1
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Kutsch N, Giza A, Robrecht S, Stumpf J, Federhen A, Stoltefuß A, Vehling-Kaiser U, Koenigsmann M, Tausch E, Schneider C, Stilgenbauer S, Illmer T, Schlag R, Dörfel S, Gaska T, Kiehl M, Müller-Hagen S, Moorahrend E, Linde H, Schlenska-Lange A, von Tresckow J, Fischer K, Eichhorst B, Hallek M, Fink AM. Fludarabine, cyclophosphamide, and rituximab as first-line treatment in patients with chronic lymphocytic leukemia: A long-term analysis of the German CLL Study Group (GCLLSG) registry. Eur J Haematol 2024. [PMID: 38693677 DOI: 10.1111/ejh.14220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 05/03/2024]
Abstract
Long-term data of chronic lymphocytic leukemia (CLL) patients with favorable risk who were treated with fludarabine, cyclophosphamide, and rituximab (FCR) within clinical trials show good efficacy. We here report long-term data collected within the GCLLSG registry. Altogether, 417 CLL patients who received first-line treatment with FCR were analyzed, of which 293 (70.3%) were treated outside of clinical trials. The median observation time from first-line was 95.8 (interquartile range 58.7-126.8) months. Focusing on data of 194 (46.5%) patients who received FCR first-line treatment after 2013 (start of data collection within GCLLSG registry), responses were documented in 85% of the patients, non-responses in 15%, and for 3.6% the assessment was missing. Median event-free survival (EFS, time until disease progression, subsequent treatment, or death) was 60.2 months with a 5-year EFS-rate of 50.6%. Patients with higher-risk disease, characterized by unmutated IGHV (N = 78), had a median EFS of 45.4 months with a 5-year EFS rate of 36.3%, while the median EFS was 77.5 months with a 5-year EFS rate of 60.3% in patients with mutated IGHV (N = 40). Median overall survival was not reached with a 5-year survival rate of 92.7%. In summary, first-line FCR was associated with long EFS, especially in patients exhibiting a mutated IGHV status.
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Affiliation(s)
- Nadine Kutsch
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Adam Giza
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Janina Stumpf
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anno Federhen
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | | | - Eugen Tausch
- Division of CLL, Department III of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | - Christof Schneider
- Division of CLL, Department III of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | - Stephan Stilgenbauer
- Division of CLL, Department III of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | - Thomas Illmer
- Gemeinschaftspraxis Hämatologie-Onkologie, Dresden, Germany
| | - Rudolf Schlag
- Hämatologisch-Onkologische Schwerpunktpraxis Würzburg, Würzburg, Germany
| | | | - Tobias Gaska
- Klinik für Hämatologie und Onkologie, Brüderkrankenhaus St. Josef, Paderborn, Germany
| | - Michael Kiehl
- Medizinische Klinik I, Klinikum Frankfurt/Oder, Frankfurt, Germany
| | | | - Enno Moorahrend
- Zentrum für Hämatologie und Onkologie MVZ Porta Westfalica, Porta Westfalica, Germany
| | - Hartmut Linde
- MVZ für Blut und Krebserkrankungen Potsdam, Potsdam, Germany
| | | | | | - Kirsten Fischer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Maria Fink
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
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2
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Fürstenau M, Giza A, Weiss J, Kleinert F, Robrecht S, Franzen F, Stumpf J, Langerbeins P, Al-Sawaf O, Simon F, Fink AM, Schneider C, Tausch E, Schetelig J, Dreger P, Böttcher S, Fischer K, Kreuzer KA, Ritgen M, Schilhabel A, Brüggemann M, Stilgenbauer S, Eichhorst B, Hallek M, Cramer P. Acalabrutinib, venetoclax and obinutuzumab in relapsed CLL: Final efficacy and ctDNA analysis of the CLL2-BAAG trial. Blood 2024:blood.2023022730. [PMID: 38620072 DOI: 10.1182/blood.2023022730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/17/2024] Open
Abstract
The phase 2 CLL2-BAAG trial tested the measurable residual disease (MRD)-guided triple combination of acalabrutinib, venetoclax and obinutuzumab after an optional bendamustine debulking in 45 patients with relapsed/refractory CLL (one patient was excluded from the analysis due to a violation of exclusion criteria). MRD was measured by flow cytometry (FCM, undetectable MRD <10-4) in peripheral blood (PB) and circulating tumor DNA (ctDNA) by digital droplet PCR (ddPCR) of variable-diversity-joining (VDJ) rearrangements and CLL-related mutations in plasma. MRD recurrence was defined as detectable ctDNA and/or MRD ≥10-4 after achieving both uMRD/undetectable ctDNA. The median number of previous treatments was 1 (range 1-4), 18 patients (40%) had received a BTK inhibitor (BTKi) and/or venetoclax prior to inclusion, 14/44 (31.8%) had TP53 aberrations, 34 (75.6%) had unmutated IGHV. With a median observation time of 36.3 months and all patients off treatment for a median of 21.9 months, uMRD <10-4 in PB was achieved in 42/45 patients (93.3%) at any time point, including 17/18 (94.4%) previously exposed to venetoclax/BTKi and 13/14 (92.9%) with TP53 aberrations. The estimated three-year progression-free and overall survival rates were 85.0% and 93.8%. Overall 585 paired FCM/ctDNA samples were analyzed and 18 MRD recurrences (5 with and 13 without clinical progression) occurred after the end of treatment. Twelve were first detected by ctDNA, three by FCM and three synchronously. Patients with earlier detection by ctDNA appeared to have genetically higher risk disease. In conclusion, time-limited MRD-guided acalabrutinib, venetoclax and obinutuzumab achieved deep remissions in almost all patients with relapsed/refractory CLL. The addition of ctDNA-based analyses to FCM MRD assessment seems to improve early detection of relapses. ClinicalTrials.gov Identifier: NCT03787264.
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Affiliation(s)
- Moritz Fürstenau
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group, University of Cologne, Cologne, Germany, Cologne, Germany
| | - Adam Giza
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD); University of Cologne, Faculty of Medicine and University Hos, Cologne, Germany
| | | | | | | | - Fabian Franzen
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group, University of Cologne,, Cologne, Germany
| | - Janina Stumpf
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group, University of Cologne,, Koeln, Germany
| | | | - Othman Al-Sawaf
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Florian Simon
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group, University of Cologne,, Cologne, Germany
| | | | | | | | - Johannes Schetelig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany, Dresden, Germany
| | | | | | | | | | - Matthias Ritgen
- Department of Internal Medicine II, University of Schleswig-Holstein, Kiel, Germany
| | - Anke Schilhabel
- 2nd Department of Internal Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | | | | | - Paula Cramer
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD); University of Cologne, Faculty of Medicine and University Hos, Cologne, Germany
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3
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Langerbeins P, Giza A, Robrecht S, Cramer P, von Tresckow J, Al-Sawaf O, Fink AM, Fürstenau M, Kutsch N, Simon F, Goede V, Hoechstetter MA, Niemann CU, da Cunha-Bang C, Kater AP, Dubois J, Gregor M, Staber PB, Tausch E, Schneider C, Stilgenbauer S, Eichhorst B, Fischer K, Hallek MJ. Reassessing the Chronic Lymphocytic Leukemia International Prognostic Index in the era of targeted therapies. Blood 2024:blood.2023022564. [PMID: 38620092 DOI: 10.1182/blood.2023022564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
We evaluated the prognostic value of the Chronic Lymphocytic Leukemia International Prognostic Index (CLL-IPI) using a pooled dataset of CLL-patients treated first-line with targeted drugs (N=991) or chemoimmunotherapy (N=1,256). With a median observation time of 40.5 months, the 3-year progression-free survival (PFS)-rates for targeted drug-treated patients varied by CLL-IPI risk group: 96.5% (low), 87.6% (intermediate), 82.4% (high), and 78.7% (very high). Differences between consecutive CLL-IPI risk groups were observed for intermediate vs. low (HR=3.296, 95%-CI 1.576-6.894, p=0.002), for high vs. intermediate (HR=1.365, 95%-CI 1.003-1.858, p=0.048), but not for very high vs. high. CLL-IPI factors β2-microglobulin, IGHV mutational status, and TP53 status each retained prognostic value for PFS. The 3-year overall survival (OS)-rates by CLL-IPI risk group were 100%, 96%, 93.9%, and 89.4% with no differences between consecutive risk groups. Age, Binet stage, β2-microglobulin, and TP53 status each retained prognostic value for OS. In chemoimmunotherapy patients (median observation time 66.9 months), 3-year PFS-rates for CLL-IPI risk groups were 78.1%, 51.4%, 40.1%, and 16.5%. Corresponding 3-year OS-rates were 97.4%, 93.1%, 81.8%, and 57.3%. In a matched-pair analysis, PFS-differences in targeted therapies (N=812) versus chemoimmunotherapy (N=812) across all risk groups, and OS-differences in all but low-risk patients were demonstrated. The CLL-IPI maintains its prognostic value in predicting PFS outcomes with targeted drugs. With the caveat of a short observation time its impact in predicting survival appears diminished. Targeted therapies showed enhanced outcomes over chemoimmunotherapy, highlighting their effectiveness across various risk groups. Our findings support ongoing assessment of prognostic tools in CLL treatment evolution. CLL2-BIG (NCT02345863), CLL2-BAG (NCT02401503), CLL2-BIO (NCT02689141), CLL2-BCG (NCT02445131), CLL2-GIVe (NCT02758665), CLL13 (NCT02950051), CLL14-trial (NCT02242942), CLL1 (NCT00262782), CLL8 (NCT00281918), and CLL11 (NCT01010061).
