Mansour
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Adult Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah, Saudi Arabia
| | - Hani Alhashmi
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Magdy Kandil
- Oncology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- Clinical Oncology Department, Cairo University, Giza, Egypt
| | - Ayman Alhejazi
- Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Central Region, Riyadh, Saudi Arabia
| | - Ahmed Sagheir
- Oncology Institute, John Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Musa Alzahrani
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ibraheem Motabi
- Department of Adult Hematology and BMT, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Pott C, Sehn LH, Belada D, Gribben J, Hoster E, Kahl B, Kehden B, Nicolas-Virelizier E, Spielewoy N, Fingerle-Rowson G, Harbron C, Mundt K, Wassner-Fritsch E, Cheson BD. MRD response in relapsed/refractory FL after obinutuzumab plus bendamustine or bendamustine alone in the GADOLIN trial. Leukemia 2019; 34:522-532. [PMID: 31462735 PMCID: PMC7214251 DOI: 10.1038/s41375-019-0559-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/25/2019] [Accepted: 07/15/2019] [Indexed: 11/09/2022]
Abstract
We report assessment of minimal residual disease (MRD) status and its association with outcome in rituximab-refractory follicular lymphoma (FL) in the randomized GADOLIN trial (NCT01059630). Patients received obinutuzumab (G) plus bendamustine (Benda) induction followed by G maintenance, or Benda induction alone. Patients with a clonal marker (t[14;18] translocation and/or immunoglobulin heavy or light chain rearrangement) detected at study screening were assessed for MRD at mid-induction (MI), end of induction (EOI), and every 6–24 months post-EOI/discontinuation by real-time quantitative PCR. At MI, 41/52 (79%) patients receiving G-Benda were MRD-negative vs. 17/36 (47%) patients receiving Benda alone (p = 0.0029). At EOI, 54/63 (86%) patients receiving G-Benda were MRD-negative vs. 30/55 (55%) receiving Benda alone (p = 0.0002). MRD-negative patients at EOI had improved progression-free survival (HR, 0.33, 95% CI, 0.19–0.56, p < 0.0001) and overall survival (HR, 0.39, 95% CI, 0.19–0.78, p = 0.008) vs. MRD-positive patients, and maintained their MRD-negative status for longer if they received G maintenance than if they did not. These results suggest that the addition of G to Benda-based treatment during induction can significantly contribute to the speed and depth of response, and G maintenance in MRD-negative patients potentially delays lymphoma regrowth.
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Affiliation(s)
| | - Laurie H Sehn
- British Columbia Cancer Agency and the University of British Columbia, Vancouver, BC, Canada
| | - David Belada
- Department of Internal Medicine-Haematology, Charles University, Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | | | - Eva Hoster
- Hospital of the Ludwig-Maximilians University, Munich, Germany
| | - Brad Kahl
- Washington University School of Medicine, St Louis, MO, USA
| | - Britta Kehden
- University Hospital Schleswig-Holstein, Kiel, Germany
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Decaup E, Rossi C, Gravelle P, Laurent C, Bordenave J, Tosolini M, Tourette A, Perrial E, Dumontet C, Poupot M, Klein C, Savina A, Fournié JJ, Bezombes C. A Tridimensional Model for NK Cell-Mediated ADCC of Follicular Lymphoma. Front Immunol 2019; 10:1943. [PMID: 31475004 PMCID: PMC6702952 DOI: 10.3389/fimmu.2019.01943] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/01/2019] [Indexed: 12/22/2022] Open
Abstract
Follicular lymphoma (FL) is the second most frequent subtype of B non-Hodgkin's lymphomas (NHL) for which the treatment is based on the use of anti-CD20 mAbs. NK cells play a crucial role in their mechanism of action and the number of these cells mediating antibody-dependent cell cycotoxicity (ADCC) in the peripheral blood of FL patients predict the outcome. However, their presence in FL biopsies, their activation and their role have been poorly investigated. Moreover, in vitro studies have not deciphered the exact signaling cascades triggered by NK cells in presence of anti-CD20 mAbs on both effector and target cells in a relevant FL model. We performed in silico analyses and ex vivo functional assays to determine the presence and the activation status of NK cells in FL biopsies. We modelized ADCC phenomenon by developing a co-culture model composed by 3D-cultured FL cells and NK cells. Thus, we investigated the biological effect of anti-CD20 mAbs by fluorescent microscopy and the phosphorylation status of survival pathways by cell bar coding phosphoflow in target cells. In parallel, we measured the status of activation of downstream FcγRIIIa signaling pathways in effector cells and their activation (CD69, perforin, granzyme B, IFNγ) by flow cytometry. We determined by in vivo experiments the effects of anti-CD20 mAbs in presence of NK cells in SCID-Beige engrafted FL mice. Here, we show that functional NK cells infiltrate FL biopsies, and that their presence tends to correlate with the survival of FL patients. Using our 3D co-culture model, we show that rituximab and GA101 are able to promote degranulation, CD69 expression, IFNγ production and activate FcγRIIIa signaling cascade in NK cells, and inhibit survival pathways and induce apoptosis in FL cells. The effect of GA101 seems to be more pronounced as observed in vivo in a xenograft FL model. This study strongly supports the role of NK cells in FL and highlights the application of the 3D co-culture model for in vitro validation.
