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Ohmachi K, Ando K, Ogura M, Uchida T, Tobinai K, Maruyama D, Namiki M, Nakanishi T. E7777 in Japanese patients with relapsed/refractory peripheral and cutaneous T-cell lymphoma: A phase I study. Cancer Sci 2018; 109:794-802. [PMID: 29363235 PMCID: PMC5834772 DOI: 10.1111/cas.13513] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/05/2018] [Accepted: 01/10/2018] [Indexed: 12/27/2022] Open
Abstract
E7777, a recombinant cytotoxic fusion protein comprising diphtheria toxin fragments A and B and human interleukin-2, shares an amino acid sequence with denileukin diftitox but has improved purity and an increased percentage of active protein monomer species. A phase I study was carried out to evaluate the tolerability, safety, pharmacokinetics, and antitumor activity of E7777 in Japanese patients with relapsed/refractory peripheral and cutaneous T-cell lymphoma. E7777 (6, 12, and expanded 9 μg/kg/day) was given to 13 patients by i.v. infusion on five consecutive days per 21-day cycle. Dose-limiting toxicities, including increased alanine aminotransferase, hyponatremia (n = 2), hypokalemia, lymphopenia, fatigue, hypoalbuminemia, rash, and increased lipase (n = 1), were observed in all three patients in the 12 μg/kg/day cohort, whereas two of six patients in the 9 μg/kg/day cohort showed decreased appetite or fatigue. The maximum tolerated and recommended dose of E7777 was 9 μg/kg/day for five consecutive days per 21-day cycle. The objective response rate was 38% (5/13) and did not appear to depend on tumor expression of CD25. E7777 was well tolerated, assuming careful management of adverse events during treatment, and preliminary but clinically meaningful antitumor activity was observed. Subsequent studies of E7777 for T-cell lymphomas are warranted. This study was registered with www.ClinicalTrials.gov (NCT1401530).
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Affiliation(s)
- Ken Ohmachi
- Department of Haematology and OncologyTokai University School of MedicineIseharaJapan
| | - Kiyoshi Ando
- Department of Haematology and OncologyTokai University School of MedicineIseharaJapan
| | - Michinori Ogura
- Department of Haematology and OncologyJapanese Red Cross Nagoya Daini HospitalNagoyaJapan
- Department of HaematologyTokai Central HospitalKakamigaharaJapan
| | - Toshiki Uchida
- Department of Haematology and OncologyJapanese Red Cross Nagoya Daini HospitalNagoyaJapan
| | - Kensei Tobinai
- Department of HaematologyNational Cancer Centre HospitalTokyoJapan
| | - Dai Maruyama
- Department of HaematologyNational Cancer Centre HospitalTokyoJapan
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202
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Zhang JY, Briski R, Devata S, Kaminski MS, Phillips TJ, Mayer TL, Bailey NG, Wilcox RA. Survival following salvage therapy for primary refractory peripheral T-cell lymphomas (PTCL). Am J Hematol 2018; 93:394-400. [PMID: 29194714 DOI: 10.1002/ajh.24992] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/07/2017] [Accepted: 11/27/2017] [Indexed: 12/11/2022]
Abstract
Optimal salvage therapy for primary refractory peripheral T-cell lymphomas (PTCL) and the role of hematopoietic stem cell transplant (SCT) remain poorly defined. We conducted a retrospective review of clinical outcomes and prognostic factors in a single-center cohort of 93 patients with primary refractory PTCL, defined as progression during first-line therapy or relapse within 6 months of its completion. Clinical outcomes were poor in this population, with median event-free survival (EFS) of 3.5 months, median overall survival (OS) of 9.1 months, and 34% 3-year survival. Outcomes were comparable in patients who progressed through first-line therapy and patients who achieved CR/PR and subsequently relapsed within 6 months. A majority exhibited high-risk features and had intermediate to high risk IPI, which correlated with inferior outcomes. There was no difference in outcomes between patients who received single-agent salvage regimens and patients who underwent traditional, multi-agent salvage regimens. Thus, participation in well-designed clinical trials should be encouraged in this population. Additionally, there may be a trend toward improved EFS and OS in patients who underwent autologous or allogeneic SCT compared to patients who achieved CR or PR but were not transplanted.
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Affiliation(s)
- Janie Y. Zhang
- Department of Internal Medicine; University of Michigan; Ann Arbor Michigan
| | - Robert Briski
- Division of Hematology, Department of Internal Medicine; University of Michigan; Ann Arbor Michigan
| | - Sumana Devata
- Division of Hematology, Department of Internal Medicine; University of Michigan; Ann Arbor Michigan
| | - Mark S. Kaminski
- Division of Hematology, Department of Internal Medicine; University of Michigan; Ann Arbor Michigan
| | - Tycel J. Phillips
- Division of Hematology, Department of Internal Medicine; University of Michigan; Ann Arbor Michigan
| | - Tera L. Mayer
- Division of Hematology, Department of Internal Medicine; University of Michigan; Ann Arbor Michigan
| | | | - Ryan A. Wilcox
- Division of Hematology, Department of Internal Medicine; University of Michigan; Ann Arbor Michigan
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203
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Yang CF, Hsu CY, Ho DMT. Aggressive natural killer (NK)-cell leukaemia and extranodal NK/T-cell lymphoma are two distinct diseases that differ in their clinical presentation and cytogenetic findings. Histopathology 2018; 72:955-964. [PMID: 29314186 DOI: 10.1111/his.13463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 12/31/2017] [Indexed: 12/12/2022]
Abstract
AIMS Aggressive natural killer (NK)-cell leukaemia (ANKCL) and extranodal NK/T-cell lymphoma (ENKTCL) with secondary bone marrow involvement are rare bone marrow NK/T-cell neoplasms and share similar features. This study aimed to distinguish these two entities. METHODS AND RESULTS We studied bone marrow NK/T-cell neoplasms by classifying them into those with no extramedullary mass (group 1, eight cases) and those with extramedullary mass (group 2, 13 cases). The two groups showed similar clinical presentations and pathological features. Fever and cytopenia were the most common clinical presentations in both groups. The neoplastic cells varied from small and relatively monotonous cells to large pleomorphic cells. In six cases (two in group 1, and four in group 2), the neoplastic infiltrate was inconspicuous, consisting of ≤10% of marrow cells in the interstitium, which were hardly identified by haematoxylin and eosin staining alone. Nearly all patients rapidly died, regardless of the neoplastic infiltrate volume. All of the group 1 patients fulfilled the World Health Organisation 2017 diagnostic criteria of ANKCL, and their survival was significantly worse than that of the group 2 patients (P = 0.035). In addition, there was a significant association between being in group 1 and chromosome 7 abnormalities. Chromosome 6q deletion, which is commonly reported in ENKTCL, was seen in two of our group 2 patients, and was not observed in any of our group 1 patients. CONCLUSION ANKCL with no extramedullary mass should be distinguished from ENKTCL with bone marrow involvement, as the former shows distinct outcomes and genetic features.
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Affiliation(s)
- Ching-Fen Yang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Yi Hsu
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Donald M-T Ho
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pathology and Laboratory Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
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204
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Reboursiere E, Le Bras F, Herbaux C, Gyan E, Clavert A, Morschhauser F, Malak S, Sibon D, Broussais F, Braun T, Fornecker LM, Garidi R, Tricot S, Houot R, Joly B, Abarah W, Choufi B, Pham AD, Gac AC, Fruchart C, Marin E, Safar V, Parcelier A, Maisonneuve H, Bachy E, Cartron G, Jaccard A, Tournilhac O, Rossi C, Schirmer L, Martignoles JA, Gaulard P, Tilly H, Damaj G. Bendamustine for the treatment of relapsed or refractory peripheral T cell lymphomas: A French retrospective multicenter study. Oncotarget 2018; 7:85573-85583. [PMID: 27458168 PMCID: PMC5356759 DOI: 10.18632/oncotarget.10764] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/10/2016] [Indexed: 12/15/2022] Open
Abstract
Peripheral T-cell lymphoma (PTCL) is a group of diseases with poor outcome and few therapeutic options. We aimed to assess the efficacy of bendamustine in real life cohort of patients. Between November 2009 and March 2015, 138 PTCL patients were treated with bendamustine in 27 centers. Population median age was 64 (28-89) years with male/female ratio of 1.4. There were mainly angio-immunoblastic (AITL = 71), PTCL-not otherwise specified (PTCL-NOS = 40) and anaplastic large cell lymphoma (ALCL = 8). The majority of patients (96%) had disseminated disease and extranodal localizations (77%). Median number of chemotherapy lines prior to bendamustine was 2 (1-8). Median duration of response (DoR) after the last chemotherapy prior to bendamustine was 4.3 months (1-70) and 50% of patients had refractory disease. Median number of administered bendamustine cycles was 2 (1-8) and 72 patients (52%) received less than 3 mostly because of disease progression. Median dose was 90 (50-150) mg/m². Overall response rate (ORR) was 32.6% with complete response (CR) rate of 24.6% and median DoR was 3.3 months (1-39). AITL patients were more sensitive than PTCL-NOS patients (ORR: 45.1 versus 20%, p = 0.01). Median PFS and OS were 3.1 (0.2-46.3) and 4.4 (0.2-55.4) months. On multivariate analysis, refractory disease (p = 0.001) and extranodal localization (p = 0.028) adversely influenced ORR. Grade 3-4 thrombocytopenia, neutropenia and infections were reported in 22, 17 and 23% of cases respectively. Bendamustine as single agent could be considered as a therapeutic option for relapsed or refractory PTCL, particularly in chemosensitive or AITL patients. Combinations of bendamustine with other drugs warrant further evaluation.
