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Bachy E, Seymour JF, Feugier P, Offner F, López-Guillermo A, Belada D, Xerri L, Catalano JV, Brice P, Lemonnier F, Martin A, Casasnovas O, Pedersen LM, Dorvaux V, Simpson D, Leppa S, Gabarre J, da Silva MG, Glaisner S, Ysebaert L, Vekhoff A, Intragumtornchai T, Le Gouill S, Lister A, Estell JA, Milone G, Sonet A, Farhi J, Zeuner H, Tilly H, Salles G. Sustained Progression-Free Survival Benefit of Rituximab Maintenance in Patients With Follicular Lymphoma: Long-Term Results of the PRIMA Study. J Clin Oncol 2019; 37:2815-2824. [PMID: 31339826 PMCID: PMC6823890 DOI: 10.1200/jco.19.01073] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The PRIMA study (ClinicalTrials.gov identifier: NCT00140582) established that 2 years of rituximab maintenance after first-line immunochemotherapy significantly improved progression-free survival (PFS) in patients with follicular lymphoma compared with observation. Here, we report the final PFS and overall survival (OS) results from the PRIMA study after 9 years of follow-up and provide a final overview of safety. METHODS Patients (> 18 years of age) with previously untreated high-tumor-burden follicular lymphoma were nonrandomly assigned to receive one of three immunochemotherapy induction regimens. Responding patients were randomly assigned (stratified by induction regimen, response to induction treatment, treatment center, and geographic region) 1:1 to receive 2 years of rituximab maintenance (375 mg/m2, once every 8 weeks), starting 8 weeks after the last induction treatment, or observation (no additional treatment). All patients in the extended follow-up provided their written informed consent (data cutoff: December 31, 2016). RESULTS In total, 1,018 patients completed induction treatment and were randomly assigned to rituximab maintenance (n = 505) or observation (n = 513). Consent for the extended follow-up was provided by 607 patients (59.6%) of 1,018 (rituximab maintenance, n = 309; observation, n = 298). After data cutoff, median PFS was 10.5 years in the rituximab maintenance arm compared with 4.1 years in the observation arm (hazard ratio, 0.61; 95% CI, 0.52 to 0.73; P < .001). No OS difference was seen in patients randomly assigned to rituximab maintenance or observation (hazard ratio, 1.04; 95% CI, 0.77 to 1.40; P = .7948); 10-year OS estimates were approximately 80% in both study arms. No new safety signals were observed. CONCLUSION Rituximab maintenance after induction immunochemotherapy provides a significant long-term PFS, but not OS, benefit over observation.
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Affiliation(s)
- Emmanuel Bachy
- Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Institut National de la Santé et de la Recherche Médicale (INSERM) 1052, Pierre-Bénite, France
| | - John F Seymour
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Pierre Feugier
- Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, INSERM 1256, Nancy, France
| | | | | | - David Belada
- Charles University, Hradec Králové, Czech Republic
| | - Luc Xerri
- Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - John V Catalano
- Frankston Hospital and Monash University, Frankston, Victoria, Australia
| | - Pauline Brice
- Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François Lemonnier
- Hôpitaux Universitaires Henri Mondor, Université Paris-Est Créteil, INSERM U955, Créteil, France
| | - Alejandro Martin
- Hospital Universitario de Salamanca-Institute for Biomedical Research of Salamanca, Centro de Investigación Biomédica en Red de Cáncer, Salamanca, Spain
| | - Olivier Casasnovas
- Department of Haematology and INSERM 1231, University Hospital F. Mitterrand, Dijon, France
| | | | - Véronique Dorvaux
- Hôpital de Mercy Centre Hospitalier Régional Metz-Thionville, Metz, France
| | | | - Sirpa Leppa
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | | | | | - Loic Ysebaert
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Anne Vekhoff
- Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Steven Le Gouill
- Centre Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes, France
| | - Andrew Lister
- Queen Mary University of London, London, United Kingdom
| | - Jane A Estell
- Concord Hospital, Concord, University of Sydney, New South Wales, Australia
| | | | | | - Jonathan Farhi
- Centre Hospitalier Universitaire d'Angers, Angers, France
| | | | | | - Gilles Salles
- Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Institut National de la Santé et de la Recherche Médicale (INSERM) 1052, Pierre-Bénite, France
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102
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Early progression after bendamustine-rituximab is associated with high risk of transformation in advanced stage follicular lymphoma. Blood 2019; 134:761-764. [PMID: 31300404 DOI: 10.1182/blood.2019000258] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 07/01/2019] [Indexed: 12/27/2022] Open
Abstract
Despite widespread use of bendamustine and rituximab (BR) as frontline therapy for advanced-stage follicular lymphoma (FL), little is known about the risk of early progression or incidence of histological transformation. We performed a retrospective analysis of a population-based cohort of 296 patients with advanced-stage FL treated with frontline BR and maintenance rituximab. As previously demonstrated, outcomes with this regimen are excellent, with 2-year event-free survival estimated at 85% (95% confidence interval [95% CI], 80-89) and 2-year overall survival 92% (95% CI, 88-95). Progression of disease within 24 months (POD24) occurred in 13% of patients and was associated with a significantly inferior outcome with 2-year overall survival of 38% (95% CI, 20-55). The only significant risk factor for POD24 at baseline was elevated lactate dehydrogenase (P < .001). Importantly, the majority of POD24 patients (76%) had transformed disease. Compared with a historical cohort treated with rituximab, cyclophosphamide, vincristine, and prednisone, event-free survival has improved and the risk of POD24 has decreased, but a higher proportion of patients with POD24 harbor transformation. The overall incidence of transformation appears unchanged. The presence of occult or early transformation is the main driver of POD24 in FL patients treated with frontline BR. Identification of biomarkers and improved management strategies for transformation will be crucial to improving outcomes.
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103
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Ritter AJ, Goldstein JS, Ayers AA, Flowers CR. Rural and urban patients with diffuse large B-cell and follicular lymphoma experience reduced overall survival: a National Cancer DataBase study. Leuk Lymphoma 2019; 60:1656-1667. [PMID: 30632824 PMCID: PMC6594869 DOI: 10.1080/10428194.2018.1546855] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 10/31/2018] [Indexed: 12/27/2022]
Abstract
We examined 83,108 patients with diffuse large B-cell lymphoma (DLBCL) and 43,393 patients with follicular lymphoma (FL) to investigate disparities related to geographic population density, stratified as rural, urban, or metropolitan. We found that urban and rural patients less commonly had private insurance and high socioeconomic status. Urban and rural DLBCL patients were more likely to receive treatment within 14 days of diagnosis (OR 0.93, 95% confidence interval [CI] 0.89-0.98; and OR 0.81, 95% CI 0.72-0.91) while urban FL patients were more likely to have treatment >14 days after diagnosis (OR 1.08, 95% CI 1.01-1.16). Multivariable analyses demonstrated that rural and urban patients had worse overall survival with DLBCL (hazard ratio [HR] 1.09; 95% CI 1-1.19 and HR 1.08; 95% CI 1.04-1.11) and FL (HR 1.11; 95% CI 1.04-1.18 and HR 1.2; 95% CI 1.02-1.41), respectively, suggesting needs for focused study and interventions for these populations.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Cities
- Databases, Factual
- Female
- Follow-Up Studies
- Georgia/epidemiology
- Humans
- Lymphoma, Follicular/epidemiology
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Prognosis
- Retrospective Studies
- Rural Population/statistics & numerical data
- Social Class
- Survival Rate
- Urban Population/statistics & numerical data
- Young Adult
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Affiliation(s)
| | | | - Amy A Ayers
- b Winship Cancer Institute , Atlanta , GA , USA
| | - Christopher R Flowers
- b Winship Cancer Institute , Atlanta , GA , USA
- c Department of Hematology and Medical Oncology , Emory University School of Medicine , Atlanta , GA , USA
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104
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Novel prognostic tools that identify high-risk follicular lymphoma. Hemasphere 2019; 3:HemaSphere-2019-0010. [PMID: 35309808 PMCID: PMC8925692 DOI: 10.1097/hs9.0000000000000214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 11/26/2022] Open
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105
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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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106
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Boughan KM, Caimi PF. Follicular Lymphoma: Diagnostic and Prognostic Considerations in Initial Treatment Approach. Curr Oncol Rep 2019; 21:63. [DOI: 10.1007/s11912-019-0808-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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107
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Fukuhara N, Ishizawa K. Current approaches and future perspectives for advanced-stage follicular lymphoma with a low tumor burden. Jpn J Clin Oncol 2019; 49:306-310. [PMID: 30715424 DOI: 10.1093/jjco/hyz008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/07/2019] [Accepted: 01/14/2019] [Indexed: 11/12/2022] Open
Abstract
The introduction of a chimeric anti-CD20 monoclonal antibody, rituximab, for the treatment of follicular lymphoma (FL) has dramatically improved the prognosis of this disease. Despite advances in therapy, the disease remains incurable with current standard therapeutic strategies. For advanced-stage and high-tumor-burden FL patients, a combination of rituximab with chemotherapy has improved the overall survival rates, and subsequent rituximab maintenance following successful rituximab-based chemotherapy induction also prolongs progression-free survival. Conversely, for advanced-stage low-tumor-burden FL patients, watchful waiting remains the appropriate approach, whereas rituximab monotherapy has also been suggested as a good alternative. However, the optimal timing of rituximab monotherapy in low-tumor-burden FL patients has not been clarified. It is important to address this issue for chemo-free treatment strategies. Furthermore, a predictive model for advanced low-tumor-burden patients is required to appropriately identify those patients who may benefit from immediate treatment. In this review, we address the current treatment approaches and present potential future management strategies for advanced-stage, low-tumor-burden patients.
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Affiliation(s)
- Noriko Fukuhara
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai
| | - Kenichi Ishizawa
- Department of Third Internal Medicine, Division of Hematology and Cell Therapy, Yamagata University Faculty of Medicine, Yamagata, Japan
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108
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109
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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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110
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Magnoli F, Tibiletti MG, Uccella S. Unraveling Tumor Heterogeneity in an Apparently Monolithic Disease: BCL2 and Other Players in the Genetic Landscape of Nodal Follicular Lymphoma. Front Med (Lausanne) 2019; 6:44. [PMID: 30931307 PMCID: PMC6428742 DOI: 10.3389/fmed.2019.00044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/20/2019] [Indexed: 02/05/2023] Open
Abstract
Follicular lymphoma (FL) is the most common form of non-Hodgkin lymphoma in Western countries. Although traditionally considered a well-defined, easy to diagnose lymphoproliferative disorder, in the last few years it has become clear that it is in fact composed of many different clinicopathological entities, encompassing a variegated and complex genetic background. This has led to the inclusion of specific FL variants and separate entities in the latest update of the WHO classification. However, even in the context of classical FL, many aspects of intra- and inter-tumoral heterogeneity have been recognized, with a major influence on diagnosis and clinical practice at different time points during the course of the disease. This review focuses on the molecular cytogenetic heterogeneity in classical FL from precursors and early development to progression and transformation, in terms of both clonal heterogeneity and unusual genetic features. Several factors have been investigated and suggested to contribute to the broad spectrum of clinicopathological, phenotypic, and genetic features observed in otherwise morphologically classical cases. Among them, deregulation of the epigenetic machinery and interactions with tumor microenvironment seem to play a pivotal role, together with genetic aberrations involving well-known molecular pathways and mechanisms physiologically operating in the germinal center. In the era of personalized medicine, precision diagnostics based both on understanding of the complex interplay among all these factors and on novel developments will become crucial to predict the outcome and guide the treatment of FL patients.
