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Iqbal M, Kumar A, Dreger P, Chavez J, Sauter CS, Sureda AM, Bachanova V, Maziarz RT, Dreyling M, Smith SM, Jacobson C, Glass B, Casulo C, Oluwole OO, Montoto S, Advani R, Cohen J, Salles G, Hamad N, Kuruvilla J, Kahl BS, Shadman M, Kanate AS, Budde LE, Kamdar M, Flowers C, Hamadani M, Kharfan-Dabaja MA. Clinical Practice Recommendations for Hematopoietic Cell Transplantation and Cellular Therapies in Follicular Lymphoma: A Collaborative Effort on Behalf of the American Society for Transplantation and Cellular Therapy and the European Society for Blood and Marrow Transplantation. Transplant Cell Ther 2024; 30:832-843. [PMID: 38972511 DOI: 10.1016/j.jtct.2024.06.025] [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: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 07/09/2024]
Abstract
Follicular lymphoma (FL) is the most common indolent B-cell non-Hodgkin lymphoma (NHL), accounting for nearly one-third of all NHL. The therapeutic landscape for patients with FL has significantly expanded over the past decade, but the disease continues to be considered incurable. Hematopoietic cell transplantation (HCT) is potentially curative in some cases. Recently, the emergence of chimeric antigen receptor T-cell therapy (CAR-T) for patients with relapsed/refractory (R/R) FL has yielded impressive response rates and long-term remissions, but definitive statement on the curative potential of CAR-T is currently not possible due to limited patient numbers and relatively short follow up. A consensus on the contemporary role, optimal timing, and sequencing of HCT (autologous or allogeneic) and cellular therapies in FL is needed. As a result, the American Society of Transplantation and Cellular Therapy (ASTCT) Committee on Practice Guidelines endorsed this effort to formulate consensus recommendations to address this unmet need. The RAND-modified Delphi method was used to generate 15 consensus statements/recommendations. These clinical practice recommendations will help guide clinicians managing patients with FL. Of note, the use of bispecific antibodies in R/R FL was not in the scope of this project.
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Affiliation(s)
- Madiha Iqbal
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida.
| | - Ambuj Kumar
- Department of Internal Medicine, Research Methodology and Biostatistics Core, Office of Research, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Peter Dreger
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | | | - Craig S Sauter
- Division of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Anna M Sureda
- Department of Hematology, Institut Català d'Oncologia (ICO), 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Richard T Maziarz
- Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Martin Dreyling
- Department of Internal Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | | | - Bertram Glass
- Klinik für Hämatologie und Stammzelltransplantation, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Carla Casulo
- Department of Hematology/Oncology, University of Rochester, Rochester, New York
| | | | - Silvia Montoto
- Department of Haemato-oncology St.Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Ranjana Advani
- Department of Medicine, Stanford University, Stanford, California
| | | | - Gilles Salles
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital Sydney, Australia. School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Australia. School of Medicine, Sydney, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - John Kuruvilla
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Brad S Kahl
- Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | | | | | | | - Manali Kamdar
- University of Colorado Cancer Center, Aurora, Colorado
| | - Christopher Flowers
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mehdi Hamadani
- CIBMTR/Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
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Scheubeck G, Hoffmann M, Jurinovic V, Fischer L, Unterhalt M, Schmidt C, Böck HP, Dührsen U, Kaesberger J, Kremers S, Lindemann HW, Mantovani L, Hiddemann W, Hoster E, Dreyling M. Rituximab, gemcitabine and oxaliplatin in relapsed or refractory indolent and mantle cell lymphoma: results of a multicenter phase I/II-study of the German Low Grade Lymphoma Study Group. Ann Hematol 2024; 103:2373-2380. [PMID: 38459156 PMCID: PMC11224115 DOI: 10.1007/s00277-024-05689-w] [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: 11/20/2023] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
Rituximab, gemcitabine and oxaliplatin (R-GemOx) has demonstrated to be effective and safe in lymphoma patients. We aimed to determine the maximum tolerated dose (MTD) of oxaliplatin in combination with rituximab and gemcitabine and to explore the efficacy and safety of R-GemOx in relapsed or refractory (r/r) indolent and mantle cell lymphoma (MCL). In this single-arm, phase I/II trial, we enrolled 55 patients with r/r indolent lymphoma and MCL not suitable for autologous stem-cell transplantation. Patients received 4 cycles of R-GemOx. In the dose escalation group, 70 mg/m2 of oxaliplatin was applied and interindividually increased by 10 mg/m2 until the MTD was reached together with fixed doses of rituximab and gemcitabine. At the oxaliplatin MTD, an extension cohort was opened. Primary aim was to detect an overall response rate (ORR) greater than 65% (α = 0.05). Oxaliplatin 70 mg/m2 (MTD) was chosen for the extension cohort after 3 of 6 patients experienced a DLT at 80 mg/m2. Among 46 patients evaluable for the efficacy analysis ORR was 72% (33/46), missing the primary aim of the study (p = 0.21). After a median follow-up of 7.9 years, median PFS and OS were 1.0 and 2.1 years. Most frequent grade ≥ 3 adverse events were cytopenias. R-GemOx induces decent response rates in r/r indolent lymphoma and MCL, though novel targeted therapies have largely replaced chemotherapy in the relapse setting. Particularly in MCL, R-GemOx might be an alternative option in late relapses or as bridging to CAR-T-cells. This study was registered with ClinicalTrials.gov on Aug 4th, 2009, number NCT00954005.
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Affiliation(s)
- Gabriel Scheubeck
- Department of Internal Medicine III, LMU University Hospital, LMU Munich, Munich, Germany.
| | - Martin Hoffmann
- Medical Clinic A, Clinical Centre Ludwigshafen, Ludwigshafen, Germany
| | - Vindi Jurinovic
- Institute for Medical Information Processing, Biometry, and Epidemiology, LMU Munich, Munich, Germany
| | - Luca Fischer
- Department of Internal Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Michael Unterhalt
- Department of Internal Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christian Schmidt
- Department of Internal Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | | | - Ulrich Dührsen
- Clinic of Hematology, University Hospital, University of Duisburg-Essen, Essen, Germany
| | | | - Stephan Kremers
- Hematology-Oncology, Caritas Hospital Lebach, Lebach, Germany
| | | | | | - Wolfgang Hiddemann
- Department of Internal Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Eva Hoster
- Department of Internal Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, LMU Munich, Munich, Germany
| | - Martin Dreyling
- Department of Internal Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
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Ladetto M, Tavarozzi R, Zanni M, Evangelista A, Ferrero S, Tucci A, Botto B, Bolis S, Volpetti S, Zilioli VR, Puccini B, Arcari A, Pavone V, Gaidano G, Corradini P, Tani M, Cavallo F, Milone G, Ghiggi C, Pinto A, Pastore D, Ferreri AJM, Latte G, Patti C, Re F, Benedetti F, Luminari S, Pennese E, Bossi E, Boccomini C, Anastasia A, Bottelli C, Ciccone G, Vitolo U. Radioimmunotherapy versus autologous hematopoietic stem cell transplantation in relapsed/refractory follicular lymphoma: a Fondazione Italiana Linfomi multicenter, randomized, phase III trial. Ann Oncol 2024; 35:118-129. [PMID: 37922989 DOI: 10.1016/j.annonc.2023.10.095] [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: 07/19/2023] [Revised: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Optimal consolidation for young patilents with relapsed/refractory (R/R) follicular lymphoma (FL) remains uncertain in the rituximab era, with an unclear benefit of autologous stem cell transplantation (ASCT). The multicenter, randomized, phase III FLAZ12 (NCT01827605) trial compared anti-CD20 radioimmunotherapy (RIT) with ASCT as consolidation after chemoimmunotherapy, both followed by rituximab maintenance. PATIENTS AND METHODS Patients (age 18-65 years) with R/R FL and without significant comorbidities were enrolled and treated with three courses of conventional, investigator-chosen chemoimmunotherapies. Those experiencing at least a partial response were randomized 1 : 1 to ASCT or RIT before CD34+ collection, and all received postconsolidation rituximab maintenance. Progression-free survival (PFS) was the primary endpoint. The target sample size was 210 (105/group). RESULTS Between August 2012 and September 2019, of 164 screened patients, 159 were enrolled [median age 57 (interquartile range 49-62) years, 55% male, 57% stage IV, 20% bulky disease]. The study was closed prematurely because of low accrual. Data were analyzed on 8 June 2023, on an intention-to-treat basis, with a 77-month median follow-up from enrollment. Of the 141 patients (89%), 70 were randomized to ASCT and 71 to RIT. The estimated 3-year PFS in both groups was 62% (hazard ratio 1.11, 95% confidence interval 0.69-1.80, P = 0.6662). The 3-year overall survival also was similar between the two groups. Rates of grade ≥3 hematological toxicity were 94% with ASCT versus 46% with RIT (P < 0.001), and grade ≥3 neutropenia occurred in 94% versus 41%, respectively (P < 0.001). Second cancers occurred in nine patients after ASCT and three after radioimmunotherapy (P = 0.189). CONCLUSIONS Even if prematurely discontinued, our study did not demonstrate the superiority of ASCT versus RIT. ASCT was more toxic and demanding for patients and health services. Both strategies yielded similar, favorable long-term outcomes, suggesting that consolidation programs milder than ASCT require further investigation in R/R FL.
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Affiliation(s)
- M Ladetto
- Department of Translational Medicine, University of Eastern Piedmont, Novara; SCDU di Ematologia, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria.
| | - R Tavarozzi
- Department of Translational Medicine, University of Eastern Piedmont, Novara; SCDU di Ematologia, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria
| | - M Zanni
- SCDU di Ematologia, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria
| | - A Evangelista
- SSD of Clinical Epidemiology, Universitaria Città della Salute e della Scienza di Torino and Centre for Cancer Prevention Piemonte, Torino
| | - S Ferrero
- Department of Molecular Biotechnologies and Health Sciences, Universitaria Città della Salute e della Scienza di Torino and Centre for Cancer Prevention Piemonte, Torino
| | - A Tucci
- Department of Hematology, Spedali Civili, Brescia
| | - B Botto
- Struttura Complessa Ematologia, AOU Città della salute e della scienza di Torino, Turin
| | - S Bolis
- SC Ematologia ASST-Monza, Monza
| | - S Volpetti
- Division of Hematology, Clinica Ematologica, Centro Trapianti e Terapie Cellulari Carlo Melzi, DISM, Azienda Ospedaliero Universitaria S. M. Misericordia, Udine
| | - V R Zilioli
- Division of Haematology, ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - B Puccini
- Department of Haematology, University of Florence, Firenze
| | - A Arcari
- Hematology Unit, Ospedale Guglielmo da Saliceto, Piacenza
| | - V Pavone
- A. O. C. Panico-U.O.C Ematologia e Trapianto, Tricase, Lecce
| | - G Gaidano
- SCDU di Ematologia, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria; Division of Hematology, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara
| | - P Corradini
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milano
| | - M Tani
- Hematology Unit, Department of Oncology and Hematology, "Santa Maria delle Croci" Hospital, Ravenna
| | - F Cavallo
- Department of Molecular Biotechnologies and Health Sciences, Universitaria Città della Salute e della Scienza di Torino and Centre for Cancer Prevention Piemonte, Torino
| | - G Milone
- Division of Hematology and Program for Hematopoietic Transplantation, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania
| | - C Ghiggi
- Hematology Division, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genova
| | - A Pinto
- Department of Hematology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico "Fondazione G Pascale", Naples
| | | | - A J M Ferreri
- Onco-Hematology Department, Fondazione Centro San Raffaele, Milano
| | - G Latte
- Unità di Ematologia e Trapianto di Midollo Osseo, San Francesco Hospital, Nuoro
| | - C Patti
- Divisione di Oncoematologia, Azienda Villa Sofia - Cervello, Palermo
| | - F Re
- Department of Hematology, A.O.U. di Parma, Parma
| | - F Benedetti
- Department of Medicine, Section of Hematology and Bone Marrow Transplant Unit, University of Verona, Verona
| | - S Luminari
- Department of Hematology, IRCCS Reggio Emilia, Reggio Emilia
| | - E Pennese
- Lymphoma Unit, Department of Hematology, Ospedale Spirito Santo, Pescara
| | - E Bossi
- SC Ematologia ASST-Monza, Monza
| | - C Boccomini
- Struttura Complessa Ematologia, AOU Città della salute e della scienza di Torino, Turin
| | - A Anastasia
- Department of Hematology, Spedali Civili, Brescia
| | - C Bottelli
- Department of Hematology, Spedali Civili, Brescia
| | - G Ciccone
- SSD of Clinical Epidemiology, Universitaria Città della Salute e della Scienza di Torino and Centre for Cancer Prevention Piemonte, Torino
| | - U Vitolo
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
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Alnasser SM, Alharbi KS, Almutairy AF, Almutairi SM, Alolayan AM. Autologous Stem Cell Transplant in Hodgkin's and Non-Hodgkin's Lymphoma, Multiple Myeloma, and AL Amyloidosis. Cells 2023; 12:2855. [PMID: 38132175 PMCID: PMC10741865 DOI: 10.3390/cells12242855] [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: 11/12/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Human body cells are stem cell (SC) derivatives originating from bone marrow. Their special characteristics include their capacity to support the formation and self-repair of the cells. Cancer cells multiply uncontrollably and invade healthy tissues, making stem cell transplants a viable option for cancer patients undergoing high-dose chemotherapy (HDC). When chemotherapy is used at very high doses to eradicate all cancer cells from aggressive tumors, blood-forming cells and leukocytes are either completely or partially destroyed. Autologous stem cell transplantation (ASCT) is necessary for patients in those circumstances. The patients who undergo autologous transplants receive their own stem cells (SCs). The transplanted stem cells first come into contact with the bone marrow and then undergo engraftment, before differentiating into blood cells. ASCT is one of the most significant and innovative strategies for treating diseases. Here we focus on the treatment of Hodgkin's lymphoma, non-Hodgkin's lymphoma, multiple myeloma, and AL amyloidosis, using ASCT. This review provides a comprehensive picture of the effectiveness and the safety of ASCT as a therapeutic approach for these diseases, based on the currently available evidence.