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Affiliation(s)
| | - Fabien Le Bras
- Department of Hematology, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Charles Herbaux
- Department of Hematology, University and Regional Hospital of Lille, Lille, France
| | - Emmanuel Gyan
- Department of Hematology, University Hospital of Tours, UMR CNRS, Tours, France
| | - Aline Clavert
- Department of Hematology, University Hospital of Angers, Angers, France
| | - Franck Morschhauser
- Department of Hematology, University and Regional Hospital of Lille, Lille, France
| | - Sandra Malak
- Department of Hematology, Institut Curie, Paris, France
| | - David Sibon
- Department of Hematology, Hôpital Necker-Enfants Malades, Paris, France
| | | | - Thorsten Braun
- Department of Hematology, Hôpital Avicenne, Bobigny, France
| | | | - Reda Garidi
- Department of Hematology, Saint Quentin Hospital, Saint Quentin, France
| | - Sabine Tricot
- Department of Hematology, Centre Hospitalier Valenciennes, Valenciennes, France
| | - Roch Houot
- Department of Hematology, University Hospital Pontchaillot, Rennes, France
| | - Bertrand Joly
- Department of Hematology, Centre Hospitalier Sud Francilien, Corbeil, France
| | - Wajed Abarah
- Department of Hematology, Meaux Hospital, Meaux, France
| | - Bachra Choufi
- Department of Hematology, Boulogne-sur-Mer Hospital, Boulogne-sur-Mer, France
| | - Anne-Dominique Pham
- Department of Biostatistics and Clinical Research, University Hospital of Caen, Caen, France
| | - Anne-Claire Gac
- Department of Hematology, University Hospital of Caen, Caen, France
| | | | - Emilie Marin
- Department of Hematology, University Hospital of Caen, Caen, France
| | - Violaine Safar
- Department of Hematology, Hospices Civils de Lyon, Pierre-Benite, France
| | - Anne Parcelier
- Department of Hematology, University Hospital of Amiens, Amiens, France
| | - Hervé Maisonneuve
- Department of Hematology, La Roche-sur-Yon Hospital, La Roche sur-Yon, France
| | - Emmanuel Bachy
- Department of Hematology, Hospices Civils de Lyon, Pierre-Benite, France
| | - Guillaume Cartron
- Department of Hematology, Université Montpellier, CHRU, UMR CNRS, Montpellier, France
| | - Arnaud Jaccard
- Department of Hematology, University Hospital of Limoges, Limoges, France
| | - Olivier Tournilhac
- Department of Hematology, University Hospital of Clermont-Ferrand, Clermont Ferrand, France
| | - Cédric Rossi
- Department of Hematology, University Hospital of Dijon, Dijon, France
| | - Luciane Schirmer
- Department of Hematology, University Hospital of Nancy, Vandoeuvre Les Nancy, France
| | - Jean-Alain Martignoles
- Department of Hematology, Institut de Cancérologie Lucien Neuwirth, Saint-Etienne, France
| | - Philippe Gaulard
- Department of Pathology, University Paris Est, Hôpital Henri Mondor, Créteil, France
| | - Hervé Tilly
- Department of Hematology, Centre Henri Becquerel, Rouen, France
| | - Gandhi Damaj
- Department of Hematology, University Hospital of Caen, Caen, France.,Microenvironnement Cellulaire et Pathologies, Normandie University, UNICAEN, MILPAT, Caen, France
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205
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Chihara D, Oki Y. Central Nervous System Involvement in Peripheral T Cell Lymphoma. Curr Hematol Malig Rep 2018; 13:1-6. [DOI: 10.1007/s11899-018-0431-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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206
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Fuji S, Utsunomiya A, Inoue Y, Miyagi T, Owatari S, Sawayama Y, Moriuchi Y, Choi I, Shindo T, Yoshida SI, Yamasaki S, Yamaguchi T, Fukuda T. Outcomes of patients with relapsed aggressive adult T-cell leukemia-lymphoma: clinical effectiveness of anti-CCR4 antibody and allogeneic hematopoietic stem cell transplantation. Haematologica 2018; 103:e211-e214. [PMID: 29371324 DOI: 10.3324/haematol.2017.184564] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Tokyo, Japan .,Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Atae Utsunomiya
- Department of Hematology, Imamura General Hospital, Kagoshima, Japan
| | - Yoshitaka Inoue
- Department of Hematology, Kumamoto University Hospital, Okinawa, Japan
| | - Takashi Miyagi
- Department of Hematology, Heart-Life Hospital, Okinawa, Japan
| | - Satsuki Owatari
- Department of Hematology, National Hospital Organization Kagoshima Medical Center, Nagasaki, Japan
| | - Yasushi Sawayama
- Department of Hematology, Nagasaki University Hospital, Nagasaki, Japan
| | | | - Ilseung Choi
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Takero Shindo
- Department of Hematology, Respiratory Medicine and Oncology, Saga University School of Medicine, Fukuoka, Japan
| | - Shin-Ichiro Yoshida
- Department of Hematology, National Hospital Organization Nagasaki Medical Center, Fukuoka, Japan
| | - Satoshi Yamasaki
- Department of Hematology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takahiro Fukuda
- Department of Hematology, Osaka International Cancer Institute, Tokyo, Japan
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207
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Shin Y, Oh JY, Lee YS, Min KH, Lee SY, Shim JJ, Kang KH, Hur GY. Anaplastic large cell lymphoma with marked peripheral eosinophilia misdiagnosed as Kimura disease. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.2.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Yoonji Shin
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jee Youn Oh
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young Seok Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kyung Hoon Min
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sung Yong Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae Jeong Shim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kyung Ho Kang
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Gyu Young Hur
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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208
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Jin J, Zheng C, Wu S. Therapeutic effect of chidamide on relapsed refractory angioimmunoblastic T-cell lymphoma: A case report and literature review. Medicine (Baltimore) 2018; 97:e9611. [PMID: 29480865 PMCID: PMC5943875 DOI: 10.1097/md.0000000000009611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Angioimmunoblastic T-cell lymphoma (AITL) is a kind of rare peripheral T cell lymphoma, which usually has acute onset at old age. MATERIALS AND METHODS Here we report a case of relapsed refractory AITL, which has achieved obvious curative effect after treatment with chidamide. RESULTS Initially, the patient received 7 courses of treatment with recombinant human endostatin (endostar)+CHOP. The patient achieved complete remission, but suffered from recurrence later. After changing chemotherapy regimens, the outcome was still not satisfactory, and the patient developed systemic skin infiltration and rashes. After 2 courses of chemotherapy with chidamide (30 mg) twice a week + intravenous injections with cyclophosphamide (0.1 g) twice every other day + thalidomide (50 mg) every night, the patient began with the oral intake of chidamide, and the therapeutic effect was satisfactory, with diminishing systemic rashes and shrunken lymph nodes. DISCUSSION AND CONCLUSIONS Chidamide has good therapeutic effect in the treatment of AITL, which provides a novel therapeutic strategy for relapsed refractory AITL. However, more cases are still needed to further validate its efficacy.
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209
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Huang L, Zhang F, Zeng J, Guo H, Liu S, Wei X, Chen F, Jiang X, Liang Z, Liu Y, Li W. ALK expression plays different roles in anaplastic large-cell lymphomas and outcome of crizotinib use in relapsed/refractory ALK+ patients in a Chinese population. Ann Hematol 2018; 97:149-159. [PMID: 29150811 DOI: 10.1007/s00277-017-3166-8] [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: 05/28/2017] [Accepted: 11/03/2017] [Indexed: 02/05/2023]
Abstract
The prognostic value of anaplastic lymphoma kinase (ALK) expression in patients with anaplastic large-cell lymphoma (ALCL) remains controversial. Data on the clinical features of ALCL in a Chinese population are limited. We retrospectively reviewed 1293 patients with pathologically diagnosed lymphoma at Guangdong General Hospital from June 2007 through August 2016. We evaluated the incidence of ALCL, clinical characteristics, survival status, and outcome of crizotinib use in four relapsed/refractory ALK-positive patients. Among the 1293 patients, 1193 (92.3%) were non-Hodgkin's lymphoma, and 53 (4.4%) of whom were ALCL. Of the 50 ALCL patients, with a median age of 34 years, were evaluated. Among them, 33 (66.0%) were ALK-positive and 17 (34.0%) were ALK-negative. Significantly, more patients younger than 40 years old were ALK-positive than ALK-negative (66.7 vs. 23.5%; P = 0.003). The 5-year progression-free survival (PFS) for ALK-positive and ALK-negative patients were 61 and 11%, and the 5-year overall survival (OS) were 70 and 22%, respectively. Median PFS and OS were significantly better for patients with ALK-positive than ALK-negative (60.1 vs. 9.4 months, P = 0. 017; not reached vs. 32.7 months, P = 0.021). Multivariate analyses identified ALK expression, stage, and bone marrow involvement as independent prognostic factors for PFS and OS. Four relapsed ALK-positive patients were treated with crizotinib and two died. Our results suggest that ALK expression has different prognostic significance in patients with ALCL. Mechanisms underlying early relapse after chemotherapy and resistance to crizotinib need further investigation.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Anaplastic Lymphoma Kinase
- China/epidemiology
- Crizotinib
- Drug Resistance, Neoplasm/genetics
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Lymphoma, Large-Cell, Anaplastic/diagnosis
- Lymphoma, Large-Cell, Anaplastic/drug therapy
- Lymphoma, Large-Cell, Anaplastic/genetics
- Lymphoma, Large-Cell, Anaplastic/mortality
- Male
- Middle Aged
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/mortality
- Prognosis
- Pyrazoles/therapeutic use
- Pyridines/therapeutic use
- Receptor Protein-Tyrosine Kinases/genetics
- Retrospective Studies
- Survival Analysis
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Ling Huang
- Lymphoma Division, Cancer Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, 123 Huifu West Road, Guangzhou, Guangdong, 510080, China
| | - Fen Zhang
- Pathology Department, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan No.2 Road, Guangzhou, Guangdong, 510080, China
| | - Jialong Zeng
- Lymphoma Division, Cancer Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, 123 Huifu West Road, Guangzhou, Guangdong, 510080, China
- Shantou University Medical College, 22 Xinling Road, Shantou, 515041, China
| | - Hanguo Guo
- Lymphoma Division, Cancer Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, 123 Huifu West Road, Guangzhou, Guangdong, 510080, China
| | - Sichu Liu
- Lymphoma Division, Cancer Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, 123 Huifu West Road, Guangzhou, Guangdong, 510080, China
| | - Xiaojuan Wei
- Lymphoma Division, Cancer Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, 123 Huifu West Road, Guangzhou, Guangdong, 510080, China
| | - Feili Chen
- Lymphoma Division, Cancer Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, 123 Huifu West Road, Guangzhou, Guangdong, 510080, China
| | - Xinmiao Jiang
- Lymphoma Division, Cancer Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, 123 Huifu West Road, Guangzhou, Guangdong, 510080, China
| | - Zhanli Liang
- Lymphoma Division, Cancer Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, 123 Huifu West Road, Guangzhou, Guangdong, 510080, China
| | - Yanhui Liu
- Pathology Department, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan No.2 Road, Guangzhou, Guangdong, 510080, China.
| | - Wenyu Li
- Lymphoma Division, Cancer Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, 123 Huifu West Road, Guangzhou, Guangdong, 510080, China.
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Activity of the PI3K-δ,γ inhibitor duvelisib in a phase 1 trial and preclinical models of T-cell lymphoma. Blood 2017; 131:888-898. [PMID: 29233821 DOI: 10.1182/blood-2017-08-802470] [Citation(s) in RCA: 191] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/01/2017] [Indexed: 12/22/2022] Open
Abstract
Duvelisib (IPI-145) is an oral inhibitor of phosphatidylinositol 3-kinase (PI3K)-δ/γ isoforms currently in clinical development. PI3K-δ/γ inhibition may directly inhibit malignant T-cell growth, making duvelisib a promising candidate for patients with peripheral (PTCL) or cutaneous (CTCL) T-cell lymphoma. Inhibition of either isoform may also contribute to clinical responses by modulating nonmalignant immune cells. We investigated these dual effects in a TCL cohort from a phase 1, open-label study of duvelisib in patients with relapsed or refractory PTCL (n = 16) and CTCL (n = 19), along with in vitro and in vivo models of TCL. The overall response rates in patients with PTCL and CTCL were 50.0% and 31.6%, respectively (P = .32). There were 3 complete responses, all among patients with PTCL. Activity was seen across a wide spectrum of subtypes. The most frequently observed grade 3 and 4 adverse events were transaminase increases (40% alanine aminotransferase, 17% aspartate aminotransferase), maculopapular rash (17%), and neutropenia (17%). Responders and nonresponders had markedly different changes in serum cytokine profiles induced by duvelisib. In vitro, duvelisib potently killed 3 of 4 TCL lines with constitutive phospho-AKT (pAKT) vs 0 of 7 lines lacking pAKT (P = .024) and exceeded cell killing by the PI3K-δ-specific inhibitor idelalisib. Administration of duvelisib to mice engrafted with a PTCL patient-derived xenograft resulted in a shift among tumor-associated macrophages from the immunosuppressive M2-like phenotype to the inflammatory M1-like phenotype. In summary, duvelisib demonstrated promising clinical activity and an acceptable safety profile in relapsed/refractory TCL, as well as preclinical evidence of both tumor cell-autonomous and immune-mediated effects. This trial was registered at www.clinicaltrials.gov as #NCT01476657.
