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Lee CH, Wu YY, Huang TC, Lin C, Zou YF, Cheng JC, Chen PH, Jhou HJ, Ho CL. Maintenance therapy for chronic lymphocytic leukaemia. Cochrane Database Syst Rev 2024; 1:CD013474. [PMID: 38174814 PMCID: PMC10765471 DOI: 10.1002/14651858.cd013474.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND Chronic lymphocytic leukaemia (CLL) is the most common lymphoproliferative disease in adults and currently remains incurable. As the progression-free period shortens after each successive treatment, strategies such as maintenance therapy are needed to improve the degree and duration of response to previous therapies. Monoclonal antibodies, immunomodulatory agents, and targeted therapies are among the available options for maintenance therapy. People with CLL who achieve remission after previous therapy may choose to undergo medical observation or maintenance therapy to deepen the response. Even though there is widespread use of therapeutic maintenance agents, the benefits and harms of these treatments are still uncertain. OBJECTIVES To assess the effects and safety of maintenance therapy, including anti-CD20 monoclonal antibody, immunomodulatory drug therapy, anti-CD52 monoclonal antibody, Bruton tyrosine kinase inhibitor, and B-cell lymphoma-2 tyrosine kinase inhibitor, for individuals with CLL. SEARCH METHODS We conducted a comprehensive literature search for randomised controlled trials (RCTs) with no language or publication status restrictions. We searched CENTRAL, MEDLINE, Embase, and three trials registers in January 2022 together with reference checking, citation searching, and contact with study authors to identify additional studies. SELECTION CRITERIA We included RCTs with prospective identification of participants. We excluded cluster-randomised trials, cross-over trial designs, and non-randomised studies. We included studies comparing maintenance therapies with placebo/observation or head-to-head comparisons. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. We assessed risk of bias in the included studies using Cochrane's RoB 1 tool for RCTs. We rated the certainty of evidence for the following outcomes using the GRADE approach: overall survival (OS), health-related quality of life (HRQoL), grade 3 and 4 adverse events (AEs), progression-free survival (PFS), treatment-related mortality (TRM), treatment discontinuation (TD), and all adverse events (AEs). MAIN RESULTS We identified 11 RCTs (2393 participants) that met the inclusion criteria, including seven trials comparing anti-CD20 monoclonal antibodies (mAbs) (rituximab or ofatumumab) with observation in 1679 participants; three trials comparing immunomodulatory drug (lenalidomide) with placebo/observation in 693 participants; and one trial comparing anti-CD 52 mAbs (alemtuzumab) with observation in 21 participants. No comparisons of novel small molecular inhibitors were found. The median age of participants was 54.1 to 71.7 years; 59.5% were males. The type of previous induction treatment, severity of disease, and baseline stage varied among the studies. Five trials included early-stage symptomatic patients, and three trials included advanced-stage patients (Rai stage III/IV or Binet stage B/C). Six trials reported a frequent occurrence of cytogenic aberrations at baseline (69.7% to 80.1%). The median follow-up duration was 12.4 to 73 months. The risk of selection bias in the included studies was unclear. We assessed overall risk of performance bias and detection bias as low risk for objective outcomes and high risk for subjective outcomes. Overall risk of attrition bias, reporting bias, and other bias was low. Anti-CD20 monoclonal antibodies (mAbs): rituximab or ofatumumab maintenance versus observation Anti-CD20 mAbs maintenance likely results in little to no difference in OS (hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.73 to 1.20; 1152 participants; 3 studies; moderate-certainty evidence) and likely increases PFS significantly (HR 0.61, 95% CI 0.50 to 0.73; 1255 participants; 5 studies; moderate-certainty evidence) compared to observation alone. Anti-CD20 mAbs may result in: an increase in grade 3/4 AEs (rate ratio 1.34, 95% CI 1.06 to 1.71; 1284 participants; 5 studies; low-certainty evidence); little to no difference in TRM (risk ratio 0.82, 95% CI 0.39 to 1.71; 1189 participants; 4 studies; low-certainty evidence); a slight reduction to no difference in TD (risk ratio 0.93, 95% CI 0.72 to 1.20; 1321 participants; 6 studies; low-certainty evidence); and an increase in all AEs (rate ratio 1.23, 95% CI 1.03 to 1.47; 1321 participants; 6 studies; low-certainty evidence) compared to the observation group. One RCT reported that there may be no difference in HRQoL between the anti-CD20 mAbs (ofatumumab) maintenance and the observation group (mean difference -1.70, 95% CI -8.59 to 5.19; 480 participants; 1 study; low-certainty evidence). Immunomodulatory drug (IMiD): lenalidomide maintenance versus placebo/observation IMiD maintenance therapy likely results in little to no difference in OS (HR 0.91, 95% CI 0.61 to 1.35; 461 participants; 3 studies; moderate-certainty evidence) and likely results in a large increase in PFS (HR 0.37, 95% CI 0.19 to 0.73; 461 participants; 3 studies; moderate-certainty evidence) compared to placebo/observation. Regarding harms, IMiD maintenance therapy may result in an increase in grade 3/4 AEs (rate ratio 1.82, 95% CI 1.38 to 2.38; 400 participants; 2 studies; low-certainty evidence) and may result in a slight increase in TRM (risk ratio 1.22, 95% CI 0.35 to 4.29; 458 participants; 3 studies; low-certainty evidence) compared to placebo/observation. The evidence for the effect on TD compared to placebo is very uncertain (risk ratio 0.71, 95% CI 0.47 to 1.05; 400 participants; 2 studies; very low-certainty evidence). IMiD maintenance therapy probably increases all AEs slightly (rate ratio 1.41, 95% CI 1.28 to 1.54; 458 participants; 3 studies; moderate-certainty evidence) compared to placebo/observation. No studies assessed HRQoL. Anti-CD52 monoclonal antibodies (mAbs): alemtuzumab maintenance versus observation Maintenance with alemtuzumab may have little to no effect on PFS, but the evidence is very uncertain (HR 0.55, 95% CI 0.32 to 0.95; 21 participants; 1 study; very low-certainty evidence). We did not identify any study reporting the outcomes OS, HRQoL, grade 3/4 AEs, TRM, TD, or all AEs. AUTHORS' CONCLUSIONS There is currently moderate- to very low-certainty evidence available regarding the benefits and harms of maintenance therapy in people with CLL. Anti-CD20 mAbs maintenance improved PFS, but also increased grade 3/4 AEs and all AEs. IMiD maintenance had a large effect on PFS, but also increased grade 3/4 AEs. However, none of the above-mentioned maintenance interventions show differences in OS between the maintenance and control groups. The effects of alemtuzumab maintenance are uncertain, coupled with a warning for drug-related infectious toxicity. We found no studies evaluating other novel maintenance interventions, such as B-cell receptor inhibitors, B-cell leukaemia-2/lymphoma-2 inhibitors, or obinutuzumab.
