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Yakubi H, Steele AP, Tsao M. Meperidine compared to morphine for rigors associated with monoclonal antibody-related infusion reactions. J Oncol Pharm Pract 2024:10781552241259986. [PMID: 38884818 DOI: 10.1177/10781552241259986] [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: 06/18/2024]
Abstract
INTRODUCTION Infusion reactions, characterized by symptoms such as rigors, fever, and hypotension, are common adverse events that occur during monoclonal antibody (MAB) therapy. The treatment of rigors often involves opioids, most commonly meperidine, despite limited evidence supporting use in the setting of MAB infusions. This study aims to compare the efficacy and safety of intravenous (IV) meperidine and morphine is treatment of MAB-related rigors, filling a significant gap in the literature. METHODS This was a single-center, retrospective cohort study which reviewed patients either inpatient or within outpatient infusion centers from January 2015 to January 2024. Patients receiving IV 2 mg morphine or 25 mg meperidine for MAB-related rigors were included. The primary outcome was defined as the number of opioid doses required for rigors ablation. Secondary outcomes included rates of naloxone administration and documented sedation. RESULTS A total of 1251 administration events were screened, of which 127 and 26 rigor events were in the meperidine and morphine cohorts, respectively, were included. A majority of both cohorts required only one dose of either agent for rigors ablation with <20% of either cohort requiring 2 or more doses (p = 0.539). Low rates of sedation were observed in both groups. CONCLUSION Both meperidine and morphine effectively manage MAB-related rigors within minimal safety concerns. These findings suggest that morphine is a suitable alternative to meperidine for this indication, which may influence future formulary decision, provide alternatives for drug shortage, and optimize supportive care for patients undergoing MAB therapy.
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Affiliation(s)
- Hanna Yakubi
- Department of Pharmacy, University of California at Davis Health System, Sacramento, CA, USA
| | - Aaron Paul Steele
- Department of Pharmacy, University of California at Davis Health System, Sacramento, CA, USA
| | - Megan Tsao
- Department of Pharmacy, University of California at Davis Health System, Sacramento, CA, USA
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2
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Sun H, Zeng X, Li Y, Li H, Yao X, Xue Y, Lu W. Successful remission induction of IgG4-related ophthalmic disease by obinutuzumab therapy: a retrospective study of 8 patients. Eye (Lond) 2024; 38:723-729. [PMID: 37749377 PMCID: PMC10920806 DOI: 10.1038/s41433-023-02758-8] [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: 05/17/2023] [Revised: 08/21/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES To evaluate the therapeutic efficacy and safety of obinutuzumab in remission induction for IgG4-related ophthalmic disease (IgG4-ROD) patients. METHODS Eight IgG4-ROD patients were retrospectively enrolled. They were intravenously administered 1000 mg obinutuzumab at baseline and examined for changes in physical signs, orbital structure imaging parameters, IgG4-related disease responder index (IgG4-RD RI), serological index, and adverse events during treatment. The number of treatment sessions was based on treatment response. RESULTS The mean IgG4-RD RI scores of all patients at baseline (7.75 ± 2.92) and after treatment (2.00 ± 0.76) were highly significantly different (P < 0.001). Six patients achieved complete remission (CR) (75%) and two patients achieved partial remission (25%). The mean serum IgG4 levels at baseline (9.45 ± 6.95 g/L) and after treatment (1.55 ± 1.09 g/L) showed a mean decrease of 83% (P = 0.0079). The serum IgG4 level correlated well with IgG4-RD RI at baseline and that after each treatment (r = 0.852, P < 0.01; r = 0.78, P < 0.001). In patients with CR, the serum IgG4 levels at baseline correlated positively with dose numbers required for CR (r = 0.86, P < 0.05). Five patients (62.5%) experienced infusion-related reactions (IRRs) during the first obinutuzumab infusion, while only one (12.5%) experienced IRRs during all subsequent eight infusions. CONCLUSION Obinutuzumab is a safe and promising therapeutic option for IgG4-ROD. It rapidly reduces ocular inflammation and serum IgG4 levels to avoid excessive corticosteroid usage and reduce potential risk of adverse events.
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Affiliation(s)
- Hetian Sun
- Department of ophthamology, The second hospital of DaLian Medical University, Dalian, Liaoning, China
| | - Xueying Zeng
- Department of ophthamology, The second hospital of DaLian Medical University, Dalian, Liaoning, China
| | - Yang Li
- Department of ophthamology, The second hospital of DaLian Medical University, Dalian, Liaoning, China
| | - Hang Li
- Department of ophthamology, The second hospital of DaLian Medical University, Dalian, Liaoning, China
| | - XinLei Yao
- Department of ophthamology, The second hospital of DaLian Medical University, Dalian, Liaoning, China
| | - Yu Xue
- Department of ophthamology, The second hospital of DaLian Medical University, Dalian, Liaoning, China
| | - Wei Lu
- Department of ophthamology, The second hospital of DaLian Medical University, Dalian, Liaoning, China.