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Affiliation(s)
- Sulaiman Mohammed Alnasser
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia; (K.S.A.); (A.F.A.)
| | - Khalid Saad Alharbi
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia; (K.S.A.); (A.F.A.)
| | - Ali F. Almutairy
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia; (K.S.A.); (A.F.A.)
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Dahi PB, Kenny S, Flynn J, Devlin SM, Ruiz JD, Chinapen SA, Lahoud OB, Matasar MJ, Moskowitz CH, Perales MA, Shah G, Sauter CS, Giralt SA, Geyer AI, Jakubowski AA. Utility of routine pulmonary function test after autologous hematopoietic cell transplantation in lymphoma. Leuk Lymphoma 2023; 64:2279-2285. [PMID: 37690007 PMCID: PMC10981269 DOI: 10.1080/10428194.2023.2256912] [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: 07/12/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023]
Abstract
This study aims to evaluate the predictive value of routine pulmonary function testing (PFT) at the 12-month mark post-autologous hematopoietic cell transplant (AHCT) in identifying clinically significant lung disease in lymphoma survivors. In 247 patients, 173 (70%) received BEAM (carmustine, etoposide, cytarabine, melphalan), and 49 (20%) received TBC (thiotepa, busulfan, cyclophosphamide) conditioning regimens. Abnormal baseline PFT was noted in 149 patients (60%). Thirty-four patients had a significant decline (reduction of >/= 20% in DLCO or FEV1 or FVC) in post-AHCT PFT, with the highest incidence in the CNS lymphoma group (39%). The incidence of clinically significant lung disease post-transplant was low at 2% and there was no association between abnormal pre- and 1-year post-transplant PFTs with the development of clinical lung disease. While this study illustrates the impact of treatment regimens on PFT changes, it did not demonstrate a predictive value of scheduled PFTs in identifying clinically significant post-AHCT lung disease.
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Affiliation(s)
- Parastoo B. Dahi
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Sheila Kenny
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean M. Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Josel D. Ruiz
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephanie A. Chinapen
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Oscar B. Lahoud
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Craig H. Moskowitz
- Hematology, University of Miami Health System, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Gunjan Shah
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Craig S. Sauter
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | - Sergio A Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Alexander I. Geyer
- Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ann A. Jakubowski
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
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Makos OL, D'Angelo CR. The shifting roles and toxicities of cellular therapies in B-cell malignancies. Transpl Infect Dis 2023; 25 Suppl 1:e14145. [PMID: 37676749 DOI: 10.1111/tid.14145] [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: 05/31/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
Cellular therapies provide a curative-intent option for patients with relapsedand refractory lymphomas. Current options including high dose chemotherapyfollowed by autologous or allogeneic hematopoietic stem cell transplantation or CD19 chimericantigen receptor T-cell (CART) therapy. The indication varies according to lymphoma sub-type and line oftherapy. The sequencing of these therapies and their use in second-line orlater settings to manage these diseases is undergoing significant changes, withCD19 CAR T becoming a preferred option for relapsed aggressive B-cell lymphoma.The mechanism of both therapies causes significant yet distinctlymphodepletion, infectious, and inflammatory toxicities. The resulting patternand timing of immune reconstitution helps guide risk-mitigating strategies,revaccination, and infectious prophylaxis. In this review, we discuss theindication, efficacy, toxicity and immune reconstitution of autologoushematopoietic stem cell transplantation and CAR T therapy for use in thetreatment of lymphoma.
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Affiliation(s)
- Olivia L Makos
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Christopher R D'Angelo
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Yucel OK, Vural E, Alhan N, Vurgun S, Atas U, Yapar D, Alemdar MS, Karaca M, Iltar U, Salim O, Undar L. Lower Body Mass Index and Prognostic Nutritional Index Are Associated with Poor Posttransplant Outcomes in Lymphoma Patients Undergoing Autologous Stem Cell Transplantation. Oncology 2023; 101:753-764. [PMID: 37364535 DOI: 10.1159/000531576] [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: 01/13/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Pretransplant inflammatory and nutritional status has not been widely explored in terms of its impact on autologous hematopoietic stem cell transplantation (auto-HSCT) outcomes in lymphoma patients. We aimed to evaluate the impact of body mass index (BMI), prognostic nutritional index (PNI), and C-reactive protein to albumin ratio (CAR) on auto-HSCT outcomes. METHODS We retrospectively analyzed 87 consecutive lymphoma patients who underwent their first auto-HSCT at the Adult Hematopoietic Stem Cell Transplantation Unit at Akdeniz University Hospital. RESULTS The CAR had no impact on posttransplant outcomes. PNI ≤50 was an independent prognostic factor for both shorter progression-free survival (PFS) (hazard ratio [HR] = 2.43, p = 0.025) and worse overall survival (OS) (HR = 2.93, p = 0.021), respectively. The 5-year PFS rate was significantly lower in patients with PNI ≤50 than in patients with PNI >50 (37.3% vs. 59.9%, p = 0.003). The 5-year OS rate in patients with PNI ≤50 was significantly low when compared with patients who had PNI >50 as well (45.5% vs. 67.2%, p = 0.011). Patients with BMI <25 had higher 100-day transplant-related mortality compared with patients with BMI ≥25 (14.7% vs. 1.9%, p = 0.020). BMI <25 was an independent prognostic factor associated with shorter PFS and OS (HR = 2.98 [p = 0.003], HR = 5.06 [p < 0.001], respectively). The 5-year PFS rate was significantly lower in patients with BMI <25 than patients with BMI ≥25 (40.2% vs. 53.7%, p = 0.037). Similarly, the 5-year OS rate in patients with BMI <25 was significantly inferior compared to patients with BMI ≥25 (42.7% vs. 64.7%, p = 0.002). CONCLUSION Our study confirms that lower BMI and CAR have negative impacts on auto-HSCT outcomes in lymphoma patients. Furthermore, higher BMI should not be considered an obstacle for lymphoma patients who need auto-HSCT; conversely, it could be an advantage for posttransplant outcomes.
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Affiliation(s)
- Orhan Kemal Yucel
- Department of Hematology and Stem Cell Transplantation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ece Vural
- Department of Hematology and Stem Cell Transplantation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Nurcan Alhan
- Department of Hematology and Stem Cell Transplantation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Sertac Vurgun
- Department of Hematology and Stem Cell Transplantation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Unal Atas
- Department of Hematology and Stem Cell Transplantation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Dilek Yapar
- Department of Public Health and Bioistatistics, Gazi University School of Medicine, Ankara, Turkey
| | | | - Mustafa Karaca
- Department of Medical Oncology, Antalya Research and Training Hospital, Antalya, Turkey
| | - Utku Iltar
- Department of Hematology and Stem Cell Transplantation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ozan Salim
- Department of Hematology and Stem Cell Transplantation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Levent Undar
- Department of Hematology and Stem Cell Transplantation, Akdeniz University School of Medicine, Antalya, Turkey
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8
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Puckrin R, Chua N, Chin K, Peters A, Duggan P, Shafey M, Storek J, Jamani K, Owen C, Stewart D. Long-term follow-up demonstrates curative potential of autologous stem cell transplantation for relapsed follicular lymphoma. Br J Haematol 2023; 201:319-325. [PMID: 36625160 DOI: 10.1111/bjh.18640] [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: 11/09/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023]
Abstract
Although autologous stem cell transplantation (ASCT) can achieve durable responses in eligible patients with follicular lymphoma (FL), long-term follow-up is needed to determine if it has curative potential. This retrospective, multicenter study included 162 patients who received ASCT for relapsed FL in Alberta, Canada. With a median (range) follow-up time of 12.5 years (0.1-27.9), the 12-year time-to-progression (TTP) was 57% (95% confidence interval [CI] 49%-65%), time-to-next-treatment was 61% (95% CI 52%-69%), progression-free survival was 51% (95% CI 42%-59%) and overall survival was 69% (95% CI 60%-76%). A plateau emerged on the TTP curve at 57% starting 9 years after ASCT with no relapses occurring beyond this timepoint. Ten patients remained in remission 20 years or more after ASCT. Patients undergoing ASCT at first or second relapse had superior outcomes compared to third or later relapse (12-year TTP 61% vs. 34%), as did patients without progression of disease within 24 months (POD24) of frontline treatment versus those with POD24 (12-year TTP 67% vs. 50%). ASCT achieves high rates of durable remission in relapsed FL, with long-term follow-up revealing that more than 50% of transplanted patients may be functionally cured of their lymphoma. The optimal timing to consider ASCT is at first or second relapse, regardless of POD24 status.
