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Mogensen N, Cananau C, Ranta S, Karlén J, Kwiecinska A, Baecklund F. Successful treatment of paediatric refractory Hodgkin lymphoma with immunotherapy - A case report and literature review. Acta Paediatr 2024; 113:1483-1495. [PMID: 38596833 DOI: 10.1111/apa.17235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024]
Abstract
AIM To describe a rare case of primary refractory Hodgkin lymphoma nodular sclerosis syncytial variant in a child and review immunotherapy in relapsed/refractory Hodgkin lymphoma. METHODS We described the treatment course of a child with primary refractory classic Hodgkin lymphoma and discussed different options for salvage therapy, with an emphasis on immunotherapy. We searched PubMed for all published clinical trials investigating immunotherapy in classic Hodgkin lymphoma written in English until 31 June, 2023. The reference list of each identified paper was searched for additional publications. RESULTS Our patient was salvaged with anti-programmed cell death 1 (PD-1) antibody therapy followed by high-dose chemotherapy with autologous stem cell rescue. Radiotherapy was avoided. We identified five one-armed phase II trials investigating anti-PD-1 therapy in first relapse/refractory disease in a total of 254 patients aged 9-71 years, of which one included 31 children. The complete remission rate before high-dose chemotherapy was 59%-95% overall and 67%-89% among those with refractory disease. CONCLUSION Although it remains to be proven in randomised trials, anti-PD-1 therapy may provide higher complete response rates than traditional chemotherapy. Anti-PD-1 therapy has the potential to increase the chance of cure while decreasing the risk of late effects from chemotherapy and radiotherapy.
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Affiliation(s)
- Nina Mogensen
- Paediatric Oncology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Carmen Cananau
- Department of Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Susanna Ranta
- Paediatric Oncology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Karlén
- Paediatric Oncology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Kwiecinska
- Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Baecklund
- Paediatric Oncology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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2
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Varma G, Diefenbach C. The role of autologous stem-cell transplantation in classical Hodgkin lymphoma in the modern era. Semin Hematol 2024:S0037-1963(24)00080-5. [PMID: 39039012 DOI: 10.1053/j.seminhematol.2024.06.003] [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: 05/07/2024] [Revised: 06/19/2024] [Accepted: 06/23/2024] [Indexed: 07/24/2024]
Abstract
Despite excellent cure rates with modern front-line regimens, up to 20% of patients with Hodgkin lymphoma will progress through front-line therapy or experience disease relapse. Worldwide, salvage chemotherapy followed by high-dose chemotherapy with autologous stem cell transplantation (HDT/ASCT) is considered the standard of care for these patients and can cure approximately 50% of relapsed or refractory (R/R) patients in the second line. Brentuximab vedotin (BV), an anti-CD30 antibody drug conjugate, and PD1 inhibitors like nivolumab and pembrolizumab, have high response rates in patients who recur after HDT/ASCT. When used prior to HDT/ASCT, BV and PD1 inhibitors appear to dramatically increase the effectiveness of salvage therapies with complete response rates often double those seen with historic chemotherapy-based regimens and durable progression free survival (PFS) post-HDT/ASCT. Emerging data in adults and from pediatric trials showing a durable PFS in a subset of relapsed patients raises the question of whether HDT/ASCT is essential for cure in R/R patients after PD1 based salvage. Future studies will help clarify if ASCT can omitted PD1 based salvage to avoid the potential toxicity of HDT/ASCT without compromising cure.
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Affiliation(s)
- Gaurav Varma
- Division of Hematology and Medical Oncology, Perlmutter Cancer Center at NYU Langone Health, New York, NY; Division of Hematology and Medical Oncology, NYU Grossman School of Medicine, New York, NY
| | - Catherine Diefenbach
- Division of Hematology and Medical Oncology, Perlmutter Cancer Center at NYU Langone Health, New York, NY; Division of Hematology and Medical Oncology, NYU Grossman School of Medicine, New York, NY.
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3
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Driessen J, de Wit F, Herrera AF, Zinzani PL, LaCasce AS, Cole PD, Moskowitz CH, García-Sanz R, Fuchs M, Müller H, Borchmann P, Santoro A, Schöder H, Zijlstra JM, Hutten BA, Moskowitz AJ, Kersten MJ. Brentuximab vedotin and chemotherapy in relapsed/refractory Hodgkin lymphoma: a propensity score-matched analysis. Blood Adv 2024; 8:2740-2752. [PMID: 38502227 PMCID: PMC11170165 DOI: 10.1182/bloodadvances.2023012145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 03/21/2024] Open
Abstract
ABSTRACT Several single-arm studies have explored the inclusion of brentuximab vedotin (BV) in salvage chemotherapy followed by autologous stem cell transplantation (ASCT) for relapsed/refractory (R/R) classical Hodgkin lymphoma (cHL). However, no head-to-head comparisons with standard salvage chemotherapy have been performed. This study presents a propensity score-matched analysis encompassing individual patient data from 10 clinical trials to evaluate the impact of BV in transplant-eligible patients with R/R cHL. We included 768 patients, of whom 386 were treated with BV with or without chemotherapy (BV cohort), whereas 382 received chemotherapy alone (chemotherapy cohort). Propensity score matching resulted in balanced cohorts of 240 patients each. No significant differences were observed in pre-ASCT complete metabolic response (CMR) rates (P = .69) or progression free survival (PFS; P = .14) between the BV and chemotherapy cohorts. However, in the BV vs chemotherapy cohort, patients with relapsed disease had a significantly better 3-year PFS of 80% vs 70%, respectively (P = .02), whereas there was no difference for patients with primary refractory disease (56% vs 62%, respectively; P = .67). Patients with stage IV disease achieved a significantly better 3-year PFS in the BV cohort (P = .015). Post-ASCT PFS was comparable for patients achieving a CMR after BV monotherapy and those receiving BV followed by sequential chemotherapy (P = .24). Although 3-year overall survival was higher in the BV cohort (92% vs 80%, respectively; P < .001), this is likely attributed to the use of other novel therapies in later lines for patients experiencing progression, given that studies in the BV cohort were conducted more recently. In conclusion, BV with or without salvage chemotherapy appears to enhance PFS in patients with relapsed disease but not in those with primary refractory cHL.
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Affiliation(s)
- Julia Driessen
- Department of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Fer de Wit
- Department of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Alex F. Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Ann S. LaCasce
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA
| | - Peter D. Cole
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Craig H. Moskowitz
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL
| | - Ramón García-Sanz
- Department of Hematology, Hospital Universitario de Salamanca, CIBERONC, CIC-IBMCC, Universidad Salamanca, Salamanca, Spain
| | - Michael Fuchs
- German Hodgkin Study Group and Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, University of Cologne, Cologne, Germany
| | - Horst Müller
- German Hodgkin Study Group and Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, University of Cologne, Cologne, Germany
| | - Peter Borchmann
- German Hodgkin Study Group and Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, University of Cologne, Cologne, Germany
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Heiko Schöder
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Josée M. Zijlstra
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Barbara A. Hutten
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Alison J. Moskowitz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
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4
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Calabretta E, di Trani M, Corrado F, Sollini M, Cristaldi V, Marino F, Terzi di Bergamo L, Bruscaggin A, Pirosa MC, Bramanti S, Chiti A, Rossi D, Carlo-Stella C. Baseline circulating tumour DNA and interim PET predict response in relapsed/refractory classical Hodgkin lymphoma. Br J Haematol 2024; 204:514-524. [PMID: 37853658 DOI: 10.1111/bjh.19162] [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: 08/13/2023] [Revised: 10/06/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023]
Abstract
Reliable biomarkers for early identification of treatment failure in relapsed/refractory (r/r) classical Hodgkin lymphoma (cHL) are lacking. Circulating tumour DNA (ctDNA) profiling has emerged as a powerful predictive and prognostic tool in several haemopoietic and non-haemopoietic malignancies and may guide rational treatment choices in r/r cHL. To assess the predictive and prognostic value of ctDNA, we performed a retrospective analysis on 55 r/r cHL patients treated with the bendamustine, gemcitabine and vinorelbine (BEGEV) regimen and additionally evaluated the potential utility of integrating ctDNA with interim [18 F]-FDG positron emission tomography (iPET). Baseline ctDNA genotyping in r/r cHL mirrored gene mutations and pathways involved in newly diagnosed cHL. We found that baseline ctDNA quantification and serial ctDNA monitoring have prognostic value in r/r cHL receiving salvage chemotherapy. Lastly, integrating ctDNA quantification with iPET evaluation may improve the early identification of patients at high risk of failing standard salvage therapy, who may benefit from an early switch to immunotherapeutic agents. Collectively, our results support the implementation of non-invasive methods to detect minimal residual disease in recurrent cHL and justify its prospective evaluation in appropriately designed clinical trials.
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Affiliation(s)
- Eleonora Calabretta
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Martina di Trani
- Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesco Corrado
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Vanessa Cristaldi
- Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Fabrizio Marino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Lodovico Terzi di Bergamo
- Laboratory of Experimental Hematology, Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Alessio Bruscaggin
- Laboratory of Experimental Hematology, Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Maria Cristina Pirosa
- Laboratory of Experimental Hematology, Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Stefania Bramanti
- Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Davide Rossi
- Laboratory of Experimental Hematology, Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Carmelo Carlo-Stella
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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5
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Liu H, Zou H, Shan D, Liu W, Huang W, Sui W, Deng S, Wang T, Lv R, Fu M, Xu Y, Yi S, An G, Zhao Y, Qiu L, Zou D. Gemcitabine-based conditioning compared to BEAM/BEAC conditioning prior to autologous stem cell transplantation for non-Hodgkin lymphoma: No difference in outcomes. Cancer Med 2024; 13:e6965. [PMID: 38348996 PMCID: PMC10831922 DOI: 10.1002/cam4.6965] [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: 11/06/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) remains an effective treatment for non-Hodgkin lymphoma (NHL). The limited availability of carmustine has prompted the exploration of novel alternative conditioning regimens. This study aimed to compare the efficacy and safety profile of GBM/GBC (gemcitabine, busulfan, and melphalan or cyclophosphamide) conditioning compared with the standard BEAM/BEAC regimens (carmustine, etoposide, cytarabine, and melphalan or cyclophosphamide) for ASCT in patients with NHL. METHODS A retrospective analysis was conducted on 231 NHL patients, who underwent ASCT from October 2010 to October 2021 at the Institute of Hematology & Blood Disease Hospital, including both first-line and salvage settings. This resulted in the inclusion of 112 patients in the GBM/GBC arm and 92 in the BEAM/BEAC arm. Propensity score matching was employed to validate the results. RESULTS Disease subtype distribution was similar between the GBM/GBC and BEAM/BEAC groups, with diffuse large B-cell lymphoma being the most common (58.9% vs. 58.7%), followed by PTCL (17.0% vs. 18.5%) and MCL (14.3% vs. 14.1%). At 3 months post-ASCT, complete response (CR) rates were comparable (GBM/GBC 93.5% vs. BEAM/BEAC 91.1%; p = 0.607). The 4-year progression-free survival (78.4% vs. 82.3%; p = 0.455) and 4-year overall survival (88.1% vs. 87.7%; p = 0.575) were also similar. Both groups exhibited low non-relapse mortality at 4 years (GBM/GBC 1.8% vs. BEAM/BEAC 3.5%; p = 0.790) with no transplant-related mortalities reported. The GBM/GBC cohort demonstrated a higher incidence of grade 3/4 oral mucositis and hepatic toxicity, whereas the BEAM/BEAC group had more frequent cases of bacteremia or sepsis (13 cases vs. 5 in GBM/GBC). CONCLUSIONS The GBM/GBC regimen is effective and well-tolerated, offering outcomes that are highly comparable to those in NHL patients conditioned with BEAM/BEAC, as demonstrated in a prognostically matched cohort.
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Affiliation(s)
- Huimin Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Hesong Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Dandan Shan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Wei Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Wenyang Huang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Weiwei Sui
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Shuhui Deng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Tingyu Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Rui Lv
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Mingwei Fu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Yan Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Shuhua Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Gang An
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Yaozhong Zhao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Dehui Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
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6
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Tomarchio V, Rigacci L. Fluorodeoxyglucose-Positron Emission Tomography in Relapsed/Refractory Hodgkin Lymphoma: A Practical Approach. Chemotherapy 2023; 69:1-10. [PMID: 37708879 PMCID: PMC10898808 DOI: 10.1159/000533766] [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: 06/26/2023] [Accepted: 08/22/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Positron emission tomography (PET) with the use of 18F-fluorodeoxyglucose (FDG), implemented with low-dosage computer tomography, is to be considered as the most important evolution of imaging in the management and assessment of classical Hodgkin lymphoma patients. SUMMARY According to Lugano response criteria, FDG-PET is mandatory to define metabolic response to frontline therapy and moreover it is important in the definition of nonresponders or refractory disease patients. Refractory disease is reported in about 15% of patients, with some variations based on the choice of first-line chemotherapy, and particularly in advanced stages, up to 40% eventually relapse within 3 years. KEY MESSAGES The aim of this review was to highlight a practical way to use FDG-PET in the subset of HL, with some notes of its use in first-line patients, and particularly centered on relapsed or refractory setting with a final focus of the evaluation of response by FDG-PET in the new treatment era of immunocheckpoint inhibitors.
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Affiliation(s)
| | - Luigi Rigacci
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Medicine and Surgery, Research Unit of Hematology, Università Campus Bio-Medico, Rome, Italy
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7
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Mei Y, Wu D, Berg J, Tolksdorf B, Roehrs V, Kurreck A, Hiller T, Kurreck J. Generation of a Perfusable 3D Lung Cancer Model by Digital Light Processing. Int J Mol Sci 2023; 24:ijms24076071. [PMID: 37047045 PMCID: PMC10094257 DOI: 10.3390/ijms24076071] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/10/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Lung cancer still has one of the highest morbidity and mortality rates among all types of cancer. Its incidence continues to increase, especially in developing countries. Although the medical field has witnessed the development of targeted therapies, new treatment options need to be developed urgently. For the discovery of new drugs, human cancer models are required to study drug efficiency in a relevant setting. Here, we report the generation of a non-small cell lung cancer model with a perfusion system. The bioprinted model was produced by digital light processing (DLP). This technique has the advantage of including simulated human blood vessels, and its simple assembly and maintenance allow for easy testing of drug candidates. In a proof-of-concept study, we applied gemcitabine and determined the IC50 values in the 3D models and 2D monolayer cultures and compared the response of the model under static and dynamic cultivation by perfusion. As the drug must penetrate the hydrogel to reach the cells, the IC50 value was three orders of magnitude higher for bioprinted constructs than for 2D cell cultures. Compared to static cultivation, the viability of cells in the bioprinted 3D model was significantly increased by approximately 60% in the perfusion system. Dynamic cultivation also enhanced the cytotoxicity of the tested drug, and the drug-mediated apoptosis was increased with a fourfold higher fraction of cells with a signal for the apoptosis marker caspase-3 and a sixfold higher fraction of cells positive for PARP-1. Altogether, this easily reproducible cancer model can be used for initial testing of the cytotoxicity of new anticancer substances. For subsequent in-depth characterization of candidate drugs, further improvements will be necessary, such as the generation of a multi-cell type lung cancer model and the lining of vascular structures with endothelial cells.
