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Egle A, Pleyer L, Melchardt T, Hartmann TN, Greil R. Remission maintenance treatment options in chronic lymphocytic leukemia. Cancer Treat Rev 2018; 70:56-66. [PMID: 30121491 DOI: 10.1016/j.ctrv.2018.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/02/2018] [Accepted: 08/07/2018] [Indexed: 02/07/2023]
Abstract
Chronic lymphocytic leukemia (CLL) treatment has come a long way in the last two decades, producing increases in tumor control to the point of generating sizeable numbers of patients with undetectable minimal residual disease and creating overall survival benefits in randomized comparisons. Most of this has been achieved by limited-term treatment approaches including chemotherapeutic and immune-therapeutic drugs. More recently, novel therapies targeting signaling pathways essential for the survival of the neoplastic clones have opened avenues that provide disease control in long-term treatment designs, mostly without producing deep remissions. In this disease, where current treatments are largely unable to effect a cure, prolonged therapy designs using maintenance approaches are explored and 5 randomized studies of maintenance have recently been published. This review shall summarize available results from a systematic literature review in a clinical context and outline basic biology principles that should be heeded in this regard.
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Affiliation(s)
- Alexander Egle
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Disease, Rheumatology, Oncologic Center, Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University Salzburg, Austria; Salzburg Cancer Research Institute and Cancer Cluster Salzburg, Austria
| | - Lisa Pleyer
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Disease, Rheumatology, Oncologic Center, Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University Salzburg, Austria; Salzburg Cancer Research Institute and Cancer Cluster Salzburg, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Disease, Rheumatology, Oncologic Center, Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University Salzburg, Austria; Salzburg Cancer Research Institute and Cancer Cluster Salzburg, Austria
| | - Tanja Nicole Hartmann
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Disease, Rheumatology, Oncologic Center, Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University Salzburg, Austria; Salzburg Cancer Research Institute and Cancer Cluster Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Disease, Rheumatology, Oncologic Center, Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University Salzburg, Austria; Salzburg Cancer Research Institute and Cancer Cluster Salzburg, Austria.
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202
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An Evidence-based Review of Anti-CD20 Antibody-containing Regimens for the Treatment of Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia, Diffuse Large B-cell Lymphoma, or Follicular Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:508-518.e14. [DOI: 10.1016/j.clml.2018.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/30/2018] [Accepted: 05/14/2018] [Indexed: 12/11/2022]
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Schuh AH, Parry-Jones N, Appleby N, Bloor A, Dearden CE, Fegan C, Follows G, Fox CP, Iyengar S, Kennedy B, McCarthy H, Parry HM, Patten P, Pettitt AR, Ringshausen I, Walewska R, Hillmen P. Guideline for the treatment of chronic lymphocytic leukaemia: A British Society for Haematology Guideline. Br J Haematol 2018; 182:344-359. [PMID: 30009455 DOI: 10.1111/bjh.15460] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Anna H Schuh
- NIHR BRC Oxford Molecular Diagnostic Centre, Oxford University Hospitals NHS Trust and Department of Oncology, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Nilima Parry-Jones
- Department of Haematology, Aneurin Bevan University Health Board, Abergavenny, UK
| | - Niamh Appleby
- NIHR BRC Oxford Molecular Diagnostic Centre, Oxford University Hospitals NHS Trust and Department of Oncology, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | | | | | | | | | - Christopher P Fox
- Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Ben Kennedy
- Department of Haematology, University Hospital Leicester, Leicester, UK
| | - Helen McCarthy
- Haematology, Bournemouth and Christchurch Hospitals, Bournemouth, UK
| | - Helen M Parry
- NIHR-ACL Haematology, University of Birmingham, Birmingham, UK
| | | | | | | | - Renata Walewska
- Haematology, Bournemouth and Christchurch Hospitals, Bournemouth, UK
| | - Peter Hillmen
- Haematology, Leeds Teaching Hospital NHS Trust, Leeds, UK
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Faisal MS, Shaikh H, Khattab A, Albrethsen M, Fazal S. Cerebral aspergillosis in a patient on ibrutinib therapy-A predisposition not to overlook. J Oncol Pharm Pract 2018; 25:1486-1490. [PMID: 30045683 DOI: 10.1177/1078155218788717] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ibrutinib has revolutionized the treatment of B-cell malignancies since its approval for chronic lymphocytic leukemia. It is also used in mantle cell lymphoma, diffuse large B-cell lymphoma, Waldenstrom's macroglobulinemia, among others. It is a Bruton's tyrosine kinase inhibitor that acts on B-cell receptor signaling pathway and predisposes to various infections due to its effects on neutrophils, monocytes and T cells. We present a case of cerebral invasive aspergillosis in a patient being treated with ibrutinib for relapsed chronic lymphocytic leukemia. It was hard to associate the condition to ibrutinib versus the chronic lymphocytic leukemia. The patient was successfully treated with a combination of voriconazole and micafungin, resulting in complete recovery and no residual deficits. This highlights the importance of recognizing the rare complication in those on ibrutinib and initiating the treatment immediately with appropriate antifungal agents to improve prognosis of this potentially fatal condition.
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Affiliation(s)
| | - Hira Shaikh
- 1 Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Ahmed Khattab
- 1 Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Mary Albrethsen
- 2 Department of Hematology-Oncology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Salman Fazal
- 2 Department of Hematology-Oncology, Allegheny Health Network, Pittsburgh, PA, USA
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205
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Tam CS, Brown JR. Vigilance for ibrutinib-associated ventricular arrhythmias: rare but be aware. Leuk Lymphoma 2018; 59:2767-2768. [PMID: 30032684 DOI: 10.1080/10428194.2018.1482546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Constantine S Tam
- a Peter MacCallum Cancer Center, St Vincent's Hospital and University of Melbourne , Melbourne , Australia
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206
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Mauro FR, Caputo MD, Rosati S, Pepe S, De Benedittis D, De Luca ML, Foà R. Balancing efficacy and toxicity of targeted agents currently used for the treatment of patients with chronic lymphocytic leukemia. Expert Rev Hematol 2018; 11:601-611. [PMID: 29969322 DOI: 10.1080/17474086.2018.1495557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION In recent years, innovative mechanism-based drugs have enriched the therapeutic armamentarium for patients with chronic lymphocytic leukemia (CLL) and are widely used in the clinical practice. These small molecules targeting the B-cell receptor signaling pathway and the BCL-2 anti-apoptotic protein offer new chemo-free options to both unfit patients and high-risk patients who show a poor response to chemoimmunotherapy. Nonetheless, treatment with ibrutinib, idelalisib and venetoclax is associated with unique side effects. Awareness, prevention and the appropriate management of these specific toxicities are of crucial importance for a successful treatment. Areas covered: The purpose of this review is to discuss the most relevant studies on small molecules in CLL, with particular attention to the emerging toxicity profile of these agents and to the factors that should be considered to address the most appropriate treatment approach for each patient. Expert opinion: The increased knowledge on the biology of CLL has translated into the development of targeted agents that are highly effective and produce deep responses. Toxicities potentially associated with these agents should be known for an optimal management of CLL patients.
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Affiliation(s)
- Francesca R Mauro
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University and Policlinico Umberto 1 , Rome , Italy
| | - Maria D Caputo
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University and Policlinico Umberto 1 , Rome , Italy
| | - Serena Rosati
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University and Policlinico Umberto 1 , Rome , Italy
| | - Sara Pepe
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University and Policlinico Umberto 1 , Rome , Italy
| | - Daniela De Benedittis
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University and Policlinico Umberto 1 , Rome , Italy
| | - Maria L De Luca
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University and Policlinico Umberto 1 , Rome , Italy
| | - Robin Foà
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University and Policlinico Umberto 1 , Rome , Italy
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Brown JR. Still a role for second-line chemoimmunotherapy in chronic lymphocytic leukemia? Haematologica 2018; 103:1096-1098. [PMID: 29970493 DOI: 10.3324/haematol.2018.196014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Jennifer R Brown
- CLL Center, Division of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
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208
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O'Brien S, Hillmen P, Coutre S, Barr PM, Fraser G, Tedeschi A, Burger JA, Dilhuydy MS, Hess G, Moreno C, Cramer P, Liu E, Chang S, Vermeulen J, Styles L, Howes A, James DF, Patel K, Graef T, Valentino R. Safety Analysis of Four Randomized Controlled Studies of Ibrutinib in Patients With Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma or Mantle Cell Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:648-657.e15. [PMID: 30061088 DOI: 10.1016/j.clml.2018.06.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/16/2018] [Accepted: 06/19/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Multiple studies have demonstrated the efficacy and safety of ibrutinib for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and mantle cell lymphoma (MCL). This first-in-class inhibitor of Bruton's tyrosine kinase has become a standard treatment for patients with CLL and MCL. PATIENTS AND METHODS We conducted an integrated safety analysis to characterize the frequency, severity, natural history, and outcomes of adverse events (AEs) with ibrutinib versus comparators. Data were pooled from 4 completed randomized controlled studies that had included 756 ibrutinib-treated and 749 comparator-treated patients with CLL/SLL or relapsed/refractory MCL. Safety analyses included reporting of AEs using crude and exposure-adjusted incidence rates. RESULTS The median treatment duration was 13.3 months (maximum, 28.2 months) for ibrutinib and 5.8 months (maximum, 27.3 months) for comparators. When adjusted for exposure, diarrhea, atrial fibrillation, and hypertension were the only common grade ≥ 3 AEs more often reported with ibrutinib than with the comparators. Dose reductions (7% vs. 14%) and discontinuation (12% vs. 16%) because of AEs occurred less often with ibrutinib, and deaths due to AEs occurred at similar rates (6% vs. 7%). When adjusted for exposure, the corresponding data were all lower with ibrutinib than with the comparators (0.06 vs. 0.22, 0.11 vs. 0.22, and 0.06 vs. 0.09 patient-exposure-years, respectively). The prevalence of common grade 3/4 AEs with ibrutinib generally decreased over time, with the exception of hypertension. CONCLUSION These results from an integrated analysis support a favorable benefit/risk profile of ibrutinib in patients with CLL/SLL and MCL.
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Affiliation(s)
- Susan O'Brien
- Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange, CA.
| | - Peter Hillmen
- The Leeds Teaching Hospitals, St. James University Hospital, Leeds, United Kingdom
| | - Steven Coutre
- Stanford University School of Medicine, Stanford, CA
| | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester Cancer Center, Rochester, NY
| | - Graeme Fraser
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | - Jan A Burger
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Georg Hess
- Universitats Medizin Mainz, Mainz, Germany
| | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Paula Cramer
- University of Cologne, German CLL Study Group, Cologne, Germany
| | - Emily Liu
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | | | | | - Lori Styles
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
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209
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Ball S, Vutthikraivit W, Maiti A, Short NJ. Infection with ibrutinib in patients with chronic lymphocytic leukemia: How strong is the association? Eur J Haematol 2018; 101:418-420. [PMID: 29791043 PMCID: PMC10168591 DOI: 10.1111/ejh.13098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Somedeb Ball
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Wasawat Vutthikraivit
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Abhishek Maiti
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicholas J Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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210
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The pH-altering agent omeprazole affects rate but not the extent of ibrutinib exposure. Cancer Chemother Pharmacol 2018; 82:299-308. [PMID: 29882017 DOI: 10.1007/s00280-018-3613-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/28/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE This drug-interaction study evaluated the effect of omeprazole, a proton-pump inhibitor, on ibrutinib's pharmacokinetics (PK) in healthy participants. METHODS This open-label, sequential-design study included 20 healthy adults aged 18-55 years. Ibrutinib (560 mg, single dose) was administered after an overnight fast alone on day 1 and with omeprazole on day 7. Omeprazole (40 mg) alone was administered on days 3-6, 1 h before breakfast; and after an overnight fast on day 7, followed by ibrutinib 2 h later. Blood was sampled on days 1 and 7 for up to 48 h postdose, and the standard PK parameters for ibrutinib and PCI-45227 were summarized using descriptive statistics. The effect of omeprazole on ibrutinib's PK was determined by assessing geometric mean ratios (GMRs) and 90% CIs. Mechanistic modeling was performed using the BTK-receptor occupancy (RO) model. RESULTS AUC48h and AUClast of ibrutinib plus omeprazole versus ibrutinib alone showed a modest decrease (GMR [90% CI] 98.3% [83.1-116.3] and 92.5% [77.8-109.9], respectively); Cmax decreased by 62.5% (GMR [90% CI] 37.5% [26.4-53.4]), with delayed tmax (1-2 h) and terminal half-life unaffected. Mean AUC for PCI-45227 (primary metabolite) was ~ 20% lower with ibrutinib plus omeprazole versus ibrutinib alone. Model predictions showed no impact of decreased Cmax on BTK target engagement. No new safety signals were identified with the use of ibrutinib in this study. CONCLUSIONS The decrease in Cmax without a corresponding decrease in AUC by omeprazole was not clinically relevant for ibrutinib's bioavailability. No dose adjustments are recommended during ibrutinib's co-administration with omeprazole or other pH-altering agents.