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Maisha N, Kulkarni C, Pandala N, Zilberberg R, Schaub L, Neidert L, Glaser J, Cannon J, Janeja V, Lavik EB. PEGylated Polyester Nanoparticles Trigger Adverse Events in a Large Animal Model of Trauma and in Naı̈ve Animals: Understanding Cytokine and Cellular Correlations with These Events. ACS NANO 2022; 16:10566-10580. [PMID: 35822898 DOI: 10.1021/acsnano.2c01993] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Intravenously infusible nanoparticles to control bleeding have shown promise in rodents, but translation into preclinical models has been challenging as many of these nanoparticle approaches have resulted in infusion responses and adverse outcomes in large animal trauma models. We developed a hemostatic nanoparticle technology that was screened to avoid one component of the infusion response: complement activation. We administered these hemostatic nanoparticles, control nanoparticles, or saline volume controls in a porcine polytrauma model. While the hemostatic nanoparticles promoted clotting as marked by a decrease in prothrombin time and both the hemostatic nanoparticles and controls did not active complement, in a subset of the animals, hard thrombi were found in uninjured tissues in both the hemostatic and control nanoparticle groups. Using data science methods that allow one to work across heterogeneous data sets, we found that the presence of these thrombi correlated with changes in IL-6, INF-alpha, lymphocytes, and neutrophils. While these findings might suggest that this formulation would not be a safe one for translation for trauma, they provide guidance for developing screening tools to make nanoparticle formulations in the complex milieux of trauma as well as for therapeutic interventions more broadly. This is important as we look to translate intravenously administered nanoparticle formulations for therapies, particularly considering the vascular changes seen in a subset of patients following COVID-19. We need to understand adverse events like thrombi more completely and screen for these events early to make nanomaterials as safe and effective as possible.
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Affiliation(s)
| | | | | | | | - Leasha Schaub
- Naval Medical Research Unit-San Antonio, San Antonio, Texas 78234, United States
| | - Leslie Neidert
- Naval Medical Research Unit-San Antonio, San Antonio, Texas 78234, United States
| | - Jacob Glaser
- Naval Medical Research Unit-San Antonio, San Antonio, Texas 78234, United States
| | - Jeremy Cannon
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
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Bourrier N, Landego I, Bucher O, Squires M, Streu E, Hibbert I, Whiteside T, Gibson SB, Geirnaert M, Johnston JB, Dawe DE, Banerji V. Real world risk of infusion reactions and effectiveness of front-line obinutuzumab plus chlorambucil compared with other frontline treatments for chronic lymphocytic leukemia. BMC Cancer 2022; 22:148. [PMID: 35123433 PMCID: PMC8818183 DOI: 10.1186/s12885-022-09256-2] [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: 06/15/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in North America. Previous studies have shown improved progression free survival (PFS) and response rates in unfit patients treated with obinutuzumab compared to other regimens. The aim of this study was to evaluate the obinutuzumab-chlorambucil regimen in the context of historical treatments and first-dose infusion reactions at CancerCare Manitoba (CCMB). Methods A retrospective chart review was conducted for patients treated with obinutuzumab from January 1, 2014 to December 31, 2017 at CCMB. A minimum data set was extracted for patients treated with other front-line therapies. Descriptive statistics were used to evaluate patient demographics, toxicity, duration and dosing of obinutuzumab treatment. Kaplan–Meier curves were used to evaluate time-to-next-treatment (TTNT), overall survival (OS) and PFS for patients treated with obinutuzumab. A multivariable logistic regression model was used to investigate associations between infusion related reactions (IRRs) and age at treatment, pre-treatment lymphocyte count, cumulative illness rating scale (CIRS) and receipt of prior chemotherapy. Results Forty seven percent of patients receiving frontline therapy received chlorambucil and obinutuzumab. Sixty-seven patients were treated with obinutuzumab and consisted of 36 males (53.7%) and 31 females (46.3%) with 29 patients (43.3%) over age 75 years. Rates of grade 3 and 4 obinutuzumab IRRs were lower (6%) compared to the CLL11 clinical trial (20%) due to local practices including slower infusion rates and using chlorambucil before starting obinutuzumab treatment. Many patients had difficulty tolerating the full dosage of chlorambucil. Only 26 patients (38.8%) had their dose of chlorambucil escalated to the full dose of 0.5 mg/kg. In addition, only 18 patients (26.9%) received all doses of obinutuzumab and all 12 doses of chlorambucil. Conclusions In summary, first dose infusion reactions with obinutuzumab can be markedly reduced by using chlorambucil to decrease the lymphocyte count before obinutuzumab and by using a very slow initial obinutuzumab infusion rate. Modifications in chlorambucil dosing and obinutuzumab administration can improve tolerance without significant loss in efficacy. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09256-2.