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Affiliation(s)
- Cho-Hao Lee
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Ying Wu
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tzu-Chuan Huang
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Fen Zou
- Department of Pharmacy, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ju-Chun Cheng
- Department of Pharmacy, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Po-Huang Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hong-Jie Jhou
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Ching-Liang Ho
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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2
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Stilgenbauer S, Bosch F, Ilhan O, Kisro J, Mahé B, Mikuskova E, Osmanov D, Reda G, Robinson S, Tausch E, Turgut M, Wójtowicz M, Böttcher S, Perretti T, Trask P, Van Hoef M, Leblond V, Foà R. Safety and efficacy of obinutuzumab alone or with chemotherapy in previously untreated or relapsed/refractory chronic lymphocytic leukaemia patients: Final analysis of the Phase IIIb GREEN study. Br J Haematol 2021; 193:325-338. [PMID: 33605445 DOI: 10.1111/bjh.17326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/21/2020] [Indexed: 02/04/2023]
Abstract
The manageable toxicity profile of obinutuzumab (GA101; G) alone or with chemotherapy in first-line (1L; fit and non-fit) and relapsed/refractory (R/R) patients with chronic lymphocytic leukaemia (CLL) was established in the primary analysis of the Phase IIIb GREEN trial (Clinicaltrials.gov: NCT01905943). The final analysis (cut-off, 31 January 2019) is reported here. Patients received G (1000 mg) alone (G-mono; fit and non-fit patients) or with chemotherapy [fludarabine and cyclophosphamide (FC; fit patients); chlorambucil (non-fit patients); bendamustine (any patient)]. Study endpoints were safety (primary) and efficacy (secondary). Subgroup analyses were performed on prognostic biomarkers in 1L CLL. Overall, 630 patients received 1L and 341 received R/R CLL treatment. At the final analysis, no new safety signals were observed [Grade ≥ 3 adverse events (AEs): 1L 82·7%, R/R 84·5%; serious AEs: 1L 58·1%, R/R 62·5%]. Neutropenia (1L 50·5%, R/R 53·4%) and thrombocytopenia (1L 14·6%, R/R 19·1%) were the most common Grade 3-5 AEs. G-mono-, G-bendamustine and G-FC-treated patients with unmutated immunoglobulin heavy chain trended towards shorter progression-free survival. Achievement of minimal residual disease negativity was greatest in 1L patients treated with G-FC. In this final analysis of the GREEN trial, the safety profile of G was consistent with current risk management strategies. Biomarker analyses supported efficacy in the specific subgroups.
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Affiliation(s)
- Stephan Stilgenbauer
- Department of Internal Medicine III, Ulm University, Ulm and Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Francesc Bosch
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Osman Ilhan
- Internal Medical Sciences Departments, Ankara University School of Medicine, Ankara, Turkey
| | - Jens Kisro
- Onkologische Schwerpunktpraxis Lübeck, Lübeck, Germany
| | - Béatrice Mahé
- Clinical Hematology, CHU Nantes Hôtel-Dieu, Nantes, France
| | - Eva Mikuskova
- Department of Hemato-oncology II, National Cancer Institute, Bratislava, Slovakia Blokhin
| | - Dzhelil Osmanov
- Cancer Research Center, Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Gianluigi Reda
- UOC Ematologia - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Sue Robinson
- QEII Health Sciences Centre, Halifax, NS, Canada
| | - Eugen Tausch
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Mehmet Turgut
- Department of Internal Medical Sciences, Ondokuz Mayis University, Samsun, Turkey
| | - Marcin Wójtowicz
- Clinical Department of Hematology, Hematological Oncology and Internal Diseases, Szpital Wojewodski, Opole, Poland
| | - Sebastian Böttcher
- Department III of Internal Medicine, Rostock University Medical Center, Rostock (current affiliation) and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Thomas Perretti
- PDB Biostatistics -Medical Affairs, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Peter Trask
- Patient Centered Outcomes Research, Genentech Inc, South San Francisco, CA, USA
| | - Marlies Van Hoef
- Global Product Development - Medical Affairs, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Véronique Leblond
- Clinical Hematology, Sorbonne Université, AP-HP Hôpital Pitié Salpêtrière, Paris, France
| | - Robin Foà
- Division of Hematology, Sapienza University, Rome, Italy
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3
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Mustafa S, Yassin A, Mohammed N, Shamoon R, Karam M, Mohammad S, Abdulrahman L, Ahmed Z, Rashid B, Mahmood T, Yousif R, Hasan K, Mohamed Z, Getta H, Jalal S, Abdullah D, Abdulla B, Numan G, Karadagh R. Long-term survival after fludarabine, cyclophosphamide, and rituximab treatment in previously untreated chronic lymphocytic leukemia patients. IRAQI JOURNAL OF HEMATOLOGY 2021. [DOI: 10.4103/ijh.ijh_22_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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4
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Szoltysek K, Ciardullo C, Zhou P, Walaszczyk A, Willmore E, Rand V, Marshall S, Hall A, J. Harrison C, Eswaran J, Soundararajan M. DAP Kinase-Related Apoptosis-Inducing Protein Kinase 2 (DRAK2) Is a Key Regulator and Molecular Marker in Chronic Lymphocytic Leukemia. Int J Mol Sci 2020; 21:ijms21207663. [PMID: 33081245 PMCID: PMC7593912 DOI: 10.3390/ijms21207663] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is the most common adult leukemia in the Western World and it is characterized by a marked degree of clinical heterogeneity. An impaired balance between pro- and anti-apoptotic stimuli determines chemorefractoriness and outcome. The low proliferation rate of CLL cells indicates that one of the primary mechanisms involved in disease development may be an apoptotic failure. Here, we study the clinical and functional significance of DRAK2, a novel stress response kinase that plays a critical role in apoptosis, T-cell biology, and B-cell activation in CLL. We have analyzed CLL patient samples and showed that low expression levels of DRAK2 were significantly associated with unfavorable outcome in our CLL cohort. DRAK2 expression levels showed a positive correlation with the expression of DAPK1, and TGFBR1. Consistent with clinical data, the downregulation of DRAK2 in MEC-1 CLL cells strongly increased cell viability and proliferation. Further, our transcriptome data from MEC-1 cells highlighted MAPK, NF-κB, and Akt and as critical signaling hubs upon DRAK2 knockdown. Taken together, our results indicate DRAK2 as a novel marker of CLL survival that plays key regulatory roles in CLL prognosis.
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MESH Headings
- Aged
- Apoptosis Regulatory Proteins/genetics
- Apoptosis Regulatory Proteins/metabolism
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Cell Proliferation
- Cell Survival
- Death-Associated Protein Kinases/genetics
- Death-Associated Protein Kinases/metabolism
- Down-Regulation
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- MAP Kinase Signaling System
- Male
- Middle Aged
- NF-kappa B/genetics
- NF-kappa B/metabolism
- Protein Serine-Threonine Kinases/genetics
- Protein Serine-Threonine Kinases/metabolism
- Proto-Oncogene Proteins c-akt/genetics
- Proto-Oncogene Proteins c-akt/metabolism
- Receptor, Transforming Growth Factor-beta Type I/genetics
- Receptor, Transforming Growth Factor-beta Type I/metabolism
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Affiliation(s)
- Katarzyna Szoltysek
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (K.S.); (C.C.); (E.W.); (A.H.); (C.J.H.)
- Maria Skłodowska-Curie Institute, Oncology Center, Gliwice Branch, 02-034 Gliwice, Poland
| | - Carmela Ciardullo
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (K.S.); (C.C.); (E.W.); (A.H.); (C.J.H.)