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211
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Abstract
Owing to the rarity of peripheral T-cell lymphoma (PTCL) and the heterogeneity of subtypes, there are no compelling data to guide the therapeutic approaches for such patients. Over the years, there have been remarkable advances in molecular subtyping and treatment of PTCL, although there are still many areas to be explored. In this review, we summarize recent updates on the evolution of understanding and treatment for PTCL.
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Affiliation(s)
- Jun Ho Yi
- Division of Hematology-Oncology, Department of Medicine, Chung-Ang University , Seoul, Korea, South
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea, South
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea, South
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Boonstra PS, Avery P, Brown N, Hristov AC, Bailey NG, Kaminski MS, Phillips T, Devata S, Mayer T, Wilcox RA. A single center phase II study of ixazomib in patients with relapsed or refractory cutaneous or peripheral T-cell lymphomas. Am J Hematol 2017; 92:1287-1294. [PMID: 28842936 PMCID: PMC6116510 DOI: 10.1002/ajh.24895] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/09/2017] [Accepted: 08/22/2017] [Indexed: 12/13/2022]
Abstract
The transcription factor GATA-3, highly expressed in many cutaneous T-cell lymphoma (CTCL) and peripheral T-cell lymphomas (PTCL), confers resistance to chemotherapy in a cell-autonomous manner. As GATA-3 is transcriptionally regulated by NF-κB, we sought to determine the extent to which proteasomal inhibition impairs NF-κB activation and GATA-3 expression and cell viability in malignant T cells. Proteasome inhibition, NF-κB activity, GATA-3 expression, and cell viability were examined in patient-derived cell lines and primary T-cell lymphoma specimens ex vivo treated with the oral proteasome inhibitor ixazomib. Significant reductions in cell viability, NF-κB activation, and GATA-3 expression were observed preclinically in ixazomib-treated cells. Therefore, an investigator-initiated, single-center, phase II study with this agent in patients with relapsed/refractory CTCL/PTCL was conducted. Concordant with our preclinical observations, a significant reduction in NF-κB activation and GATA-3 expression was observed in an exceptional responder following one month of treatment with ixazomib. While ixazomib had limited activity in this small and heterogeneous cohort of patients, inhibition of the NF-κB/GATA-3 axis in a single exceptional responder suggests that ixazomib may have utility in appropriately selected patients or in combination with other agents.
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Affiliation(s)
| | - Polk Avery
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Noah Brown
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | | | | | - Mark S. Kaminski
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Tycel Phillips
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Sumana Devata
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Tera Mayer
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Ryan A. Wilcox
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
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213
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Unusual Presentation of a Small-Cell Variant of Anaplastic Large-Cell Lymphoma Case: When a Septic Picture Is Not Sepsis. Case Rep Hematol 2017; 2017:7292148. [PMID: 29147592 PMCID: PMC5632856 DOI: 10.1155/2017/7292148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/26/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022] Open
Abstract
We report a case of a small-cell variant of anaplastic large-cell lymphoma, with an unusual clinical presentation mimicking sepsis and a fulminant clinic course, in a 48-year-old Caucasian female. In this report, we discuss the diagnostic challenge, histopathologic features, and unique cytogenetic features of this case, in order to raise awareness of this rare presentation and emphasize the importance of meticulous peripheral smear examination and early bone marrow evaluation.
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214
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Gleeson M, Peckitt C, Cunningham D, Gibb A, Hawkes EA, Back M, Yasar B, Foley K, Lee R, Dash J, Johnson H, O'Hara C, Wotherspoon A, Attygalle A, Menasce L, Shenjere P, Potter M, Ethell ME, Dearden C, Radford J, Chau I, Linton K. Outcomes following front-line chemotherapy in peripheral T-cell lymphoma: 10-year experience at The Royal Marsden and The Christie Hospital. Leuk Lymphoma 2017; 59:1586-1595. [PMID: 29119842 DOI: 10.1080/10428194.2017.1393671] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We evaluated the outcomes for patients with peripheral T-cell lymphoma (PTCL) undergoing front-line chemotherapy at our institutions between 2002 and 2012. One hundred and fifty-six patients were eligible, comprising PTCL not otherwise specified (NOS) (n = 50, 32.0%), angioimmunoblastic T-cell lymphoma (AITL) (n = 44, 28.2%), anaplastic large-cell lymphoma (ALCL) ALK negative (n = 23, 14.7%), ALCL ALK positive (n = 16, 10.3%), and other (n = 23, 14.7%). Most patients received CHOP (66.0%) and 13.0% received an autologous hematopoietic progenitor cell transplant (HPCT). With a median follow-up of 63.4 months, 5-year overall survival (OS) and progression-free survival (PFS) was 38.8% and 19.8% respectively. Independent risk factors for inferior OS were age >60 years, International Prognostic Index (IPI) ≥ 2 and lack of complete response to induction. When responding patients were compared by receipt of an autologous HPCT versus not, HPCT was associated with improved PFS (p = .001) and OS (p = .046) and remained significant for PFS in multivariate analysis suggesting a possible therapeutic benefit.
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Affiliation(s)
- Mary Gleeson
- a The Royal Marsden Hospital, London and Surrey , UK
| | - Clare Peckitt
- a The Royal Marsden Hospital, London and Surrey , UK
| | | | - Adam Gibb
- b The University of Manchester and The Christie NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - Eliza A Hawkes
- c Department of Oncology and Clinical Haematology , Austin Health , Heidelberg , Australia.,d Eastern Health , Melbourne , Australia
| | - Morgan Back
- b The University of Manchester and The Christie NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - Binnaz Yasar
- b The University of Manchester and The Christie NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - Kate Foley
- b The University of Manchester and The Christie NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - Rebecca Lee
- b The University of Manchester and The Christie NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - Joanna Dash
- b The University of Manchester and The Christie NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - Hannah Johnson
- b The University of Manchester and The Christie NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - Catherine O'Hara
- b The University of Manchester and The Christie NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | | | | | - Lia Menasce
- b The University of Manchester and The Christie NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - Patrick Shenjere
- b The University of Manchester and The Christie NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - Mike Potter
- a The Royal Marsden Hospital, London and Surrey , UK
| | - Mark E Ethell
- a The Royal Marsden Hospital, London and Surrey , UK
| | | | - John Radford
- b The University of Manchester and The Christie NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - Ian Chau
- a The Royal Marsden Hospital, London and Surrey , UK
| | - Kim Linton
- b The University of Manchester and The Christie NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
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215
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Peripheral T-cell lymphomas: Focusing on novel agents in relapsed and refractory disease. Cancer Treat Rev 2017; 60:120-129. [DOI: 10.1016/j.ctrv.2017.09.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 12/24/2022]
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216
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Maurer MJ, Ellin F, Srour L, Jerkeman M, Bennani NN, Connors JM, Slack GW, Smedby KE, Ansell SM, Link BK, Cerhan JR, Relander T, Savage KJ, Feldman AL. International Assessment of Event-Free Survival at 24 Months and Subsequent Survival in Peripheral T-Cell Lymphoma. J Clin Oncol 2017; 35:4019-4026. [PMID: 29072976 DOI: 10.1200/jco.2017.73.8195] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Purpose Peripheral T-cell lymphomas (PTCLs) have aggressive clinical behavior. We have previously shown that event-free survival (EFS) at 24 months (EFS24) is a clinically useful end point in diffuse large B-cell lymphoma. Here, we assess EFS24 and subsequent overall survival (OS) in large, multinational PTCL cohorts. Patients and Methods Patients with systemic PTCL newly diagnosed from 2000 to 2012 and treated with curative intent were included from the United States and Sweden (initial cohorts) and from Canada (replication cohort). EFS was defined as time from date of diagnosis to progression after primary treatment, retreatment, or death. Subsequent OS was measured after achieving EFS24 or from the time of progression if it occurred within 24 months. OS rates were compared with the age-, sex-, and country-matched general population. Results Seven hundred seventy-five patients were included in the study (the median age at diagnosis was 64 years; 63% were men). Results were similar in the initial and replication cohorts, and a combined analysis was undertaken. Sixty-four percent of patients progressed within the first 24 months and had a median OS of only 4.9 months (5-year OS, 11%). In contrast, median OS after achieving EFS24 was not reached (5-year OS, 78%), although relapses within 5 years of achieving EFS24 occurred in 23% of patients. Superior outcomes after achieving EFS24 were observed in younger patients (≤ 60 years of age: 5-year OS, 91%). Conclusion EFS24 stratifies subsequent outcome in PTCL. Patients with PTCL with primary refractory disease or early relapse have extremely poor survival. However, more than one third of patients with PTCL remain in remission 2 years after diagnosis with encouraging subsequent OS, especially in younger patients. These marked differences in outcome suggest that EFS24 has utility for patient counseling, study design, and risk stratification in PTCL.
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Affiliation(s)
- Matthew J Maurer
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Fredrik Ellin
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Line Srour
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Mats Jerkeman
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - N Nora Bennani
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Joseph M Connors
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Graham W Slack
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Karin E Smedby
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Stephen M Ansell
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Brian K Link
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - James R Cerhan
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Thomas Relander
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Kerry J Savage
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Andrew L Feldman
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
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Five-year results of brentuximab vedotin in patients with relapsed or refractory systemic anaplastic large cell lymphoma. Blood 2017; 130:2709-2717. [PMID: 28974506 DOI: 10.1182/blood-2017-05-780049] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/13/2017] [Indexed: 12/24/2022] Open
Abstract
This pivotal phase 2 study evaluated the safety and efficacy of brentuximab vedotin in patients with relapsed or refractory (R/R) systemic anaplastic large cell lymphoma (ALCL). After a median observation period of approximately 6 years from first treatment, we examined the durability of remission, progression-free survival (PFS), overall survival (OS), and safety outcomes of patients treated on this trial. Among all enrolled patients (n = 58), no progressions were observed beyond 40 months, and median OS was not reached. Patients with a complete response (CR), as assessed by the investigator (38 of 58, 66%), continued to demonstrate improved outcomes with neither median OS nor PFS reached. Of the 38 CR patients, 16 received a consolidative stem cell transplant (SCT) with median PFS not reached. Among patients who were on-study and in remission at study closure, 16 patients had not received any new treatment after single-agent brentuximab vedotin other than consolidative SCT. Among this subset of 16 patients, 8 received SCT, and the remaining 8 patients (14% of all enrolled patients) remained in sustained remission without consolidative SCT or any new anticancer therapy. Thirty-three patients experienced peripheral neuropathy, among whom, the majority (30 of 33, 91%) had experienced resolution or improvement at their last assessment. These final results, which demonstrated a high rate of peripheral neuropathy resolution, and durable remissions in a subset of patients with relapsed or refractory systemic ALCL, provide evidence that single-agent brentuximab vedotin may be a potentially curative treatment option. This trial was registered at www.clinicaltrials.gov as #NCT00866047.
