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Patel K, Ivanov A, Jocelyn T, Hantel A, Garcia JS, Abel GA. Patient-Reported Outcomes in Phase 3 Clinical Trials for Blood Cancers: A Systematic Review. JAMA Netw Open 2024; 7:e2414425. [PMID: 38829615 PMCID: PMC11148691 DOI: 10.1001/jamanetworkopen.2024.14425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/01/2024] [Indexed: 06/05/2024] Open
Abstract
Importance Published research suggests that patient-reported outcomes (PROs) are neither commonly collected nor reported in randomized clinical trials (RCTs) for solid tumors. Little is known about these practices in RCTs for hematological malignant neoplasms. Objective To evaluate the prevalence of PROs as prespecified end points in RCTs of hematological malignant neoplasms, and to assess reporting of PROs in associated trial publications. Evidence Review All issues of 8 journals known for publishing high-impact RCTs (NEJM, Lancet, Lancet Hematology, Lancet Oncology, Journal of Clinical Oncology, Blood, JAMA, and JAMA Oncology) between January 1, 2018, and December 13, 2022, were searched for primary publications of therapeutic phase 3 trials for adults with hematological malignant neoplasms. Studies that evaluated pretransplant conditioning regimens, graft-vs-host disease treatment, or radiotherapy as experimental treatment were excluded. Data regarding trial characteristics and PROs were extracted from manuscripts and trial protocols. Univariable analyses assessed associations between trial characteristics and PRO collection or reporting. Findings Ninety RCTs were eligible for analysis. PROs were an end point in 66 (73%) trials: in 1 trial (1%) as a primary end point, in 50 (56%) as a secondary end point, and in 15 (17%) as an exploratory end point. PRO data were reported in 26 of 66 primary publications (39%): outcomes were unchanged in 18 and improved in 8, with none reporting worse PROs with experimental treatment. Trials sponsored by for-profit entities were more likely to include PROs as an end point (49 of 55 [89%] vs 17 of 35 [49%]; P < .001) but were not significantly more likely to report PRO data (20 of 49 [41%] vs 6 of 17 [35%]; P = .69). Compared with trials involving lymphoma (18 of 29 [62%]) or leukemia or myelodysplastic syndrome (18 of 28 [64%]), those involving plasma cell disorders or multiple myeloma (27 of 30 [90%]) or myeloproliferative neoplasms (3 of 3 [100%]) were more likely to include PROs as an end point (P = .03). Similarly, compared with trials involving lymphoma (3 of 18 [17%]) or leukemia or myelodysplastic syndrome (5 of 18 [28%]), those involving plasma cell disorders or multiple myeloma (16 of 27 [59%]) or myeloproliferative neoplasms (2 of 3 [67%]) were more likely to report PROs in the primary publication (P = .01). Conclusions and Relevance In this systematic review, almost 3 of every 4 therapeutic RCTs for blood cancers collected PRO data; however, only 1 RCT included PROs as a primary end point. Moreover, most did not report resulting PRO data in the primary publication and when reported, PROs were either better or unchanged, raising concern for publication bias. This analysis suggests a critical gap in dissemination of data on the lived experiences of patients enrolled in RCTs for hematological malignant neoplasms.
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Affiliation(s)
- Kishan Patel
- Department of Internal Medicine, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Alexandra Ivanov
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Tajmah Jocelyn
- Center for Clinical Investigation, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Andrew Hantel
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jacqueline S. Garcia
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gregory A. Abel
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
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Dabkowska A, Domka K, Firczuk M. Advancements in cancer immunotherapies targeting CD20: from pioneering monoclonal antibodies to chimeric antigen receptor-modified T cells. Front Immunol 2024; 15:1363102. [PMID: 38638442 PMCID: PMC11024268 DOI: 10.3389/fimmu.2024.1363102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/25/2024] [Indexed: 04/20/2024] Open
Abstract
CD20 located predominantly on the B cells plays a crucial role in their development, differentiation, and activation, and serves as a key therapeutic target for the treatment of B-cell malignancies. The breakthrough of monoclonal antibodies directed against CD20, notably exemplified by rituximab, revolutionized the prognosis of B-cell malignancies. Rituximab, approved across various hematological malignancies, marked a paradigm shift in cancer treatment. In the current landscape, immunotherapies targeting CD20 continue to evolve rapidly. Beyond traditional mAbs, advancements include antibody-drug conjugates (ADCs), bispecific antibodies (BsAbs), and chimeric antigen receptor-modified (CAR) T cells. ADCs combine the precision of antibodies with the cytotoxic potential of drugs, presenting a promising avenue for enhanced therapeutic efficacy. BsAbs, particularly CD20xCD3 constructs, redirect cytotoxic T cells to eliminate cancer cells, thereby enhancing both precision and potency in their therapeutic action. CAR-T cells stand as a promising strategy for combatting hematological malignancies, representing one of the truly personalized therapeutic interventions. Many new therapies are currently being evaluated in clinical trials. This review serves as a comprehensive summary of CD20-targeted therapies, highlighting the progress and challenges that persist. Despite significant advancements, adverse events associated with these therapies and the development of resistance remain critical issues. Understanding and mitigating these challenges is paramount for the continued success of CD20-targeted immunotherapies.
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Affiliation(s)
- Agnieszka Dabkowska
- Laboratory of Immunology, Mossakowski Medical Research Institute Polish Academy of Sciences, Warsaw, Poland
- Department of Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Domka
- Laboratory of Immunology, Mossakowski Medical Research Institute Polish Academy of Sciences, Warsaw, Poland
- Department of Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Malgorzata Firczuk
- Laboratory of Immunology, Mossakowski Medical Research Institute Polish Academy of Sciences, Warsaw, Poland
- Department of Immunology, Medical University of Warsaw, Warsaw, Poland
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3
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Fox CP, Chaganti S, McIlroy G, Barrington SF, Burton C, Cwynarski K, Eyre TA, Illidge T, Kalakonda N, Kuhnl A, McKay P, Davies AJ. The management of newly diagnosed large B-cell lymphoma: A British Society for Haematology Guideline. Br J Haematol 2024; 204:1178-1192. [PMID: 38247115 DOI: 10.1111/bjh.19273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/20/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024]
Affiliation(s)
| | - Sridhar Chaganti
- Centre for Clinical Haematology, University Hospitals Birmingham, Birmingham, UK
| | - Graham McIlroy
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Sally F Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Cathy Burton
- Department of Haematology, The Leeds Teaching Hospitals, Leeds, UK
| | - Kate Cwynarski
- Department of Haematology, University College London Hospitals, London, UK
| | - Toby A Eyre
- Oxford Cancer and Haematology Centre, Oxford University Hospitals, Oxford, UK
| | - Timothy Illidge
- Division of Cancer Sciences, Manchester NIHR Biomedical Research Centre, University of Manchester, Manchester, UK
| | - Nagesh Kalakonda
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Andrea Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - Pam McKay
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Andrew J Davies
- Cancer Sciences Division, Centre for Cancer Immunology, University of Southampton, Southampton, UK
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4
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Ghesquières H, Cherblanc F, Belot A, Micon S, Bouabdallah KK, Esnault C, Fornecker LM, Thokagevistk K, Bonjour M, Bijou F, Haioun C, Morineau N, Ysebaert L, Damaj G, Tessoulin B, Guidez S, Morschhauser F, Thiéblemont C, Chauchet A, Gressin R, Jardin F, Fruchart C, Labouré G, Fouillet L, Lionne-Huyghe P, Bonnet A, Lebras L, Amorim S, Leyronnas C, Olivier G, Guieze R, Houot R, Launay V, Drénou B, Fitoussi O, Detourmignies L, Abraham J, Soussain C, Lachenal F, Pica GM, Fogarty P, Cony-Makhoul P, Bernier A, Le Guyader-Peyrou S, Monnereau A, Boissard F, Rossi C, Camus V. Challenges for quality and utilization of real-world data for diffuse large B-cell lymphoma in REALYSA, a LYSA cohort. Blood Adv 2024; 8:296-308. [PMID: 37874913 PMCID: PMC10824688 DOI: 10.1182/bloodadvances.2023010798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/05/2023] [Accepted: 10/01/2023] [Indexed: 10/26/2023] Open
Abstract
ABSTRACT Real-world data (RWD) are essential to complement clinical trial (CT) data, but major challenges remain, such as data quality. REal world dAta in LYmphoma and Survival in Adults (REALYSA) is a prospective noninterventional multicentric cohort started in 2018 that included patients newly diagnosed with lymphoma in France. Herein is a proof-of-concept analysis on patients with first-line diffuse large B-cell lymphoma (DLBCL) to (1) evaluate the capacity of the cohort to provide robust data through a multistep validation process; (2) assess the consistency of the results; and (3) conduct an exploratory transportability assessment of 2 recent phase 3 CTs (POLARIX and SENIOR). The analysis population comprised 645 patients with DLBCL included before 31 March 2021 who received immunochemotherapy and for whom 3589 queries were generated, resulting in high data completeness (<4% missing data). Median age was 66 years, with mostly advanced-stage disease and high international prognostic index (IPI) score. Treatments were mostly rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone (R-CHOP 75%) and reduced dose R-CHOP (13%). Estimated 1-year event-free survival (EFS) and overall survival rates were 77.9% and 90.0%, respectively (median follow-up, 9.9 months). Regarding transportability, when applying the CT's main inclusion criteria (age, performance status, and IPI), outcomes seemed comparable between patients in REALYSA and standard arms of POLARIX (1-year progression-free survival 79.8% vs 79.8%) and SENIOR (1-year EFS, 64.5% vs 60.0%). With its rigorous data validation process, REALYSA provides high-quality RWD, thus constituting a platform for numerous scientific purposes. The REALYSA study was registered at www.clinicaltrials.gov as #NCT03869619.
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Affiliation(s)
- Hervé Ghesquières
- Department of Hematology, Hopital Lyon Sud, Claude Bernard Lyon 1 University, Pierre Benite, France
| | - Fanny Cherblanc
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Aurélien Belot
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | | | - Krimo K. Bouabdallah
- Hematology and Cell Therapy Department, University Hospital of Bordeaux, Bordeaux, France
| | | | - Luc-Matthieu Fornecker
- Institut de Cancérologie Strasbourg Europe (ICANS) and University of Strasbourg, Strasbourg, France
| | | | - Maxime Bonjour
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Fontanet Bijou
- Department of Hematology, Institut Bergonie, Bordeaux, France
| | - Corinne Haioun
- Lymphoid Malignancies Unit, Assistante Publique Hôpitaux de Paris APHP, Hopital Henri Mondor, Creteil, France
| | - Nadine Morineau
- Department of Hematology, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | - Loïc Ysebaert
- Institut universitaire du cancer de Toulouse Oncopole, Toulouse, France
| | - Gandhi Damaj
- Hematology Institute of Basse Normandie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Benoit Tessoulin
- Department of Hematology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Stéphanie Guidez
- Department of Hematology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Franck Morschhauser
- Department of Hematology, Universite de Lille, Centre Hospitalier Universitaire de Lille, Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Catherine Thiéblemont
- Université Paris Cité, Assistante Publique Hôpitaux de Paris, Hôpital Saint-Louis, Service d’Hémato-Oncologie, Paris, France
| | - Adrien Chauchet
- Department of Hematology, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Rémy Gressin
- Department of Hematology, Centre Hospitalier Universitaire de Grenoble, Institute for Advanced Biosciences, INSERM U1209/CNRS UMR 5309/Grenoble Alpes University, Grenoble, France
| | - Fabrice Jardin
- Department of Clinical Hematology, INSERM U1245 Unit, Centre Henri Becquerel, Rouen, France
| | | | - Gaëlle Labouré
- Deparment of Hematology, Centre Hospitalier de Libourne, Libourne, France
| | - Ludovic Fouillet
- Department of Hematology, Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France
| | | | - Antoine Bonnet
- Department of Hematology, Centre Hospitalier de Bretagne Atlantique, Vannes, France
| | - Laure Lebras
- Department of Hematology, Leon Berard Cancer Center, Lyon, France
| | - Sandy Amorim
- Department of Hematology, Hopital Saint Vincent de Paul, Lille, France
| | - Cécile Leyronnas
- Department of Hematology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Gaelle Olivier
- Department of Hematology, Centre Hospitalier de Niort, Niort, France
| | - Romain Guieze
- Department of Hematology, Centre Hospitalier Universitaire de Clermont Ferrand, Clermont Ferrand, France
| | - Roch Houot
- Department of Hematology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Vincent Launay
- Department of Hematology, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France
| | - Bernard Drénou
- Department Hematology, Groupe Hospitalier Mulhouse Sud Alsace, Mulhouse, France
| | - Olivier Fitoussi
- Department of Hematology, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | | | - Julie Abraham
- Department of Hematology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Carole Soussain
- Department of Hematology, Institut Curie, Saint-Cloud, France
| | - Florence Lachenal
- Department of Hematology, Centre Hospitalier Pierre Oudot, Bourgoin-Jallieu, France
| | - Gian Matteo Pica
- Department of Hematology, Centre Hospitalier Metropole Savoie, Chambery, France
| | - Patrick Fogarty
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Pascale Cony-Makhoul
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Adeline Bernier
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Sandra Le Guyader-Peyrou
- Registre des Hémopathies Malignes de la Gironde, Institut Bergonié, University of Bordeaux, Inserm, Team EPICENE, Bordeaux, France
| | - Alain Monnereau
- Registre des Hémopathies Malignes de la Gironde, Institut Bergonié, University of Bordeaux, Inserm, Team EPICENE, Bordeaux, France
| | | | - Cédric Rossi
- Department of Hematology, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
| | - Vincent Camus
- Department of Clinical Hematology, INSERM U1245 Unit, Centre Henri Becquerel, Rouen, France
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5
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Carlier T, Frécon G, Mateus D, Rizkallah M, Kraeber-Bodéré F, Kanoun S, Blanc-Durand P, Itti E, Le Gouill S, Casasnovas RO, Bodet-Milin C, Bailly C. Prognostic Value of 18F-FDG PET Radiomics Features at Baseline in PET-Guided Consolidation Strategy in Diffuse Large B-Cell Lymphoma: A Machine-Learning Analysis from the GAINED Study. J Nucl Med 2024; 65:156-162. [PMID: 37945379 DOI: 10.2967/jnumed.123.265872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/17/2023] [Indexed: 11/12/2023] Open
Abstract
The results of the GA in Newly Diagnosed Diffuse Large B-Cell Lymphoma (GAINED) study demonstrated the success of an 18F-FDG PET-driven approach to allow early identification-for intensification therapy-of diffuse large B-cell lymphoma patients with a high risk of relapse. Besides, some works have reported the prognostic value of baseline PET radiomics features (RFs). This work investigated the added value of such biomarkers on survival of patients involved in the GAINED protocol. Methods: Conventional PET features and RFs were computed from 18F-FDG PET at baseline and extracted using different volume definitions (patient level, largest lesion, and hottest lesion). Clinical features and the consolidation treatment information were also considered in the model. Two machine-learning pipelines were trained with 80% of patients and tested on the remaining 20%. The training was repeated 100 times to highlight the test set variability. For the 2-y progression-free survival (PFS) outcome, the pipeline included a data augmentation and an elastic net logistic regression model. Results for different feature groups were compared using the mean area under the curve (AUC). For the survival outcome, the pipeline included a Cox univariate model to select the features. Then, the model included a split between high- and low-risk patients using the median of a regression score based on the coefficients of a penalized Cox multivariate approach. The log-rank test P values over the 100 loops were compared with a Wilcoxon signed-ranked test. Results: In total, 545 patients were included for the 2-y PFS classification and 561 for survival analysis. Clinical features alone, consolidation features alone, conventional PET features, and RFs extracted at patient level achieved an AUC of, respectively, 0.65 ± 0.07, 0.64 ± 0.06, 0.60 ± 0.07, and 0.62 ± 0.07 (0.62 ± 0.07 for the largest lesion and 0.54 ± 0.07 for the hottest). Combining clinical features with the consolidation features led to the best AUC (0.72 ± 0.06). Adding conventional PET features or RFs did not improve the results. For survival, the log-rank P values of the model involving clinical and consolidation features together were significantly smaller than all combined-feature groups (P < 0.007). Conclusion: The results showed that a concatenation of multimodal features coupled with a simple machine-learning model does not seem to improve the results in terms of 2-y PFS classification and PFS prediction for patient treated according to the GAINED protocol.