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Affiliation(s)
- Francesca Magnoli
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy.,Department of Pathology, ASST Sette Laghi, Varese, Italy
| | | | - Silvia Uccella
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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111
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Magnano L, Alonso-Alvarez S, Alcoceba M, Rivas-Delgado A, Muntañola A, Nadeu F, Setoain X, Rodríguez S, Andrade-Campos M, Espinosa-Lara N, Rodríguez G, Sancho JM, Moreno M, Mercadal S, Carro I, Salar A, Garcia-Pallarols F, Arranz R, Cannata J, Terol MJ, Teruel AI, Jiménez-Ubieto A, Rodriguez A, González de Villambrosía S, Bello JL, López L, Novelli S, de Cabo E, Infante ME, Pardal E, Monsalvo S, González M, Martín A, Caballero MD, López-Guillermo A. Life expectancy of follicular lymphoma patients in complete response at 30 months is similar to that of the Spanish general population. Br J Haematol 2019; 185:480-491. [PMID: 30793290 DOI: 10.1111/bjh.15805] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/21/2018] [Indexed: 12/29/2022]
Abstract
The use of immunochemotherapy has improved the outcome of follicular lymphoma (FL). Recently, complete response at 30 months (CR30) has been suggested as a surrogate for progression-free survival. This study aimed to analyse the life expectancy of FL patients according to their status at 30 months from the start of treatment in comparison with the sex and age-matched Spanish general population (relative survival; RS). The training series comprised 263 patients consecutively diagnosed with FL in a 10-year period who needed therapy and were treated with rituximab-containing regimens. An independent cohort of 693 FL patients from the Grupo Español de Linfomas y Trasplante Autólogo de Médula Ósea (GELTAMO) group was used for validation. In the training cohort, 188 patients were in CR30, with a 10-year overall survival (OS) of 53% and 87% for non-CR30 and CR30 patients, respectively. Ten-year RS was 73% and 100%, showing no decrease in life expectancy for CR30 patients. Multivariate analysis indicated that the FL International Prognostic Index was the most important variable predicting OS in the CR30 group. The impact of CR30 status on RS was validated in the independent GELTAMO series. In conclusion, FL patients treated with immunochemotherapy who were in CR at 30 months showed similar survival to a sex- and age-matched Spanish general population.
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Affiliation(s)
- Laura Magnano
- Haematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
| | - Sara Alonso-Alvarez
- Haematology Department, Hospital Universitario de Salamanca and IBSAL, Salamanca, Spain
| | - Miguel Alcoceba
- CIBERONC, Madrid, Spain.,Haematology Department, Hospital Universitario de Salamanca and IBSAL, Salamanca, Spain
| | - Alfredo Rivas-Delgado
- Haematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
| | - Anna Muntañola
- Haematology Department, Hospital Universitario Mutua de Terrassa, Terrassa, Spain
| | - Ferran Nadeu
- Lymphoid Neoplasms Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Xavier Setoain
- Nuclear Medicine Department, Hospital Clinic de Barcelona, Barcelona, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN)2, Barcelona, Spain
| | - Sonia Rodríguez
- Nuclear Medicine Department, Hospital Clinic de Barcelona, Barcelona, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN)2, Barcelona, Spain
| | | | | | | | - Juan Manuel Sancho
- Haematology Department, Hospital GermansTrias i Pujol (ICO-IJC), Badalona, Spain
| | - Miriam Moreno
- Haematology Department, Hospital GermansTrias i Pujol (ICO-IJC), Badalona, Spain
| | - Santiago Mercadal
- Haematology Department, Hospital Duran i Reynals (ICO), Hospitalet, Spain
| | - Itziar Carro
- Haematology Department, Hospital Duran i Reynals (ICO), Hospitalet, Spain
| | - Antonio Salar
- Haematology Department, Hospital del Mar, Barcelona, Spain
| | | | - Reyes Arranz
- Haematology Department, Hospital de la Princesa, Madrid, Spain
| | - Jimena Cannata
- Haematology Department, Hospital de la Princesa, Madrid, Spain
| | - María J Terol
- Haematology Department, Hospital Clínico de Valencia, Valencia, Spain
| | - Ana I Teruel
- Haematology Department, Hospital Clínico de Valencia, Valencia, Spain
| | | | | | | | - José L Bello
- Haematology Department, Hospital de Nuestra Señora de la Esperanza, Santiago de Compostela, Spain
| | - Lourdes López
- Haematology Department, Hospital MD Anderson, Madrid, Spain
| | | | - Erik de Cabo
- Haematology Department, Hospital del Bierzo, Ponferrada, Spain
| | - María E Infante
- Haematology Department, Hospital Infanta Leonor, Madrid, Spain
| | - Emilia Pardal
- Haematology Department, Hospital Virgen del Puerto, Plasencia, Spain
| | - Silvia Monsalvo
- Haematology Department, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Marcos González
- CIBERONC, Madrid, Spain.,Haematology Department, Hospital Universitario de Salamanca and IBSAL, Salamanca, Spain
| | - Alejandro Martín
- CIBERONC, Madrid, Spain.,Haematology Department, Hospital Universitario de Salamanca and IBSAL, Salamanca, Spain
| | - M Dolores Caballero
- Haematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
| | - Armando López-Guillermo
- Haematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
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112
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Sujobert P, Le Bris Y, de Leval L, Gros A, Merlio JP, Pastoret C, Huet S, Sarkozy C, Davi F, Callanan M, Thieblemont C, Sibon D, Asnafi V, Preudhomme C, Gaulard P, Jardin F, Salles G, Macintyre E. The Need for a Consensus Next-generation Sequencing Panel for Mature Lymphoid Malignancies. Hemasphere 2019; 3:e169. [PMID: 31723808 PMCID: PMC6745936 DOI: 10.1097/hs9.0000000000000169] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/27/2018] [Indexed: 02/07/2023] Open
Abstract
Supplemental Digital Content is available in the text.
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Affiliation(s)
- Pierre Sujobert
- Hospices Civils de Lyon, Service d’Hématologie Biologique, Pierre Bénite, France
- INSERM1052, CNRS 5286, Université Claude Bernard, Faculté de Médecine Lyon-Sud Charles Mérieux, Université de Lyon, Pierre Bénite, France
| | - Yannick Le Bris
- Service d’Hématologie Biologique, Centre Hospitalier Universitaire de Nantes, France
- CRCINA, INSERM, CNRS, Université de Nantes, Université d’Angers, Nantes, France
| | - Laurence de Leval
- Institut de Pathologie, Hôpital Universitaire de Lausanne (CHUV), Lausanne, Suisse
| | - Audrey Gros
- CHU de Bordeaux et Université de Bordeaux, INSERM U 1053, Bordeaux, France
| | | | - Cedric Pastoret
- Laboratoire d’Hématologie, Pôle de Biologie, CHU Rennes; INSERM, UMR U1236, Université Rennes1, Rennes, France
| | - Sarah Huet
- Hospices Civils de Lyon, Service d’Hématologie Biologique, Pierre Bénite, France
- INSERM1052, CNRS 5286, Université Claude Bernard, Faculté de Médecine Lyon-Sud Charles Mérieux, Université de Lyon, Pierre Bénite, France
- Université de Lyon, Université Lyon 1, Faculté de Pharmacie Rockefeller, 69373 Lyon Cedex, France
| | - Clémentine Sarkozy
- INSERM1052, CNRS 5286, Université Claude Bernard, Faculté de Médecine Lyon-Sud Charles Mérieux, Université de Lyon, Pierre Bénite, France
- Hospices Civils de Lyon, Service d’Hématologie Clinique, Pierre Bénite, France
| | - Frédéric Davi
- AP-HP, Hôpital Pitié-Salpêtrière, Service d’Hématologie Biologique, et Sorbonne Université, UMR-S 1138, Paris, France
| | - Mary Callanan
- INSERM 1209, CNRS UMR 5309, Universite Grenoble-Alpes, Institut Pour l’Avancee des Biosciences, Grenoble, France
- Centre d’Innovation en Genetique et Epigenetique Onco-Hematologique, Centre Hospitalier de Dijon-Bourgogne, Dijon, France
| | - Catherine Thieblemont
- AP-HP, Hôpital Saint-Louis, Hémato-Oncologie, Paris, France
- Diderot Université, Sorbonne Paris-Cité, Paris, France
- Descartes Université, Paris, France
| | - David Sibon
- Service d’Hématologie Adultes, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Vahid Asnafi
- APHP Necker Enfants Malades, Université Paris Descartes, Institut Necker-Enfants Malades (INEM) et INSERM UMR 1151, Paris, France
| | - Claude Preudhomme
- Université Lille, Inserm, CHU Lille, UMR-S 1172—JPArc—Centre de Recherche Jean-Pierre Aubert Neurosciences et Cancer, Lille, France
| | - Philippe Gaulard
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Département de Pathologie, Créteil, France
- INSERM U955 Équipe 9, Université Paris Est, Créteil, France
| | - Fabrice Jardin
- Département d’Hématologie Clinique et INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Gilles Salles
- INSERM1052, CNRS 5286, Université Claude Bernard, Faculté de Médecine Lyon-Sud Charles Mérieux, Université de Lyon, Pierre Bénite, France
- Hospices Civils de Lyon, Service d’Hématologie Clinique, Pierre Bénite, France
| | - Elizabeth Macintyre
- APHP Necker Enfants Malades, Université Paris Descartes, Institut Necker-Enfants Malades (INEM) et INSERM UMR 1151, Paris, France
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113
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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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114
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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)
| | - 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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115
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Silva A, Bassim S, Sarkozy C, Mottok A, Lackraj T, Jurinovic V, Brodtkorb M, Lingjaerde OC, Sehn LH, Gascoyne RD, Weigert O, Steidl C, Kridel R. Convergence of risk prediction models in follicular lymphoma. Haematologica 2019; 104:e252-e255. [PMID: 30606786 DOI: 10.3324/haematol.2018.209031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Anjali Silva
- Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
| | - Sleiman Bassim
- Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
| | | | - Anja Mottok
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Germany
| | - Tracy Lackraj
- Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
| | - Vindi Jurinovic
- Department of Medicine III, University Hospital, Ludwig Maximilians University Munich, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Germany
| | | | | | - Laurie H Sehn
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada
| | - Randy D Gascoyne
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada
| | - Oliver Weigert
- Department of Medicine III, University Hospital, Ludwig Maximilians University Munich, Germany
| | - Christian Steidl
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada
| | - Robert Kridel
- Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
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116
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Qu X, Li H, Braziel RM, Passerini V, Rimsza LM, Hsi ED, Leonard JP, Smith SM, Kridel R, Press O, Weigert O, LeBlanc M, Friedberg JW, Fang M. Genomic alterations important for the prognosis in patients with follicular lymphoma treated in SWOG study S0016. Blood 2019; 133:81-93. [PMID: 30446494 PMCID: PMC6318431 DOI: 10.1182/blood-2018-07-865428] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/06/2018] [Indexed: 02/08/2023] Open
Abstract
Although recent advances in molecular genetics have enabled improved risk classification of follicular lymphoma (FL) using, for example, the m7-FLIPI score, the impact on treatment has been limited. We aimed to assess the prognostic significance of copy-number aberrations (CNAs) and copy-neutral loss of heterozygosity (cnLOH) identified by chromosome genomic-array testing (CGAT) at FL diagnosis using prospectively collected clinical trial specimens from 255 patients enrolled in the SWOG study S0016. The impact of genomic aberrations was assessed for early progression (progressed or died within 2 years after registration), progression-free survival (PFS), and overall survival (OS). We showed that increased genomic complexity (ie, the total number of aberration calls) was associated with poor outcome in FL. Certain chromosome arms were critical for clinical outcome. Prognostic CNAs/cnLOH were identified: whereas early progression was correlated with 2p gain (P = .007; odds ratio [OR] = 2.55 [1.29, 5.03]) and 2p cnLOH (P = .005; OR = 10.9 [2.08, 57.2]), 2p gain specifically encompassing VRK2 and FANCL predicted PFS (P = .01; hazard ratio = 1.80 [1.14, 2.68]) as well as OS (P = .005; 2.40 [1.30, 4.40]); CDKN2A/B (9p) deletion correlated with worse PFS (P = .004, 3.50 [1.51, 8.28]); whereas CREBBP (16p) (P < .001; 6.70 [2.52, 17.58]) and TP53 (17p) (P < .001; 3.90 [1.85, 8.31]) deletion predicted worse OS. An independent cohort from the m7-FLIPI study was explored, and the prognostic significance of aberration count, and TP53 and CDKN2A/B deletion were further validated. In conclusion, assessing genomic aberrations at FL diagnosis with CGAT improves risk stratification independent of known clinical parameters, and provides a framework for development of future rational targeted therapies.