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Fludarabine and rituximab with escalating doses of lenalidomide followed by lenalidomide/rituximab maintenance in previously untreated chronic lymphocytic leukaemia (CLL): the REVLIRIT CLL-5 AGMT phase I/II study. Ann Hematol 2018; 97:1825-1839. [PMID: 29862437 PMCID: PMC6097797 DOI: 10.1007/s00277-018-3380-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/21/2018] [Indexed: 12/11/2022]
Abstract
Despite recent advances, chemoimmunotherapy remains a standard for fit previously untreated chronic lymphocytic leukaemia patients. Lenalidomide had activity in early monotherapy trials, but tumour lysis and flare proved major obstacles in its development. We combined lenalidomide in increasing doses with six cycles of fludarabine and rituximab (FR), followed by lenalidomide/rituximab maintenance. In 45 chemo-naive patients, included in this trial, individual tolerability of the combination was highly divergent and no systematic toxicity determining a maximum tolerated dose was found. Grade 3/4 neutropenia (71%) was high, but only 7% experienced grade 3 infections. No tumour lysis or flare > grade 2 was observed, but skin toxicity proved dose-limiting in nine patients (20%). Overall and complete response rates after induction were 89 and 44% by intention-to-treat, respectively. At a median follow-up of 78.7 months, median progression-free survival (PFS) was 60.3 months. Minimal residual disease and immunoglobulin variable region heavy chain mutation state predicted PFS and TP53 mutation most strongly predicted OS. Baseline clinical factors did not predict tolerance to the immunomodulatory drug lenalidomide, but pretreatment immunophenotypes of T cells showed exhausted memory CD4 cells to predict early dose-limiting non-haematologic events. Overall, combining lenalidomide with FR was feasible and effective, but individual changes in the immune system seemed associated with limiting side effects. clinicaltrials.gov (NCT00738829) and EU Clinical Trials Register (www.clinicaltrialsregister.eu, 2008-001430-27)
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Gopal AK, Schuster SJ, Fowler NH, Trotman J, Hess G, Hou JZ, Yacoub A, Lill M, Martin P, Vitolo U, Spencer A, Radford J, Jurczak W, Morton J, Caballero D, Deshpande S, Gartenberg GJ, Wang SS, Damle RN, Schaffer M, Balasubramanian S, Vermeulen J, Cheson BD, Salles G. Ibrutinib as Treatment for Patients With Relapsed/Refractory Follicular Lymphoma: Results From the Open-Label, Multicenter, Phase II DAWN Study. J Clin Oncol 2018; 36:2405-2412. [PMID: 29851546 DOI: 10.1200/jco.2017.76.8853] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The Bruton's tyrosine kinase inhibitor ibrutinib has demonstrated clinical activity in B-cell malignancies. The DAWN study assessed the efficacy and safety of single-agent ibrutinib in chemoimmunotherapy relapsed/refractory follicular lymphoma (FL) patients. Methods DAWN was an open-label, single-arm, phase II study of ibrutinib in patients with FL with two or more prior lines of therapy. Patients received ibrutinib 560 mg daily until progressive disease/unacceptable toxicity. The primary objective was independent review committee-assessed overall response rate (ORR; complete response plus partial response). Exploratory analyses of T-cell subsets in peripheral blood (baseline/cycle 3) and cytokines/chemokines (baseline/cycle 2) were performed for available samples. Results Between March 2013 and May 2016, 110 patients with a median of three prior lines of therapy were enrolled. At median follow-up of 27.7 months, ORR was 20.9% (95% CI, 13.7% to 29.7%, which did not meet the 18% lower-bound threshold for the primary end point). Twelve patients achieved a complete response (11%; 95% CI, 5.8% to 18.3%). Median duration of response was 19.4 months (range, 1 to ≥ 33 months), with a median progression-free survival of 4.6 months and a 30-month overall survival of 61% (95% CI, 0.51% to 0.70%). Lymphoma symptoms resolved in 67%. Seven of 32 patients who experienced initial radiologic progression responded upon continuing therapy (pseudoprogression). The most common adverse events were diarrhea, fatigue, cough, and muscle spasms; 48.2% of patients reported serious adverse events. In patients who experienced a response, regulatory T cells were downregulated at C3D1 ( P = .02), and Th1-promoting (antitumor) cytokines interferon-γ and interleukin-12 increased ( P ≤ .035). Conclusion With an ORR of 20.9%, ibrutinib failed to meet its primary efficacy end point in chemoimmunotherapy in patients with relapsed/refractory FL, although responses were durable and associated with a reduction in regulatory T cells and increases in proinflammatory cytokines.
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Affiliation(s)
- Ajay K Gopal
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Stephen J Schuster
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Nathan H Fowler
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Judith Trotman
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Georg Hess
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Jing-Zhou Hou
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Abdulraheem Yacoub
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Michael Lill
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Peter Martin
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Umberto Vitolo
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Andrew Spencer
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - John Radford
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Wojciech Jurczak
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - James Morton
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Dolores Caballero
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Sanjay Deshpande
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Gary J Gartenberg
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Shean-Sheng Wang
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Rajendra N Damle
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Michael Schaffer
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Sriram Balasubramanian
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Jessica Vermeulen
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Bruce D Cheson
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
| | - Gilles Salles
- Ajay K. Gopal, The University of Washington; Ajay K. Gopal, Fred Hutchinson Cancer Research Center, Seattle, WA; Stephen J. Schuster, Abramson Cancer Center of the University of Pennsylvania, Philadelphia; Jing-Zhou Hou, University of Pittsburgh Medical Center; Jing-Zhou Hou, University of Pittsburgh Cancer Institute, Pittsburgh; Rajendra N. Damle, Michael Schaffer, and Sriram Balasubramanian, Janssen Research & Development, Spring House, PA; Nathan H. Fowler, The University of Texas MD Anderson Cancer Center, Houston, TX; Judith Trotman, Concord Hospital, University of Sydney, Sydney, New South Wales; Andrew Spencer, Alfred Hospital-Monash University, Melbourne, Victoria; James Morton, Haematology and Oncology Clinics of Australia, Milton, Queensland, Australia; Georg Hess, Johannes Gutenberg-University, Mainz, Germany; Abdulraheem Yacoub, Kansas University Medical Center, Kansas City, KS; Michael Lill, Cedars-Sinai Medical Center, Los Angeles, CA; Peter Martin, Weill Cornell Medical College, Cornell University, New York, NY; Umberto Vitolo, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; John Radford, University of Manchester; John Radford, Christie National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wojciech Jurczak, Jagiellonian University, Kraków, Poland; Dolores Caballero, Hospital Clínico Universitario, Salamanca, Spain; Sanjay Deshpande, Gary J. Gartenberg, and Shean-Sheng Wang, Janssen Research & Development, Raritan, NJ; Jessica Vermeulen, Janssen Research & Development, Leiden, the Netherlands; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; and Gilles Salles, Hospices Civils de Lyon-Université de Lyon, Pierre-Bénite cedex, Lyon, France
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213
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Affiliation(s)
- John F Seymour
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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214
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Tomuleasa C, Selicean C, Cismas S, Jurj A, Marian M, Dima D, Pasca S, Petrushev B, Moisoiu V, Micu WT, Vischer A, Arifeen K, Selicean S, Zdrenghea M, Bumbea H, Tanase A, Grewal R, Pop L, Aanei C, Berindan-Neagoe I. Minimal residual disease in chronic lymphocytic leukemia: A consensus paper that presents the clinical impact of the presently available laboratory approaches. Crit Rev Clin Lab Sci 2018; 55:329-345. [PMID: 29801428 DOI: 10.1080/10408363.2018.1463508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is a malignancy defined by the accumulation of mature lymphocytes in the lymphoid tissues, bone marrow, and blood. Therapy for CLL is guided according to the Rai and Binet staging systems. Nevertheless, state-of-the-art protocols in disease monitoring, diagnostics, and prognostics for CLL are based on the assessment of minimal residual disease (MRD). MRD is internationally considered to be the level of disease that can be detected by sensitive techniques and represents incomplete treatment and a probability of disease relapse. MRD detection has been continuously improved by the quick development of both flow cytometry and molecular biology technology, as well as by next-generation sequencing. Considering that MRD detection is moving more and more from research to clinical practice, where it can be an independent prognostic marker, in this paper, we present the methodologies by which MRD is evaluated, from translational research to clinical practice.
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Affiliation(s)
- Ciprian Tomuleasa
- a Department of Hematology , Ion Chiricuta Clinical Cancer Center , Cluj Napoca , Romania.,b Research Center for Functional Genomics and Translational Medicine/Hematology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Cristina Selicean
- a Department of Hematology , Ion Chiricuta Clinical Cancer Center , Cluj Napoca , Romania
| | - Sonia Cismas
- c Department of Genetics , Victor Babes University of Medicine and Pharmacy , Timisoara , Romania.,d Department of Hematology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Anca Jurj
- e Research Center for Functional Genomics and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Mirela Marian
- a Department of Hematology , Ion Chiricuta Clinical Cancer Center , Cluj Napoca , Romania
| | - Delia Dima
- a Department of Hematology , Ion Chiricuta Clinical Cancer Center , Cluj Napoca , Romania
| | - Sergiu Pasca
- e Research Center for Functional Genomics and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Bobe Petrushev
- e Research Center for Functional Genomics and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Vlad Moisoiu
- e Research Center for Functional Genomics and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Wilhelm-Thomas Micu
- e Research Center for Functional Genomics and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Anna Vischer
- d Department of Hematology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Kanza Arifeen
- d Department of Hematology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Sonia Selicean
- d Department of Hematology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Mihnea Zdrenghea
- a Department of Hematology , Ion Chiricuta Clinical Cancer Center , Cluj Napoca , Romania.,d Department of Hematology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Horia Bumbea
- f Department of Hematology , Carol Davila University of Medicine and Pharmacy , Bucharest , Romania.,g Department of Hematology , University Clinical Hospital , Bucharest , Romania
| | - Alina Tanase
- h Department of Stem Cell Transplantation , Fundeni Clinical Institute , Bucharest , Romania
| | - Ravnit Grewal
- i South African Medical Research Council Bioinformatics Unit , The South African National Bioinformatics Institute (SANBI), University of the Western Cape , Bellville , South Africa
| | - Laura Pop
- e Research Center for Functional Genomics and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Carmen Aanei
- j Hematology Laboratory, Pole de Biologie-Pathologie , University Hospital of St. Etienne , St. Etienne , France
| | - Ioana Berindan-Neagoe
- e Research Center for Functional Genomics and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
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215
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Jain N, Thompson P, Ferrajoli A, Nabhan C, Mato AR, O'Brien S. Approaches to Chronic Lymphocytic Leukemia Therapy in the Era of New Agents: The Conundrum of Many Options. Am Soc Clin Oncol Educ Book 2018; 38:580-591. [PMID: 30231393 DOI: 10.1200/edbk_200691] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Three small molecule inhibitors have been approved for the treatment of chronic lymphocytic leukemia (CLL) in the last 4 years. Ibrutinib, idelalisib, and venetoclax are oral agents with excellent efficacy and different toxicity profiles. Issues discussed herein include the current role for chemoimmunotherapy in CLL, the use of oral inhibitors in older patients, and the sequencing of these molecules in daily practice.
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Affiliation(s)
- Nitin Jain
- From the Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Cardinal Health Specialty Solutions, Chicago, IL; Chronic Lymphocytic Leukemia Program, Memorial Sloan Kettering Cancer Center, New York, NY; Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | - Philip Thompson
- From the Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Cardinal Health Specialty Solutions, Chicago, IL; Chronic Lymphocytic Leukemia Program, Memorial Sloan Kettering Cancer Center, New York, NY; Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | - Alessandra Ferrajoli
- From the Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Cardinal Health Specialty Solutions, Chicago, IL; Chronic Lymphocytic Leukemia Program, Memorial Sloan Kettering Cancer Center, New York, NY; Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | - Chadi Nabhan
- From the Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Cardinal Health Specialty Solutions, Chicago, IL; Chronic Lymphocytic Leukemia Program, Memorial Sloan Kettering Cancer Center, New York, NY; Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | - Anthony R Mato
- From the Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Cardinal Health Specialty Solutions, Chicago, IL; Chronic Lymphocytic Leukemia Program, Memorial Sloan Kettering Cancer Center, New York, NY; Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | - Susan O'Brien
- From the Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Cardinal Health Specialty Solutions, Chicago, IL; Chronic Lymphocytic Leukemia Program, Memorial Sloan Kettering Cancer Center, New York, NY; Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
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216
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Early-onset invasive aspergillosis and other fungal infections in patients treated with ibrutinib. Blood 2018; 131:1955-1959. [DOI: 10.1182/blood-2017-11-818286] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 01/20/2018] [Indexed: 11/20/2022] Open
Abstract
Key Points
Ibrutinib may be associated with invasive fungal infections especially IA. Most infections usually occur during the first months of treatment, often in patients with other risk factors for fungal infections.
