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Jacobson CA, Rosenthal AC, Arnason J, Agarwal S, Zhang P, Wu W, Amber V, Yared JA. A phase 2 trial of defibrotide for the prevention of chimeric antigen receptor T-cell-associated neurotoxicity syndrome. Blood Adv 2023; 7:6790-6799. [PMID: 37399456 PMCID: PMC10692301 DOI: 10.1182/bloodadvances.2023009961] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/16/2023] [Revised: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023] Open
Abstract
Chimeric antigen receptor T-cell (CAR-T) therapy represents a major advance in cancer immunotherapy; however, it can be associated with life-threatening neurotoxicity linked to blood-brain barrier disruption and endothelial activation. Defibrotide was shown to reduce endothelial cell activation in vitro and is approved in the United States for treatment of veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) in patients with renal or pulmonary dysfunction after hematopoietic cell transplantation (HCT), and in the European Union for severe VOD/SOS after HCT in patients aged >1 month. Defibrotide may stabilize the endothelium during CAR-T therapy and reduce the rate of CAR-T-associated neurotoxicity. This phase 2 study evaluated the safety and efficacy of defibrotide for prevention of CAR-T-associated neurotoxicity in patients with relapsed/refractory large B-cell lymphoma receiving axicabtagene ciloleucel. Part 1 established the recommended phase 2 dose (RP2D; 6.25 mg/kg); 20 patients (from parts 1 and 2) receiving the RP2D were evaluable for efficacy. Rate of CAR-T-associated neurotoxicity by day 30 (primary end point) was ∼50%, lower than reported in the ZUMA-1 trial (64%). Median event duration of grade ≥3 neurotoxicity was 7 days. No unexpected defibrotide-related safety findings and defibrotide-related treatment-emergent adverse events or deaths were reported. Results showed modest reduction in rate of CAR-T-associated neurotoxicity and high-grade neurotoxicity event duration relative to historical data; however, reduction was unlikely to meet the primary end point, so the study was terminated early. Nevertheless, results contribute valuable data for potential therapeutic insight on the management of CAR-T-associated neurotoxicity. This trial was registered at www.clinicaltrials.gov as #NCT03954106.
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Affiliation(s)
- Caron A. Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Jon Arnason
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | - Wendy Wu
- Jazz Pharmaceuticals, Palo Alto, CA
| | - Vian Amber
- Jazz Pharmaceuticals, Oxford, United Kingdom
| | - Jean A. Yared
- Department of Medical Oncology, University of Maryland Medical Center, Baltimore, MD
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2
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Bi L, Rosenthal AC, Kuo PH, Yang M. Physiologic 18F-FDG Uptake in Brown Adipose Tissue and Lactating Breast in a Patient with Hodgkin Lymphoma. J Nucl Med Technol 2023:jnmt.123.266472. [PMID: 37852645 DOI: 10.2967/jnmt.123.266472] [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: 08/07/2023] [Revised: 09/05/2023] [Indexed: 10/20/2023] Open
Abstract
We present the case of a young woman with Hodgkin lymphoma exhibiting physiologic 18F-FDG uptake in brown adipose tissue and lactating breast on consecutive 18F-FDG PET/CT scans. Both entities are common imaging interpretation pitfalls and should be recognized in oncologic 18F-FDG PET/CT practice. We review the imaging features and differential diagnosis of these 2 entities and discuss the radiation safety precautions during breastfeeding.
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Affiliation(s)
- Lulu Bi
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Phillip H Kuo
- Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, Arizona; and
| | - Ming Yang
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
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3
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Huntington SF, Schuster SJ, Ding W, Koehler AB, Brander DM, Rosenthal AC, Leis JF, Tun HW, Moustafa MA, Iqbal M, He W, Kearney AS, McKinlay TP, Gui M, Mato AR. DTRMWXHS-12, a novel Bruton tyrosine kinase inhibitor, in combination with everolimus and pomalidomide in patients with relapsed/refractory lymphomas: An open-label, multicenter, phase 1a/1b study. Am J Hematol 2023; 98:739-749. [PMID: 36810799 DOI: 10.1002/ajh.26888] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/04/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
Preclinical studies have shown augmented activity when combining Bruton tyrosine kinase inhibitors (BTKi) with inhibitors of mammalian target of rapamycin (mTOR) and immunomodulatory agents (IMiD). We conducted a phase 1, open-label study at five centers in USA to evaluate the safety of triplet BTKi/mTOR/IMiD therapy. Eligible patients were adults aged 18 years or older with relapsed/refractory CLL, B cell NHL, or Hodgkin lymphoma. Our dose escalation study used an accelerated titration design and moved sequentially from single agent BTKi (DTRMWXHS-12), doublet (DTRMWXHS-12 + everolimus), and then to triplet therapy (DTRMWXHS-12 + everolimus + pomalidomide). All drugs were dosed once daily on days 1-21 of each 28-day cycle. The primary goal was to establish the recommended phase 2 dose of the triplet combination. Between September 27, 2016, and July 24, 2019, a total of 32 patients with a median age of 70 years (range 46 to 94 years) were enrolled. No MTD was identified for monotherapy and the doublet combination. The MTD for the triplet combination was determined to be DTRMWXHS-12 200 mg + everolimus 5 mg + pomalidomide 2 mg. Responses across all studied cohorts were seen in 13 of 32 (41.9%). Combining DTRMWXHS-12 with everolimus and pomalidomide is tolerable and shows clinical activity. Additional trials could confirm benefit of this all-oral combination therapy for relapsed/refractory lymphomas.
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Affiliation(s)
| | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wei Ding
- Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Jose F Leis
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Han W Tun
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Madiha Iqbal
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Wei He
- Zhejiang DTRM Biopharma LLC, Plymoth Meeting, Pennsylvania, USA
| | | | | | - Min Gui
- Zhejiang DTRM Biopharma LLC, Plymoth Meeting, Pennsylvania, USA
| | - Anthony R Mato
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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4
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Loveday T, Duns G, Rimsza LM, Rech KL, Cook JR, Robetorye RS, Rosenthal AC, Ramsower CA, Yip TK, McKinney CL, Swerdlow SH, Bhavsar S, Steidl C, Gibson SE. Transformation of FL into DLBCL with a PMBL gene expression signature. Blood Adv 2023; 7:893-899. [PMID: 36240289 PMCID: PMC10025110 DOI: 10.1182/bloodadvances.2022007360] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/17/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/20/2022] Open
Abstract
We investigated the clinicopathologic features of 5 follicular lymphomas (FLs) that transformed (tFL) morphologically to diffuse large B-cell lymphomas (DLBCLs) and had a primary mediastinal large B-cell lymphoma (PMBL)-like gene expression profile (tFL-PMBLsig-pos). None of the tFL-PMBLsig-pos cases arose in the mediastinum, all cases tested had a germinal center B-cell phenotype, 20% were CD30+, 60% CD23+, 80% MAL+, 20% CD200+, and 0% CD273/PDL2+. Whole-exome sequencing detected alterations in genes associated with both FL/DLBCL (CREBBP, KMT2C, KMT2D, ARID1A, HIST1 members, and TNFRSF14) and PMBL (JAK-STAT pathway genes, B2M, and CD58). Copy number (CN) analysis detected gains/amplification of REL and STAT6 in 60%, gains of SOCS1 in 40%, and gains of chromosome 16, including IL4R, in 40% of the cases. CN gains/amplification of BCL6 and MYC and loss of TNFRSF14 and TNFAIP3 were identified in 20% of the cases. Three of 5 cases lacked a BCL2 rearrangement. Despite having some features that are less common in DLBCL (MAL and CD23 expression and JAK-STAT activation), these tFL-PMBLsig-pos cases lack the most characteristic CN alteration seen in PMBL (9p24.1 gain/amplification). This cohort expands the biologic heterogeneity of tFL, illustrating a subset with gene expression and some genetic features reminiscent of PMBL, with potential treatment implications that include the use of novel targeted therapies.