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Affiliation(s)
- Thomas Carlier
- Nantes Université, INSERM, CNRS, CRCINA, Université d'Angers, Nantes, France
- Nuclear Medicine Department, University Hospital, Nantes, France
| | - Gauthier Frécon
- Nantes Université, INSERM, CNRS, CRCINA, Université d'Angers, Nantes, France
- Nuclear Medicine Department, University Hospital, Nantes, France
| | - Diana Mateus
- Laboratoire des Sciences Numériques de Nantes, Ecole Centrale de Nantes, CNRS UMR 6004, Nantes, France
| | - Mira Rizkallah
- Laboratoire des Sciences Numériques de Nantes, Ecole Centrale de Nantes, CNRS UMR 6004, Nantes, France
| | - Françoise Kraeber-Bodéré
- Nantes Université, INSERM, CNRS, CRCINA, Université d'Angers, Nantes, France
- Nuclear Medicine Department, University Hospital, Nantes, France
| | - Salim Kanoun
- Nuclear Medicine, Georges-François Leclerc Center, Dijon, France
| | - Paul Blanc-Durand
- Nuclear Medicine, CHU Henri Mondor, Paris-Est University, Créteil, France
| | - Emmanuel Itti
- Nuclear Medicine, CHU Henri Mondor, Paris-Est University, Créteil, France
| | - Steven Le Gouill
- Haematology Department, University Hospital, Nantes, France; and
| | | | - Caroline Bodet-Milin
- Nantes Université, INSERM, CNRS, CRCINA, Université d'Angers, Nantes, France
- Nuclear Medicine Department, University Hospital, Nantes, France
| | - Clément Bailly
- Nantes Université, INSERM, CNRS, CRCINA, Université d'Angers, Nantes, France;
- Nuclear Medicine Department, University Hospital, Nantes, France
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Puckrin R, Sterrett R, Chua N, Owen C, Duggan P, Shafey M, Stewart D. Consolidative Autotransplantation Achieves High Cure Rates in Adverse-Risk Large B Cell Lymphoma. Transplant Cell Ther 2023; 29:763.e1-763.e5. [PMID: 37703996 DOI: 10.1016/j.jtct.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
There remains an unmet need to optimize the first-line treatment of patients with high-risk large B cell lymphoma (LBCL), particularly those with a high International Prognostic Index (IPI) score or a positive interim positron emission tomography (PET) scan who experience poor outcomes with R-CHOP. This study was conducted to evaluate the real-world effectiveness of consolidative autologous stem cell transplantation (ASCT) among patients with high-risk LBCL. This retrospective study included consecutive patients with LBCL and IPI score 4 or 5 who underwent consolidative ASCT as part of first-line therapy in Alberta, Canada. Progression-free survival (PFS), overall survival (OS), and disease-specific survival (DSS) were determined using the Kaplan-Meier method. The study cohort comprised 114 patients with median age of 60 years (range, 18 to 73 years), of whom 81 (71%) had an IPI score of 4 and 33 (29%) had an IPI score of 5. With a median follow-up of 5.6 years, the 5-year PFS was 72% (95% confidence interval [CI], 62% to 79%), 5-year OS was 74% (95% CI, 64% to 81%), and 5-year DSS was 80% (95% CI, 71% to 87%). There was no significant difference in PFS among patients with and patients without positive interim PET scans (n = 24), MYC and BCL2 and/or BCL6 rearrangements (n = 26), or central nervous system involvement (n = 15). Consolidative ASCT is associated with high cure rates and favorable survival outcomes in patients with high-risk LBCL and may overcome the adverse prognostic impact of a positive interim PET scan.
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Affiliation(s)
- Robert Puckrin
- Tom Baker Cancer Centre and University of Calgary, Calgary, Canada.
| | - Russell Sterrett
- Cross Cancer Institute and University of Alberta, Edmonton, Canada
| | - Neil Chua
- Cross Cancer Institute and University of Alberta, Edmonton, Canada
| | - Carolyn Owen
- Tom Baker Cancer Centre and University of Calgary, Calgary, Canada
| | - Peter Duggan
- Tom Baker Cancer Centre and University of Calgary, Calgary, Canada
| | - Mona Shafey
- Tom Baker Cancer Centre and University of Calgary, Calgary, Canada
| | - Douglas Stewart
- Tom Baker Cancer Centre and University of Calgary, Calgary, Canada
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7
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Itti E, Blanc-Durand P, Berriolo-Riedinger A, Kanoun S, Kraeber-Bodéré F, Meignan M, Gat E, Gouill SL, Casasnovas RO, Bodet-Milin C. Validation of the ΔSUV max for Interim PET Interpretation in Diffuse Large B-Cell Lymphoma on the Basis of the GAINED Clinical Trial. J Nucl Med 2023; 64:1706-1711. [PMID: 37734837 DOI: 10.2967/jnumed.123.265871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/18/2023] [Indexed: 09/23/2023] Open
Abstract
The GAINED phase 3 trial (ClinicalTrials.gov identifier: NCT01659099) evaluated a PET-driven consolidative strategy in patients with diffuse large B-cell lymphoma. In this post hoc analysis, we aimed to compare the prognostic value of the per-protocol PET interpretation criteria (Menton 2011 consensus) with the change in the SUVmax (ΔSUVmax) alone. Methods: Real-time central review of 18F-FDG PET/CT was performed in 581 patients after 2 cycles (PET2) and 4 cycles (PET4) of immunochemotherapy using the Menton 2011 criteria, combining the ΔSUVmax (cutoffs of 66% and 70% at PET2 and PET4, respectively) and the Deauville scale. In "special cases," when the baseline SUVmax was less than 10.0 or the interim residual tumor SUVmax was greater than 5.0, the Menton 2011 experts' consensus agreed that the ΔSUVmax may not be reliable and that the Deauville score is preferable. Prognostic values of Menton 2011 and ΔSUVmax were evaluated by Kaplan-Meier analyses in terms of progression-free survival (PFS). Results: Seventeen percent of patients at PET2 (100/581) and 8% at PET4 (49/581) had PET-negative results by ΔSUVmax but were considered to have PET-positive results according to Menton 2011 with residual SUVmax of greater than 5.0. For the population with PET2-positive results, 2-y PFS was 70% (range, 58%-80%) with ΔSUVmax alone, whereas the outcome tended to be better for those who were considered to have PET-positive results by Menton 2011, 81% (range, 72%-87%). Conversely, all 10 patients with baseline SUVmax of less than 10.0 had PET2-positive results by ΔSUVmax but were considered to have PET2-negative results by Menton 2011. These patients had the same 2-y PFS as patients with PET2-negative/PET4-negative results, indicating that the ΔSUVmax yielded false-positive results in this situation. Conclusion: We recommend the use of the ΔSUVmax alone rather than the Menton 2011 criteria for assessing the interim metabolic response in patients with diffuse large B-cell lymphoma, except when the baseline SUVmax is less than 10.0.
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Affiliation(s)
- Emmanuel Itti
- Nuclear Medicine, CHU Henri Mondor, Paris-Est University, Créteil, France;
| | - Paul Blanc-Durand
- Nuclear Medicine, CHU Henri Mondor, Paris-Est University, Créteil, France
| | | | - Salim Kanoun
- Nuclear Medicine, Georges-François Leclerc Center, Dijon, France
| | | | - Michel Meignan
- Nuclear Medicine, CHU Henri Mondor, Paris-Est University, Créteil, France
| | - Elodie Gat
- Lymphoma Study Association Recherche Clinique (LYSARC), Pierre-Bénite, France
| | | | | | - Caroline Bodet-Milin
- Nantes University, Angers University, CHU Nantes, INSERM, CNRS, CRCI2NA, Nantes, France
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8
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Sheng L, Li T, Li Y, Zhou M, Wang J, Lai Y, Zhang Y, Yi P, Mu Q, Ouyang G. Prognostic and immunological characterization of diffuse large B-cell lymphoma evaluated by co-stimulatory molecular-related features. Heliyon 2023; 9:e19342. [PMID: 37809743 PMCID: PMC10558338 DOI: 10.1016/j.heliyon.2023.e19342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/06/2023] [Accepted: 08/18/2023] [Indexed: 10/10/2023] Open
Abstract
Background Co-stimulatory molecules have been shown to enhance antitumor immune responses, but their role in Diffuse Large B-cell Lymphoma (DLBCL) remains unexplored. Methods This study aimed to explore the molecular typing of DLBCL with co-stimulatory molecule genes and to construct a prognostic profile to improve treatment decisions and clinical outcomes. Results We conducted the first comprehensive analysis of co-stimulatory molecules in DLBCL patients and identified five co-stimulatory molecule genes with prognostic and diagnostic values. Consensus cluster analysis based on these five co-stimulatory molecule genes revealed that the two identified clusters had different distribution patterns and prognostic differences. Co-stimulatory molecular correlation signatures were then constructed based on these five co-stimulatory molecular genes and validated in an external dataset, showing good performance in predicting patient prognosis. The signature is an independent risk factor for DLBCL patients and significantly correlates with clinical factors in patients and can be used as a complement to clinical factors. Furthermore, the signature was associated with the tumor immune microenvironment. Patients identified as being at high risk according to our signature exhibit high levels of immune cell infiltration microenvironment. Conclusions In conclusion, our signature can provide clinicians with prognostic predictions and help guide the treatment of patients with DLBCL.
