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Cordas Dos Santos DM, Tix T, Shouval R, Gafter-Gvili A, Alberge JB, Cliff ERS, Theurich S, von Bergwelt-Baildon M, Ghobrial IM, Subklewe M, Perales MA, Rejeski K. A systematic review and meta-analysis of nonrelapse mortality after CAR T cell therapy. Nat Med 2024; 30:2667-2678. [PMID: 38977912 DOI: 10.1038/s41591-024-03084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/22/2024] [Indexed: 07/10/2024]
Abstract
Although chimeric antigen receptor (CAR) T cell therapy represents a transformative immunotherapy, it is also associated with distinct toxicities that contribute to morbidity and mortality. In this systematic review and meta-analysis, we searched MEDLINE, Embase and CINAHL (Cochrane) for reports of nonrelapse mortality (NRM) after CAR T cell therapy in lymphoma and multiple myeloma up to March 2024. After extraction of causes and numbers of death, we analyzed NRM point estimates using random-effect models. We identified 7,604 patients across 18 clinical trials and 28 real-world studies. NRM point estimates varied across disease entities and were highest in patients with mantle-cell lymphoma (10.6%), followed by multiple myeloma (8.0%), large B cell lymphoma (6.1%) and indolent lymphoma (5.7%). Entity-specific meta-regression models for large B cell lymphoma and multiple myeloma revealed that axicabtagene ciloleucel and ciltacabtagene autoleucel were independently associated with increased NRM point estimates, respectively. Of 574 reported nonrelapse deaths, over half were attributed to infections (50.9%), followed by other malignancies (7.8%) and cardiovascular/respiratory events (7.3%). Conversely, the CAR T cell-specific side effects, immune effector cell-associated neurotoxicity syndrome/neurotoxicity, cytokine release syndrome and hemophagocytic lymphohistiocytosis, represented only a minority of nonrelapse deaths (cumulatively 11.5%). Our findings underline the critical importance of infectious complications after CAR T cell therapy and support the comprehensive reporting of NRM, including specific causes and long-term outcomes.
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Affiliation(s)
- David M Cordas Dos Santos
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Tobias Tix
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Roni Shouval
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Anat Gafter-Gvili
- Department of Medicine A and Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Jean-Baptiste Alberge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Edward R Scheffer Cliff
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Program on Regulation, Therapeutics and Law, Brigham and Women's Hospital, Boston, MA, USA
| | - Sebastian Theurich
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium, Partner Site Munich, Munich, Germany
| | - Michael von Bergwelt-Baildon
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium, Partner Site Munich, Munich, Germany
| | - Irene M Ghobrial
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Marion Subklewe
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium, Partner Site Munich, Munich, Germany
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Kai Rejeski
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany.
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
- German Cancer Consortium, Partner Site Munich, Munich, Germany.
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Tun AM, Patel RD, St-Pierre F, Ouchveridze E, Niu A, Thordardottir T, Obasi J, Rosenthal A, Pophali PA, Fenske TS, Karmali R, Ahmed S, Johnston PB. Anti-CD19 chimeric antigen receptor T-cell therapy in older patients with relapsed or refractory large B-cell lymphoma: A multicenter study. Am J Hematol 2024; 99:1712-1720. [PMID: 38837403 DOI: 10.1002/ajh.27381] [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: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
Chimeric antigen receptor T-cell (CAR-T) therapy, despite being a potentially curative therapy in relapsed or refractory (RR) large B-cell lymphoma (LBCL), remains underutilized in older patients due to limited clinical data. We therefore studied the safety and efficacy of CAR-T therapy in older patients with RR LBCL in the real-world setting. Patients aged ≥65 years with RR LBCL, treated with anti-CD19 CAR-T therapy at 7 US institutions were included in this multicenter, retrospective, observational study. In total, 226 patients were included. Median age at infusion was 71 years (range 65-89). Best objective and complete response rates were 86% and 62%, respectively. Median follow-up after infusion was 18.3 months. The median progression-free survival (PFS) was 6.9 months, with 6- and 12-month PFS estimates of 54% and 44%, respectively. The nonrelapse mortality (NRM) rate was 10.9% at day 180, primarily due to infections, and not impacted by the age groups. Grade ≥3 cytokine release syndrome and neurotoxicity occurred in 7% and 26%, respectively. In univariate analysis, no significant difference in PFS was seen regardless of the age groups or CAR-T type, whereas ECOG PS ≥2, elevated LDH, bulky disease, advanced stage, extranodal involvement, the need for bridging therapy, and prior bendamustine exposure were associated with shorter PFS. These findings support the use of CAR-T in older patients, including those aged ≥80 years. The age at CAR-T therapy did not influence safety, survival, and NRM outcomes. Older patients should not be excluded from receiving CAR-T therapy solely based on their chronological age.