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Affiliation(s)
| | - Gerben Duns
- Centre for Lymphoid Cancer, British Columbia (BC) Cancer, Vancouver, BC
| | - Lisa M. Rimsza
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
| | - Karen L. Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - James R. Cook
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Ryan S. Robetorye
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
| | | | | | - Tameson K. Yip
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
| | | | - Steven H. Swerdlow
- Division of Hematopathology, University of Pittsburgh School of Medicine/UPMC, Pittsburgh, PA
| | - Shweta Bhavsar
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
- Division of Hematopathology, University of Pittsburgh School of Medicine/UPMC, Pittsburgh, PA
| | - Christian Steidl
- Centre for Lymphoid Cancer, British Columbia (BC) Cancer, Vancouver, BC
| | - Sarah E. Gibson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
- Correspondence: Sarah E. Gibson, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054;
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5
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Rosenthal AC, Munoz JL, Villasboas JC. Clinical advances in epigenetic therapies for lymphoma. Clin Epigenetics 2023; 15:39. [PMID: 36871057 PMCID: PMC9985856 DOI: 10.1186/s13148-023-01452-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 02/19/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Advances in understanding of cancer biology, genomics, epigenomics, and immunology have resulted in development of several therapeutic options that expand cancer care beyond traditional chemotherapy or radiotherapy, including individualized treatment strategies, novel treatments based on monotherapies or combination therapy to reduce toxicities, and implementation of strategies for overcoming resistance to anticancer therapy. RESULTS This review covers the latest applications of epigenetic therapies for treatment of B cell, T cell, and Hodgkin lymphomas, highlighting key clinical trial results with monotherapies and combination therapies from the main classes of epigenetic therapies, including inhibitors of DNA methyltransferases, protein arginine methyltransferases, enhancer of zeste homolog 2, histone deacetylases, and the bromodomain and extraterminal domain. CONCLUSION Epigenetic therapies are emerging as an attractive add-on to traditional chemotherapy and immunotherapy regimens. New classes of epigenetic therapies promise low toxicity and may work synergistically with other cancer treatments to overcome drug resistance mechanisms.
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Affiliation(s)
- Allison C Rosenthal
- Division of Hematology, Medical Oncology, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
| | - Javier L Munoz
- Division of Hematology, Medical Oncology, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - J C Villasboas
- Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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6
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Wiedmeier-Nutor JE, Iqbal M, Rosenthal AC, Bezerra ED, Garcia-Robledo JE, Bansal R, Johnston PB, Hathcock M, Larsen JT, Bergsagel PL, Wang Y, Reeder CB, Leis JF, Fonseca R, Palmer JM, Gysbers BJ, Mwangi R, Warsame RM, Kourelis T, Hayman SR, Dingli D, Kapoor P, Kumar SK, Durani U, Villasboas JC, Paludo J, Bennani NN, Nowakowski G, Ansell SM, Castro JE, Kharfan-Dabaja MA, Lin Y, Vergidis P, Murthy HS, Munoz J. Response to COVID-19 vaccination post CAR T therapy in patients with non-Hodgkin lymphoma and multiple myeloma. Clinical Lymphoma Myeloma and Leukemia 2023; 23:456-462. [PMID: 37003846 PMCID: PMC9990888 DOI: 10.1016/j.clml.2023.03.002] [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] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/17/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
COVID-19 adversely affects individuals with cancer. Several studies have found that seroconversion rates among patients with hematologic malignancies are suboptimal when compared to patients without cancer. Patients with non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) are immunocompromised due to impaired humoral and cellular immunity in addition to prescribed immunosuppressive therapy. Chimeric antigen receptor T-cell (CAR T) therapy is now widely used for NHL and MM, but little is known about seroconversion rates after COVID-19 vaccination among these populations. We evaluated SARS-CoV-2 spike-binding IgG antibody levels following COVID-19 vaccination among NHL and MM CAR T therapy recipients. Out of 104 CAR T infusions, 19 patients developed known COVID-19 infection post-CAR T. We tested 17 patients that received CAR T for antibody spike titers post COVID-19 vaccination, only 29 % (n = 5) were able to mount a clinically relevant antibody response (>250 IU/mL).
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Affiliation(s)
| | - Madiha Iqbal
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | | | | | - Jeremy T Larsen
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - P Leif Bergsagel
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Craig B Reeder
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Jose F Leis
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Rafael Fonseca
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Jeanne M Palmer
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Brianna J Gysbers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Raphael Mwangi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Urshila Durani
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - Januario E Castro
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Hemant S Murthy
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Javier Munoz
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
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7
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Borcherding N, Severson KJ, Henderson N, Ortolan LS, Rosenthal AC, Bellizzi AM, Liu V, Link BK, Mangold AR, Jabbari A. Single-cell analysis of Sézary syndrome reveals novel markers and shifting gene profiles associated with treatment. Blood Adv 2023; 7:321-335. [PMID: 35390145 PMCID: PMC9881051 DOI: 10.1182/bloodadvances.2021005991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/08/2022] [Accepted: 03/10/2022] [Indexed: 02/02/2023] Open
Abstract
Cutaneous T-cell lymphomas (CTCLs) are a spectrum of diseases with varied clinical courses caused by malignant clonal proliferation of skin-tropic T cells. Most patients have an indolent disease course managed with skin-directed therapies. In contrast, others, especially in advanced stages of disease or with specific forms, have aggressive progression and poor median survival. Sézary syndrome (SS), a leukemic variant of CTCL, lacks highly consistent phenotypic and genetic markers that may be leveraged to prevent the delay in diagnosis experienced by most patients with CTCL and could be useful for optimal treatment selection. Using single-cell mRNA and T-cell receptor sequencing of peripheral blood immune cells in SS, we extensively mapped the transcriptomic variations of nearly 50 000 T cells of both malignant and nonmalignant origins. We identified potential diverging SS cell populations, including quiescent and proliferative populations shared across multiple patients. In particular, the expression of AIRE was the most highly upregulated gene in our analysis, and AIRE protein expression could be observed over a variety of CTCLs. Furthermore, within a single patient, we were able to characterize differences in cell populations by comparing malignant T cells over the course of treatment with histone deacetylase inhibition and photopheresis. New cellular clusters after progression of the therapy notably exhibited increased expression of the transcriptional factor FOXP3, a master regulator of regulatory T-cell function, raising the potential implication of an evolving mechanism of immune evasion.
