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Scheubeck G, Hoffmann M, Jurinovic V, Fischer L, Unterhalt M, Schmidt C, Böck HP, Dührsen U, Kaesberger J, Kremers S, Lindemann HW, Mantovani L, Hiddemann W, Hoster E, Dreyling M. Rituximab, gemcitabine and oxaliplatin in relapsed or refractory indolent and mantle cell lymphoma: results of a multicenter phase I/II-study of the German Low Grade Lymphoma Study Group. Ann Hematol 2024; 103:2373-2380. [PMID: 38459156 PMCID: PMC11224115 DOI: 10.1007/s00277-024-05689-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
Rituximab, gemcitabine and oxaliplatin (R-GemOx) has demonstrated to be effective and safe in lymphoma patients. We aimed to determine the maximum tolerated dose (MTD) of oxaliplatin in combination with rituximab and gemcitabine and to explore the efficacy and safety of R-GemOx in relapsed or refractory (r/r) indolent and mantle cell lymphoma (MCL). In this single-arm, phase I/II trial, we enrolled 55 patients with r/r indolent lymphoma and MCL not suitable for autologous stem-cell transplantation. Patients received 4 cycles of R-GemOx. In the dose escalation group, 70 mg/m2 of oxaliplatin was applied and interindividually increased by 10 mg/m2 until the MTD was reached together with fixed doses of rituximab and gemcitabine. At the oxaliplatin MTD, an extension cohort was opened. Primary aim was to detect an overall response rate (ORR) greater than 65% (α = 0.05). Oxaliplatin 70 mg/m2 (MTD) was chosen for the extension cohort after 3 of 6 patients experienced a DLT at 80 mg/m2. Among 46 patients evaluable for the efficacy analysis ORR was 72% (33/46), missing the primary aim of the study (p = 0.21). After a median follow-up of 7.9 years, median PFS and OS were 1.0 and 2.1 years. Most frequent grade ≥ 3 adverse events were cytopenias. R-GemOx induces decent response rates in r/r indolent lymphoma and MCL, though novel targeted therapies have largely replaced chemotherapy in the relapse setting. Particularly in MCL, R-GemOx might be an alternative option in late relapses or as bridging to CAR-T-cells. This study was registered with ClinicalTrials.gov on Aug 4th, 2009, number NCT00954005.
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Affiliation(s)
- Gabriel Scheubeck
- Department of Internal Medicine III, LMU University Hospital, LMU Munich, Munich, Germany.
| | - Martin Hoffmann
- Medical Clinic A, Clinical Centre Ludwigshafen, Ludwigshafen, Germany
| | - Vindi Jurinovic
- Institute for Medical Information Processing, Biometry, and Epidemiology, LMU Munich, Munich, Germany
| | - Luca Fischer
- Department of Internal Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Michael Unterhalt
- Department of Internal Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christian Schmidt
- Department of Internal Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | | | - Ulrich Dührsen
- Clinic of Hematology, University Hospital, University of Duisburg-Essen, Essen, Germany
| | | | - Stephan Kremers
- Hematology-Oncology, Caritas Hospital Lebach, Lebach, Germany
| | | | | | - Wolfgang Hiddemann
- Department of Internal Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Eva Hoster
- Department of Internal Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, LMU Munich, Munich, Germany
| | - Martin Dreyling
- Department of Internal Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
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2
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Mohty R, Moreno Vanegas Y, Chavez JC, Kharfan-Dabaja MA. Lisocabtagene maraleucel for relapsed or refractory large B-cell non-Hodgkin lymphoma. Expert Rev Anticancer Ther 2023; 23:121-126. [PMID: 36662602 DOI: 10.1080/14737140.2023.2171397] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Chimeric antigen receptor T (CAR T) cell therapy epitomizes the success of T cell engineering. Today, it is an integral component of the treatment algorithm for various types of B-cell non-Hodgkin lymphoma (NHL). Large B-cell lymphoma (LBCL) is the most common subtype of NHL accounting for 30-35% of cases. A lack of response to second-line therapy portends a poor prognosis as only 7-15% of patients attain complete remission (CR) with subsequent conventional chemoimmunotherapy. AREAS COVERED Lisocabtagene maraleucel (liso-cel) is an autologous CD-19 directed CAR T-cell product with a 4-1BB co-stimulatory domain administered as a sequential infusion of 2 separately manufactured components: CD8+ and CD4+ CAR T-cells in equal doses. Liso-cel showed an impressive objective response rate of 73% (CR = 53%) in patients who had received a median of 3 prior therapies. Median time-to-first CR or partial response (PR) was 1 month. EXPERT OPINION When evaluated in the second line setting in LBCL, liso-cel demonstrated superior event-free survival (EFS) versus standard of care. While acknowledging that choice of a particular CAR T-cell is based chiefly on familiarity of the treating physician with a specific product, liso-cel definitely represents an important addition to the treatment armamentarium of R/R LBCL whether in the second-line setting or beyond.
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Affiliation(s)
- Razan Mohty
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA.,Department of Blood and Marrow Transplantation and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Yenny Moreno Vanegas
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
| | - Julio C Chavez
- Department of Blood and Marrow Transplantation and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
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Lin C, Galal A, Rizzieri D, Chawla S, Lee ST, Georgy A, Dabovic K, Strack T, McKinney M. Combinatorial Efficacy and Toxicity of an Engineered Toxin Body MT-3724 with Gemcitabine and Oxaliplatin in Relapsed or Refractory Diffuse Large B Cell Lymphoma. Cancer Invest 2023; 41:1-10. [PMID: 36657101 PMCID: PMC10387504 DOI: 10.1080/07357907.2022.2162073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 01/21/2023]
Abstract
MT-3724 is an engineered direct-kill immunotoxin comprised of a CD20-specific scFv fused to a Shiga-like toxin subunit. In this phase IIa study, eight patients with relapsed diffuse large B-cell lymphoma were treated with MT-3724 combined with gemcitabine and oxaliplatin (GEMOX). The objective response rate was 85.7%, with a median duration of response of 2.2 months. The 12-month overall survival and progression-free survival were 71.4% and 28.6%, respectively. Two patients experienced grade 2 capillary leak syndrome (CLS). Combination therapy with MT-3724 and GEMOX demonstrated an early efficacy signal but was limited by the incidence of CLS.
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Affiliation(s)
- Chenyu Lin
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Ahmed Galal
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | | | - Sant Chawla
- Sarcoma Oncology Center, Santa Monica, CA, USA
| | - Seung T. Lee
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | - Matthew McKinney
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
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Nowakowski GS, Yoon DH, Peters A, Mondello P, Joffe E, Fleury I, Greil R, Ku M, Marks R, Kim K, Zinzani PL, Trotman J, Huang D, Waltl EE, Winderlich M, Kurukulasuriya NC, Ambarkhane S, Hess G, Salles G. Improved Efficacy of Tafasitamab plus Lenalidomide versus Systemic Therapies for Relapsed/Refractory DLBCL: RE-MIND2, an Observational Retrospective Matched Cohort Study. Clin Cancer Res 2022; 28:4003-4017. [PMID: 35674661 PMCID: PMC9475241 DOI: 10.1158/1078-0432.ccr-21-3648] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/07/2022] [Accepted: 05/16/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE In RE-MIND2 (NCT04697160), patient-level outcomes from the L-MIND study (NCT02399085) of tafasitamab plus lenalidomide were retrospectively compared with patient-level matched observational cohorts treated with National Cancer Care Network (NCCN)/European Society for Medical Oncology (ESMO)-listed systemic therapies for relapsed/refractory diffuse large B-cell lymphoma (DLBCL). PATIENTS AND METHODS Data were collected from health records of eligible patients aged ≥18 years with histologically confirmed DLBCL who had received ≥2 systemic therapies for DLBCL (including ≥1 anti-CD20 therapy). Patients from L-MIND were matched with patients from the RE-MIND2 observational cohort using estimated propensity score-based 1:1 nearest-neighbor matching, balanced for nine covariates. The primary analysis compared tafasitamab plus lenalidomide with patients who received any systemic therapy for R/R DLBCL (pooled in one cohort) or bendamustine plus rituximab (BR) or rituximab plus gemcitabine and oxaliplatin (R-GemOx; as two distinct cohorts). The primary endpoint was overall survival (OS). Secondary endpoints included treatment response and time-to-event outcomes. RESULTS In RE-MIND2, 3,454 patients were enrolled from 200 sites in North America, Europe, and Asia-Pacific. Strictly matched pairs of patients consisted of tafasitamab plus lenalidomide versus systemic therapies pooled (n = 76 pairs), versus BR (n = 75 pairs), and versus R-GemOx (n = 74 pairs). Significantly prolonged OS was reported with tafasitamab plus lenalidomide versus systemic pooled therapies [hazard ratios (HR): 0.55; P = 0.0068], BR (HR: 0.42; P < 0.0001), and R-GemOx (HR: 0.47; P = 0.0003). CONCLUSIONS RE-MIND2, a retrospective observational study, met its primary endpoint, demonstrating prolonged OS with tafasitamab plus lenalidomide versus BR and R-GemOx. See related commentary by Cherng and Westin, p. 3908.
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Affiliation(s)
- Grzegorz S. Nowakowski
- Division of Hematology, Mayo Clinic, Rochester, Minnesota.,Corresponding Author: Grzegorz S. Nowakowski, Division of Hematology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905. Phone: 507-405-0312; E-mail:
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Anthea Peters
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Patrizia Mondello
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erel Joffe
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Isabelle Fleury
- Institut d'Hématologie-Oncologie-Transplantation Cellulaire, Maisonneuve-Rosemont Hospital, Montréal University, Montreal, Quebec, Canada
| | - Richard Greil
- Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute-CCCIT, and Cancer Cluster Salzburg, Salzburg, Austria
| | - Matthew Ku
- Department of Haematology, St Vincent's Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Reinhard Marks
- University Hospital Freiburg Internal Medicine I, Freiburg im Breisgau, Germany
| | - Kibum Kim
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah.,Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia “Seràgnoli” & Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
| | - Judith Trotman
- Haematology Department, Concord Repatriation General Hospital, University of Sydney, Concord, New South Wales, Australia
| | | | | | | | | | | | - Georg Hess
- Department of Hematology, Oncology and Pneumology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Gilles Salles
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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The effect of ciprofloxacin on doxorubicin cytotoxic activity in the acquired resistance to doxorubicin in DU145 prostate carcinoma cells. MEDICAL ONCOLOGY (NORTHWOOD, LONDON, ENGLAND) 2022; 39:194. [PMID: 36071289 DOI: 10.1007/s12032-022-01787-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/28/2022] [Indexed: 10/14/2022]
Abstract
The present study aimed to assess the influence of ciprofloxacin (CIP) against the doxorubicin (DOX)-resistant androgen-independent prostate cancer DU145 cells. The DOX-resistant DU145 (DU145/DOX20) cells were established by exposing DU145 cells to the increasing concentrations of DOX. The antiproliferative effect of CIP was examined through employing MTT, colony formation, and 3D culture assays. DU145/DOX20 cells exhibited a twofold higher IC50 value for DOX, an increased ABCB1 transporter activity, and some morphological changes accompanied by a decrease in spheroid size, adhesive and migration potential compared to DU145 cells. CIP (5 and 25 µg mL-1) resulted in a higher reduction in the viability of DU145/DOX20 cells than in DU145 cells. DU145/DOX20 cells were more resistant to CIP in 3D culture compared to the 2D one. No spheroid formation was observed for DU145/DOX20 cells treated with DOX and CIP combination. CIP and DOX, alone or in combination, significantly reduced the growth of DU145 spheroids. CIP in combination with 20 nM DOX prevented the colony formation of DU145 cells. The clonogenicity of DU145/DOX20 cells could not be estimated due to their low adhesive potential. CIP alone caused a significant reduction in the migration of DU145 cells and resulted in a more severe decrease in the wound closure ability of DOX-exposed ones. We identified that CIP enhanced DOX sensitivity in DU145 and DU145/DOX20 cells. This study suggested the co-delivery of low concentrations of CIP and DOX may be a promising strategy in treating the DOX-resistant and -sensitive hormone-refractory prostate cancer.
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[In vitro pharmacodynamic studies of novel class Ⅰ and Ⅱb selective histone deacetylase inhibitor purinostat mesylate in the treatment of diffuse large B-cell lymphoma and its mechanism]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:753-759. [PMID: 36709169 PMCID: PMC9613491 DOI: 10.3760/cma.j.issn.0253-2727.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: To investigate the in vitro inhibitory activity of a novel class Ⅰ and Ⅱb selective histone deacetylase (HDAC) inhibitor, purinostat mesylate (PM) , in diffuse large B-cell lymphoma and its mechanism. Methods: The 3- (4,5-dimethylthiazol-2-yl) -2,5-diphenyl tetrazolium bromide method was used to detect the effect of PM on cell proliferation. The effects of PM on cell cycle and apoptosis were detected by flow cytometry. The acetylation levels of HDAC substrate, cell cycle protein, apoptosis-related protein, and oncogene protein expression were detected by Western blot. Results: PM significantly inhibited the proliferation of lymphoma SUDHL-4 and SUDHL-6 cells and increased the acetylation levels of HDAC substrates H3, H4, and α-tubulin. In cell cycle experiments, PM induced G(0)/G(1) phase arrest in SUDHL-4 and SUDHL-6 cells. Western blot experiment showed that PM could significantly downregulate the expression of cyclin-dependent kinases Cdk2, Cdk4, Cdk6, cyclin D1, and cyclin E and upregulate the expression of CDK inhibitor protein p21. In the apoptosis experiment, PM could induce the apoptosis of SUDHL-4 and SUDHL-6 cells. Western blot experiment demonstrated that PM promoted endogenous apoptosis by activating caspase-3 kinase and affecting antiapoptotic protein Bcl-2. In addition, PM could downregulate the expression of oncogene marker proteins MYC, IKZF1, and IKZF3. Conclusion: PM has an efficient biological activity in vitro for diffuse large B-cell lymphoma, including double-hit lymphoma, and provides valuable experimental evidence for PM in clinical treatment.
