1
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Chen H, Ma R, Zhang Q, Lu F, Ma Y, Zhou J, Cao J, Qi K, Yan Z, Sang W, Zhu F, Sun H, Li D, Li Z, Cheng H, Xu K, Chen W. The prognostic significance of POD24 in peripheral T-cell lymphoma. Hematology 2024; 29:2304483. [PMID: 38251872 DOI: 10.1080/16078454.2024.2304483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Peripheral T-cell lymphomas (PTCL) are an aggressive group of mature T-cell neoplasms, often associated with poor outcomes, in part, due to frequent relapsed/refractory disease. The objective of this study was to assess the prognostic impact of disease progression within 24 months (POD24) on overall survival (OS) for patients diagnosed with PTCL. METHODS A retrospective analysis was conducted on a cohort of patients with newly diagnosed PTCL who underwent chemotherapy at the Affiliated Hospital of Xuzhou Medical University between January 2010 and September 2021. Prognostic assessment was limited to patients who were evaluable for POD24. RESULTS Records were reviewed for 106 patients with PTCL, of whom 66 patients experienced POD24 (referred to as the POD24 group) and 40 patients did not experience POD24 (referred to as the no POD24 group). Significant differences were observed between the POD24 group and the no POD24 group in regard to clinical stage, Eastern Cooperative Oncology Group (ECOG) performance status (PS), International Prognostic Index (IPI) score, lactate dehydrogenase (LDH) levels, β2-microglobulin (β2-MG) levels, prealbumin and albumin levels. Patients in the POD24 group had a significant shorter median OS compared to the no POD24 group (11.9 months vs not reached, respectively; P < 0.001). Non response (NR) to treatment and POD24 were identified as independent negative prognostic factors for survival in patients with PTCL. CONCLUSION POD24 is a prognostic factor associated with unfavorable outcomes in patients with PTCL and can be used to identify high-risk patients and guide treatment decisions.
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Affiliation(s)
- Huimin Chen
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Ruixue Ma
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Qianqian Zhang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Fengyi Lu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Yuhan Ma
- Department of Hematology, The First People's Hospital of Suqian, Suqian, People's Republic of China
| | - Jingxin Zhou
- Department of Hematology, The First People's Hospital of Suqian, Suqian, People's Republic of China
| | - Jiang Cao
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Kunming Qi
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Zhiling Yan
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Wei Sang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Feng Zhu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Haiying Sun
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Depeng Li
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Zhenyu Li
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Hai Cheng
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Kailin Xu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Wei Chen
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
- Department of Hematology, The First People's Hospital of Suqian, Suqian, People's Republic of China
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, People's Republic of China
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2
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Sarkozy C, Thieblemont C, Oberic L, Moreau A, Bouabdallah K, Damaj G, Gastinne T, Tessoulin B, Ribrag V, Casasnovas O, Haioun C, Houot R, Jardin F, Van Den Neste E, Cheminant M, Morschhauser F, Callanan M, Safar V, Gressin R, Hermine O, Le Gouill S. Long-Term Follow-Up of Rituximab Maintenance in Young Patients With Mantle-Cell Lymphoma Included in the LYMA Trial: A LYSA Study. J Clin Oncol 2024; 42:769-773. [PMID: 38109684 DOI: 10.1200/jco.23.01586] [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: 07/26/2023] [Revised: 09/12/2023] [Accepted: 10/03/2023] [Indexed: 12/20/2023] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned coprimary or secondary analyses are not yet available. Clinical trial updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The LYMA trial demonstrated the benefit of rituximab maintenance (RM) in first-line young patients with mantle-cell lymphoma. In this prolonged follow-up of 7.5 years (95% CI, 7.4 to 7.7) from inclusion, the median progression-free survival (PFS) and overall survival (OS) for the full population were not reached (NR) with a 7-year PFS of 55.5% (95% CI, 49.5 to 61) and OS of 69.5% (95% CI, 63.8 to 74.5). The EFS remained statistically superior in favor of RM (median NR v 5.8 years, P < .0001; HR, 0.39 [95% CI, 0.52 to 0.6] and 7-year estimate, 76.2% versus 46% for RM and observation, respectively). Similarly, RM prolonged PFS (estimated PFS at 7 years, 78.5% v 47.4% and HR, 0.36 [95% CI, 0.23 to 0.56] for RM and observation, respectively, P < .0001). The 7-year OS estimate was 83.2% versus 72.2%, respectively (P = .088, HR, 0.63 [95% CI, 0.37 to 1.08]). Cause of death was not significantly distinct between the two groups, with lymphoma being the leading cause with a very low rate of infection-related death. Overall, the PFS benefit of RM after autologous stem cell transplantation remains after 7-year follow-up, and RM was not associated with an increase in infection-related mortality, making this strategy a safe standard of care with long-term follow-up.