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Affiliation(s)
- Lixia Sheng
- Department of Hematology, Pital of Ningbo University, No.59 Liuting Street, Ningbo, Zhejiang, People's Republic of China
- Ningbo Clinical Research Center for Hematologic Malignancies, The First Affiliated Hospital of Ningbo University, No.59 Liuting Street, Ningbo, 315000, Zhejiang, People's Republic of China
| | - Tongyu Li
- Department of Hematology, Pital of Ningbo University, No.59 Liuting Street, Ningbo, Zhejiang, People's Republic of China
- Ningbo Clinical Research Center for Hematologic Malignancies, The First Affiliated Hospital of Ningbo University, No.59 Liuting Street, Ningbo, 315000, Zhejiang, People's Republic of China
| | - Yun Li
- Kindstar Global Precision Medicine Institute, Wuhan, China
- Department of Scientific Research Project, Wuhan Kindstar Medical Laboratory Co., Ltd., Wuhan, 430000, China
| | - Miao Zhou
- Department of Hematology, Pital of Ningbo University, No.59 Liuting Street, Ningbo, Zhejiang, People's Republic of China
- Ningbo Clinical Research Center for Hematologic Malignancies, The First Affiliated Hospital of Ningbo University, No.59 Liuting Street, Ningbo, 315000, Zhejiang, People's Republic of China
| | - Jiaping Wang
- Department of Hematology, Pital of Ningbo University, No.59 Liuting Street, Ningbo, Zhejiang, People's Republic of China
- Ningbo Clinical Research Center for Hematologic Malignancies, The First Affiliated Hospital of Ningbo University, No.59 Liuting Street, Ningbo, 315000, Zhejiang, People's Republic of China
| | - Yanli Lai
- Department of Hematology, Pital of Ningbo University, No.59 Liuting Street, Ningbo, Zhejiang, People's Republic of China
- Ningbo Clinical Research Center for Hematologic Malignancies, The First Affiliated Hospital of Ningbo University, No.59 Liuting Street, Ningbo, 315000, Zhejiang, People's Republic of China
| | - Yanli Zhang
- Department of Hematology, Pital of Ningbo University, No.59 Liuting Street, Ningbo, Zhejiang, People's Republic of China
- Ningbo Clinical Research Center for Hematologic Malignancies, The First Affiliated Hospital of Ningbo University, No.59 Liuting Street, Ningbo, 315000, Zhejiang, People's Republic of China
| | - Ping Yi
- Kindstar Global Precision Medicine Institute, Wuhan, China
- Department of Scientific Research Project, Wuhan Kindstar Medical Laboratory Co., Ltd., Wuhan, 430000, China
| | - Qitian Mu
- Department of Hematology, Pital of Ningbo University, No.59 Liuting Street, Ningbo, Zhejiang, People's Republic of China
- Ningbo Clinical Research Center for Hematologic Malignancies, The First Affiliated Hospital of Ningbo University, No.59 Liuting Street, Ningbo, 315000, Zhejiang, People's Republic of China
- Stem Cell Transplantation Laboratory, The First Affiliated Hospital of Ningbo University, No.59 Liuting Street, Ningbo, 315000, Zhejiang, People's Republic of China
| | - Guifang Ouyang
- Department of Hematology, Pital of Ningbo University, No.59 Liuting Street, Ningbo, Zhejiang, People's Republic of China
- Ningbo Clinical Research Center for Hematologic Malignancies, The First Affiliated Hospital of Ningbo University, No.59 Liuting Street, Ningbo, 315000, Zhejiang, People's Republic of China
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9
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Thieblemont C, Altmann B, Frontzek F, Renaud L, Chartier L, Ketterer N, Récher C, Poeschel V, Fitoussi O, Held G, Casasnovas O, Haioun C, Morschhauser F, Glass B, Mounier N, Tilly H, Rosenwald A, Ott G, Lenz G, Molina T, Ziepert M, Schmitz N. Central nervous system relapse in younger patients with diffuse large B-cell lymphoma: a LYSA and GLA/DSHNHL analysis. Blood Adv 2023; 7:3968-3977. [PMID: 36716220 PMCID: PMC10410133 DOI: 10.1182/bloodadvances.2022008888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/31/2023] Open
Abstract
Most patients with diffuse large B-cell lymphoma (DLBCL) can be cured with immunochemotherapy such as R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Patients with progression or relapse in the central nervous system (CNS) face dismal outcomes. The impact of more aggressive regimens used in frontline therapy has not been systematically investigated in this context. To this end, we analyzed a large cohort of 2203 younger patients with DLBCL treated on 10 German (German Lymphoma Alliance [GLA]/The German High Grade Non-Hodgkin's Lymphoma Study Group [DSHNHL]) and French (The Lymphoma Study Association [LYSA]) prospective phase 2 and 3 trials after first-line therapy with R-CHOP, R-CHOEP (R-CHOP + etoposide), dose-escalated R-CHOEP followed by repetitive stem cell transplantation (R-MegaCHOEP), or R-ACVBP (rituximab, doxorubicin, cyclophosphamide, vindesine, bleomycine, and prednisone) followed by consolidation including multiple drugs crossing the blood-brain barrier (BBB). Patients with DLBCL with an age-adjusted International Prognostic Index (aaIPI) of 0 to 1 showed very low cumulative incidence rates of CNS relapse regardless of first-line therapy and CNS prophylaxis (3-year cumulative incidences 0%-1%). Younger high-risk patients with aaIPI of 2 to 3 had 3-year cumulative incidence rates of 1.6% and 4% after R-ACVBP plus consolidation or R-(Mega)CHO(E)P, respectively (hazard ratio 2.4; 95% confidence interval: 0.8-7.4; P = .118). Thus, for younger high-risk patients, frontline regimens incorporating agents crossing the BBB may reduce often fatal CNS relapse.
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Affiliation(s)
- Catherine Thieblemont
- Université de Paris, Assistance Publique-Hôpitaux de Paris (APHP), Hemato-oncologie, Saint-Louis Hôpital, Paris, France
| | - Bettina Altmann
- Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Fabian Frontzek
- Department of Medicine A, Hematology, Oncology, and Pneumonology, Münster University Hospital, Münster, Germany
| | - Loïc Renaud
- Université de Paris, Assistance Publique-Hôpitaux de Paris (APHP), Hemato-oncologie, Saint-Louis Hôpital, Paris, France
| | - Loic Chartier
- Statistique, Lymphoma Academic Research Organisation, Pierre-Benite, France
| | - Nicolas Ketterer
- Centre d’Oncologie-Hématologie, Bois-Cerf Clinique, Lausanne, Switzerland
| | - Christian Récher
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Viola Poeschel
- Department of Internal Medicine I, Medical School, Saarland University, Homburg/Saar, Germany
| | - Olivier Fitoussi
- Oncologie-Hematologie, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Gerhard Held
- Department for Hematology and Oncology, Westpfalz-Klnikum Kaiserslautern, Kaiserslautern, Germany
| | - Olivier Casasnovas
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire Dijon, INSERM UMR1231, Dijon, France
| | - Corinne Haioun
- APHP, Hematologie, Hôpital Henri Mondor, Creteil, France
| | | | - Bertram Glass
- Department for Hematology, Oncology, Tumor Immunology, and Palliative Care, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Nicolas Mounier
- Hematologie, Centre Hospitalier Universitaire L’Archet, Nice, France
| | - Herve Tilly
- INSERM U1245, Centre Henri Becquerel, Rouen, France
| | | | - German Ott
- Department of Clinical Pathology, Dr. Margarete Fischer-Bosch Institute for Clinical Pharmacology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology, and Pneumonology, Münster University Hospital, Münster, Germany
| | - Thierry Molina
- Université de Paris, APHP, Anatomo-pathologie, Necker Hôpital, Paris, France
| | - Marita Ziepert
- Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Norbert Schmitz
- Department of Medicine A, Hematology, Oncology, and Pneumonology, Münster University Hospital, Münster, Germany
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10
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Damlaj M, Jaber W, Al Najjar A, Altamimi S, Al Onazi T, Alzayed M, Damlaj A, Yassin R, Alahmari B, Alhejazi A, Gmati G, Abuelgasim K, Salama H, Alaskar A, Al Zahrani M. Role of interim PET/CT as predictor of outcome in newly diagnosed diffuse large b-cell lymphoma in the chemo-immunotherapy era. Curr Res Transl Med 2023; 71:103406. [PMID: 37542921 DOI: 10.1016/j.retram.2023.103406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/08/2023] [Accepted: 07/24/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Moussab Damlaj
- Division of Hematology & Oncology, Sheikh Shakhbout Medical City, Abu Dhabi, UAE; Khalifa University, College of Medicine, Abu Dhabi, UAE; Department of Oncology, King Abdulaziz Medical City, Riyadh, KSA; King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA; King Abdullah International Medical Research Center, Riyadh, KSA.
| | - Waed Jaber
- Division of Hematology & Oncology, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Afnan Al Najjar
- Department of Oncology, King Abdulaziz Medical City, Riyadh, KSA
| | | | - Tarfa Al Onazi
- Department of Oncology, King Abdulaziz Medical City, Riyadh, KSA
| | - Mohammed Alzayed
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA; King Abdullah International Medical Research Center, Riyadh, KSA; Department of Medical Imaging, King Abdulaziz Medical City, Riyadh, KSA
| | | | - Rehab Yassin
- Department of Oncology, King Abdulaziz Medical City, Riyadh, KSA; King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA; King Abdullah International Medical Research Center, Riyadh, KSA
| | - Bader Alahmari
- Department of Oncology, King Abdulaziz Medical City, Riyadh, KSA; King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA; King Abdullah International Medical Research Center, Riyadh, KSA
| | - Ayman Alhejazi
- Department of Oncology, King Abdulaziz Medical City, Riyadh, KSA; King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA; King Abdullah International Medical Research Center, Riyadh, KSA
| | - Giamal Gmati
- Department of Oncology, King Abdulaziz Medical City, Riyadh, KSA; King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA; King Abdullah International Medical Research Center, Riyadh, KSA
| | - Khadega Abuelgasim
- Department of Oncology, King Abdulaziz Medical City, Riyadh, KSA; King Abdullah International Medical Research Center, Riyadh, KSA; Department of Medical Imaging, King Abdulaziz Medical City, Riyadh, KSA
| | - Hind Salama
- Department of Oncology, King Abdulaziz Medical City, Riyadh, KSA; King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA; King Abdullah International Medical Research Center, Riyadh, KSA
| | - Ahmed Alaskar
- Department of Oncology, King Abdulaziz Medical City, Riyadh, KSA; King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA; King Abdullah International Medical Research Center, Riyadh, KSA
| | - Mohsen Al Zahrani
- Department of Oncology, King Abdulaziz Medical City, Riyadh, KSA; King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA; King Abdullah International Medical Research Center, Riyadh, KSA
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11
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Barrington SF. Advances in positron emission tomography and radiomics. Hematol Oncol 2023; 41 Suppl 1:11-19. [PMID: 37294959 PMCID: PMC10775708 DOI: 10.1002/hon.3137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 06/11/2023]
Abstract
Positron emission tomography is established for staging and response evaluation in lymphoma using visual evaluation and semi-quantitative analysis. Radiomic analysis involving quantitative imaging features at baseline, such as metabolic tumor volume and markers of disease dissemination and changes in the standardized uptake value during treatment are emerging as powerful biomarkers. The combination of radiomic features with clinical risk factors and genomic analysis offers the potential to improve clinical risk prediction. This review discusses the state of current knowledge, progress toward standardization of tumor delineation for radiomic analysis and argues that radiomic features, molecular markers and circulating tumor DNA should be included in clinical trial designs to enable the development of baseline and dynamic risk scores that could further advance the field to facilitate testing of novel treatments and personalized therapy in aggressive lymphomas.
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Affiliation(s)
- Sally F. Barrington
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Campus, Kings College LondonLondonUK
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12
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Zanoni L, Bezzi D, Nanni C, Paccagnella A, Farina A, Broccoli A, Casadei B, Zinzani PL, Fanti S. PET/CT in Non-Hodgkin Lymphoma: An Update. Semin Nucl Med 2023; 53:320-351. [PMID: 36522191 DOI: 10.1053/j.semnuclmed.2022.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 12/15/2022]
Abstract
Non-Hodgkin lymphomas represents a heterogeneous group of lymphoproliferative disorders characterized by different clinical courses, varying from indolent to highly aggressive. 18F-FDG-PET/CT is the current state-of-the-art diagnostic imaging, for the staging, restaging and evaluation of response to treatment in lymphomas with avidity for 18F-FDG, despite it is not routinely recommended for surveillance. PET-based response criteria (using five-point Deauville Score) are nowadays uniformly applied in FDG-avid lymphomas. In this review, a comprehensive overview of the role of 18F-FDG-PET in Non-Hodgkin lymphomas is provided, at each relevant point of patient management, particularly focusing on recent advances on diffuse large B-cell lymphoma and follicular lymphoma, with brief updates also on other histotypes (such as marginal zone, mantle cell, primary mediastinal- B cell lymphoma and T cell lymphoma). PET-derived semiquantitative factors useful for patient stratification and prognostication and emerging radiomics research are also presented.
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Affiliation(s)
- Lucia Zanoni
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Davide Bezzi
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Paccagnella
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy; Nuclear Medicine Unit, AUSL Romagna, Cesena, Italy
| | - Arianna Farina
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandro Broccoli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Beatrice Casadei
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
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13
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Deng L, Xu G. Update on the Application of Monoclonal Antibody Therapy in Primary Membranous Nephropathy. Drugs 2023; 83:507-530. [PMID: 37017915 DOI: 10.1007/s40265-023-01855-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 04/06/2023]
Abstract
When first introduced, rituximab (RTX), a chimeric anti-CD20 monoclonal antibody, brought about an alternative therapeutic paradigm for primary membranous nephropathy (PMN). Rituximab was shown to be effective and safe in PMN patients with kidney dysfunction, with. patients receiving second-line rituximab therapy achieving remission as effectively as those patients who had not previously received immunotherapy. No safety issues were reported. The B cell-driven protocol seems to be as efficient as the 375 mg/m2 × 4 regimen or 1 g × 2 regimen in achieving B cell depletion and remission, but patients with high M-type phospholipase A2 receptor (PLA2R) antibody levels may benefit from a higher dose of rituximab. While rituximab added another therapeutic option to the treatment regimen, it does have limitations as 20 to 40% of patients do not respond. Not all patients respond to RTX therapy for lymphoproliferative disorders either, therefore further novel anti-CD20 monoclonal antibodies have been developed and these may provide alternative therapeutic options for PMN. Ofatumumab, a fully human monoclonal antibody, specifically recognizes an epitope encompassing both the small and large extracellular loops of the CD20 molecule, resulting in increased complement-dependent cytotoxic activity. Ocrelizumab binds an alternative but overlapping epitope region to rituximab and displays enhanced antibody-dependent cellular cytotoxic (ADCC) activities. Obinutuzumab is designed to have a modified elbow-hinge amino acid sequence, leading to increased direct cell death induction and ADCC activities. In PMN clinical studies, ocrelizumab and obinutuzumab showed promising results, while ofatumumab displayed mixed results. However, there is a lack of randomized controlled trials with large samples, especially direct head-to-head comparisons. Alternative molecular mechanisms have been suggested in this context to explore novel therapeutic strategies. B cell activator-targeted, plasma cell-targeted and complement-directed treatments may lead to novel therapy paradigms for PMN. Exploratory strategies for the use of drugs with different mechanisms, such as a combination of rituximab and cyclophosphamide and a steroid, a combination of rituximab and a calcineurin inhibitor, may provide more rapid and efficient remission, but the combination of standard immunosuppression with rituximab could increase infection risk.
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Affiliation(s)
- Le Deng
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Gaosi Xu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, Jiangxi, China.