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Milunović V, Mišura Jakobac K, Mandac Rogulj I, Martinović M, Radić-Krišto D, Ostojić Kolonić S. The fading star of obinutuzumab-chlorambucil regimen in patients with comorbidities with chronic lymphocytic leukemia - are we ready for chemo-free immunotherapy approach? Expert Rev Hematol 2020; 13:771-779. [PMID: 32579408 DOI: 10.1080/17474086.2020.1775575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Chronic lymphocytic leukemia (CLL) is the most common leukemia in Western countries occurring typically in elderly patients. These patients often present with comorbidities limiting treatment options. During the last decade, the treatment paradigm has rapidly changed with the introduction of novel oral targeted agents and monoclonal antibodies. AREAS COVERED The review focuses on the combination of type II antiCD20 antibody obinutuzumab in combination with chemotherapy or oral targeted agents in patients not suited for fludarabine-based therapy because of comorbidities or age. The main focus of the review is whether classical immunochemotherapy with obinutuzumab-chlorambucil is still a valid therapeutic option or whether the combination of obinutuzumab and ibrutinib or venetoclax presents novel standard of care. EXPERT OPINION Both pivotal and registrational studies iLLLUMINATE study testing the combination of ibrutinib and obinutuzumab and CLL14 study testing the fixed combination of venetoclax and obinutuzumab have shown major benefit over chemoimmunotherapy approach in this population. Furthermore, they have excellent activity in high-risk subgroups of CLL paving the road toward a chemo-free immunotherapy approach in this setting. However, there are some pitfalls in these strategies warranting further research.
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Affiliation(s)
- Vibor Milunović
- Division of Hematology, Clinical Department of Internal Diseases, Clinical Hospital Merkur , Zagreb, Croatia
| | - Karla Mišura Jakobac
- Division of Hematology, Clinical Department of Internal Diseases, Clinical Hospital Merkur , Zagreb, Croatia
| | - Inga Mandac Rogulj
- Division of Hematology, Clinical Department of Internal Diseases, Clinical Hospital Merkur , Zagreb, Croatia
| | - Marko Martinović
- Division of Hematology, Clinical Department of Internal Diseases, Clinical Hospital Merkur , Zagreb, Croatia
| | - Delfa Radić-Krišto
- Division of Hematology, Clinical Department of Internal Diseases, Clinical Hospital Merkur , Zagreb, Croatia.,School of Medicine in Osijek, Josip Juraj Strossmajer University in Osijek , Osijek, Croatia
| | - Slobodanka Ostojić Kolonić
- Division of Hematology, Clinical Department of Internal Diseases, Clinical Hospital Merkur , Zagreb, Croatia.,School of Medicine in Zagreb, University of Zagreb , Zagreb, Croatia
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Hara T, Suzuki R, Ohno A, Yamakawa K, Yamagishi Y, Sugiyama Y, Sobajima T, Yamada R, Matsumoto R, Ikeda Y, Murayama M, Tsurumi H. Safe administration of rituximab for follicular lymphoma after obinutuzumab infusion-related reaction. Int J Hematol 2019; 111:585-590. [PMID: 31848991 DOI: 10.1007/s12185-019-02793-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 01/10/2023]
Abstract
Obinutuzumab is a novel glycoengineered, type-II anti-CD20 monoclonal antibody that was recently developed to treat follicular lymphoma (FL), the most prevalent subtype of indolent B-cell lymphoma. Several intensely hypermetabolic lesions (SUVmax: 40) were identified in the post-mediastinal and paraaortic lymph nodes by 18F-FDG-PET maximum-intensity projection images of a 58-year-old man who presented with systemic lymphadenopathy. A biopsy at the time of laparotomy definitively diagnosed grade 1 FL. The patient was given the recommended standard premedication, comprising acetaminophen (1000 mg), diphenhydramine (50 mg), and dexamethasone (20 mg), and then started on six cycles of obinutuzumab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP). However, the patient developed severe hypotension and dyspnea about 15 min after starting obinutuzumab. It was difficult to differentiate between a possible allergic reaction and infusion-related reaction. A pleural effusion was drained to reduce the tumor burden, after which a single course of CHOP was started. Rituximab (R) was added 10 days later without incident, and the patient completed six cycles of the R-CHOP therapy without adverse events. We conclude that R-CHOP was safe for administration to patients who react to infused obinutuzumab. Such patients should be carefully monitored during R infusion, given the risk of cross-reactivity.