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Affiliation(s)
| | - Adam Giza
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD); University of Cologne, Faculty of Medicine and University Hos, Cologne, Germany
| | | | - Paula Cramer
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD); University of Cologne, Faculty of Medicine and University Hos, Cologne, Germany
| | | | - Othman Al-Sawaf
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Moritz Fürstenau
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group, University of Cologne, Cologne, Germany, Cologne, Germany
| | | | - Florian Simon
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group, University of Cologne,, Cologne, Germany
| | | | - Manuela A Hoechstetter
- Interdisciplinary Oncology Center (IOZ) Munich, Hematology and Oncology, Munich, Germany
| | | | | | - Arnon P Kater
- Department of Hematology, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands, Amsterdam, Netherlands
| | - Julie Dubois
- Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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4
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Cramer P, von Tresckow J, Fink AM, Robrecht S, Giza A, Tausch E, Müller L, Knauf W, Zingerle M, Al-Sawaf O, Langerbeins P, Fischer K, Kreuzer KA, Kneba M, Wendtner CM, Stilgenbauer S, Eichhorst B, Hallek M. Bendamustine, followed by obinutuzumab and idelalisib in chronic lymphocytic leukemia (CLL2-BCG): Final analysis of a multicenter, open-label phase-II-trial. Am J Hematol 2024. [PMID: 38578022 DOI: 10.1002/ajh.27304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/03/2024] [Accepted: 03/11/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Paula Cramer
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Julia von Tresckow
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Adam Giza
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Eugen Tausch
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Lothar Müller
- Practice for Hematology and Oncology UnterEms, Leer, Germany
| | - Wolfgang Knauf
- Practice for Hematology and Oncology Bethanien, Frankfurt/Main, Germany
| | - Matthias Zingerle
- Practice for Hematology and Oncology Pasing and Fürstenfeldbruck, Munich, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Karl-Anton Kreuzer
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Michael Kneba
- Department of Internal Medicine II, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | - Clemens-Martin Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Munich Clinic Schwabing, Munich, Germany
| | | | - Barbara Eichhorst
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
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5
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von Tresckow J, Heyl N, Robrecht S, Giza A, Aldaoud A, Schlag R, Klausmann M, Linde H, Stein W, Schwarzer A, Fischer K, Cramer P, Eichhorst B, Hallek M, Fink AM. Treatment with idelalisib in patients with chronic lymphocytic leukemia - real world data from the registry of the German CLL Study Group. Ann Hematol 2023; 102:3083-3090. [PMID: 37358640 PMCID: PMC10567876 DOI: 10.1007/s00277-023-05314-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
Idelalisib in combination with rituximab is an efficacious treatment for patients suffering from chronic lymphocytic leukemia (CLL) with known limitations due to toxicities. However, the benefit after prior Bruton tyrosine kinase inhibitor (BTKi) therapy remains unclear. For this analysis, 81 patients included in a non-interventional registry study of the German CLL study group (registered at www.clinicaltrials.gov as # NCT02863692) meeting the predefined criteria of a confirmed diagnosis of CLL and being treated with idelalisib containing regimens outside clinical trials were considered. 11 patients were treatment naïve (13.6%) and 70 patients (86.4%) pretreated. Patients had median of one prior therapy line (range 0-11). Median treatment duration with idelalisib was 5.1 months (range 0-55.0 months). Of 58 patients with documented treatment outcome, 39 responded to idelalisib containing therapy (67.2%). Patients treated with the BTKi ibrutinib as last prior treatment prior to idelalisib responded in 71.4% compared to a response rate of 61.9% in patients without prior ibrutinib. Median event free survival (EFS) was 15.9 months with a 16 versus 14 months EFS in patients with ibrutinib as last prior treatment or not, respectively. Median overall survival was 46.6 months. In conclusion, treatment with idelalisib appears to have a valuable impact in patients being refractory to prior ibrutinib therapy even though there are limitations in our analysis due to the low number of patients included.
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Affiliation(s)
- Julia von Tresckow
- Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Nikola Heyl
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Adam Giza
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ali Aldaoud
- Praxis für Hämatologie und Onkologie, Leipzig, Germany
| | - Rudolf Schlag
- Hämatologisch-Onkologische Schwerpunktpraxis, Würzburg, Germany
| | | | - Hartmut Linde
- MVZ für Blut und Krebserkrankungen, Potsdam, Germany
| | | | | | - Kirsten Fischer
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Paula Cramer
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Maria Fink
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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6
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Huber H, Tausch E, Schneider C, Edenhofer S, von Tresckow J, Robrecht S, Giza A, Zhang C, Fürstenau M, Dreger P, Ritgen M, Illmer T, Illert AL, Dürig J, Böttcher S, Niemann CU, Kneba M, Al-Sawaf O, Kreuzer KA, Fink AM, Fischer K, Döhner H, Hallek M, Eichhorst B, Stilgenbauer S. Final analysis of the CLL2-GIVe trial: obinutuzumab, ibrutinib, and venetoclax for untreated CLL with del(17p)/TP53mut. Blood 2023; 142:961-972. [PMID: 37363867 DOI: 10.1182/blood.2023020013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
The final analysis of the open-label, multicenter phase 2 CLL2-GIVe trial shows response and tolerability of the triple combination of obinutuzumab, ibrutinib, and venetoclax (GIVe regimen) in 41 previously untreated patients with high-risk chronic lymphocytic leukemia (CLL) with del(17p) and/or TP53 mutation. Induction consisted of 6 cycles of GIVe; venetoclax and ibrutinib were continued up to cycle 12 as consolidation. Ibrutinib was given until cycle 15 or up to cycle 36 in patients not achieving a complete response and with detectable minimal residual disease. The primary end point was the complete remission rate at cycle 15, which was achieved at 58.5% (95% CI, 42.1-73.7; P < .001). The last patient reached the end of the study in January 2022. After a median observation time of 38.4 months (range, 3.7-44.9), the 36-month progression-free survival was 79.9%, and the 36-month overall survival was 92.6%. Only 6 patients continued ibrutinib maintenance. Adverse events of concern were neutropenia (48.8%, grade ≥3) and infections (19.5%, grade ≥3). Cardiovascular toxicity grade 3 occurred as atrial fibrillation at a rate of 2.4% between cycles 1 and 12, as well as hypertension (4.9%) between cycles 1 and 6. The incidence of adverse events of any grade and grade ≥3 was highest during induction and decreased over time. Progressive disease was observed in 7 patients between cycles 27 and 42. In conclusion, the CLL2-GIVe regimen is a promising fixed-duration, first-line treatment for patients with high-risk CLL with a manageable safety profile.
