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Ujjani C, Gooley TA, Spurgeon SE, Stephens DM, Lai C, Broome CM, O’Brien S, Zhu H, Laing KJ, Winter AM, Pongas G, Greninger AL, Koelle DM, Siddiqi T, Davids MS, Rogers KA, Danilov AV, Sperling A, Tu B, Sorensen T, Launchbury K, Burrow CJ, Quezada G, Hill JA, Shadman M, Thompson PA. Diminished humoral and cellular responses to SARS-CoV-2 vaccines in patients with chronic lymphocytic leukemia. Blood Adv 2023; 7:4728-4737. [PMID: 36516082 PMCID: PMC9906469 DOI: 10.1182/bloodadvances.2022009164] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/07/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
Previous studies have demonstrated low rates of seroconversion to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines in patients with chronic lymphocytic leukemia (CLL). In this national collaboration of 11 cancer centers in the United States, we aimed to further characterize and understand vaccine-induced immune responses, including T-cell responses, and the impact of CLL therapeutics (#NCT04852822). Eligible patients were enrolled in 2 cohorts (1) at the time of initial vaccination and (2) at the time of booster vaccination. The serologic response rates (anti-S) from 210 patients in the initial vaccination cohort and 117 in the booster vaccination cohort were 56% (95% confidence interval [CI], 50-63) and 68% (95% CI, 60-77), respectively. Compared with patients not on therapy, those receiving B-cell-directed therapy were less likely to seroconvert (odds ratio [OR], 0.27; 95% CI, 0.15-0.49). Persistence of response was observed at 6 months; anti-S titers increased with the administration of booster vaccinations. In the initial vaccination cohort, positive correlations were observed between the quantitative serologic response and CD4 T-cell response for the Wuhan variant and, to a lesser degree, for the Omicron variant (Spearman P = 0.45 Wuhan; P = 0.25 Omicron). In the booster vaccination cohort, positive correlations were observed between serologic responses and CD4 T-cell responses for both variants (P = 0.58 Wuhan; P = 0.57 Omicron) and to a lesser degree for CD8 T-cell responses (P = 0.33 Wuhan; P = 0.22 Omicron). Although no deaths from coronavirus disease 2019 (COVID-19) have been reported after booster vaccinations, patients should use caution as newer variants emerge and escape vaccine-induced immunity. This trial was registered at www.clinicaltrials.gov as #NCT04852822.
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Affiliation(s)
- Chaitra Ujjani
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | | | | | | | - Catherine Lai
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Catherine M. Broome
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC
| | - Susan O’Brien
- Chao Family Comprehensive Cancer Center, University of California-Irvine, Irvine, CA
| | - Haiying Zhu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Kerry J. Laing
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Georgios Pongas
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Alexander L Greninger
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - David M. Koelle
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
- Benaroya Research Institute, Seattle, WA
| | | | | | - Kerry A. Rogers
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | | | | | - Brian Tu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | | | | | | | | | - Joshua A. Hill
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Mazyar Shadman
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
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Major A, Yu J, Shukla N, Che Y, Karrison TG, Treitman R, Kamdar MK, Haverkos BM, Godfrey J, Babcook MA, Voorhees TJ, Carlson S, Gaut D, Oliai C, Romancik JT, Winter AM, Hill BT, Bansal R, Villasboas Bisneto JC, Nizamuddin IA, Karmali R, Fitzgerald LA, Stephens DM, Pophali PA, Trabolsi A, Schatz JH, Hu M, Bachanova V, Slade MJ, Singh N, Ahmed N, McGuirk JP, Bishop MR, Riedell PA, Kline J. Efficacy of checkpoint inhibition after CAR-T failure in aggressive B-cell lymphomas: outcomes from 15 US institutions. Blood Adv 2023; 7:4528-4538. [PMID: 37026796 PMCID: PMC10425681 DOI: 10.1182/bloodadvances.2023010016] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023] Open
Abstract
Checkpoint inhibitor (CPI) therapy with anti-PD-1 antibodies has been associated with mixed outcomes in small cohorts of patients with relapsed aggressive B-cell lymphomas after CAR-T failure. To define CPI therapy efficacy more definitively in this population, we retrospectively evaluated clinical outcomes in a large cohort of 96 patients with aggressive B-cell lymphomas receiving CPI therapy after CAR-T failure across 15 US academic centers. Most patients (53%) had diffuse large B-cell lymphoma, were treated with axicabtagene ciloleucel (53%), relapsed early (≤180 days) after CAR-T (83%), and received pembrolizumab (49%) or nivolumab (43%). CPI therapy was associated with an overall response rate of 19% and a complete response rate of 10%. Median duration of response was 221 days. Median progression-free survival (PFS) and overall survival (OS) were 54 and 159 days, respectively. Outcomes to CPI therapy were significantly improved in patients with primary mediastinal B-cell lymphoma. PFS (128 vs 51 days) and OS (387 vs 131 days) were significantly longer in patients with late (>180 days) vs early (≤180 days) relapse after CAR-T. Grade ≥3 adverse events occurred in 19% of patients treated with CPI. Most patients (83%) died, commonly because of progressive disease. Only 5% had durable responses to CPI therapy. In the largest cohort of patients with aggressive B-cell lymphoma treated with CPI therapy after CAR-T relapse, our results reveal poor outcomes, particularly among those relapsing early after CAR-T. In conclusion, CPI therapy is not an effective salvage strategy for most patients after CAR-T, where alternative approaches are needed to improve post-CAR-T outcomes.