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Affiliation(s)
- Yikun Mei
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, TIB 4/3-2, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
| | - Dongwei Wu
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, TIB 4/3-2, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
| | - Johanna Berg
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, TIB 4/3-2, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
| | - Beatrice Tolksdorf
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, TIB 4/3-2, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
| | - Viola Roehrs
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, TIB 4/3-2, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
| | - Anke Kurreck
- BioNukleo GmbH, Ackerstr. 76, 13355 Berlin, Germany
| | - Thomas Hiller
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, TIB 4/3-2, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
- PRAMOMOLECULAR GmbH, Robert-Rössle-Strasse 10, 13125 Berlin, Germany
| | - Jens Kurreck
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, TIB 4/3-2, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
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8
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Desai SH, Spinner MA, David K, Bachanova V, Goyal G, Kahl B, Dorritie K, Azzi J, Kenkre VP, Arai S, Chang C, Fusco B, Sumransub N, Hatic H, Saba R, Ibrahim U, Harris EI, Shah H, Murphy J, Ansell S, Jagadish D, Orellana-noia V, Diefenbach C, Iyenger S, Rappazzo KC, Mishra R, Choi Y, Nowakowski GS, Advani RH, Micallef IN. Checkpoint inhibitor-based salvage regimens prior to autologous stem cell transplant improve event-free survival in relapsed/refractory classic Hodgkin lymphoma. Am J Hematol 2023; 98:464-471. [PMID: 36629030 PMCID: PMC11234511 DOI: 10.1002/ajh.26827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023]
Abstract
Clinical trials of novel salvage therapies have encouraging outcomes for relapsed/refractory transplant-eligible classic Hodgkin lymphoma (R/R cHL) but comparison with conventional chemotherapy is lacking. Herein, we report the final analysis of a multicenter retrospective cohort of R/R cHL assessing outcomes by type of salvage therapy before autologous stem cell transplant (ASCT). R/R cHL patients who underwent ASCT at 14 institutions across the United States were included. Outcomes were compared among patients receiving conventional chemotherapy, brentuximab vedotin (BV) + chemotherapy, BV alone, and a checkpoint inhibitor (CPI)-based regimens before ASCT. Study endpoints included event-free survival (EFS), progression-free survival (PFS), and overall survival (OS). All endpoints are defined from relapse. Of 936 patients, 728 received conventional chemotherapy, 73 received BV + chemotherapy, 70 received BV alone, and 65 received CPI-based regimens prior to ASCT. When adjusted for time to relapse, pre-ASCT response and use of BV maintenance, patients receiving CPI-based regimens had superior 2-year EFS compared to conventional chemotherapy, BV + chemotherapy, and BV alone (79.7, 49.6, 62.3, and 36.9%, respectively, p < .0001). Among 649 patients transplanted after 1 line of salvage therapy, CPI-based regimens were associated with superior 2-year PFS compared to conventional chemotherapy (98% vs. 68.8%, hazard ratio: 0.1, 95% confidence interval: 0.03-0.5, p < .0001). OS did not differ by pre-ASCT salvage regimen. In this large multicenter retrospective study, CPI-based regimens improved EFS and PFS compared to other salvage regimens independent of pre-ASCT response. These data support earlier sequencing of CPI-based regimens in R/R cHL in the pre-ASCT setting.
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Affiliation(s)
- Sanjal H. Desai
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, USA
| | - Michael A. Spinner
- Division of Oncology, Department of Medicine, Stanford University Medical Center, Stanford, California, USA
| | - Kevin David
- Department of Hematology and Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, USA
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gaurav Goyal
- O’Neal Comprehensive Cancer Center, University of Alabama, Birmingham, Alabama, USA
| | - Brad Kahl
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kathleen Dorritie
- Division of Hematology-Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Jacques Azzi
- Division of Hematology and Medical Oncology, Icahn School of Medicine Mount Sinai, New York, New York, USA
| | | | - Sally Arai
- Division of Oncology, Department of Medicine, Stanford University Medical Center, Stanford, California, USA
| | - Cheryl Chang
- Division of Oncology, Department of Medicine, Stanford University Medical Center, Stanford, California, USA
| | - Brendon Fusco
- Department of Hematology and Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Nuttavut Sumransub
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, USA
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Haris Hatic
- O’Neal Comprehensive Cancer Center, University of Alabama, Birmingham, Alabama, USA
| | - Raya Saba
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Uroosa Ibrahim
- Division of Hematology and Medical Oncology, Icahn School of Medicine Mount Sinai, New York, New York, USA
| | - Elyse I. Harris
- Department of Hematology, University of Wisconsin, Madison, Wisconsin, USA
| | - Harsh Shah
- Division of Hematology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Jacob Murphy
- Department of Oncology, the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - Stephen Ansell
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Victor Orellana-noia
- Division of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | | | - Siddharth Iyenger
- Division of Hematology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - K. C. Rappazzo
- Department of Oncology, the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - Rahul Mishra
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Yun Choi
- Perlmutter Cancer Center, NYU Grossman Medical School, New York, New York, USA
| | | | - Ranjana H. Advani
- Division of Oncology, Department of Medicine, Stanford University Medical Center, Stanford, California, USA
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9
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Stefoni V, Argnani L, Carella M, Casadei B, Morigi A, Lolli G, Broccoli A, Pellegrini C, Nanni L, Coppola PE, Zinzani PL. BEGEV salvage regimen in relapsed/refractory classical Hodgkin lymphoma: a real-life experience. J Cancer Res Clin Oncol 2023; 149:1043-1047. [PMID: 35239000 PMCID: PMC9984336 DOI: 10.1007/s00432-022-03955-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE One of the most critical issues in the management of Hodgkin lymphoma (HL) patients who resulted as primary relapsed or refractory is to obtain a minimal disease status before autologous stem cell transplantation (ASCT). Finding a salvage regimen able to induce this status without severe toxicity would represent a major achievement in this setting. METHODS A single-center retrospective study was conducted to assess effectiveness and safety of BEGEV (bendamustine, gemcitabine, and vinorelbine) regimen as first salvage setting prior to ASCT in HL patients. RESULTS Forty-three patients were treated in our institution between October 2017 and November 2020. Median age at BEGEV therapy was 35.0 years (range 17.2- 70.0), and the median time from frontline therapy to the first cycle of BEGEV was 79.5 days (range 4-2267). At the end of treatment, 31 patients achieved a complete response (CR), with an overall response rate of 76.7%. Forty-one patients harvested CD34+ cells and 35/43 (81.4%) patients underwent ASCT. With a median follow-up of 22 months, 4 CR patients had disease relapse, yielding an estimated disease-free survival of 73.9% at 34 months. The estimated 2-year progression-free survival was 66.7%. Response to first-line chemotherapy did not significantly influence prognosis. CONCLUSIONS BEGEV regimen was well tolerated, and reversible haematological toxic effects were the most common adverse events. Real-life data on BEGEV regimen as first salvage setting showed a relevant rate of objective responses and a limited myelotoxicity with no impairment of a subsequent mobilization of peripheral blood stem cells.
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Affiliation(s)
- Vittorio Stefoni
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Lisa Argnani
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Matteo Carella
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Beatrice Casadei
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Alice Morigi
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Ginevra Lolli
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Alessandro Broccoli
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Cinzia Pellegrini
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Laura Nanni
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Paolo Elia Coppola
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy. .,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy.
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10
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Sharkawi MMZ, Mohamed NR, El-Saadi MT, Amin NH. Ecofriendly LC-MS/MS and TLC-densitometric methods for simultaneous quantitative assay and monitoring of BEGEV regimen, in vivo pharmacokinetic study application. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2023; 15:1016-1027. [PMID: 36727667 DOI: 10.1039/d3ay00081h] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
To date no analytical method has been developed for the determination of the BEGEV regimen and no study has investigated the kinetic interaction between the drugs, to give us priorities for further clinical study, so two rapid, accurate, sensitive and ecofriendly chromatographic methods were developed for the simultaneous determination of bendamustine (BEN), gemcitabine (GEM) and vinorelbine (VIB) using sildenafil (SIL) as an internal standard (IS) for the purpose of an in vivo pharmacokinetics study in rats. Firstly, the LC-MS/MS method was performed using a mixture of methanol and a 0.1% aqueous solution of formic acid as the mobile phase on a ZORBAX Eclipse Plus C18 (4.6 mm × 150 mm, 5 μm) column as the stationary phase. BEN, GEM and VIB were ionized by positive ions and detected in the multi-reaction monitoring (MRM) mode using precursor → products of m/z 358.20 → 228.25 for BEN, m/z 264.05 → 112.15 for GEM, m/z 779.55 → 122.20 for VIB and m/z 475.00 → 58.35 for SIL. Secondly, TLC-densitometry was applied on TLC silica gel plates using methanol : ethyl acetate (8 : 2, v/v) as the developing system when the separated peaks were scanned at 280 nm. FDA guidelines were followed for validation of the proposed methods, which presented acceptable ranges; then they were applied for an in vivo study in rats with a quantitative determination of each drug after single or combined administration for an investigation of any suspected drug-drug interaction, and all pharmacokinetic parameters were calculated for therapeutic drug monitoring of those drugs. Green analytical chemistry principles were considered during all the procedural steps to ensure the greenness and the safety of the methods, which were evaluated using four assessment tools, eco-scale assessment, the national environmental method index (NEMI), the green analytical procedure index (GAPI) and the analytical greenness metric approach (AGREE), and the results were satisfactory.
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Affiliation(s)
- Marco M Z Sharkawi
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Beni-Suef University, Alshaheed Shehata Ahmed Hegazy St., Beni-Suef 62514, Egypt
| | - Norhan R Mohamed
- Department of Medicinal Chemistry, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt.
| | - Mohammed T El-Saadi
- Department of Medicinal Chemistry, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt.
- Medicinal Chemistry Department, Faculty of Pharmacy, Sinai University, Kantra Branch, Egypt
| | - Noha H Amin
- Department of Medicinal Chemistry, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt.
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11
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Zhang P, Shi C, Song Y, Li Z, Zhang M, Jin M. Brentuxinmab vedotin, alone or combine with bendamustine in the treatment of natural killer T cell lymphoma. Hematol Oncol 2022; 40:941-952. [PMID: 35797410 DOI: 10.1002/hon.3042] [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: 05/06/2022] [Accepted: 06/26/2022] [Indexed: 12/13/2022]
Abstract
Natural killer (NK)/T cell lymphoma is a highly aggressive subtype of non-Hodgkin lymphoma. The prognosis of patients with natural killer T cell lymphoma (NKTCL) remains poor. More potent treatment strategies are urgently needed to improve the survival of these patients with R/R NKTCL. CD30 expression has been reported to occur in about 40% of NK/T cell lymphoma. Brentuximab vedotin (BV), a monomethyl auristatin E conjugated CD30 antibody, targets CD30 to kill cancer cells. Therapeutic combination of BV and bendamustine has been shown to be highly effective in Hodgkin lymphoma. We investigated efficacy of BV in treating NKTCL as a single therapy, and in combination with bendamustine in vitro and in vivo. We determined CD30 expression levels in 6 NKTCL cell lines. The efficiency of lymphoma cell inhibition by BV correlates with CD30 expression. We also determined the efficacy of BV in combination with bendamustine and found synergistic effects with bendamustine in NKTCL. Combined BV and bendamustine treatment exerted synergistic antiproliferation effect and enhanced cell apoptotic in vitro and in vivo. Brentuximab vedotin and bendamustine synergistically arrested cell cycle at the G2/M phase in NKTCL cell lines. The combination of BV and bendamustine was demonstrated to synergistically damage DNA in NKTCL. This study provides a reference for possible application on using BV for the treatment of NKTCL, either as a single agent or in combination with bendamustine.
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Affiliation(s)
- Ping Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Academy of Medical Sciences of Zhengzhou University, Zhengzhou, Henan, China
| | - Cunzhen Shi
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yue Song
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Academy of Medical Sciences of Zhengzhou University, Zhengzhou, Henan, China.,State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhaoming Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengyuan Jin
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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12
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Li Q, Zhang W. Progress in Anticancer Drug Development Targeting Ubiquitination-Related Factors. Int J Mol Sci 2022; 23:ijms232315104. [PMID: 36499442 PMCID: PMC9737479 DOI: 10.3390/ijms232315104] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 12/05/2022] Open
Abstract
Ubiquitination is extensively involved in critical signaling pathways through monitoring protein stability, subcellular localization, and activity. Dysregulation of this process results in severe diseases including malignant cancers. To develop drugs targeting ubiquitination-related factors is a hotspot in research to realize better therapy of human diseases. Ubiquitination comprises three successive reactions mediated by Ub-activating enzyme E1, Ub-conjugating enzyme E2, and Ub ligase E3. As expected, multiple ubiquitination enzymes have been highlighted as targets for anticancer drug development due to their dominant effect on tumorigenesis and cancer progression. In this review, we discuss recent progresses in anticancer drug development targeting enzymatic machinery components.
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13
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Stamatoullas A, Ghesquières H, Feugier P, André M, Le Bras F, Gac AC, Borel C, Gastinne T, Quittet P, Morschhauser F, Ribrag V, Guidez S, Nicolas-Virelizier E, Berriolo-Riedinger A, Vander Borght T, Edeline V, Brice P. Final results of brentuximab vedotin combined with ifosfamide-carboplatin-etoposide in first refractory/relapsed Hodgkin lymphoma: a lymphoma study association phase I/II study. Leuk Lymphoma 2022; 63:3063-3071. [PMID: 35975738 DOI: 10.1080/10428194.2022.2107204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This phase I/II study assessed the combination of brentuximab vedotin (BV) with ifosfamide-carboplatin-etoposide (ICE) as a second-line therapy in refractory/relapsed (R/R) classical Hodgkin lymphoma (cHL) patients. Phase I study was designed to determine the maximum tolerated dose (MTD) of BV (10 patients) and phase II evaluated the rate of complete metabolic response (CMR) after 2 cycles of BV-ICE (42 patients). There were no dose-limiting toxicities (DLT) during phase I recommending BV 1.8 mg/kg for phase II. Twenty-six patients (61.9%) achieved CMR after 2 cycles of BV-ICE and 37 patients (88%) were transplanted. With a median follow-up of 38 months, the 3-year progression free survival (PFS) and overall survival (OS) rate were 64.3% and 100%, respectively. Hematological toxicities (81%) and infections (21%) were the most frequent adverse event encountered BV-ICE regimen is feasible with manageable toxicities and could be an alternative to other salvage treatments. Trial Registration: ClinicalTrials.gov identifier: NCT02686346.