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217
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Alexandre J, Moslehi JJ, Bersell KR, Funck-Brentano C, Roden DM, Salem JE. Anticancer drug-induced cardiac rhythm disorders: Current knowledge and basic underlying mechanisms. Pharmacol Ther 2018; 189:89-103. [PMID: 29698683 DOI: 10.1016/j.pharmthera.2018.04.009] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Significant advances in cancer treatment have resulted in decreased cancer related mortality for many malignancies with some cancer types now considered chronic diseases. Despite these improvements, there is increasing recognition that many cancer patients or cancer survivors can develop cardiovascular diseases, either due to the cancer itself or as a result of anticancer therapy. Much attention has focused on heart failure; however, other cardiotoxicities, notably cardiac rhythm disorders, can occur without underlying cardiomyopathy. Supraventricular tachycardias occur in cancer patients treated with cytotoxic chemotherapy (anthracyclines, gemcitabine, cisplatin and alkylating-agents) or kinase-inhibitors (KIs) such as ibrutinib. Ventricular arrhythmias, with a subset of them being torsades-de-pointes (TdP) favored by QTc prolongation have been reported: this may be the result of direct hERG-channel inhibition or a more recently-described mechanism of phosphoinositide-3-kinase inhibition. The major anticancer drugs responsible for QTc prolongation in this context are KIs, arsenic trioxide, anthracyclines, histone deacetylase inhibitors, and selective estrogen receptor modulators. Anticancer drug-induced cardiac rhythm disorders remain an underappreciated complication even by experienced clinicians. Moreover, the causal relationship of a particular anticancer drug with cardiac arrhythmia occurrence remains challenging due in part to patient comorbidities and complex treatment regimens. For example, any cancer patient may also be diagnosed with common diseases such as hypertension, diabetes or heart failure which increase an individual's arrhythmia susceptibility. Further, anticancer drugs are generally usually used in combination, increasing the challenge around establishing causation. Thus, arrhythmias appear to be an underappreciated adverse effect of anticancer agents and the incidence, significance and underlying mechanisms are now being investigated.
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Affiliation(s)
- Joachim Alexandre
- CHU Caen, PICARO Cardio-oncology Program, Department of Pharmacology, F-14033 Caen, France; Normandie Univ, UNICAEN, CHU Caen, EA 4650, Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, 14000 Caen, France
| | - Javid J Moslehi
- Vanderbilt University Medical Center, Cardio-oncology Program, Department of Medicine, Nashville, Tennessee, USA
| | - Kevin R Bersell
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christian Funck-Brentano
- Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013 Paris, France
| | - Dan M Roden
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joe-Elie Salem
- Vanderbilt University Medical Center, Cardio-oncology Program, Department of Medicine, Nashville, Tennessee, USA; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA; Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013 Paris, France.
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218
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Ali N, Malik F, Jafri SIM, Naglak M, Sundermeyer M, Pickens PV. Analysis of Efficacy and Tolerability of Bruton Tyrosine Kinase Inhibitor Ibrutinib in Various B-cell Malignancies in the General Community: A Single-center Experience. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 17S:S53-S61. [PMID: 28760303 DOI: 10.1016/j.clml.2017.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 02/28/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ibrutinib, an irreversible inhibitor of Bruton tyrosine kinase (BTK), is a novel drug that has shown significant efficacy and survival benefit for treatment of various B-cell malignancies. The primary objective of the present study was to investigate the efficacy of ibrutinib therapy in various B-cell malignancies in the general community. The secondary objectives included studying the adverse effects, ibrutinib-induced peripheral lymphocytosis, and effect on immunoglobulin levels. PATIENTS AND METHODS The present study was a retrospective observational cohort analysis conducted at Abington Jefferson Health. The clinical response was determined from the hematologist's assessment and evaluated independently using the response criteria for each B-cell malignancy. Adverse effects were graded according to the Common Terminology Criteria for Adverse Events, version 4.0. The Wilcoxon signed-rank test was used to compare immunoglobulin levels before and after ibrutinib. Forty five patients with B-cell malignancies and receiving ibrutinib therapy were eligible. RESULTS The median age was 73 years (range, 49-96 years), and 84.4% of the patients had received ≥ 1 previous therapy. The best overall response rate of all cohorts combined was 63.8%. The greatest overall response rate was observed in patients with chronic lymphocytic leukemia or small lymphocytic lymphoma (76.1%), followed by those with Waldenström macroglobulinemia (75%). Of the 45 patients, 88.9% experienced adverse effects. Antiplatelet activity of ibrutinib was most commonly observed (30.5%). Of note, 5 patients (11%) developed new-onset atrial fibrillation after drug initiation. Peripheral lymphocytosis after drug initiation was observed in most patients, with a peak level at 1 month (median lymphocyte count, 2.7 × 103 cells/μL). Although the IgG levels at 3, 6, and 12 months had decreased (P = .01 for all) compared with the levels before ibrutinib, the IgA levels had not increased at 3, 6, 12, and 24 months (P = .6, P = .5, P = .3, and P = .9, respectively). CONCLUSION Ibrutinib is a highly effective and tolerable drug for B-cell malignancies in the general community. In contrast to the previously reported rate of 5% to 7%, we observed a higher rate (11%) of atrial fibrillation, which might have resulted from the smaller sample size in the present study and the multiple comorbidities. Nonetheless, this treatment-limiting side effect requires further elucidation. Paradoxical lymphocytosis at the outset of therapy was a common and benign finding. In conjunction with the reported trials, the IgG levels decreased in the first year of continued therapy. However, the IgA levels did not increase, even after 2 years of therapy.
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Affiliation(s)
- Naveed Ali
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA.
| | - Faizan Malik
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA
| | | | - Mary Naglak
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA
| | - Mark Sundermeyer
- Department of Hematology and Oncology, Abington Jefferson Health, Abington, PA
| | - Peter V Pickens
- Department of Hematology and Oncology, Abington Jefferson Health, Abington, PA
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219
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Cuneo A, Follows G, Rigolin GM, Piciocchi A, Tedeschi A, Trentin L, Perez AM, Coscia M, Laurenti L, Musuraca G, Farina L, Delgado AR, Orlandi EM, Galieni P, Mauro FR, Visco C, Amendola A, Billio A, Marasca R, Chiarenza A, Meneghini V, Ilariucci F, Marchetti M, Molica S, Re F, Gaidano G, Gonzalez M, Forconi F, Ciolli S, Cortelezzi A, Montillo M, Smolej L, Schuh A, Eyre TA, Kennedy B, Bowles KM, Vignetti M, de la Serna J, Moreno C, Foà R, Ghia P. Efficacy of bendamustine and rituximab as first salvage treatment in chronic lymphocytic leukemia and indirect comparison with ibrutinib: a GIMEMA, ERIC and UK CLL FORUM study. Haematologica 2018; 103:1209-1217. [PMID: 29674504 PMCID: PMC6029555 DOI: 10.3324/haematol.2018.189837] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/18/2018] [Indexed: 11/09/2022] Open
Abstract
We performed an observational study on the efficacy of ben-damustine and rituximab (BR) as first salvage regimen in chronic lymphocytic leukemia (CLL). In an intention-to-treat analysis including 237 patients, the median progression-free survival (PFS) was 25 months. The presence of del(17p), unmutated IGHV and advanced stage were associated with a shorter PFS at multivariate analysis. The median time-to-next treatment was 31.3 months. Front-line treatment with a chemoimmunotherapy regimen was the only predictive factor for a shorter time to next treatment at multivariate analysis. The median overall survival (OS) was 74.5 months. Advanced disease stage (i.e. Rai stage III-IV or Binet stage C) and resistant disease were the only parameters significantly associated with a shorter OS. Grade 3-5 infections were recorded in 6.3% of patients. A matched-adjusted indirect comparison with ibrutinib given second-line within Named Patient Programs in the United Kingdom and in Italy was carried out with OS as objective end point. When restricting the analysis to patients with intact 17p who had received chemoimmunotherapy in first line, there was no difference in OS between patients treated with ibrutinib (63% alive at 36 months) and patients treated with BR (74.4% alive at 36 months). BR is an efficacious first salvage regimen in CLL in a real-life population, including the elderly and unfit patients. BR and ibrutinib may be equally effective in terms of OS when used as first salvage treatment in patients without 17p deletion.
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Affiliation(s)
- Antonio Cuneo
- Hematology, Department of Medical Sciences, St. Anna University Hospital, Ferrara, Italy
| | - George Follows
- UK CLL Forum, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Gian Matteo Rigolin
- Hematology, Department of Medical Sciences, St. Anna University Hospital, Ferrara, Italy
| | - Alfonso Piciocchi
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Alessandra Tedeschi
- Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology, Department of Medicine, University of Padua, Italy
| | | | - Marta Coscia
- Hematology Unit, Città della Salute e della Scienza, University of Turin, Italy
| | - Luca Laurenti
- Hematology, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy
| | - Gerardo Musuraca
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Lucia Farina
- Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Alfredo Rivas Delgado
- Department of Hematology, Hospital Clinic, Institut Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Piero Galieni
- Hematology and Cellular Therapy, "Ospedale C. e G. Mazzoni", Ascoli Piceno, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Biomedical Sciences and Hematology, "Sapienza" University, Rome, Italy
| | - Carlo Visco
- Hematology, San Bortolo Hospital, Vicenza, Italy
| | | | - Atto Billio
- Hematology and Transplant Unit, San Maurizio Hospital, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | | | - Annalisa Chiarenza
- Hematology Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Vittorio Meneghini
- Hematology, Department of Cell Therapy and Hematology, University Hospital, Verona, Italy
| | | | | | - Stefano Molica
- Hematology Unit, A. Pugliese Hospital, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
| | | | - Gianluca Gaidano
- Hematology, DIMECS e Dipartimento Oncologico, Università del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Marcos Gonzalez
- Hematology, University Hospital-IBSAL and CIBERONC, Salamanca, Spain
| | - Francesco Forconi
- Haematology Department, University Hospital National Health Service Trust, Southampton, UK
| | | | - Agostino Cortelezzi
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Marco Montillo
- Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lukas Smolej
- Department of Hematology, University Hospital, Hradec Kralove, Czech Republic
| | - Anna Schuh
- UK CLL Forum, Oxford University Hospitals NHS Foundation Trust, UK
| | - Toby A Eyre
- Oxford University Hospitals NHS Foundation Trust, UK
| | - Ben Kennedy
- University Hospitals of Leicester NHS Trust, UK
| | | | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | | | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Barcellona, Spain
| | - Robin Foà
- Hematology, Department of Biomedical Sciences and Hematology, "Sapienza" University, Rome, Italy
| | - Paolo Ghia
- Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
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Hallek M, Shanafelt TD, Eichhorst B. Chronic lymphocytic leukaemia. Lancet 2018; 391:1524-1537. [PMID: 29477250 DOI: 10.1016/s0140-6736(18)30422-7] [Citation(s) in RCA: 209] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 10/30/2017] [Accepted: 11/13/2017] [Indexed: 12/15/2022]
Abstract
Important advances in understanding the pathogenesis of chronic lymphocytic leukaemia in the past two decades have led to the development of new prognostic tools and novel targeted therapies that have improved clinical outcome. Chronic lymphocytic leukaemia is the most common type of leukaemia in developed countries, and the median age at diagnosis is 72 years. The criteria for initiating treatment rely on the Rai and Binet staging systems and on the presence of disease-related symptoms. For many patients with chronic lymphocytic leukaemia, treatment with chemotherapy and anti-CD20 monoclonal antibodies is the standard of care. The impressive efficacy of kinase inhibitors ibrutinib and idelalisib and the BCL-2 antagonist venetoclax have changed the standard of care in specific subsets of patients. In this Seminar, we review the recent progress in the management of chronic lymphocytic leukaemia and highlight new questions surrounding the optimal disease management.