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Affiliation(s)
- Ajay Major
- The University of Chicago Comprehensive Cancer Center, Chicago, IL
- University of Colorado Cancer Center, Aurora, CO
| | - Jovian Yu
- The University of Chicago Comprehensive Cancer Center, Chicago, IL
| | - Navika Shukla
- The University of Chicago Comprehensive Cancer Center, Chicago, IL
| | - Yan Che
- The University of Chicago Comprehensive Cancer Center, Chicago, IL
| | | | | | | | | | - James Godfrey
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Melissa A. Babcook
- The Ohio State University James Comprehensive Cancer Center, Columbus, OH
| | | | - Sophie Carlson
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Daria Gaut
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Caspian Oliai
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | | | | | - Brian T. Hill
- Taussig Cancer Institute at Cleveland Clinic, Cleveland, OH
| | | | | | - Imran A. Nizamuddin
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Reem Karmali
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | | | | | - Asaad Trabolsi
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
| | | | - Marie Hu
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | | | - Michael J. Slade
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Nathan Singh
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | | | | | - Michael R. Bishop
- The University of Chicago Comprehensive Cancer Center, Chicago, IL
- David and Etta Jonas Center for Cellular Therapy, The University of Chicago Medicine, Chicago, IL
| | - Peter A. Riedell
- The University of Chicago Comprehensive Cancer Center, Chicago, IL
- David and Etta Jonas Center for Cellular Therapy, The University of Chicago Medicine, Chicago, IL
| | - Justin Kline
- The University of Chicago Comprehensive Cancer Center, Chicago, IL
- David and Etta Jonas Center for Cellular Therapy, The University of Chicago Medicine, Chicago, IL
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3
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Brooks T, Mian A, Hamilton BK, Dean RM, Winter AM, Jagadeesh D, Sauter CS, Hill BT, Caimi PF. Cell Product Differences on Incidence of Venous Thromboembolism in Patients Treated with CAR T-Cells for Aggressive B Cell Lymphomas. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00353-6] [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: 02/07/2023]
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4
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Mian A, Wei W, Winter AM, Khouri J, Jagadeesh D, Anwer F, Gerds AT, Dean RM, Sobecks RM, Pohlman B, Kalaycio ME, Hamilton BK, Caimi PF, Hill BT. Validation of Pre-Treatment Modified Easix Score As a Predictor of Cytokine Release Syndrome Related to Anti CD19 Chimeric Antigen Receptor (CAR) T-Cell Therapy in Patients with Relapsed/Refractory (R/R) Large B-Cell Lymphoma (LBCL). Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00337-2] [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: 10/18/2022]
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5
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Pereira Aleixo GF, Rybicki L, Chen PH, Gandhi NS, Anwer F, Dean RM, Hamilton BK, Hill BT, Jagadeesh D, Khouri J, Pohlman B, Sobecks RM, Winter AM, Caimi PF, Majhail NS. The Association of Pre-Transplant Adiposity with Autologous Hematopoietic Stem Cell Transplantation Outcomes in Lymphoma. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00688-1] [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: 11/28/2022]
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6
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Eyre TA, Lamanna N, Roeker LE, Ujjani CS, Hill BT, Barr PM, Lansigan E, Cheson BD, Yazdy M, Allan JN, Rhodes J, Schuster SJ, Nabhan C, Skarbnik A, Leslie L, Islam P, Whitaker K, Coombs CC, Tuncer HH, Pagel JM, Jacobs R, Winter AM, Bailey N, Sitlinger A, Schuh AH, Follows G, Fox CP, Brander DM, Shadman M, Mato AR. Comparative analysis of targeted novel therapies in relapsed, refractory chronic lymphocytic leukaemia. Haematologica 2021; 106:284-287. [PMID: 32079693 PMCID: PMC7776352 DOI: 10.3324/haematol.2019.241539] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Toby A Eyre
- Hematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Nicole Lamanna
- New York-Presbyterian Columbia University Medical Center, New York, NY
| | | | - Chaitra S Ujjani
- Seattle Cancer Care Alliance/Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Brian T Hill
- Dept. of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation
| | - Paul M Barr
- Division of Hematology/Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | | | - Bruce D Cheson
- Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Maryam Yazdy
- Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC
| | - John N Allan
- Weill Cornell Medicine School of Medicine, Long Island City, NY
| | - Joanna Rhodes
- Div. of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Stephen J Schuster
- Div of Hematology and Oncology,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | | | - Lori Leslie
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ
| | - Prioty Islam
- Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC
| | | | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Hande H Tuncer
- Department of Medicine, Cancer Center, Tufts Medical Center, Boston, MA
| | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA
| | - Ryan Jacobs
- Department of Hematology, Lymphoma Division, Levine Cancer Institute, Charlotte, NC
| | - Allison M Winter
- Dept of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation
| | - Neil Bailey
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA
| | - Andrea Sitlinger
- Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC
| | - Anna H Schuh
- Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford
| | | | | | - Danielle M Brander
- Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC
| | - Mazyar Shadman
- Seattle Cancer Care Alliance/Fred Hutchinson Cancer Research Center, Seattle, WA
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7
