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Locke FL, Siddiqi T, Jacobson CA, Ghobadi A, Ahmed S, Miklos DB, Perales MA, Munoz J, Fingrut WB, Pennisi M, Gauthier J, Shadman M, Gowda L, Mirza AS, Abid MB, Hong S, Majhail NS, Kharfan-Dabaja MA, Khurana A, Badar T, Lin Y, Bennani NN, Herr MM, Hu ZH, Wang HL, Baer A, Baro E, Miao H, Spooner C, Xu H, Pasquini MC. Real-world and clinical trial outcomes in large B-cell lymphoma with axicabtagene ciloleucel across race and ethnicity. Blood 2024; 143:2722-2734. [PMID: 38635762 PMCID: PMC11251200 DOI: 10.1182/blood.2023023447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024] Open
Abstract
ABSTRACT Axicabtagene ciloleucel (axi-cel) is an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy approved for relapsed/refractory (R/R) large B-cell lymphoma (LBCL). Despite extensive data supporting its use, outcomes stratified by race and ethnicity groups are limited. Here, we report clinical outcomes with axi-cel in patients with R/R LBCL by race and ethnicity in both real-world and clinical trial settings. In the real-world setting, 1290 patients who received axi-cel between 2017 and 2020 were identified from the Center for International Blood and Marrow Transplant Research database; 106 and 169 patients were included from the ZUMA-1 and ZUMA-7 trials, respectively. Overall survival was consistent across race/ethnicity groups. However, non-Hispanic (NH) Black patients had lower overall response rate (OR, 0.37; 95% CI, 0.22-0.63) and lower complete response rate (OR, 0.57; 95% CI, 0.33-0.97) than NH White patients. NH Black patients also had a shorter progression-free survival vs NH White (HR, 1.41; 95% CI, 1.04-1.90) and NH Asian patients (HR, 1.67; 95% CI, 1.08-2.59). NH Asian patients had a longer duration of response than NH White (HR, 0.56; 95% CI, 0.33-0.94) and Hispanic patients (HR, 0.54; 95% CI, 0.30-0.97). There was no difference in cytokine release syndrome by race/ethnicity; however, higher rates of any-grade immune effector cell-associated neurotoxicity syndrome were observed in NH White patients than in other patients. These results provide important context when treating patients with R/R LBCL with CAR T-cell therapy across different racial and ethnic groups. ZUMA-1 and ZUMA-7 (ClinicalTrials.gov identifiers: #NCT02348216 and #NCT03391466, respectively) are registered on ClinicalTrials.gov.
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Affiliation(s)
| | | | | | - Armin Ghobadi
- Division of Oncology, Washington University School of Medicine, St Louis, MO
| | - Sairah Ahmed
- Department of Lymphoma-Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David B. Miklos
- Blood and Marrow Transplantation and Cellular Therapy Division, Stanford University School of Medicine, Stanford, CA
| | | | - Javier Munoz
- Department of Hematology, Mayo Clinic Arizona, Phoenix, AZ
| | | | - Martina Pennisi
- Hematology Division, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Jordan Gauthier
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA
| | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA
| | - Lohith Gowda
- Yale School of Medicine, Yale Cancer Center, New Haven, CT
| | - Abu-Sayeef Mirza
- Moffitt Cancer Center, Tampa, FL
- Yale School of Medicine, Yale Cancer Center, New Haven, CT
| | - Muhammad Bilal Abid
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Sanghee Hong
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Navneet S. Majhail
- Sarah Cannon Transplant and Cellular Therapy Program, Sarah Cannon Cancer Institute, Nashville, TN
| | | | | | - Talha Badar
- Departments of Hematology and Oncology (Medical), Mayo Clinic Florida, Jacksonville, FL
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Megan M. Herr
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | | | | | | | - Harry Miao
- Kite, a Gilead company, Santa Monica, CA
| | | | - Hairong Xu
- Kite, a Gilead company, Santa Monica, CA
| | - Marcelo C. Pasquini
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
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Rosenberg M, Poluch M, Thomas C, Sindaco P, Khoo A, Porcu P. Hepatitis B Virus and B-cell lymphoma: evidence, unmet need, clinical impact, and opportunities. Front Oncol 2023; 13:1275800. [PMID: 37927464 PMCID: PMC10623156 DOI: 10.3389/fonc.2023.1275800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Nearly a billion people worldwide are infected with the hepatitis B Virus (HBV) and about a third of them have chronic infection. HBV is an important cause of morbidity and mortality, including acute and chronic hepatitis and hepatocellular carcinoma (HCC). Screening and control of primary HBV infection through vaccination represent a major advance in global public health, but large sections of the world population, in both developed and underdeveloped countries, remain unscreened and unvaccinated. In addition to being a global cause of liver disease, an important role of HBV in lymphoma has also emerged. First, the high risk of HBV reactivation in previously infected patients receiving chemo-immunotherapy necessitates the systematic evaluation of HBV serological status in all non-Hodgkin's lymphoma (NHL) cases and preemptive antiviral therapy for those who may have chronic or occult HBV infection. Second, HBV has been shown to infect lymphocytes, namely B-cells, and has been associated with a higher risk of developing B-cell lymphoma, most clearly in countries where HBV is endemic. While the risk of HBV reactivation with chemoimmunotherapy in NHL is well known, the role and the impact of HBV as a global lymphoma risk factor and potential oncogenic driver in B-cells are very poorly understood. Here, we review the clinical and scientific evidence supporting an association between HBV and B-cell lymphoma, with a particular focus on diffuse large B-cell lymphoma (DLBCL) and provide an overview of the estimated impact of HBV infection on the biology and clinical course of DLBCL. We also discuss ways to gain a better insight into the unmet need posed by HBV in lymphoma and whether assessing immune responses to HBV, measuring viral loads, and detecting the presence of HBV-encoded proteins in tumor tissue could be integrated into the molecular and clinical risk stratification of patients with DLBCL.