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Affiliation(s)
| | | | | | - Marc André
- Département d'Hématologie, CHU UCL, Namur, Belgique
| | - Fabien Le Bras
- Unité Hémopathies Lymphoïdes, Hôpital Henri Mondor, Créteil, France
| | | | - Cécile Borel
- Département d'Hématologie, IUCT Oncopole, Toulouse, France
| | | | | | | | - Vincent Ribrag
- Département of Hématologie, Institut Gustave Roussy, Paris, France
| | - Stephanie Guidez
- Service d'Oncologie Hématologique et Thérapie Cellulaire, CHU Poitiers, Poitiers, France
| | | | | | | | - Véronique Edeline
- Service de Médecine Nucléaire, Institut Curie, Hôpital R Huguenin, Saint-Cloud, France
| | - Pauline Brice
- Département d'Hématologie, Hôpital Saint Louis, APHP Paris, Paris, France
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14
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De Re V, Repetto O, Mussolin L, Brisotto G, Elia C, Lopci E, d’Amore ESG, Burnelli R, Mascarin M. Promising drugs and treatment options for pediatric and adolescent patients with Hodgkin lymphoma. Front Cell Dev Biol 2022; 10:965803. [PMID: 36506094 PMCID: PMC9729954 DOI: 10.3389/fcell.2022.965803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Currently-available therapies for newly-diagnosed pediatric and adolescent patients with Hodgkin lymphoma result in >95% survival at 5 years. Long-term survivors may suffer from long-term treatment-related side effects, however, so the past 20 years have seen clinical trials for children and adolescents with HL gradually abandon the regimens used in adults in an effort to improve this situation. Narrower-field radiotherapy can reduce long-term toxicity while maintaining good tumor control. Various risk-adapted chemo-radiotherapy strategies have been used. Early assessment of tumor response with interim positron emission tomography and/or measuring metabolic tumor volume has been used both to limit RT in patients with favorable characteristics and to adopt more aggressive therapies in patients with a poor response. Most classical Hodgkin's lymphoma relapses occur within 3 years of initial treatment, while relapses occurring 5 years or more after diagnosis are rare. As the outcome for patients with relapsed/refractory classical Hodgkin lymphoma remains unsatisfactory, new drugs have been proposed for its prevention or treatment. This review summarizes the important advances made in recent years in the management of pediatric and adolescent with classical Hodgkin lymphoma, and the novel targeted treatments for relapsed and refractory classical Hodgkin lymphoma.
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Affiliation(s)
- Valli De Re
- Immunopatologia e Biomarcatori Oncologici, Dipartimento di Ricerca e Diagnostica Avanzata dei Tumori, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, Aviano, Italy,*Correspondence: Valli De Re, ; Maurizio Mascarin,
| | - Ombretta Repetto
- Immunopatologia e Biomarcatori Oncologici, Dipartimento di Ricerca e Diagnostica Avanzata dei Tumori, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, Aviano, Italy
| | - Lara Mussolin
- Pediatric Hemato-Oncology Unit, Department of Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Giulia Brisotto
- Immunopatologia e Biomarcatori Oncologici, Dipartimento di Ricerca e Diagnostica Avanzata dei Tumori, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, Aviano, Italy
| | - Caterina Elia
- AYA Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico IRCCS, Aviano, Italy
| | - Egesta Lopci
- Nuclear Medicine, IRCCS—Humanitas Research Hospital, Rozzano, MI, Italy
| | | | - Roberta Burnelli
- Pediatric Hematology-Oncology Unit, Azienda Ospedaliera Universitaria, Ospedale Sant’Anna, Ferrara, Italy
| | - Maurizio Mascarin
- AYA Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico IRCCS, Aviano, Italy,*Correspondence: Valli De Re, ; Maurizio Mascarin,
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15
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Zhang XY, Collins GP. Checkpoint Inhibitors and the Changing Face of the Relapsed/Refractory Classical Hodgkin Lymphoma Pathway. Curr Oncol Rep 2022; 24:1477-1488. [PMID: 35696020 PMCID: PMC9606050 DOI: 10.1007/s11912-022-01292-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Checkpoint inhibitors (CPIs) targeting PD1 are highly active in relapsed/refractory classical Hodgkin lymphoma. A plethora of recent studies, often small and non-randomised, have raised many questions about how to optimally integrate these into clinical practice. We aim to discuss the use of CPIs in different relapsed/refractory settings in an effort to better define their role and highlight areas of research. RECENT FINDINGS CPIs have shown efficacy at first relapse, as salvage pre- and post-autologous (ASCT) and allogeneic stem cell transplant (alloSCT) and as maintenance post-ASCT. Immune-related adverse events require careful attention, especially when used peri-alloSCT, where it is associated with hyperacute graft-versus-host disease. Newer PD1 inhibitors, as well as strategies to overcome CPI resistance, are being tested. CPIs are increasingly deployed at earlier points in the classical Hodgkin lymphoma pathway. Whilst progress is clearly being made, randomised studies are required to more clearly define the optimal positioning of these agents.
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Affiliation(s)
- Xiao-Yin Zhang
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Graham P Collins
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- Department of Haematology, Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK.
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16
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Gokmen A, Sahin U, Soydan E, Gokgoz Z, Okcu MK, Ozan U, Arslan O, Ilhan O, Ozcan M. Gemcitabine, Cisplatin, and Dexamethasone as a Salvage and Mobilization Chemotherapy Before Autologous Stem Cell Transplantation is Effective and Safe Outpatient Regimen in Relapsed and Refractory Hodgkin Lymphoma Patients. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e885-e892. [PMID: 35927182 DOI: 10.1016/j.clml.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Second line salvage chemotherapy followed by autologous stem cell transplantation (ASCT) is the current standard treatment for eligible patients with relapsed and refractory (R/R) Hodgkin lymphoma (HL). Several salvage regimens have been used before ASCT. However the optimal salvage regimen is still unclear. We report outcome of patients with R/R HL treated with gemcitabine, cisplatin, and dexamethasone (GDP) regimen before ASCT in this retrospective study aiming at evaluating efficacy, stem cell mobilization activity and safety of GDP in a real-life setting. PATIENTS AND METHODS Forty-five patients with R/R HL who were treated with GDP as salvage and mobilization regimen before ASCT were analyzed retrospectively. Peripheral blood stem cells (PBSC) were collected after GDP. All patients underwent ASCT after 2 cycles of GDP. RESULTS Thirty-six (80%) patients achieved overall response including 24 (53.3%) complete response (CR). PBSC collections were adequate in all patients with a median number of 11.01 × 106/kg CD34+ cells. The most common grade 3/4 hematological adverse events were thrombocytopenia (31.1%) and neutropenia (22.2%). There were no febrile neutropenic episodes. Grade 3 or 4 renal, hepatic, or cardiac toxicity was not observed. The 4 year progression-free survival and overall survival for patients receiving GDP followed by ASCT were 72% and 92%, respectively. CONCLUSION Our results suggest that GDP is a viable therapeutic option before ASCT with high response rate, favorable toxicity profile and excellent mobilization potential. Applicability of GDP on an outpatient setting also provides advantage over other effective salvage regimens.
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Affiliation(s)
- Ayla Gokmen
- Department of Hematology, Medicana Bursa Hospital, Bursa, Turkey.
| | - Ugur Sahin
- Department of Hematology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Ender Soydan
- Department of Hematology, Guven Hospital, Ankara, Turkey
| | - Zafer Gokgoz
- Department of Hematology, Losante Hospital, Ankara, Turkey
| | - Mevlude Kurdal Okcu
- Department of Hematology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Ulku Ozan
- Department of Hematology, Medicana Bursa Hospital, Bursa, Turkey
| | - Onder Arslan
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - Osman Ilhan
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - Muhit Ozcan
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
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17
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Calabretta E, Guidetti A, Ricci F, Di Trani M, Monfrini C, Magagnoli M, Bramanti S, Maspero D, Morello L, Merli M, Di Rocco A, Graudenzi A, Derenzini E, Antoniotti M, Rossi D, Corradini P, Santoro A, Carlo-Stella C. Chemotherapy after PD-1 inhibitors in relapsed/refractory Hodgkin lymphoma: Outcomes and clonal evolution dynamics. Br J Haematol 2022; 198:82-92. [PMID: 35468225 PMCID: PMC9321573 DOI: 10.1111/bjh.18183] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/27/2022]
Abstract
Checkpoint inhibitors (CPIs) are routinely employed in relapsed/refractory classical Hodgkin lymphoma. Nonetheless, persistent long-term responses are uncommon, and one-third of patients are refractory. Several reports have suggested that treatment with CPIs may re-sensitize patients to chemotherapy, however there is no consensus on the optimal chemotherapy regimen and subsequent consolidation strategy. In this retrospective study we analysed the response to rechallenge with chemotherapy after CPI failure. Furthermore, we exploratively characterized the clonal evolution profile of a small sample of patients (n = 5) by employing the CALDER approach. Among the 28 patients included in the study, 17 (71%) were primary refractory and 26 (92%) were refractory to the last chemotherapy prior to CPIs. Following rechallenge with chemotherapy, response was recorded in 23 (82%) patients experiencing complete remission and 3 (11%) patients experiencing partial remission. The tumour evolution of the patients inferred by CALDER seemingly occurred prior to the first cycle of therapy and was characterized either by linear or branching evolution patterns. Twenty-five patients proceeded to allogeneic stem cell transplantation. At a median follow-up of 21 months, median PFS and OS were not reached. In conclusion, patients who fail CPIs can be effectively rescued by salvage chemotherapy and bridged to allo-SCT/auto-SCT.
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Affiliation(s)
- Eleonora Calabretta
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Anna Guidetti
- Division of Hematology and Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,University of Milano, Milan, Italy
| | - Francesca Ricci
- Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Martina Di Trani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Chiara Monfrini
- Division of Hematology and Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Massimo Magagnoli
- Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Stefania Bramanti
- Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Davide Maspero
- Dipartimento di Informatica, Sistemistica e Comunicazione, Università degli Studi di Milano-Bicocca, Milan, Italy.,Institute of Molecular Bioimaging and Physiology, Consiglio Nazionale delle Ricerche (IBFM-CNR), Segrate, Milan, Italy
| | - Lucia Morello
- Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Michele Merli
- Department of Hematology, University Hospital "Ospedale di Circolo e Fondazione Macchi - ASST Sette Laghi", University of Insubria, Varese, Italy
| | - Alice Di Rocco
- Department of Translational and Precision Medicine, La Sapienza University, Rome, Italy
| | - Alex Graudenzi
- Institute of Molecular Bioimaging and Physiology, Consiglio Nazionale delle Ricerche (IBFM-CNR), Segrate, Milan, Italy.,Bicocca Bioinformatics, Biostatistics and Bioimaging Centre (B4), Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Enrico Derenzini
- IEO European Institute of Oncology IRCCS, Milan, Italy.,Department of Health Sciences, University of Milan, Italy
| | - Marco Antoniotti
- Dipartimento di Informatica, Sistemistica e Comunicazione, Università degli Studi di Milano-Bicocca, Milan, Italy.,Bicocca Bioinformatics, Biostatistics and Bioimaging Centre (B4), Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Davide Rossi
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,Institute of Oncology Research, Bellinzona, Switzerland.,Faculty of Biomedical Sciences, USI, Lugano, Switzerland
| | - Paolo Corradini
- Division of Hematology and Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,University of Milano, Milan, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Carmelo Carlo-Stella
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
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18
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Response-adapted anti-PD1 based salvage therapy for Hodgkin lymphoma with nivolumab +/- ICE (NICE). Blood 2022; 139:3605-3616. [PMID: 35316328 DOI: 10.1182/blood.2022015423] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/09/2022] [Indexed: 11/20/2022] Open
Abstract
This phase 2 trial evaluated PET-adapted nivolumab (Nivo) alone or in combination with ifosfamide, carboplatin, and etoposide (NICE) as first salvage therapy and bridge to autologous hematopoietic cell transplantation (AHCT) in relapsed/refractory (RR) classical Hodgkin lymphoma (cHL). Patients with RR cHL received 240mg Nivo every 2 weeks for up to 6 cycles (C). Patients in complete response (CR) after C6 proceeded to AHCT, while patients with progressive disease (PD) at any point or not in CR after C6 received NICE for 2 cycles. The primary endpoint was CR rate per the 2014 Lugano classification at completion of protocol therapy. 43 patients were evaluable for toxicity; 42 were evaluable for response. 34 patients received Nivo alone and 9 patients received Nivo+NICE. No unexpected toxicities were observed after Nivo or NICE. After Nivo, the overall response rate (ORR) was 81% and the CR rate was 71%. Among the 9 patients who received NICE, all responded with 8 (89%) achieving CR. At the end of all protocol therapy, the ORR and CR rates were 93% and 91%. Thirty-three patients were bridged directly to AHCT, including 26 after Nivo alone. The 2-year progression-free survival (PFS) and overall survival in all treated patients (n=43) were 72% (95%CI:56-83) and 95% (95%CI:82-99), respectively. Among the 33 patients who bridged directly to AHCT after protocol therapy, the 2-year PFS was 94% (95%CI:78-98). PET-adapted sequential salvage therapy with Nivo or Nivo+NICE was well-tolerated and effective, resulting in a high CR rate and bridging most patients to AHCT without chemotherapy. This Clinical Trial is registered under NCT03016871.
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19
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Moretti M, Liberati AM, Rigacci L, Puccini B, Pulsoni A, Gini G, Galieni P, Fabbri A, Cantonetti M, Pavone V, Bolis S, Botto B, Renzi D, Falchi L. Brentuximab Vedotin and Bendamustine Produce Long-Term Clinical Benefit in Patients With Relapsed or Refractory Classical Hodgkin Lymphoma: A Multicenter Real-Life Experience. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:198-204. [PMID: 34690088 PMCID: PMC9531864 DOI: 10.1016/j.clml.2021.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/24/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Patients with relapsed or refractory classical Hodgkin lymphoma (R/R cHL) have limited opportunities for curative therapy. High-dose therapy followed by autologous stem cell transplantation (HDT-ASCT) produces cure rates of 50% to 60%. Patients relapsing after, or ineligible for HDT-ASCT have limited therapeutic options and long-term remission is uncommon. Furthermore, few patients are candidate to allogeneic stem cell transplantation (AlSCT), a potentially curative approach. The combination of brentuximab vedotin and bendamustine (BVB) is a promising treatment for patients with R/R cHL, regardless of SCT eligibility. PATIENTS AND METHODS We conducted a real-life study of BVB in 41 patients with R/R cHL after failure of ≥ 1 therapy including ASCT, AlSCT, or BV. RESULTS Among 40 patients evaluable for efficacy, the overall response rate and complete response (CR) rate were 75% and 50%, respectively. No significant differences were observed between patients with primary refractory and relapsed disease, previously treated with ≤ 2 and ≥ 3 lines of therapy, or BV-exposed and BV-naïve. After a median follow-up of 38 months, the median progression free survival (PFS) for the entire population is 26 months; PFS is not reached, 10.5 months, and 4 months for patients achieving CR, partial response and no response, respectively (P < .0001). BVB was well tolerated and no grade 4 toxicity or new safety signals were observed. The most common treatment-emergent adverse events were infections. CONCLUSION Our experience supports the efficacy and tolerability of the BVB combination in R/R cHL as a bridge to SCT, or as a definitive therapy for SCT-ineligible patients. Larger comparative studies testing BVB against standards of care are warranted in both settings.