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Affiliation(s)
- Clémentine Sarkozy
- Service d'hématologie, Institut Curie, Saint Cloud, France
- Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), U1288 Inserm/Institut Curie centre de recherche, Paris cedex, France
| | | | - Lucie Oberic
- Service d'hématologie, Institut Universitaire du Cancer Toulouse, Oncopole, Toulouse, France
| | - Anne Moreau
- Service d'anatomopathologie, CHU Nantes, Nantes, France
| | | | - Gandhi Damaj
- Service d'hématologie, CHU de Caen, Caen, France
| | | | | | - Vincent Ribrag
- département d'hématologie, Institut Gustave Roussy, Villejuif, France
| | | | - Corinne Haioun
- Service d'hématologie, Hôpital Henri Mondor, APHP, Créteil, France
| | - Roch Houot
- Service d'hématologie, CHU Rennes, Rennes, France
| | - Fabrice Jardin
- Service d'hématologie, Centre Henri Becquerel, Rouen, France
| | - Eric Van Den Neste
- Service d'hématologie, Clinique universitaire UCL Saint Luc, Bruxelles, Belgique
| | | | | | | | - Violaine Safar
- Service d'hématologie, Hôpital Lyon Sud, Pierre Bénite, France
| | - Remy Gressin
- Service d'hématologie, Hôpital Necker, Paris, France
| | | | - Steven Le Gouill
- Service d'hématologie, Institut Curie, Saint Cloud, France
- Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), U1288 Inserm/Institut Curie centre de recherche, Paris cedex, France
- université Versailles Saint-Quentin (UVSQ), France
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3
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Jerkeman M, Kolstad A, Hutchings M, Pasanen A, Meriranta L, Niemann CU, Kragh Jørgensen RR, El-Galaly TC, Riise J, Leppä S, Christensen JH, Sonnevi K, Pedersen LB, Wader KF, Glimelius I. MRD-driven treatment with venetoclax-R2 in mantle cell lymphoma: the Nordic Lymphoma Group MCL7 VALERIA trial. Blood Adv 2024; 8:407-415. [PMID: 38113470 PMCID: PMC10827399 DOI: 10.1182/bloodadvances.2023011920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023] Open
Abstract
ABSTRACT Despite improvements in treatment of mantle cell lymphoma (MCL), most patients eventually relapse. In this multicenter phase 1b/2 trial, we evaluated safety and efficacy of minimal residual disease (MRD)-driven venetoclax, lenalidomide, and rituximab (venetoclax-R2) in relapsed/refractory (R/R) MCL and explored the feasibility of stopping treatment in molecular remission. The primary end point was overall response rate (ORR) at 6 months. After dose escalation, the recommended phase 2 dose was lenalidomide 20 mg daily, days 1 to 21; venetoclax 600 mg daily after ramp-up; and rituximab 375 mg/m2 weekly for 4 weeks, then every 8 weeks. MRD monitoring by RQ-PCR was performed every 3 months. When MRD-negativity in the blood was reached, treatment was continued for another 3 months; if MRD-negativity was then confirmed, treatment was stopped. In total, 59 patients were enrolled, with a median age of 73 years. At 6 months, the ORR was 63% (29 complete remission [CR], 8 partial remission [PR]), and 40% (4 CR, 2 PR) for patients previously failing a Bruton tyrosine kinase (BTK) inhibitor. Median progression-free survival (PFS) was 21 months, with median overall survival of 31 months. TP53 mutation was associated with inferior PFS (P < .01). Overall, 28 patients (48%) discontinued treatment in molecular remission, and 25 remain MRD negative after a median of 17.4 months. Hematological toxicity was frequent, with 52 of 59 (88%) patients with G3-4 neutropenia and 21 of 59 (36%) patients with G3-4 thrombocytopenia. To conclude, MRD-driven venetoclax-R2 is feasible and tolerable and shows efficacy in R/R MCL, also after BTK inhibitor failure. This trial was registered at www.ClinicalTrials.gov as #NCT03505944.
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Affiliation(s)
- Mats Jerkeman
- Department of Oncology, Institute of Clinical Sciences, Lund University and Skane University Hospital SE22185, Lund, Sweden
| | - Arne Kolstad
- Department of Oncology, Innlandet Hospital, Brumunddal, Norway
| | | | - Annika Pasanen
- Department of Oncology, Helsinki University Hospital, Helsinki, Finland
| | - Leo Meriranta
- Department of Oncology, Helsinki University Hospital, Helsinki, Finland
| | | | - Rasmus Rask Kragh Jørgensen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Tarec Christoffer El-Galaly
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jon Riise
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Sirpa Leppä
- Department of Oncology, Helsinki University Hospital, Helsinki, Finland
| | | | - Kristina Sonnevi
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | | | - Karin Fahl Wader
- Department of Oncology, St Olav University Hospital, Trondheim, Norway
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Unit of Cancer Precision Medicine, Uppsala University, Uppsala, Sweden
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4
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Lu T, Zhang J, McCracken JM, Young KH. Recent advances in genomics and therapeutics in mantle cell lymphoma. Cancer Treat Rev 2024; 122:102651. [PMID: 37976759 DOI: 10.1016/j.ctrv.2023.102651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
Over the past decades, significant strides have been made in understanding the pathobiology, prognosis, and treatment options for mantle cell lymphoma (MCL). The heterogeneity observed in MCL's biology, genomics, and clinical manifestations, including indolent and aggressive forms, is intricately linked to factors such as the mutational status of the variable region of the immunoglobulin heavy chain gene, epigenetic profiling, and Sox11 expression. Several intriguing subtypes of MCL, such as Cyclin D1-negative MCL, in situ mantle cell neoplasm, CCND1/IGH FISH-negative MCL, and the impact of karyotypic complexity on prognosis, have been explored. Notably, recent immunochemotherapy regimens have yielded long-lasting remissions in select patients. The therapeutic landscape for MCL is continuously evolving, with a shift towards nonchemotherapeutic agents like ibrutinib, acalabrutinib, and venetoclax. The introduction of BTK inhibitors has brought about a transformative change in MCL treatment. Nevertheless, the challenge of resistance to BTK inhibitors persists, prompting ongoing efforts to discover strategies for overcoming this resistance. These strategies encompass non-covalent BTK inhibitors, immunomodulatory agents, BCL2 inhibitors, and CAR-T cell therapy, either as standalone treatments or in combination regimens. Furthermore, developing novel drugs holds promise for further improving the survival of patients with relapsed or refractory MCL. In this comprehensive review, we methodically encapsulate MCL's clinical and pathological attributes and the factors influencing prognosis. We also undertake an in-depth examination of stratified treatment alternatives. We investigate conceivable resistance mechanisms in MCL from a genetic standpoint and offer precise insights into various therapeutic approaches for relapsed or refractory MCL.