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Affiliation(s)
- Robert Puckrin
- Tom Baker Cancer Centre and University of Calgary, Calgary, Canada
| | - Neil Chua
- Cross Cancer Institute and University of Alberta, Edmonton, Canada
| | - Kelly Chin
- Tom Baker Cancer Centre and University of Calgary, Calgary, Canada
| | - Anthea Peters
- Cross Cancer Institute and University of Alberta, Edmonton, Canada
| | - Peter Duggan
- Tom Baker Cancer Centre and University of Calgary, Calgary, Canada
| | - Mona Shafey
- Tom Baker Cancer Centre and University of Calgary, Calgary, Canada
| | - Jan Storek
- Tom Baker Cancer Centre and University of Calgary, Calgary, Canada
| | - Kareem Jamani
- Tom Baker Cancer Centre and University of Calgary, Calgary, Canada
| | - Carolyn Owen
- Tom Baker Cancer Centre and University of Calgary, Calgary, Canada
| | - Douglas Stewart
- Tom Baker Cancer Centre and University of Calgary, Calgary, Canada
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9
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Jacobsen E. Follicular lymphoma: 2023 update on diagnosis and management. Am J Hematol 2022; 97:1638-1651. [PMID: 36255040 DOI: 10.1002/ajh.26737] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 01/31/2023]
Abstract
DISEASE OVERVIEW Follicular lymphoma (FL) is generally an indolent B cell lymphoproliferative disorder of transformed follicular center B cells. FL is characterized by diffuse lymphadenopathy, bone marrow involvement, and splenomegaly. Extranodal involvement is less common. Cytopenias are relatively common but constitutional symptoms of fever, night sweats, and weight loss are uncommon in the absence of transformation to diffuse large B cell lymphoma. DIAGNOSIS The diagnosis is based on histology from a biopsy of a lymph node or other affected tissue. Incisional biopsy is preferred over needle biopsies in order to give adequate tissue to assign grade and assess for transformation. Immunohistochemical staining is positive in virtually all cases for cell surface CD19, CD20, CD10, and monoclonal immunoglobulin, as well as cytoplasmic expression of bcl-2 protein. The overwhelming majority of cases have the characteristic t(14;18) translocation involving the IgH/bcl-2 genes. RISK STRATIFICATION The Follicular Lymphoma International Prognostic Index (FLIPI) uses five independent predictors of inferior survival: age >60 years, hemoglobin <12 g/dL, serum LDH > normal, Ann Arbor stage III/IV, number of involved nodal areas >4. The presence of 0-1, 2, and ≥3 adverse factors defines low, intermediate, and high-risk disease. There are other clinical prognostic models but the FLIPI remains the most common. Other factors such as time to relapse of less than 2 years from chemoimmunotherapy and specific gene mutations may also be useful for prognosis. Regardless of the prognostic model used, modern therapies have demonstrably improved prognosis. RISK-ADAPTED THERAPY Observation continues to be appropriate for asymptomatic patients with low bulk disease and no cytopenias. There is no overall survival (OS) advantage for early treatment with either chemotherapy or single-agent rituximab. For patients needing therapy, most patients are treated with chemoimmunotherapy, which has improved overall response rates (ORR), DOR, and OS. Randomized studies have shown additional benefits for maintenance of rituximab. Lenalidomide was non-inferior to chemoimmunotherapy in a randomized front-line study and, when combined with rituximab, was superior to rituximab alone in relapsed FL. Kinase inhibitors, stem cell transplantation (SCT), and chimeric antigen receptor T cells (CAR-T) are also considered for recurrent disease.
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Affiliation(s)
- Eric Jacobsen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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10
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Survival Outcomes of Patients with Follicular Lymphoma after Relapse or Progression: A Single-Center Real-World Data Analysis. JOURNAL OF ONCOLOGY 2022; 2022:2263217. [PMID: 36199784 PMCID: PMC9529394 DOI: 10.1155/2022/2263217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022]
Abstract
Background Follicular lymphoma (FL) is considered incurable because remission and relapse are common. Although various salvage treatment options have been proposed, there is no consensus on treatment strategy for FL patients who failed primary treatment. Methods This single-center study analyzed postevent overall survival (OS) among 70 patients who experienced relapse or progression after rituximab-containing immunochemotherapy according to type of salvage treatment and nature of relapse or progression. Results Of 70 patients, 42 experienced progression of disease within 24 months (POD24), and six showed disease progression during first-line treatment. Large-cell transformation was found in nine patients with POD24. At the median follow-up of 104 months (95% CI: 90-118 months), POD24 patients experienced significantly worse OS than patients without POD24, and postevent OS was not satisfactory after conventional salvage chemotherapy because the majority of patients relapsed or progressed. However, autologous stem cell transplantation (ASCT) after the first relapse resulted in survival prolongation in patients with POD24. Half of the patients (34/67, 51%) participated in at least one clinical trial during treatment after first relapse, and patients participating in at least one clinical trial irrespective of line of treatment tended to experience better survival. Conclusions Relapsed or refractory FL patients showed various clinical courses and treatment outcomes according to relapse or progression. Consolidation treatment with ASCT and active participation to clinical trials might prolong survival duration, especially in POD24 cases.
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11
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Dahi PB, Lin A, Scordo M, Flynn JR, Devlin SM, Ruiz JD, DeRespiris L, Carlow D, Cho C, Lahoud OB, Perales MA, Sauter CS, Boelens JJ, Admiraal R, Giralt SA, Shah GL. Evaluation of Melphalan Exposure in Lymphoma Patients Undergoing BEAM and Autologous Hematopoietic Cell Transplantation. Transplant Cell Ther 2022; 28:485.e1-485.e6. [PMID: 35545213 PMCID: PMC9357179 DOI: 10.1016/j.jtct.2022.05.003] [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: 03/17/2022] [Revised: 04/26/2022] [Accepted: 05/03/2022] [Indexed: 11/24/2022]
Abstract
High-dose melphalan is one of the main cytotoxic DNA alkylating agents and is used in many transplantation conditioning regimens. Studies have shown a wide range of drug exposure when a traditional weight-based dose of melphalan is used. The optimal melphalan dose in BEAM (carmustine, etoposide, cytarabine, and melphalan), which results in maximum efficacy with acceptable toxicity, is unknown. In this pharmacokinetic (PK) analysis of 105 patients with lymphoma undergoing treatment with BEAM and autologous hematopoietic cell transplantation, we initially estimated melphalan exposure as area under the curve (AUC) by a noncompartmental analysis and subsequently compared it with a newly developed 2-compartment population-PK model. The 2 models correlated closely with each other. We found that the traditional fixed weight-based dosing of propylene glycol-free (captisol-enabled) melphalan in BEAM results in a wide variation in exposure as estimated by both models. Higher melphalan exposure was significantly associated with increased metabolic toxicities but did not seem to impact progression-free survival. Although our study suggests a melphalan AUC of 8 mg·h/L as a potential target in BEAM, larger prospective studies using personalized PK-directed melphalan dosing are needed to determine the optimal melphalan exposure in lymphomas.
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Affiliation(s)
- Parastoo B Dahi
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
| | - Andrew Lin
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Scordo
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Jessica R Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Josel D Ruiz
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lauren DeRespiris
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dean Carlow
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christina Cho
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Oscar B Lahoud
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Craig S Sauter
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Jan Jaap Boelens
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Rick Admiraal
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, the Netherlands; Pediatric Blood and Marrow Transplantation Program, Princes Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Sergio A Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Gunjan L Shah
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
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12
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BeEAM High-Dose Chemotherapy with Polatuzumab (Pola-BeEAM) before ASCT in Patients with DLBCL—A Pilot Study. J Clin Med 2022; 11:jcm11133748. [PMID: 35807041 PMCID: PMC9267272 DOI: 10.3390/jcm11133748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/15/2022] [Accepted: 06/24/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Introduction: BEAM is a high-dose chemotherapy (HDCT) frequently administered before autologous stem cell transplantation (ASCT) in diffuse large B-cell lymphoma (DLBCL). Bendamustine replacing BCNU (BeEAM) is similarly effective at lower toxicities. However, relapse remains the major cause of death in DLBCL. (2) Methods: This is a 12-patient pilot study of the BeEAM preparative regimen with additional polatuzumab vedotin (PV, targeting CD79b) aiming to establish feasibility and to reduce toxicity without increasing the early progression rate. PV was given once at the standard dose of 1.8 mg/kg at day −6 together with BeEAM-HDCT (days −7 to −1) before ASCT. (3) Results: 8/12 patients (67%) received PV with BeEAM as a consolidation of first-line treatment, and 4/12 patients (33%) received PV with BeEAM after relapse treatment. All patients experienced complete engraftment (neutrophils: median 11 days; platelets: 13 days). Gastrointestinal toxicities occurred in 7/12 patients (58%, grade 3). All patients developed neutropenic infections with at least one identified pathogen (bacterial: 10/12 patients; viral: 2/12; and fungal: 1/12). The complete remission rate by PET-CT 100 days post-ASCT was 92%, with one mortality due to early progression. Eleven out of twelve patients (92%) were alive without progression after a median follow-up of 15 months. (4) Conclusions: Our study with 12 patients suggests that combining PV with BeEAM HDCT is feasible and safe, but the limited cohort prevents definite conclusions regarding efficacy. Larger cohorts must be evaluated.
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13
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Jeong SH. Treatment of indolent lymphoma. Blood Res 2022; 57:120-129. [PMID: 35483936 PMCID: PMC9057664 DOI: 10.5045/br.2022.2022054] [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: 03/01/2022] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Treatment of indolent lymphoma has improved significantly in recent decades since the advent of rituximab (anti-CD20 monoclonal antibody). Although, some patients with limited disease can be cured with radiation therapy alone, most patients experience disease progression and recurrence during follow-up despite early initiation of treatment. Thus, watch-and-wait is still regarded the standard for asymptomatic patients. Patients with indolent lymphoma have a significant heterogeneity in terms of tumor burden, symptoms (according to anatomical sites) and the need for instant therapy. Therefore, the initiation of treatment and treatment option should be decided with a clear goal in each patient according to the need for therapy and clinical benefits with the chosen treatment. In this review, we cover the current treatment of follicular lymphoma and marginal zone lymphoma.
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Affiliation(s)
- Seong Hyun Jeong
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
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14
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Qualls D, Salles G. Prospects in the management of patients with follicular lymphoma beyond first-line therapy. Haematologica 2022; 107:19-34. [PMID: 34985231 PMCID: PMC8719064 DOI: 10.3324/haematol.2021.278717] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 10/05/2021] [Indexed: 12/25/2022] Open
Abstract
The management of patients with relapsed or refractory follicular lymphoma has evolved markedly in the last decade, with the availability of new classes of agents (phosphoinositide 3-kinase inhibitors, immunomodulators, epigenetic therapies, and chimeric antigen receptor T cells) supplementing the multiple approaches already available (cytotoxic agents, anti-CD20 antibodies, radiation therapy, radioimmunotherapy, and autologous and allogeneic transplants). The diversity of clinical scenarios, the flood of data derived from phase II studies, and the lack of randomized studies comparing treatment strategies preclude firm recommendations and require personalized decisions. Patients with early progression require specific attention given the risk of histological transformation and their lower response to standard therapies. In sequencing therapies, one must consider prior treatment regimens and the potential need for future lines of therapy. Careful evaluation of risks and expected benefits of available options, which vary depending on location and socioeconomics, should be undertaken, and should incorporate the patient's goals. Preserving quality of life for these patients is essential, given the likelihood of years to decades of survival and the possibility of multiple lines of therapy. The current landscape is likely to continue evolving rapidly with other effective agents emerging (notably bispecific antibodies and other targeted therapies), and multiple combinations being evaluated. It is hoped that new treatments under development will achieve longer progression-free intervals and minimize toxicity. A better understanding of disease biology and the mechanisms of these different agents should provide further insights to select the optimal therapy at each stage of disease.
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Affiliation(s)
- David Qualls
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Gilles Salles
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; Weill Cornell Medicine, New York, NY, USA.