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Mian A, Wei W, Winter AM, Khouri J, Jagadeesh D, Anwer F, Gerds AT, Dean RM, Sobecks R, Pohlman B, Hamilton BK, Majhail NS, Hill BT. Outcomes and factors impacting use of axicabtagene ciloleucel in patients with relapsed or refractory large B-cell lymphoma: results from an intention-to-treat analysis. Leuk Lymphoma 2020; 62:1344-1352. [PMID: 33375873 DOI: 10.1080/10428194.2020.1864349] [Citation(s) in RCA: 4] [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] [Indexed: 10/25/2022]
Abstract
Data on real-world outcomes of axicabtagene ciloleucel (axi-cel) therapy for relapsed/refractory large B-cell lymphoma (R/R LBCL) are limited. In this intent to treat (ITT) analysis, we reviewed records of 38 consecutive patients with R/R LBCL for whom axi-cel was intended. Twenty-seven (71%) patients received axi-cel and 11 (29%) did not. Patients in the non-axi-cel group had a higher hematopoietic cell transplantation comorbidity index (HCT-CI) (median 4 vs. 2, p = .04). Median overall survival for the ITT, axi-cel and non-axi-cel group was 10 (95% CI, 3.7 to 13), 13 (95% CI, 7.7 to N.R.) and 1 (95% CI, 0.4 to 3.7) month(s) respectively. Factors limiting axi-cel use were disease progression, sepsis, manufacturing failure and socioeconomic barrier in 6 (55%), 3 (27%), 1 (9%) and 1 (9%) patient(s) respectively. Additional strategies are needed to ensure all LBCL patients for whom chimeric antigen receptor (CAR) T-cell therapy is prescribed can receive this treatment.
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Affiliation(s)
- Agrima Mian
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Wei Wei
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Allison M Winter
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jack Khouri
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Deepa Jagadeesh
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Faiz Anwer
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aaron T Gerds
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robert M Dean
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ronald Sobecks
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brad Pohlman
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Betty K Hamilton
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Navneet S Majhail
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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8
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Smith SD, Lopedote P, Samara Y, Mei M, Herrera AF, Winter AM, Hill BT, Shadman M, Ujjani C, Lynch RC, Jacobson CA, Kim AI, Caimi P, Milano F, Gopal AK. Polatuzumab Vedotin for Relapsed/Refractory Aggressive B-cell Lymphoma: A Multicenter Post-marketing Analysis. Clin Lymphoma Myeloma Leuk 2020; 21:170-175. [PMID: 33431309 DOI: 10.1016/j.clml.2020.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/07/2020] [Accepted: 12/12/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Polatuzumab vedotin is approved therapy in the United States for relapsed/refractory diffuse large B-cell lymphoma in combination with bendamustine and rituximab (Pola+BR). However, the safety and efficacy of Pola+BR outside of a clinical trial setting is unknown. PATIENTS AND METHODS We analyzed use of pola-based therapy at 5 centers in the United States, including dose, response rates, progression-free survival (PFS), survival, and toxicity. RESULTS Sixty-nine patients with aggressive B-cell lymphoma, including 66 with diffuse large B-cell lymphoma/high-grade B-cell lymphoma and 84% refractory to prior therapy, were treated. Responses occurred in of 50%, including 24% complete response. Median duration of response was 5.1 months, PFS was 2.0 months, and survival was 5.3 months, at 4 months median follow-up. Inferior PFS was associated with prior refractory disease (median, 57 days vs. not reached; P = .003) and lack of response to Pola+BR (PFS, 27 days vs. 152 days; P < .001). Discontinuation owing to planned cellular therapy was seen in 36% and owing to toxicity occurred in 12%; unplanned hospitalizations occurred in 36%. CONCLUSIONS We conclude that commercial Pola is applied to highly refractory lymphomas at our centers, often with intent to bridge to subsequent therapy. Although some clinical benefit was observed, efficacy was inferior to clinical trial data, especially among those with refractory disease.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Disease Management
- Drug Resistance, Neoplasm
- Female
- Humans
- Immunoconjugates/administration & dosage
- Immunoconjugates/adverse effects
- Immunoconjugates/therapeutic use
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/mortality
- Male
- Middle Aged
- Product Surveillance, Postmarketing
- Prognosis
- Recurrence
- Retreatment
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Stephen D Smith
- Division of Medical Oncology, Department of Internal Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
| | - Paolo Lopedote
- Institute of Hematology, University of Bologna, Bologna, Italy
| | - Yazeed Samara
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Matthew Mei
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Alex F Herrera
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Allison M Winter
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Chaitra Ujjani
- Division of Medical Oncology, Department of Internal Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ryan C Lynch
- Division of Medical Oncology, Department of Internal Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Caron A Jacobson
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA
| | - Austin I Kim
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA
| | - Paolo Caimi
- Department of Medicine-Hematology and Oncology, University Hospital/Case Western Reserve Medical Center, Cleveland, OH
| | - Filippo Milano
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ajay K Gopal
- Division of Medical Oncology, Department of Internal Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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9
