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Intzes S, Symeonidou M, Zagoridis K, Pentidou A, Bezirgianidou Z, Papoutselis M, Misidou C, Roumpakis C, Spanoudaki A, Liapis K, Spanoudakis E. How to improve RCHOP as frontline therapy for diffuse large B-cell lymphoma: a systematic review and meta-analysis of 21 randomized controlled trials. Ann Hematol 2024; 103:1623-1633. [PMID: 38191715 DOI: 10.1007/s00277-023-05551-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/13/2023] [Indexed: 01/10/2024]
Abstract
RCHOP is the standard of care for patients with diffuse large b-cell lymphoma (DLBCL) but failures occur in approximately 40% of them. We performed a meta-analysis of 21 randomized controlled trials (RCTs) comparing experimental regimens with RCHOP. We searched the database of PubMed with proper criteria, and data of efficacy (Progression Free Survival-PFS) in the ITT population were extracted and analyzed. Cross comparisons of RCTs were performed by using the CINEMA software. Odds ratio (OR) and 95% confidence intervals (95%, CI) are reported. The literature search yielded 21 RCTs including 5785 patients in the RCHOP arm and 5648 patients in the experimental arm. Odds ratio (OR) for PFS in the total cohort was OR (95%, CI): 0.87 (0.76-0.99), p=0.02. Among different strategies to improve RCHOP, addition of a novel agent on RCHOP improved PFS. In total 1740 patients in the RCHOP arm were compared with 1755 in the RCHOP plus a novel agent arm, and the OR (95% CI) for PFS was 0.84 (0.71-0.97), p=0.02. Indirect comparisons of nine studies adding a novel agent on RCHOP does not give prominence to any agent. Subgroup analysis according to cell of origin was performed for non-GC DLBCL patients. In this subgroup, 1546 patients treated with RCHOP were compared with 1538 patients treated with experimental regimens. The OR (95% CI) for PFS was 0.86 (0.73-1.02), p=0.34. Overall survival data extracted from 18 studies showed no superiority of experimental regimens over RCHOP. Efficacy of RCHOP backbone is marginally improved when adding a novel anti-lymphoma agent.
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Affiliation(s)
- Stergios Intzes
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Marianthi Symeonidou
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Konstantinos Zagoridis
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Aikaterini Pentidou
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Zoi Bezirgianidou
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Menelaos Papoutselis
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Christina Misidou
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Christoforos Roumpakis
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Athina Spanoudaki
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Konstantinos Liapis
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Emmanouil Spanoudakis
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece.
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2
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Singh C, Malhotra P, Jandial A, Jain A, Lad D, Khadwal A, Bal A, Das A, Mittal BR, Prakash G. Improving outcomes for high-risk DLBCL: a pilot study looking at the role of fractionated cyclophosphamide with RCHOP chemo-immunotherapy (SCUBA-1 trial). Indian J Hematol Blood Transfus 2023; 39:77-84. [PMID: 36091934 PMCID: PMC9441818 DOI: 10.1007/s12288-022-01562-w] [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: 04/16/2022] [Accepted: 06/23/2022] [Indexed: 01/26/2023] Open
Abstract
The outcomes for patients with high-risk DLBCL are suboptimal, especially in Low-middle income countries in comparison to published data from the western world. Most newer therapies aimed at improving outcomes are either unavailable or out of reach for the majority of patients in low-middle income countries. Cyclophosphamide is an easily available and accessible drug that forms the backbone for therapy for DLBCL. We conducted a single-center, open-label randomized pilot study comparing standard RCHOP to RCHOP with fractionated cyclophosphamide (RfCHOP) in patients with newly diagnosed, high-risk DLBCL. Fifty-five patients were randomized- 28 to RfCHOP and 27 to the RCHOP arm. RfCHOP was associated with a higher complete response rate than RCHOP at the end of 6 cycles of therapy (81.2% vs. 59.3%; p-0.062). Grade III/IV adverse events were comparable in both arms with the use of prophylactic GCSF in the RfCHOP arm. At a median follow-up of 22 months, the Median EFS and OS was not reached in either arm. RfCHOP may represent a therapeutic option for patients with newly-diagnosed, high-risk DLBCL, especially in Low-middle income countries. Larger studies are required to confirm these findings.
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Affiliation(s)
- Charanpreet Singh
- grid.415131.30000 0004 1767 2903Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- grid.415131.30000 0004 1767 2903Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya Jandial
- grid.415131.30000 0004 1767 2903Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arihant Jain
- grid.415131.30000 0004 1767 2903Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepesh Lad
- grid.415131.30000 0004 1767 2903Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- grid.415131.30000 0004 1767 2903Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- grid.415131.30000 0004 1767 2903Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- grid.415131.30000 0004 1767 2903Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - BR Mittal
- grid.415131.30000 0004 1767 2903Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- grid.415131.30000 0004 1767 2903Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Takahashi H, Nishimaki H, Nakanishi Y, Hamada T, Nakagawa M, Iizuka K, Uchino Y, Iriyama N, Miura K, Nakayama T, Masuda S, Hatta Y, Nakamura H. Clinical impact of central nervous system-directed therapies on intravascular large B-cell lymphoma: A single institution's experience. EJHAEM 2022; 3:467-470. [PMID: 35846032 PMCID: PMC9176124 DOI: 10.1002/jha2.380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 01/08/2023]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of B-cell lymphoma characterized by aggressive disease progression with a high incidence of central nervous system (CNS) involvement. We retrospectively analyzed 16 patients with de novo IVLBCL treated at our hospital between 2004 and 2018 with either standard therapy plus CNS-directed therapy or standard therapy alone. CNS-directed therapy was associated with a significantly better 2-year CNS-free survival (100% vs. 63%, p = 0.0191), despite no significant effects on progression-free or overall survival. Further studies should assess CNS-focused treatment in patients with IVLBCL with or without primary CNS involvement.