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Affiliation(s)
- Nicholas Borcherding
- Department of Pathology, University of Iowa, Iowa City, IA
- Department of Pathology and Immunology, Washington University, St. Louis, MO
| | | | | | - Luana S. Ortolan
- Department of Dermatology, University of Iowa, Iowa City, IA
- Seattle Children’s Research Institute, Seattle, WA
| | | | | | - Vincent Liu
- Department of Pathology, University of Iowa, Iowa City, IA
- Department of Dermatology, University of Iowa, Iowa City, IA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA
| | - Brian K. Link
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA
- Department of Internal Medicine, University of Iowa, Iowa City, IA
| | | | - Ali Jabbari
- Department of Pathology, University of Iowa, Iowa City, IA
- Department of Dermatology, University of Iowa, Iowa City, IA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA
- Iowa City Veterans Affairs Medical Center, Iowa City, IA
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8
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Forero-Forero JV, Lengerke-Diaz PA, Moreno-Cortes E, Melody M, Rahman ZA, Rosenthal AC, Kharfan-Dabaja MA, Castro JE. Predictors and Management of Relapse to Axicabtagene Ciloleucel in Patients with Aggressive B-cell Lymphoma. Hematol Oncol Stem Cell Ther 2023; 16:133-143. [PMID: 34562407 DOI: 10.1016/j.hemonc.2021.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/25/2021] [Accepted: 09/02/2021] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE/BACKGROUND Despite the success of chimeric antigen receptor (CAR) T-cell therapy in patients with aggressive non-Hodgkin lymphoma (aNHL), some patients still fail treatment, and their prognosis is dismal. METHODS We performed a retrospective study of aNHL patients treated with axicabtagene ciloleucel (axi-cel) at two Mayo Clinic centers between 2018 and 2020. We evaluated predictive factors, toxicities, and responses to salvage regimens after CAR T-cell therapy. RESULTS Thirty-four patients received axi-cel with a median length of hospitalization of 14 days. Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome of any grade occurred in 91% and 41% of patients, respectively. Furthermore, 71% of patients responded to therapy, with 53% achieving a complete response (CR). The CRS grade and absolute lymphocyte count at leukapheresis (ALCLeuk) correlated with CR and overall survival (OS), respectively. After a median follow-up of 6.8 months (interquartile range [IQR] 4.6-14.9), 15 patients (44%) showed progressive disease (PD). Most patients (60%) progressed during the first 3 months and had persistent CD19 tumor expression. Elevated C-reactive protein at baseline increased the risk of PD, whereas elevated ferritin increased PD and mortality risk. Twelve patients received salvage therapy, but only three responded. Median OS of relapsed/refractory patients to axi-cel was 3 months (IQR 1.3-5.1). CONCLUSION The grade of CRS and ALCLeuk correlated with better outcomes to axi-cel therapy. In addition, elevated inflammatory markers at baseline were associated with PD and shorter survival. Relapses after treatment frequently occur within months after axi-cel infusion; they confer a poor prognosis and create an urgent need for novel and effective treatment options in this patient population.
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Affiliation(s)
| | - Paula A Lengerke-Diaz
- Department of Internal Medicine, Division Hematology-Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Eider Moreno-Cortes
- Department of Internal Medicine, Division Hematology-Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Megan Melody
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Zaid Abdel Rahman
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
| | - Allison C Rosenthal
- Department of Internal Medicine, Division Hematology-Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
| | - Januario E Castro
- Department of Internal Medicine, Division Hematology-Oncology, Mayo Clinic, Phoenix, AZ, USA
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9
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Chhabra N, Cebak JE, Schmitt A, Lal D, Rosenthal AC, Taylor CM, Thorwarth RM, Shah AA, Rodriguez-Pla A. Concomitant presentation of eosinophilic or oncocytic mucoepidermoid carcinoma, immunoglobulin G4-related disease, and adult-onset asthma and periocular xanthogranuloma: Case report of 3 uncommon clinical entities. Medicine (Baltimore) 2022; 101:e30067. [PMID: 35960078 PMCID: PMC9371478 DOI: 10.1097/md.0000000000030067] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Immunoglobulin (Ig) G4-related disease (IgG4-RD) reportedly has a strong relationship with adult-onset asthma and periocular xanthogranuloma (AAPOX) and may be linked to sclerosing mucoepidermoid carcinoma (MEC). We present a rare case of IgG4-RD and AAPOX occurring in a patient with resected eosinophilic or oncocytic MEC. PATIENT CONCERNS A 52-year-old woman was referred to our rheumatology clinic in 2020 to be evaluated for suspected IgG4-RD. DIAGNOSES The patient had diagnoses of periorbital xanthelasmas, worsening glucocorticoid-dependent chronic rhinosinusitis and adult-onset asthma, and cervical lymphadenopathy persisting 2 years after resection of a low-grade MEC of a minor salivary gland. INTERVENTIONS Because the patient's symptomatic relief was glucocorticoid dependent, IgG4-RD was suspected, and she was referred to our medical center. Her amylase and lipase levels were elevated. Serum IgG4 levels were initially within normal limits, but IgG4-RD was diagnosed because of the presence of lymphadenopathy and evidence of pancreatitis, which was shown on positron emission tomography/computed tomography. Furthermore, the IgG4 levels later increased without explanation. After the patient began combination therapy with a glucocorticoid (prednisone) and methotrexate, her symptoms improved but recurred when the daily oral glucocorticoid dosage decreased below 10 mg. An excisional biopsy of her right submandibular gland in 2021 yielded results consistent with IgG4-RD. In addition, AAPOX was diagnosed, given the presence of periocular edema and plaques, adult-onset asthma, and rhinosinusitis. OUTCOME The patient was carcinoma free at last follow-up and was receiving medication to treat the other conditions. LESSONS The diagnosis of these 3 concomitant, uncommon entities required approximately 7 years of medical investigations. Clinicians should know that IgG4-RD, AAPOX, and MEC may occur together.
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Affiliation(s)
- Nikita Chhabra
- Department of Neurology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona
| | - John E. Cebak
- Department of Neurology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona
| | | | - Devyani Lal
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona
| | | | - Cullen M. Taylor
- Department of Otorhinolaryngology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Ryan M. Thorwarth
- Department of Otorhinolaryngology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Ami A. Shah
- Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
| | - Alicia Rodriguez-Pla
- Division of Rheumatology, Mayo Clinic, Scottsdale, Arizona
- *Correspondence: Alicia Rodriguez-Pla, Division of Rheumatology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (e-mail: )
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10
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Gouni S, Rosenthal AC, Crombie JL, Ip A, Kamdar MK, Hess B, Feng L, Watson G, Ayers A, Neelapu SS, Khurana A, Lin Y, Iqbal M, Merryman RW, Strati P. A multicenter retrospective study of polatuzumab vedotin in patients with large B-cell lymphoma after CAR T-cell therapy. Blood Adv 2022; 6:2757-2762. [PMID: 35240681 PMCID: PMC9092406 DOI: 10.1182/bloodadvances.2021006801] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/25/2022] [Indexed: 11/24/2022] Open
Abstract
Polatuzumab vedotin (PV) is an antibody-drug conjugate targeting CD79b that is approved for patients with relapsed/refractory large B-cell lymphoma (LBCL). Patients who relapse after chimeric antigen receptor (CAR) T-cell therapy were not included in the registration study, and reports of PV use after CAR T cells are limited. This multicenter retrospective analysis included patients with LBCL who relapsed or progressed after CAR T-cell therapy and subsequently received PV with or without rituximab and bendamustine between July 2019 and May 2021. Response to treatment and progression were assessed based on the 2014 Lugano criteria. Fifty-seven patients were included in the study: 18 (32%) patients were primary refractory to CAR T-cell therapy, and 34 (60%) patients received PV-based therapy immediately after CAR T-cell therapy. PV was combined with rituximab in 54 (95%) patients and administered with bendamustine in 35 (61%) patients. A response was achieved in 25 (44%) patients, including complete remission in 8 (14%). No significant association between baseline characteristics and response was observed. After a median follow-up of 47 weeks (95% confidence interval [CI], 40-54), 46 (81%) patients had disease progression or died, and the median progression-free survival was 10 weeks (95% CI, 5-15). On a multivariate analysis, bone marrow involvement (hazard ratio, 5.2; 95% CI, 1.8-15; P = .003) and elevated lactate dehydrogenase levels (hazard ratio, 5.0; 95% CI, 1.4-16; P = .01) were associated with shorter progression-free survival. Studies aimed at better characterizing the intrinsic mechanism of resistance and identifying optimal consolidation strategies for these patients are warranted.