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Affiliation(s)
- Henriette Huber
- Sektion CLL, Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
- Medizinische Klinik III, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Eugen Tausch
- Sektion CLL, Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - Christof Schneider
- Sektion CLL, Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - Simone Edenhofer
- Sektion CLL, Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - Julia von Tresckow
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Cologne Bonn Duesseldorf, University Hospital of Cologne, Cologne, Germany
- Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Cologne Bonn Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Adam Giza
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Cologne Bonn Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Can Zhang
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Cologne Bonn Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Moritz Fürstenau
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Cologne Bonn Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Peter Dreger
- Department Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Matthias Ritgen
- Klinik für Innere Medizin II, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Thomas Illmer
- Group Practice for Hematology and Oncology, Dresden, Germany
| | - Anna Lena Illert
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Dürig
- Deptartment of Internal Medicine, St. Josef Krankenhaus Werden, University Medicine Essen, Essen, Germany
| | | | - Carsten U Niemann
- Department of Clinical Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Michael Kneba
- Klinik für Innere Medizin II, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Cologne Bonn Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Karl-Anton Kreuzer
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Cologne Bonn Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Cologne Bonn Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Cologne Bonn Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Hartmut Döhner
- Sektion CLL, Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - Michael Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Cologne Bonn Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Cologne Bonn Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Stephan Stilgenbauer
- Sektion CLL, Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
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7
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Simon F, Giza A, Robrecht S, Fink AM, Cramer P, von Tresckow J, Fürstenau M, Goede V, Tausch E, Schneider C, Stilgenbauer S, Wendtner CM, Eichhorst B, Fischer K, Hallek M, Al-Sawaf O. Pooled analysis of first-line treatment with targeted agents in patients with chronic lymphocytic leukemia aged 80 years and older. Leuk Lymphoma 2022; 63:3299-3306. [PMID: 36120898 DOI: 10.1080/10428194.2022.2123223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Patients aged 80 years and older make up a fifth of patients with CLL but are underrepresented in clinical trials. We analyzed the outcomes of these patients treated with targeted agents in the front-line setting in six trials of the German CLL Study Group. Targeted agents included venetoclax, ibrutinib, and idelalisib, mainly used in combination with anti-CD20 antibodies. Among 716 patients, 33 matched the selection criteria (5%). Of those, the majority had relevant comorbidity, organ dysfunctions, and/or high-/very high-risk disease. The overall response rate was 73%. The median progression-free survival was 49.2 months compared with those not reached in younger patients. There were 11 documented deaths of which two were deemed related to therapy. Additional results including 40 patients treated with BTK-inhibitors from the GCLLSG registry suggest that treatment with targeted agents is feasible and effective. Dedicated studies are warranted for this particular subgroup of patients.
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Affiliation(s)
- Florian Simon
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Adam Giza
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Paula Cramer
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Julia von Tresckow
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Moritz Fürstenau
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Valentin Goede
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,Department of Oncogeriatrics, Center for Geriatric Medicine, St. Marien-Hospital, Cologne, Germany
| | - Eugen Tausch
- Division of CLL, Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Christof Schneider
- Division of CLL, Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Stephan Stilgenbauer
- Division of CLL, Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Clemens-Martin Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, German CLL Study Group, Munich Clinic Schwabing, Munich, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,The Francis Crick Institute, London, United Kingdom.,UCL Cancer Institute, University College London, London, United Kingdom
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8
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Fürstenau M, Weiss J, Giza A, Franzen F, Robrecht S, Fink AM, Fischer K, Schneider C, Tausch E, Stilgenbauer S, Ritgen M, Schilhabel A, Brüggemann M, Eichhorst B, Hallek M, Cramer P. Circulating Tumor DNA-Based MRD Assessment in Patients with CLL Treated with Obinutuzumab, Acalabrutinib, and Venetoclax. Clin Cancer Res 2022; 28:4203-4211. [PMID: 35594173 DOI: 10.1158/1078-0432.ccr-22-0433] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/12/2022] [Accepted: 05/17/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE With the advent of highly efficacious time-limited combination treatments of targeted agents in chronic lymphocytic leukemia (CLL), minimal residual disease (MRD) assessment has gained importance as a measure for therapeutic success and as a surrogate for progression-free survival. The currently most widely used method is multicolor flow cytometry, which detects circulating CLL cells in the peripheral blood. However, it seems to be less sensitive for the detection of MRD in the lymph node compartment. PATIENTS AND METHODS To evaluate whether a cell-free approach can overcome this limitation, we performed serial assessments of circulating tumor DNA (ctDNA) in patients with CLL treated with obinutuzumab, acalabrutinib, and venetoclax in the phase II CLL2-BAAG trial. Patient-specific variability, diversity, joining (VDJ) rearrangements as well as somatic driver mutations were tracked before, during and after treatment by digital droplet PCR in blood plasma. Furthermore, these were systematically compared to matched flow cytometry data. RESULTS In the 381 sample pairs, ctDNA and flow cytometry yielded highly concordant results. However, clone-specific ctDNA was detected in 44 of 152 samples (29%) that were assessed as undetectable MRD (uMRD) by flow cytometry (defined as less than one CLL cell in 10,000 normal leukocytes). 29 ctDNA-negative samples showed detectable MRD >10-4 by flow cytometry. Also, somatic driver mutations were detected with a similar sensitivity compared with patient-specific VDJ rearrangements in plasma. In patients with predominantly nodal residual disease, ctDNA compared favorably with 4-color flow cytometry and seemed to more accurately reflect the entire disease burden across compartments. CONCLUSIONS On the basis of these findings, ctDNA-based MRD assessment appears to be a promising method to complement cell-based MRD approaches like flow cytometry that focus on circulating CLL cells in the peripheral blood.
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MESH Headings
- Antibodies, Monoclonal, Humanized
- Benzamides
- Bridged Bicyclo Compounds, Heterocyclic
- Circulating Tumor DNA/genetics
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/drug therapy
- Neoplasm, Residual/genetics
- Pyrazines
- Sulfonamides
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Affiliation(s)
- Moritz Fürstenau
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jonathan Weiss
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Adam Giza
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Fabian Franzen
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christof Schneider
- Division of CLL, Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Eugen Tausch
- Division of CLL, Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Stephan Stilgenbauer
- Division of CLL, Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Matthias Ritgen
- Department of Internal Medicine II, Faculty of Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Anke Schilhabel
- Department of Internal Medicine II, Faculty of Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Monika Brüggemann
- Department of Internal Medicine II, Faculty of Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Paula Cramer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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9
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Cramer P, Fürstenau M, Robrecht S, Giza A, Zhang C, Fink AM, Fischer K, Langerbeins P, Al-Sawaf O, Tausch E, Schneider C, Schetelig J, Dreger P, Böttcher S, Kreuzer KA, Schilhabel A, Ritgen M, Brüggemann M, Kneba M, Stilgenbauer S, Eichhorst B, Hallek M. Obinutuzumab, acalabrutinib, and venetoclax, after an optional debulking with bendamustine in relapsed or refractory chronic lymphocytic leukaemia (CLL2-BAAG): a multicentre, open-label, phase 2 trial. Lancet Haematol 2022; 9:e745-e755. [PMID: 35988545 DOI: 10.1016/s2352-3026(22)00211-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although BTK inhibitors provide long-term disease-control in patients with chronic lymphocytic leukaemia, they need to be combined with BCL2 inhibitors or antibodies to achieve deep responses with undetectable minimal residual disease (uMRD), which allows for time-limited treatment. This trial aims to evaluate the triple combination of obinutuzumab, acalabrutinib, and venetoclax after an optional debulking with bendamustine. METHODS This multicentre, open-label, investigator-initiated, phase 2 study evaluates a sequential treatment consisting of a debulking with two cycles of bendamustine for patients with a higher tumour load (70 mg/m2 intravenously on days 1 and 2, repeated after 28 days), followed by an induction and a maintenance with obinutuzumab (1000 mg intravenously on days 1-2, 8, and 15 of the first induction cycle, every 4 weeks in induction cycles 2-6 and every 12 weeks in the maintenance phase), acalabrutinib (100 mg orally twice daily continuously from induction cycle 2 day 1 onwards) and venetoclax (starting in induction cycle 3 with 20 mg per day with a weekly dose ramp-up over 5 weeks to the target dose of 400 mg per day). Eligible patients were aged 18 years or older with an ECOG performance score 0-2 and had relapsed or refractory chronic lymphocytic leukaemia requiring treatment according to the 2018 International Workshop on Chronic Lymphocytic Leukemia criteria. The primary endpoint was uMRD (<10-4) in peripheral blood at the end of induction treatment assessed centrally at the final restaging, 12 weeks after the start of the last induction cycle. As per protocol, all patients with more than two induction cycles were included in the analyses. This study is registered with ClinicalTrials.gov, number NCT03787264, and is ongoing. FINDINGS Between Jan 14, 2019, and June 25, 2020, 45 evaluable patients with relapsed or refractory chronic lymphocytic leukaemia were enrolled; 13 (29%) were female, 32 (71%) were male, 21 (47%) had already received a targeted agent, and 14 (32%) had del(17)(p13.1) or TP53 mutation. Ethnicity-race data was not collected. At data cutoff (Feb 25, 2021), all patients had completed the induction treatment. 34 patients (76%; 95% CI 61-87, p=0·26) had uMRD in peripheral blood after 6 months of triple therapy. Until data cutoff, 32 (71%) patients started maintenance and nine (28%) were able to stop with uMRD. After a median observation time of 13·8 months (IQR 10·4-18·4), there were two (4%) Richter transformations, but no progressions and no deaths observed. The most common adverse events of grade 3 and 4 during the entire treatment were thrombocytopenia and neutropenia (12 [27%] of 45 patients each), tumour lysis syndrome and infections (five [11%] of 45 patients each, grade 3 adverse events only), infusion-associated reactions (four [9%] of 45 patients) and anaemia (four [9%] of 45 patients). INTERPRETATION With 76% of patients achieving uMRD in peripheral blood, this trial did not reach the prespecified activity threshold. Triple therapy with obinutuzumab, acalabrutinib, and venetoclax after an optional debulking with bendamustine regimen requires further evaluation in larger trials to define its value compared with double treatment with a BTK or BCL2 inhibitor combined with obinutuzumab or a combination of the two oral targeted drugs. Until these trials show a clear benefit, the use of the triple combination in routine practice cannot be recommended. FUNDING Acerta, AstraZeneca, F Hoffmann-La Roche, and AbbVie.