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Affiliation(s)
- Aung M Tun
- Division of Hematologic Malignancies and Cellular Therapeutics, The University of Kansas, Kansas City, Kansas, USA
| | - Romil D Patel
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Frederique St-Pierre
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Evguenia Ouchveridze
- Division of Hematologic Malignancies and Cellular Therapeutics, The University of Kansas, Kansas City, Kansas, USA
| | - Alex Niu
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thorunn Thordardottir
- Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Jennifer Obasi
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Allison Rosenthal
- Division of Hematology/Oncology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Priyanka A Pophali
- Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Timothy S Fenske
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Reem Karmali
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Sairah Ahmed
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Sýkorová A, Folber F, Polgárová K, Móciková H, Ďuraš J, Steinerová K, Obr A, Heindorfer A, Ladická M, Lukáčová Ľ, Čellárová E, Plameňová I, Belada D, Janíková A, Trněný M, Jančárková T, Procházka V, Vranovský A, Králiková M, Vydra J, Smolej L, Drgoňa Ľ, Sedmina M, Čermáková E, Pytlík R. Several factors that predict the outcome of large B-cell lymphoma patients who relapse/progress after chimeric antigen receptor (CAR) T-cell therapy can be identified before cell administration. Cancer Med 2024; 13:e70138. [PMID: 39248284 PMCID: PMC11382134 DOI: 10.1002/cam4.70138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 07/13/2024] [Accepted: 08/09/2024] [Indexed: 09/10/2024] Open
Abstract
AIM The aim of this study was to analyse the outcomes of patients with large B-cell lymphoma (LBCL) treated with chimeric antigen receptor T-cell therapy (CAR-Tx), with a focus on outcomes after CAR T-cell failure, and to define the risk factors for rapid progression and further treatment. METHODS We analysed 107 patients with LBCL from the Czech Republic and Slovakia who were treated in ≥3rd-line with tisagenlecleucel or axicabtagene ciloleucel between 2019 and 2022. RESULTS The overall response rate (ORR) was 60%, with a 50% complete response (CR) rate. The median progression-free survival (PFS) and overall survival (OS) were 4.3 and 26.4 months, respectively. Sixty-three patients (59%) were refractory or relapsed after CAR-Tx. Of these patients, 39 received radiotherapy or systemic therapy, with an ORR of 22% (CR 8%). The median follow-up of surviving patients in whom treatment failed was 10.6 months. Several factors predicting further treatment administration and outcomes were present even before CAR-Tx. Risk factors for not receiving further therapy after CAR-Tx failure were high lactate dehydrogenase (LDH) levels before apheresis, extranodal involvement (EN), high ferritin levels before lymphodepletion (LD) and ECOG PS >1 at R/P. The median OS-2 (from R/P after CAR-Tx) was 6.7 months (6-month 57.9%) for treated patients and 0.4 months (6-month 4.2%) for untreated patients (p < 0.001). The median PFS-2 (from R/P after CAR-Tx) was 3.2 months (6-month 28.5%) for treated patients. The risk factors for a shorter PFS-2 (n = 39) included: CRP > limit of the normal range (LNR) before LD, albumin < LNR and ECOG PS > 1 at R/P. All these factors, together with LDH > LNR before LD and EN involvement at R/P, predicted OS-2 for treated patients. CONCLUSION Our findings allow better stratification of CAR-Tx candidates and stress the need for a proactive approach (earlier restaging, intervention after partial remission achievement).
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MESH Headings
- Humans
- Male
- Female
- Middle Aged
- Immunotherapy, Adoptive/methods
- Aged
- Adult
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/immunology
- Neoplasm Recurrence, Local
- Biological Products/therapeutic use
- Receptors, Chimeric Antigen/immunology
- Young Adult
- Risk Factors
- Czech Republic
- Aged, 80 and over
- Slovakia
- Treatment Outcome
- Antigens, CD19/immunology
- Progression-Free Survival
- Disease Progression
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/metabolism
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Affiliation(s)
- Alice Sýkorová
- 4th Department of Internal Medicine - Haematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - František Folber
- Department of Internal Medicine, Haematology and Oncology, Masaryk University Hospital, Brno, Czech Republic
| | - Kamila Polgárová
- 1st Department of Medicine-Department of Haematology, Charles University, General University Hospital, Prague, Czech Republic
| | - Heidi Móciková
- Department of Haematology, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Juraj Ďuraš
- Department of Haemato-oncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Kateřina Steinerová
- Department of Haematology and Oncology, University Hospital, Pilsen, Czech Republic
| | - Aleš Obr
- Department of Haemato-Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | | | - Miriam Ladická
- Clinic of Oncohaematology, Medical Faculty of Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Ľubica Lukáčová
- Oncology Clinic, J.A. Reiman Faculty Hospital, Prešov, Slovakia
| | - Erika Čellárová
- Department of Haematology, F.D. Roosevelt University Hospital, Banská Bystrica, Slovakia
| | - Ivana Plameňová
- Clinic of Haematology and Transfusion Medicine, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - David Belada
- 4th Department of Internal Medicine - Haematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - Andrea Janíková
- Department of Internal Medicine, Haematology and Oncology, Masaryk University Hospital, Brno, Czech Republic
| | - Marek Trněný
- 1st Department of Medicine-Department of Haematology, Charles University, General University Hospital, Prague, Czech Republic
| | - Tereza Jančárková
- Department of Haematology, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vít Procházka
- Department of Haemato-Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Andrej Vranovský
- Clinic of Oncohaematology, Medical Faculty of Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Margaréta Králiková
- Department of Haematology, F.D. Roosevelt University Hospital, Banská Bystrica, Slovakia
| | - Jan Vydra
- Institute of Haematology and Blood Transfusion, Prague, Czech Republic
| | - Lukáš Smolej
- 4th Department of Internal Medicine - Haematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - Ľuboš Drgoňa
- Clinic of Oncohaematology, Medical Faculty of Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Martin Sedmina
- Department of Haematology, F.D. Roosevelt University Hospital, Banská Bystrica, Slovakia
| | - Eva Čermáková
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Robert Pytlík
- Institute of Haematology and Blood Transfusion, Prague, Czech Republic
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Gong IY, Tran D, Saibil S, Laister RC, Kuruvilla J. Biomarkers of outcome in patients undergoing CD19 CAR-T therapy for large B cell lymphoma. Hemasphere 2024; 8:e130. [PMID: 39175824 PMCID: PMC11339649 DOI: 10.1002/hem3.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/12/2024] [Accepted: 06/26/2024] [Indexed: 08/24/2024] Open
Abstract
CD19-directed autologous chimeric antigen receptor T cell (CAR-T) therapy has transformed the management of relapsed/refractory (R/R) large B cell lymphoma (LBCL). Initially approved in the third line and beyond setting, CAR-T is now standard of care (SOC) for second-line treatment in patients with refractory disease or early relapse (progression within 12 months) following primary chemoimmunotherapy. Despite becoming SOC, most patients do not achieve complete response, and long-term cure is only observed in approximately 40% of patients. Accordingly, there is an urgent need to better understand the mechanisms of treatment failure and to identify patients that are unlikely to benefit from SOC CAR-T. The field needs robust biomarkers to predict treatment outcome, as better understanding of prognostic factors and mechanisms of resistance can inform on the design of novel treatment approaches for patients predicted to respond poorly to SOC CAR-T. This review aims to provide a comprehensive overview of clinical, molecular, imaging, and cellular features that have been shown to influence outcomes of CAR-T therapy in patients with R/R LBCL.