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Affiliation(s)
- Sushanth Gouni
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Andrew Ip
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | | | - Brian Hess
- Division of Haematology, Medical University of South Carolina, Charleston, SC
| | - Lei Feng
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Grace Watson
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amy Ayers
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sattva S. Neelapu
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN; and
| | - Madiha Iqbal
- Division of Hematology, Mayo Clinic, Jacksonville, FL
| | - Reid W. Merryman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Paolo Strati
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
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11
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Brumfiel CM, Patel MH, Puri P, Besch-Stokes J, Lester S, Rule WG, Khera N, Sluzevich JC, DiCaudo DJ, Comfere N, Bennani NN, Rosenthal AC, Pittelkow MR, Mangold AR. How to Sequence Therapies in Mycosis Fungoides. Curr Treat Options Oncol 2021; 22:101. [PMID: 34570278 DOI: 10.1007/s11864-021-00899-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 12/11/2022]
Abstract
OPINION STATEMENT Choice of therapy in mycosis fungoides is based on both patient- and lymphoma-specific factors, such as disease characteristics, comorbidities, symptoms and effect on quality of life, potential associated toxicities of therapy, response and tolerance to prior lines of therapy, and convenience and practicality. Generally, we sequence therapies from least toxic, targeted, nonimmunosuppressive to more toxic, immunosuppressive and from single agent to multiple agents, as necessary. If more toxic, immunosuppressive agents are required to alleviate disease burden or symptoms, we generally use them just long enough to control the disease, then transition to a maintenance regimen with less toxic, less immunosuppressive agents.
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Affiliation(s)
- Caitlin M Brumfiel
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Meera H Patel
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Pranav Puri
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Jake Besch-Stokes
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Scott Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - William G Rule
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Nandita Khera
- Division of Hematology Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - David J DiCaudo
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Nneka Comfere
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - N Nora Bennani
- Division of Hematology Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA.
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12
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Gustafson MP, Wheatley-Guy CM, Rosenthal AC, Gastineau DA, Katsanis E, Johnson BD, Simpson RJ. Exercise and the immune system: taking steps to improve responses to cancer immunotherapy. J Immunother Cancer 2021; 9:e001872. [PMID: 34215686 PMCID: PMC8256759 DOI: 10.1136/jitc-2020-001872] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 12/18/2022] Open
Abstract
The remarkable success of cancer immunotherapies has provided new hope to cancer patients. Unfortunately, a significant proportion of patients remain unable to respond to immunotherapy or maintain durable clinical responses. The lack of objective responses likely results from profound immune dysfunction often observed in patients with cancer. There is substantial evidence that exercise and physical activity can reduce incidence and improve outcomes in cancer patients. As the immune system is highly responsive to exercise, one potential avenue to improve immune function is through exercise and physical activity. A single event of dynamic exercise results in the substantial mobilization of leukocytes with increased functional capacities into the circulation. Chronic, or long-term, exercise leads to higher physical fitness in terms of greater cardiorespiratory function and/or muscle strength and endurance. High aerobic capacity, as measured by maximal oxygen uptake, has been associated with the reduction of dysfunctional T cells and improvements in the abundance of some T cell populations. To be sure, however, the mechanisms of exercise-mediated immune changes are both extensive and diverse. Here, we examine the evidence and theorize how acute and chronic exercise could be used to improve responses to cancer immunotherapies including immune checkpoint inhibitors, dendritic cell vaccines, natural killer cell therapies, and adoptive T cell therapies such as chimeric antigen receptor (CAR) T cells. Although the parameters of optimal exercise to yield defined outcomes remain to be determined, the available current data provide a compelling justification for additional human studies and clinical trials investigating the adjuvant use of exercise in immuno-oncology.
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Affiliation(s)
- Michael P Gustafson
- Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | | | - Dennis A Gastineau
- Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Emmanuel Katsanis
- Pediatrics, Immunobiology, University of Arizona Medical Center - University Campus, Tucson, Arizona, USA
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Richard J Simpson
- Pediatrics, Immunobiology, and Nutritional Sciences, University of Arizona Medical Center - University Campus, Tucson, Arizona, USA
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13
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Brumfiel CM, Patel MH, DiCaudo DJ, Rosenthal AC, Pittelkow MR, Mangold AR. Recurrence of primary cutaneous CD30-positive lymphoproliferative disorder following COVID-19 vaccination. Leuk Lymphoma 2021; 62:2554-2555. [PMID: 33974494 DOI: 10.1080/10428194.2021.1924371] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Meera H Patel
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, USA
| | - David J DiCaudo
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, USA
| | | | | | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, USA
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14
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Breen ID, Brumfiel CM, Patel MH, Rosenthal AC, Rule WG, DiCaudo DJ, Craig FE, Pittelkow MR, Mangold AR. Mogamulizumab-induced interface dermatitis drug rash treated successfully with methotrexate and extracorporeal photopheresis in a patient with Sézary syndrome. JAAD Case Rep 2021; 9:24-27. [PMID: 33604439 PMCID: PMC7873348 DOI: 10.1016/j.jdcr.2020.12.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ilana D. Breen
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | | | | | | | | | - David J. DiCaudo
- Mayo Clinic Arizona, Dermatology, Scottsdale, Arizona
- Mayo Clinic Arizona, Laboratory Medicine and Pathology, Phoenix, Arizona
| | - Fiona E. Craig
- Mayo Clinic Arizona, Laboratory Medicine and Pathology, Phoenix, Arizona
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15
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Puri P, Severson KJ, Patel MH, Brumfiel CM, DiCaudo DJ, Rosenthal AC, Mangold AR. A case of B-cell lymphoblastic leukemia cutis flaring following CAR T-cell therapy in a patient with refractory acute lymphoblastic leukemia. JAAD Case Rep 2021; 8:64-66. [PMID: 33521213 PMCID: PMC7820298 DOI: 10.1016/j.jdcr.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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16
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Severson KJ, Cumsky HJL, Brumfiel CM, Janeczek MC, Ginos BF, Kosiorek HE, Besch-Stokes J, Patel MH, Rule WG, DiCaudo DJ, Rosenthal AC, Pittelkow MR, Mangold AR. Blue light photodynamic therapy with 5-aminolevulinic acid in refractory mycosis fungoides: A prospective, open-label study. J Am Acad Dermatol 2021; 85:969-971. [PMID: 33493572 DOI: 10.1016/j.jaad.2021.01.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Kevin J Severson
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Helen J L Cumsky
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona
| | | | | | - Brenda F Ginos
- Department of Health Sciences Research, Mayo Clinic Arizona, Phoenix, Arizona
| | - Heidi E Kosiorek
- Department of Health Sciences Research, Mayo Clinic Arizona, Phoenix, Arizona
| | | | - Meera H Patel
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona
| | - William G Rule
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - David J DiCaudo
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Allison C Rosenthal
- Division Hematology-Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona
| | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona.