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Affiliation(s)
- Emilie Decaup
- Centre de Recherches en Cancérologie de Toulouse (CRCT), UMR1037 INSERM, Université Toulouse III: Paul-Sabatier, ERL5294 CNRS, Université de Toulouse, Toulouse, France.,Laboratoire d'Excellence TOUCAN, Toulouse, France.,Programme Hospitalo-Universitaire en Cancérologie CAPTOR, Toulouse, France
| | - Cédric Rossi
- Centre de Recherches en Cancérologie de Toulouse (CRCT), UMR1037 INSERM, Université Toulouse III: Paul-Sabatier, ERL5294 CNRS, Université de Toulouse, Toulouse, France.,Laboratoire d'Excellence TOUCAN, Toulouse, France.,Programme Hospitalo-Universitaire en Cancérologie CAPTOR, Toulouse, France.,CHU Dijon, Hématologie Clinique, Hôpital François Mitterand, Dijon, France
| | - Pauline Gravelle
- Centre de Recherches en Cancérologie de Toulouse (CRCT), UMR1037 INSERM, Université Toulouse III: Paul-Sabatier, ERL5294 CNRS, Université de Toulouse, Toulouse, France.,Laboratoire d'Excellence TOUCAN, Toulouse, France.,Programme Hospitalo-Universitaire en Cancérologie CAPTOR, Toulouse, France.,Department of Pathology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Camille Laurent
- Centre de Recherches en Cancérologie de Toulouse (CRCT), UMR1037 INSERM, Université Toulouse III: Paul-Sabatier, ERL5294 CNRS, Université de Toulouse, Toulouse, France.,Laboratoire d'Excellence TOUCAN, Toulouse, France.,Programme Hospitalo-Universitaire en Cancérologie CAPTOR, Toulouse, France.,Department of Pathology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Julie Bordenave
- Centre de Recherches en Cancérologie de Toulouse (CRCT), UMR1037 INSERM, Université Toulouse III: Paul-Sabatier, ERL5294 CNRS, Université de Toulouse, Toulouse, France.,Laboratoire d'Excellence TOUCAN, Toulouse, France.,Programme Hospitalo-Universitaire en Cancérologie CAPTOR, Toulouse, France
| | - Marie Tosolini
- Pôle Technologique du Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
| | - Anne Tourette
- INSERM1052/CNRS5286/Université Claude Bernard, Lyon, France
| | | | | | - Mary Poupot
- Centre de Recherches en Cancérologie de Toulouse (CRCT), UMR1037 INSERM, Université Toulouse III: Paul-Sabatier, ERL5294 CNRS, Université de Toulouse, Toulouse, France.,Laboratoire d'Excellence TOUCAN, Toulouse, France.,Programme Hospitalo-Universitaire en Cancérologie CAPTOR, Toulouse, France
| | - Christian Klein
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Zurich, Schlieren, Switzerland
| | | | - Jean-Jacques Fournié
- Centre de Recherches en Cancérologie de Toulouse (CRCT), UMR1037 INSERM, Université Toulouse III: Paul-Sabatier, ERL5294 CNRS, Université de Toulouse, Toulouse, France.,Laboratoire d'Excellence TOUCAN, Toulouse, France.,Programme Hospitalo-Universitaire en Cancérologie CAPTOR, Toulouse, France
| | - Christine Bezombes
- Centre de Recherches en Cancérologie de Toulouse (CRCT), UMR1037 INSERM, Université Toulouse III: Paul-Sabatier, ERL5294 CNRS, Université de Toulouse, Toulouse, France.,Laboratoire d'Excellence TOUCAN, Toulouse, France.,Programme Hospitalo-Universitaire en Cancérologie CAPTOR, Toulouse, France
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Lau KM, Derry K, Dalton A, Martino J. Outcomes of Inpatient Administration of Restricted Antineoplastic Medications at a Large Academic Medical Institution. P & T : A PEER-REVIEWED JOURNAL FOR FORMULARY MANAGEMENT 2019; 44:481-496. [PMID: 31447536 PMCID: PMC6679954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Restricting oncology and hematology medications to outpatient infusion centers may be considered when infrequent administration is required, a low risk of serious adverse effects exists, or when prompt amelioration of a condition is not expected. At the University of California, San Diego (UCSD), we created a new formulary status for medications designated "formulary, outpatient-restricted use only." This designation could optimize payer reimbursement, as well as improve patient comfort, by negating the need for inpatient admission. When the inpatient administration of a restricted medication is requested at UCSD, there ensues a loosely defined review process involving an informal conversation between the requesting prescriber and the oncology pharmacy and therapeutics (P&T) chair. Patient outcomes associated with this formulary status and informal request process are limited. The purpose of this study is to describe the use of formulary, outpatient-restricted oncology and hematology medications in the inpatient setting at a single-center, academic, and comprehensive cancer center. METHODS A retrospective chart review was conducted between January 1, 2015 and May 1, 2017. The primary outcome was to determine the percentage of formulary, outpatient-restricted oncology or hematology medications that were administered in the inpatient setting and continued to the outpatient setting. Secondary outcomes included overall survival, hospice enrollment, disease progression status, level of evidence supporting the medication usage, and cost. RESULTS Twenty-three patients and 24 outpatient-restricted medications met the inclusion criteria. Thirteen (54%) medications were continued upon discharge and eight (33%) were not continued in the outpatient setting. Five of those eight medications were discontinued as a result of patient death. CONCLUSION In this single-center study, approximately one-third of the outpatient-restricted medications were not continued upon discharge. The findings suggest that our informal approval process could result in the suboptimal use of formulary outpatient-restricted medications for oncology and hematology indications. A more formalized request process might lead to the more effective utilization of these medications.
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Gibiansky E, Gibiansky L, Buchheit V, Frey N, Brewster M, Fingerle-Rowson G, Jamois C. Pharmacokinetics, exposure, efficacy and safety of obinutuzumab in rituximab-refractory follicular lymphoma patients in the GADOLIN phase III study. Br J Clin Pharmacol 2019; 85:1935-1945. [PMID: 31050355 PMCID: PMC6710522 DOI: 10.1111/bcp.13974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 04/03/2019] [Accepted: 04/17/2019] [Indexed: 12/13/2022] Open
Abstract
Aims Rituximab is standard care in a number of lymphoma subtypes, including follicular lymphoma (FL), although many patients are resistant to rituximab, or develop resistance with repeated treatment, and a high proportion relapse. Obinutuzumab is a novel anti‐CD20 monoclonal antibody with improved efficacy over rituximab. It is approved for previously untreated chronic lymphocytic leukaemia (CLL), and for use with bendamustine in patients with rituximab‐relapsed/refractory FL. Methods Using a previously described population pharmacokinetic (PK) model of obinutuzumab in patients with non‐Hodgkin lymphoma and CLL, we conducted an exposure‐response analysis using data from 6 clinical trials in patients with CD20+ B‐cell malignancies (CLL11, GADOLIN, GATHER, GAUDI, GAUGUIN and GAUSS) to describe the PK properties of obinutuzumab, identify covariates influencing exposure, and explore how exposure affects safety, efficacy and pharmacodynamics. Results A 2‐compartment model with linear and time‐dependent clearance described obinutuzumab PK. Disease type and subtype, body weight, baseline tumour size, and sex had the largest effects on PK. Obinutuzumab exposure was not associated with occurrence or severity of adverse events, but higher exposure appeared to be associated with greater efficacy, particularly longer progression‐free survival. However, in multivariate Cox regression analysis, progression‐free survival benefit in the obinutuzumab plus bendamustine arm was independent of exposure. Conclusion The updated population PK model reported here accurately describes the PK of obinutuzumab patients with non‐Hodgkin lymphoma and CLL. The selected obinutuzumab dosing regimen offers clinical benefit in a majority of rituximab‐refractory FL patients treated with bendamustine, irrespective of variability in exposure, whilst minimising adverse events.
