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Wang TP, Ahn KW, Shadman M, Kaur M, Ahmed N, Bacher U, Cerny J, Chen A, Epperla N, Frigault M, Grover N, Haverkos B, Hill B, Hossain N, Iqbal M, Jain T, Krem MM, Maakaron J, Modi D, Alhaj Moustafa M, Riedell P, Savani B, Sica RA, Sureda A, Wudhikarn K, Herrera AF, Sauter C, Hamadani M, Jimenez Jimenez A. Chimeric antigen receptor T-cell infusion for large B-cell lymphoma in complete remission: a center for international blood and marrow transplant research analysis. Leukemia 2024; 38:1564-1569. [PMID: 38750138 PMCID: PMC11271761 DOI: 10.1038/s41375-024-02242-6] [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: 12/15/2023] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 07/03/2024]
Abstract
CD19 CAR T-cell (CAR-T) therapy is commonly administered to patients with relapsed or refractory large B-cell lymphomas (LBCL), but salvage or bridging therapy can sometimes lead to a complete response (CR) prior to infusion. Limited studies have assessed the outcomes of patients infused in CR. A total of 134 patients with LBCL in CR prior to CAR-T infusion were identified from the CIBMTR registry, with median prior lines of therapy of 3 (range 2-9). At two years post-infusion, the probability of progression-free survival was 43.5% (95% CI 34.4-52.8) and the probability of overall survival was 63.8% (95% CI 54.4-72.6). The cumulative incidence rates of non-relapse mortality and relapse/progression at two years were 9.2% (95% CI 4.5-15.4) and 47.3% (95% CI 38.2-56.6), respectively. The rate of grade 3 or higher cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) were 2.2% and 8.2%, respectively. In summary, CAR-T in heavily pretreated patients with LBCL who are in CR following two or more lines of prior therapy demonstrate that a subset of patients may remain free of progression at two years. Additionally, the toxicity profile was impressive with very low rates of grade 3 CRS and ICANS.
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Affiliation(s)
- Trent P Wang
- Division of Transplantation and Cellular Therapy, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Kwang W Ahn
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, USA
| | - Manmeet Kaur
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nausheen Ahmed
- University of Kansas Cancer Center, Division of Hematologic Malignancies and Cellular Therapeutics, Kansas City, KS, USA
| | - Ulrike Bacher
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Jan Cerny
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Andy Chen
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Narendranath Epperla
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Matthew Frigault
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Division of Hematology & Oncology, Boston, MA, USA
| | - Natalie Grover
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Brian Hill
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Nasheed Hossain
- Cell Therapy and Transplant Program, Division of Hematology/Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Madiha Iqbal
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Tania Jain
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Joseph Maakaron
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Dipenkumar Modi
- Division of Hematology/Oncology, Karmanos Cancer Institute, Detroit, MI, USA
| | | | - Peter Riedell
- The David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL, USA
| | - Bipin Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - R Alejandro Sica
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY, USA
| | - Anna Sureda
- Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - Kitsada Wudhikarn
- Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Stem Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Craig Sauter
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Antonio Jimenez Jimenez
- Division of Transplantation and Cellular Therapy, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
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Jackson Levin N, Tan CY, Stelmak D, Iannarino NT, Zhang A, Ellman E, Herrel LA, Walling EB, Moravek MB, Chugh R, Haymart MR, Zebrack B. Banking on Fertility Preservation: Financial Concern for Adolescent and Young Adult Cancer Patients Considering Oncofertility Services. J Adolesc Young Adult Oncol 2023; 12:710-717. [PMID: 36603107 PMCID: PMC10611956 DOI: 10.1089/jayao.2022.0055] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: Financial concern is a major issue for adolescent and young adult (AYA) cancer patients. Furthermore, unaddressed oncofertility challenges (e.g., infertility) are linked to psychological distress and decreased overall quality of life. Little is known about how financial concern in terms of oncofertility (i.e., concern regarding affording fertility preservation [FP] services) impacts AYAs' decision making and experiences. Methods: AYA cancer patients (n = 27) aged 12-25 years whose cancer treatment conferred risk of infertility were recruited through electronic health record query. Participants completed semi-structured interviews, which were recorded, transcribed, and deductively coded for themes related to information needs, knowledge of treatment effects on fertility, and reproductive concerns after cancer. Emergent, inductive themes related to financial concern were identified. The Institutional Review Board at the University of Michigan approved this study (HUM#00157267). Results: Financial concern was a dominant theme across the qualitative data. Emergent themes included (1) varied access to health insurance, (2) presence of parental/guardian support, (3) reliance upon financial aid, (4) negotiating infertility risk, and (5) lack of preparation for long-term costs. AYAs relied heavily upon parents for out-of-pocket and insurance coverage support. Some participants sought financial aid when guided by providers. Several participants indicated that no financial support existed for their circumstance. Conclusions: Financial consequences in terms of oncofertility are a major issue affecting AYA cancer patients. The incidence and gravity of financial concern surrounding affording oncofertility services merits attention in future research (measuring financial resources of AYAs' parental/support networks), clinical practice (strategically addressing short- and long-term costs; tailored psychosocial support), and health care policy (promoting legislation to mandate pre- and post-treatment FP coverage).