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Affiliation(s)
- Hiromichi Takahashi
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
- Department of Pathology and MicrobiologyDivision of Laboratory MedicineNihon University School of MedicineTokyoJapan
| | - Haruna Nishimaki
- Department of Pathology and MicrobiologyDivision of Oncologic PathologyNihon University School of MedicineTokyoJapan
| | - Yoko Nakanishi
- Department of Pathology and MicrobiologyDivision of Oncologic PathologyNihon University School of MedicineTokyoJapan
| | - Takashi Hamada
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
| | - Masaru Nakagawa
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
| | - Kazuhide Iizuka
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
- Department of Pathology and MicrobiologyDivision of Laboratory MedicineNihon University School of MedicineTokyoJapan
| | - Yoshihito Uchino
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
| | - Noriyoshi Iriyama
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
| | - Katsuhiro Miura
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
| | - Tomohiro Nakayama
- Department of Pathology and MicrobiologyDivision of Laboratory MedicineNihon University School of MedicineTokyoJapan
| | - Shinobu Masuda
- Department of Pathology and MicrobiologyDivision of Oncologic PathologyNihon University School of MedicineTokyoJapan
| | - Yoshihiro Hatta
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
| | - Hideki Nakamura
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
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Sonnevi K, Ljungqvist M, Jóelsson JK, Harrysson S, Wästerlid T, Bernell P, Wahlin BE. Excellent survival after R-Hyper-CVAD in hospitalized patients with high-risk large B-cell lymphoma: The Karolinska experience. EJHAEM 2021; 2:774-784. [PMID: 35845206 PMCID: PMC9175941 DOI: 10.1002/jha2.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/06/2022]
Abstract
Patients with high-risk aggressive B-cell lymphoma exhibit poor survival after R-CHOP. More intensive regimens yield higher rates of remission but also of complication. We investigated all 401 patients < 70 years with high-risk (age-adjusted [aa] international prognostic index [IPI] ≥2, extranodal, or bulky) aggressive B-cell lymphoma hospitalized at Karolinska for urgent start of immunochemotherapy (129 R-Hyper-CVAD; 261 R-CHOP/R-CHOEP). Patients showed IPI 3-5 (70%), WHO PS ≥2 (49%), bulky disease (70%), extranodal (75%) and CNS (8%) involvement. Five-year overall/progression-free survival (OS/PFS) was better in patients who started R-Hyper-CVAD (84%/77%) compared with R-CHOP/R-CHOEP (66%/55%). Differences were independent in multivariable analysis, seen in all patient categories, and accentuated in extreme high-risk disease: R-Hyper-CVAD vs. R-CHOP/R-CHOEP showed 5-year PFS 69% vs.40% in aaIPI 3 and 88% vs. 38% in CNS involvement. For validation, survival was compared between the two Karolinska sites and calendar periods. Survival was superior 2006-2010 at the site that introduced R-Hyper-CVAD/R-MA 2006, identical at both sites 2011-2017 after the other site adopted R-Hyper-CVAD/R-MA 2011, and excellent 2018-2020 when R-Hyper-CVAD/R-MA use increased to 75% of patients. Despite considerable toxicity, also patients aged 61-69 years showed better survival with R-Hyper-CVAD/R-MA. This is the largest single-centre series of patients treated with R-Hyper-CVAD/R-MA, showing favourable outcome in high-risk aggressive B-cell lymphoma.
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Affiliation(s)
- Kristina Sonnevi
- Haematology Medical UnitKarolinska University HospitalStockholmSweden
- Division of Haematology, Department of Medicine, HuddingeKarolinska InstitutetStockholmSweden
| | - Maria Ljungqvist
- Haematology Medical UnitKarolinska University HospitalStockholmSweden
- Division of Haematology, Department of MedicineKarolinska InstitutetStockholmSweden
| | - Jóel Kristinn Jóelsson
- Haematology Medical UnitKarolinska University HospitalStockholmSweden
- Division of Haematology, Department of MedicineKarolinska InstitutetStockholmSweden
| | - Sara Harrysson
- Haematology Medical UnitKarolinska University HospitalStockholmSweden
- Division of Haematology, Department of MedicineKarolinska InstitutetStockholmSweden
| | - Tove Wästerlid
- Haematology Medical UnitKarolinska University HospitalStockholmSweden
- Division of Haematology, Department of MedicineKarolinska InstitutetStockholmSweden
| | - Per Bernell
- Haematology Medical UnitKarolinska University HospitalStockholmSweden
- Division of Haematology, Department of MedicineKarolinska InstitutetStockholmSweden
| | - Björn Engelbrekt Wahlin
- Haematology Medical UnitKarolinska University HospitalStockholmSweden
- Division of Haematology, Department of Medicine, HuddingeKarolinska InstitutetStockholmSweden
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5
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Shimada K, Kiyoi H. Current progress and future perspectives of research on intravascular large B-cell lymphoma. Cancer Sci 2021; 112:3953-3961. [PMID: 34327781 PMCID: PMC8486207 DOI: 10.1111/cas.15091] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/12/2021] [Accepted: 07/25/2021] [Indexed: 12/30/2022] Open
Abstract
Intravascular large B‐cell lymphoma is a rare disease of the large B cells characterized by selective growth in the lumina of small vessels in systemic organs. Since first reported in 1959, the difficulty of obtaining sufficient tumor cells from biopsy specimens has hampered the elucidation of its underlying biology. Recent progress using xenograft models and plasma cell‐free DNA has uncovered genetic features that are similar to those of activated B‐cell type diffuse large B‐cell lymphoma, including MYD88 and CD79B mutations and frequent alterations in immune check point‐related genes such as PD‐L1 and PD‐L2. Given the improvement in clinical outcomes and a higher risk of secondary central nervous system (CNS) involvement in the rituximab era, a phase 2 trial of R‐CHOP combined with high‐dose methotrexate and intrathecal chemotherapy as a CNS‐oriented therapy has been conducted. This trial, the PRIMEUR‐IVL study, has displayed good progression‐free survival and a low cumulative incidence of secondary CNS involvement. Long‐term follow‐up within this trial is still ongoing. Further understanding of the pathophysiology of the disease and improvements in clinical outcomes are still needed.