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Affiliation(s)
| | | | - Vincent Buchheit
- Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Nicolas Frey
- Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Michael Brewster
- Clinical Development, Roche Innovation Center Welwyn, Welwyn Garden City, UK
| | | | - Candice Jamois
- Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
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Morschhauser F, Le Gouill S, Feugier P, Bailly S, Nicolas-Virelizier E, Bijou F, Salles GA, Tilly H, Fruchart C, Van Eygen K, Snauwaert S, Bonnet C, Haioun C, Thieblemont C, Bouabdallah R, Wu KL, Canioni D, Meignin V, Cartron G, Houot R. Obinutuzumab combined with lenalidomide for relapsed or refractory follicular B-cell lymphoma (GALEN): a multicentre, single-arm, phase 2 study. LANCET HAEMATOLOGY 2019; 6:e429-e437. [PMID: 31296423 DOI: 10.1016/s2352-3026(19)30089-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Lenalidomide plus rituximab is approved to treat patients with relapsed or refractory follicular lymphoma. Obinutuzumab has been shown to enhance antibody-dependent cellular cytotoxicity, phagocytosis, and direct B-cell killing better than rituximab. Our aim was to determine the activity and safety of lenalidomide plus obinutuzumab in previously treated patients with relapsed or refractory follicular lymphoma. METHODS In this multicentre, single-arm, phase 2 study, patients were enrolled from 24 Lymphoma Academic Research Organisation centres in France. Eligible patients (age ≥18 years) had histologically confirmed CD20-positive relapsed or refractory follicular lymphoma of WHO grade 1, 2, or 3a; an ECOG performance status of 0-2; and received at least one previous rituximab-containing therapy. Patients received oral lenalidomide (20 mg) plus intravenously infused obinutuzumab as induction therapy (1000 mg; six 28-day cycles), 1-year maintenance with lenalidomide (10 mg; 12 28-day cycles; days 2-22) plus obinutuzumab (1000 mg; alternate cycles), and 1-year maintenance with obinutuzumab (1000 mg; six 56-day cycles; day 1). The primary endpoint was the proportion of patients who achieved an overall response at induction end as per investigator assessment using the 1999 international working group criteria. The secondary endpoints were event-free survival, progression-free survival, overall survival, and safety. Analyses were per-protocol; the efficacy population included all patients who received at least one dose of both obinutuzumab and lenalidomide, and the safety population included all patients who received one dose of either investigational drug. The study is registered with ClinicalTrials.gov, number NCT01582776, and is ongoing but closed to accrual. FINDINGS Between June 11, 2014, and Dec 18, 2015, 89 patients were recruited and 86 patients were evaluable for efficacy and 88 for safety. Median follow-up was 2·6 years (IQR 2·2-2·8). 68 (79%) of 86 evaluable patients (95% CI 69-87) achieved an overall response at induction end, meeting the prespecified primary endpoint. At 2 years, event-free survival was 62% (95% CI 51-72), progression-free survival 65% (95% CI 54-74), duration of response 70% (95% CI 57-79), and overall survival 87% (95% CI 78-93). Complete response was achieved by 33 (38%, 95% CI 28-50) of 86 patients at induction end, and the proportion of patients achieving a best overall response was 70 (81%, 95% CI 72-89) and 72 (84%, 74-91) of 86 patients during induction and treatment, respectively. The most common adverse events were asthenia (n=54, 61%), neutropenia (n=38, 43%), bronchitis (n=36, 41%), diarrhoea (n=35, 40%), and muscle spasms (n=34, 39%). Neutropenia was the most common toxicity of grade 3 or more; four (5%) patients had febrile neutropenia. 57 serious adverse events were reported in 30 (34%) of 88 patients. The most common serious adverse events were basal cell carcinoma (n=5, 6%), febrile neutropenia (n=4, 5%), and infusion-related reaction (n=3, 3%). One patient died due to treatment-related febrile neutropenia. INTERPRETATION Our data shows that lenalidomide plus obinutuzumab is active in previously treated patients with relapsed or refractory follicular lymphoma, including those with early relapse, and has a manageable safety profile. Randomised trials of new immunomodulatory regimens, such as GALEN or using GALEN as a backbone, versus lenalidomide plus rituximab, are warranted. FUNDING Lymphoma Academic Research Organisation, and Celgene and Roche.
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Affiliation(s)
- Franck Morschhauser
- Université Lille, Centre Hospitalier Régional Universitaire de Lille, EA 7365, Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France.
| | - Steven Le Gouill
- Department of Haematology, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Pierre Feugier
- Centre Hospitalier Régional Universitaire de Nancy, Vandœuvre-lès-Nancy, France
| | - Sarah Bailly
- Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | | | | | - Gilles A Salles
- Department of Haematology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Lyon, France
| | - Hervé Tilly
- Department of Haematology and INSERM 1245, Centre Henri Becquerel, University of Rouen, Rouen, France
| | - Christophe Fruchart
- Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire de Caen, France
| | | | | | - Christophe Bonnet
- Clinical Hematology, Centre Hospitalier Universitaire, University of Liège, Liège, Belgium
| | - Corinne Haioun
- Lymphoid Malignancies Unit, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor, Créteil, France
| | - Catherine Thieblemont
- Hemato-Oncology, Hospital Saint-Louis, Assistance Publique-Hôpitaux de Paris, INSERM U 728, Institut Universitaire d'Hematologie, Paris, France
| | - Reda Bouabdallah
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Ka Lung Wu
- Ziekenhuis Netwerk Antwerpen Stuivenberg, Antwerpen, Belgium
| | - Danielle Canioni
- Pathology Department, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France et Paris V Descartes University, Sorbonne-Paris-Cité, Paris, France
| | - Véronique Meignin
- Pathology Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris et Paris Cité Sorbonne Diderot 7 University, Paris, France
| | - Guillaume Cartron
- Centre Hospitalier Universitaire, UMR 5235, University of Montpellier, Montpellier, France
| | - Roch Houot
- Haematology Department, Centre Hospitalier Universitaire de Rennes, Rennes, France
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132
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Budau L, Wilhelm C, Moll R, Jäkel J, Hirt C, Dölken G, Maschmeyer G, Neubauer E, Strauch K, Burchert A, Herold M, Neubauer A. Low number of intrafollicular T cells may predict favourable response to rituximab-based immuno-chemotherapy in advanced follicular lymphoma: a secondary analysis of a randomized clinical trial. J Cancer Res Clin Oncol 2019; 145:2149-2156. [PMID: 31273513 PMCID: PMC6658576 DOI: 10.1007/s00432-019-02961-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/22/2019] [Indexed: 12/24/2022]
Abstract