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Affiliation(s)
- Inna Y. Gong
- Princess Margaret Cancer CenterTorontoOntarioCanada
- Division of Medical Oncology and HematologyUniversity Health NetworkTorontoOntarioCanada
| | - Daisy Tran
- Princess Margaret Cancer CenterTorontoOntarioCanada
- Division of Medical Oncology and HematologyUniversity Health NetworkTorontoOntarioCanada
| | - Samuel Saibil
- Princess Margaret Cancer CenterTorontoOntarioCanada
- Division of Medical Oncology and HematologyUniversity Health NetworkTorontoOntarioCanada
- Department of ImmunologyUniversity of TorontoTorontoOntarioCanada
| | - Rob C. Laister
- Princess Margaret Cancer CenterTorontoOntarioCanada
- Division of Medical Oncology and HematologyUniversity Health NetworkTorontoOntarioCanada
| | - John Kuruvilla
- Princess Margaret Cancer CenterTorontoOntarioCanada
- Division of Medical Oncology and HematologyUniversity Health NetworkTorontoOntarioCanada
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5
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Bailén R, Iacoboni G, Delgado J, López-Corral L, Hernani-Morales R, Ortiz-Maldonado V, Guerreiro M, Caballero AC, Guerra-Domínguez ML, Sánchez-Pina JM, Peña M, Torrent A, Pérez-Martínez A, Bastos-Oreiro M, Reguera-Ortega JL, Martín A, Hernandez-Boluda JC, Martínez-Cibrián N, Sanz J, Briones J, Henriquez HL, Calbacho M, Mussetti A, Sancho JM, Barba P, Kwon M. Anti-CD19 CAR-T Cell Therapy in Elderly Patients: Multicentric Real-World Experience from GETH-TC/GELTAMO. Transplant Cell Ther 2024:S2666-6367(24)00485-8. [PMID: 39069076 DOI: 10.1016/j.jtct.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/30/2024]
Abstract
Chimeric antigen receptor (CAR)-T cell therapy is approved for the treatment of relapsed/refractory (R/R) large B cell lymphoma (LBCL). However, elderly patients might not be candidates for this therapy due to its toxicity, and criteria for candidate selection are lacking. Our aim was to analyze efficacy and toxicity results of CAR-T cell therapy in the population of patients 70 years and older as compared to those obtained in younger patients in the real-world setting. A multicentric retrospective study was performed including patients with R/R aggressive LBCL who received commercial CAR-T cell therapy with either tisagenlecleucel or axicabtagene ciloleucel within the Spanish Group of Hematopoietic Transplant and Cell Therapy/Spanish Group of Lymphomas and Autologous Transplant (GETH-TC/GELTAMO) centers between 2019 and 2023. As of August 2023, 442 adult patients with aggressive LBCL underwent apheresis for CAR-T cell therapy as third or subsequent line and follow-up data was collected. Of 412 infused patients, 71 (17%) were 70 years or older. Baseline characteristics, product selection, and characteristics at apheresis (including disease status, Ann Arbor stage, revised international prognosis index (R-IPI), bulky disease, lactate dehydrogenase [LDH] and ECOG [Eastern Cooperative Group performance status]) were comparable between groups. Median time from both approval to infusion and apheresis to infusion did not differ. No differences were found between groups in overall and complete response rates at 1 and 3 months. With a median follow-up of 12.2 months (range 1-44), 12-month progression-free survival (PFS) and overall survival (OS) were comparable between groups (35.2% in <70 years vs. 35.9% in ≥70 years (P = .938) and 51.1% and 52.1% (P = .885), respectively). Age ≥70 years did not affect PFS (hazard ratio (HR) 0.98, P = .941) and OS (HR 0.97, P = .890) in the univariate and multivariate analysis. Cytokine release syndrome (CRS) was observed in 82% of patients <70 years old and 84.5% in ≥ 70 years old (P = .408). Grade ≥3 CRS was more frequent in the older group (5% vs. 15%, P = .002). In the multivariate analysis, age ≥70 years was associated with an increased risk of grade ≥3 CRS (OR 3.7, P = .013). No differences were observed in terms of overall neurotoxicity (35% vs. 42%, P = .281) or grade ≥3 (12% vs. 17%, P = .33). The proportion of patients with infections, admission to the intensive care unit within the first month, and non-relapse mortality were similar between both groups. CAR-T cell therapy in patients older than 70 years showed similar efficacy to that observed in younger patients in the real-world setting. However, age ≥70 years was an independent risk factor for grades 3-4 CRS. The need for additional strategies to reduce toxicity in this population should be addressed in future studies.
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Affiliation(s)
- Rebeca Bailén
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Gloria Iacoboni
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.; Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Javier Delgado
- Department of Haematology, Hospital Universitario Virgen del Rocío, Institute of Biomedicine of Seville (IBiS/CSIC/CIBERONC), University of Seville, Seville, Spain
| | - Lucía López-Corral
- Department of Hematology, Hospital Clínico Universitario de Salamanca, IBSAL, Salamanca, Spain
| | - Rafael Hernani-Morales
- Department of Hematology, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | | | - Manuel Guerreiro
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - María Luisa Guerra-Domínguez
- Department of Hematology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Marta Peña
- Department of Hematology, Hospital Duran i Reynals, Instituto Catalán de Oncología, IDIBELL, Barcelona, Spain
| | - Anna Torrent
- Department of Hematology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Mariana Bastos-Oreiro
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Gregorio Marañón Health Research Institute, Madrid, Spain.; Universidad Complutense de Madrid, Spain
| | - Juan Luis Reguera-Ortega
- Department of Haematology, Hospital Universitario Virgen del Rocío, Institute of Biomedicine of Seville (IBiS/CSIC/CIBERONC), University of Seville, Seville, Spain
| | - Alejandro Martín
- Department of Hematology, Hospital Clínico Universitario de Salamanca, IBSAL, Salamanca, Spain
| | - Juan Carlos Hernandez-Boluda
- Department of Hematology, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | | | - Jaime Sanz
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Javier Briones
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Hugo Luzardo Henriquez
- Department of Hematology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - María Calbacho
- Department of Hematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alberto Mussetti
- Department of Hematology, Hospital Duran i Reynals, Instituto Catalán de Oncología, IDIBELL, Barcelona, Spain
| | - Juan Manuel Sancho
- Department of Hematology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Pere Barba
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.; Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Mi Kwon
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Gregorio Marañón Health Research Institute, Madrid, Spain.; Universidad Complutense de Madrid, Spain..
