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Yates SJ, Cursio JF, Artz A, Kordas K, Bishop MR, Derman BA, Kosuri S, Riedell PA, Kline J, Jakubowiak A, Mortel M, Johnson S, Nawas MT. Optimization of older adults by a geriatric assessment-guided multidisciplinary clinic before CAR T-cell therapy. Blood Adv 2024; 8:3785-3797. [PMID: 38810262 DOI: 10.1182/bloodadvances.2024012727] [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: 01/22/2024] [Revised: 04/29/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024] Open
Abstract
ABSTRACT The optimal means of assessing candidacy of older adults (≥65 years) for chimeric antigen receptor T-cell (CAR-T) therapy are unknown. We explored the role of a geriatric assessment (GA)-guided multidisciplinary clinic (GA-MDC) in selecting and optimizing older adults for CAR-T. Sixty-one patients were evaluated in a GA-MDC (median age, 73 years; range, 58-83). A nonbinding recommendation ("proceed" or "decline") regarding suitability for CAR-T was provided for each patient based on GA results. Fifty-three patients ultimately received CAR-T (proceed, n = 47; decline, n = 6). Among patients who received B-cell maturation antigen (BCMA)-directed (n = 11) and CD19-directed CAR-T (n = 42), the median overall survival (OS) was 14.2 months and 16.6 months, respectively. GA uncovered high rates of geriatric impairment among patients proceeding to CAR-T therapy, with fewer impairments in those recommended "proceed." Patients recommended "proceed" had shorter median length of stay (17 vs 31 days; P = .05) and lower rates of intensive care unit admission (6% vs 50%; P = .01) than those recommended "decline." In patients receiving CD19- and BCMA-directed CAR-T therapy, a "proceed" recommendation was associated with superior OS compared with "decline" (median, 16.6 vs 11.4 months [P = .02]; and median, 16.4 vs 4.2 months [P = .03], respectively). When controlling for Karnofsky performance status, C-reactive protein, and lactate dehydrogenase at time of lymphodepletion, the GA-MDC treatment recommendation remained prognostic for OS (hazard ratio, 3.26; P = .04). Patients optimized via the GA-MDC without serious vulnerabilities achieved promising outcomes, whereas patients with high vulnerability experienced high toxicity and poor outcomes after CAR-T therapy.
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Affiliation(s)
- Samuel J Yates
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - John F Cursio
- Department of Public Health Sciences, University of Chicago Biological Sciences Division, Chicago, IL
| | - Andrew Artz
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Keriann Kordas
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Michael R Bishop
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
- The David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Benjamin A Derman
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Satyajit Kosuri
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Peter A Riedell
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Justin Kline
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Andrzej Jakubowiak
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Mylove Mortel
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Shalitha Johnson
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Mariam T Nawas
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
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2
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Lownik J, Boiarsky J, Birhiray R, Merchant A, Mead M. Sequencing of Anti-CD19 Therapies in the Management of Diffuse Large B-Cell Lymphoma. Clin Cancer Res 2024; 30:2895-2904. [PMID: 38661647 PMCID: PMC11247318 DOI: 10.1158/1078-0432.ccr-23-1962] [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: 07/17/2023] [Revised: 12/01/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024]
Abstract
Several second- and third-line immunotherapeutic options for patients with relapsed or refractory diffuse large B-cell lymphoma ineligible for autologous stem cell transplant are directed against the B-cell antigen cluster of differentiation 19 (CD19). The anti-CD19 monoclonal antibody tafasitamab, paired with the immunomodulator lenalidomide, mediates antibody-dependent cellular toxicity and phagocytosis; the antibody-drug conjugate loncastuximab tesirine delivers the DNA cross-linking agent tesirine via CD19 binding and internalization; and CD19-directed chimeric antigen receptor T-cell therapy (CAR-T) products are engineered from autologous T cells. Although CD19 expression is assessed at diagnosis, clinically relevant thresholds of CD19 expression-which may not be detectable using current routine methodologies-have not been defined and may vary between CD19-directed treatment modalities. Determining optimal treatment sequencing strategies for CD19-directed therapy is hampered by the exclusion of patients who have received prior CD19-directed therapies from major clinical trials. Antigen escape, which is attributed to mechanisms including epitope loss and defective cell surface trafficking of CD19, is an important cause of CAR-T failure. Limited data suggest that CD19 expression may be maintained after non-CAR-T CD19-directed therapy, and retrospective analyses indicate that some patients with disease relapse after CAR-T may benefit from subsequent CD19-directed therapy. To date, clinical evidence on the effect of anti-CD19 therapy prior to CAR-T has been limited to small case series. Prospective studies and detailed analyses are needed to understand how pretreatment and posttreatment CD19 expression correlates with clinical responses to subsequent CD19-directed therapy to fully maximize treatment strategies.
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MESH Headings
- Humans
- Antigens, CD19/immunology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Immunotherapy, Adoptive/methods
- Disease Management
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Affiliation(s)
- Joseph Lownik
- Cedars Sinai Medical Center, Samuel Oschin Cancer Center, Los Angeles, California.
| | | | - Ruemu Birhiray
- Hematology Oncology of Indiana/American Oncology Network, Indianapolis, Indiana.
| | - Akil Merchant
- Cedars Sinai Medical Center, Samuel Oschin Cancer Center, Los Angeles, California.
| | - Monica Mead
- UCLA, Santa Monica Cancer Care, Santa Monica, California.
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3
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Bock AM, Mwangi R, Wang Y, Khurana A, Maurer MJ, Ayers A, Kahl BS, Martin P, Cohen JB, Casulo C, Lossos IS, Farooq U, Ayyappan S, Reicks T, Habermann TM, Witzig TE, Flowers CR, Cerhan JR, Nastoupil LJ, Nowakowski GS. Defining primary refractory large B-cell lymphoma. Blood Adv 2024; 8:3402-3415. [PMID: 38669353 DOI: 10.1182/bloodadvances.2024012760] [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: 01/24/2024] [Revised: 03/24/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
ABSTRACT Patients with large B-cell lymphoma (LBCL) that fail to achieve a complete response (CR) or who relapse early after anthracycline-containing immunochemotherapy (IC) have a poor prognosis and are commonly considered to have "primary refractory disease." However, different definitions of primary refractory disease are used in the literature and clinical practice. In this study, we examined variation in the time to relapse used to define refractory status and association with survival outcomes in patients with primary refractory LBCL in a single-center prospective cohort with validation in an independent multicenter cohort. Patients with newly diagnosed LBCL were enrolled in the Molecular Epidemiological Resource cohort (MER; N = 949) or the Lymphoma Epidemiology of Outcomes cohort (LEO; N = 2755) from September 2002 to May 2021. Primary refractory LBCL was defined as no response (stable disease [SD]) or progressive disease (PD) during, or by the end of, frontline (1L) IC (primary PD; PPD); partial response at end of treatment (EOT PR); or relapse within 3 to 12 months after achieving CR at EOT to 1L IC (early relapse). In the MER cohort, patients with PPD had inferior overall survival (OS; 2-year OS rate: 15% MER, 31% LEO) when compared with other subgroups considered in defining primary refractory disease, EOT PR (2-year OS rate: 38% MER, 50% LEO) and early relapse (2-year OS rate: 44% MER, 58% LEO). Among patients receiving 1L IC with curative intent, we identified that patients with PPD are the key subgroup with poor outcomes. We propose a definition of primary refractory LBCL as SD or PD during, or by the end of, 1L treatment.
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Affiliation(s)
- Allison M Bock
- Division of Hematology, Mayo Clinic, Rochester, MN
- Department of Hematology and Hematologic Malignancies, Huntsman Cancer Institute/University of Utah, Salt Lake City, UT
| | - Raphael Mwangi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Matthew J Maurer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Amy Ayers
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brad S Kahl
- Division of Oncology, Washington University in St. Louis, St. Louis, MO
| | - Peter Martin
- Division of Hematology/Oncology, Weill Cornell Medicine, New York, NY
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Carla Casulo
- Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
| | | | - Umar Farooq
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Sabarish Ayyappan
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Tanner Reicks
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | - Christopher R Flowers
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James R Cerhan
- Department of Hematology and Hematologic Malignancies, Huntsman Cancer Institute/University of Utah, Salt Lake City, UT
| | - Loretta J Nastoupil
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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4
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Cordas Dos Santos DM, Tix T, Shouval R, Gafter-Gvili A, Alberge JB, Cliff ERS, Theurich S, von Bergwelt-Baildon M, Ghobrial IM, Subklewe M, Perales MA, Rejeski K. A systematic review and meta-analysis of nonrelapse mortality after CAR T cell therapy. Nat Med 2024:10.1038/s41591-024-03084-6. [PMID: 38977912 DOI: 10.1038/s41591-024-03084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/22/2024] [Indexed: 07/10/2024]
Abstract
Although chimeric antigen receptor (CAR) T cell therapy represents a transformative immunotherapy, it is also associated with distinct toxicities that contribute to morbidity and mortality. In this systematic review and meta-analysis, we searched MEDLINE, Embase and CINAHL (Cochrane) for reports of nonrelapse mortality (NRM) after CAR T cell therapy in lymphoma and multiple myeloma up to March 2024. After extraction of causes and numbers of death, we analyzed NRM point estimates using random-effect models. We identified 7,604 patients across 18 clinical trials and 28 real-world studies. NRM point estimates varied across disease entities and were highest in patients with mantle-cell lymphoma (10.6%), followed by multiple myeloma (8.0%), large B cell lymphoma (6.1%) and indolent lymphoma (5.7%). Entity-specific meta-regression models for large B cell lymphoma and multiple myeloma revealed that axicabtagene ciloleucel and ciltacabtagene autoleucel were independently associated with increased NRM point estimates, respectively. Of 574 reported nonrelapse deaths, over half were attributed to infections (50.9%), followed by other malignancies (7.8%) and cardiovascular/respiratory events (7.3%). Conversely, the CAR T cell-specific side effects, immune effector cell-associated neurotoxicity syndrome/neurotoxicity, cytokine release syndrome and hemophagocytic lymphohistiocytosis, represented only a minority of nonrelapse deaths (cumulatively 11.5%). Our findings underline the critical importance of infectious complications after CAR T cell therapy and support the comprehensive reporting of NRM, including specific causes and long-term outcomes.
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Affiliation(s)
- David M Cordas Dos Santos
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Tobias Tix
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Roni Shouval
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Anat Gafter-Gvili
- Department of Medicine A and Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Jean-Baptiste Alberge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Edward R Scheffer Cliff
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Program on Regulation, Therapeutics and Law, Brigham and Women's Hospital, Boston, MA, USA
| | - Sebastian Theurich
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium, Partner Site Munich, Munich, Germany
| | - Michael von Bergwelt-Baildon
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium, Partner Site Munich, Munich, Germany
| | - Irene M Ghobrial
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Marion Subklewe
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium, Partner Site Munich, Munich, Germany
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Kai Rejeski
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany.
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
- German Cancer Consortium, Partner Site Munich, Munich, Germany.
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5
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Shadman M, Ahn KW, Kaur M, Lekakis L, Beitinjaneh A, Iqbal M, Ahmed N, Hill B, Hossain NM, Riedell P, Gopal AK, Grover N, Frigault M, Brammer J, Ghosh N, Merryman R, Lazaryan A, Ram R, Hertzberg M, Savani B, Awan F, Khimani F, Ahmed S, Kenkre VP, Ulrickson M, Shah N, Kharfan-Dabaja MA, Herrera A, Sauter C, Hamadani M. Autologous transplant vs. CAR-T therapy in patients with DLBCL treated while in complete remission. Blood Cancer J 2024; 14:108. [PMID: 38977682 PMCID: PMC11231252 DOI: 10.1038/s41408-024-01084-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/24/2024] [Accepted: 06/13/2024] [Indexed: 07/10/2024] Open
Abstract
In patients with relapsed DLBCL in complete remission (CR), autologous hematopoietic cell transplantation (auto-HCT) and CAR-T therapy are both effective, but it is unknown which modality provides superior outcomes. We compared the efficacy of auto-HCT vs. CAR-T in patients with DLBCL in a CR. A retrospective observational study comparing auto-HCT (2015-2021) vs. CAR-T (2018-2021) using the Center for International Blood & Marrow Transplant Research registry. Median follow-up was 49.7 months for the auto-HCT and 24.7 months for the CAR-T cohort. Patients ages 18 and 75 with a diagnosis of DLBCL were included if they received auto-HCT (n = 281) or commercial CAR-T (n = 79) while in a CR. Patients undergoing auto-HCT with only one prior therapy line and CAR-T patients with a previous history of auto-HCT treatment were excluded. Endpoints included Progression-free survival (PFS), relapse rate, non-relapse mortality (NRM) and overall survival (OS). In univariate analysis, treatment with auto-HCT was associated with a higher rate of 2-year PFS (66.2% vs. 47.8%; p < 0.001), a lower 2-year cumulative incidence of relapse (27.8% vs. 48% ; p < 0.001), and a superior 2-year OS (78.9% vs. 65.6%; p = 0.037). In patients with early (within 12 months) treatment failure, auto-HCT was associated with a superior 2-year PFS (70.9% vs. 48.3% ; p < 0.001), lower 2-year cumulative incidence of relapse (22.8% vs. 45.9% ; p < 0.001) and trend for higher 2-year OS (82.4% vs. 66.1% ; p = 0.076). In the multivariable analysis, treatment with auto-HCT was associated with a superior PFS (hazard ratio 1.83; p = 0.0011) and lower incidence of relapse (hazard ratio 2.18; p < 0.0001) compared to CAR-T. In patients with relapsed LBCL who achieve a CR, treatment with auto-HCT is associated with improved clinical outcomes compared to CAR-T. These data support the consideration of auto-HCT in select patients with LBCL achieving a CR in the relapsed setting.
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Affiliation(s)
- Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Division of Hematology and Medical Oncology, University of Washington, Seattle, WA, USA
| | - Kwang W Ahn
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Manmeet Kaur
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lazaros Lekakis
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Madiha Iqbal
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Nausheen Ahmed
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Cancer Center, Westwood, KS, USA
| | - Brian Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nasheed M Hossain
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Peter Riedell
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Ajay K Gopal
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Division of Hematology and Medical Oncology, University of Washington, Seattle, WA, USA
| | - Natalie Grover
- Lineberger Comprehensive Cancer Center, Department of Medicine, Hematology Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Matthew Frigault
- Hematopoietic Cell Transplant and Cell Therapy Program, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Brammer
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Nilanjan Ghosh
- Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Reid Merryman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Aleksandr Lazaryan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ron Ram
- Bone Marrow Transplantation Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Bipin Savani
- Long Term Transplant Clinic, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Farrukh Awan
- Division of Hematology and Oncology, UT Southwestern, Dallas, TX, USA
| | - Farhad Khimani
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Sairah Ahmed
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Stem Cell Transplantation & Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vaishalee P Kenkre
- Division of Hematology, Oncology, Palliative Care, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | | | - Nirav Shah
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Alex Herrera
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Craig Sauter
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA.
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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6
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Berning P, Fekom M, Ngoya M, Goldstone AH, Dreger P, Montoto S, Finel H, Shumilov E, Chevallier P, Blaise D, Strüssmann T, Carpenter B, Forcade E, Castilla-Llorente C, Trneny M, Ghesquieres H, Capria S, Thieblemont C, Blau IW, Meijer E, Broers AEC, Huynh A, Caillot D, Rösler W, Nguyen Quoc S, Bittenbring J, Nagler A, Galimard JE, Glass B, Sureda A, Schmitz N. Hematopoietic stem cell transplantation for DLBCL: a report from the European Society for Blood and Marrow Transplantation on more than 40,000 patients over 32 years. Blood Cancer J 2024; 14:106. [PMID: 38969655 PMCID: PMC11226679 DOI: 10.1038/s41408-024-01085-9] [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: 04/04/2024] [Revised: 06/06/2024] [Accepted: 06/13/2024] [Indexed: 07/07/2024] Open
Abstract
Autologous(auto-) and allogeneic(allo-) hematopoietic stem cell transplantation (HSCT) are key treatments for relapsed/refractory diffuse large B-cell lymphoma (DLBCL), although their roles are challenged by CAR-T-cells and other immunotherapies. We examined the transplantation trends and outcomes for DLBCL patients undergoing auto-/allo-HSCT between 1990 and 2021 reported to EBMT. Over this period, 41,148 patients underwent auto-HSCT, peaking at 1911 cases in 2016, while allo-HSCT saw a maximum of 294 cases in 2018. The recent decline in transplants corresponds to increased CAR-T treatments (1117 cases in 2021). Median age for auto-HSCT rose from 42 (1990-1994) to 58 years (2015-2021), with peripheral blood becoming the primary stem cell source post-1994. Allo-HSCT median age increased from 36 (1990-1994) to 54 (2015-2021) years, with mobilized blood as the primary source post-1998 and reduced intensity conditioning post-2000. Unrelated and mismatched allo-HSCT accounted for 50% and 19% of allo-HSCT in 2015-2021. Three-year overall survival (OS) after auto-HSCT improved from 56% (1990-1994) to 70% (2015-2021), p < 0.001, with a decrease in relapse incidence (RI) from 49% to 38%, while non-relapse mortality (NRM) remained unchanged (4%). After allo-HSCT, 3-year-OS increased from 33% (1990-1999) to 46% (2015-2021) (p < 0.001); 3-year RI remained at 39% and 1-year-NRM decreased to 19% (p < 0.001). Our data reflect advancements over 32 years and >40,000 transplants, providing insights for evaluating emerging DLBCL therapies.