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218
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Maruyama D, Nagai H, Maeda Y, Nakane T, Shimoyama T, Nakazato T, Sakai R, Ishikawa T, Izutsu K, Ueda R, Tobinai K. Phase I/II study of pralatrexate in Japanese patients with relapsed or refractory peripheral T-cell lymphoma. Cancer Sci 2017; 108:2061-2068. [PMID: 28771889 PMCID: PMC5623731 DOI: 10.1111/cas.13340] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/03/2017] [Accepted: 07/31/2017] [Indexed: 12/02/2022] Open
Abstract
Pralatrexate is a novel antifolate approved in the USA for the treatment of relapsed or refractory peripheral T‐cell lymphoma. To assess its safety, efficacy, and pharmacokinetics in Japanese patients with this disease, we undertook a phase I/II study. Pralatrexate was given i.v. weekly for 6 weeks of a 7‐week cycle. All patients received concurrent vitamin B12 and folic acid. In phase I, three patients received pralatrexate 30 mg/m2 and none experienced a dose‐limiting toxicity. In phase II, we treated 22 additional patients with that dose. The median number of treatment cycles was 1 (range, 1–9). Nine of 20 evaluable patients (45%) achieved an objective response by central review, including two complete responses. All responses occurred within the first treatment cycle. At the time of data cut‐off, median progression‐free survival was 150 days. Median overall survival was not reached. In the total population, the most commonly reported adverse events included mucositis (88%), thrombocytopenia (68%), liver function test abnormality (64%), anemia (60%), and lymphopenia (56%). Grade 3/4 adverse events included lymphopenia (52%), thrombocytopenia (40%), leukopenia (28%), neutropenia (24%), anemia (20%), and mucositis (20%). The pharmacokinetic profile showed no drug accumulation with repeat dosing. These results indicate that pralatrexate is generally well tolerated and effective in Japanese patients with relapsed or refractory peripheral T‐cell lymphoma. This trial was registered with ClinicalTrials.gov (NCT02013362).
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Affiliation(s)
- Dai Maruyama
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Hirokazu Nagai
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Takahiko Nakane
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tatsu Shimoyama
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tomonori Nakazato
- Department of Hematology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Rika Sakai
- Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan.,Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Ryuzo Ueda
- Department of Tumor Immunology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
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Long-term outcomes of adults with first-relapsed/refractory systemic anaplastic large-cell lymphoma in the pre-brentuximab vedotin era: A LYSA/SFGM-TC study. Eur J Cancer 2017; 83:146-153. [DOI: 10.1016/j.ejca.2017.06.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/03/2017] [Accepted: 06/17/2017] [Indexed: 11/18/2022]
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220
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Wolska-Washer A, Robak P, Smolewski P, Robak T. Emerging antibody-drug conjugates for treating lymphoid malignancies. Expert Opin Emerg Drugs 2017; 22:259-273. [PMID: 28792782 DOI: 10.1080/14728214.2017.1366447] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Antibody-drug conjugates (ADC) are monoclonal antibodies (Mabs) attached to biologically active drugs through specialized chemical linkers. They deliver and release cytotoxic agents at the tumor site, reducing the likelihood of systemic exposure and therefore toxicity. These agents should improve the potency of chemotherapy by increasing the accumulation of cytotoxic the drug within or near the neoplastic cells with reduced systemic effects. Areas covered: A literature review was conducted of the MEDLINE database PubMed for articles in English examining Mabs, B-cell receptor pathway inhibitors and immunomodulating drugs. Publications from 2000 through April 2017 were scrutinized. Conference proceedings from the previous five years of the American Society of Hematology, European Hematology Association, American Society of Clinical Oncology, and ACR/ARHP Annual Scientific Meetings were searched manually. Additional relevant publications were obtained by reviewing the references from the chosen articles. Expert opinion: Newer ADCs show promise as treatment for several hematologic malignancies, especially lymphoma, multiple myeloma, and leukemia. However, definitive data from ongoing and future clinical trials will aid in better defining the status of these agents in the treatment of these diseases.
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Affiliation(s)
| | - Pawel Robak
- b Department of Experimental Hematology , Medical University of Lodz , Lodz , Poland
| | - Piotr Smolewski
- b Department of Experimental Hematology , Medical University of Lodz , Lodz , Poland
| | - Tadeusz Robak
- a Department of Hematology , Medical University of Lodz , Lodz , Poland
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Maruyama D, Tobinai K, Ogura M, Uchida T, Hatake K, Taniwaki M, Ando K, Tsukasaki K, Ishida T, Kobayashi N, Ishizawa K, Tatsumi Y, Kato K, Kiguchi T, Ikezoe T, Laille E, Ro T, Tamakoshi H, Sakurai S, Ohtsu T. Romidepsin in Japanese patients with relapsed or refractory peripheral T-cell lymphoma: a phase I/II and pharmacokinetics study. Int J Hematol 2017; 106:655-665. [PMID: 28664499 DOI: 10.1007/s12185-017-2286-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 12/31/2022]
Abstract
This phase I/II multicenter study evaluated romidepsin treatment in Japanese patients with relapsed/refractory peripheral T-cell lymphoma (PTCL) or cutaneous T-cell lymphoma (CTCL). Patients aged ≥20 years received romidepsin via a 4-h intravenous infusion on days 1, 8, and 15 of each 28-day cycle. Phase I used a 3 + 3 design to identify any dose-limiting toxicity (DLT) for regimens of romidepsin 9 and 14 mg/m2. The primary endpoints for phase I and II were DLT and overall response rate (ORR), respectively. Intent-to-treat patients were those who received ≥1 romidepsin dose (PTCL, n = 48; CTCL, n = 2). In phase I, none of the patients (n = 3, 9 mg/m2; n = 6, 14 mg/m2) exhibited DLT. In phase II, 40 patients with PTCL were treated with 14 mg/m2 romidepsin. The most common treatment-emergent grade ≥3 adverse events were lymphopenia (74%), neutropenia (54%), leukopenia (46%), and thrombocytopenia (38%). Patients in phase II showed a 43% ORR, including 25% complete responses. Median progression-free survival was 5.6 months and median duration of response was 11.1 months. This phase I/II study identified a well-tolerated dose of romidepsin, with an acceptable toxicity profile and clinically meaningful efficacy in Japanese patients with relapsed/refractory PTCL. ClinicalTrials.gov Identifier NCT01456039.
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Affiliation(s)
- Dai Maruyama
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan.
| | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Michinori Ogura
- Department of Hematology, Tokai Central Hospital, Gifu, Japan.,Department of Hematology and Oncology, Nagoya Daini Red Cross Hospital, Aichi, Japan
| | - Toshiki Uchida
- Department of Hematology and Oncology, Nagoya Daini Red Cross Hospital, Aichi, Japan
| | - Kiyohiko Hatake
- Department of Hematology and Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masafumi Taniwaki
- Department of Hematology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kiyoshi Ando
- Department of Hematology/Oncology, Tokai University School of Medicine, Kanagawa, Japan
| | - Kunihiro Tsukasaki
- Department of Hematology and Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Takashi Ishida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Naoki Kobayashi
- Department of Hematology, Sapporo Hokuyu Hospital, Hokkaido, Japan
| | - Kenichi Ishizawa
- Department of Hematology and Rheumatology, Tohoku University Hospital, Miyagi, Japan.,Hematology and Cell Therapy, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yoichi Tatsumi
- Department of Hematology and Rheumatology, Kinki University Hospital, Faculty of Medicine, Osaka, Japan
| | - Koji Kato
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Japan
| | - Toru Kiguchi
- Department of Hematology, Chugoku Central Hospital, Hiroshima, Japan
| | - Takayuki Ikezoe
- Department of Hematology and Respiratory Medicine, Kochi Medical School Hospital, Kochi, Japan.,Department of Hematology, Fukushima Medical University School of Medicine, Fukushima, Japan
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222
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Li L, Duan W, Zhang L, Li X, Fu X, Wang X, Wu J, Sun Z, Zhang X, Chang Y, Nan F, Yan J, Li Z, Young KH, Zhang M. The efficacy and safety of gemcitabine, cisplatin, prednisone, thalidomide versus CHOP in patients with newly diagnosed peripheral T-cell lymphoma with analysis of biomarkers. Br J Haematol 2017; 178:772-780. [PMID: 28597542 DOI: 10.1111/bjh.14763] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/20/2017] [Indexed: 01/18/2023]
Abstract
We compared the efficacy and safety of gemcitabine, cisplatin, prednisone and thalidomide (GDPT) with standard CHOP regimen (cyclophosphamide, doxorubicin, vincristine, prednisone) for patients with newly diagnosed peripheral T-cell lymphoma (PTCL) in a prospective randomized controlled and open-label clinical trial. Between July 2010 and June 2016, 103 patients were randomly allocated into two groups, of whom 52 were treated with GDPT therapy and 51 with CHOP therapy. The 2-year progression-free survival (PFS) and overall survival (OS) rates were better in the GDPT group than in the CHOP group (57% vs. 35% for 2-year PFS, P = 0·0035; 71% vs 50% for 2-year OS, P = 0·0001). The complete remission rate (CRR) and the overall response rate (ORR) in the GDPT group were higher than in the CHOP group (52% vs. 33%, P = 0·044 for CRR; 67% vs. 49%, P = 0·046 for ORR). Haemocytopenia was the predominant adverse effect, and acute toxicity was moderate, tolerable and well managed in both arms. mRNA expression of ERCC1, RRM1, TUBB3 and TOP2A genes varied among patients but the difference did not reach statistical significance, mainly due to the relatively small sample size. The precise characters of these biomarkers remain to be identified. In conclusion, GDPT is a promising new regimen as potential first-line therapy against PTCL. This study was registered at www.clinicaltrials.gov as #NCT01664975.