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15
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Khouri IF, Milton DR, Gulbis AM, Jabbour EJ, Nastoupil L, Ledesma C, Anderlini P, Bashir Q, Daher M, Im JS, Iyer SP, Marin D, Mehta RS, Olson AL, Popat UR, Qazilbash M, Saini N, Samaniego F, Rondon G, Medeiros LJ, Champlin RE. Nine-Year Follow-up of Patients with Relapsed Follicular Lymphoma after Nonmyeloablative Allogeneic Stem Cell Transplant and Autologous Transplant. Clin Cancer Res 2021; 27:5847-5856. [PMID: 34380640 DOI: 10.1158/1078-0432.ccr-21-1377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/27/2021] [Accepted: 07/30/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare outcomes between patients with relapsed follicular lymphoma who received a nonmyeloablative allogeneic stem cell transplant (alloSCT) and those who received an autologous transplant (autoSCT). PATIENTS AND METHODS We evaluated 194 patients with follicular lymphoma who received an alloSCT (n = 98) or autoSCT (n = 96) at MD Anderson Cancer Center (Houston, TX). The transplant type used was based on donor availability and by Medicare reimbursement guidelines. Patients who received an alloSCT were enrolled in four consecutive trials in which they received fludarabine, cyclophosphamide (or bendamustine), and rituximab conditioning. autoSCT patients received R-BEAM (rituximab, carmustine, etoposide, cytarabine, and melphalan). RESULTS The median follow-up of survivors was 108 months for the alloSCT group and 102 months for the autoSCT group. Overall survival was significantly better for patients who received an alloSCT compared with those who received an autoSCT (62% vs. 46%; P = 0.048). Similarly, progression-free survival rates were 52% in patients who received an alloSCT and 31% in those who received an autoSCT (P < 0.001), and the 8-year relapse rates were 11% and 43%, respectively (P < 0.0001). Only three patients in the alloSCT group relapsed beyond 3.5 years. In the alloSCT group, the rates for grade 2 to 4 acute graft-versus-host disease (GVHD), grade 3 to 4 acute GVHD, and extensive chronic GVHD were 22%, 9%, and 38%, respectively. In the autoSCT group, the 8-year incidence of secondary myelodysplasia was 11%. Nonrelapse mortality was similar between the two groups (15% vs. 11% at 8 years; P = 0.27). CONCLUSIONS This study shows that alloSCT is curative and confers superior survival compared with autoSCT in patients with follicular lymphoma.
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Affiliation(s)
- Issa F Khouri
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Denái R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alison M Gulbis
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elias J Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Loretta Nastoupil
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Celina Ledesma
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paolo Anderlini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - May Daher
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jin S Im
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Swaminathan P Iyer
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Marin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rohtesh S Mehta
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amanda L Olson
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Uday R Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Muzaffar Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neeraj Saini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Felipe Samaniego
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
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16
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Sorigue M, Kuittinen O. Robustness and pragmatism of the evidence supporting the European Society for Medical Oncology guidelines for the diagnosis, treatment, and follow-up of follicular lymphoma. Expert Rev Hematol 2021; 14:655-668. [PMID: 34128764 DOI: 10.1080/17474086.2021.1943351] [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: 10/21/2022]
Abstract
Background: Results of randomized clinical trials may not be entirely applicable to clinical practice. The present manuscript aims to explore the pragmatism and robustness of the evidence that supports the European Society for Medical Oncology (ESMO) follicular lymphoma (FL) guidelines.Methods & design: Analysis of all trials used to support positive, therapeutic, oncological recommendations in the 2020 ESMO FL guidelines. Predefined data points were extracted from each trial. Pragmatism was assessed by means of the PRECIS-2 tool, the difference in overall survival in the interventions compared and the source of funding. Robustness was assessed by means of the fragility index and the p value.Results: 28 trials were included. The full protocol or a protocol summary was provided for 12 (43%). Based on the PRECIS-2 domains, trials were considered pragmatic in organization, analysis and flexibility and explanatory in eligibility. Robustness was high, with 4/24 (17%) trials with p values between 0.05 and 0.005 and a median fragility index of 18.Conclusions: Results of trials to support ESMO recommendations in FL were robust. Pragmatism was high in some domains but modest to low in others and the pattern was similar across trials. Transparency in the publication of trial protocols was suboptimal.
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Affiliation(s)
- Marc Sorigue
- Department of Hematology, ICO-IJC-Hospital Germans Trias I Pujol, LUMN, UAB, Badalona, Spain
| | - Outi Kuittinen
- Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu; Institute of Clinical Medicine, Faculty of Health Medicine, University of Eastern Finland & Department of Oncology, Kuopio University Hospital, Kuopio, Finland
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17
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Toxicities of high-dose chemotherapy and autologous hematopoietic cell transplantation in older patients with lymphoma. Blood Adv 2021; 5:2608-2618. [PMID: 34152404 DOI: 10.1182/bloodadvances.2020004167] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/30/2021] [Indexed: 01/04/2023] Open
Abstract
High-dose chemotherapy and autologous hematopoietic cell transplantation is an effective consolidation therapy in lymphoma; however, its use in elderly patients has been limited because of concerns for greater toxicity in this group. We investigated the toxicities of carmustine, etoposide, cytarabine, and melphalan (BEAM) and autologous hematopoietic cell transplantation (AHCT) in 346 patients in 2 age groups: 279 patients aged 60 to 69 years and 67 patients aged ≥70 years. The majority developed severe toxicities; the most common were febrile neutropenia, gastrointestinal, infections, and cardiovascular. Older patients were at higher risk for grade ≥3 cardiovascular toxicities (hazard ratio [HR], 3.36; 95% confidence interval [CI], 2.25-5.00; P < .001) and skin toxicities (HR, 2.45; 95% CI, 1.08-5.54, P = .032). In the older group, nonrelapse mortality at 100 days and at 2 years was 2.99% (95% CI, 0.55-9.32) and 6.2% (95% CI, 1.97-13.95), respectively, vs 1.79% (95% CI, 0.68-3.92) and 2.91% (95% CI, 1.37-5.42), respectively, in the younger group. When adjusting for the number of grade ≥3 toxicities within the first 100 days, older patients had a 1.71-fold (95% CI, 1.08-2.71) increased risk for progression or death relative to younger patients. Although BEAM followed by AHCT is effective, it is associated with significant organ toxicities, especially in patients aged ≥70 years. Interventions to mitigate toxicities while maintaining efficacy are much needed.
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Dreyling M, Ghielmini M, Rule S, Salles G, Ladetto M, Tonino SH, Herfarth K, Seymour JF, Jerkeman M. Newly diagnosed and relapsed follicular lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2021; 32:298-308. [PMID: 33249059 DOI: 10.1016/j.annonc.2020.11.008] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- M Dreyling
- Department of Medicine III, LMU Hospital Munich, Germany
| | - M Ghielmini
- Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - S Rule
- Haematology, Peninsula School of Medicine, Plymouth, UK
| | - G Salles
- Service d'Hématologie, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Lyon; Université Claude Bernard Lyon-1, Pierre-Benite, France
| | - M Ladetto
- Divisione di Ematologia, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - S H Tonino
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - K Herfarth
- Department of Radiation Oncology, University of Heidelberg, Germany
| | - J F Seymour
- Department of Haematology, Peter McCallum Cancer Center & Royal Melbourne Hospital, Melbourne, University of Melbourne, Parkville, Australia
| | - M Jerkeman
- Department of Oncology, Skåne University Hospital, Lund University, Lund, Sweden
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19
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Yahya A, Radhwi O, Sobh M, Huebsch L, MacDonald D. Does Up-front Autologous Stem-Cell Transplantation at First Relapse Improve Outcome in Transplant-Eligible Follicular Lymphoma Patients Whose Disease Relapses Within 24 Months? CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e423-e427. [PMID: 33558203 DOI: 10.1016/j.clml.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/05/2020] [Accepted: 12/12/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In Canadian adults, follicular lymphoma (FL) is the most common subtype of non-Hodgkin lymphomas. Approximately 20% of patients with FL experience progression of disease within 2 years of first-line chemoimmunotherapy. Those patients have an expected overall survival of less than 5 years. The optimal second-line treatment for these high-risk patients is unclear. PATIENTS AND METHODS We analyzed data from the Blood and Bone Marrow Transplantation Center at Ottawa Hospital to determine whether autologous stem-cell transplantation as up-front therapy for first relapse can improve outcomes in this high-risk FL subgroup. We identified 17 patients who underwent up-front autologous stem-cell transplantation between February 2012 and February 2019. RESULTS The disease of all patients had relapsed within 24 months after receipt of their first rituximab-based chemotherapy. Overall survival at 2 and 5 years was 86.2% (95% confidence interval [CI], 55-96) and 71.8% (95% CI, 31-91), respectively. The progression-free survival at 2 and 5 years was 62.6% (95% CI, 35-81) and 53.6% (95% CI, 25-75), respectively. CONCLUSION Overall survival is improved when receiving autologous hematopoietic stem-cell transplantation as up-front therapy at first relapse in transplant-eligible FL whose disease relapses within 24 months of first-line therapy. Data from our single center look promising, but the data need to be replicated with a larger sample size.
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Affiliation(s)
- Ayel Yahya
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Osman Radhwi
- Division of Hematology, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamad Sobh
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lothar Huebsch
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David MacDonald
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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20
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Shah NN, Hamadani M. Is There Still a Role for Allogeneic Transplantation in the Management of Lymphoma? J Clin Oncol 2021; 39:487-498. [PMID: 33434076 DOI: 10.1200/jco.20.01447] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Nirav N Shah
- Blood and Bone Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI
| | - Mehdi Hamadani
- Blood and Bone Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI.,Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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21
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Abstract
The appropriate selection of patients to undergo hematopoietic stem cell transplant (HSCT) is critical due to the risk of treatment-related morbidity and mortality. The prognostic value of FDG-PET/CT in response assessment in hematologic malignancies is well-established and has led to numerous investigations into the role of FDG-PET/CT in the evaluation of patients in the setting of HSCT. This article discusses the most common indications for autologous stem cell transplant (autoSCT) in which FDG-PET/CT has been evaluated, including for lymphoma and multiple myeloma. For relapsed/refractory Hodgkin lymphoma, achieving a negative FDG-PET/CT scan, regardless of the number of the regimens, prior to autoSCT is an important prognostic factor for posttransplant outcome. The data in the pretransplant setting are more variable for non-Hodgkin lymphoma. For both Hodgkin and non-Hodgkin lymphoma, studies have primarily used a visual assessment for FDG-PET/CT interpretation, with the Deauville score the current standard criteria. Optimization of thresholds for specific regimens pretransplant as well as integration of additional semiquantitative parameters to assess response remain active areas of research. For multiple myeloma, FDG-PET/CT has emerged as the recommended imaging modality of choice for assessing response to treatment. Data suggest that FDG-PET/CT may provide prognostic and predictive value for assessing outcome after autoSCT.
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Affiliation(s)
- Heather A Jacene
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
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22
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Pettengell R, Uddin R, Boumendil A, Johnson R, Metzner B, Martín A, Romejko-Jarosinska J, Bence-Bruckler I, Giri P, Niemann CU, Robinson SP, Kimby E, Schmitz N, Dreger P, Goldstone AH, Montoto S. Durable benefit of rituximab maintenance post-autograft in patients with relapsed follicular lymphoma: 12-year follow-up of the EBMT lymphoma working party Lym1 trial. Bone Marrow Transplant 2021; 56:1413-1421. [PMID: 33452448 DOI: 10.1038/s41409-020-01182-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/12/2020] [Accepted: 11/30/2020] [Indexed: 01/16/2023]
Abstract
We report the 12-year follow-up of the prospective randomized EBMT LYM1 trial to determine whether the benefit of brief duration rituximab maintenance (RM) on progression-free survival (PFS) in patients with relapsed follicular lymphoma (FL) receiving an autologous stem cell transplant (ASCT) is sustained. One hundred and thirty-eight patients received RM with or without purging. The median follow-up after random assignment is 12 years (range 10-13) for the whole series. The 10-year PFS after ASCT is 47% (95% CI 40-54) with only 4 patients relapsing after 7.5 years. RM continues to significantly improve 10-year PFS after ASCT in comparison with NM [P = 0.002; HR 0.548 (95% CI 0.38-0.80)]. Ten-year non-relapse mortality (NRM) was not significantly different between treatment groups (7% overall). 10-year overall survival (OS) after ASCT was 75% (69-81) for the whole series, with no significant differences according to treatment sub-groups. 10-year OS for patients who progressed within 24 months (POD24T) was 60%, in comparison with 85% for patients without progression. Thus the benefit of rituximab maintenance after ASCT on relapse prevention is sustained at 12 years, suggesting that RM adds to ASCT-mediated disease eradication and may enhance the curative potential of ASCT.