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Affiliation(s)
- Philipp Berning
- Department of Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Mathilde Fekom
- European Society for Blood and Marrow Transplantation, Paris, France
| | - Maud Ngoya
- European Society for Blood and Marrow Transplantation, Paris, France
| | | | - Peter Dreger
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Silvia Montoto
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Hervé Finel
- European Society for Blood and Marrow Transplantation, Paris, France
| | - Evgenii Shumilov
- Department of Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | | | - Didier Blaise
- Transplantation and Cellular Immunotherapy Program, Department of Hematology, Instititut Paoli Calmettes, MSC Lab, Aix Marseille University, Marseille, France
| | - Tim Strüssmann
- Department of Hematology, Oncology and Stem Cell Transplantation, University of Freiburg Medical Center, Freiburg, Germany
| | - Ben Carpenter
- Department of Hematology, University College London Hospitals, London, United Kingdom
| | - Edouard Forcade
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, F-33000, Bordeaux, France
| | | | - Marek Trneny
- First Faculty of Medicine, Charles University, Praha, Czech Republic
| | - Hervé Ghesquieres
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'Hématologie, Pierre Bénite, France
| | - Saveria Capria
- Department of Translational and Precision Medicine, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Igor Wolfgang Blau
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Berlin, Department of Hematology, Oncology and Tumor Immunology, Campus Virchow Clinic, Berlin, Germany
| | - Ellen Meijer
- Department of Hematology, Amsterdam University Medical Center, Free University, Amsterdam, the Netherlands
| | - Annoek E C Broers
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Anne Huynh
- CHU - Institut Universitaire du Cancer Toulouse, Oncopole, I.U.C.T-O, Toulouse, France
| | | | - Wolf Rösler
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stephanie Nguyen Quoc
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Jörg Bittenbring
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Bertram Glass
- Department of Hematology, Oncology, Tumor Immunology, and Palliative Care, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Anna Sureda
- Department of Hematology, Institut Català d'Oncologia Hospitalet, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Norbert Schmitz
- Department of Hematology and Oncology, University Hospital Muenster, Muenster, Germany.
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7
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Baron JA, Wright CM, Dreyfuss AD, Chong EA, Svoboda J, LaRiviere MJ, Jones JA, Maity A, Plastaras JP, Paydar I, Maxwell R. Radiotherapy dose response in bulky relapsed/refractory large B-cell lymphoma. Pract Radiat Oncol 2024:S1879-8500(24)00144-9. [PMID: 38971218 DOI: 10.1016/j.prro.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/06/2024] [Accepted: 06/12/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE To assess whether a radiotherapy (RT) dose affects response in bulky tumors in relapsed/refractory (r/r) diffuse large B-cell lymphoma (DLBCL). METHODS Data from r/r DLBCL patients treated with salvage- or palliative-intent RT (2008-2020) at a single institution were examined. Index lesion size ≥7.5 cm was defined as bulky. Equivalent doses in 2 Gray (Gy) fractions (EQD2) were calculated to compare doses between conventional and hypofractionated (HF, ≥2.5 Gy/fraction) schemes. Objective response rates (ORR) were compared using non-parametric Mann-Whitney U test or Kruskal-Wallis tests with Dunn's multiple comparison corrections. Freedom from local progression (FFLP) was assessed using Kaplan-Meier and Cox proportional hazard regression analyzes. RESULTS 183 courses of 151 unique patients were included (salvage: 37%, palliative: 63%). Non-bulky and bulky tumors were irradiated in 109 (60%) and 74 (40%) courses, respectively. Median EQD2 was 33 Gy (IQR=23-39 Gy) with HF in 84 (46%) cases. Of those with post-RT imaging (80%), the ORR was 59% with a trend towards worsened ORR in bulky tumors (50% vs. 65%, p=0.077). For bulky tumors, RT regimens with EQD2s >30 Gy were associated with better ORR (≤30 Gy vs. >30 Gy: 27% vs. 64%, p=0.0073), whereas a lower EQD2 cut-off was sufficient for non-bulky tumors (≤20 Gy vs. >20 Gy: 38% vs. 75%, p=0.0011). On multivariable regression, bulky tumor size was associated with worsened FFLP (HR=2.07, 95% CI=1.16-3.68, p=0.014), while high EQD2s >30 Gy were associated with better FFLP (HR=0.48, 95% CI=0.25-0.93, p=0.031). Bulky tumors treated with EQD2s ≤30 Gy had the lowest median FFLP (4.0 months), while EQD2s >30 Gy had an unreached median FFLP (p=0.0047). CONCLUSIONS Bulky r/r DLBCL tumors were associated with less favorable tumor control outcomes in the salvage and palliative settings. RT regimens with higher EQD2s (>30 Gy) should be considered if durable local control of bulky tumors is desired.
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Affiliation(s)
- Jonathan A Baron
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Christopher M Wright
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Radiation Oncology Associates, Burlington, MA, USA
| | - Alexandra D Dreyfuss
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elise A Chong
- Department of Hematology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jakub Svoboda
- Department of Hematology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael J LaRiviere
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua A Jones
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Amit Maity
- Department of Radiation Oncology, Huntsman Cancer Institute and University of Utah Health, Salt Lake City, UT, USA
| | - John P Plastaras
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ima Paydar
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Russell Maxwell
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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8
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Park J, Palomba ML, Perica K, Devlin S, Shah G, Dahi P, Lin R, Salles G, Scordo M, Nath K, Valtis Y, Lynch A, Cathcart E, Zhang H, Schöder H, Leithner D, Liotta K, Yu A, Stocker K, Li J, Dey A, Sellner L, Singh R, Sundaresan V, Zhao F, Mansilla-Soto J, He C, Meyerson J, Hosszu K, McAvoy D, Wang X, Riviere I, Sadelain M. Calibrated CAR Signaling Enables Low-Dose Therapy in Large B-Cell Lymphoma. RESEARCH SQUARE 2024:rs.3.rs-4619285. [PMID: 39011120 PMCID: PMC11247921 DOI: 10.21203/rs.3.rs-4619285/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
We designed a CD19-targeted CAR comprising a calibrated signaling module, termed 1XX, that differs from that of conventional CD28/CD3z and 4-1BB/CD3z CARs. Here we report the first-in-human, phase 1 clinical trial of 19(T2)28z-1XX CAR T cells in relapsed/refractory large B-cell lymphoma. We hypothesized that 1XX CAR T cells may be effective at low doses and investigated 4 doubling dose levels starting from 25x10 6 CAR T cells. The overall response rate (ORR) was 82% and complete response (CR) rate 71% in the entire cohort (n=28) and 88% ORR and 75% CR in 16 patients treated at 25x10 6 . With the median follow-up of 24 months, the 1-year EFS was 61% (95% CI: 45-82%). Overall, grade ≥3 CRS and ICANS rates were low at 4% and 7%. The calibrated potency of the 1XX CAR affords excellent efficacy at low cell doses and may benefit the treatment of other hematological malignancies, solid tumors and autoimmunity.
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9
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Hu B, Korsos V, Palomba ML. Chimeric antigen receptor T-cell therapy for aggressive B-cell lymphomas. Front Oncol 2024; 14:1394057. [PMID: 39011476 PMCID: PMC11246842 DOI: 10.3389/fonc.2024.1394057] [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: 02/29/2024] [Accepted: 05/21/2024] [Indexed: 07/17/2024] Open
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is a revolutionary approach in the treatment of lymphoma. This review article provides an overview of the four FDA-approved CAR T-cell products for aggressive B-cell lymphoma, including diffuse large B-cell lymphoma and mantle cell lymphoma, highlighting their efficacy and toxicity as well as discussing future directions.
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Affiliation(s)
- Bei Hu
- Department of Hematologic Oncology and Blood Disorders, Atrium Health Levine Cancer Institute/Wake Forest School of Medicine, Charlotte, NC, United States
| | - Victoria Korsos
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - M Lia Palomba
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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10
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Goto H, Onozawa M, Teshima T. Novel CAR T cell therapies for patients with large B cell lymphoma. Int J Hematol 2024; 120:6-14. [PMID: 38795249 DOI: 10.1007/s12185-024-03792-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 05/27/2024]
Abstract
Approximately 60-70% of patients with large B cell lymphoma (LBCL) achieve long-term remission or a cure after initial treatment. However, patients who relapse or are refractory to initial treatment have a poor prognosis. Chimeric antigen receptor (CAR) T cell therapy has recently attracted attention for its potential to provide a cure or long-term remission even for LBCL that has relapsed or is refractory to conventional chemotherapy. Currently, three CAR T cell products are clinically available for LBCL: tisagenlecleucel (tisa-cel), axicabtagene ciloleucel (axi-cel) and lisocabtagene maraleucel (liso-cel). These CAR T cell products were initially approved as third- or later-line therapies worldwide. Recently, axi-cel and liso-cel have become feasible as second-line therapies for patients with early relapsed or refractory disease after first-line chemotherapy. Although a large body of data on CAR T cell therapy has been accumulated, the clinical question of how to choose between these three available CAR T cell products has yet to be resolved. The appropriate approach to treatment selection for patients who relapse after CAR T cell therapy also remains unclear. This review discusses treatment strategies to maximize the benefits of CAR T cell therapy.
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Affiliation(s)
- Hideki Goto
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, W7, N15, Kita-Ku, Sapporo, Hokkaido, Japan.
| | - Masahiro Onozawa
- Department of Hematology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takanori Teshima
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, W7, N15, Kita-Ku, Sapporo, Hokkaido, Japan
- Department of Hematology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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11
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D’Alò F, Bellesi S, Maiolo E, Alma E, Bellisario F, Malafronte R, Viscovo M, Campana F, Hohaus S. Novel Targets and Advanced Therapies in Diffuse Large B Cell Lymphomas. Cancers (Basel) 2024; 16:2243. [PMID: 38927948 PMCID: PMC11201587 DOI: 10.3390/cancers16122243] [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: 05/10/2024] [Revised: 06/07/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Since the introduction of rituximab in the late 1990s, significant progress has been made in advancing targeted therapies for B cell lymphomas, improving patients' chance of being cured and clinicians' therapeutic armamentarium. A better understanding of disease biology and pathogenic pathways, coupled with refinements in immunophenotypic and molecular diagnostics, have been instrumental in these achievements. While traditional chemotherapy remains fundamental in most cases, concerns surrounding chemorefractoriness and cumulative toxicities, particularly the depletion of the hemopoietic reserve, underscore the imperative for personalized treatment approaches. Integrating targeted agents, notably monoclonal antibodies, alongside chemotherapy has yielded heightened response rates and prolonged survival. A notable paradigm shift is underway with innovative-targeted therapies replacing cytotoxic drugs, challenging conventional salvage strategies like stem cell transplantation. This review examines the landscape of emerging targets for lymphoma cells and explores innovative therapies for diffuse large B cell lymphoma (DLBCL). From Chimeric Antigen Receptor-T cells to more potent monoclonal antibodies, antibody-drug conjugates, bispecific antibodies, checkpoint inhibitors, and small molecules targeting intracellular pathways, each modality offers promising avenues for therapeutic advancement. This review aims to furnish insights into their potential implications for the future of DLBCL treatment strategies.
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Affiliation(s)
- Francesco D’Alò
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.B.); (R.M.); (M.V.); (F.C.); (S.H.)
- UOSD Malattie Linfoproliferative Extramidollari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Silvia Bellesi
- UOC Servizio e DH di Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (S.B.); (E.M.)
| | - Elena Maiolo
- UOC Servizio e DH di Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (S.B.); (E.M.)
| | - Eleonora Alma
- UOSD Malattie Linfoproliferative Extramidollari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Flaminia Bellisario
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.B.); (R.M.); (M.V.); (F.C.); (S.H.)
- UOSD Malattie Linfoproliferative Extramidollari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Rosalia Malafronte
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.B.); (R.M.); (M.V.); (F.C.); (S.H.)
- UOSD Malattie Linfoproliferative Extramidollari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Marcello Viscovo
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.B.); (R.M.); (M.V.); (F.C.); (S.H.)
- UOSD Malattie Linfoproliferative Extramidollari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Fabrizia Campana
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.B.); (R.M.); (M.V.); (F.C.); (S.H.)
- UOSD Malattie Linfoproliferative Extramidollari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Stefan Hohaus
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.B.); (R.M.); (M.V.); (F.C.); (S.H.)
- UOSD Malattie Linfoproliferative Extramidollari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
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12
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Wu S, Rhee JW, Iukuridze A, Bosworth A, Chen S, Atencio L, Manubolu V, Bhandari R, Jamal F, Mei M, Herrera A, Rodriguez F, Forman S, Nakamura R, Wong FL, Budoff M, Armenian SH. Coronary artery calcium and cardiovascular outcomes in patients with lymphoma undergoing autologous hematopoietic cell transplantation. Cancer 2024; 130:2205-2214. [PMID: 38358333 DOI: 10.1002/cncr.35252] [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: 10/17/2023] [Revised: 12/17/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Patients undergoing autologous hematopoietic cell transplantation (HCT) have a >2-fold risk of developing cardiovascular disease (CVD; heart failure, myocardial infarction, and stroke), compared to the general population. Coronary artery calcium (CAC) is predictive of CVD in nononcology patients but is not as well studied in patients who underwent HCT and survivors of HCT.The objective of this study was to examine the association between CAC and CVD risk and outcomes after HCT in patients with lymphoma. METHODS This was a retrospective cohort study of 243 consecutive patients who underwent a first autologous HCT for lymphoma between 2009 and 2014. CAC (Agatston score) was determined from chest computed tomography obtained <60 days from HCT. Multivariable Cox regression analysis was used to calculate hazard ratio (HR) estimates and 95% confidence intervals (CIs), adjusted for covariates (age, conventional risk factors [e.g., hypertension and dyslipidemia], and cancer treatment). RESULTS The median age at HCT was 55.7 years (range, 18.5-75.1 years), 59% were male, and 60% were non-Hispanic White. The prevalence of CAC was 37%. The 5-year CVD incidence for the cohort was 12%, and there was an incremental increase in the incidence according to CAC score: 0 (6%), 1-100 (20%), and >100 (32%) (p = .001). CAC was significantly associated with CVD risk (HR, 3.0; 95% CI, 1.2-7.5) and worse 5-year survival (77% vs. 50%; p < .001; HR, 2.0; 95% CI, 1.1-3.4), compared to those without CAC. CONCLUSIONS CAC is independently associated with CVD and survival after HCT. This highlights the importance of integrating readily available imaging information in risk stratification and decision-making in patients undergoing HCT, which sets the stage for strategies to optimize outcomes after HCT.
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Affiliation(s)
- Stephanie Wu
- Department of Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - June-Wha Rhee
- Department of Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Aleksi Iukuridze
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Alysia Bosworth
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Sitong Chen
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Liezl Atencio
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Venkat Manubolu
- Department of Cardiology, Lundquist Institute, Torrance, California, USA
| | - Rusha Bhandari
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, USA
- Department of Pediatrics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Faizi Jamal
- Department of Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Matthew Mei
- Department of Hematology & Hematopoietic Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Alex Herrera
- Department of Hematology & Hematopoietic Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Fatima Rodriguez
- Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - Stephen Forman
- Department of Hematology & Hematopoietic Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - F Lennie Wong
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Matthew Budoff
- Department of Cardiology, Lundquist Institute, Torrance, California, USA
| | - Saro H Armenian
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, USA
- Department of Pediatrics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
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13
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Hamilton MP, Sugio T, Noordenbos T, Shi S, Bulterys PL, Liu CL, Kang X, Olsen MN, Good Z, Dahiya S, Frank MJ, Sahaf B, Mackall CL, Gratzinger D, Diehn M, Alizadeh AA, Miklos DB. Risk of Second Tumors and T-Cell Lymphoma after CAR T-Cell Therapy. N Engl J Med 2024; 390:2047-2060. [PMID: 38865660 DOI: 10.1056/nejmoa2401361] [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] [Indexed: 06/14/2024]
Abstract
BACKGROUND The risk of second tumors after chimeric antigen receptor (CAR) T-cell therapy, especially the risk of T-cell neoplasms related to viral vector integration, is an emerging concern. METHODS We reviewed our clinical experience with adoptive cellular CAR T-cell therapy at our institution since 2016 and ascertained the occurrence of second tumors. In one case of secondary T-cell lymphoma, a broad array of molecular, genetic, and cellular techniques were used to interrogate the tumor, the CAR T cells, and the normal hematopoietic cells in the patient. RESULTS A total of 724 patients who had received T-cell therapies at our center were included in the study. A lethal T-cell lymphoma was identified in a patient who had received axicabtagene ciloleucel therapy for diffuse large B-cell lymphoma, and both lymphomas were deeply profiled. Each lymphoma had molecularly distinct immunophenotypes and genomic profiles, but both were positive for Epstein-Barr virus and were associated with DNMT3A and TET2 mutant clonal hematopoiesis. No evidence of oncogenic retroviral integration was found with the use of multiple techniques. CONCLUSIONS Our results highlight the rarity of second tumors and provide a framework for defining clonal relationships and viral vector monitoring. (Funded by the National Cancer Institute and others.).