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Zhong W, Zhang X, Duan X, Liu H, Fang Y, Luo M, Fang Z, Miao C, Lin D, Wu J. Redox-responsive self-assembled polymeric nanoprodrug for delivery of gemcitabine in B-cell lymphoma therapy. Acta Biomater 2022; 144:67-80. [PMID: 35331940 DOI: 10.1016/j.actbio.2022.03.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 12/30/2022]
Abstract
Gemcitabine, as a standard and classic strategy for B-cell lymphoma in the clinic, is limited by its poor pharmacodynamics. Although stimuli-responsive polymeric nanodelivery systems have been widely investigated in the past decade, issues such as complicated procedures, low loading capacity, and uncontrollable release kinetics still hinder their clinical translation. In view of the above considerations, we attempt to construct hyperbranched polyprodrug micelles with considerable drug loading via simple procedures and make use of the particularity of the tumor microenvironment to ensure that the micelles are "inactivated" in normal tissues and "activated" in the tumor microenvironment. Hence, in this work, a redox-responsive polymeric gemcitabine-prodrug (GEM-S-S-PEG) was one-pot synthesized via facile esterification and acylation. The self-assembled subsize (< 100 nm) GEM-S-S-PEG (GSP NPs) with considerable loading capacity (≈ 24.6%) exhibited on-demand and accurate control of gemcitabine release under a simulated tumor microenvironment and thus significantly induced the apoptosis of B-cell lymphoma in vitro. Moreover, in the A20 tumor xenograft murine model, GSP NPs efficiently decreased the expansion of tumor tissues with minimal systemic toxicity. In summary, these redox-responsive and self-assembling GSP NPs with a facile one-pot synthesis procedure may hold great potency in clinical translation for enhanced chemotherapy of B-cell lymphoma. STATEMENT OF SIGNIFICANCE: A redox-responsive polymeric gemcitabine-prodrug (GEM-S-S-PEG) was one-pot synthesized via facile esterification and acylation. The self-assembled subsize (< 100 nm) GEM-S-S-PEG (GSP NPs) exhibited significant tumor therapeutic effects in vitro and in vivo. The polyprodrug GEM-S-S-PEG prepared in this study shows the great potential of redox-responsive nanodrugs for antitumor activity, which provides a reference value for the optimization of the design of functional polyprodrugs.
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Affiliation(s)
- Wenhao Zhong
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, China
| | - Xinyu Zhang
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, China
| | - Xiao Duan
- Department of Reproductive Genetics, Heping Hospital of Changzhi Medical College, The Stem Cell and Tissue Engineering Research Center, Changzhi Medical College, Changzhi, Shanxi 046000, China
| | - Hengyu Liu
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, China
| | - Yifen Fang
- The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, 511436, China
| | - Moucheng Luo
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, 518107, China
| | - Zhengwen Fang
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, 518107, China
| | - Congxiu Miao
- Department of Reproductive Genetics, Heping Hospital of Changzhi Medical College, The Stem Cell and Tissue Engineering Research Center, Changzhi Medical College, Changzhi, Shanxi 046000, China.
| | - Dongjun Lin
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, China.
| | - Jun Wu
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, China; School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, 518107, China.
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8
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Hess G, Hüttmann A, Witzens-Harig M, Dreyling MH, Keller U, Marks R, Ernst T, Pott C, Viardot A, Frontzek F, Trautmann M, Ruckes C, Deuster O, Rosenwald A, Theobald M, Lenz G. A phase II trial to evaluate the combination of pixantrone and obinutuzumab for patients with relapsed aggressive lymphoma: Final results of the prospective, multicentre GOAL trial. Br J Haematol 2022; 198:482-491. [PMID: 35362552 DOI: 10.1111/bjh.18161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/08/2022] [Accepted: 03/13/2022] [Indexed: 12/14/2022]
Abstract
The prognosis of patients with relapsed diffuse large B-cell lymphoma (DLBCL) remains poor with current options. Here we prospectively evaluated the combination of pixantrone with obinutuzumab for up to six cycles for patients with relapsed or refractory DLBCL. Overall response rate (ORR) was the primary end-point. Sixty-eight patients were evaluated, median age was 75 years, median number of prior lines was three (range 1-10), 52 patients (76.5%) were diagnosed with DLBCL and 16 (23.5%) patients had transformed indolent lymphoma or follicular lymphoma (FL) IIIB. ORR was 35.3% for all and 40% for evaluable patients (16.6% complete response), median progression-free survival (PFS) and overall survival (OS) were 2.8 months and 8 months, respectively. Analysis of the cell of origin revealed a superior course for patients with non-GCB (germinal centre B-cell-like) phenotype [median OS not reached (n.r.) vs 5.2 months]. Patients with one prior line had an improved outcome over patients treated in later lines (PFS n.r. vs 2.5 months). Disease progression was the main reason for premature termination. Adverse events were mainly haematologic. The combination treatment revealed no unexpected adverse events. Most relevant non-haematologic toxicity was infection in 28% of patients. In summary, pixantrone-obinutuzumab showed clinical activity with sometimes long-term remission; however, the trial failed to meet its primary end-point.
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Affiliation(s)
- Georg Hess
- Department of Internal Medicine III, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Andreas Hüttmann
- Department of Hematology, University Hospital Essen, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Mathias Witzens-Harig
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin H Dreyling
- Department of Internal Medicine III, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Ulrich Keller
- Internal Medicine III, Technical University of Munich, Munich, Germany
| | - Reinhard Marks
- Department of Hematology/Oncology and Stem Cell Transplantation, University Medical Center, Freiburg, Germany
| | - Thomas Ernst
- Department of Internal Medicine II, Jena University Hospital, Jena, Germany
| | - Christiane Pott
- Department of Internal Medicine II, University of Schleswig-Holstein, Kiel, Germany
| | - Andreas Viardot
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Fabian Frontzek
- Department of Medicine A, University Hospital Münster, Münster, Germany
| | - Marcel Trautmann
- Division of Translational Pathology, Gerhard Domagk Institute of Pathology, Münster University Hospital, Münster, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Oliver Deuster
- Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | | | - Matthias Theobald
- Department of Internal Medicine III, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Georg Lenz
- Department of Medicine A, University Hospital Münster, Münster, Germany
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Perrone S, Lopedote P, Levis M, Di Rocco A, Smith SD. Management of relapsed or refractory large B-cell lymphoma in patients ineligible for CAR-T cell therapy. Expert Rev Hematol 2022; 15:215-232. [PMID: 35184664 DOI: 10.1080/17474086.2022.2044778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chimeric antigen receptor T (CAR-T) therapy has revolutionized the treatment of relapsed/refractory large B-cell lymphoma (LBCL). However, patients who are excluded or have no access to CAR-T represent a challenge for clinicians and have generally a dismal outcome. The landscape for this category of patients is constantly evolving: new agents have been approved in the last 2-3 years, alone or in combination, and novel treatment modalities are under investigations. AREAS COVERED Thereafter, we reviewed the currently available therapeutic strategies: conventional chemotherapy, Antibody-drug conjugate ADC (mainly polatuzumab and loncastuxumab), bispecific antibodies (CD19/CD3 and focus on novel CD20/CD3 Abs), immunomodulatory drugs (covering tafasitamab and lenalidomide, checkpoint inhibitors mainly in PMBL), small molecules (selinexor, BTK and PI3K inhibitors), and the role of radiotherapy. EXPERT OPINION Navigating this scenario, will uncover new challenges, including identifying an ideal sequence for these therapies, the most effective combinations, and search for consistent predictive factors to help selecting the appropriate population of LBCL patients. At present, supporting clinical research for CAR-T ineligible patients, a new and challenging group, must remain a major focus that is complementary to advances in CAR T-cell therapy.
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Affiliation(s)
- Salvatore Perrone
- Hematology, Polo Universitario Pontino, S.M. Goretti Hospital, Latina, Italy
| | - Paolo Lopedote
- Internal Medicine, St Elizabeth's Medical Center, Boston University, Boston, U.S
| | - Mario Levis
- Department of Oncology, University of Torino, Torino, Italy
| | - Alice Di Rocco
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Stephen Douglas Smith
- Division of Medical Oncology, Department of Internal Medicine, University of Washington, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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10
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Qi CZ, Bollu V, Yang H, Dalal A, Zhang S, Zhang J. Cost-Effectiveness Analysis of Tisagenlecleucel for the Treatment of Patients With Relapsed or Refractory Diffuse Large B-Cell Lymphoma in the United States. Clin Ther 2021; 43:1300-1319.e8. [PMID: 34380609 DOI: 10.1016/j.clinthera.2021.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/03/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To assess the cost-effectiveness and cost-effective price of tisagenlecleucel, a novel, effective chimeric antigen receptor T-cell therapy, versus salvage chemotherapy (SC) for the treatment of relapsed or refractory diffuse large B-cell lymphoma (r/r DLBCL) using a willingness-to-pay (WTP) threshold of $150,000 per quality-adjusted life year (QALY) gained from a US third-party payer's perspective. METHODS A three-state (progression-free survival, progressive disease, and death), responder-based partitioned survival model with a lifetime horizon and 3% annual discount rate was developed. Overall survival (OS) and progression-free survival of tisagenlecleucel were estimated separately for patients with and without an overall response (OR), using data from JULIET ( Study of Efficacy and Safety of CTL019 in Adult DLBCL Patients). OS of SC was informed by SCHOLAR-1 (Retrospective Non-Hodgkin Lymphoma Research). Mixture cure models were used to inform the survival of tisagenlecleucel responders, supported by JULIET. The median OS was 11.1 months in all tisagenlecleucel-treated patients but not reached for responders; no progression or death occurred among responders since month 22 of treatment. For tisagenlecleucel nonresponders and SC, survival was based on standard parametric models until month 60and the survival of DLBCL long-term survivors thereafter. The model prediction validated well against the observed trial data. Costs and utilities were from the literature; utilities depended on health states and were used to estimate QALYs. Total costs, QALYs, and incremental cost per QALY gained were estimated. A cost-effective price range was estimated for all tisagenlecleucel-treated patients, OR responders, and complete response (CR) responders. Deterministic sensitivity and scenario analyses and a probabilistic sensitivity analysis were performed. All costs were reported in or inflated to 2020 US dollars. FINDINGS Tisagenlecleucel was associated with 3.35 QALYs gained versus SC.,The estimated incremental costs per QALY gained versus SC were $78,652 using the wholesale acquisition cost of $373,000 for tisagenlecleucel. The estimated cost-effective price of tisagenlecleucel in all treated patients was $612,270 at the WTP threshold of $150,000. Tisagenlecleucel OR and CR responders had an increase of 7.82 and 9.34 QALYs versus SC, with cost-effective prices estimated at $1,281,456 and $1,551,974, respectively. Sensitivity analysis results supported the base case findings. IMPLICATIONS Tisagenlecleucel is a cost-effective treatment versus SC for r/r DLBCL from the perspective of a US third-party payer. The estimated cost-effective prices ranged from $612,270 (all tisagenlecleucel-treated patients) to up to $1.5 million (patients achieving CR). Limitations include the use of single-arm trials due to data availability. (Clin Ther. 2021;43:XXX-XXX) © 2021 Elsevier HS Journals, Inc.
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Affiliation(s)
| | - Vamsi Bollu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Anand Dalal
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Su Zhang
- Analysis Group, Inc, Boston, MA, USA
| | - Jie Zhang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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11
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Lyu C, Cui R, Wang J, Mou N, Jiang Y, Li W, Deng Q. Intensive Debulking Chemotherapy Improves the Short-Term and Long-Term Efficacy of Anti-CD19-CAR-T in Refractory/Relapsed DLBCL With High Tumor Bulk. Front Oncol 2021; 11:706087. [PMID: 34395279 PMCID: PMC8361834 DOI: 10.3389/fonc.2021.706087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/12/2021] [Indexed: 01/12/2023] Open
Abstract
Anti-CD19 chimeric antigen receptor T (CAR-T) therapy has achieved remarkable effects in refractory/relapsed (R/R) diffuse large B-cell lymphoma (DLBCL). However, when high tumor bulk occurs, patients tend to early progression after CAR-T therapy. Here, we investigated whether pretreatment with intensive debulking chemotherapy could improve the outcome of CAR-T in such patients. Fifty-seven patients with R/R DLBCL were enrolled, and 42 patients received anti-CD19-CAR-T therapy, among which, 25 patients (the combined group) with high tumor bulk received debulking chemotherapy and anti-CD19-CAR-T therapy sequentially. Another 17 patients (the control group) without high tumor bulk received anti-CD19-CAR-T therapy only. According to the response to debulking chemotherapy, patients of the combined group were divided into chemo-sensitive and chemo-refractory groups. Within 2 months, the objective response rate (ORR) was higher in the chemo-sensitive group than in the chemo-refractory group (P = 0.031). Grades 1-3 cytokine release syndrome (CRS) was reported, and no difference was shown in CRS grade distribution between the chemo-sensitive and chemo-refractory groups (P = 0.514). The chemo-sensitive group demonstrated longer overall survival (OS) than the chemo-refractory group (P = 0.042). Of the chemo-sensitive group, the 1-year disease free survival (DFS) and OS rates were 52.6 and 57.9%, respectively. Besides, no significant differences were found in ORR, DFS, and OS between the chemo-sensitive and control groups (ORR: P = 0.593; DFS: P = 0.762; OS: P = 0.531). In summary, effective debulking chemotherapy improved the short-term ORR and long-term OS of CAR-T therapy in R/R DLBCL with high tumor bulk, with outcomes comparable to those of R/R DLBCL without high tumor bulk. The clinical trial of our study was registered at http://www.chictr.org.cn/index.aspx as ChiCTR-ONN-16009862 and ChiCTR1800019622. Clinical Trial Registration http://www.chictr.org.cn/index.aspx, identifier (ChiCTR-ONN-16009862 and ChiCTR1800019622).
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Affiliation(s)
- Cuicui Lyu
- Department of Hematology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Rui Cui
- Department of Hematology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Jia Wang
- Department of Hematology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Nan Mou
- Department of Cell Therapy Platform, Shanghai Genbase Biotechnology Co., Ltd, Shanghai, China
| | - Yanyu Jiang
- Department of Hematology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Wei Li
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China
| | - Qi Deng
- Department of Hematology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
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12
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Cazelles C, Belhadj K, Vellemans H, Camus V, Poullot E, Gaulard P, Veresezan L, Itti E, Becker S, Carvalho M, Dupuis J, Le Bras F, Lemonnier F, Roulin L, El Gnaoui T, Jardin F, Mounier N, Tilly H, Haioun C. Rituximab plus gemcitabine and oxaliplatin (R-GemOx) in refractory/relapsed diffuse large B-cell lymphoma: a real-life study in patients ineligible for autologous stem-cell transplantation. Leuk Lymphoma 2021; 62:2161-2168. [PMID: 33764240 DOI: 10.1080/10428194.2021.1901090] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There is no established standard treatment for relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) in patients who are not eligible to receive an intensive treatment. The combination of rituximab gemcitabine and oxaliplatin (R-GemOx) is widely used in this population but data are scarce. We retrospectively collected the data of 196 patients with R/R DLBCL treated with R-GemOx in two French centers over a period of 15 years. The median age of the population was 72 years (range, 24-89), 63% of the patients had an international prognostic index of 3 or higher and 57% were refractory to the last treatment. At the end of R-GemOx treatment, 33% of the patients obtained a complete response. The median progression-free survival (PFS) of the population was 5 months and the median overall survival (OS) was 10 months. Several factors were predictors of unfavorable survival: age over 75 years, international prognostic index of 2 or higher, refractory disease and de novo DLBCL. The median PFS and OS of the patients who obtained a complete response were 22 months and 40 months, respectively. The most significant toxicities were grade 3-4 hematological toxicities (31% of patients). Given its efficacy and tolerability, R-GemOx can be used in patients ineligible for intensive treatment and serve as a basis for new regimen combinations.
