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Ryan CE, Cohen JB. Is rituximab retro in mantle cell lymphoma? Blood 2024; 144:241-243. [PMID: 39023870 DOI: 10.1182/blood.2024024711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
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2
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Sarkozy C, Callanan M, Thieblemont C, Obéric L, Burroni B, Bouabdallah K, Damaj G, Tessoulin B, Ribrag V, Houot R, Morschhauser F, Griolet S, Joubert C, Cacheux V, Delwail V, Safar V, Gressin R, Cheminant M, Delfau-Larue MH, Hermine O, Macintyre E, Le Gouill S. Obinutuzumab vs rituximab for transplant-eligible patients with mantle cell lymphoma. Blood 2024; 144:262-271. [PMID: 38669626 DOI: 10.1182/blood.2024023944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/01/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024] Open
Abstract
ABSTRACT Obinutuzumab (O) and rituximab (R) are 2 CD antibodies that have never been compared in a prospective randomized trial of mantle cell lymphoma (MCL). Herein, we report the long-term outcome of the LyMa-101 trial, in which newly diagnosed patients with MCL were treated with chemotherapy plus O before transplantation, followed by O maintenance (O group). We then compared these patients with those treated with the same treatment design with R instead of O (R group). A propensity score matching (PSM) was used to compare the 2 populations (O vs R groups) in terms of measurable residual disease (MRD) at the end of induction (EOI), progression-free survival (PFS), and overall survival (OS). In LyMa-101, the estimated 5-year PFS and OS after inclusion (n = 85) were 83.4% (95% confidence interval [CI], 73.5-89.8) and 86.9% (95% CI, 77.6-92.5), respectively. At EOI, patients treated in the O group had more frequent bone marrow MRD negativity than those treated in the R group (83.1% vs 63.4%; χ2, P = .007). PSM resulted in 2 sets of 82 patients with comparable characteristics at inclusion. From treatment initiation, the O group had a longer estimated 5-year PFS (P = .029; 82.8% vs 66.6%; hazard ratio [HR], 1.99; 95% confidence interval (CI), 1.05-3.76) and OS (P = .039; 86.4% vs 71.4%; HR, 2.08; 95% CI, 1.01-4.16) compared with the R group. Causes of death were comparable in the 2 groups, the most common cause being lymphoma. O before transplantation and in maintenance provides better disease control and enhances PFS and OS compared with R in transplant-eligible patients with MCL. These trials were registered at www.clinicaltrials.gov as #NCT00921414 and NCT02896582.
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MESH Headings
- Humans
- Lymphoma, Mantle-Cell/drug therapy
- Lymphoma, Mantle-Cell/mortality
- Lymphoma, Mantle-Cell/therapy
- Lymphoma, Mantle-Cell/pathology
- Rituximab/administration & dosage
- Rituximab/therapeutic use
- Male
- Female
- Middle Aged
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/administration & dosage
- Aged
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/adverse effects
- Adult
- Hematopoietic Stem Cell Transplantation
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Progression-Free Survival
- Neoplasm, Residual
- Prospective Studies
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Affiliation(s)
- Clémentine Sarkozy
- Service d'hématologie, Institut Curie, Saint Cloud, France
- Université de Versailles Saint-Quentin, Versailles, France
- Laboratoire d'Imagerie Translationnelle en Oncologie, U1288 INSERM/Institut Curie Centre de Recherche, Paris, France
| | - Mary Callanan
- University of Burgundy, INSERM U1231, Unit for Innovation in Genetics and Epigenetics in Oncology, University Hospital, Dijon, France
| | - Catherine Thieblemont
- Service d'Hématologie, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lucie Obéric
- Service d'Hématologie, Institut Universitaire du Cancer Toulouse, Oncopole, Toulouse, France
| | - Barbara Burroni
- Service d'Anatomopathologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Krimo Bouabdallah
- Service d'Hématologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Gandhi Damaj
- Service d'Hématologie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Benoit Tessoulin
- Service d'Hématologie, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Vincent Ribrag
- Département d'Hématologie, Institut Gustave Roussy, Villejuif, France
| | - Roch Houot
- Service d'Hématologie, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Franck Morschhauser
- Department of Hematology, Claude Huriez Hospital, University of Lille, EA 7365, Research Group on Injectable Forms and Associated Technologies, Lille, France
| | - Samuel Griolet
- LYSARC, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | | | - Victoria Cacheux
- Service d'Hématologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Violaine Safar
- Service d'Hématologie, Hôpital Lyon Sud, Pierre Bénite, France
| | - Remy Gressin
- Service d'Hématologie, Centre Hospitalier Universitaire Grenoble, Grenoble, France
| | - Morgane Cheminant
- Department of Clinical Hematology, INSERM U1163, University of Paris, Necker University Hospital, Paris, France
| | - Marie-Hélène Delfau-Larue
- Department of Immunology, INSERM U955 Équipe 9, Institut Mondor de Recherche Biomédicale, Hospital Henri Mondor, Creteil, France
| | - Olivier Hermine
- Department of Clinical Hematology, INSERM U1163, University of Paris, Necker University Hospital, Paris, France
| | - Elizabeth Macintyre
- Laboratory of Onco-Haematology, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, INSERM U1151, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France
| | - Steven Le Gouill
- Service d'hématologie, Institut Curie, Saint Cloud, France
- Université de Versailles Saint-Quentin, Versailles, France
- Laboratoire d'Imagerie Translationnelle en Oncologie, U1288 INSERM/Institut Curie Centre de Recherche, Paris, France
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3
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Yoon SE, Shin SH, Nam DK, Cho J, Kim WS, Kim SJ. Feasibility of Circulating Tumor DNA Analysis in Patients with Follicular Lymphoma. Cancer Res Treat 2024; 56:920-935. [PMID: 38228081 DOI: 10.4143/crt.2023.869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/15/2024] [Indexed: 01/18/2024] Open
Abstract
PURPOSE The feasibility of sequencing circulating tumor DNA (ctDNA) in plasma as a biomarker to predict early relapse or poor prognosis in patients with follicular lymphoma (FL) receiving systemic immunochemotherapy is not clear. MATERIALS AND METHODS We sequenced DNA from cell-free plasma that was serially obtained from newly diagnosed FL patients undergoing systemic immunochemotherapy. The mutation profiles of ctDNA at the time of diagnosis and at response evaluation and relapse and/or progression were compared with clinical course and treatment outcomes. RESULTS Forty samples from patients receiving rituximab-containing immunochemotherapy were analyzed. Baseline sequencing detected mutations in all cases, with the major detected mutations being KMT2C (50%), CREBBP (45%), and KMT2D (45%). The concentration of ctDNA and tumor mutation burden showed a significant association with survival outcome. In particular, the presence of mutations in CREBBP and TP53 showed poor prognosis compared with patients without them. Longitudinal analysis of ctDNA using serially collected plasma samples showed an association between persistence or reappearance of ctDNA mutations and disease relapse or progression. CONCLUSION Analysis of ctDNA mutations in plasma at diagnosis might help predict outcome of disease, while analysis during follow-up may help to monitor disease status of patients with advanced FL. However, the feasibility of ctDNA measurement must be improved in order for it to become an appropriate and clinically relevant test in FL patients.
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Affiliation(s)
- Sang Eun Yoon
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | - Junhun Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, Seoul, Korea
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4
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Morris BA, Merfeld EC, Burr AR, Bradley KA, Fletcher CD. Combining Obinutuzumab With Radiation for Refractory DLBCL: Retrospective Safety and Efficacy Analysis. Adv Radiat Oncol 2024; 9:101524. [PMID: 38799107 PMCID: PMC11127189 DOI: 10.1016/j.adro.2024.101524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/19/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose Approximately 30% of patients with diffuse large B cell lymphoma (DLBCL) will develop relapsed or treatment-refractory disease after primary chemotherapy. Patients unable to undergo aggressive chemotherapy and stem cell transplant or chimeric antigen receptor T-cell (CAR T-cell) therapy have limited treatment options. Here, we investigated the safety and efficacy of combining obinutuzumab with cytoreductive radiation to all areas of disease in patients with relapsed DLBCL. Methods and Materials A retrospective review of patients with treatment refractory DLBCL was performed. All patients were treated with external beam radiation to all sites of refractory disease with concurrent and adjuvant obinutuzumab. Toxicities were evaluated based on Common Terminology Criteria for Adverse Events v5.0 criteria. Kaplan-Meier analysis was used to calculate progression-free survival and overall survival. Results Between 2016 and 2022, 7 patients with refractory DLBCL were treated with concurrent radiation and obinutuzumab. No grade 3 or greater treatment-related toxicity was observed. Four of the 7 patients had a complete response at the radiated site on first postradiation imaging. The median progression-free survival and overall survival were 30 months. Conclusions In this small cohort of treatment-refractory patients with DLBCL, the combination of radiation and obinutuzumab was well tolerated without excessive treatment-related toxicity. The combination resulted in durable disease control with a prolonged overall survival without additional treatment in a subset of patients.
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Affiliation(s)
- Brett A. Morris
- Department of Human Oncology, Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Emily C. Merfeld
- Department of Human Oncology, Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Adam R. Burr
- Department of Human Oncology, Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kristin A. Bradley
- Department of Human Oncology, Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christopher D. Fletcher
- Division of Hematology and Oncology, Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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5
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Manos K, Churilov L, Grigg A, Di Ciaccio P, Wong J, Chandra Sekaran U, Wight J, Goh Z, Jina H, Butler L, Yannakou CK, Hamad N, Gregory GP, Gangatharan S, Cochrane T, Hawkes EA, Lasica M. Infection risk and antimicrobial prophylaxis in bendamustine-treated patients with indolent non-Hodgkin lymphoma: An Australasian Lymphoma Alliance study. Br J Haematol 2024; 205:146-157. [PMID: 38485116 DOI: 10.1111/bjh.19407] [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: 12/20/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 07/13/2024]
Abstract
Infection and lymphopenia are established bendamustine-related complications. The relationship between lymphopenia severity and infection risk, and the role of antimicrobial prophylaxis, is not well described. This multicentre retrospective study analysed infection characteristics and antimicrobial prophylaxis in 302 bendamustine-treated indolent non-Hodgkin lymphoma patients. Lymphopenia (<1 × 109/L) was near universal and time to lymphocyte recovery correlated with cumulative bendamustine dose. No association between lymphopenia severity and duration with infection was observed. Infections occurred in 44% of patients (50% bacterial) with 27% hospitalised; 32% of infections occurred ≥3 months post bendamustine completion. Infection was associated with obinutuzumab and/or maintenance anti-CD20 therapy, prior therapy and advanced stage. Twenty-four opportunistic infections occurred in 21 patients: ten varicella zoster virus (VZV), seven herpes simplex virus (HSV), one cytomegalovirus, one progressive multifocal leucoencephalopathy, one nocardiosis, one Pneumocystis jiroveci pneumonia (PJP) and three other fungal infections. VZV/HSV and PJP prophylaxis were prescribed to 42% and 54% respectively. Fewer VZV/HSV infections occurred in patients receiving prophylaxis (HR 0.14, p = 0.061) while PJP prophylaxis was associated with reduced risk of bacterial infection (HR 0.48, p = 0.004). Our study demonstrates a significant infection risk regardless of lymphopenia severity and supports prophylaxis to mitigate the risk of early and delayed infections.
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Affiliation(s)
- Kate Manos
- Department of Haematology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Leonid Churilov
- Department of Medicine, The University of Melbourne Medical School, Melbourne, Victoria, Australia
| | - Andrew Grigg
- Department of Clinical Haematology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Pietro Di Ciaccio
- Department of Haematology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jonathan Wong
- Department of Haematology, Monash Health, Clayton, Victoria, Australia
| | - Usha Chandra Sekaran
- Department of Haematology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Pathwest Laboratory, Nedlands, Western Australia, Australia
| | - Joel Wight
- Department of Haematology and Bone Marrow Transplantation, Townsville Hospital and Health Service, Townsville, Queensland, Australia
- Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Zhong Goh
- Department of Haematology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Hayden Jina
- Department of Haematology, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Llewyn Butler
- Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | | | - Nada Hamad
- Department of Haematology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- Faculty of Medicine and Health, School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Gareth P Gregory
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Shane Gangatharan
- Department of Haematology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Tara Cochrane
- Department of Haematology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Eliza A Hawkes
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Olivia Newton-John Cancer Research Institute at Austin Health, Heidelberg, Victoria, Australia
| | - Masa Lasica
- Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia
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6
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Lim YJ, Ward V, Brown A, Phillips E, Kronsteiner B, Malone T, Jennings D, Healy S, Longet S, James T, Thomson P, Farrell L, Oates M, Jackson R, Morrison A, Burns M, Carroll M, Klenerman P, Turtle L, Naisbitt D, Rhodes M, Robinson K, Gatto S, Young M, Linton K, Eyre TA, Eyre DW, Dunachie S, Barnes E, Pettitt A. Immunogenicity of COVID-19 vaccines in patients with follicular lymphoma receiving frontline chemoimmunotherapy. Br J Haematol 2024. [PMID: 38867615 DOI: 10.1111/bjh.19562] [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: 04/08/2024] [Accepted: 05/14/2024] [Indexed: 06/14/2024]
Abstract
Immune responses to primary COVID-19 vaccination were investigated in 58 patients with follicular lymphoma (FL) as part of the PETReA trial of frontline therapy (EudraCT 2016-004010-10). COVID-19 vaccines (BNT162b2 or ChAdOx1) were administered before, during or after cytoreductive treatment comprising rituximab (depletes B cells) and either bendamustine (depletes CD4+ T cells) or cyclophosphamide-based chemotherapy. Blood samples obtained after vaccine doses 1 and 2 (V1, V2) were analysed for antibodies and T cells reactive to the SARS-CoV-2 spike protein using the Abbott Architect and interferon-gamma ELISpot assays respectively. Compared to 149 healthy controls, patients with FL exhibited lower antibody but preserved T-cell responses. Within the FL cohort, multivariable analysis identified low pre-treatment serum IgA levels and V2 administration during induction or maintenance treatment as independent determinants of lower antibody and higher T-cell responses, and bendamustine and high/intermediate FLIPI-2 score as additional determinants of a lower antibody response. Several clinical scenarios were identified where dichotomous immune responses were estimated with >95% confidence based on combinations of predictive variables. In conclusion, the immunogenicity of COVID-19 vaccines in FL patients is influenced by multiple disease- and treatment-related factors, among which B-cell depletion showed differential effects on antibody and T-cell responses.
