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Metheny LL, Sobecks R, Cho C, Fu P, Margevicius S, Wang J, Ciarrone L, Kopp S, Convents RD, Majhail N, Caimi PF, Otegbeye F, Cooper BW, Gallogly M, Malek E, Tomlinson B, Gerds AT, Hamilton B, Giralt S, Perales MA, de Lima M. A multicenter study of posttransplantation low-dose inotuzumab ozogamicin to prevent relapse of acute lymphoblastic leukemia. Blood Adv 2024; 8:1384-1391. [PMID: 38170741 PMCID: PMC10945150 DOI: 10.1182/bloodadvances.2023011514] [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: 08/23/2023] [Revised: 11/15/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024] Open
Abstract
ABSTRACT The curative potential of allogeneic hematopoietic transplantation (allo-HCT) in patients with acute lymphoblastic leukemia (ALL) is hampered by relapse. Inotuzumab ozogamicin (INO) is an anti-CD22 monoclonal antibody bound to calicheamicin, which has significant activity against ALL. We hypothesized that low-dose INO would be safe and feasible after allo-HCT. Therefore, we conducted a phase 1 study to determine the dose and safety in this setting. Patients were eligible if they were aged 16 to 75 years, had undergone allo-HCT for CD22+ ALL, were in complete remission (CR) after allo-HCT, had high risk of recurrence, were between day 40 and 100 after allo-HCT with adequate graft function, and did not have a history of sinusoidal obstruction syndrome (SOS). The objectives of this trial were to define INO maximum tolerated dose (MTD), to determine post-allo-HCT INO safety, and to measure 1-year progression-free survival (PFS). The trial design followed a "3+3" model. The treatment consisted of INO given on day 1 of 28-day cycles. Dose levels were 0.3 mg/m2, 0.4 mg/m2, 0.5 mg/m2, and 0.6 mg/m2. Median age was 44 years (range, 17-66 years; n = 18). Disease status at transplantation was first CR (n = 14) or second CR or beyond (n = 4). Preparative regimen was of reduced intensity in 72% of patients who received transplantation. Most common toxicity was thrombocytopenia. There were no instances of SOS; the MTD was 0.6 mg/m2. One-year nonrelapse mortality was 5.6%. With a median follow-up of 18.1 months (range, 8.6-59 months) 1-year post-allo-HCT PFS and overall survival is 89% and 94%, respectively. Low-dose INO has a favorable safety profile and was associated with high rates of 1-year PFS. This trial was registered at www.clinicaltrials.gov as #NCT03104491.
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Affiliation(s)
- Leland L. Metheny
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
- Case Comprehensive Cancer Center, Cleveland, OH
| | - Ronald Sobecks
- Case Comprehensive Cancer Center, Cleveland, OH
- Blood and Marrow Transplant, Cleveland Clinic Foundation, Cleveland, OH
| | - Christina Cho
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Pingfu Fu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Seunghee Margevicius
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Jiasheng Wang
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
- Case Comprehensive Cancer Center, Cleveland, OH
| | - Lisa Ciarrone
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
| | - Shelby Kopp
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
| | - Robin D. Convents
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
| | - Navneet Majhail
- Case Comprehensive Cancer Center, Cleveland, OH
- Blood and Marrow Transplant, Cleveland Clinic Foundation, Cleveland, OH
| | - Paolo F. Caimi
- Case Comprehensive Cancer Center, Cleveland, OH
- Blood and Marrow Transplant, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Brenda W. Cooper
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
- Case Comprehensive Cancer Center, Cleveland, OH
| | - Molly Gallogly
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
- Case Comprehensive Cancer Center, Cleveland, OH
| | - Ehsan Malek
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
- Case Comprehensive Cancer Center, Cleveland, OH
| | - Benjamin Tomlinson
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
- Case Comprehensive Cancer Center, Cleveland, OH
| | - Aaron T. Gerds
- Case Comprehensive Cancer Center, Cleveland, OH
- Blood and Marrow Transplant, Cleveland Clinic Foundation, Cleveland, OH
| | - Betty Hamilton
- Case Comprehensive Cancer Center, Cleveland, OH
- Blood and Marrow Transplant, Cleveland Clinic Foundation, Cleveland, OH
| | - Sergio Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
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Kako S, Morita S, Sakamaki H, Iida H, Kurokawa M, Miyamura K, Kanamori H, Hara M, Kobayashi N, Morishima Y, Kawa K, Kyo T, Sakura T, Jinnai I, Takeuchi J, Miyazaki Y, Miyawaki S, Ohnishi K, Naoe T, Kanda Y. The role of HLA-matched unrelated transplantation in adult patients with Ph chromosome-negative ALL in first remission. A decision analysis. Bone Marrow Transplant 2013; 48:1077-83. [DOI: 10.1038/bmt.2013.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/19/2012] [Accepted: 12/20/2012] [Indexed: 11/10/2022]
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Meenaghan T, Dowling M, Kelly M. Acute leukaemia: making sense of a complex blood cancer. ACTA ACUST UNITED AC 2012; 21:76, 78-83. [PMID: 22306635 DOI: 10.12968/bjon.2012.21.2.76] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acute leukaemia represents a diverse group of blood cancers that affect both children and adults. Treatment schedules for these haematology cancers are often prolonged, with many associated side effects and complications. Nurses caring for patients with acute leukaemia require an anticipatory approach, where care is aimed at minimizing the side effects of treatment and being constantly vigilant for any impending adverse effects. Moreover, patients require support for the psychosocial issues that can arise for patients during their illness. This article provides an overview of acute lymphoblastic leukaemia and acute myeloid leukaemia. Nursing considerations in the care of patients being treated for acute leukaemia are also explored.
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Affiliation(s)
- Teresa Meenaghan
- Haematology Department, Galway University Hospital, and School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
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Paulson K, Szwajcer D, Seftel MD. The role of allogeneic stem cell transplantation for adult acute lymphoblastic leukemia. Transfus Apher Sci 2011; 44:197-203. [PMID: 21330213 DOI: 10.1016/j.transci.2011.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Acute lymphoblastic leukemia remains a challenging disease in adults. With modern multi-drug induction chemotherapy regimens, complete remission can be achieved in most patients. However, without additional therapy at the time of the first remission, most patients will eventually relapse. Regardless of the treatment option chosen at the time of relapse, outcomes after relapse are poor, with only around 10% of all patients surviving after relapse. Thus, decision-making at the time of achieving the first complete remission is critical. Allogeneic stem cell transplantation is highly effective at preventing relapse, but with significant treatment related toxicity. Ongoing chemotherapy in the form of consolidation and maintenance may be less effective at preventing relapse, but with lower toxicities. Thus, the superiority of allogeneic stem cell transplantation must be balanced against the lower toxicity of consolidation chemotherapy. This decision is further complicated by rapid changes in the field of hematopoietic stem cell transplantation, such as the use of reduced intensity conditioning regimens and alternative stem cell sources such as cord blood transplants. The available evidence suggests that allogeneic transplantation is a viable treatment option for patients in first complete remission, with overall survival superior to traditional consolidation and maintenance chemotherapy. However, whether transplantation based post-remission therapy is superior to modern, pediatric-based non-transplant chemotherapy regimens remains unclear.
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Affiliation(s)
- K Paulson
- University of Manitoba, CancerCare Manitoba, ON 2076, 675 McDermot Avenue, Winnipeg, MB, Canada R3E 0V9
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