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Wang M, Robak T, Maddocks KJ, Phillips T, Smith SD, Gallinson D, Calvo R, Wun CC, Munugalavadla V, Jurczak W. Acalabrutinib plus venetoclax and rituximab in treatment-naive mantle cell lymphoma: 2-year safety and efficacy analysis. Blood Adv 2024; 8:4539-4548. [PMID: 38781315 PMCID: PMC11399641 DOI: 10.1182/bloodadvances.2023012424] [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: 12/14/2023] [Revised: 04/03/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024] Open
Abstract
ABSTRACT This phase 1b study evaluated safety and efficacy of acalabrutinib, venetoclax, and rituximab (AVR) in treatment-naive mantle cell lymphoma (TN MCL). Patients received acalabrutinib from cycle 1 until progressive disease (PD) or undue toxicity, rituximab for 6 cycles with maintenance every other cycle through cycle 24 or until PD, and venetoclax, beginning at cycle 2, for 24 cycles. Twenty-one patients were enrolled; 95.2% completed induction (6 AVR cycles) and 47.6% continued acalabrutinib maintenance. Thirteen (61.9%) patients had grade 3-4 adverse events (AEs), most commonly neutropenia (33.3%). Seven (33.3%) patients had COVID-19 infection (6 [28.6%] serious AEs and 5 [23.8%] deaths, all among unvaccinated patients). There was no grade ≥3 atrial fibrillation, ventricular tachyarrhythmias, major hemorrhages, or tumor lysis syndrome. Overall response rate (ORR) was 100% (95% CI, 83.9-100.0) with 71.4% complete response. With median follow-up of 27.8 months, median progression-free survival (PFS) and overall survival (OS) were not reached. PFS rates at 1 and 2 years were 90.5% (95% CI, 67.0-97.5) and 63.2% (95% CI, 34.7-82.0), respectively; both were 95% after censoring COVID-19 deaths. OS rates at 1 and 2 years were 95.2% (95% CI, 70.7-99.3) and 75.2% (95% CI, 50.3-88.9), respectively; both were 100% after censoring COVID-19 deaths. Overall, 87.5% of patients with available minimal residual disease (MRD) data achieved MRD negativity (10-6; next-generation sequencing) during treatment. AVR represents a chemotherapy-free regimen for TN MCL and resulted in high ORR and high rates of MRD negativity. The trial was registered at www.ClinicalTrials.gov as #NCT02717624.
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Affiliation(s)
- Michael Wang
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, MD Anderson Cancer Center, The University of Texas, Houston, TX
| | - Tadeusz Robak
- Department of Hematology, Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Kami J Maddocks
- Division of Hematology, The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Tycel Phillips
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Stephen D Smith
- University of Washington/Fred Hutchinson Cancer Center, Seattle, WA
| | | | | | | | | | - Wojciech Jurczak
- Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland
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Cheson BD, Sharman JP. Current Approaches and Novel New Agents in the Treatment of Chronic Lymphocytic Leukemia. JCO Oncol Pract 2024:OP2300770. [PMID: 38848511 DOI: 10.1200/op.23.00770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 06/09/2024] Open
Abstract
The treatment of CLL has evolved from traditional chemoimmunotherapy (CIT) to an increasing number of targeted and biologic approaches. Randomized trials have demonstrated superiority of covalent bruton tyrosine kinase inhibitors (cBTKis) over CIT, and second-generation compounds such as acalabrutinib and zanubrutinib appear to have a more favorable efficacy/safety profile than ibrutinib. The noncovalent BTKi, pirtobrutinib, has shown impressive activity after failure of the cBTKis and is quite tolerable. The Bcl-2 inhibitor venetoclax plus a CD20, generally obinutuzumab, provides a high level of efficacy as initial treatment or after failure on a cBTKi, with many patients achieving a state of undetectable minimal residual disease. Promising novel approaches include BTK degraders, bispecific antibodies, and chimeric antigen receptor T-cell (CAR-T)-cell therapy. What is clear is that CIT is archaic, and current and future targeted approaches will continue to improve the outcome for patients with chronic lymphocytic leukemia.