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Affiliation(s)
- Yeong Jer Lim
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Victoria Ward
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Medical Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Anthony Brown
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Eloise Phillips
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Tom Malone
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Daisy Jennings
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Saoirse Healy
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Stephanie Longet
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Timothy James
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford, UK
| | - Paul Thomson
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, UK
| | - Liam Farrell
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, UK
| | - Melanie Oates
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Richard Jackson
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Andrew Morrison
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Matthew Burns
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Miles Carroll
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Paul Klenerman
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lance Turtle
- Department of Clinical Infection, Microbiology & Immunology, University of Liverpool, Liverpool, UK
| | - Dean Naisbitt
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, UK
| | - Malcolm Rhodes
- National Cancer Research Institute Consumer Forum, London, UK
| | - Kate Robinson
- National Cancer Research Institute Consumer Forum, London, UK
| | - Simona Gatto
- Cardiff and Vale University Hospitals Board, Cardiff, UK
| | - Moya Young
- East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - Kim Linton
- University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Toby A Eyre
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David W Eyre
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Susanna Dunachie
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew Pettitt
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
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7
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Paul S, Konig MF, Pardoll DM, Bettegowda C, Papadopoulos N, Wright KM, Gabelli SB, Ho M, van Elsas A, Zhou S. Cancer therapy with antibodies. Nat Rev Cancer 2024; 24:399-426. [PMID: 38740967 PMCID: PMC11180426 DOI: 10.1038/s41568-024-00690-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/16/2024]
Abstract
The greatest challenge in cancer therapy is to eradicate cancer cells with minimal damage to normal cells. Targeted therapy has been developed to meet that challenge, showing a substantially increased therapeutic index compared with conventional cancer therapies. Antibodies are important members of the family of targeted therapeutic agents because of their extraordinarily high specificity to the target antigens. Therapeutic antibodies use a range of mechanisms that directly or indirectly kill the cancer cells. Early antibodies were developed to directly antagonize targets on cancer cells. This was followed by advancements in linker technologies that allowed the production of antibody-drug conjugates (ADCs) that guide cytotoxic payloads to the cancer cells. Improvement in our understanding of the biology of T cells led to the production of immune checkpoint-inhibiting antibodies that indirectly kill the cancer cells through activation of the T cells. Even more recently, bispecific antibodies were synthetically designed to redirect the T cells of a patient to kill the cancer cells. In this Review, we summarize the different approaches used by therapeutic antibodies to target cancer cells. We discuss their mechanisms of action, the structural basis for target specificity, clinical applications and the ongoing research to improve efficacy and reduce toxicity.
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Affiliation(s)
- Suman Paul
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Maximilian F Konig
- Division of Rheumatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Drew M Pardoll
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Katharine M Wright
- Discovery Chemistry, Merck Research Laboratory, Merck and Co, West Point, PA, USA
| | - Sandra B Gabelli
- Discovery Chemistry, Merck Research Laboratory, Merck and Co, West Point, PA, USA.
| | - Mitchell Ho
- Antibody Engineering Program, Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
| | | | - Shibin Zhou
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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8
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Attygalle AD, Chan JKC, Coupland SE, Du MQ, Ferry JA, de Jong D, Gratzinger D, Lim MS, Nicolae A, Ott G, Rosenwald A, Schuh A, Siebert R. What is new in the 5th edition of the World Health Organization classification of mature B and T/NK cell tumors and stromal neoplasms? J Hematop 2024; 17:71-89. [PMID: 38683440 DOI: 10.1007/s12308-024-00585-8] [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: 02/15/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024] Open
Abstract
The classification of tumors is essential in the diagnosis and clinical management of patients with malignant neoplasms. The World Health Organization (WHO) provides a globally applicable classification scheme of neoplasms and it was updated several times. In this review, we briefly outline the cornerstones of the upcoming 5th edition of the World Health Organization Classification of Haematolymphoid Tumours on lymphoid neoplasms. As is adopted throughout the 5th edition of the WHO classification of tumors of all organ systems, entities are listed by a hierarchical system. For the first time, tumor-like lesions have been included in the classification, and modifications of nomenclature for some entities, revisions of diagnostic criteria or subtypes, deletion of certain entities, and introduction of new entities are presented along with mesenchymal lesions specific to the stroma of lymph nodes and the spleen. In addition to specific outlines on constitutional and somatic genetic changes associated with given entities, a separate chapter on germline predisposition syndromes related to hematologic neoplasms has been added.
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Affiliation(s)
- Ayoma D Attygalle
- Department of Histopathology, The Royal Marsden Hospital, London, SW3 6JJ, UK
| | - John K C Chan
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR, China
| | - Sarah E Coupland
- Department of Molecular and Clinical Cancer Medicine, ISMIB, University of Liverpool, Liverpool, UK
- Liverpool Clinical Laboratories, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Ming-Qing Du
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Judith A Ferry
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Daphne de Jong
- Department of Pathology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, USA
| | - Megan S Lim
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Alina Nicolae
- Department of Pathology, Hautepierre, University Hospital of Strasbourg, Strasbourg, France
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Germany.
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.
| | - Andreas Rosenwald
- Institute of Pathology, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
- Cancer Center Mainfranken, Würzburg, Germany
| | - Anna Schuh
- Department of Oncology, University of Oxford, Oxford, UK
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
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9
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Rajamaki A, Sorigue M, Prusila REI, Kuusisto MEL, Kuitunen H, Jantunen E, Mercadal S, Turpeenniemi-Hujanen T, Sancho JM, Sunela K, Kuittinen O. Progression-free survival after front line, second line and third line in patients with follicular lymphoma treated in clinical practice. Acta Oncol 2024; 63:267-272. [PMID: 38709114 DOI: 10.2340/1651-226x.2024.24377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/12/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND The modern-day therapeutic landscape for follicular lymphoma (FL) includes a number of highly effective therapies. PATIENTS AND METHODS We set out to determine progression-free survival (PFS) after front line, second line, and third line of therapy on the basis of relevant biological characteristics and therapeutic choices. Patients (n = 743, 51% females, median 60 years old) diagnosed with grade 1-2 FL between 1997 and 2016 in nine institutions were included. RESULTS The median PFS1, PFS2, and PFS3 were 8.1 years (95% confidence interval [CI]: 7-9.3 years), 4.2 years (95% CI: 2.8-5.6 years) and 2.2 years (95% CI 1.7-2.8 years). We found longer PFS1 for (1) females, (2) younger age, (3) lower-risk follicular lymphoma international prognostic index (FLIPI), (4) standard intensity (over low intensity) regimens and (5) immunochemotherapy strategies and (6) maintenance rituximab. We found a shorter PFS2 for patients who received front-line immunochemotherapy. Older age at diagnosis correlated with a shorter PFS3. Intensity of front-line chemotherapy, maintenance, or POD24 status did not correlate with PFS2 or PFS3 in this dataset. INTERPRETATION With current immunochemotherapy strategies, the natural course of FL is characterized by shorter-lasting remissions after each relapse. It will be interesting to see whether new therapies can alter this pattern.
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Affiliation(s)
- Aino Rajamaki
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Marc Sorigue
- Medical Department, Trialing Health, Barcelona, Spain.
| | - Roosa E I Prusila
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Milla E L Kuusisto
- Department of Internal Medicine, Länsi-Pohja Central Hospital, Kemi, Finland
| | - Hanne Kuitunen
- Department of Internal Medicine, Länsi-Pohja Central Hospital, Kemi, Finland
| | - Esa Jantunen
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | | | - Taina Turpeenniemi-Hujanen
- Medical Research Center, Oulu University Hospital and Translational Medicine Research Unit, University of Oulu, Oulu, Finland
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, IJC, UAB, Badalona, Barcelona, Spain
| | - Kaisa Sunela
- Finnish Medicines Agency FIMEA, Barcelona, Spain
| | - Outi Kuittinen
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Medical Research Center, Oulu University Hospital and Translational Medicine Research Unit, University of Oulu, Oulu, Finland; Department of Oncology, Kuopio University Hospital, Kuopio, Finland
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10
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Silkenstedt E, Salles G, Campo E, Dreyling M. B-cell non-Hodgkin lymphomas. Lancet 2024; 403:1791-1807. [PMID: 38614113 DOI: 10.1016/s0140-6736(23)02705-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 07/31/2023] [Accepted: 11/30/2023] [Indexed: 04/15/2024]
Abstract
B-cell lymphomas occur with an incidence of 20 new cases per 100 000 people per year in high-income countries. They can affect any organ and are characterised by heterogeneous clinical presentations and courses, varying from asymptomatic, to indolent, to very aggressive cases. Since the topic of B-cell non-Hodgkin lymphomas was last reviewed in The Lancet in 2017, a deeper understanding of the biological background of this heterogeneous group of malignancies, the availability of new diagnostic methods, and the development and implementation of new targeted and immunotherapeutic approaches have improved our ability to treat patients. This Seminar provides an overview of the pathobiology, classification, and prognostication of B-cell non-Hodgkin lymphomas and summarises the current knowledge and standard of care regarding biology and clinical management of the most common subtypes of mature B-cell non-Hodgkin lymphomas. It also highlights new findings in deciphering the molecular background of disease development and the implementation of new therapeutic approaches, particularly those targeting the immune system.
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Affiliation(s)
| | - Gilles Salles
- Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Elias Campo
- Department of Pathology, Hospital Clinic, Institute for Biomedical Research August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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11
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Li D, Xu Z, Wen S, Ananthakrishnan R, Kim Y, Rantell KR, Anderson P, Whitmore J, Chiang A. Challenges and Lessons Learned in Autologous Chimeric Antigen Receptor T-Cell Therapy Development from a Statistical Perspective. Ther Innov Regul Sci 2024:10.1007/s43441-024-00652-3. [PMID: 38704515 DOI: 10.1007/s43441-024-00652-3] [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: 01/23/2024] [Accepted: 03/29/2024] [Indexed: 05/06/2024]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is a human gene therapy product where T cells from a patient are genetically modified to enable them to recognize desired target antigen(s) more effectively. In recent years, promising antitumor activity has been seen with autologous CAR T cells. Since 2017, six CAR T-cell therapies for the treatment of hematological malignancies have been approved by the Food and Drug Administration (FDA). Despite the rapid progress of CAR T-cell therapies, considerable statistical challenges still exist for this category of products across all phases of clinical development that need to be addressed. These include (but not limited to) dose finding strategy, implementation of the estimand framework, use of real-world data in contextualizing single-arm CAR T trials, analysis of safety data and long-term follow-up studies. This paper is the first step in summarizing and addressing these statistical hurdles based on the development of the six approved CAR T-cell products.
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Affiliation(s)
- Daniel Li
- Bristol Myers Squibb, Seattle, WA, USA.
| | - Zhenzhen Xu
- US Food and Drug Administration, Silver Spring, MD, USA
| | - Shihua Wen
- Novartis Pharmaceuticals, East Hanover, NJ, USA
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12
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Hellmuth JC, Koch R, Weigert O. [Targeted therapies in the management of malignant lymphoma - is the end of conventional chemotherapy near?]. Dtsch Med Wochenschr 2024; 149:621-629. [PMID: 38749438 DOI: 10.1055/a-2160-5353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Advances in the understanding of the biology of malignant lymphoma has facilitated the development of numerous molecularly targeted therapies. The incorporation of these precision therapeutics has produced more effective and often less-toxic treatment regimens leading to a significant improvement of treatment outcomes for individuals with lymphoid malignancies.In relapsed diseases, molecularly targeted therapeutic approaches have demonstrated superior outcomes compared to conventional chemotherapy, leading to a growing number of patients being treated entirely chemotherapy-free. This review outlines the current landscape of targeted therapies for both B-cell (B-NHL) and T-cell non-Hodgkin lymphomas (T-NHL) and provides an overview of targeted agents currently approved for the treatment of malignant lymphoma.
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13
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Chauhan A, Lai C, Kuhr F, Simmons H, Cheson BD. Long-Term Follow-Up of Patients With Follicular Lymphoma Using Next Generation Sequencing to Detect Minimal Residual Disease. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00171-X. [PMID: 38789312 DOI: 10.1016/j.clml.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Follicular lymphoma (FL) is a highly treatable, indolent non-Hodgkin lymphoma. Although FL is considered incurable, a patient without progression of disease by 24 months after treatment is predicted to have a survival consistent with persons without lymphoma. Using a sensitive assessment of minimal residual disease (MRD), we tested the hypothesis that MRD monitoring can predict long term remissions. METHODS Unselected patients who were in a clinical remission for at least 24 months after their last treatment were enrolled and monitored prospectively for MRD detectability using a sensitive next-generation sequencing assay (clonoSEQ, Adaptive Biotechnologies, Seattle, WA). RESULTS Forty-seven consecutive patients were monitored. We evaluated the MRD thresholds 10-4, 10-5, and 10-6 for the ability to predict long-term remissions in this cohort and determined that undetectable disease at 10-6 was the best predictor with a specificity and negative predictive value (NPV) of 70% and 100%, respectively. While 3 patients exhibited clinical disease progression during the course of the study, none of the 31 patients with persistent MRD undetectability at 10-6 experienced relapse. CONCLUSIONS A significant proportion (31/47; 66.0%) of FL patients in clinical remission after ≥24 months following last therapy were undetectable at 10-6 by a sensitive assay of MRD. The threshold of sensitivity was 100%, specificity 70%, with a PPV of 19%, but a NPV of 100%. Although longer follow-up is needed for confirmation, many of these patients may continue to have durable complete remissions.
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Affiliation(s)
| | - Catherine Lai
- Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA
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14
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Chu Y, Liu Y, Yu Z, Zhan L, Lu T, Jiang Y, Fang X, Zhou X, Wang X. Maintenance and consolidation strategies for patients with untreated advanced follicular lymphoma: A systematic review and network meta-analysis of randomized trials. Cancer 2024; 130:1072-1082. [PMID: 38041532 DOI: 10.1002/cncr.35137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND The emergence of novel and efficient antibody maintenance approaches has provided more options for post-induction treatment of advanced follicular lymphoma (FL), and further comparisons are required to determine the most clinically beneficial regimen. The authors conducted a systematic review and meta-analysis to evaluate the maintenance or consolidation strategy. METHODS The authors performed two independent searches in PubMed, Web of Science, the Cochrane library databases, Scopus, and Embase for randomized controlled trials (RCTs) evaluating maintenance or consolidation therapy in untreated FL patients. Extracted data included the clinical characteristics, treatment regimen, progression-free survival (PFS), overall survival (OS), and adverse effects. They then pooled the data and used a Bayesian random-effects model to combine direct comparisons with indirect evidence. RESULTS The authors screened 1515 records and identified 13 eligible RCTs that assessed nine different regimens in 5681 advanced FL patients. Reconstructed individual survival data presented that obinutuzumab had the highest effect sizes and certainty of the evidence for PFS (hazard ratio, 0.43; 95% confidence interval, 0.22-0.79) and tolerability compared with observation. However, no benefit was observed in patients according to the OS, regardless of which regimen was taken. Considering other regimens, although an extended course of rituximab maintenance and consolidation therapies presented PFS benefits compared with standard rituximab maintenance, they were also associated with higher toxicity. CONCLUSIONS Although obinutuzumab and rituximab maintenance treatment improved PFS significantly, its clinical benefit requires further validation in larger populations. Furthermore, because few trials informed each treatment comparison, research is needed to refine the understanding of this complex and rapidly evolving treatment landscape.