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Mato AR, Roeker LE, Jacobs R, Hill BT, Lamanna N, Brander D, Shadman M, Ujjani CS, Yazdy MS, Perini GF, Pinilla-Ibarz JA, Barrientos J, Skarbnik AP, Torka P, Pu JJ, Pagel JM, Gohil S, Fakhri B, Choi M, Coombs CC, Rhodes J, Barr PM, Portell CA, Parry H, Garcia CA, Whitaker KJ, Winter AM, Sitlinger A, Khajavian S, Grajales-Cruz AF, Isaac KM, Shah P, Akhtar OS, Pocock R, Lam K, Voorhees TJ, Schuster SJ, Rodgers TD, Fox CP, Martinez-Calle N, Munir T, Bhavsar EB, Bailey N, Lee JC, Weissbrot HB, Nabhan C, Goodfriend JM, King AC, Zelenetz AD, Dorsey C, Bigelow K, Cheson BD, Allan JN, Eyre TA. Assessment of the Efficacy of Therapies Following Venetoclax Discontinuation in CLL Reveals BTK Inhibition as an Effective Strategy. Clin Cancer Res 2020; 26:3589-3596. [PMID: 32198151 PMCID: PMC8588795 DOI: 10.1158/1078-0432.ccr-19-3815] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/05/2020] [Accepted: 03/17/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Venetoclax-based therapy is a standard-of-care option in first-line and relapsed/refractory chronic lymphocytic leukemia (CLL). Patient management following venetoclax discontinuation remains nonstandard and poorly understood. EXPERIMENTAL DESIGN To address this, we conducted a large international study to identify a cohort of 326 patients who discontinued venetoclax and have been subsequently treated. Coprimary endpoints were overall response rate (ORR) and progression-free survival for the post-venetoclax treatments stratified by treatment type [Bruton's tyrosine kinase inhibitor (BTKi), PI3K inhibitor (PI3Ki), and cellular therapies]. RESULTS We identified patients with CLL who discontinued venetoclax in the first-line (4%) and relapsed/refractory settings (96%). Patients received a median of three therapies prior to venetoclax; 40% were BTKi naïve (n = 130), and 81% were idelalisib naïve (n = 263). ORR to BTKi was 84% (n = 44) in BTKi-naïve patients versus 54% (n = 30) in BTKi-exposed patients. We demonstrate therapy selection following venetoclax requires prior novel agent exposure consideration and discontinuation reasons. CONCLUSIONS For BTKi-naïve patients, selection of covalently binding BTKis results in high ORR and durable remissions. For BTKi-exposed patients, covalent BTK inhibition is not effective in the setting of BTKi resistance. PI3Kis following venetoclax do not appear to result in durable remissions. We conclude that BTKi in naïve or previously responsive patients and cellular therapies following venetoclax may be the most effective strategies.See related commentary by Rogers, p. 3501.
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Affiliation(s)
- Anthony R Mato
- Memorial Sloan Kettering Cancer Center, New York, New York.
| | | | - Ryan Jacobs
- Department of Hematology, Lymphoma Division, Levine Cancer Institute, Charlotte, North Carolina
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicole Lamanna
- Herbert Irving Comprehensive Cancer Center (New York-Presbyterian Columbia University Medical Center), New York, New York
| | | | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Chaitra S Ujjani
- Seattle Cancer Care Alliance/Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Maryam Sarraf Yazdy
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington D.C
| | | | | | | | | | - Pallawi Torka
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Jeffrey J Pu
- SUNY Upstate Medical University, Syracuse, New York
| | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, Washington
| | - Satyen Gohil
- University College London, London, United Kingdom
| | - Bita Fakhri
- Department of Medicine, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
| | - Michael Choi
- Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Joanna Rhodes
- Division of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul M Barr
- Division of Hematology/Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | - Craig A Portell
- Division of Hematology and Oncology, University of Virginia, Charlottesville, Virginia
| | - Helen Parry
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Christine A Garcia
- Hillman Cancer Pavilion, Division of Hematology and Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Allison M Winter
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andrea Sitlinger
- Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | | | | | - Krista M Isaac
- Division of Hematology and Oncology, University of Virginia, Charlottesville, Virginia
| | | | | | | | - Kentson Lam
- Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Timothy J Voorhees
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Stephen J Schuster
- Division of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Christopher P Fox
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Nicolas Martinez-Calle
- Clinical Haematology Department, Nottingham University Hospitals NHS Trust, Nottingham, England, United Kingdom
| | - Talha Munir
- Weill Cornell Medicine, Long Island City, New York
| | - Erica B Bhavsar
- Department of Haematology, St James's University Hospital, Leeds, United Kingdom
| | - Neil Bailey
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, Washington
| | - Jason C Lee
- Herbert Irving Comprehensive Cancer Center (New York-Presbyterian Columbia University Medical Center), New York, New York
| | - Hanna B Weissbrot
- Herbert Irving Comprehensive Cancer Center (New York-Presbyterian Columbia University Medical Center), New York, New York
| | | | | | - Amber C King
- Clinical Pharmacy Specialist-Leukemia, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew D Zelenetz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Colleen Dorsey
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kayla Bigelow
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bruce D Cheson
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington D.C
| | - John N Allan
- Department of Haematology, St James's University Hospital, Leeds, United Kingdom
| | - Toby A Eyre
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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10