Background First-line rituximab therapy together with chemotherapy is the standard care for patients with advanced follicular B-cell lymphoma, as rituximab together with chemotherapy prolongs progression-free and overall survival (Herold et al. 2007; Marcus et al. 2005). However, as not all patient subgroups benefit from combined immuno-chemotherapy, we asked whether the microenvironment may predict benefit from rituximab-based therapy. Design To address this question, we performed a retrospective immunohistochemical analysis on pathological specimens of 18 patients recruited into a randomized clinical trial, where patients with advanced follicular lymphoma were randomized into either chemotherapy or immuno-chemotherapy with rituximab (Herold et al. 2007). Results We show here that rituximab exerts beneficial effects, especially in the subgroup of follicular lymphoma patients with low intrafollicular CD3, CD5, CD8, and ZAP70 and high CD56 and CD68 expression. Conclusion Rituximab may overcome immune-dormancy in follicular lymphoma in cases with lower intrafollicular T-cell numbers and higher CD56 and CD68 cell counts. As this was a retrospective analysis on a small subgroup of patients, these data need to be corroborated in larger clinical trials. Electronic supplementary material The online version of this article (10.1007/s00432-019-02961-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Budau
- Klinik für Hämatologie Onkologie, Immunologie, Philipps Universität Marburg, und Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße 1, 35033, Marburg, Germany.,, Kath. Marienkrankenhaus, gynäkologie Alfredstraße 9, 22087, Hamburg, Germany
| | - Christian Wilhelm
- Klinik für Hämatologie Onkologie, Immunologie, Philipps Universität Marburg, und Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße 1, 35033, Marburg, Germany
| | - Roland Moll
- Institut für Pathologie, Philipps Universität Marburg, und Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße 1, 35033, Marburg, Germany
| | - Jörg Jäkel
- Institut für Pathologie, Universitätsklinik der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Carsten Hirt
- Klinik und Poliklinik für Innere Medizin Hämatologie und Onkologie, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Gottfried Dölken
- Klinik und Poliklinik für Innere Medizin Hämatologie und Onkologie, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Georg Maschmeyer
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Klinikum Ernst von Bergmann gemeinnützige GmbH, Charlottenstraße 72, 14467, Potsdam, Germany
| | - Ellen Neubauer
- Klinik für Gynäkologie, Philipps Universität Marburg, und Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße 1, 35033, Marburg, Germany
| | - Konstantin Strauch
- Institut für Genetische Epidemiologie, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie Faculty of Medicine, LMU Munich, Marchioninistraße 15, 81377, München, Germany
| | - Andreas Burchert
- Klinik für Hämatologie Onkologie, Immunologie, Philipps Universität Marburg, und Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße 1, 35033, Marburg, Germany
| | - Michael Herold
- Onkologisches Zentrum, Helios-Klinikum Erfurt, Nordhäuserstr. 74, 99089, Erfurt, Germany
| | - Andreas Neubauer
- Klinik für Hämatologie Onkologie, Immunologie, Philipps Universität Marburg, und Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße 1, 35033, Marburg, Germany.
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133
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Dada R. Diagnosis and management of follicular lymphoma: A comprehensive review. Eur J Haematol 2019; 103:152-163. [PMID: 31270855 DOI: 10.1111/ejh.13271] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/18/2022]
Abstract
Follicular Lymphoma (FL) is an indolent lymphoma and may have various clinical courses. Worldwide, FL is the second most common non-Hodgkin lymphoma (NHL) type after diffuse large B-cell lymphoma. In this review article, the author is discussing relevant diagnostic tools, prognostic factors, and updated study results on the management of patients with newly diagnosed and relapsed/refractory FL. Controversies in the treatment, maintenance therapy, stem cell transplantation, and novel treatment approaches will be comprehensively discussed.
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Affiliation(s)
- Reyad Dada
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.,College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
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134
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Abstract
Recent advances in the treatment of follicular lymphoma (FL) have provided insight into molecular and biological influences on pathogenesis and prognosis. Additionally, numerous available treatment strategies for both newly diagnosed and relapsed disease require thoughtful consideration of patient selection to avoid the burden of overtreatment and toxicities. This review provides a broad overview on our approach to managing patients with low grade FL.
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Affiliation(s)
- Carla Casulo
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
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135
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Jamois C, Gibiansky E, Gibiansky L, Buchheit V, Sahin D, Cartron G, Marcus R, Hiddemann W, Seymour JF, Strefford JC, Hargreaves CE, Meneses-Lorente G, Frey N, Fingerle-Rowson G. Role of obinutuzumab exposure on clinical outcome of follicular lymphoma treated with first-line immunochemotherapy. Br J Clin Pharmacol 2019; 85:1495-1506. [PMID: 30866056 PMCID: PMC6595360 DOI: 10.1111/bcp.13920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/06/2019] [Accepted: 03/10/2019] [Indexed: 01/12/2023] Open
Abstract
AIMS Obinutuzumab (G) is a humanized type II, Fc-glycoengineered anti-CD20 monoclonal antibody used in various indications, including patients with previously untreated front-line follicular lymphoma. We investigated sources of variability in G exposure and association of progression-free survival (PFS) with average concentration over induction (CmeanIND ) in front-line follicular lymphoma patients treated with G plus chemotherapy (bendamustine, CHOP, or CVP) in the GALLIUM trial. METHODS Individual exposures (CmeanIND ) were obtained from a previously established population pharmacokinetic model updated with GALLIUM data. Multivariate Cox proportional hazard models and univariate Kaplan-Meier plots investigated relationships of PFS with exposure and other potential prognostic factors. RESULTS Overall, G exposure was lower in high body-weight patients and in males, and slightly lower in patients with high baseline tumour burden. Analysis of clinical outcomes showed that variability in G exposure did not impact PFS in G-bendamustine-treated patients; PFS was inferior in males and patients with FCGR2a/2b T232 T low-affinity receptor variant, and superior in patients with FCGR2a/2b I232T variant. In G-CHOP/CVP arms, PFS improved with increasing CmeanIND (hazard ratio = 1.74 and 0.394 at 5th and 95th percentile compared to median CmeanIND ) and was inferior in patients with high baseline tumour size and B symptoms. CONCLUSIONS It remains unclear whether for G-CHOP/CVP patients lower G exposure is a consequence of adverse disease biology and/or resistance to chemotherapy backbone (higher clearance in nonresponder patients, as demonstrated for rituximab) rather than being the cause of poorer clinical outcome. A study with >1 dose level of G could help resolve this uncertainty.