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Affiliation(s)
- Yurou Chu
- Department of Hematology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Yingyue Liu
- Department of Hematology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Zhuoya Yu
- Department of Hematology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Linquan Zhan
- Department of Hematology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Tiange Lu
- Department of Hematology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Yujie Jiang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiaosheng Fang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiangxiang Zhou
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, Shandong, China
| | - Xin Wang
- Department of Hematology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, Shandong, China
- National Clinical Research Center for Hematologic Diseases, the First Affiliated Hospital of Soochow University, Suzhou, China
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15
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Pedersen MA, Gormsen LC, Jakobsen LH, Eyre TA, Severinsen MT, Baech J, Dann EJ, Knapp A, Sahin D, Vestergaard P, El-Galaly TC, Jensen P. The impact of CHOP versus bendamustine on bone mineral density in patients with indolent lymphoma enrolled in the GALLIUM study. Br J Haematol 2024; 204:1271-1278. [PMID: 37957542 DOI: 10.1111/bjh.19194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023]
Abstract
Standard CHOP treatment includes a high cumulative dose of prednisone, and studies have shown increased fracture risk following CHOP. It is unclear whether reductions in bone mineral density (BMD) are caused by glucocorticoids or by the combination with chemotherapy. Our objective was to determine the effect of obinutuzumab (G)/rituximab (R)-bendamustine versus G/R-CHOP on BMD in follicular lymphoma patients. Patients in this GALLIUM post hoc study were ≥60 years old and in complete remission at induction treatment completion (ITC), following treatment with G or R in combination with bendamustine or CHOP. To assess BMD, Hounsfield units (HU) were measured in lumbar vertebra L1 on annual computed tomography. Furthermore, vertebral compression fractures were recorded. Of 173 patients included, 59 (34%) received CHOP and 114 (66%) received bendamustine. At baseline, there was no difference in HU between groups. The mean HU decrease from baseline to ITC was 27.8 after CHOP and 17.3 after bendamustine, corresponding to a difference of 10.4 (95% CI: 3.2-17.6). Vertebral fractures were recorded in 5/59 patients receiving CHOP and in 2/114 receiving bendamustine. CHOP was associated with a significant greater decrease in BMD and more frequent fractures. These results suggest that prophylaxis against BMD loss should be considered.
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Affiliation(s)
- Mette Abildgaard Pedersen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Lars C Gormsen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lasse H Jakobsen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Toby A Eyre
- Hematology and Cancer Centre, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, UK
| | - Marianne T Severinsen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Joachim Baech
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Eldad J Dann
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | - Denis Sahin
- F. Hoffman-La Roche Ltd., Basel, Switzerland
| | - Peter Vestergaard
- Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Tarec C El-Galaly
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Hematology Research Unit, Department of Hematology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Paw Jensen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
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Attygalle AD, Chan JKC, Coupland SE, Du MQ, Ferry JA, Jong DD, Gratzinger D, Lim MS, Naresh KN, Nicolae A, Ott G, Rosenwald A, Schuh A, Siebert R. The 5th edition of the World Health Organization Classification of mature lymphoid and stromal tumors - an overview and update. Leuk Lymphoma 2024; 65:413-429. [PMID: 38189838 DOI: 10.1080/10428194.2023.2297939] [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: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 01/09/2024]
Abstract
The purpose of this review is to give an overview on the conceptual framework and major developments of the upcoming 5th edition of the World Health Organization (WHO) Classification of Haematolymphoid tumours (WHO-HAEM5) and to highlight the most significant changes made in WHO-HAEM5 compared with the revised 4th edition (WHO-HAEM4R) of lymphoid and stromal neoplasms. The changes from the revised 4th edition include the reorganization of entities by means of a hierarchical system that is realized throughout the 5th edition of the WHO classification of tumors of all organ systems, a modification of nomenclature for some entities, the refinement of diagnostic criteria or subtypes, deletion of certain entities, and introduction of new entities. For the first time, tumor-like lesions, mesenchymal lesions specific to lymph node and spleen, and germline predisposition syndromes associated with the lymphoid neoplasms are included in the classification.
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Affiliation(s)
- Ayoma D Attygalle
- Department of Histopathology, The Royal Marsden Hospital, London, UK
| | - John K C Chan
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong, SAR China
| | - Sarah E Coupland
- Department of Molecular and Clinical Cancer Medicine, ISMIB, University of Liverpool, Liverpool, UK
- Liverpool Clinical Laboratories, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Ming-Qing Du
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Judith A Ferry
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Daphne de Jong
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, USA
| | - Megan S Lim
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Kikkeri N Naresh
- Fred Hutchinson Cancer Center, University of Washington, Seattle, USA
| | - Alina Nicolae
- Department of Pathology, University Hospital of Strasbourg, Strasbourg, France
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, and Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - Andreas Rosenwald
- Institute of Pathology, Julius-Maximilians-UniversitätWürzburg, and Cancer Center Mainfranken, Würzburg, Germany
| | - Anna Schuh
- Department of Oncology, University of Oxford, Oxford, UK
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
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Bastos-Oreiro M, Gutierrez A, Cabero A, López J, Villafuerte P, Jiménez-Ubieto A, de Oña R, De la Fuente A, Navarro B, Peñalver J, Martínez P, Alonso C, Infante M, Córdoba R, Perez-Montero B, Pérez de Oteyza J, González de Villambrosio S, Fernández-Caldas P, del Campo R, García Belmonte D, Diaz-Gálvez J, Salar A, Sancho JM. Comparing R-Bendamustine vs. R-CHOP Plus Maintenance Therapy as First-Line Systemic Treatment in Follicular Lymphoma: A Multicenter Retrospective GELTAMO Study. Cancers (Basel) 2024; 16:1285. [PMID: 38610963 PMCID: PMC11010804 DOI: 10.3390/cancers16071285] [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: 01/21/2024] [Revised: 03/08/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024] Open
Abstract
Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and R-bendamustine (R-B) are the most common frontline treatment strategies for advanced-stage follicular lymphoma (FL). After R-CHOP induction therapy, using rituximab for maintenance therapy notably improves outcomes; however, whether this can be achieved by using the same approach after R-B therapy is still being determined. This retrospective analysis compared 476 FL patients from 17 GELTAMO centers who received R-based regimens followed by rituximab maintenance therapy for untreated advanced-stage FL. The complete response rate at the end of induction was higher with R-B and relapses were more frequent with R-CHOP. During induction, cytopenias were significantly more frequent with R-CHOP and so was the use of colony-stimulating factors. During maintenance therapy, R-B showed more neutropenia and infectious toxicity. After a median follow-up of 81 months (95% CI: 77-86), the 6-year rates of progression-free survival (PFS) were 79% (95% CI: 72-86) for R-bendamustine vs. 67% (95% CI: 61-73) for R-CHOP (p = 0.046), and 6-year overall survival (OS) values were 91% (95% CI: 86-96) for R-B vs. 91% (95% CI: 87-94) for R-CHOP (p = 0.49). In conclusion, R-B followed by rituximab maintenance therapy in patients with previously untreated FL resulted in significantly longer PFS than R-CHOP, with older patients also benefiting from this treatment without further toxicity. Adverse events during maintenance were more frequent with R-B without impacting mortality.
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Affiliation(s)
- Mariana Bastos-Oreiro
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | | | | | | | | | | | - Raquel de Oña
- MD Anderson, 28033 Madrid, Spain; (R.d.O.); (A.D.l.F.)
| | | | | | - Javier Peñalver
- Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain; (J.P.); (P.M.)
| | - Pilar Martínez
- Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain; (J.P.); (P.M.)
| | | | | | - Raúl Córdoba
- Hospital Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | | | | | | | - Paula Fernández-Caldas
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
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18
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McIlroy G, Lax S, Gaskell C, Jackson A, Rhodes M, Seale T, Fox S, Hopkins L, Okosun J, Barrington SF, Ringshausen I, Ramsay AG, Calaminici M, Linton K, Bishton M. Investigator choice of standard therapy versus sequential novel therapy arms in the treatment of relapsed follicular lymphoma (REFRACT): study protocol for a multi-centre, open-label, randomised, phase II platform trial. BMC Cancer 2024; 24:370. [PMID: 38528445 PMCID: PMC10962099 DOI: 10.1186/s12885-024-12112-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Relapsed or refractory follicular lymphoma (rrFL) is an incurable disease associated with shorter remissions and survival after each line of standard therapy. Many promising novel, chemotherapy-free therapies are in development, but few are licensed as their role in current treatment pathways is poorly defined. METHODS The REFRACT trial is an investigator-initiated, UK National Cancer Research Institute, open-label, multi-centre, randomised phase II platform trial aimed at accelerating clinical development of novel therapies by addressing evidence gaps. The first of the three sequential novel therapy arms is epcoritamab plus lenalidomide, to be compared with investigator choice standard therapy (ICT). Patients aged 18 years or older with biopsy proven relapsed or refractory CD20 positive, grade 1-3a follicular lymphoma and assessable disease by PET-CT are eligible. The primary outcome is complete metabolic response by PET-CT at 24 weeks using the Deauville 5-point scale and Lugano 2014 criteria. Secondary outcomes include overall metabolic response, progression-free survival, overall survival, duration of response, and quality of life assessed by EQ-5D-5 L and FACT-Lym. The trial employs an innovative Bayesian design with a target sample size of 284 patients: 95 in the ICT arm and 189 in the novel therapy arms. DISCUSSION Whilst there are many promising novel drugs in early clinical development for rrFL, understanding the relative efficacy and safety of these agents, and their place in modern treatment pathways, is limited by a lack of randomised trials and dearth of published outcomes for standard regimens to act as historic controls. Therefore, the aim of REFRACT is to provide an efficient platform to evaluate novel agents against standard therapies for rrFL. The adaptive Bayesian power prior methodology design will minimise patient numbers and accelerate trial delivery. TRIAL REGISTRATION ClinicalTrials.gov: NCT05848765; 08-May-2023. EUDRACT 2022-000677-75; 10-Feb-2022.
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Affiliation(s)
- Graham McIlroy
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK.
| | - Siân Lax
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Charlotte Gaskell
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Aimee Jackson
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | | | - Tania Seale
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Sonia Fox
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Lousie Hopkins
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Jessica Okosun
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Sally F Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK
| | | | - Alan G Ramsay
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Maria Calaminici
- Department of Cellular Pathology Barts Health and Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Kim Linton
- Division of Cancer Sciences, University of Manchester, Manchester, UK
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Mark Bishton
- Translational Medical Sciences, University of Nottingham, Nottingham, UK
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Laurent C, Dietrich S, Tarte K. Cell cross talk within the lymphoma tumor microenvironment: follicular lymphoma as a paradigm. Blood 2024; 143:1080-1090. [PMID: 38096368 DOI: 10.1182/blood.2023021000] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/30/2023] [Indexed: 03/22/2024] Open
Abstract
ABSTRACT Follicular lymphoma (FL) is an indolent yet incurable germinal center B-cell lymphoma retaining a characteristic follicular architecture. FL tumor B cells are highly dependent on direct and indirect interactions with a specific and complex tumor microenvironment (TME). Recently, great progress has been made in describing the heterogeneity and dynamics of the FL TME and in depicting how tumor clonal and functional heterogeneity rely on the integration of TME-related signals. Specifically, the FL TME is enriched for exhausted cytotoxic T cells, immunosuppressive regulatory T cells of various origins, and follicular helper T cells overexpressing B-cell and TME reprogramming factors. FL stromal cells have also emerged as crucial determinants of tumor growth and remodeling, with a key role in the deregulation of chemokines and extracellular matrix composition. Finally, tumor-associated macrophages play a dual function, contributing to FL cell phagocytosis and FL cell survival through long-lasting B-cell receptor activation. The resulting tumor-permissive niches show additional layers of site-to-site and kinetic heterogeneity, which raise questions about the niche of FL-committed precursor cells supporting early lymphomagenesis, clonal evolution, relapse, and transformation. In turn, FL B-cell genetic and nongenetic determinants drive the reprogramming of FL immune and stromal TME. Therefore, offering a functional picture of the dynamic cross talk between FL cells and TME holds the promise of identifying the mechanisms of therapy resistance, stratifying patients, and developing new therapeutic approaches capable of eradicating FL disease in its different ecosystems.
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Affiliation(s)
- Camille Laurent
- Department of Pathology, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalo-Universitaire Toulouse, Centre de Recherches en Cancérologie de Toulouse, Laboratoire d'Excellence TOUCAN, INSERM Unité Mixte de Recherche 1037, Toulouse, France
| | - Sascha Dietrich
- Department of Haematology and Oncology, University Hospital Düsseldorf and Center for Integrated Oncology Aachen Bonn Cologne, Düsseldorf, Germany
| | - Karin Tarte
- Unité Mixte de Recherche S1236, INSERM, Université de Rennes, Etablissement Français du Sang Bretagne, Equipe Labellisée Ligue, Rennes, France
- Department of Biology, Centre Hospitalo-Universitaire de Rennes, Rennes, France
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20
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Lupia T, Corcione S, Staffilano E, Bosio R, Curtoni A, Busca A, De Rosa FG. Disseminated Enterovirus Infection in a Patient Affected by Follicular Lymphoma Treated with Obinutuzumab: A Case Report and a Narrative Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:495. [PMID: 38541221 PMCID: PMC10972032 DOI: 10.3390/medicina60030495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/04/2024] [Accepted: 03/12/2024] [Indexed: 04/09/2024]
Abstract
Background and Objectives: the principal purpose of this literature review is to cluster adults with hematological malignancies after treatment or on maintenance with obinutuzumab who experienced disseminated EV infection to understand clinical characteristics and outcome of this rare condition in these patients. We report the first clinical case of a male affected by follicular lymphoma treated with immune-chemotherapy including obinutuzumab who was affected by disseminated EV infection with cardiovascular involvement. Materials and Methods: this narrative review summarizes all the research about disseminated EV infection in immunosuppressed adult patients treated with obinutuzumab from January 2000 to January 2024 using the Scale for the Assessment of Narrative Review Articles (SANRA) flow-chart. We performed a descriptive statistic using the standard statistical measures for quantitative data. Results: we included six studies, five case reports, and one case report with literature analysis. We collected a total of seven patients, all female, with disseminated EV infection. The most common signs and clinical presentations of EV infection were fever and encephalitis symptoms (N = 6, 85.7%), followed by hepatitis/acute liver failure (N = 5, 71.4%). Conclusions: onco-hematological patients who receive immune-chemotherapy with a combination of treatments which depress adaptative immunity, which includes the antiCD20 obinutuzumab, could be at higher risk of disseminated EV infection, including CNS and cardiac involvement.
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Affiliation(s)
- Tommaso Lupia
- Unit of Infectious Diseases, AOU City of Health and Sciences, 10100 Turin, Italy; (S.C.); (F.G.D.R.)
| | - Silvia Corcione
- Unit of Infectious Diseases, AOU City of Health and Sciences, 10100 Turin, Italy; (S.C.); (F.G.D.R.)
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (E.S.); (R.B.)
| | - Elena Staffilano
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (E.S.); (R.B.)
| | - Roberta Bosio
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (E.S.); (R.B.)
| | - Antonio Curtoni
- Microbiology and Virology Unit, AOU City of Health and Sciences, 10100 Turin, Italy;
| | - Alessandro Busca
- Department of Oncology, Stem Cell Transplant Center, Città Della Salute e Della Scienza Hospital, 10100 Turin, Italy;
| | - Francesco Giuseppe De Rosa
- Unit of Infectious Diseases, AOU City of Health and Sciences, 10100 Turin, Italy; (S.C.); (F.G.D.R.)
