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Oluwole OO, Ray MD, Rosettie KL, Ball G, Jacob J, Bilir SP, Patel AR, Jacobson CA. Cost-Effectiveness of Axicabtagene Ciloleucel for Adult Patients With Relapsed or Refractory Follicular Lymphoma in the United States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:1030-1038. [PMID: 38641058 DOI: 10.1016/j.jval.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES The results of a recent single-arm trial (ZUMA-5) of axicabtagene ciloleucel (axi-cel) for relapsed/refractory (r/r) follicular lymphoma (FL) demonstrated high rates of durable response and tolerable toxicity among treated patients. To quantify the value of axi-cel compared with standard of care (SOC) to manage r/r FL patients who have had at least 2 prior lines of systemic therapy (3L+), a cost-effectiveness model was developed from a US third-party payer perspective. METHODS A 3-state partitioned-survival cost-effectiveness model was developed with a lifetime horizon. Patient-level analyses of the 36-month ZUMA-5 (axi-cel) and SCHOLAR-5 (SOC) studies were used to extrapolate progression-free and overall survivals. After 5 years of survival, an estimated 40% of the modeled population was assumed to experience long-term remission based on literature. Results include the incremental cost-effectiveness ratio (ICER) measured as incremental cost per quality-adjusted life year (QALY) gained. One-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analyses were performed. All outcomes were discounted 3% per year. RESULTS Axi-cel led to an increase of 4.28 life-years, 3.64 QALYs, and a total cost increase of $321 192 relative to SOC, resulting in an ICER of $88 300 per QALY. Across all parameters varied in the one-way sensitivity analysis, the ICER varied between $133 030 and $67 277. In the probabilistic sensitivity analysis, axi-cel had a 99% probability of being cost-effective across 5000 iterations using a $150 000 willingness-to-pay threshold. CONCLUSIONS Given the robustness of the model results and sensitivity analyses, axi-cel is expected to be a cost-effective treatment in 3L+ r/r FL.
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Affiliation(s)
- Olalekan O Oluwole
- Vanderbilt University Medical Center, School of Medicine, Nashville, TN, USA.
| | | | | | - Graeme Ball
- Kite, A Gilead Company, Santa Monica, CA, USA
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Davis O, Lessani C, Kasht R, Cohoon A, Ibrahimi S, Asch A, Day S, Al-Juhaishi T. Impact of Primary Disease Site of Involvement by Early-Stage Follicular Lymphoma on Patient Outcomes. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00269-6. [PMID: 39147647 DOI: 10.1016/j.clml.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/07/2024] [Accepted: 07/11/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Follicular lymphoma is a common non-Hodgkin lymphoma that can start in a diverse array of tissues throughout the body. While the majority of patients may be able to live many years with this disease, cure remains very difficult to achieve. OBJECTIVE We sought to investigate the impact of follicular lymphoma primary disease site in early-stage disease on patient outcomes using a large national database. METHODS Baseline demographic and disease data for patients diagnosed with follicular lymphoma from 2000-2015 was identified and extracted from the NCI Surveillance, Epidemiology, and End Results (SEER) database. Primary disease sites were grouped into one of two cohorts: nodal disease (lymph nodes and spleen) and extranodal disease (everything else). Analysis was performed using summary statistics, Kaplan-Meier method, and Cox-proportional hazards models for univariate and multivariate analysis. RESULTS A total of 13,400 patients were included in the final analysis and the majority were non-Hispanic white (81%), with stage I (63%), and nodal FL (79%). Median overall survival for nodal disease was 15.1 years [95% CI (14.6-15.6)] while median overall survival for extranodal disease was 15.8 years [95% CI (14.9-16.3)]. Overall survival was slightly better for patients with extranodal disease [HR = 0.89, 95% CI (0.84-0.96); p-value = 0.00012]. This finding remained consistent after controlling for age and race [HR = 0.84, 95% CI (0.79-0.90); p-value <0.0001]. CONCLUSIONS The primary site of involvement by early-stage follicular lymphoma may have an impact on patient outcomes and warrants further investigation.
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Affiliation(s)
- Olivia Davis
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Carmen Lessani
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Rana Kasht
- Department of Internal Medicine, OU Health, Oklahoma City, OK
| | - Andrew Cohoon
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Sami Ibrahimi
- Department of Medicine, Section of Hematology and Medical Oncology, OU Health-Stephenson Cancer Center, Oklahoma City, OK
| | - Adam Asch
- Department of Medicine, Section of Hematology and Medical Oncology, OU Health-Stephenson Cancer Center, Oklahoma City, OK
| | - Silas Day
- Department of Medicine, Section of Hematology and Medical Oncology, OU Health-Stephenson Cancer Center, Oklahoma City, OK
| | - Taha Al-Juhaishi
- Department of Medicine, Section of Hematology and Medical Oncology, OU Health-Stephenson Cancer Center, Oklahoma City, OK.
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Fowler NH, Chavez JC, Riedell PA. Moving T-Cell Therapies into the Standard of Care for Patients with Relapsed or Refractory Follicular Lymphoma: A Review. Target Oncol 2024; 19:495-510. [PMID: 38896212 PMCID: PMC11271334 DOI: 10.1007/s11523-024-01070-z] [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] [Accepted: 05/06/2024] [Indexed: 06/21/2024]
Abstract
Patients with follicular lymphoma, an indolent form of non-Hodgkin lymphoma, typically experience multiple relapses over their disease course. Periods of remission become progressively shorter with worse clinical outcomes after each subsequent line of therapy. Currently, no clear standard of care/preferred treatment approach exists for patients with relapsed or refractory follicular lymphoma. As novel agents continue to emerge for treatment in the third-line setting, guidance is needed for selecting the most appropriate therapy for each patient. Several classes of targeted therapeutic agents, including monoclonal antibodies, phosphoinositide 3-kinase inhibitors, enhancer of zeste homolog 2 inhibitors, chimeric antigen receptor (CAR) T-cell therapies, and bispecific antibodies, have been approved by regulatory authorities based on clinical benefit in patients with relapsed or refractory follicular lymphoma. Additionally, antibody-drug conjugates and other immunocellular therapies are being evaluated in this setting. Effective integration of CAR-T cell therapy into the treatment paradigm after two or more prior therapies requires appropriate patient selection based on transformation status following a rebiopsy; a risk evaluation based on age, fitness, and remission length; and eligibility for CAR-T cell therapy. Consideration of important logistical factors (e.g., proximity to the treatment center and caregiver support during key periods of CAR-T cell therapy) is also critical. Overall, an individualized treatment plan that considers patient-related factors (e.g., age, disease status, tumor burden, comorbidities) and prior treatment types is recommended for patients with relapsed or refractory follicular lymphoma. Future analyses of real-world data and a better understanding of mechanisms of relapse are needed to further refine patient selection and identify optimal sequencing of therapies in this setting.