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17
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Abstract
PURPOSE OF REVIEW Adolescents and young adults (AYAs) with cancer are a vulnerable population with unique needs that are under-recognized and often overlooked by healthcare providers. This review focuses on identifying and meeting some of those needs including adherence to treatment, financial implications, impact on fertility and intimacy, issues with work/school, isolation, challenges with re-entry, and long-term side effects and survivorship. RECENT FINDINGS Survival rates have not improved in adolescents and young adults with cancer at the same rate as in children and older adults (the so called "AYA gap"). Restricted or delayed access to care and inconsistent cancer treatment and follow-up care contribute to this. Importantly, fertility preservation options have broadened and efforts to provide age appropriate counseling prior to treatment have improved. Additionally, AYAs face a variety of psychosocial issues while dealing with a cancer diagnosis during critical developmental years, and yet data pertaining to the successful identification and management of these issues is lacking. As a result, there has been recent increasing awareness that this patient population warrants strong advocates, additional research, and requires age group specific resources to be successful in navigating their cancer experience during treatment and into survivorship care. Members of the healthcare team should familiarize themselves with the unique needs of AYA cancer patients to provide optimal patient care. In order to build upon early progress, this group calls for additional study particularly when it comes to barriers to enrollment for AYA-specific research (including clinical trials), recognizing psychosocial needs (both during and after treatment), transition planning for returning to life after cancer, and managing long-term effects of treatment (including neuro cognitive changes). In addition, access to financial resources and appropriate mental health support needs to be improved.
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Affiliation(s)
- Zhaohui Jin
- Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Melody A Griffith
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, 85054, USA
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18
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Ramsower CA, Maguire A, Robetorye RS, Feldman AL, Syrbu SI, Rosenthal AC, Rimsza LM. Clinical laboratory validation of the MCL35 assay for molecular risk stratification of mantle cell lymphoma. J Hematop 2020; 13:231-238. [PMID: 33193905 PMCID: PMC7661397 DOI: 10.1007/s12308-020-00418-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/29/2020] [Indexed: 12/31/2022] Open
Abstract
Mantle cell lymphoma (MCL) is a clinically heterogeneous B cell malignancy for which a variety of prognostic factors have been proposed. Previously, a digital gene expression profiling "proliferation signature" capable of risk stratifying MCL was identified and subsequently developed into a multi-analyte prognostic assay, known as the "MCL35" assay. In this study, we sought to explore the performance characteristics of the MCL35 assay in a clinical laboratory and compare results with the Ki67 proliferation marker. The results describe the clinical validation of the MCL35 assay for molecular risk stratification of MCL including accuracy, sensitivity, specificity, use in acid-decalcified bone marrow core biopsies, fixatives, lower limit of RNA input, quality metrics, and other laboratory parameters. The resulting data indicate that this is a robust technique with outstanding reproducibility. Overall, the data support the concept of molecular signatures, as assessed with digital gene expression profiling, for improved standardization and reproducibility for proliferation assessment in MCL.
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Affiliation(s)
- Colleen A. Ramsower
- Department of Laboratory Medicine & Pathology, Mayo Clinic Arizona, 13400 E. Shea Blvd, CRB1-263, Scottsdale, AZ 85259 USA
| | - Alanna Maguire
- Department of Research, Mayo Clinic Arizona, Scottsdale, AZ USA
| | - Ryan S. Robetorye
- Department of Laboratory Medicine & Pathology, Mayo Clinic Arizona, 13400 E. Shea Blvd, CRB1-263, Scottsdale, AZ 85259 USA
| | - Andrew L. Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, MN USA
| | - Sergei I. Syrbu
- Department of Pathology, University of Iowa, Iowa City, IA USA
| | - Allison C. Rosenthal
- Internal Medicine, Division of Hematology/Oncology, Mayo Clinic Arizona, Scottsdale, AZ USA
| | - Lisa M. Rimsza
- Department of Laboratory Medicine & Pathology, Mayo Clinic Arizona, 13400 E. Shea Blvd, CRB1-263, Scottsdale, AZ 85259 USA
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19
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Pophali PA, Larson MC, Rosenthal AC, Robinson D, Habermann TM, Thanarajasingam G, Call T, Allmer C, Farooq U, Maurer MJ, Yost KJ, Cerhan JR, Thompson CA. The association of health behaviors with quality of life in lymphoma survivors. Leuk Lymphoma 2020; 62:271-280. [PMID: 33047636 DOI: 10.1080/10428194.2020.1830389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/23/2022]
Abstract
The impact of change in health behaviors (physical activity [PA], alcohol and smoking) on quality of life (QOL) in lymphoma survivors is not well understood. We evaluated the associations of health behaviors with QOL domains at diagnosis and at 3-year follow-up (FU3) in 2805 lymphoma survivors. We report clinically significant QOL score differences, defined as scores that exceeded a minimally important difference threshold and were statistically significant. Current smoking was associated with lower QOL at baseline (p < 0.01) and at FU3 (p < 0.01). Meeting the American Cancer Society PA guidelines was associated with better functional wellbeing and overall QOL at FU3 (p < 0.01). An increase in PA from baseline to FU3 was associated with improvement in physical, functional wellbeing and overall QOL at FU3 compared to baseline (p < 0.01). Thus, QOL in lymphoma survivors is associated with their health behaviors and active interventions to promote positive lifestyle changes in lymphoma survivors are needed.