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Peixun Zhou
- School of Health & Life Sciences, Teesside University, Middlesbrough TS1 3JN, UK; (P.Z.); (V.R.)
- National Horizons Centre, Teesside University, Darlington DL1 1HG, UK
| | - Anna Walaszczyk
- Institute of Biosciences, International Centre for Life, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - Elaine Willmore
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (K.S.); (C.C.); (E.W.); (A.H.); (C.J.H.)
| | - Vikki Rand
- School of Health & Life Sciences, Teesside University, Middlesbrough TS1 3JN, UK; (P.Z.); (V.R.)
- National Horizons Centre, Teesside University, Darlington DL1 1HG, UK
| | - Scott Marshall
- Department of Haematology, City Hospitals Sunderland NHS Trust, Sunderland SR4 7TP, UK;
| | - Andy Hall
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (K.S.); (C.C.); (E.W.); (A.H.); (C.J.H.)
| | - Christine J. Harrison
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (K.S.); (C.C.); (E.W.); (A.H.); (C.J.H.)
| | - Jeyanthy Eswaran
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (K.S.); (C.C.); (E.W.); (A.H.); (C.J.H.)
- Newcastle University Medicine Malaysia (NUMed Malaysia), EduCity, Iskandar 79200, Johor, Malaysia
- Correspondence: or (J.E); (M.S.)
| | - Meera Soundararajan
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
- Correspondence: or (J.E); (M.S.)
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5
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Herling CD, Cymbalista F, Groß-Ophoff-Müller C, Bahlo J, Robrecht S, Langerbeins P, Fink AM, Al-Sawaf O, Busch R, Porcher R, Cazin B, Dreyfus B, Ibach S, Leprêtre S, Fischer K, Kaiser F, Eichhorst B, Wentner CM, Hoechstetter MA, Döhner H, Leblond V, Kneba M, Letestu R, Böttcher S, Stilgenbauer S, Hallek M, Levy V. Early treatment with FCR versus watch and wait in patients with stage Binet A high-risk chronic lymphocytic leukemia (CLL): a randomized phase 3 trial. Leukemia 2020; 34:2038-2050. [PMID: 32071431 PMCID: PMC7387319 DOI: 10.1038/s41375-020-0747-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 01/20/2020] [Accepted: 02/06/2020] [Indexed: 02/04/2023]
Abstract
We report a randomized prospective phase 3 study (CLL7), designed to evaluate the efficacy of fludarabine, cyclophosphamide, and rituximab (FCR) in patients with an early-stage high-risk chronic lymphocytic leukemia (CLL). Eight hundred patients with untreated-stage Binet A disease were enrolled as intent-to-treat population and assessed for four prognostic markers: lymphocyte doubling time <12 months, serum thymidine kinase >10 U/L, unmutated IGHV genes, and unfavorable cytogenetics (del(11q)/del(17p)/trisomy 12). Two hundred and one patients with ≥2 risk features were classified as high-risk CLL and 1:1 randomized to receive either immediate therapy with 6xFCR (Hi-FCR, 100 patients), or to be observed according to standard of care (Hi-W&W, 101 patients). The overall response rate after early FCR was 92.7%. Common adverse events were hematological toxicities and infections (61.0%/41.5% of patients, respectively). After median observation time of 55.6 (0-99.2) months, event-free survival was significantly prolonged in Hi-FCR compared with Hi-W&W patients (median not reached vs. 18.5 months, p < 0.001). There was no significant overall survival benefit for high-risk patients receiving early FCR therapy (5-year OS 82.9% in Hi-FCR vs. 79.9% in Hi-W&W, p = 0.864). In conclusion, although FCR is efficient to induce remissions in the Binet A high-risk CLL, our data do not provide evidence that alters the current standard of care "watch and wait" for these patients.
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Affiliation(s)
- Carmen D Herling
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany.
| | - Florence Cymbalista
- Hopital Avicenne, Assistance Publique-Hopitaux de Paris (AP-HP), Service d'Hematologie Biologique, Bobigny, France
| | - Carolin Groß-Ophoff-Müller
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Raymonde Busch
- Institute for Medical Statistics and Epidemiology, Technical University, Munich, Germany
| | - Raphael Porcher
- Center of Clinical Epidemiology, Hopital Hotel-Dieu, Paris, France
| | - Bruno Cazin
- Service de Maladies du Sang, CHU Claude Huriez, Lille Cedex, France
| | | | - Stefan Ibach
- WiSP Wissenschaftlicher Service Pharma GmbH, Langenfeld, Germany
| | - Stéphane Leprêtre
- Inserm Unit U1245 and Department of Hematology, Cancer Centre Henri Becquerel and Normandie University Rouen, Rouen, France
| | - Kirsten Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Florian Kaiser
- Day Clinic Hematology Oncology Palliative Care, Landshut, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Clemens-Martin Wentner
- Department of Hematology Oncology, Immunology, Palliative Medicine, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | - Manuela A Hoechstetter
- Department of Hematology Oncology, Immunology, Palliative Medicine, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Veronique Leblond
- Department of Haematology, Hopital de la Pitie-Salpetriere, Paris, France
| | - Michael Kneba
- Second Department of Medicine, University of Schleswig-Holstein, Kiel, Germany
| | - Remi Letestu
- Hopital Avicenne, Assistance Publique-Hopitaux de Paris (AP-HP), Service d'Hematologie Biologique, Bobigny, France
| | - Sebastian Böttcher
- Second Department of Medicine, University of Schleswig-Holstein, Kiel, Germany
- Department of Hematology, Oncology and Palliative Medicine, Center for Internal Medicine, University of Rostock, Rostock, Germany
| | | | - Michael Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
- Cluster of Excellence on Cellular Stress Responses in Aging-associated Diseases (CECAD), Cologne, Germany
| | - Vincent Levy
- Unite de Recherche Clinique, Hopital Avicenne, Bobigny, France
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6
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Huang SJ, Gerrie AS, Young S, Tucker T, Bruyere H, Hrynchak M, Galbraith P, Al Tourah AJ, Dueck G, Noble MC, Ramadan KM, Tsang P, Hardy E, Sehn L, Toze CL. Comparison of real-world treatment patterns in chronic lymphocytic leukemia management before and after availability of ibrutinib in the province of British Columbia, Canada. Leuk Res 2020; 91:106335. [PMID: 32114372 DOI: 10.1016/j.leukres.2020.106335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
We performed a retrospective study comparing treatment patterns and overall survival (OS) in chronic lymphocytic leukemia (CLL) patients with the advent of ibrutinib to provide current real-world data. METHODS Using a provincial population-based database, we analyzed CLL patients who received upfront treatment in British Columbia before ibrutinib availability (1984-2014), during ibrutinib access for: relapse only (2014-2015) and for upfront treatment of patients (with 17p deletion or unfit for chemotherapy) (2015-2016). Analysis included up to third-line treatment. RESULTS Of 1729 patients meeting inclusion criteria (median age, 66 years; 1466, period 1; 140, period 2; 123, period 3), FR was the most common first-line therapy (35.8 %, 54.3 % and 40.7 %, periods 1-3, respectively) and 18.7 % received ibrutinib upfront in period 3. The most common therapies in relapse were chemoimmunotherapy (36.1 % and 55.6 %, periods 1 and 2, second-line; 29.2 %, period 1, third-line) and ibrutinib (69.8 %, period 3, second-line; 46.4 % and 70.3 %, periods 2 and 3, third-line). OS improved for patients treated in periods 2-3 over period 1 (median OS not reached vs. 11.9 years, p < 0.001; no difference in OS for periods 2-3, p = 0.385). CONCLUSION Ibrutinib has replaced chemoimmunotherapy as the preferred therapy in relapse. Overall survival has improved over time with access to ibrutinib.