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Affiliation(s)
| | - Julio C Chavez
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Peter A Riedell
- David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL, USA
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Watanabe T, Tobinai K, Wakabayashi M, Maruyama D, Yamamoto K, Kubota N, Shimada K, Asagoe K, Yamaguchi M, Ando K, Ogura M, Kuroda J, Suehiro Y, Matsuno Y, Tsukasaki K, Nagai H. R-CHOP treatment for patients with advanced follicular lymphoma: Over 15-year follow-up of JCOG0203. Br J Haematol 2024; 204:849-860. [PMID: 37996986 DOI: 10.1111/bjh.19213] [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: 09/01/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
Anti-CD20 antibody in combination with chemotherapy extends overall survival (OS) in untreated advanced-stage follicular lymphoma (FL), yet the optimal associated therapy is unclear. Data on the cumulative incidence of secondary malignancies postrelapse after conventional immunochemotherapy are scarce. A long-term analysis of rituximab combined with cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) as first-line treatment was conducted in a randomised clinical trial. A six-cycle R-CHOP regimen was administered every 2 or 3 weeks without rituximab maintenance. A prespecified evaluation was conducted 15 years after the completion of enrolment, following initial analysis results that showed no significant differences in outcomes at the 3-year mark. In-depth analyses were performed on the cohort of 248 patients with FL who were allocated to the two treatment arms. With a median follow-up period of 15.9 years, the 15-year OS was 76.2%. There were no protocol treatment-related deaths, nor were there any fatal infections attributable to subsequent lymphoma treatment. At 15 years, the cumulative incidence of non-haematological and haematological malignancies was 12.8% and 3.7% respectively. Histological transformation appeared after a median of 8 years. R-CHOP maintains safety and efficacy in patients with advanced FL over extended follow-up, making it a viable first-line option for patients with advanced-stage FL.
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Affiliation(s)
- Takashi Watanabe
- Department of Haematology, National Cancer Center Hospital, Tokyo, Japan
| | - Kensei Tobinai
- Department of Haematology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Dai Maruyama
- Department of Haematology, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuhito Yamamoto
- Department of Haematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan
| | - Nobuko Kubota
- Department of Haematology, Saitama Cancer Center, Saitama, Japan
| | - Kazuyuki Shimada
- Department of Haematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kohsuke Asagoe
- Department of Haematology and Oncology, Shiga General Hospital, Moriyama, Japan
| | - Motoko Yamaguchi
- Department of Haematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kiyoshi Ando
- Division of Haematology/Oncology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Michinori Ogura
- Department of Haematology and Oncology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Junya Kuroda
- Division of Haematology and Oncology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Youko Suehiro
- Department of Haematology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yoshihiro Matsuno
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Kunihiro Tsukasaki
- Department of Haematology, International Medical Center, Saitama Medical University, Moriyama, Japan
| | - Hirokazu Nagai
- Department of Haematology and Oncology Research National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
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Neelapu SS, Chavez JC, Sehgal AR, Epperla N, Ulrickson M, Bachy E, Munshi PN, Casulo C, Maloney DG, de Vos S, Reshef R, Leslie LA, Oluwole OO, Yakoub-Agha I, Khanal R, Rosenblatt J, Korn R, Peng W, Lui C, Wulff J, Shen R, Poddar S, Jung AS, Miao H, Beygi S, Jacobson CA. Three-year follow-up analysis of axicabtagene ciloleucel in relapsed/refractory indolent non-Hodgkin lymphoma (ZUMA-5). Blood 2024; 143:496-506. [PMID: 37879047 PMCID: PMC10934297 DOI: 10.1182/blood.2023021243] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023] 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) follicular lymphoma (FL). Approval was supported by the phase 2, multicenter, single-arm ZUMA-5 study of axi-cel for patients with R/R indolent non-Hodgkin lymphoma (iNHL; N = 104), including FL and marginal zone lymphoma (MZL). In the primary analysis (median follow-up, 17.5 months), the overall response rate (ORR) was 92% (complete response rate, 74%). Here, we report long-term outcomes from ZUMA-5. Eligible patients with R/R iNHL after ≥2 lines of therapy underwent leukapheresis, followed by lymphodepleting chemotherapy and axi-cel infusion (2 × 106 CAR T cells per kg). The primary end point was ORR, assessed in this analysis by investigators in all enrolled patients (intent-to-treat). After median follow-up of 41.7 months in FL (n = 127) and 31.8 months in MZL (n = 31), ORR was comparable with that of the primary analysis (FL, 94%; MZL, 77%). Median progression-free survival was 40.2 months in FL and not reached in MZL. Medians of overall survival were not reached in either disease type. Grade ≥3 adverse events of interest that occurred after the prior analyses were largely in recently treated patients. Clinical and pharmacokinetic outcomes correlated negatively with recent exposure to bendamustine and high metabolic tumor volume. After 3 years of follow-up in ZUMA-5, axi-cel demonstrated continued durable responses, with very few relapses beyond 2 years, and manageable safety in patients with R/R iNHL. The ZUMA-5 study was registered at www.clinicaltrials.gov as #NCT03105336.
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Affiliation(s)
- Sattva S. Neelapu
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Alison R. Sehgal
- University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA
| | | | | | | | | | - Carla Casulo
- Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | | | - Sven de Vos
- Ronald Reagan University of California Los Angeles Medical Center, Santa Monica, CA
| | - Ran Reshef
- Columbia University Herbert Irving Comprehensive Cancer Center, New York City, NY
| | - Lori A. Leslie
- John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, NJ
| | | | - Ibrahim Yakoub-Agha
- INSERM U1286, Infinite, Centre Hospitalier Universitaire de Lille, Lille, France
| | | | - Joseph Rosenblatt
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
| | | | | | | | | | - Rhine Shen
- Kite, a Gilead company, Santa Monica, CA
| | | | | | - Harry Miao
- Kite, a Gilead company, Santa Monica, CA
| | - Sara Beygi
- Kite, a Gilead company, Santa Monica, CA
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Ferreri AJM, Zinzani PL, Messina C, Valsecchi D, Rendace MC, Premoli E, Giacomini E, Veronesi C, Degli Esposti L, Di Matteo P. Burden of Illness in Follicular Lymphoma with Multiple Lines of Treatment, Italian RWE Analysis. Cancers (Basel) 2023; 15:4403. [PMID: 37686679 PMCID: PMC10486445 DOI: 10.3390/cancers15174403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/13/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
This real-world analysis investigated patients with follicular lymphoma in Italy receiving three or more treatment lines (≥3L), focusing on therapeutic pathways with their rebounds on healthcare resource consumptions and costs. Data were retrieved from administrative databases from healthcare entities covering about 13.3 million residents. Adults diagnosed with follicular lymphoma were identified between January 2015 and June 2020, and among them 2434 patients with ≥3L of treatment during the data availability interval (January 2009 to June 2021) were included. Of them, 1318 were in 3L, 494 in 4L and 622 in ≥5L. A relevant proportion of patients (12-32%) switched to a later line within the same calendar year. At 3-year follow-up (median), 34% patients died. Total mean annual expenses were euro 14,508 in the year preceding inclusion and rose to euro 21,081 at 1-year follow-up (on average euro 22,230/patient/year for the whole follow-up), with hospitalization and drug expenses as weightiest cost items. In conclusion, the clinical and economic burden of follicular lymphoma increases along with later treatment lines. The high mortality rates indicate that further efforts are needed to optimize disease management.