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Affiliation(s)
| | | | - Luigi Rigacci
- Hematology and Stem Cell Transplant, AziendaOspedalieraSan Camillo Forlanini Roma
| | - Benedetta Puccini
- Hematology Department, Azienda Ospedaliero Universitaria Careggi, Firenze
| | - Alessandro Pulsoni
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University of Roma
| | - Guido Gini
- HematologyDepartment, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Politecnica delle Marche
| | - Piero Galieni
- Hematology and Cell Therapy Unit, Ospedale C. e G. Mazzoni Ascoli Piceno
| | - Alberto Fabbri
- Hematology Unit, Azienda Ospedaliero Universitaria Senese
| | - Maria Cantonetti
- Onco-Hematology Department, Policlinico Ospedaliero Universitario "Tor Vergata" Roma
| | - Vincenzo Pavone
- Hematology and Bone Marrow Transplant, Azienda Ospedaliera Cardinale G. Panico Tricase
| | - Silvia Bolis
- Hematology Department, Azienda Ospedaliera San Gerardo Monza
| | - Barbara Botto
- Hematology Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza Torino
| | - Daniela Renzi
- Hematology and Stem Cell Transplantation Unit, IRCCS Istituto Nazionale Tumori Regina Elena Roma
| | - Lorenzo Falchi
- Lymphoma service, Memorial Sloan Kettering Cancer Center, New York.
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20
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Veilleux O, Claveau JS, Alaoui H, Roy J, Ahmad I, Delisle JS, Kiss T, Bambace NM, Bernard L, Cohen S, Sauvageau G, Fleury I, Mollica L, Roy DC, Seroukh Y, Lachance S. Real-world outcomes of autologous and allogeneic hematopoietic stem cell transplantation for relapsed/refractory Hodgkin lymphoma in the era of novel therapies: a Canadian perspective. Transplant Cell Ther 2021; 28:145-151. [PMID: 34954149 DOI: 10.1016/j.jtct.2021.12.005] [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] [Received: 03/27/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite high cure rates with frontline therapy for Hodgkin lymphoma (HL), about 30% of patients will relapse or have primary refractory disease (R/r). Autologous hematopoietic stem cell transplantation (AHSCT) is the standard of care for R/r disease and alloHSCT is a curative option for patients in second relapse. Novel agents are being incorporated for the treatment of R/r HL, such that the optimal timing of transplant is currently being challenged. Additionally, because access to these new agents varies amongst transplant centers, we sought to offer a Canadian perspective to the treatment of R/r HL and demonstrate the utility and effectiveness of both AHSCT and alloHSCT for the treatment of R/r HL. METHODS This single-center retrospective study examined outcomes in 89 consecutive patients with R/r HL treated with AHSCT between January 2007 and December 2019. A total of 17 patients underwent alloHSCT either as a tandem auto-allo approach or as salvage therapy. RESULTS With a median follow-up of 5.0 years, the estimated 5-year PFS and OS for patients undergoing AHSCT were 57.5% (95% CI 45.2-68.0) and 81.3% (95% CI 70.0-88.8), respectively. Corresponding figures for patients who underwent alloHSCT were 76.5% (95% CI 48.8-90.4) and 82.4% (95% CI 54.7-93.9). NRM at 100 days and 5 years was 0% and 9.4% post AHSCT and 0% and 5.9% post alloHSCT. Cumulative incidence (CI) of acute GVHD at day +100 was 35.3% (95% CI 17.7 - 62.3) and CI of chronic GVHD at 1 year was 23.5% (95% CI 6.9 - 45.8). CONCLUSIONS AHSCT and alloHSCT can both provide robust and prolonged disease control and new agents should be used as a bridge to improve the curative potential of these definitive cellular therapies.
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Affiliation(s)
- Olivier Veilleux
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Sébastien Claveau
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Habiba Alaoui
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Jean Roy
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Imran Ahmad
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Sébastien Delisle
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Thomas Kiss
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Nadia M Bambace
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Léa Bernard
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Sandra Cohen
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Guy Sauvageau
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Isabelle Fleury
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Luigina Mollica
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Denis-Claude Roy
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Yasmina Seroukh
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Sylvie Lachance
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada.
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21
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Herrera AF, Palmer J, Adhikarla V, Yamauchi D, Poku EK, Bading J, Yazaki P, Dandapani S, Mei M, Chen R, Cao T, Karras N, McTague P, Nademanee A, Popplewell L, Sahebi F, Shively JE, Simpson J, Smith DL, Song J, Spielberger R, Tsai NC, Thomas SH, Forman SJ, Colcher D, Wu AM, Wong J, Smith E. Anti-CD25 radioimmunotherapy with BEAM autologous hematopoietic cell transplantation conditioning in Hodgkin lymphoma. Blood Adv 2021; 5:5300-5311. [PMID: 34638132 PMCID: PMC9153018 DOI: 10.1182/bloodadvances.2021004981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/31/2021] [Indexed: 11/27/2022] Open
Abstract
High-risk relapsed or refractory (R/R) classical Hodgkin lymphoma (HL) is associated with poor outcomes after conventional salvage therapy and autologous hematopoietic cell transplantation (AHCT). Post-AHCT consolidation with brentuximab vedotin (BV) improves progression-free survival (PFS), but with increasing use of BV early in the treatment course, the utility of consolidation is unclear. CD25 is often expressed on Reed-Sternberg cells and in the tumor microenvironment in HL, and we hypothesized that the addition of 90Y-antiCD25 (aTac) to carmustine, etoposide, cytarabine, melphalan (BEAM) AHCT would be safe and result in a transplantation platform that is agnostic to prior HL-directed therapy. Twenty-five patients with high-risk R/R HL were enrolled in this phase 1 dose-escalation trial of aTac-BEAM. Following an imaging dose of 111In-antiCD25, 2 patients had altered biodistribution, and a third developed an unrelated catheter-associated bacteremia; therefore, 22 patients ultimately received therapeutic 90Y-aTac-BEAM AHCT. No dose-limiting toxicities were observed, and 0.6 mCi/kg was deemed the recommended phase 2 dose, the dose at which the heart wall would not receive >2500 cGy. Toxicities and time to engraftment were similar to those observed with standard AHCT, though 95% of patients developed stomatitis (all grade 1-2 per Bearman toxicity scale). Seven relapses (32%) were observed, most commonly in patients with ≥3 risk factors. The estimated 5-year PFS and overall survival probabilities among 22 evaluable patients were 68% and 95%, respectively, and non-relapse mortality was 0%. aTac-BEAM AHCT was tolerable in patients with high-risk R/R HL, and we are further evaluating the efficacy of this approach in a phase 2 trial. This trial was registered at www.clinicaltrials.gov as #NCT01476839.
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Affiliation(s)
- Alex F. Herrera
- Department of Hematology and Hematopoietic Cell Transplantation
| | | | | | | | | | | | | | | | - Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation
| | - Robert Chen
- Department of Hematology and Hematopoietic Cell Transplantation
| | - Thai Cao
- Department of Hematology and Hematopoietic Cell Transplantation
| | | | | | | | | | - Firoozeh Sahebi
- Department of Hematology and Hematopoietic Cell Transplantation
| | | | | | | | - Joo Song
- Department of Pathology, City of Hope National Medical Center, Duarte, CA
| | | | - Ni-Chun Tsai
- Department of Computational and Quantitative Biology
| | | | | | | | - Anna M. Wu
- Department of Immunology and Theranostics
| | | | - Eileen Smith
- Department of Hematology and Hematopoietic Cell Transplantation
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22
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Stem-Cell Transplantation in Adult Patients with Relapsed/Refractory Hodgkin Lymphoma. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2040038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although the majority of patients with Hodgkin lymphoma (HL) are cured with initial therapy, in 85–90% of early stage and 70–80% of advanced-stage disease cases, relapse remains a major problem. Autologous stem-cell transplantation (auto-HCT) after salvage chemotherapy is currently considered to be the standard of care for patients who relapse after first-line chemotherapy or for whom first-line treatment fails. The curative capacity of auto-HCT has been improving with the introduction of new drug-based salvage strategies and consolidation strategies after auto-HCT. Allogeneic stem-cell transplantation (allo-HCT) represents a reasonable treatment option for young patients who relapse or progress after auto-HCT and have chemosensitive disease at the time of transplantation. Allo-HCT is a valid treatment strategy for patients with relapse/refractory HL (r/r HL) because the results have improved over time, mainly with the safe combination of allo-HCT and new drugs. Bearing in mind that outcomes after haploidentical stem-cell transplantation (haplo-HCT) are comparable with those for matched sibling donors and matched unrelated donors, haplo-HCT is now the preferred alternative donor source for patients with r/r HL without a donor or when there is urgency to find a donor if a matched related donor is not present. The development of new drugs such as anti-CD 30 monoclonal antibodies and checkpoint inhibitors (CPI) for relapsed or refractory HL has demonstrated high response rates and durable remissions, and challenged the role and timing of HCT. The treatment of patients with HL who develop disease recurrence or progression after allo-HCT remains a real challenge and an unmet need.
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23
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Prakash G, Jain A, Sahu K, Bal A, Singh C, Basher R, Singh H, Mishra K, Jandial A, Lad D, Khadwal A, Srinivasan R, Das A, Varma N, Varma S, Malhotra P. Bendamustine in combination with ifosfamide, etoposide, and vinorelbine (VIBE) is an effective salvage regimen for heavily pre-treated patients with relapsed or refractory Hodgkin lymphoma: a single-center experience. Blood Res 2021; 56:134-140. [PMID: 34400589 PMCID: PMC8478624 DOI: 10.5045/br.2021.2021039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/07/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study evaluated the outcomes of patients with refractory/relapsed Hodgkin lymphoma (RRHL) treated with a bendamustine-based regimen in combination with ifosfamide, etoposide, and vinorelbine (VIBE). Methods Consecutive RRHL patients who were treated with the VIBE regimen were identified and studied for clinicopathologic characteristics, response to VIBE regimen, event-free survival (EFS), and feasibility of an autologous stem-cell transplant (autoSCT). Results In total, 24 patients received the VIBE regimen, and a median of 3 cycles were administered. In this cohort, 80% of the patients had received ≥2 prior lines of therapy. The overall and complete response rates with VIBE were 79% and 42%, respectively. After a median follow-up (following VIBE regimen) of 14 months (range, 3‒76), the 3-year EFS and OS were 46% and 74%, respectively. Of the eligible patients, 92% underwent successful AutoSCT. The mean CD34+ cell count in the autograft was 5.5×106/kg (SD 2.07). Neutropenia was the commonest hematologic toxicity and it was observed in 42% of the patients. However, only 9% of the patients developed grade III/IV febrile neutropenia. Chemotherapy-induced nausea and vomiting were the second most common grade III/IV toxicities in our cohort of patients. Conclusion In this retrospective analysis, the combination regimen, VIBE, has shown good efficacy in heavily pre-treated patients with RRHL without compromising stem cell collection. These encouraging results provide a rationale for further development of this regimen.
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Affiliation(s)
- Gaurav Prakash
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arihant Jain
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamalkant Sahu
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Charanpreet Singh
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajender Basher
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harmandeep Singh
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kundan Mishra
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya Jandial
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepesh Lad
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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24
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Akay OM, Ozbalak M, Pehlivan M, Yildiz B, Uzay A, Yigenoglu TN, Elverdi T, Kaynar L, Ayyildiz O, Yonal Hindilerden I, Goksoy HS, Izmir Guner S, Gunes AK, Sonmez M, Kurt Yuksel M, Civriz Bozdag S, Ozkurt ZN, Toptas T, Dogu MH, Salim O, Saydam G, Yavasoglu I, Ayli M, Ozet G, Albayrak M, Birtas Atesoglu E, Toprak SK, Yildirim R, Mehtap O, Kalayoglu Besisik S, Nalcaci M, Altuntas F, Ferhanoglu B. Brentuximab vedotin consolidation therapy after autologous stem-cell transplantation in patients with high-risk Hodgkin lymphoma: Multicenter retrospective study. Hematol Oncol 2021; 39:498-505. [PMID: 34171130 DOI: 10.1002/hon.2897] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/03/2021] [Accepted: 06/17/2021] [Indexed: 11/09/2022]
Abstract
The AETHERA trial reported an increased progression-free survival (PFS) when brentuximab vedotin (BV) was used as maintenance therapy in high-risk Hodgkin lymphoma (HL) after autologous stem cell transplantation (ASCT). Thus, we aimed to determine the impact and safety of BV as maintenance after ASCT in real-world patients. Seventy-five patients with relapsed/refractory HL started on BV consolidation therapy after ASCT due to high risk of relapse, between January 2016 and July 2019, from 25 institutions, were included in the study. The median follow-up time was 26 months. The most common high-risk features were primary refractory or relapsed disease <12 months (n = 61), lack of complete response (CR) to the last salvage regimen (n = 51), and having had at least two salvage regimens (n = 29). At the time of analysis, 42 patients completed consolidation courses, and BV was discontinued in 33 patients. Fifty patients had an ongoing response (CR in 41, PR in 6, and SD in 3 patients), 25 had progressed. Ten died in the follow-up, eight with progressive disease and two due to infection while in CR. The 2-year PFS and OS rates were 67.75% (95% confidence interval [CI]: 0.55-0.77) and 87.61% (95% CI: 0.76-0.94), respectively. Seventeen patients (23%) received BV in the pre-ASCT treatment lines, and there was no survival difference between the BV-naïve and BV-exposed groups. The most common adverse events were neutropenia (27%) and peripheral neuropathy (21%). Sixteen patients (21.3%) experienced grade 3 or 4 toxicity. BV was discontinued due to adverse event in 12 patients. Consolidation with BV after ASCT can achieve a 2-year PFS of 67.75% (95% CI: 0.55-0.75) with an acceptable toxicity profile.