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Affiliation(s)
- Steven J Huang
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Canada
| | - Alina S Gerrie
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Canada; British Columbia Cancer - Vancouver, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean Young
- Pathology and Laboratory Medicine, British Columbia Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tracy Tucker
- Pathology and Laboratory Medicine, British Columbia Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Helene Bruyere
- Division of Pathology and Laboratory Medicine, Cytogenetics Laboratory, Vancouver General Hospital, University of British Columbia, Canada
| | - Monica Hrynchak
- Molecular Cytogenetic Laboratory, Royal Columbian Hospital, University of British Columbia, New Westminster, British Columbia, Canada
| | - Paul Galbraith
- British Columbia Cancer - Abbotsford, University of British Columbia, Abbotsford, British Columbia, Canada
| | - Abdulwahab J Al Tourah
- British Columbia Cancer - Surrey, University of British Columbia, Surrey, British Columbia, Canada
| | - Gregory Dueck
- British Columbia Cancer - Kelowna, University of British Columbia, Kelowna, British Columbia, Canada
| | - Michael C Noble
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Khaled M Ramadan
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Tsang
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Canada; Richmond Hospital, Richmond, British Columbia, Canada
| | - Edward Hardy
- Tom McMurty & Peter Baerg Cancer Centre, Vernon Jubilee Hospital, Vernon, British Columbia, Canada
| | - Laurie Sehn
- British Columbia Cancer - Vancouver, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cynthia L Toze
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Canada; British Columbia Cancer - Vancouver, University of British Columbia, Vancouver, British Columbia, Canada.
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7
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Risnik D, Colado A, Podaza E, Almejún MB, Elías EE, Bezares RF, Fernández-Grecco H, Seija N, Oppezzo P, Borge M, Gamberale R, Giordano M. Immunoregulatory effects of Lurbinectedin in chronic lymphocytic leukemia. Cancer Immunol Immunother 2020; 69:813-824. [PMID: 32055920 DOI: 10.1007/s00262-020-02513-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/02/2020] [Indexed: 12/17/2022]
Abstract
Despite significant therapeutic improvements chronic lymphocytic leukemia (CLL) remains an incurable disease and there is a persistent pursuit of new treatment alternatives. Lurbinectedin, a selective inhibitor of active transcription of protein-coding genes, is currently in phase II/III clinical trials for solid tumors such as small-cell lung cancer (SCLC). In this study, we aimed to evaluate the activity of Lurbinectedin on circulating mononuclear cells from CLL patients and to determine whether Lurbinectedin could affect the cross-talk between B-CLL cells and the tumor microenvironment. We found that Lurbinectedin induced a dose- and time-dependent death in all cell types evaluated, with B cells, monocytes and monocytic myeloid derived suppressor cells (Mo-MDSC) being the most susceptible populations. At sub-apoptotic doses, Lurbinectedin decreased the expression of CCR7 in B-CLL cells and impaired their migration towards CCL19 and CCL21. Furthermore, low concentrations of Lurbinectedin stimulated the synthesis of pro-IL1β in monocytes and nurse-like cells, without inducing the inflammasome activation. Altogether, these results indicate that Lurbinectedin might have antitumor activity in CLL due to its direct action on leukemic cells in combination with its effects on the tumor microenvironment. Our findings encourage further investigation of Lurbinectedin as a potential therapy for CLL.
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Affiliation(s)
- Denise Risnik
- Laboratorio de Inmunología Oncológica, Instituto de Medicina Experimental (IMEX), CONICET-Academia Nacional de Medicina (ANM), Pacheco de Melo 3081, 1425, Buenos Aires, Argentina.
| | - Ana Colado
- Laboratorio de Inmunología Oncológica, Instituto de Medicina Experimental (IMEX), CONICET-Academia Nacional de Medicina (ANM), Pacheco de Melo 3081, 1425, Buenos Aires, Argentina
| | - Enrique Podaza
- Laboratorio de Inmunología Oncológica, Instituto de Medicina Experimental (IMEX), CONICET-Academia Nacional de Medicina (ANM), Pacheco de Melo 3081, 1425, Buenos Aires, Argentina
| | - María Belén Almejún
- Laboratorio de Inmunología Oncológica, Instituto de Medicina Experimental (IMEX), CONICET-Academia Nacional de Medicina (ANM), Pacheco de Melo 3081, 1425, Buenos Aires, Argentina
| | - Esteban Enrique Elías
- Laboratorio de Inmunología Oncológica, Instituto de Medicina Experimental (IMEX), CONICET-Academia Nacional de Medicina (ANM), Pacheco de Melo 3081, 1425, Buenos Aires, Argentina
| | | | | | - Noé Seija
- Laboratorio de Leucemia Linfocítica Crónica, Institut Pasteur Montevideo, Montevideo, Uruguay
| | - Pablo Oppezzo
- Laboratorio de Leucemia Linfocítica Crónica, Institut Pasteur Montevideo, Montevideo, Uruguay
| | - Mercedes Borge
- Laboratorio de Inmunología Oncológica, Instituto de Medicina Experimental (IMEX), CONICET-Academia Nacional de Medicina (ANM), Pacheco de Melo 3081, 1425, Buenos Aires, Argentina
| | - Romina Gamberale
- Laboratorio de Inmunología Oncológica, Instituto de Medicina Experimental (IMEX), CONICET-Academia Nacional de Medicina (ANM), Pacheco de Melo 3081, 1425, Buenos Aires, Argentina
| | - Mirta Giordano
- Laboratorio de Inmunología Oncológica, Instituto de Medicina Experimental (IMEX), CONICET-Academia Nacional de Medicina (ANM), Pacheco de Melo 3081, 1425, Buenos Aires, Argentina
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8
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Lee CH, Wu YY, Huang TC, Lin C, Zou YF, Cheng JC, Ho CL. Maintenance therapy for chronic lymphocytic leukaemia. Hippokratia 2019. [DOI: 10.1002/14651858.cd013474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Cho-Hao Lee
- Tri-Service General Hospital, National Defense Medical Center; Division of Hematology and Oncology Medicine, Department of Internal Medicine; No.325, Sec. 2, Chenggong Rd.,Neihu Dist., Taipei City 114, Taiwan (R.O.C.) Taipei Taiwan Taiwan 114
| | - Yi-Ying Wu
- Tri-Service General Hospital, National Defense Medical Center; Division of Hematology and Oncology Medicine, Department of Internal Medicine; No.325, Sec. 2, Chenggong Rd.,Neihu Dist., Taipei City 114, Taiwan (R.O.C.) Taipei Taiwan Taiwan 114
| | - Tzu-Chuan Huang
- Tri-Service General Hospital, National Defense Medical Center; Division of Hematology and Oncology Medicine, Department of Internal Medicine; No.325, Sec. 2, Chenggong Rd.,Neihu Dist., Taipei City 114, Taiwan (R.O.C.) Taipei Taiwan Taiwan 114
| | - Chin Lin
- National Defense Medical Center; School of Public Health; No.325, Sec. 2, Chenggong Rd.,Neihu Dist., Taipei City 114, Taiwan (R.O.C.) Taipei Taipei Taiwan 114
| | - Yi-Fen Zou
- Tri-Service General Hospital, National Defense Medical Center; Department of Pharmacy; No.325, Sec. 2, Chenggong Rd.,Neihu Dist., Taipei City 114, Taiwan (R.O.C.) Taipei Taipei Taiwan 114
| | - Ju-Chun Cheng
- Tri-Service General Hospital, National Defense Medical Center; Department of Pharmacy; No.325, Sec. 2, Chenggong Rd.,Neihu Dist., Taipei City 114, Taiwan (R.O.C.) Taipei Taipei Taiwan 114
| | - Ching-Liang Ho
- Tri-Service General Hospital, National Defense Medical Center; Division of Hematology and Oncology Medicine, Department of Internal Medicine; No.325, Sec. 2, Chenggong Rd.,Neihu Dist., Taipei City 114, Taiwan (R.O.C.) Taipei Taiwan Taiwan 114
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9
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Abstract
Assays that measure DNA damage and repair are critical in evaluating the extent to which therapeutic agents damage DNA and in identifying whether DNA repair can limit the toxicity of chemotherapy. The COMET assays described in this guide should help readers evaluate single and double-strand breaks cause by chemotherapeutic agents and also monitor the ability of the cells to repair such damage. The EJDR assay described is a valuable tool to assess the ability of drugs and DNA repair proteins to modulate DNA repair capacity. Finally, the immunofluorescence assay described should allow accurate assessments of DNA damage and the kinetics of repair as measured by Ɣ-H2AX foci. This procedure can also be used to mechanistically investigate the recruitment of specific DNA damage and repair proteins in CLL cells.