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Affiliation(s)
- R Pettengell
- Institute of Medical & Biomedical Education, St George's University of London, London, United Kingdom.
| | - R Uddin
- EBMT Clinical Trials Office, European Society for Blood and Marrow Transplantation, London, United Kingdom
| | - A Boumendil
- Statistics, European Society for Blood and Marrow Transplantation, Paris, France
| | - R Johnson
- Department of Haematology, St James's University Hospital, Leeds, United Kingdom
| | - B Metzner
- University Clinic for Internal Medicine, Oncology and Haematology, Klinikum Oldenburg, Oldenburg, Germany
| | - A Martín
- Hematology Department, Hospital Universitario de Salamanca, IBSAL, CIBERONC, Salamanca, Spain
| | - J Romejko-Jarosinska
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw, Poland
| | | | - P Giri
- Haematology, Royal Adelaide Hospital, Adelaide, Southern Australia, Australia
| | - C U Niemann
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - S P Robinson
- Department of Haematology, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - E Kimby
- Department of Hematology, Karolinska Institute, Stockholm, Sweden
| | - N Schmitz
- Department of Internal Medicine A, University Hospital Muenster, Muenster, Germany
| | - P Dreger
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - A H Goldstone
- University College London Hospital, London, United Kingdom
| | - S Montoto
- Department of Haemato-oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
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23
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Goto H, Hidaka D, Yamamoto S, Hayasaka K, Michimata R, Kagawa I, Sunagoya K, Iijima H, Hayase E, Shiratori S, Okada K, Sugita J, Onozawa M, Hashimoto D, Kahata K, Fujimoto K, Endo T, Shimizu C, Teshima T. Feasibility and efficacy of low-dose pegfilgrastim for CD34 + cell mobilization in lymphoma. J Clin Apher 2020; 35:413-419. [PMID: 33043486 DOI: 10.1002/jca.21816] [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: 03/23/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pegfilgrastim has equivalent efficacy to daily granulocyte colony-stimulating factor (G-CSF) in enhancing neutrophil recovery after chemotherapy, but data on its use for peripheral blood stem cell (PBSC) mobilization are limited. We evaluated the safety and efficacy of CD34+ PBSC mobilization by low-dose (3.6 mg) pegfilgrastim after chemotherapy in patients with malignant lymphoma. STUDY DESIGN AND METHODS Twenty patients with malignant lymphoma were enrolled in this study. Cytotoxic chemotherapy was started on day 1, and 3.6 mg of pegfilgrastim was subcutaneously administered on day 7. CD34+ cells were counted in the peripheral blood daily from days 11 to 14 using a flow cytometric analysis. RESULTS In 19 of the 20 patients (95%), the CD34+ cell counts in the peripheral blood exceeded 10 × 106/L, with a mean value of 20.3 on day 11, 38.0 on day 12, 40.3 on day 13, and 40.1 on day 14. Older age was associated with lower maximum CD34+ cell mobilization. The most frequent adverse events associated with pegfilgrastim were back pain, nausea, appetite loss, and lactate dehydrogenase elevation. CONCLUSION Our data indicated that a single dose of 3.6 mg pegfilgrastim on day 7 after chemotherapy safely and effectively mobilized CD34+ cells.
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Affiliation(s)
- Hideki Goto
- Department of Hematology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Hidaka
- Department of Hematology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Yamamoto
- Department of Hematology, Sapporo City General Hospital, Sapporo, Japan
| | - Koji Hayasaka
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Rie Michimata
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Ikuko Kagawa
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Kana Sunagoya
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroaki Iijima
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Eiko Hayase
- Department of Hematology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Souichi Shiratori
- Department of Hematology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kohei Okada
- Department of Hematology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Junichi Sugita
- Department of Hematology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Masahiro Onozawa
- Department of Hematology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daigo Hashimoto
- Department of Hematology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kaoru Kahata
- Department of Hematology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Katsuya Fujimoto
- Department of Hematology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomoyuki Endo
- Department of Hematology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Chikara Shimizu
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Takanori Teshima
- Department of Hematology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
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24
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Tuazon SA, Cassaday RD, Gooley TA, Sandmaier BM, Holmberg LA, Smith SD, Maloney DG, Till BG, Martin DB, Chow VA, Rajendran JG, Fisher DR, Matesan MC, Lundberg SJ, Green DJ, Pagel JM, Press OW, Gopal AK. Yttrium-90 Anti-CD45 Immunotherapy Followed by Autologous Hematopoietic Cell Transplantation for Relapsed or Refractory Lymphoma. Transplant Cell Ther 2020; 27:57.e1-57.e8. [PMID: 32980545 DOI: 10.1016/j.bbmt.2020.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
Autologous hematopoietic cell transplantation (AHCT) is a standard of care for several subtypes of high-risk lymphoma, but durable remissions are not achieved in the majority of patients. Intensified conditioning using CD45-targeted antibody-radionuclide conjugate (ARC) preceding AHCT may improve outcomes in lymphoma by permitting the delivery of curative doses of radiation to disease sites while minimizing toxicity. We performed sequential phase I trials of escalating doses of yttrium-90 (90Y)-labeled anti-CD45 antibody with or without BEAM (carmustine, etoposide, cytarabine, melphalan) chemotherapy followed by AHCT in adults with relapsed/refractory or high-risk B cell non-Hodgkin lymphoma (NHL), T cell NHL (T-NHL), or Hodgkin lymphoma (HL). Twenty-one patients were enrolled (16 NHL, 4 HL, 1 T-NHL). Nineteen patients received BEAM concurrently. No dose-limiting toxicities were observed; therefore, the maximum tolerated dose is estimated to be ≥34 Gy to the liver. Nonhematologic toxicities and engraftment kinetics were similar to standard myeloablative AHCT. Late myeloid malignancies and 100-day nonrelapse deaths were not observed. At a median follow-up of 5 years, the estimates of progression-free and overall survival of 19 patients were 37% and 68%, respectively. Two patients did not receive BEAM; one had stable disease and the other progressive disease post-transplant. The combination of 90Y-anti-CD45 with BEAM and AHCT was feasible and tolerable in patients with relapsed and refractory lymphoma. The use of anti-CD45 ARC as an adjunct to hematopoietic cell transplantation regimens or in combination with novel therapies/immunotherapies should be further explored based on these and other data.
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Affiliation(s)
- Sherilyn A Tuazon
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Ryan D Cassaday
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, Division of Hematology, University of Washington, Seattle, Washington
| | - Theodore A Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Brenda M Sandmaier
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Leona A Holmberg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Stephen D Smith
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington
| | - David G Maloney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Brian G Till
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Daniel B Martin
- Department of Medicine, Division of Hematology, University of Washington, Seattle, Washington
| | - Victor A Chow
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Joseph G Rajendran
- Department of Nuclear Medicine, University of Washington, Seattle, Washington
| | - Darrell R Fisher
- Versant Medical Physics and Radiation Safety, Richland, Washington
| | - Manuela C Matesan
- Department of Nuclear Medicine, University of Washington, Seattle, Washington
| | - Sally J Lundberg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Damian J Green
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington
| | | | - Oliver W Press
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Ajay K Gopal
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington.
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25
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Armenian SH, Iukuridze A, Teh JB, Mascarenhas K, Herrera A, McCune JS, Zain JM, Mostoufi‐Moab S, McCormack S, Slavin TP, Scott JM, Jones LW, Sun C, Forman SJ, Wong FL, Nakamura R. Abnormal body composition is a predictor of adverse outcomes after autologous haematopoietic cell transplantation. J Cachexia Sarcopenia Muscle 2020; 11:962-972. [PMID: 32212263 PMCID: PMC7432567 DOI: 10.1002/jcsm.12570] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/27/2020] [Accepted: 02/25/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The number of patients undergoing autologous haematopoietic cell transplant (HCT) is growing, but little is known about the factors that predict adverse outcomes. Low muscle mass and obesity are associated with disability and premature mortality in individuals with non-malignant diseases and may predict outcomes after autologous HCT. METHODS This was a retrospective cohort study of 320 patients who underwent autologous HCT for Hodgkin or non-Hodgkin lymphoma between 2009 and 2014. Sarcopenia {skeletal muscle index male: <43 cm/m2 [body mass index (BMI) < 25 kg/m2 ] or < 53 cm/m2 [BMI ≥ 25 kg/m2 ] and female: <41 cm/m2 [regardless of BMI]) and obesity [total abdominal adiposity ≥450.0 cm2 (male), ≥396.4 cm2 (female)] were assessed from single-slice abdominal pre-HCT computed tomography images. Length of hospital stay, first unplanned intensive care unit admission, and 30-day unplanned readmission were evaluated based on body composition using multivariable regression analysis, and mortality was evaluated with Kaplan-Meier analysis and Gray's test. RESULTS Median age at HCT was 53.3 years (range, 18.5 to 78.1 years); 26.3% were sarcopenic and an additional 7.8% were sarcopenic obese pre-HCT. Sarcopenic obesity was associated with increased risk of prolonged hospitalization [odds ratio (OR) = 3.6, 95% confidence interval (CI) 1.3-9.8], intensive care unit admission (OR = 4.7, 95% CI 1.5-16.1), and unplanned readmission after HCT (OR = 13.6, 95% CI 2.5-62.8). Patients who were sarcopenic obese also had the highest mortality risk at 1 year [hazard ratio (HR): 3.9, 95% CI 1.1-11.0] and 5 years (HR: 2.5, 95% CI 1.1-5.5), compared with patients with normal body composition. Sarcopenia alone, but not obesity alone, was associated with an increased risk of these outcomes, albeit with a lower magnitude of risk than in patients who were sarcopenic obese. CONCLUSIONS Sarcopenic obesity was an important predictor of outcomes in patients undergoing autologous HCT. These findings could inform targeted prevention strategies in patients at highest risk of complications after HCT.
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Affiliation(s)
| | | | | | | | - Alex Herrera
- Department of Hematology and Hematopoietic Cell TransplantationCity of HopeDuarteCAUSA
| | | | - Jasmine M. Zain
- Department of Hematology and Hematopoietic Cell TransplantationCity of HopeDuarteCAUSA
| | - Sogol Mostoufi‐Moab
- Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Shana McCormack
- Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | | | - Jessica M. Scott
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Lee W. Jones
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
- Department of MedicineWeill Cornell Medical CenterNew YorkNYUSA
| | - Can‐Lan Sun
- Department of Supportive Care MedicineCity of HopeDuarteCAUSA
| | - Stephen J. Forman
- Department of Hematology and Hematopoietic Cell TransplantationCity of HopeDuarteCAUSA
| | - F. Lennie Wong
- Department of Population SciencesCity of HopeDuarteCAUSA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell TransplantationCity of HopeDuarteCAUSA
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26
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Chow VA, Rajendran JG, Fisher DR, Appelbaum FR, Cassaday RD, Martin PS, Holmberg LA, Gooley TA, Stevenson PA, Pagel JM, Green DJ, Press OW, Gopal AK. A phase II trial evaluating the efficacy of high-dose Radioiodinated Tositumomab (Anti-CD20) antibody, etoposide and cyclophosphamide followed by autologous transplantation, for high-risk relapsed or refractory non-hodgkin lymphoma. Am J Hematol 2020; 95:775-783. [PMID: 32243637 DOI: 10.1002/ajh.25818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/18/2020] [Accepted: 03/28/2020] [Indexed: 01/23/2023]
Abstract
Radiation is the most effective treatment for localized lymphoma, but treatment of multifocal disease is limited by toxicity. Radioimmunotherapy (RIT) delivers tumoricidal radiation to multifocal sites, further augmenting response by dose-escalation. This phase II trial evaluated high-dose RIT and chemotherapy prior to autologous stem-cell transplant (ASCT) for high-risk, relapsed or refractory (R/R) B-cell non-Hodgkin lymphoma (NHL). The primary endpoint was progression free survival (PFS). Secondary endpoints were overall survival (OS), toxicity, and tolerability. Patients age < 60 years with R/R NHL expressing CD20 were eligible. Mantle cell lymphoma (MCL) patients could proceed to transplant in first remission. Patients received I-131-tositumomab delivered at ≤25Gy to critical normal organs, followed by etoposide, cyclophosphamide and ASCT. A group of 107 patients were treated including aggressive lymphoma (N = 29), indolent lymphoma (N = 45), and MCL (N = 33). After a median follow-up of 10.1 years, the 10-year PFS for the aggressive, indolent, and MCL groups were 62%, 64%, 43% respectively. The 10-year OS for the aggressive, indolent, and MCL groups were 61%, 71%, 48% respectively. Toxicities were similar to standard conditioning regimens and non-relapse mortality at 100 days was 2.8%. Late myeloid malignancies were seen in 6% of patients. High-dose I-131-tositumomab, etoposide and cyclophosphamide followed by ASCT appeared feasible, safe, and effective in treating NHL, with estimated PFS at 10-years of 43%-64%. In light of novel cellular therapies for R/R NHL, high-dose RIT-containing regimens yield comparable efficacy and safety and could be prospectively compared.