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Affiliation(s)
| | - Jeff P Sharman
- Willamette Valley Cancer Institute, Medical Director of Hematology Research: Sara Cannon, Eugene, OR
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3
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Tivey A, Shotton R, Eyre TA, Lewis D, Stanton L, Allchin R, Walter H, Miall F, Zhao R, Santarsieri A, McCulloch R, Bishton M, Beech A, Willimott V, Fowler N, Bedford C, Goddard J, Protheroe S, Everden A, Tucker D, Wright J, Dukka V, Reeve M, Paneesha S, Prahladan M, Hodson A, Qureshi I, Koppana M, Owen M, Ediriwickrema K, Marr H, Wilson J, Lambert J, Wrench D, Burney C, Knott C, Talbot G, Gibb A, Lord A, Jackson B, Stern S, Sutton T, Webb A, Wilson M, Thomas N, Norman J, Davies E, Lowry L, Maddox J, Phillips N, Crosbie N, Flont M, Nga E, Virchis A, Camacho RG, Swe W, Pillai A, Rees C, Bailey J, Jones S, Smith S, Sharpley F, Hildyard C, Mohamedbhai S, Nicholson T, Moule S, Chaturvedi A, Linton K. Ibrutinib as first-line therapy for mantle cell lymphoma: a multicenter, real-world UK study. Blood Adv 2024; 8:1209-1219. [PMID: 38127279 PMCID: PMC10912842 DOI: 10.1182/bloodadvances.2023011152] [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: 07/14/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
ABSTRACT During the COVID-19 pandemic, ibrutinib with or without rituximab was approved in England for initial treatment of mantle cell lymphoma (MCL) instead of immunochemotherapy. Because limited data are available in this setting, we conducted an observational cohort study evaluating safety and efficacy. Adults receiving ibrutinib with or without rituximab for untreated MCL were evaluated for treatment toxicity, response, and survival, including outcomes in high-risk MCL (TP53 mutation/deletion/p53 overexpression, blastoid/pleomorphic, or Ki67 ≥ 30%). A total of 149 patients from 43 participating centers were enrolled: 74.1% male, median age 75 years, 75.2% Eastern Cooperative Oncology Group status of 0 to 1, 36.2% high-risk, and 8.9% autologous transplant candidates. All patients received ≥1 cycle ibrutinib (median, 8 cycles), 39.0% with rituximab. Grade ≥3 toxicity occurred in 20.3%, and 33.8% required dose reductions/delays. At 15.6-month median follow-up, 41.6% discontinued ibrutinib, 8.1% due to toxicity. Of 104 response-assessed patients, overall (ORR) and complete response (CR) rates were 71.2% and 20.2%, respectively. ORR was 77.3% (low risk) vs 59.0% (high risk) (P = .05) and 78.7% (ibrutinib-rituximab) vs 64.9% (ibrutinib; P = .13). Median progression-free survival (PFS) was 26.0 months (all patients); 13.7 months (high risk) vs not reached (NR) (low risk; hazard ratio [HR], 2.19; P = .004). Median overall survival was NR (all); 14.8 months (high risk) vs NR (low risk; HR, 2.36; P = .005). Median post-ibrutinib survival was 1.4 months, longer in 41.9% patients receiving subsequent treatment (median, 8.6 vs 0.6 months; HR, 0.36; P = .002). Ibrutinib with or without rituximab was effective and well tolerated as first-line treatment of MCL, including older and transplant-ineligible patients. PFS and OS were significantly inferior in one-third of patients with high-risk disease and those unsuitable for post-ibrutinib treatment, highlighting the need for novel approaches in these groups.