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (E.S.); (R.B.)
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21
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Coupland SE, Du MQ, Ferry JA, de Jong D, Khoury JD, Leoncini L, Naresh KN, Ott G, Siebert R, Xerri L. The fifth edition of the WHO classification of mature B-cell neoplasms: open questions for research. J Pathol 2024; 262:255-270. [PMID: 38180354 DOI: 10.1002/path.6246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024]
Abstract
The fifth edition of the World Health Organization Classification of Haematolymphoid Tumours (WHO-HAEM5) is the product of an evidence-based evolution of the revised fourth edition with wide multidisciplinary consultation. Nonetheless, while every classification incorporates scientific advances and aims to improve upon the prior version, medical knowledge remains incomplete and individual neoplasms may not be easily subclassified in a given scheme. Thus, optimal classification requires ongoing study, and there are certain aspects of some entities and subtypes that require further refinements. In this review, we highlight a selection of these challenging areas to prompt more research investigations. These include (1) a 'placeholder term' of splenic B-cell lymphoma/leukaemia with prominent nucleoli (SBLPN) to accommodate many of the splenic lymphomas previously classified as hairy cell leukaemia variant and B-prolymphocytic leukaemia, a clear new start to define their pathobiology; (2) how best to classify BCL2 rearrangement negative follicular lymphoma including those with BCL6 rearrangement, integrating the emerging new knowledge on various germinal centre B-cell subsets; (3) what is the spectrum of non-IG gene partners of MYC translocation in diffuse large B-cell lymphoma/high-grade B-cell lymphoma and how they impact MYC expression and clinical outcome; how best to investigate this in a routine clinical setting; and (4) how best to define high-grade B-cell lymphoma not otherwise specified and high-grade B-cell lymphoma with 11q aberrations to distinguish them from their mimics and characterise their molecular pathogenetic mechanism. Addressing these questions would provide more robust evidence to better define these entities/subtypes, improve their diagnosis and/or prognostic stratification, leading to better patient care. © 2024 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Sarah E Coupland
- Liverpool Clinical Laboratories, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Ming-Qing Du
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Judith A Ferry
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Daphne de Jong
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joseph D Khoury
- Department of Pathology, Microbiology and Immunology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lorenzo Leoncini
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Kikkeri N Naresh
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, and Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - Luc Xerri
- Institut Paoli-Calmettes, CRCM and Aix-Marseille University, Marseille, France
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22
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Yılmaz U, Küçükyurt S, Ar MC, Eşkazan AE. Acute Thrombocytopenia Complicating the Initial Administration of Obinutuzumab: Is It More Frequent Than We Think? Oncol Ther 2024; 12:157-161. [PMID: 38252230 PMCID: PMC10881447 DOI: 10.1007/s40487-023-00259-y] [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: 10/13/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024] Open
Abstract
Thrombocytopenia has been reported more frequently with obinutuzumab in clinical trials where it was directly compared with rituximab. However, more significant than the frequency, a unique form of severe thrombocytopenia manifesting very early after the first obinutuzumab infusion has been published in case reports. To further explore this subject, we went through the records of our clinic to identify similar cases of obinutuzumab-induced acute thrombocytopenia (OIAT). Among 24 patients who received obinutuzumab outside of clinical trials, we recovered three cases with OIAT. This paper describes these three cases in detail, placing emphasis on the timing, severity, and the clinical course. Notably, all three patients developed severe OIAT within 5 days of their first obinutuzumab exposure, responded well to transfusion, and recovered within a few days without severe bleeding. None of the patients experienced a similar event in the second course of the obinutuzumab-based therapy. Our observations suggest that OIAT may be a frequent, possibly non-relapsing, and unique event that deserves more attention than it currently receives.
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Affiliation(s)
- Umut Yılmaz
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Fatih, Istanbul, Turkey
| | - Selin Küçükyurt
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Fatih, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Fatih, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Fatih, Istanbul, Turkey.
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23
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Roider T, Baertsch MA, Fitzgerald D, Vöhringer H, Brinkmann BJ, Czernilofsky F, Knoll M, Llaó-Cid L, Mathioudaki A, Faßbender B, Herbon M, Lautwein T, Bruch PM, Liebers N, Schürch CM, Passerini V, Seifert M, Brobeil A, Mechtersheimer G, Müller-Tidow C, Weigert O, Seiffert M, Nolan GP, Huber W, Dietrich S. Multimodal and spatially resolved profiling identifies distinct patterns of T cell infiltration in nodal B cell lymphoma entities. Nat Cell Biol 2024; 26:478-489. [PMID: 38379051 PMCID: PMC10940160 DOI: 10.1038/s41556-024-01358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 01/15/2024] [Indexed: 02/22/2024]
Abstract
The redirection of T cells has emerged as an attractive therapeutic principle in B cell non-Hodgkin lymphoma (B-NHL). However, a detailed characterization of lymphoma-infiltrating T cells across B-NHL entities is missing. Here we present an in-depth T cell reference map of nodal B-NHL, based on cellular indexing of transcriptomes and epitopes, T cell receptor sequencing, flow cytometry and multiplexed immunofluorescence applied to 101 lymph nodes from patients with diffuse large B cell, mantle cell, follicular or marginal zone lymphoma, and from healthy controls. This multimodal resource revealed quantitative and spatial aberrations of the T cell microenvironment across and within B-NHL entities. Quantitative differences in PD1+ TCF7- cytotoxic T cells, T follicular helper cells or IKZF3+ regulatory T cells were linked to their clonal expansion. The abundance of PD1+ TCF7- cytotoxic T cells was associated with poor survival. Our study portrays lymphoma-infiltrating T cells with unprecedented comprehensiveness and provides a unique resource for the investigation of lymphoma biology and prognosis.
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Affiliation(s)
- Tobias Roider
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
- Molecular Medicine Partnership Unit, Heidelberg, Germany
- European Molecular Biology Laboratory, Heidelberg, Germany
| | - Marc A Baertsch
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Donnacha Fitzgerald
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
- Molecular Medicine Partnership Unit, Heidelberg, Germany
- European Molecular Biology Laboratory, Heidelberg, Germany
| | - Harald Vöhringer
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
- Molecular Medicine Partnership Unit, Heidelberg, Germany
- European Molecular Biology Laboratory, Heidelberg, Germany
| | - Berit J Brinkmann
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
- Molecular Medicine Partnership Unit, Heidelberg, Germany
- European Molecular Biology Laboratory, Heidelberg, Germany
- Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Felix Czernilofsky
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
- Molecular Medicine Partnership Unit, Heidelberg, Germany
- European Molecular Biology Laboratory, Heidelberg, Germany
| | - Mareike Knoll
- European Molecular Biology Laboratory, Heidelberg, Germany
| | - Laura Llaó-Cid
- Division of Molecular Genetics, German Cancer Research Center, Heidelberg, Germany
- Molecular Pathology of Lymphoid Neoplasms, Fundació de Recerca Clinic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
| | | | - Bianca Faßbender
- Department of Hematology and Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Maxime Herbon
- Department of Hematology and Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Tobias Lautwein
- Genomics and Transcriptomics Laboratory, University of Düsseldorf, Düsseldorf, Germany
| | - Peter-Martin Bruch
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
- Molecular Medicine Partnership Unit, Heidelberg, Germany
- European Molecular Biology Laboratory, Heidelberg, Germany
- Department of Hematology and Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Nora Liebers
- European Molecular Biology Laboratory, Heidelberg, Germany
- Department of Hematology and Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
- National Center for Tumor Diseases, Heidelberg, Germany
- German Cancer Research Center, Heidelberg, Germany
| | - Christian M Schürch
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology and Neuropathology, University Hospital and Comprehensive Cancer Center Tübingen, Tübingen, Germany
| | - Verena Passerini
- Department of Medicine III, Laboratory for Experimental Leukemia and Lymphoma Research, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Marc Seifert
- Department of Hematology and Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Alexander Brobeil
- Department of Pathology, University of Heidelberg, Heidelberg, Germany
| | | | - Carsten Müller-Tidow
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
- Molecular Medicine Partnership Unit, Heidelberg, Germany
| | - Oliver Weigert
- German Cancer Research Center, Heidelberg, Germany
- Department of Medicine III, Laboratory for Experimental Leukemia and Lymphoma Research, Ludwig-Maximilians-University Hospital, Munich, Germany
- German Cancer Consortium, Munich, Germany
| | - Martina Seiffert
- Division of Molecular Genetics, German Cancer Research Center, Heidelberg, Germany
| | - Garry P Nolan
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Wolfgang Huber
- Molecular Medicine Partnership Unit, Heidelberg, Germany.
- European Molecular Biology Laboratory, Heidelberg, Germany.
| | - Sascha Dietrich
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.
- Molecular Medicine Partnership Unit, Heidelberg, Germany.
- European Molecular Biology Laboratory, Heidelberg, Germany.
- Department of Hematology and Oncology, University Hospital Düsseldorf, Düsseldorf, Germany.
- Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), Aachen Bonn Cologne Düsseldorf, Germany.
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24
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Schuster SJ, Huw LY, Bolen CR, Maximov V, Polson AG, Hatzi K, Lasater EA, Assouline SE, Bartlett NL, Budde LE, Matasar MJ, Koeppen H, Piccione EC, Wilson D, Wei MC, Yin S, Penuel E. Loss of CD20 expression as a mechanism of resistance to mosunetuzumab in relapsed/refractory B-cell lymphomas. Blood 2024; 143:822-832. [PMID: 38048694 PMCID: PMC10934296 DOI: 10.1182/blood.2023022348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/24/2023] [Accepted: 11/15/2023] [Indexed: 12/06/2023] Open
Abstract
ABSTRACT CD20 is an established therapeutic target in B-cell malignancies. The CD20 × CD3 bispecific antibody mosunetuzumab has significant efficacy in B-cell non-Hodgkin lymphomas (NHLs). Because target antigen loss is a recognized mechanism of resistance, we evaluated CD20 expression relative to clinical response in patients with relapsed and/or refractory NHL in the phase 1/2 GO29781 trial investigating mosunetuzumab monotherapy. CD20 was studied using immunohistochemistry (IHC), RNA sequencing, and whole-exome sequencing performed centrally in biopsy specimens collected before treatment at predose, during treatment, or upon progression. Before treatment, most patients exhibited a high proportion of tumor cells expressing CD20; however, in 16 of 293 patients (5.5%) the proportion was <10%. Analyses of paired biopsy specimens from patients on treatment revealed that CD20 levels were maintained in 29 of 30 patients (97%) vs at progression, where CD20 loss was observed in 11 of 32 patients (34%). Reduced transcription or acquisition of truncating mutations explained most but not all cases of CD20 loss. In vitro modeling confirmed the effects of CD20 variants identified in clinical samples on reduction of CD20 expression and missense mutations in the extracellular domain that could block mosunetuzumab binding. This study expands the knowledge about the occurrence of target antigen loss after anti-CD20 therapeutics to include CD20-targeting bispecific antibodies and elucidates mechanisms of reduced CD20 expression at disease progression that may be generalizable to other anti-CD20 targeting agents. These results also confirm the utility of readily available IHC staining for CD20 as a tool to inform clinical decisions. This trial was registered at www.ClinicalTrials.gov as #NCT02500407.
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Affiliation(s)
- Stephen J. Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | | | | | - Nancy L. Bartlett
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | | | | | | | | | | | | | - Shen Yin
- Genentech, Inc., South San Francisco, CA
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25
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Al Sbihi A, Alasfour M, Pongas G. Innovations in Antibody-Drug Conjugate (ADC) in the Treatment of Lymphoma. Cancers (Basel) 2024; 16:827. [PMID: 38398219 PMCID: PMC10887180 DOI: 10.3390/cancers16040827] [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: 01/21/2024] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024] Open
Abstract
Chemoimmunotherapy and cellular therapy are the mainstay of the treatment of relapsed/refractory (R/R) lymphomas. Development of resistance and commonly encountered toxicities of these treatments limit their role in achieving desired response rates and durable remissions. The Antibody-Drug Conjugate (ADC) is a novel class of targeted therapy that has demonstrated significant efficacy in treating various cancers, including lymphomas. To date, three ADC agents have been approved for different lymphomas, marking a significant advancement in the field. In this article, we aim to review the concept of ADCs and their application in lymphoma treatment, provide an analysis of currently approved agents, and discuss the ongoing advancements of ADC development.
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Affiliation(s)
| | | | - Georgios Pongas
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA
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26
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Pezot M, Nocturne G, Belkhir R, Henry J, Pavy S, Seror R, Mariette X, Bitoun S. Obinutuzumab in patients with Sjogren's disease immunised against rituximab. Ann Rheum Dis 2024; 83:407-408. [PMID: 37945315 DOI: 10.1136/ard-2023-224999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Mathilde Pezot
- Rheumatology Department, Université Paris-Saclay, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, FHU CARE, INSERM UMR1184, Le Kremlin Bicêtre, France
| | - Gaétane Nocturne
- Rheumatology Department, Université Paris-Saclay, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, FHU CARE, INSERM UMR1184, Le Kremlin Bicêtre, France
| | - Rakiba Belkhir
- Rheumatology Department, Université Paris-Saclay, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, FHU CARE, INSERM UMR1184, Le Kremlin Bicêtre, France
| | - Julien Henry
- Rheumatology Department, Université Paris-Saclay, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, FHU CARE, INSERM UMR1184, Le Kremlin Bicêtre, France
| | - Stephan Pavy
- Rheumatology Department, Université Paris-Saclay, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, FHU CARE, INSERM UMR1184, Le Kremlin Bicêtre, France
| | - Raphaèle Seror
- Rheumatology Department, Université Paris-Saclay, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, FHU CARE, INSERM UMR1184, Le Kremlin Bicêtre, France
| | - Xavier Mariette
- Rheumatology Department, Université Paris-Saclay, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, FHU CARE, INSERM UMR1184, Le Kremlin Bicêtre, France
| | - Samuel Bitoun
- Rheumatology Department, Université Paris-Saclay, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, FHU CARE, INSERM UMR1184, Le Kremlin Bicêtre, France
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27
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Pott C, Jurinovic V, Trotman J, Kehden B, Unterhalt M, Herold M, Jagt RVD, Janssens A, Kneba M, Mayer J, Young M, Schmidt C, Knapp A, Nielsen T, Brown H, Spielewoy N, Harbron C, Bottos A, Mundt K, Marcus R, Hiddemann W, Hoster E. Minimal Residual Disease Status Predicts Outcome in Patients With Previously Untreated Follicular Lymphoma: A Prospective Analysis of the Phase III GALLIUM Study. J Clin Oncol 2024; 42:550-561. [PMID: 38096461 DOI: 10.1200/jco.23.00838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/23/2023] [Accepted: 10/12/2023] [Indexed: 02/09/2024] Open
Abstract
PURPOSE We report an analysis of minimal residual/detectable disease (MRD) as a predictor of outcome in previously untreated patients with follicular lymphoma (FL) from the randomized, multicenter GALLIUM (ClinicalTrials.gov identifier: NCT01332968) trial. PATIENTS AND METHODS Patients received induction with obinutuzumab (G) or rituximab (R) plus bendamustine, or cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) or cyclophosphamide, vincristine, prednisone (CVP) chemotherapy, followed by maintenance with the same antibody in responders. MRD status was assessed at predefined time points (mid-induction [MI], end of induction [EOI], and at 4-6 monthly intervals during maintenance and follow-up). Patients with evaluable biomarker data at diagnosis were included in the survival analysis. RESULTS MRD positivity was associated with inferior progression-free survival (PFS) at MI (hazard ratio [HR], 3.03 [95% CI, 2.07 to 4.45]; P < .0001) and EOI (HR, 2.25 [95% CI, 1.53 to 3.32]; P < .0001). MRD response was higher after G- versus R-chemotherapy at MI (94.2% v 88.9%; P = .013) and at EOI (93.1% v 86.7%; P = .0077). Late responders (MI-positive/EOI-negative) had a significantly poorer PFS than early responders (MI-negative/EOI-negative; HR, 3.11 [95% CI, 1.75 to 5.52]; P = .00011). The smallest proportion of MRD positivity was observed in patients receiving bendamustine at MI (4.8% v 16.0% in those receiving CHOP; P < .0001). G appeared to compensate for less effective chemotherapy regimens, with similar MRD response rates observed across the G-chemo groups. During the maintenance period, more patients treated with R than with G were MRD-positive (R-CHOP, 20.7% v G-CHOP, 7.0%; R-CVP, 21.7% v G-CVP, 9.4%). Throughout maintenance, MRD positivity was associated with clinical relapse. CONCLUSION MRD status can determine outcome after induction and during maintenance, and MRD negativity is a prerequisite for long-term disease control in FL. The higher MRD responses after G- versus R-based treatment confirm more effective tumor cell clearance.