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Affiliation(s)
- Olga Meltem Akay
- Department of Internal Medicine, Division of Hematology, Koç University Medical Faculty, Istanbul, Turkey
| | - Murat Ozbalak
- Department of Internal Medicine, Division of Hematology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mustafa Pehlivan
- Department of Internal Medicine, Division of Hematology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Birol Yildiz
- Department of Internal Medicine, Division of Medical Oncology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Ant Uzay
- Depatment of Hematology, Acıbadem University Medical Faculty, Istanbul, Turkey
| | - Tugce Nur Yigenoglu
- Division of Hematology, Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Tugrul Elverdi
- Department of Internal Medicine, Division of Hematology, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Leylagul Kaynar
- Department of Internal Medicine, Division of Hematology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Orhan Ayyildiz
- Department of Internal Medicine, Division of Hematology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Ipek Yonal Hindilerden
- Department of Internal Medicine, Division of Hematology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hasan Sami Goksoy
- Depatment of Hematology, Yeniyuzyıl University Gaziosmanpaşa Hospital, Istanbul, Turkey
| | | | | | - Mehmet Sonmez
- Department of Internal Medicine, Division of Hematology, Karadeniz Technical University, Trabzon, Turkey
| | - Meltem Kurt Yuksel
- Department of Internal Medicine, Division of Hematology, Ankara University Medical Faculty, Ankara, Turkey
| | - Sinem Civriz Bozdag
- Department of Internal Medicine, Division of Hematology, Ankara University Medical Faculty, Ankara, Turkey
| | - Zubeyde Nur Ozkurt
- Department of Internal Medicine, Division of Hematology, Gazi University Medical Faculty, Ankara, Turkey
| | - Tayfur Toptas
- Department of Internal Medicine, Division of Hematology, Marmara University Medical Faculty, Istanbul, Turkey
| | - Mehmet Hilmi Dogu
- Division of Hematology, Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Ozan Salim
- Department of Internal Medicine, Division of Hematology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Guray Saydam
- Department of Internal Medicine, Division of Hematology, Ege University Medical Faculty, Izmir, Turkey
| | - Irfan Yavasoglu
- Department of Internal Medicine, Division of Hematology, Adnan Menderes University Medical Faculty, Aydın, Turkey
| | - Meltem Ayli
- Department of Internal Medicine, Division of Medical Oncology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Gulsum Ozet
- Division of Hematology, Ankara City Hospital, Ankara, Turkey
| | - Murat Albayrak
- Division of Hematology, Dışkapı Research and Training Hospital, Ankara, Turkey
| | | | - Selami K Toprak
- Department of Internal Medicine, Division of Hematology, Ankara University Medical Faculty, Ankara, Turkey
| | - Rahsan Yildirim
- Department of Internal Medicine, Division of Hematology, Ataturk University Medical Faculty, Erzurum, Turkey
| | - Ozgur Mehtap
- Department of Internal Medicine, Division of Hematology, Kocaeli University Medical Faculty, İzmit, Turkey
| | - Sevgi Kalayoglu Besisik
- Department of Internal Medicine, Division of Hematology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Meliha Nalcaci
- Department of Internal Medicine, Division of Hematology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fevzi Altuntas
- Division of Hematology, Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Burhan Ferhanoglu
- Department of Internal Medicine, Division of Hematology, Koç University Medical Faculty, Istanbul, Turkey.,Division of Hematology, V.K.V. American Hospital, İstanbul, Turkey
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25
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Chen M, Jiang Y, Cai X, Lu X, Chao H. Combination of Gemcitabine and Thymosin alpha 1 exhibit a better anti-tumor effect on nasal natural killer/T-cell lymphoma. Int Immunopharmacol 2021; 98:107829. [PMID: 34119916 DOI: 10.1016/j.intimp.2021.107829] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/13/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nasal natural killer/T-cell lymphoma (NNKTL) is an aggressive and poor prognostic malignant tumor along with high-level infection of Epstein-Barr virus (EBV). Gemcitabine (Gem) and Thymosin alpha 1 (Tα1) exert an anti-tumor effect in various cancers. However, the effect of the combination of Gem and Tα1 in NNKTL remains unknown. METHODS SNK6 cells were treated with Gem, Tα1 and Gem plus Tα1 for 48 h. The expression levels of EBV and inflammatory factors were measured by qRT-PCR assay. The effect of Gem and Tα1 on cell viability, proliferation, apoptosis, autophagy was detected by CCK-8, colony formation, flow cytometry, autophagic flux measurement, respectively. Western blot was used to evaluate the expression of proteins related to epithelial-mesenchymal transition (EMT), apoptosis and autophagy. In vivo xenograft models were used to further verify the roles of Gem and Tα1. Tumors were removed for weight measurement, H&E and IHC staining. RESULTS We identified that the half maximal inhibitory concentration (IC50) of Gem and Tα1 was 116.5 μmol/ml and 1.334 μmol/ml. Alone or combined administration of Gem and Tα1 dramatically attenuated the EBV viral load and promoted inflammatory factors expression in SNK6 cells, among which the combination of Gem and Tα1 treatment showed the most significant effect. Besides, combination treatment with Gem and Tα1 markedly inhibited cell growth and EMT progress, and enhanced apoptosis and autophagy. Similarly, Gem combined with Tα1 suppressed tumor growth, promoted apoptosis and autophagy in vivo. Additionally, combination treatment with Gem and Tα1 inhibited PI3K/AKT/mTOR pathway. CONCLUSION In summary, combination administration of Gem and Tα1 suppressed the progression of NNKTL in vivo and in vitro. Our study provided an effective therapeutic strategy potentially for the clinical treatment of NNKTL.
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Affiliation(s)
- Meiyu Chen
- Department of Hematology, Affiliated Changzhou Second Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China.
| | - Yu Jiang
- Department of Hematology, Affiliated Changzhou Second Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China.
| | - Xiaohui Cai
- Department of Hematology, Affiliated Changzhou Second Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China
| | - Xuzhang Lu
- Department of Hematology, Affiliated Changzhou Second Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China
| | - Hongying Chao
- Department of Hematology, Affiliated Changzhou Second Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China.
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26
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Five-year results of the BEGEV salvage regimen in relapsed/refractory classical Hodgkin lymphoma. Blood Adv 2021; 4:136-140. [PMID: 31935284 DOI: 10.1182/bloodadvances.2019000984] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/19/2019] [Indexed: 12/11/2022] Open
Abstract
The complete remission (CR) rate achieved with induction chemotherapy prior to autologous stem cell transplantation (ASCT) represents the strongest prognostic factor in relapsed/refractory (R/R) classical Hodgkin lymphoma (cHL). By inducing a CR rate of 75%, the bendamustine, gemcitabine, vinorelbine (BEGEV) regimen represents an optimal chemotherapy regimen prior to ASCT. Presented here are the 5-year results of BEGEV followed by ASCT in R/R cHL. With a median follow-up of 5 years, progression-free survival (PFS) and overall survival (OS) for the whole series (n = 59) were 59% and 78%, respectively. ASCT was performed in 43 of 49 responding patients (73% by intention to treat [ITT]; 88% by response to BEGEV) and resulted in 33 with continuous CR (56% by ITT; 77% of transplanted patients), 7 with disease relapse, and 3 with nonrelapse mortality. For patients who received transplants, the 5-year PFS and OS were 77% and 91%, respectively, with no significant difference between relapsed and refractory patients. No patient experienced secondary leukemia or myelodysplasia. In summary, the long-term efficacy data, the benefits for both relapsed and refractory patients, and the excellent safety profile provide a strong rationale for further development of the BEGEV regimen. This trial was registered at EudraCT as #2010-022169-91 and at www.clinicaltrials.gov as #NCT01884441.
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27
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How we incorporate novel agents into the treatment of classic Hodgkin lymphoma. Blood 2021; 138:520-530. [PMID: 33889927 DOI: 10.1182/blood.2020007900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/26/2021] [Indexed: 11/20/2022] Open
Abstract
The introduction of targeted immunotherapies specifically, brentuximab vedotin (BV) and programmed death-1 (PD-1) blocking antibodies (nivolumab and pembrolizumab), has reshaped the therapeutic landscape of classic Hodgkin lymphoma (cHL) in the past decade. Targeting specific biologic features of cHL, these novel agents have expanded treatment options for patients with multiply rel/ref cHL and have increasingly been studied at earlier points in a patient's disease course. With the plethora of studies evaluating BV and PD-1 blockade as part of cHL therapy, often in non-randomized, controlled studies, more questions than answers have arisen about how to optimally integrate these drugs into clinical practice. In this article, we use a case-based format to offer practical guidance on how we incorporate BV and anti-PD1 antibodies into the management of cHL and review the data supporting those recommendations.
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Brentuximab vedotin in combination with nivolumab in relapsed or refractory Hodgkin lymphoma: 3-year study results. Blood 2021; 138:427-438. [PMID: 33827139 DOI: 10.1182/blood.2020009178] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/18/2021] [Indexed: 01/17/2023] Open
Abstract
This phase 1-2 study evaluated brentuximab vedotin (BV) combined with nivolumab (Nivo) as first salvage therapy in patients with relapsed or refractory classical Hodgkin lymphoma. In parts 1 and 2, patients received staggered dosing of BV and Nivo in cycle 1, followed by same-day dosing in cycles 2-4. In part 3, both study drugs were dosed same day for all 4 cycles. At end of study treatment, patients could undergo autologous stem cell transplantation (ASCT) per investigator discretion. The objective response rate (N=91) was 85%, with 67% achieving a complete response. At a median follow-up of 34.3 months, the estimated progression-free survival (PFS) rate at 3 years was 77% (95% confidence interval [CI]: 65% to 86%) and 91% (95% CI, 79% to 96%) for patients undergoing ASCT directly after study treatment. Overall survival at 3 years was 93% (95% CI, 85% to 97%). The most common adverse events (AEs) prior to ASCT were nausea (52%) and infusion-related reactions (43%), all grade 1 or 2. A total of 16 patients (18%) had immune-related AEs that required systemic corticosteroid treatment. Peripheral blood immune signatures were consistent with an activated T-cell response. Median gene expression of CD30 in tumors was higher in patients who responded compared with those who did not. Longer-term follow up of BV and Nivo as a first salvage regimen shows durable efficacy and impressive PFS, especially in patients who proceeded directly to transplant, without additional toxicity concerns.
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29
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Kersten MJ, Driessen J, Zijlstra JM, Plattel WJ, Morschhauser F, Lugtenburg PJ, Brice P, Hutchings M, Gastinne T, Liu R, Burggraaff CN, Nijland M, Tonino SH, Arens AIJ, Valkema R, van Tinteren H, Lopez-Yurda M, Diepstra A, De Jong D, Hagenbeek A. Combining brentuximab vedotin with dexamethasone, high-dose cytarabine and cisplatin as salvage treatment in relapsed or refractory Hodgkin lymphoma: the phase II HOVON/LLPC Transplant BRaVE study. Haematologica 2021; 106:1129-1137. [PMID: 32273476 PMCID: PMC8018114 DOI: 10.3324/haematol.2019.243238] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/19/2020] [Indexed: 12/13/2022] Open
Abstract
Achieving a metabolic complete response (mCR) before high-dose chemotherapy (HDC) and autologous peripheral blood stem-cell transplant (auto-PBSCT) predicts progression free survival (PFS) in relapsed/refractory classical Hodgkin lymphoma (R/R cHL). We added brentuximab vedotin (BV) to DHAP to improve the mCR rate. In a Phase I dose-escalation part in 12 patients, we showed that BV-DHAP is feasible. This Phase II study included 55 R/R cHL patients (23 primary refractory). Treatment consisted of three 21-day cycles of BV 1.8 mg/kg on day 1, and DHAP (dexamethasone 40mg days 1-4, cisplatin 100mg/m2; day 1 and cytarabine 2x2g/m2; day 2). Patients with a metabolic partial response (mPR) or mCR proceeded to HDC/auto-PBSCT. Based on independent central FDG-PET-CT review, 42 of 52 evaluable patients (81% [95% CI: 67-90]) achieved an mCR before HDC/auto-PBSCT, five had an mPR and five had progressive disease (three were not evaluable). After HDC/auto-PBSCT, four patients with an mPR converted to an mCR. The 2-year PFS was 74% [95% CI: 63-86], and the overall survival 95% [95% CI: 90-100]. Toxicity was manageable and mainly consisted of grade 3/4 hematological toxicity, fever, nephrotoxicity, ototoxicity (grade 1/2) and transiently elevated liver enzymes during BV-DHAP. Eighteen patients developed new onset peripheral neuropathy (maximum grade 1/2) and all recovered. In conclusion, BV-DHAP is a very effective salvage regimen in R/R cHL patients, but patients should be monitored closely for toxicity. ClinicalTrials.gov identifier: NCT02280993.
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Affiliation(s)
- Marie José Kersten
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE, Amsterdam, The Netherlands
| | - Julia Driessen
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE, Amsterdam, The Netherlands
| | - Josée M Zijlstra
- Dept of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wouter J Plattel
- Dept of Hematology, University of Groningen, UMC Groningen, Groningen, The Netherlands
| | | | | | - Pauline Brice
- Dept of Hematology, Hopital Saint Louis, Paris, France
| | | | - Thomas Gastinne
- Dept of Hematology, Centre Hospitalier Universitaire, Nantes, France
| | - Roberto Liu
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Coreline N Burggraaff
- Dept of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marcel Nijland
- Dept of Hematology, University of Groningen, UMC Groningen, Groningen, The Netherlands
| | - Sanne H Tonino
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE, Amsterdam, The Netherlands
| | - Anne I J Arens
- Dept of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Roelf Valkema
- Dept of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Harm van Tinteren
- Dept of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marta Lopez-Yurda
- Dept of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Arjan Diepstra
- Dept. of Pathology and Medical Biology, UMC Groningen, University of Groningen, the Netherlands
| | - Daphne De Jong
- Dept of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anton Hagenbeek
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE, Amsterdam, The Netherlands
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Swoboda R, Giebel S, Knopińska-Posłuszny W, Chmielowska E, Drozd-Sokołowska J, Paszkiewicz-Kozik E, Kulikowski W, Taszner M, Mendrek W, Najda J, Czerw T, Olszewska-Szopa M, Czyż A, Giza A, Spychałowicz W, Subocz E, Szwedyk P, Krzywon A, Wilk A, Zaucha JM. High efficacy of BGD (bendamustine, gemcitabine, and dexamethasone) in relapsed/refractory Hodgkin Lymphoma. Ann Hematol 2021; 100:1755-1767. [PMID: 33625572 PMCID: PMC8195914 DOI: 10.1007/s00277-021-04448-5] [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: 05/30/2020] [Accepted: 02/02/2021] [Indexed: 10/25/2022]
Abstract
The optimal salvage therapy in relapsed/refractory Hodgkin lymphoma (R/R HL) has not been defined so far. The goal of this multicenter retrospective study was to evaluate efficacy and safety of BGD (bendamustine, gemcitabine, dexamethasone) as a second or subsequent line of therapy in classical R/R HL. We have evaluated 92 consecutive R/R HL patients treated with BGD. Median age was 34.5 (19-82) years. Fifty-eight patients (63%) had received 2 or more lines of chemotherapy, 32 patients (34.8%) radiotherapy, and 21 patients (22.8%) an autologous hematopoietic stem cell transplantation (autoHCT). Forty-four patients (47.8%) were resistant to first line of chemotherapy. BGD therapy consisted of bendamustine 90 mg/m2 on days 1 and 2, gemcitabine 800 mg/m2 on days 1 and 4, dexamethasone 40 mg on days 1-4. Median number of BGD cycles was 4 (2-7). The following adverse events ≥ 3 grade were noted: neutropenia (22.8%), thrombocytopenia (20.7%), anemia (15.2%), infections (10.9%), AST/ALT increase (2.2%), and skin rush (1.1%). After BGD therapy, 51 (55.4%) patients achieved complete remission, 23 (25%)-partial response, 7 (7.6%)-stable disease, and 11 (12%) patients experienced progression disease. AutoHCT was conducted in 42 (45.7%) patients after BGD therapy, and allogeneic HCT (alloHCT) in 16 (17.4%) patients. Median progression-free survival was 21 months. BGD is a highly effective, well-tolerated salvage regimen for patients with R/R HL, providing an excellent bridge to auto- or alloHCT.
