1
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Callander NS, Silbermann R, Kaufman JL, Godby KN, Laubach J, Schmidt TM, Sborov DW, Medvedova E, Reeves B, Dhakal B, Rodriguez C, Chhabra S, Chari A, Bal S, Anderson LD, Dholaria BR, Nathwani N, Hari P, Shah N, Bumma N, Holstein SA, Costello C, Jakubowiak A, Wildes TM, Orlowski RZ, Shain KH, Cowan AJ, Pei H, Cortoos A, Patel S, Lin TS, Giri S, Costa LJ, Usmani SZ, Richardson PG, Voorhees PM. Daratumumab-based quadruplet therapy for transplant-eligible newly diagnosed multiple myeloma with high cytogenetic risk. Blood Cancer J 2024; 14:69. [PMID: 38649340 PMCID: PMC11035596 DOI: 10.1038/s41408-024-01030-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 04/25/2024] Open
Abstract
In the MASTER study (NCT03224507), daratumumab+carfilzomib/lenalidomide/dexamethasone (D-KRd) demonstrated promising efficacy in transplant-eligible newly diagnosed multiple myeloma (NDMM). In GRIFFIN (NCT02874742), daratumumab+lenalidomide/bortezomib/dexamethasone (D-RVd) improved outcomes for transplant-eligible NDMM. Here, we present a post hoc analysis of patients with high-risk cytogenetic abnormalities (HRCAs; del[17p], t[4;14], t[14;16], t[14;20], or gain/amp[1q21]). Among 123 D-KRd patients, 43.1%, 37.4%, and 19.5% had 0, 1, or ≥2 HRCAs. Among 120 D-RVd patients, 55.8%, 28.3%, and 10.8% had 0, 1, or ≥2 HRCAs. Rates of complete response or better (best on study) for 0, 1, or ≥2 HRCAs were 90.6%, 89.1%, and 70.8% for D-KRd, and 90.9%, 78.8%, and 61.5% for D-RVd. At median follow-up (MASTER, 31.1 months; GRIFFIN, 49.6 months for randomized patients/59.5 months for safety run-in patients), MRD-negativity rates as assessed by next-generation sequencing (10-5) were 80.0%, 86.4%, and 83.3% for 0, 1, or ≥2 HRCAs for D-KRd, and 76.1%, 55.9%, and 61.5% for D-RVd. PFS was similar between studies and superior for 0 or 1 versus ≥2 HRCAs: 36-month PFS rates for D-KRd were 89.9%, 86.2%, and 52.4%, and 96.7%, 90.5%, and 53.5% for D-RVd. These data support the use of daratumumab-containing regimens for transplant-eligible NDMM with HCRAs; however, additional strategies are needed for ultra-high-risk disease (≥2 HRCAs). Video Abstract.
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Affiliation(s)
| | - Rebecca Silbermann
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | | | - Kelly N Godby
- University of Alabama at Birmingham Hospital, Birmingham, AL, USA
| | - Jacob Laubach
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Douglas W Sborov
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Eva Medvedova
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Brandi Reeves
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Binod Dhakal
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Ajai Chari
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susan Bal
- University of Alabama at Birmingham Hospital, Birmingham, AL, USA
| | - Larry D Anderson
- Myeloma, Waldenstrӧm's and Amyloidosis Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Nitya Nathwani
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Parameswaran Hari
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Nina Shah
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Naresh Bumma
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Sarah A Holstein
- Division of Oncology & Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Caitlin Costello
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | | | - Tanya M Wildes
- Division of Oncology & Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Robert Z Orlowski
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kenneth H Shain
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Andrew J Cowan
- Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Huiling Pei
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | | | | | - Thomas S Lin
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - Smith Giri
- Division of Hematology & Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Luciano J Costa
- University of Alabama at Birmingham Hospital, Birmingham, AL, USA
| | - Saad Z Usmani
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Paul G Richardson
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Peter M Voorhees
- Levine Cancer Institute, Atrium Health Wake Forest Baptist, Charlotte, NC, USA.