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Affiliation(s)
- Kazuyuki Shimada
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitoshi Kiyoi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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6
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Patients with high-risk DLBCL benefit from dose-dense immunochemotherapy combined with early systemic CNS prophylaxis. Blood Adv 2021; 4:1906-1915. [PMID: 32380536 DOI: 10.1182/bloodadvances.2020001518] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/26/2020] [Indexed: 01/04/2023] Open
Abstract
Survival of patients with high-risk diffuse large B-cell lymphoma (DLBCL) is suboptimal, and the risk of central nervous system (CNS) progression is relatively high. We conducted a phase 2 trial in 139 patients aged 18 to 64 years who had primary DLBCL with an age-adjusted International Prognostic Index (aaIPI) score of 2 to 3 or site-specific risk factors for CNS recurrence. The goal was to assess whether a dose-dense immunochemotherapy with early systemic CNS prophylaxis improves the outcome and reduces the incidence of CNS events. Treatment consisted of 2 courses of high-dose methotrexate in combination with biweekly rituximab (R), cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP-14), followed by 4 courses of R-CHOP-14 with etoposide (R-CHOEP) and 1 course of high-dose cytarabine with R. In addition, liposomal cytarabine was administered intrathecally at courses 1, 3, and 5. Coprimary endpoints were failure-free survival and CNS progression rates. Thirty-six (26%) patients experienced treatment failure. Progression occurred in 23 (16%) patients, including three (2.2%) CNS events. At 5 years of median follow-up, failure-free survival, overall survival, and CNS progression rates were 74%, 83%, and 2.3%, respectively. Treatment reduced the risk of progression compared with our previous trial, in which systemic CNS prophylaxis was given after 6 courses of biweekly R-CHOEP (hazard ratio, 0.49; 95% CI, 0.31-0.77; P = .002) and overcame the adverse impact of an aaIPI score of 3 on survival. In addition, outcome of the patients with BCL2/MYC double-hit lymphomas was comparable to the patients without the rearrangements. The results are encouraging, with a low toxic death rate, low number of CNS events, and favorable survival rates. This trial was registered at www.clinicaltrials.gov as #NCT01325194.
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Dholaria B, Vanegas YAM, Diehl N, Spaulding AC, Visscher S, Tun HW, Ailawadhi S, Vishnu P. Cost Analysis of R-CHOP Versus Dose-Adjusted R-EPOCH in Treatment of Diffuse Large B-Cell Lymphoma with High-Risk Features. Clin Hematol Int 2020; 2:117-124. [PMID: 34595452 PMCID: PMC8432333 DOI: 10.2991/chi.d.200410.001] [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: 02/17/2020] [Accepted: 04/07/2020] [Indexed: 11/12/2022] Open
Abstract
Dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (DA.R-EPOCH) is used for upfront treatment of high-risk diffuse large B cell lymphoma (DLBCL). In this study, we compared the outcomes in patients with high-risk DLBCL who received frontline rituximab, cycophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) or DA.R-EPOCH immunochemotherapy. Outcomes and treatment-related cost were analyzed. DLBCL with one of the following features were included in the study: MYC ± BCL2 or BCL6 rearrangement by FISH or MYC overexpression by immunohistochemistry, Ki67 index ≥ 80% or nongerminal center immunophenotype, tumor measuring ≥5 cm and NCCN- IPI score ≥4. A total of 80 patients were treated with R-CHOP (n = 52, 65%) or DA.R-EPOCH (n = 28, 35%), with a median follow-up of 11.2 months (range: 0.7–151.3 months). The hazard ratios (HRs) for progression-free survival and overall survival were 0.79 [95% confidence interval (CI) 0.28%–2.29%, p = 0.67] and 0.86 (95% CI 0.26%–2.78%, p = 0.80), respectively for DA.R-EPOCH compared to R-CHOP. The total mean cost was USD106,940 ± USD39,351 and USD58,509 ± 24,588 for DA.R-EPOCH and R-CHOP respectively (p < 0.001). In our analysis, DA.R-EPOCH resulted comparable clinical outcomes and increased treatment-related expenses compared to R-CHOP in high-risk DLBCL.