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Affiliation(s)
- Clarisse Cazelles
- Lymphoid Malignancies Unit, Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Karim Belhadj
- Lymphoid Malignancies Unit, Hôpital Henri Mondor, AP-HP, Créteil, France
| | | | | | - Elsa Poullot
- Department of Pathology, Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Philippe Gaulard
- Department of Pathology, Hôpital Henri Mondor, AP-HP, Créteil, France.,Paris-East, Créteil University, Créteil, France.,INSERM U955, Mondor Biomedical Research Institute, Créteil, France
| | | | - Emmanuel Itti
- Paris-East, Créteil University, Créteil, France.,Department of Nuclear Medicine, Hôpital Henri Mondor, AP-HP, Créteil, France
| | | | - Muriel Carvalho
- Department of Pharmacy, Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Jehan Dupuis
- Lymphoid Malignancies Unit, Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Fabien Le Bras
- Lymphoid Malignancies Unit, Hôpital Henri Mondor, AP-HP, Créteil, France
| | - François Lemonnier
- Lymphoid Malignancies Unit, Hôpital Henri Mondor, AP-HP, Créteil, France.,Paris-East, Créteil University, Créteil, France.,INSERM U955, Mondor Biomedical Research Institute, Créteil, France
| | - Louise Roulin
- Lymphoid Malignancies Unit, Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Taoufik El Gnaoui
- Lymphoid Malignancies Unit, Hôpital Henri Mondor, AP-HP, Créteil, France
| | | | | | - Hervé Tilly
- Department of Hematology and U1245, Rouen, France
| | - Corinne Haioun
- Lymphoid Malignancies Unit, Hôpital Henri Mondor, AP-HP, Créteil, France.,Paris-East, Créteil University, Créteil, France.,INSERM U955, Mondor Biomedical Research Institute, Créteil, France
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13
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Abdayem P, Ibrahim N, El Dakdouki Y, Willekens C, Ghez D, A Rouche J, Dartigues P, Desmaris R, Danu A, Rossignol J, Lazarovici J, Fermé C, Ribrag V, Michot JM. Attenuated cytarabine, etoposide, dexamethasone plus rituximab (R-Mini-CYVE) regimen for patients with relapsed or refractory B-cell non-Hodgkin's lymphoma not eligible for intensive chemotherapy. Eur J Haematol 2021; 106:574-583. [PMID: 33512026 DOI: 10.1111/ejh.13589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the efficacy and tolerability of an attenuated immunochemotherapy regimen based on cytarabine, etoposide and dexamethasone plus rituximab (R-mini-CYVE) in patients with relapsed or refractory B-cell non-Hodgkin's lymphoma (NHL). METHODS We included pretreated adult patients with B-cell NHL who were ineligible for high-dose immunochemotherapy (HDT). Cytarabine and etoposide were given at four different dose levels, depending on the patient's frailty. Up to 8 cycles were administered. RESULTS Between 2013 and 2019, 56 patients with diffuse large B-cell lymphoma (n = 45, 80%) and indolent B-cell lymphoma (n = 11, 20%) were included. Median age was 75 (range: 36-88). Nineteen patients (35%) had a performance status ≥2. Patients received a median of 4 cycles of R-mini-CYVE. The objective response and the complete response rates were 50% and 33%, respectively. Median progression-free survival and overall survival times were 5.7 (95% CI: 0.5-10.9) and 14.7 (95% CI: 3.5-25.9) months, respectively. Grade ≥3 anaemia, thrombocytopenia and neutropenia occurred in 44%, 55% and 60% of the patients, respectively. The most frequent non-haematological grade ≥3 adverse events were sepsis (21%), fatigue (13%) and cytarabine-related neurotoxicity (5%). CONCLUSION R-mini-CYVE demonstrated a meaningful antitumour efficacy and an acceptable safety profile in patients with relapsed/refractory B-cell NHL who were ineligible for HDT.
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Affiliation(s)
- Pamela Abdayem
- Department of Haematology, Gustave Roussy Cancer Campus, Villejuif, France.,Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Nathalie Ibrahim
- Department of Haematology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Yolla El Dakdouki
- Department of Haematology, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - David Ghez
- Department of Haematology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Julia A Rouche
- Department of Radiology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Peggy Dartigues
- Department of Pathology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Romain Desmaris
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, Villejuif, France
| | - Alina Danu
- Department of Haematology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Julien Rossignol
- Department of Haematology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Julien Lazarovici
- Department of Haematology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Christophe Fermé
- Department of Haematology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Vincent Ribrag
- Department of Haematology, Gustave Roussy Cancer Campus, Villejuif, France.,Department of Early Drug Development (DITEP), Gustave Roussy Cancer Campus, Villejuif, France
| | - Jean M Michot
- Department of Haematology, Gustave Roussy Cancer Campus, Villejuif, France.,Department of Early Drug Development (DITEP), Gustave Roussy Cancer Campus, Villejuif, France
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14
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Bazzell BG, Benitez LL, Marini BL, Perissinotti AJ, Phillips TJ, Nachar VR. Evaluating the Role of Novel Oncology Agents: Oncology Stewardship in Relapsed/Refractory Diffuse Large B-Cell Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:295-308. [PMID: 33485834 DOI: 10.1016/j.clml.2020.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/11/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
Novel treatment strategies have shifted the treatment landscape for patients with diffuse large B-cell lymphoma, particularly for those with relapsed/refractory disease. However, uncertainty remains regarding the therapeutic value of these novel agents compared to existing salvage chemotherapy regimens. In addition, the high cost associated with these agents puts both patients and health systems at risk of financial toxicity, further complicating their use. The development of clinical pathways incorporating oncology stewardship principles are necessary in order to maximize value-based care. This comprehensive review assesses the efficacy and safety data available for novel treatment options in relapsed/refractory diffuse large B-cell lymphoma and applies stewardship principles to evaluate their optimal place in therapy, with the aim of optimizing safe, effective, and financially responsible patient care.
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Affiliation(s)
- Brian G Bazzell
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI; Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Lydia L Benitez
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI; Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Bernard L Marini
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI; Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Anthony J Perissinotti
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI; Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Tycel J Phillips
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI
| | - Victoria R Nachar
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI; Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI.
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15
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Wang XJ, Wang YH, Li SCT, Gkitzia C, Lim ST, Koh LP, Lim FLWI, Hwang WYK. Cost-effectiveness and budget impact analyses of tisagenlecleucel in adult patients with relapsed or refractory diffuse large B-cell lymphoma from Singapore's private insurance payer's perspective. J Med Econ 2021; 24:637-653. [PMID: 33904359 DOI: 10.1080/13696998.2021.1922066] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients experiencing relapsed or refractory diffuse large B-cell lymphoma (r/r DLBCL) have limited treatment options and poor prognosis. Tisagenlecleucel (TIS) has shown improved clinical outcomes, but at a high upfront cost. Singapore has a multi-payer healthcare system where private insurance is one of the major payers. This study evaluated the cost-effectiveness and budget impact of TIS against salvage chemotherapy regimen (SCR) for treating r/r DLBCL patients who have failed ≥2 lines of systemic therapy from Singapore's private insurance payer's perspective. METHODS Over a life-time horizon, a partitioned survival model with three health-states was developed to evaluate the cost-effectiveness of TIS vs. SCR with or without hematopoietic stem cell transplantation (HSCT). Efficacy inputs for TIS and SCR were based on 43 months of observation data from pooled JULIET and UPenn trials, and CORAL extension studies respectively. Direct costs for pre-treatment, treatment, adverse events, follow-up, subsequent-HSCT, relapse, and terminal care were included. Incremental cost-effectiveness ratios (ICERs) were calculated as the total incremental costs per quality-adjusted life-year (QALY) gained. Additionally, the financial implication of introducing TIS in Singapore from a private payer's perspective was analyzed, comparing the current treatment pathway (without TIS) with a future scenario (with TIS) over 5 years. RESULTS Compared with SCR, TIS was the dominant option, with cost savings of S$8,477 alongside an additional gain of 2.78 QALYs in privately insured patients who shifted from private to public hospitals for TIS treatment. Scenario analyses for patients starting in public hospitals show ICERs of S$99,623 (no subsidy) and S$133,261 (50% subsidy for SCR treatment, no subsidy for TIS), supporting the base case. The projected annual budget impact ranges from S$850,000 to S$3.4 million during the first 5 years. CONCLUSIONS TIS for treating r/r DLBCL patients who have failed ≥2 lines of systemic therapies, is likely to be cost effective with limited budget impact.
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Affiliation(s)
| | - Yi-Ho Wang
- Novartis Singapore Pte Ltd., Singapore, Singapore
| | | | | | - Soon Thye Lim
- National Cancer Centre Singapore, Singapore, Singapore
| | - Liang Piu Koh
- National University Cancer Institute, Singapore, Singapore
| | | | - William Ying Khee Hwang
- National University Cancer Institute, Singapore, Singapore
- Singapore General Hospital, Singapore, Singapore
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16
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Di M, Huntington SF, Olszewski AJ. Challenges and Opportunities in the Management of Diffuse Large B-Cell Lymphoma in Older Patients. Oncologist 2020; 26:120-132. [PMID: 33230948 DOI: 10.1002/onco.13610] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
Most patients with diffuse large B-cell lymphoma (DLBCL) are diagnosed at age 60 years or older. Challenges to effective therapy among older individuals include unfavorable biologic features of DLBCL, geriatric vulnerabilities, suboptimal treatment selection, and toxicities of cytotoxic chemotherapy. Wider application of geriatric assessments may help identify fit older patients who benefit from standard immunochemotherapy without unnecessary dose reductions. Conversely, attenuated regimens may provide a better balance of risk and benefit for selected unfit or frail patients. Supportive care with the use of corticosteroid-based prephase, prophylactic growth factors, and early institution of supportive and palliative care can help maximize treatment tolerance. Several novel or emerging therapies have demonstrated favorable toxicity profiles, thus facilitating effective treatment for elderly patients. In the relapsed or refractory setting, patients who are not candidates for stem cell transplantation can benefit from newly approved options including polatuzumab vedotin-based combinations or tafasitamab plus lenalidomide, which may have higher efficacy and/or lower toxicity than historical chemotherapy regimens. Chimeric antigen receptor T-cell therapy has been successfully applied to older patients outside of clinical trials. In the first-line setting, emerging immunotherapy options (bispecific antibodies) and targeted therapies (anti-CD20 antibodies combined with lenalidomide and/or B-cell receptor inhibitors) may provide chemotherapy-free approaches for DLBCL. Enrolling older patients in clinical trials will be paramount to fully examine potential efficacy and toxicity of these strategies. In this review, we discuss recent advances in fitness stratification and therapy that have expanded curative options for older patients, as well as future opportunities to improve outcomes in this population. IMPLICATIONS FOR PRACTICE: Management of diffuse large B-cell lymphoma in older patients poses challenges due to aggressive disease biology and geriatric vulnerability. Although R-CHOP remains standard first-line treatment, geriatric assessment may help evaluate patients' fitness for immunochemotherapy. Corticosteroid prephase, prophylactic growth factors, and early palliative care can improve tolerance of treatment. Novel salvage options (polatuzumab vedotin-based combinations, tafasitamab plus lenalidomide) or chimeric antigen receptor T-cell therapy should be considered in the relapsed or refractory setting for patients ineligible for stem cell transplantation. Emerging immunotherapies (bispecific antibodies) and targeted therapies provide potential first-line chemotherapy-free approaches, which need to be rigorously assessed in clinical trials that involve geriatric patients.
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Affiliation(s)
- Mengyang Di
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Scott F Huntington
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Adam J Olszewski
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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17
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Patel KK, Isufi I, Kothari S, Foss F, Huntington S. Cost-effectiveness of polatuzumab vedotin in relapsed or refractory diffuse large B-cell lymphoma. Leuk Lymphoma 2020; 61:3387-3394. [PMID: 32835553 DOI: 10.1080/10428194.2020.1808208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A recent phase II trial showed that use of polatuzumab vedotin in combination with bendamustine plus rituximab (Pola-BR) in transplant-ineligible patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) resulted in longer progression-free survival and overall survival compared to bendamustine plus rituximab (BR) alone. In this study, we constructed a Markov model to assess the cost-effectiveness of Pola-BR versus BR in transplant-ineligible R/R DLBCL. We calculated the incremental cost-effectiveness ratio (ICER) of each treatment strategy from a US payer perspective, using a lifetime horizon and a willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY). Use of Pola-BR was associated with an incremental cost of $92,641 compared to BR alone ($200,905 vs $108,265, respectively), an incremental effectiveness of 1.76 QALYs (2.35 vs 0.59 QALYs, respectively), and an ICER of $52,519/QALY. These data suggest that use of Pola-BR for R/R DLBCL is likely to be cost-effective compared to BR alone.
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Affiliation(s)
- Kishan K Patel
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Iris Isufi
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Shalin Kothari
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Francine Foss
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Scott Huntington
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT, USA
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18
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Walji M, Assouline S. An evaluation of polatuzumab vedotin for the treatment of patients with diffuse large B-cell lymphoma. Expert Rev Hematol 2020; 13:933-942. [PMID: 32700586 DOI: 10.1080/17474086.2020.1795828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Diffuse Large B-Cell lymphoma (DLBCL) is the most commonly diagnosed form of non-Hodgkin lymphoma (NHL) in adults. Most patients receive an initial treatment with chemo-immunotherapy, which includes rituximab, cyclophosphamide, vincristine, doxorubicin and prednisone (R-CHOP). Cure rates are high but those who relapse, or do not respond to initial therapy, have a poor prognosis. Polatuzumab vedotin, an anti-CD79b monoclonal antibody conjugated to the cytotoxic payload monomethyl aurostatin-E (MMAE), in combination with bendamustine and rituximab (polatuzumab-BR) is a new, effective therapeutic option to add to the treatment of relapsed/refractory (R/R) DLBCL. AREAS COVERED This review covers the clinical development of polatuzumab for the treatment of lymphoma, its current and future use in patients with DLBCL and identifies its place in the treatment of R/R DLBCL. A search of PubMed and oncology/hematology congresses using 'polatuzumab' as the search term was undertaken to identify the most pertinent clinical reports. EXPERT OPINION Polatuzumab-BR is an effective and safe option for transplant-ineligible patients with R/R DLBCL either before or after CAR-T (chimeric antigen receptor T-cell therapy). Ongoing combination trials with polatuzumab will expand its applications in the treatment of this disease.