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MESH Headings
- Adenine/analogs & derivatives
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bridged Bicyclo Compounds, Heterocyclic/therapeutic use
- Diagnosis, Differential
- Genetic Predisposition to Disease
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Mutation
- Piperidines
- Prognosis
- Purines/therapeutic use
- Pyrazoles/therapeutic use
- Pyrimidines/therapeutic use
- Quinazolinones/therapeutic use
- Recurrence
- Risk Factors
- Sulfonamides/therapeutic use
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- Michael Hallek
- Department of Internal Medicine, Center of Integrated Oncology Köln Bonn, University Hospital of Cologne, Cologne, Germany.
| | | | - Barbara Eichhorst
- Department of Internal Medicine, Center of Integrated Oncology Köln Bonn, University Hospital of Cologne, Cologne, Germany
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Abstract
PURPOSE REVIEW B cell signaling agents, including ibrutinib, idelalisib, and the BCL-2 inhibitor venetoclax have become an integral part of therapy for patients with non-Hodgkin's lymphomas. The toxicity profiles of these medications is distinct from chemoimmunotherapy. Here, we will review the mechanism of action of these drugs, their efficacy, and toxicity management. RECENT FINDINGS Ibrutinib use is associated with increased risk of atrial fibrillation and bleeding which can be managed using dose interruptions and modifications. Patients on idelalisib require close clinical and frequent laboratory monitoring, particularly of liver function tests to ensure there are no serious adverse events. Monitoring for infections is important in patients on both idelalisib and ibrutinib. Venetoclax requires close clinical and laboratory monitoring to prevent significant tumor lysis. Targeted B cell receptor therapies each have unique side effect profiles which require careful clinical monitoring. As we continue to use these therapies, optimal management strategies will continue to be elucidated.
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Minimal residual disease analysis in chronic lymphocytic leukemia: a way for achieving more personalized treatments. Leukemia 2018; 32:1307-1316. [DOI: 10.1038/s41375-018-0109-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/08/2017] [Accepted: 11/28/2017] [Indexed: 12/28/2022]
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Seymour JF, Kipps TJ, Eichhorst B, Hillmen P, D'Rozario J, Assouline S, Owen C, Gerecitano J, Robak T, De la Serna J, Jaeger U, Cartron G, Montillo M, Humerickhouse R, Punnoose EA, Li Y, Boyer M, Humphrey K, Mobasher M, Kater AP. Venetoclax-Rituximab in Relapsed or Refractory Chronic Lymphocytic Leukemia. N Engl J Med 2018; 378:1107-1120. [PMID: 29562156 DOI: 10.1056/nejmoa1713976] [Citation(s) in RCA: 614] [Impact Index Per Article: 102.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Venetoclax inhibits BCL2, an antiapoptotic protein that is pathologically overexpressed and that is central to the survival of chronic lymphocytic leukemia cells. We evaluated the efficacy of venetoclax in combination with rituximab in patients with relapsed or refractory chronic lymphocytic leukemia. METHODS In this randomized, open-label, phase 3 trial, we randomly assigned 389 patients to receive venetoclax for up to 2 years (from day 1 of cycle 1) plus rituximab for the first 6 months (venetoclax-rituximab group) or bendamustine plus rituximab for 6 months (bendamustine-rituximab group). The trial design did not include crossover to venetoclax plus rituximab for patients in the bendamustine-rituximab group in whom progression occurred. The primary end point was investigator-assessed progression-free survival. RESULTS After a median follow-up period of 23.8 months, the rate of investigator-assessed progression-free survival was significantly higher in the venetoclax-rituximab group (32 events of progression or death in 194 patients) than in the bendamustine-rituximab group (114 events in 195 patients); the 2-year rates of progression-free survival were 84.9% and 36.3%, respectively (hazard ratio for progression or death, 0.17; 95% confidence interval [CI], 0.11 to 0.25; P<0.001 by the stratified log-rank test). The benefit was maintained across all clinical and biologic subgroups, including the subgroup of patients with chromosome 17p deletion; the 2-year rate of progression-free survival among patients with chromosome 17p deletion was 81.5% in the venetoclax-rituximab group versus 27.8% in the bendamustine-rituximab group (hazard ratio, 0.13; 95% CI, 0.05 to 0.29), and the 2-year rate among those without chromosome 17p deletion was 85.9% versus 41.0% (hazard ratio, 0.19; 95% CI, 0.12 to 0.32). The benefit of venetoclax plus rituximab over bendamustine plus rituximab was confirmed by an independent review committee assessment of progression-free survival and other secondary efficacy end points. The rate of grade 3 or 4 neutropenia was higher in the venetoclax-rituximab group than in the bendamustine-rituximab group, but the rates of grade 3 or 4 febrile neutropenia and infections or infestations were lower with venetoclax than with bendamustine. The rate of grade 3 or 4 tumor lysis syndrome in the venetoclax-rituximab group was 3.1% (6 of 194 patients). CONCLUSIONS Among patients with relapsed or refractory chronic lymphocytic leukemia, venetoclax plus rituximab resulted in significantly higher rates of progression-free survival than bendamustine plus rituximab. (Funded by Genentech and AbbVie; ClinicalTrials.gov number, NCT02005471 .).
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bendamustine Hydrochloride/administration & dosage
- Bendamustine Hydrochloride/adverse effects
- Bridged Bicyclo Compounds, Heterocyclic/administration & dosage
- Bridged Bicyclo Compounds, Heterocyclic/adverse effects
- Disease-Free Survival
- Drug Resistance, Neoplasm
- Female
- Humans
- Kaplan-Meier Estimate
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Middle Aged
- Neoplasm, Residual
- Neutropenia/chemically induced
- Recurrence
- Rituximab/administration & dosage
- Rituximab/adverse effects
- Sulfonamides/administration & dosage
- Sulfonamides/adverse effects
- Tumor Lysis Syndrome/etiology
- Young Adult
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Affiliation(s)
- John F Seymour
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - Thomas J Kipps
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - Barbara Eichhorst
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - Peter Hillmen
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - James D'Rozario
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - Sarit Assouline
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - Carolyn Owen
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - John Gerecitano
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - Tadeusz Robak
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - Javier De la Serna
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - Ulrich Jaeger
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - Guillaume Cartron
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - Marco Montillo
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - Rod Humerickhouse
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - Elizabeth A Punnoose
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - Yan Li
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - Michelle Boyer
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - Kathryn Humphrey
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - Mehrdad Mobasher
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
| | - Arnon P Kater
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and University of Melbourne, Melbourne, VIC (J.F.S.), and the John Curtin School of Medical Research, Australian National University, Canberra, ACT (J.D.) - all in Australia; the University of California School of Medicine, San Diego (T.J.K.), and Genentech, South San Francisco (E.A.P., Y.L., M. Mobasher) - both in California; University Hospital Cologne and the Center for Integrated Oncology Cologne-Bonn, Cologne, Germany (B.E.); St. James's University Hospital, Leeds (P.H.), and F. Hoffmann-La Roche, Welwyn Garden City (M.B., K.H.) - both in the United Kingdom; Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, Montreal (S.A.), and the Departments of Medicine and Oncology, University of Calgary, Calgary, AB (C.O.) - all in Canada; Memorial Sloan Kettering Cancer Center, New York (J.G.); the Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland (T.R.); Hospital Universitario 12 de Octubre, Madrid (J.D.S.); Medical University of Vienna, Department of Medicine I, Division of Hematology and Hemostaseology, Vienna (U.J.); the Department of Hematology, Centre Hospitalier Universitaire Montpellier, Montpellier, France (G.C.); the Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan (M. Montillo); AbbVie, North Chicago, IL (R.H.); and the Department of Hematology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam (A.P.K.)
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225
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Campbell R, Chong G, Hawkes EA. Novel Indications for Bruton's Tyrosine Kinase Inhibitors, beyond Hematological Malignancies. J Clin Med 2018; 7:jcm7040062. [PMID: 29561760 PMCID: PMC5920436 DOI: 10.3390/jcm7040062] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 02/18/2018] [Accepted: 03/06/2018] [Indexed: 12/22/2022] Open
Abstract
Bruton’s tyrosine kinase (BTK) is a critical terminal enzyme in the B-cell antigen receptor (BCR) pathway. BTK activation has been implicated in the pathogenesis of certain B-cell malignancies. Targeting this pathway has emerged as a novel target in B-cell malignancies, of which ibrutinib is the first-in-class agent. A few other BTK inhibitors (BTKi) are also under development (e.g., acalabrutinib). While the predominant action of BTKi is the blockade of B-cell receptor pathway within malignant B-cells, increasing the knowledge of off-target effects as well as a potential role for B-cells in proliferation of solid malignancies is expanding the indication of BTKi into non-hematological malignancies. In addition to the expansion of the role of BTKi monotherapy, combination therapy strategies utilizing ibrutinib with established regimens and combination with modern immunotherapy compounds are being explored.
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Affiliation(s)
- Robert Campbell
- Department of Medical Oncology and Clinical Haematology, Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, VIC 3084, Australia.
- Bendigo Cancer Centre, Bendigo Health, Bendigo, VIC 3084, Australia.
| | - Geoffrey Chong
- Department of Medical Oncology and Clinical Haematology, Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, VIC 3084, Australia.
- Department of Oncology, Northern Hospital, Melbourne, VIC 3084, Australia.
- Department of Medical Oncology, Ballarat Health Services, Ballarat, VIC 3084, Australia.
| | - Eliza A Hawkes
- Department of Medical Oncology and Clinical Haematology, Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, VIC 3084, Australia.
- Department of Medical Oncology, Eastern Health, Melbourne, VIC 3084, Australia.
- Eastern Health, Monash University Clinical School, Melbourne, VIC 3084, Australia.
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226
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Boriani G, Corradini P, Cuneo A, Falanga A, Foà R, Gaidano G, Ghia PP, Martelli M, Marasca R, Massaia M, Mauro FR, Minotti G, Molica S, Montillo M, Pinto A, Tedeschi A, Vitolo U, Zinzani PL. Practical management of ibrutinib in the real life: Focus on atrial fibrillation and bleeding. Hematol Oncol 2018; 36:624-632. [PMID: 29512173 DOI: 10.1002/hon.2503] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 12/15/2022]
Abstract
The Bruton tyrosine kinase inhibitor ibrutinib (IB) has attained an important role in the treatment of patients with chronic lymphocytic leukaemia, mantle cell lymphoma, and Waldenström macroglobulinemia, significantly improving clinical outcomes. However, IB therapy has been associated with an increased risk of atrial fibrillation (AF) and bleeding. We report on the expert opinion that a group of Italian haematologists, cardiologists, and pharmacologists jointly released to improve the practical management of patients at risk for AF and bleeding during treatment with IB. A proper pretreatment assessment to identify patients who are at a higher risk, careful choice of concomitant drugs, regular monitoring, and multispecialist approach were characterized as the main principles of clinical management of these patients. For patients developing AF, anticoagulant and antiarrhythmic therapy must be guided by considerations about efficacy, safety, and risk of pharmacokinetic interactions with IB. For patients experiencing bleeding or requiring procedures that increase the risk of bleeding, considerations about platelet turnover, IB-related platelet dysfunctions, and bleeding worsening by concomitant anticoagulants or antiplatelet agents provide clues to manage bleeding. Overall, AF and bleeding are manageable clinical events in patients receiving IB, not requiring drug interruption in most cases. Preexisting AF should not represent an absolute contraindication to IB therapy. For each patient candidate for IB, strategies of risk assessment and mitigation may allow to exploit the life-saving effects of in chronic lymphocytic leukaemia and mantle cell lymphoma.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Paolo Corradini
- Dipartimento di Oncologia ed Emato-oncologia, Universita' degli Studi di Milano, Milan, Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Anna Falanga
- Department of Immunohematology and Transfusion Medicine, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Robin Foà
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Paolo Prospero Ghia
- Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele, Milano, Italy
| | - Maurizio Martelli
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Roberto Marasca
- Hematology Division, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Massaia
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Giorgio Minotti
- Department of Medicine and Center for Drug Sciences, University Campus Bio-Medico, Rome, Italy
| | - Stefano Molica
- Department of Hematology-Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | - Marco Montillo
- Department of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan, Italy
| | - Antonio Pinto
- Hematology-Oncology and Stem Cell Transplantation Unit, National Cancer Institute, Fondazione "G. Pascale" IRCCS, Naples, Italy
| | | | - Umberto Vitolo
- Città della Salute e della Scienza Hospital and University, on behalf of FIL, Turin, Italy
| | - Pier Luigi Zinzani
- Institute of Hematology and Medical Oncology "Seragnoli", University of Bologna, Bologna, Italy
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227
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Abstract
B cell receptor (BCR) signalling is crucial for normal B cell development and adaptive immunity. BCR signalling also supports the survival and growth of malignant B cells in patients with B cell leukaemias or lymphomas. The mechanism of BCR pathway activation in these diseases includes continuous BCR stimulation by microbial antigens or autoantigens present in the tissue microenvironment, activating mutations within the BCR complex or downstream signalling components and ligand-independent tonic BCR signalling. The most established agents targeting BCR signalling are Bruton tyrosine kinase (BTK) inhibitors and PI3K isoform-specific inhibitors, and their introduction into the clinic is rapidly changing how B cell malignancies are treated. B cells and BCR-related kinases, such as BTK, also play a role in the microenvironment of solid tumours, such as squamous cell carcinoma and pancreatic cancer, and therefore targeting B cells or BCR-related kinases may have anticancer activity beyond B cell malignancies.