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Affiliation(s)
- Xiaoyu Qu
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Hongli Li
- SWOG Statistical Center, Seattle, WA
| | - Rita M Braziel
- Department of Pathology, Oregon Health & Science University, Portland, OR
| | - Verena Passerini
- Department of Medicine III, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
- German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | | | | | - John P Leonard
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY
| | - Sonali M Smith
- Department of Medicine, University of Chicago, Chicago, IL
| | - Robert Kridel
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, ON, Canada; and
| | - Oliver Press
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Oliver Weigert
- Department of Medicine III, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
- German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | | | | | - Min Fang
- Fred Hutchinson Cancer Research Center, Seattle, WA
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117
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Lansigan F, Barak I, Pitcher B, Jung SH, Cheson BD, Czuczman M, Martin P, Hsi E, Schöder H, Smith S, Bartlett NL, Leonard JP, Blum KA. The prognostic significance of PFS24 in follicular lymphoma following firstline immunotherapy: A combined analysis of 3 CALGB trials. Cancer Med 2018; 8:165-173. [PMID: 30575311 PMCID: PMC6346218 DOI: 10.1002/cam4.1918] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 11/02/2018] [Accepted: 11/19/2018] [Indexed: 12/22/2022] Open
Abstract
Follicular lymphoma (FL) patients treated with firstline R‐CHOP who experience progression of disease (POD) within 2 years have a shorter survival than those who do not have POD within 2 years. Whether this observation holds for patients treated initially with biologic immunotherapy alone is unknown. We performed a retrospective analysis of 174 patients pooled from three frontline rituximab (R)‐based nonchemotherapy doublet trials: R‐galiximab (Anti‐CD80, CALGB 50402), R‐epratuzumab (Anti‐CD22, CALGB 50701), and R‐lenalidomide (CALGB 50803) to determine outcomes of early progressors and risk factors for early POD, defined as progression within 24 months from study entry. Twenty‐eight percent (48/174) of patients had early POD. After adjusting for the Follicular Lymphoma International Prognostic Index (FLIPI), patients with early POD from study entry had a worse OS compared with patients who did not progress within 2 years (HR = 4.33 (95% CI 1.50‐12.5), P = 0.007). For early POD, the 2‐year survival was 80% vs 99% for nonearly POD, and the 5‐year survival was 74% vs 90%, respectively. These findings suggest that the adverse survival of patients with early POD may be independent of initial treatment modality.
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Affiliation(s)
| | - Ian Barak
- Alliance Statistics and Data Center, Duke University, Durham, North Carolina
| | - Brandelyn Pitcher
- Alliance Statistics and Data Center, Duke University, Durham, North Carolina
| | - Sin-Ho Jung
- Alliance Statistics and Data Center, Duke University, Durham, North Carolina
| | - Bruce D Cheson
- MedStar Georgetown University Hospital, Washington, District of Columbia
| | | | - Peter Martin
- Weill Medical College of Cornell University, New York, New York
| | - Eric Hsi
- Cleveland Clinic Foundation, Cleveland, Ohio
| | - Heiko Schöder
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Scott Smith
- Alliance Protocol Office, University of Chicago, Chicago, Illinois
| | | | - John P Leonard
- Weill Medical College of Cornell University, New York, New York
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118
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Seymour JF, Marcus R, Davies A, Gallop-Evans E, Grigg A, Haynes A, Herold M, Illmer T, Nilsson-Ehle H, Sökler M, Dünzinger U, Nielsen T, Launonen A, Hiddemann W. Association of early disease progression and very poor survival in the GALLIUM study in follicular lymphoma: benefit of obinutuzumab in reducing the rate of early progression. Haematologica 2018; 104:1202-1208. [PMID: 30573503 PMCID: PMC6545851 DOI: 10.3324/haematol.2018.209015] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 12/17/2018] [Indexed: 12/26/2022] Open
Abstract
We evaluated early disease progression and its impact on overall survival (OS) in previously untreated follicular lymphoma patients in GALLIUM (clinicaltrials.gov identifier: 01332968), and investigated the effect on early disease progression of the two randomization arms: obinutuzumab-based versus rituximab-based immunochemotherapy. Cause-specific Cox regression was used to estimate the effect of treatment on the risk of disease progression or death due to disease progression within 24 months of randomization and to analyze OS in patients with or without disease progression after 24 months. Mortality in both groups was analyzed 6, 12, and 18 months post randomization (median follow up, 41 months). Fewer early disease progression events occurred in obinutuzumab (57 out of 601) versus rituximab (98 out of 601) immunochemotherapy patients, with an average risk reduction of 46.0% (95%CI: 25.0-61.1%; cumulative incidence rate 10.1% vs. 17.4%). At a median post-progression follow up of 22.6 months, risk of mortality increased markedly following a progression event [HR of time-varying progression status, 25.5 (95%CI: 16.2-40.3)]. Mortality risk was higher the earlier patients progressed within the first 24 months. Age-adjusted HR for OS after 24 months in surviving patients with disease progression versus those without was 12.2 (95%CI: 5.6-26.5). Post-progression survival was similar by treatment arm. In conclusion, obinutuzumab plus chemotherapy was associated with a marked reduction in the rate of early disease progression events relative to rituximab plus chemotherapy. Early disease progression in patients with follicular lymphoma was associated with poor prognosis, with mortality risk higher after earlier progression. Survival post progression did not seem to be influenced by treatment arm.
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Affiliation(s)
- John F Seymour
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Victoria, Australia
| | | | - Andrew Davies
- Cancer Research UK Centre, University of Southampton, UK
| | | | | | | | | | - Thomas Illmer
- BAG Freiberg-Richter, Jacobasch, Illmer and Wolf, Dresden, Germany
| | - Herman Nilsson-Ehle
- Section of Hematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | | | | | - Wolfgang Hiddemann
- Department of Medicine III, Ludwig-Maximilians-University, Munich, Germany
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119
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Rivas-Delgado A, Magnano L, Moreno-Velázquez M, García O, Nadeu F, Mozas P, Dlouhy I, Baumann T, Rovira J, González-Farre B, Martínez A, Balague O, Delgado J, Villamor N, Giné E, Campo E, Sancho-Cia JM, López-Guillermo A. Response duration and survival shorten after each relapse in patients with follicular lymphoma treated in the rituximab era. Br J Haematol 2018; 184:753-759. [PMID: 30515755 DOI: 10.1111/bjh.15708] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/05/2018] [Indexed: 11/26/2022]
Abstract
Follicular lymphoma (FL) is an indolent disease characterized by long survival but frequent relapses. Before the introduction of rituximab, the clinical course of these patients showed a shorter response duration (RD) after each relapse. In this study, we analysed if this pattern of shortened responses remains in patients treated in the rituximab era. We selected 348 patients newly diagnosed with FL in two institutions between 2001 and 2014 that received chemoimmunotherapy. After a median follow-up of 6·3 years, 10-year progression-free and overall survivals were 53% and 72%, respectively. All patients received first-line, 111 second-line and 41 third-line treatments, with a 5-year RD of 62%, 39% and 24%, respectively (P < 0·0001). Variables predicting longer RD after first-line treatment were normal β2microglobulin, complete remission achievement and maintenance with rituximab. Patients with longer RD after first-line showed significantly longer RD after second-line therapy. Autologous stem-cell transplantation after second-line therapy did not significantly impact RD. Median survival after first, second and third therapies was not reached, 7·6 and 4·8 years, respectively, whereas relative survival with respect to a sex- and age-matched Spanish population, the decrease in the life expectancy at 10 years was 17%, 45% and 79%, respectively. Thus, RD still shortens after each relapse in patients with FL treated in first line with rituximab combinations.
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Affiliation(s)
- Alfredo Rivas-Delgado
- Department of Haematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Magnano
- Haematopathology Unit, Department of Pathology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBERONC, Barcelona, Spain
| | - Miriam Moreno-Velázquez
- Haematology Department, ICO-IJC-Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Olga García
- Haematology Department, ICO-IJC-Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Ferran Nadeu
- Lymphoid Neoplasm Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBERONC, Barcelona, Spain
| | - Pablo Mozas
- Department of Haematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ivan Dlouhy
- Department of Haematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Tycho Baumann
- Department of Haematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBERONC, Barcelona, Spain
| | - Jordina Rovira
- Department of Haematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Blanca González-Farre
- Department of Pathology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.,CIBERONC, Barcelona, Spain
| | - Antonio Martínez
- Department of Pathology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.,CIBERONC, Barcelona, Spain
| | - Olga Balague
- Department of Pathology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.,CIBERONC, Barcelona, Spain
| | - Julio Delgado
- Department of Haematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBERONC, Barcelona, Spain
| | - Neus Villamor
- Haematopathology Unit, Department of Pathology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBERONC, Barcelona, Spain
| | - Eva Giné
- Department of Haematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBERONC, Barcelona, Spain
| | - Elías Campo
- Haematopathology Unit, Department of Pathology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Lymphoid Neoplasm Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBERONC, Barcelona, Spain
| | - Juan M Sancho-Cia
- Haematology Department, ICO-IJC-Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Armando López-Guillermo
- Department of Haematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBERONC, Barcelona, Spain
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120
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Nastoupil LJ, Flowers CR, Leonard JP. Sequencing of therapies in relapsed follicular lymphoma. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2018; 2018:189-193. [PMID: 30504309 PMCID: PMC6245973 DOI: 10.1182/asheducation-2018.1.189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Follicular lymphoma (FL) is an incurable but treatable disease with vast treatment options. Despite the abundance of efficacious treatment modalities, there is no universally agreed upon standard approach to treatment, particularly in the relapsed/refractory setting. There is an increasing need for more robust and clinically available tools to risk-stratify patients and identify those likely to experience early relapse, which is currently recognized as the unmet need in FL. Additionally, the use of gene-expression profiling and next-generation sequencing techniques in recent years has led to a wealth of knowledge regarding the molecular drivers of lymphomagenesis. However, much of this knowledge is not currently available in the clinic to inform treatment decisions. Future studies are needed to generate clinically relevant predictive models adept at incorporating patient-specific and molecular features to inform management strategies along the entire disease continuum as treatment decisions should not be made in a vacuum with a one-size-fits-all approach. Sequencing of therapy in the management of relapsed FL should involve personalized decision-making for care plans that balance patient characteristics, preferences, and comorbidities with treatment-related factors such as efficacy, toxicity profile, and mechanisms of action to achieve a durable, quality remission.
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Affiliation(s)
- Loretta J. Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher R. Flowers
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA; and
| | - John P. Leonard
- Division of Hematology and Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY
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121
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Shimono J, Miyoshi H, Yoshida N, Kato T, Sato K, Sugio T, Miyawaki K, Kurita D, Sasaki Y, Kawamoto K, Imaizumi Y, Kato K, Nagafuji K, Akashi K, Seto M, Teshima T, Ohshima K. Analysis of GNA13 Protein in Follicular Lymphoma and its Association With Poor Prognosis. Am J Surg Pathol 2018; 42:1466-1471. [PMID: 30307409 PMCID: PMC6266301 DOI: 10.1097/pas.0000000000000969] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GNA13 is a G protein involved in modulating tumor proliferative capacity, infiltration, metastasis, and migration. Genomic alteration of GNA13 was frequently observed in follicular lymphoma (FL). In this study, we examined 167 cases of FL by immunostaining of GNA13 using tissue microarray to evaluate the clinical significance. There were 26 GNA13-positive cases (15.6%) and 141 GNA13-negative cases (84.4%). GNA13-positive cases had a higher incidence of early progression of disease for which disease progression was recognized within 2 years compared with GNA13-negative cases (P=0.03). There were no significant differences in other clinicopathologic factors including histological grade, BCL2-IGH translocation, immunohistochemical phenotype, and Follicular Lymphoma International Prognostic Index. In addition, overall survival and progression-free survival were poorer in GNA13-positive cases than in GNA13-negative cases (P=0.009 and 0.005, respectively). In multivariate analysis, GNA13 positivity was found to be a poor prognostic factor for overall survival and progression-free survival. Thus, GNA13 protein expression was an independent prognostic factor and may affect disease progression in FL.