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MESH Headings
- Antibodies, Monoclonal, Humanized
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Bendamustine Hydrochloride/adverse effects
- Benzamides
- Bridged Bicyclo Compounds, Heterocyclic
- Cytoreduction Surgical Procedures
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Neoplasm, Residual
- Proto-Oncogene Proteins c-bcl-2
- Pyrazines
- Sulfonamides
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Affiliation(s)
- Paula Cramer
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.
| | - Moritz Fürstenau
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Adam Giza
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Can Zhang
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Eugen Tausch
- Department of Internal Medicine III, Division of CLL, University Hospital Ulm, Ulm, Germany
| | - Christof Schneider
- Department of Internal Medicine III, Division of CLL, University Hospital Ulm, Ulm, Germany
| | - Johannes Schetelig
- Department I of Internal Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Peter Dreger
- Department V of Internal Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Böttcher
- Clinic for Internal Medicine III (Hematology, Oncology, Palliative Care), Rostock University Medical School, Rostock, Germany
| | - Karl-Anton Kreuzer
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Anke Schilhabel
- Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | - Matthias Ritgen
- Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | - Monika Brüggemann
- Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | - Michael Kneba
- Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | - Stephan Stilgenbauer
- Department of Internal Medicine III, Division of CLL, University Hospital Ulm, Ulm, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
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10
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Cramer P, Fürstenau M, Giza A, Robrecht S, Tausch E, Schneider C, Wendtner CM, Hoechstetter M, Schetelig J, Böttcher S, Dreger P, Fink AM, Langerbeins P, Al-Sawaf O, Fischer K, Stilgenbauer S, Eichhorst B, Hallek M. P641: RETREATMENT WITH VENETOCLAX AFTER VENETOCLAX, OBINUTUZUMAB +/- IBRUTINIB: POOLED ANALYSIS OF 13 PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) TREATED IN GCLLSG TRIALS. Hemasphere 2022. [DOI: 10.1097/01.hs9.0000845448.71709.3a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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11
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Fürstenau M, Giza A, Stumpf T, Robrecht S, Maurer C, Linde H, Jacobasch L, Dörfel S, Aldaoud A, Tresckow J, Koenigsmann M, Gaska T, Kaiser U, Harich H, Fischer K, Eichhorst B, Hallek M, Fink A. Second primary malignancies in treated and untreated patients with chronic lymphocytic leukemia. Am J Hematol 2021; 96:E457-E460. [PMID: 34591989 DOI: 10.1002/ajh.26363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Moritz Fürstenau
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
- Cancer Center Cologne Essen (CCCE)—Partner Site Cologne University of Cologne Cologne Germany
| | - Adam Giza
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
| | - Thomas Stumpf
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
| | - Sandra Robrecht
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
| | - Christian Maurer
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
- Cancer Center Cologne Essen (CCCE)—Partner Site Cologne University of Cologne Cologne Germany
| | - Hartmut Linde
- MVZ für Blut‐ und Krebserkrankungen Potsdam Potsdam Germany
| | - Lutz Jacobasch
- BAG Freiberg‐Richter, Jacobasch, Wolf, Illmer Dresden Germany
| | - Steffen Dörfel
- Onkologische Gemeinschaftspraxis Dres. Dörfel/Göhler/Boldt Dresden Germany
| | - Ali Aldaoud
- Praxis für Hämatologie/ Onkologie Dr. Aldaoud Leipzig Germany
| | - Julia Tresckow
- Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen University of Duisburg‐Essen Essen Germany
| | | | | | | | | | - Kirsten Fischer
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
| | - Barbara Eichhorst
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
- Cancer Center Cologne Essen (CCCE)—Partner Site Cologne University of Cologne Cologne Germany
| | - Michael Hallek
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
- Cancer Center Cologne Essen (CCCE)—Partner Site Cologne University of Cologne Cologne Germany
- Cologne Excellence Cluster on Cellular Stress Response in Aging‐Associated Diseases (CECAD) University of Cologne Cologne Germany
| | - Anna‐Maria Fink
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
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12
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Bloehdorn J, Braun A, Taylor-Weiner A, Jebaraj BMC, Robrecht S, Krzykalla J, Pan H, Giza A, Akylzhanova G, Holzmann K, Scheffold A, Johnston HE, Yeh RF, Klymenko T, Tausch E, Eichhorst B, Bullinger L, Fischer K, Weisser M, Robak T, Schneider C, Gribben J, Dahal LN, Carter MJ, Elemento O, Landau DA, Neuberg DS, Cragg MS, Benner A, Hallek M, Wu CJ, Döhner H, Stilgenbauer S, Mertens D. Multi-platform profiling characterizes molecular subgroups and resistance networks in chronic lymphocytic leukemia. Nat Commun 2021; 12:5395. [PMID: 34518531 PMCID: PMC8438057 DOI: 10.1038/s41467-021-25403-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/03/2021] [Indexed: 02/07/2023] Open
Abstract
Knowledge of the genomic landscape of chronic lymphocytic leukemia (CLL) grows increasingly detailed, providing challenges in contextualizing the accumulated information. To define the underlying networks, we here perform a multi-platform molecular characterization. We identify major subgroups characterized by genomic instability (GI) or activation of epithelial-mesenchymal-transition (EMT)-like programs, which subdivide into non-inflammatory and inflammatory subtypes. GI CLL exhibit disruption of genome integrity, DNA-damage response and are associated with mutagenesis mediated through activation-induced cytidine deaminase or defective mismatch repair. TP53 wild-type and mutated/deleted cases constitute a transcriptionally uniform entity in GI CLL and show similarly poor progression-free survival at relapse. EMT-like CLL exhibit high genomic stability, reduced benefit from the addition of rituximab and EMT-like differentiation is inhibited by induction of DNA damage. This work extends the perspective on CLL biology and risk categories in TP53 wild-type CLL. Furthermore, molecular targets identified within each subgroup provide opportunities for new treatment approaches.