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MESH Headings
- Agammaglobulinaemia Tyrosine Kinase/antagonists & inhibitors
- Antineoplastic Agents/pharmacology
- B-Lymphocytes/metabolism
- B-Lymphocytes/pathology
- Drug Resistance, Neoplasm
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Lymphoma, Mantle-Cell/drug therapy
- Lymphoma, Mantle-Cell/metabolism
- Molecular Targeted Therapy/methods
- Neoplasms/drug therapy
- Neoplasms/metabolism
- Protein Kinase Inhibitors/pharmacology
- Receptors, Antigen, B-Cell/antagonists & inhibitors
- Receptors, Antigen, B-Cell/immunology
- Receptors, Antigen, B-Cell/metabolism
- Signal Transduction/drug effects
- Tumor Microenvironment
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Affiliation(s)
- Jan A Burger
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Adrian Wiestner
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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228
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Brown JR, Cymbalista F, Sharman J, Jacobs I, Nava-Parada P, Mato A. The Role of Rituximab in Chronic Lymphocytic Leukemia Treatment and the Potential Utility of Biosimilars. Oncologist 2018; 23:288-296. [PMID: 29212732 PMCID: PMC5905689 DOI: 10.1634/theoncologist.2017-0150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/17/2017] [Indexed: 11/17/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is managed with observation for asymptomatic or clinically silent disease; pharmacologic intervention is generally required for symptomatic patients with clinically significant adenopathy or cytopenia. In the front-line treatment of CLL, the current standard-of-care includes chemotherapy in combination with an anti-CD20 monoclonal antibody (e.g., rituximab, ofatumumab, or obinutuzumab) or ibrutinib as single agent. Despite the evolving treatment paradigm toward targeted therapy, it is likely that rituximab (plus chemotherapy), with or without targeted agents, will retain a significant role in CLL treatment. However, patents for many biologics, including rituximab, have expired or will expire in the near future. Furthermore, access to rituximab has remained challenging, particularly in countries with restricted resources. Together, these concerns have prompted the development of safe and effective rituximab biosimilars. The term "biosimilar" refers to a biologic that is highly similar to an approved reference (originator) product, notwithstanding minor differences in clinically inactive components, and for which there are no clinically meaningful differences in purity, potency, or safety. Biosimilars are developed to treat the same condition(s) using the same treatment regimens as an approved reference biologic and have the potential to increase access to more affordable treatments. We review the importance of rituximab in the current treatment of CLL, the scientific basis of its future role in combination with chemotherapy, and the role of new and emerging agents in the treatment of CLL, which could potentially be used in combination with rituximab biosimilars. We also discuss rituximab biosimilars currently in development. IMPLICATIONS FOR PRACTICE Front-line treatments for chronic lymphocytic leukemia (CLL) include chemotherapy in combination with an anti-CD20 monoclonal antibody (e.g., rituximab, ofatumumab, or obinutuzumab) or ibrutinib as single agent. Despite the evolving treatment paradigm, it is likely rituximab (plus chemotherapy) and targeted agents undergoing clinical evaluation will retain a significant role in CLL treatment. However, patents for many biologics, including rituximab, have expired or will expire in the near future and, in many regions, access to rituximab remains challenging. Together, these concerns have prompted the development of safe and effective rituximab biosimilars, with the potential to increase access to more affordable treatments.
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Affiliation(s)
| | | | - Jeff Sharman
- Willamette Valley Cancer Institute, Springfield, Oregon, USA
- US Oncology Research, The Woodlands, Texas, USA
| | - Ira Jacobs
- Pfizer, Inc., New York City, New York, USA
| | | | - Anthony Mato
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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229
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Ribes D, Hachem HEL, Oberic L, Vergez F, Delas A, Belliere J, Protin C, Kamar N, Ferrandiz I, Tavitian S, Laurent C, Huart A, Chauveau D, Ysebaert L, Faguer S. Bendamustine plus rituximab for indolent B-cell lymphoma of renal significance. Am J Hematol 2018; 93:356-362. [PMID: 29168251 DOI: 10.1002/ajh.24984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/08/2017] [Accepted: 11/20/2017] [Indexed: 11/11/2022]
Abstract
Treatment of indolent B-cell non-Hodgkin lymphomas (iNHL) of renal significance is challenging given the need for deep and prolonged hematological response to restore and control renal function overtime, yet to be balanced with the risk of adverse drug-related events. This prospective single-center study included 20 patients with iNHL of renal significance (tubulointerstitial presentation [n = 8], glomerulopathy with or without monoclonal Ig deposits [n = 12]) who received a steroid-sparing regimen of rituximab plus bendamustine (BR), with either no or <1 month of steroid intake (as a first line therapy in 80%). Seventeen patients (85%) achieved a complete (CHR, n = 12) or a partial (PHR, n = 5) hematological response. Nine out of the 12 patients (75%) with iNHL-related glomerulopathy had a complete (CRR) or a partial (PRR) renal response. Among the six patients with glomerulopathy and CHR, five had a CRR (83%) compared to 1/6 (17%) that did not reach CHR. eGFR increased from 38 to 58 mL/min/1.73 m2 , and returned to baseline in five patients. Among the eight patients with a tubulointerstitial presentation, six (75%) had a renal response (5 CRR), and eGFR increased from 29 to 48 mL/min/1.73 m2 . One patient with a PHR had a renal relapse. Mortality rate was 10% at 12 months. The BR regimen was well tolerated overall. Thus, despite severe renal disease at presentation, a relapsing iNHL in 20% of patients and several comorbidities, the BR regimen was efficient and safe in our series. It should be further assessed as a first line therapy for patients with iNHL of renal significance.
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Affiliation(s)
- David Ribes
- Département de Néphrologie et Transplantation d'organes; Centre Hospitalier Universitaire de Toulouse; France
| | - Hélène E. L. Hachem
- Département de Néphrologie et Transplantation d'organes; Centre Hospitalier Universitaire de Toulouse; France
| | - Lucie Oberic
- Service d'Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopole, Centre Hospitalier Universitaire de Toulouse; France
| | - François Vergez
- Laboratoire d'Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopole, Centre Hospitalier Universitaire de Toulouse; France
- Université Paul Sabatier - Toulouse III; Toulouse France
| | - Audrey Delas
- Service d'anatomopathologie, Institut Universitaire du Cancer de Toulouse, Centre Hospitalier Universitaire de Toulouse; France
| | - Julie Belliere
- Département de Néphrologie et Transplantation d'organes; Centre Hospitalier Universitaire de Toulouse; France
| | - Caroline Protin
- Service d'Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopole, Centre Hospitalier Universitaire de Toulouse; France
| | - Nassim Kamar
- Département de Néphrologie et Transplantation d'organes; Centre Hospitalier Universitaire de Toulouse; France
| | - Inès Ferrandiz
- Département de Néphrologie et Transplantation d'organes; Centre Hospitalier Universitaire de Toulouse; France
| | - Suzanne Tavitian
- Service d'Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopole, Centre Hospitalier Universitaire de Toulouse; France
| | - Camille Laurent
- Université Paul Sabatier - Toulouse III; Toulouse France
- Service d'anatomopathologie, Institut Universitaire du Cancer de Toulouse, Centre Hospitalier Universitaire de Toulouse; France
| | - Antoine Huart
- Département de Néphrologie et Transplantation d'organes; Centre Hospitalier Universitaire de Toulouse; France
| | - Dominique Chauveau
- Département de Néphrologie et Transplantation d'organes; Centre Hospitalier Universitaire de Toulouse; France
- Université Paul Sabatier - Toulouse III; Toulouse France
- Centre de référence des maladies rénales rares, Centre Hospitalier Universitaire deToulouse; France
| | - Loïc Ysebaert
- Service d'Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopole, Centre Hospitalier Universitaire de Toulouse; France
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d'organes; Centre Hospitalier Universitaire de Toulouse; France
- Université Paul Sabatier - Toulouse III; Toulouse France
- Centre de référence des maladies rénales rares, Centre Hospitalier Universitaire deToulouse; France
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Jakšić B, Pejša V, Ostojić-Kolonić S, Kardum-Skelin I, Bašić-Kinda S, Coha B, Gverić-Krečak V, Vrhovac R, Jakšić O, Aurer I, Sinčić-Petričević J, Načinović-Duletić A, Nemet D. Guidelines for Diagnosis and Treatment of Chronic Lymphocytic Leukemia. Krohem B-Cll 2017. Acta Clin Croat 2018; 57:190-215. [PMID: 30256032 PMCID: PMC6400341 DOI: 10.20471/acc.2018.57.01.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/26/2017] [Indexed: 12/22/2022] Open
Abstract
Recent developments in the diagnosis and treatment of chronic lymphocytic leukemia (B-CLL) have led to change of approach in clinical practice. New treatments have been approved based on the results of randomized multicenter trials for first line and for salvage therapy, and the results of numerous ongoing clinical trials are permanently providing new answers and further refining of therapeutic strategies. This is paralleled by substantial increase in understanding the disease genetics due to major advances in the next generation sequencing (NGS) technology. We define current position of the Croatian Cooperative Group for Hematologic Disease on diagnosis and treatment of CLL in the transition from chemo-immunotherapy paradigm into a new one that is based on new diagnostic stratification and unprecedented therapeutic results of B-cell receptor inhibitors (BRI) and Bcl-2 antagonists. This is a rapidly evolving field as a great number of ongoing clinical trials con-stantly accumulate and provide new knowledge. We believe that novel therapy research including genomic diagnosis is likely to offer new options that will eventually lead to time limited therapies without chemotherapy and more effective clinical care for B-CLL based on individualized precision medicine.
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Affiliation(s)
- Branimir Jakšić
- Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Vlatko Pejša
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Ika Kardum-Skelin
- Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sandra Bašić-Kinda
- Dubrava University Hospital, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Božena Coha
- Zagreb University Hospital Center, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Radovan Vrhovac
- Dubrava University Hospital, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ozren Jakšić
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Igor Aurer
- Dubrava University Hospital, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Antica Načinović-Duletić
- Osijek University Hospital Center, Faculty of Medicine, Josip Juraj University of Osijek, Osijek, Croatia
| | - Damir Nemet
- Dubrava University Hospital, School of Medicine, University of Zagreb, Zagreb, Croatia
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231
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de Jong MRW, Visser L, Huls G, Diepstra A, van Vugt M, Ammatuna E, van Rijn RS, Vellenga E, van den Berg A, Fehrmann RSN, van Meerten T. Identification of relevant drugable targets in diffuse large B-cell lymphoma using a genome-wide unbiased CD20 guilt-by association approach. PLoS One 2018; 13:e0193098. [PMID: 29489886 PMCID: PMC5831110 DOI: 10.1371/journal.pone.0193098] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/01/2018] [Indexed: 12/28/2022] Open
Abstract
Forty percent of patients with diffuse large B-cell lymphoma (DLBCL) show resistant disease to standard chemotherapy (CHOP) in combination with the anti-CD20 monoclonal antibody rituximab (R). Although many new anti-cancer drugs were developed in the last years, it is unclear which of these drugs can be safely combined to improve standard therapy without antagonizing anti-CD20 efficacy. In this study, we aimed to identify rituximab compatible drug-target combinations for DLBCL. For this, we collected gene expression profiles of 1,804 DLBCL patient samples. Subsequently, we performed a guilt-by-association analysis with MS4A1 (CD20) and prioritized the 500 top-ranked CD20-associated gene probes for drug-target interactions. This analysis showed the well-known genes involved in DLBCL pathobiology, but also revealed several genes that are relatively unknown in DLBCL, such as WEE1 and PARP1. To demonstrate potential clinical relevance of these targets, we confirmed high protein expression of WEE1 and PARP1 in patient samples. Using clinically approved WEE1 and PARP1 inhibiting drugs in combination with rituximab, we demonstrated significantly improved DLBCL cell killing, also in rituximab-insensitive cell lines. In conclusion, as exemplified by WEE1 and PARP1, our CD20-based genome-wide analysis can be used as an approach to identify biological relevant drug-targets that are rituximab compatible and may be implemented in phase 1/2 clinical trials to improve DLBCL treatment.