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Affiliation(s)
- Candice Jamois
- Department of Clinical Pharmacology, F. Hoffmann-La Roche, Roche Innovation Center Basel, Switzerland
| | | | | | - Vincent Buchheit
- Department of Clinical Pharmacology, F. Hoffmann-La Roche, Roche Innovation Center Basel, Switzerland
| | | | | | | | | | - John F Seymour
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Jonathan C Strefford
- Cancer Genomics, Cancer Sciences, Faculty of Medicine, Group University of Southampton, Southampton, UK
| | - Chantal E Hargreaves
- Cancer Genomics, Cancer Sciences, Faculty of Medicine, Group University of Southampton, Southampton, UK
| | | | - Nicolas Frey
- Department of Clinical Pharmacology, F. Hoffmann-La Roche, Roche Innovation Center Basel, Switzerland
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136
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Epstein-Barr virus-related post-transplant lymphoproliferative disease (EBV-PTLD) in the setting of allogeneic stem cell transplantation: a comprehensive review from pathogenesis to forthcoming treatment modalities. Bone Marrow Transplant 2019; 55:25-39. [DOI: 10.1038/s41409-019-0548-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 12/17/2022]
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137
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Abstract
Chemotherapy nonspecifically affects all cells undergoing DNA replication and has severe side effects. Understanding of the biology of non-Hodgkin lymphomas has led to development of drugs that target specific lymphoma cell functions and tumor microenvironment. Targeted agents used in combination with chemotherapy pave the way to a chemotherapy-free world. These drugs target multiple oncogenic pathways and modulate the immune system, with better outcomes. Such combinations should be administered only in clinical trials. Incorporating studies of the biology and genetics of these tumors into therapeutic studies may lead to a chemotherapy-free world with improved outcomes and reduced toxicities.
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Affiliation(s)
- Mayur Narkhede
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Lombardi Comprehensive Cancer Center Podium A, 3800 Reservoir Road Northwest, Washington, DC 20007, USA
| | - Maryam Sarraf Yazdy
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Lombardi Comprehensive Cancer Center Podium A, 3800 Reservoir Road Northwest, Washington, DC 20007, USA
| | - Bruce D Cheson
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Lombardi Comprehensive Cancer Center Podium A, 3800 Reservoir Road Northwest, Washington, DC 20007, USA.
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138
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Chiappella A, Vitolo U. Monoclonal antibody-drug conjugates in B-cell lymphomas. LANCET HAEMATOLOGY 2019; 6:e232-e233. [DOI: 10.1016/s2352-3026(19)30048-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 11/29/2022]
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139
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Recent landmark studies in follicular lymphoma. Blood Rev 2019; 35:68-80. [DOI: 10.1016/j.blre.2019.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/12/2019] [Accepted: 03/22/2019] [Indexed: 12/20/2022]
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140
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Sorigue M, Bishton M, Domingo-Domenech E, McMillan A, Prusila R, García O, Kuusisto M, Condom M, Tapia G, Ribera JM, Kuittinen O, Fox CP, Sancho JM. Refractoriness to rituximab-based therapy and elevated serum B2-microglobulin predict for inferior survival in marginal zone lymphoma. Leuk Lymphoma 2019; 60:2524-2531. [PMID: 30942640 DOI: 10.1080/10428194.2019.1594212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Short responses to immunochemotherapy predict for an inferior OS in follicular lymphoma. We set out to determine whether this is also the case in marginal zone lymphoma. A group of 139 marginal zone lymphoma (MZL) patients treated with front-line immuno- or immunochemotherapy (I/ICT) were categorized into I/ICT-refractory (non-response or relapse/progression within six months of treatment response assessment) or I/ICT-sensitive. Twenty-three patients (17%) were refractory. Refractory patients had inferior OS (4-yr probabilities of 57% vs. 83%, p = .0003) as did those with beta2-microglobulin (B2M)>3 mg/L (4-yr probabilities of 80% vs. 100%, p = .0029). On multivariable analysis they both showed a borderline significant correlation with OS (p = .06 and .07, respectively). B2M > 3 mg/L was also an adverse prognostic factor for progression-free survival in both univariable (4-yr probability of 61% vs. 83%, p = .02) and multivariable analysis (HR 2.9, p = .02). In conclusion, B2M and refractoriness to I/ICT may identify patients with MZL at higher risk of inferior survival.
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Affiliation(s)
- Marc Sorigue
- Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol. Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona , Badalona , Spain
| | - Mark Bishton
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust , Nottingham , UK
| | | | - Andrew McMillan
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust , Nottingham , UK
| | - Roosa Prusila
- Department of Oncology, MRC, Oulu University Hospital , Oulu , Finland
| | - Olga García
- Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol. Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona , Badalona , Spain
| | - Milla Kuusisto
- Department of Oncology, North Karelia Central Hospital , Joensuu , Finland
| | - Maria Condom
- Department of Hematology, Hospital Duran i Reynals , Barcelona , Spain
| | - Gustavo Tapia
- Department of Pathology, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona , Badalona , Spain
| | - Josep-María Ribera
- Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol. Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona , Badalona , Spain
| | - Outi Kuittinen
- Department of Oncology, MRC, Oulu University Hospital , Oulu , Finland
| | - Christopher P Fox
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust , Nottingham , UK
| | - Juan-Manuel Sancho
- Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol. Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona , Badalona , Spain
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141
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Appukkuttan S, Duchesneau E, Zichlin ML, Bhak RH, Yaldo A, Gharibo M, Babajanyan S, Duh MS. A Budget Impact Analysis of the Introduction of Copanlisib for Treatment of Relapsed Follicular Lymphoma in the United States. J Manag Care Spec Pharm 2019; 25:437-446. [PMID: 30608008 PMCID: PMC10398118 DOI: 10.18553/jmcp.2019.18259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Copanlisib was recently granted accelerated approval by the FDA for the treatment of adult patients with relapsed follicular lymphoma (FL) after 2 previous systemic therapies. It is important to assess the effect that this and other changes in the treatment landscape of relapsed FL have on a payer's budget to inform formulary decisions. OBJECTIVE To assess the budget impact associated with the addition of copanlisib to a formulary as third- or higher-line treatment for adult patients with relapsed FL who have received at least 2 previous systemic therapies, from the perspective of a U.S. third-party payer. METHODS A budget impact model was developed over a 1-year horizon. The model considered a hypothetical population of 1 million people enrolled in a commercial health plan; patients with relapsed FL were identified based on epidemiology data. Treatments included copanlisib and approved and off-label therapies used for management of relapsed FL. Treatment distributions within the target population were based on a market research survey. Drug acquisition, administration, prophylaxis, and monitoring costs were based on prescribing information, clinical trials, literature, and expert opinion. All costs were inflated to 2017 U.S. dollars. Total costs were compared between 2 scenarios, 1 without and 1 with copanlisib on a formulary. A deterministic sensitivity analysis (DSA) was conducted to evaluate the robustness of the model. RESULTS Within the 1 million-member health care plan, 18 patients had relapsed FL and had received at least 2 previous systemic therapies. Over 1 year, the addition of copanlisib and an increase in the use of obinutuzumab + bendamustine (from 9.0% without copanlisib to 13.1% with copanlisib) and lenalidomide + rituximab (from 0.3% to 12.0%) were estimated to increase drug acquisition costs by $238,536, drug administration and prophylaxis costs by $3,565, and monitoring costs by $539. The increase in total budget was $242,641, corresponding to $0.02 per member per month; 21.8% of this increase was attributable to copanlisib, 12.9% to obinutuzumab + bendamustine, and 65.3% to lenalidomide + rituximab. Results were generally robust in the DSA. CONCLUSIONS Over a 1-year period, the model found that the addition of copanlisib to a formulary resulted in a small increase in total budget of $242,641, corresponding to $0.02 per patient per month and taking into account a concurrent increase in the use of obinutuzumab + bendamustine and lenalidomide + rituximab. Therefore, adding copanlisib to a formulary appears to be an affordable option for payers. Further studies should be conducted to more comprehensively assess the clinical and economic implications of adding copanlisib to the treatment armamentarium of relapsed FL. DISCLOSURES This study was funded by Bayer HealthCare Pharmaceuticals. The study sponsor was involved in study design, data interpretation. and data review. All authors contributed to the development of the manuscript and maintained control over the final content. Appukkuttan, Yaldo, Gharibo, and Babajanyan report employment with Bayer HealthCare Pharmaceuticals at the time of this study. Duchesneau, Zichlin, Bhak, and Duh report employment with Analysis Group, which received research funds from Bayer HealthCare Pharmaceuticals for work on this study. A synopsis of the current research was presented in poster format at the AMCP Managed Care & Specialty Pharmacy Annual Meeting; April 23-26, 2018; Boston, MA.
