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Abramson JS, Palomba ML, Gordon LI, Lunning M, Wang M, Arnason J, Purev E, Maloney DG, Andreadis C, Sehgal A, Solomon SR, Ghosh N, Dehner C, Kim Y, Ogasawara K, Kostic A, Siddiqi T. Two-year follow-up of lisocabtagene maraleucel in relapsed or refractory large B-cell lymphoma in TRANSCEND NHL 001. Blood 2024; 143:404-416. [PMID: 37890149 DOI: 10.1182/blood.2023020854] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
ABSTRACT Lisocabtagene maraleucel (liso-cel) demonstrated significant efficacy with a manageable safety profile as third-line or later treatment for patients with relapsed or refractory (R/R) large B-cell lymphoma (LBCL) in the TRANSCEND NHL 001 study. Primary end points were adverse events (AEs), dose-limiting toxicities, and objective response rate (ORR) per independent review committee. Key secondary end points were complete response (CR) rate, duration of response (DOR), progression-free survival (PFS), and overall survival (OS). After 2-year follow-up, patients could enroll in a separate study assessing long-term (≤15 years) safety and OS. Liso-cel-treated patients (N = 270) had a median age of 63 years (range, 18-86 years) and a median of 3 prior lines (range, 1-8) of systemic therapy, and 181 of them (67%) had chemotherapy-refractory LBCL. Median follow-up was 19.9 months. In efficacy-evaluable patients (N = 257), the ORR was 73% and CR rate was 53%. The median (95% confidence interval) DOR, PFS, and OS were 23.1 (8.6 to not reached), 6.8 (3.3-12.7), and 27.3 months (16.2-45.6), respectively. Estimated 2-year DOR, PFS, and OS rates were 49.5%, 40.6%, and 50.5%, respectively. In the 90-day treatment-emergent period (N = 270), grade 3 to 4 cytokine release syndrome and neurological events occurred in 2% and 10% of patients, respectively. The most common grade ≥3 AEs in treatment-emergent and posttreatment-emergent periods, respectively, were neutropenia (60% and 7%) and anemia (37% and 6%). Liso-cel demonstrated durable remissions and a manageable safety profile with no new safety signals during the 2-year follow-up in patients with R/R LBCL. These trials were registered at www.ClinicalTrials.gov as #NCT02631044 and #NCT03435796.
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Affiliation(s)
- Jeremy S Abramson
- Lymphoma Program, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - M Lia Palomba
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leo I Gordon
- Department of Hematology/Oncology, Northwestern University, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Matthew Lunning
- Hematology/Oncology Division, University of Nebraska Medical Center, Omaha, NE
| | - Michael Wang
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jon Arnason
- Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - David G Maloney
- Clinical Research Division Medicine and Oncology, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Alison Sehgal
- University of Pittsburgh Medical Center: Hillman Cancer Center, Pittsburgh, PA
| | - Scott R Solomon
- Transplant and Cellular Immunotherapy Program, Northside Hospital Cancer Institute, Atlanta, GA
| | - Nilanjan Ghosh
- Department of Hematologic Oncology and Blood Disorders, Atrium Health, Levine Cancer Institute, Charlotte, NC
| | | | | | | | | | - Tanya Siddiqi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
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Simard J, Roschewski M. SOHO State of the Art Updates and Next Questions: Prophylaxis and Management of Secondary CNS Lymphoma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:709-717. [PMID: 35787364 PMCID: PMC9529879 DOI: 10.1016/j.clml.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
Secondary CNS lymphoma (SCNSL) is a rare but frequently fatal complication of systemic lymphoma. There is no standard treatment for SCNSL, and patients who develop SCNSL at diagnosis or after frontline therapy often receive highly intensive chemotherapy regimens that are inactive against primary chemorefractory disease and too toxic for older, frail patients to tolerate. Because the prognosis of SCNSL is so poor, management has historically emphasized prevention, but the current methods of CNS prophylaxis are not universally effective. To improve both the prevention and management of SCNSL, better characterization of the molecular determinants of CNS invasion is needed. Novel treatments that are currently being studied in SCNSL include targeted pathway inhibitors and cellular therapy, but SCNSL patients are often excluded from clinical trials of promising new therapies.