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Affiliation(s)
- Ryszard Swoboda
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice branch, Gliwice, Poland
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice branch, Gliwice, Poland
| | | | - Ewa Chmielowska
- Oncologic Hospital, Tomaszów Mazowiecki, Poland.,Department of Oncology, Oncology Centre, Bydgoszcz, Poland
| | - Joanna Drozd-Sokołowska
- Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Paszkiewicz-Kozik
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw branch, Warsaw, Poland
| | - Waldemar Kulikowski
- Department of Hematology, Independent Public Health Care Ministry of the Interior of Warmia and Mazury Oncology Center, Olsztyn, Poland
| | - Michał Taszner
- Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk, Poland
| | - Włodzimierz Mendrek
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice branch, Gliwice, Poland
| | - Jacek Najda
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice branch, Gliwice, Poland
| | - Tomasz Czerw
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice branch, Gliwice, Poland
| | - Magdalena Olszewska-Szopa
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wrocław Medical University, Wrocław, Poland
| | - Anna Czyż
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wrocław Medical University, Wrocław, Poland
| | - Agnieszka Giza
- Department of Hematology, Jagiellonian University, Krakow, Poland
| | - Wojciech Spychałowicz
- Internal Medicine and Oncology Clinic, Silesian Medical University, Katowice, Poland
| | - Edyta Subocz
- Department of Hematology, Military Institute of Medicine, Warsaw, Poland
| | - Paweł Szwedyk
- Department of Hematology, Ludwik Rydygier Hospital, Krakow, Poland
| | - Aleksandra Krzywon
- Department of Biostatistics and Bioinformatics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Agata Wilk
- Department of Biostatistics and Bioinformatics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Jan Maciej Zaucha
- Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk, Poland.
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Integrating Novel Agents in Relapsed or Refractory Hodgkin Lymphoma: Highlights From SOHO 2020. J Adv Pract Oncol 2021; 12:23-26. [PMID: 33614187 PMCID: PMC7871662 DOI: 10.6004/jadpro.2021.12.1.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
At the 2020 SOHO Annual Meeting, Alex F. Herrera, MD, of City of Hope, discussed the integration of novel agents into the management of patients with relapsed or refractory Hodgkin lymphoma. Kelly Valla, PharmD, BCOP, of Winship Cancer Institute of Emory University, discusses insights from this session for advanced practitioners.
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32
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Dada R, Abdelghani EM, Boubakra T, Vayani J, Yousof O, Heaphy ELG, Nawaz A. Outpatient fractionated ICE protocol in relapsed/refractory lymphomas: Efficacy and safety. J Oncol Pharm Pract 2021; 28:287-295. [PMID: 33470173 DOI: 10.1177/1078155220988062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
METHODS In this retrospective trial, we analyzed data of patients with relapsed/refractory lymphoma who received outpatient fractionated ICE between 2011-2017 at a tertiary care center. The three weekly ICE protocol consisted of: ifosfamide 1500 mg/m2 infused over 2 h on days 1-3, carboplatin (5 AUC) on day 1, and etoposide 100 mg/m2 on days 1-3. Rituximab 375 mg/m2 was given to patients with CD20 positive B cell Non-Hodgkin lymphoma. RESULTS Total of 89 patients were included in this research project. Majority of patients had Hodgkin lymphoma (64%). Mean number of ICE cycles received was 2.5. Complete remission and partial remission rates for primary refractory (62.9%) and non-primary refractory (36.4%) disease were 10.5% and 26.3% versus 41.9% and 29.0% respectively. Event free survival rate was 14.5 months (95% CI 7.7-28.0) and overall survival rate 88.7 months (95% CI 48.1-NR). Grade 3 hematological toxicities were documented in 19.1% of patients with 10.1% experiencing neutropenia and 9% thrombocytopenia. 5.6% had febrile neutropenia. CONCLUSIONS Our study included, to our knowledge, the largest number of patients treated with outpatient fractionated ICE. Results demonstrated that this regimen might be a reasonable replacement for classic ICE regimen in many patients with lymphoma. It has a favorable safety profile. However, patients with primary refractory lymphomas need more effective regimens.
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Affiliation(s)
- Reyad Dada
- Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah, Kingdom of Saudi Arabia.,College of Medicine, Al-Faisal University, Riyadh, Kingdom of Saudi Arabia
| | - Ehab Mosaad Abdelghani
- Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah, Kingdom of Saudi Arabia.,Medical Oncology, Cairo University, Egypt
| | - Tarek Boubakra
- Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah, Kingdom of Saudi Arabia
| | - Jaweed Vayani
- Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah, Kingdom of Saudi Arabia
| | - Osama Yousof
- Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah, Kingdom of Saudi Arabia.,Radiation Oncology and Nuclear Medicine, Cairo University, Egypt
| | - Emily L Goldman Heaphy
- Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah, Kingdom of Saudi Arabia
| | - Azhar Nawaz
- Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah, Kingdom of Saudi Arabia
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Lee JM, Choi JY, Hong KT, Kang HJ, Shin HY, Baek HJ, Kook H, Kim S, Lee JW, Chung NG, Cho B, Cho SG, Park KM, Yang EJ, Lim YT, Suh JK, Kang SH, Kim H, Koh KN, Im HJ, Seo JJ, Cho HW, Ju HY, Lee JW, Yoo KH, Sung KW, Koo HH, Park KD, Hah JO, Kim MK, Han JW, Hahn SM, Lyu CJ, Shim YJ, Kim HS, Do YR, Yoo JW, Lim YJ, Jeon IS, Chueh HW, Oh SY, Choi HS, Park JE, Lee JA, Park HJ, Park BK, Kim SK, Lim JY, Park ES, Park SK, Choi EJ, Choi YB, Yoon JH. Clinical Characteristics and Treatment Outcomes in Children, Adolescents, and Young-adults with Hodgkin's Lymphoma: a KPHOG Lymphoma Working-party, Multicenter, Retrospective Study. J Korean Med Sci 2020; 35:e393. [PMID: 33258329 PMCID: PMC7707923 DOI: 10.3346/jkms.2020.35.e393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/23/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Hodgkin's lymphoma (HL) constitutes 10%-20% of all malignant lymphomas and has a high cure rate (5-year survival, around 90%). Recently, interest has increased concerning preventing secondary complications (secondary cancer, endocrine disorders) in long-term survivors. We aimed to study the epidemiologic features and therapeutic outcomes of HL in children, adolescents, and young adults in Korea. METHODS We performed a multicenter, retrospective study of 224 patients aged < 25 years diagnosed with HL at 22 participating institutes in Korea from January 2007 to August 2016. RESULTS A higher percentage of males was diagnosed at a younger age. Nodular sclerosis histopathological HL subtype was most common, followed by mixed cellularity subtype. Eighty-one (36.2%), 101 (45.1%), and 42 (18.8%) patients were classified into low, intermediate, and high-risk groups, respectively. Doxorubicin, bleomycin, vinblastine, dacarbazine was the most common protocol (n = 102, 45.5%). Event-free survival rate was 86.0% ± 2.4%, while five-year overall survival (OS) rate was 96.1% ± 1.4%: 98.7% ± 1.3%, 97.7% ± 1.6%, and 86.5% ± 5.6% in the low, intermediate, and high-risk groups, respectively (P = 0.021). Five-year OS was worse in patients with B-symptoms, stage IV disease, high-risk, splenic involvement, extra-nodal lymphoma, and elevated lactate dehydrogenase level. In multivariate analysis, B-symptoms and extra-nodal involvement were prognostic factors for poor OS. Late complications of endocrine disorders and secondary malignancy were observed in 17 and 6 patients, respectively. CONCLUSION This is the first study on the epidemiology and treatment outcomes of HL in children, adolescents, and young adults in Korea. Future prospective studies are indicated to develop therapies that minimize treatment toxicity while maximizing cure rates in children, adolescents, and young adults with HL.
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Affiliation(s)
- Jae Min Lee
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Korea
| | - Jung Yoon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Seoul National University Cancer Institute, Seoul, Korea
| | - Kyung Taek Hong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Seoul National University Cancer Institute, Seoul, Korea
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Seoul National University Cancer Institute, Seoul, Korea
| | - Hee Young Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Seoul National University Cancer Institute, Seoul, Korea
| | - Hee Jo Baek
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hoon Kook
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea.
| | - Seongkoo Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Wook Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nack Gyun Chung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Bin Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Goo Cho
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Mi Park
- Department of Pediatrics, Pusan National University School of Medicines, Yangsan, Korea
| | - Eu Jeen Yang
- Department of Pediatrics, Pusan National University School of Medicines, Yangsan, Korea
| | - Young Tak Lim
- Department of Pediatrics, Pusan National University School of Medicines, Yangsan, Korea
| | - Jin Kyung Suh
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Han Kang
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyery Kim
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Nam Koh
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Joon Im
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Jin Seo
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Won Cho
- Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Hee Young Ju
- Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Kyung Duk Park
- Department of Pediatrics and Research Institute of Clinical Medicine of Jeonbuk National University-Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Jeong Ok Hah
- Department of Pediatrics, Daegu Fatima Hospital, Daegu, Korea
| | - Min Kyoung Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Jung Woo Han
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Hahn
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Chuhl Joo Lyu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ye Jee Shim
- Department of Pediatrics, Keimyung University School of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Heung Sik Kim
- Department of Pediatrics, Keimyung University School of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Young Rok Do
- Division of Hemato-oncology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jae Won Yoo
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yeon Jung Lim
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
| | - In Sang Jeon
- Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea
| | - Hee Won Chueh
- Department of Pediatrics, Dong-A University College of Medicine, Busan, Korea
| | - Sung Yong Oh
- Department of Hematology, Dong-A University Hospital, Busan, Korea
| | - Hyoung Soo Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jun Eun Park
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Jun Ah Lee
- Center for Pediatric Oncology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hyeon Jin Park
- Center for Pediatric Oncology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Byung Kiu Park
- Center for Pediatric Oncology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Soon Ki Kim
- Department of Pediatrics, Inha University Hospital, Incheon, Korea
| | - Jae Young Lim
- Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Eun Sil Park
- Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sang Kyu Park
- Department of Pediatrics, School of Medicine, University of Ulsan, Ulsan, Korea
| | - Eun Jin Choi
- Department of Pediatrics, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Young Bae Choi
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Korea
| | - Jong Hyung Yoon
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
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Sureda A, André M, Borchmann P, da Silva MG, Gisselbrecht C, Vassilakopoulos TP, Zinzani PL, Walewski J. Improving outcomes after autologous transplantation in relapsed/refractory Hodgkin lymphoma: a European expert perspective. BMC Cancer 2020; 20:1088. [PMID: 33172440 PMCID: PMC7657361 DOI: 10.1186/s12885-020-07561-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/23/2020] [Indexed: 01/07/2023] Open
Abstract
Autologous stem cell transplantation (ASCT) is a well-established approach to treatment of patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL) recommended by both the European Society for Medical Oncology and the National Comprehensive Cancer Network based on the results from randomized controlled studies. However, a considerable number of patients who receive ASCT will progress/relapse and display suboptimal post-transplant outcomes. Over recent years, a number of different strategies have been assessed to improve post-ASCT outcomes and augment HL cure rates. These include use of pre- and post-ASCT salvage therapies and post-ASCT consolidative therapy, with the greatest benefits demonstrated by targeted therapies, such as brentuximab vedotin. However, adoption of these new approaches has been inconsistent across different centers and regions. In this article, we provide a European perspective on the available treatment options and likely future developments in the salvage and consolidation settings, with the aim to improve management of patients with HL who have a high risk of post-ASCT failure. CONCLUSIONS: We conclude that early intervention with post-ASCT consolidation improves outcomes in patients with R/R HL who require ASCT. Future approvals of targeted agents are expected to further improve outcomes and provide additional treatment options in the coming age of personalized medicine.
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Affiliation(s)
- Anna Sureda
- Hematology Department, Hematopoietic Stem Cell Transplant Programme, Institut Català d'Oncologia-Hospital Duran i Reynals, Gran Via de l'Hospitalet, 199 - 203, 08908, Barcelona, Spain.
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (UB), Barcelona, Spain.
| | - Marc André
- Department of Hematology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Peter Borchmann
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - Maria G da Silva
- Department of Hematology, Instituto Português de Oncologia - Francisco Gentil, Lisbon, Portugal
| | | | - Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Pier Luigi Zinzani
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università degli Studi, Bologna, Italy
| | - Jan Walewski
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie Institute Oncology Center, Warszawa, Poland
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35
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Castagna L, Santoro A, Carlo-Stella C. Salvage Therapy for Hodgkin's Lymphoma: A Review of Current Regimens and Outcomes. J Blood Med 2020; 11:389-403. [PMID: 33149713 PMCID: PMC7603406 DOI: 10.2147/jbm.s250581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/06/2020] [Indexed: 12/20/2022] Open
Abstract
Relapse/refractory Hodgkin lymphoma patients are still a clinical concern. Indeed, despite more effective first-line chemotherapy regimens and better stratification of unresponsive patients by clinical factors and use of early PET, roughly one-third of such patients need salvage chemotherapy and consolidation with high-dose chemotherapy. In this paper, the authors review the different salvage treatments, with special emphasis on newer combinations with brentuximab vedotin or check point inhibitors. The overall response rate is constantly increasing, with a complete remission rate approaching 80%. Functional response evaluation by PET imaging is a strong predictive factor of longer survival, and more sophisticated tools, such as detection of circulating tumour DNA, are emerging to refine the disease-status assessment after treatment. Consolidation by high-dose chemotherapy is still considered the standard of care in chemosensitive patients, leading to a high fraction of patients towards long-term disease control. Maintenance therapy with BV is now approved, reducing disease relapse/progression. An increasing number of Hodgkin lymphoma patients will be cured after first- and second-line therapy, and long-term toxicity needs to be continuously assessed and avoided.
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Affiliation(s)
- Luca Castagna
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan 20089, Italy
| | - Armando Santoro
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan 20089, Italy.,Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan 20090, Italy
| | - Carmelo Carlo-Stella
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan 20089, Italy.,Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan 20090, Italy
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36
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Voorhees TJ, Beaven AW. Therapeutic Updates for Relapsed and Refractory Classical Hodgkin Lymphoma. Cancers (Basel) 2020; 12:E2887. [PMID: 33050054 PMCID: PMC7601361 DOI: 10.3390/cancers12102887] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 11/16/2022] Open
Abstract
Hodgkin lymphoma (HL) is a B-cell malignancy representing approximately one in ten lymphomas diagnosed in the United States annually. The majority of patients with HL can be cured with chemotherapy; however, 5-10% will have refractory disease to front-line therapy and 10-30% will relapse. For those with relapsed or refractory (r/r) HL, salvage chemotherapy followed by autologous stem cell transplant (ASCT) is standard of care, but half of patients will subsequently have disease progression. Relapse following ASCT has been associated with exceedingly poor prognosis with a median survival of only 26 months. However, in recent years, novel agents including brentuximab vedotin (BV) and programmed cell death protein 1 monoclonal antibodies (anti-PD-1, nivolumab and pembrolizumab) have been shown to extend overall survival in r/r HL. With the success of novel agents in relapsed disease after ASCT, these therapies are beginning to show clinically meaningful response rates prior to ASCT. Finally, a new investigation in r/r HL continues to produce promising treatment options even after ASCT including CD30 directed chimeric antigen receptor T-cell therapy. In this review, we will discuss the recent advances of BV and anti-PD-1 therapy prior to ASCT, novel approaches in r/r HL after ASCT, and review active clinical trials.