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Affiliation(s)
- Bhagirathbhai Dholaria
- Department of Hematology-Oncology, Pierce Ave, Preston Research Building, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Hematology and Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Yenny Alejandra Moreno Vanegas
- Department of Hematology and Oncology, Mayo Clinic Florida, Jacksonville, FL, USA.,Department of Internal Medicine, St. Elizabeth Medical Center, Boston, MA, USA
| | - Nancy Diehl
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Aaron C Spaulding
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - Sue Visscher
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Han W Tun
- Department of Hematology and Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Sikander Ailawadhi
- Department of Hematology and Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Prakash Vishnu
- Department of Hematology and Oncology, Mayo Clinic Florida, Jacksonville, FL, USA.,Harrison Health Partners Hematology and Oncology, Bremerton, WA, USA
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Ayers EC, Li S, Medeiros LJ, Bond DA, Maddocks KJ, Torka P, Mier Hicks A, Curry M, Wagner-Johnston ND, Karmali R, Behdad A, Fakhri B, Kahl BS, Churnetski MC, Cohen JB, Reddy NM, Modi D, Ramchandren R, Howlett C, Leslie LA, Cytryn S, Diefenbach CS, Faramand R, Chavez JC, Olszewski AJ, Liu Y, Barta SK, Mukhija D, Hill BT, Ma H, Amengual JE, Nathan S, Assouline SE, Orellana-Noia VM, Portell CA, Chandar A, David KA, Giri A, Hess BT, Landsburg DJ. Outcomes in patients with aggressive B-cell non-Hodgkin lymphoma after intensive frontline treatment failure. Cancer 2019; 126:293-303. [PMID: 31568564 DOI: 10.1002/cncr.32526] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/19/2019] [Accepted: 07/12/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Salvage immunochemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation is the standard-of-care second-line treatment for patients with relapsed/refractory diffuse large B-cell lymphoma after first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Outcomes after receipt of second-line immunochemotherapy in patients with aggressive B-cell lymphomas who relapse or are refractory to intensive first-line immunochemotherapy regimens (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab [R-EPOCH], rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and cytarabine [R-HyperCVAD], rituximab, cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate alternating with ifosfamide, etoposide, and cytarabine [R-CODOX-M/IVAC]) remain unknown. METHODS Outcomes of patients with non-Burkitt, aggressive B-cell lymphomas and relapsed/refractory disease after first-line treatment with intensive immunochemotherapy regimens who received platinum-based second-line immunochemotherapy were reviewed retrospectively. Analyses were performed to determine progression-free survival (PFS) and overall survival (OS) from the time of receipt of second-line immunochemotherapy. RESULTS In total, 195 patients from 19 academic centers were included in the study. The overall response rate to second-line immunochemotherapy was 44%, with a median PFS of 3 months and a median OS of 8 months. Patients with early treatment failure (primary refractory or relapse <12 months from completion of first-line therapy) experienced inferior median PFS (2.8 vs 23 months; P < .001) and OS (6 months vs not reached; P < .001) compared with patients with late treatment failure. Although the 17% of patients with early failure who achieved a complete response to second-line immunochemotherapy experienced prolonged survival, this outcome could not be predicted by clinicopathologic features at the start of second-line immunochemotherapy. CONCLUSIONS Patients with early treatment failure after intensive first-line immunochemotherapy experience poor outcomes after receiving standard second-line immunochemotherapy. The use of standard-of-care or experimental therapies currently available in the third-line setting and beyond should be investigated in the second-line setting for these patients.
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Affiliation(s)
- Emily C Ayers
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shaoying Li
- Department of Hematopathology, The University of Texas MD Anderson Cancer, Houston, Texas
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer, Houston, Texas
| | - David A Bond
- Department of Internal Medicine, The Ohio State University Cancer Center, Columbus, Ohio
| | - Kami J Maddocks
- Department of Hematology, The Ohio State University Cancer Center, Columbus, Ohio
| | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Madeira Curry
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | | | - Reem Karmali
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg.,School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Amir Behdad
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bita Fakhri
- Washington University School of Medicine, St. Louis, Missouri
| | - Brad S Kahl
- Washington University School of Medicine, St. Louis, Missouri
| | - Michael C Churnetski
- Department of Hematology, Winship Cancer Institute, Emory University, Atlanta, Georgia.,Department of Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jonathon B Cohen
- Department of Hematology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Nishitha M Reddy
- Department of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dipenkumar Modi
- Karmanos Cancer Institute/Wayne State University, Detroit, Michigan
| | | | - Christina Howlett
- Deparrment of Pharmacy and Clinical Services, John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, New Jersey
| | - Lori A Leslie
- John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, New Jersey
| | - Samuel Cytryn
- New York University Perlmutter Cancer Center, New York, New York
| | | | - Rawan Faramand
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Julio C Chavez
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Adam J Olszewski
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island
| | - Yang Liu
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Stefan K Barta
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.,Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - Brian T Hill
- Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Helen Ma
- Center for Lymphoid Malignancies, Department of Medicine, and Department of Pathology and Cell Biology, Columbia University Medical Center , New York
| | - Jennifer E Amengual