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MESH Headings
- Female
- Humans
- Middle Aged
- Biological Products/adverse effects
- Biological Products/therapeutic use
- Clonal Hematopoiesis
- Herpesvirus 4, Human/immunology
- Herpesvirus 4, Human/genetics
- Immunotherapy, Adoptive/adverse effects
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, T-Cell/etiology
- Lymphoma, T-Cell/genetics
- Lymphoma, T-Cell/immunology
- Lymphoma, T-Cell/therapy
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/etiology
- Receptors, Chimeric Antigen/immunology
- Receptors, Chimeric Antigen/therapeutic use
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Virus Integration
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Affiliation(s)
- Mark P Hamilton
- From the Divisions of Oncology (M.P.H., T.S., T.N., C.L.L., X.K., M.N.O., A.A.A.) and Blood and Marrow Transplantation and Cellular Therapy (M.P.H., S.D., M.J.F., D.B.M.), Department of Medicine, the Center for Cancer Cell Therapy (M.P.H., Z.G., S.D., M.J.F., B.S., C.L.M., D.B.M.), Stanford Cancer Institute (T.S., T.N., C.L.L., X.K., M.N.O., C.L.M., M.D., A.A.A., D.B.M.), the Department of Pathology (P.L.B., D.G.), the Department of Biomedical Data Science (Z.G.), the Division of Hematology and Oncology, Department of Pediatrics (C.L.M.), the Department of Radiation Oncology (M.D.), and the Institute for Stem Cell Biology and Regenerative Medicine (M.D., A.A.A.), School of Medicine, and the Department of Bioengineering, Schools of Medicine and Engineering (S.S.), Stanford University, Stanford, CA; and the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (T.N.)
| | - Takeshi Sugio
- From the Divisions of Oncology (M.P.H., T.S., T.N., C.L.L., X.K., M.N.O., A.A.A.) and Blood and Marrow Transplantation and Cellular Therapy (M.P.H., S.D., M.J.F., D.B.M.), Department of Medicine, the Center for Cancer Cell Therapy (M.P.H., Z.G., S.D., M.J.F., B.S., C.L.M., D.B.M.), Stanford Cancer Institute (T.S., T.N., C.L.L., X.K., M.N.O., C.L.M., M.D., A.A.A., D.B.M.), the Department of Pathology (P.L.B., D.G.), the Department of Biomedical Data Science (Z.G.), the Division of Hematology and Oncology, Department of Pediatrics (C.L.M.), the Department of Radiation Oncology (M.D.), and the Institute for Stem Cell Biology and Regenerative Medicine (M.D., A.A.A.), School of Medicine, and the Department of Bioengineering, Schools of Medicine and Engineering (S.S.), Stanford University, Stanford, CA; and the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (T.N.)
| | - Troy Noordenbos
- From the Divisions of Oncology (M.P.H., T.S., T.N., C.L.L., X.K., M.N.O., A.A.A.) and Blood and Marrow Transplantation and Cellular Therapy (M.P.H., S.D., M.J.F., D.B.M.), Department of Medicine, the Center for Cancer Cell Therapy (M.P.H., Z.G., S.D., M.J.F., B.S., C.L.M., D.B.M.), Stanford Cancer Institute (T.S., T.N., C.L.L., X.K., M.N.O., C.L.M., M.D., A.A.A., D.B.M.), the Department of Pathology (P.L.B., D.G.), the Department of Biomedical Data Science (Z.G.), the Division of Hematology and Oncology, Department of Pediatrics (C.L.M.), the Department of Radiation Oncology (M.D.), and the Institute for Stem Cell Biology and Regenerative Medicine (M.D., A.A.A.), School of Medicine, and the Department of Bioengineering, Schools of Medicine and Engineering (S.S.), Stanford University, Stanford, CA; and the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (T.N.)
| | - Shuyu Shi
- From the Divisions of Oncology (M.P.H., T.S., T.N., C.L.L., X.K., M.N.O., A.A.A.) and Blood and Marrow Transplantation and Cellular Therapy (M.P.H., S.D., M.J.F., D.B.M.), Department of Medicine, the Center for Cancer Cell Therapy (M.P.H., Z.G., S.D., M.J.F., B.S., C.L.M., D.B.M.), Stanford Cancer Institute (T.S., T.N., C.L.L., X.K., M.N.O., C.L.M., M.D., A.A.A., D.B.M.), the Department of Pathology (P.L.B., D.G.), the Department of Biomedical Data Science (Z.G.), the Division of Hematology and Oncology, Department of Pediatrics (C.L.M.), the Department of Radiation Oncology (M.D.), and the Institute for Stem Cell Biology and Regenerative Medicine (M.D., A.A.A.), School of Medicine, and the Department of Bioengineering, Schools of Medicine and Engineering (S.S.), Stanford University, Stanford, CA; and the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (T.N.)
| | - Philip L Bulterys
- From the Divisions of Oncology (M.P.H., T.S., T.N., C.L.L., X.K., M.N.O., A.A.A.) and Blood and Marrow Transplantation and Cellular Therapy (M.P.H., S.D., M.J.F., D.B.M.), Department of Medicine, the Center for Cancer Cell Therapy (M.P.H., Z.G., S.D., M.J.F., B.S., C.L.M., D.B.M.), Stanford Cancer Institute (T.S., T.N., C.L.L., X.K., M.N.O., C.L.M., M.D., A.A.A., D.B.M.), the Department of Pathology (P.L.B., D.G.), the Department of Biomedical Data Science (Z.G.), the Division of Hematology and Oncology, Department of Pediatrics (C.L.M.), the Department of Radiation Oncology (M.D.), and the Institute for Stem Cell Biology and Regenerative Medicine (M.D., A.A.A.), School of Medicine, and the Department of Bioengineering, Schools of Medicine and Engineering (S.S.), Stanford University, Stanford, CA; and the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (T.N.)
| | - Chih Long Liu
- From the Divisions of Oncology (M.P.H., T.S., T.N., C.L.L., X.K., M.N.O., A.A.A.) and Blood and Marrow Transplantation and Cellular Therapy (M.P.H., S.D., M.J.F., D.B.M.), Department of Medicine, the Center for Cancer Cell Therapy (M.P.H., Z.G., S.D., M.J.F., B.S., C.L.M., D.B.M.), Stanford Cancer Institute (T.S., T.N., C.L.L., X.K., M.N.O., C.L.M., M.D., A.A.A., D.B.M.), the Department of Pathology (P.L.B., D.G.), the Department of Biomedical Data Science (Z.G.), the Division of Hematology and Oncology, Department of Pediatrics (C.L.M.), the Department of Radiation Oncology (M.D.), and the Institute for Stem Cell Biology and Regenerative Medicine (M.D., A.A.A.), School of Medicine, and the Department of Bioengineering, Schools of Medicine and Engineering (S.S.), Stanford University, Stanford, CA; and the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (T.N.)
| | - Xiaoman Kang
- From the Divisions of Oncology (M.P.H., T.S., T.N., C.L.L., X.K., M.N.O., A.A.A.) and Blood and Marrow Transplantation and Cellular Therapy (M.P.H., S.D., M.J.F., D.B.M.), Department of Medicine, the Center for Cancer Cell Therapy (M.P.H., Z.G., S.D., M.J.F., B.S., C.L.M., D.B.M.), Stanford Cancer Institute (T.S., T.N., C.L.L., X.K., M.N.O., C.L.M., M.D., A.A.A., D.B.M.), the Department of Pathology (P.L.B., D.G.), the Department of Biomedical Data Science (Z.G.), the Division of Hematology and Oncology, Department of Pediatrics (C.L.M.), the Department of Radiation Oncology (M.D.), and the Institute for Stem Cell Biology and Regenerative Medicine (M.D., A.A.A.), School of Medicine, and the Department of Bioengineering, Schools of Medicine and Engineering (S.S.), Stanford University, Stanford, CA; and the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (T.N.)
| | - Mari N Olsen
- From the Divisions of Oncology (M.P.H., T.S., T.N., C.L.L., X.K., M.N.O., A.A.A.) and Blood and Marrow Transplantation and Cellular Therapy (M.P.H., S.D., M.J.F., D.B.M.), Department of Medicine, the Center for Cancer Cell Therapy (M.P.H., Z.G., S.D., M.J.F., B.S., C.L.M., D.B.M.), Stanford Cancer Institute (T.S., T.N., C.L.L., X.K., M.N.O., C.L.M., M.D., A.A.A., D.B.M.), the Department of Pathology (P.L.B., D.G.), the Department of Biomedical Data Science (Z.G.), the Division of Hematology and Oncology, Department of Pediatrics (C.L.M.), the Department of Radiation Oncology (M.D.), and the Institute for Stem Cell Biology and Regenerative Medicine (M.D., A.A.A.), School of Medicine, and the Department of Bioengineering, Schools of Medicine and Engineering (S.S.), Stanford University, Stanford, CA; and the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (T.N.)
| | - Zinaida Good
- From the Divisions of Oncology (M.P.H., T.S., T.N., C.L.L., X.K., M.N.O., A.A.A.) and Blood and Marrow Transplantation and Cellular Therapy (M.P.H., S.D., M.J.F., D.B.M.), Department of Medicine, the Center for Cancer Cell Therapy (M.P.H., Z.G., S.D., M.J.F., B.S., C.L.M., D.B.M.), Stanford Cancer Institute (T.S., T.N., C.L.L., X.K., M.N.O., C.L.M., M.D., A.A.A., D.B.M.), the Department of Pathology (P.L.B., D.G.), the Department of Biomedical Data Science (Z.G.), the Division of Hematology and Oncology, Department of Pediatrics (C.L.M.), the Department of Radiation Oncology (M.D.), and the Institute for Stem Cell Biology and Regenerative Medicine (M.D., A.A.A.), School of Medicine, and the Department of Bioengineering, Schools of Medicine and Engineering (S.S.), Stanford University, Stanford, CA; and the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (T.N.)
| | - Saurabh Dahiya
- From the Divisions of Oncology (M.P.H., T.S., T.N., C.L.L., X.K., M.N.O., A.A.A.) and Blood and Marrow Transplantation and Cellular Therapy (M.P.H., S.D., M.J.F., D.B.M.), Department of Medicine, the Center for Cancer Cell Therapy (M.P.H., Z.G., S.D., M.J.F., B.S., C.L.M., D.B.M.), Stanford Cancer Institute (T.S., T.N., C.L.L., X.K., M.N.O., C.L.M., M.D., A.A.A., D.B.M.), the Department of Pathology (P.L.B., D.G.), the Department of Biomedical Data Science (Z.G.), the Division of Hematology and Oncology, Department of Pediatrics (C.L.M.), the Department of Radiation Oncology (M.D.), and the Institute for Stem Cell Biology and Regenerative Medicine (M.D., A.A.A.), School of Medicine, and the Department of Bioengineering, Schools of Medicine and Engineering (S.S.), Stanford University, Stanford, CA; and the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (T.N.)
| | - Matthew J Frank
- From the Divisions of Oncology (M.P.H., T.S., T.N., C.L.L., X.K., M.N.O., A.A.A.) and Blood and Marrow Transplantation and Cellular Therapy (M.P.H., S.D., M.J.F., D.B.M.), Department of Medicine, the Center for Cancer Cell Therapy (M.P.H., Z.G., S.D., M.J.F., B.S., C.L.M., D.B.M.), Stanford Cancer Institute (T.S., T.N., C.L.L., X.K., M.N.O., C.L.M., M.D., A.A.A., D.B.M.), the Department of Pathology (P.L.B., D.G.), the Department of Biomedical Data Science (Z.G.), the Division of Hematology and Oncology, Department of Pediatrics (C.L.M.), the Department of Radiation Oncology (M.D.), and the Institute for Stem Cell Biology and Regenerative Medicine (M.D., A.A.A.), School of Medicine, and the Department of Bioengineering, Schools of Medicine and Engineering (S.S.), Stanford University, Stanford, CA; and the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (T.N.)
| | - Bita Sahaf
- From the Divisions of Oncology (M.P.H., T.S., T.N., C.L.L., X.K., M.N.O., A.A.A.) and Blood and Marrow Transplantation and Cellular Therapy (M.P.H., S.D., M.J.F., D.B.M.), Department of Medicine, the Center for Cancer Cell Therapy (M.P.H., Z.G., S.D., M.J.F., B.S., C.L.M., D.B.M.), Stanford Cancer Institute (T.S., T.N., C.L.L., X.K., M.N.O., C.L.M., M.D., A.A.A., D.B.M.), the Department of Pathology (P.L.B., D.G.), the Department of Biomedical Data Science (Z.G.), the Division of Hematology and Oncology, Department of Pediatrics (C.L.M.), the Department of Radiation Oncology (M.D.), and the Institute for Stem Cell Biology and Regenerative Medicine (M.D., A.A.A.), School of Medicine, and the Department of Bioengineering, Schools of Medicine and Engineering (S.S.), Stanford University, Stanford, CA; and the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (T.N.)
| | - Crystal L Mackall
- From the Divisions of Oncology (M.P.H., T.S., T.N., C.L.L., X.K., M.N.O., A.A.A.) and Blood and Marrow Transplantation and Cellular Therapy (M.P.H., S.D., M.J.F., D.B.M.), Department of Medicine, the Center for Cancer Cell Therapy (M.P.H., Z.G., S.D., M.J.F., B.S., C.L.M., D.B.M.), Stanford Cancer Institute (T.S., T.N., C.L.L., X.K., M.N.O., C.L.M., M.D., A.A.A., D.B.M.), the Department of Pathology (P.L.B., D.G.), the Department of Biomedical Data Science (Z.G.), the Division of Hematology and Oncology, Department of Pediatrics (C.L.M.), the Department of Radiation Oncology (M.D.), and the Institute for Stem Cell Biology and Regenerative Medicine (M.D., A.A.A.), School of Medicine, and the Department of Bioengineering, Schools of Medicine and Engineering (S.S.), Stanford University, Stanford, CA; and the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (T.N.)
| | - Dita Gratzinger
- From the Divisions of Oncology (M.P.H., T.S., T.N., C.L.L., X.K., M.N.O., A.A.A.) and Blood and Marrow Transplantation and Cellular Therapy (M.P.H., S.D., M.J.F., D.B.M.), Department of Medicine, the Center for Cancer Cell Therapy (M.P.H., Z.G., S.D., M.J.F., B.S., C.L.M., D.B.M.), Stanford Cancer Institute (T.S., T.N., C.L.L., X.K., M.N.O., C.L.M., M.D., A.A.A., D.B.M.), the Department of Pathology (P.L.B., D.G.), the Department of Biomedical Data Science (Z.G.), the Division of Hematology and Oncology, Department of Pediatrics (C.L.M.), the Department of Radiation Oncology (M.D.), and the Institute for Stem Cell Biology and Regenerative Medicine (M.D., A.A.A.), School of Medicine, and the Department of Bioengineering, Schools of Medicine and Engineering (S.S.), Stanford University, Stanford, CA; and the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (T.N.)
| | - Maximilian Diehn
- From the Divisions of Oncology (M.P.H., T.S., T.N., C.L.L., X.K., M.N.O., A.A.A.) and Blood and Marrow Transplantation and Cellular Therapy (M.P.H., S.D., M.J.F., D.B.M.), Department of Medicine, the Center for Cancer Cell Therapy (M.P.H., Z.G., S.D., M.J.F., B.S., C.L.M., D.B.M.), Stanford Cancer Institute (T.S., T.N., C.L.L., X.K., M.N.O., C.L.M., M.D., A.A.A., D.B.M.), the Department of Pathology (P.L.B., D.G.), the Department of Biomedical Data Science (Z.G.), the Division of Hematology and Oncology, Department of Pediatrics (C.L.M.), the Department of Radiation Oncology (M.D.), and the Institute for Stem Cell Biology and Regenerative Medicine (M.D., A.A.A.), School of Medicine, and the Department of Bioengineering, Schools of Medicine and Engineering (S.S.), Stanford University, Stanford, CA; and the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (T.N.)
| | - Ash A Alizadeh
- From the Divisions of Oncology (M.P.H., T.S., T.N., C.L.L., X.K., M.N.O., A.A.A.) and Blood and Marrow Transplantation and Cellular Therapy (M.P.H., S.D., M.J.F., D.B.M.), Department of Medicine, the Center for Cancer Cell Therapy (M.P.H., Z.G., S.D., M.J.F., B.S., C.L.M., D.B.M.), Stanford Cancer Institute (T.S., T.N., C.L.L., X.K., M.N.O., C.L.M., M.D., A.A.A., D.B.M.), the Department of Pathology (P.L.B., D.G.), the Department of Biomedical Data Science (Z.G.), the Division of Hematology and Oncology, Department of Pediatrics (C.L.M.), the Department of Radiation Oncology (M.D.), and the Institute for Stem Cell Biology and Regenerative Medicine (M.D., A.A.A.), School of Medicine, and the Department of Bioengineering, Schools of Medicine and Engineering (S.S.), Stanford University, Stanford, CA; and the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (T.N.)
| | - David B Miklos
- From the Divisions of Oncology (M.P.H., T.S., T.N., C.L.L., X.K., M.N.O., A.A.A.) and Blood and Marrow Transplantation and Cellular Therapy (M.P.H., S.D., M.J.F., D.B.M.), Department of Medicine, the Center for Cancer Cell Therapy (M.P.H., Z.G., S.D., M.J.F., B.S., C.L.M., D.B.M.), Stanford Cancer Institute (T.S., T.N., C.L.L., X.K., M.N.O., C.L.M., M.D., A.A.A., D.B.M.), the Department of Pathology (P.L.B., D.G.), the Department of Biomedical Data Science (Z.G.), the Division of Hematology and Oncology, Department of Pediatrics (C.L.M.), the Department of Radiation Oncology (M.D.), and the Institute for Stem Cell Biology and Regenerative Medicine (M.D., A.A.A.), School of Medicine, and the Department of Bioengineering, Schools of Medicine and Engineering (S.S.), Stanford University, Stanford, CA; and the Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands (T.N.)