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6
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Yates SJ, Cursio JF, Artz A, Kordas K, Bishop MR, Derman BA, Kosuri S, Riedell PA, Kline J, Jakubowiak A, Mortel M, Johnson S, Nawas MT. Optimization of older adults by a geriatric assessment-guided multidisciplinary clinic before CAR T-cell therapy. Blood Adv 2024; 8:3785-3797. [PMID: 38810262 PMCID: PMC11298834 DOI: 10.1182/bloodadvances.2024012727] [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: 01/22/2024] [Revised: 04/29/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024] Open
Abstract
ABSTRACT The optimal means of assessing candidacy of older adults (≥65 years) for chimeric antigen receptor T-cell (CAR-T) therapy are unknown. We explored the role of a geriatric assessment (GA)-guided multidisciplinary clinic (GA-MDC) in selecting and optimizing older adults for CAR-T. Sixty-one patients were evaluated in a GA-MDC (median age, 73 years; range, 58-83). A nonbinding recommendation ("proceed" or "decline") regarding suitability for CAR-T was provided for each patient based on GA results. Fifty-three patients ultimately received CAR-T (proceed, n = 47; decline, n = 6). Among patients who received B-cell maturation antigen (BCMA)-directed (n = 11) and CD19-directed CAR-T (n = 42), the median overall survival (OS) was 14.2 months and 16.6 months, respectively. GA uncovered high rates of geriatric impairment among patients proceeding to CAR-T therapy, with fewer impairments in those recommended "proceed." Patients recommended "proceed" had shorter median length of stay (17 vs 31 days; P = .05) and lower rates of intensive care unit admission (6% vs 50%; P = .01) than those recommended "decline." In patients receiving CD19- and BCMA-directed CAR-T therapy, a "proceed" recommendation was associated with superior OS compared with "decline" (median, 16.6 vs 11.4 months [P = .02]; and median, 16.4 vs 4.2 months [P = .03], respectively). When controlling for Karnofsky performance status, C-reactive protein, and lactate dehydrogenase at time of lymphodepletion, the GA-MDC treatment recommendation remained prognostic for OS (hazard ratio, 3.26; P = .04). Patients optimized via the GA-MDC without serious vulnerabilities achieved promising outcomes, whereas patients with high vulnerability experienced high toxicity and poor outcomes after CAR-T therapy.
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Affiliation(s)
- Samuel J. Yates
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - John F. Cursio
- Department of Public Health Sciences, University of Chicago Biological Sciences Division, Chicago, IL
| | - Andrew Artz
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Keriann Kordas
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Michael R. Bishop
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
- The David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Benjamin A. Derman
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Satyajit Kosuri
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Peter A. Riedell
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Justin Kline
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Andrzej Jakubowiak
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Mylove Mortel
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Shalitha Johnson
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Mariam T. Nawas
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
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7
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Akkad N, Chihara D. License for a CAR T: Examining patient eligibility. Semin Hematol 2024:S0037-1963(24)00083-0. [PMID: 39117489 DOI: 10.1053/j.seminhematol.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/17/2024] [Accepted: 07/03/2024] [Indexed: 08/10/2024]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy has transformed the treatment landscape of lymphoma and is now approved by the FDA for multiple indications. Given that the indications for CAR T-cell therapy are expanding, a larger patient population will be eligible to receive this treatment in the coming years. Pivotal clinical trials leading to FDA approval of CAR T-cell products required patients to have adequate organ function and good performance status. In the real world, however, the patient population eligible for CAR T-cell therapy includes patients who are older, frail, have poor performance status, and have multiple comorbidities. Studies have shown that CAR T-cell therapy is relatively safe and tolerable in such frail patients, however, there is no agreed upon consensus or guidelines to assess eligibility for CAR T-cell therapy at this moment. Gaining further insight into such patient populations will be vital in order to safely provide and expand access to CAR T-cell therapy.
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Affiliation(s)
- Neha Akkad
- Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX.
| | - Dai Chihara
- Department of Lymphoma-Myeloma, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX
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8
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Wesson W, Ahmed N. Axi-cel outcomes among non-Hispanic Black patients. Blood 2024; 143:2681-2682. [PMID: 38935357 DOI: 10.1182/blood.2024024959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
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9
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Levstek L, Janžič L, Ihan A, Kopitar AN. Biomarkers for prediction of CAR T therapy outcomes: current and future perspectives. Front Immunol 2024; 15:1378944. [PMID: 38558801 PMCID: PMC10979304 DOI: 10.3389/fimmu.2024.1378944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Chimeric antigen receptor (CAR) T cell therapy holds enormous potential for the treatment of hematologic malignancies. Despite its benefits, it is still used as a second line of therapy, mainly because of its severe side effects and patient unresponsiveness. Numerous researchers worldwide have attempted to identify effective predictive biomarkers for early prediction of treatment outcomes and adverse effects in CAR T cell therapy, albeit so far only with limited success. This review provides a comprehensive overview of the current state of predictive biomarkers. Although existing predictive metrics correlate to some extent with treatment outcomes, they fail to encapsulate the complexity of the immune system dynamics. The aim of this review is to identify six major groups of predictive biomarkers and propose their use in developing improved and efficient prediction models. These groups include changes in mitochondrial dynamics, endothelial activation, central nervous system impairment, immune system markers, extracellular vesicles, and the inhibitory tumor microenvironment. A comprehensive understanding of the multiple factors that influence therapeutic efficacy has the potential to significantly improve the course of CAR T cell therapy and patient care, thereby making this advanced immunotherapy more appealing and the course of therapy more convenient and favorable for patients.