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Affiliation(s)
| | - Vindi Jurinovic
- Department of Internal Medicine III, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, Sydney, NSW, Australia
| | - Britta Kehden
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - Michael Unterhalt
- Department of Internal Medicine III, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | | | | | | | - Michael Kneba
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jiri Mayer
- University Hospital and Masaryk University, Brno, Czech Republic
| | - Moya Young
- East Kent Hospital, Canterbury, United Kingdom
| | - Christian Schmidt
- Department of Internal Medicine III, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | | | | | - Helen Brown
- Roche Products Ltd, Welwyn Garden City, United Kingdom
| | | | - Chris Harbron
- Roche Products Ltd, Welwyn Garden City, United Kingdom
| | | | | | | | - Wolfgang Hiddemann
- Department of Internal Medicine III, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Eva Hoster
- Department of Internal Medicine III, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
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Xing S, Pu Y, Zhao X, Hu Y, Zhang F, Gu Z, Xu W, Fan L, Miao Y, Li J. Safety of a 90-min duration of intravenous infusion of obinutuzumab in patients with B-cell non-Hodgkin's lymphoma in a tertiary hospital in China: a prospective, open-label, exploratory clinical trial. Braz J Med Biol Res 2024; 57:e13284. [PMID: 38359273 PMCID: PMC10868189 DOI: 10.1590/1414-431x2023e13284] [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: 09/21/2023] [Accepted: 12/19/2023] [Indexed: 02/17/2024] Open
Abstract
This study aimed to analyze the safety and applicability of a 90-min duration of infusion (SDI) of obinutuzumab in patients with B-cell non-Hodgkin's lymphoma (NHL) in a tertiary hospital in China. This exploratory clinical trial was performed at Jiangsu Province Hospital. All patients were treated with the standard infusion regimen for the first infusion. If no grade ≥3 infusion-related reactions (IRRs) occurred, the subsequent infusions were given as SDI. The primary endpoint was the incidence of IRR during the standard infusion (3-4 h) and 90-min SDI regimens. This study enrolled 208 patients and all completed cycle 1. Forty-one patients (19.71%) had IRRs: five (2.40%) with grade 1, twenty-eight (13.46%) with grade 2, and eight (3.85%) with grade 3. The 41 patients had 71 IRRs, mainly fever (40.85%), chest pain/tightness (12.68%), and dyspnea (9.86%). The occurrence of IRRs in the first infusion was significantly lower in patients who received oral acetaminophen prophylaxis than those who did not (10.72% vs 30.21%, P<0.001). For the subsequent cycles with 90-min SDI, only two (0.25%) IRRs occurred among 814 infusions (one grade 1 hand numbness and one grade 2 chill/fever). The 90-min obinutuzumab SDI might be safe and feasible in patients with B-cell NHL in China.
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Affiliation(s)
- Shuangshuang Xing
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Yiqin Pu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Xiaoqian Zhao
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Yan Hu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Feiyan Zhang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Zejuan Gu
- Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Lei Fan
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Yi Miao
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Jianyong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
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Shafat T, Grupel D, Porges T, Abuhasira R, Belkin A, Deri O, Oster Y, Zahran S, Horwitz E, Horowitz NA, Khatib H, Batista MV, Cortez AC, Brosh‐Nissimov T, Segman Y, Ishay L, Cohen R, Atamna A, Spallone A, Chemaly RF, Ramos‐Ramos JC, Chowers M, Rogozin E, Oren NC, Keske Ş, Barchad OW, Nesher L. An international multicenter study comparing COVID-19 omicron outcomes in patients with hematological malignancies treated with obinutuzumab versus rituximab. Cancer Med 2024; 13:e6997. [PMID: 38400683 PMCID: PMC10891459 DOI: 10.1002/cam4.6997] [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: 10/18/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES Hematological malignancy (HM) patients treated with anti-CD20 monoclonal antibodies are at higher risk for severe COVID-19. A previous single-center study showed worse outcomes in patients treated with obinutuzumab compared to rituximab. We examined this hypothesis in a large international multicenter cohort. METHODS We included HM patients from 15 centers, from five countries treated with anti-CD20, comparing those treated with obinutuzumab (O-G) to rituximab (R-G) between December 2021 and June 2022, when Omicron lineage was dominant. RESULTS We collected data on 1048 patients. Within the R-G (n = 762, 73%), 191 (25%) contracted COVID-19 compared to 103 (36%) in the O-G. COVID-19 patients in the O-G were younger (61 ± 11.7 vs. 64 ± 14.5, p = 0.039), had more indolent HM diagnosis (aggressive lymphoma: 3.9% vs. 67.0%, p < 0.001), and most were on maintenance therapy at COVID-19 diagnosis (63.0% vs. 16.8%, p < 0.001). Severe-critical COVID-19 occurred in 31.1% of patients in the O-G and 22.5% in the R-G. In multivariable analysis, O-G had a 2.08-fold increased risk for severe-critical COVID-19 compared to R-G (95% CI 1.13-3.84), adjusted for Charlson comorbidity index, sex, and tixagevimab/cilgavimab (T-C) prophylaxis. Further analysis comparing O-G to R-G demonstrated increased hospitalizations (51.5% vs. 35.6% p = 0.008), ICU admissions (12.6% vs. 5.8%, p = 0.042), but the nonsignificant difference in COVID-19-related mortality (n = 10, 9.7% vs. n = 12, 6.3%, p = 0.293). CONCLUSIONS Despite younger age and a more indolent HM diagnosis, patients receiving obinutuzumab had more severe COVID-19 outcomes than those receiving rituximab. Our findings underscore the need to evaluate the risk-benefit balance when considering obinutuzumab therapy for HM patients during respiratory viral outbreaks.
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Affiliation(s)
- Tali Shafat
- Infectious Diseases Institute, Soroka University Medical Center, and the Faculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
- Clinical Research Center, Soroka University Medical Center, and the Faculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
- Department of Infectious Diseases, Infection Control and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)BaselSwitzerland
| | - Daniel Grupel
- Department of Clinical Microbiology and Infectious DiseasesHadassah Medical CenterJerusalemIsrael
- Faculty of MedicineHebrew UniversityJerusalemIsrael
| | - Tzvika Porges
- Hematology Department, Soroka University Medical Center, and the Faculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
| | - Ran Abuhasira
- Clinical Research Center, Soroka University Medical Center, and the Faculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
| | - Ana Belkin
- Internal Medicine D and Infectious Diseases UnitSheba Medical CenterRamat‐GanIsrael
- Sackler Faculty of MedicineTel Aviv UniversityRamat‐AvivIsrael
| | - Ofir Deri
- Internal Medicine TSheba Medical CenterRamat‐GanIsrael
| | - Yonatan Oster
- Department of Clinical Microbiology and Infectious DiseasesHadassah Medical CenterJerusalemIsrael
- Faculty of MedicineHebrew UniversityJerusalemIsrael
| | - Shadi Zahran
- Department of Clinical Microbiology and Infectious DiseasesHadassah Medical CenterJerusalemIsrael
- Faculty of MedicineHebrew UniversityJerusalemIsrael
| | - Ehud Horwitz
- Department of Clinical Microbiology and Infectious DiseasesHadassah Medical CenterJerusalemIsrael
- Faculty of MedicineHebrew UniversityJerusalemIsrael
| | - Netanel A. Horowitz
- Department of Hematology and Bone Marrow TransplantationRambam Health Care CampusHaifaIsrael
| | - Hazim Khatib
- Department of Hematology and Bone Marrow TransplantationRambam Health Care CampusHaifaIsrael
| | - Marjorie Vieira Batista
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)BaselSwitzerland
- Department of Infectious DiseasesAC Camargo Cancer CenterSão PauloSão PauloBrazil
| | - Anita Cassoli Cortez
- Department of Hematology and Cell TherapyAC Camargo Cancer CenterSão PauloSão PauloBrazil
| | - Tal Brosh‐Nissimov
- Infectious Diseases UnitSamson Assuta Ashdod University HospitalAshdodIsrael
- The Faculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
| | - Yafit Segman
- The Faculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
- Hematology InstituteSamson Assuta Ashdod University HospitalAshdodIsrael
| | - Linor Ishay
- Rappaport Faculty of MedicineTechnionHaifaIsrael
- Hillel Yaffe Medical CenterHaderaIsrael
| | - Regev Cohen
- Rappaport Faculty of MedicineTechnionHaifaIsrael
- Hillel Yaffe Medical CenterHaderaIsrael
| | - Alaa Atamna
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)BaselSwitzerland
- Infectious Diseases Unit, Rabin Medical CenterBeilinson HospitalPetah TikvaIsrael
| | - Amy Spallone
- Department of Infectious Diseases, Infection Control and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)BaselSwitzerland
| | - Roy F. Chemaly
- Department of Infectious Diseases, Infection Control and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)BaselSwitzerland
| | - Juan Carlos Ramos‐Ramos
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)BaselSwitzerland
- Infectious Disease UnitInternal Medicine Service. CIBERINFEC. Hospital Universitario La PazMadridSpain
| | - Michal Chowers
- Meir Medical CentreKfar SabaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Evgeny Rogozin
- Infectious Diseases unitShamir (Assaf Harofeh) Medical CenterBe'er Ya'akovIsrael
| | - Noga Carmi Oren
- Infectious Diseases unitShamir (Assaf Harofeh) Medical CenterBe'er Ya'akovIsrael
| | - Şiran Keske
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)BaselSwitzerland
- Department of Infectious DiseasesVKV American HospitalIstanbulTurkey
| | | | - Lior Nesher
- Infectious Diseases Institute, Soroka University Medical Center, and the Faculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)BaselSwitzerland
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Aurer I, Jakšić O, Bašić-Kinda S, Mrđenović S, Ostojić-Kolonić S, Lozić D, Holik H, Novaković-Coha S, Berneš P, Krečak I, Morić-Perić M, Narančić M, Mitrović Z, Valković T. Treatment-Related Risk Factors for Adverse Outcomes of COVID-19 in Patients Treated for Lymphoid Malignancies in the Pre-Omicron Era-A Study of KroHem, the Croatian Group for Hematologic Diseases. Biomedicines 2024; 12:331. [PMID: 38397933 PMCID: PMC10887065 DOI: 10.3390/biomedicines12020331] [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: 01/14/2024] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
Patients with lymphoid malignancies are at increased risk of death or prolonged infection due to COVID-19. Data on the influence of different antineoplastic treatment modalities on outcomes are conflicting. Anti-CD20 monoclonal antibodies increase the risk of prolonged infection. It is unclear whether this risk is affected by the choice of the antibody (rituximab vs. obinutuzumab). To elucidate the role of antineoplastic therapy on COVID-19 outcomes, KroHem collected data on patients with lymphoid malignancies diagnosed with COVID-19 between October 2020 and April 2021. A total of 314 patients were identified, 75 untreated, 61 off treatment and 178 on treatment. The mortality rate in untreated and off-treatment patients was 15% and 16%; 9% and 10% had prolonged infection. In the on-treatment group, 3% were still prolonged positive at time of data collection, 62% recovered and 35% died; 42% had prolonged infection. Disease type, use of anti-CD20 monoclonal antibodies, prior autologous stem-cell transplantation (ASCT) and line of treatment did not significantly affect mortality. Mortality was higher in older patients (p = 0.0078) and those treated with purine analogues (p = 0.012). Prolonged COVID-19 was significantly more frequent in patients treated with anti-CD20 monoclonal antibodies (p = 0.012), especially obinutuzumab, and purine analogues (p = 0.012). Age, prior ASCT and treatment line did not significantly affect risk of prolonged infection. These data suggest that increased age and use of purine analogues are main risk factors for increased mortality of COVID-19 in patients with lymphoid malignancies. Obinutuzumab further increases the risk of prolonged disease, but not of death, in comparison to rituximab. Epidemiological considerations should be taken into account when choosing the appropriate antineoplastic therapy for patients with lymphoid malignancies.
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Affiliation(s)
- Igor Aurer
- University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia or (O.J.); (S.O.-K.); or (Z.M.)
| | - Ozren Jakšić
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia or (O.J.); (S.O.-K.); or (Z.M.)
- University Hospital Dubrava, Av. G. Šuška 6, 10000 Zagreb, Croatia
| | - Sandra Bašić-Kinda
- University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia;
| | - Stefan Mrđenović
- University Hospital Centre Osijek, J. Huttlera 4, 31000 Osijek, Croatia;
- Medical School, University of Osijek, J. Huttlera 4, 31000 Osijek, Croatia
| | - Slobodanka Ostojić-Kolonić
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia or (O.J.); (S.O.-K.); or (Z.M.)
- University Hospital Merkur, Zajčeva 19, 10000 Zagreb, Croatia
| | - Dominik Lozić
- University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia;
| | - Hrvoje Holik
- General Hospital Dr. Josip Benčević, A. Štampara 42, 35000 Slavonski Brod, Croatia;
| | - Sabina Novaković-Coha
- University Hospital Centre Sisters of Mercy, Vinogradska c. 29, 10000 Zagreb, Croatia;
| | - Petra Berneš
- General Hospital Pula, Santoriova ul. 24a, 52100 Pula, Croatia;
| | - Ivan Krečak
- General Hospital Šibenik, S. Radića 83, 22000 Šibenik, Croatia;
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia;
| | - Martina Morić-Perić
- General Hospital Zadar, B. Peričića 5, 23000 Zadar, Croatia; (M.M.-P.); (M.N.)
| | - Marino Narančić
- General Hospital Zadar, B. Peričića 5, 23000 Zadar, Croatia; (M.M.-P.); (M.N.)
| | - Zdravko Mitrović
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia or (O.J.); (S.O.-K.); or (Z.M.)