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Affiliation(s)
- Joji Shimono
- Departments of Pathology
- Department of Hematology, Faculty of Medicine, Hokkaido University, Sapporo
| | | | | | - Takeharu Kato
- Department of Hematology, Sasebo City General Hospital, Sasebo
- Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki
| | | | - Takeshi Sugio
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medicine Sciences, Fukuoka, Japan
| | - Kohta Miyawaki
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medicine Sciences, Fukuoka, Japan
| | | | | | | | - Yoshitaka Imaizumi
- Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki
| | - Koji Kato
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medicine Sciences, Fukuoka, Japan
| | - Koji Nagafuji
- Division of Hematology and Oncology, Hematology, School of Medicine, Kurume University, Kurume
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medicine Sciences, Fukuoka, Japan
| | | | - Takanori Teshima
- Department of Hematology, Faculty of Medicine, Hokkaido University, Sapporo
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122
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Devan J, Janikova A, Mraz M. New concepts in follicular lymphoma biology: From BCL2 to epigenetic regulators and non-coding RNAs. Semin Oncol 2018; 45:291-302. [PMID: 30360879 DOI: 10.1053/j.seminoncol.2018.07.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 07/06/2018] [Accepted: 07/18/2018] [Indexed: 02/06/2023]
Abstract
The molecular pathogenesis of follicular lymphoma (FL) was partially revealed 3 decades ago, with the discovery of the translocation that brings BCL2 under the influence of immunoglobulin heavy chain enhancers in a vast majority of cases. Despite the importance of this seminal observation, it has become increasingly clear that additional genetic alterations need to occur to trigger neoplastic transformation and disease progression. The evolution of FL involves developmental arrest and disruption of the normal function of one or more of epigenetic regulators including KMT2D/MLL2, EZH2, CBP/CREBBP, p300/EP300, and HIST1H1 in >95% of cases. B-cells "arrested" in germinal centers acquire dozens of additional genetic aberrations that influence key pathways controlling their physiological development including B Cell Receptor (BCR) signaling, PI3K/AKT, TLR, mTOR, NF-κB, JAK/STAT, MAPK, CD40/CD40L, chemokine, and interleukin signaling. Additionally, most cases of FL do not result from linear accumulation of genomic aberrations, but rather evolve from a common progenitor cell population by diverse evolution, creating multiple FL subclones in one patient. Moreover, one of the subclones might acquire a combination of aberrations involving genes controlling cell survival and proliferation including MDM2, CDKN2A/B, BCL6, MYC, TP53, β2M, FOXO1, MYD88, STAT3, or miR-17-92, and this can lead to the transformation of an initially indolent FL to an aggressive lymphoma (2%-3% risk per year). The complexity of the disease is also underscored by the importance of its interactions with the microenvironment that can substantially influence disease development and prognosis. Interpreting individual aberrations in relation to their impact on normal processes, their frequency, position in the disease evolution, and the consequences of their (co)occurrence, are the basis for understanding FL pathogenesis. This is necessary for the identification of patients with risk of early progression or transformation, for the development of novel targeted therapies, and for personalized treatment approaches. In this review, we summarize recent knowledge of molecular pathways and microenvironmental components involved in FL biology, and discuss them in the context of physiological B-cell development, FL evolution, and targeted therapies.
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Affiliation(s)
- Jan Devan
- Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Andrea Janikova
- Department of Internal Medicine, Haematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marek Mraz
- Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czech Republic; Department of Internal Medicine, Haematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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123
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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, Martínez-Sánchez P, Martín A, Coria E, López-Guillermo A, Salar A, Lahuerta JJ. Autologous stem cell transplantation may be curative for patients with follicular lymphoma with early therapy failure who reach complete response after rescue treatment. Hematol Oncol 2018; 36:765-772. [PMID: 30129233 DOI: 10.1002/hon.2553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/04/2018] [Accepted: 08/11/2018] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | - Lucrecia Yáñez
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | - Reyes Arranz
- Hospital Universitario La Princesa, Madrid, Spain
| | | | | | - Santiago Mercadal
- Hospital Universitario de Bellvitge, l'Hospitalet de Llobregat, Spain
| | - Andrea Galeo
- Hospital Universitario A Coruña, A Coruña, Spain
| | | | | | | | | | - Elena Pérez
- Hospital Universitario Morales de Messeguer, Murcia, Spain
| | - Carmen Marrero
- Hospital Universitario Nuestra Señora de La Candelaria, Tenerife, Spain
| | | | - Luis Palomera
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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125
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Manna M, Lee-Ying R, Davies G, Stewart C, Oh DH, Peters A, Stewart DA. Autologous transplantation improves survival rates for follicular lymphoma patients who relapse within two years of chemoimmunotherapy: a multi-center retrospective analysis of consecutively treated patients in the real world. Leuk Lymphoma 2018; 60:133-141. [DOI: 10.1080/10428194.2018.1473576] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mita Manna
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Richard Lee-Ying
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Gwynivere Davies
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Colin Stewart
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Danielle H. Oh
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Anthea Peters
- Department of Medicine, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Douglas A. Stewart
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
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Jurinovic V, Metzner B, Pfreundschuh M, Schmitz N, Wandt H, Keller U, Dreger P, Dreyling M, Hiddemann W, Unterhalt M, Hoster E, Weigert O. Autologous Stem Cell Transplantation for Patients with Early Progression of Follicular Lymphoma: A Follow-Up Study of 2 Randomized Trials from the German Low Grade Lymphoma Study Group. Biol Blood Marrow Transplant 2018; 24:1172-1179. [DOI: 10.1016/j.bbmt.2018.03.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/23/2018] [Indexed: 11/16/2022]
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Casulo C, Friedberg JW, Ahn KW, Flowers C, DiGilio A, Smith SM, Ahmed S, Inwards D, Aljurf M, Chen AI, Choe H, Cohen J, Copelan E, Farooq U, Fenske TS, Freytes C, Gaballa S, Ganguly S, Jethava Y, Kamble RT, Kenkre VP, Lazarus H, Lazaryan A, Olsson RF, Rezvani AR, Rizzieri D, Seo S, Shah GL, Shah N, Solh M, Sureda A, William B, Cumpston A, Zelenetz AD, Link BK, Hamadani M. Autologous Transplantation in Follicular Lymphoma with Early Therapy Failure: A National LymphoCare Study and Center for International Blood and Marrow Transplant Research Analysis. Biol Blood Marrow Transplant 2018; 24:1163-1171. [PMID: 29242111 PMCID: PMC5993598 DOI: 10.1016/j.bbmt.2017.12.771] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/03/2017] [Indexed: 12/12/2022]
Abstract
Patients with follicular lymphoma (FL) experiencing early therapy failure (ETF) within 2 years of frontline chemoimmunotherapy have poor overall survival (OS). We analyzed data from the Center for International Blood and Marrow Transplant Research (CIBMTR) and the National LymphoCare Study (NLCS) to determine whether autologous hematopoietic cell transplant (autoHCT) can improve outcomes in this high-risk FL subgroup. ETF was defined as failure to achieve at least partial response after frontline chemoimmunotherapy or lymphoma progression within 2 years of frontline chemoimmunotherapy. We identified 2 groups: the non-autoHCT cohort (patients from the NLCS with ETF not undergoing autoHCT) and the autoHCT cohort (CIBMTR patients with ETF undergoing autoHCT). All patients received rituximab-based chemotherapy as frontline treatment; 174 non-autoHCT patients and 175 autoHCT patients were identified and analyzed. There was no difference in 5-year OS between the 2 groups (60% versus 67%, respectively; P = .16). A planned subgroup analysis showed that patients with ETF receiving autoHCT soon after treatment failure (≤1 year of ETF; n = 123) had higher 5-year OS than those without autoHCT (73% versus 60%, P = .05). On multivariate analysis, early use of autoHCT was associated with significantly reduced mortality (hazard ratio, .63; 95% confidence interval, .42 to .94; P = .02). Patients with FL experiencing ETF after frontline chemoimmunotherapy lack optimal therapy. We demonstrate improved OS when receiving autoHCT within 1 year of treatment failure. Results from this unique collaboration between the NLCS and CIBMTR support consideration of early consolidation with autoHCT in select FL patients experiencing ETF.
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Affiliation(s)
- Carla Casulo
- Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | | | - Kwang W Ahn
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christopher Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Alyssa DiGilio
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | - Sairah Ahmed
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of MD Anderson Cancer Center, Houston, Texas
| | - David Inwards
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riydah, Saudi Arabia
| | - Andy I Chen
- Blood and Marrow Transplant Program, Oregon Health and Science University, Portland, Oregon
| | - Hannah Choe
- Blood and Marrow Transplant Program, Weill Cornell Medical College, New York, New York
| | - Jonathon Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Umar Farooq
- Department of Medicine, University of Iowa, Iowa City, Iowa
| | - Timothy S Fenske
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Cesar Freytes
- Blood and Marrow Transplant Program, Texas Transplant Institute, San Antonio, Texas
| | - Sameh Gaballa
- Blood and Marrow Transplant Program, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Siddhartha Ganguly
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, Kansas
| | - Yogesh Jethava
- Blood and Marrow Transplant Program, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Vaishalee P Kenkre
- Division of Hematology and Oncology, University of Wisconsin, Madison, Wisconsin
| | - Hillard Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Aleksandr Lazaryan
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Andrew R Rezvani
- Blood and Marrow Transplant Program, Stanford Health Care, Stanford, California
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina
| | - Sachiko Seo
- National Cancer Research Center, East Hospital, Chiba, Japan
| | - Gunjan L Shah
- Blood and Marrow Transplant Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nina Shah
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of MD Anderson Cancer Center, Houston, Texas
| | - Melham Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia
| | - Anna Sureda
- Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - Basem William
- James Cancer Center, Ohio State Medical Center, Columbus, Ohio
| | - Aaron Cumpston
- Blood and Marrow Transplant Program, West Virginia University Hospitals, Morgantown, West Virginia
| | - Andrew D Zelenetz
- Blood and Marrow Transplant Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brian K Link
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Predictive gene-expression score for follicular lymphoma. Lancet Oncol 2018; 19:e279. [DOI: 10.1016/s1470-2045(18)30262-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/28/2018] [Indexed: 10/14/2022]
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Casulo C, Nastoupil L, Fowler NH, Friedberg JW, Flowers CR. Unmet needs in the first-line treatment of follicular lymphoma. Ann Oncol 2018; 28:2094-2106. [PMID: 28430865 DOI: 10.1093/annonc/mdx189] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
For the majority of patients with newly diagnosed follicular lymphoma (FL), current treatments, while not curative, allow for long remission durations. However, several important needs remain unaddressed. Studies have consistently shown that ∼20% of patients with FL experience disease progression within 2 years of first-line treatment, and consequently have a 50% risk of death in 5 years. Better characterization of this group of patients at diagnosis may provide insight into those in need of alternate or intensive therapies, facilitate a precision approach to inform clinical trials, and allow for improved patient counseling. Prognostic methods to date have employed clinical parameters, genomic methods, and a wide assortment of biological and biochemical markers, but none so far has been able to adequately identify this high-risk population. Advances in the first-line treatment of FL with chemoimmunotherapy have led to a median progression-free survival (PFS) of approximately 7 years; creating a challenge in the development of clinical trials where PFS is a primary end point. A surrogate end point that accurately predicts PFS would allow for new treatments to reach patients with FL sooner, or lessen toxicity, time, and expense to those patients requiring little to no therapy. Quality of response to treatment may predict PFS and overall survival in FL; as such complete response rates, either alone or in conjunction with PET imaging or minimal residual disease negativity, are being studied as surrogates, with complete response at 30 months after induction providing the strongest surrogacy evidence to date. A better understanding of how to optimize quality of life in the context of this chronic illness is another important focus deserving of further study. Ongoing efforts to address these important unmet needs are herein discussed.
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Affiliation(s)
- C Casulo
- Department of Medicine, Hematology/Oncology, WIlmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - L Nastoupil
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston
| | - N H Fowler
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston
| | - J W Friedberg
- Department of Medicine, Hematology/Oncology, WIlmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - C R Flowers
- Department of Bone Marrow and Stem Cell Transplantation, Winship Cancer Institute, Emory University, Atlanta, USA
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Chavez JC, Locke FL. CAR T cell therapy for B-cell lymphomas. Best Pract Res Clin Haematol 2018; 31:135-146. [PMID: 29909914 DOI: 10.1016/j.beha.2018.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 01/15/2023]
Abstract
B-cell non-Hodgkin's lymphoma (NHLs)is a very heterogonous malignancy with diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) as the most common subtypes. Standard treatment with anti-CD20 based chemoimmunotherapy is usually very effective for disease control. However a significant proportion of patients with high-risk features (double hit lymphoma, transformed lymphomas or early relapses) will become refractory to standard therapies and will have limited alternatives for cure. Adoptive therapy with chimeric antigen receptor (CAR) T-cells is a new paradigm for effective treatment of poor prognosis lymphomas. Here we review the biology of poor risk DLBCL and FL, the rationale for CAR T-cell therapy in malignant lymphoma and the efficacy/toxicity profile of CD19 directed CAR T cell therapy for DLBCL and FL from early single center studies to multicenter/global clinical trial with different CAR T cell constructs.
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Affiliation(s)
- Julio C Chavez
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, USA
| | - Frederick L Locke
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, USA.