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Affiliation(s)
- Tzung-Huei Lai
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Deepa Sampath
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA.
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10
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Evers M, Jak M, Leusen JHW. The latest developments with anti-CD20 monoclonal antibodies in chronic lymphocytic leukemia. Expert Opin Biol Ther 2018; 18:973-982. [DOI: 10.1080/14712598.2018.1508444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mitchell Evers
- Laboratory of Translational Immunology, UMC Utrecht, Utrecht, the Netherlands
| | - Margot Jak
- Department of Hematology, UMC Utrecht, Utrecht, the Netherlands
| | - J. H. W. Leusen
- Laboratory of Translational Immunology, UMC Utrecht, Utrecht, the Netherlands
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11
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Bordron A, Bagacean C, Mohr A, Tempescul A, Bendaoud B, Deshayes S, Dalbies F, Buors C, Saad H, Berthou C, Pers JO, Renaudineau Y. Resistance to complement activation, cell membrane hypersialylation and relapses in chronic lymphocytic leukemia patients treated with rituximab and chemotherapy. Oncotarget 2018; 9:31590-31605. [PMID: 30167081 PMCID: PMC6114972 DOI: 10.18632/oncotarget.25657] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 06/04/2018] [Indexed: 01/27/2023] Open
Abstract
The anti-CD20-specific monoclonal antibody rituximab (RTX), in combination with chemotherapy, is commonly used for primary treatment in chronic lymphocytic leukemia (CLL). However, relapses remain important and activation of the complement pathway is one of the mechanisms by which RTX generates the destruction of B cells directly by complement-dependent cytotoxicity (CDC), or indirectly by antibody-dependent cellular phagocytosis. In this study, the RTX capacity to induce CDC was established in 69 untreated CLL patients, this cohort including 34 patients tested before the initiation of RTX-chemotherapy. In vitro CDC-resistance to RTX predicts lower response rates to RTX-chemotherapy and shorter treatment free survival. Furthermore, the predictive value of CDC-resistance was independent from the clinical, cytogenetic and FcγR3A V158F polymorphism status. In contrast, CLL cell resistance to CDC predominates in IGHV unmutated patients and was related to an important α2-6 sialyl transferase activity, which in turn increases cell surface α2-6 hypersialylation. Suspected factors associated with resistance to CDC (CD20, CD55, CD59, factor H, GM1, and sphingomyelin) were not differentially expressed or recruited between the two CLL groups. Altogether, results provide evidence that testing RTX capacity to induce CDC in vitro represents an independent predictive factor of therapeutic effects of RTX, and that α2-6 hypersialylation in CLL cells controls RTX response through the control of the complement pathway. At a time when CLL therapy is moving towards chemo-free treatments, further experiments are required to determine whether performing an initial in vitro assay to appreciate CLL CDC resistance might be useful to select patients.
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Affiliation(s)
- Anne Bordron
- U1227 B Lymphocytes and Autoimmunity, Université de Brest, INSERM, IBSAM, Labex IGO, Networks IC-CGO and REpiCGO from 'Canceropole Grand Ouest, Brest, France
| | - Cristina Bagacean
- U1227 B Lymphocytes and Autoimmunity, Université de Brest, INSERM, IBSAM, Labex IGO, Networks IC-CGO and REpiCGO from 'Canceropole Grand Ouest, Brest, France.,Laboratory of Immunology and Immunotherapy, CHRU Brest, Hôpital Morvan, Brest, France
| | - Audrey Mohr
- U1227 B Lymphocytes and Autoimmunity, Université de Brest, INSERM, IBSAM, Labex IGO, Networks IC-CGO and REpiCGO from 'Canceropole Grand Ouest, Brest, France
| | - Adrian Tempescul
- U1227 B Lymphocytes and Autoimmunity, Université de Brest, INSERM, IBSAM, Labex IGO, Networks IC-CGO and REpiCGO from 'Canceropole Grand Ouest, Brest, France.,Department of Haematology, CHRU Brest, Hôpital Morvan, Brest, France
| | - Boutahar Bendaoud
- U1227 B Lymphocytes and Autoimmunity, Université de Brest, INSERM, IBSAM, Labex IGO, Networks IC-CGO and REpiCGO from 'Canceropole Grand Ouest, Brest, France.,Laboratory of Immunology and Immunotherapy, CHRU Brest, Hôpital Morvan, Brest, France
| | - Stéphanie Deshayes
- U1227 B Lymphocytes and Autoimmunity, Université de Brest, INSERM, IBSAM, Labex IGO, Networks IC-CGO and REpiCGO from 'Canceropole Grand Ouest, Brest, France
| | - Florence Dalbies
- Department of Haematology, CHRU Brest, Hôpital Morvan, Brest, France
| | - Caroline Buors
- Laboratory of Haematology, CHRU Brest, Hôpital Morvan, Brest, France
| | - Hussam Saad
- Department of Haematology, CHRU Brest, Hôpital Morvan, Brest, France
| | - Christian Berthou
- U1227 B Lymphocytes and Autoimmunity, Université de Brest, INSERM, IBSAM, Labex IGO, Networks IC-CGO and REpiCGO from 'Canceropole Grand Ouest, Brest, France.,Department of Haematology, CHRU Brest, Hôpital Morvan, Brest, France
| | - Jacques-Olivier Pers
- U1227 B Lymphocytes and Autoimmunity, Université de Brest, INSERM, IBSAM, Labex IGO, Networks IC-CGO and REpiCGO from 'Canceropole Grand Ouest, Brest, France
| | - Yves Renaudineau
- U1227 B Lymphocytes and Autoimmunity, Université de Brest, INSERM, IBSAM, Labex IGO, Networks IC-CGO and REpiCGO from 'Canceropole Grand Ouest, Brest, France.,Laboratory of Immunology and Immunotherapy, CHRU Brest, Hôpital Morvan, Brest, France
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12