- Division of Hematology and Oncology, Department of Medicine, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York
| | | | - Sarit E Assouline
- Medicine and Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Craig A Portell
- Hematology and Oncology, University of Virginia, Charlottesville, Virginia
| | - Ashwin Chandar
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | | | - Anshu Giri
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Brian T Hess
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel J Landsburg
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
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The Use of Optimal Treatment for DLBCL Is Improving in All Age Groups and Is a Key Factor in Overall Survival, but Non-Clinical Factors Influence Treatment. Cancers (Basel) 2019; 11:cancers11070928. [PMID: 31269764 PMCID: PMC6678990 DOI: 10.3390/cancers11070928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/17/2019] [Accepted: 06/28/2019] [Indexed: 12/12/2022] Open
Abstract
Introduction: Diffuse large B cell lymphoma (DLBCL) is an aggressive form of non-Hodgkin lymphoma for which a cure is usually the therapeutic goal of optimal treatment. Using a large population-based cohort we sought to examine the factors associated with optimal DLBCL treatment and survival. Methods: DLBCL cases were identified through the population-based Victorian Cancer Registry, capturing new diagnoses for two time periods: 2008–2009 and 2012–2013. Treatment was pre-emptively classified as ‘optimal’ or ‘suboptimal’, according to compliance with current treatment guidelines. Univariable and multivariable logistic regression models were fitted to determine factors associated with treatment and survival. Results: Altogether, 1442 DLBCL cases were included. Based on multivariable analysis, delivery of optimal treatment was less likely for those aged ≥80 years (p < 0.001), women (p = 0.012), those with medical comorbidity (p < 0.001), those treated in a non-metropolitan hospital (p = 0.02) and those who were ex-smokers (p = 0.02). Delivery of optimal treatment increased between 2008–2009 and the 2012–2013 (from 60% to 79%, p < 0.001). Delivery of optimal treatment was independently associated with a lower risk of death (hazard ratio (HR) = 0.60 (95% confidence interval (CI) 0.45–0.81), p = 0.001). Conclusion: Delivery of optimal treatment for DLBCL is associated with hospital location and category, highlighting possible demographic variation in treatment patterns. Together with an increase in the proportion of patients receiving optimal treatment in the more recent time period, this suggests that treatment decisions in DLBCL may be subject to non-clinical influences, which may have implications when evaluating equity of treatment access. The positive association with survival emphasizes the importance of delivering optimal treatment in DLBCL.
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10
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Hapgood G, Stone JM, Zannino D, George A, Marlton P, Prince HM, Hui CH, Prosser I, Lewis ID, Bradstock K, Seymour JF. A phase II study of a modified hyper-CVAD frontline therapy for patients with adverse risk diffuse large B-cell and peripheral T-cell non-Hodgkin lymphoma. Leuk Lymphoma 2018; 60:904-911. [DOI: 10.1080/10428194.2018.1516873] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Greg Hapgood
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Australia
| | - Janey M. Stone
- Australasian Leukaemia and Lymphoma Group, Melbourne, Australia
| | - Diana Zannino
- Australasian Leukaemia and Lymphoma Group, Melbourne, Australia
| | - Anup George
- Wellington Blood and Cancer Centre, Wellington Regional Hospital, Wellington, New Zealand
| | - Paula Marlton
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine University of Queensland, Brisbane, Australia
| | - Henry Miles Prince
- Epworth Healthcare and Peter MacCallum, Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Chi-Hung Hui
- Department of Haematology, Adelaide Cancer Centre, Adelaide, Australia
| | - Ian Prosser
- Department of Haematology, Canberra Hospital, Canberra, Australia
| | - Ian D. Lewis
- Faculty of Health & Medical Sciences, Department of Haematology, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| | | | - John F. Seymour
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
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11
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Goy A. Reply to H. Tilly et al. J Clin Oncol 2018; 36:923-925. [DOI: 10.1200/jco.2017.76.8754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andre Goy
- Andre Goy, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
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12
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Concordant bone marrow involvement of diffuse large B-cell lymphoma represents a distinct clinical and biological entity in the era of immunotherapy. Leukemia 2017; 32:353-363. [PMID: 28745330 DOI: 10.1038/leu.2017.222] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/24/2017] [Accepted: 06/29/2017] [Indexed: 12/24/2022]
Abstract
In diffuse large B-cell lymphoma (DLBCL), the clinical and biological significance of concordant and discordant bone marrow (BM) involvement have not been well investigated. We evaluated 712 de novo DLBCL patients with front-line rituximab-containing treatment, including 263 patients with positive and 449 with negative BM status. Compared with negative BM disease, concordant BM adversely impacted overall and progression-free survival, independent of the International Prognostic Index (IPI) and cell-of-origin classification. Once BM is concordantly involved, poor prognosis was not associated with the extent of BM involvement. Conversely, patients with discordant BM showed favorable overall survival similar to stage I-II DLBCL. A BM-adjusted IPI, using three parameters: concordant BM involvement, age >60 years, and performance status >1, improves the risk stratification for DLBCL with positive BM. Intensive immunochemotherapy seemingly rendered survival benefit for patients with concordant BM, as did rituximab maintenance for the discordant BM group. Frequently revealing adverse clinical and molecular characteristics, patients with concordant BM demonstrated gene expression signatures relevant to tumor cell proliferation, migration and immune escape. In conclusion, clinical and biological heterogeneity is seen in DLBCL with positive BM but concordant BM involvement represents a distinct subset with unfavorable gene signatures, high-risk clinicopathologic features and poor prognosis.