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14
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Korell F, Olson ML, Salas-Benito D, Leick MB, Larson RC, Bouffard A, Silva H, Gasparetto A, Berger TR, Kann MC, Mergen M, Kienka T, Wehrli M, Haradhvala NJ, Bailey SR, Letai A, Maus MV. Comparative analysis of Bcl-2 family protein overexpression in CAR T cells alone and in combination with BH3 mimetics. Sci Transl Med 2024; 16:eadk7640. [PMID: 38838132 DOI: 10.1126/scitranslmed.adk7640] [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: 09/09/2023] [Accepted: 05/07/2024] [Indexed: 06/07/2024]
Abstract
Approximately 50% of patients with hematologic malignancies relapse after chimeric antigen receptor (CAR) T cell treatment; mechanisms of failure include loss of CAR T persistence and tumor resistance to apoptosis. We hypothesized that both of these challenges could potentially be overcome by overexpressing one or more of the Bcl-2 family proteins in CAR T cells to reduce their susceptibility to apoptosis, both alone and in the presence of BH3 mimetics, which can be used to activate apoptotic machinery in malignant cells. We comprehensively investigated overexpression of different Bcl-2 family proteins in CAR T cells with different signaling domains as well as in different tumor types. We found that Bcl-xL and Bcl-2 overexpression in CAR T cells bearing a 4-1BB costimulatory domain resulted in increased expansion and antitumor activity, reduced exhaustion, and decreased apoptotic priming. In addition, CAR T cells expressing either Bcl-xL or a venetoclax-resistant Bcl-2 variant led to enhanced antitumor efficacy and survival in murine xenograft models of lymphoma and leukemia in the presence or absence of the BH3 mimetic venetoclax, a clinically approved BH3 mimetic. In this setting, Bcl-xL overexpression had stronger effects than overexpression of Bcl-2 or the Bcl-2(G101V) variant. These findings suggest that CAR T cells could be optimally engineered by overexpressing Bcl-xL to enhance their persistence while opening a therapeutic window for combination with BH3 mimetics to prime tumors for apoptosis.
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Affiliation(s)
- Felix Korell
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Charlestown, MA 02129, USA
- Harvard Medical School, Boston, MA 02115, USA
- Broad Institute of Harvard University and Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Michael L Olson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Diego Salas-Benito
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Charlestown, MA 02129, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Mark B Leick
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Charlestown, MA 02129, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Rebecca C Larson
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Charlestown, MA 02129, USA
- Harvard Medical School, Boston, MA 02115, USA
- Broad Institute of Harvard University and Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Amanda Bouffard
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Charlestown, MA 02129, USA
| | - Harrison Silva
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Charlestown, MA 02129, USA
| | - Alessandro Gasparetto
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Charlestown, MA 02129, USA
| | - Trisha R Berger
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Charlestown, MA 02129, USA
| | - Michael C Kann
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Charlestown, MA 02129, USA
| | - Markus Mergen
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Charlestown, MA 02129, USA
| | - Tamina Kienka
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Charlestown, MA 02129, USA
- Harvard Medical School, Boston, MA 02115, USA
- Broad Institute of Harvard University and Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Marc Wehrli
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Charlestown, MA 02129, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Nicholas J Haradhvala
- Broad Institute of Harvard University and Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Stefanie R Bailey
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Charlestown, MA 02129, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Anthony Letai
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Marcela V Maus
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Charlestown, MA 02129, USA
- Harvard Medical School, Boston, MA 02115, USA
- Broad Institute of Harvard University and Massachusetts Institute of Technology, Cambridge, MA 02142, USA
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15
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Tun AM, Patel RD, St-Pierre F, Ouchveridze E, Niu A, Thordardottir T, Obasi J, Rosenthal A, Pophali PA, Fenske TS, Karmali R, Ahmed S, Johnston PB. Anti-CD19 chimeric antigen receptor T-cell therapy in older patients with relapsed or refractory large B-cell lymphoma: A multicenter study. Am J Hematol 2024. [PMID: 38837403 DOI: 10.1002/ajh.27381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
Chimeric antigen receptor T-cell (CAR-T) therapy, despite being a potentially curative therapy in relapsed or refractory (RR) large B-cell lymphoma (LBCL), remains underutilized in older patients due to limited clinical data. We therefore studied the safety and efficacy of CAR-T therapy in older patients with RR LBCL in the real-world setting. Patients aged ≥65 years with RR LBCL, treated with anti-CD19 CAR-T therapy at 7 US institutions were included in this multicenter, retrospective, observational study. In total, 226 patients were included. Median age at infusion was 71 years (range 65-89). Best objective and complete response rates were 86% and 62%, respectively. Median follow-up after infusion was 18.3 months. The median progression-free survival (PFS) was 6.9 months, with 6- and 12-month PFS estimates of 54% and 44%, respectively. The nonrelapse mortality (NRM) rate was 10.9% at day 180, primarily due to infections, and not impacted by the age groups. Grade ≥3 cytokine release syndrome and neurotoxicity occurred in 7% and 26%, respectively. In univariate analysis, no significant difference in PFS was seen regardless of the age groups or CAR-T type, whereas ECOG PS ≥2, elevated LDH, bulky disease, advanced stage, extranodal involvement, the need for bridging therapy, and prior bendamustine exposure were associated with shorter PFS. These findings support the use of CAR-T in older patients, including those aged ≥80 years. The age at CAR-T therapy did not influence safety, survival, and NRM outcomes. Older patients should not be excluded from receiving CAR-T therapy solely based on their chronological age.
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Affiliation(s)
- Aung M Tun
- Division of Hematologic Malignancies and Cellular Therapeutics, The University of Kansas, Kansas City, Kansas, USA
| | - Romil D Patel
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Frederique St-Pierre
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Evguenia Ouchveridze
- Division of Hematologic Malignancies and Cellular Therapeutics, The University of Kansas, Kansas City, Kansas, USA
| | - Alex Niu
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thorunn Thordardottir
- Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Jennifer Obasi
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Allison Rosenthal
- Division of Hematology/Oncology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Priyanka A Pophali
- Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Timothy S Fenske
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Reem Karmali
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Sairah Ahmed
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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16
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Patel K, Ivanov A, Jocelyn T, Hantel A, Garcia JS, Abel GA. Patient-Reported Outcomes in Phase 3 Clinical Trials for Blood Cancers: A Systematic Review. JAMA Netw Open 2024; 7:e2414425. [PMID: 38829615 PMCID: PMC11148691 DOI: 10.1001/jamanetworkopen.2024.14425] [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: 12/05/2023] [Accepted: 04/01/2024] [Indexed: 06/05/2024] Open
Abstract
Importance Published research suggests that patient-reported outcomes (PROs) are neither commonly collected nor reported in randomized clinical trials (RCTs) for solid tumors. Little is known about these practices in RCTs for hematological malignant neoplasms. Objective To evaluate the prevalence of PROs as prespecified end points in RCTs of hematological malignant neoplasms, and to assess reporting of PROs in associated trial publications. Evidence Review All issues of 8 journals known for publishing high-impact RCTs (NEJM, Lancet, Lancet Hematology, Lancet Oncology, Journal of Clinical Oncology, Blood, JAMA, and JAMA Oncology) between January 1, 2018, and December 13, 2022, were searched for primary publications of therapeutic phase 3 trials for adults with hematological malignant neoplasms. Studies that evaluated pretransplant conditioning regimens, graft-vs-host disease treatment, or radiotherapy as experimental treatment were excluded. Data regarding trial characteristics and PROs were extracted from manuscripts and trial protocols. Univariable analyses assessed associations between trial characteristics and PRO collection or reporting. Findings Ninety RCTs were eligible for analysis. PROs were an end point in 66 (73%) trials: in 1 trial (1%) as a primary end point, in 50 (56%) as a secondary end point, and in 15 (17%) as an exploratory end point. PRO data were reported in 26 of 66 primary publications (39%): outcomes were unchanged in 18 and improved in 8, with none reporting worse PROs with experimental treatment. Trials sponsored by for-profit entities were more likely to include PROs as an end point (49 of 55 [89%] vs 17 of 35 [49%]; P < .001) but were not significantly more likely to report PRO data (20 of 49 [41%] vs 6 of 17 [35%]; P = .69). Compared with trials involving lymphoma (18 of 29 [62%]) or leukemia or myelodysplastic syndrome (18 of 28 [64%]), those involving plasma cell disorders or multiple myeloma (27 of 30 [90%]) or myeloproliferative neoplasms (3 of 3 [100%]) were more likely to include PROs as an end point (P = .03). Similarly, compared with trials involving lymphoma (3 of 18 [17%]) or leukemia or myelodysplastic syndrome (5 of 18 [28%]), those involving plasma cell disorders or multiple myeloma (16 of 27 [59%]) or myeloproliferative neoplasms (2 of 3 [67%]) were more likely to report PROs in the primary publication (P = .01). Conclusions and Relevance In this systematic review, almost 3 of every 4 therapeutic RCTs for blood cancers collected PRO data; however, only 1 RCT included PROs as a primary end point. Moreover, most did not report resulting PRO data in the primary publication and when reported, PROs were either better or unchanged, raising concern for publication bias. This analysis suggests a critical gap in dissemination of data on the lived experiences of patients enrolled in RCTs for hematological malignant neoplasms.
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Affiliation(s)
- Kishan Patel
- Department of Internal Medicine, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Alexandra Ivanov
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Tajmah Jocelyn
- Center for Clinical Investigation, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Andrew Hantel
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jacqueline S. Garcia
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gregory A. Abel
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
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17
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Qi C, Liu C, Gong J, Liu D, Wang X, Zhang P, Qin Y, Ge S, Zhang M, Peng Z, Zhou J, Lu Z, Lu M, Cao Y, Yuan J, Wang Y, Wang Z, Xue R, Peng X, Wang Y, Yuan D, Li J, Zhang X, Shen L. Claudin18.2-specific CAR T cells in gastrointestinal cancers: phase 1 trial final results. Nat Med 2024:10.1038/s41591-024-03037-z. [PMID: 38830992 DOI: 10.1038/s41591-024-03037-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/30/2024] [Indexed: 06/05/2024]
Abstract
Claudin18.2 (CLDN18.2) is highly expressed with the development of various malignant tumors, especially gastrointestinal cancers, and is emerging as a new target for cancer treatment. Satricabtagene autoleucel (satri-cel)/CT041 is an autologous chimeric antigen receptor (CAR) T cell targeting CLDN18.2, and the interim results of the CT041-CG4006 trial were reported in June 2022. Here we present the final results of this single-arm, open-label, phase 1 trial, which evaluated the safety and efficacy of satri-cel in patients with CLDN18.2-positive advanced gastrointestinal cancers. This trial included a dose-escalation stage (n = 15) and a dose-expansion stage in four different cohorts (total n = 83): cohort 1, satri-cel monotherapy in 61 patients with standard chemotherapy-refractory gastrointestinal cancers; cohort 2, satri-cel plus anti-PD-1 therapy in 15 patients with standard chemotherapy-refractory gastrointestinal cancers; cohort 3, satri-cel as sequential treatment after first-line therapy in five patients with gastrointestinal cancers; and cohort 4, satri-cel monotherapy in two patients with anti-CLDN18.2 monoclonal antibody-refractory gastric cancer. The primary endpoint was safety; secondary endpoints included efficacy, pharmacokinetics and immunogenicity. A total of 98 patients received satri-cel infusion, among whom 89 were dosed with 2.5 × 108, six with 3.75 × 108 and three with 5.0 × 108 CAR T cells. Median follow-up was 32.4 months (95% confidence interval (CI): 27.3, 36.5) since apheresis. No dose-limiting toxicities, treatment-related deaths or immune effector cell-associated neurotoxicity syndrome were reported. Cytokine release syndrome occurred in 96.9% of patients, all classified as grade 1-2. Gastric mucosal injuries were identified in eight (8.2%) patients. The overall response rate and disease control rate in all 98 patients were 38.8% and 91.8%, respectively, and the median progression-free survival and overall survival were 4.4 months (95% CI: 3.7, 6.6) and 8.8 months (95% CI: 7.1, 10.2), respectively. Satri-cel demonstrates therapeutic potential with a manageable safety profile in patients with CLDN18.2-positive advanced gastrointestinal cancer. ClinicalTrials.gov identifier: NCT03874897 .
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Affiliation(s)
- Changsong Qi
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Early Drug Development Centre, Peking University Cancer Hospital & Institute, Beijing, China.
| | - Chang Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Early Drug Development Centre, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jifang Gong
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Dan Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Early Drug Development Centre, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xicheng Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Panpan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Early Drug Development Centre, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yanru Qin
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sai Ge
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Miao Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Early Drug Development Centre, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhi Peng
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jun Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhihao Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ming Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yanshuo Cao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jiajia Yuan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yakun Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhenghang Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ran Xue
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | | | - Yumeng Wang
- CARsgen Therapeutics Co., Ltd., Shanghai, China
| | | | - Jian Li
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, China.
| | - Xiaotian Zhang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, China.
| | - Lin Shen
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, China.
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18
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Lewis KL, Cheah CY. The value of bispecific antibodies in relapsed and refractory DLBCL. Leuk Lymphoma 2024; 65:720-735. [PMID: 38454535 DOI: 10.1080/10428194.2024.2323085] [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] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Abstract
Diffuse large B-cell lymphoma (DLBCL) may be cured with anti-CD20 based chemoimmunotherapy in the majority of cases, however, relapsed/refractory disease occurs in 30-40% patients, and despite significant recent therapeutic advances, continues to represent an unmet clinical need. Bispecific antibodies represent a novel class of therapy currently in development for relapsed/refractory B-cell lymphoma. This review discusses the background clinical need, mechanism of action, and clinical data including efficacy and toxicity for bispecific antibodies in DLBCL, focusing on the most advanced class in development; CD20 targeting T-cell engaging antibodies. Emerging possibilities for future use of bispecific antibodies is also discussed, including novel and cytotoxic combination regimens in relapsed and first-line settings.
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MESH Headings
- Humans
- Antibodies, Bispecific/therapeutic use
- Antibodies, Bispecific/pharmacology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/immunology
- Drug Resistance, Neoplasm/immunology
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Agents, Immunological/adverse effects
- Neoplasm Recurrence, Local/immunology
- Neoplasm Recurrence, Local/drug therapy
- Treatment Outcome
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
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Affiliation(s)
- Katharine Louise Lewis
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Australia
- Linear Clinical Research, Nedlands, Australia
- Medical School, Division of Internal Medicine, University of Western Australia, Nedlands, Australia
| | - Chan Yoon Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Australia
- Linear Clinical Research, Nedlands, Australia
- Medical School, Division of Internal Medicine, University of Western Australia, Nedlands, Australia
- Department of Haematology, Pathwest, QEII, Nedlands, Australia
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19
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Little JS, Kampouri E, Friedman DZ, McCarty T, Thompson GR, Kontoyiannis DP, Vazquez J, Baddley JW, Hammond SP. The Burden of Invasive Fungal Disease Following Chimeric Antigen Receptor T-Cell Therapy and Strategies for Prevention. Open Forum Infect Dis 2024; 11:ofae133. [PMID: 38887472 PMCID: PMC11181190 DOI: 10.1093/ofid/ofae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/05/2024] [Indexed: 06/20/2024] Open
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is a novel immunotherapy approved for the treatment of hematologic malignancies. This therapy leads to a variety of immunologic deficits that could place patients at risk for invasive fungal disease (IFD). Studies assessing IFD in this setting are limited by inconsistent definitions and heterogeneity in prophylaxis use, although the incidence of IFD after CAR T-cell therapy, particularly for lymphoma and myeloma, appears to be low. This review evaluates the incidence of IFD after CAR T-cell therapy, and discusses optimal approaches to prevention, highlighting areas that require further study as well as future applications of cellular therapy that may impact IFD risk. As the use of CAR T-cell therapy continues to expand for hematologic malignancies, solid tumors, and most recently to include non-oncologic diseases, understanding the risk for IFD in this uniquely immunosuppressed population is imperative to prevent morbidity and mortality.