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Affiliation(s)
- Victor A Chow
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Frederick R Appelbaum
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ryan D Cassaday
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Paul S Martin
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Leona A Holmberg
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Theodore A Gooley
- Public Health Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Philip A Stevenson
- Public Health Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA
| | - Damian J Green
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Oliver W Press
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ajay K Gopal
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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27
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Okosun J, Montoto S. Cellular Therapy in Follicular Lymphoma: Autologous Stem Cell Transplantation, Allogeneic Stem Cell Transplantation, and Chimeric Antigen Receptor T-cell Therapy. Hematol Oncol Clin North Am 2020; 34:701-714. [PMID: 32586575 DOI: 10.1016/j.hoc.2020.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A subset of follicular lymphoma patients with high-risk clinical features continues to pose a therapeutic challenge. Hematopoietic stem cell transplantation is a suitable consolidative treatment option for these patients. Data on chimeric antigen receptor T-cell therapy are promising in relapsed/refractory and transformed patients. The increasing armamentarium of nontransplant options coupled with the associated potential long-term sequelae of transplantation raises questions about the placement of transplant strategies in the follicular lymphoma treatment hierarchy.
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Affiliation(s)
- Jessica Okosun
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London EC1M 6BQ, UK
| | - Silvia Montoto
- Department of Haemato-Oncology, St Bartholomew's Hospital, London, UK.
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28
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A multi-center retrospective analysis of patients with relapsed/refractory follicular lymphoma after third-line chemotherapy. Ann Hematol 2020; 99:2133-2139. [PMID: 32533251 DOI: 10.1007/s00277-020-04126-y] [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: 03/10/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
The overall outcome of patients with advanced-stage follicular lymphoma (FL) has improved significantly. However, some patients still develop multiple relapsed/refractory FL (RRFL). To address the still-limited data on this population, we performed this multi-center retrospective study. We analyzed 41 patients who received third-line treatment for RRFL at 8 institutes. The median age at diagnosis was 59 years (range, 38-70). The median progression-free survival (PFS) and probability of PFS at 2 years were 1.61 years and 39.4%, respectively, after third-line chemotherapy, and 0.45 years and 19.0%, respectively, after fourth-line chemotherapy. Objective response (OR) after third-line chemotherapy was achieved in 24 patients (53.7%). Bendamustine (Ben)-based regimens were associated with a significantly higher OR rate than other regimens (77.8% vs. 40.0%, respectively, P = 0.025). The median overall survival (OS) and probability of OS at 2 years were 4.71 years and 65.9%, respectively, after third-line chemotherapy, and 1.01 year and 45.1%, respectively, after fourth-line chemotherapy. In conclusion, this study had a small sample size and retrospective design, but it was able to demonstrate poor response rate and duration in patients with multiple RRFL, particularly after fourth-line chemotherapy. The optimal treatment strategy in this population should be clarified, including possibly hematopoietic stem cell transplantation.
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29
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Results of R-ESHAP as salvage therapy in refractory/relapsed follicular lymphoma: a real-world experience on behalf of GELCAB group. Ann Hematol 2020; 99:1627-1634. [PMID: 32451707 DOI: 10.1007/s00277-020-04101-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/19/2020] [Indexed: 11/27/2022]
Abstract
There is no standard treatment for relapsed follicular lymphoma (FL). Although platinum-based combinations are one of the most used treatments, few data have been reported in this setting. Our aim was to analyse R-ESHAP efficacy in relapsed FL patients. We retrospectively analysed 80 FL patients treated with R-ESHAP in the first or successive relapses. Responding patients received a stem cell transplantation following R-ESHAP. Seventeen histologically transformed patients were included. Median age was 50 years. At R-ESHAP initiation, 85% of the patients were in an advanced stage, 28% had a bulky disease and 40% had increased LDH. There were no statistically significant differences between POD24 and non-POD24 patients in terms of response to R-ESHAP (ORR 72% vs. 93%, p = 0.109). When analyzing R-ESHAP efficacy according to the response to the immediately previous line, patients achieving CR or PR had better CR rates to R-ESHAP than those who did not respond (CR of 57% vs. 15%, respectively, p = 0.009), as well as differences in OS (7.2 vs. 1.4 years, p < 0.0001) and in PFS (2.1 vs. 0.3 years, p < 0.0001). R-ESHAP is an effective treatment in relapsed FL patients who respond to the previous line and has to be considered as an adequate alternative for some patients.
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30
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Freedman A, Jacobsen E. Follicular lymphoma: 2020 update on diagnosis and management. Am J Hematol 2020; 95:316-327. [PMID: 31814159 DOI: 10.1002/ajh.25696] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 12/13/2022]
Abstract
DISEASE OVERVIEW Follicular lymphoma (FL) is generally an indolent B cell lymphoproliferative disorder of transformed follicular center B cells. Follicular lymphoma is characterized by diffuse lymphadenopathy, bone marrow involvement, and splenomegaly. Extranodal involvement is less common. Cytopenias are relatively common but constitutional symptoms of fever, night sweats, and weight loss are uncommon in the absence of transformation to diffuse large B cell lymphoma. DIAGNOSIS The diagnosis is based on histology from a biopsy of a lymph node or other affected tissue. Incisional biopsy is preferred over needle biopsies in order to give adequate tissue to assign grade and assess for transformation. Immunohistochemical staining is positive in virtually all cases for cell surface CD19, CD20, CD10 and monoclonal immunoglobulin, as well as cytoplasmic expression of bcl-2 protein. The overwhelming majority of cases have the characteristic t(14;18) translocation involving the IgH/bcl-2 genes. RISK STRATIFICATION The Follicular Lymphoma International Prognostic Index (FLIPI) uses five independent predictors of inferior survival: age > 60 years, hemoglobin <12 g/dL, serum LDH > normal, Ann Arbor stage III/IV, number of involved nodal areas >4. The presence of 0-1, 2, and ≥ 3 adverse factors defines low, intermediate, and high-risk disease. There are other clinical prognostic models but the FLIPI remains the most common. Other factors such as time to relapse of less than 2 years from chemoimmunotherapy and specific gene mutations may also be useful for prognosis. Regardless of the prognostic model used, modern therapies have demonstrably improved prognosis. RISK-ADAPTED THERAPY Observation continues to be appropriate for asymptomatic patients with low bulk disease and no cytopenias. There is no overall survival advantage for early treatment with either chemotherapy or single agent rituximab. For patients needing therapy, most patients are treated with chemoimmunotherapy, which has improved response rates, duration of response and overall survival (OS). Randomized studies have shown additional benefit for maintenance rituximab. Lenalidomide was non-inferior to chemoimmunotherapy in a randomized front-line study and, when combined with rituximab, was superior to rituximab alone in relapsed FL. Kinase inhibitors, other immunotherapies, and stem cell transplantation (SCT) are also considered for recurrent disease.
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Affiliation(s)
- Arnold Freedman
- Department of Medical OncologyDana‐Farber Cancer Institute Boston Massachusetts
| | - Eric Jacobsen
- Department of Medical OncologyDana‐Farber Cancer Institute Boston Massachusetts
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31
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Sesques P, Bourcier J, Golfier C, Lebras L, Nicolas-Virelizier E, Hacini M, Perrin MC, Voillat L, Bachy E, Traverse-Glehen A, Moreau A, Martin L, Ramla S, Casasnovas O, Le Gouill S, Salles G, Ghesquières H. Clinical characteristics and outcomes of relapsed follicular lymphoma after autologous stem cell transplantation in the rituximab era. Hematol Oncol 2020; 38:137-145. [PMID: 31953963 DOI: 10.1002/hon.2713] [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] [Received: 10/04/2019] [Revised: 01/03/2020] [Accepted: 01/12/2020] [Indexed: 11/09/2022]
Abstract
High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a therapeutic option for patients with relapsed follicular lymphoma (FL). The clinical characteristics and outcomes of FL relapse after ASCT in the rituximab era have not yet been fully elucidated. We retrospectively reviewed 414 FL patients treated with ASCT between 2000 and 2014 in four hematology departments. All patients received rituximab as a first-line treatment. We specifically analyzed the clinical characteristics, treatment strategies at relapse, and outcomes of 95 patients (23%) who relapsed after ASCT. The patients (median age, 57 y) received a median of two lines of therapy (range, 2-6) prior to ASCT, with 92% in complete response (CR) or partial response (PR) before ASCT. Histological transformation at relapse after ASCT was observed in 20% of the patients. Treatment at relapse after ASCT consisted of chemotherapy with or without rituximab (n = 45/90, 50%), targeted agents (18%), rituximab monotherapy (14%), or consolidation allogeneic transplantation after induction chemotherapy (12%) and radiotherapy (6%). After relapse, the median progression-free survival (PFS) and overall survival (OS) were 1 year (95% CI, 0.541-1.579) and 5.5 years (95% CI, 1.910-9.099), respectively. In the multivariate analysis, histological transformation (HT) was associated with OS (P = .044; HR 2.439; 95% CI, 1.025-5.806), and a high FLIPI score at relapse was associated with PFS (P = .028; HR 2.469; 95% CI, 1.104-5.521). This retrospective study showed that the period of PFS of patients who relapsed after ASCT is short. A biopsy should be performed for these patients to document the HT. Our results indicate that new treatment strategies will need to be developed for these patients.
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Affiliation(s)
- Pierre Sesques
- Department of Hematology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - Jessie Bourcier
- Department of Hematology, Nantes University Hospital, CHU of Nantes and CHD Vendée, La Roche-sur-Yon, France
| | - Camille Golfier
- Department of Hematology, Dijon University Hospital, Dijon, France
| | - Laure Lebras
- Department of Hematology, Centre Léon Bérard, Lyon, France
| | | | - Maya Hacini
- Department of Hematology, Centre Hospitalier Métropole Savoie, Chambéry, France
| | - Marie Claire Perrin
- Department of Hematology, Centre Hospitalier Fleyriat, Bourg-en-Bresse, France
| | - Laurent Voillat
- Department of Hematology, Centre Hospitalier of Chalon-sur-Saône, Chalon-sur-Saône, France
| | - Emmanuel Bachy
- Department of Hematology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - Alexandra Traverse-Glehen
- Department of Pathology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre Bénite, France
| | - Anne Moreau
- Department of Pathology, CHU of Nantes, Nantes, France
| | - Laurent Martin
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Selim Ramla
- Department of Pathology, Dijon University Hospital, Dijon, France
| | | | - Steven Le Gouill
- Department of Hematology, CHU of Nantes CRCINA INSERM team 10 Nantes, Nantes University NUN Next, Nantes, France
| | - Gilles Salles
- Department of Hematology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - Hervé Ghesquières
- Department of Hematology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre-Bénite, France
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32
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Chow VA, Gopal AK. Where does transplant fit in the age of targeted therapies? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:287-293. [PMID: 31808860 PMCID: PMC6913492 DOI: 10.1182/hematology.2019000033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The role of hematopoietic cell transplantation (HCT) for indolent lymphoma has evolved over the last 5 years with the availability of novel low-toxicity therapies and a better understanding of the prognosis of these entities. However, despite numerous treatment options for patients with follicular lymphoma, none are thought to be curative, and many require ongoing therapy with chronic toxicity. Historical trials indicate that autologous HCT as initial consolidation leads to improved progression-free survival, but not overall survival (OS) and, thus, is not typically recommended. However, autologous HCT for chemosensitive relapse can be carried out with ∼1% early mortality risk, affording disease control lasting a median of 3 to 5 years and the potential to improve OS. These results may compare favorably in efficacy, toxicity, and cost vs multiple sequential novel therapies with shorter durations of benefit. Recent data indicate that autologous HCT in follicular lymphoma patients with early initial progression will result in more than one third being alive and without relapse at 5 years, leading to improved OS when used within a year of the first recurrence. Unlike other available therapies, allogeneic HCT has the potential to cure up to one half of those transplanted with indolent B-cell non-Hodgkin lymphoma, although the risks need to be recognized and appropriate patient and donor selection is critical to ensure the best outcomes. HCT continues to remain a viable option in the current era of multiple targeted agents.