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Affiliation(s)
| | - Pier Luigi Zinzani
- Istituto di Ematologia “Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, 40126 Bologna, Italy
| | - Carlo Messina
- Novartis Farma S.p.A., 20154 Milan, Italy; (C.M.); (D.V.); (M.C.R.); (E.P.); (P.D.M.)
| | - Diletta Valsecchi
- Novartis Farma S.p.A., 20154 Milan, Italy; (C.M.); (D.V.); (M.C.R.); (E.P.); (P.D.M.)
| | - Maria Chiara Rendace
- Novartis Farma S.p.A., 20154 Milan, Italy; (C.M.); (D.V.); (M.C.R.); (E.P.); (P.D.M.)
| | - Eleonora Premoli
- Novartis Farma S.p.A., 20154 Milan, Italy; (C.M.); (D.V.); (M.C.R.); (E.P.); (P.D.M.)
| | - Elisa Giacomini
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Via Murri, 40137 Bologna, Italy; (E.G.); (C.V.)
| | - Chiara Veronesi
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Via Murri, 40137 Bologna, Italy; (E.G.); (C.V.)
| | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Via Murri, 40137 Bologna, Italy; (E.G.); (C.V.)
| | - Paola Di Matteo
- Novartis Farma S.p.A., 20154 Milan, Italy; (C.M.); (D.V.); (M.C.R.); (E.P.); (P.D.M.)
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Kambhampati S, Shouse G, Danilov AV. Thinking "outside the germinal center": Re-educating T cells to combat follicular lymphoma. Blood Rev 2023; 61:101099. [PMID: 37173225 DOI: 10.1016/j.blre.2023.101099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/04/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Abstract
There have been significant advancements in the management of follicular lymphoma (FL), the most common indolent lymphoma. These include immunomodulatory agents such as lenalidomide, epigenetic modifiers (tazemetostat), and phosphoinotiside-3 kinase inhibitors (copanlisib). The focus of this review is T cell-engager therapies, namely chimeric antigen receptor (CAR) T-cell therapy and bispecific antibodies, have recently transformed the treatment landscape of FL. Two CAR T cell products, axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel), and one bispecific antibody, mosunetuzumab, recently received FDA approvals in FL. Several other new immune effector drugs are being evaluated and will expand the treatment armamentarium. This review focuses on CAR T-cell and bispecific antibody therapies, details their safety and efficacy and considers their evolving role in the current treatment landscape of FL.
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8
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Kuruvilla J, Ewara EM, Elia-Pacitti J, Ng R, Eberg M, Kukaswadia A, Sharma A. Estimating the Burden of Illness of Relapsed Follicular Lymphoma and Marginal Zone Lymphoma in Ontario, Canada. Curr Oncol 2023; 30:4663-4676. [PMID: 37232810 DOI: 10.3390/curroncol30050352] [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: 03/14/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Many patients with advanced follicular lymphoma (FL) and marginal zone lymphoma (MZL) relapse after first-line chemotherapy. OBJECTIVE To examine healthcare resource utilization (HCRU) and cost, treatment patterns, progression, and survival of patients with FL and MZL who relapse after first-line treatment, in Ontario, Canada. METHODS A retrospective, administrative data study identified patients with relapsed FL and MZL (1 January 2005-31 December 2018). Patients were followed for up to three years post relapse to assess HCRU, healthcare costs, time to next treatment (TTNT), and overall survival (OS), stratified by first- and second-line treatment. RESULTS The study identified 285 FL and 68 MZL cases who relapsed after first-line treatment. Average duration of first-line treatment was 12.4 and 13.4 months for FL and MZL patients, respectively. Drug (35.9%) and cancer clinic costs (28.1%) were major contributors to higher costs in year 1. Three-year OS was 83.9% after FL and 74.2% after MZL relapse. No statistically significant differences were observed in TTNT and OS between patients with FL who received R-CHOP/R-CVP/BR in the first line only versus both the first- and second- line. A total of 31% of FL and 34% of MZL patients progressed to third-line treatment within three years of initial relapse. CONCLUSION Relapsing and remitting nature of FL and MZL in a subset of patients results in substantial burden to patients and the healthcare system.
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Affiliation(s)
- John Kuruvilla
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2C1, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 3H7, Canada
| | - Emmanuel M Ewara
- Market Access, Janssen Canada Inc., 19 Green Belt Drive, North York, ON M3C 1L9, Canada
| | - Julia Elia-Pacitti
- Medical Affairs, Janssen Canada Inc., 19 Green Belt Drive, North York, ON M3C 1L9, Canada
| | - Ryan Ng
- Real World Solutions, IQVIA, 16720 Rte Transcanadienne, Kirkland, QC H9H 5M3, Canada
| | - Maria Eberg
- Real World Solutions, IQVIA, 16720 Rte Transcanadienne, Kirkland, QC H9H 5M3, Canada
| | - Atif Kukaswadia
- Real World Solutions, IQVIA, 300-6700 Century Avenue, Mississauga, ON L5N 6A4, Canada
| | - Arushi Sharma
- Real World Solutions, IQVIA, 535 Legget Drive, Tower C, 7th Floor, Ottawa, ON K2K 3B8, Canada
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Rivero A, Mozas P, Magnano L, López-Guillermo A. Novel targeted drugs for follicular and marginal zone lymphoma: a comprehensive review. Front Oncol 2023; 13:1170394. [PMID: 37207160 PMCID: PMC10189145 DOI: 10.3389/fonc.2023.1170394] [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: 02/20/2023] [Accepted: 04/03/2023] [Indexed: 05/21/2023] Open
Abstract
Although mostly incurable, indolent non-Hodgkin lymphomas (iNHL) are chronic diseases with a median overall survival approaching 20 years. In recent years, important advances in the knowledge of the biology of these lymphomas have led to the development of new drugs, mostly chemotherapy-free, with promising outcomes. With a median age of around 70 years at diagnosis, many patients with iNHL suffer from comorbid conditions that may limit treatment options. Therefore, nowadays, in the transition towards personalized medicine, several challenges lie ahead, such as identifying predictive markers for the selection of treatment, the adequate sequencing of available therapies, and the management of new and accumulated toxicities. In this review, we include a perspective on recent therapeutic advances in follicular and marginal zone lymphoma. We describe emerging data on approved and emerging novel therapies, such as targeted therapies (PI3K inhibitors, BTK inhibitors, EZH2 inhibitors), monoclonal antibodies and antibody-drug conjugates. Finally, we describe immune-directed approaches such as combinations with lenalidomide or the even more innovative bispecific T-cell engagers and chimeric antigen receptor T-cell therapy, which can achieve a high rate of durable responses with manageable toxicities, further obviating the need for chemotherapy.