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Roeker LE, Fox CP, Eyre TA, Brander DM, Allan JN, Schuster SJ, Nabhan C, Hill BT, Shah NN, Lansigan F, Yazdy M, Cheson BD, Lamanna N, Singavi AK, Coombs CC, Barr PM, Skarbnik AP, Shadman M, Ujjani CS, Tuncer HH, Winter AM, Rhodes J, Dorsey C, Morse H, Kabel C, Pagel JM, Williams AM, Jacobs R, Goy A, Muralikrishnan S, Pearson L, Sitlinger A, Bailey N, Schuh A, Kirkwood AA, Mato AR. Tumor Lysis, Adverse Events, and Dose Adjustments in 297 Venetoclax-Treated CLL Patients in Routine Clinical Practice. Clin Cancer Res 2019; 25:4264-4270. [PMID: 31004001 DOI: 10.1158/1078-0432.ccr-19-0361] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/08/2019] [Accepted: 04/15/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Clinical trials of venetoclax reported negligible rates of clinical tumor lysis syndrome (TLS) in patients with chronic lymphocytic leukemia (CLL) when using an extended dose escalation schedule. We aimed to understand TLS prophylaxis, rates of select adverse events (AE), and impact of dosing modifications in routine clinical practice. EXPERIMENTAL DESIGN This retrospective cohort study included 297 CLL venetoclax-treated patients outside of clinical trials in academic and community centers. Demographics, baseline disease characteristics, venetoclax dosing, TLS risk and prophylaxis, and AEs were collected. RESULTS The group was 69% male, 96% had relapsed/refractory CLL, 45% had deletion chromosome 17p, 84% had unmutated IGHV, 80% received venetoclax monotherapy, and median age was 67. TLS risk was categorized as low (40%), intermediate (32%), or high (28%), and 62% had imaging prior to venetoclax initiation. Clinical TLS occurred in 2.7% of patients and laboratory TLS occurred in 5.7%. Pre-venetoclax TLS risk group and creatinine clearance independently predict TLS development in multivariable analysis. Grade 3/4 AEs included neutropenia (39.6%), thrombocytopenia (29.2%), infection (25%), neutropenic fever (7.9%), and diarrhea (6.9%). Twenty-two patients (7.4%) discontinued venetoclax due to an AE. Progression-free survival was similar regardless of number of dose interruptions, length of dose interruption, and stable venetoclax dose. CONCLUSIONS These data provide insights into current use of venetoclax in clinical practice, including TLS rates observed in clinical practice. We identified opportunities for improved adherence to TLS risk stratification and prophylaxis, which may improve safety.
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Affiliation(s)
- Lindsey E Roeker
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Christopher P Fox
- Department of Clinical Haematology, Nottingham University Hospitals NHS Foundation Trust, Nottingham, United Kingdom
| | - Toby A Eyre
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Danielle M Brander
- Duke Cancer Institute, Duke University Health System, Durham, North Carolina
| | - John N Allan
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, New York
| | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Brian T Hill
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nirav N Shah
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Maryam Yazdy
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, D
| | - Bruce D Cheson
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, D
| | - Nicole Lamanna
- Hematology/Oncology Division, Columbia University Medical Center, New York, New York
| | - Arun K Singavi
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | - Alan P Skarbnik
- John Theurer Cancer Center, Hackensack University Medical Center, Closter, New Jersey
| | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | - Joanna Rhodes
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Colleen Dorsey
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Hannah Morse
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Charlene Kabel
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | | | - Ryan Jacobs
- Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Andre Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Closter, New Jersey
| | | | | | - Andrea Sitlinger
- Duke Cancer Institute, Duke University Health System, Durham, North Carolina
| | - Neil Bailey
- Swedish Cancer Institute, Seattle, Washington
| | - Anna Schuh
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Amy A Kirkwood
- Cancer Research UK and University College London Cancer Trials Centre, London, United Kingdom
| | - Anthony R Mato
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
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11
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Hill BT, Nastoupil L, Winter AM, Becnel MR, Cerhan JR, Habermann TM, Link BK, Maurer MJ, Fakhri B, Reddy P, Smith SD, Mukhija D, Jagadeesh D, Desai A, Alderuccio JP, Lossos IS, Mehra P, Portell CA, Goldman ML, Calzada O, Cohen JB, Hussain MJ, Ghosh N, Caimi P, Tiutan T, Martin P, Kodali A, Evens AM, Kahl BS. Maintenance rituximab or observation after frontline treatment with bendamustine-rituximab for follicular lymphoma. Br J Haematol 2018; 184:524-535. [PMID: 30575016 DOI: 10.1111/bjh.15720] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 08/26/2018] [Accepted: 11/05/2018] [Indexed: 12/26/2022]
Abstract
Bendamustine (B) with rituximab (R) is a standard frontline treatment for medically fit follicular lymphoma (FL) patients. The safety and efficacy of maintenance rituximab (MR) after BR induction has not been formally compared to observation for FL, resulting in disparate practice patterns. Prospective trials have shown benefit of MR after R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) or R-CVP (rituximab, cyclophosphamide, vincristine, prednisone), yet recent data from the GALLIUM study comparing outcomes of patients treated with chemotherapy with R or obinutuzumab (G) showed higher than anticipated fatal adverse events with BR/BG. In order to assess the efficacy and tolerability of MR after BR, we retrospectively collected data on 640 newly diagnosed patients treated with FL. We found that patients who achieved partial remission (PR) after ≥4 cycles of BR had improved duration of response (DOR) with MR vs. no maintenance, whereas those in complete remission did not. These findings were confirmed in a validation cohort. In the entire study population, the known fatal adverse event rate after BR was 2·5% and did not significantly differ in those receiving MR versus no maintenance. [Correction added on 14 January 2019, after online publication: The preceding sentence has been corrected in this current version.] Within the limitations inherent to retrospective analysis, these data suggest that FL patients with a PR to BR experience prolongation of remission with MR with an acceptable safety profile.