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Affiliation(s)
- Moneeza Walji
- Faculty of Medicine- Medicine, McGill University , Montreal, Quebec, Canada
| | - Sarit Assouline
- Department of Medicine, McGill University, Lady Davis Institute, Jewish General Hospital , Montreal, Quebec, Canada
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19
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Painschab MS, Kohler RE, Kasonkanji E, Zuze T, Kaimila B, Nyasosela R, Nyirenda R, Krysiak R, Gopal S. Microcosting Analysis of Diffuse Large B-Cell Lymphoma Treatment in Malawi. J Glob Oncol 2020; 5:1-10. [PMID: 31322992 PMCID: PMC6690619 DOI: 10.1200/jgo.19.00059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To describe the cost of treating diffuse large B-cell lymphoma (DLBCL) in Malawi under the following circumstances: (1) palliation only, (2) first-line cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), (3) salvage etoposide, ifosfamide, and cisplatin (EPIC), and (4) salvage gemcitabine and oxaliplatin (GEMOX). METHODS We conducted a microcosting analysis from the health system perspective in the context of a prospective cohort study at a national teaching hospital in Lilongwe, Malawi. Clinical outcomes data were derived from previously published literature from the cohort. Cost data were collected for treatment and 2-year follow-up, reflecting costs incurred by the research institution or referral hospital for goods and services. Costs were collected in Malawian kwacha, inflated and converted to 2017 US dollars. RESULTS On a per-patient basis, palliative care alone cost $728 per person. Total costs for first-line treatment with CHOP chemotherapy was $1,844, of which chemotherapy drugs made up 15%. Separate salvage EPIC and GEMOX cost $2,597 and $3,176, respectively. Chemotherapy drugs accounted for 30% of EPIC and 47% of GEMOX. CONCLUSION To our knowledge, this is among the first published efforts to characterize detailed costs of cancer treatment in sub-Saharan Africa. The per-patient cost of first-line treatment of DLBCL in Malawi is low relative to high-income countries, suggesting that investments in fixed-duration, curative-intent DLBCL treatment may be attractive in sub-Saharan Africa. Salvage treatment of relapsed/refractory DLBCL costs much more than first-line therapy. Formal cost-effectiveness modeling for CHOP and salvage treatment in the Malawian and other low-resource settings is needed to inform decision makers about optimal use of resources for cancer treatment.
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Affiliation(s)
- Matthew S Painschab
- The University of North Carolina Project-Malawi, Lilongwe, Malawi.,University of North Carolina, Chapel Hill, NC
| | | | | | - Takondwa Zuze
- The University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Bongani Kaimila
- The University of North Carolina Project-Malawi, Lilongwe, Malawi
| | | | | | - Robert Krysiak
- The University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Satish Gopal
- The University of North Carolina Project-Malawi, Lilongwe, Malawi.,University of North Carolina, Chapel Hill, NC.,University of Malawi College of Medicine, Blantyre, Malawi
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Vorobyev VI, Gemdzhian EG, Dubrovin EI, Nesterova ES, Kaplanov KD, Volodicheva EM, Zherebtsova VA, Kravchenko SK. [Risk - adapted intensive induction therapy, autologous stem cell transplantation, and rituximab maintenance allow to reach a high 7-year survival rate in patients with mantle cell lymphoma]. TERAPEVT ARKH 2019; 91:41-51. [PMID: 32598735 DOI: 10.26442/00403660.2019.07.000322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 01/19/2023]
Abstract
Mantle cell lymphoma (MCL) is aggressive B-cell neoplasm diagnosed predominantly among older men. R-CHOP-like regimens allow to achieve high response rate, but the overall survival (OS) are disappointingly short - 3-4 years. An addition of high - dose cytarabine to the upfront therapy and autoSCT significantly improved outcomes but remain feasible largely for medically fit patients. Based on the activity and good tolerance of gemcitabine - oxaliplatin schemes in relapsed and refractory MCL patients, we developed an alternative first - line course for patients who are not eligible for R-HD-MTX-AraC. AIM Assess toxicity and efficacy of R-DA-EPOCH/ R-HD-MTX-AraC and R-DA-EPOCH/R-GIDIOX schemes, autoSCT and R-maintenance in untreated MCL patients. MATERIALS AND METHODS 47 untreated MCL patients from 6 centers were enrolled in prospective study between April 2008 and September 2013. All patients have stage II-V; ECOG 0-3; median age 55 years (29-64); Male/Female 76%/24%. MIPIb: 28% low, 33% intermediate and 39% high risk. Following 1st R-EPOCH patients were assigned to receive either R-DA-EPOCH/ R-HD-MTX-AraC or R-DA-EPOCH/ R-GIDIOX regimen. In the absence of renal failure, hematological toxicity grade 4 more than 3 days and severe infections patients received R-HD-MTX-AraC scheme (R 375 mg/m2 Day 0, Methotrexate 1000 mg/m2/24 hours Day 1, AraC 3000 mg/m2 q 12 hrs Days 2-3). Patients who had at least one of these complications received R-GIDIOX scheme (R 375 mg/m2 day 0, gemcitabine 800 mg/m2 days 1 and 4, ifosfamide 1000 mg/m2 days 1-5, dexamethasone 10 mg/m2 IV days 1-5, irinotecan 100 mg/m2 day 3, oxaliplatin 120 mg/m2 day 2). Subsequently these courses were alternating with R-DA-EPOCH in each arm of the protocol. Depending on the time of achieving CR patients received 6 or 8 courses, unless they progressed on therapy. Those patients who achieved PR/CR/CRu underwent autoSCT (BEAM-R). Post - transplant R-maintenance was administered for 3 years (R - 375 mg/m2 every 3 months). RESULTS 29/47 patients were treated on R-HD-MTX-AraC arm (median 50 years; MIPIb: 35.7% low, 28.6% intermediate, 35.7% high risk) and 18/47 patients were on R-GIDIOX arm (median 60 years; MIPIb: 16.7% low, 38.9% intermediate, 44.4% high risk). In R-HD-MTX-AraC arm CR rate was 96.5%. In R-GIDIOX arm OR and CR rates were 94.4% and 77.7% respectively. Main hematological toxicity of R-GIDIOX was leukopenia gr. 4 occurred in 74.1%. With median follow - up of 76 months, the estimated 7-years OS and EFS in R-HD-MTX-AraC arm are 76% and 57% respectively. In R-GIDIOX arm the estimated 7-years OS and EFS are 59% and 44%, respectively. There are no statistical differences in EFS (p=0.47) and OS (p=0.06) between two arms. CONCLUSIONS The use of a risk - adapted strategy allowed 95.7% of patients achieve PR/CR/CRu, performed autoSCT and begun R-maintenance therapy with rituximab. None of the patients needed a premature discontinuation of therapy because of unacceptable toxicity. The performance of autoSCT and R-maintenance apparently allowed to partially offset differences in the intensity of induction therapy and to maintain comparable results of therapy in both induction arms.
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Affiliation(s)
| | | | | | | | - K D Kaplanov
- Volgograd Regional Clinical Oncologic Dispensary
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21
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Lugtenburg PJ, Zijlstra JM, Doorduijn JK, Böhmer LH, Hoogendoorn M, Berenschot HW, Beeker A, van der Burg-de Graauw NC, Schouten HC, Bilgin YM, Kersten MJ, Koene HR, Herbers AHE, de Jong D, Hijmering N, Lam KH, Chiţu D, Brouwer RE, van Imhoff GW. Rituximab-PECC induction followed by 90 Y-ibritumomab tiuxetan consolidation in relapsed or refractory DLBCL patients who are ineligible for or have failed ASCT: results from a phase II HOVON study. Br J Haematol 2019; 187:347-355. [PMID: 31290569 DOI: 10.1111/bjh.16087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/11/2019] [Indexed: 12/25/2022]
Abstract
Patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) after, or ineligible for, autologous stem cell transplantation (ASCT) have a dismal prognosis. This phase II study evaluated treatment with R-PECC (rituximab, prednisolone, etoposide, chlorambucil, lomustine), every 28 days for 4 cycles in 62 patients, followed by radio-immunotherapy consolidation with 90 Y-ibritumomab tiuxetan in responsive patients. Primary endpoints were failure-free survival (FFS) and incidence of grade ≥3 adverse events from start of 90 Y-ibritumomab tiuxetan. The overall response rate after R-PECC was 50%. Twenty-nine of 31 responsive patients proceeded to 90 Y-ibritumomab tiuxetan. Five out of 15 partial remission patients converted to complete remission after 90 Y-ibritumomab tiuxetan. One-year FFS and overall survival (OS) from start of 90 Y-ibritumomab tiuxetan was 52% (95% confidence interval [CI], 33-68%) and 62% (95% CI, 42-77%), respectively. One-year FFS and OS from start of R-PECC was 28% (95% CI, 17-39%) and 49% (95% CI, 36-61%), respectively. Toxicities of R-PECC and 90 Y-ibritumomab tiuxetan were mainly haematological. In conclusion, for relapsed DLBCL patients the largely oral R-PECC regimen achieves promising response rates, combined with an acceptable safety profile. Consolidation with 90 Y-ibritumomab tiuxetan resulted in long-term response durations in approximately one third of the patients that received it.
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Affiliation(s)
| | - Josee M Zijlstra
- Department of Haematology, Amsterdam University Medical Centre VUmc, Amsterdam, The Netherlands
| | - Jeanette K Doorduijn
- Department of Haematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Lara H Böhmer
- Department of Haematology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Mels Hoogendoorn
- Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | | | - Aart Beeker
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | - Harry C Schouten
- Department of Haematology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Yavuz M Bilgin
- Department of Internal Medicine, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - Marie-Jose Kersten
- Department of Haematology, Amsterdam University Medical Centre AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Harry R Koene
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Alexandra H E Herbers
- Department of Haematology and Medical Oncology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Daphne de Jong
- HOVON Pathology Facility and Biobank (HOP), Department of Pathology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Nathalie Hijmering
- HOVON Pathology Facility and Biobank (HOP), Department of Pathology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - King H Lam
- Department of Pathology, Erasmus MC, Rotterdam, The Netherlands
| | - Dana Chiţu
- HOVON Data Centre, Department of Haematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Rolf E Brouwer
- Department of Haematology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Gustaaf W van Imhoff
- Department of Haematology, University Medical Centre Groningen, Groningen, The Netherlands
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Remer M, White A, Glennie M, Al-Shamkhani A, Johnson P. The Use of Anti-CD40 mAb in Cancer. Curr Top Microbiol Immunol 2019; 405:165-207. [PMID: 25651948 DOI: 10.1007/82_2014_427] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Immunomodulatory monoclonal antibody (mAb) therapy is at the forefront of developing cancer therapeutics with numerous targeted agents proving highly effective in selective patients at stimulating protective host immunity, capable of eradicating established tumours and leading to long-term disease-free states. The cell surface marker CD40 is expressed on a range of immune cells and transformed cells in malignant states whose signalling plays a critical role in modulating adaptive immune responses. Anti-CD40 mAb therapy acts via multiple mechanisms to stimulate anti-tumour immunity across a broad range of lymphoid and solid malignancies. A wealth of preclinical research in this field has led to the successful development of multiple anti-CD40 mAb agents that have shown promise in early-phase clinical trials. Significant progress has been made to enhance the engagement of antibodies with immune effectors through their interactions with Fcγ receptors (FcγRs) by the process of Fc engineering. As more is understood about how to best optimise these agents, principally through the fine-tuning of mAb structure and choice of synergistic partnerships, our ability to generate robust, clinically beneficial anti-tumour activity will form the foundation for the next generation of cancer therapeutics.
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Affiliation(s)
- Marcus Remer
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
| | - Ann White
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Martin Glennie
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Aymen Al-Shamkhani
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Peter Johnson
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
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The metronomic all-oral DEVEC is an effective schedule in elderly patients with diffuse large b-cell lymphoma. Invest New Drugs 2019; 37:548-558. [PMID: 31028663 DOI: 10.1007/s10637-019-00769-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 03/22/2019] [Indexed: 02/07/2023]
Abstract
Metronomic-chemotherapy (M-CHT) has been rarely assessed in non-Hodgkin-lymphoma (NHL). Therefore, in 2011 we started experimenting a new all-oral M-CHT schedule termed DEVEC (Deltacortene®, etoposide, vinorelbine, cyclophosphamide, +/-Rituximab) in diffuse-large-B-cell lymphoma (DLBCL) patients. Methods Patients with stage Ib-IV were enrolled as follows: 1) treatment-naïve, frail ≥65y, or unfit ≥85y; and 2) relapsed/refractory (R/R) ≥55y. Data were prospectively collected from six Italian centres and compared for efficacy to two reference groups, treated with established iv Rituximab-CHT in 1st and 2nd line respectively. Results from April-2011 to March-2018, 17/51(33%) naïve, 21/51(41%) refractory and 13/51(25.5%) relapsed patients started DEVEC; 39/51(76.5%) were de-novo DLBCL; 10/51(19.6%) transformed-DLBCL and 2/51(3.9%) unclassifiable-DLBCL/classical-Hodgkin-lymphoma. The median age was 85y (range=77-93) and 78y (range=57-91) in naïve and R/R respectively and overall the DEVEC patients had very poor features compared to the reference. The rate of grade≥3 haematological-AEs was 43%(95CI=29-58%): G3-neutropenia was the most frequent; grade≥3 extra-haematological-AEs was 13.7% (95%CI=5.4-25.9%), the most frequent was infection. One-year OS and PFS were 67% and 61% for naive, 60% and 50% for reference-naïve respectively; Cox proportional hazard ratio (Cox-PH-ratio) for OS and PFS were 0.69 (95%CI=0.27-1.76;p=.441) and 0.68 (95%CI=0.28-1.62;p=.381) respectively. One-year OS and PFS were 48% and 39% in the R/R, 36% and 17% in the reference-R/R respectively; Cox-PH-ratio for OS and PFS, were 0.76 (95%CI=0.42-1.40; p=.386) and 0.48 (95%CI=0.28-0.82; p=.007) respectively. Conclusion The favourable activity of DEVEC compared to a real-life series and the convenience of an oral administration, may possibly lay the groundwork for a paradigm-shift in the treatment of elderly DLBCL.