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Affiliation(s)
- Ling Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Wenjing Duan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Lei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Xiaorui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Xinhua Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Jingjing Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Zhenchang Sun
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Xudong Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Yu Chang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Feifei Nan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Jiaqin Yan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Zhaoming Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Ken H Young
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
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223
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Treatment of Peripheral T-Cell Lymphoma in Community Settings. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017. [DOI: 10.1016/j.clml.2017.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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224
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DUSP22 and TP63 rearrangements predict outcome of ALK-negative anaplastic large cell lymphoma: a Danish cohort study. Blood 2017; 130:554-557. [PMID: 28522440 DOI: 10.1182/blood-2016-12-755496] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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225
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Skamene T, Crump M, Savage KJ, Reiman T, Kuruvilla J, Good D, LeBrun D, Meyer RM, Sehn LH, Soulières D, Stakiw J, Laferriere N, Luminari S, Shepherd LE, Djurfeldt M, Zhu L, Chen BE, Hay AE. Salvage chemotherapy and autologous stem cell transplantation for peripheral T-cell lymphoma: a subset analysis of the Canadian Cancer Trials Group LY.12 randomized phase 3 study . Leuk Lymphoma 2017; 58:2319-2327. [PMID: 28504033 DOI: 10.1080/10428194.2017.1312379] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Peripheral T-cell lymphoma (PTCL) is a rare, heterogeneous malignancy. Of the 619 patients with relapsed and refractory (R/R) aggressive lymphoma enrolled in the Canadian Cancer Trials Group LY.12 phase 3 trial, 59 (9.5%) had PTCL. Among these, 81% had advanced stage disease, 41% had an International Prognostic Score ≥3, and 41% were refractory to primary therapy. Within the PTCL cohort, the overall response rate after two cycles of salvage chemotherapy was 36%; no difference was observed between dexamethasone, cytarabine, cisplatin (10/30, 33%), and gemcitabine, cisplatin, dexamethasone (11/29, 38%) therapy. At one year, event-free survival (EFS) was 16% and overall survival (OS) was 28%. For PTCL patients, who received autologous stem cell transplant, two-year EFS and OS were 21% and 42%, respectively. Patients with PTCL had inferior OS (HR 0.49, p < .0001) and EFS (HR 0.53, p < .0001) compared to B-cell lymphoma. Outcomes for patients with R/R PTCL are poor with currently available therapies.
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Affiliation(s)
- Tanya Skamene
- a Canadian Cancer Trials Group, Queen's University , Kingston , Canada
| | - Michael Crump
- b Princess Margaret Cancer Centre , Toronto , Canada
| | - Kerry J Savage
- c Centre for Lymphoid Cancer, BC Cancer Agency , Vancouver , Canada
| | - Tony Reiman
- d Department of Medicine , Dalhousie University , Halifax , Canada.,e Department of Biology , University of New Brunswick , Saint John , Canada.,f Saint John Regional Hospital , Saint John , Canada
| | | | - David Good
- g Department of Pathology & Molecular Medicine , Queen's University , Kingston , Canada
| | - David LeBrun
- g Department of Pathology & Molecular Medicine , Queen's University , Kingston , Canada
| | - Ralph M Meyer
- h Department of Oncology , Juravinski Hospital and Cancer Centre, McMaster University , Hamilton , Canada
| | - Laurie H Sehn
- c Centre for Lymphoid Cancer, BC Cancer Agency , Vancouver , Canada
| | - Denis Soulières
- i Centre Hospitalier de l'Université de Montréal , Montréal , Canada
| | | | - Nicole Laferriere
- k Department of Oncology , Thunder Bay Regional Health Sciences, Lakehead University , Thunder Bay , Canada
| | - Stefano Luminari
- l Hematology , Arcispedale Santa Maria Nuova IRCCS, University of Modena and Reggio Emilia , Reggio Emilia , Italy
| | - Lois E Shepherd
- a Canadian Cancer Trials Group, Queen's University , Kingston , Canada.,g Department of Pathology & Molecular Medicine , Queen's University , Kingston , Canada
| | - Marina Djurfeldt
- a Canadian Cancer Trials Group, Queen's University , Kingston , Canada
| | - Liting Zhu
- a Canadian Cancer Trials Group, Queen's University , Kingston , Canada
| | - Bingshu E Chen
- a Canadian Cancer Trials Group, Queen's University , Kingston , Canada
| | - Annette E Hay
- a Canadian Cancer Trials Group, Queen's University , Kingston , Canada.,m Department of Medicine , Queen's University , Kingston , Canada
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226
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Hildyard C, Shiekh S, Browning J, Collins GP. Toward a Biology-Driven Treatment Strategy for Peripheral T-cell Lymphoma. Clin Med Insights Blood Disord 2017; 10:1179545X17705863. [PMID: 28579857 PMCID: PMC5428136 DOI: 10.1177/1179545x17705863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/03/2017] [Indexed: 12/12/2022]
Abstract
T-cell and natural killer–cell lymphomas are a relatively rare and heterogeneous group of diseases that are difficult to treat and usually have poor outcomes. To date, therapeutic interventions are of limited efficacy and there is a pressing need to find better treatments. In recent years, advances in molecular biology have helped to elucidate the underlying genetic complexity of this group of diseases and to identify mutations and signaling pathways involved in lymphomagenesis. In this review, we highlight the unique biological characteristics of some of the different subtypes and discuss how these may be targeted to provide more individualized and effective treatment approaches.
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Affiliation(s)
- Cat Hildyard
- Department of Clinical Haematology, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - S Shiekh
- Department of Clinical Haematology, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals, Oxford, UK.,Laboratory of Cancer Biology, Department of Oncology, University of Oxford, Oxford, UK
| | - Jab Browning
- Department of Clinical Haematology, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - G P Collins
- Department of Clinical Haematology, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals, Oxford, UK
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227
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228
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Chihara D, Fanale MA. Management of Anaplastic Large Cell Lymphoma. Hematol Oncol Clin North Am 2017; 31:209-222. [DOI: 10.1016/j.hoc.2016.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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229
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Novel Agents in the Treatment of Relapsed or Refractory Peripheral T-Cell Lymphoma. Hematol Oncol Clin North Am 2017; 31:359-375. [DOI: 10.1016/j.hoc.2016.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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230
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Al-Zahrani M, Savage KJ. Peripheral T-Cell Lymphoma, Not Otherwise Specified. Hematol Oncol Clin North Am 2017; 31:189-207. [DOI: 10.1016/j.hoc.2016.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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231
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Fuji S, Yamaguchi T, Inoue Y, Utsunomiya A, Moriuchi Y, Uchimaru K, Owatari S, Miyagi T, Taguchi J, Choi I, Otsuka E, Nakachi S, Yamamoto H, Kurosawa S, Tobinai K, Fukuda T. Development of a modified prognostic index for patients with aggressive adult T-cell leukemia-lymphoma aged 70 years or younger: possible risk-adapted management strategies including allogeneic transplantation. Haematologica 2017; 102:1258-1265. [PMID: 28341734 PMCID: PMC5566038 DOI: 10.3324/haematol.2017.164996] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/17/2017] [Indexed: 11/09/2022] Open
Abstract
Adult T-cell leukemia-lymphoma is a distinct type of peripheral T-cell lymphoma caused by human T-cell lymphotropic virus type I. Although allogeneic stem cell transplantation after chemotherapy is a recommended treatment option for patients with aggressive adult T-cell leukemia-lymphoma, there is no consensus about indications for allogeneic stem cell transplantation because there is no established risk stratification system for transplant eligible patients. We conducted a nationwide survey of patients with aggressive adult T-cell leukemia-lymphoma in order to construct a new, large database that includes 1,792 patients aged 70 years or younger with aggressive adult T-cell leukemia-lymphoma who were diagnosed between 2000 and 2013 and received intensive first-line chemotherapy. We randomly divided patients into two groups (training and validation sets). Acute type, poor performance status, high soluble interleukin-2 receptor levels (> 5,000 U/mL), high adjusted calcium levels (≥ 12 mg/dL), and high C-reactive protein levels (≥ 2.5 mg/dL) were independent adverse prognostic factors used in the training set. We used these five variables to divide patients into three risk groups. In the validation set, median overall survival for the low-, intermediate-, and high-risk groups was 626 days, 322 days, and 197 days, respectively. In the intermediate- and high-risk groups, transplanted recipients had significantly better overall survival than non-transplanted patients. We developed a promising new risk stratification system to identify patients aged 70 years or younger with aggressive adult T-cell leukemia-lymphoma who may benefit from upfront allogeneic stem cell transplantation. Prospective studies are warranted to confirm the benefit of this treatment strategy.
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Affiliation(s)
- Shigeo Fuji
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan .,Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshitaka Inoue
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.,Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Hematology, Kumamoto University Hospital, Kagoshima, Japan
| | - Atae Utsunomiya
- Department of Hematology, Imamura Bun-in Hospital, Kagoshima, Japan
| | - Yukiyoshi Moriuchi
- Department of Hematology, Sasebo City General Hospital, The University of Tokyo, Japan
| | - Kaoru Uchimaru
- Department of Hematology/Oncology, Institute of Medical Science, The University of Tokyo, Japan
| | - Satsuki Owatari
- Department of Hematology, National Hospital Organization Kagoshima Medical Center, Okinawa
| | - Takashi Miyagi
- Department of Hematology, Heart-Life Hospital, Okinawa, Japan
| | - Jun Taguchi
- Department of Hematology, Nagasaki University Hospital, Fukuoka, Japan
| | - Ilseung Choi
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Eiichi Otsuka
- Department of Hematology, Oita Prefectural Hospital, Okinawa, Japan
| | - Sawako Nakachi
- Second Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan
| | | | - Saiko Kurosawa
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Kensei Tobinai
- Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Takahiro Fukuda
- Department of Hematology, Nagasaki University Hospital, Fukuoka, Japan
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232
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Cederleuf H, Hjort Jakobsen L, Ellin F, de Nully Brown P, Stauffer Larsen T, Bøgsted M, Relander T, Jerkeman M, El-Galaly TC. Outcome of peripheral T-cell lymphoma in first complete remission: a Danish-Swedish population-based study. Leuk Lymphoma 2017; 58:2815-2823. [DOI: 10.1080/10428194.2017.1300888] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Henrik Cederleuf
- Department of Clinical Sciences, Oncology and Pathology, Lund University, Lund, Sweden
| | - Lasse Hjort Jakobsen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Fredrik Ellin
- Department of Clinical Sciences, Oncology and Pathology, Lund University, Lund, Sweden
- Department of Internal Medicine, Kalmar County Hospital, Kalmar, Sweden
| | - Peter de Nully Brown
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Martin Bøgsted
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Thomas Relander
- Department of Clinical Sciences, Oncology and Pathology, Lund University, Lund, Sweden
| | - Mats Jerkeman
- Department of Clinical Sciences, Oncology and Pathology, Lund University, Lund, Sweden
| | - Tarec Christoffer El-Galaly
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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233
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Shustov A, Coiffier B, Horwitz S, Sokol L, Pro B, Wolfson J, Balser B, Eisch R, Popplewell L, Prince HM, Allen SL, Piekarz R, Bates S. Romidepsin is effective and well tolerated in older patients with peripheral T-cell lymphoma: analysis of two phase II trials. Leuk Lymphoma 2017; 58:2335-2341. [PMID: 28264616 DOI: 10.1080/10428194.2017.1295143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Peripheral T-cell lymphomas (PTCLs) are a rare group of lymphoid neoplasms with high relapse rates after initial therapy and poor prognosis. Most patients are aged ≥60 years and are often not candidates for aggressive salvage therapies. Romidepsin, a potent class I histone deacetylase inhibitor, has shown significant single-agent activity in relapsed/refractory PTCL. We evaluated the efficacy and tolerability of romidepsin in elderly patients in this setting. Ninety-five patients aged ≥60 years were identified from 2 prospective phase 2 registration trials of romidepsin, and comparative analyses were performed with younger patients from these trials. Response rates, progression-free survival, and overall survival were not statistically different for younger vs older patients. The toxicity profile in older and younger patients was similar in both trials. Romidepsin demonstrated similar efficacy and tolerability in younger and older patients and presents an attractive treatment option for relapsed/refractory PTCL regardless of age. TRIAL REGISTRATION Clinicaltrials.gov identifiers: NCT00426764, NCT00007345.