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MESH Headings
- Antigens, CD20/genetics
- Antigens, CD20/metabolism
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cell Cycle Proteins/genetics
- Cell Cycle Proteins/metabolism
- Cell Line, Tumor
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Drug Resistance, Neoplasm/drug effects
- Drug Resistance, Neoplasm/genetics
- Female
- Genome-Wide Association Study
- Humans
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Nuclear Proteins/genetics
- Nuclear Proteins/metabolism
- Poly (ADP-Ribose) Polymerase-1/genetics
- Poly (ADP-Ribose) Polymerase-1/metabolism
- Prednisone/therapeutic use
- Protein-Tyrosine Kinases/genetics
- Protein-Tyrosine Kinases/metabolism
- Rituximab/pharmacology
- Vincristine/therapeutic use
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Affiliation(s)
- Mathilde R. W. de Jong
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lydia Visser
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gerwin Huls
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Arjan Diepstra
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marcel van Vugt
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Emanuele Ammatuna
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Edo Vellenga
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Anke van den Berg
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rudolf S. N. Fehrmann
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Tom van Meerten
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- * E-mail:
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232
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García Vela JA, García Marco JA. Minimal residual disease in chronic lymphocytic leukaemia. Med Clin (Barc) 2018; 150:144-149. [PMID: 28864095 DOI: 10.1016/j.medcli.2017.06.067] [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: 06/02/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 11/26/2022]
Abstract
Minimal residual disease (MRD) assessment is an important endpoint in the treatment of chronic lymphocytic leukaemia (CLL). It is highly predictive of prolonged progression-free survival (PFS) and overall survival and could be considered a surrogate for PFS in the context of chemoimmunotherapy based treatment. Evaluation of MRD level by flow cytometry or molecular techniques in the era of the new BCR and Bcl-2 targeted inhibitors could identify the most cost-effective and durable treatment sequencing. A therapeutic approach guided by the level of MRD might also determine which patients would benefit from an early stop or consolidation therapy. In this review, we discuss the different MRD methods of analysis, which source of tumour samples must be analysed, the future role of the detection of circulating tumour DNA, and the potential role of MRD negativity in clinical practice in the modern era of CLL therapy.
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Affiliation(s)
- José Antonio García Vela
- Laboratorio de Citometría de Flujo, Servicio de Hematología y Hemoterapia, Hospital Universitario de Getafe, Getafe, Madrid, España.
| | - José Antonio García Marco
- Laboratorio de Genética Molecular, Servicio de Hematología y Hemoterapia, Hospital Universitario Puerta de Hierro, Madrid, España
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233
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Pal Singh S, Dammeijer F, Hendriks RW. Role of Bruton's tyrosine kinase in B cells and malignancies. Mol Cancer 2018; 17:57. [PMID: 29455639 PMCID: PMC5817726 DOI: 10.1186/s12943-018-0779-z] [Citation(s) in RCA: 419] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/01/2018] [Indexed: 12/14/2022] Open
Abstract
Bruton’s tyrosine kinase (BTK) is a non-receptor kinase that plays a crucial role in oncogenic signaling that is critical for proliferation and survival of leukemic cells in many B cell malignancies. BTK was initially shown to be defective in the primary immunodeficiency X-linked agammaglobulinemia (XLA) and is essential both for B cell development and function of mature B cells. Shortly after its discovery, BTK was placed in the signal transduction pathway downstream of the B cell antigen receptor (BCR). More recently, small-molecule inhibitors of this kinase have shown excellent anti-tumor activity, first in animal models and subsequently in clinical studies. In particular, the orally administered irreversible BTK inhibitor ibrutinib is associated with high response rates in patients with relapsed/refractory chronic lymphocytic leukemia (CLL) and mantle-cell lymphoma (MCL), including patients with high-risk genetic lesions. Because ibrutinib is generally well tolerated and shows durable single-agent efficacy, it was rapidly approved for first-line treatment of patients with CLL in 2016. To date, evidence is accumulating for efficacy of ibrutinib in various other B cell malignancies. BTK inhibition has molecular effects beyond its classic role in BCR signaling. These involve B cell-intrinsic signaling pathways central to cellular survival, proliferation or retention in supportive lymphoid niches. Moreover, BTK functions in several myeloid cell populations representing important components of the tumor microenvironment. As a result, there is currently a considerable interest in BTK inhibition as an anti-cancer therapy, not only in B cell malignancies but also in solid tumors. Efficacy of BTK inhibition as a single agent therapy is strong, but resistance may develop, fueling the development of combination therapies that improve clinical responses. In this review, we discuss the role of BTK in B cell differentiation and B cell malignancies and highlight the importance of BTK inhibition in cancer therapy.
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Affiliation(s)
- Simar Pal Singh
- Department of Pulmonary Medicine, Room Ee2251a, Erasmus MC Rotterdam, PO Box 2040, NL 3000, CA, Rotterdam, The Netherlands.,Department of Immunology, Rotterdam, The Netherlands.,Post graduate school Molecular Medicine, Rotterdam, The Netherlands
| | - Floris Dammeijer
- Department of Pulmonary Medicine, Room Ee2251a, Erasmus MC Rotterdam, PO Box 2040, NL 3000, CA, Rotterdam, The Netherlands.,Post graduate school Molecular Medicine, Rotterdam, The Netherlands.,Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Rudi W Hendriks
- Department of Pulmonary Medicine, Room Ee2251a, Erasmus MC Rotterdam, PO Box 2040, NL 3000, CA, Rotterdam, The Netherlands.
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234
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Allan JN, Furman RR. Optimal management of the young patient CLL patient. Best Pract Res Clin Haematol 2018; 31:73-82. [PMID: 29452669 DOI: 10.1016/j.beha.2017.10.012] [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: 10/02/2017] [Accepted: 10/23/2017] [Indexed: 11/26/2022]
Abstract
The emergence of targeted therapy for patients with chronic lymphocytic leukemia (CLL) has permanently altered the therapeutic landscape. In both upfront and relapsed settings, safe and effective oral kinase inhibitors are available which rival the responses and durability seen with standard chemo immunotherapy regimens. In 2016, ibrutinib was granted Federal Drug Administration approval for first-line therapy in patients with CLL. While its role as initial therapy for older, unfit or deleted 17p CLL patients is less controversial, its role as first-line treatment for younger fit patients is less clear, begging the question, what is the optimal treatment for these patients, novel agents or standard CIT strategies? In this review, we aim to provide guidance for what we believe is the optimal management of young fit patients with CLL.
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Affiliation(s)
- John N Allan
- Weill Cornell Medicine, Division of Hematology and Medical Oncology, CLL Research Center, 1305 York Ave, New York, NY, 10021, USA.
| | - Richard R Furman
- Weill Cornell Medicine, Division of Hematology and Medical Oncology, CLL Research Center, 1305 York Ave, New York, NY, 10021, USA
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235
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Affiliation(s)
- Prashant Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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236
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Reinwald M, Silva JT, Mueller NJ, Fortún J, Garzoni C, de Fijter JW, Fernández-Ruiz M, Grossi P, Aguado JM. ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Intracellular signaling pathways: tyrosine kinase and mTOR inhibitors). Clin Microbiol Infect 2018; 24 Suppl 2:S53-S70. [PMID: 29454849 DOI: 10.1016/j.cmi.2018.02.009] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/08/2018] [Accepted: 02/11/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The present review is part of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biologic therapies. AIMS To review, from an infectious diseases perspective, the safety profile of therapies targeting different intracellular signaling pathways and to suggest preventive recommendations. SOURCES Computer-based Medline searches with MeSH terms pertaining to each agent or therapeutic family. CONTENT Although BCR-ABL tyrosine kinase inhibitors modestly increase the overall risk of infection, dasatinib has been associated with cytomegalovirus and hepatitis B virus reactivation. BRAF/MEK kinase inhibitors do not significantly affect infection susceptibility. The effect of Bruton tyrosine kinase inhibitors (ibrutinib) among patients with B-cell malignancies is difficult to distinguish from that of previous immunosuppression. However, cases of Pneumocystis jirovecii pneumonia (PCP), invasive fungal infection and progressive multifocal leukoencephalopathy have been occasionally reported. Because phosphatidylinositol-3-kinase inhibitors (idelalisib) may predispose to opportunistic infections, anti-Pneumocystis prophylaxis and prevention strategies for cytomegalovirus are recommended. No increased rates of infection have been observed with venetoclax (antiapoptotic protein Bcl-2 inhibitor). Therapy with Janus kinase inhibitors markedly increases the incidence of infection. Pretreatment screening for chronic hepatitis B virus and latent tuberculosis infection must be performed, and anti-Pneumocystis prophylaxis should be considered for patients with additional risk factors. Cancer patients receiving mTOR inhibitors face an increased incidence of overall infection, especially those with additional risk factors (prior therapies or delayed wound healing). IMPLICATIONS Specific preventive approaches are warranted in view of the increased risk of infection associated with some of the reviewed agents.
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Affiliation(s)
- M Reinwald
- Department of Hematology and Oncology, Klinikum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg an der Havel, Germany.
| | - J T Silva
- Department of Infectious Diseases, University Hospital of Badajoz, Fundación para la Formación e Investigación de los Profesionales de la Salud (FundeSalud), Badajoz, Spain
| | - N J Mueller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - J Fortún
- Department of Infectious Diseases, Hospital Universitario 'Ramon y Cajal', Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - C Garzoni
- Department of Internal Medicine, Clinica Luganese, Lugano, Switzerland; Department of Infectious Disease, Clinica Luganese, Lugano, Switzerland
| | - J W de Fijter
- Department of Medicine, Division of Nephrology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (i+12), School of Medicine, Universidad Complutense, Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - P Grossi
- Department of Infectious and Tropical Diseases, University of Insubria, Ospedale di Circolo-Fondazioni Macchi, Varese, Italy
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (i+12), School of Medicine, Universidad Complutense, Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
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237
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O'Reilly A, Murphy J, Rawe S, Garvey M. Chronic Lymphocytic Leukemia: A Review of Front-line Treatment Options, With a Focus on Elderly CLL Patients. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:249-256. [PMID: 29477297 DOI: 10.1016/j.clml.2018.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/18/2018] [Accepted: 02/02/2018] [Indexed: 11/25/2022]
Abstract
Chronic lymphocytic leukemia (CLL) remains the most prevalent form of leukemia in the Western world, with no cure to date. Ongoing and essential research into this heterogeneous disease has led to a number of new treatment options becoming available to CLL patients in the past decade. The present review presents the recent developments in the field of CLL treatment, with the main focus on elderly patients and CLL patients with coexisting comorbidities. The review discusses the current treatment regimens that provide the most promising outcomes for patients in this subgroup, with a number of important clinical trials summarized. These clinical trials, which have investigated promising single-agent therapies or combination therapies, are discussed, with an emphasis on the efficacy and tolerability for patients aged ≥ 65 years. Also, the misrepresentation of the true CLL population in many clinical trials and the need for better guidelines for participant inclusion criteria to provide a more realistic and accurate study population are noted.