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Affiliation(s)
- Tingxun Lu
- Division of Hematopathology, Duke University Medical Center, Durham, NC 27710, USA; Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province 214122, China
| | - Jie Zhang
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province 214122, China
| | - Jenna M McCracken
- Division of Hematopathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Ken H Young
- Division of Hematopathology, Duke University Medical Center, Durham, NC 27710, USA; Duke Cancer Institute, Duke University, Durham, NC 27710, USA.
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5
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Harmanen M, Klaavuniemi T, Sorigue M, Khan M, Prusila R, Kari E, Alanne E, Rajamäki A, Sunela K, Jukkola A, Jantunen E, Sancho JM, Ketola S, Kuitunen H, Selander T, Rönkä A, Kuittinen O. Real-world Data: MCL2 Protocol Demonstrates Excellent Treatment Results Among Patients With Mantle Cell Lymphoma Not Fulfilling the Original Trial Inclusion Criteria. Hemasphere 2023; 7:e954. [PMID: 37693119 PMCID: PMC10489256 DOI: 10.1097/hs9.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 08/02/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Minna Harmanen
- Department of Oncology, Faculty of Health Medicine, Institute of Clinical Medicine, Kuopio University Hospital Cancer Center, Kuopio, Finland
| | - Tuula Klaavuniemi
- Department of Oncology, Mikkeli Central Hospital, Southern Savonia Municipality District, Mikkeli, Finland
| | - Marc Sorigue
- Department of Hematology, ICO-Badalona, Hospital Germans Trias i Pujol, IJC, LUMN, Badalona, Spain
| | - Madiha Khan
- Department of Oncology, Faculty of Health Medicine, Institute of Clinical Medicine, Kuopio University Hospital Cancer Center, Kuopio, Finland
| | - Roosa Prusila
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
- Cancer Center and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Esa Kari
- Department of Oncology, Tampere University Hospital, Tampere Cancer Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Erika Alanne
- Department of Oncology and Radiotherapy, Turku University Hospital, Western Finland, Cancer Center, Turku, Finland
| | - Aino Rajamäki
- Department of Oncology, Faculty of Health Medicine, Institute of Clinical Medicine, Kuopio University Hospital Cancer Center, Kuopio, Finland
- Department of Oncology, Tampere University Hospital, Tampere Cancer Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Oncology, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Kaisa Sunela
- Department of Oncology, Tampere University Hospital, Tampere Cancer Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Medicines Agency, Tampere, Finland
| | - Arja Jukkola
- Department of Oncology, Tampere University Hospital, Tampere Cancer Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Esa Jantunen
- Institute of Clinical Medicine, University of Eastern Finland and Department of Medicine, North Carelia Central Hospital, Joensuu, Finland
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-Badalona, Hospital Germans Trias i Pujol, IJC, LUMN, Badalona, Spain
| | - Sanna Ketola
- Department of Oncology, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Hanne Kuitunen
- Cancer Center and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Aino Rönkä
- Department of Oncology and Radiotherapy, Kuopio University Hospital, Kuopio, Finland
| | - Outi Kuittinen
- Department of Oncology, Faculty of Health Medicine, Institute of Clinical Medicine, Kuopio University Hospital Cancer Center, Kuopio, Finland
- Cancer Center and Medical Research Center, Oulu University Hospital, Oulu, Finland
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6
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Fischer L, Jiang L, Bittenbring JT, Huebel K, Schmidt C, Duell J, Metzner B, Krauter J, Glass B, Huettmann A, Schaefer-Eckart K, Silkenstedt E, Klapper W, Hiddemann W, Unterhalt M, Dreyling M, Hoster E. The addition of rituximab to chemotherapy improves overall survival in mantle cell lymphoma-a pooled trials analysis. Ann Hematol 2023; 102:2791-2801. [PMID: 37552322 PMCID: PMC10492741 DOI: 10.1007/s00277-023-05385-1] [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: 03/08/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
Mantle cell lymphoma (MCL) is a distinct subtype of B-cell lymphoma and commonly used induction immunochemotherapies include the anti-CD20 antibody rituximab. However, efficacy data for rituximab regarding overall survival (OS) in first line MCL therapy remain conflicting.We report long-term outcomes of a pooled trials analysis comparing Cyclophosphamide, Doxorubicine, Vincristine, Prednisone (CHOP) to R-CHOP in MCL to confirm efficacy on failure free survival (FFS) and OS in relevant subgroups. Untreated, adult MCL patients of two prospective trials assigned to CHOP or R-CHOP were included. Primary endpoints were FFS and OS, secondary endpoints included duration of response (DOR), secondary malignancies and OS after relapse. Between 1996 and 2003, 385 MCL patients were assigned to CHOP (201) or R-CHOP (184). After a median follow-up of 13.4 years, the addition of Rituximab significantly improved FFS (1.36 vs. 2.07 years, HR 0.62 (0.50-0.77)), OS (4.84 vs. 5.81 years, HR 0.78 (0.61-0.99)) and DOR (1.48 vs. 2.08 years, HR 0.67 (0.53-0.86)). Furthermore, Rituximab improved survival across different MCL risk groups. In a post-hoc analysis of OS after relapse comparing patients receiving chemotherapy with / without rituximab, rituximab maintained efficacy with a median OS of 3.10 vs. 2.11 years (HR 0.70, 0.54-0.91). The rate of secondary malignancies was 0.5 and 3.9% for hematological and 7 and 8% for non-hematological malignancies for CHOP and R-CHOP patients, respectively. We present mature results of a pooled MCL cohort, demonstrating prolonged FFS, OS and DOR for the combined immuno-chemotherapy, confirming the standard of care in first line treatment.