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Affiliation(s)
- Jessica S Little
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eleftheria Kampouri
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Daniel Z Friedman
- Section of Infectious Diseases and Global Health, The University of Chicago, Chicago, Illinois, USA
| | - Todd McCarty
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - George R Thompson
- Division of Infectious Diseases, University of California-Davis, Sacramento, California, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas, M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Jose Vazquez
- Division of Infectious Diseases, Medical College of Georgia/Augusta University, Augusta, Georgia, USA
| | - John W Baddley
- Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sarah P Hammond
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medical Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
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20
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Gagelmann N, Bishop M, Ayuk F, Bethge W, Glass B, Sureda A, Pasquini MC, Kröger N. Axicabtagene Ciloleucel versus Tisagenlecleucel for Relapsed or Refractory Large B Cell Lymphoma: A Systematic Review and Meta-Analysis. Transplant Cell Ther 2024; 30:584.e1-584.e13. [PMID: 38281590 DOI: 10.1016/j.jtct.2024.01.074] [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: 10/24/2023] [Revised: 12/28/2023] [Accepted: 01/23/2024] [Indexed: 01/30/2024]
Abstract
Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) are CD19-directed chimeric antigen receptor T cell (CAR-T) therapies approved for relapsed/refractory aggressive large B cell lymphoma (LBCL). Significant costs and complex manufacturing underscore the importance of evidence-based counseling regarding the outcomes of these treatments. With the aim of examining the efficacy and safety of axi-cel versus tisa-cel in patients with relapsed/refractory aggressive LBCL, we performed a systematic literature search of comparative studies evaluating outcomes in relapsed/refractory aggressive LBCL after treatment with axi-cel or tisa-cel. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for response, progression-free survival (PFS), overall survival (OS), cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and hematotoxicity. Meta-analysis and meta-regression were used to generate summary statistics. A total of 2372 participants were included in the 8 studies in our analysis. The dropout rate between apheresis and infusion was 13% for axi-cel versus 18% for tisa-cel, and the median time from apheresis to infusion was 32 days versus 45 days. Axi-cel showed higher odds for a complete response (OR, 1.65; P < .001) and was associated with higher odds for PFS at 1 year after infusion (OR, .60; P < .001). OS appeared to be improved with axi-cel (OR, .84; 95% CI, .68 to 1.02; P = .08), whereas the cumulative incidence of nonrelapse mortality (NRM) was 11.5% for axi-cel versus 3.7% for tisa-cel (P = .002). The main predictors for survival were lactate dehydrogenase level, Eastern Cooperative Oncology Group Performance Status, and response to bridging, and axi-cel maintained superior efficacy even in elderly patients. In terms of safety, axi-cel was associated with significantly higher odds of any-grade CRS (OR, 3.23; P < .001), but not of grade ≥3 CRS (P = .92). Axi-cel was associated with significantly higher odds of severe ICANS grade ≥3 (OR, 4.03; P < .001). In terms of hematotoxicity, axi-cel was significantly associated with higher odds of severe neutropenia at 1 month after infusion (OR, 2.06; P = .003). As a result, axi-cel was associated with significantly greater resource utilization, including prolonged hospital stay, more frequent intensive care admission, and use of agents such as tocilizumab for toxicity management. We provide strong evidence of the greater efficacy of axi-cel versus tisa-cel in relapsed/refractory aggressive LBCL. The higher toxicity and NRM seen with axi-cel might not counterbalance the overall results, highlighting the need for timely intervention and careful selection of patients, balancing resource utilization and clinical benefit.
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Affiliation(s)
- Nico Gagelmann
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Michael Bishop
- The David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, Illinois
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Bethge
- Department of Hematology and Oncology, University Hospital Tuebingen, Tuebingen, Germany
| | - Bertram Glass
- Department of Hematology and Cell Therapy, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Anna Sureda
- Bellvitge Institute for Biomedical Research, Universitat de Barcelona, Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - Marcelo C Pasquini
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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21
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Yamshon S, Gribbin C, Alhomoud M, Chokr N, Chen Z, Demetres M, Pasciolla M, Leonard J, Shore T, Martin P. Safety and Toxicity Profiles of CAR T Cell Therapy in Non-Hodgkin Lymphoma: A Systematic Review and Meta-Analysis. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e235-e256.e2. [PMID: 38582666 DOI: 10.1016/j.clml.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The application of CD19-directed chimeric antigen receptor T (CAR T) cell therapy has improved outcomes for thousands of patients with non-Hodgkin B cell lymphoma (NHL). The toxicities associated with various CAR T cell products, however, can be severe and difficult to anticipate. METHODS In this systematic review and meta-analysis, we set out to determine whether there are measurable differences in common toxicities, including cytokine release syndrome (CRS), immune effector cell associated neurotoxicity syndrome (ICANS), cytopenias, and infections, between CAR T products that are commercially available for the treatment of NHL. RESULTS After a stringent study selection process, we used a cohort of 1364 patients enrolled in 15 prospective clinical trials investigating the use of axicabtagene ciloleucel (axi-cel), lisocabtagene maraleucel (liso-cel), and tisagenlecleucel (tisa-cel). We found that the rates of CRS and ICANS were significantly higher with axi-cel as compared to both liso-cel and tisa-cel. Conversely, we demonstrated that rates of all-grade and severe neutropenia were significantly greater with liso-cel. Febrile neutropenia and all-grade infection rates did not differ significantly between products though rates of severe infection were increased with axi-cel. CONCLUSIONS Overall, this study serves as the first to delineate toxicity profiles associated with various available CAR T products. By better understanding associated toxicities, it may become possible to tailor therapies towards individual patients and anticipate the development of toxicities at earlier stages.
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Affiliation(s)
- Samuel Yamshon
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY.
| | - Caitlin Gribbin
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Mohammad Alhomoud
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Nora Chokr
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Zhengming Chen
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Michelle Demetres
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY
| | - Michelle Pasciolla
- Department of Pharmacy, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
| | - John Leonard
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Tsiporah Shore
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Peter Martin
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
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22
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Lin HK, Uricoli B, Freeman RM, Hossian AKMN, He Z, Anderson JYL, Neffling M, Legier JM, Blake DA, Doxie DB, Nair R, Koff JL, Dhodapkar KM, Shanmugam M, Dreaden EC, Rafiq S. Engineering Improved CAR T Cell Products with A Multi-Cytokine Particle Platform for Hematologic and Solid Tumors. Adv Healthc Mater 2024; 13:e2302425. [PMID: 38245855 PMCID: PMC11144092 DOI: 10.1002/adhm.202302425] [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: 07/28/2023] [Revised: 01/05/2024] [Indexed: 01/22/2024]
Abstract
Despite the remarkable clinical efficacy of chimeric antigen receptor (CAR) T cells in hematological malignancies, only a subset of patients achieves a durable complete response (dCR). DCR has been correlated with CAR T cell products enriched with T cells memory phenotypes. Therefore, reagents that consistently promote memory phenotypes during the manufacturing of CAR T cells have the potential to significantly improve clinical outcomes. A novel modular multi-cytokine particle (MCP) platform is developed that combines the signals necessary for activation, costimulation, and cytokine support into a single "all-in-one" stimulation reagent for CAR T cell manufacturing. This platform allows for the assembly and screening of compositionally diverse MCP libraries to identify formulations tailored to promote specific phenotypes with a high degree of flexibility. The approach is leveraged to identify unique MCP formulations that manufacture CAR T cell products from diffuse large B cell patients with increased proportions of memory-like phenotypes MCP-manufactured CAR T cells demonstrate superior anti-tumor efficacy in mouse models of lymphoma and ovarian cancer through enhanced persistence. These findings serve as a proof-of-principle of the powerful utility of the MCP platform to identify "all-in-one" stimulation reagents that can improve the effectiveness of cell therapy products through optimal manufacturing.
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Affiliation(s)
- Heather K. Lin
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Biaggio Uricoli
- Wallace H. Coulter Department of Biomedical Engineering at Emory University and Georgia Institute of Technology Atlanta, GA, USA
| | - Ruby M. Freeman
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - AKM Nawshad Hossian
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Zhulin He
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Jonathan M. Legier
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Dejah A. Blake
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Deon B. Doxie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute, Atlanta, GA, USA
| | - Remya Nair
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jean L. Koff
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute, Atlanta, GA, USA
| | - Kavita M. Dhodapkar
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute, Atlanta, GA, USA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Mala Shanmugam
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute, Atlanta, GA, USA
| | - Erik C. Dreaden
- Wallace H. Coulter Department of Biomedical Engineering at Emory University and Georgia Institute of Technology Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute, Atlanta, GA, USA
| | - Sarwish Rafiq
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute, Atlanta, GA, USA
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23
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Stewart DA, Kuruvilla J, Lee D, Dudebout JJ, Chua N, Larouche JF, Baetz T, Shafey M, Abdel-Samad N, Robinson S, Fleury I, Fraser G, Skrabek P, Kukreti V, Kelly J, Hay AE, Shepherd LE, Chen BE, Crump M. Canadian cancer trials group LY.17: A randomized phase II study evaluating novel salvage therapy pre-autologous stem cell transplant in relapsed/refractory diffuse large B-cell lymphoma-outcome of rituximab-dose-intensive cyclophosphamide, etoposide, cisplatin (R-DICEP) versus R-GDP. Br J Haematol 2024. [PMID: 38802107 DOI: 10.1111/bjh.19555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
The Canadian Cancer Trials Group (CCTG) LY.17 is an ongoing multi-arm randomized phase II trial evaluating novel salvage therapies compared with R-GDP (rituximab, gemcitabine, dexamethasone and cisplatin) in autologous stem cell transplantation (ASCT)-eligible patients with relapsed/refractory diffuse large B-cell lymphoma (RR-DLBCL). This component of the LY.17 trial evaluated a dose-intensive chemotherapy approach using a single cycle of inpatient R-DICEP (rituximab, dose-intensive cyclophosphamide, etoposide and cisplatin) to achieve both lymphoma response and stem cell mobilization, shortening time to ASCT. This report is the result of the protocol-specified second interim analysis of the 67 patients who were randomized to either 1 cycle of R-DICEP or to 3 cycles of R-GDP. The overall response rate (ORR) was 65.6% for R-DICEP and 48.6% for R-GDP. The ASCT rate was 71.9% versus 54.3%, and 1-year progression-free survival rate was 42% versus 32%, respectively, for R-DICEP versus R-GDP. Although the improvement in ORR for R-DICEP versus R-GDP exceeded the pre-specified 10% threshold to proceed to full accrual of 64 patients/arm, higher rates of grade 3-5 toxicities, and the need for hospitalization led to the decision to stop this arm of the study. CCTG LY.17 will continue to evaluate different salvage regimens that incorporate novel agents.
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Affiliation(s)
- Douglas A Stewart
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - John Kuruvilla
- University Health Network, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - David Lee
- Queens University, Kingston, Ontario, Canada
| | | | - Neil Chua
- Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jean-François Larouche
- Hôpital Enfant-Jésus, Centre Hospitalier Universitaire de Quebec, Quebec City, Quebec, Canada
| | - Tara Baetz
- Queens University, Kingston, Ontario, Canada
| | - Mona Shafey
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | | | - Sue Robinson
- Queen Elizabeth II Health Science Center, Halifax, Nova Scotia, Canada
| | - Isabelle Fleury
- Maisonneuve-Rosemont Hospital, Institute of Hematology, Oncology and Cell Therapy, Montreal University, Montreal, Quebec, Canada
| | - Graeme Fraser
- Juravinski Cancer Centre, McMaster University, Ontario, Hamilton, Canada
| | - Pamela Skrabek
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Vishal Kukreti
- University Health Network, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Jesse Kelly
- Canadian Cancer Trials Group, Queen's University, Kingston, Ontario, Canada
| | - Annette E Hay
- Canadian Cancer Trials Group, Queen's University, Kingston, Ontario, Canada
| | - Lois E Shepherd
- Canadian Cancer Trials Group, Queen's University, Kingston, Ontario, Canada
| | - Bingshu E Chen
- Canadian Cancer Trials Group, Queen's University, Kingston, Ontario, Canada
| | - Michael Crump
- University Health Network, Princess Margaret Cancer Center, Toronto, Ontario, Canada
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24
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Yamasaki S. Appropriate Treatment Intensity for Diffuse Large B-Cell Lymphoma in the Older Population: A Review of the Literature. Hematol Rep 2024; 16:317-330. [PMID: 38921180 PMCID: PMC11204029 DOI: 10.3390/hematolrep16020032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/13/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
Most patients with diffuse large B-cell lymphoma (DLBCL) are >65 years of age, with the number of patients expected to increase in the coming years. A comprehensive geriatric assessment that carefully evaluates fitness status and comorbidities is essential for selecting the appropriate treatment intensity. Although generally healthy patients or those <80 years of age may benefit from standard immunochemotherapy, unfit/frail patients or patients >80 years old may require reduced-intensity chemotherapy or less-toxic drugs. Some new drugs are currently being tested as single or combined agents for first-line treatment, aiming to improve the outcomes of conventional chemotherapy. This review systematically collates and discusses the outcomes associated with the use of immunochemotherapy in older patients with DLBCL, as well as considering the impact of full-dose immunochemotherapy on quality of life in older and frail patients, summarizing the rationale for reduced dosing in the older population, and presenting recommendations for selecting patients likely to benefit from reduced dosing. If preliminary efficacy and safety data are confirmed in future clinical trials, non-chemotherapy-based immunotherapy approaches could become an alternative potentially curative option in frail patients and those >80 years of age with DLBCL.
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Affiliation(s)
- Satoshi Yamasaki
- Department of Hematology, St. Mary’s Hospital, 422 Tsubukuhonmachi, Kurume 830-8543, Japan; ; Tel.: +81-942-35-3322; Fax: +81-9442-34-3115
- Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu 874-0838, Japan
- Department of Hematology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka 810-0065, Japan
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25
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Elmarasi M, Elkonaissi I, Elsabagh AA, Elsayed E, Elsayed A, Elsayed B, Elmakaty I, Yassin M. CAR-T cell therapy: Efficacy in management of cancers, adverse effects, dose-limiting toxicities and long-term follow up. Int Immunopharmacol 2024; 135:112312. [PMID: 38788449 DOI: 10.1016/j.intimp.2024.112312] [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: 03/18/2024] [Revised: 05/16/2024] [Accepted: 05/19/2024] [Indexed: 05/26/2024]
Abstract
Chimeric Antigen Receptor T-cell (CAR-T) therapy has emerged as a groundbreaking and highly promising approach for the management of cancer. This paper reviews the efficacy of CAR-T therapy in the treatment of various hematological malignancies, also, with a mention of its effect on solid tumors, for which they have not received FDA approval yet. Different common and uncommon side effects are also discussed in this paper, with attention to the effect of each drug separately. By reviewing the recommendations of the FDA for CAR-T therapy research, we have extensively discussed dose-limiting toxicities. This further highlights the need for precise dosing strategies, striking a balance between therapeutic benefits and potential risks. Additionally, we reviewed the long-term follow-up of patients receiving CAR-T therapy to gain valuable insights into response durability and late-onset effects.
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Affiliation(s)
- Mohamed Elmarasi
- Department of Medical Education, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Islam Elkonaissi
- Department of Hematology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Ahmed Adel Elsabagh
- Department of Medical Education, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Engy Elsayed
- College of Medicine, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Abdelrahman Elsayed
- Department of Medical Education, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Basant Elsayed
- Department of Medical Education, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Ibrahim Elmakaty
- Department of Medical Education, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar.
| | - Mohamed Yassin
- College of Medicine, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar; Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), P.O. Box 3050, Doha, Qatar.
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Strüßmann T, Marks R, Wäsch R. Relapsed/Refractory Diffuse Large B-Cell Lymphoma: Is There Still a Role for Autologous Stem Cell Transplantation in the CAR T-Cell Era? Cancers (Basel) 2024; 16:1987. [PMID: 38893108 PMCID: PMC11171011 DOI: 10.3390/cancers16111987] [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: 04/25/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Recently, CD19-directed chimeric antigen receptor (CAR) T-cell therapies have revolutionized treatment strategies for diffuse large B-cell lymphoma (DLBCL). CAR T-cell therapy is increasingly used as a second-line therapy for patients with DLBCL with early relapse or refractoriness to initial chemoimmunotherapy and displaced high-dose chemotherapy, followed by autologous stem cell transplantation (ASCT) as the standard of care for these patients. However, patients with late relapse or chemosensitive disease still benefit from autologous stem cell transplantation. We will review practice-changing studies in early relapse (ZUMA-7 and TRANSFORM) under consideration of the negative BELINDA trial, with a focus on register data, comparing CAR T-cell therapy and ASCT for patients responding to salvage therapy.
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Affiliation(s)
- Tim Strüßmann
- Department of Medicine I, Faculty of Medicine, Medical Center–University of Freiburg, University of Freiburg, 79106 Freiburg, Germany; (R.M.); (R.W.)
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Leache L, Gutiérrez Valencia M, Saiz LC, Erviti J, Rojas Reyes MX. Efficacy and safety of chimeric antigen receptor T-cell (CAR-T) therapy in hematologic malignancies: a living systematic review (protocol). OPEN RESEARCH EUROPE 2024; 2:38. [PMID: 38827275 PMCID: PMC11140298 DOI: 10.12688/openreseurope.14390.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/04/2024]
Abstract
Objective To determine the efficacy and safety of CAR-T therapy in the treatment of patients with hematologic malignancies, in comparison with other current therapies. Design A living systematic review. Methods We will include randomized trials evaluating the effect of CAR-T therapy versus other active treatments, hematopoietic stem cell transplantation, best supportive care or any other intervention in patients with hematologic malignancies. Non-randomized primary studies will be searched in case we found no direct evidence from randomized controlled trials. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. Efficacy measures will include overall survival rate, overall response rate, complete response/remission (CR) rate, partial response/remission (PR) rate, relapse from CR, progression-free survival, and time from CAR-T infusion to transplantation. Safety measures will include serious adverse events, the incidence of cytokine release syndrome, graft-versus-host disease, neurotoxicity, and total adverse events. Quality of life will also be assessed. Meta-analyses will be carried out to summarize the results. We will apply the GRADE approach to assess the certainty of the evidence for each outcome. A living, web-based version of this review will be openly available until there is solid evidence to respond to the review objective. We will resubmit it for publication every time the conclusions change or whenever there are substantial updates.