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Affiliation(s)
| | - Anne W Beaven
- Department of Internal Medicine, Division of Hematology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27514, USA;
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37
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Casadei B, Argnani L, Morigi A, Lolli G, Broccoli A, Pellegrini C, Nanni L, Stefoni V, Coppola PE, Carella M, Cavo M, Zinzani PL. Potential survival benefit for patients receiving autologous hematopoietic stem cell transplantation after checkpoint inhibitors for relapsed/refractory Hodgkin lymphoma: A real-life experience. Hematol Oncol 2020; 38:737-741. [PMID: 32905626 DOI: 10.1002/hon.2803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 12/22/2022]
Abstract
In recent years, novel drugs are available for the patients with relapsed/refractory Hodgkin lymphoma (HL), like immune checkpoint inhibitors (CPi). These drugs have been able to rescue a cohort of patients who subsequently could receive an allogeneic stem-cell transplant (SCT). No data were reported for subsequent autologous SCT (ASCT) after CPi. Here, we report our real-life experience in heavily pretreated HL patients undergoing ASCT as consolidation approach after CPi treatment. A retrospective observational study was conducted. Patients had CPi therapy in the context of clinical trials (n = 6) or in the named patient program (n = 7) between July 2014 and November 2019: 9 out of 13 received pembrolizumab and the remaining four underwent nivolumab. A median of 12 cycles (range, 3-16) of CPi therapy were infused. Thirteen patients underwent ASCT after CPi: 11 (84.6%) patients obtained a complete response (CR) and 2 had progression of disease, with an overall response rate of 84.6%. With a median follow-up of 3.3 years (range, 1.1-5.5), only one CR patient had disease relapse after 3.9 months from ASCT, leading to an estimated disease-free survival of 87.5% at 56.9 months. The estimated 5-year progression-free survival was 73.4% and overall survival was 92.3% at 4.8 years, respectively. No unexpected or cumulative toxicity was observed. Our results indicated that ASCT may represent a further effective therapeutic option as consolidation in HL after CPi treatment that today represents the last conventionally recognized therapeutic line.
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Affiliation(s)
- Beatrice Casadei
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italia
| | - Lisa Argnani
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italia
| | - Alice Morigi
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italia
| | - Ginevra Lolli
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italia
| | - Alessandro Broccoli
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italia
| | - Cinzia Pellegrini
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italia
| | - Laura Nanni
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italia
| | - Vittorio Stefoni
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italia
| | - Paolo Elia Coppola
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italia
| | - Matteo Carella
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italia
| | - Michele Cavo
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italia
| | - Pier Luigi Zinzani
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italia
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38
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Pinczés LI, Szabó R, Illés Á, Földeák D, Piukovics K, Szomor Á, Gopcsa L, Miltényi Z. Real-world efficacy of brentuximab vedotin plus bendamustine as a bridge to autologous hematopoietic stem cell transplantation in primary refractory or relapsed classical Hodgkin lymphoma. Ann Hematol 2020; 99:2385-2392. [PMID: 32748163 PMCID: PMC7481161 DOI: 10.1007/s00277-020-04204-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/27/2020] [Indexed: 11/26/2022]
Abstract
Up to 30% of patients with classical Hodgkin lymphoma (cHL) are not responsive to frontline therapy or relapse after primary treatment. In these cases, autologous hematopoietic stem cell transplantation (AHSCT) is the standard of care. The combination of brentuximab vedotin and bendamustine (BV + B) is an effective salvage regimen in this challenging subpopulation. This nationwide multicenter study investigated the real-world efficacy and safety of the BV + B regimen as a bridge to AHSCT in patients with primary refractory or relapsed cHL. A total of 41 cHL patients underwent AHSCT after receiving at least 1 cycle of BV + B (with brentuximab vedotin given at 1.8 mg/kg on day 1 and bendamustine at 90 mg/m2 on days 1-2 every 4 weeks). After a median of 3 (1-6) cycles of BV + B, the objective response rate was 78%, with 29 (70.7%) patients achieving complete remission. Twelve (29.3%) patients relapsed after AHSCT, 2 (4.9%) of them died, while 2 (4.9%) patients are lost to follow-up. After a median of 17 months of follow-up, the estimated 2-year overall- and progression-free survival after AHSCT was 93 and 62%, respectively. Features of advanced disease at recurrence (p = 0.038) and the presence of stage IV cHL at relapse (p = 0.024) are strong predictor markers of unfavorable outcomes. Twenty-four (58.5%) patients experienced adverse events of any grade, while no grade IV toxicities were reported. BV + B is an effective salvage option with a manageable toxicity profile in cHL. The real-world safety and efficacy of this combination are similar to the observations made on the study population.
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Affiliation(s)
- László Imre Pinczés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - Roxána Szabó
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Árpád Illés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - Dóra Földeák
- Division of Hematology, 2nd Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Klára Piukovics
- Division of Hematology, 2nd Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Árpád Szomor
- Division of Hematology, 1st Department of Internal Medicine, Faculty of Medicine, University of Pécs, Pecs, Hungary
| | - László Gopcsa
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Zsófia Miltényi
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary.
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary.
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39
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Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Armand P, Bello CM, Benitez CM, Bierman PJ, Boughan KM, Dabaja B, Gordon LI, Hernandez-Ilizaliturri FJ, Herrera AF, Hochberg EP, Huang J, Johnston PB, Kaminski MS, Kenkre VP, Khan N, Lynch RC, Maddocks K, McConathy J, McKinney M, Metzger M, Morgan D, Mulroney C, Rabinovitch R, Rosenspire KC, Seropian S, Tao R, Winter JN, Yahalom J, Burns JL, Ogba N. Hodgkin Lymphoma, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:755-781. [PMID: 32502987 DOI: 10.6004/jnccn.2020.0026] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The NCCN Clinical Practice Guidelines in Oncology for Hodgkin Lymphoma (HL) provide recommendations for the management of adult patients with HL. The NCCN panel meets at least annually to review comments from reviewers within their institutions, examine relevant data, and reevaluate and update their recommendations. Current management of classic HL involves initial treatment with chemotherapy alone or combined modality therapy followed by restaging with PET/CT to assess treatment response. Overall, the introduction of less toxic and more effective regimens has significantly advanced HL cure rates. This portion of the NCCN Guidelines focuses on the management of classic HL.
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Affiliation(s)
| | | | - Weiyun Z Ai
- 2UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | | | - Kirsten M Boughan
- 7Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Leo I Gordon
- 9Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Jiayi Huang
- 13Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Ryan C Lynch
- 18Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Kami Maddocks
- 19The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Monika Metzger
- 22St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | - Randa Tao
- 28Huntsman Cancer Institute at the University of Utah
| | - Jane N Winter
- 9Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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40
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Rusconi C, Ciavarella S, Fabbri A, Flenghi L, Puccini B, Re A, Sorio M, Vanazzi A, Zanni M. Treatment of very high-risk classical Hodgkin Lymphoma: cases' selection from real life and critical review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:13-22. [PMID: 32525130 PMCID: PMC7944652 DOI: 10.23750/abm.v91is-5.9911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022]
Abstract
Over the last 4 decades, advances in radiation therapy and the addition of combination chemotherapy have significantly increased the cure rate of patients with HL, with a 5-year OS of about 90% . However, despite high rate of cure after first line of therapy, 5%-10% of HLs are refractory to the treatment, and 10-30% of patients have a disease relapse after a complete response (CR). Relapsed HL can be treated with salvage therapies with a long-lasting complete remission in 80% of cases. In recent years, novel drugs are available for the patients with relapsed/refractory HL, like Brentuximab Vedotin and immune checkpoint inhibitors. These drugs have been able to rescue a cohort of patients who subsequently could receive an allogeneic stem-cell transplant. Our cases have been chosen because they are representative of critical issues in the management of relapsed/refractory HL; our experiences are consistent with what reported by other Authors.
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Affiliation(s)
- Chiara Rusconi
- Division of Haematology, Department of Haematology and Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano.
| | - Sabino Ciavarella
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy.
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy.
| | | | - Benedetta Puccini
- Haematology Unit, Careggi Hospital-University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Alessandro Re
- Department of Hematology, ASST Spedali Civili di Brescia, Italy.
| | - Marco Sorio
- Department of Clinical and Experimental Medicine, Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy.
| | - Anna Vanazzi
- Division of Clinical Hemato-Oncology, Istituto Europeo di Oncologia, Milan, Italy.
| | - Manuela Zanni
- Hematology Unit, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
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Merli F, Ballerini F, Botto B, Gotti M, Pavone V, Pulsoni A, Stefani PM, Massaro F, Viviani S. Hodgkin's lymphoma: post- autologous transplantation consolidation therapy. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:23-29. [PMID: 32525131 PMCID: PMC7944651 DOI: 10.23750/abm.v91is-5.9914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 11/23/2022]
Abstract
A first-line chemotherapy program based on the ABVD regimen is currently considered the golden standard by most hematologists, being able to achieve a cure without any need of subsequent therapies in >70% of patients with advanced-stage Hodgkin's lymphoma (HL). To increase this percentage, efforts in recent decades focused on the development of new therapeutic strategies. A first major effort was the introduction of the BEACOPP chemotherapy regimen, which is able to increase the response rate and to reduce the need of salvage therapies. However, this result did not demonstrate an advantage in terms of overall survival compared to ABVD, mainly due to an excess of non lymphoma-related events in the follow-up phase. Here we describe three clinical cases of young HL patients who had relapsed/refractory disease after the induction chemotherapy. These three clinical cases provide practical and real world evidence in favor of the use of BV in monotherapy as consolidation treatment after autologous stem cells transplantation in patients with relapsed/refractory HL.
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Affiliation(s)
- Francesco Merli
- Hematology Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy.
| | - Filippo Ballerini
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Italy; S. Martino Hospital IRCCS, Genoa, Italy .
| | - Barbara Botto
- Dipartimento di Oncologia ed Ematologia, A.O Città della Salute e della Scienza di Torino, San Giovanni Battista. Torino, Italy .
| | - Manuel Gotti
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Vincenzo Pavone
- Dept. of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
| | - Alessandro Pulsoni
- Department of Cellular Biotechnologies and Hematology, La Sapienza University, Rome, Italy.
| | | | - Fulvio Massaro
- Hematology Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy.
| | - Simonetta Viviani
- Onco-Hematology Division, IEO, European Institute of Oncology, IRCCS, Milan, Italy.
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Brentuximab vedotin followed by bendamustine supercharge for refractory or relapsed Hodgkin lymphoma. Blood Adv 2020; 3:1546-1552. [PMID: 31088808 DOI: 10.1182/bloodadvances.2019000123] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 04/14/2019] [Indexed: 02/07/2023] Open
Abstract
We evaluated the impact on progression-free survival (PFS) of achieving a deep metabolic response at 2-deoxy-2[18F] fluoro-d-glucose positron emission tomography (FDG-PET) in patients with refractory or relapsed (R/R) classic Hodgkin lymphoma (cHL) following a new salvage regimen named Bv+Bs (brentuximab vedotin + bendamustine supercharge), from 2013 to 2017. In this real-life study, 20 consecutive patients (aged <60 years) with R/R cHL after failure of ≥1 salvage treatments received Bv+Bs regimen consisting of 3-days outpatient IV infusions of 1.8 mg/kg of Bv on day 1 of each 3-week cycle combined in sequence to bendamustine on days 2 and 3 of the treatment cycle at a fixed dose of 120 mg/m2 per day, for a total of 4 courses. A robust primary prophylaxis approach, including premedication, antimicrobials, stimulating factors, and cytomegalovirus monitoring, was systematically performed. The 20 patients (all evaluable) underwent 4 courses of Bv+Bs with a median dose intensity of 100% for both Bv and Bs. Ten patients (50%) experienced grade ≥3 treatment-related adverse events, without requiring hospitalization. At post-Bv+Bs reevaluation, 80% of patients had deep metabolic responses with Deauville 5-point scale scores ≤2. Thereafter, 14 patients (70%) received autologous hematopoietic stem cell transplantation (HSCT; peripheral blood stem cells previously harvested in 12 cases), and 4 patients (10%) received allogeneic HSCT. At a median follow-up of 27 months from Bv+Bs regimen initiation, the 2-year PFS of the entire population was 93.7% (95% confidence interval, 62.7% to 99.6%). Our data suggest that Bv+Bs regimen-driven strategy may be a promising salvage option to improve long-term control of high-risk Hodgkin lymphoma.
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Barreca M, Stathis A, Barraja P, Bertoni F. An overview on anti-tubulin agents for the treatment of lymphoma patients. Pharmacol Ther 2020; 211:107552. [PMID: 32305312 DOI: 10.1016/j.pharmthera.2020.107552] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/14/2020] [Indexed: 01/19/2023]
Abstract
Anti-tubulin agents constitute a large class of compounds with broad activity both in solid tumors and hematologic malignancies, due to the interference with microtubule dynamics. Since microtubules play crucial roles in the regulation of the mitotic spindles, the interference with their function usually leads to a block in cell division with arrest at the metaphase/anaphase junction of mitosis, followed to apoptosis. This explains the reason why tubulin-binding agents (TBAs) proved to be extremely active in patients with cancer. Several anti-tubulin agents are indicated in the treatment of patients with lymphomas both alone and in combination chemotherapy regimens. The article reviews the literature on classic and more recent anti-tubulin agents, providing an insight into their mechanisms of action and their use in the treatment of lymphoma.
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Affiliation(s)
- Marilia Barreca
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Palermo, Italy; Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland,; Faculty of Biomedical Sciences, USI, Lugano, Switzerland
| | - Paola Barraja
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Palermo, Italy
| | - Francesco Bertoni
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland,; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland,.