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14
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Ricard F, Barrington S, Korn R, Brueggenwerth G, Trotman J, Cheson B, Salles G, Schwartz L, Goldmacher G, Jarecha R, Narang J, Broussais F, Galette P, Liu M, Bajpai S, Perlman E, Gillis J, Smalberg I, Terve P, Zahlmann G, Schmid A. Application of the Lugano Classification for Initial Evaluation, Staging, and Response Assessment of Hodgkin and Non-Hodgkin Lymphoma: The PRoLoG Consensus Initiative (Part 2-Technical). J Nucl Med 2023; 64:239-243. [PMID: 35835581 PMCID: PMC9902846 DOI: 10.2967/jnumed.122.264124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 02/04/2023] Open
Abstract
The aim of this initiative was to provide consensus recommendations from a consortium of academic and industry experts in the field of lymphoma and imaging for the consistent application of imaging assessment with the Lugano classification. Methods: Consensus was obtained through a series of meetings from July 2019 to October 2021 sponsored by the PINTaD (Pharma Imaging Network for Therapeutics and Diagnostics) as part of the ProLoG (PINTaD RespOnse criteria in Lymphoma wOrking Group) consensus initiative. Results: Consensus recommendations encompass all technical imaging aspects of the Lugano classification. Some technical considerations for PET/CT and diagnostic CT are clarified with regards to required imaging series and scan visits, as well as acquisition and reconstruction of PET images and influence of lesion size and background activity. Recommendations are given on the role of imaging and clinical reviewers as well as on training and monitoring. Finally, an example template of an imaging case report form is provided to support efficient collection of data with Lugano Classification. Conclusion: Consensus recommendations are made to comprehensively address technical and imaging areas of inconsistency and ambiguity in the classification encountered by end users. Such guidance should be used to support standardized acquisition and evaluation with the Lugano 2014.
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Affiliation(s)
| | - Sally Barrington
- King’s College London and Guy’s and St. Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, King’s College London, King’s Health Partners, London, United Kingdom
| | - Ron Korn
- Adjunct Faculty TGEN/City of Hope and Imaging Endpoints Core Lab, Scottsdale, Arizona
| | | | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, Concord, Australia
| | - Bruce Cheson
- Lymphoma Research Foundation, New York, New York
| | - Gilles Salles
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weil Cornell Medicine, New York, New York
| | - Larry Schwartz
- Department of Radiology, Columbia University College of Physicians and Surgeons and Radiologist-in-Chief, The New York Presbyterian Hospital, Columbia, New York
| | | | | | - Jayant Narang
- Takeda Pharmaceutical Company Ltd, Cambridge, Massachusetts
| | - Florence Broussais
- Lymphoma Study Association Research Center LYSARC, Pierre Benite, France Calyx International, Billerica, Massachusetts
| | | | - Min Liu
- Autolus Therapeutics, London, United Kingdom
| | | | - Eric Perlman
- Perlman Advisory Group LLC, Boynton Beach, Florida
| | | | - Ira Smalberg
- Saint John’s Cancer Institute and Tower Imaging Medical Group, Sherman Oaks, California
| | - Pierre Terve
- KEOSYS Medical Imaging, Saint Herblain, France; and
| | - Gudrun Zahlmann
- QIBA/RSNA, Radiological Society of North America, Oak Brook, Illinois
| | - Annette Schmid
- Takeda Pharmaceutical Company Ltd, Cambridge, Massachusetts
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15
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Vodicka P, Klener P, Trneny M. Diffuse Large B-Cell Lymphoma (DLBCL): Early Patient Management and Emerging Treatment Options. Onco Targets Ther 2022; 15:1481-1501. [PMID: 36510607 PMCID: PMC9739046 DOI: 10.2147/ott.s326632] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) represents a curable disease with a 60-70% chance of cure with current R-CHOP chemoimmunotherapy. However, 30-40% of patients are refractory or relapsing. Many attempts failed to improve the outcome of DLBCL patients, including the intensification of R-CHOP regimen, consolidation, or maintenance therapy since the introduction of R-CHOP in 2000. Better understanding of both molecular biology of lymphoma cells and the tumor microenvironment raised the hope for future improvement of DLBCL patients' survival. Novel molecular findings have initiated clinical trials exploring targeted therapy based on driver genetic alterations with an intent to improve survival of high-risk subsets of patients. But the preliminary results remain ambiguous. The approach "agnostic" to specific molecular alterations of lymphoma cell includes antibody-drug conjugates (especially polatuzumab vedotin), immunotherapy comprising different antibodies with immunomodulatory effect (tafasitamab, lenalidomide), and T-cell engaging therapy (bispecific antibodies, early use of CAR T-cell). This approach could increase the cure rates and change the current therapeutic paradigm. However, better prognostic stratification, smarter designs of clinical trials, modification of endpoints including the use of ctDNA are needed. This review covers the complexity of DLBCL management.
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Affiliation(s)
- Prokop Vodicka
- First Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Klener
- First Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Marek Trneny
- First Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic,Correspondence: Marek Trneny, First Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, U Nemocnice 499/2, Prague, 128 08, Czech Republic, Tel +420 224 96 25 27, Fax +420 224 96 35 56, Email
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16
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Cabrera ME, Peña C, Leon P, Lois V, Rojas H, Vega V, Pizarro A, Calderon S, Rojas C, Aspillaga A, Gonzalez ML, Intriago M, Rojas B, Hales C, Oliva J, Romero M, Capurro M, Castillo JJ. Diffuse Large B-Cell Lymphoma in Chile: The Impact of Combined CHOP Plus Rituximab in the Public Health System. JCO Glob Oncol 2022; 8:e2200165. [PMID: 36351213 PMCID: PMC10166504 DOI: 10.1200/go.22.00165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma subtype. The purpose of this study was to evaluate the clinical features, prognostic factors, and results of DLBCL that was treated in the cancer centers of the public health system in Chile and compare cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). PATIENTS AND METHODS Patients age > 15 years who were treated in 18 cancer centers in the country between 2001 and 2017 were included. The Kaplan-Meier method was used to calculate overall survival (OS), and Cox proportional hazard regression modeling was used to evaluate the effect of the addition of rituximab to CHOP on OS. RESULTS A total of 1,807 patients were evaluated. The median age at diagnosis was 62 (range, 15-95) years, with a female predominance (53%). Half of the patients were age ≥ 60 years. Serology for HIV infection was positive in 5% of cases (96 cases). International Prognostic Index scores were available for 90% of patients, of which 45% had low-risk, 25% low-intermediate-risk, 18% high-intermediate-risk, and 11% high-risk scores. CHOP was administered to 986 patients (55%; median follow-up, 13.2 years) and R-CHOP to 821 patients (45%; median follow-up, 8.4 years). R-CHOP was associated with superior OS compared with CHOP (5-year 66% v 48%, and 10-year 53% v 35%; P < .001). CONCLUSION Rituximab improved the survival of patients with DLBCL diagnosed and treated in Chile. The benefit was sustained over time, with curative rates of > 50%. This intervention shows that the inclusion of this biological drug justified the expenses incurred by the Ministry of Health in the National Lymphoma Protocols in Chile.
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Affiliation(s)
- María Elena Cabrera
- Hospital del Salvador, Titular Professor of Medicine, Universidad de Chile, Santiago, Chile
| | | | - Pilar Leon
- Hospital Carlos van Buren, Valparaiso, Chile
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jorge J Castillo
- Division of Hematological Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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17
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Vic S, Lemoine J, Armand P, Lemonnier F, Houot R. Transplant-ineligible but chimeric antigen receptor T-cells eligible: a real and relevant population. Eur J Cancer 2022; 175:246-253. [PMID: 36166850 DOI: 10.1016/j.ejca.2022.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022]
Abstract
Autologous stem cell transplantation (ASCT) and chimeric antigen receptor (CAR) T-cells are two therapeutic options for relapsed/refractory diffuse large B-cell lymphoma. Both are intensive and potentially curative therapies but differ in their efficacy and toxicity. ASCT may be offered to 'fit' patients (i.e. usually young with limited comorbidities) with chemosensitive disease. On the other hand, real world studies have shown that CAR T-cells may be safely administered to less fit and older patients. Thus, there is a potentially significant population of patients who may be offered CAR T-cell therapy despite not being eligible for ASCT. As the relative role of ASCT and CAR T-cells evolves, recognising and defining this population may be increasingly relevant. Here, we review criteria which may help identify this 'ASCT-ineligible but CAR T-cells eligible' population of patients.
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Affiliation(s)
- Samuel Vic
- Department of Hematology, CHU de Rennes, Université de Rennes, Rennes, France
| | - Jean Lemoine
- Department of Hematology, AP-HP, Université de Paris, Paris, France
| | - Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - François Lemonnier
- Department of Hematology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Roch Houot
- Department of Hematology, CHU de Rennes, Université de Rennes, Rennes, France.
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18
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Davies A, Kater AP, Sharman JP, Stilgenbauer S, Vitolo U, Klein C, Parreira J, Salles G. Obinutuzumab in the treatment of B-cell malignancies: a comprehensive review. Future Oncol 2022; 18:2943-2966. [PMID: 35856239 DOI: 10.2217/fon-2022-0112] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The type II anti-CD20 antibody obinutuzumab has structural and mechanistic features that distinguish it from the first anti-CD20 antibody, rituximab, which have translated into improved efficacy in phase III trials in indolent non-Hodgkin lymphoma and chronic lymphocytic leukemia (CLL). These gains have been shown through improvements in, and/or increased durability of, tumor response, and increases in progression-free survival in patients with CLL or follicular lymphoma (FL). Ongoing research is focusing on the use of biomarkers and the development of chemotherapy-free regimens involving obinutuzumab. phase II trials of such treatment regimens have shown promise for CLL, FL and mantle cell lymphoma, while phase III trials have highlighted obinutuzumab as the antibody partner of choice for novel agents in first-line CLL treatment.
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Affiliation(s)
- Andrew Davies
- Cancer Research UK Centre, University of Southampton, Southampton, UK
| | - Arnon P Kater
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jeff P Sharman
- Willamette Valley Cancer Institute & Research Center & US Oncology, Eugene, OR 97401, USA
| | - Stephan Stilgenbauer
- Comprehensive Cancer Center Ulm, Early Clinical Trials Unit (ECTU), Ulm, & Division of CLL, Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Umberto Vitolo
- Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | | | | | - Gilles Salles
- Memorial Sloan Kettering Cancer Center, Department of Medicine, NY 10021, USA
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19
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Poletto S, Novo M, Paruzzo L, Frascione PMM, Vitolo U. Treatment strategies for patients with Diffuse Large B-Cell Lymphoma. Cancer Treat Rev 2022; 110:102443. [DOI: 10.1016/j.ctrv.2022.102443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/30/2022] [Accepted: 07/27/2022] [Indexed: 11/02/2022]
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20
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Burggraaff CN, Eertink JJ, Lugtenburg PJ, Hoekstra OS, Arens AI, de Keizer B, Heymans MW, van der Holt B, Wiegers SE, Pieplenbosch S, Boellaard R, de Vet HC, Zijlstra JM. 18F-FDG PET Improves Baseline Clinical Predictors of Response in Diffuse Large B-Cell Lymphoma: The HOVON-84 Study. J Nucl Med 2022; 63:1001-1007. [PMID: 34675112 PMCID: PMC9258573 DOI: 10.2967/jnumed.121.262205] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/29/2021] [Indexed: 01/03/2023] Open
Abstract
We aimed to determine the added value of baseline metabolic tumor volume (MTV) and interim PET (I-PET) to the age-adjusted international prognostic index (aaIPI) to predict 2-y progression-free survival (PFS) in diffuse large B-cell lymphoma. Secondary objectives were to investigate optimal I-PET response criteria (using Deauville score [DS] or quantitative change in SUVmax [ΔSUVmax] between baseline and I-PET4 [observational I-PET scans after 4 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone administered in 2-wk intervals with intensified rituximab in the first 4 cycles [R(R)-CHOP14]). Methods: I-PET4 scans in the HOVON-84 (Hemato-Oncologie voor Volwassenen Nederland [Haemato Oncology Foundation for Adults in the Netherlands]) randomized clinical trial (EudraCT 2006-005174-42) were centrally reviewed using DS (cutoff, 4-5). Additionally, ΔSUVmax (prespecified cutoff, 70%) and baseline MTV were measured. Multivariable hazard ratio (HR), positive predictive value (PPV), and negative predictive value (NPV) were obtained for 2-y PFS. Results: In total, 513 I-PET4 scans were reviewed according to DS, and ΔSUVmax and baseline MTV were available for 367 and 296 patients. The NPV of I-PET ranged between 82% and 86% for all PET response criteria. Univariate HR and PPV were better for ΔSUVmax (4.8% and 53%, respectively) than for DS (3.1% and 38%, respectively). aaIPI and ΔSUVmax independently predicted 2-y PFS (HR, 3.2 and 5.0, respectively); adding MTV brought about a slight improvement. Low or low-intermediate aaIPI combined with a ΔSUVmax of more than 70% (37% of patients) yielded an NPV of 93%, and the combination of high-intermediate or high aaIPI and a ΔSUVmax of 70% or less yielded a PPV of 65%. Conclusion: In this study on diffuse large B-cell lymphoma, I-PET after 4 cycles of R(R)-CHOP14 added predictive value to aaIPI for 2-y PFS, and both were independent response biomarkers in a multivariable Cox model. We externally validated that ΔSUVmax outperformed DS in 2-y PFS prediction.