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Affiliation(s)
| | - Andrejs Braun
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | | | - Sandra Robrecht
- Department I for Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne, Germany
| | - Julia Krzykalla
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Heng Pan
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA
| | - Adam Giza
- Department I for Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne, Germany
| | - Gulnara Akylzhanova
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | - Annika Scheffold
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Harvey E Johnston
- Centre for Cancer Immunology, Cancer Sciences, Faculty of Medicine, Cancer Research UK Centre and Experimental Cancer Medicine Centre, University of Southampton, Southampton, UK
| | - Ru-Fang Yeh
- Biostatistics, Genentech Inc., South San Francisco, CA, USA
| | - Tetyana Klymenko
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Eugen Tausch
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Barbara Eichhorst
- Department I for Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne, Germany
| | - Lars Bullinger
- Medical Clinic for Hematology, Oncology and Tumor Biology, Charité University Hospital, Berlin, Germany
| | - Kirsten Fischer
- Department I for Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne, Germany
| | - Martin Weisser
- Roche Pharma Research and Early Development, Penzberg, Germany
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | | | - John Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Lekh N Dahal
- Centre for Cancer Immunology, Cancer Sciences, Faculty of Medicine, Cancer Research UK Centre and Experimental Cancer Medicine Centre, University of Southampton, Southampton, UK
- Department of Pharmacology and Therapeutics, Faculty of Life and Health Sciences, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Mathew J Carter
- Centre for Cancer Immunology, Cancer Sciences, Faculty of Medicine, Cancer Research UK Centre and Experimental Cancer Medicine Centre, University of Southampton, Southampton, UK
| | - Olivier Elemento
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Dan A Landau
- Cancer Genomics and Evolutionary Dynamics, Weill Cornell Medicine, New York, NY, USA
- New York Genome Center, New York, NY, USA
| | - Donna S Neuberg
- Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mark S Cragg
- Centre for Cancer Immunology, Cancer Sciences, Faculty of Medicine, Cancer Research UK Centre and Experimental Cancer Medicine Centre, University of Southampton, Southampton, UK
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Michael Hallek
- Department I for Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne, Germany
| | - Catherine J Wu
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Hartmut Döhner
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | | | - Daniel Mertens
- Department of Internal Medicine III, University of Ulm, Ulm, Germany.
- German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Cramer P, Fürstenau M, Robrecht S, Giza A, Fink AM, Fischer K, Langerbeins P, Al Sawaf O, Tausch E, Schneider C, Schetelig J, Dreger P, Böttcher S, Kreuzer KA, Schilhabel A, Brüggemann M, Kneba M, Wendtner CM, Stilgenbauer S, Eichhorst B, Hallek M. BENDAMUSTINE, FOLLOWED BY OBINUTUZUMAB, ACALABRUTINIB AND VENETOCLAX IN PATIENTS (PTS) WITH RELAPSED/REFRACTORY CHRONIC LYMPHOCYTIC LEUKEMIA (CLL): CLL2‐BAAG TRIAL OF THE GCLLSG. Hematol Oncol 2021. [DOI: 10.1002/hon.34_2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- P Cramer
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - M Fürstenau
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - S Robrecht
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - A Giza
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - A. M Fink
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - K Fischer
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - P Langerbeins
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - O Al Sawaf
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - E Tausch
- University Hospital Ulm Department III of Internal Medicine Ulm Germany
| | - C Schneider
- University Hospital Ulm Department III of Internal Medicine Ulm Germany
| | - J Schetelig
- University Hospital Carl Gustav Carus Department I of Internal Medicine Dresden Germany
| | - P Dreger
- University Hospital Heidelberg Department V of Internal Medicine Heidelberg Germany
| | - S Böttcher
- University Hospital Rostock Department III of Internal Medicine Rostock Germany
| | - K. A Kreuzer
- Klinikum Schwabing Department of Hematology, Oncology, Immunology, Palliative Care Infectious Diseases and Tropical Medicine Munich Germany
| | - A Schilhabel
- University of Schleswig‐Holstein Campus Kiel, Department II of Internal Medicine, Kiel Germany
| | - M Brüggemann
- University of Schleswig‐Holstein Campus Kiel, Department II of Internal Medicine, Kiel Germany
| | - M Kneba
- University of Schleswig‐Holstein Campus Kiel, Department II of Internal Medicine, Kiel Germany
| | - C. M Wendtner
- Klinikum Schwabing Department of Hematology, Oncology, Immunology, Palliative Care Infectious Diseases and Tropical Medicine Munich Germany
| | - S Stilgenbauer
- University Hospital Ulm Department III of Internal Medicine Ulm Germany
| | - B Eichhorst
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - M Hallek
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
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14
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Liphard M, Giza A. Einflub des Schaums auf die Waschleistung unter Berücksichtigung neuer elektronischer Waschmaschinensteuerungen („fuzzy logic“) / The effect of foam on the washing performance with regard to new control systems for washing machines (“fuzzy logic”). TENSIDE SURFACT DET 2021. [DOI: 10.1515/tsd-1997-340608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Zaucha JM, Malkowski B, Chauvie S, Subocz E, Tajer J, Kulikowski W, Fijolek-Warszewska A, Biggi A, Fallanca F, Kobylecka M, Dziuk M, Woszczyk D, Rybka J, Kroll-Balcerzak R, Bergesio F, Romanowicz A, Chamier-Cieminska A, Kurczab P, Giza A, Lesniewski-Kmak K, Zaucha R, Swietlik D, Wróbel T, Knopinska-Posluszny W, Walewski J, Gallamini A. The predictive role of interim PET after the first chemotherapy cycle and sequential evaluation of response to ABVD in Hodgkin's lymphoma patients-the Polish Lymphoma Research Group (PLRG) Observational Study. Ann Oncol 2018; 28:3051-3057. [PMID: 28950332 DOI: 10.1093/annonc/mdx524] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Interim PET after two ABVD cycles (iPET2) predicts treatment outcome in classical Hodgkin's lymphoma. To test whether an earlier assessment of chemosensitivity would improve the prediction accuracy, we launched a prospective, multicenter observational study aimed at assessing the predictive value of iPET after one ABVD (iPET1) and the kinetics of response assessed by sequential PET scanning. Patients and methods Consecutive patients with newly diagnosed classical Hodgkin's lymphoma underwent interim PET scan after one ABVD course (iPET1). PETs were interpreted according to the Deauville score (DS) as negative (-) (DS 1-3) and positive (+) (DS 4, 5). Patients with iPET1 DS 3-5 underwent iPET2. Results About 106 early (I-IIA) and 204 advanced (IIB-IV) patients were enrolled between January 2008 and October 2014. iPET1 was (-) in 87/106 (82%) or (+) in 19/106 (18%) of early, and (-) in 133/204 (65%) or (+) in 71/204 (35%) of advanced stage patients, respectively. Twenty-four patients were excluded from response analysis due to treatment escalation. After a median follow-up of 38.2 (3.2-90.2) months, 9/102 (9%) early and 43/184 (23%) advanced patients experienced a progression-free survival event. At 36 months, negative and positive predictive value for iPET1 were 94% and 41% (early) and 84% and 43% (advanced), respectively. The kinetics of PET response was assessed in 198 patients with both iPETs. All 116 patients with iPET1(-) remained iPET2(-) (fast responders), 41/82 with IPET1(+) became iPET2(-) (slow responders), and the remaining 41 stayed iPET2(+) (non-responders); progression-free survival at 36 months for fast, slow and non-responders was 0.88, 0.79 and 0.34, respectively. Conclusion The optimal tool to predict ABVD outcome in HL remains iPET2 because it distinguishes responders, whatever their time to response, from non-responders. However, iPET1 identified fast responders with the best outcome and might guide early treatment de-escalation in both early and advanced-stage HL.