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Affiliation(s)
| | | | | | - Andreja Nataša Kopitar
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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10
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Berning P, Shumilov E, Maulhardt M, Boyadzhiev H, Kerkhoff A, Call S, Reicherts C, Saidy AO, Aydilek E, Hoffmann M, Novak U, Daskalakis M, Schmitz N, Stelljes M, Wulf G, Bacher U, Lenz G, Pabst T. Chimeric antigen receptor-T cell therapy shows similar efficacy and toxicity in patients with diffuse large B-cell lymphoma aged 70 and older compared to younger patients: A multicenter cohort study. Hemasphere 2024; 8:e54. [PMID: 38510993 PMCID: PMC10953542 DOI: 10.1002/hem3.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/21/2024] [Accepted: 02/03/2024] [Indexed: 03/22/2024] Open
Abstract
CD19-directed chimeric antigen receptor (CAR)-T cell therapy has become a standard treatment for relapsed/refractory diffuse large B-cell lymphoma (r/r DLBCL). While the benefits of CAR-T cell treatment are clear in the general patient population, there remains a relative scarcity of real-world evidence regarding its efficacy and toxicity in patients (pts) aged ≥70 years with DLBCL. We conducted a multicenter retrospective analysis including 172 r/r DLBCL pts with CAR-T cell treatment, axicabtagene ciloleucel or tisagenlecleucel, between 2019 and 2023 at three tertiary centers. Pts were grouped by age at CAR-T infusion (<70 vs. ≥70 years). Subsequently, descriptive and survival analyses, including propensity score matching, were performed to compare outcomes between both age groups. We identified 109 pts aged <70 and 63 pts aged ≥70 years. Overall response rates for both age groups were comparable (77.7% vs. 78.3%; p = 0.63). With a median follow-up of 8.3 months, median progression-free survival was 10.2 months (95% confidence interval [CI]: 6.5-21.8) and 11.1 months (95% CI: 4.9-NR) (p = 0.93) for both cohorts. Median overall survival reached 21.8 months (95% CI: 11.8-NR) and 34.4 months (95% CI: 10.1-NR) (p = 0.97), respectively. No significant differences in the incidence of cytokine release syndrome (p = 0.53) or grade ≥3 neurotoxicity (p = 0.56) were observed. Relapse and nonrelapse mortality were not significantly different between both groups. Our findings provide additional support that CAR-T cell therapy is feasible and effective in patients with r/r DLBCL aged 70 years or older, demonstrating outcomes comparable to those observed in younger patients. CAR-T cell therapy should be not withheld for elderly patients with r/r DLBCL.
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Affiliation(s)
- Philipp Berning
- Department of Hematology and OncologyUniversity Hospital MuensterMuensterGermany
| | - Evgenii Shumilov
- Department of Hematology and OncologyUniversity Hospital MuensterMuensterGermany
| | - Markus Maulhardt
- Department of Hematology and Medical OncologyUniversity Hospital GöttingenGöttingenGermany
| | - Hristo Boyadzhiev
- Department of Medical Oncology, University Hospital BernUniversity of BernBernSwitzerland
- Habichtswald HospitalKasselGermany
| | - Andrea Kerkhoff
- Department of Hematology and OncologyUniversity Hospital MuensterMuensterGermany
| | - Simon Call
- Department of Hematology and OncologyUniversity Hospital MuensterMuensterGermany
| | - Christian Reicherts
- Department of Hematology and OncologyUniversity Hospital MuensterMuensterGermany
| | - Anna O. Saidy
- Department of Hematology, Oncology, and Tumor ImmunologyHelios Klinikum Berlin‐BuchBerlinGermany
| | - Enver Aydilek
- Department of Hematology and Medical OncologyUniversity Hospital GöttingenGöttingenGermany
| | - Michèle Hoffmann
- Department of Medical Oncology, University Hospital BernUniversity of BernBernSwitzerland
| | - Urban Novak
- Department of Medical Oncology, University Hospital BernUniversity of BernBernSwitzerland
| | - Michael Daskalakis
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Norbert Schmitz
- Department of Hematology and OncologyUniversity Hospital MuensterMuensterGermany
| | - Matthias Stelljes
- Department of Hematology and OncologyUniversity Hospital MuensterMuensterGermany
| | - Gerald Wulf
- Department of Hematology and Medical OncologyUniversity Hospital GöttingenGöttingenGermany
| | - Ulrike Bacher
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Georg Lenz
- Department of Hematology and OncologyUniversity Hospital MuensterMuensterGermany
| | - Thomas Pabst
- Department of Medical Oncology, University Hospital BernUniversity of BernBernSwitzerland
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11
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Lu T, Zhang J, McCracken JM, Young KH. Recent advances in genomics and therapeutics in mantle cell lymphoma. Cancer Treat Rev 2024; 122:102651. [PMID: 37976759 DOI: 10.1016/j.ctrv.2023.102651] [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: 09/15/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
Over the past decades, significant strides have been made in understanding the pathobiology, prognosis, and treatment options for mantle cell lymphoma (MCL). The heterogeneity observed in MCL's biology, genomics, and clinical manifestations, including indolent and aggressive forms, is intricately linked to factors such as the mutational status of the variable region of the immunoglobulin heavy chain gene, epigenetic profiling, and Sox11 expression. Several intriguing subtypes of MCL, such as Cyclin D1-negative MCL, in situ mantle cell neoplasm, CCND1/IGH FISH-negative MCL, and the impact of karyotypic complexity on prognosis, have been explored. Notably, recent immunochemotherapy regimens have yielded long-lasting remissions in select patients. The therapeutic landscape for MCL is continuously evolving, with a shift towards nonchemotherapeutic agents like ibrutinib, acalabrutinib, and venetoclax. The introduction of BTK inhibitors has brought about a transformative change in MCL treatment. Nevertheless, the challenge of resistance to BTK inhibitors persists, prompting ongoing efforts to discover strategies for overcoming this resistance. These strategies encompass non-covalent BTK inhibitors, immunomodulatory agents, BCL2 inhibitors, and CAR-T cell therapy, either as standalone treatments or in combination regimens. Furthermore, developing novel drugs holds promise for further improving the survival of patients with relapsed or refractory MCL. In this comprehensive review, we methodically encapsulate MCL's clinical and pathological attributes and the factors influencing prognosis. We also undertake an in-depth examination of stratified treatment alternatives. We investigate conceivable resistance mechanisms in MCL from a genetic standpoint and offer precise insights into various therapeutic approaches for relapsed or refractory MCL.
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Affiliation(s)
- Tingxun Lu
- Division of Hematopathology, Duke University Medical Center, Durham, NC 27710, USA; Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province 214122, China
| | - Jie Zhang
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province 214122, China
| | - Jenna M McCracken
- Division of Hematopathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Ken H Young
- Division of Hematopathology, Duke University Medical Center, Durham, NC 27710, USA; Duke Cancer Institute, Duke University, Durham, NC 27710, USA.