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Affiliation(s)
- Coreline N. Burggraaff
- Department of Hematology, Amsterdam UMC, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jakoba J. Eertink
- Department of Hematology, Amsterdam UMC, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pieternella J. Lugtenburg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Otto S. Hoekstra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anne I.J. Arens
- Department of Radiology, Nuclear Medicine, and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martijn W. Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; and
| | - Bronno van der Holt
- Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Sanne E. Wiegers
- Department of Hematology, Amsterdam UMC, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Simone Pieplenbosch
- Department of Hematology, Amsterdam UMC, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henrica C.W. de Vet
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; and
| | - Josée M. Zijlstra
- Department of Hematology, Amsterdam UMC, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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21
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Rösler W, Zenz T. GOALs in relapsed DLBCL. Br J Haematol 2022; 198:419-420. [PMID: 35695285 PMCID: PMC9544586 DOI: 10.1111/bjh.18296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Wiebke Rösler
- Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thorsten Zenz
- Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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22
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Galtier J, Vercellino L, Chartier L, Olivier P, Tabouret-Viaud C, Mesguich C, Di Blasi R, Durand A, Raffy L, Gros FX, Madelaine I, Meignin V, Mebarki M, Rubio MT, Feugier P, Casasnovas O, Meignan M, Thieblemont C. Positron emission tomography-imaging assessment for guiding strategy in patients with relapsed/refractory large B-cell lymphoma receiving CAR T cells. Haematologica 2022; 108:171-180. [PMID: 35678029 PMCID: PMC9827160 DOI: 10.3324/haematol.2021.280550] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to evaluate the prognostic impact of the F-fluorodeoxyglucose positron emission tomography response at 1 month (M1) and 3 months (M3) after anti-CD19 chimeric antigen receptor (CAR) T-cell therapy in a multicenter cohort of 160 patients with relapsed/refractory large B-cell lymphomas (R/R LBCL). In total, 119 (75%) patients reached M1 evaluation; 64 (53%, 64/119) had a complete response (CR); 91% were Deauville Score (DS) 1-3. Progressionfree survival (PFS) and overall survival (OS) were significantly worse in patients with DS-5 at M1, than in patients with DS 1-3 (PFS hazard ratio [HR]=6.37, 95% confidence interval [CI]: 3.5-11.5 vs. OS HR=3.79, 95% CI: 1.7-8.5) and DS-4 (PFS HR=11.99, 95% CI: 5.0-28.9 vs. OS HR=12.49, 95% CI: 2.8-55.8). The 1-year PFS rates were 78.9% (95% CI: 58.9-89.9) for DS-4 at M1, similar to 67.3% (95% CI: 51.8-78.8) for patients with DS 1-3 at M1, very different to 8.6% (95% CI: 1.8-22.4) for DS-5, respectively. Only eight of 30 (26%) patients with DS-4 progressed. Response at M3 evaluated in 90 (57%) patients was prognostic for PFS with lower discrimination (HR=3.28, 95% CI: 1.5-7.0; P=0.003) but did not predict OS (HR=0.61, 95% CI: 0.2-2.3; P=0.45). Patients with a high baseline total metabolic tumor volume (TMTV) >80 mL had worse PFS (HR=2.05, 95% CI: 1.2-3.5; P=0.009) and OS (HR=4.52, 95% CI: 2.5-8.1; P<0.001) than patients with low TMTV. Multivariable analyses identified baseline elevated lactate dehydrogenase, DS-5, CAR T cells at M1 for PFS and baseline elevated lactate dehydrogenase, TMTV >80 mL, and DS-5 at M1 for OS. In conclusion, baseline TMTV and response at M1 strongly predicts outcomes of patients with R/R LBCL undergoing CAR T-cell therapy.
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Affiliation(s)
- Jean Galtier
- Université de Paris, Paris,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Hemato-oncologie, Paris
| | - Laetitia Vercellino
- Assistance Publique-Hôpitaux de Paris, Hopital Saint-Louis, Medecine Nucléaire, Paris
| | | | - Pierre Olivier
- Medecine Nucleaire Centre Hospitalier Universitaire Nancy, Nancy
| | | | - Charles Mesguich
- Medecine Nucléaire, Centre Hospitalier Universitaire de Bordeaux, Bordeaux
| | - Roberta Di Blasi
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Hemato-oncologie, Paris
| | - Amandine Durand
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire Dijon, INSERM UMR1231, Dijon
| | - Léo Raffy
- Medecine Nucléaire, Centre Hospitalier Universitaire de Bordeaux, Bordeaux
| | - François-Xavier Gros
- Service d’Hématologie Clinique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux
| | - Isabelle Madelaine
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Pharmacie, Paris
| | - Veronique Meignin
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Service de Pathologie, Paris
| | - Miryam Mebarki
- Assistance Publique-Hôpitaux de Paris, Saint-Louis Hospital, Therapie Cellulaire, Paris
| | | | - Pierre Feugier
- Hématologie, Centre Hospitalier Universitaire, Vandoeuvre-les-Nancy
| | - Olivier Casasnovas
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire Dijon, INSERM UMR1231, Dijon
| | | | - Catherine Thieblemont
- Université de Paris, Paris,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Hemato-oncologie, Paris,C. Thieblemont
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23
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Dreyling M, André M, Gökbuget N, Tilly H, Jerkeman M, Gribben J, Ferreri A, Morel P, Stilgenbauer S, Fox C, Maria Ribera J, Zweegman S, Aurer I, Bödör C, Burkhardt B, Buske C, Dollores Caballero M, Campo E, Chapuy B, Davies A, de Leval L, Doorduijn J, Federico M, Gaulard P, Gay F, Ghia P, Grønbæk K, Goldschmidt H, Kersten MJ, Kiesewetter B, Landman-Parker J, Le Gouill S, Lenz G, Leppä S, Lopez-Guillermo A, Macintyre E, Mantega MVM, Moreau P, Moreno C, Nadel B, Okosun J, Owen R, Pospisilova S, Pott C, Robak T, Spina M, Stamatopoulos K, Stary J, Tarte K, Tedeschi A, Thieblemont C, Trappe RU, Trümper LH, Salles G. The EHA Research Roadmap: Malignant Lymphoid Diseases. Hemasphere 2022; 6:e726. [PMID: 35620592 PMCID: PMC9126526 DOI: 10.1097/hs9.0000000000000726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/21/2022] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Marc André
- Université Catholique de Louvain, CHU UcL Namur, Yvoir, Belgium
| | - Nicola Gökbuget
- Department of Medicine II, Hematology/Oncology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Hervé Tilly
- INSERM U1245, Department of Hematology, Centre Henri Becquerel and Université de Rouen, France
| | | | - John Gribben
- Barts Cancer Institute, Queen Mary University of London, United Kingdom
| | - Andrés Ferreri
- Lymphoma Unit, Department of Onco-hematology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Pierre Morel
- Service Hematologie Clinique Therapie Cellulaire, CHU Amiens Picardie, Amiens, France
| | - Stephan Stilgenbauer
- Comprehensive Cancer Center Ulm (CCCU), Sektion CLL Klinik für Innere Medizin III, Universität Ulm, Germany
| | - Christopher Fox
- School of Medicine, University of Nottingham, United Kingdom
| | - José Maria Ribera
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Badalona, Spain
| | - Sonja Zweegman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, the Netherlands
| | - Igor Aurer
- University Hospital Centre Zagreb and Medical School, University of Zagreb, Croatia
| | - Csaba Bödör
- HCEMM-SE Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Birgit Burkhardt
- Experimentelle und Translationale päd. Hämatologie u Onkologie, Leitung der Bereiche Lymphome und Stammzelltransplantation, Universitätsklinikum Münster (UKM), Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Munich, Germany
| | - Christian Buske
- Institute of Experimental Cancer Research, CCC Ulm, University Hospital Ulm, Germany
| | - Maria Dollores Caballero
- Clinical and Transplant Unit, University Hospital of Salamanca, Spain
- Department of Medicine at the University of Salamanca, Spain
- El Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Elias Campo
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Bjoern Chapuy
- Department of Hematology, Oncology and Tumor Immunology, Charité, University Medical Center Berlin, Campus Benjamin Franklin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Andrew Davies
- Southampton NCRI/UK Experimental Cancer Medicines Centre, Faculty of Medicine, University of Southampton, United Kingdom
| | - Laurence de Leval
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Jeanette Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Philippe Gaulard
- Département de Pathologie, Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Francesca Gay
- Clinical Trial Unit, Division of Hematology 1, AOU Città Della Salute e Della Scienza, University of Torino, Italy
| | - Paolo Ghia
- Università Vita Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | - Kirsten Grønbæk
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Biotech Research & Innovation Centre (BRIC), University of Copenhagen, Denmark
| | - Hartmut Goldschmidt
- University Hospital Heidelberg, Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Marie-Jose Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam and LYMMCARE, Amsterdam, the Netherlands
| | - Barbara Kiesewetter
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria
| | - Judith Landman-Parker
- Pediatric Hematology Oncology, Sorbonne Université APHP/hôpital A Trousseau, Paris, France
| | - Steven Le Gouill
- Service d’Hématologie, Clinique du Centre Hospitalier Universitaire (CHU) de Nantes, France
| | - Georg Lenz
- Medical Department A for Hematology, Oncology and Pneumology, University Hospital Münster, Germany
| | - Sirpa Leppä
- University of Helsinki and Helsinki University Hospital Comprehensive Cancer Centre, Helsinki, Finland
| | | | - Elizabeth Macintyre
- Onco-hematology, Université de Paris and Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, France
| | | | - Philippe Moreau
- Hematology Department, University Hospital Hotel-Dieu, Nantes, France
| | - Carol Moreno
- Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona, Spain
| | - Bertrand Nadel
- Aix Marseille Univ, CNRS, INSERM, CIML, Marseille, France
| | - Jessica Okosun
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, United Kingdom
| | - Roger Owen
- St James’s Institute of Oncology, Leeds, United Kingdom
| | - Sarka Pospisilova
- Department of Internal Medicine—Hematology and Oncology and Department of Medical Genetics and Genomics, Faculty of Medicine, Masaryk University and University Hospital Brno, Czech Republic
| | - Christiane Pott
- Klinisch-experimentelle Hämatologie, Medizinische Klinik II, Hämatologie und Internistische Onkologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany
| | | | - Michelle Spina
- Division of Medical Oncology and Immune-related Tumors, National Cancer Institute, Aviano, Italy
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Jan Stary
- Department of Pediatric Hematology and Oncology 2nd Faculty of Medicine, Charles University Prague University Hospital, Prague, Czech Republic
| | - Karin Tarte
- Immunology and Cell Therapy Lab at Rennes University Hospital, Rennes, France
| | | | - Catherine Thieblemont
- Department of Hemato-Oncology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Ralf Ulrich Trappe
- Department of Internal Medicine II: Haematology and Oncology, DIAKO Hospital Bremen, Germany
| | - Lorenz H. Trümper
- Hematology and Medical Oncology, University Medicine Goettingen, Germany
| | - Gilles Salles
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, NY, USA
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24
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Indications for haematopoietic cell transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2022. Bone Marrow Transplant 2022; 57:1217-1239. [PMID: 35589997 PMCID: PMC9119216 DOI: 10.1038/s41409-022-01691-w] [Citation(s) in RCA: 110] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 12/17/2022]
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25
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Teisseyre M, Cremoni M, Boyer-Suavet S, Ruetsch C, Graça D, Esnault VLM, Brglez V, Seitz-Polski B. Advances in the Management of Primary Membranous Nephropathy and Rituximab-Refractory Membranous Nephropathy. Front Immunol 2022; 13:859419. [PMID: 35603210 PMCID: PMC9114510 DOI: 10.3389/fimmu.2022.859419] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/22/2022] [Indexed: 02/06/2023] Open
Abstract
Primary membranous nephropathy (pMN) is an auto-immune disease characterized by auto-antibodies targeting podocyte antigens resulting in activation of complement and damage to the glomerular basement membrane. pMN is the most common cause of nephrotic syndrome in adults without diabetes. Despite a very heterogeneous course of the disease, the treatment of pMN has for many years been based on uniform management of all patients regardless of the severity of the disease. The identification of prognostic markers has radically changed the vision of pMN and allowed KDIGO guidelines to evolve in 2021 towards a more personalized management based on the assessment of the risk of progressive loss of kidney function. The recognition of pMN as an antibody-mediated autoimmune disease has rationalized the use immunosuppressive drugs such as rituximab. Rituximab is now a first line immunosuppressive therapy for patients with pMN with proven safety and efficacy achieving remission in 60-80% of patients. For the remaining 20-40% of patients, several mechanisms may explain rituximab resistance: (i) decreased rituximab bioavailability; (ii) immunization against rituximab; and (iii) chronic glomerular damage. The treatment of patients with rituximab-refractory pMN remains controversial and challenging. In this review, we provide an overview of recent advances in the management of pMN (according to the KDIGO 2021 guidelines), in the understanding of the pathophysiology of rituximab resistance, and in the management of rituximab-refractory pMN. We propose a treatment decision aid based on immunomonitoring to identify failures related to underdosing or immunization against rituximab to overcome treatment resistance.
