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Crump M, Leppä S, Fayad L, Lee JJ, Di Rocco A, Ogura M, Hagberg H, Schnell F, Rifkin R, Mackensen A, Offner F, Pinter-Brown L, Smith S, Tobinai K, Yeh SP, Hsi ED, Nguyen T, Shi P, Hahka-Kemppinen M, Thornton D, Lin B, Kahl B, Schmitz N, Savage KJ, Habermann T. Randomized, Double-Blind, Phase III Trial of Enzastaurin Versus Placebo in Patients Achieving Remission After First-Line Therapy for High-Risk Diffuse Large B-Cell Lymphoma. J Clin Oncol 2016; 34:2484-92. [PMID: 27217449 DOI: 10.1200/jco.2015.65.7171] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To compare disease-free survival (DFS) after maintenance therapy with the selective protein kinase C β (PKCβ) inhibitor, enzastaurin, versus placebo in patients with diffuse large B-cell lymphoma (DLBCL) in complete remission and with a high risk of relapse after first-line therapy. PATIENTS AND METHODS This multicenter, phase III, randomized, double-blind, placebo-controlled trial enrolled patients who were at high risk of recurrence after rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Patients (N = 758) with stage II bulky or stage III to IV DLBCL, three or more International Prognostic Index risk factors at diagnosis, and a complete response or unconfirmed complete response after 6 to 8 cycles of R-CHOP were assigned 2:1 to receive oral enzastaurin 500 mg daily or placebo for 3 years or until disease progression or unacceptable toxicity. Primary end point was DFS 3 years after the last patient entered treatment. Correlative analyses of biomarkers, including cell of origin by immunohistochemistry and PKCβ expression, with efficacy outcomes were exploratory objectives. RESULTS After a median follow-up of 48 months, DFS hazard ratio for enzastaurin versus placebo was 0.92 (95% CI, 0.689 to 1.216; two-sided log-rank P = .541; 4-year DFS, 70% v 71%, respectively). Independent of treatment, no significant associations were observed between PKCβ protein expression or cell of origin and DFS or overall survival. CONCLUSION Enzastaurin did not significantly improve DFS in patients with high-risk DLBCL after achieving complete response to R-CHOP. Achievement of a complete response may have abrogated the prognostic significance of cell of origin by immunohistochemistry.
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Affiliation(s)
- Michael Crump
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China.
| | - Sirpa Leppä
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Luis Fayad
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Je Jung Lee
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Alice Di Rocco
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Michinori Ogura
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Hans Hagberg
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Frederick Schnell
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Robert Rifkin
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Andreas Mackensen
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Fritz Offner
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Lauren Pinter-Brown
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Sonali Smith
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Kensei Tobinai
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Su-Peng Yeh
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Eric D Hsi
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Tuan Nguyen
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Peipei Shi
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Marjo Hahka-Kemppinen
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Don Thornton
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Boris Lin
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Brad Kahl
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Norbert Schmitz
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Kerry J Savage
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
| | - Thomas Habermann
- Michael Crump, Princess Margaret Cancer Centre, Toronto, Ontario; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Sirpa Leppä, Helsinki University Hospital Cancer Center, Helsinki, Finland; Luis Fayad, The University of Texas MD Anderson Cancer Center, Houston, TX; Frederick Schnell, Central Georgia Cancer Care, Macon, GA; Robert Rifkin, US Oncology Research Network and Rocky Mountain Cancer Centers, Denver, CO; Lauren Pinter-Brown, University of California at Los Angeles, Santa Monica, CA; Sonali Smith, University of Chicago, Chicago, IL; Eric D. Hsi, Cleveland Clinic, Cleveland, OH; Tuan Nguyen, Peipei Shi, Marjo Hahka-Kemppinen, Don Thornton, and Boris Lin, Eli Lilly and Company, Indianapolis, IN; Brad Kahl, University of Wisconsin, Madison, WI; Thomas Habermann, Mayo Clinic Cancer Research Consortium, Rochester, NY; Je Jung Lee, Chonnam National University Hwasun Hospital, Gwangju, South Korea; Alice Di Rocco, Sapienza University, Rome, Italy; Michinori Ogura, Tokai Central Hospital, Kakamigahara; Kensei Tobinai, National Cancer Center Hospital, Tokyo, Japan; Hans Hagberg, Akademiska Sjukhuset, Onkologkliniken, Uppsala, Sweden; Andreas Mackensen, University of Erlangen, Erlangen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg, Germany; Fritz Offner, University of Gent, Gent, Belgium; and Su-Peng Yeh, China Medical University Hospital, Taichung, Republic of China
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