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Affiliation(s)
| | | | | | | | - Avin Yaldo
- Bayer HealthCare Pharmaceuticals, Wayne, New Jersey
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142
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Yarian F, Alibakhshi A, Eyvazi S, Arezumand R, Ahangarzadeh S. Antibody-drug therapeutic conjugates: Potential of antibody-siRNAs in cancer therapy. J Cell Physiol 2019; 234:16724-16738. [PMID: 30908646 DOI: 10.1002/jcp.28490] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/11/2019] [Accepted: 02/19/2019] [Indexed: 12/22/2022]
Abstract
Codelivery is a promising strategy of targeted delivery of cytotoxic drugs for eradicating tumor cells. This rapidly growing method of drug delivery uses a conjugate containing drug linked to a smart carrier. Both two parts usually have therapeutic properties on the tumor cells. Monoclonal antibodies and their derivatives, such as Fab, scFv, and bsAb due to targeting high potent have now been attractive candidates as drug targeting carrier systems. The success of some therapeutic agents like small interfering RNA (siRNA), a small noncoding RNAs, with having problems such as enzymatic degradation and rapid renal filtration need to an appropriate carrier. Therefore, the aim of this study is to review the recent enhancements in development of antibody drug conjugates (ADCs), especially antibody-siRNA conjugates (SRCs), its characterizations and mechanisms in innovative cancer therapy approaches.
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Affiliation(s)
- Fatemeh Yarian
- Cellular and Molecular Biology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Alibakhshi
- Cellular and Molecular Biology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shirin Eyvazi
- Cellular and Molecular Biology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roghaye Arezumand
- Department of Medical Biotechnology and Molecular Science, North Khorasan University of Medical Science, Bojnurd, Iran
| | - Shahrzad Ahangarzadeh
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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143
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Leonard JP, Trneny M, Izutsu K, Fowler NH, Hong X, Zhu J, Zhang H, Offner F, Scheliga A, Nowakowski GS, Pinto A, Re F, Fogliatto LM, Scheinberg P, Flinn IW, Moreira C, Cabeçadas J, Liu D, Kalambakas S, Fustier P, Wu C, Gribben JG. AUGMENT: A Phase III Study of Lenalidomide Plus Rituximab Versus Placebo Plus Rituximab in Relapsed or Refractory Indolent Lymphoma. J Clin Oncol 2019; 37:1188-1199. [PMID: 30897038 PMCID: PMC7035866 DOI: 10.1200/jco.19.00010] [Citation(s) in RCA: 247] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Patients with indolent non-Hodgkin lymphoma typically respond well to first-line immunochemotherapy. At relapse, single-agent rituximab is commonly administered. Data suggest the immunomodulatory agent lenalidomide could increase the activity of rituximab. METHODS A phase III, multicenter, randomized trial of lenalidomide plus rituximab versus placebo plus rituximab was conducted in patients with relapsed and/or refractory follicular or marginal zone lymphoma. Patients received lenalidomide or placebo for 12 cycles plus rituximab once per week for 4 weeks in cycle 1 and day 1 of cycles 2 through 5. The primary end point was progression-free survival per independent radiology review. RESULTS A total of 358 patients were randomly assigned to lenalidomide plus rituximab (n = 178) or placebo plus rituximab (n = 180). Infections (63% v 49%), neutropenia (58% v 23%), and cutaneous reactions (32% v 12%) were more common with lenalidomide plus rituximab. Grade 3 or 4 neutropenia (50% v 13%) and leukopenia (7% v 2%) were higher with lenalidomide plus rituximab; no other grade 3 or 4 adverse event differed by 5% or more between groups. Progression-free survival was significantly improved for lenalidomide plus rituximab versus placebo plus rituximab, with a hazard ratio of 0.46 (95% CI, 0.34 to 0.62; P < .001) and median duration of 39.4 months (95% CI, 22.9 months to not reached) versus 14.1 months (95% CI, 11.4 to 16.7 months), respectively. CONCLUSION Lenalidomide improved efficacy of rituximab in patients with recurrent indolent lymphoma, with an acceptable safety profile.