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Affiliation(s)
- Maxime Teisseyre
- Centre de Référence Maladies Rares Syndrome Néphrotique Idiopathique, CHU de Nice, Université Côte d’Azur, Nice, France
- Unité de Recherche Clinique de la Côte d’Azur (UR2CA), Université Côte d’Azur, Nice, France
| | - Marion Cremoni
- Centre de Référence Maladies Rares Syndrome Néphrotique Idiopathique, CHU de Nice, Université Côte d’Azur, Nice, France
- Unité de Recherche Clinique de la Côte d’Azur (UR2CA), Université Côte d’Azur, Nice, France
| | - Sonia Boyer-Suavet
- Unité de Recherche Clinique de la Côte d’Azur (UR2CA), Université Côte d’Azur, Nice, France
| | - Caroline Ruetsch
- Laboratoire d’Immunologie, CHU de Nice, Université Côte d’Azur, Nice, France
| | - Daisy Graça
- Centre de Référence Maladies Rares Syndrome Néphrotique Idiopathique, CHU de Nice, Université Côte d’Azur, Nice, France
- Unité de Recherche Clinique de la Côte d’Azur (UR2CA), Université Côte d’Azur, Nice, France
| | - Vincent L. M. Esnault
- Centre de Référence Maladies Rares Syndrome Néphrotique Idiopathique, CHU de Nice, Université Côte d’Azur, Nice, France
- Service de Néphrologie-Dialyse-Transplantation, CHU de Nice, Université Côte d’Azur, Nice, France
| | - Vesna Brglez
- Centre de Référence Maladies Rares Syndrome Néphrotique Idiopathique, CHU de Nice, Université Côte d’Azur, Nice, France
- Unité de Recherche Clinique de la Côte d’Azur (UR2CA), Université Côte d’Azur, Nice, France
| | - Barbara Seitz-Polski
- Centre de Référence Maladies Rares Syndrome Néphrotique Idiopathique, CHU de Nice, Université Côte d’Azur, Nice, France
- Unité de Recherche Clinique de la Côte d’Azur (UR2CA), Université Côte d’Azur, Nice, France
- Laboratoire d’Immunologie, CHU de Nice, Université Côte d’Azur, Nice, France
- Service de Néphrologie-Dialyse-Transplantation, CHU de Nice, Université Côte d’Azur, Nice, France
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Miura K, Takahashi H, Nakagawa M, Hamada T, Uchino Y, Iizuka K, Ohtake S, Iriyama N, Hatta Y, Nakamura H. Ideal dose intensity of R-CHOP in diffuse large B-cell lymphoma. Expert Rev Anticancer Ther 2022; 22:583-595. [PMID: 35472312 DOI: 10.1080/14737140.2022.2071262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The standard of care for diffuse large B-cell lymphoma (DLBCL) is rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). However, its ideal dose intensity varies among cases. AREAS COVERED This review provides the latest insights on the dose intensity of R-CHOP for DLBCL patients. Specifically, we discussed the optimal dose intensity for elderly patients, the optimal number of treatment cycles for limited or advanced-stage diseases, and the role of dose-intensified therapies or adding targeted inhibitors. EXPERT OPINION Performing a comprehensive or simplified geriatric assessment can distinguish elderly DLBCL patients who will likely benefit from curative R-CHOP. Very elderly or medically unfit patients may need dose reduction in R-CHOP; the Age, Comorbidities, and Albumin index may aid decision-making. Four cycles of R-CHOP followed by two rituximab cycles comprise a new standard for low-risk, limited-stage DLBCL patients. Compared to eight cycles, six cycles of R-CHOP have similar efficacy and fewer toxicities for advanced-stage DLBCL. Dose-intensified therapy is not recommended in most DLBCL cases but may be considered for patients with double (or triple)-hit lymphoma. Applying targeted inhibitors and not merely escalating R-CHOP dose intensity through molecular subtyping will improve the treatment outcome for DLBCL.
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Affiliation(s)
- Katsuhiro Miura
- Tumor Center, Nihon University Itabashi Hospital (Director); 2Department of Hematology and Rheumatology, Nihon University School of Medicine (Associate Professor), Tokyo, Japan.,Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiromichi Takahashi
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Masaru Nakagawa
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Takashi Hamada
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshihito Uchino
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Kazuhide Iizuka
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Shimon Ohtake
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Noriyoshi Iriyama
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshihiro Hatta
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hideki Nakamura
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
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Papageorgiou SG, Thomopoulos TP, Liaskas A, Vassilakopoulos TP. Monoclonal Antibodies in the Treatment of Diffuse Large B-Cell Lymphoma: Moving beyond Rituximab. Cancers (Basel) 2022; 14:1917. [PMID: 35454825 PMCID: PMC9026383 DOI: 10.3390/cancers14081917] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 11/23/2022] Open
Abstract
Although rituximab has revolutionized the treatment of diffuse large B-cell lymphoma (DLBCL), a significant proportion of patients experience refractory disease or relapse early after the end of treatment. The lack of effective treatment options in the relapsed/refractory (R/R) setting had made the prognosis of these patients dismal. The initial enthusiasm for novel anti-CD20 antibodies had been short-lived as they failed to prove their superiority to rituximab. Therefore, research has focused on developing novel agents with a unique mechanism of action. Among them, two antibody-drug conjugates, namely polatuzumab vedotin (PolaV) and loncastuximab tesirine, along with tafasitamab, an anti-CD19 bioengineered antibody, have been approved for the treatment of R/R DLBCL. Whereas PolaV has been FDA and EMA approved, EMA has not approved loncastuximab tesirine and tafasitamab yet. Results from randomized trials, as well as real-life data for PolaV have been promising. Novel agents as bispecific antibodies bridging CD3 on T-cells to CD20 have shown very promising results in clinical trials and are expected to gain approval for treatment of R/R DLBCL soon. As the therapeutic armamentarium against DLBCL is expanding, an improvement in survival of patients with R/R and higher cure rates might soon become evident.
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Affiliation(s)
- Sotirios G. Papageorgiou
- Hematology Unit, Second Propaedeutic Department of Internal Medicine and Research Institute, School of Medicine, National and Kapodistrian University of Athens, University General Hospital “Attikon”, 18120 Athens, Greece; (S.G.P.); (T.P.T.)
| | - Thomas P. Thomopoulos
- Hematology Unit, Second Propaedeutic Department of Internal Medicine and Research Institute, School of Medicine, National and Kapodistrian University of Athens, University General Hospital “Attikon”, 18120 Athens, Greece; (S.G.P.); (T.P.T.)
| | - Athanasios Liaskas
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece;
| | - Theodoros P. Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece;
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Casasnovas RO, Bouabdallah R, Brice P, Lazarovici J, Ghesquieres H, Stamatoullas A, Dupuis J, Gac AC, Gastinne T, Joly B, Bouabdallah K, Nicolas-Virelizier E, Feugier P, Morschhauser F, Sibon D, Bonnet C, Berriolo-Riedinger A, Edeline V, Parrens M, Damotte D, Coso D, André M, Meignan M, Rossi C. Positron Emission Tomography-Driven Strategy in Advanced Hodgkin Lymphoma: Prolonged Follow-Up of the AHL2011 Phase III Lymphoma Study Association Study. J Clin Oncol 2022; 40:1091-1101. [PMID: 34990281 DOI: 10.1200/jco.21.01777] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The AHL2011 study (ClinicalTrials.gov identifier: NCT01358747) demonstrated that a positron emission tomography (PET)-driven de-escalation strategy after two cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) provides similar progression-free survival (PFS) and overall survival (OS) and reduces early toxicity compared with a nonmonitored standard treatment. Here, we report, with a prolonged follow-up, the final study results. METHODS Patients with advanced Hodgkin lymphoma (stage III, IV, or IIB with mediastinum/thorax ratio > 0.33 or extranodal involvement) age 16-60 years were prospectively randomly assigned between 6 × BEACOPP and a PET-driven arm after 2 × BEACOPP delivering 4 × ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in PET2- and 4 × BEACOPP in PET2+ patients. PET performed after four cycles of chemotherapy had to be negative to complete the planned treatment. RESULTS In total, 823 patients were enrolled including 413 in the standard arm and 410 in the PET-driven arm. With a 67.2-month median follow-up, 5-year PFS (87.5% v 86.7%; hazard ratio [HR] = 1.07; 95% CI, 0.74 to 1.57; P = .67) and OS (97.7% in both arms; HR = 1.012; 95% CI, 0.50 to 2.10; P = .53) were similar in both randomization arms. In the whole cohort, full interim PET assessment predicted patients' 5-year PFS (92.3% in PET2-/PET4-, 75.4% [HR = 3.26; 95% CI, 18.3 to 5.77] in PET2+/PET4- and 46.5% [HR = 12.4; 95% CI, 7.31 to 19.51] in PET4+ patients, respectively; P < .0001) independent of international prognosis score. Five-year OS was also affected by interim PET results, and PET2+/PET4- patients (93.5%; HR = 3.3; 95% CI, 1.07 to 10.1; P = .036) and PET4+ patients (91.9%; HR = 3.756; 95% CI, 1.07 to 13.18; P = .038) had a significant lower OS than PET2-/PET4- patients (98.2%). Twenty-two patients (2.7%) developed a second primary malignancy, 13 (3.2%) and 9 (2.2%) in the standard and experimental arms, respectively. CONCLUSION The extended follow-up confirms the continued efficacy and favorable safety of AHL2011 PET-driven strategy, which is noninferior to standard six cycles of BEACOPP. PET4 provides additional prognostic information to PET2 and allows identifying patients with particularly poor prognosis.
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Affiliation(s)
- René-Olivier Casasnovas
- Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, Dijon, France
| | - Reda Bouabdallah
- Department of Hematology, Institut P. Calmette, Marseille, France.,Department of Hematology, Hopital privé de Provence, Aix en Provence, France
| | - Pauline Brice
- Department of Hematology, APHP, Hopital Saint Louis, Paris, France
| | | | - Hervé Ghesquieres
- Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, et Université Claude Bernard Lyon-1, Pierre Bénite, France
| | | | - Jehan Dupuis
- Lymphoid Malignancies Unit, Henri Mondor University Hospital, Créteil, France
| | - Anne-Claire Gac
- Department of Hematology, Institut d'hématologie de basse normandie, Caen, France
| | - Thomas Gastinne
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - Bertrand Joly
- Department of Hematology, Hospital Sud Francilien, Corbeille-Essonnes, France
| | - Krimo Bouabdallah
- Department of Hematology, University Hospital of Bordeaux, Bordeaux, France
| | | | - Pierre Feugier
- Department of Hematology, University Hospital of Nancy, Vandoeuvre les Nancy, France
| | - Franck Morschhauser
- Department of Hematology, CHU Lille, Unité GRITA, Université de Lille 2, Lille, France
| | - David Sibon
- Department of Hematology, Hopital Necker, Paris, France
| | | | | | - Véronique Edeline
- Department of Nuclear Medicine, Hopital R. Huguenin, Institut Curie, St-Cloud, France
| | - Marie Parrens
- Department of Pathology, University Hospital of Bordeaux and Inserm UMR 1053, Bordeaux, France
| | - Diane Damotte
- Department of Pathology, Université de Paris et GH Paris Centre APHP, Paris, France
| | - Diane Coso
- Department of Hematology, Institut P. Calmette, Marseille, France
| | - Marc André
- Department of Hematology, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium.,Pole Mont, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Michel Meignan
- Department of Nuclear Medicine, University Hospital H. Mondor, Creteil, France
| | - Cédric Rossi
- Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, Dijon, France
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DLBCL 1L—What to Expect beyond R-CHOP? Cancers (Basel) 2022; 14:cancers14061453. [PMID: 35326604 PMCID: PMC8946010 DOI: 10.3390/cancers14061453] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/26/2022] Open
Abstract
Simple Summary Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin’s lymphoma. About two-thirds of patients are cured by the first-line (1L) standard of care (SOC), the R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisolone) immunochemotherapy protocol. The profound molecular heterogeneity of DLBCL is the underlying reason why many patients, despite improved next-line options, eventually succumb to the disease. Hence, enhancing the efficacy of 1L treatment is critical for improving long-term outcomes in DLBCL. A plethora of novel treatment options with potential in later lines is currently under evaluation in 1L settings. We summarize here the established and emerging strategies for newly diagnosed DLBCL and emphasize the need for individualized treatment decisions. Abstract The R-CHOP immunochemotherapy protocol has been the first-line (1L) standard of care (SOC) for diffuse large B-cell lymphoma (DLBCL) patients for decades and is curative in approximately two-thirds of patients. Numerous randomized phase III trials, most of them in an “R-CHOP ± X” design, failed to further improve outcomes. This was mainly due to increased toxicity, the large proportion of patients not in need of more than R-CHOP, and the extensive molecular heterogeneity of the disease, raising the bar for “one-size-fits-all” concepts. Recently, an R-CHP regimen extended by the anti-CD79b antibody–drug conjugate (ADC) Polatuzumab Vedotin proved superior to R-CHOP in terms of progression-free survival (PFS) in the POLARIX phase III trial. Moreover, a number of targeted agents, especially the Bruton’s tyrosine kinase (BTK) inhibitor Ibrutinib, seem to have activity in certain patient subsets in 1L and are currently being tested in front-line regimens. Chimeric antigen receptor (CAR) T-cells, achieving remarkable results in ≥3L scenarios, are being exploited in earlier lines of therapy, while T-cell-engaging bispecific antibodies emerge as conceptual competitors of CAR T-cells. Hence, we present here the findings and lessons learnt from phase III 1L trials and piloting phase II studies in relapsed/refractory (R/R) and 1L settings, and survey chemotherapy-free regimens with respect to their efficacy and future potential in 1L. Novel agents and their mode of action will be discussed in light of the molecular landscape of DLBCL and personalized 1L perspectives for the challenging patient population not cured by the SOC.
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Perrone S, Lopedote P, Levis M, Di Rocco A, Smith SD. Management of relapsed or refractory large B-cell lymphoma in patients ineligible for CAR-T cell therapy. Expert Rev Hematol 2022; 15:215-232. [PMID: 35184664 DOI: 10.1080/17474086.2022.2044778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chimeric antigen receptor T (CAR-T) therapy has revolutionized the treatment of relapsed/refractory large B-cell lymphoma (LBCL). However, patients who are excluded or have no access to CAR-T represent a challenge for clinicians and have generally a dismal outcome. The landscape for this category of patients is constantly evolving: new agents have been approved in the last 2-3 years, alone or in combination, and novel treatment modalities are under investigations. AREAS COVERED Thereafter, we reviewed the currently available therapeutic strategies: conventional chemotherapy, Antibody-drug conjugate ADC (mainly polatuzumab and loncastuxumab), bispecific antibodies (CD19/CD3 and focus on novel CD20/CD3 Abs), immunomodulatory drugs (covering tafasitamab and lenalidomide, checkpoint inhibitors mainly in PMBL), small molecules (selinexor, BTK and PI3K inhibitors), and the role of radiotherapy. EXPERT OPINION Navigating this scenario, will uncover new challenges, including identifying an ideal sequence for these therapies, the most effective combinations, and search for consistent predictive factors to help selecting the appropriate population of LBCL patients. At present, supporting clinical research for CAR-T ineligible patients, a new and challenging group, must remain a major focus that is complementary to advances in CAR T-cell therapy.