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Affiliation(s)
- Luca Fischer
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.
| | - Linmiao Jiang
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
| | | | | | - Christian Schmidt
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Johannes Duell
- Department of Internal Medicine II, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Bernd Metzner
- University Clinic for Oncology and Hematology, Klinikum Oldenburg, Oldenburg, Germany
| | - Juergen Krauter
- Department of Internal Medicine III, Braunschweig Municipal Hospital, Brunswick, Germany
| | - Bertram Glass
- Department of Hematology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Andreas Huettmann
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center Essen, University Hospital Essen (AöR), University of Duisburg-Essen, Essen, Germany
| | | | | | - Wolfram Klapper
- Department of Pathology, Hematopathology Section, University Hospital Schleswig-Holstein, Christian-Albrecht-University of Kiel, Kiel, Germany
| | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Michael Unterhalt
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Martin Dreyling
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Eva Hoster
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
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7
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Villa D, Jiang A, Visco C, Crosbie N, McCulloch R, Buege MJ, Kumar A, Bond DA, Paludo J, Maurer MJ, Thanarajasingam G, Lewis KL, Cheah CY, Baech J, El-Galaly TC, Kugathasan L, Scott DW, Gerrie AS, Lewis D. Time to progression of disease and outcomes with second-line BTK inhibitors in relapsed/refractory mantle cell lymphoma. Blood Adv 2023; 7:4576-4585. [PMID: 37307169 PMCID: PMC10425680 DOI: 10.1182/bloodadvances.2023009804] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023] Open
Abstract
Time to progression of disease (POD) after first-line (1L) therapy is prognostic in mantle cell lymphoma (MCL), although studies have included a broad range of 1L, second-line (2L), and subsequent lines of therapy. The purpose of this study was to evaluate the factors predicting outcomes in patients with relapsed/refractory (R/R) MCL exclusively initiating 2L Bruton's tyrosine kinase inhibitors (BTKis) after 1L rituximab-containing therapy. Patients were accrued from 8 international centers (7 main, 1 validation cohort). Multivariable models evaluating the association between time to POD and clinical/pathologic factors were constructed and converted into nomograms and prognostic indexes predicting outcomes in this population. A total of 360 patients were included, including 160 in the main cohort and 200 in the validation cohort. Time to POD, Ki67 ≥ 30%, and MCL International Prognostic Index (MIPI) were associated with progression-free survival (PFS2) and overall survival (OS2) from the start of 2L BTKis. C-indexes were consistently ≥0.68 in both cohorts. Web/application-based calculators based on nomograms and prognostic indexes to estimate PFS2 and OS2 were constructed. The 2L BTKi MIPI identifies 3 groups with distinct 2-year PFS2, including high risk (14%), intermediate risk (50%), and low risk (64%). Time to POD, Ki67, and MIPI are associated with survival outcomes in patients with R/R MCL receiving 2L BTKis. Simple clinical models incorporating these variables may assist in planning for alternative therapies such as chimeric antigen receptor T-cell therapy, allogeneic stem cell transplantation, or novel agents with alternative mechanisms of action.
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Affiliation(s)
- Diego Villa
- British Columbia Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - Aixiang Jiang
- British Columbia Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - Carlo Visco
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Nicola Crosbie
- Haematology, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Rory McCulloch
- Department of Haematology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom
| | - Michael J. Buege
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
- University of Illinois Chicago College of Pharmacy, Chicago, IL
| | - Anita Kumar
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David A. Bond
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Matthew J. Maurer
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | | | - Katharine L. Lewis
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - Chan Y. Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - Joachim Baech
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Haematology, Aalborg, Denmark
| | - Tarec C. El-Galaly
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Haematology, Aalborg, Denmark
| | | | - David W. Scott
- British Columbia Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - Alina S. Gerrie
- British Columbia Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - David Lewis
- Haematology, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
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8
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Metzner B, Müller TH, Casper J, Kimmich C, Köhne CH, Petershofen E, Renzelmann A, Thole R, Voss A, Dreyling M, Hoster E, Klapper W, Pott C. Long-term outcome in patients with mantle cell lymphoma following high-dose therapy and autologous stem cell transplantation. Eur J Haematol 2023. [PMID: 37094812 DOI: 10.1111/ejh.13985] [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: 12/07/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Long-term clinical and molecular remissions in patients with mantle cell lymphoma (MCL) after autologous stem cell transplantation (ASCT) have been evaluated in only a few studies. DESIGN AND METHODS Sixty-five patients with MCL received ASCT (54 first-line ASCT, 10 second-line ASCT, and 1 third-line ASCT). In the case of long-term remission (≥5 years; n = 27), peripheral blood was tested for minimal residual disease (MRD) by t(11;14)- and IGH-PCR at the last follow-up. RESULTS Ten-year overall survival (OS), progression-free survival (PFS), and freedom from progression (FFP) after first-line ASCT were 64%, 52%, and 59% versus after second-line ASCT 50%, 20%, and 20%, respectively. Five-year OS, PFS, and FFP for the first-line cohort were 79%, 63%, and 69%, respectively. Five-year OS, PFS, and FFP after second-line ASCT were 60%, 30%, and 30%, respectively. Treatment-related mortality (3 months after ASCT) was 1.5%. So far 26 patients developed sustained long-term clinical and molecular complete remissions of up to 19 years following ASCT in first treatment line. CONCLUSION Sustained long-term clinical and molecular remissions are achievable following ASCT.