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Stadnik EA, Strugov VV, Andreeva TO, Virts YV, Rumyantsev AM, Mirolyubova YV, Butylin PA, Zaritsky AY. [Efficacy of a bendamustine and rituximab combination in first-line therapy for chronic lymphocytic leukemia: Results of the BEN-001 study]. TERAPEVT ARKH 2017; 89:57-64. [PMID: 28766542 DOI: 10.17116/terarkh201789757-64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To evaluate the efficacy and safety of the BR regimen containing bendamustine in patients with chronic lymphocytic leukemia (CLL) who have not previously received specific therapy. SUBJECTS AND METHODS The results of the Russian prospective observational multicenter study BEN-001 (2012-2015) covering 196 CLL patients from 34 centers of the Russian Federation were analyzed. The diagnosis was confirmed by the results of peripheral blood lymphocyte immunophenotyping. A centralized approach was employed to make IGHV gene mutational status analysis, FISH examination, and minimal residual disease according to standardized methods. Quality-of-life (QOL) indicators were estimated using the EQ-5D and FACT-Leu questionnaires. Survival rates were calculated applying by the Kaplan-Meier method. RESULTS The patients' median age was 61 years. 41% of patients had a decline in estimated creatinine clearance less than 70 ml/min/1.73 m2. The combination of bendamustine and rituximab could achieve a common response in 83.2% of the patients, including complete remission in 59.7%. Eradication of minimal residual disease was achieved in 23 (27.4%) of 84 patients. Two-year progression-free survival rates were 85.9%. The QOL indicators were noted to be improved during the treatment. CONCLUSION The investigation shows the good tolerability of bendamustine when it is used in clinical practice. Due to the high cost of new drugs (ibrutinib, obinutuzumab, ofatumumab, etc.) and toxicity of the FCR regimen, the combination including bendamustine can be the best first-line therapy option for all CLL patients, regardless of their age and comorbidity.
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Affiliation(s)
- E A Stadnik
- Institute of Hematology, V.A. Almazov North-Western Federal Medical Research Center, Ministry of Health of Russia, Saint Petersburg, Russia
| | - V V Strugov
- Institute of Hematology, V.A. Almazov North-Western Federal Medical Research Center, Ministry of Health of Russia, Saint Petersburg, Russia
| | - T O Andreeva
- Institute of Hematology, V.A. Almazov North-Western Federal Medical Research Center, Ministry of Health of Russia, Saint Petersburg, Russia
| | - Yu V Virts
- Institute of Hematology, V.A. Almazov North-Western Federal Medical Research Center, Ministry of Health of Russia, Saint Petersburg, Russia
| | - A M Rumyantsev
- Institute of Hematology, V.A. Almazov North-Western Federal Medical Research Center, Ministry of Health of Russia, Saint Petersburg, Russia
| | - Yu V Mirolyubova
- Institute of Hematology, V.A. Almazov North-Western Federal Medical Research Center, Ministry of Health of Russia, Saint Petersburg, Russia
| | - P A Butylin
- Institute of Hematology, V.A. Almazov North-Western Federal Medical Research Center, Ministry of Health of Russia, Saint Petersburg, Russia
| | - A Yu Zaritsky
- Institute of Hematology, V.A. Almazov North-Western Federal Medical Research Center, Ministry of Health of Russia, Saint Petersburg, Russia
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13
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CAR T Cell Therapy in Acute Lymphoblastic Leukemia and Potential for Chronic Lymphocytic Leukemia. Curr Treat Options Oncol 2017; 17:28. [PMID: 27098534 DOI: 10.1007/s11864-016-0406-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OPINION STATEMENT Adoptive transfer of autologous T cells engineered to express a chimeric antigen receptor (CAR) represents a powerful targeted immunotherapy that has shown great promise in some of the most refractory leukemias. CAR-modified T cells directed against CD19 have led the way, setting a high standard with remission rates as high as 90 % in clinical trials for relapsed/refractory acute lymphoblastic leukemia (ALL). Yet, the first demonstration of efficacy was in another disease, chronic lymphocytic leukemia (CLL), in which CD19-targeted CAR T cells eradicated bulky, highly refractory disease. Despite early encouraging results, clinical trials in CLL have yielded lower response rates, revealing disease-specific differences in response in this form of immunotherapy. Ongoing research focused on identifying and overcoming these limitations, promises to improve response rates. Beyond the induction of remission, the transformative impact of engineered T cell therapy lies in its potential for long-term disease control. With longer follow-up and durable T cell persistence now reported, we are closer to answering the question of whether sustained remissions are possible with CAR T cell monotherapy. As might be expected with a highly effective therapy using a single mechanism of action, escape pathways have emerged. Combinatorial approaches are needed to anticipate and prevent this mode of relapse. Lastly, toxicity management is vital to ensure the safety of this exciting cancer immunotherapy.
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14
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Knittel G, Rehkämper T, Korovkina D, Liedgens P, Fritz C, Torgovnick A, Al-Baldawi Y, Al-Maarri M, Cun Y, Fedorchenko O, Riabinska A, Beleggia F, Nguyen PH, Wunderlich FT, Ortmann M, Montesinos-Rongen M, Tausch E, Stilgenbauer S, P Frenzel L, Herling M, Herling C, Bahlo J, Hallek M, Peifer M, Buettner R, Persigehl T, Reinhardt HC. Two mouse models reveal an actionable PARP1 dependence in aggressive chronic lymphocytic leukemia. Nat Commun 2017; 8:153. [PMID: 28751718 PMCID: PMC5532225 DOI: 10.1038/s41467-017-00210-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 06/13/2017] [Indexed: 12/11/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) remains an incurable disease. Two recurrent cytogenetic aberrations, namely del(17p), affecting TP53, and del(11q), affecting ATM, are associated with resistance against genotoxic chemotherapy (del17p) and poor outcome (del11q and del17p). Both del(17p) and del(11q) are also associated with inferior outcome to the novel targeted agents, such as the BTK inhibitor ibrutinib. Thus, even in the era of targeted therapies, CLL with alterations in the ATM/p53 pathway remains a clinical challenge. Here we generated two mouse models of Atm- and Trp53-deficient CLL. These animals display a significantly earlier disease onset and reduced overall survival, compared to controls. We employed these models in conjunction with transcriptome analyses following cyclophosphamide treatment to reveal that Atm deficiency is associated with an exquisite and genotype-specific sensitivity against PARP inhibition. Thus, we generate two aggressive CLL models and provide a preclinical rational for the use of PARP inhibitors in ATM-affected human CLL. ATM and TP53 mutations are associated with poor prognosis in chronic lymphocytic leukaemia (CLL). Here the authors generate mouse models of Tp53- and Atm-defective CLL mimicking the high-risk form of human disease and show that Atm-deficient CLL is sensitive to PARP1 inhibition.