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Affiliation(s)
| | | | | | - Melody R Becnel
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Brian K Link
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Bita Fakhri
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Prathima Reddy
- Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - Stephen D Smith
- Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | | | | | - Amrita Desai
- University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | | | - Izidore S Lossos
- University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Pooja Mehra
- University of Virginia, Charlottesville, VA, USA
| | | | | | | | | | | | | | - Paolo Caimi
- University Hospitals of Cleveland, Cleveland, OH, USA
| | - Timothy Tiutan
- Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY, USA
| | - Peter Martin
- Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY, USA
| | - Abhigna Kodali
- Tufts University School of Medicine and Cancer Center, Boston, MA, USA
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Brad S Kahl
- Washington University School of Medicine, Saint Louis, MO, USA
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12
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Mato AR, Thompson M, Allan JN, Brander DM, Pagel JM, Ujjani CS, Hill BT, Lamanna N, Lansigan F, Jacobs R, Shadman M, Skarbnik AP, Pu JJ, Barr PM, Sehgal AR, Cheson BD, Zent CS, Tuncer HH, Schuster SJ, Pickens PV, Shah NN, Goy A, Winter AM, Garcia C, Kennard K, Isaac K, Dorsey C, Gashonia LM, Singavi AK, Roeker LE, Zelenetz A, Williams A, Howlett C, Weissbrot H, Ali N, Khajavian S, Sitlinger A, Tranchito E, Rhodes J, Felsenfeld J, Bailey N, Patel B, Burns TF, Yacur M, Malhotra M, Svoboda J, Furman RR, Nabhan C. Real-world outcomes and management strategies for venetoclax-treated chronic lymphocytic leukemia patients in the United States. Haematologica 2018; 103:1511-1517. [PMID: 29880613 PMCID: PMC6119152 DOI: 10.3324/haematol.2018.193615] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/05/2018] [Indexed: 11/09/2022] Open
Abstract
Venetoclax is a BCL2 inhibitor approved for 17p-deleted relapsed/refractory chronic lymphocytic leukemia with activity following kinase inhibitors. We conducted a multicenter retrospective cohort analysis of patients with chronic lymphocytic leukemia treated with venetoclax to describe outcomes, toxicities, and treatment selection following venetoclax discontinuation. A total of 141 chronic lymphocytic leukemia patients were included (98% relapsed/refractory). Median age at venetoclax initiation was 67 years (range 37-91), median prior therapies was 3 (0-11), 81% unmutated IGHV, 45% del(17p), and 26.8% complex karyotype (≥ 3 abnormalities). Prior to venetoclax initiation, 89% received a B-cell receptor antagonist. For tumor lysis syndrome prophylaxis, 93% received allopurinol, 92% normal saline, and 45% rasburicase. Dose escalation to the maximum recommended dose of 400 mg daily was achieved in 85% of patients. Adverse events of interest included neutropenia in 47.4%, thrombocytopenia in 36%, tumor lysis syndrome in 13.4%, neutropenic fever in 11.6%, and diarrhea in 7.3%. The overall response rate to venetoclax was 72% (19.4% complete remission). With a median follow up of 7 months, median progression free survival and overall survival for the entire cohort have not been reached. To date, 41 venetoclax treated patients have discontinued therapy and 24 have received a subsequent therapy, most commonly ibrutinib. In the largest clinical experience of venetoclax-treated chronic lymphocytic leukemia patients, the majority successfully completed and maintained a maximum recommended dose. Response rates and duration of response appear comparable to clinical trial data. Venetoclax was active in patients with mutations known to confer ibrutinib resistance. Optimal sequencing of newer chronic lymphocytic leukemia therapies requires further study.