- University Hospital Dubrava, Av. G. Šuška 6, 10000 Zagreb, Croatia
| | - Toni Valković
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia;
- University Hospital Centre Rijeka, Krešimirova 42, 51000 Rijeka, Croatia
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31
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Bai SJ, Geng Y, Gao YN, Zhang CX, Mi Q, Zhang C, Yang JL, He SJ, Yan ZY, He JX. Marginal zone lymphoma with severe rashes: A case report. World J Clin Cases 2024; 12:565-574. [PMID: 38322474 PMCID: PMC10841955 DOI: 10.12998/wjcc.v12.i3.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/22/2023] [Accepted: 01/03/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Marginal zone lymphoma (MZL) is an indolent subtype of non-Hodgkin lymphoma (NHL), which is rare clinically with severe rashes as the initial symptom. CASE SUMMARY This study reports a case of MZL with generalized skin rashes accompanied by pruritus and purulent discharge. First-line treatment with rituximab combined with zanubrutinib had poor effects. However, after switching to obinutuzumab combined with zanubrutinib, the case was alleviated, and the rashes disappeared. CONCLUSION For patients with advanced stage MZL not benefiting from type I anti-CD20 monoclonal antibody (mAb) combination therapy, switching to a type II anti-CD20 mAb combination regimen may be considered. This approach may provide a new perspective in the treatment of MZL.
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Affiliation(s)
- Si-Jun Bai
- Department of Hematology, Shanxi Provincial People’s Hospital, Taiyuan 030012, Shanxi Province, China
| | - Ye Geng
- Department of Hematology, Shanxi Provincial People’s Hospital, Taiyuan 030012, Shanxi Province, China
| | - Yi-Nan Gao
- Department of Hematology, Shanxi Provincial People’s Hospital, Taiyuan 030012, Shanxi Province, China
| | - Cai-Xia Zhang
- Department of Hematology, Shanxi Provincial People’s Hospital, Taiyuan 030012, Shanxi Province, China
| | - Qian Mi
- Department of Hematology, Shanxi Provincial People’s Hospital, Taiyuan 030012, Shanxi Province, China
| | - Chen Zhang
- Department of Hematology, Shanxi Provincial People’s Hospital, Taiyuan 030012, Shanxi Province, China
| | - Jia-Ling Yang
- Department of Hematology, Shanxi Provincial People’s Hospital, Taiyuan 030012, Shanxi Province, China
| | - Si-Jie He
- Department of Hematology, Shanxi Provincial People’s Hospital, Taiyuan 030012, Shanxi Province, China
| | - Zhen-Ying Yan
- Department of Hematology, Shanxi Provincial People’s Hospital, Taiyuan 030012, Shanxi Province, China
| | - Jian-Xia He
- Department of Hematology, Shanxi Provincial People’s Hospital, Taiyuan 030012, Shanxi Province, China
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Galvez-Cancino F, Simpson AP, Costoya C, Matos I, Qian D, Peggs KS, Litchfield K, Quezada SA. Fcγ receptors and immunomodulatory antibodies in cancer. Nat Rev Cancer 2024; 24:51-71. [PMID: 38062252 DOI: 10.1038/s41568-023-00637-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 12/24/2023]
Abstract
The discovery of both cytotoxic T lymphocyte-associated antigen 4 (CTLA4) and programmed cell death protein 1 (PD1) as negative regulators of antitumour immunity led to the development of numerous immunomodulatory antibodies as cancer treatments. Preclinical studies have demonstrated that the efficacy of immunoglobulin G (IgG)-based therapies depends not only on their ability to block or engage their targets but also on the antibody's constant region (Fc) and its interactions with Fcγ receptors (FcγRs). Fc-FcγR interactions are essential for the activity of tumour-targeting antibodies, such as rituximab, trastuzumab and cetuximab, where the killing of tumour cells occurs at least in part due to these mechanisms. However, our understanding of these interactions in the context of immunomodulatory antibodies designed to boost antitumour immunity remains less explored. In this Review, we discuss our current understanding of the contribution of FcγRs to the in vivo activity of immunomodulatory antibodies and the challenges of translating results from preclinical models into the clinic. In addition, we review the impact of genetic variability of human FcγRs on the activity of therapeutic antibodies and how antibody engineering is being utilized to develop the next generation of cancer immunotherapies.
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Affiliation(s)
- Felipe Galvez-Cancino
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Alexander P Simpson
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Cristobal Costoya
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Ignacio Matos
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Danwen Qian
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Tumour Immunogenomics and Immunosurveillance Laboratory, University College London Cancer Institute, London, UK
| | - Karl S Peggs
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Kevin Litchfield
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Tumour Immunogenomics and Immunosurveillance Laboratory, University College London Cancer Institute, London, UK
| | - Sergio A Quezada
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK.
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK.
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Dossier C, Bonneric S, Baudouin V, Kwon T, Prim B, Cambier A, Couderc A, Moreau C, Deschenes G, Hogan J. Obinutuzumab in Frequently Relapsing and Steroid-Dependent Nephrotic Syndrome in Children. Clin J Am Soc Nephrol 2023; 18:1555-1562. [PMID: 37678236 PMCID: PMC10723910 DOI: 10.2215/cjn.0000000000000288] [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: 04/18/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND B-cell depletion with rituximab induces sustained remission in children with steroid-dependent or frequently relapsing nephrotic syndrome. However, most patients relapse after B-cell recovery, and some patients do not achieve B-cell depletion. Obinutuzumab is a second-generation anti-CD20 antibody designed to overcome such situations in B-cell malignancies and was recently reported to be safe and effective in other autoimmune diseases affecting the kidneys. METHODS We retrospectively report 41 children with steroid-dependent or frequently relapsing nephrotic syndrome treated with a single low-dose infusion of obinutuzumab at Robert-Debre Hospital between April 2018 and December 2020. Participants were treated because of rituximab resistance or relapse after rituximab and received a single infusion of 300 mg/1.73 m 2 obinutuzumab with cessation of oral immunosuppressors within 2 months. RESULTS B-cell depletion was achieved in all participants and lasted a median of 8.3 months (interquartile range, 6.4-11.1), a duration exceeding that for last rituximab treatment. At 12 and 24 months, 92% (38/41) and 68% (28/41) of patients, respectively, were in sustained remission. Mild infusion reactions occurred in five participants (12%) and neutropenia in nine (21%). No significant decrease in IgG level was reported during treatment, and whereas IgM levels decreased in 34 patients (83%), they were normal at last follow-up in 32 (78%). CONCLUSIONS These results identified low-dose obinituzumab as a promising treatment option in children with steroid-dependent or frequently relapsing nephrotic syndrome, including those resistant to rituximab. The tolerance profile of obinutuzumab was similar to that of rituximab, but hemogram and immunoglobulin levels should be monitored.
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Affiliation(s)
- Claire Dossier
- Pediatric Nephrology Department, Robert-Debré Hospital, APHP, Paris, France
| | - Stéphanie Bonneric
- Pediatric Nephrology Department, Robert-Debré Hospital, APHP, Paris, France
| | - Véronique Baudouin
- Pediatric Nephrology Department, Robert-Debré Hospital, APHP, Paris, France
| | - Thérésa Kwon
- Pediatric Nephrology Department, Robert-Debré Hospital, APHP, Paris, France
| | - Benjamin Prim
- Pediatric Nephrology Department, Robert-Debré Hospital, APHP, Paris, France
| | - Alexandra Cambier
- Pediatric Nephrology Department, Robert-Debré Hospital, APHP, Paris, France
| | - Anne Couderc
- Pediatric Nephrology Department, Robert-Debré Hospital, APHP, Paris, France
| | | | - Georges Deschenes
- Pediatric Nephrology Department, Robert-Debré Hospital, APHP, Paris, France
| | - Julien Hogan
- Pediatric Nephrology Department, Robert-Debré Hospital, APHP, Paris, France
- Université Paris Cité, INSERM, UMR-S970, PARCC, Paris Translational Research Center for Organ Transplantation, Paris, France
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Tang B, Yang X. Clinical advances in immunotherapy for immune-mediated glomerular diseases. Clin Exp Med 2023; 23:4091-4105. [PMID: 37889398 PMCID: PMC10725396 DOI: 10.1007/s10238-023-01218-7] [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: 08/25/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND AND OBJECTIVE Due to the suboptimal therapeutic efficacy and potential adverse effects associated with traditional immunosuppressive medications, there has been an increasing emphasis on the development and utilization of immunotherapies. This paper aims to provide clinicians with valuable insights for selecting appropriate therapeutic approaches and contribute to the development of novel immunotherapeutic drugs. MAIN BODY This paper categorizes the immunotherapeutic drugs that are used for the treatment of immune-mediated glomerular diseases into three groups: immunotherapies targeting antigen-presenting cells (anti-CD80), immunotherapies targeting T/B cells (anti-CD20, anti-CD22, BAFF and APRIL inhibitors, CD40-CD40L inhibitors, proteasome inhibitors, Syk inhibitors, and Btk inhibitors), and immunotherapies targeting the complement system (C5 inhibitors, C5a/C5aR inhibitors, C3 inhibitors, MASP2 inhibitors, factor B inhibitors, and factor D inhibitors). The article then provides a comprehensive overview of advances related to these immunotherapeutic drugs in clinical research. CONCLUSION Certain immunotherapeutic drugs, such as rituximab, belimumab, and eculizumab, have exhibited notable efficacy in treating specific immune-mediated glomerular diseases, thereby providing novel therapeutic approaches for patients. Nonetheless, the efficacy of numerous immunotherapeutic drugs remains to be substantiated.
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Affiliation(s)
- Bihui Tang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Xiao Yang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
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35
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Gutierrez A, Alonso A, Garcia-Recio M, Perez S, Garcia-Maño L, Martinez-Serra J, Ros T, Garcia-Gasalla M, Ferrer J, Vögler O, Alemany R, Salar A, Sampol A, Bento L. Analysis of vaccine responses after anti-CD20 maintenance in B-cell lymphoma in the Balearic Islands. A single reference center experience. Front Immunol 2023; 14:1267485. [PMID: 38022668 PMCID: PMC10646481 DOI: 10.3389/fimmu.2023.1267485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The use of maintenance approaches with anti-CD20 monoclonal antibodies has improved the outcomes of B-cell indolent lymphomas but may lead to significant peripheral B-cell depletion. This depletion can potentially hinder the serological response to neoantigens. Methods Our objective was to analyze the effect of anti-CD20 maintenance therapy in a reliable model of response to neoantigens: SARS-CoV-2 vaccine responses and the incidence/severity ofCOVID-19 in a reference hospital. Results In our series (n=118), the rate of vaccination failures was 31%. Through ROC curve analysis, we determined a cutoff for SARS-CoV-2 vaccine serologic response at 24 months from the last anti-CD20 dose. The risk of severe COVID-19 was notably higher within the first 24months following the last anti-CD20 dose (52%) compared to after this period (just 18%) (p=0.007). In our survival analysis, neither vaccine response nor hypogammaglobulinemia significantly affected OS. While COVID-19 led to a modest mortality rate of 2.5%, this figure was comparable to the OS reported in the general immunocompetent population. However, most patients with hypogammaglobulinemia received intravenous immunoglobulin therapy and all were vaccinated. In conclusion, anti-CD20 maintenance therapy impairs serological responses to SARS-CoV-2 vaccines. Discussion We report for the first time that patients during maintenance therapy and up to 24 months after the last anti-CD20 dose are at a higher risk of vaccine failure and more severe cases of COVID-19. Nevertheless, with close monitoring, intravenous immunoglobulin supplementation or proper vaccination, the impact on survival due to the lack of serological response in this high-risk population can be mitigated, allowing for the benefits of anti-CD20 maintenance therapy, even in the presence of hypogammaglobulinemia.
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Affiliation(s)
- Antonio Gutierrez
- Service of Hematology, University Hospital Son Espases/Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Aser Alonso
- Service of Hematology, University Hospital Son Espases/Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Marta Garcia-Recio
- Service of Hematology, University Hospital Son Espases/Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Sandra Perez
- Service of Hematology, University Hospital Son Espases/Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Lucia Garcia-Maño
- Service of Hematology, University Hospital Son Espases/Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Jordi Martinez-Serra
- Service of Hematology, University Hospital Son Espases/Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Teresa Ros
- Service of Hematology, University Hospital Son Espases/Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Mercedes Garcia-Gasalla
- Service of Internal Medicine and Infecious Diseases, University Hospital Son Espases/Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Joana Ferrer
- Service of Immunology, University Hospital Son Espases, Palma, Spain
| | - Oliver Vögler
- Group of Advanced Therapies and Biomarkers in Clinical Oncology, Health Research Institute of the Balearic Islands (IdISBa), Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, Palma, Spain
- Group of Clinical and Translational Research, Department of Biology, University of the Balearic Islands, Palma, Spain
| | - Regina Alemany
- Group of Advanced Therapies and Biomarkers in Clinical Oncology, Health Research Institute of the Balearic Islands (IdISBa), Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, Palma, Spain
- Group of Clinical and Translational Research, Department of Biology, University of the Balearic Islands, Palma, Spain
| | - Antonio Salar
- Service of Hematology , Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Antonia Sampol
- Service of Hematology, University Hospital Son Espases/Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Leyre Bento
- Service of Hematology, University Hospital Son Espases/Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
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Bauer-Smith H, Sudol ASL, Beers SA, Crispin M. Serum immunoglobulin and the threshold of Fc receptor-mediated immune activation. Biochim Biophys Acta Gen Subj 2023; 1867:130448. [PMID: 37652365 PMCID: PMC11032748 DOI: 10.1016/j.bbagen.2023.130448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023]
Abstract
Antibodies can mediate immune recruitment or clearance of immune complexes through the interaction of their Fc domain with cellular Fc receptors. Clustering of antibodies is a key step in generating sufficient avidity for efficacious receptor recognition. However, Fc receptors may be saturated with prevailing, endogenous serum immunoglobulin and this raises the threshold by which cellular receptors can be productively engaged. Here, we review the factors controlling serum IgG levels in both healthy and disease states, and discuss how the presence of endogenous IgG is encoded into the functional activation thresholds for low- and high-affinity Fc receptors. We discuss the circumstances where antibody engineering can help overcome these physiological limitations of therapeutic antibodies. Finally, we discuss how the pharmacological control of Fc receptor saturation by endogenous IgG is emerging as a feasible mechanism for the enhancement of antibody therapeutics.
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Affiliation(s)
- Hannah Bauer-Smith
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, UK; Centre for Cancer Immunology, School of Cancer Sciences, University of Southampton Faculty of Medicine, Southampton SO16 6YD, UK
| | - Abigail S L Sudol
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Stephen A Beers
- Centre for Cancer Immunology, School of Cancer Sciences, University of Southampton Faculty of Medicine, Southampton SO16 6YD, UK.
| | - Max Crispin
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, UK.