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12
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Forberg AL, Unrau J, Weber KS, Rutz AC, Lund S, Guidinger J, Pelzel A, Hauge J, Hemmen AJ, Hartert KT. Integrative analyses reveal outcome-associated and targetable molecular partnerships between TP53, BRD4, TNFRSF10B, and CDKN1A in diffuse large B-cell lymphoma. Ann Hematol 2024; 103:199-209. [PMID: 37792064 DOI: 10.1007/s00277-023-05478-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/23/2023] [Indexed: 10/05/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a common, genomically heterogenous disease that presents a clinical challenge despite the success of frontline regimens and second-line chimeric antigen receptor T-cell (CAR-T) therapy. Recently, genomic alterations and tumor microenvironment features associated with poor CAR-T response have been identified, namely those to the TP53 tumor suppressor gene. This retrospective analysis aimed to integrate various data to identify genomic partnerships capable of providing further clarity and actionable treatment targets within this population. Publicly available data were analyzed for differential expression based on TP53 and 24-month event-free survival (EFS24) status, revealing enrichments of the BRD4 bromodomain oncogene (p < 0.0001, p = 0.001). High-BRD4 and TP53 alterations were significantly associated with lower CDKN1A (p21) and TNFRSF10B (TRAIL-R2), a key tumor suppressor and CAR-T modulator, respectively. Significant loss of CD8 T-cell presence within low-TNFRSF0B (p = 0.0042) and altered-TP53 (p = 0.0424) patients showcased relevant outcome-associated tumor microenvironment features. Furthermore, reduced expression of CDKN1A was associated with low TNFRSF10B (FDR < 0.0001) and increased BRD4 interactant genes (FDR < 0.0001). Promisingly, in vitro MDM2 inhibition with Idasnutlin and TP53 reactivation via Eprenetapopt was able to renew TNFRSF10B protein expression. Additionally, applying the BRD4-degrading PROTAC ARV-825 and the CDK4/6 inhibitor Abemaciclib as single-agents and in synergistic combination significantly reduced TP53-altered DLBCL cell line viability. Our analysis presents key associations within a genomic network of actionable targets capable of providing clarity within the evolving precision CAR-T treatment landscape.
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Affiliation(s)
- Aidan L Forberg
- Department of Biological Sciences, Minnesota State University Mankato, Mankato, MN, 56001, USA
| | - Jordan Unrau
- Department of Biological Sciences, Minnesota State University Mankato, Mankato, MN, 56001, USA
| | - Kennedee S Weber
- Department of Biological Sciences, Minnesota State University Mankato, Mankato, MN, 56001, USA
| | - Alison C Rutz
- Department of Biological Sciences, Minnesota State University Mankato, Mankato, MN, 56001, USA
| | - Shelby Lund
- Department of Biological Sciences, Minnesota State University Mankato, Mankato, MN, 56001, USA
| | - Jinda Guidinger
- Department of Biological Sciences, Minnesota State University Mankato, Mankato, MN, 56001, USA
| | - Andrew Pelzel
- Department of Biological Sciences, Minnesota State University Mankato, Mankato, MN, 56001, USA
| | - Jackson Hauge
- Department of Biological Sciences, Minnesota State University Mankato, Mankato, MN, 56001, USA
| | - Ainslee J Hemmen
- Department of Biological Sciences, Minnesota State University Mankato, Mankato, MN, 56001, USA
| | - Keenan T Hartert
- Department of Biological Sciences, Minnesota State University Mankato, Mankato, MN, 56001, USA.
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13
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Major A, Kamdar M. Selection of bispecific antibody therapies or CAR-T cell therapy in relapsed lymphomas. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:370-381. [PMID: 38066907 PMCID: PMC10727048 DOI: 10.1182/hematology.2023000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Patients with relapsed and refractory (R/R) aggressive B-cell non-Hodgkin lymphomas have historically poor survival outcomes, with chimeric antigen receptor T-cell (CAR-T) therapy now presenting a curative option for a subset of those patients. However, with the approval of several novel bispecific monoclonal antibody (BsAb) therapies with considerable activity in R/R aggressive large B-cell lymphomas (LBCL), patients and oncologists will be faced with decisions regarding how to sequence CAR-T and BsAb therapies based on patient- and disease-related factors. In this review, we compare CAR-T and BsAb therapies for R/R LBCL, highlighting data on the efficacy and toxicity of each treatment paradigm, and provide a roadmap for sequencing these highly effective therapies.
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Affiliation(s)
- Ajay Major
- Division of Hematology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Manali Kamdar
- Division of Hematology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
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14
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Dominguez EC, Roleder C, Ball B, Danilov AV. Cyclin-dependent kinase-9 in B-cell malignancies: pathogenic role and therapeutic implications. Leuk Lymphoma 2023; 64:1893-1904. [PMID: 37552126 DOI: 10.1080/10428194.2023.2244102] [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: 06/02/2023] [Accepted: 07/29/2023] [Indexed: 08/09/2023]
Abstract
Cyclin-dependent kinases (CDK) regulate cell cycle and transcriptional activity. Pan-CDK inhibitors demonstrated early efficacy in lymphoid malignancies, but also have been associated with narrow therapeutic index. Among transcriptional CDKs, CDK7 and CDK9 emerged as promising targets. CDK9 serves as a component of P-TEFb elongation complex and thus is indispensable in mRNA transcription. Selective CDK9 inhibitors demonstrated pre-clinical efficacy in in vitro and in vivo models of B-cell non-Hodgkin lymphoma. CDK9 inhibition results in transcriptional pausing with rapid downmodulation of short-lived oncogenic proteins, e.g. Myc and Mcl-1, followed by cell apoptosis. Early phase clinical trials established safety of CDK9 inhibitors, with manageable neutropenia, infections and gastrointestinal toxicities. In this review, we summarize the rationale of targeting CDK9 in lymphoid malignancies, as well as pre-clinical and early clinical data with pan-CDK and selective CDK9 inhibitors.