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Cheson BD, Chua N, Mayer J, Dueck G, Trněný M, Bouabdallah K, Fowler N, Delwail V, Press O, Salles G, Gribben JG, Lennard A, Lugtenburg PJ, Fingerle-Rowson G, Mattiello F, Knapp A, Sehn LH. Overall Survival Benefit in Patients With Rituximab-Refractory Indolent Non-Hodgkin Lymphoma Who Received Obinutuzumab Plus Bendamustine Induction and Obinutuzumab Maintenance in the GADOLIN Study. J Clin Oncol 2018; 36:2259-2266. [PMID: 29584548 DOI: 10.1200/jco.2017.76.3656] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose To perform an updated analysis of the randomized phase III GADOLIN trial in patients with rituximab-refractory indolent non-Hodgkin lymphoma treated with obinutuzumab (GA101; G) and bendamustine (B). Patients and Methods Patients with histologically documented, rituximab-refractory CD20+ indolent non-Hodgkin lymphoma received G 1,000 mg (days 1, 8, and 15, cycle 1; day 1, cycles 2 to 6) plus B 90 mg/m2/d (days 1 and 2, all cycles) or B 120 mg/m2/d monotherapy. Patients who did not experience disease progression with G-B received G maintenance (1,000 mg every 2 months) for up to 2 years. The primary end point was progression-free survival (PFS). Results Of 413 randomly assigned patients (intention-to-treat [ITT]: G-B, n = 204; B monotherapy, n = 209), 335 had follicular lymphoma (FL; G-B, n = 164; B monotherapy, n = 171). After a median follow-up of 31.8 months, median PFS in ITT patients was 25.8 months (G-B) and 14.1 months (B monotherapy; hazard ratio [HR], 0.57; 95% CI, 0.44 to 0.73; P < .001). Overall survival (OS) also was prolonged (HR, 0.67; 95% CI, 0.47 to 0.96; P = .027). PFS and OS benefits were similar in patients with FL. Grade 3 to 5 adverse events (AEs) were reported by 148 (72.5%) and 133 (65.5%) patients in the G-B and B monotherapy arms, respectively, most commonly neutropenia (G-B, 34.8%; B monotherapy, 27.1%), thrombocytopenia (10.8% and 15.8%), anemia (7.4% and 10.8%), and infusion-related reactions (9.3% and 3.4%). Serious AEs occurred in 89 G-B patients (43.6%) and 75 B monotherapy patients (36.9%); fatal AEs occurred in 16 (7.8%) and 13 (6.4%), respectively. Conclusion This updated analysis confirms the PFS benefit for G-B shown in the primary analysis. A substantial OS benefit also was demonstrated in the ITT population and in patients with FL. Toxicity was similar for both treatments.
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Affiliation(s)
- Bruce D Cheson
- Bruce D. Cheson, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; Neil Chua, University of Alberta, Edmonton, Alberta; Greg Dueck, British Columbia Cancer Agency, Kelowna; Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Jiri Mayer, University Hospital and Masaryk University, Brno; Marek Trněný, Charles University General Hospital, Prague, Czech Republic; Kamal Bouabdallah, Centre Hospitalier Universitaire Haut-Leveque, Bordeaux; Vincent Delwail, Centre Hospitalier Universitaire de Poitiers, Poitiers; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Nathan Fowler, University of Texas, Houston, TX; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA; John G. Gribben, Queen Mary University of London, London; Anne Lennard, Newcastle University, Newcastle upon Tyne, United Kingdom; Pieternella J. Lugtenburg, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Günter Fingerle-Rowson, Federico Mattiello, and Andrea Knapp, F. Hoffmann-La Roche, Basel, Switzerland
| | - Neil Chua
- Bruce D. Cheson, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; Neil Chua, University of Alberta, Edmonton, Alberta; Greg Dueck, British Columbia Cancer Agency, Kelowna; Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Jiri Mayer, University Hospital and Masaryk University, Brno; Marek Trněný, Charles University General Hospital, Prague, Czech Republic; Kamal Bouabdallah, Centre Hospitalier Universitaire Haut-Leveque, Bordeaux; Vincent Delwail, Centre Hospitalier Universitaire de Poitiers, Poitiers; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Nathan Fowler, University of Texas, Houston, TX; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA; John G. Gribben, Queen Mary University of London, London; Anne Lennard, Newcastle University, Newcastle upon Tyne, United Kingdom; Pieternella J. Lugtenburg, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Günter Fingerle-Rowson, Federico Mattiello, and Andrea Knapp, F. Hoffmann-La Roche, Basel, Switzerland
| | - Jiri Mayer
- Bruce D. Cheson, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; Neil Chua, University of Alberta, Edmonton, Alberta; Greg Dueck, British Columbia Cancer Agency, Kelowna; Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Jiri Mayer, University Hospital and Masaryk University, Brno; Marek Trněný, Charles University General Hospital, Prague, Czech Republic; Kamal Bouabdallah, Centre Hospitalier Universitaire Haut-Leveque, Bordeaux; Vincent Delwail, Centre Hospitalier Universitaire de Poitiers, Poitiers; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Nathan Fowler, University of Texas, Houston, TX; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA; John G. Gribben, Queen Mary University of London, London; Anne Lennard, Newcastle University, Newcastle upon Tyne, United Kingdom; Pieternella J. Lugtenburg, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Günter Fingerle-Rowson, Federico Mattiello, and Andrea Knapp, F. Hoffmann-La Roche, Basel, Switzerland
| | - Greg Dueck
- Bruce D. Cheson, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; Neil Chua, University of Alberta, Edmonton, Alberta; Greg Dueck, British Columbia Cancer Agency, Kelowna; Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Jiri Mayer, University Hospital and Masaryk University, Brno; Marek Trněný, Charles University General Hospital, Prague, Czech Republic; Kamal Bouabdallah, Centre Hospitalier Universitaire Haut-Leveque, Bordeaux; Vincent Delwail, Centre Hospitalier Universitaire de Poitiers, Poitiers; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Nathan Fowler, University of Texas, Houston, TX; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA; John G. Gribben, Queen Mary University of London, London; Anne Lennard, Newcastle University, Newcastle upon Tyne, United Kingdom; Pieternella J. Lugtenburg, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Günter Fingerle-Rowson, Federico Mattiello, and Andrea Knapp, F. Hoffmann-La Roche, Basel, Switzerland
| | - Marek Trněný
- Bruce D. Cheson, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; Neil Chua, University of Alberta, Edmonton, Alberta; Greg Dueck, British Columbia Cancer Agency, Kelowna; Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Jiri Mayer, University Hospital and Masaryk University, Brno; Marek Trněný, Charles University General Hospital, Prague, Czech Republic; Kamal Bouabdallah, Centre Hospitalier Universitaire Haut-Leveque, Bordeaux; Vincent Delwail, Centre Hospitalier Universitaire de Poitiers, Poitiers; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Nathan Fowler, University of Texas, Houston, TX; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA; John G. Gribben, Queen Mary University of London, London; Anne Lennard, Newcastle University, Newcastle upon Tyne, United Kingdom; Pieternella J. Lugtenburg, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Günter Fingerle-Rowson, Federico Mattiello, and Andrea Knapp, F. Hoffmann-La Roche, Basel, Switzerland
| | - Kamal Bouabdallah
- Bruce D. Cheson, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; Neil Chua, University of Alberta, Edmonton, Alberta; Greg Dueck, British Columbia Cancer Agency, Kelowna; Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Jiri Mayer, University Hospital and Masaryk University, Brno; Marek Trněný, Charles University General Hospital, Prague, Czech Republic; Kamal Bouabdallah, Centre Hospitalier Universitaire Haut-Leveque, Bordeaux; Vincent Delwail, Centre Hospitalier Universitaire de Poitiers, Poitiers; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Nathan Fowler, University of Texas, Houston, TX; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA; John G. Gribben, Queen Mary University of London, London; Anne Lennard, Newcastle University, Newcastle upon Tyne, United Kingdom; Pieternella J. Lugtenburg, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Günter Fingerle-Rowson, Federico Mattiello, and Andrea Knapp, F. Hoffmann-La Roche, Basel, Switzerland
| | - Nathan Fowler
- Bruce D. Cheson, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; Neil Chua, University of Alberta, Edmonton, Alberta; Greg Dueck, British Columbia Cancer Agency, Kelowna; Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Jiri Mayer, University Hospital and Masaryk University, Brno; Marek Trněný, Charles University General Hospital, Prague, Czech Republic; Kamal Bouabdallah, Centre Hospitalier Universitaire Haut-Leveque, Bordeaux; Vincent Delwail, Centre Hospitalier Universitaire de Poitiers, Poitiers; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Nathan Fowler, University of Texas, Houston, TX; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA; John G. Gribben, Queen Mary University of London, London; Anne Lennard, Newcastle University, Newcastle upon Tyne, United Kingdom; Pieternella J. Lugtenburg, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Günter Fingerle-Rowson, Federico Mattiello, and Andrea Knapp, F. Hoffmann-La Roche, Basel, Switzerland
| | - Vincent Delwail
- Bruce D. Cheson, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; Neil Chua, University of Alberta, Edmonton, Alberta; Greg Dueck, British Columbia Cancer Agency, Kelowna; Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Jiri Mayer, University Hospital and Masaryk University, Brno; Marek Trněný, Charles University General Hospital, Prague, Czech Republic; Kamal Bouabdallah, Centre Hospitalier Universitaire Haut-Leveque, Bordeaux; Vincent Delwail, Centre Hospitalier Universitaire de Poitiers, Poitiers; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Nathan Fowler, University of Texas, Houston, TX; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA; John G. Gribben, Queen Mary University of London, London; Anne Lennard, Newcastle University, Newcastle upon Tyne, United Kingdom; Pieternella J. Lugtenburg, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Günter Fingerle-Rowson, Federico Mattiello, and Andrea Knapp, F. Hoffmann-La Roche, Basel, Switzerland
| | - Oliver Press
- Bruce D. Cheson, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; Neil Chua, University of Alberta, Edmonton, Alberta; Greg Dueck, British Columbia Cancer Agency, Kelowna; Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Jiri Mayer, University Hospital and Masaryk University, Brno; Marek Trněný, Charles University General Hospital, Prague, Czech Republic; Kamal Bouabdallah, Centre Hospitalier Universitaire Haut-Leveque, Bordeaux; Vincent Delwail, Centre Hospitalier Universitaire de Poitiers, Poitiers; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Nathan Fowler, University of Texas, Houston, TX; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA; John G. Gribben, Queen Mary University of London, London; Anne Lennard, Newcastle University, Newcastle upon Tyne, United Kingdom; Pieternella J. Lugtenburg, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Günter Fingerle-Rowson, Federico Mattiello, and Andrea Knapp, F. Hoffmann-La Roche, Basel, Switzerland
| | - Gilles Salles
- Bruce D. Cheson, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; Neil Chua, University of Alberta, Edmonton, Alberta; Greg Dueck, British Columbia Cancer Agency, Kelowna; Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Jiri Mayer, University Hospital and Masaryk University, Brno; Marek Trněný, Charles University General Hospital, Prague, Czech Republic; Kamal Bouabdallah, Centre Hospitalier Universitaire Haut-Leveque, Bordeaux; Vincent Delwail, Centre Hospitalier Universitaire de Poitiers, Poitiers; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Nathan Fowler, University of Texas, Houston, TX; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA; John G. Gribben, Queen Mary University of London, London; Anne Lennard, Newcastle University, Newcastle upon Tyne, United Kingdom; Pieternella J. Lugtenburg, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Günter Fingerle-Rowson, Federico Mattiello, and Andrea Knapp, F. Hoffmann-La Roche, Basel, Switzerland
| | - John G Gribben
- Bruce D. Cheson, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; Neil Chua, University of Alberta, Edmonton, Alberta; Greg Dueck, British Columbia Cancer Agency, Kelowna; Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Jiri Mayer, University Hospital and Masaryk University, Brno; Marek Trněný, Charles University General Hospital, Prague, Czech Republic; Kamal Bouabdallah, Centre Hospitalier Universitaire Haut-Leveque, Bordeaux; Vincent Delwail, Centre Hospitalier Universitaire de Poitiers, Poitiers; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Nathan Fowler, University of Texas, Houston, TX; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA; John G. Gribben, Queen Mary University of London, London; Anne Lennard, Newcastle University, Newcastle upon Tyne, United Kingdom; Pieternella J. Lugtenburg, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Günter Fingerle-Rowson, Federico Mattiello, and Andrea Knapp, F. Hoffmann-La Roche, Basel, Switzerland
| | - Anne Lennard
- Bruce D. Cheson, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; Neil Chua, University of Alberta, Edmonton, Alberta; Greg Dueck, British Columbia Cancer Agency, Kelowna; Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Jiri Mayer, University Hospital and Masaryk University, Brno; Marek Trněný, Charles University General Hospital, Prague, Czech Republic; Kamal Bouabdallah, Centre Hospitalier Universitaire Haut-Leveque, Bordeaux; Vincent Delwail, Centre Hospitalier Universitaire de Poitiers, Poitiers; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Nathan Fowler, University of Texas, Houston, TX; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA; John G. Gribben, Queen Mary University of London, London; Anne Lennard, Newcastle University, Newcastle upon Tyne, United Kingdom; Pieternella J. Lugtenburg, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Günter Fingerle-Rowson, Federico Mattiello, and Andrea Knapp, F. Hoffmann-La Roche, Basel, Switzerland
| | - Pieternella J Lugtenburg