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Iannitto E, Romano A, Scalzulli PR, Bonanno V, Scalone R, Chiarenza A, Pirosa MC, Caruso AL, Minoia C, Mantuano S, De Santis G, Salerno M, Crescimanno A, Porretto F, Li Gioi F, Ricciuti G, Greco A, Pavone E, Guarini A, Tarantini G, Mannina D, Consoli U, Cascavilla N, Di Raimondo F, Musso M. Brentuximab vedotin in association with bendamustine in refractory or multiple relapsed Hodgkin lymphoma. A retrospective real-world study. Eur J Haematol 2020; 104:581-587. [PMID: 32107795 DOI: 10.1111/ejh.13400] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/20/2020] [Accepted: 02/25/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE AND METHODS In order to assess the efficacy of brentuximab vedotin (Bv) in combination with bendamustine (B) in multiple relapsed or refractory (RR) classic Hodgkin lymphoma (cHL), medical records of 47 patients treated with BvB in second relapse or beyond were reviewed. RESULTS The median number of previous treatments was 2 (1-4). Bv was given at 1.8 mg/kg on day 1 and bendamustine at 90 mg/m2 on days 1 and 2 of a 21-day cycle. The median number of BvB cycles was 4 (2-7), and all patients were evaluable for efficacy. The CR and OR rates were 49% and 79%, respectively; 67% of responding patients and 2 in stable disease proceeded to a SCT procedure. After a median follow-up of 19 months (5-47), median PFS was 18 months (95%CI: 23-29), and the 2-year OS was 72%. Significantly longer PFS and OS were observed in patients attaining a major clinical response to treatment and in those who received consolidation with SCT. Fifteen (32%) patients experienced severe (G > 2) toxicity. The main toxicities were neutropenia (23%), gastrointestinal (10%), peripheral sensory neuropathy (11%), and infection (4%). CONCLUSION Our real-world results suggest that BvB is an effective third-line rescue and bridge-to-transplant regimen for RR-cHL patients.
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Affiliation(s)
- Emilio Iannitto
- Department of Oncology, Hematology and BMT Unit, Casa di Cura La Maddalena, Palermo, Italy
| | - Alessandra Romano
- Division of Hematology, AOU Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | | | - Vincenza Bonanno
- Department of Oncology, Hematology and BMT Unit, Casa di Cura La Maddalena, Palermo, Italy
| | - Renato Scalone
- Department of Oncology, Hematology and BMT Unit, Casa di Cura La Maddalena, Palermo, Italy
| | - Annalisa Chiarenza
- Division of Hematology, AOU Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Maria Cristina Pirosa
- Division of Hematology, AOU Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Anastasia Laura Caruso
- Division of Hematology, AOU Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Carla Minoia
- IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Saverio Mantuano
- UOC di Ematologia, Casa di Cura Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | | | - Alessandra Crescimanno
- Department of Oncology, Hematology and BMT Unit, Casa di Cura La Maddalena, Palermo, Italy
| | - Ferdinando Porretto
- Department of Oncology, Hematology and BMT Unit, Casa di Cura La Maddalena, Palermo, Italy
| | | | - Giuseppina Ricciuti
- UOC di Ematologia, Casa di Cura Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Antonino Greco
- UOC di Ematologia Azienda Ospedaliera Pia Fondazione Cardinale Giovanni Panìco, Tricase, Italy
| | - Enzo Pavone
- UOC di Ematologia Azienda Ospedaliera Pia Fondazione Cardinale Giovanni Panìco, Tricase, Italy
| | | | | | - Donato Mannina
- UOC di Ematologia Azienda Ospedaliera Papardo, Messina, Italy
| | - Ugo Consoli
- UOC di Ematologia Ospedale Garibaldi-Nesima, Catania, Italy
| | - Nicola Cascavilla
- UOC di Ematologia, Casa di Cura Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Francesco Di Raimondo
- Division of Hematology, AOU Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Maurizio Musso
- Department of Oncology, Hematology and BMT Unit, Casa di Cura La Maddalena, Palermo, Italy
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Vassilakopoulos TP, Asimakopoulos JV, Konstantopoulos K, Angelopoulou MK. Optimizing outcomes in relapsed/refractory Hodgkin lymphoma: a review of current and forthcoming therapeutic strategies. Ther Adv Hematol 2020; 11:2040620720902911. [PMID: 32110285 PMCID: PMC7026824 DOI: 10.1177/2040620720902911] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 12/18/2019] [Indexed: 12/21/2022] Open
Abstract
The outcome of patients with relapsed/refractory classical Hodgkin lymphoma (rr-cHL) has improved considerably in recent years owing to the approval of highly active novel agents such as brentuximab vedotin and Programmed Death-1 (PD-1) inhibitors. Although no randomized trials have been conducted to provide formal proof, it is almost undisputable that the survival of these patients has been prolonged. As autologous stem-cell transplantation (SCT) remains the standard of care for second-line therapy of most patients with rr-cHL, optimization of second-line regimens with the use of brentuximab vedotin, or, in the future, checkpoint inhibitors, is promising to increase both the eligibility rate for transplant and the final outcome. The need for subsequent therapy, and especially allogeneic SCT, can be reduced with brentuximab vedotin consolidation for 1 year, while pembrolizumab is also being tested in this setting. Several other drug categories appear to be active in rr-cHL, but their development has been delayed by the appearance of brentuximab vedotin, nivolumab and pembrolizumab, which have dominated the field of rr-cHL treatment in the last 5 years. Combinations of active drugs in chemo-free approaches may further increase efficacy and hopefully reduce toxicity in rr-cHL, but are still under development.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., Goudi, Athens, 11527, Greece
| | - John V Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria K Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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46
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LaCasce AS, Bociek RG, Sawas A, Caimi P, Agura E, Matous J, Ansell SM, Crosswell HE, Islas‐Ohlmayer M, Behler C, Cheung E, Forero‐Torres A, Vose J, O’Connor OA, Josephson N, Wang Y, Advani R. Three‐year outcomes with brentuximab vedotin plus bendamustine as first salvage therapy in relapsed or refractory Hodgkin lymphoma. Br J Haematol 2020; 189:e86-e90. [DOI: 10.1111/bjh.16499] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Ahmed Sawas
- Columbia University Medical Center New York NY USA
| | - Paolo Caimi
- University Hospitals Seidman Cancer Center Cleveland OH USA
| | | | | | | | | | | | | | - Eric Cheung
- The Oncology Institute of Hope & Innovation Whittier CA USA
| | | | - Julie Vose
- University of Nebraska Medical Center Omaha NE USA
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Daw S, Hasenclever D, Mascarin M, Fernández-Teijeiro A, Balwierz W, Beishuizen A, Burnelli R, Cepelova M, Claviez A, Dieckmann K, Landman-Parker J, Kluge R, Körholz D, Mauz-Körholz C, Wallace WH, Leblanc T. Risk and Response Adapted Treatment Guidelines for Managing First Relapsed and Refractory Classical Hodgkin Lymphoma in Children and Young People. Recommendations from the EuroNet Pediatric Hodgkin Lymphoma Group. Hemasphere 2020; 4:e329. [PMID: 32072145 PMCID: PMC7000476 DOI: 10.1097/hs9.0000000000000329] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/14/2019] [Accepted: 11/22/2019] [Indexed: 01/21/2023] Open
Abstract
The objective of this guideline is to aid clinicians in making individual salvage treatment plans for pediatric and adolescent patients with first relapse or refractory (R/R) classical Hodgkin lymphoma (cHL). While salvage with standard dose chemotherapy followed by high dose chemotherapy and autologous stem cell transplant is often considered the standard of care in adult practice, pediatric practice adopts a more individualized risk stratified and response adapted approach to salvage treatment with greater use of non-transplant salvage. Here, we present on behalf of the EuroNet Pediatric Hodgkin Lymphoma group, evidence and consensus-based guidelines for standardized diagnostic, prognostic and response procedures to allocate children and adolescents with R/R cHL to stratified salvage treatments.
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Affiliation(s)
- Stephen Daw
- Children and Young People's Cancer Services, University College Hospital London, London, UK
| | - Dirk Hasenclever
- Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Maurizio Mascarin
- AYA and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Ana Fernández-Teijeiro
- Unit of Pediatric Onco-Hematology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Auke Beishuizen
- Prinses Máxima Centrum voor Kinderoncologie, Utrecht, The Netherlands
| | - Roberta Burnelli
- Section of Pediatrics, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Michaela Cepelova
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Czech Republic
| | - Alexander Claviez
- University Hospital Schleswig Holstein, Department of Pediatric and Adolescent Medicine, Pediatric Hematology, Oncology and Stem Cell Transplantation, Kiel, Germany
| | - Karin Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna
| | | | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Dieter Körholz
- Pädiatrische Hämatologie und Onkologie, Zentrum für Kinderheilkunde der Justus-Liebig-Universität Gießen, Gießen, Germany
| | - Christine Mauz-Körholz
- Pädiatrische Hämatologie und Onkologie, Zentrum für Kinderheilkunde der Justus-Liebig-Universität Gießen, Gießen, Germany
| | | | - Thierry Leblanc
- University of Edinburgh and Department of Pediatrics, Royal Hospital for Sick Children, Edinburgh, Scotland, UK
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48
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Outcome after autologous stem cell transplantation in primary refractory or relapsed Hodgkin lymphoma-a long-term follow-up single center experience. Ann Hematol 2020; 99:265-276. [PMID: 31897675 DOI: 10.1007/s00277-019-03900-x] [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] [Received: 08/04/2019] [Accepted: 12/11/2019] [Indexed: 02/07/2023]
Abstract
Autologous stem cell transplantation (autoSCT) can achieve long-term remission in primary refractory or relapsed Hodgkin lymphoma (r/r HL); however, still up to 50% of patients relapse after autoSCT. In this retrospective analysis, we investigated the impact of autologous stem cell transplantation in a consecutive, unselected cohort of primary refractory and relapsed Hodgkin lymphoma patients (n = 66) with the majority of patients treated in the pre-brentuximab vedotin and immune checkpoint inhibitor era. In our cohort, a 5-year overall survival (OS) from autoSCT of 59.5% and a 5-year progression-free survival (PFS) after autoSCT of 46.1% was achieved. Multivariate analysis revealed primary refractory disease and early relapse (< 12 months) after initial therapy as well as the presence of B symptoms at relapse as independent risk factors associated with a higher risk for relapse and an inferior PFS and OS. Several other clinical factors, including the presence of extranodal disease at relapse and failure to achieve a complete response to salvage chemotherapy, were associated with a trend towards an inferior survival. Patients relapsing after autoSCT had a particularly poor outcome, regardless of eligibility to undergo allogeneic stem cell transplantation (alloSCT). We further evaluated recently published prognostic models for r/r HL patients undergoing autoSCT and could validate several risk scores in our independent "real world" cohort.
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49
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Broccoli A, Argnani L, Botto B, Corradini P, Pinto A, Re A, Vitolo U, Fanti S, Stefoni V, Zinzani PL. First salvage treatment with bendamustine and brentuximab vedotin in Hodgkin lymphoma: a phase 2 study of the Fondazione Italiana Linfomi. Blood Cancer J 2019; 9:100. [PMID: 31827067 PMCID: PMC6906387 DOI: 10.1038/s41408-019-0265-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/12/2019] [Accepted: 11/20/2019] [Indexed: 12/30/2022] Open
Abstract
Effective salvage options inducing high complete metabolic response (CMR) rates without significant toxicity are needed for Hodgkin lymphoma (HL) patients failing induction treatment and who are candidate to autologous stem cell transplantation (ASCT). Brentuximab vedotin (BV) and bendamustine are active monotherapies in the relapsed/refractory setting and their combination (the BBV regimen) possibly enhances their activity. This single-arm multicenter phase 2 study investigated the efficacy and safety of BBV as first salvage therapy in 40 patients with relapsed/refractory HL. Thirty-eight patients were evaluable for efficacy: 30 (78.9%) had a CMR and 2 (5.3%) a partial response, leading to an overall response rate (ORR) of 84.2%. The ORR in the primary refractory subset was 75.0%, among relapsed patients it was 94.4%. Thirty-five patients could mobilize peripheral blood stem cells and 33 underwent ASCT. At a median follow-up of 23 months, the estimated 3-year overall survival and progression-free survival are 88.1% and 67.3%. During therapy, only 3 grade IV cases of neutropenia occurred and resolved within a week. No grade 4 extrahematologic toxicities were reported; skin reactions were however rather frequent (65%). These results suggest that the BBV regimen exhibits promising efficacy and a manageable toxicity in a challenging subpopulation of HL patients.
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Affiliation(s)
- A Broccoli
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
| | - L Argnani
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
| | - B Botto
- Hematology, Department of Oncology, University Hospital Città della Salute e della Scienza, Torino, Italy
| | - P Corradini
- IRCCS Istituto Nazionale dei Tumori, University of Milano, Milano, Italy
| | - A Pinto
- Hematology-Oncology and Stem Cell Transplantation Unit, National Cancer Institute, Fondazione Pascale, Napoli, Italy
| | - A Re
- Hematology, Azienda socio-sanitaria territoriale, Spedali Civili di Brescia, Brescia, Italy
| | - U Vitolo
- Hematology, Department of Oncology, University Hospital Città della Salute e della Scienza, Torino, Italy
| | - S Fanti
- Nuclear Medicine, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - V Stefoni
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
| | - P L Zinzani
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy.
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50
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Cohen JB, Wei L, Maddocks KJ, Christian B, Heffner LT, Langston AA, Lechowicz MJ, Porcu P, Flowers CR, Devine SM, Blum KA. Gemcitabine and bendamustine is a safe and effective salvage regimen for patients with recurrent/refractory Hodgkin lymphoma: Results of a phase 1/2 study. Cancer 2019; 126:1235-1242. [PMID: 31821549 DOI: 10.1002/cncr.32640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/28/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Both gemcitabine and bendamustine have been evaluated in patients with recurrent/refractory Hodgkin lymphoma but to the authors' knowledge not as a doublet. The authors completed a phase 1/2 trial to identify the optimal dose and frequency of administration and to assess the efficacy of this combination in patients with recurrent/refractory Hodgkin lymphoma. METHODS Patients were treated up to a maximum dose of gemcitabine (1000 mg/m2 on day 1) and bendamustine (120 mg/m2 on days 1 and 2), which was determined to be the recommended phase 2 dose, administered every 21 days for up to 6 cycles. Patients could discontinue study therapy after 2 cycles to proceed with autologous or allogeneic stem cell transplantation. RESULTS No dose-limiting toxicities were identified, but 4 patients experienced grade 3 to 5 pulmonary adverse events (toxicity was graded according to Common Terminology Criteria for Adverse Events [version 4]). A total of 26 patients were enrolled having completed a median of 4 prior lines of therapy (range, 1-7 lines), including 13 patients at the recommended phase 2 dose, in whom the overall response rate was 69% and the complete response rate was 46%. The median progression-free survival for the phase 2 patients was 11 months (95% CI, 3 months to not reached), and the median overall survival for this group had not been reached at the time of last follow-up (95% CI, 4 months to not reached). CONCLUSIONS This doublet was found to be tolerable and effective, but patients must be monitored closely for pulmonary toxicity. The authors currently are evaluating this doublet in combination with nivolumab.
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Affiliation(s)
- Jonathon B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Lai Wei
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Kami J Maddocks
- Division of Hematology, James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Beth Christian
- Division of Hematology, James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Leonard T Heffner
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Amelia A Langston
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Mary Jo Lechowicz
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Pierluigi Porcu
- Division of Hematology, James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Christopher R Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Steven M Devine
- Division of Hematology, James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Kristie A Blum
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.,Division of Hematology, James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
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