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13
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Melén CM, Enblad G, Sonnevi K, Junlén HR, Smedby KE, Jerkeman M, Wahlin BE. Chemotherapeutic intensity and survival differences in young patients with diffuse large B-cell lymphoma: a Swedish Lymphoma Registry study. Br J Haematol 2016; 175:614-622. [PMID: 27790699 DOI: 10.1111/bjh.14399] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/20/2016] [Indexed: 11/27/2022]
Abstract
Young patients with diffuse large B-cell lymphoma (DLBCL) are variably treated with rituximab combined with cyclophosphamide-doxorubicin-vincristine-prednisone (R-CHOP), CHOP-etoposide (R-CHOEP), and anthracycline-based regimens with the addition of high-dose cytarabine/methotrexate (R-HDA/M). Using the nationwide, population-based Swedish Lymphoma Registry, we evaluated outcome, by treatment and Healthcare Region, in all 751 DLBCL patients aged ≤60 years without central nervous involvement, diagnosed in Sweden between 2007 and 2012. Overall survival was estimated using multivariate Cox analysis. In patients with age-adjusted international prognostic index (aaIPI) ≥ 2, the 5-year overall survival (OS) was 70%, 76% and 85% after R-CHOP, R-CHOEP and R-HDA/M, respectively (P = 0·002); the corresponding estimates were 40%, 55%, and 92% in aaIPI = 3 (P = 0·014). There were large therapeutic differences between Sweden's six Healthcare Regions for aaIPI ≥ 2: three were "Moderate" (more R-CHOP) and three "Intensive" (more R-CHOEP and R-HDA/M). Patients with aaIPI ≥ 2 who were treated in the Intensive Regions, showed better OS (P < 0·00005), particularly those with aaIPI = 3 (5-year OS, 62% vs. 30%; P < 0·00005). There were no regional differences in therapy or survival in patients with aaIPI < 2. We conclude that in younger high-risk patients, survival appears superior after more intensive therapy than R-CHOP.
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Affiliation(s)
- Christopher M Melén
- Division of Haematology, Department of Medicine, Huddinge, Sweden.,Karolinska Institutet, and Haematology Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Gunilla Enblad
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Kristina Sonnevi
- Division of Haematology, Department of Medicine, Huddinge, Sweden.,Karolinska Institutet, and Haematology Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Henna Riikka Junlén
- Division of Haematology, Department of Medicine, Huddinge, Sweden.,Karolinska Institutet, and Haematology Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Karin E Smedby
- Unit of Clinical Epidemiology, Department of Medicine, Solna, Sweden
| | - Mats Jerkeman
- Department of Oncology, Lund University Hospital, Lund, Sweden
| | - Björn Engelbrekt Wahlin
- Division of Haematology, Department of Medicine, Huddinge, Sweden.,Karolinska Institutet, and Haematology Centre, Karolinska University Hospital, Stockholm, Sweden
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14
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Lesovaya E, Yemelyanov A, Swart AC, Swart P, Haegeman G, Budunova I. Discovery of Compound A--a selective activator of the glucocorticoid receptor with anti-inflammatory and anti-cancer activity. Oncotarget 2016; 6:30730-44. [PMID: 26436695 PMCID: PMC4741564 DOI: 10.18632/oncotarget.5078] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/19/2015] [Indexed: 12/19/2022] Open
Abstract
Glucocorticoids are among the most effective anti-inflammatory drugs, and are widely used for cancer therapy. Unfortunately, chronic treatment with glucocorticoids results in multiple side effects. Thus, there was an intensive search for selective glucocorticoid receptor (GR) activators (SEGRA), which retain therapeutic potential of glucocorticoids, but with fewer adverse effects. GR regulates gene expression by transactivation (TA), by binding as homodimer to gene promoters, or transrepression (TR), via diverse mechanisms including negative interaction between monomeric GR and other transcription factors. It is well accepted that metabolic and atrophogenic effects of glucocorticoids are mediated by GR TA. Here we summarized the results of extensive international collaboration that led to discovery and characterization of Compound A (CpdA), a unique SEGRA with a proven “dissociating” GR ligand profile, preventing GR dimerization and shifting GR activity towards TR both in vitro and in vivo. We outlined here the unusual story of compound's discovery, and presented a comprehensive overview of CpdA ligand properties, its anti-inflammatory effects in numerous animal models of inflammation and autoimmune diseases, as well as its anti-cancer effects. Finally, we presented mechanistic analysis of CpdA and glucocorticoid effects in skin, muscle, bone, and regulation of glucose and fat metabolism to explain decreased CpdA side effects compared to glucocorticoids. Overall, the results obtained by our and other laboratories underline translational potential of CpdA and its derivatives for treatment of inflammation, autoimmune diseases and cancer.
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Affiliation(s)
- Ekaterina Lesovaya
- Department of Chemical Carcinogenesis, N.N. Blokhin Russian Cancer Research Center, Moscow, Russia
| | - Alexander Yemelyanov
- Pulmonary Division, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amanda C Swart
- Department of Biochemistry, Stellenbosch University, Stellenbosch, South Africa
| | - Pieter Swart
- Department of Biochemistry, Stellenbosch University, Stellenbosch, South Africa
| | | | - Irina Budunova
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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15
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Sundahl N, Clarisse D, Bracke M, Offner F, Berghe WV, Beck IM. Selective glucocorticoid receptor-activating adjuvant therapy in cancer treatments. Oncoscience 2016; 3:188-202. [PMID: 27713909 PMCID: PMC5043069 DOI: 10.18632/oncoscience.315] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/08/2016] [Indexed: 02/07/2023] Open
Abstract
Although adverse effects and glucocorticoid resistance cripple their chronic use, glucocorticoids form the mainstay therapy for acute and chronic inflammatory disorders, and play an important role in treatment protocols of both lymphoid malignancies and as adjuvant to stimulate therapy tolerability in various solid tumors. Glucocorticoid binding to their designate glucocorticoid receptor (GR), sets off a plethora of cell-specific events including therapeutically desirable effects, such as cell death, as well as undesirable effects, including chemotherapy resistance, systemic side effects and glucocorticoid resistance. In this context, selective GR agonists and modulators (SEGRAMs) with a more restricted GR activity profile have been developed, holding promise for further clinical development in anti-inflammatory and potentially in cancer therapies. Thus far, the research into the prospective benefits of selective GR modulators in cancer therapy limped behind. Our review discusses how selective GR agonists and modulators could improve the therapy regimens for lymphoid malignancies, prostate or breast cancer. We summarize our current knowledge and look forward to where the field should move to in the future. Altogether, our review clarifies novel therapeutic perspectives in cancer modulation via selective GR targeting.