- Bruce D. Cheson, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; Neil Chua, University of Alberta, Edmonton, Alberta; Greg Dueck, British Columbia Cancer Agency, Kelowna; Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Jiri Mayer, University Hospital and Masaryk University, Brno; Marek Trněný, Charles University General Hospital, Prague, Czech Republic; Kamal Bouabdallah, Centre Hospitalier Universitaire Haut-Leveque, Bordeaux; Vincent Delwail, Centre Hospitalier Universitaire de Poitiers, Poitiers; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Nathan Fowler, University of Texas, Houston, TX; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA; John G. Gribben, Queen Mary University of London, London; Anne Lennard, Newcastle University, Newcastle upon Tyne, United Kingdom; Pieternella J. Lugtenburg, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Günter Fingerle-Rowson, Federico Mattiello, and Andrea Knapp, F. Hoffmann-La Roche, Basel, Switzerland
| | - Günter Fingerle-Rowson
- Bruce D. Cheson, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; Neil Chua, University of Alberta, Edmonton, Alberta; Greg Dueck, British Columbia Cancer Agency, Kelowna; Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Jiri Mayer, University Hospital and Masaryk University, Brno; Marek Trněný, Charles University General Hospital, Prague, Czech Republic; Kamal Bouabdallah, Centre Hospitalier Universitaire Haut-Leveque, Bordeaux; Vincent Delwail, Centre Hospitalier Universitaire de Poitiers, Poitiers; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Nathan Fowler, University of Texas, Houston, TX; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA; John G. Gribben, Queen Mary University of London, London; Anne Lennard, Newcastle University, Newcastle upon Tyne, United Kingdom; Pieternella J. Lugtenburg, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Günter Fingerle-Rowson, Federico Mattiello, and Andrea Knapp, F. Hoffmann-La Roche, Basel, Switzerland
| | - Federico Mattiello
- Bruce D. Cheson, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; Neil Chua, University of Alberta, Edmonton, Alberta; Greg Dueck, British Columbia Cancer Agency, Kelowna; Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Jiri Mayer, University Hospital and Masaryk University, Brno; Marek Trněný, Charles University General Hospital, Prague, Czech Republic; Kamal Bouabdallah, Centre Hospitalier Universitaire Haut-Leveque, Bordeaux; Vincent Delwail, Centre Hospitalier Universitaire de Poitiers, Poitiers; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Nathan Fowler, University of Texas, Houston, TX; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA; John G. Gribben, Queen Mary University of London, London; Anne Lennard, Newcastle University, Newcastle upon Tyne, United Kingdom; Pieternella J. Lugtenburg, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Günter Fingerle-Rowson, Federico Mattiello, and Andrea Knapp, F. Hoffmann-La Roche, Basel, Switzerland
| | - Andrea Knapp
- Bruce D. Cheson, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; Neil Chua, University of Alberta, Edmonton, Alberta; Greg Dueck, British Columbia Cancer Agency, Kelowna; Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Jiri Mayer, University Hospital and Masaryk University, Brno; Marek Trněný, Charles University General Hospital, Prague, Czech Republic; Kamal Bouabdallah, Centre Hospitalier Universitaire Haut-Leveque, Bordeaux; Vincent Delwail, Centre Hospitalier Universitaire de Poitiers, Poitiers; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Nathan Fowler, University of Texas, Houston, TX; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA; John G. Gribben, Queen Mary University of London, London; Anne Lennard, Newcastle University, Newcastle upon Tyne, United Kingdom; Pieternella J. Lugtenburg, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Günter Fingerle-Rowson, Federico Mattiello, and Andrea Knapp, F. Hoffmann-La Roche, Basel, Switzerland
| | - Laurie H Sehn
- Bruce D. Cheson, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; Neil Chua, University of Alberta, Edmonton, Alberta; Greg Dueck, British Columbia Cancer Agency, Kelowna; Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Jiri Mayer, University Hospital and Masaryk University, Brno; Marek Trněný, Charles University General Hospital, Prague, Czech Republic; Kamal Bouabdallah, Centre Hospitalier Universitaire Haut-Leveque, Bordeaux; Vincent Delwail, Centre Hospitalier Universitaire de Poitiers, Poitiers; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Nathan Fowler, University of Texas, Houston, TX; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA; John G. Gribben, Queen Mary University of London, London; Anne Lennard, Newcastle University, Newcastle upon Tyne, United Kingdom; Pieternella J. Lugtenburg, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Günter Fingerle-Rowson, Federico Mattiello, and Andrea Knapp, F. Hoffmann-La Roche, Basel, Switzerland
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A gene-expression profiling score for prediction of outcome in patients with follicular lymphoma: a retrospective training and validation analysis in three international cohorts. Lancet Oncol 2018; 19:549-561. [PMID: 29475724 PMCID: PMC5882539 DOI: 10.1016/s1470-2045(18)30102-5] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 02/07/2023]
Abstract
Background Patients with follicular lymphoma (FL) have heterogeneous outcomes. Predictor models able to distinguish, at diagnosis, patients at high versus low risk of progression are still needed. Methods The primary objective of this study was to use gene-expression profiling data to build a signature predictive of outcome in patients treated in the rituximab era. In a retrospectively assembled training cohort of 134 pretreatment FL patients from the prospective randomized PRIMA trial, we developed an expression-based predictor of progression-free survival (PFS) that was further evaluated in FFPE samples obtained from three independent international cohorts, using NanoString technology. The validation cohorts comprised a distinct set of patients from the PRIMA trial (n=178), a cohort from the University of Iowa/Mayo Clinic Lymphoma SPORE (n=201) and the Hospital Clinic University of Barcelona (n=109). All tissue samples consisted of pretreatment diagnostic biopsies and were confirmed as FL grade 1-3a. The patients were all treated with regimens containing rituximab and chemotherapy, possibly followed by either rituximab maintenance or ibritumomab-tiuxetan consolidation. Findings The expression levels of 395 genes were associated with a risk of progression. Twenty-three genes reflecting both B-cell biology and tumor microenvironment were retained to build a predictive model, which identified a population at an increased risk of progression (p<0.0001). In a multivariate Cox model for PFS adjusted on rituximab maintenance treatment and FLIPI-1, this predictor was found to independently predict progression (adjusted hazard ratio (HR) of the high-risk compared to the low-risk group: 3.68; 95%CI: 2.19-6.17). The digital gene expression data met quality criteria for 460/488 (94%) FFPE samples of the validation cohorts. The predictor performances were confirmed in each of the individual validation cohorts (adjusted HR [95%CI] comparing high risk to low risk groups were respectively 2.57 [1.65-4.01], 2.12 [1.32-3.39] and 2.11 [1.01-4.41]). In the combined validation cohort, the median PFS values were 3.1 (95%CI: 2.4-2.8) and 10.8 (95%CI: 10.1-NR) years in the high- and low-risk groups, respectively. The risk of lymphoma progression at 2 years was twice as high in the high-risk group (38% (95%CI: 29-46) versus 19% (95%CI: 15-24)). In a multivariate analysis, the score predicted PFS independently of anti-CD20 maintenance treatment and of the FLIPI score (hazard ratio for the combined cohort, 2.30; 95%CI, 1.72-3.07). Interpretation We developed a robust 23-gene expression-based predictor of PFS, applicable to routinely available FFPE biopsies from FL patients at diagnosis. This score may allow individualizing therapy for patients with FL according to the patient risk category. Funding Roche Company, SIRIC Lyric, LYSARC, NIH and the Henry J. Predolin Foundation, Spanish Plan Nacional de Investigacion SAF2015-64885-R.
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133
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Kahl BS. Follicular lymphoma: are we ready for a risk-adapted approach? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:358-364. [PMID: 29222279 PMCID: PMC6142597 DOI: 10.1182/asheducation-2017.1.358] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Follicular lymphoma is the most common indolent non-Hodgkin lymphoma in the Western hemisphere. The natural history of FL appears to have been favorably impacted by the introduction of rituximab after randomized clinical trials demonstrated that the addition of rituximab to standard chemotherapy induction has improved the overall survival. Yet, the disease is biologically and clinically heterogeneous with wide variations in outcomes for individual patients. The ability to accurately risk-stratify patients and then tailor therapy to the individual is an area of ongoing research. Historically, tumor grade, tumor burden, and the FL international prognostic index (version 1 and version 2) have been used to distinguish low-risk from high-risk patients. Biologic factors such as mutations in key genes can identify patients at high risk for poor outcomes to first-line therapy (mutational status of 7 genes [EZH2, ARID1A, MEF2B, EP300, FOX01, CREBBP, and CARD11] with Follicular Lymphoma International Prognostic Index). More recently, the quality of the response to initial therapy, as measured by either PET imaging or by remission duration, has been show to identify individuals at high risk. However, several unmet needs remain, including a better ability to identify high-risk patients at diagnosis, the development of predictive biomarkers for targeted agents, and strategies to reduce the risk of transformation.
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Affiliation(s)
- Brad S Kahl
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
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134
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Casulo C. Risk stratification in follicular lymphoma. Best Pract Res Clin Haematol 2017; 31:15-22. [PMID: 29452661 DOI: 10.1016/j.beha.2017.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/08/2017] [Accepted: 11/10/2017] [Indexed: 12/11/2022]
Abstract
Advances in the understanding of FL biology, molecular characteristics and clinical risk factors are further highlighting the heterogeneity of this disease. Historically used prognostic factors were broadly based on clinical and laboratory features at the time of diagnosis. However novel prognostic factors are emerging that can be studied at the time of diagnosis, and relapse, and use a variety of tools including gene alterations and diagnostic imaging. These novel discoveries are being implemented into daily practice with the ultimate goal of providing a precise, individualized approach to every patient with FL.
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Affiliation(s)
- Carla Casulo
- James P. Wilmot Cancer Institute, University of Rochester, 601Elmwood Ave Box 704, Rochester, NY 14642, USA.
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135
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Hess G. The role of stem cell transplantation in follicular lymphoma. Best Pract Res Clin Haematol 2017; 31:31-40. [PMID: 29452664 DOI: 10.1016/j.beha.2017.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/27/2017] [Accepted: 10/31/2017] [Indexed: 12/14/2022]
Abstract
With the introduction of novel treatments paradigms to if or when to use transplantation strategies for patients with follicular lymphoma have changed substantially. Autologous transplantation has been intensively evaluated as consolidation after first induction treatment with positive effects, however the introduction of Rituximab led to comparable improvements and HDT has been moved to relapse treatment. In this indication HDT was frequently use already at first relapse, but now is dominantly used in patients with a highrisk profile, e.g. failure of response, early or multiply relapse and/or signs of transformation. The ideal place for allogeneic transplantation is even harder to define, as the curative potential might be outweighed by the substantial side effect profile and the indication must always be discussed in the light of available alternatives. In consequence, transplantation strategies remain an important therapeutic instrument for patients with FL, however timing within the treatment course has to be defined individually.
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Affiliation(s)
- Georg Hess
- Department of Hematology, Oncology and Pneumology, University Cancer Center Mainz, University Medical School of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany.
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136
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Tsukamoto T, Nakano M, Sato R, Adachi H, Kiyota M, Kawata E, Uoshima N, Yasukawa S, Chinen Y, Mizutani S, Shimura Y, Kobayashi T, Horiike S, Yanagisawa A, Taniwaki M, Tashiro K, Kuroda J. High-risk follicular lymphomas harbour more somatic mutations including those in the AID-motif. Sci Rep 2017; 7:14039. [PMID: 29070849 PMCID: PMC5656578 DOI: 10.1038/s41598-017-14150-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 10/05/2017] [Indexed: 01/11/2023] Open
Abstract
We investigated clinical and genetic characteristics of high-risk follicular lymphoma (FL), that lacked evidence of large cell transformation at diagnosis, in the rituximab era. First, we retrospectively analysed the clinical features of 100 patients with non-transformed FL that were consecutively treated with rituximab-containing therapies in a discovery cohort. The presence of either peripheral blood and/or bone involvement was associated with short progression-free survival. This was confirmed in a validation cohort of 66 FL patients. Then, whole exome sequencing was performed on randomly selected 5 high- and 9 standard-risk FL tumours. The most common mutational signature was a CG > TG substitution-enriched signature associated with spontaneous deamination of 5-methylcytosine at CpG, but mutations in WA and WRC(Y) motifs (so-called activation-induced cytidine deaminase (AID) motifs) were also enriched throughout the whole exome. We found clustered mutations in target sequences of AID in the IG and BCL2 loci. Importantly, high-risk FLs harboured more somatic mutations (mean 190 vs. 138, P = 0.04), including mutations in WA (33 vs. 22, P = 0.038), WRC (34 vs. 22, P = 0.016) and WRCY motifs (17 vs. 11, P = 0.004). These results suggest that genomic instability that allows for emergence of distinct mutations through AID activity underlies development of the high-risk FL phenotype.