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Kampouri E, Krantz EM, Xie H, Ibrahimi SS, Kiem ES, Sekhon MK, Liang EC, Cowan AJ, Portuguese AJ, Green DJ, Albittar A, Huang JJ, Gauthier J, Pérez-Osorio AC, Jerome KR, Zerr D, Boeckh MJ, Hill JA. Human Herpesvirus-6 Reactivation and Disease Are Infrequent in Chimeric Antigen Receptor T-cell Therapy Recipients. Blood 2024:blood.2024024145. [PMID: 38635788 DOI: 10.1182/blood.2024024145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024] Open
Abstract
Human herpesvirus-6B (HHV-6B) reactivation and disease are increasingly reported after CAR-T-cell therapy (CARTx). HHV-6 reactivation in the CAR-T-cell product was recently reported, raising questions about product and patient management. Due to overlapping manifestations with immune effector cell-associated neurotoxicity syndrome, diagnosing HHV-6B encephalitis is challenging. We provide two lines of evidence assessing the incidence and outcomes of HHV-6B after CARTx. First, in a prospective study with weekly HHV-6B testing for up to 12 weeks post-infusion, HHV-6B reactivation occurred in eight of 89 participants; three had chromosomally integrated HHV-6 and were excluded, resulting in a cumulative incidence of HHV-6B reactivation of 6% (95% confidence interval (CI), 2.2-12.5%). HHV-6B detection was low level (median peak, 435 copies/mL; IQR, 164-979) and did not require therapy. Second, we retrospectively analyzed HHV-6B detection in blood and/or cerebrospinal fluid (CSF) within 12 weeks post-infusion in CARTx recipients. Of 626 patients, 24 had symptom-driven plasma testing with detection in one. Among 34 patients with CSF HHV-6 testing, one patient had possible HHV-6 encephalitis for a cumulative incidence of 0.17% (95% CI, 0.02-0.94%), although symptoms improved without treatment. Our data demonstrate that HHV-6B reactivation and disease are infrequent after CARTx. Routine HHV-6 monitoring is not warranted.
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Affiliation(s)
| | - Elizabeth M Krantz
- Fred Hutchinson Cancer Research Institute, Seattle, Washington, United States
| | - Hu Xie
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | | | - Erika S Kiem
- Fred Hutchinson Cancer Center, Seattle, Washington, United States
| | - Mandeep K Sekhon
- Fred Hutchinson Cancer Center, Seattle, Washington, United States
| | - Emily C Liang
- Fred Hutchinson Cancer Center, Seattle, Washington, United States
| | - Andrew J Cowan
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | | | | | - Aya Albittar
- Fred Hutchinson Cancer Center, Seattle, Washington, United States
| | - Jennifer J Huang
- Fred Hutchinson Cancer Center, Seattle, Washington, United States
| | - Jordan Gauthier
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | | | - Keith R Jerome
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | - Danielle Zerr
- University of Washington and Seattle Children's Hospital, Seattle, Washington, United States
| | - Michael J Boeckh
- Fred Hutchinson Cancer Center, Seattle, Washington, United States
| | - Joshua A Hill
- Fred Hutchinson Cancer Center, Seattle, Washington, United States
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3
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Silbermann R, Laubach J, Kaufman JL, Sborov DW, Reeves B, Rodriguez C, Chari A, Costa LJ, Anderson LD, Nathwani N, Shah N, Bumma N, Holstein SA, Costello C, Jakubowiak A, Orlowski RZ, Shain KH, Cowan AJ, Gries KS, Pei H, Cortoos A, Patel S, Lin TS, Voorhees PM, Usmani SZ, Richardson PG. Health-related quality of life in transplant-eligible patients with newly diagnosed multiple myeloma treated with daratumumab, lenalidomide, bortezomib, and dexamethasone: Patient-reported outcomes from GRIFFIN. Am J Hematol 2024. [PMID: 38622840 DOI: 10.1002/ajh.27326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/07/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
In the phase 2 GRIFFIN trial (ClinicalTrials.gov identifier: NCT02874742), daratumumab added to lenalidomide, bortezomib, and dexamethasone (D-RVd) improved depth of response and progression-free survival (PFS) versus lenalidomide, bortezomib, and dexamethasone (RVd) alone in transplant-eligible (TE) patients with newly diagnosed multiple myeloma (NDMM). Here, we present patient-reported outcomes (PROs) collected using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30-item (QLQ-C30), EORTC Quality of Life Questionnaire Multiple Myeloma Module 20-item (QLQ-MY20), and EuroQol 5-Dimension 5-Level (EQ-5D-5L) tools on day 1 of cycles 1, 2, and 3; on day 21 of cycle 4 (end of induction therapy); on day 1 of cycle 5; on day 21 of cycle 6 (end of posttransplant consolidation therapy); and at months 6, 12, 18, and 24 of maintenance therapy. Meaningful improvements from baseline were seen in most of the PRO scales with both treatments after consolidation and were sustained for at least 2 years of maintenance treatment. Large reductions from baseline (~20 points) were especially observed in pain symptoms for both treatment groups, although these were numerically higher for patients receiving D-RVd during the majority of the time points. In addition, improvements in key scales, such as global health status, fatigue symptoms, and physical functioning, were also seen with both D-RVd and RVd. These improvements in health-related quality of life contribute to the totality of evidence supporting the improvement in clinical outcomes such as response rates and PFS with D-RVd in induction, consolidation, and maintenance therapy in TE patients with NDMM.