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Affiliation(s)
- Priyanka A Pophali
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Hematology, Oncology and Palliative Care, Department of Medicine, University of Wisconsin- Carbone Cancer Center, Madison, WI, USA
| | - Melissa C Larson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Allison C Rosenthal
- Division of Hematology/Oncology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Dennis Robinson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Thomas M Habermann
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Gita Thanarajasingam
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Timothy Call
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Cristine Allmer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Umar Farooq
- Division of Hematology, Oncology and Bone Marrow Transplantation, University of Iowa, Iowa City, IA, USA
| | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Carrie A Thompson
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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20
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Staack SO, Rosenthal AC, Cook CB, Yang M. Glucocorticoid-Induced Hypermetabolism in White Adipose Tissue in Cushing Syndrome. J Nucl Med Technol 2020; 48:285-286. [DOI: 10.2967/jnmt.119.237545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/21/2019] [Indexed: 11/16/2022] Open
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21
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Teven CM, Rosenthal AC, Pockaj BA. Breast implant‐associated anaplastic large cell lymphoma and the obligation of insurance providers. Breast J 2020; 26:2110-2111. [DOI: 10.1111/tbj.13893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Chad M. Teven
- Division of Plastic and Reconstructive Surgery Mayo Clinic Phoenix AZ USA
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22
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Costello CM, Maly CJ, Snider S, Severson KJ, DiCaudo DJ, Rosenthal AC, Northfelt DW, Rule W, Craig FE, Pittelkow MR, Mangold AR. Immunosuppression-associated primary cutaneous plasmablastic lymphoma secondary to romidepsin. JAAD Case Rep 2019; 6:19-22. [PMID: 31909131 PMCID: PMC6938883 DOI: 10.1016/j.jdcr.2019.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Connor J. Maly
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Sam Snider
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | | | | | | | - Donald W. Northfelt
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona
| | - William Rule
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Fiona E. Craig
- Department of Pathology, Mayo Clinic, Scottsdale, Arizona
| | | | - Aaron R. Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
- Correspondence to: Aaron R. Mangold, MD, Mayo Clinic – Department of Dermatology, 13400 E Shea Blvd, Scottsdale, AZ 85259.
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23
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Besch-Stokes JG, Costello CM, Bhullar PK, Maly CJ, Rosenthal AC, DiCaudo DJ, Pittelkow MR, Mangold AR. Regression of mycosis fungoides with large-cell transformation following skin biopsy. J Eur Acad Dermatol Venereol 2019; 34:e82-e84. [PMID: 31566801 DOI: 10.1111/jdv.15976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - C M Costello
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - P K Bhullar
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - C J Maly
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - A C Rosenthal
- Department of Hematology Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - D J DiCaudo
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - M R Pittelkow
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - A R Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
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24
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Hilal T, Maguire A, Kosiorek HE, Rimsza LM, Rosenthal AC. Clinical features and cell of origin subtyping using gene expression profiling in HIV-negative patients with primary central nervous system lymphoma. Leuk Lymphoma 2019; 60:3581-3583. [PMID: 31246148 DOI: 10.1080/10428194.2019.1633637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Talal Hilal
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | | | - Lisa M Rimsza
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Phoenix, AZ, USA
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25
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Yonan YA, Cumsky HJL, Costello CM, Maly CJ, Rosenthal AC, Reeder CB, Rule WG, Pittelkow MR, Craig FE, DiCaudo DJ, Mangold AR. Syringotropic and folliculotropic mycosis fungoides with mycosis fungoides-associated vasculopathic ulcers. JAAD Case Rep 2019; 5:231-233. [PMID: 30834284 PMCID: PMC6384313 DOI: 10.1016/j.jdcr.2019.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Yousif A Yonan
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Helen J L Cumsky
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Connor J Maly
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona.,Georgetown University School of Medicine, Washington, DC
| | | | - Craig B Reeder
- Department of Hematology, Mayo Clinic, Scottsdale, Arizona
| | - William G Rule
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
| | | | - Fiona E Craig
- Department of Pathology, Mayo Clinic, Scottsdale, Arizona
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26
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Yang M, Rosenthal AC, Ashman JB, Craig FE. The Role and Pitfall of F18-FDG PET/CT in Surveillance of High Grade Pulmonary Lymphomatoid Granulomatosis. Curr Probl Diagn Radiol 2019; 50:443-449. [PMID: 30826140 DOI: 10.1067/j.cpradiol.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 02/02/2019] [Accepted: 02/06/2019] [Indexed: 11/22/2022]
Abstract
Lymphomatoid granulomatosis (LYG) is an uncommon angiocentric and angiodestructive T-cell rich, Epstein-Barr virus (EBV) positive B-cell multisystem lymphoproliferative disorder, predominately affecting the lungs. Since both clinical presentation and radiographic imaging findings, including X-ray and computed tomographic (CT), are nonspecific, the ultimate diagnosis of LYG relies on lung tissue sample diagnosis with its WHO grading based on the degree of cytologic atypia, necrosis and density of EBV positive B-cells. In addition, its histopathologic grading is correlated with clinical manifestation with high grade LYG mimicking aggressive B-cell lymphoma. Discordant grading between pulmonary and cutaneous LYG lesion has have been observed and might be a potential diagnostic and prognostic pitfall. F18-FDG PET/CT has been used to monitor disease progression and treatment response. In this study, we reviewed and summarized the clinical role of F18-FDG PET/CT in the surveillance of high grade pulmonary LYG, and examined its limitations in grading multisystem LYG.
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Affiliation(s)
- Ming Yang
- Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ..
| | - Allison C Rosenthal
- Division of Hematology and Medical Oncology, Mayo Clinic Arizona, Scottsdale, AZ
| | - Jonathan B Ashman
- Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, AZ
| | - Fiona E Craig
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ
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27
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Robetorye RS, Ramsower CA, Rosenthal AC, Yip TK, Wendel Spiczka AJ, Glinsmann-Gibson BJ, Rimsza LM. Incorporation of Digital Gene Expression Profiling for Cell-of-Origin Determination (Lymph2Cx Testing) into the Routine Work-Up of Diffuse Large B-Cell Lymphoma. J Hematop 2019; 12:3-10. [PMID: 34447482 PMCID: PMC8386504 DOI: 10.1007/s12308-019-00344-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/16/2018] [Accepted: 01/31/2019] [Indexed: 12/13/2022] Open
Abstract
Diffuse large B-cell lymphomas (DLBCL) represent a clinically heterogeneous group of lymphomas that are classified together based on similarities in morphology and immunophenotype. Gene expression profiling further classifies DLBCL into distinct molecular subgroups based on cell-of-origin (COO), including Germinal Center B-cell type, Activated B-cell type, and Unclassified type. COO assignment of DLBCL has important biological and prognostic significance, as well as emerging therapeutic implications. Herein, we describe the first clinical validation of a digital gene expression profiling assay (Lymph2Cx) to perform COO assignment in the routine work-up of DLBCL using formalin-fixed paraffin-embedded (FFPE) tissue sections and describe the results of 90 consecutive DLBCL cases analyzed prospectively by a College of American Pathologists/Clinical Laboratory Improvement Amendments (CAP/CLIA)-certified clinical molecular diagnostics laboratory.