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Affiliation(s)
- Andrea Rivero
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pablo Mozas
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- *Correspondence: Pablo Mozas,
| | - Laura Magnano
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Armando López-Guillermo
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
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10
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Dixon JG, Çağlayan Ç, Chihara D, Nielsen T, Dimier N, Zheng J, Wall AK, Salles G, Morschhauser F, Marcus R, Herold M, Kimby E, Blum KA, Ghielmini M, Shi Q, Flowers CR. Factors Affecting the Clinical Course of Follicular Lymphoma: A Multistate Survival Analysis Using Individual Patient Data from Eight Multicenter Randomized Clinical Trials. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e1009-e1018. [PMID: 36045021 PMCID: PMC11265299 DOI: 10.1016/j.clml.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/19/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION/BACKGROUND Leveraging the Follicular Lymphoma Analysis of Surrogacy Hypothesis database of individual patient data from first-line clinical trials, we studied the clinical course of follicular lymphoma (FL) and investigated clinical factors associated with FL outcomes. PATIENTS AND METHODS We examined 2428 patients from 8 randomized trials using multistate survival models with 4 states: induction treatment, progression, death from FL, and death from other causes. We utilized Aalen-Johansen estimator and Cox models to assess the likelihood of FL outcomes and quantify predictors' effects. RESULTS Two-year progression, FL-related death, and death from other causes estimates were 26.5%, 3.4% and 1.4%, respectively. FL-associated deaths were the primary cause of mortality within 10 years of follow-up. Male sex (hazard ratio: 1.25; 95% confidence interval: 1.05-1.47), > 4 involved nodal areas (1.51; 1.23-1.86), elevated LDH (1.20; 1.01-1.43), low hemoglobin (1.44; 1.15-1.81), and elevated β-2 levels (1.23; 1.02-1.47) increased risk of progression. CD20-targeting agents reduced risks for progression (0.29; 0.22-0.39), death from FL (0.05; 0.01-0.20), and death from other causes without progression (0.13; 0.05-0.33) and following progression (0.52; 0.30-0.92). Estimated 2-year progression rates were 22.3% and 43.5% with or without CD20-targeting agents, respectively. Two-year FL-associated mortality rate was 8.3% among patients without CD20-targeting agents, 5.4% with B-symptoms, 4.9% with elevated LDH, and 9.1% with low hemoglobin. CONCLUSION This study identified independent contributions of baseline clinical factors to distinct outcomes for patients with FL following first-line therapy on a clinical trial. Similar analytical approaches are needed to increase understanding of factors that influence FL outcomes in other settings.
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Affiliation(s)
- Jesse G Dixon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.
| | - Çağlar Çağlayan
- Asymmetric Operations Sector, Johns Hopkins University Applied Physics Laboratory, Laurel, MD
| | - Dai Chihara
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, University of Texas, Houston, TX
| | - Tina Nielsen
- Department of Biostatistics, Roche Products Ltd, Welwyn Garden City, Hertfordshire, United Kingdom
| | - Natalie Dimier
- Department of Biostatistics, Roche Products Ltd, Welwyn Garden City, Hertfordshire, United Kingdom
| | | | - Anna K Wall
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Gilles Salles
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Franck Morschhauser
- Department of Hematology, University of Lille, Lille, Hauts-de-France, France
| | - Robert Marcus
- Department of Haematology, Addenbrookes Hospital, Cambridge, Cambridgeshire, United Kingdom
| | - Michael Herold
- Helios Klinikum Erfurt, Onkologisches Zentrum, Erfurt, Thuringia, Germany
| | - Eva Kimby
- Unit for Hematology Karolinska University Hospital, Stockholm, Sweden
| | - Kristie A Blum
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Michele Ghielmini
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Ticino, Switzerland
| | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Christopher R Flowers
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, University of Texas, Houston, TX
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11
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Ge J, Lei Y, Wen Q, Zhang Y, Kong X, Wang W, Qian S, Hou H, Wang Z, Wu S, Dong M, Ding M, Wu X, Feng X, Zhu L, Zhang M, Chen Q, Zhang X. The prognostic nutritional index, an independent predictor of overall survival for newly diagnosed follicular lymphoma in China. Front Nutr 2022; 9:981338. [PMID: 36276809 PMCID: PMC9579693 DOI: 10.3389/fnut.2022.981338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The prognostic nutritional index (PNI) is an important prognostic factor for survival outcomes in various hematological malignancies. The current study focused on exploring the predictive value of the PNI in newly diagnosed follicular lymphoma (FL) in China. Materials and methods The clinical indicators and follow-up data of 176 patients who received chemotherapy or immunotherapy combined with chemotherapy with FL in our hospital from January 2016 to March 2022 were retrospectively analyzed. Cox proportional hazard model was used for univariate and multivariate analyses. Kaplan–Meier curves were used to calculate survival rates and draw survival curves. The log-rank test was applied to compare differences between groups. Results The optimal cut-off value of PNI was 44.3. All patients were divided into a high PNI group (>44.3) and a low PNI group (≤44.3). The low PNI group had a low CR rate and a high risk of death, with a tendency toward POD24, and Both OS and PFS were worse than those in the high PNI group. PNI was able to predict OS and PFS in FL patients and was the only independent predictor of OS (P = 0.014 HR 5.024; 95%CI 1.388∼18.178) in multivariate analysis. PNI could re-stratify patients into groups of high FLIPI score, high FLIPI2 score, no POD24, and rituximab combined with chemotherapy. Moreover, integrating PNI into the FLIPI and FLIPI2 models improved the area under the curve (AUC) for more accurate survival prediction and prognosis. Conclusion PNI is a significant prognostic indicator for newly diagnosed FL in China that can early identify patients with poor prognosis and guide clinical treatment decisions.
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12
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Rajamäki A, Hujo M, Sund R, Prusila REI, Kuusisto MEL, Kuitunen H, Jantunen E, Mercadal S, Sorigue M, Sancho J, Sunela K, Kuittinen O. Mortality among patients with low-grade follicular lymphoma: A binational retrospective analysis. Cancer 2022; 128:2474-2482. [PMID: 35417924 PMCID: PMC9325396 DOI: 10.1002/cncr.34221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The life expectancy of patients with follicular lymphoma (FL) has improved considerably since the introduction of rituximab. This study examined the proportion of deaths from progressive lymphoma and the impact of FL on survival compared with that in the general population. METHODS Altogether, 749 patients with grades 1 and 2 FL in 9 institutions between 1997 and 2016 were enrolled. Competing risk models were used to estimate the cumulative incidences of deaths from progressive lymphoma and from other reasons. Excess mortality was analyzed with respect to the corresponding background populations standardized for age and sex using the excess mortality model based on the penalized spline approach. RESULTS The median follow-up duration was 69 months (range, 0-226 months). The estimated 10-year overall, disease-specific, and net survival rates were 72.4%, 86.6%, and 86.4%, respectively. The cumulative incidence of deaths from progressive lymphoma was slightly smaller than that of other causes in the study population (estimated 10-year cumulative incidences: 12.3% [95% CI, 9.6%-15.3%] and 15.4% [95% CI, 12.2%-18.8%], respectively). Excess mortality was observed for up to 10 years after diagnosis, and it slightly increased with time. CONCLUSIONS Deaths from progressive lymphoma are nearly as common as deaths from other causes in FL patients during the rituximab era. Despite the improvements in survival, there was evidence of excess mortality resulting from FL for at least 10 years after diagnosis.