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Affiliation(s)
- Andrei Shustov
- a Department of Hematology , University of Washington Medical Center , Seattle , WA , USA
| | - Bertrand Coiffier
- b Department of Hematology , Hospices Civils de Lyon , Lyon , France
| | - Steven Horwitz
- c Department of Oncology , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Lubomir Sokol
- d Department of Hematology , Moffitt Cancer Center , Tampa , FL , USA
| | - Barbara Pro
- e Department of Hematology/Oncology , Kimmel Cancer Center, Thomas Jefferson University , Philadelphia , PA , USA
| | | | | | - Robin Eisch
- g Department of Investigational Therapeutics , National Cancer Institute , Bethesda , MD , USA
| | - Leslie Popplewell
- h Department of Hematology/Oncology , City of Hope Medical Center-Oncology , Duarte , CA , USA
| | - H Miles Prince
- i Department of Hematology , Peter MacCallum Cancer Centre and University of Melbourne , Melbourne , Australia
| | - Steven L Allen
- j Department of Hematology , Hofstra North Shore-LIJ School of Medicine and Monter Cancer Center , Lake Success , NY , USA
| | - Richard Piekarz
- g Department of Investigational Therapeutics , National Cancer Institute , Bethesda , MD , USA
| | - Susan Bates
- k Department of Hematology/Oncology , Columbia University Medical Center , New York , NY , USA
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234
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Nandagopal L, Mehta A. Treatment approaches of hard-to-treat non-Hodgkin lymphomas. Expert Rev Hematol 2017; 10:259-273. [DOI: 10.1080/17474086.2017.1283214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Amitkumar Mehta
- Hematology & Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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235
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Angioimmunoblastic T-cell lymphoma: the many-faced lymphoma. Blood 2017; 129:1095-1102. [PMID: 28115369 DOI: 10.1182/blood-2016-09-692541] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/09/2016] [Indexed: 02/07/2023] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is an uncommon subtype of mature peripheral T-cell lymphoma (PTCL). The history of AITL is much longer and deeper than the literature would suggest given the many names that have preceded it. Advanced-stage disease is common with uncharacteristic laboratory and autoimmune findings that often slow or mask the diagnosis. Significant strides in the immunohistochemical and molecular signature of AITL have brought increased ability to diagnose this uncommon type of PTCL. The 2016 World Health Organization classification of lymphoid neoplasms recently acknowledged the complexity of this diagnosis with the addition of other AITL-like subsets. AITL now resides under the umbrella of nodal T-cell lymphomas with follicular T helper phenotype. Induction strategies continue to focus on increasing complete remission rates that allow more transplant-eligible patients to proceed toward consolidative high-dose therapy and autologous stem cell rescue with improving long-term survival. There are several clinical trials in which recently approved drugs with known activity in AITL are paired with induction regimens with the hope of demonstrating long-term progression-free survival over cyclophosphamide, doxorubicin, vincristine, and prednisone. The treatment of relapsed or refractory AITL remains an unmet need. The spectrum of AITL from diagnosis to treatment is reviewed subsequently in a fashion that may one day lead to personalized treatment approaches in a many-faced disease.
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236
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Peripheral T-cell lymphoma, not otherwise specified. Blood 2017; 129:1103-1112. [PMID: 28115372 DOI: 10.1182/blood-2016-08-692566] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/27/2016] [Indexed: 12/19/2022] Open
Abstract
Peripheral T-cell lymphoma, not otherwise specified, is a broad category of biologically and clinically heterogeneous diseases that cannot be further classified into any other of the existing entities defined by the World Health Organization classification. Anthracycline-containing regimens, namely cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), nowadays represent the standard first-line treatment; for patients who achieve a satisfactory response, a consolidation by means of autologous stem cell transplantation may offer a greater chance of long-term survival. Several patients, however, display treatment refractoriness or relapse soon after obtaining a response, and just a few of them are suitable transplant candidates. This is why several new agents, with innovative mechanisms of action, have been investigated in this context: pralatrexate, romidepsin, belinostat, and brentuximab vedotin have been approved for relapsed and refractory peripheral T-cell lymphomas based on their activity, although they do not significantly affect survival rates. The incorporation of such new drugs within a CHOP backbone is under investigation to enhance response rates, allow a higher proportion of patients to be transplanted in remission, and prolong survival.
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237
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Fujiwara H, Fuji S, Wake A, Kato K, Takatsuka Y, Fukuda T, Taguchi J, Uchida N, Miyamoto T, Hidaka M, Miyazaki Y, Tomoyose T, Onizuka M, Takanashi M, Ichinohe T, Atsuta Y, Utsunomiya A. Dismal outcome of allogeneic hematopoietic stem cell transplantation for relapsed adult T-cell leukemia/lymphoma, a Japanese nation-wide study. Bone Marrow Transplant 2017; 52:484-488. [DOI: 10.1038/bmt.2016.313] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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238
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Casulo C, O'Connor O, Shustov A, Fanale M, Friedberg JW, Leonard JP, Kahl BS, Little RF, Pinter-Brown L, Advani R, Horwitz S. T-Cell Lymphoma: Recent Advances in Characterization and New Opportunities for Treatment. J Natl Cancer Inst 2016; 109:djw248. [PMID: 28040682 DOI: 10.1093/jnci/djw248] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/14/2016] [Accepted: 09/26/2016] [Indexed: 11/14/2022] Open
Abstract
Peripheral T-cell lymphomas (PTCLs) are uncommon, heterogeneous, and aggressive non-Hodgkin's lymphomas. Despite progress in the last several years resulting in a deeper understanding of PTCL biology and pathogenesis, there is currently no accepted single standard of care for newly diagnosed patients, and for those with relapsed or refractory disease, prognosis is dismal. The National Cancer Institute convened a Clinical Trials Planning Meeting to advance the national clinical trial agenda in lymphoma. The objective was to identify unmet needs specific to five major lymphoma subtypes and develop strategies to address them. This consensus statement reviews recent advances in the molecular and genetic characterization of PTCL that may inform novel treatments, proposes strategies to test novel therapies in the relapsed setting with the hopes of rapid advancement into frontline trials, and underscores the need for the identification and development of active and biologically rational therapies to cure PTCL at higher rates, with iterative biomarker evaluation.
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Affiliation(s)
- Carla Casulo
- Wilmot Cancer Center, University of Rochester, Rochester, NY, USA
| | - Owen O'Connor
- Columbia University Medical Center, New York, NY, USA
| | | | - Michelle Fanale
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - John P Leonard
- Department of Medicine, Weil Cornell University, New York, NY, USA
| | - Brad S Kahl
- Oncology Division, Washington University, St. Louis, MO, USA
| | - Richard F Little
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Lauren Pinter-Brown
- University of California-Irvine Chao Family Comprehensive Cancer Center in Orange, CA, USA
| | - Ranjani Advani
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Steven Horwitz
- Memorial Sloan-Kettering Cancer Center, New York, NY , USA
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Abstract
INTRODUCTION CD30 is a cell surface receptor expressed in classical Hodgkin lymphoma (HL), anaplastic large cell lymphoma (ALCL), and many other lymphomas to a variable degree. It has been identified as an important therapeutic target in lymphoma. Areas covered: CD30 testing is essential in diagnosis of classical HL and ALCL, and expression can also be seen in other lymphoma subtypes. Development of Brentuximab vedotin (BV), an antibody-drug conjugate directed to CD30, has been an important advance in lymphoma treatment. It is approved in treatment of relapsed HL and ALCL, as well as post-transplant maintenance for HL, and has been shown to be effective in other CD30-expressing lymphomas. This review describes the role of CD30 and the use of CD30-targeted agents in HL, ALCL, and other lymphomas, including review of relevant trials of BV. Expert commentary: Recognition of CD30 expression in lymphoma has led to the development of important therapeutic options. Multiple trials are ongoing combining BV with other agents, such as chemotherapy or immunotherapy, to develop more effective regimens. In addition, treatments targeting CD30 in different ways are being developed, such as bispecific antibodies and chimeric antigen receptor (CAR) T-cells.
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Affiliation(s)
- John Matthew R Pierce
- a Hematology & Oncology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Amitkumar Mehta
- a Hematology & Oncology , University of Alabama at Birmingham , Birmingham , AL , USA.,b Department Of Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
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240
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Phillips T, Devata S, Wilcox RA. Challenges and opportunities for checkpoint blockade in T-cell lymphoproliferative disorders. J Immunother Cancer 2016; 4:95. [PMID: 28031823 PMCID: PMC5170899 DOI: 10.1186/s40425-016-0201-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 12/01/2016] [Indexed: 01/05/2023] Open
Abstract
The T-cell lymphoproliferative disorders are a heterogeneous group of non-Hodgkin’s lymphomas (NHL) for which current therapeutic strategies are inadequate, as most patients afflicted with these NHL will succumb to disease progression within 2 years of diagnosis. Appreciation of the genetic and immunologic landscape of these aggressive NHL, including PD-L1 (B7-H1, CD274) expression by malignant T cells and within the tumor microenvironment, provides a strong rationale for therapeutic targeting this immune checkpoint. While further studies are needed, the available data suggests that responses with PD-1 checkpoint blockade alone will unlikely approach those achieved in other lymphoproliferative disorders. Herein, we review the unique challenges posed by the T-cell lymphoproliferative disorders and discuss potential strategies to optimize checkpoint blockade in these T-cell derived malignancies.
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Affiliation(s)
- Tycel Phillips
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI USA
| | - Sumana Devata
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI USA
| | - Ryan A Wilcox
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI USA ; University of Michigan Comprehensive Cancer Center, 4310 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
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241
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Chihara D, Fanale MA, Miranda RN, Noorani M, Westin JR, Nastoupil LJ, Hagemeister FB, Fayad LE, Romaguera JE, Samaniego F, Turturro F, Lee HJ, Neelapu SS, Rodriguez MA, Wang M, Fowler NH, Davis RE, Medeiros LJ, Hosing C, Nieto YL, Oki Y. The survival outcome of patients with relapsed/refractory peripheral T-cell lymphoma-not otherwise specified and angioimmunoblastic T-cell lymphoma. Br J Haematol 2016; 176:750-758. [PMID: 27983760 DOI: 10.1111/bjh.14477] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/10/2016] [Indexed: 12/24/2022]
Abstract
Survival outcome of patients with peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS) and angioimmunoblastic T-cell lymphoma (AITL) who experience disease progression/relapse remains very poor. A total of 321 patients, newly diagnosed with PTCL-NOS (n = 180) or AITL (n = 141) between 1999 and 2015, were analysed. Failure-free survival (FFS) and overall survival (OS) were calculated from the time of first disease progression (FFS1, OS1), from second disease progression (FFS2, OS2) and from third progression (FFS3, OS3). With a median follow-up duration of 52 months, 240 patients (135 PTCL-NOS, 105 AITL) experienced progression/relapse. In patients with PTCL-NOS, the median durations of FFS1, FFS2 and FFS3 were 3·1, 2·5 and 2·1 months, respectively. In patients with AITL, they were 5·5, 2·9 and 2·3 months, respectively. There was no improvement in FFS1 and OS1 by the time of recurrence during this period (1999-2004, 2005-2009 and 2010-2015). The median FFS after pralatrexate and romidepsin was only 3·0 and 2·5 months, respectively. The 5-year OS rates after salvage autologous and allogeneic transplant were 32% and 52%, respectively; while the 5-year OS rates for patients who did not undergo transplant was 10%. Further research for novel therapeutic approaches with higher efficacy and better safety profile are needed.