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Affiliation(s)
- Victor A Chow
- Division of Medical Oncology, University of Washington, Seattle, WA; and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ajay K Gopal
- Division of Medical Oncology, University of Washington, Seattle, WA; and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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33
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Jiménez-Ubieto A, Grande C, Caballero D, Yáñez L, Novelli S, Hernández-Garcia MT, Manzanares M, Arranz R, Ferreiro JJ, Bobillo S, Mercadal S, Galeo A, Jiménez JL, Moraleda JM, Vallejo C, Albo C, Pérez E, Marrero C, Magnano L, Palomera L, Jarque I, Rodriguez A, Lorza L, Martín A, Coria E, López-Guillermo A, Salar A, José Lahuerta J. Autologous stem cell transplantation may be curative for patients with follicular lymphoma with early therapy failure without the need for immunotherapy. Hematol Oncol Stem Cell Ther 2019; 12:194-203. [DOI: 10.1016/j.hemonc.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/23/2019] [Indexed: 12/01/2022] Open
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34
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Dada R. Diagnosis and management of follicular lymphoma: A comprehensive review. Eur J Haematol 2019; 103:152-163. [PMID: 31270855 DOI: 10.1111/ejh.13271] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/18/2022]
Abstract
Follicular Lymphoma (FL) is an indolent lymphoma and may have various clinical courses. Worldwide, FL is the second most common non-Hodgkin lymphoma (NHL) type after diffuse large B-cell lymphoma. In this review article, the author is discussing relevant diagnostic tools, prognostic factors, and updated study results on the management of patients with newly diagnosed and relapsed/refractory FL. Controversies in the treatment, maintenance therapy, stem cell transplantation, and novel treatment approaches will be comprehensively discussed.
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Affiliation(s)
- Reyad Dada
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.,College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
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35
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Dahi PB, Lazarus HM, Sauter CS, Giralt SA. Strategies to improve outcomes of autologous hematopoietic cell transplant in lymphoma. Bone Marrow Transplant 2019; 54:943-960. [PMID: 30390059 PMCID: PMC9062884 DOI: 10.1038/s41409-018-0378-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/05/2018] [Accepted: 09/30/2018] [Indexed: 11/08/2022]
Abstract
High-dose chemotherapy and autologous hematopoietic cell transplantation (HDT-AHCT) remains an effective therapy in lymphoma. Over the past several decades, HDT with BEAM (carmustine, etoposide, cytarabine, and melphalan) and CBV (cyclophosphamide, carmustine, and etoposide) have been the most frequently used preparatory regimens for AHCT in Hodgkin (HL) and non-Hodgkin lymphoma (NHL). This article reviews alternative combination conditioning regimens, as well as novel transplant strategies that have been developed, to reduce transplant-related toxicity while maintaining or improving efficacy. These data demonstrate that incorporation of maintenance therapy posttransplant might be the best way to improve outcomes.
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Affiliation(s)
- Parastoo B Dahi
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Weill Cornell Medical College, New York, NY, USA.
| | - Hillard M Lazarus
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Craig S Sauter
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
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36
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Abstract
Recent advances in the treatment of follicular lymphoma (FL) have provided insight into molecular and biological influences on pathogenesis and prognosis. Additionally, numerous available treatment strategies for both newly diagnosed and relapsed disease require thoughtful consideration of patient selection to avoid the burden of overtreatment and toxicities. This review provides a broad overview on our approach to managing patients with low grade FL.
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Affiliation(s)
- Carla Casulo
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
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37
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Carlsten M, Jädersten M, Hellström A, Littmann K, Melén CM, Junlén HR, Sonnevi K, Ljungman P, Björkstrand B, Wahlin BE. The Karolinska experience of autologous stem-cell transplantation for lymphoma: a population-based study of all 433 patients 1994-2016. Exp Hematol Oncol 2019; 8:7. [PMID: 30923643 PMCID: PMC6423752 DOI: 10.1186/s40164-019-0131-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/13/2019] [Indexed: 01/26/2023] Open
Abstract
Background Autologous stem-cell transplantation (ASCT) is a common treatment for lymphoma but it has some mortality. Methods All 433 lymphoma patients who underwent ASCT for lymphoma at Karolinska Huddinge 1994–2016 were investigated, including CD34+ cell amounts, medications, infectious and other complications, intensive care, longitudinal laboratory values, and secondary myeloid neoplasia. Results The 100-day non-relapse and overall mortalities were 5.6% and 7.2%. Stem-cell harvests < 5 million CD34+ cells/kg correlated with inferior 100-day and long-term survival. Prior to conditioning (93% BEAM), elevated (both 3–9 and ≥ 10 mg/L) C-reactive protein (CRP) and creatinine, and low albumin (but not higher age) predicted inferior higher 100-day survival. Intravenous antibiotics were given to 97% (22% positive blood cultures) and parenteral nutrition to 89%. After 1 year, 86% had normalized hemoglobin. The 5-year risk for secondary myeloid neoplasia was 4.1%, associated with smaller harvests. Conclusions Before starting conditioning, patients should have preferably harvested ≥ 5 million CD34+ cells/kg and normal CRP, albumin, and creatinine. It appears safe to transplant patients ≥ 66 years. Electronic supplementary material The online version of this article (10.1186/s40164-019-0131-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mattias Carlsten
- 1Center for Hematology and Regenerative Medicine, Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.,2PO Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Jädersten
- 1Center for Hematology and Regenerative Medicine, Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.,2PO Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Hellström
- 1Center for Hematology and Regenerative Medicine, Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.,2PO Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Littmann
- 3Division of Clinical Chemistry, Dept. of Laboratory Medicine, H5, Karolinska Institutet, Stockholm, Sweden
| | - Christopher M Melén
- 2PO Hematology, Karolinska University Hospital, Stockholm, Sweden.,4Division of Hematology, Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Henna Riikka Junlén
- 2PO Hematology, Karolinska University Hospital, Stockholm, Sweden.,4Division of Hematology, Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Sonnevi
- 2PO Hematology, Karolinska University Hospital, Stockholm, Sweden.,4Division of Hematology, Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Per Ljungman
- 4Division of Hematology, Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.,5Dept. of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Bo Björkstrand
- 2PO Hematology, Karolinska University Hospital, Stockholm, Sweden.,4Division of Hematology, Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Björn Engelbrekt Wahlin
- 2PO Hematology, Karolinska University Hospital, Stockholm, Sweden.,4Division of Hematology, Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
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38
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Rivas-Delgado A, Magnano L, Moreno-Velázquez M, García O, Nadeu F, Mozas P, Dlouhy I, Baumann T, Rovira J, González-Farre B, Martínez A, Balague O, Delgado J, Villamor N, Giné E, Campo E, Sancho-Cia JM, López-Guillermo A. Response duration and survival shorten after each relapse in patients with follicular lymphoma treated in the rituximab era. Br J Haematol 2018; 184:753-759. [PMID: 30515755 DOI: 10.1111/bjh.15708] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/05/2018] [Indexed: 11/26/2022]
Abstract
Follicular lymphoma (FL) is an indolent disease characterized by long survival but frequent relapses. Before the introduction of rituximab, the clinical course of these patients showed a shorter response duration (RD) after each relapse. In this study, we analysed if this pattern of shortened responses remains in patients treated in the rituximab era. We selected 348 patients newly diagnosed with FL in two institutions between 2001 and 2014 that received chemoimmunotherapy. After a median follow-up of 6·3 years, 10-year progression-free and overall survivals were 53% and 72%, respectively. All patients received first-line, 111 second-line and 41 third-line treatments, with a 5-year RD of 62%, 39% and 24%, respectively (P < 0·0001). Variables predicting longer RD after first-line treatment were normal β2microglobulin, complete remission achievement and maintenance with rituximab. Patients with longer RD after first-line showed significantly longer RD after second-line therapy. Autologous stem-cell transplantation after second-line therapy did not significantly impact RD. Median survival after first, second and third therapies was not reached, 7·6 and 4·8 years, respectively, whereas relative survival with respect to a sex- and age-matched Spanish population, the decrease in the life expectancy at 10 years was 17%, 45% and 79%, respectively. Thus, RD still shortens after each relapse in patients with FL treated in first line with rituximab combinations.
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Affiliation(s)
- Alfredo Rivas-Delgado
- Department of Haematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Magnano
- Haematopathology Unit, Department of Pathology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBERONC, Barcelona, Spain
| | - Miriam Moreno-Velázquez
- Haematology Department, ICO-IJC-Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Olga García
- Haematology Department, ICO-IJC-Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Ferran Nadeu
- Lymphoid Neoplasm Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBERONC, Barcelona, Spain
| | - Pablo Mozas
- Department of Haematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ivan Dlouhy
- Department of Haematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Tycho Baumann
- Department of Haematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBERONC, Barcelona, Spain
| | - Jordina Rovira
- Department of Haematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Blanca González-Farre
- Department of Pathology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.,CIBERONC, Barcelona, Spain
| | - Antonio Martínez
- Department of Pathology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.,CIBERONC, Barcelona, Spain
| | - Olga Balague
- Department of Pathology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.,CIBERONC, Barcelona, Spain
| | - Julio Delgado
- Department of Haematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBERONC, Barcelona, Spain
| | - Neus Villamor
- Haematopathology Unit, Department of Pathology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBERONC, Barcelona, Spain
| | - Eva Giné
- Department of Haematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBERONC, Barcelona, Spain
| | - Elías Campo
- Haematopathology Unit, Department of Pathology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Lymphoid Neoplasm Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBERONC, Barcelona, Spain
| | - Juan M Sancho-Cia
- Haematology Department, ICO-IJC-Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Armando López-Guillermo
- Department of Haematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBERONC, Barcelona, Spain
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Norman JE, Schouten HC, Dreger P, Robinson SP. The role of stem cell transplantation in the management of relapsed follicular lymphoma in the era of targeted therapies. Bone Marrow Transplant 2018; 54:787-797. [DOI: 10.1038/s41409-018-0372-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 02/06/2023]
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40
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Hamadani M. Advances in Transplantation for Lymphomas Resulting from CIBMTR Lymphoma Working Committee's Research Portfolio: A Five-Year Report (2013-2018). ADVANCES IN CELL AND GENE THERAPY 2018; 1:e17. [PMID: 33709060 PMCID: PMC7946113 DOI: 10.1002/acg2.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The Center for International Blood and Marrow Transplant Research (CIBMTR) is a research collaboration between the National Marrow Donor Program (NMDP)/Be The Match and the Medical College of Wisconsin (MCW). The CIBMTR collaborates with the global scientific community to advance hematopoietic cell transplantation (HCT) and cellular therapy worldwide to increase survival and enrich quality of life for patients. The observation research program within CIBMTR is organized into 15 working committees. This review is aiming to highlight the observational research studies published by the CIBMTR Lymphoma Working committee over the last five years (2013-18) and to summarize how these studies have impacted the field by helping inform clinical practice in scenarios where prospective data from high quality randomized trials were not available or where owing to the rarity of a particular transplant indication such data were unlikely to be generated, outside the setting of a large observational research database. The salient findings reviewed include; (a) studies supporting role of autologous HCT in diffuse large B-cell lymphoma (DLBCL) patients with sensitive relapse of disease within one year of diagnosis, (b) role of autologous HCT vs allogeneic HCT in follicular lymphoma patients with early therapy failure, (c) prognostic scoring system development for classical Hodgkin lymphoma and DLBCL patients with prior autograft failure, (d) defining the role of alternative donor transplantation in lymphomas, (e) evaluating appropriate conditioning regimens for HCT in lymphoma, and (f) outcomes of HCT in rare lymphoid malignancies.