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Affiliation(s)
- Anthony R Mato
- CLL Program, Leukemia Service, Division of Hematologic Oncology, Department of Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meghan Thompson
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Danielle M Brander
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA
| | - Chaitra S Ujjani
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Brian T Hill
- Taussig Cancer Institute, Cleveland Clinic Foundation, OH, USA
| | | | | | - Ryan Jacobs
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA
| | - Mazyar Shadman
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, WA, USA
| | - Alan P Skarbnik
- John Theurer Cancer Center, Hackensack Meridian Health, NJ, USA
| | | | - Paul M Barr
- Wilmot Cancer Institute Division of Hematology/Oncology, University of Rochester Medical Center, NY, USA
| | | | - Bruce D Cheson
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Clive S Zent
- Wilmot Cancer Institute Division of Hematology/Oncology, University of Rochester Medical Center, NY, USA
| | | | - Stephen J Schuster
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Nirav N Shah
- Division of Hematology & Oncology, Medical College of Wisconsin, Brookfield, WI, USA
| | - Andre Goy
- John Theurer Cancer Center, Hackensack Meridian Health, NJ, USA
| | | | | | - Kaitlin Kennard
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Krista Isaac
- Internal Medicine, Lankenau Medical Center, Wynnewood, PA, USA
| | - Colleen Dorsey
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa M Gashonia
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Arun K Singavi
- Division of Hematology & Oncology, Medical College of Wisconsin, Brookfield, WI, USA
| | - Lindsey E Roeker
- CLL Program, Leukemia Service, Division of Hematologic Oncology, Department of Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Zelenetz
- CLL Program, Leukemia Service, Division of Hematologic Oncology, Department of Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Annalynn Williams
- Wilmot Cancer Institute Division of Hematology/Oncology, University of Rochester Medical Center, NY, USA
| | | | | | - Naveed Ali
- Abington Hem. Onc. Assoc., Inc., Willow Grove, PA, USA
| | - Sirin Khajavian
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, WA, USA
| | - Andrea Sitlinger
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Eve Tranchito
- Taussig Cancer Institute, Cleveland Clinic Foundation, OH, USA
| | - Joanna Rhodes
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Neil Bailey
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA
| | | | | | | | | | - Jakub Svoboda
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
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13
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Mato AR, Hill BT, Lamanna N, Barr PM, Ujjani CS, Brander DM, Howlett C, Skarbnik AP, Cheson BD, Zent CS, Pu JJ, Kiselev P, Foon K, Lenhart J, Henick Bachow S, Winter AM, Cruz AL, Claxton DF, Goy A, Daniel C, Isaac K, Kennard KH, Timlin C, Fanning M, Gashonia L, Yacur M, Svoboda J, Schuster SJ, Nabhan C. Optimal sequencing of ibrutinib, idelalisib, and venetoclax in chronic lymphocytic leukemia: results from a multicenter study of 683 patients. Ann Oncol 2018; 28:1050-1056. [PMID: 28453705 DOI: 10.1093/annonc/mdx031] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Ibrutinib, idelalisib, and venetoclax are approved for treating CLL patients in the United States. However, there is no guidance as to their optimal sequence. Patients and methods We conducted a multicenter, retrospective analysis of CLL patients treated with kinase inhibitors (KIs) or venetoclax. We examined demographics, discontinuation reasons, overall response rates (ORR), survival, and post-KI salvage strategies. Primary endpoint was progression-free survival (PFS). Results A total of 683 patients were identified. Baseline characteristics were similar in the ibrutinib and idelalisib groups. ORR to ibrutinib and idelalisib as first KI was 69% and 81%, respectively. With a median follow-up of 17 months (range 1-60), median PFS and OS for the entire cohort were 35 months and not reached. Patients treated with ibrutinib (versus idelalisib) as first KI had a significantly better PFS in all settings; front-line [hazard ratios (HR) 2.8, CI 1.3-6.3, P = 0.01], relapsed-refractory (HR 2.8, CI 1.9-4.1, P < 0.001), del17p (HR 2.0, CI 1.2-3.4, P = 0.008), and complex karyotype (HR 2.5, CI 1.2-5.2, P = 0.02). At the time of initial KI failure, use of an alternate KI or venetoclax had a superior PFS when compared with chemoimmunotherapy. Furthermore, patients who discontinued ibrutinib due to progression or toxicity had marginally improved outcomes if they received venetoclax (ORR 79%) versus idelalisib (ORR 46%) (PFS HR .6, CI.3-1.0, P = 0.06). Conclusions In the largest real-world experience of novel agents in CLL, ibrutinib appears superior to idelalisib as first KI. Furthermore, in the setting of KI failure, alternate KI or venetoclax therapy appear superior to chemoimmunotherapy combinations. The use of venetoclax upon ibrutinib failure might be superior to idelalisib. These data support the need for trials testing sequencing strategies to optimize treatment algorithms.