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Affiliation(s)
- John P Leonard
- 1 Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Marek Trneny
- 2 Charles University, General Hospital, Prague, Czech Republic
| | - Koji Izutsu
- 3 National Cancer Center Hospital, Tokyo, Japan
| | - Nathan H Fowler
- 4 The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xiaonan Hong
- 5 Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Jun Zhu
- 6 Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Huilai Zhang
- 7 Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | | | | | | | - Antonio Pinto
- 11 Istituto Nazionale Tumori IRCCS - Fondazione Pascale, Naples, Italy
| | - Francesca Re
- 12 Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | | | | | - Ian W Flinn
- 15 Sarah Cannon Research Institute, Nashville, TN
| | - Claudia Moreira
- 16 Instituto Português de Oncologia do Porto Francisco Gentil Epe, Porto, Portugal
| | - José Cabeçadas
- 17 Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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144
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Flinn IW, Miller CB, Ardeshna KM, Tetreault S, Assouline SE, Mayer J, Merli M, Lunin SD, Pettitt AR, Nagy Z, Tournilhac O, Abou-Nassar KE, Crump M, Jacobsen ED, de Vos S, Kelly VM, Shi W, Steelman L, Le N, Weaver DT, Lustgarten S, Wagner-Johnston ND, Zinzani PL. DYNAMO: A Phase II Study of Duvelisib (IPI-145) in Patients With Refractory Indolent Non-Hodgkin Lymphoma. J Clin Oncol 2019; 37:912-922. [PMID: 30742566 DOI: 10.1200/jco.18.00915] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Indolent non-Hodgkin lymphoma (iNHL) remains largely incurable and often requires multiple lines of treatment after becoming refractory to standard therapies. Duvelisib was approved by the Food and Drug Administration for relapsed or refractory (RR) chronic lymphocytic leukemia or small lymphocytic lymphoma (SLL) and RR follicular lymphoma (FL) after two or more prior systemic therapies. On the basis of the activity of duvelisib, a first-in-class oral dual inhibitor of phosphoinositide 3-kinase-δ,-γ, in RR iNHL in a phase I study, the safety and efficacy of duvelisib monotherapy was evaluated in iNHL refractory to rituximab and either chemotherapy or radioimmunotherapy. PATIENTS AND METHODS Eligible patients had measurable iNHL (FL, SLL, or marginal zone B-cell lymphoma) double refractory to rituximab (monotherapy or in combination) and to either chemotherapy or radioimmunotherapy. All were treated with duvelisib 25 mg orally twice daily in 28-day cycles until progression, unacceptable toxicity, or death. The primary end point was overall response rate (ORR) using the revised International Working Group criteria for malignant lymphoma. RESULTS This open-label, global phase II trial enrolled 129 patients (median age, 65 years; median of three prior lines of therapy) with an ORR of 47.3% (SLL, 67.9%; FL, 42.2%; MZL, 38.9%). The estimated median duration of response was 10 months, and the estimated median progression-free survival was 9.5 months. The most frequent any-grade treatment-emergent adverse events (TEAEs) were diarrhea (48.8%), nausea (29.5%), neutropenia (28.7%), fatigue (27.9%), and cough (27.1%). Among the 88.4% of patients with at least one grade 3 or greater TEAE, the most common TEAEs were neutropenia (24.8%), diarrhea (14.7%), anemia (14.7%), and thrombocytopenia (11.6%). CONCLUSION In the DYNAMO study, oral duvelisib monotherapy demonstrated clinically meaningful activity and a manageable safety profile in heavily pretreated, double-refractory iNHL, consistent with previous observations. Duvelisib may provide a new oral treatment option for this patient population of which many are elderly and in need of additional therapies.
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Affiliation(s)
- Ian W Flinn
- 1 Sarah Cannon Research Institute, Nashville, TN.,2 Tennessee Oncology, Nashville, TN
| | - Carole B Miller
- 3 Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Kirit M Ardeshna
- 4 University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | | | | | - Jiri Mayer
- 7 Fakultní Nemocnice Brno, Brno, Czech Republic
| | - Michele Merli
- 8 Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | | | | | | | | | - Michael Crump
- 13 Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Sven de Vos
- 15 Ronald Reagan University of California, Los Angeles, Medical Center, Los Angeles, CA
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145
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How I treat early-relapsing follicular lymphoma. Blood 2019; 133:1540-1547. [PMID: 30700421 DOI: 10.1182/blood-2018-08-822148] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/24/2019] [Indexed: 01/13/2023] Open
Abstract
Follicular lymphoma (FL) is the most frequently occurring indolent non-Hodgkin lymphoma, with generally favorable outcomes but a variable clinical course. Recent studies have elucidated the consistent and reproducible frequency of early disease progression in FL, occurring in ∼20% of patients. Relapse of FL within 24 months of chemoimmunotherapy (POD24) is now established as a robust marker of poor survival, leading to increased risk of death. Currently, there is no established method of identifying patients at risk for early disease progression at the time of their FL diagnosis. However, numerous studies worldwide are investigating clinical, pathologic, and radiographic biomarkers to help predict POD24, thereby improving subsequent outcomes and adapting therapy based on individual risk. There is also a paucity of standardized treatments for patients with POD24, but investigations are ongoing testing novel targeted therapies and autologous stem cell transplantation strategies. This review provides an overview of early-relapsing FL and our approach to patient management based on recent available data.
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146
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Prica A, Crump M. Improving CD20 antibody therapy: obinutuzumab in lymphoproliferative disorders. Leuk Lymphoma 2019; 60:573-582. [PMID: 30668192 DOI: 10.1080/10428194.2018.1498490] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Soon after the anti-CD20 monoclonal antibody rituximab began to change the management of indolent and aggressive B cell lymphomas, development of alternative antibodies - including chemoimmunoconjugates - was undertaken. Among humanized and fully human CD20 antibodies, obinutuzumab has emerged as one antibody that seems to have lived up to the promise of improved efficacy based on in vitro and preclinical experiments. The data available, thus, far establish obinutuzumab's preferred role as the anti-CD20 antibody of choice in chronic lymphocytic leukemia and untreated follicular lymphoma, as well as an important addition to the treatment of rituximab-refractory indolent lymphomas. Additional trials in aggressive lymphoma are required to define the place of this new antibody in the management of patients with curable lymphoma subtypes. There are greater toxicities associated with this treatment, including increased infusion-related reactions and cytopenias, but these are manageable with standard supportive care measures.
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Affiliation(s)
- Anca Prica
- a Division of Medical Oncology and Hematology , Princess Margaret Cancer Centre, University of Toronto , Toronto , Canada
| | - Michael Crump
- a Division of Medical Oncology and Hematology , Princess Margaret Cancer Centre, University of Toronto , Toronto , Canada
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147
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Sutamtewagul G, Link BK. Novel treatment approaches and future perspectives in follicular lymphoma. Ther Adv Hematol 2019; 10:2040620718820510. [PMID: 30719267 PMCID: PMC6348550 DOI: 10.1177/2040620718820510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/30/2018] [Indexed: 12/14/2022] Open
Abstract
Follicular lymphoma (FL) is a common B-cell malignancy characterized by relatively indolent growth and incurability with an expected lifetime course of serial intermittent treatment courses. Many patients with FL have lives shortened by the disease and despite a relatively favorable prognosis relative to other incurable systemic malignancies, optimal management of FL has not been achieved. This review focuses on identifying both patients for whom novel therapies might be most beneficial as well as systematically reviewing novel strategies at various levels of investigation. Prognostic markers incorporating clinical measurements and tumor genetics are discussed, yet at the time of diagnosis do not yet powerfully discriminate patients for whom specific strategies are beneficial. Reassessment of prognosis after evaluating the response to initial therapy is the most powerful identifier of those in need of novel management strategies. For initial therapy of high burden systemic disease, anti-CD20 antibody along with chemotherapy or immunomodulators all offer relatively similar effects on overall survival with subtly different effects on progression-free survival and quality of life. Several new agents currently under investigation in the upfront setting are discussed. Perhaps the best testing ground for novel therapies is in patients with early relapse following initial immunochemotherapy. Ongoing research in multiple therapy classes including, novel monoclonal antibodies, antibody drug conjugates, immunomodulatory agents, intracellular pathway inhibitors, immune checkpoint inhibitors, and epigenetic regulators are discussed herein.