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Affiliation(s)
- Rebecca Silbermann
- Division of Hematology/Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Jacob Laubach
- Department of Medical Oncology, Dana-Farber/Partners Cancer Care, Boston, Massachusetts, USA
| | - Jonathan L Kaufman
- Department of Mematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Douglas W Sborov
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Brandi Reeves
- Division of Hematology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cesar Rodriguez
- Department of Hematology and Medical Oncology, Mount Sinai School of Medicine, New York, New York, USA
| | - Ajai Chari
- Department of Hematology and Medical Oncology, Mount Sinai School of Medicine, New York, New York, USA
| | - Luciano J Costa
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Larry D Anderson
- Division of Hematology/Oncology, Simmons Comprehensive Cancer Center, UT Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nitya Nathwani
- Division of Myeloma, Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Nina Shah
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Naresh Bumma
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Sarah A Holstein
- Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Caitlin Costello
- Division of Blood and Marrow Transplantation, Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Andrzej Jakubowiak
- Medicine- Hematology and Oncology, University of Chicago, Chicago, Illinois, USA
| | - Robert Z Orlowski
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kenneth H Shain
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Andrew J Cowan
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Huiling Pei
- Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | | | - Sharmila Patel
- Janssen Scientific Affairs, LLC, Horsham, Pennsylvania, USA
| | - Thomas S Lin
- Janssen Scientific Affairs, LLC, Horsham, Pennsylvania, USA
| | - Peter M Voorhees
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health/Wake Forest University School of Medicine, Charlotte, North Carolina, USA
| | - Saad Z Usmani
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Paul G Richardson
- Department of Medical Oncology, Dana-Farber/Partners Cancer Care, Boston, Massachusetts, USA
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Hoff FW, Banerjee R, Khan AM, McCaughan G, Wang B, Wang X, Roose J, Anderson LD, Cowan AJ, Rajkumar SV, Kaur G. Once-weekly versus twice-weekly bortezomib in newly diagnosed multiple myeloma: a real-world analysis. Blood Cancer J 2024; 14:52. [PMID: 38519476 PMCID: PMC10959949 DOI: 10.1038/s41408-024-01034-6] [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: 11/11/2023] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024] Open
Abstract
Induction regimens for multiple myeloma (MM) commonly include bortezomib, which has typically been administered twice weekly despite studies demonstrating comparable efficacy and less peripheral neuropathy (PN) with once-weekly bortezomib. We aimed to analyze the real-world prevalence and efficacy of once-weekly versus twice-weekly bortezomib regimens in newly diagnosed MM. We analyzed 2497 US patients aged 18-70 years treated with commercial first-line bortezomib using nationwide Flatiron Health electronic health record-derived data, including 910 (36.4%) patients who received twice-weekly and 1522 (63.2%) who received once-weekly bortezomib. Once-weekly bortezomib use increased over time, from 57.7% in 2017 to 73.1% in 2022. Multivariate analysis identified worsened performance status and more recent year of diagnosis with higher odds of receiving once-weekly bortezomib. Real-world progression-free survival (median 37.2 months with once-weekly versus 39.6 months with twice-weekly, p = 0.906) and overall survival (medians not reached in either cohort, p = 0.800) were comparable. PN rates were higher in patients receiving twice-weekly bortezomib (34.7% versus 18.5%, p < 0.001). In conclusion, once-weekly bortezomib is clearly associated with similar efficacy and fewer toxicities compared to twice-weekly bortezomib. Our findings support once-weekly bortezomib as a standard-of-care regimen for newly diagnosed patients with MM.