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Affiliation(s)
- Takeshi Hara
- Department of Hematology, Matsunami General Hospital, 185-1 Dendai, Kasamatsu-cho, Hashima, 501-6062, Japan
| | - Ryohei Suzuki
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Akihisa Ohno
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Kengo Yamakawa
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Yasumasa Yamagishi
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Yoshihiro Sugiyama
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Takuya Sobajima
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Rie Yamada
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Rie Matsumoto
- Department of Pharmacy, Matsunami General Hospital, Hashima, Japan
| | - Yoko Ikeda
- Department of Pathology, Matsunami General Hospital, Hashima, Japan
| | - Masanori Murayama
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Hisashi Tsurumi
- Department of Hematology, Matsunami General Hospital, 185-1 Dendai, Kasamatsu-cho, Hashima, 501-6062, Japan.
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Pejsa V, Lucijanic M, Vrkljan Vuk A, Stoos-Veic T, Jaksic O, Jonjic Z, Pirsic M, Prka Z, Ivic M, Fazlic Dzankic A, Mitrovic Z. Prolonged methylprednisolone premedication prior to obinutuzumab in patients with chronic lymphocytic leukemia. Leuk Lymphoma 2019; 61:934-939. [DOI: 10.1080/10428194.2019.1702182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Vlatko Pejsa
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marko Lucijanic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
| | | | - Tajana Stoos-Veic
- Department of Clinical Cytology and Cytometry, University Hospital Dubrava, Zagreb, Croatia
- Faculty of Medicine, University of Osijek, Osijek, Croatia
| | - Ozren Jaksic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zeljko Jonjic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Mario Pirsic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Zeljko Prka
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Marija Ivic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
| | | | - Zdravko Mitrovic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Obinutuzumab pretreatment abrogates tumor lysis risk while maintaining undetectable MRD for venetoclax + obinutuzumab in CLL. Blood Adv 2019; 2:3566-3571. [PMID: 30552161 DOI: 10.1182/bloodadvances.2018019422] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 11/08/2018] [Indexed: 12/11/2022] Open
Abstract
Early data on venetoclax-containing regimens for the treatment of chronic lymphocytic leukemia (CLL) show promising results with deep remissions, but are hampered by potential risk for tumor lysis syndrome (TLS). Whether optimal duration of venetoclax treatment can be guided by minimal residual disease (MRD) is currently unknown. To study whether TLS risk can be mitigated in an unfit population by introducing preinduction, and whether MRD-guided duration of venetoclax treatment is a feasible and efficacious approach, we performed the Dutch-Belgian Cooperative Trial Group for Hemato-oncology (HOVON) 139/GIVE trial. The study treatment consists of 4 treatment phases: preinduction (2 cycles obinutuzumab), induction I (6 cycles obinutuzumab and venetoclax), induction II (6 cycles venetoclax), and a randomization phase (group A: maintenance with 12 additional cycles of venetoclax irrespective of MRD; group B: MRD guided venetoclax maintenance with a maximum of 12 cycles). Here we report on a planned interim safety analysis as well as preliminary efficacy and MRD data of the first 30 patients enrolled. Downgrading of TLS risk after preinduction occurred in 25 patients: 3 from high to medium, 3 from high to low, and 19 from medium to low risk. No patient remained high risk. From these 30 patients, peripheral blood MRD data were obtained for 28 patients at the end of induction II (6 months after the last obinutuzumab dose), of whom 26 had undetectable MRD levels, and for 18 patients who reached the 3-month after-randomization point, of whom 16 had undetectable MRD levels. Obinutuzumab preinduction is tolerated well in these unfit patients and results in abrogating high TLS risk in all patients. Preliminary data indicate that efficacy is maintained with a high proportion of patients with undetectable MRD levels after combination treatment.