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Affiliation(s)
- Bernd Metzner
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Oldenburg, Germany
| | - Thomas H Müller
- Red Cross Blood Transfusion Service NSTOB, Oldenburg, Germany
| | - Jochen Casper
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Oldenburg, Germany
| | - Christoph Kimmich
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Oldenburg, Germany
| | - Claus-Henning Köhne
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Oldenburg, Germany
| | | | - Andrea Renzelmann
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Oldenburg, Germany
| | - Ruth Thole
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Oldenburg, Germany
| | - Andreas Voss
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Oldenburg, Germany
| | - Martin Dreyling
- Department of Internal Medicine III, University Hospital Munich, Grosshadern, Germany
| | - Eva Hoster
- Department of Internal Medicine III, University Hospital Munich, Grosshadern, Germany
| | - Wolfram Klapper
- Department of Pathology, Hematopathology Section and Lymph Node Registry, University of Schleswig-Holstein, Kiel, Germany
| | - Christiane Pott
- Department of Medicine II, University of Schleswig-Holstein, Kiel, Germany
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9
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Huang Z, Chavda VP, Bezbaruah R, Dhamne H, Yang DH, Zhao HB. CAR T-Cell therapy for the management of mantle cell lymphoma. Mol Cancer 2023; 22:67. [PMID: 37004047 PMCID: PMC10064560 DOI: 10.1186/s12943-023-01755-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/04/2023] [Indexed: 04/03/2023] Open
Abstract
Mantle cell lymphoma (MCL) is a subtype of Non-Hodgkin lymphoma (NHL) of mature B-cells characterized by translocation, which is typically due to excess expression of Cyclin D1. Although with the progress in our knowledge of the causes for MCL and available treatments for MCL, this cancer is still incurable. Age, male gender, rapid advancement, significant nodal involvement, elevated serum lactate dehydrogenase level, and prognostic indications including increased expression of Ki-67 and presence of TP53 mutation, are symbols of poor outcome. Advanced immunotherapy using chimeric antigen receptor (CAR)-T cells is advantageous for patients suffering from B-cell malignancies and MCL. Targeting B-cell antigens on the cell surface is a feasible approach in re-occurring (R/R) MCL because of significant responses obtained in other B-cell cancers. USFDA has approved brexucabtagene autoleucel (Tecartus, KTE-X19), a novel CAR T-cell therapy to be used in patients with MCL who have not responded to previous treatments or have relapsed. The FDA approved this new treatment depending on the outcomes of the ZUMA-2 clinical trial. Serious adverse reactions, moderate anti-tumor activity, allergen withdrawal, antigen escape, limited tumor infiltration, and trafficking are major barriers to successful CAR T-cell therapy. This review is a brief synopsis of the development of CAR T-cell therapy for MCL.
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Affiliation(s)
- Zoufang Huang
- Department of Hematology, Ganzhou Key Laboratory of Hematology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Vivek P Chavda
- Department of Pharmaceutics and Pharmaceutical Technology, L M College of Pharmacy, Ahmedabad, , 380009, Gujarat, India.
| | - Rajashri Bezbaruah
- Department of Pharmaceutical Sciences, Faculty of Science and Engineering, Dibrugarh University, Dibrugarh, India
| | - Hemant Dhamne
- Process Development, Gene Therapy Vector Facility, Research Management and Innvotations Directorate, King's College London, London, WC2R 2LS, UK
| | - Dong-Hua Yang
- New York College of Traditional Chinese Medicine, Mineola, NY, 11501, USA
| | - Hong-Bing Zhao
- Department of Oncology, the First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.
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10
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Lew TE, Minson A, Dickinson M, Handunnetti SM, Blombery P, Khot A, Anderson MA, Ritchie D, Tam CS, Seymour JF. Treatment approaches for patients with TP53-mutated mantle cell lymphoma. Lancet Haematol 2023; 10:e142-e154. [PMID: 36725119 DOI: 10.1016/s2352-3026(22)00355-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 02/01/2023]
Abstract
Mantle cell lymphoma is an uncommon subtype of lymphoma characterised by clinical and biological heterogeneity. Although most patients with mantle cell lymphoma have durable responses after chemoimmunotherapy, there is a need to prospectively identify high-risk subsets of patients for whom disease control with standard chemotherapy will be short lived. Among the available prognostic factors, TP53 mutations are uniquely informative owing to their strong association with early disease progression and death among patients receiving conventional chemoimmunotherapy, with the highest negative prognostic value compared with other established risk indicators, including the mantle cell lymphoma international prognostic index, histological features, elevated Ki-67, and other genetic lesions. The poor outcomes for patients with TP53-mutated mantle cell lymphoma receiving chemoimmunotherapy and second-line Bruton tyrosine kinase inhibitors represent an urgent need for alternative approaches. In this Review, we synthesise the available data to inform the management of this high-risk subset of patients and present a treatment strategy prioritising clinical trials and early use of cellular therapies.