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Affiliation(s)
- Nora Sundahl
- Laboratory of Experimental Cancer Research (LECR), Department of Radiation Oncology & Experimental Cancer Research, Ghent University, Gent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Dorien Clarisse
- Laboratory of Experimental Cancer Research (LECR), Department of Radiation Oncology & Experimental Cancer Research, Ghent University, Gent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Receptor Research Laboratories, Nuclear Receptor Lab (NRL), VIB Medical Biotechnology Center, Ghent University, Ghent, Belgium
| | - Marc Bracke
- Laboratory of Experimental Cancer Research (LECR), Department of Radiation Oncology & Experimental Cancer Research, Ghent University, Gent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Fritz Offner
- Hematology, Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Wim Vanden Berghe
- Laboratory of Protein Chemistry, Proteomics and Epigenetic Signaling, Department of Biomedical Sciences, University of Antwerp, Wilrijk, Belgium
| | - Ilse M Beck
- Laboratory of Experimental Cancer Research (LECR), Department of Radiation Oncology & Experimental Cancer Research, Ghent University, Gent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium
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16
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Pinnix CC, Shah JJ, Chuang H, Costelloe CM, Medeiros LJ, Wogan CF, Reed V, Smith GL, Milgrom S, Patel K, Huo J, Turturro F, Romaguera J, Fayad L, Oki Y, Fanale MA, Westin J, Nastoupil L, Hagemeister FB, Rodriguez A, Qazilbash M, Shah N, Bashir Q, Ahmed S, Nieto Y, Hosing C, Rohren E, Dabaja B. Doxorubicin-Based Chemotherapy and Radiation Therapy Produces Favorable Outcomes in Limited-Stage Plasmablastic Lymphoma: A Single-Institution Review. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:122-8. [DOI: 10.1016/j.clml.2015.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/27/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
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17
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Watanabe K, Terakura S, Martens AC, van Meerten T, Uchiyama S, Imai M, Sakemura R, Goto T, Hanajiri R, Imahashi N, Shimada K, Tomita A, Kiyoi H, Nishida T, Naoe T, Murata M. Target antigen density governs the efficacy of anti-CD20-CD28-CD3 ζ chimeric antigen receptor-modified effector CD8+ T cells. THE JOURNAL OF IMMUNOLOGY 2014; 194:911-20. [PMID: 25520398 DOI: 10.4049/jimmunol.1402346] [Citation(s) in RCA: 214] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The effectiveness of chimeric Ag receptor (CAR)-transduced T (CAR-T) cells has been attributed to supraphysiological signaling through CARs. Second- and later-generation CARs simultaneously transmit costimulatory signals with CD3ζ signals upon ligation, but may lead to severe adverse effects owing to the recognition of minimal Ag expression outside the target tumor. Currently, the threshold target Ag density for CAR-T cell lysis and further activation, including cytokine production, has not yet been investigated in detail. Therefore, we determined the threshold target Ag density required to induce CAR-T cell responses using novel anti-CD20 CAR-T cells with a CD28 intracellular domain and a CD20-transduced CEM cell model. The newly developed CD20CAR-T cells demonstrated Ag-specific lysis and cytokine secretion, which was a reasonable level as a second-generation CAR. For lytic activity, the threshold Ag density was determined to be ∼200 molecules per target cell, whereas the Ag density required for cytokine production of CAR-T cells was ∼10-fold higher, at a few thousand per target cell. CD20CAR-T cells responded efficiently to CD20-downregulated lymphoma and leukemia targets, including rituximab- or ofatumumab-refractory primary chronic lymphocytic leukemia cells. Despite the potential influence of the structure, localization, and binding affinity of the CAR/Ag, the threshold determined may be used for target Ag selection. An Ag density below the threshold may not result in adverse effects, whereas that above the threshold may be sufficient for practical effectiveness. CD20CAR-T cells also demonstrated significant lytic activity against CD20-downregulated tumor cells and may exhibit effectiveness for CD20-positive lymphoid malignancies.