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Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Tudela 20, 1st floor, 31003, Spain
| | - Marta Gutiérrez Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Tudela 20, 1st floor, 31003, Spain
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Tudela 20, 1st floor, 31003, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Tudela 20, 1st floor, 31003, Spain
| | - Maria Ximena Rojas Reyes
- Institut d'Recerca-Servei d'Epidemiologia Clínica i Salut Pública, Hospital de la Santa Creu i Sant Pau, Barcelona, Carrer de Sant Quintí, 08041, Spain
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Bennett R, Dickinson M. SOHO State of the Art Updates and Next Questions | Current Evidence and Future Directions for Bispecific Antibodies in Large B-Cell Lymphoma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00181-2. [PMID: 38871556 DOI: 10.1016/j.clml.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 06/15/2024]
Abstract
The CD20xCD3 bispecific antibodies (bsAb) are "off-the-shelf" T-cell re-directing therapies that demonstrate remarkable single-agent clinical activity in B-cell lymphomas. Two agents, epcoritamab (epcor) and glofitamab (glofit) have recent global approvals for patients with relapsed/refractory DLBCL (RR DLBCL) following 2 prior treatment lines. Both agents demonstrate activity in patients with prior exposure to chimeric antigen receptor T-cell (CAR-T) treatment. As multiyear follow-up data become available, it is clear that the majority of patients achieving complete remissions do not relapse and that outcomes are similar between epcor and glofit. CD20xCD3 bsAb have a safety profile that reflect their mechanism of action, with cytokine release syndrome (CRS) the key management issue. Neurotoxicity is far less common than observed with CD19-directed CAR-T. BsAbs are attractive, rapidly available, treatment options for patients with RR DLBCL, without the practical and financial challenges seen with autologous CAR-T therapies. Recent data also demonstrate the feasibility and potential efficacy of bsAb in combination with chemoimmunotherapy with large randomized trials evaluating bsAb-chemotherapy combinations underway. There are open questions about the future role of bsAB for LBCL, the optimal duration of therapy, optimal CRS risk mitigation strategies, and potential resistance mechanisms. In this review we seek to describe the current evidence for bsAb in LBCL, and offer opinion regarding these open questions.
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Affiliation(s)
- Rory Bennett
- Department of Clinical Haematology, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Victoria, Australia
| | - Michael Dickinson
- Department of Clinical Haematology, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia.
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Liang J, Liu G, Wang W, Xue H. Causal relationships between gut microbiota and lymphoma: a bidirectional Mendelian randomization study. Front Cell Infect Microbiol 2024; 14:1374775. [PMID: 38803568 PMCID: PMC11128559 DOI: 10.3389/fcimb.2024.1374775] [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: 01/22/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Background Multiple studies have suggested a possible connection between the gut microbiota and the development of lymphoma, though the exact nature of this relationship remains unclear. This study aimed to explore whether a causal association exists between gut microbiota and lymphoma. Methods A bidirectional two-sample Mendelian randomization (MR) approach was conducted to investigate potential causal effects between gut microbiota and various lymphoma subtypes. The primary method employed for MR analysis was inverse variance weighted (IVW), supplemented by additional methods including MR-Egger, weighted median, and weighted mode approaches. The Cochrane Q test, MR-PRESSO global test and MR-Egger intercept test were performed to assess pleiotropy and heterogeneity. Furthermore, a reverse MR analysis was performed to explore potential reverse causal effect. Results The primary MR analysis identified 36 causal relationships between genetic liabilities in gut microbiota and different lymphoma subtypes. Neither the MR-PRESSO test nor the MR-Egger regression detected any pleiotropy, and Cochran's Q test indicated no significant heterogeneity. Conclusions Our MR analysis revealed substantial causal associations between gut microbiota and lymphoma, offering new insights into lymphoma prevention and management microbiota.
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Affiliation(s)
- Jing Liang
- Pediatric Hematology Laboratory, Division of Hematology/Oncology, Department of Pediatrics, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Gengqiu Liu
- Department of Thoracic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Wenqing Wang
- Pediatric Hematology Laboratory, Division of Hematology/Oncology, Department of Pediatrics, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Hongman Xue
- Pediatric Hematology Laboratory, Division of Hematology/Oncology, Department of Pediatrics, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
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Grauwet K, Berger T, Kann MC, Silva H, Larson R, Leick MB, Bailey SR, Bouffard AA, Millar D, Gallagher K, Turtle CJ, Frigault MJ, Maus MV. Stealth transgenes enable CAR-T cells to evade host immune responses. J Immunother Cancer 2024; 12:e008417. [PMID: 38724463 PMCID: PMC11086422 DOI: 10.1136/jitc-2023-008417] [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] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Adoptive cell therapy, such as chimeric antigen receptor (CAR)-T cell therapy, has improved patient outcomes for hematological malignancies. Currently, four of the six FDA-approved CAR-T cell products use the FMC63-based αCD19 single-chain variable fragment, derived from a murine monoclonal antibody, as the extracellular binding domain. Clinical studies demonstrate that patients develop humoral and cellular immune responses to the non-self CAR components of autologous CAR-T cells or donor-specific antigens of allogeneic CAR-T cells, which is thought to potentially limit CAR-T cell persistence and the success of repeated dosing. METHODS In this study, we implemented a one-shot approach to prevent rejection of engineered T cells by simultaneously reducing antigen presentation and the surface expression of both Classes of the major histocompatibility complex (MHC) via expression of the viral inhibitors of transporter associated with antigen processing (TAPi) in combination with a transgene coding for shRNA targeting class II MHC transactivator (CIITA). The optimal combination was screened in vitro by flow cytometric analysis and mixed lymphocyte reaction assays and was validated in vivo in mouse models of leukemia and lymphoma. Functionality was assessed in an autologous setting using patient samples and in an allogeneic setting using an allogeneic mouse model. RESULTS The combination of the Epstein-Barr virus TAPi and an shRNA targeting CIITA was efficient and effective at reducing cell surface MHC classes I and II in αCD19 'stealth' CAR-T cells while retaining in vitro and in vivo antitumor functionality. Mixed lymphocyte reaction assays and IFNγ ELISpot assays performed with T cells from patients previously treated with autologous αCD19 CAR-T cells confirm that CAR T cells expressing the stealth transgenes evade allogeneic and autologous anti-CAR responses, which was further validated in vivo. Importantly, we noted anti-CAR-T cell responses in patients who had received multiple CAR-T cell infusions, and this response was reduced on in vitro restimulation with autologous CARs containing the stealth transgenes. CONCLUSIONS Together, these data suggest that the proposed stealth transgenes may reduce the immunogenicity of autologous and allogeneic cellular therapeutics. Moreover, patient data indicate that repeated doses of autologous FMC63-based αCD19 CAR-T cells significantly increased the anti-CAR T cell responses in these patients.
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Affiliation(s)
- Korneel Grauwet
- Cellular Immunotherapy Program, Krantz Family Center for Cancer Research, Massachusetts General Hosptial, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Trisha Berger
- Cellular Immunotherapy Program, Krantz Family Center for Cancer Research, Massachusetts General Hosptial, Charlestown, Massachusetts, USA
| | - Michael C Kann
- Cellular Immunotherapy Program, Krantz Family Center for Cancer Research, Massachusetts General Hosptial, Charlestown, Massachusetts, USA
| | - Harrison Silva
- Cellular Immunotherapy Program, Krantz Family Center for Cancer Research, Massachusetts General Hosptial, Charlestown, Massachusetts, USA
| | - Rebecca Larson
- Cellular Immunotherapy Program, Krantz Family Center for Cancer Research, Massachusetts General Hosptial, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Mark B Leick
- Cellular Immunotherapy Program, Krantz Family Center for Cancer Research, Massachusetts General Hosptial, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stefanie R Bailey
- Cellular Immunotherapy Program, Krantz Family Center for Cancer Research, Massachusetts General Hosptial, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Amanda A Bouffard
- Cellular Immunotherapy Program, Krantz Family Center for Cancer Research, Massachusetts General Hosptial, Charlestown, Massachusetts, USA
| | - David Millar
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathleen Gallagher
- Cellular Immunotherapy Program, Krantz Family Center for Cancer Research, Massachusetts General Hosptial, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cameron J Turtle
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Matthew J Frigault
- Cellular Immunotherapy Program, Krantz Family Center for Cancer Research, Massachusetts General Hosptial, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marcela V Maus
- Cellular Immunotherapy Program, Krantz Family Center for Cancer Research, Massachusetts General Hosptial, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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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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Xin X, Lin L, Yang Y, Wang N, Wang J, Xu J, Wei J, Huang L, Zheng M, Xiao Y, Meng F, Cao Y, Zhu X, Zhang Y. Prognostic differences between carmustine, etoposide, cytarabine and melphalan (BEAM) and carmustine, etoposide, cytarabine, melphalan and fludarabine (BEAMF) regimens before autologous stem cell transplantation plus chimeric antigen receptor T therapy in patients with refractory/relapsed B-cell non-Hodgkin-lymphoma. Cytotherapy 2024; 26:456-465. [PMID: 38385909 DOI: 10.1016/j.jcyt.2024.01.012] [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: 10/12/2023] [Revised: 01/10/2024] [Accepted: 01/30/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND AIMS The combination therapy of autologous hematopoietic stem cell transplantation (ASCT) and chimeric antigen receptor T-cell (CART) therapy has been employed to improve outcomes for relapsed or refractory (R/R) B-cell non-Hodgkin-lymphoma (B-NHL). The widely used conditioning regimen before ASCT plus CART therapy reported in the literature was carmustine, etoposide, cytarabine and melphalan (BEAM). However, whether adding fludarabine to the BEAM regimen (BEAMF) can improve the survival of patients with R/R B-NHL remains unknown. METHODS In total, 39 and 19 patients with R/R B-NHL were enrolled to compare clinical outcomes in the BEAM and BEAMF regimens before ASCT plus CD19/22 CART therapy, respectively. RESULTS The objective response (OR) rates at 3 months to BEAM and BEAMF regimens before ASCT plus CD19/22 CART therapy were 71.8% and 94.7%, respectively (P = 0.093). The BEAMF regimen showed a trend towards a superior duration of response compared with the BEAM regimen (P = 0.09). After a median follow-up of 28 months (range: 0.93-51.9 months), the BEAMF regimen demonstrated superior 2-year progression-free survival (PFS) (89.5% versus 63.9%; P = 0.048) and 2-year overall survival (OS) (100% vs 77.3%; P = 0.035) compared with the BEAM regimen. In the multivariable Cox regression analysis, OR at month 3 (responders) was remarkably correlated with better OS (hazard ratio: 0.112, P = 0.005) compared with OR (non-responders). CONCLUSIONS For patients with R/R B-NHL, the BEAMF regimen before ASCT plus CD19/22 CART therapy was correlated with superior PFS and OS than the BEAM regimen, and the BEAMF regimen is a promising alternative conditioning regimen for ASCT plus CAR-T therapy.
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Affiliation(s)
- Xiangke Xin
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Lin
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yang Yang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei, China
| | - Na Wang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei, China
| | - Jue Wang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei, China
| | - Jinhuan Xu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei, China
| | - Jia Wei
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei, China
| | - Liang Huang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei, China
| | - Miao Zheng
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei, China
| | - Yi Xiao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei, China
| | - Fankai Meng
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei, China
| | - Yang Cao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei, China.
| | - Xiaojian Zhu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei, China
| | - Yicheng Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei, China.
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Shumnalieva R, Velikova T, Monov S. Expanding the role of CAR T-cell therapy: From B-cell hematological malignancies to autoimmune rheumatic diseases. Int J Rheum Dis 2024; 27:e15182. [PMID: 38742463 DOI: 10.1111/1756-185x.15182] [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: 10/23/2023] [Revised: 04/04/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is a form of immunotherapy where the lymphocytes, mostly T-cells, are redirected to specifically recognize and eliminate a target antigen by coupling them with CARs. The binding of CAR and target cell surface antigens leads to vigorous T cell activation and robust anti-tumor immune responses. Areas of implication of CAR T-cell therapies include mainly hematological malignancies (i.e., advanced B-cell cancers); however, recent studies have proven the unprecedented success of the new immunotherapy also in autoimmune rheumatic diseases. We aim to review the recent advances in CAR T-cell therapies in rheumatology but also to address the limitations of their use in the real clinical practice based on the data on their efficacy and safety.
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Affiliation(s)
- Russka Shumnalieva
- Department of Rheumatology, Clinic of Rheumatology, Medical University-Sofia, Faculty of Medicine, Sofia, Bulgaria
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University "St. Kliment Ohridski"- Sofia, Sofia, Bulgaria
| | - Simeon Monov
- Department of Rheumatology, Clinic of Rheumatology, Medical University-Sofia, Faculty of Medicine, Sofia, Bulgaria
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Eigendorff F, Filimonova I, Scholl S, Sayer-Klink A, Rummler S, Kunert C, Pietschmann K, Wittig A, Hochhaus A, Schnetzke U. Effective bridging strategies prior to infusion with tisagenlecleucel results in high response rates and long-term remission in relapsed/refractory large B-cell lymphoma: findings from a German monocentric study. J Cancer Res Clin Oncol 2024; 150:224. [PMID: 38693452 PMCID: PMC11062962 DOI: 10.1007/s00432-024-05765-8] [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: 03/01/2024] [Accepted: 04/23/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Incorporating chimeric antigen receptor (CAR)-T cell therapy into relapsed or refractory large B-cell lymphoma (rr LBCL) treatment algorithms has yielded remarkable response rates and durable remissions, yet a substantial portion of patients experience progression or relapse. Variations in outcomes across treatment centers may be attributed to different bridging strategies and remission statuses preceding CAR-T cell therapy. PATIENTS Twenty-nine consecutive adult patients receiving tisagenlecleucel (tisa-cel) for rr LBCL from December 2019 to February 2023 at Jena University Hospital were analyzed. RESULTS The median age was 63, with a median of 3 prior treatments. Twenty patients (69%) were refractory to any systemic therapy before CAR-T cell treatment. Following leukapheresis, 25 patients (86%) received bridging therapy with the majority undergoing chemotherapy (52%) or combined modality therapy (32%). Radiotherapy (RT) was part of the bridging strategy in 44%, with moderately hypofractionated involved site RT (30.0 Gy/2.5 Gy) being applied most frequently (64%). Post-CAR-T infusion, the objective response rate at 30 days was 83%, with 55% achieving complete response. Twelve-month progression-free (PFS) and overall survival (OS) were 60% and 74%, respectively, with a median follow up of 11.1 months for PFS and 17.9 months for OS. Factors significantly associated with PFS were chemotherapy sensitivity pre-leukapheresis and response to bridging. CONCLUSION The study underscores the importance of minimal tumor burden at CAR-T initiation, emphasizing the need for suitable bridging regimens. The findings advocate for clinical trials and further real-world analyses to optimize CAR-T cell therapy outcomes by identifying the most effective bridging strategies.
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MESH Headings
- Humans
- Male
- Middle Aged
- Female
- Aged
- Immunotherapy, Adoptive/methods
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Adult
- Remission Induction
- Neoplasm Recurrence, Local/therapy
- Neoplasm Recurrence, Local/pathology
- Germany
- Receptors, Antigen, T-Cell/therapeutic use
- Retrospective Studies
- Combined Modality Therapy
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Affiliation(s)
- Farina Eigendorff
- Klinik Für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG) Jena/Leipzig, Campus Jena, Jena, Germany
| | - Irina Filimonova
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG) Jena/Leipzig, Campus Jena, Jena, Germany
| | - Sebastian Scholl
- Klinik Für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG) Jena/Leipzig, Campus Jena, Jena, Germany
| | - Anne Sayer-Klink
- Institut für Transfusionsmedizin, Universitätsklinikum Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG) Jena/Leipzig, Campus Jena, Jena, Germany
| | - Silke Rummler
- Institut für Transfusionsmedizin, Universitätsklinikum Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG) Jena/Leipzig, Campus Jena, Jena, Germany
| | - Christa Kunert
- Klinik Für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG) Jena/Leipzig, Campus Jena, Jena, Germany
| | - Klaus Pietschmann
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG) Jena/Leipzig, Campus Jena, Jena, Germany
| | - Andrea Wittig
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Jena, Jena, Germany
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Andreas Hochhaus
- Klinik Für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG) Jena/Leipzig, Campus Jena, Jena, Germany
| | - Ulf Schnetzke
- Klinik Für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
- Comprehensive Cancer Center Central Germany (CCCG) Jena/Leipzig, Campus Jena, Jena, Germany.
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Yamauchi N, Maruyama D. Current development of chimeric antigen receptor T-cell therapy for diffuse large B-cell lymphoma and high-grade B-cell lymphoma. Eur J Haematol 2024; 112:662-677. [PMID: 38168033 DOI: 10.1111/ejh.14166] [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: 07/29/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy has become a commercially available treatment option for relapsed or refractory (r/r) diffuse large B-cell lymphoma (DLBCL) with two or more lines of prior therapies, and recently for high-risk r/r DLBCL with one prior line of therapy. The successful development of CAR T-cell therapy for multiple relapsed DLBCL has led to a boom in subsequent trials that investigated its utility in patients with other r/r B-cell lymphoma subtypes. However, CAR T-cell therapy is a multistep process that includes leukapheresis and manipulation which take several weeks. Therefore, patients with rapidly progressing or bulky disease may not be able to complete the therapeutic regimen involving CAR T-cell products. This raises the question of the generalizability of the results of pivotal studies to the entire population. In this review, we summarize the development of CAR-T cell therapy for B-cell lymphoma and discuss strategies to further improve the clinical outcomes of this treatment.