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Affiliation(s)
- Aino Rajamäki
- Department of OncologyCentral Finland Central HospitalJyväskyläFinland
- University of Eastern FinlandKuopioFinland
| | - Mika Hujo
- University of Eastern FinlandKuopioFinland
| | - Reijo Sund
- University of Eastern FinlandKuopioFinland
| | | | - Milla E. L. Kuusisto
- University of Oulu and Oulu University HospitalOuluFinland
- Department of HematologyOulu University HospitalOuluFinland
| | - Hanne Kuitunen
- Department of OncologyOulu University HospitalOuluFinland
| | - Esa Jantunen
- University of Eastern FinlandKuopioFinland
- Department of MedicineKuopio University HospitalKuopioFinland
- Department of MedicineNorth Carelia Central HospitalJoensuuFinland
| | - Santiago Mercadal
- Institut Català d'Oncologia‐Hospital Duran i ReynalsL'HospitaletSpain
| | - Marc Sorigue
- Department of HematologyInstitut Català d'Oncologia‐Hospital Germans Trias i PujolFunctional Cytomics‐Institut Josep CarrerasBadalonaSpain
| | - Juan‐Manuel Sancho
- Department of HematologyInstitut Català d'Oncologia‐Hospital Germans Trias i PujolFunctional Cytomics‐Institut Josep CarrerasBadalonaSpain
| | - Kaisa Sunela
- Department of OncologyTampere University HospitalTampereFinland
| | - Outi Kuittinen
- University of Eastern FinlandKuopioFinland
- University of Oulu and Oulu University HospitalOuluFinland
- Department of OncologyKuopio University HospitalKuopioFinland
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13
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Qualls D, Salles G. Prospects in the management of patients with follicular lymphoma beyond first-line therapy. Haematologica 2022; 107:19-34. [PMID: 34985231 PMCID: PMC8719064 DOI: 10.3324/haematol.2021.278717] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 10/05/2021] [Indexed: 12/25/2022] Open
Abstract
The management of patients with relapsed or refractory follicular lymphoma has evolved markedly in the last decade, with the availability of new classes of agents (phosphoinositide 3-kinase inhibitors, immunomodulators, epigenetic therapies, and chimeric antigen receptor T cells) supplementing the multiple approaches already available (cytotoxic agents, anti-CD20 antibodies, radiation therapy, radioimmunotherapy, and autologous and allogeneic transplants). The diversity of clinical scenarios, the flood of data derived from phase II studies, and the lack of randomized studies comparing treatment strategies preclude firm recommendations and require personalized decisions. Patients with early progression require specific attention given the risk of histological transformation and their lower response to standard therapies. In sequencing therapies, one must consider prior treatment regimens and the potential need for future lines of therapy. Careful evaluation of risks and expected benefits of available options, which vary depending on location and socioeconomics, should be undertaken, and should incorporate the patient's goals. Preserving quality of life for these patients is essential, given the likelihood of years to decades of survival and the possibility of multiple lines of therapy. The current landscape is likely to continue evolving rapidly with other effective agents emerging (notably bispecific antibodies and other targeted therapies), and multiple combinations being evaluated. It is hoped that new treatments under development will achieve longer progression-free intervals and minimize toxicity. A better understanding of disease biology and the mechanisms of these different agents should provide further insights to select the optimal therapy at each stage of disease.
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Affiliation(s)
- David Qualls
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Gilles Salles
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; Weill Cornell Medicine, New York, NY, USA.
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14
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Watanabe T. Approaches of the Innate Immune System to Ameliorate Adaptive Immunotherapy for B-Cell Non-Hodgkin Lymphoma in Their Microenvironment. Cancers (Basel) 2021; 14:cancers14010141. [PMID: 35008305 PMCID: PMC8750340 DOI: 10.3390/cancers14010141] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/14/2021] [Accepted: 12/23/2021] [Indexed: 12/21/2022] Open
Abstract
A dominant paradigm being developed in immunotherapy for hematologic malignancies is of adaptive immunotherapy that involves chimeric antigen receptor (CAR) T cells and bispecific T-cell engagers. CAR T-cell therapy has yielded results that surpass those of the existing salvage immunochemotherapy for patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) after first-line immunochemotherapy, while offering a therapeutic option for patients with follicular lymphoma (FL) and mantle cell lymphoma (MCL). However, the role of the innate immune system has been shown to prolong CAR T-cell persistence. Cluster of differentiation (CD) 47-blocking antibodies, which are a promising therapeutic armamentarium for DLBCL, are novel innate immune checkpoint inhibitors that allow macrophages to phagocytose tumor cells. Intratumoral Toll-like receptor 9 agonist CpG oligodeoxynucleotide plays a pivotal role in FL, and vaccination may be required in MCL. Additionally, local stimulator of interferon gene agonists, which induce a systemic anti-lymphoma CD8+ T-cell response, and the costimulatory molecule 4-1BB/CD137 or OX40/CD134 agonistic antibodies represent attractive agents for dendritic cell activations, which subsequently, facilitates initiation of productive T-cell priming and NK cells. This review describes the exploitation of approaches that trigger innate immune activation for adaptive immune cells to operate maximally in the tumor microenvironment of these lymphomas.
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Affiliation(s)
- Takashi Watanabe
- Department of Personalized Cancer Immunotherapy, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu City 514-8507, Japan
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15
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Mozas P, Rivero A, Rivas-Delgado A, Nadeu F, Giné E, Delgado J, Villamor N, Campo E, Pérez-Galán P, Magnano L, López-Guillermo A. The Prognostic Nutritional Index (PNI) is an independent predictor of overall survival in older patients with follicular lymphoma. Leuk Lymphoma 2021; 63:903-910. [PMID: 34844497 DOI: 10.1080/10428194.2021.2010064] [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: 10/19/2022]
Abstract
The Prognostic Nutritional Index (PNI), a parameter combining serum albumin concentration and absolute lymphocyte count, is considered a measure of the nutritional and inflammatory status and the host's anti-tumor response. We analyzed the clinical characteristics and outcomes according to the PNI of 351 grades 1-3 A FL patients. Forty-one patients (12%) had a PNI ≤45, who were older and showed adverse baseline features. A low PNI was associated with a shorter PFS (only for patients >60 years), and OS (for all patients, 10-year OS, 52% versus 74%, p = 0.0001). The prognostic impact of the PNI on OS was confirmed in a multivariate model for patients >60 years (HR = 3, p = 0.006). In conclusion, the PNI is a readily accessible piece of information that can identify a small subset of FL patients with shorter survival, and it could be an aid to improve the nutritional status of patients prior to treatment initiation.