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Dahi PB, Moskowitz CH, Giralt SA, Lazarus HM. Novel agents may positively impact chemotherapy and transplantation in subsets of diffuse large B-cell lymphoma. Expert Rev Hematol 2019; 12:407-418. [PMID: 30884247 DOI: 10.1080/17474086.2019.1596793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Molecular and biologic heterogeneity in diffuse large B-cell lymphoma (DLBCL) has resulted in a broad range of clinical outcomes. While standard frontline chemoimmunotherapy cures majority of patients with DLBCL, treatment failure in certain DLBCL subsets remains high. Prognosis in these patients is dismal. Therefore, optimization of front-line therapy, as well as development of more effective salvage treatments, is an unmet medical need. Areas covered: This article reviews the treatment advances in DLBCL with novel and targeted agents that are aimed to improve efficacy especially in those with high-risk features. Expert opinion: Incorporation of novel therapies such as immunomodulatory agents and Bruton tyrosine kinase (BTK) inhibitors in the treatment of higher-risk DLBCL subgroups have shown to be effective; however, confirmatory data are required to change the standard of care. While autologous chimeric antigen receptor (CAR) T-cell therapy targeting CD19-positive B-cells have revolutionized the outcomes of refractory DLBCL, the complexity of its production, post-infusion care, and the associated cost, currently has limited its use to select academic centers in the US. A multitude of other targeted agents and combinations as well as cellular and immunotherapeutic agents are under investigation.
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Affiliation(s)
- Parastoo B Dahi
- a Adult Bone Marrow Transplant Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , NY , New York , USA.,b Weill Cornell Medical College , NY , New York , USA
| | - Craig H Moskowitz
- c Sylvester Comprehensive Cancer Center , University of Miami , Coral Gables , FL , USA
| | - Sergio A Giralt
- a Adult Bone Marrow Transplant Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , NY , New York , USA.,b Weill Cornell Medical College , NY , New York , USA
| | - Hillard M Lazarus
- d Case Comprehensive Cancer Center , Case Western Reserve University , Cleveland , OH , USA
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Zlotnick M, Avigdor A, Ribakovsky E, Nagler A, Kedmi M. Efficacy of Gemcitabine as Salvage Therapy for Relapsed and Refractory Aggressive Non-Hodgkin Lymphoma. Acta Haematol 2019; 141:84-90. [PMID: 30630175 DOI: 10.1159/000495283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 10/23/2018] [Indexed: 11/19/2022]
Abstract
Gemcitabine-based salvage therapy is considered an effective treatment for relapsed and refractory Non-Hodgkin's lymphoma (NHL). We analyzed the outcome of 41 consecutive NHL patients treated with gemcitabine-based regimens between January 2007 and October 2015. Twenty-eight males and 13 females (median age 66.4 years) were included. The median follow-up from gemcitabine initiation was 7.3 months. Thirty patients (73%) had B-cell, and eleven (27%) had T-cell, lymphoma. All patients received a median of 2 prior regimens, of which at least 1 was anthracycline based. Twenty-eight patients (78%) received full-dose while 9 (22%) received reduced-dose regimens. The overall response rate was 37%, with 24% (n = 10) complete response, 12% (n = 5) partial response, and 63% (n = 22) progressive disease or stable disease. The median progression-free survival (PFS) was 47 days (range 12-1,318), the median overall survival (OS) was 1.9 years. Twenty patients (49%) died during follow-up. Grade 3-4 hematological toxicity was reported in 21 patients (51%). Relapsed vs. refractory disease, as well as a response to gemcitabine, predicted better PFS and OS. Use of a full-dose regimen predicted a better OS. Compared to previously published data, we observed less favorable outcomes. The administration of gemcitabine-based therapy as a salvage regimen for patients with relapsed or refractory NHL had limited success. Innovative therapies for these patients are an unmet need.
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Affiliation(s)
- Maya Zlotnick
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Avigdor
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elena Ribakovsky
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meirav Kedmi
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel,
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,
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Jurczak W, Długosz-Danecka M, Rivas Navarro F. The rationale for combination therapy in patients with aggressive B-cell non-Hodgkin lymphoma: ten questions. Future Oncol 2019; 15:305-317. [DOI: 10.2217/fon-2018-0388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone immunochemotherapy remains standard of care for first-line treatment of diffuse large B-cell lymphoma (DLBCL). High-dose chemotherapy and stem cell transplantation is offered to most relapsing/refractory patients who respond to salvage therapy. This Q&A review evaluates recommended management strategies for second and subsequent lines of therapy in patients with DLBCL, outlining the relative efficacies of currently available options including novel agents such as ibrutinib and CAR-T cells. The combination of pixantrone and rituximab is currently under investigation as a second-line treatment for patients ineligible for stem cell transplantation, while pixantrone monotherapy is the only therapeutic option approved for multiply relapsed and refractory DLBCL beyond the second line at this time.
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Affiliation(s)
- Wojciech Jurczak
- Department of Hematology, Jagiellonian University, Kraków 31-501, Poland
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(R)-GEMOX chemotherapy for unfit patients with refractory or recurrent primary central nervous system lymphoma: a LOC study. Ann Hematol 2018; 98:915-922. [DOI: 10.1007/s00277-018-3564-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/19/2018] [Indexed: 01/08/2023]
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Franch-Sarto M, Sorigue M, López L, Moreno M, Ribera JM, Sancho JM. Overall survival in patients with relapsed/refractory high grade B-cell lymphomas treated with gemcitabine, oxaliplatin with or without rituximab. Leuk Lymphoma 2018; 60:3324-3326. [PMID: 30322316 DOI: 10.1080/10428194.2018.1519813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mireia Franch-Sarto
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Marc Sorigue
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Laia López
- Department of Hematology, ICO-Hospital de Mataró, Mataró, Spain
| | - Miriam Moreno
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Josep-Maria Ribera
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
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Nair R, Kakroo A, Bapna A, Gogia A, Vora A, Pathak A, Korula A, Chakrapani A, Doval D, Prakash G, Biswas G, Menon H, Bhattacharya M, Chandy M, Parihar M, Vamshi Krishna M, Arora N, Gadhyalpatil N, Malhotra P, Narayanan P, Nair R, Basu R, Shah S, Bhave S, Bondarde S, Bhartiya S, Nityanand S, Gujral S, Tilak TVS, Radhakrishnan V. Management of Lymphomas: Consensus Document 2018 by an Indian Expert Group. Indian J Hematol Blood Transfus 2018; 34:398-421. [PMID: 30127547 PMCID: PMC6081314 DOI: 10.1007/s12288-018-0991-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 12/20/2022] Open
Abstract
The clinical course of lymphoma depends on the indolent or aggressive nature of the disease. Hence, the optimal management of lymphoma needs a correct diagnosis and classification as B cell, T-cell or natural killer (NK)/T-cell as well as indolent or high-grade type lymphoma. The current consensus statement, developed by experts in the field across India, is intended to help healthcare professionals manage lymphomas in adults over 18 years of age. However, it should be noted that the information provided may not be appropriate to all patients and individual patient circumstances may dictate alternative approaches. The consensus statement discusses the diagnosis, staging and prognosis applicable to all subtypes of lymphoma, and detailed treatment regimens for specific entities of lymphoma including diffuse large B-cell lymphoma, Hodgkin's lymphoma, follicular lymphoma, T-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, Burkitt's lymphoma, and anaplastic large cell lymphoma.
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Affiliation(s)
- Reena Nair
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | - Ajay Bapna
- Bhagwan Mahavir Cancer Hospital Research Center (BMCHRC), Jaipur, India
| | - Ajay Gogia
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | | | - Anu Korula
- Christian Medical College (CMC), Vellore, India
| | | | - Dinesh Doval
- Rajiv Gandhi Cancer Institute and Research Centre (RGCI), New Delhi, Delhi India
| | - Gaurav Prakash
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ghanashyam Biswas
- Sparsh Hospital American Oncology Institute (AOI), Bhubaneswar, India
| | - Hari Menon
- Cytecare Cancer Hospitals, Bangalore, India
| | | | - Mammen Chandy
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | - Mayur Parihar
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | - Neeraj Arora
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | - Pankaj Malhotra
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Rekha Nair
- Regional Cancer Centre (RCC), Thiruvananthapuram, India
| | - Rimpa Basu
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | - Sandip Shah
- Vedant Institute of Medical Sciences, Ahmedabad, India
| | - Saurabh Bhave
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | | | - Soniya Nityanand
- Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | | | | | - Vivek Radhakrishnan
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
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Yee K. Management of Multiply Relapsed Aggressive Non-Hodgkin Lymphoma: New Perspectives. EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10313871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Patients with refractory/relapsed (R/R) non-Hodgkin lymphoma (NHL) make up a very heterogeneous population with a poor life expectancy. The objective of this symposium was to provide an overview of the current treatment landscape for aggressive NHL, as well as the future research on new treatments. Transplant-eligible patients receive salvage chemotherapy, followed by high-dose chemotherapy and autologous stem cell transplantation (ASCT). Patients who fail transplant or are transplant-ineligible generally receive palliative treatment or enter clinical trials; there is no standard of care and thus there is a high unmet clinical need. Pixantrone is currently indicated for adult patients with multiply R/R aggressive B-cell NHL, thereby filling the unmet clinical need in this field. The symposium started with a brief overview of the meeting objectives. This was followed by an overview of the current and future treatment landscape for aggressive NHL, including a case study of a patient with diffuse large B-cell lymphoma (DLBCL) with multiple relapses receiving pixantrone as monotherapy. The results and post hoc analysis of the CORAL and the SCHOLAR1 studies were reviewed, including the relative merits of combination therapy versus monotherapy for patients with relapsed DLBCL who had failed second-line salvage therapy. The symposium ended with an outline of the profile and mechanism of action of pixantrone, and evidence from the PIX301 study that provided the basis for regulatory approval for the use of pixantrone in third and fourth-line treatment of R/R aggressive B-cell NHL. The clinical efficacy and safety of pixantrone were reviewed, together with a future perspective on the ongoing PIX306 trial. The symposium concluded with the presentation of two clinical cases of patients treated with pixantrone, a ‘Question and Answer’ session, and a panel discussion.
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Dhanapal V, Gunasekara M, Lianwea C, Marcus R, De Lord C, Bowcock S, Devereux S, Patten P, Yallop D, Wrench D, Fields P, Kassam S. Outcome for patients with relapsed/refractory aggressive lymphoma treated with gemcitabine and oxaliplatin with or without rituximab; a retrospective, multicentre study. Leuk Lymphoma 2017; 58:1-9. [DOI: 10.1080/10428194.2016.1276288] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Vijay Dhanapal
- Department of Haematology, Medway Maritime Hospital, London, UK
| | | | - Chia Lianwea
- Department of Haematology, Medway Maritime Hospital, London, UK
| | - Robert Marcus
- Department of Haematology, King’s College Hospital, London, UK
| | - Corinne De Lord
- Department of Haematology, King’s College Hospital, London, UK
| | - Stella Bowcock
- Department of Haematology, King’s College Hospital, London, UK
| | | | - Piers Patten
- Department of Haematology, King’s College Hospital, London, UK
| | - Deborah Yallop
- Department of Haematology, King’s College Hospital, London, UK
| | - David Wrench
- Department of Haematology, Guy’s & St Thomas’ Hospital, London, UK
| | - Paul Fields
- Department of Haematology, Guy’s & St Thomas’ Hospital, London, UK
| | - Shireen Kassam
- Department of Haematology, King’s College Hospital, London, UK
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Tamjid B, Mckendrick J, Schwarer A, Doig R, James P, Hosking P, Hawkes EA. Efficacy and toxicity of PACEBOM chemotherapy in relapsed/refractory aggressive lymphoma in the rituximab era. Asia Pac J Clin Oncol 2016; 13:226-233. [PMID: 28004881 DOI: 10.1111/ajco.12611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/28/2016] [Accepted: 09/06/2016] [Indexed: 11/26/2022]
Abstract
AIM Relapsed/refractory (R/R) aggressive lymphoma outcomes are poor. There is no standard treatment. PACEBOM (prednisolone, doxorubicin, cyclophosphamide, etoposide, bleomycin, vincristine and methotrexate) has shown efficacy for several lymphoma subtypes in published reports. We evaluate PACEBOM+/-rituximab for R/R aggressive lymphomas in this millennium. METHODS In this retrospective, single-center study, R/R aggressive lymphoma patients who received PACEBOM or its derivatives were identified from the pharmacy database. Demographic, treatment, toxicity and survival data were collected. RESULTS A total of 37 eligible patients were identified. Histological subtypes included 20 Diffuse Large B-Cell Lymphoma (DLBCL), 10 T-Cell Lymphoma (TCL) and 7 Hodgkin lymphoma. All DLBCL patients had received prior rituximab. Thirty-one (84%) received second-line PACEBOM. Median number of cycles was six (1-6). Eighteen out of 20 B-cell lymphoma patients received R-PACEBOM. Overall response rate was 65%, 70% and 71% in patients with DLBCL, TCL and Hodgkin lymphoma respectively. Thirteen patients underwent autologous stem cell transplant post-PACEBOM. Median follow-up was 49 months (3-201). Most common grade 3-4 toxicities were neutropenia (46%), anemia (24%) and thrombocytopenia (16%). No additional toxicity was seen in patients who received rituximab. CONCLUSION In this cohort, PACEBOM is active in R/R aggressive lymphoma with manageable toxicity and can be safely combined with rituximab. Outcomes were similar to reports of other salvage regimens. PACEBOM remains a suitable option for R/R aggressive lymphoma, in patients exposed to prior rituximab and those planned for autologous stem cell transplant.