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Affiliation(s)
- Maya Rosenberg
- Department of Internal Medicine, New York University Langone Health, New York, NY, United States
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Maria Poluch
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Colin Thomas
- Department of Medical Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Paola Sindaco
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Alan Khoo
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Pierluigi Porcu
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
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Hooper MJ, Veon FL, Enriquez GL, Nguyen M, Grimes CB, LeWitt TM, Pang Y, Case S, Choi J, Guitart J, Burns MB, Zhou XA. Retrospective analysis of sepsis in cutaneous T-cell lymphoma reveals significantly greater risk in Black patients. J Am Acad Dermatol 2023; 88:329-337. [PMID: 36265823 PMCID: PMC9839541 DOI: 10.1016/j.jaad.2022.10.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/17/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sepsis is a leading cause of morbidity, mortality, and resource utilization among patients with cutaneous T-cell lymphoma (CTCL). OBJECTIVE To characterize the demographic, clinical, and microbial attributes distinguishing patients with CTCL sepsis from other patients with non-Hodgkin lymphoma (NHL) sepsis and patients with CTCL in general. METHODS Two-part retrospective cohort study at an academic medical center from 2001-2019 involving patients with CTCL (n = 97) and non-CTCL NHL (n = 88) admitted with sepsis, and a same-institution CTCL patient database (n = 1094). Overall survival was estimated by Kaplan-Meier analyses. RESULTS Patients with CTCL sepsis were more likely to be older, Black, experience more sepsis episodes, die or be readmitted within 30 days of an inpatient sepsis episode, and develop Gram-positive bacteremia than patients with non-CTCL NHL sepsis. Staphylococcus aureus and Escherichia coli were the most frequently speciated organisms in CTCL (26%) and non-CTCL NHL (14%), respectively. No between-group differences were identified regarding sex, presence of central line, chemotherapy use, or disease stage. Compared with general patients with CTCL, patients with sepsis were Black and exhibited advanced-stage disease, higher body surface area involvement, and higher lactate dehydrogenase levels. LIMITATIONS Single institution, retrospective nature may limit generalizability. CONCLUSION Awareness of CTCL-specific risk factors is crucial for guiding sepsis prevention and improving patient outcomes.