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Affiliation(s)
- J M Zaucha
- Gdynia Oncology Center, Gdynia.,Departments of Oncological Propedeutics.,Hematology and Transplantology, Medical University of Gdańsk, Gdańsk
| | - B Malkowski
- Nuclear Medicine Department, Oncology Center, Bydgoszcz.,Positron Emission Tomography and Molecular Imagining Department, Collegium Medicum N. Copernicus University, Bydgoszcz, Poland
| | - S Chauvie
- Medical Physics Department, Santa Croce e Carle Hospital, Cuneo, Italy
| | - E Subocz
- Department of Hematology, Military Institute of Medicine, Warszawa
| | - J Tajer
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie Memorial Institute, Warszawa
| | - W Kulikowski
- Clinical Department of Hematology, Interior Ministry Hospital, Warmia.,Mazury Medical University, Olsztyn
| | | | - A Biggi
- Nuclear Medicine Department, Santa Croce e Carle Hospital, Cuneo
| | - F Fallanca
- Nuclear Medicine Department, San Raffaele Hospital, Milano, Italy
| | - M Kobylecka
- Nuclear Medicine Department, Warsaw Medical University, Warszawa
| | - M Dziuk
- Nuclear Medicine Department, Military Institute of Medicine, Warszawa
| | - D Woszczyk
- Hematology Unit, Regional Hospital, Opole
| | - J Rybka
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw
| | | | - F Bergesio
- Medical Physics Department, Santa Croce e Carle Hospital, Cuneo, Italy
| | - A Romanowicz
- Department of Hematology, Central Clinical Hospital MSW, Warszawa
| | | | - P Kurczab
- Poradnia Onkologiczna z Oddzialem Chemioterapii Dziennej NZOZ Mrukmed, Rzeszów
| | - A Giza
- Department of Hematology, Jagiellonian University Medical College, Krakow
| | - K Lesniewski-Kmak
- Gdynia Oncology Center, Gdynia.,Departments of Oncological Propedeutics.,Hematology and Transplantology, Medical University of Gdańsk, Gdańsk
| | - R Zaucha
- Department of Clinical Oncology and Radiotherapy
| | - D Swietlik
- Intrafaculty College of Medical Informatics & Biostatistics, Medical University of Gdansk, Poland
| | - T Wróbel
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw
| | - W Knopinska-Posluszny
- Clinical Department of Hematology, Interior Ministry Hospital, Warmia.,Mazury Medical University, Olsztyn
| | - J Walewski
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie Memorial Institute, Warszawa
| | - A Gallamini
- Department of Research, Innovation and Statistics, A. Lacassagne Cancer Center, Nice, France
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16
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Wertheim-Tysarowska K, Ołdak M, Giza A, Kutkowska-Kaźmierczak A, Sota J, Przybylska D, Woźniak K, Śniegórska D, Niepokój K, Sobczyńska-Tomaszewska A, Rygiel AM, Płoski R, Bal J, Kowalewski C. Novel sporadic and recurrent mutations in KRT5 and KRT14 genes in Polish epidermolysis bullosa simplex patients: further insights into epidemiology and genotype-phenotype correlation. J Appl Genet 2015; 57:175-81. [PMID: 26432462 PMCID: PMC4830863 DOI: 10.1007/s13353-015-0310-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 07/26/2015] [Accepted: 08/12/2015] [Indexed: 12/25/2022]
Abstract
Epidermolysis bullosa simplex (EBS) is a hereditary genodermatosis characterised by trauma-induced intraepidermal blistering of the skin. EBS is mostly caused by mutations in the KRT5 and KRT14 genes. Disease severity partially depends on the affected keratin type and may be modulated by mutation type and location. The aim of our study was to identify the molecular defects in KRT5 and KRT14 in a cohort of 46 Polish and one Belarusian probands with clinical suspicion of EBS and to determine the genotype-phenotype correlation. The group of 47 patients with clinical recognition of EBS was enrolled in the study. We analysed all coding exons of KRT5 and KRT14 using Sanger sequencing. The pathogenic status of novel variants was evaluated using bioinformatical tools, control group analysis (DNA from 100 healthy population-matched subjects) and probands' parents testing. We identified mutations in 80 % of patients and found 29 different mutations, 11 of which were novel and six were found in more than one family. All novel mutations were ascertained as pathogenic. In the majority of cases, the most severe genotype was associated with mutations in highly conserved regions. In some cases, different inheritance mode and clinical significance, than previously reported by others, was observed. We report 11 novel variants and show novel genotype-phenotype correlations. Our data give further insight into the natural history of EBS molecular pathology, epidemiology and mutation origin.
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Affiliation(s)
- K Wertheim-Tysarowska
- Department of Medical Genetics, Institute of Mother and Child, Kasprzaka 17a, 01211, Warsaw, Poland.
| | - M Ołdak
- Department of Histology and Embryology, Center of Biostructure Research, Medical University of Warsaw, Chalubinskiego 5, 02004, Warsaw, Poland.,Department of Genetics, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - A Giza
- Department of Medical Genetics, Institute of Mother and Child, Kasprzaka 17a, 01211, Warsaw, Poland
| | - A Kutkowska-Kaźmierczak
- Department of Medical Genetics, Institute of Mother and Child, Kasprzaka 17a, 01211, Warsaw, Poland
| | - J Sota
- Department of Medical Genetics, Institute of Mother and Child, Kasprzaka 17a, 01211, Warsaw, Poland
| | - D Przybylska
- Department of Histology and Embryology, Center of Biostructure Research, Medical University of Warsaw, Chalubinskiego 5, 02004, Warsaw, Poland
| | - K Woźniak
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Chalubinskiego 5, 02004, Warsaw, Poland
| | - D Śniegórska
- Department of Medical Genetics, Institute of Mother and Child, Kasprzaka 17a, 01211, Warsaw, Poland
| | - K Niepokój
- Department of Medical Genetics, Institute of Mother and Child, Kasprzaka 17a, 01211, Warsaw, Poland
| | - A Sobczyńska-Tomaszewska
- Department of Medical Genetics, Institute of Mother and Child, Kasprzaka 17a, 01211, Warsaw, Poland
| | - A M Rygiel
- Department of Medical Genetics, Institute of Mother and Child, Kasprzaka 17a, 01211, Warsaw, Poland
| | - R Płoski
- Department of Genetics, Medical University of Warsaw, Pawińskiego 5a, 02004, Warsaw, Poland
| | - J Bal
- Department of Medical Genetics, Institute of Mother and Child, Kasprzaka 17a, 01211, Warsaw, Poland
| | - C Kowalewski
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Chalubinskiego 5, 02004, Warsaw, Poland