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Affiliation(s)
- Mehdi Hamadani
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee WI, 53226
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI 53226
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41
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Jiménez-Ubieto A, Grande C, Caballero D, Yáñez L, Novelli S, Hernández-Garcia MT, Manzanares M, Arranz R, Ferreiro JJ, Bobillo S, Mercadal S, Galeo A, Jiménez JL, Moraleda JM, Vallejo C, Albo C, Pérez E, Marrero C, Magnano L, Palomera L, Jarque I, Martínez-Sánchez P, Martín A, Coria E, López-Guillermo A, Salar A, Lahuerta JJ. Autologous stem cell transplantation may be curative for patients with follicular lymphoma with early therapy failure who reach complete response after rescue treatment. Hematol Oncol 2018; 36:765-772. [PMID: 30129233 DOI: 10.1002/hon.2553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/04/2018] [Accepted: 08/11/2018] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | - Lucrecia Yáñez
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | - Reyes Arranz
- Hospital Universitario La Princesa, Madrid, Spain
| | | | | | - Santiago Mercadal
- Hospital Universitario de Bellvitge, l'Hospitalet de Llobregat, Spain
| | - Andrea Galeo
- Hospital Universitario A Coruña, A Coruña, Spain
| | | | | | | | | | - Elena Pérez
- Hospital Universitario Morales de Messeguer, Murcia, Spain
| | - Carmen Marrero
- Hospital Universitario Nuestra Señora de La Candelaria, Tenerife, Spain
| | | | - Luis Palomera
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Dreyling M, Ghielmini M, Rule S, Salles G, Vitolo U, Ladetto M. Newly diagnosed and relapsed follicular lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 27:v83-v90. [PMID: 27664263 DOI: 10.1093/annonc/mdw400] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Dreyling
- Department of Medicine III, University of Munich, Germany
| | - M Ghielmini
- Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - S Rule
- Haematology, Peninsula School of Medicine, Plymouth, UK
| | - G Salles
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service d'Hématologie & Université Claude Bernard Lyon-1, Pierre-Benite, France
| | - U Vitolo
- Haematology, University-Hospital Città della Salute e della Scienza, Torino
| | - M Ladetto
- Divisione di Ematologia, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Gribben JG. The role of stem cell transplant for lymphoma in 2017. Hematol Oncol 2018; 35 Suppl 1:25-29. [PMID: 28591422 DOI: 10.1002/hon.2396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- John G Gribben
- Barts Cancer Institute, Queen Mary University of London, London, UK
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Chaekal OK, van Besien K. A renaissance for autologous transplantation in follicular lymphoma? Leuk Lymphoma 2018; 60:3-5. [PMID: 29966478 DOI: 10.1080/10428194.2018.1480777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ok-Kyong Chaekal
- a Weill Cornell College of Medicine/New York Presbyterian Hospital , New York , NY , USA
| | - Koen van Besien
- a Weill Cornell College of Medicine/New York Presbyterian Hospital , New York , NY , USA
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Manna M, Lee-Ying R, Davies G, Stewart C, Oh DH, Peters A, Stewart DA. Autologous transplantation improves survival rates for follicular lymphoma patients who relapse within two years of chemoimmunotherapy: a multi-center retrospective analysis of consecutively treated patients in the real world. Leuk Lymphoma 2018; 60:133-141. [DOI: 10.1080/10428194.2018.1473576] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mita Manna
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Richard Lee-Ying
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Gwynivere Davies
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Colin Stewart
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Danielle H. Oh
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Anthea Peters
- Department of Medicine, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Douglas A. Stewart
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
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46
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Lynch RC, Gopal AK. Have we found the right patient population for transplantation in follicular lymphoma? Cancer 2018; 124:2484-2487. [PMID: 29645081 DOI: 10.1002/cncr.31376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/05/2018] [Accepted: 03/09/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Ryan C Lynch
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ajay K Gopal
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Jurinovic V, Metzner B, Pfreundschuh M, Schmitz N, Wandt H, Keller U, Dreger P, Dreyling M, Hiddemann W, Unterhalt M, Hoster E, Weigert O. Autologous Stem Cell Transplantation for Patients with Early Progression of Follicular Lymphoma: A Follow-Up Study of 2 Randomized Trials from the German Low Grade Lymphoma Study Group. Biol Blood Marrow Transplant 2018; 24:1172-1179. [DOI: 10.1016/j.bbmt.2018.03.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/23/2018] [Indexed: 11/16/2022]
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Casulo C, Friedberg JW, Ahn KW, Flowers C, DiGilio A, Smith SM, Ahmed S, Inwards D, Aljurf M, Chen AI, Choe H, Cohen J, Copelan E, Farooq U, Fenske TS, Freytes C, Gaballa S, Ganguly S, Jethava Y, Kamble RT, Kenkre VP, Lazarus H, Lazaryan A, Olsson RF, Rezvani AR, Rizzieri D, Seo S, Shah GL, Shah N, Solh M, Sureda A, William B, Cumpston A, Zelenetz AD, Link BK, Hamadani M. Autologous Transplantation in Follicular Lymphoma with Early Therapy Failure: A National LymphoCare Study and Center for International Blood and Marrow Transplant Research Analysis. Biol Blood Marrow Transplant 2018; 24:1163-1171. [PMID: 29242111 PMCID: PMC5993598 DOI: 10.1016/j.bbmt.2017.12.771] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/03/2017] [Indexed: 12/12/2022]
Abstract
Patients with follicular lymphoma (FL) experiencing early therapy failure (ETF) within 2 years of frontline chemoimmunotherapy have poor overall survival (OS). We analyzed data from the Center for International Blood and Marrow Transplant Research (CIBMTR) and the National LymphoCare Study (NLCS) to determine whether autologous hematopoietic cell transplant (autoHCT) can improve outcomes in this high-risk FL subgroup. ETF was defined as failure to achieve at least partial response after frontline chemoimmunotherapy or lymphoma progression within 2 years of frontline chemoimmunotherapy. We identified 2 groups: the non-autoHCT cohort (patients from the NLCS with ETF not undergoing autoHCT) and the autoHCT cohort (CIBMTR patients with ETF undergoing autoHCT). All patients received rituximab-based chemotherapy as frontline treatment; 174 non-autoHCT patients and 175 autoHCT patients were identified and analyzed. There was no difference in 5-year OS between the 2 groups (60% versus 67%, respectively; P = .16). A planned subgroup analysis showed that patients with ETF receiving autoHCT soon after treatment failure (≤1 year of ETF; n = 123) had higher 5-year OS than those without autoHCT (73% versus 60%, P = .05). On multivariate analysis, early use of autoHCT was associated with significantly reduced mortality (hazard ratio, .63; 95% confidence interval, .42 to .94; P = .02). Patients with FL experiencing ETF after frontline chemoimmunotherapy lack optimal therapy. We demonstrate improved OS when receiving autoHCT within 1 year of treatment failure. Results from this unique collaboration between the NLCS and CIBMTR support consideration of early consolidation with autoHCT in select FL patients experiencing ETF.
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Affiliation(s)
- Carla Casulo
- Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | | | - Kwang W Ahn
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christopher Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Alyssa DiGilio
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | - Sairah Ahmed
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of MD Anderson Cancer Center, Houston, Texas
| | - David Inwards
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riydah, Saudi Arabia
| | - Andy I Chen
- Blood and Marrow Transplant Program, Oregon Health and Science University, Portland, Oregon
| | - Hannah Choe
- Blood and Marrow Transplant Program, Weill Cornell Medical College, New York, New York
| | - Jonathon Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Umar Farooq
- Department of Medicine, University of Iowa, Iowa City, Iowa
| | - Timothy S Fenske
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Cesar Freytes
- Blood and Marrow Transplant Program, Texas Transplant Institute, San Antonio, Texas
| | - Sameh Gaballa
- Blood and Marrow Transplant Program, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Siddhartha Ganguly
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, Kansas
| | - Yogesh Jethava
- Blood and Marrow Transplant Program, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Vaishalee P Kenkre
- Division of Hematology and Oncology, University of Wisconsin, Madison, Wisconsin
| | - Hillard Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Aleksandr Lazaryan
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Andrew R Rezvani
- Blood and Marrow Transplant Program, Stanford Health Care, Stanford, California
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina
| | - Sachiko Seo
- National Cancer Research Center, East Hospital, Chiba, Japan
| | - Gunjan L Shah
- Blood and Marrow Transplant Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nina Shah
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of MD Anderson Cancer Center, Houston, Texas
| | - Melham Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia
| | - Anna Sureda
- Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - Basem William
- James Cancer Center, Ohio State Medical Center, Columbus, Ohio
| | - Aaron Cumpston
- Blood and Marrow Transplant Program, West Virginia University Hospitals, Morgantown, West Virginia
| | - Andrew D Zelenetz
- Blood and Marrow Transplant Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brian K Link
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Affiliation(s)
- Thomas Erblich
- Department of Haemato-oncology, St Bartholomew’s Hospital, London, UK
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Nagai S, Ozawa K. Drug approval based on randomized phase 3 trials for relapsed malignancy: analysis of oncologic drugs granted accelerated approval, publications and clinical trial databases. Invest New Drugs 2018; 36:487-495. [PMID: 29453626 DOI: 10.1007/s10637-018-0572-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/07/2018] [Indexed: 10/18/2022]
Abstract
Background As relapsed disease is frequently the first target of newly developed therapies, it is vital to address the difficulty in demonstrating the efficacy of new drugs for relapsed malignancy in randomized phase 3 trials. Methods We analyzed the approved indications, target populations, and development status of post-marketing confirmatory trials of all oncology-related drugs that were granted accelerated approval for both hematological and solid malignancies. Furthermore, we searched for randomized phase 3 trials for adult patients with relapsed lymphoid malignancy, other than chronic lymphocytic leukemia (CLL) and multiple myeloma (MM). Results Thirty-one (81.6%) of the 38 hematological indications and 23 (53.5%) of the 43 solid malignancy indications were in the relapsed settings. The target population of post-marketing studies was different from the approved indication in 18 (47.4%) of 38 hematological indications and 11 (25.6%) of 43 solid malignancy indications; all 18 hematological indications involved relapsed settings. Improved time-to-event outcome for relapsed patients was the primary endpoint in 6 (19.3%) of the 31 relapsed hematological indications. In 4 published studies of relapsed lymphoid malignancy, the medication significantly improved outcomes. From 33 trials listed at Clinicaltrials.gov , 2 were positive and 13 were negative. Five out of the 13 negative trials were terminated due to poor accrual. Conclusion Our analysis indicates that drug approval based on phase 3 trials is more challenging for relapsed hematological malignancies than for solid malignancies. Therefore, determining proper evaluation methods for the efficacy and safety of drugs for relapsed malignancy, without randomized trials, is important.
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Affiliation(s)
- Sumimasa Nagai
- Division of Genetic Therapeutics, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 1088639, Japan.
| | - Keiya Ozawa
- Division of Genetic Therapeutics, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 1088639, Japan
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