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Affiliation(s)
- Babak Tamjid
- Oncology and Haematology Department, Box Hill Hospital, Melbourne, Victoria, Australia
- Department of Medical Oncology & Clinical Haematology, Olivia Newton John Cancer Research Institute, Austin Hospital, Melbourne, Victoria, Australia
| | - Joseph Mckendrick
- Oncology and Haematology Department, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Anthony Schwarer
- Oncology and Haematology Department, Box Hill Hospital, Melbourne, Victoria, Australia
- Department of Medical Oncology & Clinical Haematology, Olivia Newton John Cancer Research Institute, Austin Hospital, Melbourne, Victoria, Australia
| | - Rowan Doig
- Oncology and Haematology Department, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Philip James
- Oncology and Haematology Department, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Patrick Hosking
- Pathology Department, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Eliza A Hawkes
- Oncology and Haematology Department, Box Hill Hospital, Melbourne, Victoria, Australia
- Department of Medical Oncology & Clinical Haematology, Olivia Newton John Cancer Research Institute, Austin Hospital, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
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Belada D, Georgiev P, Dakhil S, Inhorn LF, Andorsky D, Beck JT, Quick D, Pettengell R, Daly R, Dean JP, Pavlyuk M, Failloux N, Hübel K. Pixantrone-rituximab versus gemcitabine-rituximab in relapsed/refractory aggressive non-Hodgkin lymphoma. Future Oncol 2016; 12:1759-68. [PMID: 27093976 DOI: 10.2217/fon-2016-0137] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
UNLABELLED We describe the rationale and design of the ongoing randomized, active-controlled, multicenter, Phase III study evaluating the efficacy of pixantrone and rituximab versus gemcitabine and rituximab in patients with diffuse large B-cell lymphoma or follicular grade 3 lymphoma, who are ineligible for high-dose chemotherapy and stem cell transplantation, and who failed front-line regimens containing rituximab. The administration schedule is pixantrone 50 mg/m(2) intravenously (iv.) or gemcitabine 1000 mg/m(2) iv. on days 1, 8 and 15, combined with rituximab 375 mg/m(2) iv. on day 1, up to six cycles. Pixantrone has a conditional European marketing approval for monotherapy in adults with multiple relapsed or refractory aggressive B-cell non-Hodgkin lymphoma. Our trial explores the efficacy of combining pixantrone with rituximab and completes postauthorization measures. TRIAL REGISTRATION NUMBER NCT01321541.
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Affiliation(s)
- David Belada
- 4th Department of Internal Medicine - Hematology, Charles University Hospital & Faculty of Medicine, Hradec Králové, Czech Republic
| | - Pencho Georgiev
- UMHAT "Sveti Georgi", Plovdiv, Clinical Haematology Clinic, Plovdiv, Bulgaria
| | | | | | | | | | - Donald Quick
- Joe Arrington Cancer Research & Treatment Center, Lubbock, TX, USA
| | | | | | | | - Mariya Pavlyuk
- Institut de Recherches Internationales Servier, Suresnes, France
| | - Nelly Failloux
- Institut de Recherches Internationales Servier, Suresnes, France
| | - Kai Hübel
- University Hospital of Cologne, Cologne, Germany
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Matsumoto T, Hara T, Shibata Y, Nakamura N, Nakamura H, Ninomiya S, Kitagawa J, Kanemura N, Goto N, Kito Y, Kasahara S, Yamada T, Sawada M, Miyazaki T, Takami T, Takeuchi T, Moriwaki H, Tsurumi H. A salvage chemotherapy of R-P-IMVP16/CBDCA consisting of rituximab, methylprednisolone, ifosfamide, methotrexate, etoposide, and carboplatin for patients with diffuse large B cell lymphoma who had previously received R-CHOP therapy as first-line chemotherapy. Hematol Oncol 2016; 35:288-295. [PMID: 26999778 DOI: 10.1002/hon.2285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/14/2015] [Accepted: 01/25/2016] [Indexed: 11/08/2022]
Abstract
We have reported the efficacy of the salvage chemotherapy P-IMVP16/CBDCA for patients with diffuse large B cell lymphoma (DLBCL) who had previously received CHOP before the availability of rituximab (R). Here, we confirmed the efficacy of R combined with P-IMVP16/CBDCA as a salvage chemotherapy for patients with DLBCL, who had previously received R-CHOP. We retrospectively analysed 59 patients with relapse or refractory DLBCL (38 male patients and 21 female patients) presenting between June 2004 and June 2013. The patients received R 375 mg/m2 on day 1, methylprednisolone 1000 mg/body for 3 days (from day 3 to day 5), ifosfamide 1000 mg/m2 for 5 days (from day 3 to day 7), methotrexate 30 mg/m2 on day 5 and day 12, etoposide 80 mg/m2 for 3 days (from day 3 to day 5), and carboplatin 300 mg/m2 on day 3 every 21 days. Patients aged 70 years or older were given 75% of the standard dose. The overall response rate (complete response + partial response) was 64.4%. The 2-year overall survival rate was 55.3%. The 2-year progression free survival rate was 34.7%. The 2-year overall survival rate was 61.5% for the relapse patients, and 15.6% for the refractory patients (p < 0.0001). One patient died because of sepsis related to the treatment regimen. Non-hematological adverse effects were mild and tolerable. The R-P-IMVP-16/CBDCA regimen displayed a significant activity in relapsed DLBCL, with acceptable toxicity, and should be considered a candidate for salvage chemotherapy. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Takuro Matsumoto
- Department of Hematology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takeshi Hara
- Department of Hematology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yuhei Shibata
- Department of Hematology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Nobuhiko Nakamura
- Department of Hematology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroshi Nakamura
- Department of Hematology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Soranobu Ninomiya
- Department of Hematology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Junichi Kitagawa
- Department of Hematology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Nobuhiro Kanemura
- Department of Hematology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Naoe Goto
- Department of Hematology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yusuke Kito
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Senji Kasahara
- Department of Hematology, Gifu Municipal Hospital, Gifu, Japan
| | - Toshiki Yamada
- Department of Hematology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Michio Sawada
- Department of Hematology, Japanese Red Cross Gifu Hospital, Gifu, Japan
| | | | - Tsuyoshi Takami
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tamotsu Takeuchi
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hisataka Moriwaki
- Department of Hematology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hisashi Tsurumi
- Department of Hematology, Gifu University Graduate School of Medicine, Gifu, Japan
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Jo JC, Baek JH, Lee JH, Joo YD, Bae SH, Lee JL, Lee JH, Kim DY, Lee WS, Ryoo HM, Choi Y, Kim H, Lee KH. Biweekly dose-dense gemcitabine-oxaliplatin and dexamethasone for relapsed/refractory aggressive non-Hodgkin lymphoma: A multicenter, single-arm, phase II trial. Asia Pac J Clin Oncol 2016; 12:159-66. [PMID: 26956432 DOI: 10.1111/ajco.12462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 11/30/2022]
Abstract
AIM We performed a phase II study to evaluate the efficacy of combination chemotherapy consisting of gemcitabine, dexamethasone and oxaliplatin (GemDOx) as a biweekly regimen and salvage therapy in patients with relapsed or refractory aggressive non-Hodgkin lymphoma (NHL). METHODS Gemcitabine (1000 mg/m(2) ) and oxaliplatin (85 mg/m(2) ) were administered intravenously on days 1 and 15, and dexamethasone (40 mg) was administered orally on days 1-4. RESULTS Twenty-nine patients were enrolled, and most patients had diffuse large B-cell lymphoma (n = 18). The median age of the patients and median prior number of chemotherapy cycles were 53 (range, 26-74) years and 1 (range, 1-4) cycle, respectively. Only 17 (58.6%) and 9 (31.0%) patients completed two or more and four or more cycles, respectively, and the median number of received cycles was two (range, 1-8). Overall response rates were 27.6% (complete response in 13.8%) among intent-to-treat patients and 47.1% (complete response in 23.5%) among patients who had received at least two GemDOx cycles. Median progression-free survival and median overall survival were 3.9 and 20.5 months, respectively. The most-frequent grade 3 or 4 toxicity was neutropenia (22.9%), and no grade 3 or 4 peripheral neurotoxicity was noted. CONCLUSION GemDOx chemotherapy, therefore, showed modest activity against relapsed or refractory aggressive NHL, although toxicities were acceptable.
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Affiliation(s)
- Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jin Ho Baek
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Je-Hwan Lee
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Don Joo
- Department of Hematology and Oncology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung-Hwa Bae
- Department of Hematology and Oncology, Daegu Catholic University Hospital, Daegu, Korea
| | - Jung-Lim Lee
- Department of Hematology and Oncology, Daegu Fatima Hospital, Daegu, Korea
| | - Jung-Hee Lee
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae-Young Kim
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won-Sik Lee
- Department of Hematology and Oncology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hun Mo Ryoo
- Department of Hematology and Oncology, Daegu Catholic University Hospital, Daegu, Korea
| | - Yunsuk Choi
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hawk Kim
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyoo-Hyung Lee
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Arcari A, Chiappella A, Spina M, Zanlari L, Bernuzzi P, Valenti V, Tani M, Marasca R, Cabras MG, Zambello R, Santagostino A, Ilariucci F, Carli G, Musto P, Savini P, Marino D, Ghio F, Gentile M, Cox MC, Vallisa D. Safety and efficacy of rituximab plus bendamustine in relapsed or refractory diffuse large B-cell lymphoma patients: an Italian retrospective multicenter study. Leuk Lymphoma 2015; 57:1823-30. [PMID: 26666433 DOI: 10.3109/10428194.2015.1106536] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Relapsed or refractory diffuse large B-cell lymphoma (DLBCL) not suitable for high dose chemotherapy with autologous stem cell transplantation (ASCT) has a dismal prognosis and no standard therapy. We designed an Italian multicenter retrospective study aimed at evaluating the safety and efficacy of rituximab plus bendamustine (R-B) as salvage treatment in patients not eligible for ASCT because of age and/or comorbidity or in patients with post-ASCT recurrence. Fifty-five patients with a median age of 76 years were included. The overall response rate was 50%, including 28% complete remission and 22% partial remission. The median overall survival (OS) was 10.8 months. The median progression free survival (PFS) was 8.8 months. Eleven patients are still alive and in complete remission at last follow-up (12-71 months). Toxicity was moderate, mainly grades 1 and 2. R-B showed promising efficacy results with an acceptable toxicity profile and should be further investigated, possibly in combination with novel drugs.
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Affiliation(s)
- Annalisa Arcari
- a Hematology Unit, Department of Onco-Hematology , Guglielmo da Saliceto Hospital , Piacenza , Italy
| | - Annalisa Chiappella
- b Department of Hematology , Città della Salute e della Scienza University Hospital , Torino , Italy
| | - Michele Spina
- c Department of Medical Oncology A , National Cancer Institute , Aviano , Italy
| | - Luca Zanlari
- d Day Hospital of Internal Medicine, Fiorenzuola d'Arda , Piacenza , Italy
| | - Patrizia Bernuzzi
- a Hematology Unit, Department of Onco-Hematology , Guglielmo da Saliceto Hospital , Piacenza , Italy
| | - Vanessa Valenti
- a Hematology Unit, Department of Onco-Hematology , Guglielmo da Saliceto Hospital , Piacenza , Italy
| | - Monica Tani
- e Department of Hematology , Santa Maria delle Croci Hospital , Ravenna , Italy
| | - Roberto Marasca
- f Division of Hematology, Department of Medical and Surgical Sciences , University of Modena and Reggio Emilia , Italy
| | | | - Renato Zambello
- h Hematology, Padua University School of Medicine , Padova , Italy
| | | | - Fiorella Ilariucci
- j Hematology Unit, Arcispedale Santa Maria Nuova-IRCCS , Reggio Emilia , Italy
| | - Giuseppe Carli
- k Department of Medicine , Section of Hematology, University of Verona , Italy
| | - Pellegrino Musto
- l Scientific Direction, IRCCS, Referral Cancer Center of Basilicata , Rionero in Vulture , Italy
| | - Paolo Savini
- m Medicine Department , Ospedale degli Infermi , Faenza , Italy
| | - Dario Marino
- n Division of Medical Oncology 1 , Istituto Oncologico Veneto-IRCCS , Padova , Italy
| | - Francesco Ghio
- o Department of Clinical and Experimental Medicine , Hematology, University of Pisa , Italy
| | - Massimo Gentile
- p Department of Hematology Unit , Ospedale Annunziata , Cosenza , Italy
| | | | - Daniele Vallisa
- a Hematology Unit, Department of Onco-Hematology , Guglielmo da Saliceto Hospital , Piacenza , Italy
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Morrison VA, Hamlin P, Soubeyran P, Stauder R, Wadhwa P, Aapro M, Lichtman SM. Approach to therapy of diffuse large B-cell lymphoma in the elderly: the International Society of Geriatric Oncology (SIOG) expert position commentary. Ann Oncol 2015; 26:1058-1068. [PMID: 25635006 DOI: 10.1093/annonc/mdv018] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/15/2014] [Indexed: 01/22/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a treatable and potentially curable malignancy that is increasing in prevalence in the elderly. Until recently, older patients with this malignancy were under-represented on clinical treatment trials, so optimal therapeutic approaches for these patients were generally extrapolated from the treatment of younger patients with this disorder. Because of heightened toxicity concerns, older patients were sometimes given reduced dose therapy, potentially negatively impacting outcome. Geriatric considerations including functional status and comorbidities often were not accounted for in treatment decisions. Because of these issues as well as the lack of treatment guidelines for the elderly population, the International Society of Geriatric Oncology convened an expert panel to review DLBCL treatment in the elderly and develop consensus guidelines for therapeutic approaches in this patient population. The following treatment guidelines address initial DLBCL therapy, in both limited and advanced stage disease, as well as approaches to the relapsed and refractory patient.
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Affiliation(s)
- V A Morrison
- Department of Medicine, University of Minnesota, Veterans Affairs Medical Center, Minneapolis.
| | - P Hamlin
- Memorial Sloan-Kettering Cancer Center, New York City, USA
| | - P Soubeyran
- Hematology/Oncology Service, University of Bordeaux and Institut Bergonié, Bordeaux, France
| | - R Stauder
- Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - P Wadhwa
- Department of Medicine, University of Minnesota, Veterans Affairs Medical Center, Minneapolis
| | - M Aapro
- Institut Multidisciplinaire d'Oncologie, Clinique de Genolier, Genolier, Switzerland
| | - S M Lichtman
- Memorial Sloan-Kettering Cancer Center, New York City, USA; Memorial Sloan-Kettering Cancer Center, Commack, USA
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Bozzoli V, Tisi MC, Maiolo E, Alma E, Bellesi S, D'Alo' F, Voso MT, Leone G, Hohaus S. Four doses of unpegylated versus one dose of pegylated filgrastim as supportive therapy in R-CHOP-14 for elderly patients with diffuse large B-cell lymphoma. Br J Haematol 2015; 169:787-94. [PMID: 25819007 DOI: 10.1111/bjh.13358] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/20/2015] [Indexed: 01/31/2023]
Abstract
The primary objective of this prospective, randomized study was to compare the efficacy of a reduced regimen of only four doses of unpegylated filgrastim from day +8 to +11 per cycle with a standard once per cycle administration of pegylated filgrastim to maintain dose-intensity of R-CHOP-14 (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone given every 14 d) in previously untreated elderly patients with diffuse large B-cell lymphoma (DLBCL). We included 51 patients (median age 66 years, range 60-76). Median dose intensity did not differ between the group of 24 patients receiving four doses of unpegylated filgrastim of each cycle (87·5%) and the group of 27 patients receiving pegylated filgrastim once per cycle on day 2 (89·4%) (P = 0·9). There was also no difference in the frequency of adverse events, such as episodes of neutropenic fever and unplanned hospitalizations. Patient characteristics that negatively influenced dose intensity were reduced performance status, advanced stage disease and poor-risk International Prognostic Index, with Eastern Cooperative Oncology Group performance status ≥2 being the most significant factor. In conclusion, a limited support with 4 d of filgrastim appears to be equivalent to pegylated filgrastim administered once per cycle, and appears to be sufficient to maintain dose-intensity of the R-CHOP-14 regimen in elderly patients with DLBCL without risk factors.