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Affiliation(s)
- Ann Tivey
- The University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Rohan Shotton
- The University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Toby A. Eyre
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - David Lewis
- Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | | | - Rebecca Allchin
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Harriet Walter
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Fiona Miall
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Rui Zhao
- Torbay Hospital, Torquay, United Kingdom
| | | | - Rory McCulloch
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom
| | - Mark Bishton
- University of Nottingham, Nottingham, United Kingdom
| | - Amy Beech
- Nottingham University Hospitals, Nottingham, United Kingdom
| | | | - Nicole Fowler
- Royal Cornwall Hospital NHS Trust, Truro, United Kingdom
| | | | - Jack Goddard
- Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Sam Protheroe
- Stockport NHS Foundation Trust, Stockport, United Kingdom
| | | | - David Tucker
- Royal Cornwall Hospital NHS Trust, Truro, United Kingdom
| | - Josh Wright
- Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Vasavi Dukka
- Stockport NHS Foundation Trust, Stockport, United Kingdom
| | - Miriam Reeve
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Shankara Paneesha
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Mahesh Prahladan
- East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom
| | - Andrew Hodson
- East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom
| | - Iman Qureshi
- University Hospital Coventry and Warwickshire NHS Foundation Trust, Coventry, United Kingdom
| | - Manasvi Koppana
- East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom
| | - Mary Owen
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Helen Marr
- Newcastle Teaching Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Jamie Wilson
- St Richard's Hospital, Chichester, United Kingdom
| | - Jonathan Lambert
- University College Hospital NHS Foundation Trust, London, United Kingdom
| | - David Wrench
- Guy's and St.Thomas' NHS Foundation Trust, London, United Kingdom
| | - Claire Burney
- University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Chloe Knott
- University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Georgina Talbot
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Adam Gibb
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Simon Stern
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, United Kingdom
| | - Taylor Sutton
- Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
| | - Amy Webb
- Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom
| | - Marketa Wilson
- Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom
| | - Nicky Thomas
- Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom
| | - Jane Norman
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Elizabeth Davies
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Lisa Lowry
- Somerset NHS Foundation Trust, Taunton and Bridgwater, United Kingdom
| | - Jamie Maddox
- South Tees Hospitals NHS Foundation Trust, Middlesborough, United Kingdom
| | - Neil Phillips
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | | | - Marcin Flont
- York and Scarborough Teaching Hospitals NHS Foundation, York, United Kingdom
| | - Emma Nga
- Airedale NHS Foundation Trust, Keighley, United Kingdom
| | - Andres Virchis
- The Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | - Wunna Swe
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, United Kingdom
| | - Arvind Pillai
- Countess of Chester Hospital NHS Foundation Trust, Chester, United Kingdom
| | - Clare Rees
- Frimley Health NHS Foundation Trust, Frimley, United Kingdom
| | - James Bailey
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Steve Jones
- Sherwood Forest Hospitals, Nottinghamshire, United Kingdom
| | - Susan Smith
- Sherwood Forest Hospitals, Nottinghamshire, United Kingdom
| | - Faye Sharpley
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Catherine Hildyard
- Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, United Kingdom
| | - Sajir Mohamedbhai
- University College Hospital NHS Foundation Trust, London, United Kingdom
| | - Toby Nicholson
- St Helens and Knowsley NHS Foundation Trust, Merseyside, United Kingdom
| | - Simon Moule
- Frimley Health NHS Foundation Trust, Frimley, United Kingdom
| | - Anshuman Chaturvedi
- The University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Kim Linton
- The University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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Aurer I, Jakšić O, Bašić-Kinda S, Mrđenović S, Ostojić-Kolonić S, Lozić D, Holik H, Novaković-Coha S, Berneš P, Krečak I, Morić-Perić M, Narančić M, Mitrović Z, Valković T. Treatment-Related Risk Factors for Adverse Outcomes of COVID-19 in Patients Treated for Lymphoid Malignancies in the Pre-Omicron Era-A Study of KroHem, the Croatian Group for Hematologic Diseases. Biomedicines 2024; 12:331. [PMID: 38397933 PMCID: PMC10887065 DOI: 10.3390/biomedicines12020331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
Patients with lymphoid malignancies are at increased risk of death or prolonged infection due to COVID-19. Data on the influence of different antineoplastic treatment modalities on outcomes are conflicting. Anti-CD20 monoclonal antibodies increase the risk of prolonged infection. It is unclear whether this risk is affected by the choice of the antibody (rituximab vs. obinutuzumab). To elucidate the role of antineoplastic therapy on COVID-19 outcomes, KroHem collected data on patients with lymphoid malignancies diagnosed with COVID-19 between October 2020 and April 2021. A total of 314 patients were identified, 75 untreated, 61 off treatment and 178 on treatment. The mortality rate in untreated and off-treatment patients was 15% and 16%; 9% and 10% had prolonged infection. In the on-treatment group, 3% were still prolonged positive at time of data collection, 62% recovered and 35% died; 42% had prolonged infection. Disease type, use of anti-CD20 monoclonal antibodies, prior autologous stem-cell transplantation (ASCT) and line of treatment did not significantly affect mortality. Mortality was higher in older patients (p = 0.0078) and those treated with purine analogues (p = 0.012). Prolonged COVID-19 was significantly more frequent in patients treated with anti-CD20 monoclonal antibodies (p = 0.012), especially obinutuzumab, and purine analogues (p = 0.012). Age, prior ASCT and treatment line did not significantly affect risk of prolonged infection. These data suggest that increased age and use of purine analogues are main risk factors for increased mortality of COVID-19 in patients with lymphoid malignancies. Obinutuzumab further increases the risk of prolonged disease, but not of death, in comparison to rituximab. Epidemiological considerations should be taken into account when choosing the appropriate antineoplastic therapy for patients with lymphoid malignancies.