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Affiliation(s)
- Nobuhiko Yamauchi
- Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | - Dai Maruyama
- Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
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Lin H, Deng T, Jiang L, Meng F, Cao Y, Zhang Y, Ge R, Zhu X. Adverse Reactions in Relapsed/Refractory B-Cell Lymphoma Administered with Chimeric Antigen Receptor T Cell Alone or in Combination with Autologous Stem Cell Transplantation. Cancers (Basel) 2024; 16:1722. [PMID: 38730674 PMCID: PMC11083715 DOI: 10.3390/cancers16091722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/21/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: The combination of CAR-T with ASCT has been observed to enhance the efficacy of CAR-T cell therapy. However, the impact of this combination on adverse reactions is still uncertain. (2) Methods: Between January 2019 and February 2023, 292 patients diagnosed with r/r B-cell lymphoma received either CAR-T therapy alone or in combination with ASCT at our institution. We evaluated the incidence of CRS and CRES and utilized a logistic regression model to identify factors contributing to severe CRS (grade 3-4) and CRES (grade 3-4). (3) Results: The overall incidence of CRS and CRES was 78.9% and 8.2% in 147 patients receiving CAR-T alone, and 95.9% and 15.2% in 145 patients receiving CAR-T combined with ASCT, respectively. The incidence of overall CRS (p < 0.0001) and mild CRS (grade 1-2) (p = 0.021) was elevated in the ASCT combined with CAR-T group. No significant difference was observed in severe CRS and CRES between the groups. Among the 26 cases of lymphoma involving the central nervous system (CNS), 96.2% (25/26) developed CRS (15.4% grade 3-4), and 34.6% (9/26) manifested CRES (7.7% grade 3-4). Female patients had a lower incidence of severe CRS but a higher incidence of severe CRES. Lymphomas with CNS involvement demonstrated a higher risk of CRES compared to those without central involvement. (4) Conclusions: The combination of ASCT with CAR-T demonstrated a preferable option in r/r B-cell lymphoma without an increased incidence of severe CRS and CRES.
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Affiliation(s)
- Haolong Lin
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.L.); (L.J.); (F.M.); (Y.C.); (Y.Z.)
- Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan 430030, China
| | - Ting Deng
- Department of Hematology, Chongqing Fifth People’s Hospital, Chongqing 400062, China;
| | - Lijun Jiang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.L.); (L.J.); (F.M.); (Y.C.); (Y.Z.)
- Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan 430030, China
| | - Fankai Meng
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.L.); (L.J.); (F.M.); (Y.C.); (Y.Z.)
- Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan 430030, China
| | - Yang Cao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.L.); (L.J.); (F.M.); (Y.C.); (Y.Z.)
- Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan 430030, China
| | - Yicheng Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.L.); (L.J.); (F.M.); (Y.C.); (Y.Z.)
- Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan 430030, China
| | - Renying Ge
- Department of Hematology, Xianning Central Hospital, The First Affiliated Hospital to Hubei University of Science and Technology, Xianning 437100, China
| | - Xiaojian Zhu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.L.); (L.J.); (F.M.); (Y.C.); (Y.Z.)
- Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan 430030, China
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Salvino MA, Mussetti A, Peña M, Paviglianiti A, Carreira AS, Rizky D, Sureda A. CAR T-cell therapy and the onco-nephrologist. FRONTIERS IN NEPHROLOGY 2024; 4:1378250. [PMID: 38706889 PMCID: PMC11066316 DOI: 10.3389/fneph.2024.1378250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/25/2024] [Indexed: 05/07/2024]
Abstract
Cell therapy, specifically the revolutionary chimeric antigen receptor (CAR) T-cell therapy, has transformed the landscape of oncology, making substantial strides in practical treatment approaches. Today, established guidelines for diseases such as lymphomas, myelomas, and leukemias actively advocate the utilization of these once-unconventional therapies. The practical impact of these therapies is underscored by their unparalleled efficacy, reshaping the way we approach and implement treatments in the realm of oncology. However, CAR T-cell therapy, with its performance in anti-tumor aggression through cellular action and inflammatory response, also comes with various adverse events, one of which is kidney injury. Therefore, the management of these side effects is extremely important. The integration of knowledge between oncologists and specialized nephrologists has led to the emergence of a new sub-area of expertise for onco-nephrologists specializing in managing kidney complications from immune effector therapies.
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Affiliation(s)
- Marco Aurelio Salvino
- Programa Pos Graduacao Medicina Saude (PPGMS), Universidade Federal da Bahia, Salvador, Brazil
- L’Hospitalet, Institut Català de Oncologia, Barcelona, Spain
- Hematology Department, Instituto D´or de Pesquisa e Ensino-Bahia (IDOR Ba), Salvador, Brazil
| | | | - Marta Peña
- L’Hospitalet, Institut Català de Oncologia, Barcelona, Spain
| | | | | | - Daniel Rizky
- L’Hospitalet, Institut Català de Oncologia, Barcelona, Spain
- Hematology Medical Oncology, Dr. Kariadi General Hospital, Semarang, Indonesia
| | - Anna Sureda
- L’Hospitalet, Institut Català de Oncologia, Barcelona, Spain
- Institut d’Investigació Biomédica de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain
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Xiang M, Li H, Zhan Y, Ma D, Gao Q, Fang Y. Functional CRISPR screens in T cells reveal new opportunities for cancer immunotherapies. Mol Cancer 2024; 23:73. [PMID: 38581063 PMCID: PMC10996278 DOI: 10.1186/s12943-024-01987-z] [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: 12/19/2023] [Accepted: 03/25/2024] [Indexed: 04/07/2024] Open
Abstract
T cells are fundamental components in tumour immunity and cancer immunotherapies, which have made immense strides and revolutionized cancer treatment paradigm. However, recent studies delineate the predicament of T cell dysregulation in tumour microenvironment and the compromised efficacy of cancer immunotherapies. CRISPR screens enable unbiased interrogation of gene function in T cells and have revealed functional determinators, genetic regulatory networks, and intercellular interactions in T cell life cycle, thereby providing opportunities to revamp cancer immunotherapies. In this review, we briefly described the central roles of T cells in successful cancer immunotherapies, comprehensively summarised the studies of CRISPR screens in T cells, elaborated resultant master genes that control T cell activation, proliferation, fate determination, effector function, and exhaustion, and highlighted genes (BATF, PRDM1, and TOX) and signalling cascades (JAK-STAT and NF-κB pathways) that extensively engage in multiple branches of T cell responses. In conclusion, this review bridged the gap between discovering element genes to a specific process of T cell activities and apprehending these genes in the global T cell life cycle, deepened the understanding of T cell biology in tumour immunity, and outlined CRISPR screens resources that might facilitate the development and implementation of cancer immunotherapies in the clinic.
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Affiliation(s)
- Minghua Xiang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Cancer Invasion and Metastasis (Ministry of Education), Hubei Key Laboratory of Tumor Invasion and Metastasis, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huayi Li
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Cancer Invasion and Metastasis (Ministry of Education), Hubei Key Laboratory of Tumor Invasion and Metastasis, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanyuan Zhan
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ding Ma
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Cancer Invasion and Metastasis (Ministry of Education), Hubei Key Laboratory of Tumor Invasion and Metastasis, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qinglei Gao
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Key Laboratory of Cancer Invasion and Metastasis (Ministry of Education), Hubei Key Laboratory of Tumor Invasion and Metastasis, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Yong Fang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Key Laboratory of Cancer Invasion and Metastasis (Ministry of Education), Hubei Key Laboratory of Tumor Invasion and Metastasis, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Neuendorff NR, Khan A, Ullrich F, Yates S, Devarakonda S, Lin RJ, von Tresckow B, Cordoba R, Artz A, Rosko AE. Cellular therapies in older adults with hematological malignancies: A case-based, state-of-the-art review. J Geriatr Oncol 2024; 15:101734. [PMID: 38430810 DOI: 10.1016/j.jgo.2024.101734] [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: 05/19/2023] [Revised: 11/05/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
Cellular therapies, including autologous stem cell transplant (ASCT), allogeneic hematopoietic cell transplantation (alloHCT), and chimeric antigen receptor- (CAR-) T cell therapies are essential treatment modalities for many hematological malignancies. Although their use in older adults has substantially increased within the past decades, cellular therapies represent intensive treatment approaches that exclude a large percentage of older adults due to comorbidities and frailty. Under- and overtreatment in older adults with hematologic malignancy is a challenge and many treatment decisions are influenced by chronologic age. The advent of efficient and well-tolerated newer treatment approaches for multiple myeloma has challenged the role of ASCT. In the modern era, there are no randomized clinical trials of transplant versus non-transplant strategies for patients ≥65 years. Nonetheless, ASCT is feasible for selected older patients and does not result in long-term compromise in quality of life. AlloHCT is the only curative approach for acute myeloid leukemia of intermediate and unfavourable risk but carries a significant risk for non-relapse mortality depending on comorbidities, general fitness, and transplant-specific characteristics, such as intensity of conditioning and donor choice. However, alloHCT is feasible in appropriately-selected older adults. Early referral for evaluation is strongly encouraged as this is the most obvious barrier. CAR-T cell therapies have shown unprecedented clinical efficacy and durability in relapsed and refractory diffuse large B cell lymphoma. Its use is well tolerated in older adults, although evidence comes from limited case numbers. Whether patients who are deemed unfit for ASCT qualify for CAR-T cell therapy remains elusive, but the tolerability and efficacy of CAR-T cell therapy appears promising, especially for older patients. The evidence from randomized trials is strong in favor of using a comprehensive geriatric assessment (CGA) to reduce treatment-related toxicities and guide treatment intensity in the care for solid tumors; its use for evaluation of cellular therapies is less evidence-based. However, CGA can provide useful information on patients' fitness, resilient mechanisms, and reveal potential optimization strategies for compensating for vulnerabilities. In this narrative review, we will discuss key questions on cellular therapies in older adults based on illustrative patient cases.
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Affiliation(s)
- Nina Rosa Neuendorff
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, D-45147 Essen, Germany.
| | - Abdullah Khan
- Department of Hematology, The Ohio State University, James Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Fabian Ullrich
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, D-45147 Essen, Germany
| | - Samuel Yates
- Department of Internal Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, United States of America
| | - Srinivas Devarakonda
- Department of Hematology, The Ohio State University, James Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Richard J Lin
- Adult Bone Marrow Transplantation (BMT) Service, Cellular Therapy Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Bastian von Tresckow
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, D-45147 Essen, Germany
| | - Raul Cordoba
- Lymphoma Unit, Department of Hematology, Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - Andrew Artz
- Division of Leukemia, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Ashley E Rosko
- Department of Hematology, The Ohio State University, James Comprehensive Cancer Center, Columbus, OH, United States of America
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Voltin CA, Paccagnella A, Winkelmann M, Heger JM, Casadei B, Beckmann L, Herrmann K, Dekorsy FJ, Kutsch N, Borchmann P, Fanti S, Kunz WG, Subklewe M, Kobe C, Zinzani PL, Stelljes M, Roth KS, Drzezga A, Noppeney R, Rahbar K, Reinhardt HC, von Tresckow B, Seifert R, Albring JC, Blumenberg V, Farolfi A, Flossdorf S, Gödel P, Hanoun C. Multicenter development of a PET-based risk assessment tool for product-specific outcome prediction in large B-cell lymphoma patients undergoing CAR T-cell therapy. Eur J Nucl Med Mol Imaging 2024; 51:1361-1370. [PMID: 38114616 PMCID: PMC10957657 DOI: 10.1007/s00259-023-06554-0] [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: 07/15/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE The emergence of chimeric antigen receptor (CAR) T-cell therapy fundamentally changed the management of individuals with relapsed and refractory large B-cell lymphoma (LBCL). However, real-world data have shown divergent outcomes for the approved products. The present study therefore set out to evaluate potential risk factors in a larger cohort. METHODS Our analysis set included 88 patients, treated in four German university hospitals and one Italian center, who had undergone 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (PET) before CAR T-cell therapy with tisagenlecleucel or axicabtagene ciloleucel. We first determined the predictive value of conventional risk factors, treatment lines, and response to bridging therapy for progression-free survival (PFS) through forward selection based on Cox regression. In a second step, the additive potential of two common PET parameters was assessed. Their optimal dichotomizing thresholds were calculated individually for each CAR T-cell product. RESULTS Extra-nodal involvement emerged as the most relevant of the conventional tumor and patient characteristics. Moreover, we found that inclusion of metabolic tumor volume (MTV) further improves outcome prediction. The hazard ratio for a PFS event was 1.68 per unit increase of our proposed risk score (95% confidence interval [1.20, 2.35], P = 0.003), which comprised both extra-nodal disease and lymphoma burden. While the most suitable MTV cut-off among patients receiving tisagenlecleucel was 11 mL, a markedly higher threshold of 259 mL showed optimal predictive performance in those undergoing axicabtagene ciloleucel treatment. CONCLUSION Our analysis demonstrates that the presence of more than one extra-nodal lesion and higher MTV in LBCL are associated with inferior outcome after CAR T-cell treatment. Based on an assessment tool including these two factors, patients can be assigned to one of three risk groups. Importantly, as shown by our study, metabolic tumor burden might facilitate CAR T-cell product selection and reflect the individual need for bridging therapy.
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Affiliation(s)
- Conrad-Amadeus Voltin
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Andrea Paccagnella
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Michael Winkelmann
- Department of Radiology, University Hospital Munich, Ludwig Maximilian University Munich, Munich, Germany
| | - Jan-Michel Heger
- Department of Internal Medicine I, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cologne Lymphoma Working Group (CLWG), Cologne, Germany
| | - Beatrice Casadei
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
- 'L. e A. Seràgnoli' Institute of Hematology, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS) 'Azienda Ospedaliero-Universitaria Di Bologna', University of Bologna, Bologna, Italy
| | - Laura Beckmann
- Department of Internal Medicine I, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Essen, Germany
| | - Franziska J Dekorsy
- Department of Nuclear Medicine, University Hospital Munich, Ludwig Maximilian University Munich, Munich, Germany
| | - Nadine Kutsch
- Department of Internal Medicine I, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cologne Lymphoma Working Group (CLWG), Cologne, Germany
| | - Peter Borchmann
- Department of Internal Medicine I, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cologne Lymphoma Working Group (CLWG), Cologne, Germany
| | - Stefano Fanti
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
- Division of Nuclear Medicine, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS) 'Azienda Ospedaliero-Universitaria Di Bologna', University of Bologna, Bologna, Italy
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital Munich, Ludwig Maximilian University Munich, Munich, Germany
| | - Marion Subklewe
- Department of Medicine III, Comprehensive Cancer Center Munich (CCCM), University Hospital Munich, Ludwig Maximilian University Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center Munich, Ludwig Maximilian University Munich, Munich, Germany
- German Cancer Consortium (DKTK) and Bavarian Center for Cancer Research (BZKF) Partner Site Munich, Munich, Germany
| | - Carsten Kobe
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Pier Luigi Zinzani
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
- 'L. e A. Seràgnoli' Institute of Hematology, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS) 'Azienda Ospedaliero-Universitaria Di Bologna', University of Bologna, Bologna, Italy
| | - Matthias Stelljes
- Department of Medicine A-Hematology, Oncology, and Pneumology, West German Cancer Center (WTZ) Network Partner Site, University Hospital Münster, University of Münster, Münster, Germany
| | - Katrin S Roth
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alexander Drzezga
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Richard Noppeney
- German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Essen, Germany
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, University of Münster, Münster, Germany
| | - H Christian Reinhardt
- German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Essen, Germany
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bastian von Tresckow
- German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Essen, Germany
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Essen, Germany
- Department of Nuclear Medicine, University Hospital Münster, University of Münster, Münster, Germany
| | - Jörn C Albring
- Department of Medicine A-Hematology, Oncology, and Pneumology, West German Cancer Center (WTZ) Network Partner Site, University Hospital Münster, University of Münster, Münster, Germany
| | - Viktoria Blumenberg
- Department of Medicine III, Comprehensive Cancer Center Munich (CCCM), University Hospital Munich, Ludwig Maximilian University Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center Munich, Ludwig Maximilian University Munich, Munich, Germany
- German Cancer Consortium (DKTK) and Bavarian Center for Cancer Research (BZKF) Partner Site Munich, Munich, Germany
| | - Andrea Farolfi
- Division of Nuclear Medicine, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS) 'Azienda Ospedaliero-Universitaria Di Bologna', University of Bologna, Bologna, Italy
| | - Sarah Flossdorf
- Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Philipp Gödel
- Department of Internal Medicine I, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cologne Lymphoma Working Group (CLWG), Cologne, Germany
| | - Christine Hanoun
- German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Essen, Germany
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Harrysson S, Eloranta S, Ekberg S, Enblad G, Andersson PO, Sonnevi K, Ljungqvist M, Sander B, Jerkeman M, Smedby KE. Outcomes for patients with secondary CNS involvement in relapsed/refractory diffuse large B-cell lymphoma and estimation of eligibility for CAR T-cell therapy. Leuk Lymphoma 2024; 65:534-537. [PMID: 38134325 DOI: 10.1080/10428194.2023.2296361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Sara Harrysson
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Solna, Sweden
| | - Sandra Eloranta
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sara Ekberg
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Per-Ola Andersson
- Department of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, and Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Kristina Sonnevi
- Department of Hematology, Karolinska University Hospital, Solna, Sweden
| | - Maria Ljungqvist
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Solna, Sweden
| | - Birgitta Sander
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Jerkeman
- Department of Oncology, Lund University, Lund, Sweden
| | - Karin E Smedby
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Solna, Sweden
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Giraudo MF, Jackson Z, Das I, Abiona OM, Wald DN. Chimeric Antigen Receptor (CAR)-T Cell Therapy for Non-Hodgkin's Lymphoma. Pathog Immun 2024; 9:1-17. [PMID: 38550613 PMCID: PMC10972674 DOI: 10.20411/pai.v9i1.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/28/2024] [Indexed: 04/15/2024] Open
Abstract
This review focuses on the use of chimeric antigen receptor (CAR)-T cell therapy to treat non-Hodgkin's lymphoma (NHL), a classification of heterogeneous malignant neoplasms of the lymphoid tissue. Despite various conventional and multidrug chemotherapies, the poor prognosis for NHL patients remains and has prompted the utilization of groundbreaking personalized therapies such as CAR-T cells. CAR-T cells are T cells engineered to express a CAR that enables T cells to specifically lyse tumor cells with extracellular expression of a tumor antigen of choice. A CAR is composed of an extracellular antibody fragment or target protein binding domain that is conjugated to activating intracellular signaling motifs common to T cells. In general, CAR-T cell therapies for NHL are designed to recognize cellular markers ubiquitously expressed on B cells such as CD19+, CD20+, and CD22+. Clinical trials using CAR-T cells such as ZUMA-7 and TRANSFORM demonstrated promising results compared to standard of care and ultimately led to FDA approval for the treatment of relapsed/refractory NHL. Despite the success of CAR-T therapy for NHL, challenges include adverse side effects as well as extrinsic and intrinsic mechanisms of tumor resistance that lead to suboptimal outcomes. Overall, CAR-T cell therapies have improved clinical outcomes in NHL patients and generated optimism around their future applications.