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Affiliation(s)
- Alma O'Reilly
- Cellular Health and Toxicology Research Group, Department of Life Sciences, Institute of Technology Sligo, Sligo, Ireland.
| | - James Murphy
- Cellular Health and Toxicology Research Group, Department of Life Sciences, Institute of Technology Sligo, Sligo, Ireland
| | - Sarah Rawe
- School of Chemical and Pharmaceutical Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - Mary Garvey
- Cellular Health and Toxicology Research Group, Department of Life Sciences, Institute of Technology Sligo, Sligo, Ireland
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238
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Tillman BF, Pauff JM, Satyanarayana G, Talbott M, Warner JL. Systematic review of infectious events with the Bruton tyrosine kinase inhibitor ibrutinib in the treatment of hematologic malignancies. Eur J Haematol 2018; 100:325-334. [DOI: 10.1111/ejh.13020] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Benjamin F. Tillman
- Department of Medicine; Division of Hematology/Oncology; Vanderbilt University Medical Center; Nashville TN USA
| | - James M. Pauff
- Department of Medicine; Division of Hematology/Oncology; Vanderbilt University Medical Center; Nashville TN USA
| | - Gowri Satyanarayana
- Department of Medicine; Division of Infectious Diseases; Vanderbilt University Medical Center; Nashville TN USA
| | - Mahsa Talbott
- Department of Pharmaceutical Services; Vanderbilt University Medical Center; Nashville TN USA
| | - Jeremy L. Warner
- Department of Medicine; Division of Hematology/Oncology; Vanderbilt University Medical Center; Nashville TN USA
- Department of Biomedical Informatics; Vanderbilt University; Nashville TN USA
- Vanderbilt-Ingram Cancer Center; Nashville TN USA
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239
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Michallet AS, Aktan M, Hiddemann W, Ilhan O, Johansson P, Laribi K, Meddeb B, Moreno C, Raposo J, Schuh A, Ünal A, Widenius T, Bernhardt A, Kellershohn K, Messeri D, Osborne S, Leblond V. Rituximab plus bendamustine or chlorambucil for chronic lymphocytic leukemia: primary analysis of the randomized, open-label MABLE study. Haematologica 2018; 103:698-706. [PMID: 29419437 PMCID: PMC5865431 DOI: 10.3324/haematol.2017.170480] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 01/22/2018] [Indexed: 11/11/2022] Open
Abstract
MABLE investigated the efficacy and safety of rituximab plus bendamustine or rituximab plus chlorambucil in fludarabine-ineligible patients with chronic lymphocytic leukemia. Patients received rituximab plus bendamustine or rituximab plus chlorambucil every four weeks for six cycles. Rituximab plus chlorambucil-treated patients without a complete response after Cycle 6 received chlorambucil monotherapy for at least six additional cycles or until complete response. The primary endpoint was complete response rate (confirmed by bone marrow biopsy) after Cycle 6 in first-line patients. Secondary endpoints included progression-free survival, overall survival, minimal residual disease, and safety. Overall, 357 patients were randomized (rituximab plus bendamustine, n=178; rituximab plus chlorambucil, n=179; intent-to-treat population), including 241 first-line patients (n=121 and n=120, respectively); 355 patients received treatment (n=177 and n=178, respectively; safety population). In first-line patients, complete response rate after Cycle 6 (rituximab plus bendamustine, 24%; rituximab plus chlorambucil, 9%; P=0.002) and median progression-free survival (rituximab plus bendamustine, 40 months; rituximab plus chlorambucil, 30 months; P=0.003) were higher with rituximab plus bendamustine than rituximab plus chlorambucil. Overall response rate and overall survival were not different. In first-line patients with a complete response, minimal residual disease-negativity was higher with rituximab plus bendamustine than rituximab plus chlorambucil (66% vs. 36%). Overall adverse event incidence was similar (rituximab plus bendamustine, 98%; rituximab plus chlorambucil, 97%). Rituximab plus bendamustine may be a valuable first-line option for fludarabine-ineligible patients with chronic lymphocytic leukemia.
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Affiliation(s)
| | - Melih Aktan
- Istanbul Medical Faculty, Istanbul University, Turkey
| | - Wolfgang Hiddemann
- Department of Internal Medicine III, Ludwig-Maximilians University of Munich, Germany
| | - Osman Ilhan
- Department of Hematology, Ankara University School of Medicine, Turkey
| | | | - Kamel Laribi
- Department of Hematology, Centre Hospitalier du Mans, Le Mans, France
| | - Balkis Meddeb
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia
| | - Carol Moreno
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - João Raposo
- Hematology Service, Hospital de Santa Maria, Lisbon, Portugal
| | - Anna Schuh
- Department of Oncology, Oxford University Hospitals, UK
| | - Ali Ünal
- Department of Hematology, Erciyes University Medical School, Kayseri, Turkey
| | - Tom Widenius
- Department of Internal Medicine, Peijas Hospital, Vantaa, Finland
| | - Alf Bernhardt
- Product Development Medical Affairs, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | - Dimitri Messeri
- Product Development Medical Affairs, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Stuart Osborne
- Product Development Medical Affairs, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Véronique Leblond
- Clinical Hematology, AP-HP Hôpital Pitié-Salpêtrière, UPMC University, Paris, France
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240
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Mato AR, Nabhan C, Thompson MC, Lamanna N, Brander DM, Hill B, Howlett C, Skarbnik A, Cheson BD, Zent C, Pu J, Kiselev P, Goy A, Claxton D, Isaac K, Kennard KH, Timlin C, Landsburg D, Winter A, Nasta SD, Bachow SH, Schuster SJ, Dorsey C, Svoboda J, Barr P, Ujjani CS. Toxicities and outcomes of 616 ibrutinib-treated patients in the United States: a real-world analysis. Haematologica 2018; 103:874-879. [PMID: 29419429 PMCID: PMC5927982 DOI: 10.3324/haematol.2017.182907] [Citation(s) in RCA: 320] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/26/2018] [Indexed: 11/09/2022] Open
Abstract
Clinical trials that led to ibrutinib's approval for the treatment of chronic lymphocytic leukemia showed that its side effects differ from those of traditional chemotherapy. Reasons for discontinuation in clinical practice have not been adequately studied. We conducted a retrospective analysis of chronic lymphocytic leukemia patients treated with ibrutinib either commercially or on clinical trials. We aimed to compare the type and frequency of toxicities reported in either setting, assess discontinuation rates, and evaluate outcomes. This multicenter, retrospective analysis included ibrutinib-treated chronic lymphocytic leukemia patients at nine United States cancer centers or from the Connect® Chronic Lymphocytic Leukemia Registry. We examined demographics, dosing, discontinuation rates and reasons, toxicities, and outcomes. The primary endpoint was progression-free survival. Six hundred sixteen ibrutinib-treated patients were identified. A total of 546 (88%) patients were treated with the commercial drug. Clinical trial patients were younger (mean age 58 versus 61 years, P=0.01) and had a similar time from diagnosis to treatment with ibrutinib (mean 85 versus 87 months, P=0.8). With a median follow-up of 17 months, an estimated 41% of patients discontinued ibrutinib (median time to ibrutinib discontinuation was 7 months). Notably, ibrutinib toxicity was the most common reason for discontinuation in all settings. The median progression-free survival and overall survival for the entire cohort were 35 months and not reached (median follow-up 17 months), respectively. In the largest reported series on ibrutinib- treated chronic lymphocytic leukemia patients, we show that 41% of patients discontinued ibrutinib. Intolerance as opposed to chronic lymphocytic leukemia progression was the most common reason for discontinuation. Outcomes remain excellent and were not affected by line of therapy or whether patients were treated on clinical studies or commercially. These data strongly argue in favor of finding strategies to minimize ibrutinib intolerance so that efficacy can be further maximized. Future clinical trials should consider time-limited therapy approaches, particularly in patients achieving a complete response, in order to minimize ibrutinib exposure.
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Affiliation(s)
- Anthony R Mato
- Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Meghan C Thompson
- Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicole Lamanna
- Hematology/Oncology, Presbyterian/Columbia University Medical Center, New York, NY, USA
| | | | - Brian Hill
- Hematology and Medical Oncology, Cleveland Clinic, OH, USA
| | - Christina Howlett
- Pharmacy, Ernest Mario School of Pharmacy, New Brunswick, NY, USA.,Hematology/Oncology, John Theurer Cancer Center, Hackensack, NY, USA
| | - Alan Skarbnik
- Hematology/Oncology, John Theurer Cancer Center, Hackensack, NY, USA
| | - Bruce D Cheson
- Hematology/Oncology, Georgetown University Hospital, Washington DC, USA
| | - Clive Zent
- Hematology/Oncology, University of Rochester Medical Center, NY, USA
| | - Jeffrey Pu
- Hematology/Oncology, Penn State Milton S Hershey Medical Center, PA, USA
| | | | - Andre Goy
- Hematology/Oncology, John Theurer Cancer Center, Hackensack, NY, USA
| | - David Claxton
- Hematology/Oncology, Penn State Milton S Hershey Medical Center, PA, USA
| | - Krista Isaac
- Hematology/Oncology, Lankenau Hospital, Wynnewood, PA, USA
| | - Kaitlin H Kennard
- Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Colleen Timlin
- Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Landsburg
- Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Allison Winter
- Hematology and Medical Oncology, Cleveland Clinic, OH, USA
| | - Sunita D Nasta
- Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Spencer H Bachow
- Hematology/Oncology, Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Stephen J Schuster
- Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Colleen Dorsey
- Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jakub Svoboda
- Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul Barr
- Division of Hematology and Oncology, University of Rochester, NY, USA
| | - Chaitra S Ujjani
- Hematology/Oncology, Georgetown University Hospital, Washington DC, USA
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241
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Hillmen P, Diels J, Healy N, Iraqi W, Aschan J, Wildgust M. Ibrutinib for chronic lymphocytic leukemia: international experience from a named patient program. Haematologica 2018; 103:e204-e206. [PMID: 29419428 DOI: 10.3324/haematol.2017.178798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Peter Hillmen
- The Leeds Teaching Hospitals, St. James Institute of Oncology, Leeds, UK
| | - Joris Diels
- Janssen EU HEMAR Statistics & Modeling, Beerse, Belgium
| | | | | | - Johan Aschan
- Janssen-Cilag EMEA Medical Affairs, Sollentuna, Sweden
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242
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Strategies to overcome resistance mutations of Bruton's tyrosine kinase inhibitor ibrutinib. Future Med Chem 2018; 10:343-356. [PMID: 29347836 DOI: 10.4155/fmc-2017-0145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Ibrutinib, as the first Bruton's tyrosine kinase (Btk) inhibitor, has been shown to have clinically significant activity in leukemias and lymphomas. However, the initially responsive tumors will develop resistance during the process of treatment in few patients. Here, we summarized the mechanism of acquired resistance and suggested the next-generation Btk inhibitors that override the target resistance. Moreover, the development of combination of selective antagonists or inhibitors targeting to multiple protein kinases have increased therapeutic potency to reduce the risk of the emergence of kinases inhibitor resistance. Thus, the reported combination of therapeutic drugs as an alternative therapy to overcome ibrutinib collapse or reduce the risk of the emergence of Btk inhibitor resistance also has been reviewed.
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243
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Malyszko J, Kozlowska K, Kozlowski L, Malyszko J. Nephrotoxicity of anticancer treatment. Nephrol Dial Transplant 2018; 32:924-936. [PMID: 28339935 DOI: 10.1093/ndt/gfw338] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 08/10/2016] [Indexed: 12/12/2022] Open
Abstract
Severe adverse systemic drug events occur commonly as a result of treatment of cancer patients. Nephrotoxicity of chemotherapeutic agents remains a significant complication limiting the efficacy of the treatment. A variety of renal disease and electrolyte disorders can result from the drugs that are used to treat malignant disease. The kidneys are a major elimination pathway for many antineoplastic drugs and their metabolites. Tumour lysis syndrome, an emergency in haematooncology, occurs most often after the initiation of cytotoxic therapy in patients with high-grade lymphomas and acute lymphoblastic leukaemia. Chemotherapeutic agents can affect the glomerulus, tubules, interstitium and renal microvasculature, with clinical manifestations that range from asymptomatic elevation of serum creatinine to acute renal failure requiring dialysis. Some factors such as intravascular volume depletion, as well as concomitant use of other drugs or radiographic ionic contrast media, can potentiate or contribute to the nephrotoxicity. Cytotoxic agents can cause nephrotoxicity by a variety of mechanisms. The most nephrotoxic chemotherapeutic drug is cisplatin, which is often associated with acute kidney injury. Many other drugs such as alkylating agents, antimetabolites, vascular endothelial growth factor pathway inhibitors and epidermal growth factor receptor pathway inhibitors may have toxic effects on the kidneys. The aim of this review is to discuss the issue of nephrotoxicity associated with chemotherapy. In routine clinical practice, monitoring of kidney function is mandatory in order to identify nephrotoxicity early, allowing dosage adjustments or withdrawal of the offending drug.