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Sobocinski M, Jurczak W, Dzietczenia J, Ogorka T, Fornagiel S, Giza A, Piatkowska-Jakubas B, Kumiega B, Blajer-Olszewska B, Cedrych IIC, Mazur G, Skotnicki AB. Prophylaxis of central nervous system (CNS) relapse in high-risk lymphoma patients with liposomal cytarabine. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Jurczak W, Giza A, Skotnicki AB, Deptala A, Windemuth-Kiesselbach C, Lorsbach M, Suh C, Zinzani PL, Linkesch WM, Trumper LH. Use of radioimmunotherapy for consolidation for chemosensitive mantle cell lymphoma (MCL): Summary of International Radioimmunotherapy Registry data. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Jurczak W, Giza A, Krochmalczyk D, Sobocinski M, Zimowska-Curylo D, Stella-Holowiecka B, Boguradzki P, Kisiel E, Wróbel T, Knopinska-Posluszny W, Skotnicki AB. Survival benefit of post induction consolidation therapy in MCL (mantle cell lymphoma): A Polish Lymphoma Research Group (PLRG) retrospective multicenter analysis. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e19510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19510 Background: In MCL, early intensification and consolidation of the first line therapy by ASCT is the treatment of choice. Elderly age and co-existing co-morbidities makes it however feasible for less than a third of patients. Methods: All MCL cases consulted in 8 PLRG centers within the last 5 years (n=140) were included in a retrospective analysis. Only 23% (n=32) were consolidated with ASCT, further 28% (n=40) by radioimmunotherapy (Ibritumomab), while in 49% (n=68) neither consolidation was performed. Rituximab was used in 36/72 patients subjected to consolidation and 25/68 treated without consolidation. There were no statistically significant differences in IPI, CS (clinical stage), frequency of extranodal manifestations and B symptoms between analyzed subgroups ( Table ) although patients subjected to ASCT were younger (median age 54 vs 62) and tend to have higher LDH (556 IU vs 473), while those who were not consolidated more frequently had a large tumor burden (defined as a mass > 7 cm, 24 vs 15%). Results: There was a clear impact of consolidation on overall and progression-free survival (OS,PFS): at 5 years OS 65 vs 20 % (p= 0.0003 in Gehan Wilcoxon test); and PFS 40 vs 0 % (p= 0.0003 in Gehan Wilcoxon test). Rituximab used in the first line therapy further increased it's efficiency in terms of PFS, prolonging median time to progression from 15 to 26 months, however the OS benefit was seen only in consolidated patients (at 5 years 75% OS in those with Rituximab including induction followed by consolidation). Conclusions: With all limitations of retrospective analysis, it strongly supports the necessity of post induction therapy in MCL patients. The role of ASCT is established in younger patients, radioimmunotherapy may prove to be a feasible approach for the elderly and unfit ones. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- W. Jurczak
- CMUJ, Krakow, Poland; SLAM, Katowice, Poland; AM, Warsaw, Poland; IH, Warsaw, Poland; AM, Wroclaw, Poland; AM, Gdansk, Poland
| | - A. Giza
- CMUJ, Krakow, Poland; SLAM, Katowice, Poland; AM, Warsaw, Poland; IH, Warsaw, Poland; AM, Wroclaw, Poland; AM, Gdansk, Poland
| | - D. Krochmalczyk
- CMUJ, Krakow, Poland; SLAM, Katowice, Poland; AM, Warsaw, Poland; IH, Warsaw, Poland; AM, Wroclaw, Poland; AM, Gdansk, Poland
| | - M. Sobocinski
- CMUJ, Krakow, Poland; SLAM, Katowice, Poland; AM, Warsaw, Poland; IH, Warsaw, Poland; AM, Wroclaw, Poland; AM, Gdansk, Poland
| | - D. Zimowska-Curylo
- CMUJ, Krakow, Poland; SLAM, Katowice, Poland; AM, Warsaw, Poland; IH, Warsaw, Poland; AM, Wroclaw, Poland; AM, Gdansk, Poland
| | - B. Stella-Holowiecka
- CMUJ, Krakow, Poland; SLAM, Katowice, Poland; AM, Warsaw, Poland; IH, Warsaw, Poland; AM, Wroclaw, Poland; AM, Gdansk, Poland
| | - P. Boguradzki
- CMUJ, Krakow, Poland; SLAM, Katowice, Poland; AM, Warsaw, Poland; IH, Warsaw, Poland; AM, Wroclaw, Poland; AM, Gdansk, Poland
| | - E. Kisiel
- CMUJ, Krakow, Poland; SLAM, Katowice, Poland; AM, Warsaw, Poland; IH, Warsaw, Poland; AM, Wroclaw, Poland; AM, Gdansk, Poland
| | - T. Wróbel
- CMUJ, Krakow, Poland; SLAM, Katowice, Poland; AM, Warsaw, Poland; IH, Warsaw, Poland; AM, Wroclaw, Poland; AM, Gdansk, Poland
| | - W. Knopinska-Posluszny
- CMUJ, Krakow, Poland; SLAM, Katowice, Poland; AM, Warsaw, Poland; IH, Warsaw, Poland; AM, Wroclaw, Poland; AM, Gdansk, Poland
| | - A. B. Skotnicki
- CMUJ, Krakow, Poland; SLAM, Katowice, Poland; AM, Warsaw, Poland; IH, Warsaw, Poland; AM, Wroclaw, Poland; AM, Gdansk, Poland
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Krochmalczyk D, Jurczak W, Giza A, Zimowska-Curylo D, Sobocinski M, Malkowski B, Pietrzak T, Szefer J, Senkus-Konefka E, Kumiega B, Skotnicki AB. Early PET assessment and therapy de-escalation in patients with advanced Hodgkin’s lymphoma treated with escalated BEACOPP regimen. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jurczak W, Krochmalczyk D, Giza A, Węgrzyn J, Sobocinski M, Gawelko J, Malkowski B, Czyz J, Pawlega J, Skotnicki AB. The choice of first-line therapy in advanced Hodgkin lymphoma: Retrospective comparison of ABVD and escalated BEACOPP regimen. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8063 Background: HD patients with high risk have a relatively poor prognosis with less than 50% 5-year overall survival (OS) if treated with ABVD regimen. Methods: Therapy results of all 105 patients with advanced HL (CS IIBX -IV) treated from diagnosis at our Department in the last decade, are presented. The choice of initial 3 cycles between ABVD and escalated BEACOPP was done at the patients preferal and physician's adivice. Further 3 chemotherapy cycles depended on initial response assessment: poorly responding ABVD treated patients were offered therapy escalation. Patients with a good response (over 80% regression) after the first 3 cycles were later treated with ABVD. EFS and OS were primary endpoints of the study. Results: We divided patients into 2 treatment groups, depending on the first 3 cycles (escalated BEACOPP n = 57 or ABVD n = 48). Poor response resulting in therapy intensification was not considered as an event defined only as a relapse or progression during therapy. There was a statistically insignificant imbalance between the risk factor distribution with less favorable prognosis in patients treated with esc BEACOPP: 38 % of pts in IV th clinical stage (as compared to 31% in ABVD group), 3,08 EORTC risk factors (as compared to 2,64 in ABVD group) and 2,19 according to German Hodgkin Study Group (1.93 respectively). Increased toxicity of esc BEACOPP regimen was due to grade 3/4 cytopaenia (present in all patients) resulting in more infection episodes (according to WHO scale stage 3 - 16 pts , stage 4 - 8 pts; in ABVD group, 2 and 1 pt respectively). There were no treatment related mortalities. In esc BEACOPP projected 5 y OS was 96% and EFS 89% , which is comparable to GHSG results. 5 y OS and EFS in ABVD group are 87% and 66% respectively. The difference in EFS is statistically significant (p< 0.05). Conclusions: In our study we checked the feasibility of esc BEACOPP regimen in high risk HD pts. The results show the importance of the intensity of the first line approach. In the poor responders after the initial 3 cycles, even early treatment intensification, didn’t improve the outcome. De-escalation of therapy after the first 3 cycles, in good responders, didn’t make OS and EFS inferior to GHSG results in which they recommend 6 cycles of esc BEACOPP therapy. No significant financial relationships to disclose.