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Affiliation(s)
- Gero Knittel
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany. .,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany. .,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany.
| | - Tim Rehkämper
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Darya Korovkina
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Paul Liedgens
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Christian Fritz
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Alessandro Torgovnick
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Yussor Al-Baldawi
- Department of Radiology, Medical Faculty, University Hospital of Cologne, Cologne, 50931, Germany
| | - Mona Al-Maarri
- Max-Planck-Institute for Metabolism Research, Cologne, 50931, Germany
| | - Yupeng Cun
- Department of Translational Genomics, University of Cologne, Cologne, 50931, Germany
| | - Oleg Fedorchenko
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Arina Riabinska
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Filippo Beleggia
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Phuong-Hien Nguyen
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | | | - Monika Ortmann
- Institute of Pathology, University Hospital of Cologne, Cologne, 50931, Germany
| | | | - Eugen Tausch
- Department of Internal Medicine III, Ulm University, Ulm, 89070, Germany
| | | | - Lukas P Frenzel
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Marco Herling
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany.,Center of Molecular Medicine, University of Cologne, Cologne, 50931, Germany
| | - Carmen Herling
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Jasmin Bahlo
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany
| | - Michael Hallek
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Martin Peifer
- Department of Translational Genomics, University of Cologne, Cologne, 50931, Germany
| | - Reinhard Buettner
- Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany.,Institute of Pathology, University Hospital of Cologne, Cologne, 50931, Germany
| | - Thorsten Persigehl
- Department of Radiology, Medical Faculty, University Hospital of Cologne, Cologne, 50931, Germany
| | - H Christian Reinhardt
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany. .,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany. .,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany. .,Center of Molecular Medicine, University of Cologne, Cologne, 50931, Germany.
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15
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Olin JL, Griffiths CL, Smith MB. Venetoclax: A novel B-cell lymphoma-2 inhibitor for chronic lymphocytic leukemia and other hematologic malignancies. J Oncol Pharm Pract 2017; 24:517-524. [DOI: 10.1177/1078155217718383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Patients with chronic lymphocytic leukemia with the 17p deletion have a poor prognosis and treatment options are limited. Venetoclax, a novel B-cell lymphoma-2 inhibitor, has been approved for treatment-experienced chronic lymphocytic leukemia patients with the 17p deletion. A phase 1 dose-escalation study to 400 mg daily showed overall response rates across all doses of 79% with a complete response achieved in 20%. A phase 2 multicenter open-label study demonstrated overall response rate of 79.4% of patients (95% confidence interval 70.5–86.6) with median duration of follow-up of 12.1 months (IQR 10.1-14.2). Tumor lysis syndrome has been observed during initiation and titration. Assessing risk of tumor lysis syndrome prior to therapy initiation is essential to provide appropriate prophylactic medications. Neutropenia, potentially warranting dose reduction or discontinuation, has been observed. Venetoclax has demonstrated activity in other leukemias, multiple myeloma, and lymphomas. Venetoclax has shown response, and is well tolerated in patients with highly resistant chronic lymphocytic leukemia. It has the potential to be part of the treatment armamentarium for other malignancies.
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Affiliation(s)
- Jacqueline L Olin
- Levine College of Health Sciences, Wingate University School of Pharmacy, Wingate, NC, USA
| | - Carrie L Griffiths
- Levine College of Health Sciences, Wingate University School of Pharmacy, Wingate, NC, USA
| | - Morgan B Smith
- Hematology/Oncology, Novant Health Presbyterian Medical Center, Charlotte, NC, USA
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16
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Bagacean C, Zdrenghea M, Tempescul A, Cristea V, Renaudineau Y. Anti-CD20 monoclonal antibodies in chronic lymphocytic leukemia: from uncertainties to promises. Immunotherapy 2017; 8:569-81. [PMID: 27140410 DOI: 10.2217/imt-2015-0015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Over the last two decades, anti-CD20 monoclonal antibody (mAb) therapy has improved patient outcome in B-cell malignancies, and confirmed CD20 as an important target in chronic lymphocytic leukemia (CLL). Until recently, the gold standard was based on the utilization of rituximab combined with chemotherapy (fludarabine and cyclophosphamide), but patients often relapse. Next, with our better understanding of mAb engineering, anti-CD20 mAb therapy has evolved with the development of new mAb permitting significant clinical responses by improving pharmacokinetics, safety, activity and immunogenicity. Last but not least, the development of key tumoral tyrosine kinase inhibitors and their association with anti-CD20 mAb is a work in progress with promising results.
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Affiliation(s)
- Cristina Bagacean
- Research Unit INSERM ESPRI, ERI29/EA2216 Immunotherapy & B Cell Diseases, Réseau épigénétique et Réseau canaux ioniques du Cancéropôle Grand Ouest, Labex IGO, European University of Brittany, Brest, France.,'Iuliu Hatieganu' University of Medicine & Pharmacy, 8 Babes Street, 400012, Cluj-Napoca, Romania
| | - Mihnea Zdrenghea
- 'Iuliu Hatieganu' University of Medicine & Pharmacy, 8 Babes Street, 400012, Cluj-Napoca, Romania.,'Ion Chiricuta' Institute of Oncology, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Adrian Tempescul
- Research Unit INSERM ESPRI, ERI29/EA2216 Immunotherapy & B Cell Diseases, Réseau épigénétique et Réseau canaux ioniques du Cancéropôle Grand Ouest, Labex IGO, European University of Brittany, Brest, France.,Department of Hematology, CHRU Morvan, Brest, France
| | - Victor Cristea
- 'Iuliu Hatieganu' University of Medicine & Pharmacy, 8 Babes Street, 400012, Cluj-Napoca, Romania
| | - Yves Renaudineau
- Research Unit INSERM ESPRI, ERI29/EA2216 Immunotherapy & B Cell Diseases, Réseau épigénétique et Réseau canaux ioniques du Cancéropôle Grand Ouest, Labex IGO, European University of Brittany, Brest, France.,Laboratory of Immunology & Immunotherapy, CHRU Morvan, Brest, France
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17
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Owen C, Christofides A, Johnson N, Lawrence T, MacDonald D, Ward C. Use of minimal residual disease assessment in the treatment of chronic lymphocytic leukemia. Leuk Lymphoma 2017; 58:2777-2785. [DOI: 10.1080/10428194.2017.1318439] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Carolyn Owen
- Division of Hematology and Hematological Malignancies, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
| | | | - Nathalie Johnson
- Division of Hematology, Jewish General Hospital and Departments of Medicine and Oncology, McGill University, Montreal, Quebec, Canada
| | | | - David MacDonald
- Division of Hematology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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18
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Targeting transcription-coupled nucleotide excision repair overcomes resistance in chronic lymphocytic leukemia. Leukemia 2016; 31:1177-1186. [DOI: 10.1038/leu.2016.294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 09/01/2016] [Accepted: 09/12/2016] [Indexed: 12/31/2022]
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19
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Walliser C, Hermkes E, Schade A, Wiese S, Deinzer J, Zapatka M, Désiré L, Mertens D, Stilgenbauer S, Gierschik P. The Phospholipase Cγ2 Mutants R665W and L845F Identified in Ibrutinib-resistant Chronic Lymphocytic Leukemia Patients Are Hypersensitive to the Rho GTPase Rac2 Protein. J Biol Chem 2016; 291:22136-22148. [PMID: 27542411 PMCID: PMC5063995 DOI: 10.1074/jbc.m116.746842] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/18/2016] [Indexed: 12/29/2022] Open
Abstract
Mutations in the gene encoding phospholipase C-γ2 (PLCγ2) have been shown to be associated with resistance to targeted therapy of chronic lymphocytic leukemia (CLL) with the Bruton's tyrosine kinase inhibitor ibrutinib. The fact that two of these mutations, R665W and L845F, imparted upon PLCγ2 an ∼2-3-fold ibrutinib-insensitive increase in the concentration of cytosolic Ca2+ following ligation of the B cell antigen receptor (BCR) led to the assumption that the two mutants exhibit constitutively enhanced intrinsic activity. Here, we show that the two PLCγ2 mutants are strikingly hypersensitive to activation by Rac2 such that even wild-type Rac2 suffices to activate the mutant enzymes upon its introduction into intact cells. Enhanced "basal" activity of PLCγ2 in intact cells is shown using the pharmacologic Rac inhibitor EHT 1864 and the PLCγ2F897Q mutation mediating Rac resistance to be caused by Rac-stimulated rather than by constitutively enhanced PLCγ2 activity. We suggest that R665W and L845F be referred to as allomorphic rather than hypermorphic mutations of PLCG2 Rerouting of the transmembrane signals emanating from BCR and converging on PLCγ2 through Rac in ibrutinib-resistant CLL cells may provide novel drug treatment strategies to overcome ibrutinib resistance mediated by PLCG2 mutations or to prevent its development in ibrutinib-treated CLL patients.
