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Greve P, Beishuizen A, Hagleitner M, Loeffen J, Veening M, Boes M, Peperzak V, Diez C, Meyer-Wentrup F. Nivolumab plus Brentuximab vedotin +/- bendamustine combination therapy: a safe and effective treatment in pediatric recurrent and refractory classical Hodgkin lymphoma. Front Immunol 2023; 14:1229558. [PMID: 37583696 PMCID: PMC10423930 DOI: 10.3389/fimmu.2023.1229558] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Classical Hodgkin lymphoma (cHL) is the most common pediatric lymphoma. Approximately 10% of patients develop refractory or recurrent disease. These patients are treated with intensive chemotherapy followed by consolidation with radiotherapy or high-dose chemotherapy and autologous stem cell reinfusion. Although this treatment is effective, it comes at the cost of severe long-term adverse events, such as reduced fertility and an increased risk of secondary cancers. Recently, promising results of inducing remission with the immune checkpoint inhibitor nivolumab (targeting PD-1) and the anti-CD30 antibody-drug conjugate Brentuximab vedotin (BV) +/- bendamustine were published. Methods Here we describe a cohort of 10 relapsed and refractory pediatric cHL patients treated with nivolumab + BV +/- bendamustine to induce remission prior to consolidation with standard treatment. Results and discussion All patients achieved complete remission prior to consolidation treatment and are in ongoing complete remission with a median follow-up of 25 months (range: 12 to 42 months) after end-of-treatment. Only one adverse event of CTCAE grade 3 or higher due to nivolumab + BV was identified. Based on these results we conclude that immunotherapy with nivolumab + BV +/- bendamustine is an effective and safe treatment to induce remission in pediatric R/R cHL patients prior to standard consolidation treatment. We propose to evaluate this treatment further to study putative long-term toxicity and the possibility to reduce the intensity of consolidation treatment.
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Affiliation(s)
- Patrick Greve
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Hemato-oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Auke Beishuizen
- Department of Hemato-oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Melanie Hagleitner
- Department of Hemato-oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Jan Loeffen
- Department of Hemato-oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Margreet Veening
- Department of Hemato-oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Marianne Boes
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Victor Peperzak
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Claudius Diez
- Department of Hemato-oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Friederike Meyer-Wentrup
- Department of Hemato-oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
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Zijtregtop EAM, Winterswijk LA, Beishuizen TPA, Zwaan CM, Nievelstein RAJ, Meyer-Wentrup FAG, Beishuizen A. Machine Learning Logistic Regression Model for Early Decision Making in Referral of Children with Cervical Lymphadenopathy Suspected of Lymphoma. Cancers (Basel) 2023; 15:cancers15041178. [PMID: 36831520 PMCID: PMC9954739 DOI: 10.3390/cancers15041178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
While cervical lymphadenopathy is common in children, a decision model for detecting high-grade lymphoma is lacking. Previously reported individual lymphoma-predicting factors and multivariate models were not sufficiently discriminative for clinical application. To develop a diagnostic scoring tool, we collected data from all children with cervical lymphadenopathy referred to our national pediatric oncology center within 30 months (n = 182). Thirty-nine putative lymphoma-predictive factors were investigated. The outcome groups were classical Hodgkin lymphoma (cHL), nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), non-Hodgkin lymphoma (NHL), other malignancies, and a benign group. We integrated the best univariate predicting factors into a multivariate, machine learning model. Logistic regression allocated each variable a weighing factor. The model was tested in a different patient cohort (n = 60). We report a 12-factor diagnostic model with a sensitivity of 95% (95% CI 89-98%) and a specificity of 88% (95% CI 77-94%) for detecting cHL and NHL. Our 12-factor diagnostic scoring model is highly sensitive and specific in detecting high-grade lymphomas in children with cervical lymphadenopathy. It may enable fast referral to a pediatric oncologist in patients with high-grade lymphoma and may reduce the number of referrals and unnecessary invasive procedures in children with benign lymphadenopathy.