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Affiliation(s)
| | - Maria C Tisi
- Institute of Haematology, Catholic University S. Cuore, Rome, Italy
| | - Elena Maiolo
- Institute of Haematology, Catholic University S. Cuore, Rome, Italy
| | - Eleonora Alma
- Institute of Haematology, Catholic University S. Cuore, Rome, Italy
| | - Silvia Bellesi
- Institute of Haematology, Catholic University S. Cuore, Rome, Italy
| | - Francesco D'Alo'
- Institute of Haematology, Catholic University S. Cuore, Rome, Italy
| | - Maria T Voso
- Institute of Haematology, Catholic University S. Cuore, Rome, Italy
| | - Giuseppe Leone
- Institute of Haematology, Catholic University S. Cuore, Rome, Italy
| | - Stefan Hohaus
- Institute of Haematology, Catholic University S. Cuore, Rome, Italy
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Barton S, Hawkes EA, Cunningham D, Peckitt C, Chua S, Wotherspoon A, Attygalle A, Horwich A, Potter M, Ethell M, Dearden C, Gleeson M, Chau I. Rituximab, Gemcitabine, Cisplatin and Methylprednisolone (R-GEM-P) is an effective regimen in relapsed diffuse large B-cell lymphoma. Eur J Haematol 2015; 94:219-26. [PMID: 25039915 DOI: 10.1111/ejh.12416] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patients with relapsed diffuse large B-cell lymphoma (DLBCL) have a poor prognosis. Gemcitabine, methylprednisolone, cisplatin +/- rituximab (GEM-P+/-R) is a salvage regimen with limited overlap in toxicity with first-line therapy and short duration of inpatient delivery. METHODS We assessed the efficacy and safety of GEM-P+/-R in a retrospective single-centre analysis including patients meeting criteria of ≥ 18 yr of age, histologically proven DLBCL, treated between 2001 and 2011 in second-line with gemcitabine 1000 mg/m(2) day 1, 8 and 15, methylprednisolone 1000 mg day 1-5, cisplatin 100 mg/m(2) day 15 (replaced with carboplatin AUC5 if contraindication/toxicity) +/- rituximab 375 mg/m(2) day 1 and 15, every 28 d. RESULTS Forty-five patients aged 25-74 received a median of three cycles of GEM-P+/-R; 64% received rituximab. In 44 evaluable patients receiving GEM-P+/-R, overall response rate (ORR) was 48%; in 28 evaluable patients treated with rituximab + GEM-P (R-GEM-P), ORR was 61%. With median follow-up of 50.5 months (95% CI: 28.3-72.7), 3-yr overall survival (OS) from start of GEM-P+/-R was 31.4% (95% CI: 16.5-46.3); in patients treated with R-GEM-P, 3-yr OS was 49.1% (95% CI: 28.7-69.5). Predominant grade ≥ 3 toxicities were haematological; thrombocytopenia 69%, neutropenia 60% and febrile neutropenia 7%. CONCLUSION R-GEM-P is a deliverable regimen with useful activity in second-line treatment of DLBCL. Our data suggest that rituximab should be given concurrently.
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MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antineoplastic Combined Chemotherapy Protocols
- Carboplatin/administration & dosage
- Carboplatin/adverse effects
- Cisplatin/administration & dosage
- Cisplatin/adverse effects
- Deoxycytidine/administration & dosage
- Deoxycytidine/adverse effects
- Deoxycytidine/analogs & derivatives
- Drug Administration Schedule
- Drug Substitution
- Female
- Follow-Up Studies
- Humans
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Methylprednisolone/administration & dosage
- Methylprednisolone/adverse effects
- Middle Aged
- Neutropenia/chemically induced
- Neutropenia/pathology
- Recurrence
- Retrospective Studies
- Rituximab
- Salvage Therapy/methods
- Survival Analysis
- Thrombocytopenia/chemically induced
- Thrombocytopenia/pathology
- Treatment Outcome
- Gemcitabine
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Affiliation(s)
- Sarah Barton
- The Royal Marsden NHS Foundation Trust, London, Surrey, UK
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Bendamustine combined with rituximab for patients with relapsed or refractory diffuse large B cell lymphoma. Ann Hematol 2013; 93:403-9. [PMID: 23955074 PMCID: PMC3918114 DOI: 10.1007/s00277-013-1879-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 08/05/2013] [Indexed: 01/12/2023]
Abstract
Patients with relapsed or refractory diffuse large B cell lymphoma (DLBCL) are treated with salvage regimens and may be considered for high-dose chemotherapy and autologous stem cell transplantation if disease is chemosensitive. Bendamustine is active in indolent B cell lymphomas and chronic lymphocytic leukemia but has not been extensively studied in aggressive lymphomas. This trial examines the combination of bendamustine and rituximab in patients with relapsed and refractory DLBCL. Patients received bendamustine at 90 mg/m2 (n = 2) or 120 mg/m2 (n = 57) on days 1 and 2 and rituximab at 375 mg/m2 on day 1 every 28 days for up to 6 cycles. The study evaluated objective response rate (ORR), duration of response (DOR), progression-free survival (PFS), and treatment safety. Fifty-nine patients were treated, and 48 were evaluable for response. Median age was 74; 89 % had stage III or IV disease, and 63 % had high revised International Prognostic Index scores; the median number of prior therapies was 1. Based on analysis using the intent-to-treat population, the ORR was 45.8 % (complete response, 15.3 %; partial response, 30.5 %). The median DOR was 17.3 months, and the median PFS was 3.6 months. Grade 3 or 4 hematological toxicities included neutropenia (36 %), leukopenia (29 %), thrombocytopenia (22 %), and anemia (12 %). The combination of bendamustine and rituximab showed modest activity in patients with relapsed and refractory DLBCL and has an acceptable toxicity profile.
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Meriggi F, Zaniboni A. Gemox: A Widely Useful Therapy Against Solid Tumors-Review and Personal Experience. J Chemother 2013; 22:298-303. [DOI: 10.1179/joc.2010.22.5.298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Ohmachi K, Niitsu N, Uchida T, Kim SJ, Ando K, Takahashi N, Takahashi N, Uike N, Eom HS, Chae YS, Terauchi T, Tateishi U, Tatsumi M, Kim WS, Tobinai K, Suh C, Ogura M. Multicenter Phase II Study of Bendamustine Plus Rituximab in Patients With Relapsed or Refractory Diffuse Large B-Cell Lymphoma. J Clin Oncol 2013; 31:2103-9. [DOI: 10.1200/jco.2012.46.5203] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose Effective and less aggressive therapies are required for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) who are not eligible for or have undergone autologous stem-cell transplantation (ASCT). The present phase II study assessed the efficacy and safety of bendamustine plus rituximab (BR) in this population. Patients and Methods Patients with relapsed or refractory DLBCL treated with one to three prior chemotherapy regimens received rituximab 375 mg/m2 intravenous (IV) infusion on day 1 and bendamustine 120 mg/m2 by IV infusion on days 2 and 3 of each 21-day cycle for up to six cycles. The primary end point was overall response rate (ORR), and the secondary end points were complete response (CR) rate, progression-free survival (PFS), and safety. Results Sixty-three patients were enrolled, and 59 received BR. The median age was 67 years (range, 36 to 75 years), and 62.7% of patients were 65 years of age or older. Fifty-seven patients (96.6%) were previously treated with rituximab-containing chemotherapy. The ORR was 62.7% (95% CI, 49.1% to 75.0%), with a CR rate of 37.3% (95% CI, 25.0% to 50.9%). The ORRs were comparable between patients ≥ 65 years of age and less than 65 years (62.2% and 63.6%, respectively). The median PFS was 6.7 months (95% CI, 3.6 to 13.7 months). The most frequently observed grade 3 or 4 adverse events were hematologic: lymphopenia (78.0%), neutropenia (76.3%), leukopenia (72.9%), CD4 lymphopenia (66.1%), and thrombocytopenia (22.0%). Conclusion BR is a promising salvage regimen for patients with relapsed or refractory DLBCL after rituximab-containing chemotherapy, warranting further investigation.
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Affiliation(s)
- Ken Ohmachi
- Ken Ohmachi and Kiyoshi Ando, Tokai University; Ukihide Tateishi, Yokohama City University Hospital, Kanagawa; Nozomi Niitsu and Naoki Takahashi, Saitama Medical University International Medical Center, Saitama; Toshiki Uchida and Michinori Ogura, Nagoya Daini Red Cross Hospital, Aichi; Naoto Takahashi, Akita University Hospital, Akita; Naokuni Uike, National Kyushu Cancer Center, Fukuoka; Takashi Terauchi, National Cancer Center; Kensei Tobinai, National Cancer Center Hospital, Tokyo; Mitsuaki Tatsumi,
| | - Nozomi Niitsu
- Ken Ohmachi and Kiyoshi Ando, Tokai University; Ukihide Tateishi, Yokohama City University Hospital, Kanagawa; Nozomi Niitsu and Naoki Takahashi, Saitama Medical University International Medical Center, Saitama; Toshiki Uchida and Michinori Ogura, Nagoya Daini Red Cross Hospital, Aichi; Naoto Takahashi, Akita University Hospital, Akita; Naokuni Uike, National Kyushu Cancer Center, Fukuoka; Takashi Terauchi, National Cancer Center; Kensei Tobinai, National Cancer Center Hospital, Tokyo; Mitsuaki Tatsumi,
| | - Toshiki Uchida
- Ken Ohmachi and Kiyoshi Ando, Tokai University; Ukihide Tateishi, Yokohama City University Hospital, Kanagawa; Nozomi Niitsu and Naoki Takahashi, Saitama Medical University International Medical Center, Saitama; Toshiki Uchida and Michinori Ogura, Nagoya Daini Red Cross Hospital, Aichi; Naoto Takahashi, Akita University Hospital, Akita; Naokuni Uike, National Kyushu Cancer Center, Fukuoka; Takashi Terauchi, National Cancer Center; Kensei Tobinai, National Cancer Center Hospital, Tokyo; Mitsuaki Tatsumi,
| | - Seok Jin Kim
- Ken Ohmachi and Kiyoshi Ando, Tokai University; Ukihide Tateishi, Yokohama City University Hospital, Kanagawa; Nozomi Niitsu and Naoki Takahashi, Saitama Medical University International Medical Center, Saitama; Toshiki Uchida and Michinori Ogura, Nagoya Daini Red Cross Hospital, Aichi; Naoto Takahashi, Akita University Hospital, Akita; Naokuni Uike, National Kyushu Cancer Center, Fukuoka; Takashi Terauchi, National Cancer Center; Kensei Tobinai, National Cancer Center Hospital, Tokyo; Mitsuaki Tatsumi,
| | - Kiyoshi Ando
- Ken Ohmachi and Kiyoshi Ando, Tokai University; Ukihide Tateishi, Yokohama City University Hospital, Kanagawa; Nozomi Niitsu and Naoki Takahashi, Saitama Medical University International Medical Center, Saitama; Toshiki Uchida and Michinori Ogura, Nagoya Daini Red Cross Hospital, Aichi; Naoto Takahashi, Akita University Hospital, Akita; Naokuni Uike, National Kyushu Cancer Center, Fukuoka; Takashi Terauchi, National Cancer Center; Kensei Tobinai, National Cancer Center Hospital, Tokyo; Mitsuaki Tatsumi,
| | - Naoki Takahashi
- Ken Ohmachi and Kiyoshi Ando, Tokai University; Ukihide Tateishi, Yokohama City University Hospital, Kanagawa; Nozomi Niitsu and Naoki Takahashi, Saitama Medical University International Medical Center, Saitama; Toshiki Uchida and Michinori Ogura, Nagoya Daini Red Cross Hospital, Aichi; Naoto Takahashi, Akita University Hospital, Akita; Naokuni Uike, National Kyushu Cancer Center, Fukuoka; Takashi Terauchi, National Cancer Center; Kensei Tobinai, National Cancer Center Hospital, Tokyo; Mitsuaki Tatsumi,
| | - Naoto Takahashi
- Ken Ohmachi and Kiyoshi Ando, Tokai University; Ukihide Tateishi, Yokohama City University Hospital, Kanagawa; Nozomi Niitsu and Naoki Takahashi, Saitama Medical University International Medical Center, Saitama; Toshiki Uchida and Michinori Ogura, Nagoya Daini Red Cross Hospital, Aichi; Naoto Takahashi, Akita University Hospital, Akita; Naokuni Uike, National Kyushu Cancer Center, Fukuoka; Takashi Terauchi, National Cancer Center; Kensei Tobinai, National Cancer Center Hospital, Tokyo; Mitsuaki Tatsumi,
| | - Naokuni Uike
- Ken Ohmachi and Kiyoshi Ando, Tokai University; Ukihide Tateishi, Yokohama City University Hospital, Kanagawa; Nozomi Niitsu and Naoki Takahashi, Saitama Medical University International Medical Center, Saitama; Toshiki Uchida and Michinori Ogura, Nagoya Daini Red Cross Hospital, Aichi; Naoto Takahashi, Akita University Hospital, Akita; Naokuni Uike, National Kyushu Cancer Center, Fukuoka; Takashi Terauchi, National Cancer Center; Kensei Tobinai, National Cancer Center Hospital, Tokyo; Mitsuaki Tatsumi,
| | - Hyeon Seok Eom
- Ken Ohmachi and Kiyoshi Ando, Tokai University; Ukihide Tateishi, Yokohama City University Hospital, Kanagawa; Nozomi Niitsu and Naoki Takahashi, Saitama Medical University International Medical Center, Saitama; Toshiki Uchida and Michinori Ogura, Nagoya Daini Red Cross Hospital, Aichi; Naoto Takahashi, Akita University Hospital, Akita; Naokuni Uike, National Kyushu Cancer Center, Fukuoka; Takashi Terauchi, National Cancer Center; Kensei Tobinai, National Cancer Center Hospital, Tokyo; Mitsuaki Tatsumi,
| | - Yee Soo Chae
- Ken Ohmachi and Kiyoshi Ando, Tokai University; Ukihide Tateishi, Yokohama City University Hospital, Kanagawa; Nozomi Niitsu and Naoki Takahashi, Saitama Medical University International Medical Center, Saitama; Toshiki Uchida and Michinori Ogura, Nagoya Daini Red Cross Hospital, Aichi; Naoto Takahashi, Akita University Hospital, Akita; Naokuni Uike, National Kyushu Cancer Center, Fukuoka; Takashi Terauchi, National Cancer Center; Kensei Tobinai, National Cancer Center Hospital, Tokyo; Mitsuaki Tatsumi,
| | - Takashi Terauchi