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Affiliation(s)
- Igor Aurer
- University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia or (O.J.); (S.O.-K.); or (Z.M.)
| | - Ozren Jakšić
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia or (O.J.); (S.O.-K.); or (Z.M.)
- University Hospital Dubrava, Av. G. Šuška 6, 10000 Zagreb, Croatia
| | - Sandra Bašić-Kinda
- University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia;
| | - Stefan Mrđenović
- University Hospital Centre Osijek, J. Huttlera 4, 31000 Osijek, Croatia;
- Medical School, University of Osijek, J. Huttlera 4, 31000 Osijek, Croatia
| | - Slobodanka Ostojić-Kolonić
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia or (O.J.); (S.O.-K.); or (Z.M.)
- University Hospital Merkur, Zajčeva 19, 10000 Zagreb, Croatia
| | - Dominik Lozić
- University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia;
| | - Hrvoje Holik
- General Hospital Dr. Josip Benčević, A. Štampara 42, 35000 Slavonski Brod, Croatia;
| | - Sabina Novaković-Coha
- University Hospital Centre Sisters of Mercy, Vinogradska c. 29, 10000 Zagreb, Croatia;
| | - Petra Berneš
- General Hospital Pula, Santoriova ul. 24a, 52100 Pula, Croatia;
| | - Ivan Krečak
- General Hospital Šibenik, S. Radića 83, 22000 Šibenik, Croatia;
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia;
| | - Martina Morić-Perić
- General Hospital Zadar, B. Peričića 5, 23000 Zadar, Croatia; (M.M.-P.); (M.N.)
| | - Marino Narančić
- General Hospital Zadar, B. Peričića 5, 23000 Zadar, Croatia; (M.M.-P.); (M.N.)
| | - Zdravko Mitrović
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia or (O.J.); (S.O.-K.); or (Z.M.)
- University Hospital Dubrava, Av. G. Šuška 6, 10000 Zagreb, Croatia
| | - Toni Valković
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia;
- University Hospital Centre Rijeka, Krešimirova 42, 51000 Rijeka, Croatia
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Xie H, Zhang J, Luo R, Qi Y, Lin Y, Han C, Li X, Zeng D. IgG antibody response to SARS-CoV-2 infection and its influencing factors in lymphoma patients. BMC Immunol 2024; 25:5. [PMID: 38218761 PMCID: PMC10788029 DOI: 10.1186/s12865-024-00596-1] [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: 11/16/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND The ability of generating effective humoral immune responses to SARS-CoV-2 infection has not been clarified in lymphoma patients. The study aimed to investigate the antibody (Ab) production after SARS-Cov-2 infection and clarify the factors affecting the Ab generation in these patients. PATIENTS & METHODS 80 lymphoma patients and 51 healthy controls were included in this prospective observational study. Clinical factors and treatment regimens affecting Ab positive rate (APR) and Ab levels were analyzed by univariate and multivariate methods. RESULTS The anti-SARS-CoV-2 IgG APR and Ab levels in lymphoma patients were significantly lower than those in healthy controls. Lymphoma patients with COVID-19 vaccination had significantly higher APR and Ab levels compared with those without vaccination. Additionally, the use of dexamethasone for COVID-19 treatment had a negative impact on Ab levels. For the impact of treatment regimens on the APR and Ab levels, the results showed that patients treated with ≥ 6 times CD20 monoclonal Ab (mAb) and patients treated with autologous hematopoietic stem cell transplantation (ASCT) prior to infection produced a statistically lower APR and Ab levels compared with those treated with 1-5 times CD20 mAb and those treated without ASCT, respectively. Furthermore, multiple regression analysis indicated that the number of anti-CD20 treatment was an independent predictor for both APR and Ab levels. CONCLUSIONS Humoral immune response to SARS-CoV-2 infection was impaired in lymphoma patients partly due to anti-CD20 and ASCT treatment. COVID-19 vaccination may be more needed for these patients.