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Affiliation(s)
- Pablo Mozas
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Andrea Rivero
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Ferran Nadeu
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Eva Giné
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Julio Delgado
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Neus Villamor
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Hematopathology Unit, Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Elías Campo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Hematopathology Unit, Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - Patricia Pérez-Galán
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Laura Magnano
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Armando López-Guillermo
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Universitat de Barcelona, Barcelona, Spain
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16
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Kim M, Hwang HS, Cho H, Yoon DH, Suh C, Park CS, Go H, Huh J. Upward trend in follicular lymphoma among the Korean population: 10-year experience at a large tertiary institution. J Pathol Transl Med 2021; 55:330-337. [PMID: 34465079 PMCID: PMC8476319 DOI: 10.4132/jptm.2021.07.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/25/2021] [Indexed: 01/31/2023] Open
Abstract
Background Follicular lymphoma (FL) is the second most common non-Hodgkin lymphoma (NHL) in Western countries. However, it is relatively rare in Asia. This study examined epidemiologic characteristics of FL in South Korea, with an emphasis on recent trends of increase in cases. Methods We retrospectively examined 239 cases of newly diagnosed FL at a large tertiary institution in Korea (Asan Medical Center, Seoul, Republic of Korea) between 2008 and 2017. Age-adjusted incidence rates and clinicopathological variables were analyzed, and joinpoint regression analysis was used to identify the changes. Results The age-adjusted incidence of FL significantly increased during the study period (p = .034), and the ratio of (relative incidence) patients with FL to patients with NHL increased from 4.28% to 9.35% in the same period. Over the 10-year study assessment duration, the proportion of patients with stage III/IV FL (p = .035) and expression of BCL2 (p = .022) or BCL6 (p = .039) significantly increased. From 2013–2017, the proportion of patients with highrisk Follicular Lymphoma International Prognostic Index (FLIPI) score increased (21.5% to 28.7%), whereas that of low-risk FLIPI decreased (55.4% to 38.6%), although those results were not statistically significant (p = .066). Conclusions We found an increasing incidence of FL, with a disproportionate increase in the incidence of high-stage disease and recent changes in the clinicopathologic features of the Korean patient population.
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Affiliation(s)
- Meejeong Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Sang Hwang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyungwoo Cho
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan Sik Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heounjeong Go
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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17
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Tuscano JM, Poh C, Kaesberg P, Luxardi G, Merleev A, Marusina A, Brunson A, Rosenberg A, Jonas B, Maverakis E. Long-term Follow-up and Correlative Analysis of Two Phase II Trials of Rituximab and Lenalidomide Followed by Continuous Lenalidomide in Untreated and Relapsed/Refractory Indolent Lymphoma. Clin Cancer Res 2021; 27:4726-4736. [PMID: 34088724 PMCID: PMC9262142 DOI: 10.1158/1078-0432.ccr-20-4622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/01/2021] [Accepted: 05/27/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE Rituximab and lenalidomide are effective for previously untreated and relapsed/refractory (R/R) indolent non-Hodgkin lymphoma (iNHL). However, long-term survival and predictive biomarkers are not well described. PATIENTS AND METHODS We conducted two phase II open-label trials involving 60 patients with previously untreated and R/R advanced-stage iNHL. Patients received lenalidomide and rituximab induction followed by continuous lenalidomide until disease progression or unacceptable toxicity. The primary endpoint was overall response rate (ORR). Correlative studies included plasma cytokine monitoring, flow cytometry of peripheral blood mononuclear cells (PBMC; days 0, 15, 30, and 60), and RNA sequencing (RNA-seq) of pretreatment tumor biopsies. RESULTS At a median follow-up of 63 months for previously untreated and 100 months for R/R, ORR was 82% for both. The 11 R/R patients who achieved complete remission remained in continuous remission for 16 to 141 months, thereafter. Median overall survival (OS) was not reached in the previously untreated and was 140 months (95% confidence interval, 53.4-140) in the R/R group. A mixed-effects linear regression model identified significant associations between Granzyme B+ (GranB+) CD8+ T cells and long-term complete response (LTCR; P = 5.3e-4). Furthermore, prior to start of therapy, treatment response could be predicted by B-cell and GranB+ CD8+ T-cell levels (% total lymphocytes). CONCLUSIONS Rituximab plus lenalidomide followed by continuous lenalidomide is effective with manageable toxicity in patients with previously untreated and R/R iNHL. This regimen produces durable remissions, even in heavily pretreated patients, with some lasting greater than 10 years. GranB+ CD8+ T cells, B cells, and plasma IFNγ allowed prediction of LTCR but need validation in larger trials.
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Affiliation(s)
- Joseph M. Tuscano
- University of California, Davis Comprehensive Cancer Center, Sacramento, CA USA,Veterans Administration Northern California Healthcare System, Sacramento, CA, USA
| | - Christina Poh
- University of California, Davis Comprehensive Cancer Center, Sacramento, CA USA,University of Washington, Division of Medical Oncology, Seattle, WA USA
| | - Paul Kaesberg
- University of California, Davis Comprehensive Cancer Center, Sacramento, CA USA
| | - Guillaume Luxardi
- University of California, Davis, Department of Dermatology, Sacramento, CA USA
| | - Alexander Merleev
- University of California, Davis, Department of Dermatology, Sacramento, CA USA
| | - Alina Marusina
- University of California, Davis, Department of Dermatology, Sacramento, CA USA
| | - Ann Brunson
- University of California, Davis Comprehensive Cancer Center, Sacramento, CA USA
| | - Aaron Rosenberg
- University of California, Davis Comprehensive Cancer Center, Sacramento, CA USA
| | - Brian Jonas
- University of California, Davis Comprehensive Cancer Center, Sacramento, CA USA
| | - Emanual Maverakis
- University of California, Davis, Department of Dermatology, Sacramento, CA USA
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18
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Mozas P, Sorigué M, López-Guillermo A. Follicular lymphoma: an update on diagnosis, prognosis, and management. Med Clin (Barc) 2021; 157:440-448. [PMID: 34210513 DOI: 10.1016/j.medcli.2021.03.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
Follicular lymphoma, the most common indolent lymphoma, originates from germinal centre B-cells of the lymphoid follicle, and is characterized by t(14;18). Clinical manifestations include the presence of lymphadenopathy, sometimes accompanied by constitutional symptoms or cytopenia. Diagnosis is established through the identification of a B-cell proliferation of nodular pattern in the lymph node biopsy. Upon staging with PET-CT and bone marrow biopsy, a significant proportion of patients do not need immediate treatment. When therapy is indicated, commonly used regimens include anti-CD20 immunotherapy with or without chemotherapy. Although overall survival for most patients is prolonged, relapses are very frequent, and early relapse and transformation to an aggressive lymphoma portend a much worse prognosis. New therapies are under development, which will most likely change outcomes for FL patients in the near future.