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37
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Kostakoglu L, Martelli M, Sehn LH, Davies A, Trněný M, Herold M, Vitolo U, Hiddemann W, Trotman J, Knapp A, Mattiello F, Nielsen TG, Sahin D, Sellam G, Ward C, Younes A. A comparison of the prognostic performance of the Lugano 2014 and RECIL 2017 response criteria in patients with NHL from the phase III GOYA and GALLIUM trials. EJHAEM 2023; 4:1042-1051. [PMID: 38024624 PMCID: PMC10660391 DOI: 10.1002/jha2.796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 12/01/2023]
Abstract
The Lugano 2014 criteria are the standard for response assessment in lymphoma. We compared the prognostic performance of Lugano 2014 and the more recently developed response evaluation criteria in lymphoma (RECIL 2017), which relies primarily on computed tomography and uses unidimensional measurements, in patients with previously untreated diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) from the phase III GOYA and GALLIUM trials, respectively. Concordance between responses according to the Lugano 2014 and RECIL 2017 criteria was analyzed. Landmark analyses of progression-free survival (PFS) and overall survival (OS) by end of treatment (EOT) and end of induction (EOI) response status according to RECIL 2017 and Lugano 2014 criteria, and prognostic value of response at EOT/EOI were also compared. Overall, 1333 patients were included from GOYA and 502 from GALLIUM. Complete response (CR) status according to RECIL 2017 criteria showed high concordance with complete metabolic response (CMR) status by Lugano 2014 criteria in both GOYA (92.5%) and GALLIUM (92.4%). EOT and EOI CR/CMR status by both criteria was highly prognostic for PFS in GOYA (RECIL 2017 [CR]: hazard ratio [HR], 0.35 [95% confidence interval [CI] 0.26-0.46]; Lugano 2014 [CMR]: HR, 0.35 [95% CI 0.26-0.48]; both p < .0001) and GALLIUM (RECIL 2017 [CR]: HR, 0.35 [95% CI 0.23-0.53]; Lugano 2014 [CMR]: HR, 0.21 [95% CI 0.14-0.31]; both p < .0001). In conclusion, response categorization by RECIL 2017 is similar to that by Lugano 2014 criteria, with high concordance observed. Both were prognostic for PFS and OS.
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Affiliation(s)
- Lale Kostakoglu
- Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision MedicineSapienza UniversityRomeItaly
| | - Laurie H. Sehn
- BC Cancer Center for Lymphoid Cancer and the University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Andrew Davies
- Cancer Research UK Centre/NIHR Experimental Cancer Medicine CentreUniversity of SouthamptonSouthamptonUK
| | - Marek Trněný
- 1st Faculty of MedicineCharles University General HospitalPragueCzech Republic
| | | | - Umberto Vitolo
- Medical Oncology, Candiolo Cancer Institute, FPO‐IRCCSCandioloItaly
| | | | - Judith Trotman
- Concord Repatriation General Hospital, University of SydneyConcordNew South WalesAustralia
| | | | | | | | | | | | - Carol Ward
- F. Hoffmann‐La Roche LtdBaselSwitzerland
| | - Anas Younes
- Memorial Sloan Kettering Cancer CenterNew York CityNew YorkUSA
- AstraZenecaNew YorkNew YorkUSA
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38
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López-Mourelle A, Rubiera M, Lamas-Álvarez S, Argüelles-Estrada P, de Francisco R, Pérez-Martínez I, Castaño-García A, Riestra S. Ulcerative colitis induced by obinutuzumab in a patient treated for a folicular lymphoma. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023. [PMID: 37882200 DOI: 10.17235/reed.2023.10009/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
An increasing use of immunomodulatory drugs has led to a corresponding increase in treatment-related pathologies such as inflammatory bowel disease. Here, we present a case of ulcerative colitis due to Obinutuzumab, an antiCD20 monoclonal approved for the treatment of Non-Hodgkin lymphomas.
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Affiliation(s)
- Ana López-Mourelle
- Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, España
| | | | - Sara Lamas-Álvarez
- Gastroenterology and Hepatology, Hospital Universitario Central de Asturias
| | | | - Ruth de Francisco
- Gastroenterology and Hepatology, Hospital Universitario Central de Asturias
| | | | | | - Sabino Riestra
- Gastroenterology and Hepatology, Hospital Universitario Central de Asturias
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Nizzoli ME, Manni M, Ghiggi C, Pulsoni A, Musuraca G, Merli M, Califano C, Bari A, Massaia M, Conconi A, Musto P, Mannina D, Perrone T, Re F, Galimberti S, Gini G, Capponi M, Vitolo U, Usai SV, Stefani PM, Ballerini F, Liberati AM, Pennese E, Pastore D, Skrypets T, Catellani H, Marcheselli L, Federico M, Luminari S. Impact of immunochemotherapy with R-bendamustine or R-CHOP for treatment naïve advanced-stage follicular lymphoma: A subset analysis of the FOLL12 trial by Fondazione Italiana Linfomi. Hematol Oncol 2023; 41:655-662. [PMID: 37246287 DOI: 10.1002/hon.3184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/30/2023]
Abstract
We conducted a post hoc analysis of the FOLL12 trial to determine the impact of different initial immunochemotherapy (ICT) regimens on patient outcomes. Patients were selected from the FOLL12 trial, which included adults with stage II-IV follicular lymphoma (FL) grade 1-3a and high tumor burden. Patients were randomized 1:1 to receive either standard ICT followed by rituximab maintenance (RM) or the same ICT followed by a response-adapted approach. ICT consisted of rituximab-bendamustine (RB) or rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHOP), per physician's decision. A total of 786 patients were included in this analysis, 341 of whom received RB and 445 R-CHOP. RB was more frequently prescribed to older subjects, females, patients without bulky disease, and those with grade 1-2 FL. After a median of 56 months of follow-up, R-CHOP and RB had similar progression-free survival (PFS) (Hazard Ratio for RB 1.11, 95% CI 0.87-1.42, p = 0.392). Standard RM was associated with improved PFS compared to response-adapted management both after R-CHOP and RB. Grade 3-4 hematologic adverse events were more frequent with R-CHOP during induction treatment and more frequent with RB during RM. Grade 3-4 infections were more frequent with RB. RB was also associated with a higher incidence of transformed FL. R-CHOP and RB showed similar activity and efficacy, but with different safety profiles and long-term events, suggesting that the treating physician should carefully select the most appropriate chemotherapy regimen for each patient based on patient's individual characteristics, choices, and risk profile.
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Affiliation(s)
- Maria E Nizzoli
- Hematology Unit, Azienda Unitа Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Martina Manni
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Ghiggi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alessandro Pulsoni
- Department of Translational and Precision Medicine, Sapienza University - UOC Ematologia, S.M. Goretti Hospital, Latina, Italy
| | - Gerardo Musuraca
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Michele Merli
- Hematology, University Hospital Ospedale di Circolo e Fondazione Macchi-ASST Sette Laghi, University of Insubria, Varese, Italy
| | | | - Alessia Bari
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, Università di Modena e Reggio Emilia, Modena, Italy
| | - Massimo Massaia
- SC Ematologia, AO S. Croce e Carle, Cuneo, Italy
- Centro di Biotecnologie Molecolari, University of Torino, Turin, Italy
| | | | - Pellegrino Musto
- Hematology, IRCCS CROB of Rionero in Vulture, Rionero in Vulture, Italy
| | - Donato Mannina
- Azienda Ospedaliera Papardo-UOC di Ematologia, Messina, Italy
| | - Tommasina Perrone
- Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, Bari, Italy
| | - Francesca Re
- Division od Immuno-Haematology, AOU Parma, Parma, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Guido Gini
- Clinic of Hematology AOU delle Marche- Università Politecnica delle Marche, Ancona, Italy
| | - Monia Capponi
- Department of Hematology, University of Perugia, Perugia, Italy
| | - Umberto Vitolo
- Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Sara V Usai
- Division of Hematology, Ospedale Oncologico Armando Businco, Cagliari, Italy
| | - Piero M Stefani
- Hematology Unit, General Hospital Ca' Foncello, Treviso, Italy
| | - Filippo Ballerini
- Clinica Ematologica, Ospedale Policlinico San Martino, Genova, Italy
| | - Anna M Liberati
- Oncohematology Unit, University of Perugia, Azienda Ospedaliera S.Maria Terni, Messina, Italy
| | - Elsa Pennese
- Lymphoma Unit, Department of Hematology, Ospedale Spirito Santo, Pescara, Italy
| | | | - Tetiana Skrypets
- Hematology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Hillary Catellani
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Massimo Federico
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Luminari
- Hematology Unit, Azienda Unitа Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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40
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Matarasso S, Assouline S. Mosunetuzumab and the emerging role of T-cell-engaging therapy in follicular lymphoma. Future Oncol 2023; 19:2083-2101. [PMID: 37882361 DOI: 10.2217/fon-2023-0274] [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] [Indexed: 10/27/2023] Open
Abstract
Follicular lymphoma (FL) is the most common indolent lymphoma. Since the advent of rituximab, FL has seen a progressive improvement in patient prognosis. While chemotherapy combined with an anti-CD20 monoclonal antibody remains standard first-line therapy, most patients will relapse and require subsequent therapy. T-cell-redirecting therapies can be very potent and are transforming the therapeutic landscape in the relapsed and refractory (R/R) setting. T-cell-dependent bispecific antibodies, of which mosunetuzumab is the first to be approved for R/R FL, are proving to be a highly effective, 'off-the-shelf' option with manageable toxicities. This review covers approved treatments for R/R FL and focuses on preclinical and clinical data available for mosunetuzumab (Lunsumio™), with the goal of determining its role in the treatment of R/R FL.
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Affiliation(s)
- Sarah Matarasso
- Lady Davis Institute, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, E725, Montreal, QC, H3T 1E2, Canada
| | - Sarit Assouline
- Lady Davis Institute, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, E725, Montreal, QC, H3T 1E2, Canada
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Saburi M, Okuhiro K, Yoshida N, Haruyama T, Moroga Y, Yanai Y, Itani K, Takano K, Honda S, Ono K, Iwanaga M, Sasaki H, Abe M, Kohno K, Nakayama T, Ohtsuka E, Ogata M. Infections associated with bendamustine and anti-CD20 antibody in untreated follicular lymphoma: a real-world study. J Clin Exp Hematop 2023; 63:197-200. [PMID: 37518273 PMCID: PMC10628822 DOI: 10.3960/jslrt.23015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 08/01/2023] Open
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Russler-Germain DA, Krysiak K, Ramirez C, Mosior M, Watkins MP, Gomez F, Skidmore ZL, Trani L, Gao F, Geyer S, Cashen AF, Mehta-Shah N, Kahl BS, Bartlett NL, Alderuccio JP, Lossos IS, Ondrejka SL, Hsi ED, Martin P, Leonard JP, Griffith M, Griffith OL, Fehniger TA. Mutations associated with progression in follicular lymphoma predict inferior outcomes at diagnosis: Alliance A151303. Blood Adv 2023; 7:5524-5539. [PMID: 37493986 PMCID: PMC10514406 DOI: 10.1182/bloodadvances.2023010779] [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: 05/19/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023] Open
Abstract
Follicular lymphoma (FL) is clinically heterogeneous, with select patients tolerating extended watch-and-wait, whereas others require prompt treatment, suffer progression of disease within 24 months of treatment (POD24), and/or experience aggressive histologic transformation (t-FL). Because our understanding of the relationship between genetic alterations in FL and patient outcomes remains limited, we conducted a clinicogenomic analysis of 370 patients with FL or t-FL (from Cancer and Leukemia Group B/Alliance trials 50402/50701/50803, or real-world cohorts from Washington University School of Medicine, Cleveland Clinic, or University of Miami). FL subsets by grade, stage, watch-and-wait, or POD24 status did not differ by mutation burden, whereas mutation burden was significantly higher in relapsed/refractory (rel/ref) FL and t-FL than in newly diagnosed (dx) FL. Nonetheless, mutation burden in dx FL was not associated with frontline progression-free survival (PFS). CREBBP was the only gene more commonly mutated in FL than in t-FL yet mutated CREBBP was associated with shorter frontline PFS in FL. Mutations in 20 genes were more common in rel/ref FL or t-FL than in dx FL, including 6 significantly mutated genes (SMGs): STAT6, TP53, IGLL5, B2M, SOCS1, and MYD88. We defined a mutations associated with progression (MAP) signature as ≥2 mutations in these 7 genes (6 rel/ref FL or t-FL SMGs plus CREBBP). Patients with dx FL possessing a MAP signature had shorter frontline PFS, revealing a 7-gene set offering insight into FL progression risk potentially more generalizable than the m7-Follicular Lymphoma International Prognostic Index (m7-FLIPI), which had modest prognostic value in our cohort. Future studies are warranted to validate the poor prognosis associated with a MAP signature in dx FL, potentially facilitating novel trials specifically in this high-risk subset of patients.
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Affiliation(s)
- David A. Russler-Germain
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Kilannin Krysiak
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Cody Ramirez
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - Matthew Mosior
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - Marcus P. Watkins
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Felicia Gomez
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Zachary L. Skidmore
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - Lee Trani
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - Feng Gao
- Public Health Sciences Division, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Susan Geyer
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Amanda F. Cashen
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Neha Mehta-Shah
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Brad S. Kahl
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Nancy L. Bartlett
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Juan P. Alderuccio
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Izidore S. Lossos
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Sarah L. Ondrejka
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Eric D. Hsi
- Department of Pathology, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Peter Martin
- Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - John P. Leonard
- Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Malachi Griffith
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
- Department of Genetics, Washington University School of Medicine, St. Louis, MO
| | - Obi L. Griffith
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
- Department of Genetics, Washington University School of Medicine, St. Louis, MO
| | - Todd A. Fehniger
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
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Chen CJJ, Choi MY, Heyman BM. Targeted Therapy in Follicular Lymphoma: Towards a Chemotherapy-Free Approach. Cancers (Basel) 2023; 15:4483. [PMID: 37760453 PMCID: PMC10526830 DOI: 10.3390/cancers15184483] [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: 06/12/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The treatment of follicular lymphoma (FL) has previously centered on chemoimmunotherapy, which can be disadvantageous due to patient intolerance, cumulative toxicities, and disease refractoriness. Targeted therapies can produce deep responses and improve progression-free and overall survival with more tolerable adverse event profiles. METHODS We summarize the current literature and key clinical trials regarding targeted therapies in follicular lymphoma both in the front-line and in the relapsed-refractory setting. RESULTS Targeted therapies studied in FL include immune modulators, anti-CD20 antibodies, Bruton's tyrosine kinase (BTK) inhibitors, enhancers of zeste homolog 2 (EZH2) inhibitors, phosphoinositide 3-kinase (PI3K) inhibitors, and B-cell lymphoma 2 (BCL-2) inhibitors. Chimeric antigen receptor (CAR-T) therapy and bispecific T-cell engager (BiTE) therapies also show promise in monotherapy and in combination with targeted therapies. These therapies exhibit high overall response rates and substantial progression-free survival and overall survival, even in high-risk patients or patients previously refractory to chemotherapy or rituximab. Adverse events vary substantially but are generally manageable and compare favorably to the cumulative toxicities of chemotherapy. CONCLUSION Targeted therapies represent a paradigm shift in the treatment of FL. Further studies are needed to directly compare these targeted therapies and their combinations, as well as to investigate biomarkers predictive of response.