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Affiliation(s)
- Grerk Sutamtewagul
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Dr., C305 GH, Iowa City, IA 52242, USA
| | - Brian K. Link
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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148
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Çağlayan Ç, Terawaki H, Ayer T, Goldstein JS, Rai A, Chen Q, Flowers C. Assessing the Effectiveness of Treatment Sequences for Older Patients With High-risk Follicular Lymphoma With a Multistate Model. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:300-309.e5. [PMID: 30686772 DOI: 10.1016/j.clml.2018.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 12/01/2018] [Accepted: 12/26/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Disease progression within < 2 years of initial chemoimmunotherapy and patient age > 60 years have been associated with poor overall survival (OS) in follicular lymphoma (FL). No standard treatment exists for these high-risk patients, and the effectiveness of sequential therapies remains unclear. PATIENTS AND METHODS We studied the course of FL with first-, second-, and third-line treatment. Using large population-based data, we identified 5234 patients with FL diagnosed in 2000 to 2009. Of these patients, 71% had received second-line therapy < 2 years, and 29% had received no therapy after first-line therapy, with a median OS of < 3 years. Treatment included rituximab, R-CVP (rituximab, cyclophosphamide, vincristine), R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine), R-Other (other rituximab-containing), and other regimens. The Aalen-Johansen estimator and Cox proportional hazards models were used to quantify the outcomes and assess the effects of the clinical and sociodemographic factors. RESULTS R-CHOP demonstrated the most favorable 5-year OS among first- (71%), second- (55%), and third-line (61%) therapies. First-line R-CHOP improved OS (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.50-0.64) and reduced the mortality risks after first-line (HR, 0.60; 95% CI, 0.47-0.77), second-line (HR, 0.40; 95% CI, 0.29-0.53), and third-line (HR, 0.63; 95% CI, 0.53-0.76) treatments. B-symptoms, being married, and histologic grade 1/2 were associated with the use of earlier second-line therapy. Early progression from second- to third-line therapy was associated with poor OS. The repeated use of R-CHOP or R-CVP as first- and second-line treatment yielded high 2-year mortality rates (R-CHOP + R-CHOP, 17.3%; R-CVP + R-CVP, 21.1%). CONCLUSION Our multistate approach assessed the effect of sequential therapy on the immediate and subsequent treatment-line outcomes. We found that R-CHOP in any line improved OS for patients with high-risk FL.
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Affiliation(s)
- Çağlar Çağlayan
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA.
| | | | - Turgay Ayer
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA
| | | | - Ashish Rai
- American Cancer Society, Inc, Atlanta, GA
| | - Qiushi Chen
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
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149
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Guha A, Armanious M, Fradley MG. Update on cardio-oncology: Novel cancer therapeutics and associated cardiotoxicities. Trends Cardiovasc Med 2019; 29:29-39. [DOI: 10.1016/j.tcm.2018.06.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/22/2018] [Accepted: 06/03/2018] [Indexed: 02/08/2023]
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150
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Hill BT, Nastoupil L, Winter AM, Becnel MR, Cerhan JR, Habermann TM, Link BK, Maurer MJ, Fakhri B, Reddy P, Smith SD, Mukhija D, Jagadeesh D, Desai A, Alderuccio JP, Lossos IS, Mehra P, Portell CA, Goldman ML, Calzada O, Cohen JB, Hussain MJ, Ghosh N, Caimi P, Tiutan T, Martin P, Kodali A, Evens AM, Kahl BS. Maintenance rituximab or observation after frontline treatment with bendamustine-rituximab for follicular lymphoma. Br J Haematol 2018; 184:524-535. [PMID: 30575016 DOI: 10.1111/bjh.15720] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 11/05/2018] [Indexed: 12/26/2022]
Abstract
Bendamustine (B) with rituximab (R) is a standard frontline treatment for medically fit follicular lymphoma (FL) patients. The safety and efficacy of maintenance rituximab (MR) after BR induction has not been formally compared to observation for FL, resulting in disparate practice patterns. Prospective trials have shown benefit of MR after R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) or R-CVP (rituximab, cyclophosphamide, vincristine, prednisone), yet recent data from the GALLIUM study comparing outcomes of patients treated with chemotherapy with R or obinutuzumab (G) showed higher than anticipated fatal adverse events with BR/BG. In order to assess the efficacy and tolerability of MR after BR, we retrospectively collected data on 640 newly diagnosed patients treated with FL. We found that patients who achieved partial remission (PR) after ≥4 cycles of BR had improved duration of response (DOR) with MR vs. no maintenance, whereas those in complete remission did not. These findings were confirmed in a validation cohort. In the entire study population, the known fatal adverse event rate after BR was 2·5% and did not significantly differ in those receiving MR versus no maintenance. [Correction added on 14 January 2019, after online publication: The preceding sentence has been corrected in this current version.] Within the limitations inherent to retrospective analysis, these data suggest that FL patients with a PR to BR experience prolongation of remission with MR with an acceptable safety profile.
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Affiliation(s)
| | | | | | - Melody R Becnel
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Brian K Link
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Bita Fakhri
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Prathima Reddy
- Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - Stephen D Smith
- Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | | | | | - Amrita Desai
- University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | | | - Izidore S Lossos
- University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Pooja Mehra
- University of Virginia, Charlottesville, VA, USA
| | | | | | | | | | | | | | - Paolo Caimi
- University Hospitals of Cleveland, Cleveland, OH, USA
| | - Timothy Tiutan
- Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY, USA
| | - Peter Martin
- Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY, USA
| | - Abhigna Kodali
- Tufts University School of Medicine and Cancer Center, Boston, MA, USA
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Brad S Kahl
- Washington University School of Medicine, Saint Louis, MO, USA
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