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Affiliation(s)
- Huan Xie
- Department of Hematology, Daping Hospital, Army Medical University, No. 10, Daping Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China
| | - Jing Zhang
- Department of Hematology, Daping Hospital, Army Medical University, No. 10, Daping Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China
| | - Ran Luo
- Department of Hematology, Daping Hospital, Army Medical University, No. 10, Daping Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China
| | - Yan Qi
- Department of Hematology, Daping Hospital, Army Medical University, No. 10, Daping Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China
| | - Yizhang Lin
- Department of Hematology, Daping Hospital, Army Medical University, No. 10, Daping Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China
| | - Changhao Han
- Department of Hematology, Daping Hospital, Army Medical University, No. 10, Daping Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China
| | - Xi Li
- Department of Hematology, Daping Hospital, Army Medical University, No. 10, Daping Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China.
| | - Dongfeng Zeng
- Department of Hematology, Daping Hospital, Army Medical University, No. 10, Daping Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China.
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Sun P, Yang H, Zhao B, Wang Y, Nie M, Huang K, Li Z. Outcomes of COVID-19 in patients with lymphomas participating in registered clinical trials: A real-world study from China in the Omicron outbreak era. Cancer Med 2023; 12:21148-21158. [PMID: 38011015 PMCID: PMC10726839 DOI: 10.1002/cam4.6678] [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: 07/27/2023] [Revised: 10/14/2023] [Accepted: 10/24/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND This real-world study investigated the outcome of COVID-19 in lymphoma patients participating in registered clinical trials and explored potential risk factors with the outcome of COVID-19 during the first wave of the Omicron outbreak in China. METHODS One hundred and ten patients participating in registered clinical trials and diagnosed with COVID-19 in our center between December 1, 2022, and January 31, 2023, were included. RESULTS Four (3.6%) patients were identified as severe COVID-19 and 2 (1.8%) as critical COVID-19, respectively. The mortality rate observed was 2.73% for the entire cohort, 33.3% for the severe/critical COVID-19 group, and 18.8% for the hospitalized group. The 90-day OS was 98.2% for the entire cohort, 66.7% for the severe/critical COVID-19 group, and 87.5% for the hospitalized group. Advanced age (≥70 years), comorbidities, and PI3K inhibitor-containing regimen were significantly associated with the severity of COVID-19. Patients with indolent B-cell non-Hodgkin lymphomas were less likely to be hospitalized for COVID-19. CONCLUSION This study reported similar clinical features of COVID-19 in our cohort with that of non-hematological malignancy (HM) patients, while the proportion of severe/critical COVID-19 and the mortality rate were relatively higher than non-HM patients. Our findings provided valuable experience to aid clinical researchers with managing lymphoma patients participating in registered clinical trials during the ongoing pandemic of the Omicron variant.
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Affiliation(s)
- Peng Sun
- Department of Medical OncologySun Yat‐Sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouChina
| | - Hang Yang
- Department of Medical OncologySun Yat‐Sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouChina
| | - Baitian Zhao
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouChina
- Department of Clinical Trials CenterSun Yat‐Sen University Cancer CenterGuangzhouChina
| | - Yu Wang
- Department of Medical OncologySun Yat‐Sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouChina
| | - Man Nie
- Department of Medical OncologySun Yat‐Sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouChina
| | - Kangming Huang
- Department of Medical OncologySun Yat‐Sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouChina
| | - Zhiming Li
- Department of Medical OncologySun Yat‐Sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouChina
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7
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Fenske TS. Frontline Therapy in Mantle Cell Lymphoma: When Clinical Trial and Real-World Data Collide. J Clin Oncol 2023; 41:452-459. [PMID: 36170622 DOI: 10.1200/jco.22.01661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.A large number of frontline treatment options exist for mantle cell lymphoma (MCL), making selection of therapy a challenge for the clinician. In this Oncology Grand Rounds article, the case of a 73-year-old woman with MCL who attained remission with bendamustine and rituximab is presented. The relevant literature regarding frontline therapy is then reviewed, with particular focus on selection of induction regimen and the potential roles for autologous transplantation and/or rituximab maintenance. This literature primarily consists of prospective phase 2 and phase 3 clinical trials; however, added to this literature now is a growing body of large retrospective real-world cohorts, such as the new analysis by Martin et al,35 the manuscript that accompanies this Oncology Grand Rounds article. In some cases, the real-world evidence is at odds with data from prospective clinical trials, such as regarding the role of rituximab maintenance after bendamustine plus rituximab induction. These important new real-world data are put into context of an ever-changing treatment landscape, in hopes of aiding clinicians in frontline treatment selection for patients with MCL.