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Affiliation(s)
- Eline A. M. Zijtregtop
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
- Department of Pediatric Hematology and Oncology, Erasmus Medical Centre-Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Louise A. Winterswijk
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
- Department of Pediatric Hematology and Oncology, Erasmus Medical Centre-Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Tammo P. A. Beishuizen
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
| | - Christian M. Zwaan
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
- Department of Pediatric Hematology and Oncology, Erasmus Medical Centre-Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Rutger A. J. Nievelstein
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
- Division Imaging & Oncology, Department of Radiology & Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Friederike A. G. Meyer-Wentrup
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
| | - Auke Beishuizen
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
- Department of Pediatric Hematology and Oncology, Erasmus Medical Centre-Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
- Correspondence: ; Tel.: +31-88-9727272
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Zijtregtop EAM, Diez C, Zwaan CM, Veening MA, Beishuizen A, Meyer-Wentrup FAG. Thymus and activation-regulated chemokine (TARC) as treatment response marker for paediatric Hodgkin lymphoma: A pilot study. Br J Haematol 2023; 200:70-78. [PMID: 36128637 PMCID: PMC10087307 DOI: 10.1111/bjh.18473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/28/2022]
Abstract
Classical Hodgkin lymphoma (cHL) is characterised by malignant Hodgkin Reed-Sternberg cells located in an inflammatory microenvironment. Blood biomarkers result from active cross-talk between malignant and non-malignant cells. One promising biomarker in adult patients with cHL is thymus and activation-regulated chemokine (TARC). We investigated TARC as marker for interim and end-of-treatment response in paediatric cHL. In this multicentre prospective study, TARC levels were measured among 99 paediatric patients with cHL before each cycle of chemotherapy and were linked with interim and end-of-treatment remission status. TARC levels were measured by enzyme-linked immunosorbent assay. At diagnosis, TARC levels were elevated in 96% of patients. Plasma TARC levels declined significantly after one cycle of chemotherapy (p < 0.01 vs. baseline) but did not differ at interim assessment by positron emission tomography (p = 0.31). In contrast, median plasma TARC at end of treatment was significantly higher in three patients with progressive disease compared to those in complete remission (1.226 vs. 90 pg/ml; p < 0.001). We demonstrate that, in paediatric patients, plasma TARC is a valuable response marker at end-of-treatment, but not at interim analysis after the first two chemotherapy cycles. Further research is necessary to investigate TARC as marker for long-term progression free survival.
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Affiliation(s)
- Eline A M Zijtregtop
- Department of Paediatric Haematology and Oncology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Paediatric Haemato-Oncology, Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - Claudius Diez
- Department of Paediatric Haemato-Oncology, Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - C Michel Zwaan
- Department of Paediatric Haematology and Oncology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Paediatric Haemato-Oncology, Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - Margreet A Veening
- Department of Paediatric Haemato-Oncology, Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands.,Department of Paediatric Haemato-Oncology, Amsterdam University Medical Centre, Location VUmc, Amsterdam, The Netherlands
| | - Auke Beishuizen
- Department of Paediatric Haematology and Oncology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Paediatric Haemato-Oncology, Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - Friederike A G Meyer-Wentrup
- Department of Paediatric Haemato-Oncology, Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
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Şumnu Ş, Mehtap Ö, Mersin S, Toptaş T, Görür G, Gedük A, Ünal S, Polat MG, Aygün K, Yenihayat EM, Albayrak H, Uluköylü Mengüç M, Tarkun P, Hacıhanifioğlu A. Serum calprotectin (S100A8/A9) levels as a new potential biomarker of treatment response in Hodgkin lymphoma. Int J Lab Hematol 2021; 43:638-644. [PMID: 33904653 DOI: 10.1111/ijlh.13559] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Hodgkin lymphoma (HL) is unusual among malignancies, with inflammation playing such a prominent role in its pathogenesis. S100A8/A9 (calprotectin) is a heterodimeric protein, which has a role in the inflammatory response and oncogenesis. In this study in HL patients, the correlation between serum S100A8/A9 levels and treatment responses was investigated along with whether this marker is correlated with other inflammatory markers. MATERIALS AND METHODS Thirty-three HL patients and 20 healthy volunteers were included. Demographic and clinical characteristics were recorded. Calprotectin levels were measured with Human S100A8/A9 Heterodimer Quantikine ELISA kit. Calprotectin levels were measured twice in patients, before and after treatment, and once in the control group. Treatment responses were evaluated with positron emission tomography-computed tomography (PET-CT). RESULTS The mean age of patients was 44.3 ± 18.1 (66.3% male). The median (IQR) values of S100A8/A9 before and after treatment in the patient group were 4.98 (2.6-7.8) and 1.87 (1.1-4.8)µg/mL. Median (IQR) S100A8/A9 concentration in the control group was 1.41 (0.98-2.73)µg/mL. In patients, pretreatment values were significantly higher than in controls (P < .001). However, median values of patients after treatment and controls were similar. Patient median S100A8/A9 levels were significantly lower post-treatment compared with pretreatment values (P = .001). When inflammatory markers were examined within groups, no relationship was found between markers. In ROC analysis, a S100A8/A9 cutoff value of ≥3.31µg/mL accurately discriminated end-of-treatment PET positivity (AUC = 0.78; 95% CI 0.58-0.98; accuracy = 76.2%). CONCLUSION S100A8/A9 may be a potential biomarker for treatment response in HL independent of inflammation. This is the first study to investigate and show this finding. However, further large-scale studies are still required.