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Affiliation(s)
- Dai Chihara
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle A Fanale
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mansoor Noorani
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason R Westin
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Loretta J Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fredrick B Hagemeister
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luis E Fayad
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jorge E Romaguera
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Felipe Samaniego
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Francesco Turturro
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hun J Lee
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sattva S Neelapu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Alma Rodriguez
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Wang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nathan H Fowler
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard E Davis
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chitra Hosing
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yago L Nieto
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yasuhiro Oki
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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242
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Schmitz N, de Leval L. How I manage peripheral T-cell lymphoma, not otherwise specified and angioimmunoblastic T-cell lymphoma: current practice and a glimpse into the future. Br J Haematol 2016; 176:851-866. [PMID: 27982416 DOI: 10.1111/bjh.14473] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Peripheral T-cell lymphoma (PTCL), not otherwise specified (NOS) and angioimmunoblastic T-cell lymphoma (AITL) are the most frequent of more than 20 mature PTCL entities featuring a broad spectrum of morphological, immunophenotypic, molecular and clinical characteristics. Unfortunately, recent progress in understanding the (epi)genetic background of PTCL has not been met with similar advances in treatment. Thus, CHO(E)P [cyclophosphamide, doxorubicin, vincristine, and prednisone (plus etoposide)] remains standard first-line therapy. Patients without comorbidities achieving complete or partial remission proceed to autologous stem cell transplantation. With this approach about 50% of patients survive long-term. Patients relapsing after or progressing during first-line therapy have a dismal prognosis. They receive salvage gemcitabine-therapy followed by allogeneic transplantation whenever possible. After allografting, approximately half of the patients survive long-term; any other treatment is palliative. New drugs investigated in phase II studies achieved response rates between 10% and 30%; long-term remissions are the exception to the rule. While most new drugs are not licensed and not readily available, a plethora of other innovative drugs targeting (epi-)genetic abnormalities are in early development. These, together with combinations of new and old drugs, will hopefully increase response to first-line therapy, bridge more patients to transplantation, and finally improve prognosis for all patients with PTCL.
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Affiliation(s)
- Norbert Schmitz
- Department of Haematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Laurence de Leval
- Institute of Pathology, University Hospital Lausanne and University of Lausanne, Switzerland
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243
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Carson KR, Horwitz SM, Pinter-Brown LC, Rosen ST, Pro B, Hsi ED, Federico M, Gisselbrecht C, Schwartz M, Bellm LA, Acosta MA, Shustov AR, Advani RH, Feldman TA, Lechowicz MJ, Smith SM, Lansigan F, Tulpule A, Craig MD, Greer JP, Kahl BS, Leach JW, Morganstein N, Casulo C, Park SI, Foss FM. A prospective cohort study of patients with peripheral T-cell lymphoma in the United States. Cancer 2016; 123:1174-1183. [PMID: 27911989 DOI: 10.1002/cncr.30416] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/27/2016] [Accepted: 10/03/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Long-term survival in patients with aggressive peripheral T-cell lymphoma (PTCL) is generally poor, and there currently is no clear consensus regarding the initial therapy used for these diseases. Herein, the authors analyzed treatment patterns and outcomes in a prospectively collected cohort of patients with a new diagnosis of nodal PTCL in the United States. METHODS Comprehensive Oncology Measures for Peripheral T-cell Lymphoma Treatment (COMPLETE) is a prospective multicenter cohort study designed to identify the most common prevailing treatment patterns used for patients newly diagnosed with PTCL in the United States. Patients with nodal PTCL and completed records regarding baseline characteristics and initial therapy were included in this analysis. All statistical tests were 2-sided. RESULTS Of a total of 499 patients enrolled, 256 (51.3%) had nodal PTCL and completed treatment records. As initial therapy, patients received doxorubicin-containing regimens (41.8%), regimens containing doxorubicin plus etoposide (20.9%), other etoposide regimens (15.8%), other single-agent or combination regimens (19.2%), and gemcitabine-containing regimens (2.1%). Survival was found to be statistically significantly longer for patients who received doxorubicin (log-rank P = .03). After controlling for disease histology and International Prognostic Index, results demonstrated a trend toward significance in mortality reduction in patients who received doxorubicin compared with those who did not (hazard ratio, 0.71; 95% confidence interval, 0.48-1.05 [P = .09]). CONCLUSIONS To the authors' knowledge, there is no clear standard of care in the treatment of patients with PTCL in the United States. Although efforts to improve frontline treatments are necessary, anthracyclines remain an important component of initial therapy for curative intent. Cancer 2017;123:1174-1183. © 2016 American Cancer Society.
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Affiliation(s)
- Kenneth R Carson
- Research Service, St Louis Veterans Affairs Medical Center, St. Louis, Missouri.,Department of Medical Oncology, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Steven M Horwitz
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - Steven T Rosen
- Provost and Chief Scientific Officer, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Barbara Pro
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Eric D Hsi
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Massimo Federico
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Mark A Acosta
- Research and Development, Spectrum Pharmaceuticals Inc, Irvine, California
| | - Andrei R Shustov
- Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ranjana H Advani
- Department of Medicine, Stanford University Medical Center, Stanford, California
| | - Tatyana A Feldman
- Department of Hematology/Oncology, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Mary Jo Lechowicz
- Department of Hematology and Oncology, Emory University, Atlanta, Georgia
| | - Sonali M Smith
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Frederick Lansigan
- Department of Medicine, Dartmouth Hitchcock Medical Center, Hanover, New Hampshire
| | - Anil Tulpule
- Department of Medicine, University of Southern California, Los Angeles, California
| | - Michael D Craig
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - John P Greer
- Department of Hematology, Vanderbilt University, Nashville, Tennessee
| | - Brad S Kahl
- Department of Medical Oncology, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Joseph W Leach
- Minnesota Oncology, Virginia Piper Cancer Institute, Minneapolis, Minnesota
| | | | - Carla Casulo
- Department of Medicine, University of Rochester, Rochester, New York
| | - Steven I Park
- Department of Internal Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Francine M Foss
- Department of Medical Oncology, Yale University, New Haven, Connecticut
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244
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Gemcitabine, dexamethasone, and cisplatin (GDP) as salvage chemotherapy for patients with relapsed or refractory peripheral T cell lymphoma-not otherwise specified. Ann Hematol 2016; 96:245-251. [PMID: 27858107 DOI: 10.1007/s00277-016-2877-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 11/08/2016] [Indexed: 12/23/2022]
Abstract
Standard therapeutic options for patients with relapsed or refractory peripheral T cell lymphoma-not otherwise specified (PTCL-NOS) remain unclear. There are few large cohort studies specifically focused on gemcitabine-based chemotherapy for PTCL-NOS. We retrospectively reviewed patients with relapsed or refractory PTCL-NOS who received salvage GDP (gemcitabine, dexamethasone, and cisplatin) chemotherapy at the Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China, from May 2008 to August 2014. Twenty-five patients were enrolled and analyzed. The median number of cycles of GDP chemotherapy per patient was four (range, 2-8 cycles). Overall response rate was 64.0% (16/25) with five achieved complete remission or complete remission unconfirmed. After a median follow-up of 9 months, median overall survival (OS) and progression-free survival after relapse or progression (second-PFS) were 9.3 and 5.4 months. One-year PFS rate and 1-year OS rate were 27.4% and 43.9%, respectively. Median second-PFS was significantly longer in patients sensitive to GDP than the ones resistant to the treatment (10.3 vs. 2.8 months, p < .01). In addition, the low International Prognostic Index, low Prognostic Index for T cell lymphoma, or normal level of LDH in serum was associated with favorable prognosis. Grade 3/4 adverse effect was observed in 10 of 25 patients treated with GDP including neutropenia (8/25), thrombocytopenia (5/25), and anemia (4/25). Taken together, our study suggests that GDP is an effective and optional salvage regimen for relapsed or refractory PTCL-NOS.
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245
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Tolkachjov SN, Weenig RH, Comfere NI. Cutaneous peripheral T-cell lymphoma, not otherwise specified: A single-center prognostic analysis. J Am Acad Dermatol 2016; 75:992-999. [DOI: 10.1016/j.jaad.2016.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/10/2016] [Accepted: 06/02/2016] [Indexed: 11/26/2022]
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246
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Piao W, Chau D, Yue LM, Kwong YL, Tse E. Arsenic trioxide degrades NPM-ALK fusion protein and inhibits growth of ALK-positive anaplastic large cell lymphoma. Leukemia 2016; 31:522-526. [DOI: 10.1038/leu.2016.311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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247
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Hux M, Zou D, Ma E, Sajosi P, Engstrom A, Selby R, Benson E, Briggs A, Bonthapally V. A Cost-effectiveness Analysis of Brentuximab Vedotin in Relapsed or Refractory Systemic Anaplastic Large Cell Lymphoma. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2016; 4:188-203. [PMID: 37661948 PMCID: PMC10471416 DOI: 10.36469/9820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Objective: To evaluate the cost-effectiveness of brentuximab vedotin in patients with R/R sALCL from a UK NHS perspective. Methods: A partitioned survival model used clinical outcomes for brentuximab vedotin from the pivotal phase-2 single-arm trial of brentuximab vedotin in 58 patients with R/R sALCL (SG035-0004; NCT00866047), over a lifetime (30-year) time horizon. Comparison with conventional chemotherapy was based on data from the Canadian British Columbia Cancer Agency registry from 40 patients starting salvage chemotherapy after front-line treatment between 1980 and 2012. Survival was extrapolated using parametric distributions, with brentuximab vedotin risk after the trial period assumed equal to conventional chemotherapy. Other modelling assumptions were based on a systematic literature review and clinical expert opinion. Results: Based on statistical extrapolation, brentuximab vedotin was associated with 3.1 years longer duration in the progression-free survival health state and an overall survival improvement of 5.4 years, prior to discounting. In addition, brentuximab vedotin was associated with 2.5 quality-adjusted life years (QALYs) gained at a total incremental cost of £88 556, resulting in an incremental cost-effectiveness ratio (ICER) of approximately £35 400. Sensitivity analyses of alternative model assumptions provided ICERs ranging from approximately £28 100 to £61 900. Comparing only first-line salvage patients reduced the ICER to £26 800 per QALY gained. Conversely, considering only patients with Eastern Corporative Oncology Group performance status of 0 or 1 increased the ICER to approximately £38 200. At a willingness-to-pay threshold of £50 000, the estimated probability that brentuximab vedotin is cost-effective compared with conventional chemotherapy was 86.5%. Conclusion: Compared to conventional chemotherapy, and considering the full survival period, brentuximab vedotin may provide a valuable treatment choice for patients with R/R sALCL, a population with limited therapeutic options.