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Affiliation(s)
| | - Zachary Jackson
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio
| | - Indrani Das
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio
| | | | - David N. Wald
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio
- Department of Pathology, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
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43
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Bellal M, Malherbe J, Damaj G, Du Cheyron D. Toxicities, intensive care management, and outcome of chimeric antigen receptor T cells in adults: an update. Crit Care 2024; 28:69. [PMID: 38444031 PMCID: PMC10916319 DOI: 10.1186/s13054-024-04851-0] [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: 12/10/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Chimeric antigen receptor T cells are a promising new immunotherapy for haematological malignancies. Six CAR-T cells products are currently available for adult patients with refractory or relapsed high-grade B cell malignancies, but they are associated with severe life-threatening toxicities and side effects that may require admission to ICU. OBJECTIVE The aim of this short pragmatic review is to synthesize for intensivists the knowledge on CAR-T cell therapy with emphasis on CAR-T cell-induced toxicities and ICU management of complications according to international recommendations, outcomes and future issues.
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Affiliation(s)
- Mathieu Bellal
- Department of Medical Intensive Care, Caen University Hospital, Avenue de la côte de nacre, 14000, Caen, France.
- UNICAEN, INSERM UMRS U1237 PhIND, Normandie Univ, 14000, Caen, France.
| | - Jolan Malherbe
- Department of Medical Intensive Care, Caen University Hospital, Avenue de la côte de nacre, 14000, Caen, France
| | - Gandhi Damaj
- Hematology Institute, Caen University Hospital, 14000, Caen, France
| | - Damien Du Cheyron
- Department of Medical Intensive Care, Caen University Hospital, Avenue de la côte de nacre, 14000, Caen, France
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Gordon LI, Liu FF, Braverman J, Hoda D, Ghosh N, Hamadani M, Hildebrandt GC, Peng L, Guo S, Shi L, Sehgal A. Lisocabtagene maraleucel for second-line relapsed or refractory large B-cell lymphoma: patient-reported outcomes from the PILOT study. Haematologica 2024; 109:857-866. [PMID: 37646670 PMCID: PMC10905070 DOI: 10.3324/haematol.2023.283162] [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: 03/23/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023] Open
Abstract
In the single-arm, open-label, multicenter, phase II PILOT study, second-line treatment with the chimeric antigen receptor (CAR) T-cell therapy lisocabtagene maraleucel (liso-cel) in patients with relapsed or refractory (R/R) large B-cell lymphoma (LBCL) for whom hematopoietic stem cell transplantation (HSCT) was not intended resulted in high response rates, durable responses, and a safety profile consistent with previous reports. Here, we analyzed changes in health-related quality of life (HRQOL) in patients who received liso-cel in PILOT. Patients received liso-cel, an autologous, CD19-directed, 4-1BB CAR T-cell product administered at equal target doses of CD8+ and CD4+ CAR+ T cells, for a total target dose of 100×10⁶ CAR+ T cells. HRQOL, a secondary endpoint of PILOT, was assessed as prespecified using three patient-reported outcome instruments (EORTC QLQ-C30; FACT-LymS; EQ-5D-5L). Evaluable datasets for the EORTC QLQ-C30, FACT-LymS, and EQ-5D-5L health utility index, and visual analog scale (EQ-VAS) included 56 (92%), 49 (80%), 55 (90%), and 54 (89%) patients, respectively. Clinically meaningful improvement was achieved across most post-treatment visits for EORTC QLQ-C30 fatigue and FACT-LymS. Overall mean changes from baseline through day 545 showed significant improvements in EORTC QLQ-C30 fatigue, pain, and appetite loss, FACT-LymS, and EQ VAS. In within-patient analyses, clinically meaningful improvements or maintenance in scores were observed in most patients at days 90, 180, 270, and 365. HRQOL was maintained or improved in patients who received liso-cel as second-line therapy in PILOT. These findings support liso-cel as a preferred second-line treatment in patients with R/R LBCL not intended for HSCT (clinicaltrials gov. Identifier: NCT03483103).
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Affiliation(s)
- Leo I Gordon
- Northwestern University, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL.
| | | | | | - Daanish Hoda
- Intermountain Healthcare, Loveland Clinic for Blood Cancer Therapy, Salt Lake City, UT
| | | | - Mehdi Hamadani
- BMT and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI
| | | | | | | | | | - Alison Sehgal
- University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA
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45
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Al-Mashhadi AL, Jakobsen LH, Brown P, Gang AO, Thorsteinsson AL, Rasoul K, Haissman JM, Tøstesen MB, Christoffersen MN, Jelicic J, Jørgensen JB, Thomsen T, Dessau-Arp A, Andersen APH, Frederiksen M, Pedersen PT, Clausen MR, Jørgensen JM, Poulsen CB, El-Galaly TC, Larsen TS. Real-world outcomes following third or subsequent lines of therapy: A Danish population-based study on 189 patients with relapsed/refractory large B-cell lymphomas. Br J Haematol 2024; 204:839-848. [PMID: 38009548 DOI: 10.1111/bjh.19201] [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: 06/24/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
Outcome data of patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) beyond the second line are scarce outside of clinical trials. Novel therapies in the R/R setting have been approved based on single-arm trials, but results need to be contextualized by real-world outcomes. Medical records from 3753 Danish adults diagnosed with DLBCL were reviewed. Patients previously treated with rituximab and anthracycline-based chemotherapy who received the third or later line (3 L+) of treatment after 1 January 2015, were included. Only 189 patients with a median age of 71 years were eligible. The median time since the last line of therapy was 6 months. Patients were treated with either best supportive care (22%), platinum-based salvage therapy (13%), low-intensity chemotherapy (22%), in clinical trial (14%) or various combination treatments (32%). The 2-year OS-/PFS estimates were 25% and 12% for all patients and 49% and 17% for those treated with platinum-based salvage therapy. Age ≥70, CNS involvement, elevated LDH and ECOG ≥2 predicted poor outcomes, and patients with 0-1 of these risk factors had a 2-year OS estimate of 65%. Only a very small fraction of DLBCL patients received third-line treatment and were eligible for inclusion. Outcomes were generally poor, but better in intensively treated, fit young patients with limited disease.
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Affiliation(s)
- Ahmed Ludvigsen Al-Mashhadi
- Department of Haematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
| | - Lasse Hjort Jakobsen
- Department of Haematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Mathematical Sciences, Aalborg University, Aalborg, Denmark
| | - Peter Brown
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Ortved Gang
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Luise Thorsteinsson
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kaziwa Rasoul
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Judith Melchior Haissman
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Haematology, Zealand University Hospital, Roskilde, Denmark
| | | | - Mette Niemann Christoffersen
- Department of Haematology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jelena Jelicic
- Department of Haematology, Vejle Hospital, Vejle, Denmark
| | | | - Troels Thomsen
- Department of Internal Medicine, Haematology Section, Goedstrup Hospital, Herning, Denmark
| | | | | | - Mikael Frederiksen
- Department of Hematology, Hospital of Southern Jutland, Sønderborg, Denmark
| | | | | | | | - Christian Bjørn Poulsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Haematology, Zealand University Hospital, Roskilde, Denmark
| | - Tarec Christoffer El-Galaly
- Department of Haematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thomas Stauffer Larsen
- Department of Haematology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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46
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Kato K, Sugio T, Ikeda T, Yoshitsugu K, Miyazaki K, Suzumiya J, Yamamoto G, Kim SW, Ikegame K, Uehara Y, Mori Y, Ishikawa J, Hiramoto N, Eto T, Nakazawa H, Kobayashi H, Serizawa K, Onizuka M, Fukuda T, Atsuta Y, Suzuki R. Outcomes of allogeneic hematopoietic stem cell transplantation for relapsed or refractory diffuse large B-cell lymphoma. Bone Marrow Transplant 2024; 59:306-314. [PMID: 38102209 DOI: 10.1038/s41409-023-02156-4] [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: 06/30/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a currative treatment modality for diffuse large B-cell lymphoma (DLBCL) because of the intrinsic graft-versus-lymphoma effect. However, limited information is available regarding which patients with relapsed or refractory DLBCL are likely to benefit from allo-HSCT. We retrospectively analyzed data from 1268 DLBCL patients who received allo-HSCT. The overall survival and progression-free survival (PFS) rates were 30.3% and 21.6% at 3 years, respectively. Multivariate analysis revealed that stable or progressive disease at transplantation, male patient, poorer performance status at transplantation, and shorter intervals from previous transplantation were associated independently with a lower PFS. Four prognostic factors were used to construct a prognostic index for PFS, predicting 3-year PFS of 55.4%, 43.7%, 20.4% and 6.6%, respectively. The prognostic model predicted relapse rates following allo-HSCT accordingly (P < 0.0001), whereas did not predict transplantation-related mortality (P = 0.249). The prognostic index can identify a subgroup of DLBCL patients who benefit from allo-HSCT and it is worthwhile to evaluate whether this model is also applicable to patients undergoing allo-HSCT in cases of relapse after chimeric antigen receptor engineered T-cell therapy, although the application of allo-HSCT has been declining with the increase of novel immunotherapies.
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Affiliation(s)
- Koji Kato
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
| | - Takeshi Sugio
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takashi Ikeda
- Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kanako Yoshitsugu
- Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kana Miyazaki
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Junji Suzumiya
- Department of Hematology, Koga Community Hospital, Yaizu, Japan
| | - Go Yamamoto
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
| | - Sung-Won Kim
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuhiro Ikegame
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Japan
| | - Yasufumi Uehara
- Department of Hematology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Yasuo Mori
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Jun Ishikawa
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Hideyuki Nakazawa
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hikaru Kobayashi
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Kentaro Serizawa
- Division of Hematology and Rheumatology, Department of Internal Medicine, Kindai University Hospital, Osaka, Japan
| | - Makoto Onizuka
- Department of Hematology/Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan
- Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Ritsuro Suzuki
- Department of Hematology and Oncology, Shimane University School of Medicine, Izumo, Japan
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47
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Daddacha W, Monroe D, Schlafstein A, Withers A, Thompson E, Danelia D, Luong N, Sesay F, Rath S, Usoro E, Essien M, Jung A, Jiang J, Hu J, Mahboubi B, Williams A, Steinbeck J, Yang X, Buchwald Z, Dynan W, Switchenko J, Kim B, Khan M, Jaye D, Yu D. SAMHD1 expression contributes to doxorubicin resistance and predicts survival outcomes in diffuse large B-cell lymphoma patients. NAR Cancer 2024; 6:zcae007. [PMID: 38406263 PMCID: PMC10894040 DOI: 10.1093/narcan/zcae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 01/31/2024] [Accepted: 02/22/2024] [Indexed: 02/27/2024] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a commonly diagnosed, aggressive non-Hodgkin's lymphoma. While R-CHOP chemoimmunotherapy is potentially curative, about 40% of DLBCL patients will fail, highlighting the need to identify biomarkers to optimize management. SAMHD1 has a dNTPase-independent role in promoting resection to facilitate DNA double-strand break (DSB) repair by homologous recombination. We evaluated the relationship of SAMHD1 levels with sensitivity to DSB-sensitizing agents in DLBCL cells and the association of SAMHD1 expression with clinical outcomes in 79 DLBCL patients treated with definitive therapy and an independent cohort dataset of 234 DLBCL patients. Low SAMHD1 expression, Vpx-mediated, or siRNA-mediated degradation/depletion in DLBCL cells was associated with greater sensitivity to doxorubicin and PARP inhibitors. On Kaplan-Meier log-rank survival analysis, low SAMHD1 expression was associated with improved overall survival (OS), which on subset analysis remained significant only in patients with advanced stage (III-IV) and moderate to high risk (2-5 International Prognostic Index (IPI)). The association of low SAMHD1 expression with improved OS remained significant on multivariate analysis independent of other adverse factors, including IPI, and was validated in an independent cohort. Our findings suggest that SAMHD1 expression mediates doxorubicin resistance and may be an important prognostic biomarker in advanced, higher-risk DLBCL patients.
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Affiliation(s)
- Waaqo Daddacha
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Dominique Monroe
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Ashley J Schlafstein
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Allison E Withers
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Elizabeth B Thompson
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Diana Danelia
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Nho C Luong
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Fatmata Sesay
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Sandip K Rath
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Edidiong R Usoro
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Mark E Essien
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Andrew T Jung
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jinmeng G Jiang
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jiaxuan Hu
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Bijan Mahboubi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Arilyn Williams
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Julia E Steinbeck
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Zachary S Buchwald
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - William S Dynan
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health and Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Baek Kim
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Mohammad K Khan
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - David L Jaye
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - David S Yu
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
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48
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Bibas M. Plasmablastic Lymphoma. A State-of-the-Art Review: Part 2-Focus on Therapy. Mediterr J Hematol Infect Dis 2024; 16:e2024015. [PMID: 38468838 PMCID: PMC10927196 DOI: 10.4084/mjhid.2024.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
The objective of this two-part review is to present a current and comprehensive understanding of the diagnosis and management of plasmablastic lymphoma. The first part, which was published previously, focused on the study of epidemiology, etiology, clinicopathological characteristics, differential diagnosis, prognostic variables, and the impact of plasmablastic lymphoma on specific populations. This second part addresses the difficult topic of the treatment of plasmablastic lymphoma, specifically examining both the conventional, consolidated approach and the novel therapeutic strategy.
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Affiliation(s)
- Michele Bibas
- Department of Clinical Research, Hematology. National Institute for Infectious Diseases "Lazzaro Spallanzani" I.R.C.S.S. Via Portuense 292 00148 Rome Italy
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49
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Haslam A, Hoeg TB, Prasad V. Estimation of eligibility for and response to CAR-T therapy in the United States. Blood Adv 2024; 8:1032-1036. [PMID: 38039516 PMCID: PMC10920105 DOI: 10.1182/bloodadvances.2023011184] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023] Open
Affiliation(s)
- Alyson Haslam
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Tracy Beth Hoeg
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
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50
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Trabolsi A, Arumov A, Schatz JH. Bispecific antibodies and CAR-T cells: dueling immunotherapies for large B-cell lymphomas. Blood Cancer J 2024; 14:27. [PMID: 38331870 PMCID: PMC10853226 DOI: 10.1038/s41408-024-00997-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024] Open
Abstract
Despite recent advances in frontline therapy for diffuse large B-cell lymphoma (DLBCL), at least a third of those diagnosed still will require second or further lines for relapsed or refractory (rel/ref) disease. A small minority of these can be cured with standard chemoimmunotherapy/stem-cell transplant salvage approaches. CD19-directed chimeric antigen receptor T-cell (CAR-19) therapies are increasingly altering the prognostic landscape for rel/ref patients with DLBCL and related aggressive B-cell non-Hodgkin lymphomas. Long-term follow up data show ongoing disease-free outcomes consistent with cure in 30-40% after CAR-19, including high-risk patients primary refractory to or relapsing within 1 year of frontline treatment. This has made CAR-19 a preferred option for these difficult-to-treat populations. Widespread adoption, however, remains challenged by logistical and patient-related hurdles, including a requirement for certified tertiary care centers concentrated in urban centers, production times of at least 3-4 weeks, and high per-patients costs similar to allogeneic bone-marrow transplantation. Bispecific antibodies (BsAbs) are molecular biotherapies designed to bind and activate effector T-cells and drive them to B-cell antigens, leading to a similar cellular-dependent cytotoxicity as CAR-19. May and June of 2023 saw initial approvals of next-generation BsAbs glofitamab and epcoritamab in DLBCL as third or higher-line therapy, or for patients ineligible for CAR-19. BsAbs have similar spectrum but generally reduced severity of immune related side effects as CAR-19 and can be administered in community settings without need to manufacture patient-specific cellular products. To date and in contrast to CAR-19, however, there is no convincing evidence of cure after BsAbs monotherapy, though follow up is limited. The role of BsAbs in DLBCL treatment is rapidly evolving with trials investigating use in both relapsed and frontline curative-intent combinations. The future of DLBCL treatment is bound increasingly to include effector cell mediated immunotherapies, but further optimization of both cellular and BsAb approaches is needed.
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Affiliation(s)
- Asaad Trabolsi
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Fl, USA
- Hematology-Oncology Fellowship Program, Jackson Memorial Health System/ University of Miami, Miami, Fl, USA
| | - Artavazd Arumov
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Fl, USA
- Division of Hematology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Fl, USA
| | - Jonathan H Schatz
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Fl, USA.
- Division of Hematology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Fl, USA.
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