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Affiliation(s)
- Jillian Simard
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Mark Roschewski
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
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Abramson JS, Palomba ML, Gordon LI, Lunning MA, Wang M, Arnason J, Mehta A, Purev E, Maloney DG, Andreadis C, Sehgal A, Solomon SR, Ghosh N, Albertson TM, Garcia J, Kostic A, Mallaney M, Ogasawara K, Newhall K, Kim Y, Li D, Siddiqi T. Lisocabtagene maraleucel for patients with relapsed or refractory large B-cell lymphomas (TRANSCEND NHL 001): a multicentre seamless design study. Lancet 2020; 396:839-852. [PMID: 32888407 DOI: 10.1016/s0140-6736(20)31366-0] [Citation(s) in RCA: 1236] [Impact Index Per Article: 309.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/22/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lisocabtagene maraleucel (liso-cel) is an autologous, CD19-directed, chimeric antigen receptor (CAR) T-cell product. We aimed to assess the activity and safety of liso-cel in patients with relapsed or refractory large B-cell lymphomas. METHODS We did a seamless design study at 14 cancer centres in the USA. We enrolled adult patients (aged ≥18 years) with relapsed or refractory large B-cell lymphomas. Eligible histological subgroups included diffuse large B-cell lymphoma, high-grade B-cell lymphoma with rearrangements of MYC and either BCL2, BCL6, or both (double-hit or triple-hit lymphoma), diffuse large B-cell lymphoma transformed from any indolent lymphoma, primary mediastinal B-cell lymphoma, and follicular lymphoma grade 3B. Patients were assigned to one of three target dose levels of liso-cel as they were sequentially tested in the trial (50 × 106 CAR+ T cells [one or two doses], 100 × 106 CAR+ T cells, and 150 × 106 CAR+ T cells), which were administered as a sequential infusion of two components (CD8+ and CD4+ CAR+ T cells) at equal target doses. Primary endpoints were adverse events, dose-limiting toxicities, and the objective response rate (assessed per Lugano criteria); endpoints were assessed by an independent review committee in the efficacy-evaluable set (comprising all patients who had confirmed PET-positive disease and received at least one dose of liso-cel). This trial is registered with ClinicalTrials.gov, NCT02631044. FINDINGS Between Jan 11, 2016, and July 5, 2019, 344 patients underwent leukapheresis for manufacture of CAR+ T cells (liso-cel), of whom 269 patients received at least one dose of liso-cel. Patients had received a median of three (range 1-8) previous lines of systemic treatment, with 260 (97%) patients having had at least two lines. 112 (42%) patients were aged 65 years or older, 181 (67%) had chemotherapy-refractory disease, and seven (3%) had secondary CNS involvement. Median follow-up for overall survival for all 344 patients who had leukapheresis was 18·8 months (95% CI 15·0-19·3). Overall safety and activity of liso-cel did not differ by dose level. The recommended target dose was 100 × 106 CAR+ T cells (50 × 106 CD8+ and 50 × 106 CD4+ CAR+ T cells). Of 256 patients included in the efficacy-evaluable set, an objective response was achieved by 186 (73%, 95% CI 66·8-78·0) patients and a complete response by 136 (53%, 46·8-59·4). The most common grade 3 or worse adverse events were neutropenia in 161 (60%) patients, anaemia in 101 (37%), and thrombocytopenia in 72 (27%). Cytokine release syndrome and neurological events occurred in 113 (42%) and 80 (30%) patients, respectively; grade 3 or worse cytokine release syndrome and neurological events occurred in six (2%) and 27 (10%) patients, respectively. Nine (6%) patients had a dose-limiting toxicity, including one patient who died from diffuse alveolar damage following a dose of 50 × 106 CAR+ T cells. INTERPRETATION Use of liso-cel resulted in a high objective response rate, with a low incidence of grade 3 or worse cytokine release syndrome and neurological events in patients with relapsed or refractory large B-cell lymphomas, including those with diverse histological subtypes and high-risk features. Liso-cel is under further evaluation at first relapse in large B-cell lymphomas and as a treatment for other relapsed or refractory B-cell malignancies. FUNDING Juno Therapeutics, a Bristol-Myers Squibb Company.