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Affiliation(s)
- Pablo Mozas
- Servicio de Hematología, Hospital Clínic, Barcelona, España.
| | - Marc Sorigué
- Servicio de Hematología, ICO-IJC-Hospital Germans Trias i Pujol, Badalona, España
| | - Armando López-Guillermo
- Servicio de Hematología, Hospital Clínic, Barcelona, España; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, España
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19
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Mozas P, Rivero A, Rivas-Delgado A, Nadeu F, Correa JG, Castillo C, Bataller A, Baumann T, Giné E, Delgado J, Villamor N, Campo E, Magnano L, López-Guillermo A. Age and comorbidity are determining factors in the overall and relative survival of patients with follicular lymphoma. Ann Hematol 2021; 100:1231-1239. [PMID: 33629152 DOI: 10.1007/s00277-021-04470-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/18/2021] [Indexed: 11/12/2022]
Abstract
Frailty and concurrent medical conditions are crucial factors in the management of follicular lymphoma (FL). We evaluated the impact of age and comorbidity on survival, causes of death, histological transformation (HT), and second malignancies (SM) in a large single-center series of grade 1-3A FL. We studied 414 patients diagnosed in the rituximab era, categorized into three age groups (≤60, 61-70, >70 years) and two comorbidity groups (Charlson Comorbidity Index, CCI, 0-1 and ≥2). Despite a similar cumulative incidence of relapse, older and comorbid patients had a lower 10-year overall survival (OS, 88, 65, and 41% for patients ≤60 years, 61-70 years, and >70 years, P<0.0001; and 76 vs. 51% for CCI 0-1 and ≥2, P<0.0001). In a multivariate analysis for OS, comorbidity retained its prognostic impact (HR=2.5, P=0.0003). The proportion of patients dying due to FL was higher among those ≤60 years (74%) and those with a CCI 0-1 (67%). Furthermore, 10-year excess mortality (survival reduction) was more prominent for patients >70 years (30%) and those with a CCI ≥2 (32%). Patients with a CCI ≥2 also had a higher incidence of SM. These data encourage a comprehensive pre-treatment evaluation and a tailored therapeutic approach for all FL patients.
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Affiliation(s)
- Pablo Mozas
- Department of Hematology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain.
| | - Andrea Rivero
- Department of Hematology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | | | - Ferran Nadeu
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Juan Gonzalo Correa
- Department of Hematology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - Carlos Castillo
- Department of Hematology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - Alex Bataller
- Department of Hematology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - Tycho Baumann
- Department of Hematology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Eva Giné
- Department of Hematology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Julio Delgado
- Department of Hematology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Neus Villamor
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
- Hematopathology Unit, Department of Pathology, Hospital Clínic, Barcelona, Spain
| | - Elías Campo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
- Hematopathology Unit, Department of Pathology, Hospital Clínic, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Laura Magnano
- Department of Hematology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Armando López-Guillermo
- Department of Hematology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
- University of Barcelona, Barcelona, Spain
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20
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Rajamäki A, Sunela K, Prusila REI, Kuusisto MEL, Mercadal S, Selander T, Kuitunen H, Pollari M, Jantunen E, Nystrand I, Sancho JM, Sorigue M, Kuittinen O. Female patients with follicular lymphoma have a better prognosis if primary remission lasts over 24 months. Leuk Lymphoma 2021; 62:1639-1647. [PMID: 33546574 DOI: 10.1080/10428194.2021.1872073] [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] [Indexed: 01/03/2023]
Abstract
Findings regarding the role of sex in follicular lymphoma (FL) are contradictory and the prognostic value of sex among patients with early progression of disease (POD) remains unclear. We collected real-life data from nine hospitals in Finland and Spain including 1020 FL patients to study the influence of sex on disease outcome. The median follow-up duration was 67 months (range 0-226 months). Female patients showed better progression-free survival (PFS) (hazard ratio [HR], 0.720; 95% confidence interval [CI], 0.588-0.881), disease-specific survival (DSS) (HR, 0.653; 95% CI, 0.448-0.951), and overall survival (OS) (HR, 0.653; 95% CI, 0.501-0.853) than male patients. However, there were no significant sex differences in prognosis in patients with early POD. This study strengthens the understanding that male sex is an adverse prognostic factor for FL. However, this difference does not apply to patients with early POD.
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Affiliation(s)
- Aino Rajamäki
- Department of Oncology, Central Finland Central Hospital, Jyväskylä, Finland.,Institute of Clinical Medicine, Faculty of Health Medicine, University of Eastern Finland, Kuopio, Finland
| | - Kaisa Sunela
- Department of Oncology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland
| | - Roosa E I Prusila
- Medical Research Centre and Cancer and Translational Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Milla E L Kuusisto
- Medical Research Centre and Cancer and Translational Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland.,Department of Haematology, Oulu University Hospital, Oulu, Finland
| | | | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Hanne Kuitunen
- Department of Oncology, Oulu University Hospital, Oulu, Finland
| | - Marjukka Pollari
- Department of Oncology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland
| | - Esa Jantunen
- Institute of Clinical Medicine, Faculty of Health Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Medicine, Kuopio University Hospital, Kuopio, Finland.,Department of Medicine, North Carelia Central Hospital, Joensuu, Finland
| | - Ilja Nystrand
- Research Program Unit, Medical Faculty, University of Helsinki, Finland
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Functional cytomics-IJC, Badalona, Spain
| | - Marc Sorigue
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Functional cytomics-IJC, Badalona, Spain
| | - Outi Kuittinen
- Institute of Clinical Medicine, Faculty of Health Medicine, University of Eastern Finland, Kuopio, Finland.,Medical Research Centre and Cancer and Translational Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland.,Department of Oncology, Kuopio University Hospital, Kuopio, Finland
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21
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Mozas P, Sorigué M, Rivas-Delgado A, Rivero A, Correa JG, Castillo C, Nadeu F, Bataller A, Giné E, Baumann T, Delgado J, Villamor N, Campo E, Magnano L, Sancho JM, López-Guillermo A. The interval between frontline treatment and the second relapse (PFS2) predicts survival from the second relapse in follicular lymphoma patients. Eur J Haematol 2020; 106:428-432. [PMID: 33247499 DOI: 10.1111/ejh.13556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/23/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Pablo Mozas
- Hematology Department, Hospital Clínic, Barcelona, Spain
| | - Marc Sorigué
- Department of Hematology, ICO-IJC-Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Andrea Rivero
- Hematology Department, Hospital Clínic, Barcelona, Spain
| | - Juan G Correa
- Hematology Department, Hospital Clínic, Barcelona, Spain
| | | | - Ferran Nadeu
- Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alex Bataller
- Hematology Department, Hospital Clínic, Barcelona, Spain
| | - Eva Giné
- Hematology Department, Hospital Clínic, Barcelona, Spain
| | - Tycho Baumann
- Hematology Department, Hospital Clínic, Barcelona, Spain
| | - Julio Delgado
- Hematology Department, Hospital Clínic, Barcelona, Spain
| | - Neus Villamor
- Hematopathology Unit, Pathology Department, Hospital Clínic, Barcelona, Spain
| | - Elias Campo
- Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hematopathology Unit, Pathology Department, Hospital Clínic, Barcelona, Spain
| | - Laura Magnano
- Hematology Department, Hospital Clínic, Barcelona, Spain.,Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-IJC-Hospital Germans Trias i Pujol, Badalona, Spain
| | - Armando López-Guillermo
- Hematology Department, Hospital Clínic, Barcelona, Spain.,Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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22
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Mozas P, Rivero A, Rivas-Delgado A, Nadeu F, Clot G, Correa JG, Castillo C, Bataller A, Baumann T, Giné E, Delgado J, Villamor N, Campo E, Pérez-Galán P, Magnano L, López-Guillermo A. A low lymphocyte-to-monocyte ratio is an independent predictor of poorer survival and higher risk of histological transformation in follicular lymphoma. Leuk Lymphoma 2020; 62:104-111. [PMID: 32954916 DOI: 10.1080/10428194.2020.1821010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The lymphocyte-to-monocyte ratio (LMR) is a prognostic factor in different neoplasms, but its potential importance in follicular lymphoma (FL) is not well defined. We studied 384 FL patients for which the LMR was available at diagnosis. Baseline features and outcomes were compared between patients with an LMR ≤/>2.5. The 76 patients (20%) who had an LMR ≤2.5 were older and had a higher tumor burden. A low LMR was predictive of a lower 10-y progression-free survival (32 vs. 55%, p = .001) and overall survival (35 vs. 78%, p < .0001; HR = 2.3, p = .003 in a 6-element multivariable model). A low LMR was also an independent risk factor for histological transformation (11 vs. 6% at 10 years, p = .01). Likewise, patients with a low LMR had a higher rate of second malignancies. The potential utility of this widely available parameter and its contribution to well-established prognostic scores need to be explored in independent, prospective series.