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Affiliation(s)
| | | | - Esprit Ma
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Peter Sajosi
- Global Pricing, Market Access and Health Economics Millennium Pharmaceuticals Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Andreas Engstrom
- Market Access and Health Economics, Takeda Pharma AB, Stockholm, Sweden
| | - Ross Selby
- Market Access, Takeda UK Ltd., Bucks, United Kingdom
| | - Eugene Benson
- Market Access, Takeda UK Ltd., Bucks, United Kingdom
| | - Andrew Briggs
- ICON plc, New York, NY, USA; Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Vijayveer Bonthapally
- Global Pricing, Market Access and Health Economics Millennium Pharmaceuticals Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
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248
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Wang T, Lu Y, Polk A, Chowdhury P, Murga-Zamalloa C, Fujiwara H, Suemori K, Beyersdorf N, Hristov AC, Lim MS, Bailey NG, Wilcox RA. T-cell Receptor Signaling Activates an ITK/NF-κB/GATA-3 axis in T-cell Lymphomas Facilitating Resistance to Chemotherapy. Clin Cancer Res 2016; 23:2506-2515. [PMID: 27780854 DOI: 10.1158/1078-0432.ccr-16-1996] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/16/2016] [Accepted: 10/11/2016] [Indexed: 12/11/2022]
Abstract
Purpose: T-cell lymphomas are a molecularly heterogeneous group of non-Hodgkin lymphomas (NHL) that account for a disproportionate number of NHL disease-related deaths due to their inherent and acquired resistance to standard multiagent chemotherapy regimens. Despite their molecular heterogeneity and frequent loss of various T cell-specific receptors, the T-cell antigen receptor is retained in the majority of these lymphomas. As T-cell receptor (TCR) engagement activates a number of signaling pathways and transcription factors that regulate T-cell growth and survival, we examined the TCR's role in mediating resistance to chemotherapy.Experimental Design: Genetic and pharmacologic strategies were utilized to determine the contribution of tyrosine kinases and transcription factors activated in conventional T cells following TCR engagement in acquired chemotherapy resistance in primary T-cell lymphoma cells and patient-derived cell lines.Results: Here, we report that TCR signaling activates a signaling axis that includes ITK, NF-κB, and GATA-3 and promotes chemotherapy resistance.Conclusions: These observations have significant therapeutic implications, as pharmacologic inhibition of ITK prevented the activation of this signaling axis and overcame chemotherapy resistance. Clin Cancer Res; 23(10); 2506-15. ©2016 AACR.
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MESH Headings
- Adenine/analogs & derivatives
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Drug Resistance, Neoplasm/genetics
- Drug Resistance, Neoplasm/immunology
- GATA3 Transcription Factor/genetics
- GATA3 Transcription Factor/immunology
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/genetics
- Lymphoma, Non-Hodgkin/immunology
- Lymphoma, T-Cell/drug therapy
- Lymphoma, T-Cell/genetics
- Lymphoma, T-Cell/immunology
- NF-kappa B/genetics
- NF-kappa B/immunology
- Piperidines
- Primary Cell Culture
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Protein-Tyrosine Kinases/immunology
- Pyrazoles/administration & dosage
- Pyrimidines/administration & dosage
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/immunology
- Signal Transduction/drug effects
- T-Lymphocytes/immunology
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Affiliation(s)
- Tianjiao Wang
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Ye Lu
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Avery Polk
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Pinki Chowdhury
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Carlos Murga-Zamalloa
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Hiroshi Fujiwara
- Department of Hematology, Clinical Immunology and Infectious Disease, Graduate School of Medicine, Ehime University, Toon, Ehime, Japan
| | - Koichiro Suemori
- Department of Hematology, Clinical Immunology and Infectious Disease, Graduate School of Medicine, Ehime University, Toon, Ehime, Japan
| | - Niklas Beyersdorf
- Institute for Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Alexandra C Hristov
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Megan S Lim
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nathanael G Bailey
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ryan A Wilcox
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan.
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249
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Yang YT, Tai CJ, Chen C, Wu HC, Mikhaylichenko N, Chiu HT, Chen YY, Hsu YHE. Highly Diverse Efficacy of Salvage Treatment Regimens for Relapsed or Refractory Peripheral T-Cell Lymphoma: A Systematic Review. PLoS One 2016; 11:e0161811. [PMID: 27711130 PMCID: PMC5053427 DOI: 10.1371/journal.pone.0161811] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 08/12/2016] [Indexed: 12/21/2022] Open
Abstract
Background The goal of this study was to perform a systematic review to examine the efficacy and safety of various salvage therapy regimens on patients with relapsed/refractory PTCL. Method The electronic searches were performed using PubMed, Cochrane Library, EMBASE, and Web of Science from inception through June 2015, with search terms related to relapsed/refractory PTCL, salvage chemotherapy regimens, and clinical trials. An eligible study met the following inclusion criteria: (1) Patients had refractory or relapsed PTCL; (2) drug regimens were used for salvage therapy; (3) the study was a clinical trial; (4) the study reported on a series of at least 10 patients of PTCL. Results Of 35 records identified, a total of 14 studies were eligible for systematic reviews, and 12 different salvage regimens were investigated. A total of 618 relapsed/refractory PTCL patients were identified. The ORRs ranged from 22% for those treated with lenalidomide to 86% for those with brentuximab vedotin. By the three most frequent subtypes, the ORRs ranged from 14.2% to 71.5% for patients with the PTCL-NOS subtype, 8% to 54% for AITL subtypes, and 24% to 86% for the ALCL subtype. The medians of DOR, PFS, and OS ranged from 2.5 to 16.6 months, 2.6 to 13.3 months, and 3.6 to 14.5 months, respectively. The most frequently reported grade 3 or 4 adverse events (AEs) were hematological AEs, such as neutropenia and thrombocytopenia. Conclusion The efficacy of salvage therapy regimens is highly diverse for patients with relapsed/refractory PTCL; this heterogeneity in therapeutic effects might be due to the diversity in mechanisms, PTCL subtype distribution, and/or numbers/profiles of prior therapy. Comparative studies with matched pair analysis are warranted for more evidence of the salvage treatment effect on relapsed or heavily pretreated patients with PTCL.
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Affiliation(s)
- Ya-Ting Yang
- Institute of Health Policy and Management, National Taiwan University, 17 Xu-Zhou Rd., Taipei, 100, Taiwan
- Golden Dream Think Tank and Research Center, 17 Songjiang Rd., Taipei, 104, Taiwan
- School of Health Care Administration, Taipei Medical University, 250 Wuxing Street, Taipei, Taiwan
| | - Cheng-Jeng Tai
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, 252 Wuxing Street, Taipei, 110, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 110, Taiwan
| | - Chiehfeng Chen
- Center for Evidence-Based Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 110, Taiwan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 110, Taiwan
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, NO.111, Section 3, Hsing-Long Rd, Taipei, 116, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, NO.111, Section 3, Hsing-Long Rd, Taipei, 116, Taiwan
| | - Hong-Cheng Wu
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, 252 Wuxing Street, Taipei, 110, Taiwan
| | | | - Hsien-Tsai Chiu
- Golden Dream Think Tank and Research Center, 17 Songjiang Rd., Taipei, 104, Taiwan
- Department of Public Health, China Medical University, 91 Hsueh-Shih Road, Taichung, 404, Taiwan
| | - Yun-Yi Chen
- Institute of Health Policy and Management, National Taiwan University, 17 Xu-Zhou Rd., Taipei, 100, Taiwan
- Golden Dream Think Tank and Research Center, 17 Songjiang Rd., Taipei, 104, Taiwan
| | - Yi-Hsin Elsa Hsu
- Golden Dream Think Tank and Research Center, 17 Songjiang Rd., Taipei, 104, Taiwan
- School of Health Care Administration, Taipei Medical University, 250 Wuxing Street, Taipei, Taiwan
- * E-mail:
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Burudpakdee C, Lin HM, Wang W, Seetasith A, Zhu Y, Bonthapally V, Carson KR. Clinical and economic burden of peripheral T-cell lymphoma in commercially insured patients in the United States: findings using real-world claims data. J Med Econ 2016; 19:965-72. [PMID: 27152635 DOI: 10.1080/13696998.2016.1187622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This retrospective cohort study utilized real-world claims data to assess the clinical and economic burden of peripheral T-cell lymphoma (PTCL) over the continuum of care in the US. METHODS Data were extracted from US administrative claims databases to identify adult patients with PTCL (ICD-9-CM code 202.7X) diagnosed between October 2007 and June 2011. Patients had to have ≥6 months of continuous enrollment before and ≥12 months of continuous enrollment after their index date (date of first PTCL diagnosis). PTCL patients were matched (1:5) by age, sex, region, plan type, payer type, and length of continuous enrollment, to a control group of randomly selected patients without PTCL. Patient-level healthcare resource utilization data and associated costs (in US dollars) were measured. Mean costs per patient per month were determined. RESULTS Of 2820 patients with PTCL, 1000 met all inclusion criteria (median age = 57 years; 57.5% male) and were matched to the control group (n = 5000). On an average monthly basis, PTCL patients were hospitalized more frequently (0.07 vs 0.01 admissions; p < 0.0001) and had a longer length of hospital stay (6.4 vs 4.0 days; p < 0.0001) compared with controls. PTCL patients also had higher monthly utilization of pharmacy services (2.85 vs 0.97 prescriptions; p < 0.0001), office visits (1.35 vs 0.34 visits; p < 0.0001), ER visits (0.07 vs 0.02 visits; p < 0.0001), hospice stays (0.05 vs 0.01 stays; p < 0.0001) and other patient services/procedures. Overall, PTCL patients incurred higher average monthly costs per patient compared with control patients ($6327.84 vs $388.39; p < 0.0001), driven mainly by hospitalizations (32.2% of overall costs) and pharmacy services (19.6%). CONCLUSIONS This is the first real-world study to quantify healthcare resource utilization, costly treatment, and overall medical expenditure in commercially insured PTCL patients. Better tolerated and more effective treatments may improve disease management and reduce the clinical and economic burden of PTCL.
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Affiliation(s)
- Chakkarin Burudpakdee
- a IMS Health , Fairfax , VA , USA
- b University of North Carolina at Charlotte , Charlotte , NC , USA
| | - Huamao Mark Lin
- c Millennium Pharmaceuticals , Inc., Cambridge , MA , USA , a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | | | | | - Yanyan Zhu
- c Millennium Pharmaceuticals , Inc., Cambridge , MA , USA , a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Vijayveer Bonthapally
- c Millennium Pharmaceuticals , Inc., Cambridge , MA , USA , a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Kenneth R Carson
- e Washington University School of Medicine , St. Louis , MO , USA
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