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Affiliation(s)
| | - Carly Roleder
- City of Hope National Medical Center, Duarte, CA, USA
| | - Brian Ball
- City of Hope National Medical Center, Duarte, CA, USA
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15
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Ryan CE, Jacobson CA. Effective sequencing of chimeric antigen receptor T-cell therapy in the treatment of LBCL in 2023. Semin Hematol 2023; 60:322-328. [PMID: 38199906 DOI: 10.1053/j.seminhematol.2023.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 01/12/2024]
Abstract
Over the last decade, CD19-targeting chimeric antigen receptor (CAR) T-cell therapy has profoundly changed the management of relapsed/refractory large-B-cell lymphoma (LBCL). At present, there are three FDA-approved anti-CD19 CAR T-cell products for LBCL: axicabtagene ciloleucel (axi-cel), lisocabtagene maraleucel (liso-cel), and tisagenlecleucel (tisa-cel). Two of these (axi-cel & liso-cel) are approved for use in the second-line setting under certain conditions. As CAR T-cell therapy continues to define a new role in the treatment armamentarium for LBCL, questions remain regarding which product to use and how to sequence CAR T-cell therapy with other therapeutic options. Here we will briefly review the key features of each FDA-approved anti-CD19 CAR T-cell product and the data that led to regulatory approval for each. Next, we will focus on the recent landmark studies that have established the use of CAR T-cell therapy as second-line treatment. While no direct prospective head-to-head comparisons exist of the 3 constructs, we will review some retrospective studies that suggest some emerging differences between the products. Lastly, we will turn our attention to the horizon as we explore some of the ongoing questions of how to best leverage the curative potential of CAR T-cell therapy for the most effective management of LBCL. These areas include the consideration of CAR T-cell therapy in the frontline setting, the optimal timing for CAR T-cell referral, the optimal bridging approach, and how to continue advancing novel CAR T-cell approaches in the context of the current treatment landscape.
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Affiliation(s)
- Christine E Ryan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Caron A Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
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16
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Testa U, Leone G, Pelosi E, Castelli G, Hohaus S. CAR-T Cell Therapy in Large B Cell Lymphoma. Mediterr J Hematol Infect Dis 2023; 15:e2023066. [PMID: 38028399 PMCID: PMC10631715 DOI: 10.4084/mjhid.2023.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Large B-cell lymphomas (LBCLs) are among the most frequent (about 30%) non-Hodgkin's lymphoma. Despite the aggressive behavior of these lymphomas, more than 60% of patients can be cured with first-line chemoimmunotherapy using the R-CHOP regimen. Patients with refractory or relapsing disease show a poor outcome even when treated with second-line therapies. CD19-targeted chimeric antigen receptor (CAR) T-cells are emerging as an efficacious second-line treatment strategy for patients with LBCL. Three CD19-CAR-T-cell products received FDA and EMA approval. CAR-T cell therapy has also been explored for treating high-risk LBCL patients in the first-line setting and for patients with central nervous system involvement. Although CD19-CAR-T therapy has transformed the care of refractory/relapsed LBCL, about 60% of these patients will ultimately progress or relapse following CD19-CAR-T; therefore, it is fundamental to identify predictive criteria of response to CAR-T therapy and to develop salvage therapies for patients relapsing after CD19-CAR-T therapies. Moreover, ongoing clinical trials evaluate bispecific CAR-T cells targeting both CD19 and CD20 or CD19 and CD22 as a tool to improve the therapeutic efficacy and reduce the number of refractory/relapsing patients.
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Affiliation(s)
| | - Giuseppe Leone
- Dipartimento Di Scienze Radiologiche Ed Ematologiche, Università Cattolica Del Sacro Cuore, Roma, Italy
| | | | | | - Stefan Hohaus
- Dipartimento Di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy. Sezione Di Ematologia
- Dipartimento Di Scienze Radiologiche Ed Ematologiche, Università Cattolica Del Sacro Cuore, Roma, Italy
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17
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Thiruvengadam SK, Shouse G, Danilov AV. Thinking "outside the germinal center": Re-educating T cells to combat follicular lymphoma. Blood Rev 2023; 61:101099. [PMID: 37173225 DOI: 10.1016/j.blre.2023.101099] [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: 02/06/2023] [Revised: 04/04/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Abstract
There have been significant advancements in the management of follicular lymphoma (FL), the most common indolent lymphoma. These include immunomodulatory agents such as lenalidomide, epigenetic modifiers (tazemetostat), and phosphoinotiside-3 kinase inhibitors (copanlisib). The focus of this review is T cell-engager therapies, namely chimeric antigen receptor (CAR) T-cell therapy and bispecific antibodies, have recently transformed the treatment landscape of FL. Two CAR T cell products, axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel), and one bispecific antibody, mosunetuzumab, recently received FDA approvals in FL. Several other new immune effector drugs are being evaluated and will expand the treatment armamentarium. This review focuses on CAR T-cell and bispecific antibody therapies, details their safety and efficacy and considers their evolving role in the current treatment landscape of FL.
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18
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Lu T, Zhang J, Xu-Monette ZY, Young KH. The progress of novel strategies on immune-based therapy in relapsed or refractory diffuse large B-cell lymphoma. Exp Hematol Oncol 2023; 12:72. [PMID: 37580826 PMCID: PMC10424456 DOI: 10.1186/s40164-023-00432-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/30/2023] [Indexed: 08/16/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) can be cured with standard front-line immunochemotherapy, whereas nearly 30-40% of patients experience refractory or relapse. For several decades, the standard treatment strategy for fit relapsed/refractory (R/R) DLBCL patients has been high-dose chemotherapy followed by autologous hematopoietic stem cell transplant (auto-SCT). However, the patients who failed in salvage treatment or those ineligible for subsequent auto-SCT have dismal outcomes. Several immune-based therapies have been developed, including monoclonal antibodies, antibody-drug conjugates, bispecific T-cell engaging antibodies, chimeric antigen receptor T-cells, immune checkpoint inhibitors, and novel small molecules. Meanwhile, allogeneic SCT and radiotherapy are still necessary for disease control for fit patients with certain conditions. In this review, to expand clinical treatment options, we summarize the recent progress of immune-related therapies and prospect the future indirections in patients with R/R DLBCL.