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Affiliation(s)
- W. Jurczak
- Jagiellonian University, Krakow, Poland; Leszczynski Hospital, Katowice, Poland; Oncology Center, Bydgoszcz, Poland; Huddersfield Royal Infirmary, Lindley, United Kingdom
| | - D. Krochmalczyk
- Jagiellonian University, Krakow, Poland; Leszczynski Hospital, Katowice, Poland; Oncology Center, Bydgoszcz, Poland; Huddersfield Royal Infirmary, Lindley, United Kingdom
| | - A. Giza
- Jagiellonian University, Krakow, Poland; Leszczynski Hospital, Katowice, Poland; Oncology Center, Bydgoszcz, Poland; Huddersfield Royal Infirmary, Lindley, United Kingdom
| | - J. Węgrzyn
- Jagiellonian University, Krakow, Poland; Leszczynski Hospital, Katowice, Poland; Oncology Center, Bydgoszcz, Poland; Huddersfield Royal Infirmary, Lindley, United Kingdom
| | - M. Sobocinski
- Jagiellonian University, Krakow, Poland; Leszczynski Hospital, Katowice, Poland; Oncology Center, Bydgoszcz, Poland; Huddersfield Royal Infirmary, Lindley, United Kingdom
| | - J. Gawelko
- Jagiellonian University, Krakow, Poland; Leszczynski Hospital, Katowice, Poland; Oncology Center, Bydgoszcz, Poland; Huddersfield Royal Infirmary, Lindley, United Kingdom
| | - B. Malkowski
- Jagiellonian University, Krakow, Poland; Leszczynski Hospital, Katowice, Poland; Oncology Center, Bydgoszcz, Poland; Huddersfield Royal Infirmary, Lindley, United Kingdom
| | - J. Czyz
- Jagiellonian University, Krakow, Poland; Leszczynski Hospital, Katowice, Poland; Oncology Center, Bydgoszcz, Poland; Huddersfield Royal Infirmary, Lindley, United Kingdom
| | - J. Pawlega
- Jagiellonian University, Krakow, Poland; Leszczynski Hospital, Katowice, Poland; Oncology Center, Bydgoszcz, Poland; Huddersfield Royal Infirmary, Lindley, United Kingdom
| | - A. B. Skotnicki
- Jagiellonian University, Krakow, Poland; Leszczynski Hospital, Katowice, Poland; Oncology Center, Bydgoszcz, Poland; Huddersfield Royal Infirmary, Lindley, United Kingdom
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Weigert O, Jurczak W, Von Schilling C, Giza A, Rummel M, Hubalewska A, Pezzutto A, Unterhalt M, Hiddemann W, Skotnicki A, Dreyling M. Efficacy of radioimmunotherapy with (90Y) ibritumomab tiuxetan is superior as consolidation in relapsed or refractory mantle cell lymphoma: Results of two phase II trials of the European MCL Network and the PLRG. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7533] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7533 Background: Radioimmunotherapy (RIT) has demonstrated high clinical efficacy in follicular lymphoma but varying results in mantle cell lymphoma (MCL). Methods: We performed a comparative analysis of two phase II studies with similar inclusion criteria to identify potential predictors of response. 32 patients with relapsed or refractory MCL, WHO performance status ≤2, appropriate hematopoesis (ANC > 1,500/mm3, platelets > 100,000/mm3) and adequate function of liver and kidneys were treated with RIT upfront (Arm A, n = 16) or as consolidation after initial cytoreduction (Arm B, n = 16). 28 patients (88%) had been previously treated with rituximab. Patients with >25% bone marrow involvement, known CNS lymphoma, HIV infection or other severe concurrent disease were excluded. Ibritumomab tiuxetan (Zevalin) was applied at a dose of 15 MBq 90Y/kg, whereas patients with reduced platelet counts (<150,000/mm3) received 11 MBq 90Y/kg. Results: The median age was 66.9 years (range 58–72) in Arm A and 63.1 years (range 45–79) in Arm B. The median number of prior regimens was 4 (range 2–6) in Arm A and 1 (1–5) in Arm B. RIT treatment was generally well tolerated with the most common toxicities being hematologic. Thrombocytopenia grade 3 and 4 was observed in 69% of patients, one patient died of hemorrhagic stroke. Granulocytopenia grade 4 occurred in 34% of patients, one patient developed a grade 4 infectious complication. Currently 22 patients are evaluable for response rate and duration of remission (DR). In Arm A a partial response (PR) was observed in 2 of 6 evaluable patients (33.3%) with a median DR of 3.9 months only. In Arm B chemoinduction achieved 2 complete responses (CR) and 14 PR. Following RIT seven of 14 PR patients (50%) converted to CR. Currently, 13 of 16 patients (81%) are still in remission. As expected the most important adverse risk factor was bulky disease before RIT with no responses seen in this patient population. Patients with less prior therapeutic lines (< 2) had significantly higher response rates. Conclusions: In future trials, RIT should be applied earlier in the treatment algorithm of MCL after a debulking strategy with combined immuno-chemotherapy. [Table: see text]
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Affiliation(s)
- O. Weigert
- University Hospital Grosshadern, Munich, Germany; Department of Hematology, Crakow, Poland; University Hospital, Munich, Germany; University Hospital, Frankfurt, Germany; Department of Nuclear Medicine CMUJ, Cracow, Poland; Charité Campus Buch, Berlin, Germany
| | - W. Jurczak
- University Hospital Grosshadern, Munich, Germany; Department of Hematology, Crakow, Poland; University Hospital, Munich, Germany; University Hospital, Frankfurt, Germany; Department of Nuclear Medicine CMUJ, Cracow, Poland; Charité Campus Buch, Berlin, Germany
| | - C. Von Schilling
- University Hospital Grosshadern, Munich, Germany; Department of Hematology, Crakow, Poland; University Hospital, Munich, Germany; University Hospital, Frankfurt, Germany; Department of Nuclear Medicine CMUJ, Cracow, Poland; Charité Campus Buch, Berlin, Germany
| | - A. Giza
- University Hospital Grosshadern, Munich, Germany; Department of Hematology, Crakow, Poland; University Hospital, Munich, Germany; University Hospital, Frankfurt, Germany; Department of Nuclear Medicine CMUJ, Cracow, Poland; Charité Campus Buch, Berlin, Germany
| | - M. Rummel
- University Hospital Grosshadern, Munich, Germany; Department of Hematology, Crakow, Poland; University Hospital, Munich, Germany; University Hospital, Frankfurt, Germany; Department of Nuclear Medicine CMUJ, Cracow, Poland; Charité Campus Buch, Berlin, Germany
| | - A. Hubalewska
- University Hospital Grosshadern, Munich, Germany; Department of Hematology, Crakow, Poland; University Hospital, Munich, Germany; University Hospital, Frankfurt, Germany; Department of Nuclear Medicine CMUJ, Cracow, Poland; Charité Campus Buch, Berlin, Germany
| | - A. Pezzutto
- University Hospital Grosshadern, Munich, Germany; Department of Hematology, Crakow, Poland; University Hospital, Munich, Germany; University Hospital, Frankfurt, Germany; Department of Nuclear Medicine CMUJ, Cracow, Poland; Charité Campus Buch, Berlin, Germany
| | - M. Unterhalt
- University Hospital Grosshadern, Munich, Germany; Department of Hematology, Crakow, Poland; University Hospital, Munich, Germany; University Hospital, Frankfurt, Germany; Department of Nuclear Medicine CMUJ, Cracow, Poland; Charité Campus Buch, Berlin, Germany
| | - W. Hiddemann
- University Hospital Grosshadern, Munich, Germany; Department of Hematology, Crakow, Poland; University Hospital, Munich, Germany; University Hospital, Frankfurt, Germany; Department of Nuclear Medicine CMUJ, Cracow, Poland; Charité Campus Buch, Berlin, Germany
| | - A. Skotnicki
- University Hospital Grosshadern, Munich, Germany; Department of Hematology, Crakow, Poland; University Hospital, Munich, Germany; University Hospital, Frankfurt, Germany; Department of Nuclear Medicine CMUJ, Cracow, Poland; Charité Campus Buch, Berlin, Germany
| | - M. Dreyling
- University Hospital Grosshadern, Munich, Germany; Department of Hematology, Crakow, Poland; University Hospital, Munich, Germany; University Hospital, Frankfurt, Germany; Department of Nuclear Medicine CMUJ, Cracow, Poland; Charité Campus Buch, Berlin, Germany
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Gomuła A, Giza A, Stawarz B. [Percutaneous descending pyelography under ultrasonographic control]. Pol Przegl Radiol 1988; 52:87-91. [PMID: 3073367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Badowski A, Paczyński A, Forgalski W, Walecki J, Giza A. [Conservatively treated splenic rupture]. Wiad Lek 1984; 37:866-73. [PMID: 6506707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Dzurak W, Dziuk E, Woynarowski M, Giza A. [Pulmonary circulation disorders based on routine radiographic studies and scintiscanning]. Wiad Lek 1976; 29:1137-43. [PMID: 951995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Giza A, Grabowski T, Zaborowski P. [Changes in subcardial gastric area in radiological and endoscopic investigations (author's transl)]. Pol Przegl Radiol Med Nukl 1976; 40:257-60. [PMID: 980935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Zaborowski P, Grabowski T, Giza A. [Duodenal cap ulcer in radiographic and endoscopic observation]. Pol Tyg Lek 1976; 31:931-3. [PMID: 951255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Grabowski T, Zaborowski P, Giza A, Frankowski I. [Simple preparation of the colon for radiographic studies endoscopy]. Wiad Lek 1976; 29:277-9. [PMID: 1251647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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