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Affiliation(s)
- Pablo Mozas
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Andrea Rivero
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Ferran Nadeu
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Guillem Clot
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Carlos Castillo
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alex Bataller
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Tycho Baumann
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eva Giné
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Julio Delgado
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Neus Villamor
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Hematopathology Unit, Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Elías Campo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Hematopathology Unit, Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - Patricia Pérez-Galán
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Laura Magnano
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Armando López-Guillermo
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Universitat de Barcelona, Barcelona, Spain
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23
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Tabassum N, Constantin TA, Cereser B, Stebbing J. A cell-cycle signature classifier for pan-cancer analysis. Oncogene 2020; 39:6041-6042. [PMID: 32820254 DOI: 10.1038/s41388-020-01426-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/25/2020] [Accepted: 08/10/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Neha Tabassum
- Department of Surgery and Cancer, Imperial College, London, UK.
| | | | | | - Justin Stebbing
- Department of Surgery and Cancer, Imperial College, London, UK
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24
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Procházka V, Belada D, Janíková A, Benešová K, Mociková H, Ďuraš J, Pirnos J, Kopečková K, Campr V, Fürst T, Pytlík R, Sýkorová A, Michalka J, Dlouhá J, Papajík T, Trněný M. Rituximab maintenance significantly reduces early follicular lymphoma progressions in patients treated with frontline R-CHOP. EJHAEM 2020; 1:170-180. [PMID: 35847728 PMCID: PMC9175682 DOI: 10.1002/jha2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 12/03/2022]
Abstract
Twenty percent of patients with high-tumor-burden (HTB) follicular lymphoma (FL) develop progression/relapse of disease (POD) within 24 months of frontline immunochemotherapy. Unfortunately, about 50% of these patients die within 5 years since POD event. Rituximab maintenance was proven to reduce relapse rate in responding FL, but its role on preventing POD was not defined. We analyzed 1360 HTB-FL patients from the Czech Lymphoma Study Group registry treated with frontline rituximab-containing regimen. Of those, 950 cases received rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and achieved complete or partial remission: 712 patients received rituximab maintenance (MAINT) and 238 were a historical observational cohort (OBS). We have proposed a modified POD24 (mPOD24) endpoint for the chemosensitive patients calculated from the end-of-induction (EOI). Survival rates since EOI were as follows: 5-year overall survival (OS) 86.2% versus 94.5% in the OBS and MAINT groups, respectively (P < .001) and 5-year progression-free survival 58.5% (OBS) and 75.4% (MAINT) (P < .001). The Cox proportional hazards model showed a decrease in mPOD24 incidence in the MAINT group with the overall hazard rate reduced by 56% (hazard ratio = 0.44; P < .001). The cumulative incidence of mPOD24 was reduced from 24.1% in OBS to 10.1% in MAINT (P < .001). Comparison of non-mPOD24 cases showed OS similar to that in the general population. Rituximab maintenance given after R-CHOP resulted in a 2.4-fold reduction in mPOD24 incidence. Once the non-POD24 status is achieved, FL does not shorten the patients' life expectancy.
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Affiliation(s)
- Vít Procházka
- Department of Hemato‐Oncology, Faculty of Medicine and DentistryUniversity Hospital in OlomoucOlomoucCzech Republic
| | - David Belada
- Fourth Department of Internal Medicine – HematologyUniversity HospitalHradec KrálovéCzech Republic
| | - Andrea Janíková
- Department of Hematology and OncologyMasaryk University Hospital BrnoBrnoCzech Republic
| | - Kateřina Benešová
- First Department of Internal Medicine – HematologyFirst Faculty of Medicine and General Teaching HospitalPragueCzech Republic
| | - Heidi Mociková
- Department of Internal Medicine and Hematology, Faculty Hospital Kralovske Vinohrady and Third Faculty of MedicineCharles UniversityPragueCzech Republic
| | - Juraj Ďuraš
- Department of Hemato‐OncologyUniversity Hospital OstravaOstravaCzech Republic
| | - Jan Pirnos
- Department of OncologyHospital České BudějoviceČeské BudějoviceCzech Republic
| | | | - Vít Campr
- Department of Pathology and Molecular MedicineUniversity Hospital in MotolPragueCzech Republic
- Second Faculty of MedicineCharles UniversityPragueCzech Republic
| | - Tomáš Fürst
- Department of Mathematical Analysis and Applications of Mathematics, Faculty of SciencePalacký UniversityOlomoucCzech Republic
| | - Robert Pytlík
- First Department of Internal Medicine – HematologyFirst Faculty of Medicine and General Teaching HospitalPragueCzech Republic
| | - Alice Sýkorová
- Fourth Department of Internal Medicine – HematologyUniversity HospitalHradec KrálovéCzech Republic
| | - Jozef Michalka
- Department of Hematology and OncologyMasaryk University Hospital BrnoBrnoCzech Republic
| | - Jitka Dlouhá
- First Department of Internal Medicine – HematologyFirst Faculty of Medicine and General Teaching HospitalPragueCzech Republic
| | - Tomáš Papajík
- Department of Hemato‐Oncology, Faculty of Medicine and DentistryUniversity Hospital in OlomoucOlomoucCzech Republic
| | - Marek Trněný
- First Department of Internal Medicine – HematologyFirst Faculty of Medicine and General Teaching HospitalPragueCzech Republic
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