- Ken Ohmachi and Kiyoshi Ando, Tokai University; Ukihide Tateishi, Yokohama City University Hospital, Kanagawa; Nozomi Niitsu and Naoki Takahashi, Saitama Medical University International Medical Center, Saitama; Toshiki Uchida and Michinori Ogura, Nagoya Daini Red Cross Hospital, Aichi; Naoto Takahashi, Akita University Hospital, Akita; Naokuni Uike, National Kyushu Cancer Center, Fukuoka; Takashi Terauchi, National Cancer Center; Kensei Tobinai, National Cancer Center Hospital, Tokyo; Mitsuaki Tatsumi,
| | - Ukihide Tateishi
- Ken Ohmachi and Kiyoshi Ando, Tokai University; Ukihide Tateishi, Yokohama City University Hospital, Kanagawa; Nozomi Niitsu and Naoki Takahashi, Saitama Medical University International Medical Center, Saitama; Toshiki Uchida and Michinori Ogura, Nagoya Daini Red Cross Hospital, Aichi; Naoto Takahashi, Akita University Hospital, Akita; Naokuni Uike, National Kyushu Cancer Center, Fukuoka; Takashi Terauchi, National Cancer Center; Kensei Tobinai, National Cancer Center Hospital, Tokyo; Mitsuaki Tatsumi,
| | - Mitsuaki Tatsumi
- Ken Ohmachi and Kiyoshi Ando, Tokai University; Ukihide Tateishi, Yokohama City University Hospital, Kanagawa; Nozomi Niitsu and Naoki Takahashi, Saitama Medical University International Medical Center, Saitama; Toshiki Uchida and Michinori Ogura, Nagoya Daini Red Cross Hospital, Aichi; Naoto Takahashi, Akita University Hospital, Akita; Naokuni Uike, National Kyushu Cancer Center, Fukuoka; Takashi Terauchi, National Cancer Center; Kensei Tobinai, National Cancer Center Hospital, Tokyo; Mitsuaki Tatsumi,
| | - Won Seog Kim
- Ken Ohmachi and Kiyoshi Ando, Tokai University; Ukihide Tateishi, Yokohama City University Hospital, Kanagawa; Nozomi Niitsu and Naoki Takahashi, Saitama Medical University International Medical Center, Saitama; Toshiki Uchida and Michinori Ogura, Nagoya Daini Red Cross Hospital, Aichi; Naoto Takahashi, Akita University Hospital, Akita; Naokuni Uike, National Kyushu Cancer Center, Fukuoka; Takashi Terauchi, National Cancer Center; Kensei Tobinai, National Cancer Center Hospital, Tokyo; Mitsuaki Tatsumi,
| | - Kensei Tobinai
- Ken Ohmachi and Kiyoshi Ando, Tokai University; Ukihide Tateishi, Yokohama City University Hospital, Kanagawa; Nozomi Niitsu and Naoki Takahashi, Saitama Medical University International Medical Center, Saitama; Toshiki Uchida and Michinori Ogura, Nagoya Daini Red Cross Hospital, Aichi; Naoto Takahashi, Akita University Hospital, Akita; Naokuni Uike, National Kyushu Cancer Center, Fukuoka; Takashi Terauchi, National Cancer Center; Kensei Tobinai, National Cancer Center Hospital, Tokyo; Mitsuaki Tatsumi,
| | - Cheolwon Suh
- Ken Ohmachi and Kiyoshi Ando, Tokai University; Ukihide Tateishi, Yokohama City University Hospital, Kanagawa; Nozomi Niitsu and Naoki Takahashi, Saitama Medical University International Medical Center, Saitama; Toshiki Uchida and Michinori Ogura, Nagoya Daini Red Cross Hospital, Aichi; Naoto Takahashi, Akita University Hospital, Akita; Naokuni Uike, National Kyushu Cancer Center, Fukuoka; Takashi Terauchi, National Cancer Center; Kensei Tobinai, National Cancer Center Hospital, Tokyo; Mitsuaki Tatsumi,
| | - Michinori Ogura
- Ken Ohmachi and Kiyoshi Ando, Tokai University; Ukihide Tateishi, Yokohama City University Hospital, Kanagawa; Nozomi Niitsu and Naoki Takahashi, Saitama Medical University International Medical Center, Saitama; Toshiki Uchida and Michinori Ogura, Nagoya Daini Red Cross Hospital, Aichi; Naoto Takahashi, Akita University Hospital, Akita; Naokuni Uike, National Kyushu Cancer Center, Fukuoka; Takashi Terauchi, National Cancer Center; Kensei Tobinai, National Cancer Center Hospital, Tokyo; Mitsuaki Tatsumi,
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Mounier N, El Gnaoui T, Tilly H, Canioni D, Sebban C, Casasnovas RO, Delarue R, Sonet A, Beaussart P, Petrella T, Castaigne S, Bologna S, Salles G, Rahmouni A, Gaulard P, Haioun C. Rituximab plus gemcitabine and oxaliplatin in patients with refractory/relapsed diffuse large B-cell lymphoma who are not candidates for high-dose therapy. A phase II Lymphoma Study Association trial. Haematologica 2013; 98:1726-31. [PMID: 23753028 DOI: 10.3324/haematol.2013.090597] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A previous pilot study with rituximab, gemcitabine and oxaliplatin showed promising activity in patients with refractory/relapsed B-cell lymphoma. We, therefore, conducted a phase II study to determine whether these results could be reproduced in a multi-institutional setting. This phase II study included 49 patients with refractory (n=6) or relapsing (n=43) diffuse large B-cell lymphoma. The median age of the patients was 69 years. Prior treatment included rituximab in 31 (63%) and autologous transplantation in 17 (35%) patients. International Prognostic Index at enrollment was >2 in 34 patients (71%). The primary endpoint was overall response rate after four cycles of treatment. Patients were planned to receive eight cycles if they reached at least partial remission after four cycles. After four cycles 21 patients (44%) were in complete remission and 8 (17%) in partial remission, resulting in an overall response rate of 61%. Factors significantly affecting overall response rate were early (<1 year) progression/relapse (18% versus 54%; P=0.001) and prior exposure to rituximab (23% versus 65%; P=0.004). Five-year progression-free and overall survival rates were 12.8% and 13.9%, respectively. Rituximab, gemcitabine and oxaliplatin were well tolerated with grade 3-4 infectious episodes in 22% of the cycles. These results are the first confirmation from a multicenter study that rituximab, gemcitabine and oxaliplatin provide a consistent response rate in patients with refractory/relapsed diffuse large B-cell lymphoma. This therapy can now be considered as a platform for new combinations with targeted treatments. This trial was registered at clinicaltrial.gov under #NCT00169195.
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Forero-Torres A, Bartlett N, Beaven A, Myint H, Nasta S, Northfelt DW, Whiting NC, Drachman JG, Lobuglio AF, Moskowitz CH. Pilot study of dacetuzumab in combination with rituximab and gemcitabine for relapsed or refractory diffuse large B-cell lymphoma. Leuk Lymphoma 2012; 54:277-83. [PMID: 22775314 DOI: 10.3109/10428194.2012.710328] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Dacetuzumab, a CD40-targeted, humanized antibody, mediates antitumor activity through effector cell functions and direct apoptotic signal transduction. Preclinical studies demonstrated synergistic activity between dacetuzumab, gemcitabine and rituximab against non-Hodgkin lymphoma in vivo. A phase 1b safety/efficacy study of dacetuzumab in combination with rituximab and gemcitabine was conducted in relapsed/refractory diffuse large B-cell lymphoma (DLBCL). Patients received dacetuzumab at doses of 8 or 12 mg/kg IV weekly with rituximab (375 mg/m(2) IV weekly in cycle 1, then every 28 days) and gemcitabine (1000 mg/m(2) IV, days 1, 8 and 15, or days 1 and 15). Thirty-three patients with a median age of 67 years were enrolled. Common adverse events (≥ 15%) were grade 1/2 cytokine release syndrome, nausea, fatigue, thrombocytopenia, headache, decreased appetite, dyspnea, neutropenia, pyrexia, anemia, diarrhea, edema, constipation and cough. Dacetuzumab-related grade 3/4 adverse events occurred infrequently. Six of 30 evaluable patients achieved a complete response (CR) and eight a partial response (PR) per investigator assessment for an overall response rate (ORR) of 47%.
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Foon KA, Takeshita K, Zinzani PL. Novel therapies for aggressive B-cell lymphoma. Adv Hematol 2012; 2012:302570. [PMID: 22536253 PMCID: PMC3318210 DOI: 10.1155/2012/302570] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 12/16/2011] [Indexed: 12/21/2022] Open
Abstract
Aggressive B-cell lymphoma (BCL) comprises a heterogeneous group of malignancies, including diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma, and mantle cell lymphoma (MCL). DLBCL, with its 3 subtypes, is the most common type of lymphoma. Advances in chemoimmunotherapy have substantially improved disease control. However, depending on the subtype, patients with DLBCL still exhibit substantially different survival rates. In MCL, a mature B-cell lymphoma, the addition of rituximab to conventional chemotherapy regimens has increased response rates, but not survival. Burkitt lymphoma, the most aggressive BCL, is characterized by a high proliferative index and requires more intensive chemotherapy regimens than DLBCL. Hence, there is a need for more effective therapies for all three diseases. Increased understanding of the molecular features of aggressive BCL has led to the development of a range of novel therapies, many of which target the tumor in a tailored manner and are summarized in this paper.
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Affiliation(s)
- Kenneth A. Foon
- Celgene Corporation, 86 Morris Avenue, Summit, NJ 07901, USA
| | | | - Pier L. Zinzani
- Department of Hematology and Oncological Sciences “L. e A. Seràgnoli”, University of Bologna, Via Massarenti, 9-40138 Bologna, Italy
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Zinzani PL, Pellegrini C, Gandolfi L, Stefoni V, Quirini F, Derenzini E, Broccoli A, Argnani L, Pileri S, Baccarani M. Combination of Lenalidomide and Rituximab in Elderly Patients With Relapsed or Refractory Diffuse Large B-Cell Lymphoma: A Phase 2 Trial. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 11:462-6. [DOI: 10.1016/j.clml.2011.02.001] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 02/15/2011] [Accepted: 02/28/2011] [Indexed: 12/29/2022]
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49
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Corazzelli G, Frigeri F, Arcamone M, Lucania A, Rosariavilla M, Morelli E, Amore A, Capobianco G, Caronna A, Becchimanzi C, Volzone F, Marcacci G, Russo F, De Filippi R, Mastrullo L, Pinto A. Biweekly rituximab, cyclophosphamide, vincristine, non-pegylated liposome-encapsulated doxorubicin and prednisone (R-COMP-14) in elderly patients with poor-risk diffuse large B-cell lymphoma and moderate to high 'life threat' impact cardiopathy. Br J Haematol 2011; 154:579-89. [PMID: 21707585 PMCID: PMC3258483 DOI: 10.1111/j.1365-2141.2011.08786.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This Phase II study assessed feasibility and efficacy of a biweekly R-COMP-14 regimen (rituximab, cyclophosphamide, non-pegylated liposome-encapsulated doxorubicin, vincristine and prednisone) in untreated elderly patients with poor-risk diffuse large B-cell lymphoma (DLBCL) and moderate to high ‘life threat’ impact NIA/NCI cardiac comorbidity. A total of 208 courses were delivered, with close cardiac monitoring, to 41 patients (median age: 73 years, range: 62–82; 37% >75 years) at a median interval of 15·6 (range, 13–29) days; 67% completed all six scheduled courses. Response rate was 73%, with 68% complete responses (CR); 4-year disease-free survival (DFS) and time to treatment failure (TTF) were 72% and 49%, respectively. Failures were due to early death (n = 3), therapy discontinuations (no-response n = 2; toxicity n = 6), relapse (n = 6) and death in CR (n = 3). Incidence of cardiac grade 3–5 adverse events was 7/41 (17%; 95% confidence interval: 8–31%). Time to progression and overall survival at 4-years were 77% and 67%, respectively. The Age-adjusted Charlson Comorbidity Index (aaCCI) correlated with failures (P = 0·007) with patients scoring ≤7 having a longer TTF (66% vs. 29%; P = 0·009). R-COMP-14 is feasible and ensures a substantial DFS to poor-risk DLBCL patients who would have been denied anthracycline-based treatment due to cardiac morbidity. The aaCCI predicted both treatment discontinuation rate and TTF.
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Affiliation(s)
- Gaetano Corazzelli
- Haematology-Oncology and Stem Cell Transplantation Unit, National Cancer Institute, Fondazione G. Pascale, IRCCS, Naples, Italy.
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Abstract
AbstractEnormous progress has been made in the treatment of diffuse large B-cell lymphoma (DLBCL), mostly due to the anti-CD20 antibody rituximab. More than 50% of elderly DLBCL patients can be expected to be cured by modern immunochemotherapy. The standard chemotherapy partner of rituximab is the CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen. Elderly patients need particular attention and thorough evaluation if they are suited for the standard treatment or if they are candidates for palliative treatment. Rigorous supportive care including anti-infectious prophylaxis and growth factor support are mandatory. Whether there is still a role of additive radiotherapy in the R-CHOP era is under debate. While further intensification of chemotherapy might hardly be feasible in elderly patients, dose and schedule of rituximab appear to be optimizable. Patients failing after R-CHOP are a particular challenge as are frail patients who are not fit enough for R-CHOP. Further progress can be expected from novel antibodies and small molecules that interfere with signal transduction pathways essential for the survival of the lymphoma cell. To achieve this goal, prospective trials with large numbers of patients are necessary for which the continuous commitment of patients and physicians is indispensable.
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