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Affiliation(s)
- Jolanta Malyszko
- 2nd Department ofNephrology and Hypertension with Dialysis Unit, Medical University in Bialystok
| | - Klaudia Kozlowska
- 2nd Department ofNephrology and Hypertension with Dialysis Unit, Medical University in Bialystok
| | - Leszek Kozlowski
- Department of Oncological Surgery, Ministry of Interior Affairs Hospital, Bialystok, Poland
| | - Jacek Malyszko
- 1st Department of Nephrology and Transplantology with Dialysis Unit, Medical University in Bialystok, Bialystok, Poland
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244
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Gribben JG, Bosch F, Cymbalista F, Geisler CH, Ghia P, Hillmen P, Moreno C, Stilgenbauer S. Optimising outcomes for patients with chronic lymphocytic leukaemia on ibrutinib therapy: European recommendations for clinical practice. Br J Haematol 2018; 180:666-679. [DOI: 10.1111/bjh.15080] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/23/2017] [Indexed: 02/06/2023]
Affiliation(s)
- John G. Gribben
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Francesc Bosch
- Department of Haematology; Vall d'Hebron University Hospital; Barcelona Spain
| | - Florence Cymbalista
- U978 Institut National de la Santé et de la Recherche Médicale; Bobigny France
- Labex Inflamex; Université Paris 13; Sorbonne Paris Cité; Bobigny France
- Hôpital Avicenne; Assistance Publique-Hôpitaux de Paris; Bobigny France
| | | | - Paolo Ghia
- Strategic Research Programme on CLL; IRCCS San Raffaele Hospital; Milan Italy
- Università Vita-Salute San Raffaele; Milan Italy
| | - Peter Hillmen
- St James' Institute of Oncology; University of Leeds; Leeds UK
| | - Carol Moreno
- Department of Haematology; Hospital de la Santa Creu Sant Pau; Autonomous University of Barcelona; Barcelona Spain
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245
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Cramer P, Fraser G, Santucci-Silva R, Grosicki S, Dilhuydy MS, Janssens A, Loscertales J, Rule S, Goy A, Traina S, Chan EKH, Diels J, Sengupta N, Mahler M, Salman M, Howes A, Chanan-Khan A. Improvement of fatigue, physical functioning, and well-being among patients with severe impairment at baseline receiving ibrutinib in combination with bendamustine and rituximab for relapsed chronic lymphocytic leukemia/small lymphocytic lymphoma in the HELIOS study. Leuk Lymphoma 2018; 59:2075-2084. [DOI: 10.1080/10428194.2017.1416364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Paula Cramer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Graeme Fraser
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | | | | | - Ann Janssens
- Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Javier Loscertales
- Hematology Department, Hospital Universitario La Princesa, IIS-IP, Madrid, Spain
| | - Simon Rule
- Plymouth University Medical School, Plymouth, UK
| | - Andre Goy
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | | | | | - Joris Diels
- Janssen EU HEMAR Statistics & Modelling, Beerse, Belgium
| | | | | | | | - Angela Howes
- Janssen Research & Development, High Wycombe, UK
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246
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Mato AR, Clasen S, Pickens P, Gashonia L, Rhodes J, Svoboda J, Hughes M, Nabhan C, Ali N, Schuster S, Carver J. Left atrial abnormality (LAA) as a predictor of ibrutinib-associated atrial fibrillation in patients with chronic lymphocytic leukemia. Cancer Biol Ther 2018; 19:1-2. [PMID: 29281559 PMCID: PMC5790349 DOI: 10.1080/15384047.2017.1394554] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 10/02/2017] [Accepted: 10/15/2017] [Indexed: 12/19/2022] Open
Abstract
Results from several recent studies in chronic lymphocytic leukemia (CLL) have demonstrated an association between ibrutinib exposure and the development of atrial fibrillation, estimated incidence of 11% with long-term follow up. This is a common cause of ibrutinib discontinuation. Risk factors for atrial fibrillation include advanced age, hypertension (HTN), mitral valve disease (MVD), left atrial remodeling, coronary artery disease (CAD) and risk factors for cardiovascular dysfunction We conducted a retrospective case control study using the presence of left atrial abnormality identified on pre-ibrutinib EKGs, defined as either (1) Lead II-bifed p wave, with 40 mcsec between peaks for ≥ 2.5 mm wide ≥ 100 msec in duration, (2) Lead V1-biphasic P wave with terminal portion ≥ 40 msec in duration or terminal portion ≥ 1 mm deep or (3) PR interval ≥ 200 msec (intra-atrial conduction delay) as a predictor for development of atrial fibrillation. 183 consecutively CLL patients treated with ibrutinib were identified. 44 patients met inclusion criteria (20 cases, 24 controls). 20 (11.3%) of patients developed atrial fibrillation. Left atrial enlargement was identified as a significant predictor of development of atrial fibrillation (OR 9.1, 95% CI 2.2-37.3, p=0.02). Age, baseline HTN, CAD, diabetes, age and sex were not significant predictors. Area under the ROC curve for the model was estimated to be 75%. LAA identified by EKG is a moderately specific and sensitive finding that can identify patients at increased risk for this toxicity.
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Affiliation(s)
- Anthony R. Mato
- Department of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA
| | - Suparna Clasen
- Department of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA
| | - Peter Pickens
- Abington-Jefferson Health, Abington PA, United States
| | - Lisa Gashonia
- Department of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA
| | - Joanna Rhodes
- Department of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA
| | - Jakub Svoboda
- Department of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA
| | - Mitchell Hughes
- Department of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA
| | | | - Naveed Ali
- Abington-Jefferson Health, Abington PA, United States
| | - Stephen Schuster
- Department of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA
| | - Joseph Carver
- Department of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA
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247
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Itchaki G, Brown JR. Experience with ibrutinib for first-line use in patients with chronic lymphocytic leukemia. Ther Adv Hematol 2018; 9:3-19. [PMID: 29317997 PMCID: PMC5753924 DOI: 10.1177/2040620717741861] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 10/17/2017] [Indexed: 01/17/2023] Open
Abstract
Ibrutinib is the first in-class, orally administered, Bruton's tyrosine kinase (BTK) inhibitor that abrogates the critical signaling downstream of the B-cell receptor (BCR). This signaling is required for B-cell survival, proliferation and interaction with the microenvironment. Ibrutinib proved active in preclinical models of lymphoproliferative diseases and achieved impressive response rates in heavily pretreated relapsed and refractory (R/R) patients with chronic lymphocytic leukemia (CLL). Ibrutinib prolonged survival compared to standard therapy and mitigated the effect of most poor prognostic factors in CLL, thus becoming the main therapeutic option in high-risk populations. Moreover, compared with standard chemoimmunotherapy (CIT) for adults, ibrutinib causes fewer cytopenias and infections, while having its own unique toxicity profile. Its efficacy in relapsed patients as well as its tolerability have led to its increased use in previously untreated patients, especially in those with poor prognostic markers and/or the elderly. This review elaborates on ibrutinib's unique toxicity profile and the mechanisms of acquired resistance leading to progression on ibrutinib, since both are critical for understanding the obstacles to its first-line use. We will further evaluate the data from ongoing clinical trials in this setting and explore future options for combination therapy.
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248
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Abstract
Abnormal B-cell receptor (BCR) signalling is a key mechanism of disease progression in B-cell malignancy. Bruton's tyrosine kinase (BTK) has a pivotal role in BCR signalling. Ibrutinib (PCI-32765) is a small molecule which serves as a covalent irreversible inhibitor of BTK. It is characterized by high selectivity for BTK and high potency. Ibrutinib is currently approved by the FDA and EMA for use in chronic lymphocytic leukaemia in any line of treatment, for treatment of Waldenstrom macroglobulinemia in patients who have received previous treatments or are not suitable to receive immunochemotherapy as well as for second line treatment of mantle cell lymphoma and for patients with marginal zone lymphoma who have received at least one prior anti-CD20-based therapy. In addition, there is emerging clinical data on its efficacy in ABC subtype diffuse large B-cell lymphoma, multiple myeloma and primary central nervous system lymphoma. Ibrutinib has opened new options for treatment of those patients that have relapsed or have been refractory to more classical modes of treatment. Moreover, Ibrutinib has been shown to be effective in patients that have been known to have little sensitivity to classical immunochemotherapy. Having a favourable risk profile, the substance is, unlike conventional immunochemotherapy, also suitable for the less physical fit patients. Cases of primary and secondary resistance to Ibrutinib have emerged and there is an ongoing effort to identify their mechanism and develop strategies to overcome them. Beyond its direct effects on survival and apoptosis of malignant B-cells, there is increasing evidence that Ibrutinib is able to modulate the tumour microenvironment to overcome mechanisms of immune evasion. This has sparked interest in use of the substance beyond lymphoid malignancy. This chapter discusses structure, mechanism of action and toxicities of Ibrutinib and also presents important preclinical and clinical data as well as mechanisms of Ibrutinib resistance. Combination strategies with immunotherapeutic strategies such as immune checkpoint blockade and CAR T-cell therapy may be synergistic and are currently under investigation.
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Affiliation(s)
| | - Mark-Alexander Schwarzbich
- Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
- Department of Haematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Mathias Witzens-Harig
- Department of Haematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
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249
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Garside J, Healy N, Besson H, Hermans R, MacDougall F, Lestelle D, Diels J, Iraqi W. PHEDRA: using real-world data to analyze treatment patterns and ibrutinib effectiveness in hematological malignancies. J Comp Eff Res 2018; 7:29-38. [DOI: 10.2217/cer-2017-0046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: PHEDRA (Platform for Haematology in EMEA: Data for Real World Analysis) is a unique, noninterventional project based on secondary data collection from real-world (RW) patient-level (health record) databases to understand treatment patterns in hematological malignancies. It compares ibrutinib's effectiveness with alternative treatments using RW data (RWD) and randomized clinical trials data. Materials & methods: RWD are cleaned, validated, harmonized into a Common Data Model, and analyzed statistically alongside randomized clinical trial data. Treatment outcomes include overall and progression-free survival. Results: To date, RWD (four databases) are available for 2840 patients in three indications, collected between 1990 and 2017. Conclusion: PHEDRA is an innovative approach to generate evidence to inform optimal treatment decisions in RW settings.
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Affiliation(s)
| | | | - Hervé Besson
- Janssen EU HEMAR Statistics & Modelling, Beerse, Belgium
| | | | | | | | - Joris Diels
- Janssen EU HEMAR Statistics & Modelling, Beerse, Belgium
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250
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Stauder R, Eichhorst B, Hamaker ME, Kaplanov K, Morrison VA, Österborg A, Poddubnaya I, Woyach JA, Shanafelt T, Smolej L, Ysebaert L, Goede V. Management of chronic lymphocytic leukemia (CLL) in the elderly: a position paper from an international Society of Geriatric Oncology (SIOG) Task Force. Ann Oncol 2017; 28:218-227. [PMID: 27803007 DOI: 10.1093/annonc/mdw547] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) mainly affects older people: the median age at diagnosis is > 70 years. Elderly patients with CLL are heterogeneous with regard both to the biology of their disease and aging. Following the diagnosis of CLL in an elderly individual, careful risk assessment is essential when treatment options are evaluated. This includes not only clinical staging and evaluation of disease-specific prognostic biomarkers such as 17p deletion and TP53 mutation, but also of comorbidities, physical capacity, nutritional status, cognitive capacity, ability to perform activities of daily living and social support. Comorbidity scoring and geriatric assessment tools are helpful in achieving such multidimensional evaluation in a systematic manner. The introduction of new drugs including novel monoclonal antibodies and kinase inhibitors offers enhanced opportunities for the treatment of elderly patients with CLL. This position paper of a Task Force of the International Society of Geriatric Oncology (SIOG) reviews currently available evidence relevant to such patients. All types of elderly patient (i.e. chronological age > 65-70 years) are considered, from robust (fit) to vulnerable (unfit) to the terminally ill. Among the topics covered are the following: (i) the relationship between chronological age, prognosis and survival, (ii) assessment of biological aging, (iii) biological age as a determinant of treatment feasibility and tolerance and (iv) tailoring of both first and further-line treatment to the circumstances of the individual patient.
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Affiliation(s)
- R Stauder
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - B Eichhorst
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology (CIO) Cologne-Bonn, Cologne, Germany
| | - M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht, The Netherlands
| | - K Kaplanov
- Department of Hematology, Volgograd Regional Clinical Oncology Center, Volgograd, Russian Federation
| | - V A Morrison
- University of Minnesota, Hennepin County Medical Center, Minneapolis, USA
| | - A Österborg
- Karolinska University Hospital and Institute, Stockholm, Sweden
| | - I Poddubnaya
- Russian Medical Academy for Postgraduate Education, Moscow, Russian Federation
| | - J A Woyach
- Department of Internal Medicine, Ohio State University, Ohio, USA
| | - T Shanafelt
- Department of Hematology and Oncology, Mayo Clinic, Rochester, USA
| | - L Smolej
- 4th Department of Internal Medicine-Hematology, University Hospital and Charles University Faculty of Medicine, Hradec Králové, Czech Republic
| | - L Ysebaert
- Hematology Department, IUC Toulouse-Oncopole, Toulouse, France
| | - V Goede
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology (CIO) Cologne-Bonn, Cologne, Germany
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