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Affiliation(s)
- Nina Jackson Levin
- Department of Anthropology, School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Chiu Yi Tan
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Daria Stelmak
- School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas T. Iannarino
- Department of Language, Culture, and the Arts at University of Michigan-Dearborn, Dearborn, Michigan, USA
| | - Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin Ellman
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsey A. Herrel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily B. Walling
- Department of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Molly B. Moravek
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rashmi Chugh
- Department of Internal Medicine, Endocrinology & Diabetes Clinic, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan R. Haymart
- Department of Metabolism, Endocrinology & Diabetes Clinic, University of Michigan, Ann Arbor, Michigan, USA
| | - Brad Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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Wesevich VG, Arkfeld C, Seifer DB. In Vitro Gametogenesis in Oncofertility: A Review of Its Potential Use and Present-Day Challenges in Moving toward Fertility Preservation and Restoration. J Clin Med 2023; 12:3305. [PMID: 37176745 PMCID: PMC10179531 DOI: 10.3390/jcm12093305] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Current fertility preservation options are limited for cancer survivor patients who wish to have their own biological children. Human in vitro gametogenesis (IVG) has the hypothetical ability to offer a unique solution to individuals receiving treatment for cancer which subsequently shortens their reproductive lifespan. Through a simple skin punch biopsy, a patient's fertility could be restored via reprogramming of dermal fibroblast cells to induced pluripotent stem cells, then from primordial germ cell-like cells into viable oocytes and spermatocytes which could be used for embryogenesis. Induced pluripotent stem cells could also be used to form in vitro environments, similar to the ovary or testes, necessary for the maturation of oogonia. This would allow for the entire creation of embryos outside the body, ex vivo. While this area in stem cell biology research offers the potential to revolutionize reproduction as we know it, there are many critical barriers, both scientific and ethical, that need to be overcome to one day see this technology utilized clinically.
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Affiliation(s)
- Victoria G Wesevich
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
| | - Christopher Arkfeld
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale New Haven Hospital, New Haven, CT 06510, USA
| | - David B Seifer
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
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Abstract
BACKGROUND A cancer diagnosis as an adolescent and young adult (AYA) poses exceptional challenges, including potential greater financial toxicity than older survivors experience who have had more time for career establishment and to build financial assets. Costs to patients have increased more than the past decade; prospects for AYA long-term survival have also increased. A better understanding of what financial toxicity is, how it presents, and the immediate and longer-term implications for AYAs is needed. OBJECTIVE The aim of this study was to analyze the concept financial toxicity in AYAs diagnosed with cancer. METHODS We used Rodgers' evolutionary method and articles published between January 2013 and December 2020. RESULTS We identified key antecedents, attributes, and consequences of financial toxicity in AYAs and review its related terms that have often been used as surrogate terms. Attributes were financial burden, financial distress, and competing financial pressures. Consequences were mostly adverse and persistent and included engaging in various financial problem-solving behaviors, material hardship and poor financial well-being, and deteriorated quality of life. CONCLUSIONS Results of this analysis clarify financial toxicity and provide guidance for a conceptual framework in the context of AYA cancer survivorship. Its consequences in AYAs with cancer are profound and will continue to evolve over time with changes in health systems and the economy. IMPLICATIONS FOR PRACTICE Oncology nurses should understand the attributes and consequences of financial toxicity for AYAs throughout the cancer trajectory. Future research on financial toxicity should extend across AYAs living with other chronic illnesses and cancer survivors in other age groups.
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