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Affiliation(s)
- Salvatore Perrone
- Hematology, Polo Universitario Pontino, S.M. Goretti Hospital, Latina, Italy
| | - Paolo Lopedote
- Internal Medicine, St Elizabeth's Medical Center, Boston University, Boston, U.S
| | - Mario Levis
- Department of Oncology, University of Torino, Torino, Italy
| | - Alice Di Rocco
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Stephen Douglas Smith
- Division of Medical Oncology, Department of Internal Medicine, University of Washington, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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31
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Revailler W, Cottereau AS, Rossi C, Noyelle R, Trouillard T, Morschhauser F, Casasnovas O, Thieblemont C, Le Gouill S, André M, Ghesquieres H, Ricci R, Meignan M, Kanoun S. Deep Learning Approach to Automatize TMTV Calculations Regardless of Segmentation Methodology for Major FDG-Avid Lymphomas. Diagnostics (Basel) 2022; 12:diagnostics12020417. [PMID: 35204515 PMCID: PMC8870809 DOI: 10.3390/diagnostics12020417] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/16/2022] Open
Abstract
The total metabolic tumor volume (TMTV) is a new prognostic factor in lymphomas that could benefit from automation with deep learning convolutional neural networks (CNN). Manual TMTV segmentations of 1218 baseline 18FDG-PET/CT have been used for training. A 3D V-NET model has been trained to generate segmentations with soft dice loss. Ground truth segmentation has been generated using a combination of different thresholds (TMTVprob), applied to the manual region of interest (Otsu, relative 41% and SUV 2.5 and 4 cutoffs). In total, 407 and 405 PET/CT were used for test and validation datasets, respectively. The training was completed in 93 h. In comparison with the TMTVprob, mean dice reached 0.84 in the training set, 0.84 in the validation set and 0.76 in the test set. The median dice scores for each TMTV methodology were 0.77, 0.70 and 0.90 for 41%, 2.5 and 4 cutoff, respectively. Differences in the median TMTV between manual and predicted TMTV were 32, 147 and 5 mL. Spearman’s correlations between manual and predicted TMTV were 0.92, 0.95 and 0.98. This generic deep learning model to compute TMTV in lymphomas can drastically reduce computation time of TMTV.
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Affiliation(s)
- Wendy Revailler
- Centre de Recherche Clinique de Toulouse, Team 9, 31100 Toulouse, France; (W.R.); (T.T.)
- Institut Universitaire du Cancer de Toulouse, Institut Claudius Regaud, Nuclear Medicine, 1 avenue Joliot Curie, 31000 Toulouse, France
| | - Anne Ségolène Cottereau
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Nuclear Medecine, René Descartes University, 75014 Paris, France;
| | - Cedric Rossi
- CHU Dijon, Hematology, 10 Boulevard Maréchal De Lattre De Tassigny, 21000 Dijon, France; (C.R.); (O.C.)
| | | | - Thomas Trouillard
- Centre de Recherche Clinique de Toulouse, Team 9, 31100 Toulouse, France; (W.R.); (T.T.)
- Institut Universitaire du Cancer de Toulouse, Institut Claudius Regaud, Nuclear Medicine, 1 avenue Joliot Curie, 31000 Toulouse, France
| | - Franck Morschhauser
- ULR 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, CHU Lille, 59000 Lille, France;
| | - Olivier Casasnovas
- CHU Dijon, Hematology, 10 Boulevard Maréchal De Lattre De Tassigny, 21000 Dijon, France; (C.R.); (O.C.)
| | - Catherine Thieblemont
- Hemato-Oncology Unit, Saint-Louis University Hospital Center, Public Hospital Network of Paris, 75010 Paris, France;
| | - Steven Le Gouill
- Department of Hematology, Nantes University Hospital, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, 44000 Nantes, France;
| | - Marc André
- Department of Hematology, Université catholique de Louvain, CHU UcL Namur, 5530 Yvoir, Belgium;
| | - Herve Ghesquieres
- Department of Hematology, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France;
| | - Romain Ricci
- LYSARC, Centre Hospitalier Lyon-Sud, 165 Chemin du Grand Revoyet Bâtiment 2D, 69310 Pierre-Bénite, France;
| | - Michel Meignan
- LYSA Imaging, Henri Mondor University Hospital, AP-HP, University Paris East, 94000 Créteil, France;
| | - Salim Kanoun
- Centre de Recherche Clinique de Toulouse, Team 9, 31100 Toulouse, France; (W.R.); (T.T.)
- Institut Universitaire du Cancer de Toulouse, Institut Claudius Regaud, Nuclear Medicine, 1 avenue Joliot Curie, 31000 Toulouse, France
- Correspondence: ; Tel.: +33-6-88-62-81-18
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Kusowska A, Kubacz M, Krawczyk M, Slusarczyk A, Winiarska M, Bobrowicz M. Molecular Aspects of Resistance to Immunotherapies-Advances in Understanding and Management of Diffuse Large B-Cell Lymphoma. Int J Mol Sci 2022; 23:ijms23031501. [PMID: 35163421 PMCID: PMC8835809 DOI: 10.3390/ijms23031501] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 12/28/2022] Open
Abstract
Despite the unquestionable success achieved by rituximab-based regimens in the management of diffuse large B-cell lymphoma (DLBCL), the high incidence of relapsed/refractory disease still remains a challenge. The widespread clinical use of chemo-immunotherapy demonstrated that it invariably leads to the induction of resistance; however, the molecular mechanisms underlying this phenomenon remain unclear. Rituximab-mediated therapeutic effect primarily relies on complement-dependent cytotoxicity and antibody-dependent cell cytotoxicity, and their outcome is often compromised following the development of resistance. Factors involved include inherent genetic characteristics and rituximab-induced changes in effectors cells, the role of ligand/receptor interactions between target and effector cells, and the tumor microenvironment. This review focuses on summarizing the emerging advances in the understanding of the molecular basis responsible for the resistance induced by various forms of immunotherapy used in DLBCL. We outline available models of resistance and delineate solutions that may improve the efficacy of standard therapeutic protocols, which might be essential for the rational design of novel therapeutic regimens.
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Affiliation(s)
- Aleksandra Kusowska
- Department of Immunology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.K.); (M.K.); (M.K.); (A.S.); (M.W.)
- Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Matylda Kubacz
- Department of Immunology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.K.); (M.K.); (M.K.); (A.S.); (M.W.)
| | - Marta Krawczyk
- Department of Immunology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.K.); (M.K.); (M.K.); (A.S.); (M.W.)
- Laboratory of Immunology, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland
- Doctoral School of Translational Medicine, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Aleksander Slusarczyk
- Department of Immunology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.K.); (M.K.); (M.K.); (A.S.); (M.W.)
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, 02-005 Warsaw, Poland
| | - Magdalena Winiarska
- Department of Immunology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.K.); (M.K.); (M.K.); (A.S.); (M.W.)
- Laboratory of Immunology, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Malgorzata Bobrowicz
- Department of Immunology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.K.); (M.K.); (M.K.); (A.S.); (M.W.)
- Correspondence:
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Le Gallou S, Lhomme F, Irish JM, Mingam A, Pangault C, Monvoisin C, Ferrant J, Azzaoui I, Rossille D, Bouabdallah K, Damaj G, Cartron G, Godmer P, Le Gouill S, Casasnovas RO, Molina TJ, Houot R, Lamy T, Tarte K, Fest T, Roussel M. Nonclassical Monocytes Are Prone to Migrate Into Tumor in Diffuse Large B-Cell Lymphoma. Front Immunol 2021; 12:755623. [PMID: 34975843 PMCID: PMC8716558 DOI: 10.3389/fimmu.2021.755623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022] Open
Abstract
Absolute count of circulating monocytes has been proposed as an independent prognostic factor in diffuse large B-cell lymphoma (DLBCL). However, monocyte nomenclature includes various subsets with pro-, anti-inflammatory, or suppressive functions, and their clinical relevance in DLBCL has been poorly explored. Herein, we broadly assessed circulating monocyte heterogeneity in 91 DLBCL patients. Classical- (cMO, CD14pos CD16neg) and intermediate- (iMO, CD14pos CD16pos) monocytes accumulated in DLBCL peripheral blood and exhibited an inflammatory phenotype. On the opposite, nonclassical monocytes (ncMOSlanpos, CD14low CD16pos Slanneg and ncMOSlanneg, CD14low CD16pos, Slanneg) were decreased in peripheral blood. Tumor-conditioned monocytes presented similarities with ncMO phenotype from DLBCL and were prone to migrate in response to CCL5 and CXCL12, and presented similarities with DLBCL-infiltrated myeloid cells, as defined by mass cytometry. Finally, we demonstrated the adverse value of an accumulation of nonclassical monocytes in 2 independent cohorts of DLBCL.
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Affiliation(s)
- Simon Le Gallou
- Centre Hospitalier Universitaire de Rennes, Pôle Biologie, Rennes, France
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche U1236, Université Rennes 1, Etablissement Français du Sang Bretagne, Rennes, France
| | - Faustine Lhomme
- Centre Hospitalier Universitaire de Rennes, Pôle Biologie, Rennes, France
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Jonathan M. Irish
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN, United States
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Anna Mingam
- Centre Hospitalier Universitaire de Rennes, Pôle Biologie, Rennes, France
| | - Celine Pangault
- Centre Hospitalier Universitaire de Rennes, Pôle Biologie, Rennes, France
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche U1236, Université Rennes 1, Etablissement Français du Sang Bretagne, Rennes, France
| | - Celine Monvoisin
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche U1236, Université Rennes 1, Etablissement Français du Sang Bretagne, Rennes, France
| | - Juliette Ferrant
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche U1236, Université Rennes 1, Etablissement Français du Sang Bretagne, Rennes, France
| | - Imane Azzaoui
- Centre Hospitalier Universitaire de Rennes, Pôle Biologie, Rennes, France
| | - Delphine Rossille
- Centre Hospitalier Universitaire de Rennes, Pôle Biologie, Rennes, France
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche U1236, Université Rennes 1, Etablissement Français du Sang Bretagne, Rennes, France
| | - Krimo Bouabdallah
- Centre Hospitalier Universitaire de Bordeaux, Service d’Hématologie Clinique, Bordeaux, France
| | - Gandhi Damaj
- Centre Hospitalier Universitaire de Caen, Service d’Hématologie Clinique, Caen, France
| | - Guillaume Cartron
- Centre Hospitalier Universitaire de Montpellier, Service d’Hématologie Clinique, Montpellier, France
| | - Pascal Godmer
- Centre Hospitalier de Bretagne Atlantique, Unité d’Hématologie Clinique, Vannes, France
| | - Steven Le Gouill
- Centre Hospitalier Universitaire de Nantes, Service d’Hématologie Clinique, Institut National de la Sante et de la Recherche Medicale, Centre de Recherche en Cancérologie et Immunologie Nantes Angers (INSERM CCRCINA) Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | | | - Thierry Jo Molina
- Asistance Publique, Hopitaux de Paris (APHP), Necker, Service d’Anatomopathologie, Sorbonne Université, Paris, France
| | - Roch Houot
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche U1236, Université Rennes 1, Etablissement Français du Sang Bretagne, Rennes, France
- Centre Hospitalier Universitaire de Rennes, Service d’Hématologie Clinique, Rennes, France
| | - Thierry Lamy
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche U1236, Université Rennes 1, Etablissement Français du Sang Bretagne, Rennes, France
- Centre Hospitalier Universitaire de Rennes, Service d’Hématologie Clinique, Rennes, France
| | - Karin Tarte
- Centre Hospitalier Universitaire de Rennes, Pôle Biologie, Rennes, France
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche U1236, Université Rennes 1, Etablissement Français du Sang Bretagne, Rennes, France
| | - Thierry Fest
- Centre Hospitalier Universitaire de Rennes, Pôle Biologie, Rennes, France
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche U1236, Université Rennes 1, Etablissement Français du Sang Bretagne, Rennes, France
| | - Mikael Roussel
- Centre Hospitalier Universitaire de Rennes, Pôle Biologie, Rennes, France
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche U1236, Université Rennes 1, Etablissement Français du Sang Bretagne, Rennes, France
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Abstract
PURPOSE OF REVIEW Functional imaging with 18FDG-PET-CT has transformed the staging and response assessment of patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL). Herein, we review the current role and future directions for functional imaging in the management of patients with lymphoma. RECENT FINDINGS Because of its increased sensitivity, PET-CT is the preferred modality for staging of FDG-avid lymphomas. It appears to have a role for interim assessment in patients with HL with adaptive strategies that reduce toxicity in lower risk patients and increase efficacy in those at high risk. Such a role has yet to be demonstrated in other histologies. FDG-PET-CT is also the gold standard for response assessment posttreatment. Newer uses include assessment of total metabolic tumor volume and radiomics in pretreatment prognosis. Whereas PET-CT is more sensitive than other current modalities for staging and response assessment, the future of PET-CT will be in conjunction with other modalities, notably assessment of minimal residual disease and microenvironmental markers to develop risk adaptive strategies to improve the outcome of patients with lymphoma.
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35
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Phillips EH, Iype R, Wirth A. PET-guided treatment for personalised therapy of Hodgkin lymphoma and aggressive non-Hodgkin lymphoma. Br J Radiol 2021; 94:20210576. [PMID: 34520242 DOI: 10.1259/bjr.20210576] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
FDG-PET scanning has a central role in lymphoma staging and response assessment. There is a growing body of evidence that PET response assessment during and after initial systemic therapy can provide useful prognostic information, and PET response has an evolving role in guiding patient care. This review provides a perspective on the role of PET response assessment for individualised management of patients with the most common aggressive lymphomas, Hodgkin lymphoma and diffuse large B-cell lymphoma.