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Affiliation(s)
- Madeline J Hooper
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Francesca L Veon
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gail L Enriquez
- Department of Biology, Loyola University Chicago, Chicago, Illinois
| | - Morgan Nguyen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cameron B Grimes
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tessa M LeWitt
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yanzhen Pang
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Slaton Case
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jaehyuk Choi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joan Guitart
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael B Burns
- Department of Biology, Loyola University Chicago, Chicago, Illinois
| | - Xiaolong A Zhou
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Parsons MW, Rock C, Chipman JJ, Shah HR, Hu B, Stephens DM, Tao R, Tward JD, Gaffney DK. Secondary malignancies in non-Hodgkin lymphoma survivors: 40 years of follow-up assessed by treatment modality. Cancer Med 2022; 12:2624-2636. [PMID: 36812123 PMCID: PMC9939160 DOI: 10.1002/cam4.5139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/02/2022] [Accepted: 07/21/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Survivors of non-Hodgkin lymphoma (NHL) have increased secondary malignancy (SM) risk. We quantified this risk by patient and treatment factors. METHODS Standardized incidence ratios (SIR, observed-to-expected [O/E] ratio) were assessed in 142,637 NHL patients diagnosed from 1975 to 2016 in the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Comparisons were made between subgroups in terms of their SIRs relative to respective endemic populations. RESULTS In total, 15,979 patients developed SM, more than the endemic rate (O/E 1.29; p < 0.05). Compared with white patients, relative to respective endemic populations, ethnic minorities had a higher risk of SM (white O/E 1.27, 95% CI 1.25-1.29; black O/E 1.40, 95% CI 1.31-1.48; other O/E 1.59, 95% CI 1.49-1.70). Relative to respective endemic populations, patients who received radiotherapy had similar SM rates to those who did not (O/E 1.29 each), but irradiated patients had increased breast cancer (p < 0.05). Patients who received chemotherapy had higher SM rates than those who did not (O/E 1.33 vs. 1.24, p < 0.05) including more leukemia, Kaposi sarcoma, kidney, pancreas, rectal, head and neck, and colon cancers (p < 0.05). CONCLUSIONS This is the largest study to examine SM risk in NHL patients with the longest follow-up. Treatment with radiotherapy did not increase overall SM risk, while chemotherapy was associated with a higher overall risk. However, certain subsites were associated with a higher risk of SM, and they varied by treatment, age group, race and time since treatment. These findings are helpful for informing screening and long-term follow-up in NHL survivors.
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Affiliation(s)
- Matthew W. Parsons
- Department of Radiation OncologyHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
| | - Calvin Rock
- Department of Radiation OncologyHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
| | - Jonathan J. Chipman
- Cancer BiostatisticsHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA,Division of Biostatistics, Department of Population Health SciencesUniversity of UtahSalt Lake CityUtahUSA
| | - Harsh R. Shah
- Division of Hematology/Hematologic MalignanciesHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
| | - Boyu Hu
- Division of Hematology/Hematologic MalignanciesHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
| | - Deborah M. Stephens
- Division of Hematology/Hematologic MalignanciesHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
| | - Randa Tao
- Department of Radiation OncologyHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
| | - Jonathan D. Tward
- Department of Radiation OncologyHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
| | - David K. Gaffney
- Department of Radiation OncologyHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
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Dance KV, Imbody CB, Chen L, McNeill L, Payne JB, Flowers CR. Perceptions of clinical care and research among African-American patients with lymphoma. Leuk Lymphoma 2021; 62:1860-1868. [PMID: 33645400 DOI: 10.1080/10428194.2021.1892092] [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: 10/22/2022]
Abstract
Across lymphoma subtypes, African Americans experience disparities in clinical trial enrollment and outcomes. Understanding the needs of this population can aid addressing these disparities. Semi-structured interviews were conducted with 14 self-identified Black/African-American lymphoma patients to determine their perceptions and attitudes about aspects of treatment and research. Constant-comparative methods identified themes including trust in medical staff, lack of diagnosis information, interest in research, research priorities, and potentially unaddressed emotional needs. Patients trusted their doctors and desired more diagnosis information. Participants often did not consider the emotions surrounding their diagnoses and concentrated on positive attitudes during treatment. Most participants were interested in clinical trials to help future lymphoma patients. Participants suggested a range of future research topics emphasizing lymphoma etiology. Building on trusting doctor-patient relationships, expanding clinical trials information, addressing emotional needs, and aligning research objectives with patient concerns are potential strategies for increasing clinical trial enrollment among Black lymphoma patients.
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Affiliation(s)
- Kaylin V Dance
- Winship Cancer Institute, Emory University, Atlanta, GE, USA
| | - Conner B Imbody
- Winship Cancer Institute, Emory University, Atlanta, GE, USA.,Department of Behavioral Science and Health Education, Rollins School of Public Health, Atlanta, GE, USA
| | - Lillian Chen
- Winship Cancer Institute, Emory University, Atlanta, GE, USA
| | - Lorna McNeill
- Winship Cancer Institute, Emory University, Atlanta, GE, USA.,Department of Behavioral Science and Health Education, Rollins School of Public Health, Atlanta, GE, USA.,Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jackelyn B Payne
- Winship Cancer Institute, Emory University, Atlanta, GE, USA.,Department of Behavioral Science and Health Education, Rollins School of Public Health, Atlanta, GE, USA.,Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Christopher R Flowers
- Winship Cancer Institute, Emory University, Atlanta, GE, USA.,Department of Behavioral Science and Health Education, Rollins School of Public Health, Atlanta, GE, USA.,Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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