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Affiliation(s)
- Chung-Jiah J. Chen
- Department of Medicine, Division of Hematology-Oncology, UC San Diego Health, La Jolla, CA 92037, USA; (C.-J.J.C.); (M.Y.C.)
| | - Michael Y. Choi
- Department of Medicine, Division of Hematology-Oncology, UC San Diego Health, La Jolla, CA 92037, USA; (C.-J.J.C.); (M.Y.C.)
| | - Benjamin M. Heyman
- Department of Medicine, Division of Regenerative Medicine, UC San Diego Health, La Jolla, CA 92037, USA
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44
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Mak JWY, Law AWH, Law KWT, Ho R, Cheung CKM, Law MF. Prevention and management of hepatitis B virus reactivation in patients with hematological malignancies in the targeted therapy era. World J Gastroenterol 2023; 29:4942-4961. [PMID: 37731995 PMCID: PMC10507505 DOI: 10.3748/wjg.v29.i33.4942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/22/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023] Open
Abstract
Hepatitis due to hepatitis B virus (HBV) reactivation can be serious and potentially fatal, but is preventable. HBV reactivation is most commonly reported in patients receiving chemotherapy, especially rituximab-containing therapy for hematological malignancies and those receiving stem cell transplantation. Patients with inactive and even resolved HBV infection still have persistence of HBV genomes in the liver. The expression of these silent genomes is controlled by the immune system. Suppression or ablation of immune cells, most importantly B cells, may lead to reactivation of seemingly resolved HBV infection. Thus, all patients with hematological malignancies receiving anticancer therapy should be screened for active or resolved HBV infection by blood tests for hepatitis B surface antigen (HBsAg) and antibody to hepatitis B core antigen. Patients found to be positive for HBsAg should be given prophylactic antiviral therapy. For patients with resolved HBV infection, there are two approaches. The first is pre-emptive therapy guided by serial HBV DNA monitoring, and treatment with antiviral therapy as soon as HBV DNA becomes detectable. The second approach is prophylactic antiviral therapy, particularly for patients receiving high-risk therapy, especially anti-CD20 monoclonal antibody or hematopoietic stem cell transplantation. Entecavir and tenofovir are the preferred antiviral choices. Many new effective therapies for hematological malignancies have been introduced in the past decade, for example, chimeric antigen receptor (CAR)-T cell therapy, novel monoclonal antibodies, bispecific antibody drug conjugates, and small molecule inhibitors, which may be associated with HBV reactivation. Although there is limited evidence to guide the optimal preventive measures, we recommend antiviral prophylaxis in HBsAg-positive patients receiving novel treatments, including Bruton's tyrosine kinase inhibitors, B-cell lymphoma 2 inhibitors, and CAR-T cell therapy. Further studies are needed to determine the risk of HBV reactivation with these agents and the best prophylactic strategy.
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Affiliation(s)
- Joyce Wing Yan Mak
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong 852, China
| | | | | | - Rita Ho
- Department of Medicine, North District Hospital, Hong Kong 852, China
| | - Carmen Ka Man Cheung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong 852, China
| | - Man Fai Law
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong 852, China
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Suleman A, Aktar SJ, Ante Z, Liu N, Chan KKW, Cheung MC, Prica A. Outcomes of patients with indolent lymphoma treated with bendamustine plus rituximab compared to rituximab plus CVP or CHOP chemoimmunotherapy in Ontario. Br J Haematol 2023; 202:1104-1118. [PMID: 37474340 DOI: 10.1111/bjh.18972] [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: 05/01/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/22/2023]
Abstract
Bendamustine (B) with rituximab (R) has become the preferred regimen for patients with indolent lymphoma in Ontario, Canada, compared to R with cyclophosphamide, vincristine, prednisone (CVP) or cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP). We conducted a propensity-matched retrospective cohort population-based study of patients treated with R-CVP/CHOP from 2005 to 2012 and patients treated with BR from 2013 to 2018. The primary outcome was 5-year overall survival (OS), and secondary outcomes included toxicities and healthcare utilization. The 5-year OS for patients treated with BR (n = 2023) and R-CVP/CHOP (n = 2023) was 80% and 75% respectively. Treatment with BR was associated with improved OS (HR 0.79, 95% CI 0.69-0.91). During the first 9 months, patients treated with BR versus R-CVP/CHOP had a higher number of admissions for infection (22% compared to 17%, p < 0.01) and a higher number of mean ED visits (mean 1.01 ± 1.68 visits vs. 0.85 ± 1.51 visits, p < 0.01). This trend persisted for 3 years. The adjusted 5-year OS for patients 75 years and older did not differ based on treatment regimen (55.5% for BR vs. 55.4% for R-CVP/CHOP). Our study supports the use of BR for patients with indolent lymphoma requiring treatment but suggests increased risk of certain toxicities warranting careful patient selection.
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Affiliation(s)
- Adam Suleman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suriya J Aktar
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Zharmaine Ante
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Ning Liu
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Matthew C Cheung
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anca Prica
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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46
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Kiesewetter B, Dafni U, de Vries EGE, Barriuso J, Curigliano G, González-Calle V, Galotti M, Gyawali B, Huntly BJP, Jäger U, Latino NJ, Malcovati L, Oosting SF, Ossenkoppele G, Piccart M, Raderer M, Scarfò L, Trapani D, Zielinski CC, Wester R, Zygoura P, Macintyre E, Cherny NI. ESMO-Magnitude of Clinical Benefit Scale for haematological malignancies (ESMO-MCBS:H) version 1.0. Ann Oncol 2023; 34:734-771. [PMID: 37343663 DOI: 10.1016/j.annonc.2023.06.002] [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: 05/03/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND The European Society for Medical Oncology (ESMO)-Magnitude of Clinical Benefit Scale (MCBS) has been accepted as a robust tool to evaluate the magnitude of clinical benefit reported in trials for oncological therapies. However, the ESMO-MCBS hitherto has only been validated for solid tumours. With the rapid development of novel therapies for haematological malignancies, we aimed to develop an ESMO-MCBS version that is specifically designed and validated for haematological malignancies. METHODS ESMO and the European Hematology Association (EHA) initiated a collaboration to develop a version for haematological malignancies (ESMO-MCBS:H). The process incorporated five landmarks: field testing of the ESMO-MCBS version 1.1 (v1.1) to identify shortcomings specific to haematological diseases, drafting of the ESMO-MCBS:H forms, peer review and revision of the draft based on re-scoring (resulting in a second draft), assessment of reasonableness of the scores generated, final review and approval by ESMO and EHA including executive boards. RESULTS Based on the field testing results of 80 haematological trials and extensive review for feasibility and reasonableness, five amendments to ESMO-MCBS were incorporated in the ESMO-MCBS:H addressing the identified shortcomings. These concerned mainly clinical trial endpoints that differ in haematology versus solid oncology and the very indolent nature of nevertheless incurable diseases such as follicular lymphoma, which hampers presentation of mature data. In addition, general changes incorporated in the draft version of the ESMO-MCBS v2 were included, and specific forms for haematological malignancies generated. Here we present the final approved forms of the ESMO-MCBS:H, including instructions. CONCLUSION The haematology-specific version ESMO-MCBS:H allows now full applicability of the scale for evaluating the magnitude of clinical benefit derived from clinical studies in haematological malignancies.
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Affiliation(s)
- B Kiesewetter
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - U Dafni
- Laboratory of Biostatistics, School of Health Sciences, National and Kapodistrian University of Athens, Athens; Frontier Science Foundation-Hellas, Athens, Greece
| | - E G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Barriuso
- The Christie NHS Foundation Trust and Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - G Curigliano
- European Institute of Oncology, IRCCS, Division of Early Drug Development, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - V González-Calle
- Servicio de Hematología, Hospital Universitario de Salamanca-IBSAL, CIBERONC and Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - M Galotti
- ESMO Head Office, Lugano, Switzerland
| | - B Gyawali
- Departments of Oncology, Oncology; Public Health Sciences, Queen's University, Kingston; Division of Cancer Care and Epidemiology, Queen's University, Kingston, Canada
| | - B J P Huntly
- Cambridge Stem Cell Institute, Department of Haematology, University of Cambridge & Cambridge University Hospitals, Cambridge, UK
| | - U Jäger
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | | | - L Malcovati
- Department of Molecular Medicine, University of Pavia, Pavia; Department of Hematology Oncology, IRCCS S. Matteo Hospital Foundation, Pavia, Italy
| | - S F Oosting
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G Ossenkoppele
- Department of Haematology, VU University Medical Center, Amsterdam, The Netherlands
| | - M Piccart
- Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - M Raderer
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - L Scarfò
- Strategic Research Program on CLL, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - D Trapani
- European Institute of Oncology, IRCCS, Division of Early Drug Development, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - C C Zielinski
- Wiener Privatklinik, Central European Academy Cancer Center, Vienna, Austria
| | - R Wester
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - P Zygoura
- Frontier Science Foundation-Hellas, Athens, Greece
| | - E Macintyre
- Onco-hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris; Université Paris Cité, INSERM, CNRS, INEM F-75015, Paris, France
| | - N I Cherny
- Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel.
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Zand L, Fervenza FC. Anti-CD20 should be the first-line treatment in high-risk membranous nephropathy. Clin Kidney J 2023; 16:1420-1425. [PMID: 37669312 PMCID: PMC10468755 DOI: 10.1093/ckj/sfad075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 09/05/2023] Open
Abstract
Membranous nephropathy (MN) is a common cause of nephrotic syndrome (NS) in adults and if untreated can progress to endstage kidney disease. Factors considered to place a patient at high or very high risk for progression include elevated serum creatinine at baseline, declining kidney function, persistent heavy proteinuria (>8 g/24 h), or persistent NS, presence of life-threatening complications related to NS (such as venous thromboembolic events), or very high anti-PLA2R antibody titers (>150 RU/ml). Patients who are at high or very high risk of progression should be treated with immunosuppression therapy to induce remission of proteinuria and to avoid progressive loss of kidney function. Traditional forms of immunosuppression for patients with MN have included the use of cyclic courses of corticosteroids with cyclophosphamide or calcineurin inhibitors. These forms of therapy are associated with significant toxicity, e.g. corticosteroids (infections, diabetes, weight gain), cyclophosphamide (infertility, severe leukopenia, malignancy), and calcineurin inhibitors (hypertension, nephrotoxicity). The introduction of anti-CD20+ B-cell therapies in the late 1990s has changed the landscape. In this article we will argue that anti-CD20+ B therapy should be the treatment of choice for patients at high/very high risk of progression when considering its efficacy and side-effect profile.
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Affiliation(s)
- Ladan Zand
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
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48
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Beck LH, Ayoub I, Caster D, Choi MJ, Cobb J, Geetha D, Rheault MN, Wadhwani S, Yau T, Whittier WL. KDOQI US Commentary on the 2021 KDIGO Clinical Practice Guideline for the Management of Glomerular Diseases. Am J Kidney Dis 2023; 82:121-175. [PMID: 37341661 DOI: 10.1053/j.ajkd.2023.02.003] [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: 12/21/2022] [Accepted: 02/20/2023] [Indexed: 06/22/2023]
Abstract
The KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases represents the first update to this set of recommendations since the initial set of KDIGO guideline recommendations was published in 2012. The pace of growth in our molecular understanding of glomerular disease has quickened and a number of newer immunosuppressive and targeted therapies have been introduced since the original set of guideline recommendations, making such an update necessary. Despite these updates, many areas of controversy remain. In addition, further updates since the publication of KDIGO 2021 have occurred which this guideline does not encompass. With this commentary, the KDOQI work group has generated a chapter-by-chapter companion opinion article that provides commentary specific to the implementation of the KDIGO 2021 guideline in the United States.
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Affiliation(s)
- Laurence H Beck
- Division of Nephrology, Department of Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Isabelle Ayoub
- Department of Medicine, Division of Nephrology, Wexner Medical, The Ohio State University, Columbus, Ohio
| | - Dawn Caster
- Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky
| | | | - Jason Cobb
- Division of Renal Medicine, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Duvuru Geetha
- Division of Nephrology, Johns Hopkins University, Baltimore, Maryland
| | - Michelle N Rheault
- Department of Pediatrics, Division of Pediatric Nephrology, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota
| | - Shikha Wadhwani
- Division of Nephrology and Hypertension, Northwestern University, Chicago, Illinois
| | - Timothy Yau
- Division of Nephrology, Department of Medicine, School of Medicine, Washington University, St. Louis, Missouri
| | - William L Whittier
- Division of Nephrology, Rush University Medical Center, Chicago, Illinois
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49
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Linton KM, Specht L, Pavlovsky A, Thompson CA, Kimby E, de Jong D, Nastoupil LJ, Cottereau AS, Casulo C, Sarkozy C, Okosun J. Personalised therapy in follicular lymphoma - is the dial turning? Hematol Oncol 2023. [PMID: 37482955 DOI: 10.1002/hon.3205] [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: 04/06/2023] [Revised: 05/25/2023] [Accepted: 06/17/2023] [Indexed: 07/25/2023]
Abstract
Follicular lymphoma is the most common indolent lymphoma accounting for approximately 20%-25% of all new non-Hodgkin lymphoma diagnoses in western countries. Whilst outcomes are mostly favorable, the spectrum of clinical phenotypes includes high-risk groups with significantly inferior outcomes. This review discusses recent updates in risk stratification and treatment approaches from upfront treatment for limited and advanced stage follicular lymphoma to the growing options for relapsed, refractory disease with perspectives on how to approach this from a personalized lens. Notable gaps remain on how one can precisely and prospectively select optimal treatment for patients based on varying risks, with an anticipation that an increased understanding of the biology of these different phenotypes and increasing refinement of imaging- and biomarker-based tools will, in time, allow these gaps to be closed.
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Affiliation(s)
- Kim M Linton
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The Manchester Cancer Research Centre, University of Manchester, Manchester, UK
| | - Lena Specht
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Astrid Pavlovsky
- Department of Hematology, Fundaleu Clinical Research Center, Buenos Aires, Argentina
- Centro de Helmatología Pavlovsky, Medical Director, Buenos Aires, Argentina
| | - Carrie A Thompson
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eva Kimby
- Department of Medicine Karolinska Institutet, Center of Hematology, Stockholm, Sweden
| | - Daphne de Jong
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Loretta J Nastoupil
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anne-Ségolène Cottereau
- Department of Nuclear Medicine, Cochin Hospital, APHP, University of Paris Cité, Paris, France
| | - Carla Casulo
- Department of Medicine, University of Rochester, Rochester, New York, USA
| | | | - Jessica Okosun
- Centre for Haemato-Oncology Barts Cancer Institute, Queen Mary University of London, London, UK
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50
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[Chinese guidelines for diagnosis and treatment of follicular lymphoma(2023)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:529-534. [PMID: 37749030 PMCID: PMC10509619 DOI: 10.3760/cma.j.issn.0253-2727.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Indexed: 09/27/2023]
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