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Affiliation(s)
- Thomas E Lew
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Adrian Minson
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Dickinson
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Sasanka M Handunnetti
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Piers Blombery
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Amit Khot
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Mary Ann Anderson
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - David Ritchie
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Constantine S Tam
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Department of Haematology, The Alfred Hospital, Melbourne, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - John F Seymour
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
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11
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Wang M, Munoz J, Goy A, Locke FL, Jacobson CA, Hill BT, Timmerman JM, Holmes H, Jaglowski S, Flinn IW, McSweeney PA, Miklos DB, Pagel JM, Kersten MJ, Bouabdallah K, Khanal R, Topp MS, Houot R, Beitinjaneh A, Peng W, Fang X, Shen RR, Siddiqi R, Kloos I, Reagan PM. Three-Year Follow-Up of KTE-X19 in Patients With Relapsed/Refractory Mantle Cell Lymphoma, Including High-Risk Subgroups, in the ZUMA-2 Study. J Clin Oncol 2023; 41:555-567. [PMID: 35658525 PMCID: PMC9870225 DOI: 10.1200/jco.21.02370] [Citation(s) in RCA: 92] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Brexucabtagene autoleucel (KTE-X19) autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy is approved for the treatment of relapsed/refractory mantle cell lymphoma (MCL). Outcomes after a 3-year follow-up in the pivotal ZUMA-2 study of KTE-X19 in relapsed/refractory MCL are reported, including for subgroups by prior therapy (bendamustine and type of Bruton tyrosine kinase inhibitor [BTKi]) or high-risk characteristics. METHODS Patients with relapsed/refractory MCL (one to five prior therapies, including prior BTKi exposure) received a single infusion of KTE-X19 (2 × 106 CAR T cells/kg). RESULTS After a median follow-up of 35.6 months, the objective response rate among all 68 treated patients was 91% (95% CI, 81.8 to 96.7) with 68% complete responses (95% CI, 55.2 to 78.5); medians for duration of response, progression-free survival, and overall survival were 28.2 months (95% CI, 13.5 to 47.1), 25.8 months (95% CI, 9.6 to 47.6), and 46.6 months (95% CI, 24.9 to not estimable), respectively. Post hoc analyses showed that objective response rates and ongoing response rates were consistent among prespecified subgroups by prior BTKi exposure or high-risk characteristics. In an exploratory analysis, patients with prior bendamustine benefited from KTE-X19, but showed a trend toward attenuated T-cell functionality, with more impact of bendamustine given within 6 versus 12 months of leukapheresis. Late-onset toxicities were infrequent; only 3% of treatment-emergent adverse events of interest in ZUMA-2 occurred during this longer follow-up period. Translational assessments revealed associations with long-term benefits of KTE-X19 including high-peak CAR T-cell expansion in responders and the predictive value of minimal residual disease for relapse. CONCLUSION These data, representing the longest follow-up of CAR T-cell therapy in patients with MCL to date, suggest that KTE-X19 induced durable long-term responses with manageable safety in patients with relapsed/refractory MCL and may also benefit those with high-risk characteristics.
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Affiliation(s)
- Michael Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX,Michael Wang, MD, Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; Twitter: @michaelwangmd; e-mail:
| | | | - Andre Goy
- John Theurer Cancer Center, Hackensack University, Hackensack, NJ
| | | | | | | | | | | | | | - Ian W. Flinn
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN
| | | | | | | | - Marie José Kersten
- Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, the Netherlands, on behalf of HOVON/LLPC
| | - Krimo Bouabdallah
- CHU Bordeaux, Service d’Hématologie et thérapie Cellulaire, Bordeaux, France
| | | | - Max S. Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Roch Houot
- CHU Rennes, Université Rennes, INSERM & EFS, Rennes, France
| | | | | | - Xiang Fang
- Kite, a Gilead Company, Santa Monica, CA
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12
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Concurrent Inhibition of Akt and ERK Using TIC-10 Can Overcome Venetoclax Resistance in Mantle Cell Lymphoma. Cancers (Basel) 2023; 15:cancers15020510. [PMID: 36672458 PMCID: PMC9856512 DOI: 10.3390/cancers15020510] [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: 12/19/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Venetoclax, a BCL-2 inhibitor, has proven to be effective in several hematological malignancies, including mantle cell lymphoma (MCL). However, development of venetoclax resistance is inevitable and understanding its underlying molecular mechanisms can optimize treatment response. We performed a thorough genetic, epigenetic and transcriptomic analysis of venetoclax-sensitive and resistant MCL cell lines, also evaluating the role of the stromal microenvironment using human and murine co-cultures. In our model, venetoclax resistance was associated with abrogated TP53 activity through an acquired mutation and transcriptional downregulation leading to a diminished apoptotic response. Venetoclax-resistant cells also exhibited an upregulation of the PI3K/Akt pathway, and pharmacological inhibition of Akt and ERK with TIC-10 led to cell death in all venetoclax-resistant cell lines. Overall, we highlight the importance of targeted therapies, such as TIC-10, against venetoclax resistance-related pathways, which might represent future therapeutic prospects.
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13
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Saburi M, Kodama Y, Uraisami K, Takata H, Miyazaki Y, Nishikawa T, Sasaki H, Abe M, Kohno K, Wada J, Urabe S, Kondo Y, Nakayama T, Ohtsuka E. Treatment outcomes of mantle cell lymphoma in real-world practice: analysis of forty-one patients. J Clin Exp Hematop 2023; 63:205-208. [PMID: 37766565 PMCID: PMC10628821 DOI: 10.3960/jslrt.23024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 09/29/2023] Open
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14
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Tackling Mantle Cell Lymphoma in Europe. Healthcare (Basel) 2022; 10:healthcare10091682. [PMID: 36141294 PMCID: PMC9498856 DOI: 10.3390/healthcare10091682] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
An expert panel convened by the European Alliance for Personalized Medicine (EAPM) reflected on achievements and outstanding challenges in Europe in mantle cell lymphoma (MCL). Through the prism of member state experience, the panel noted advances in outcomes over the last decade, but highlighted issues constituting barriers to better care. The list notably included availability of newer treatments, infrastructure and funding for related testing, and shortages of relevant skills and of research support. The prospect of improvements was held to reside in closer coordination and cooperation within and between individual countries, and in changes in policy and scale of investment at both national and EU levels.