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Affiliation(s)
- Ryan S. Robetorye
- Molecular Diagnostics Laboratory Arizona (MDAZL), Department of Laboratory Medicine and Pathology, Mayo Clinic in Arizona, Scottsdale, AZ
| | - Colleen A. Ramsower
- Molecular Diagnostics Laboratory Arizona (MDAZL), Department of Laboratory Medicine and Pathology, Mayo Clinic in Arizona, Scottsdale, AZ
| | - Allison C. Rosenthal
- Division of Hematology and Oncology, Department of Internal Medicine, Mayo Clinic in Arizona, Phoenix, AZ
| | - Tameson K. Yip
- Molecular Diagnostics Laboratory Arizona (MDAZL), Department of Laboratory Medicine and Pathology, Mayo Clinic in Arizona, Scottsdale, AZ
| | - Amy J. Wendel Spiczka
- Molecular Diagnostics Laboratory Arizona (MDAZL), Department of Laboratory Medicine and Pathology, Mayo Clinic in Arizona, Scottsdale, AZ
| | - Betty J. Glinsmann-Gibson
- Molecular Diagnostics Laboratory Arizona (MDAZL), Department of Laboratory Medicine and Pathology, Mayo Clinic in Arizona, Scottsdale, AZ
| | - Lisa M. Rimsza
- Molecular Diagnostics Laboratory Arizona (MDAZL), Department of Laboratory Medicine and Pathology, Mayo Clinic in Arizona, Scottsdale, AZ
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Pophali PA, Ip A, Larson MC, Rosenthal AC, Maurer MJ, Flowers CR, Link BK, Farooq U, Feldman AL, Allmer C, Slager SL, Witzig TE, Habermann TM, Cohen JB, Cerhan JR, Thompson CA. The association of physical activity before and after lymphoma diagnosis with survival outcomes. Am J Hematol 2018; 93:1543-1550. [PMID: 30230581 PMCID: PMC6386179 DOI: 10.1002/ajh.25288] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 12/19/2022]
Abstract
The impact of physical activity (PA) on lymphoma survival is not known. The association of PA and change in PA with overall (OS), lymphoma-specific (LSS) and event-free (EFS) survival was evaluated in a prospective cohort of newly diagnosed lymphoma patients (2002-2012). We calculated Leisure Score Indexes (mLSI) from the self-reported usual adult PA (baseline) and at 3-years post-diagnosis (FU3), grouping patients by active vs insufficiently active by the American Cancer Society PA guidelines. Associations of PA with survival were assessed using hazard ratios (HRs) and 95% confidence intervals (CI) from Cox models stratified by lymphoma subtype, adjusted for age, sex, baseline BMI, and comorbidity score with change scores further adjusted for baseline PA. Three thousand sixty participants were evaluable at baseline and 1371 at FU3. Active patients had superior survival from baseline [HR (CI): OS 0.82 (0.72-0.94); LSS 0.74 (0.61-0.90); EFS 0.92 (0.82-1.02)] and FU3 [HR (CI): OS 0.64 (0.46-0.88); LSS 0.32 (0.18-0.59); EFS 0.82 (0.61-1.10)] compared to insufficiently active. An increase in mLSI from baseline to FU3 (vs stable mLSI) was associated with superior OS (HR = 0.70, CI 0.49-1.00) and LSS (HR = 0.49, CI 0.26-0.94).The continuous change in mLSI at FU3 was significantly associated with OS, LSS and EFS; maintained across subgroups and appeared linear. Higher PA among lymphoma patients at diagnosis and 3 years is significantly associated with OS, LSS, and EFS. Increasing PA after diagnosis is significantly associated with improved OS and LSS supporting an important role for PA in lymphoma survivorship and the need for intervention trials.
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Affiliation(s)
- Priyanka A. Pophali
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Andrew Ip
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | | | - Allison C. Rosenthal
- Division of Hematology/Oncology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ
| | | | - Christopher R. Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Brian K. Link
- Division of Hematology, Oncology and Bone and Marrow Transplantation, University of Iowa, Iowa City, IO
| | - Umar Farooq
- Division of Hematology, Oncology and Bone and Marrow Transplantation, University of Iowa, Iowa City, IO
| | - Andrew L. Feldman
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Cristine Allmer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Susan L. Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Thomas E. Witzig
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Thomas M. Habermann
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jonathon B. Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - James R. Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Carrie A. Thompson
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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29
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Raza HA, Nokes BT, Rosenthal AC, Mangold AR, Kelemen K, Jokerst CE, Cartin-Ceba R. Unicentric castleman disease complicated by paraneoplastic bronchiolitis obliterans and pemphigus. Respir Med Case Rep 2018; 25:129-132. [PMID: 30128272 PMCID: PMC6098213 DOI: 10.1016/j.rmcr.2018.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 04/26/2018] [Revised: 08/03/2018] [Accepted: 08/04/2018] [Indexed: 11/24/2022] Open
Abstract
Bronchiolitis obliterans (BO) and paraneoplastic pemphigus are rare and ominous complications of Castleman disease. Collectively, these processes have been reported as part of paraneoplastic autoimmune multiorgan syndrome (PAMS), and they can occur in the setting of various hematologic malignant tumors, carcinoid tumors, and melanoma. Irrespective of the underlying malignancy driving PAMS, the clinical outcomes are uniformly poor, and there are no standard treatment regimens, given the clinical rarity of the syndrome. We describe 2 patients with unicentric Castleman disease complicated by paraneoplastic pemphigus and bronchiolitis obliterans. In addition to primary surgical resection for Castleman disease, we also used therapy from a treatment protocol used for bronchiolitis obliterans resulting from hematopoietic stem cell transplant (HSCT). We were able to treat the patients using intravenous immunoglobulin; rituximab; fluticasone, azithromycin, and montelukast (FAM); and rosuvastatin therapy. One patient demonstrated a favorable response, while the other demonstrated minimal response to this therapy.
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Affiliation(s)
- Hassan A Raza
- Division of Pulmonary Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Brandon T Nokes
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Allison C Rosenthal
- Division of Hematology and Medical Oncology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | | | - Katalin Kelemen
- Division of Pulmonary Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Clinton E Jokerst
- Division of Cardiothoracic Radiology, Mayo Clinic, Scottsdale, AZ, USA
| | - Rodrigo Cartin-Ceba
- Division of Pulmonary Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA.,Division of Pulmonary Medicine, Mayo Clinic, Scottsdale, AZ, USA
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30
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Tung K, Rosenthal AC, Craig FE, Ashman JB, Yang M. Pitfall of 18F-FDG PET/CT in Characterization of Relapsed Multisystem Lymphomatoid Granulomatosis. J Nucl Med Technol 2018; 46:396-397. [PMID: 29884684 DOI: 10.2967/jnmt.118.212274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/02/2018] [Accepted: 05/31/2018] [Indexed: 11/16/2022] Open
Abstract
We present serial 18F-FDG PET/CT findings in a case of grade 3 pulmonary lymphomatoid granulomatosis positive for the Epstein-Barr virus. The patient experienced a transient complete response to R-CHOP chemotherapy and subsequent multisystem recurrence, predominately involving the subcutaneous region of the torso on 18F-FDG PET/CT. Biopsy of the most hypermetabolic subcutaneous lesion demonstrated grade 1 cutaneous lymphomatoid granulomatosis negative for the Epstein-Barr virus. This report highlights the role of 18F-FDG PET/CT in characterizing and monitoring disease progression and regression, as well as the limitations of 18F-FDG PET/CT in accurate grading of multisystem recurrence, given the diversity of clinical and histopathologic features of lymphomatoid granulomatosis.