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Affiliation(s)
- A R Mato
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - B T Hill
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA
| | - N Lamanna
- Division of Hematology and Oncology, New York Presbyterian/Columbia University Medical Center, New York, USA
| | - P M Barr
- Wilmot Cancer Institute, University of Rochester, Rochester, USA
| | - C S Ujjani
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, USA
| | | | - C Howlett
- Department of Pharmacy and Clinical Services, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, USA.,Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, USA
| | - A P Skarbnik
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, USA
| | - B D Cheson
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, USA
| | - C S Zent
- Wilmot Cancer Institute, University of Rochester, Rochester, USA
| | - J J Pu
- Penn State Hershey Cancer Institute, Penn State University College of Medicine, Hershey, USA
| | | | - K Foon
- Celgene Corporation, Summit, USA
| | | | - S Henick Bachow
- Division of Hematology and Oncology, New York Presbyterian/Columbia University Medical Center, New York, USA
| | - A M Winter
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA
| | - A-L Cruz
- Medstar Washington Hospital Center, Washington, USA
| | - D F Claxton
- Penn State Hershey Cancer Institute, Penn State University College of Medicine, Hershey, USA
| | - A Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, USA
| | - C Daniel
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - K Isaac
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - K H Kennard
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - C Timlin
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - M Fanning
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - L Gashonia
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - M Yacur
- Penn State Hershey Cancer Institute, Penn State University College of Medicine, Hershey, USA
| | - J Svoboda
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - S J Schuster
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - C Nabhan
- Cardinal Health Specialty Solutions, Waukegan, USA
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14
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Philippo H, Huiskamp R, Winter AM, Gharbaran B, van der Kogel AJ. Age dependence of the radiosensitivity of glial progenitors for In vivo fission-neutron and X irradiation. Radiat Res 2000; 154:44-53. [PMID: 10856965 DOI: 10.1667/0033-7587(2000)154[0044:adotro]2.0.co;2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
O-2A progenitor cells are the stem cells of the myelin-forming oligodendrocytes in the central nervous system. In the epithermal reactor beams used for boron neutron capture therapy (BNCT) for treatment of brain tumors, fission neutrons are a contaminating component. To estimate the radiosensitivity of the O-2A progenitors for fission neutrons, an in vivo-in vitro clonogenic assay was used. Radiosensitivity of progenitors obtained from the spinal cord of 1- or 5-day-old rats or the optic nerve of 2- or 12-week-old rats for 1 MeV fission neutrons was compared to that for 300 kVp X rays. Dose-survival curves were fitted according to the linear-quadratic model. The resulting beta component was very small to negligible. Progenitor cells obtained from rats of different ages show differences in radiosensitivity, characterized by different alpha values. RBE values for fission neutrons were 3.5 for 1-day-old spinal cord, 3.2 for 5-day-old spinal cord, 3.0 for 2-week-old optic nerve, and 4.3 for 12-week-old optic nerve. These high RBE values indicate the importance of minimizing the fast-neutron component in the epithermal neutron beams used for BNCT.
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Affiliation(s)
- H Philippo
- Division of Radiation & Environment, NRG, Petten, The Netherlands
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15
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Affiliation(s)
- A M Winter
- Department of Pathology, University of Chicago Hospitals, Illinois 60637, USA
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16
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Winter AM, Hanauer SB. Medical management of perianal Crohn's disease. Semin Gastrointest Dis 1998; 9:10-4. [PMID: 9547851] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Perianal disease is a frequent complication necessitating both medical and surgical management in Crohn's disease. Fissures, fistulae, or abscesses are found in approximately 36% of patients; occur more often in the ileocolonic and colonic disease; and may precede the onset of intestinal symptoms (Farmer et al, Gastroenterology 68:627-635, 1975; Rankin et al, Gastroenterology 77:914-920, 1979; Gray et al, Gut 6:515-524, 1965; and Homan et al, Arch Surg 111:1333-1335, 1976). To approach perianal manifestations, the physician must identify the anatomic location of the disease, treat the suppurative complications, and consider a long-term approach to palliation of chronic inflammatory sequelae. This article will review the medical management of perianal Crohn's disease and indications for surgery.
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Affiliation(s)
- A M Winter
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Hospitals, IL 60637, USA
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17
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Winter AM, Banks PA, Petros JG. Healing of transsphincteric perianal fistulas in Crohn's disease using a new technique. Am J Gastroenterol 1993; 88:2022-5. [PMID: 8249967] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Transsphincteric perianal fistulas in Crohn's disease are often refractory to medical therapy and difficult to treat surgically. Our objective was to determine whether a new method of anal fistulotomy was effective in healing these fistulas. METHODS In this new method, the internal opening of the fistula tract was displaced distally to the region of the anal mucosa in 26 patients with Crohn's disease. RESULTS Healing was achieved within 5 weeks of surgery in 45/49 (92%) of the fistulas and was not influenced by perioperative medication, site of preexisting Crohn's disease, or condition of the rectum. There has been no alteration of preoperative continence. CONCLUSIONS We conclude that this method is highly effective in treating transsphincteric perianal fistulas in Crohn's disease.
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Affiliation(s)
- A M Winter
- Department of Medicine, St. Elizabeth's Hospital, Boston, Massachusetts
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18
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Potter S, Uknes S, Lawton K, Winter AM, Chandler D, DiMaio J, Novitzky R, Ward E, Ryals J. Regulation of a hevein-like gene in Arabidopsis. Mol Plant Microbe Interact 1993; 6:680-5. [PMID: 8118053 DOI: 10.1094/mpmi-6-680] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
An Arabidopisis cDNA clone was isolated that encodes a protein similar to the antifungal chitin-binding protein hevein from rubber tree latex. This hevein-like (HEL) mRNA was inducible by either turnip crinkle virus infection or ethylene treatment. In addition, expression was moderately inducible by treatment with the resistance-inducing compounds salicylic acid and 2,6-dichlorisonicotinic acid. The 786-bp cDNA contains an open reading frame of 212 codons. The deduced amino acid sequence contains a putative signal sequence of 21 amino acids followed by a 43-amino-acid cysteine-rich lectin domain and a 129-amino-acid carboxy-terminal domain. The predicted protein is approximately 70% identical to hevein, to the wound-inducible WIN1 and WIN2 proteins from potato, and to PR-4, a pathogenesis-related protein from tobacco.
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Affiliation(s)
- S Potter
- Department of Molecular Genetics, Ciba-Geigy Corporation, Research Triangle Park, NC 27709
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