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Affiliation(s)
- Elizabeth H Phillips
- Division of Cancer Sciences, University of Manchester, Manchester, UK.,Department of Medical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Rohan Iype
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Andrew Wirth
- Department of Clinical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Australia
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36
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Early FDG PET response predicts CAR-T failure in large B-cell lymphoma. Blood Adv 2021; 6:321-326. [PMID: 34700342 PMCID: PMC8753214 DOI: 10.1182/bloodadvances.2021005807] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/04/2021] [Indexed: 11/20/2022] Open
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37
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Al Tabaa Y, Bailly C, Kanoun S. FDG-PET/CT in Lymphoma: Where Do We Go Now? Cancers (Basel) 2021; 13:cancers13205222. [PMID: 34680370 PMCID: PMC8533807 DOI: 10.3390/cancers13205222] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 01/06/2023] Open
Abstract
18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) is an essential part of the management of patients with lymphoma at staging and response evaluation. Efforts to standardize PET acquisition and reporting, including the 5-point Deauville scale, have enabled PET to become a surrogate for treatment success or failure in common lymphoma subtypes. This review summarizes the key clinical-trial evidence that supports PET-directed personalized approaches in lymphoma but also points out the potential place of innovative PET/CT metrics or new radiopharmaceuticals in the future.
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Affiliation(s)
- Yassine Al Tabaa
- Scintidoc Nuclear Medicine Center, 25 rue de Clémentville, 34070 Montpellier, France
- Correspondence:
| | - Clement Bailly
- CRCINA, INSERM, CNRS, Université d’Angers, Université de Nantes, 44093 Nantes, France;
- Nuclear Medicine Department, University Hospital, 44093 Nantes, France
| | - Salim Kanoun
- Nuclear Medicine Department, Institute Claudius Regaud, 31100 Toulouse, France;
- Cancer Research Center of Toulouse (CRCT), Team 9, INSERM UMR 1037, 31400 Toulouse, France
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38
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Outcomes after first-line immunochemotherapy for primary mediastinal B-cell lymphoma: a LYSA study. Blood Adv 2021; 5:3862-3872. [PMID: 34461634 DOI: 10.1182/bloodadvances.2021004778] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/04/2021] [Indexed: 11/20/2022] Open
Abstract
Primary mediastinal B-cell lymphoma (PMBL) is a rare type of aggressive lymphoma typically affecting young female patients. The first-line standard of care remains debated. We performed a large multicenter retrospective study in 25 centers in France and Belgium to describe PMBL patient outcomes after first-line treatment in real-life settings. A total of 313 patients were enrolled and received rituximab (R) plus ACVBP (doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone) (n = 180) or CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) delivered every 14 days (R-CHOP14, n = 76) or 21 days (R-CHOP21, n = 57) and consolidation strategies in modalities that varied according to time and institution, mainly guided by positron emission tomography. Consolidation autologous stem cell transplantation was performed for 46 (25.6%), 24 (31.6%), and 1 (1.8%) patient in the R-ACVBP, R-CHOP14, and R-CHOP21 groups, respectively (P < .001); only 17 (5.4%) patients received mediastinal radiotherapy. The end-of-treatment complete metabolic response rates were 86.3%, 86.8%, and 76.6% (P = .23) in the R-ACVBP, R-CHOP14, and R-CHOP21 groups. The median follow-up was 44 months, and the R-ACVBP, R-CHOP14, and R-CHOP21 three-year progression-free survival probabilities were 89.4% (95% confidence interval [CI], 84.8-94.2), 89.4% (95% CI, 82.7-96.6), and 74.7% (95% CI, 64-87.1) (P = .018). A baseline total metabolic tumor volume (TMTV) ≥360 cm3 was associated with a lower progression-free survival (hazard ratio, 2.18; 95% CI, 1.05-4.53). Excess febrile neutropenia (24.4% vs 5.3% vs 5.3%; P < .001) and mucositis (22.8% vs 3.9% vs 1.8%; P < .001) were observed with R-ACVBP compared with the R-CHOP regimens. Patients with PMBL treated with dose-dense immunochemotherapy without radiotherapy have excellent outcomes. R-ACVBP acute toxicity was higher than that of R-CHOP14. Our data confirmed the prognostic importance of baseline TMTV.
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39
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Jullien M, Tessoulin B, Ghesquières H, Oberic L, Morschhauser F, Tilly H, Ribrag V, Lamy T, Thieblemont C, Villemagne B, Gressin R, Bouabdallah K, Haioun C, Damaj G, Fornecker LM, Schiano De Colella JM, Feugier P, Hermine O, Cartron G, Bonnet C, André M, Bailly C, Casasnovas RO, Le Gouill S. Deep-Learning Assessed Muscular Hypodensity Independently Predicts Mortality in DLBCL Patients Younger Than 60 Years. Cancers (Basel) 2021; 13:cancers13184503. [PMID: 34572728 PMCID: PMC8466314 DOI: 10.3390/cancers13184503] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/27/2021] [Accepted: 09/03/2021] [Indexed: 01/06/2023] Open
Abstract
Simple Summary Cachexia is a major cause of mortality in cancer patients and is characterized by a continuous skeletal muscle loss. Muscle depletion assessed by computed tomography (CT) is a predictive marker in solid tumors but has never been assessed in non-Hodgkin’s lymphoma. Despite software improvements, its measurement remains highly time-consuming and cannot be performed in clinical practice. We report the development of a CT segmentation algorithm based on convolutional neural networks. It automates the extraction of anthropometric data from pretherapeutic CT to assess precise body composition of young diffuse large B cell lymphoma (DLBCL) patients at the time of diagnosis. In this population, muscle hypodensity appears to be an independent risk factor for mortality, and can be estimated at diagnosis with this new tool. Abstract Background. Muscle depletion (MD) assessed by computed tomography (CT) has been shown to be a predictive marker in solid tumors, but has not been assessed in non-Hodgkin’s lymphomas. Despite software improvements, MD measurement remains highly time-consuming and cannot be used in clinical practice. Methods. This study reports the development of a Deep-Learning automatic segmentation algorithm (DLASA) to measure MD, and investigate its predictive value in a cohort of 656 diffuse large B cell lymphoma (DLBCL) patients included in the GAINED phase III prospective trial (NCT01659099). Results. After training on a series of 190 patients, the DLASA achieved a Dice coefficient of 0.97 ± 0.03. In the cohort, the median skeletal muscle index was 50.2 cm2/m2 and median muscle attenuation (MA) was 36.1 Hounsfield units (HU). No impact of sarcopenia was found on either progression free survival (PFS) or overall survival (OS). Muscular hypodensity, defined as MA below the tenth percentile according to sex, was associated with a lower OS and PFS, respectively (HR = 2.80 (95% CI 1.58–4.95), p < 0.001, and HR = 2.22 (95% CI 1.43–3.45), p < 0.001). Muscular hypodensity appears to be an independent risk factor for mortality in DLBCL and because of DLASA can be estimated in routine practice.
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Affiliation(s)
- Maxime Jullien
- Department of Hematology, Nantes University Hospital, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, 44000 Nantes, France; (M.J.); (B.T.)
| | - Benoit Tessoulin
- Department of Hematology, Nantes University Hospital, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, 44000 Nantes, France; (M.J.); (B.T.)
| | - Hervé Ghesquières
- Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Claude Bernard Lyon-1 University, 69310 Pierre Bénite, France;
| | - Lucie Oberic
- Department of Hematology, IUC Toulouse Oncopole, 31000 Toulouse, France;
| | - Franck Morschhauser
- Department of Hematology, Univ. Lille, CHU Lille, EA 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, 59000 Lille, France;
| | - Hervé Tilly
- Department of Hematology, Centre H. Becquerel, 76000 Rouen, France;
| | - Vincent Ribrag
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, 94800 Villejuif, France;
| | - Thierry Lamy
- Department of Hematology, University Hospital of Rennes, 35000 Rennes, France;
| | - Catherine Thieblemont
- Department of Hematology, APHP, Hopital Saint Louis, Université Paris Diderot, 75011 Paris, France;
| | - Bruno Villemagne
- Department of Hematology, Hopital Departemental de Vendée, 85000 La Roche sur Yon, France;
| | - Rémy Gressin
- Department of Hematology, CHU Grenoble, 38000 Grenoble, France;
| | - Kamal Bouabdallah
- Department of Hematology, University Hospital of Bordeaux, F-33000 Bordeaux, France;
| | - Corinne Haioun
- Lymphoïd Malignancies Unit, Hôpital Henri Mondor, AP-HP, 94000 Créteil, France;
| | - Gandhi Damaj
- Department of Hematology, Institut D’hématologie de Basse Normandie, 14000 Caen, France;
| | - Luc-Matthieu Fornecker
- Department of Hematology, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospital of Strasbourg, 67000 Strasbourg, France;
| | | | - Pierre Feugier
- Department of Hematology, University Hospital of Nancy, 54000 Nancy, France;
| | - Olivier Hermine
- Department of Hematology, Hopital Necker, F-75015 Paris, France;
| | - Guillaume Cartron
- Department of Clinical Hematology, University Hospital of Montpellier, UMR-CNRS 5535, 34000 Montpellier, France;
| | - Christophe Bonnet
- Department of Hematology, CHU Liege, Liege University, 4000 Liege, Belgium;
| | - Marc André
- Department of Hematology, CHU UCL Namur, Université Catholique de Louvain, 5000 Namur, Belgium;
| | - Clément Bailly
- Department of Nuclear Medicine, University Hospital of Nantes, 44000 Nantes, France;
| | - René-Olivier Casasnovas
- Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, 21000 Dijon, France;
| | - Steven Le Gouill
- Department of Hematology, Nantes University Hospital, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, 44000 Nantes, France; (M.J.); (B.T.)
- Correspondence: ; Tel.: +33-(0)1-44-32-41-00
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40
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Prognostic Value of Baseline and Interim Positron Emission Tomography Markers in Diffuse Large B-cell Lymphoma Patients: A Real-world Perspective. Hemasphere 2021; 5:e621. [PMID: 34263145 PMCID: PMC8274798 DOI: 10.1097/hs9.0000000000000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/23/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022] Open
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41
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Wight J, Wai SH, Shen E, Lee ST, Berlangieri S, Fancourt T, Hawkes E, Hannah A, Leung T, Chong G. Predicting primary treatment failure using interim FDG-PET scanning in diffuse large B-cell lymphoma. Eur J Haematol 2021; 107:475-483. [PMID: 34240453 DOI: 10.1111/ejh.13684] [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: 05/26/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/28/2022]
Abstract
Interim FDG-PET (iPET) in diffuse large B-cell lymphoma (DLBCL) is increasingly practised and used in clinical trials to adapt further therapy. However, the optimum timing and methodology of iPET remains controversial. We retrospectively analysed the iPET results and outcomes of 200 DLBCL patients where FDG-PET was routinely performed at baseline, after 2 cycles (iPET2) and at completion of chemoimmunotherapy. iPET was also performed after 4 cycles (iPET4) where at iPET2, Deauville score (DS) was ≥4. Scans were assessed by blinded expert lymphoma PET physicians for DS, maximum standard uptake value (SUVmax), total metabolic tumour volume (TMTV) and total lesion glycolysis (TLG). Treatment failure was defined as death, progression or refractory disease. 95.5% of patients received R-CHOP. No baseline PET parameter was predicted for EFS or OS independent of the NCCN-IPI. The multivariable analysis at iPET2 showed DS5 (19.5% of cases) predicted treatment failure (HR 6.29, 95% CI 3.01-13.17, P < .001), but DS4 was equivalent to DS1-3. At iPET4, ΔSUVmax < 66% predicted treatment failure (HR 5.49, 95% CI 3.03-9.99, P < .001). By multivariable analysis of all time points, high NCCN-IPI and DS5 at iPET2 were negative predictors of survival. These findings were independent of novel prognostic markers.
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Affiliation(s)
- Joel Wight
- Austin Health, Heidelberg, Australia.,Olivia Newton John Cancer Research Institute, Heidelberg, VIC, Australia.,The University of Melbourne, Melbourne, VIC, Australia.,Townsville University Hospital, Townsville, QLD, Australia
| | - Shin Hnin Wai
- Austin Health, Heidelberg, Australia.,Olivia Newton John Cancer Research Institute, Heidelberg, VIC, Australia
| | - Edward Shen
- Austin Health, Heidelberg, Australia.,The University of Melbourne, Melbourne, VIC, Australia
| | - Sze-Ting Lee
- Austin Health, Heidelberg, Australia.,Olivia Newton John Cancer Research Institute, Heidelberg, VIC, Australia.,La Trobe University, Melbourne, VIC, Australia
| | | | | | - Eliza Hawkes
- Austin Health, Heidelberg, Australia.,Olivia Newton John Cancer Research Institute, Heidelberg, VIC, Australia.,The University of Melbourne, Melbourne, VIC, Australia.,La Trobe University, Melbourne, VIC, Australia
| | | | - Teresa Leung
- The Northern Hospital, Melbourne, VIC, Australia
| | - Geoffrey Chong
- Austin Health, Heidelberg, Australia.,Olivia Newton John Cancer Research Institute, Heidelberg, VIC, Australia.,The University of Melbourne, Melbourne, VIC, Australia.,The Northern Hospital, Melbourne, VIC, Australia
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42
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DLBCL outcomes: much ventured, much GAINED. Blood 2021; 137:2277-2278. [PMID: 33914077 DOI: 10.1182/blood.2020009964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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43
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Barrington SF, Trotman J. The role of PET in the first-line treatment of the most common subtypes of non-Hodgkin lymphoma. LANCET HAEMATOLOGY 2021; 8:e80-e93. [DOI: 10.1016/s2352-3026(20)30365-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/12/2020] [Accepted: 11/02/2020] [Indexed: 01/24/2023]
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