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MESH Headings
- Aged
- Aged, 80 and over
- Anemia/epidemiology
- Antigens, CD19/administration & dosage
- Antigens, CD19/adverse effects
- Antigens, CD19/therapeutic use
- Biological Products
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/transplantation
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/transplantation
- Cytokine Release Syndrome/epidemiology
- Female
- Humans
- Immunotherapy, Adoptive/adverse effects
- Immunotherapy, Adoptive/methods
- Infusions, Intravenous
- Leukapheresis/methods
- Lymphoma, Large B-Cell, Diffuse/classification
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Nervous System Diseases/epidemiology
- Neutropenia/epidemiology
- Recurrence
- Safety
- Survival Analysis
- Thrombocytopenia/epidemiology
- Treatment Outcome
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Affiliation(s)
| | - M Lia Palomba
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Leo I Gordon
- Northwestern University Feinberg School of Medicine, Robert H Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | | | - Michael Wang
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jon Arnason
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Alison Sehgal
- University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, USA
| | | | - Nilanjan Ghosh
- Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Tina M Albertson
- Juno Therapeutics, a Bristol-Myers Squibb Company, Seattle, WA, USA
| | - Jacob Garcia
- Juno Therapeutics, a Bristol-Myers Squibb Company, Seattle, WA, USA
| | - Ana Kostic
- Juno Therapeutics, a Bristol-Myers Squibb Company, Seattle, WA, USA
| | - Mary Mallaney
- Juno Therapeutics, a Bristol-Myers Squibb Company, Seattle, WA, USA
| | | | | | - Yeonhee Kim
- Juno Therapeutics, a Bristol-Myers Squibb Company, Seattle, WA, USA
| | - Daniel Li
- Juno Therapeutics, a Bristol-Myers Squibb Company, Seattle, WA, USA
| | - Tanya Siddiqi
- City of Hope National Medical Center, Duarte, CA, USA
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CNS relapse in patients with DLBCL treated with lenalidomide plus R-CHOP (R2CHOP): analysis from two phase 2 studies. Blood Cancer J 2018; 8:63. [PMID: 29946110 PMCID: PMC6018787 DOI: 10.1038/s41408-018-0097-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 05/18/2018] [Accepted: 05/25/2018] [Indexed: 11/14/2022] Open
Abstract
Central nervous system (CNS) relapse of diffuse large B-cell lymphoma (DLBCL) is a devastating event occurring in ~ 5% of patients treated with R-CHOP. We hypothesized that adding lenalidomide to R-CHOP (R2CHOP) may decrease the risk of CNS relapse. We analyzed records for patients with DLBCL from two R2CHOP trials. We assessed variables pertinent to the CNS-International Prognostic Index (CNS-IPI) scoring system and classified patients into groups of low, intermediate, and high risk of CNS relapse. The 2-year CNS relapse rate for each risk group was estimated using the Kaplan–Meier method and compared with reported rates in cohorts treated with contemporary chemoimmunotherapy. A total of 136 patients were included. Mean age was 65 and median follow-up was 48.2 months. 10.3, 71.3, and 18.4% of patients were classified into low, intermediate, and high-risk CNS-IPI groups, respectively. Only one of 136 patients developed CNS relapse, corresponding to an incidence of 0.7% and an estimated 2-year CNS relapse rate of 0.9% for the entire R2CHOP cohort. The estimated 2-year CNS relapse rates for the low, intermediate, and high-risk groups were 0, 0, and 5.0%, respectively. Frontline therapy with R2CHOP in patients with DLBCL is associated with a lower-than-expected rate of CNS relapse.