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8
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Horgan D, Walewski J, Aurer I, Visco C, Giné E, Fetica B, Jerkeman M, Kozaric M, da Silva MG, Dreyling M. Tackling Mantle Cell Lymphoma in Europe. Healthcare (Basel) 2022; 10:1682. [PMID: 36141294 PMCID: PMC9498856 DOI: 10.3390/healthcare10091682] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [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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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, 1040 Brussels, Belgium
| | - Jan Walewski
- The Maria Sklodowska-Curie National Research Institute of Oncology, 00-001 Warszawa, Poland
| | - Igor Aurer
- Division of Hematology, Department of Internal Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Carlo Visco
- Department of Medicine, Section of Hematology, University of Verona, 37129 Verona, Italy
| | - Eva Giné
- Instituto Clínic de Enfermedades Hematológicas y Oncológicas, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Bogdan Fetica
- Department of Pathology, Institute of Oncology “Prof. Dr. Ion Chiricuta” Cluj-Napoca, 400015 Cluj-Napoca, Romania
| | - Mats Jerkeman
- Department of Oncology, Institute of Clinical Sciences, Lund University and Skane, University Hospital, BMC F12, 221 84 Lund, Sweden
| | - Marta Kozaric
- European Alliance for Personalised Medicine, 1040 Brussels, Belgium
| | - Maria Gomes da Silva
- Haematology Unit, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisbon, Portugal
| | - Martin Dreyling
- Medical Clinic III, Groβhadern Clinic, Ludwig-Maximilians-Universität, 81377 Munich, Germany
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Is There Still a Role for Transplant for Patients with Mantle Cell Lymphoma (MCL) in the Era of CAR-T Cell Therapy? Curr Treat Options Oncol 2022; 23:1614-1625. [PMID: 36227407 PMCID: PMC9557996 DOI: 10.1007/s11864-022-01020-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2022] [Indexed: 01/30/2023]
Abstract
OPINION STATEMENT For years, upfront autologous hematopoietic cell transplant (auto-HCT) has been the standard of care for younger and physically fit mantle cell lymphoma (MCL) patients after chemoimmunotherapy (CIT) induction. Bruton's tyrosine kinase (BTK) inhibitors have proven to be excellent salvage therapies, but their durability remains a question, especially in high-risk (HR) MCL. Allogeneic HCT (allo-HCT) was the only option for long-term remission and possibly cure for MCL relapse after auto-HCT and sometime as upfront consolidation for a young patient with HR MCL (debatable). We have seen a paradigm shift since the FDA approval in July 2020 of the brexucabtagene autoleucel chimeric antigen receptor T (CAR-T) cell therapy for relapsed and refractory (R/R) MCL with an preliminary evidence suggesting CAR-T may overcome known biological risk factors in MCL. Given its safety profile and excellent efficacy, the role of CAR-T among other approved therapies and HCT may need to be better defined. Based on the current evidence, auto-HCT remains a standard frontline consolidation therapy. CAR-T therapy is a preferred option for patients with relapsed/refractory (R/R) MCL, particularly those who failed BTK inhibitors. In certain high-risk MCL patients (such as high ki 67, TP53 alterations, complex karyotype, blastoid morphology, early relapse after initial diagnosis), CAR-T cell therapy may be considered before BTK inhibitors (preferably on a clinical trial). The role of allo-HCT is unclear in the CAR-T era, but remains a viable option for eligible patients who have no access or who have failed CAR-T therapy. Our review discusses current standards and the shifting paradigms in the indications for HCT and the role of CAR-T cell therapy for MCL. Prospective studies tailored based on risk factors are needed to better define the optimal sequences of HCT and cellular therapy and other approved novel therapies.
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