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MESH Headings
- Adenine/analogs & derivatives
- Amino Acid Substitution
- Animals
- COS Cells
- Chlorocebus aethiops
- Drug Resistance, Neoplasm/drug effects
- Drug Resistance, Neoplasm/genetics
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/enzymology
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Mutation, Missense
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Phospholipase C gamma/antagonists & inhibitors
- Phospholipase C gamma/genetics
- Phospholipase C gamma/metabolism
- Piperidines
- Pyrazoles/pharmacology
- Pyrimidines/pharmacology
- Pyrones/pharmacology
- Quinolines/pharmacology
- Receptors, Antigen, B-Cell/genetics
- Receptors, Antigen, B-Cell/metabolism
- Signal Transduction/drug effects
- Signal Transduction/genetics
- rac GTP-Binding Proteins/genetics
- rac GTP-Binding Proteins/metabolism
- RAC2 GTP-Binding Protein
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Affiliation(s)
| | | | - Anja Schade
- From the Institute of Pharmacology and Toxicology and
| | - Sebastian Wiese
- the Core Unit Mass Spectrometry and Proteomics, Medical Faculty, Ulm University, 89081 Ulm, Germany
| | - Julia Deinzer
- From the Institute of Pharmacology and Toxicology and
| | - Marc Zapatka
- the Division of Molecular Genetics, German Cancer Research Center (DKFZ), 69121 Heidelberg, Germany, and
| | - Laurent Désiré
- the Diaxonhit, 63-65 Boulevard Masséna, 75013 Paris, France
| | - Daniel Mertens
- Department of Internal Medicine III, Ulm University Medical Center, 89070 Ulm, Germany
| | - Stephan Stilgenbauer
- Department of Internal Medicine III, Ulm University Medical Center, 89070 Ulm, Germany
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20
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Strati P, Chaffee KG, Achenbach SJ, Slager SL, Leung N, Call TG, Ding W, Parikh SA, Kay NE, Shanafelt TD. Renal insufficiency is an independent prognostic factor in patients with chronic lymphocytic leukemia. Haematologica 2016; 102:e22-e25. [PMID: 27634202 DOI: 10.3324/haematol.2016.150706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Paolo Strati
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | | | | | - Nelson Leung
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Wei Ding
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Neil E Kay
- Mayo Clinic College of Medicine, Rochester, MN, USA
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21
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Sánchez-Ramón S, Dhalla F, Chapel H. Challenges in the Role of Gammaglobulin Replacement Therapy and Vaccination Strategies for Hematological Malignancy. Front Immunol 2016; 7:317. [PMID: 27597852 PMCID: PMC4993076 DOI: 10.3389/fimmu.2016.00317] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/05/2016] [Indexed: 12/13/2022] Open
Abstract
Patients with chronic lymphocytic leukemia (CLL) and multiple myeloma (MM) are prone to present with antibody production deficits associated with recurrent or severe bacterial infections that might benefit from human immunoglobulin (Ig) (IVIg/SCIg) replacement therapy. However, the original IVIg trial data were done before modern therapies were available, and the current indications do not take into account the shift in the immune situation of current treatment combinations and changes in the spectrum of infections. Besides, patients affected by other B cell malignancies present with similar immunodeficiency and manifestations while they are not covered by the current IVIg indications. A potential beneficial strategy could be to vaccinate patients at monoclonal B lymphocytosis and monoclonal gammopathy of undetermined significance stages (for CLL and MM, respectively) or at B-cell malignancy diagnosis, when better antibody responses are attained. We have to re-emphasize the need for assessing and monitoring specific antibody responses; these are warranted to select adequately those patients for whom early intervention with prophylactic anti-infective therapy and/or IVIg is preferred. This review provides an overview of the current scenario, with a focus on prevention of infection in patients with hematological malignancies and the role of Ig replacement therapy.
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Affiliation(s)
- Silvia Sánchez-Ramón
- Department of Clinical Immunology and IdISSC, Hospital Clínico San Carlos, Madrid, Spain; Department of Microbiology I, Complutense University School of Medicine, Madrid, Spain
| | - Fatima Dhalla
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Clinical Immunology, John Radcliffe Hospital, Headington, Oxford, UK
| | - Helen Chapel
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Clinical Immunology, John Radcliffe Hospital, Headington, Oxford, UK
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22
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Engelhard M. Anti-CD20 antibody treatment of non-Hodgkin lymphomas. Clin Immunol 2016; 172:101-104. [PMID: 27531574 DOI: 10.1016/j.clim.2016.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/05/2016] [Accepted: 08/06/2016] [Indexed: 01/01/2023]
Abstract
The CD20 antigen characteristic for mature B-cell is also expressed on B-cell Non-Hodgkin lymphomas (NHL). It thus presents a possible target for immunotherapy. NHL respond readily to radio- and/or chemotherapy but this standard treatment bears a high risk of relapse. The specific monoclonal anti-CD20-antibody Rituximab, the first to be approved for clinical use, could be shown to improve response rates, response duration, and survival in NHL when combined with standard therapy. This review details the development, clinical application, and future perspectives of anti-CD20-antibody treatment of NHL, thereby proving the efficiency of immunotherapy via targeting of a tumor associated antigen.
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23
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Bruce DR, Schuh A. Role of precision medicine in the treatment of chronic lymphocytic leukaemia. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016. [DOI: 10.1080/23808993.2016.1159510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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