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Affiliation(s)
- Tingxun Lu
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, 214122, China
- Division of Hematopathology, Department of Pathology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Jie Zhang
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, 214122, China
| | - Zijun Y Xu-Monette
- Division of Hematopathology, Department of Pathology, Duke University School of Medicine, Durham, NC, 27710, USA
- Duke Cancer Institute, Durham, NC, 27710, USA
| | - Ken H Young
- Division of Hematopathology, Department of Pathology, Duke University School of Medicine, Durham, NC, 27710, USA.
- Duke Cancer Institute, Durham, NC, 27710, USA.
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19
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Lin RJ, Kim SJ, Brown S, Elko TA, Ruiz JD, Hanley DM, Lia Palomba M, Perales MA, Shah GL, Dahi PB, Scordo M, Sauter CS, Batlevi CL, Tomas AA, Shouval R, Lee N, Pavkovic EA, Engstler DE, Park JH, Salles GA, Devlin SM, Korc-Grodzicki B, Hamlin PA, Giralt SA. Prospective geriatric assessment and geriatric consultation in CAR T-cell therapy for older patients with lymphoma. Blood Adv 2023; 7:3501-3505. [PMID: 37078703 PMCID: PMC10362256 DOI: 10.1182/bloodadvances.2023010003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023] Open
Affiliation(s)
- Richard J. Lin
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Soo Jung Kim
- Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samantha Brown
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Theresa A. Elko
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Josel D. Ruiz
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Danielle M. Hanley
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M. Lia Palomba
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Miguel-Angel Perales
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Gunjan L. Shah
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Parastoo B. Dahi
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Michael Scordo
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Craig S. Sauter
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Connie L. Batlevi
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ana Alarcon Tomas
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Roni Shouval
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Nicole Lee
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emma A. Pavkovic
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Danielle E. Engstler
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jae H. Park
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Gilles A. Salles
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean M. Devlin
- Weill Cornell Medical College, New York, NY
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Beatriz Korc-Grodzicki
- Weill Cornell Medical College, New York, NY
- Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul A. Hamlin
- Weill Cornell Medical College, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio A. Giralt
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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20
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Maakaron JE, William BM. Age is No Barrier: CAR-T Therapy in Older Adults. Drugs Aging 2023:10.1007/s40266-023-01047-z. [PMID: 37432595 DOI: 10.1007/s40266-023-01047-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 07/12/2023]
Abstract
In the last decade, chimeric antigen receptor-T (CAR-T) cells have revolutionized the treatment of hematological malignancies. With six different products for five diseases in various settings, CAR-T use has increased, and the comfort level of prescribers continues to expand. These therapies carry substantial toxicities that may limit their applicability to all patient populations. In the registrational trials, older adults are represented as part of a whole and risks specific to older age may not be clearly outlined. The aim of this review is to summarize the data from clinical trials, as well as real-life evidence, that outline the safety of CAR-T in older adults. With most of the data coming from CD19 CAR-T for diffuse large B-cell lymphoma, it appears that CAR-T can be safely administered to older individuals.
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Affiliation(s)
| | - Basem M William
- OhioHealth Blood and Marrow Transplant Program, OhioHealth, 500 Thomas Lane; A3, Columbus, OH, 43214, USA.
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21
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Martino M, Canale FA, Porto G, Verduci C, Utano G, Policastro G, Germanò J, Alati C, Santoro L, Imbalzano L, Pitea M. Integrating CAR-T cell therapy into the management of DLBCL: what we are learning. Expert Opin Biol Ther 2023; 23:1277-1285. [PMID: 38078446 DOI: 10.1080/14712598.2023.2292634] [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: 08/23/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Chimeric Antigen Receptor ;(CAR) T cells therapies have become part of the standard of care for patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). The weakness of CAR-T therapies is that there are no comparative clinical trials, although many publications based on real-life data have confirmed the results obtained in pivotal studies. After several years of the commercialization of CAR-T, some points still need to be fully clarified. Healthcare professionals have questions about identifying patients who may benefit from therapy. There are aspects inherent in the accessibility of care related to improved relationships between CAR-T-delivering and referral centers. AREAS COVERED Open questions are inherent in the salvage and bridge therapy, predictive criteria for response and persistence of CAR-T after infusion. Managing toxicities remain a top priority and one of the points on which further knowledge is needed. EXPERT OPINION This review aims to describe the current landscape of CAR-T cells in DLBCL, outline their outcomes and toxicities, and explain the outstanding questions that remain to be addressed.
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Affiliation(s)
- Massimo Martino
- Stem Cell Transplantation and Cellular Therapies Unit (CTMO), Department of Hemato-Oncology and Radiotherapy Grande OspedaleMetropolitano "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Filippo Antonio Canale
- Stem Cell Transplantation and Cellular Therapies Unit (CTMO), Department of Hemato-Oncology and Radiotherapy Grande OspedaleMetropolitano "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Gaetana Porto
- Stem Cell Transplantation and Cellular Therapies Unit (CTMO), Department of Hemato-Oncology and Radiotherapy Grande OspedaleMetropolitano "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Chiara Verduci
- Stem Cell Transplantation and Cellular Therapies Unit (CTMO), Department of Hemato-Oncology and Radiotherapy Grande OspedaleMetropolitano "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Giovanna Utano
- Stem Cell Transplantation and Cellular Therapies Unit (CTMO), Department of Hemato-Oncology and Radiotherapy Grande OspedaleMetropolitano "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Giorgia Policastro
- Stem Cell Transplantation and Cellular Therapies Unit (CTMO), Department of Hemato-Oncology and Radiotherapy Grande OspedaleMetropolitano "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Jessyca Germanò
- Hematology Unit, Department of Hemato-Oncology and Radiotherapy Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Caterina Alati
- Hematology Unit, Department of Hemato-Oncology and Radiotherapy Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Ludovica Santoro
- Stem Cell Transplantation and Cellular Therapies Unit (CTMO), Department of Hemato-Oncology and Radiotherapy Grande OspedaleMetropolitano "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Lucrezia Imbalzano
- Stem Cell Transplantation and Cellular Therapies Unit (CTMO), Department of Hemato-Oncology and Radiotherapy Grande OspedaleMetropolitano "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Martina Pitea
- Stem Cell Transplantation and Cellular Therapies Unit (CTMO), Department of Hemato-Oncology and Radiotherapy Grande OspedaleMetropolitano "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
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