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Abstract
Chronic lymphocytic leukemia (CLL) is a disease characterized by an increasing incidence with age reaching 35/100,000 in patients over 85 years. Elderly CLL patients carry several challenges, which have to be considered particularly in advanced stages including a higher risk of infections and individual differences in comorbidities and geriatric syndromes. Although no specific tool for geriatric evaluation in CLL has been developed so far, several of them (e.g. CIRS or Charlson-Score) have been tested in CLL patients. Several treatment options exist for frontline and relapse therapy in unfit CLL patients. Less intensive chemoimmunotherapy with engineered CD20 antibodies (e.g. obinutuzumab) is one of the treatment options, if TP53 mutation or deletion has been ruled out by genetic testing. Single agent treatment with the Btk-inhibitor ibrutinib is not only approved in relapsed CLL; but also for frontline therapy. The kinase inhibitor idelalisib (plus rituximab) and the bcl2 inhibitor venetoclax are other novel compounds, which showed great efficacy in relapsed CLL even in unfit patients. Treatment decisions in unfit patients have to take patient-related as well as disease-related risk factors into consideration.
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MESH Headings
- Age Factors
- Aged
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Combined Modality Therapy
- Disease Management
- Geriatric Assessment
- Humans
- Immunotherapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Molecular Targeted Therapy
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/therapeutic use
- Randomized Controlled Trials as Topic
- Receptors, Antigen, B-Cell/antagonists & inhibitors
- Treatment Outcome
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Affiliation(s)
- Barbara Eichhorst
- German CLL Study Group (GCLLSG), Dept. I of Internal Medicine, Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Germany.
| | - Michael Hallek
- German CLL Study Group (GCLLSG), Dept. I of Internal Medicine, Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Germany; Excellence Cluster Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Valentin Goede
- German CLL Study Group (GCLLSG), Dept. I of Internal Medicine, Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Germany; Oncogeriatric Unit, Dept. of Geriatric Medicine, St. Marien Hospital, Cologne, Germany
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Leblond V, Aktan M, Ferra Coll CM, Dartigeas C, Kisro J, Montillo M, Raposo J, Merot JL, Robson S, Gresko E, Bosch F, Stilgenbauer S, Foà R. Safety of obinutuzumab alone or combined with chemotherapy for previously untreated or relapsed/refractory chronic lymphocytic leukemia in the phase IIIb GREEN study. Haematologica 2018; 103:1889-1898. [PMID: 29976743 PMCID: PMC6278964 DOI: 10.3324/haematol.2017.186387] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 07/04/2018] [Indexed: 01/17/2023] Open
Abstract
The safety of obinutuzumab, alone or with chemotherapy, was studied in a non-randomized, open-label, non-comparative, phase IIIb study (GREEN) in previously untreated or relapsed/refractory chronic lymphocytic leukemia. Patients received obinutuzumab 1000 mg alone or with chemotherapy (investigator’s choice of fludarabine-cyclophosphamide for fit patients, chlorambucil for unfit patients, or bendamustine for any patient) on days 1, 8 and 15 of cycle 1, and day 1 of cycles 2–6 (28-day cycles), with the cycle 1/day 1 dose administered over two days. The primary end point was safety/tolerability. Between October 2013 and March 2016, 972 patients were enrolled and 971 treated (126 with obinutuzumab monotherapy, 193 with obinutuzumab-fludarabine-cyclophosphamide, 114 with obinutuzumab-chlorambucil, and 538 with obinutuzumab-bendamustine). Grade ≥3 adverse events occurred in 80.3% of patients, and included neutropenia (49.9%), thrombocytopenia (16.4%), anemia (9.6%), and pneumonia (9.0%); rates were similar in first-line and relapsed/refractory patients, and in first-line fit and unfit patients. Using expanded definitions, infusion-related reactions were observed in 65.4% of patients (grade ≥3, 19.9%; mainly seen during the first obinutuzumab infusion), tumor lysis syndrome in 6.4% [clinical and laboratory; highest incidence with obinutuzumab-bendamustine (9.3%)], and infections in 53.7% (grade ≥3, 20.1%). Serious and fatal adverse events were seen in 53.1% and 7.3% of patients, respectively. In first-line patients, overall response rates at three months post treatment exceeded 80% for all obinutuzumab-chemotherapy combinations. In the largest trial of obinutuzumab to date, toxicities were generally manageable in this broad patient population. Safety data were consistent with previous reports, and response rates were high. (clinicaltrials.gov identifier: 01905943).
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Affiliation(s)
| | | | - Christelle M Ferra Coll
- Institut Català d'Oncologia (ICO), Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | | | - Jens Kisro
- Onkologische Schwerpunktpraxis Lübeck, Germany
| | - Marco Montillo
- Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | | | | | | | | | - Robin Foà
- Hematology, 'Sapienza' University, Rome, Italy
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