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El-Galaly TC, Cheah CY, Bendtsen MD, Nowakowski GS, Kansara R, Savage KJ, Connors JM, Sehn LH, Goldschmidt N, Shaulov A, Farooq U, Link BK, Ferreri AJM, Calimeri T, Cecchetti C, Dann EJ, Thompson CA, Inbar T, Maurer MJ, Gade IL, Juul MB, Hansen JW, Holmberg S, Larsen TS, Cordua S, Mikhaeel NG, Hutchings M, Seymour JF, Clausen MR, Smith D, Opat S, Gilbertson M, Thanarajasingam G, Villa D. Treatment strategies, outcomes and prognostic factors in 291 patients with secondary CNS involvement by diffuse large B-cell lymphoma. Eur J Cancer 2018; 93:57-68. [PMID: 29477102 DOI: 10.1016/j.ejca.2018.01.073] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 12/24/2017] [Accepted: 01/09/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Secondary CNS involvement (SCNS) is a profoundly adverse complication of diffuse large B-cell lymphoma. Evidence from older series indicated a median overall survival (OS) < 6 months; however, data from the immunochemotherapy era are limited. METHODS Patients diagnosed with SCNS during or after first-line immunochemotherapy were identified from databases and/or regional/national registries from three continents. Clinical information was retrospectively collected from medical records. RESULTS In total, 291 patients with SCNS were included. SCNS occurred as part of first relapse in 254 (87%) patients and 113 (39%) had concurrent systemic relapse. With a median post-SCNS follow-up of 48 months, the median post-SCNS OS was 3.9 months and 2-year OS rate was 20% (95% CI: 15-25). In multivariable analysis of 173 patients treated with curative/intensive therapy (such as high-dose methotrexate [HDMTX] or platinum-containing regimens), age ≤60 years, performance status 0-1, absence of combined leptomeningeal and parenchymal involvement, and SCNS occurring after completion of first-line therapy were associated with superior outcomes. Patients ≤60 years with performance status 0-1 and treated with HDMTX-based regimens for isolated parenchymal SCNS had a 2-year OS of 62% (95% CI: 36-80). In patients with isolated SCNS, the addition of rituximab to HDMTX-based regimens was associated with improved OS. Amongst patients with isolated SCNS in CR following intensive treatment, high-dose chemotherapy and autologous stem cell transplantation did not improve OS (P = 0.9). CONCLUSIONS In this large international cohort of patients treated with first-line immunochemotherapy, outcomes following SCNS remain poor. However, a moderate proportion of patients with isolated SCNS who received intensive therapies achieved durable remissions.
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Affiliation(s)
| | - Chan Yoon Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia
| | | | | | - Roopesh Kansara
- Section of Medical Oncology and Hematology, Cancer Care Manitoba, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada; Division of Medical Oncology and Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Kerry J Savage
- Division of Medical Oncology and Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Joseph M Connors
- Division of Medical Oncology and Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Laurie H Sehn
- Division of Medical Oncology and Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Neta Goldschmidt
- Hematology Department, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Adir Shaulov
- Hematology Department, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Umar Farooq
- Division of Hematology, Oncology, Blood & Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Brian K Link
- Division of Hematology, Oncology, Blood & Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Andrés J M Ferreri
- Unit of Lymphoid Malignancies, Department of OncoHematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Teresa Calimeri
- Unit of Lymphoid Malignancies, Department of OncoHematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Cecchetti
- Unit of Lymphoid Malignancies, Department of OncoHematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eldad J Dann
- Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | | | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - Inger Lise Gade
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Maja Bech Juul
- Department of Hematology, Vejle Hospital, Vejle, Denmark
| | - Jakob W Hansen
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Staffan Holmberg
- Department of Hematology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Sabrina Cordua
- Department of Hematology, Zealand University Hospital, Denmark
| | - N George Mikhaeel
- Department of Clinical Oncology, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Martin Hutchings
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Daniel Smith
- Department of Clinical Oncology, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Stephen Opat
- Monash Health and Monash University, Melbourne, Australia
| | | | | | - Diego Villa
- Division of Medical Oncology and Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
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