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Affiliation(s)
- Taku Tsukamoto
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masakazu Nakano
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryuichi Sato
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroko Adachi
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Miki Kiyota
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Hematology, Matsushita Memorial Hospital, Osaka, Japan
| | - Eri Kawata
- Department of Hematology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Nobuhiko Uoshima
- Department of Hematology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Satoru Yasukawa
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshiaki Chinen
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinsuke Mizutani
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Shimura
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsutomu Kobayashi
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigeo Horiike
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akio Yanagisawa
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masafumi Taniwaki
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kei Tashiro
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Junya Kuroda
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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137
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Sorigue M, Sancho JM. Current prognostic and predictive factors in follicular lymphoma. Ann Hematol 2017; 97:209-227. [PMID: 29032510 DOI: 10.1007/s00277-017-3154-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 10/09/2017] [Indexed: 12/27/2022]
Abstract
Follicular lymphoma (FL) is generally considered an indolent disorder. With modern day treatments, long remissions are often achieved both in the front-line and relapsed setting. However, a subset of patients has a more aggressive course and a worse outcome. Their identification is the main purpose of modern day prognostic tools. In this review, we attempt to summarize the evidence concerning prognostic and predictive factors in FL, including (1) pre-treatment factors, from baseline clinical characteristics and imaging tests to histological grade, the microenvironment and genomic abnormalities; (2) post-treatment factors, i.e., depth of response, measured both by imaging tests and minimal residual disease; (3) factors at relapse and duration of response; and (4) prognostic factors in histological transformation. We conclude that, despite the existence of numerous tools, the availability of some of them is still limited; they generally suffer from notable downsides, and most have unproven predictive value, thus having scarce bearing on the choice of regimen at present. However, with the technological and scientific developments of the last few years, the potential for these prognostic factors is promising, particularly in combination, which will probably, in time, help guide therapeutic decisions.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols
- Bone Marrow/drug effects
- Bone Marrow/metabolism
- Bone Marrow/pathology
- Chromosomes, Human, Pair 14/chemistry
- Chromosomes, Human, Pair 18/chemistry
- Clinical Trials as Topic
- Disease-Free Survival
- Humans
- Lymphoma, Follicular/diagnostic imaging
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/mortality
- Mutation
- Neoplasm Grading
- Neoplasm, Residual/diagnostic imaging
- Neoplasm, Residual/drug therapy
- Neoplasm, Residual/genetics
- Neoplasm, Residual/mortality
- Positron-Emission Tomography
- Prognosis
- Recurrence
- Risk Factors
- Translocation, Genetic
- Tumor Suppressor Protein p53/genetics
- Tumor Suppressor Protein p53/metabolism
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Affiliation(s)
- Marc Sorigue
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Ctra. Canyet, 08916, Badalona, Spain.
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Ctra. Canyet, 08916, Badalona, Spain
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138
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The promises and challenges of using gene mutations for patient stratification in follicular lymphoma. Blood 2017; 130:1491-1498. [DOI: 10.1182/blood-2017-07-737353] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/07/2017] [Indexed: 02/07/2023] Open
Abstract
Abstract
Follicular lymphoma (FL) is a clinically and molecularly highly heterogeneous disease. Most patients achieve long-lasting remissions and have excellent overall survival (OS) with current treatment. However, ∼20% of patients have early progression of disease and short OS. At present, therapies are not guided by individual risk or disease biology. Reliable tools for patient stratification are urgently needed to avoid overtreatment of low-risk patients and to prioritize alternative approaches in high-risk patients. A rapidly expanding repertoire of promising therapeutic options is available for clinical evaluation; however, the numbers of patients with FL and the resources to conduct adequately powered trials are limited. Recent studies have shown that gene mutations can serve as prognostic and/or predictive biomarkers, in particular when integrated into composite risk models. Before translating these findings into routine clinical practice, however, several challenges loom. We review aspects of “clinicogenetic” risk model development and validation that apply to FL and more generally to other cancers. Finally, we propose a crowdsourcing effort that could expedite the development, validation, refinement, and selection of risk models. A new era of collaboration and harmonization is required if we hope to transition from empiric selection of therapeutics to risk-based, biology-guided treatment of patients with FL.
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139
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Abstract
New therapies are needed for patients with Hodgkin or non-Hodgkin lymphomas that are resistant to standard therapies. Indeed, unresponsiveness to standard chemotherapy and relapse after autologous stem-cell transplantation are indicators of an especially poor prognosis. Chimeric antigen receptor (CAR) T cells are emerging as a novel treatment modality for these patients. Clinical trial data have demonstrated the potent activity of anti-CD19 CAR T cells against multiple subtypes of B-cell lymphoma, including diffuse large-B-cell lymphoma (DLBCL), follicular lymphoma, mantle-cell lymphoma, and marginal-zone lymphoma. Importantly, anti-CD19 CAR T cells have impressive activity against chemotherapy-refractory lymphoma, inducing durable complete remissions lasting >2 years in some patients with refractory DLBCL. CAR-T-cell therapies are, however, associated with potentially fatal toxicities, including cytokine-release syndrome and neurological toxicities. CAR T cells with novel target antigens, including CD20, CD22, and κ-light chain for B-cell lymphomas, and CD30 for Hodgkin and T-cell lymphomas, are currently being investigated in clinical trials. Centrally manufactured CAR T cells are also being tested in industry-sponsored multicentre clinical trials, and will probably soon become a standard therapy. Herein, we review the clinical efficacy and toxicity of CAR-T-cell therapies for lymphoma, and discuss their limitations and future directions with regard to toxicity management, CAR designs and CAR-T-cell phenotypes, conditioning regimens, and combination therapies.
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140
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Can histologic transformation of follicular lymphoma be predicted and prevented? Blood 2017; 130:258-266. [DOI: 10.1182/blood-2017-03-691345] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/06/2017] [Indexed: 12/28/2022] Open
Abstract
Abstract
Transformation to aggressive lymphoma is a critical event in the clinical course of follicular lymphoma (FL) patients. Yet, it is a challenge to reliably predict transformation at the time of diagnosis. Understanding the risk of transformation would be useful for guiding and monitoring patients, as well as for evaluating novel treatment strategies that could potentially prevent transformation. Herein, we review the contribution of clinical, pathological, and genetic risk factors to transformation. Patients with multiple clinical high-risk factors are at elevated risk of transformation but we are currently lacking a prognostic index that would specifically address transformation rather than disease progression or overall survival. From the biological standpoint, multiple studies have correlated individual biomarkers with transformation. However, accurate prediction of this event is currently hampered by our limited knowledge of the evolutionary pathways leading to transformation, as well as the scarcity of comprehensive, large-scale studies that assess both the genomic landscape of alterations within tumor cells and the composition of the microenvironment. Liquid biopsies hold great promise for achieving precision medicine. Indeed, mutations detected within circulating tumor DNA may be a better reflection of the inherent intratumoral heterogeneity than the biopsy of a single site. Last, we will assess whether evidence exists in the literature that transformation might be prevented altogether, based on the choice of therapy for FL.
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141
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Evolution of lymphoma staging and response evaluation: current limitations and future directions. Nat Rev Clin Oncol 2017; 14:631-645. [DOI: 10.1038/nrclinonc.2017.78] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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142
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EZH2 alterations in follicular lymphoma: biological and clinical correlations. Blood Cancer J 2017; 7:e555. [PMID: 28430172 PMCID: PMC5436075 DOI: 10.1038/bcj.2017.32] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/23/2017] [Accepted: 03/02/2017] [Indexed: 12/19/2022] Open
Abstract
The histone methyltransferase EZH2 has an essential role in the development of follicular lymphoma (FL). Recurrent gain-of-function mutations in EZH2 have been described in 25% of FL patients and induce aberrant methylation of histone H3 lysine 27 (H3K27). We evaluated the role of EZH2 genomic gains in FL biology. Using RNA sequencing, Sanger sequencing and SNP-arrays, the mutation status, copy-number and gene-expression profiles of EZH2 were assessed in a cohort of 159 FL patients from the PRIMA trial. Immunohistochemical (IHC) EZH2 expression (n=55) and H3K27 methylation (n=63) profiles were also evaluated. In total, 37% of patients (59/159) harbored an alteration in the EZH2 gene (mutation n=46, gain n=23). Both types of alterations were associated with highly similar transcriptional changes, with increased proliferation programs. An H3K27me3/me2 IHC score fully distinguished mutated from wild-type samples, showing its applicability as surrogate for EZH2 mutation analysis. However, this score did not predict the presence of gains at the EZH2 locus. The presence of an EZH2 genetic alteration was an independent factor associated with a longer progression-free survival (hazard ratio 0.58, 95% confidence interval 0.36–0.93, P=0.025). We propose that the copy-number status of EZH2 should also be considered when evaluating patient stratification and selecting patients for EZH2 inhibitor-targeted therapies.
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143
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Stevens WBC, Mendeville M, Redd R, Clear AJ, Bladergroen R, Calaminici M, Rosenwald A, Hoster E, Hiddemann W, Gaulard P, Xerri L, Salles G, Klapper W, Pfreundschuh M, Jack A, Gascoyne RD, Natkunam Y, Advani R, Kimby E, Sander B, Sehn LH, Hagenbeek A, Raemaekers J, Gribben J, Kersten MJ, Ylstra B, Weller E, de Jong D. Prognostic relevance of CD163 and CD8 combined with EZH2 and gain of chromosome 18 in follicular lymphoma: a study by the Lunenburg Lymphoma Biomarker Consortium. Haematologica 2017; 102:1413-1423. [PMID: 28411252 PMCID: PMC6643731 DOI: 10.3324/haematol.2017.165415] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/11/2017] [Indexed: 01/25/2023] Open
Abstract
In follicular lymphoma, studies addressing the prognostic value of microenvironment-related immunohistochemical markers and tumor cell-related genetic markers have yielded conflicting results, precluding implementation in practice. Therefore, the Lunenburg Lymphoma Biomarker Consortium performed a validation study evaluating published markers. To maximize sensitivity, an end of spectrum design was applied for 122 uniformly immunochemotherapy-treated follicular lymphoma patients retrieved from international trials and registries. The criteria were: early failure, progression or lymphoma-related death <2 years versus long remission, response duration of >5 years. Immunohistochemical staining for T cells and macrophages was performed on tissue microarrays from initial biopsies and scored with a validated computer-assisted protocol. Shallow whole-genome and deep targeted sequencing was performed on the same samples. The 96/122 cases with complete molecular and immunohistochemical data were included in the analysis. EZH2 wild-type (P=0.006), gain of chromosome 18 (P=0.002), low percentages of CD8+ cells (P=0.011) and CD163+ areas (P=0.038) were associated with early failure. No significant differences in other markers were observed, thereby refuting previous claims of their prognostic significance. Using an optimized study design, this Lunenburg Lymphoma Biomarker Consortium study substantiates wild-type EZH2 status, gain of chromosome 18, low percentages of CD8+ cells and CD163+ area as predictors of early failure to immunochemotherapy in follicular lymphoma treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP [-like]), while refuting the prognostic impact of various other markers.