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15
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Treatment of Mantle Cell Lymphoma in the Frontline Setting: Are We Ready for a Risk-Adapted Approach? J Pers Med 2022; 12:jpm12071134. [PMID: 35887631 PMCID: PMC9324979 DOI: 10.3390/jpm12071134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 12/29/2022] Open
Abstract
Mantle cell lymphoma (MCL), a type of B-cell non-Hodgkin lymphoma characterized by the t(11;14)(q13q32) translocation, is a clinically heterogenous disease which can range from indolent to highly aggressive. Numerous prognostic factors have been identified, including blastoid histology, the Mantle Cell Lymphoma International Prognostic Index (MIPI) score, high proliferation index, p53 deletions and/or mutations, complex karyotype, minimal residual disease, and several others. However, using these prognostic factors to guide treatment selection has largely remained elusive. Given the heterogeneous behavior of this disease and varying patient characteristics, we suggest that the time has come for a more risk-adapted approach to this disease. In this article, we review the numerous prognostic factors that have been described for MCL, both at the time of diagnosis and following first-line treatment. We then propose a risk-adapted approach to first-line therapy for MCL, which would reserve intensive therapy for the highest risk patients and spare others excessive toxicity.
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16
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Sancho JM, Marín-Niebla A, Fernández S, Capote FJ, Cañigral C, Grande C, Donato E, Zeberio I, Puerta JM, Rivas A, Pérez-Ceballos E, Vale A, Martín García-Sancho A, Salar A, González-Barca E, Teruel A, Pastoriza C, Conde-Royo D, Sánchez-García J, Barrenetxea C, Arranz R, Hernández-Rivas JÁ, Ramírez MJ, Jiménez A, Rubio-Azpeitia E. IBRORS-MCL study: a Spanish retrospective and observational study of relapsed/refractory mantle-cell lymphoma treated with ibrutinib in routine clinical practice. Int J Hematol 2022; 116:381-392. [PMID: 35551632 PMCID: PMC9392694 DOI: 10.1007/s12185-022-03367-z] [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: 02/02/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022]
Abstract
This retrospective study evaluated 66 patients diagnosed with relapsed and/or refractory mantle cell lymphoma (R/R MCL) treated with ibrutinib in Spain in routine clinical practice. At diagnosis, patients had a median age of 64.5 years, 63.6% presented with intermediate/high sMIPI (simplified prognostic index for advanced-stage mantle cell lymphoma), 24.5% had the blastoid variant, and 55.6% had a Ki67 > 30%. Patients had received a median of 2 prior lines of therapy (range 1-2; min-max 1-7). Overall response rate was 63.5%, with 38.1% of patients achieving complete response (CR). With a median duration of ibrutinib exposure of 10.7 months (range 5.2-19.6; min-max 0.3-36), the median progression-free survival (PFS) and overall survival (OS) were 20 months [95% confidence interval (CI) 8.8-31.1] and 32 months (95% CI 22.6-41.3), respectively, and were not reached in patients achieving CR. No grade ≥ 3 cardiovascular toxicity or bleeding was reported. This study supports that treatment with ibrutinib leads to high response rates and favorable survival outcomes in patients with R/R MCL.
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Affiliation(s)
- Juan-Manuel Sancho
- Clinical Hematology Department, Catalan Institute of Oncology (ICO), ICO Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Barcelona, Spain.
| | - Ana Marín-Niebla
- Hospital Universitario Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | | | | | - Carolina Cañigral
- Hospital de Castellón, Av. de Benicàssim, 128, 12004, Castellón de la Plana, Castellón, Spain
| | - Carlos Grande
- Hospital Doce de Octubre, Av. de Córdoba, s/n, 28041, Madrid, Spain
| | - Eva Donato
- Hospital Universitario Dr. Peset, Av. de Gaspar Aguilar, 90, 46017, Valencia, Spain
| | - Izaskun Zeberio
- Hospital Donostia, Begiristain Doktorea Pasealekua, s/n, 20014, Donostia, Gipuzkoa, Spain
| | - Jose-Manuel Puerta
- Hospital Virgen de Las Nieves, Av. de las Fuerzas Armadas, 2, 18014, Granada, Spain
| | - Alfredo Rivas
- Hospital Clìnic i Provincial, C. de Villarroel, 170, 08036, Barcelona, Spain
| | | | - Ana Vale
- Complejo Hospitalario Universiatrio A Coruña, As Xubias, 84, 15006 A, Coruña, Spain
| | | | - Antonio Salar
- Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 29, 08003, Barcelona, Spain
| | - Eva González-Barca
- Hospital Duran i Reynals, Av. de la Granvia de l'Hospitalet, 199,, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anabel Teruel
- Hospital Clínico Universitario de Valencia, Av. de Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - Carmen Pastoriza
- Hospital de Orense, Ramón Puga Noguerol, 54, 32005, Orense, Spain
| | - Diego Conde-Royo
- Hospital Príncipe de Asturias, Carr. de Alcalá, s/n, 28805, Meco, Madrid, Spain
| | | | | | - Reyes Arranz
- Hospital la Princesa, Diego de León, 62, 28006, Madrid, Spain
| | | | - María-José Ramírez
- Hospital Universitario de Jerez, Ctra. Trebujena, s/n, 11407, Jerez de la Frontera, Cádiz, Spain
| | - Aroa Jiménez
- Medical Department Janssen-Cilag, S.A., Madrid, Spain
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17
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Pu JJ, Savani M, Huang N, Epner EM. Mantle cell lymphoma management trends and novel agents: where are we going? Ther Adv Hematol 2022; 13:20406207221080743. [PMID: 35237397 PMCID: PMC8882940 DOI: 10.1177/20406207221080743] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/31/2022] [Indexed: 11/20/2022] Open
Abstract
The heterogeneity in disease pathology, the unpredictability in disease
prognosis, and the variability in response to therapy make mantle cell lymphoma
(MCL) a focus of novel therapeutic development. MCL is characterized by
dysregulated expression of cyclin D1 through a chromosome
t(11;14) translocation. MCL international prognostic index
(MIPI), ki-67 proliferation index, and TP53
mutation status are currently utilized for prognostication. With advances in
pharmacokinetic analysis and drug discovery, treatment strategy has evolved from
chemotherapy to combination of targeted, epigenetic, and immune therapies. In
this review, we discuss investigational and newly approved treatment approaches.