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Affiliation(s)
- Şeyma Şumnu
- Department of Hematology, Medical Faculty, University of Kocaeli, Kocaeli, Turkey
| | - Özgür Mehtap
- Department of Hematology, Medical Faculty, University of Kocaeli, Kocaeli, Turkey
| | - Sinan Mersin
- Department of Hematology, Medical Faculty, University of Kocaeli, Kocaeli, Turkey
| | - Tayfur Toptaş
- Department of Hematology, Marmara University Hospital, Istanbul, Turkey
| | - Gözde Görür
- Department of Nuclear Medicine, Medical Faculty, University of Kocaeli, Kocaeli, Turkey
| | - Ayfer Gedük
- Department of Hematology, Medical Faculty, University of Kocaeli, Kocaeli, Turkey
| | - Serkan Ünal
- Department of Hematology, Medical Faculty, University of Kocaeli, Kocaeli, Turkey
| | - Merve Gökçen Polat
- Department of Hematology, Medical Faculty, University of Kocaeli, Kocaeli, Turkey
| | - Kemal Aygün
- Department of Hematology, Medical Faculty, University of Kocaeli, Kocaeli, Turkey
| | - Emel Merve Yenihayat
- Department of Hematology, Medical Faculty, University of Kocaeli, Kocaeli, Turkey
| | - Hayrunnisa Albayrak
- Department of Hematology, Medical Faculty, University of Kocaeli, Kocaeli, Turkey
| | - Meral Uluköylü Mengüç
- Department of Hematology, Medical Faculty, Bolu İzzet Baysal University, Bolu, Turkey
| | - Pınar Tarkun
- Department of Hematology, Medical Faculty, University of Kocaeli, Kocaeli, Turkey
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Zijtregtop EAM, van der Strate I, Beishuizen A, Zwaan CM, Scheijde-Vermeulen MA, Brandsma AM, Meyer-Wentrup F. Biology and Clinical Applicability of Plasma Thymus and Activation-Regulated Chemokine (TARC) in Classical Hodgkin Lymphoma. Cancers (Basel) 2021; 13:884. [PMID: 33672548 PMCID: PMC7923750 DOI: 10.3390/cancers13040884] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 01/05/2023] Open
Abstract
Thymus and activation-regulated chemokine (TARC) is produced by different cell types and is highly expressed in the thymus. It plays an important role in T cell development, trafficking and activation of mature T cells after binding to its receptor C-C chemokine receptor type 4 (CCR4) and consecutive signal transducer and activator of transcription 6 (STAT6) activation. Importantly, TARC is also produced by malignant Hodgkin and Reed-Sternberg (HRS) cells of classical Hodgkin lymphoma (cHL). In cHL, HRS cells survive and proliferate due to the micro-environment consisting primarily of type 2 T helper (Th2) cells. TARC-mediated signaling initiates a positive feedback loop that is crucial for the interaction between HRS and T cells. The clinical applicability of TARC is diverse. It is useful as diagnostic biomarker in both children and adults with cHL and in other Th2-driven diseases. In adult cHL patients, TARC is also a biomarker for treatment response and prognosis. Finally, blocking TARC signaling and thus inhibiting pathological Th2 cell recruitment could be a therapeutic strategy in cHL. In this review, we summarize the biological functions of TARC and focus on its role in cHL pathogenesis and as a biomarker for cHL and other diseases. We conclude by giving an outlook on putative therapeutic applications of antagonists and inhibitors of TARC-mediated signaling.
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Affiliation(s)
- Eline A. M. Zijtregtop
- Department of Pediatric Hematology and Oncology, Erasmus Medical Center-Sophia Children’s Hospital, 3015 GD Rotterdam, The Netherlands; (E.A.M.Z.); (A.B.); (C.M.Z.)
- Department of Pediatric Hemato-oncology, Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (I.v.d.S.); (A.M.B.)
| | - Iris van der Strate
- Department of Pediatric Hemato-oncology, Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (I.v.d.S.); (A.M.B.)
| | - Auke Beishuizen
- Department of Pediatric Hematology and Oncology, Erasmus Medical Center-Sophia Children’s Hospital, 3015 GD Rotterdam, The Netherlands; (E.A.M.Z.); (A.B.); (C.M.Z.)
- Department of Pediatric Hemato-oncology, Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (I.v.d.S.); (A.M.B.)
| | - Christian M. Zwaan
- Department of Pediatric Hematology and Oncology, Erasmus Medical Center-Sophia Children’s Hospital, 3015 GD Rotterdam, The Netherlands; (E.A.M.Z.); (A.B.); (C.M.Z.)
- Department of Pediatric Hemato-oncology, Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (I.v.d.S.); (A.M.B.)
| | | | - Arianne M. Brandsma
- Department of Pediatric Hemato-oncology, Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (I.v.d.S.); (A.M.B.)
| | - Friederike Meyer-Wentrup
- Department of Pediatric Hemato-oncology, Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (I.v.d.S.); (A.M.B.)
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