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Affiliation(s)
| | - Matias Mendeville
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Robert Redd
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andrew J Clear
- Centre for Haemato-Oncology, Barts Cancer Institute, University of London, UK
| | - Reno Bladergroen
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Maria Calaminici
- Centre for Haemato-Oncology, Barts Cancer Institute, University of London, UK
| | - Andreas Rosenwald
- Institute of Pathology, Comprehensive Cancer Center Mainfranken, University of Würzburg, Germany
| | - Eva Hoster
- Department of Medicine III, University Hospital Grosshadern, Munich, Germany
| | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital Grosshadern, Munich, Germany
| | - Philippe Gaulard
- Department of Pathology and Inserm U955, Hôpital Henri Mondor, University Paris-Est, Créteil, France
| | - Luc Xerri
- Département de Biopathologie, Institut Paoli-Calmettes, Marseille, France
| | - Gilles Salles
- Service d'Hématologie,Hospices Civils de Lyon & Université Claude Bernard Lyon-1, UMR CNRS 5239, France
| | - Wolfram Klapper
- Institute of Pathology, University of Schleswig-Holstein, Kiel, Germany
| | | | - Andrew Jack
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Randy D Gascoyne
- Department of Pathology & Medical Oncology, Centre for Lymphoid Cancer, British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada
| | - Yasodha Natkunam
- Department of Pathology, Stanford University School of Medicine, CA, USA
| | - Ranjana Advani
- Department of Hematology, Stanford University School of Medicine, CA, USA
| | - Eva Kimby
- Department of Medicine, Division of Hematology, Karolinska Institute, Stockholm, Sweden
| | - Birgitta Sander
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Laurie H Sehn
- Department of Pathology & Medical Oncology, Centre for Lymphoid Cancer, British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada
| | - Anton Hagenbeek
- Department of Hematology, Academic Medical Center, Amsterdam, the Netherlands
| | - John Raemaekers
- Department of Hematology, Radboudumc, Nijmegen, the Netherlands
| | - John Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, University of London, UK
| | - Marie José Kersten
- Department of Hematology, Academic Medical Center, Amsterdam, the Netherlands
| | - Bauke Ylstra
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Edie Weller
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Daphne de Jong
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
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144
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Idelalisib is effective in patients with high-risk follicular lymphoma and early relapse after initial chemoimmunotherapy. Blood 2017; 129:3037-3039. [PMID: 28325864 DOI: 10.1182/blood-2016-12-757740] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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145
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Frazzi R, Zanetti E, Pistoni M, Tamagnini I, Valli R, Braglia L, Merli F. Methylation changes of SIRT1, KLF4, DAPK1 and SPG20 in B-lymphocytes derived from follicular and diffuse large B-cell lymphoma. Leuk Res 2017; 57:89-96. [PMID: 28324774 DOI: 10.1016/j.leukres.2017.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/26/2017] [Accepted: 02/26/2017] [Indexed: 12/24/2022]
Abstract
Diffuse large-B cell lymphomas (DLBCL) and follicular lymphomas (FL) are the most represented subtypes among mature B-cell neoplasms and originate from malignant B lymphocytes. Methylation represents one of the major epigenetic mechanisms of gene regulation. Silent information regulator 1 (SIRT1) is a class III lysine-deacetylase playing several functions and considered to be a context-dependent tumor promoter. We present the quantitative methylation, gene expression and tissue distribution of SIRT1 and some key mediators related to lymphoma pathogenesis in B lymphocytes purified from biopsies of follicular hyperplasias, FL and DLBCL. SIRT1 mRNA levels are higher in FL than follicular hyperplasias and DLBCL. B cell lymphoma 6 (BCL6) positively correlates with SIRT1. SIRT1 promoter shows a methylation decrease in the order: follicular hyperplasia - FL - DLBCL. Kruppel-like factor 4 (KLF4), Death-associated protein kinase 1 (DAPK1) and Spastic Paraplegia 20 (SPG20) methylation increase significantly in FL and DLBCL compared to follicular hyperplasias. Gene expression of DAPK1 and SPG20 inversely correlates with their degree of methylation. Our findings evidence a positive correlation between SIRT1 and BCL6 expression increase in FL. SIRT1 methylation decreases in FL and DLBCL accordingly and this parallels the increase of KLF4, DAPK1 and SPG20 methylation.
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Affiliation(s)
- Raffaele Frazzi
- Laboratory of Translational Research, Arcispedale S. Maria Nuova IRCCS, Viale Risorgimento 80, 42124 Reggio Emilia, Italy.
| | - Eleonora Zanetti
- Laboratory of Translational Research, Arcispedale S. Maria Nuova IRCCS, Viale Risorgimento 80, 42124 Reggio Emilia, Italy.
| | - Mariaelena Pistoni
- Laboratory of Translational Research, Arcispedale S. Maria Nuova IRCCS, Viale Risorgimento 80, 42124 Reggio Emilia, Italy.
| | - Ione Tamagnini
- Pathology Division, Arcispedale S. Maria Nuova IRCCS, Viale Risorgimento 80, 42124 Reggio Emilia, Italy.
| | - Riccardo Valli
- Pathology Division, Arcispedale S. Maria Nuova IRCCS, Viale Risorgimento 80, 42124 Reggio Emilia, Italy.
| | - Luca Braglia
- Scientific Direction, Arcispedale S. Maria Nuova IRCCS, Viale Umberto I, 42123 Reggio Emilia, Italy.
| | - Francesco Merli
- Hematology Division, Arcispedale S. Maria Nuova IRCCS, Viale Risorgimento 80, 42124 Reggio Emilia, Italy.
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146
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Nandagopal L, Mehta A. Treatment approaches of hard-to-treat non-Hodgkin lymphomas. Expert Rev Hematol 2017; 10:259-273. [DOI: 10.1080/17474086.2017.1283214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Amitkumar Mehta
- Hematology & Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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147
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Sorigue M, Mercadal S, Alonso S, Fernández-Álvarez R, García O, Moreno M, Pomares H, Alcoceba M, González-García E, Motlló C, González-Barca E, Martin A, Sureda A, Caballero D, Ribera JM, Sancho JM. Refractoriness to immunochemotherapy in follicular lymphoma: Predictive factors and outcome. Hematol Oncol 2017; 35:520-527. [PMID: 28156010 DOI: 10.1002/hon.2378] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/17/2016] [Accepted: 11/28/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Marc Sorigue
- Department of Hematology. ICO-Badalona, Hospital Germans Trias i Pujol, Institut de Recerce Josep Carreras; Universitat Autònoma de Barcelona; Badalona Spain
| | - Santiago Mercadal
- Department of Hematology. ICO-Duran y Reynals; Hospitalet de Llobregat; Bacelona Spain
| | - Sara Alonso
- Department of Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | | | - Olga García
- Department of Clinical Hematology. ICO-Badalona, Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras; Universitat Autònoma de Barcelona; Badalona Spain
| | - Miriam Moreno
- Department of Clinical Hematology. ICO-Badalona, Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras; Universitat Autònoma de Barcelona; Badalona Spain
| | - Helena Pomares
- Department of Hematology. ICO-Duran y Reynals; Hospitalet de Llobregat; Bacelona Spain
| | - Miguel Alcoceba
- Department of Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | | | - Cristina Motlló
- Department of Clinical Hematology. ICO-Badalona, Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras; Universitat Autònoma de Barcelona; Badalona Spain
| | - Eva González-Barca
- Department of Hematology. ICO-Duran y Reynals; Hospitalet de Llobregat; Bacelona Spain
| | - Alejandro Martin
- Department of Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | - Anna Sureda
- Department of Hematology. ICO-Duran y Reynals; Hospitalet de Llobregat; Bacelona Spain
| | - Dolores Caballero
- Department of Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | - Josep-María Ribera
- Department of Clinical Hematology. ICO-Badalona, Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras; Universitat Autònoma de Barcelona; Badalona Spain
| | - Juan-Manuel Sancho
- Department of Clinical Hematology. ICO-Badalona, Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras; Universitat Autònoma de Barcelona; Badalona Spain
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148
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Gritti G, Pavoni C, Rambaldi A. Is There a Role for Minimal Residual Disease Monitoring in Follicular Lymphoma in the Chemo-Immunotherapy Era? Mediterr J Hematol Infect Dis 2017; 9:e2017010. [PMID: 28101314 PMCID: PMC5224815 DOI: 10.4084/mjhid.2017.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 11/24/2016] [Indexed: 11/23/2022] Open
Abstract
After 25 years, evaluation of minimal residual disease (MRD) in follicular lymphoma (FL) has become a standardized technique frequently integrated into clinical trials for its consistent and independent prognostic significance. Achievement of a sustained MRD negativity is a marker of treatment sensibility that has been associated with excellent clinical outcome in terms of clinical response and progression-free survival, independently from the employed therapy. However, no survival advantages has been reported for MRD negative patients and despite the compelling results of clinical trials, MRD evaluation has currently no role in clinical practice. Ongoing clinical trials will help in clarifying the potential setting in which MRD monitoring may have a routine clinical application i.e. allowing de-escalation of standard maintenance therapy in very low risk patients. In this review the clinical implications of MRD monitoring in Rituximab-era are discussed in light of the current treatment paradigms most aimed at reducing toxicities, and the response definition that now routinely integrates PET scan.
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Affiliation(s)
- Giuseppe Gritti
- Hematology and Bone Marrow Transplant Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Pavoni
- Hematology and Bone Marrow Transplant Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandro Rambaldi
- Hematology and Bone Marrow Transplant Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy
- Department of Oncology and Oncohematology, Università degli Studi di Milano, Milano, Italy
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149
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Sehn LH. Novel agents in follicular lymphoma: choosing the best target. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:284-292. [PMID: 27913493 PMCID: PMC6142508 DOI: 10.1182/asheducation-2016.1.284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Outcomes in patients with follicular lymphoma (FL) have improved dramatically over the last decade. However, novel agents are greatly needed for those who exhibit treatment resistance, in order to minimize lifelong toxicity and to enable combinations that may allow us to achieve the elusive goal of cure. Biological advances have led to the discovery of a large number of potential therapeutic targets and the development of a plethora of novel agents designed to exploit these processes. Possible targets include tumor cell surface markers, key components of intracellular pathways and epigenetic mechanisms, and reactive cells of the microenvironment. Given the large number of candidate drugs and potential combinations, it will be crucial to prioritize evaluation based on sound preclinical and early clinical studies. Combinations that exploit driver mechanisms within tumor cells and target parallel pathways to minimize the development of drug resistance, as well as harness the potential of the immune system would seem most logical. In order to expedite progress, future studies will need to use innovative trial designs and employ surrogate end points. The development of validated prognostic tools to identify higher risk patients and reliable predictive markers to select subgroups most likely to benefit from targeted agents will be paramount. The potential for unexpected toxicity with novel combinations must be recognized, necessitating both short- and long-term vigilance. Finally, as a greater number of treatment options become available, optimal sequencing must be determined in order to both prolong life and maintain its quality.
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Affiliation(s)
- Laurie H Sehn
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, and the University of British Columbia, Vancouver, Canada
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150
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Histological Transformation and Progression in Follicular Lymphoma: A Clonal Evolution Study. PLoS Med 2016; 13:e1002197. [PMID: 27959929 PMCID: PMC5154502 DOI: 10.1371/journal.pmed.1002197] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/07/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Follicular lymphoma (FL) is an indolent, yet incurable B cell malignancy. A subset of patients experience an increased mortality rate driven by two distinct clinical end points: histological transformation and early progression after immunochemotherapy. The nature of tumor clonal dynamics leading to these clinical end points is poorly understood, and previously determined genetic alterations do not explain the majority of transformed cases or accurately predict early progressive disease. We contend that detailed knowledge of the expansion patterns of specific cell populations plus their associated mutations would provide insight into therapeutic strategies and disease biology over the time course of FL clinical histories. METHODS AND FINDINGS Using a combination of whole genome sequencing, targeted deep sequencing, and digital droplet PCR on matched diagnostic and relapse specimens, we deciphered the constituent clonal populations in 15 transformation cases and 6 progression cases, and measured the change in clonal population abundance over time. We observed widely divergent patterns of clonal dynamics in transformed cases relative to progressed cases. Transformation specimens were generally composed of clones that were rare or absent in diagnostic specimens, consistent with dramatic clonal expansions that came to dominate the transformation specimens. This pattern was independent of time to transformation and treatment modality. By contrast, early progression specimens were composed of clones that were already present in the diagnostic specimens and exhibited only moderate clonal dynamics, even in the presence of immunochemotherapy. Analysis of somatic mutations impacting 94 genes was undertaken in an extension cohort consisting of 395 samples from 277 patients in order to decipher disrupted biology in the two clinical end points. We found 12 genes that were more commonly mutated in transformed samples than in the preceding FL tumors, including TP53, B2M, CCND3, GNA13, S1PR2, and P2RY8. Moreover, ten genes were more commonly mutated in diagnostic specimens of patients with early progression, including TP53, BTG1, MKI67, and XBP1. CONCLUSIONS Our results illuminate contrasting modes of evolution shaping the clinical histories of transformation and progression. They have implications for interpretation of evolutionary dynamics in the context of treatment-induced selective pressures, and indicate that transformation and progression will require different clinical management strategies.
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