In a short time, the US Food and Drug Administration (FDA) has approved five
agents for the treatment of MCL: lenalidomide, an immunomodulatory agent;
bortezomib, a proteasome inhibitor; and ibrutinib, acalabrutinib, and
zanubrutinib, all Bruton kinase inhibitors. Epigenetic agents (e.g. cladribine
and vorinostat), mammalian target of rapamycin (mTOR) inhibitors (e.g.
temsirolimus and everolimus), and monoclonal antibodies and/or antibody-drug
conjugates (e.g. obinutuzumab, polatuzumab, and ublituximab) are promising
therapeutic agents currently under clinical trial investigation. Most recently,
chimeric antigen receptor (CAR)-T cell therapy and bispecific T-cell engager
(BiTE) therapy even open a new venue for MCL treatment. However, due to its
intricate pathology nature and high relapse incidence, there are still unmet
needs in developing optimal therapeutic strategies for both frontline and
relapsed/refractory settings. The ultimate goal is to develop innovative
personalized combination therapy approaches for the purpose of delivering
precision medicine to cure this disease.
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Affiliation(s)
- Jeffrey J. Pu
- University of Arizona Cancer Center, 1515 N Campbell Avenue, Room #1968C, Tucson, AZ 85724, USA
| | - Malvi Savani
- University of Arizona Cancer Center, Tucson, AZ, USA
| | - Nick Huang
- State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Elliot M. Epner
- Penn State Hershey Cancer Institute, 100 University Drive, Hershey, PA, USA
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18
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Riedell PA, Hamadani M, Ahn KW, Litovich C, Brunstein CG, Cashen AF, Cohen JB, Epperla N, Hill BT, Im A, Inwards DJ, Lister J, McCarty JM, Ravi Kiran Pingali S, Shadman M, Shaughnessy P, Solh M, Stiff PJ, Vose JM, Kharfan-Dabaja MA, Herrera AF, Sauter CS, Smith SM. Effect of time to relapse on overall survival in patients with mantle cell lymphoma following autologous haematopoietic cell transplantation. Br J Haematol 2021; 195:757-763. [PMID: 34581433 DOI: 10.1111/bjh.17865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/28/2022]
Abstract
In young and fit patients with mantle cell lymphoma (MCL), intensive induction therapy followed by a consolidative autologous haematopoietic cell transplant (autoHCT) is the standard of care in the front-line setting. Recently, time-to-event analysis has emerged as an important risk assessment tool in lymphoma, though its impact in MCL is not well defined. We utilized the Center for International Blood and Marrow Transplant Research database to evaluate the effect of post-autoHCT time to relapse on overall survival (OS) over time in 461 patients who underwent autoHCT within 12 months of MCL diagnosis. On multivariate analysis, the impact of relapse on OS was greatest at the six-month [hazard ratio (HR) = 7·68], 12-month (HR = 6·68), and 18-month (HR = 5·81) landmark timepoints. Using a dynamic landmark model we demonstrate that adjusted OS at five years following each landmark timepoint improved with time for relapsing and non-relapsing patients. Furthermore, early relapse (<18 months) following autoHCT defines a high-risk group with inferior post-relapse OS. This retrospective analysis highlights the impact of time to relapse on OS in MCL patients undergoing up-front autoHCT and emphasizes the need to consider novel therapeutic approaches for patients suffering early relapse.
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Affiliation(s)
- Peter A Riedell
- Division of Hematology and Oncology, University of Chicago Medicine, Chicago, IL, USA
| | - Mehdi Hamadani
- Department of Medicine, CIBMTR® (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
| | - Kwang W Ahn
- Department of Medicine, CIBMTR® (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
| | - Carlos Litovich
- Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Claudio G Brunstein
- Department of Medicine, Adult Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
| | - Amanda F Cashen
- Division of Oncology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Narendranath Epperla
- Division of Hematology, Department of Medicine, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Annie Im
- Division of Hematology/Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | | | - John Lister
- Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - John M McCarty
- Bone Marrow Transplant Program, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Medical Oncology Division, University of Washington, Seattle, WA, USA
| | - Paul Shaughnessy
- Sarah Cannon Transplant and Cellular Therapy Program Methodist Hospital, San Antonio, TX, USA
| | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA, USA
| | - Patrick J Stiff
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Julie M Vose
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Craig S Sauter
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, IL, USA
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