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Affiliation(s)
- Keisuke Watanabe
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan
| | - Seitaro Terakura
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan;
| | - Anton C Martens
- Department of Hematology, VU University Medical Center Amsterdam, 1007 MB Amsterdam, the Netherlands; Department of Immunology, University Medical Center Utrecht, 3508 GA Utrecht, the Netherlands
| | - Tom van Meerten
- Department of Hematology, University Medical Center Groningen, 9700 RB Groningen, the Netherlands
| | - Susumu Uchiyama
- Division of Advanced Science and Biotechnology, Graduate School of Engineering, Osaka University, Osaka 565-0871, Japan
| | - Misa Imai
- Faculty of Pharmacy, Meijo University, Nagoya 468-8503, Japan
| | - Reona Sakemura
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan
| | - Tatsunori Goto
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan
| | - Ryo Hanajiri
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan
| | - Nobuhiko Imahashi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan
| | - Kazuyuki Shimada
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; Institute for Advanced Research, Nagoya University, Nagoya 464-8601, Japan; and
| | - Akihiro Tomita
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan
| | - Hitoshi Kiyoi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan
| | - Tetsuya Nishida
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan
| | - Tomoki Naoe
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; National Hospital Organization Nagoya Medical Center, Nagoya 460-0001, Japan
| | - Makoto Murata
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan
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18
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Impact of induction regimen and stem cell transplantation on outcomes in double-hit lymphoma: a multicenter retrospective analysis. Blood 2014; 124:2354-61. [PMID: 25161267 DOI: 10.1182/blood-2014-05-578963] [Citation(s) in RCA: 330] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Patients with double-hit lymphoma (DHL), which is characterized by rearrangements of MYC and either BCL2 or BCL6, face poor prognoses. We conducted a retrospective multicenter study of the impact of baseline clinical factors, induction therapy, and stem cell transplant (SCT) on the outcomes of 311 patients with previously untreated DHL. At median follow-up of 23 months, the median progression-free survival (PFS) and overall survival (OS) rates among all patients were 10.9 and 21.9 months, respectively. Forty percent of patients remain disease-free and 49% remain alive at 2 years. Intensive induction was associated with improved PFS, but not OS, and SCT was not associated with improved OS among patients achieving first complete remission (P = .14). By multivariate analysis, advanced stage, central nervous system involvement, leukocytosis, and LDH >3 times the upper limit of normal were associated with higher risk of death. Correcting for these, intensive induction was associated with improved OS. We developed a novel risk score for DHL, which divides patients into high-, intermediate-, and low-risk groups. In conclusion, a subset of DHL patients may be cured, and some patients may benefit from intensive induction. Further investigations into the roles of SCT and novel agents are needed.
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19
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Oki Y, Noorani M, Lin P, Davis RE, Neelapu SS, Ma L, Ahmed M, Rodriguez MA, Hagemeister FB, Fowler N, Wang M, Fanale MA, Nastoupil L, Samaniego F, Lee HJ, Dabaja BS, Pinnix CC, Medeiros LJ, Nieto Y, Khouri I, Kwak LW, Turturro F, Romaguera JE, Fayad LE, Westin JR. Double hit lymphoma: the MD Anderson Cancer Center clinical experience. Br J Haematol 2014; 166:891-901. [PMID: 24943107 DOI: 10.1111/bjh.12982] [Citation(s) in RCA: 273] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 05/13/2014] [Indexed: 12/18/2022]
Abstract
We report our experience with 129 cases of double hit lymphoma (DHL), defined as B-cell lymphoma with translocations and/or extra signals involving MYC plus BCL2 and/or BCL6. All cases were reviewed for histopathological classification. Median age was 62 years (range, 18-85), 84% of patients had advanced-stage disease, and 87% had an International Prognostic Index score ≥2. Fourteen patients (11%) had a history of low-grade follicular lymphoma. MYC translocation was present in 81%, and extra signals of MYC in 25% of patients. IGH-BCL2 translocation was present in 84% and extra signals of BCL2 in 12% of patients. Two-year event-free survival (EFS) rates in all patients and patients who received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin), and R-HyperCVAD/MA (rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, alternating with cytarabine plus methotrexate) were 33%, 25%, 67% and 32%, respectively. In patients achieving complete response with initial therapy (n = 71), 2-year EFS rates in patients who did (n = 23) or did not (n = 48) receive frontline stem cell transplantation were 68% and 53%, respectively (P = 0·155). The cumulative incidence of central nervous system involvement was 13% at 3 years. Multivariate analysis identified performance status ≥2 and bone marrow involvement as independent adverse prognostic factors for EFS and OS. Further research is needed to identify predictive and/or targetable biological markers and novel therapeutic approaches for DHL patients.
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Affiliation(s)
- Yasuhiro Oki
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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20
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Landsburg DJ, Nasta SD, Svoboda J, Morrissette JJD, Schuster SJ. ‘Double-Hit’ cytogenetic status may not be predicted by baseline clinicopathological characteristics and is highly associated with overall survival in B cell lymphoma patients. Br J Haematol 2014; 166:369-74. [DOI: 10.1111/bjh.12901] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 03/17/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Daniel J. Landsburg
- Lymphoma Program; Abramson Cancer Center; University of Pennsylvania; Philadelphia PA USA
| | - Sunita D. Nasta
- Lymphoma Program; Abramson Cancer Center; University of Pennsylvania; Philadelphia PA USA
| | - Jakub Svoboda
- Lymphoma Program; Abramson Cancer Center; University of Pennsylvania; Philadelphia PA USA
| | | | - Stephen J. Schuster
- Lymphoma Program; Abramson Cancer Center; University of Pennsylvania; Philadelphia PA USA
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21
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Landsburg DJ, Schuster SJ, Svoboda J, Nasta SD. Could treatment with R-HCVAD/R-MA as compared to R-CHOP truly result in improved outcomes for patients with high-risk diffuse large B cell lymphoma? Br J Haematol 2013; 165:145-6. [PMID: 24354694 DOI: 10.1111/bjh.12702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Daniel J Landsburg
- Hematologic Malignancies Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
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22
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Westin J, Oki Y, Fayad L. Could treatment with R-HCVAD/R-MA as compared to R- CHOP truly result in improved outcomes for patients with high-risk diffuse large B cell lymphoma? - Response to Landsburg et al. Br J Haematol 2013; 165:146-7. [PMID: 24329994 DOI: 10.1111/bjh.12704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jason Westin
- Department of Lymphoma and Myeloma, University of Texas, M.D. Anderson Cancer Center, Houston, Texas, USA
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