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Affiliation(s)
- Kelly Tung
- Department of Radiology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Fiona E Craig
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona; and
| | - Jonathan B Ashman
- Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Ming Yang
- Department of Radiology, Mayo Clinic Arizona, Scottsdale, Arizona
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31
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Thompson CA, Yost KJ, Maurer MJ, Allmer C, Farooq U, Habermann TM, Inwards DJ, Macon WR, Link BK, Rosenthal AC, Cerhan JR. Quality of life at diagnosis predicts overall survival in patients with aggressive lymphoma. Hematol Oncol 2018; 36:749-756. [PMID: 29862550 DOI: 10.1002/hon.2522] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 12/20/2017] [Revised: 04/02/2018] [Accepted: 04/18/2018] [Indexed: 01/06/2023]
Abstract
Our aim was to evaluate whether quality of life (QOL) scores at diagnosis predict survival among patients with aggressive lymphoma. Newly diagnosed lymphoma patients were prospectively enrolled within 9 months of diagnosis in the University of Iowa/Mayo Clinic SPORE and systematically followed for event-free and overall survival (OS). QOL was measured with the Functional Assessment of Cancer Treatment-General (FACT-G), which measures 4 domains: physical, social/family, emotional, and functional well-being (WB); a single item Linear Analogue Self-Assessment (LASA) measuring overall QOL; and a spiritual WB LASA. From 9/2002 to 12/2009, 701 patients with aggressive lymphoma who completed baseline QOL questionnaires were enrolled. At a median follow-up of 71 months (range 6-128), 316 patients (45%) had an event and 228 patients (33%) died. All baseline QOL measures but emotional WB were significantly associated with OS (all P < 0.04); of which all but LASA spiritual remained significant after adjusting for IPI and NHL subtype. The strongest associations were with total FACT-G (adjusted HR = 0.86, 95% CI: 0.79-0.94, P = 0.00062) and functional WB (adjusted HR = 0.88, 95% CI: 0.83-0.93, P < .0001). QOL LASA was associated with OS (adjusted HR = 0.92, 95% CI: 0.87-0.97, P = 0.0041). Patients with clinically deficient QOL (overall QOL ≤50) had a median OS of 92 months compared with 121 months for patients with QOL >50 (P = 0.0004). In this large sample of patients with aggressive lymphoma, we found that baseline QOL is independently predictive of OS. QOL should be assessed as a prognostic factor in patients with aggressive lymphoma.
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Affiliation(s)
- Carrie A Thompson
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Cristine Allmer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Umar Farooq
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA, USA
| | - Thomas M Habermann
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - David J Inwards
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Brian K Link
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA, USA
| | - Allison C Rosenthal
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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32
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Sonbol MB, Hilal T, Dueck AC, Rosenthal AC, Conley CR, Kosiorek HE, Ginos BF, Gano KM, Nichols CS, Leis JF, Johnston PB, Habermann TM, Northfelt DW, Bergsagel PL, Inwards DJ, Witzig TE, Ansell SM, Reeder CB. A phase 2 study of rituximab, cyclophosphamide, bortezomib and dexamethasone (R-CyBorD) in relapsed low grade and mantle cell lymphoma. Leuk Lymphoma 2018; 59:2128-2134. [PMID: 29320913 DOI: 10.1080/10428194.2017.1416368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/17/2023]
Abstract
In this phase 2 trial, we sought to evaluate the efficacy and safety of rituximab, cyclophosphamide, bortezomib, and dexamethasone (R-CyBorD) in patients with low-grade NHL. The regimen included rituximab on day 1 with weekly cyclophosphamide, dexamethasone, and bortezomib 1.3 mg/m2 IV in a 28-day cycle. Twenty one patients were enrolled on the study. Median age was 69 years (range 51-80) and 17 (81%) patients had two or more prior treatments. Histologies included FL (n = 8), MCL (n = 8), and LPL/WM (n = 5). Hematologic toxicity and peripheral sensory neuropathy were the most common adverse events. With a median follow-up of 38.1 months, ORR was 13/21 (62%), with 4 (19%) CR. The ORR was 7/8 (88%) in FL and was 4/5 (80%) in LPL/WM. Median PFS and OS were 11.6 months and 54.8 months, respectively. R-CyBorD is an effective regimen in relapsed FL and LPL/WM patients with an acceptable safety profile.
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Affiliation(s)
| | - Talal Hilal
- a Division of Hematology/Oncology , Mayo Clinic , Phoenix , AZ , USA
| | - Amylou C Dueck
- b Section of Biostatistics , Mayo Clinic , Scottsdale , AZ , USA
| | | | - Christopher R Conley
- c Department of Laboratory Medicine and Pathology , Mayo Clinic , Scottsdale , AZ , USA
| | - Heidi E Kosiorek
- b Section of Biostatistics , Mayo Clinic , Scottsdale , AZ , USA
| | - Brenda F Ginos
- b Section of Biostatistics , Mayo Clinic , Scottsdale , AZ , USA
| | - Katherine M Gano
- d Cancer Clinical Research Office, Mayo Clinic , Phoenix , AZ , USA
| | - Craig S Nichols
- e Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Jose F Leis
- a Division of Hematology/Oncology , Mayo Clinic , Phoenix , AZ , USA
| | | | | | | | | | - David J Inwards
- e Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Thomas E Witzig
- e Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | | | - Craig B Reeder
- a Division of Hematology/Oncology , Mayo Clinic , Phoenix , AZ , USA
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33
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Husten CG, Rosenthal AC. At work with the CDC. Business & tobacco. Bus Health 2001; 19:42. [PMID: 11771055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- C G Husten
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, USA
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Abstract
OBJECTIVE The purpose of this study was to measure the content and comprehensiveness of pregnancy specific smoking cessation strategies within managed care organisations (MCOs) responding affirmatively to the national 1997-98 Addressing Tobacco in Managed Care (ATMC) survey. DESIGN This cross sectional follow up study consisted of a fax survey sent to medical directors and a 37 question telephone survey of program overseers about the smoking cessation strategy. SUBJECTS 147 MCOs identifying a pregnancy specific smoking cessation strategy on the 1997-98 ATMC survey served as the initial sample; 88 MCOs of 128 eligible plans completed both components, with a response rate of 69%. RESULTS Pregnancy specific smoking cessation strategies varied. 40% of respondents used the Agency for Health Care Policy and Research guidelines for clinical smoking cessation to design their strategy. Strategies included self help materials, quit classes, telephone support and brief counselling by providers, linkages to quality improvement efforts, and use of patient databases for outreach. Only 42% offered a postpartum relapse prevention element. Lack of patient interest, competing clinic priorities, and the lack of a smoker identification system were the most problematic barriers to implementing strategies, common to at least a quarter of respondents. A majority ranked best practice manuals and web site linkages as the most useful form of technical assistance, followed by peer-to-peer counselling, regional workshops, newsletters, on-site assistance, and national conferences. CONCLUSIONS The survey provides the first profile of prenatal tobacco treatment strategies in managed care. While design limitations prevent generalisation of these results to all MCOs, such information can help guide technical assistance to plans interested in reducing smoking among pregnant women.
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Affiliation(s)
- D C Barker
- Barker Bi-Coastal Health Consultants, Calabasas, California 91302, USA.
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35
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Rosenthal AC. Addressing Tobacco in Managed Care program. Tob Control 2000; 9 Suppl 1:I71. [PMID: 10688949 PMCID: PMC1766259 DOI: 10.1136/tc.9.suppl_1.i71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- A C Rosenthal
- National Technical Assistance Office, Health Alliance Plan, One Ford Place, 5-C, Detroit, MI 48202, USA.
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