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Affiliation(s)
- Fieke W Hoff
- Myeloma, Waldenstrom's, and Amyloidosis Program, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rahul Banerjee
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Adeel M Khan
- Myeloma, Waldenstrom's, and Amyloidosis Program, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Georgia McCaughan
- Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Bo Wang
- Willamette Valley Cancer Institute, Eugene, OR, USA
| | | | | | - Larry D Anderson
- Myeloma, Waldenstrom's, and Amyloidosis Program, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Andrew J Cowan
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Gurbakhash Kaur
- Myeloma, Waldenstrom's, and Amyloidosis Program, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.
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5
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Treger RS, Mathias PC, Cowan AJ, Green D, Hutchinson K, Bryan A, Chaudhary A, Fink SL, Wener MH, Morishima C. Data analytics improves the diagnostic accuracy of serum free light chain results for detecting monoclonal gammopathy. Am J Clin Pathol 2024; 161:216-231. [PMID: 37936261 PMCID: PMC10905508 DOI: 10.1093/ajcp/aqad137] [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: 07/26/2023] [Accepted: 09/18/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVES To evaluate the real-world performance and reference intervals of the Binding Site Freelite serum free light chain (SFLC) assay (Thermo Fisher Scientific), a global standard for diagnosis, prognostication, and response assessment for monoclonal gammopathies. METHODS An informatics-based approach was used to retrospectively evaluate concordance between SFLC and the orthogonal Sebia HYDRASYS immunofixation assay results in a large clinical data set consecutively reported between 2010 and 2020. RESULTS Among patients with monoclonal-negative results by both SFLC and Sebia HYDRASYS immunofixation assays, 25% (1226/5057) had κ/λ ratios (KLRs) outside the manufacturer-defined and International Myeloma Working Group-cited normal reference interval of 0.26 to 1.65. These results were consistent over the study period and were not affected by sex, age, impaired kidney function, or assay antisera lot variation. Assay drift, in addition to other potential factors, affected the KLR distribution. Using International Statistical Classification of Diseases (ICD) codes, kidney function data, and the central 95% of KLR values generated on the Optilite platform (Thermo Fisher Scientific), we derived a new reference interval of 0.67 to 2.13, reducing the KLR false-positive rate to 8%. However, normal KLR persisted among 16% (14/85) of samples with free λ chains by immunofixation, warranting caution during interpretation. CONCLUSIONS Our analysis indicated that revision of Freelite SFLC reference intervals improves assay interpretation and should prompt reconsideration of Freelite reference intervals worldwide.
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Affiliation(s)
- Rebecca S Treger
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, US
| | - Patrick C Mathias
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, US
| | - Andrew J Cowan
- Division of Medical Oncology, University of Washington, Seattle, WA, US
- Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, US
| | - Damian Green
- Division of Medical Oncology, University of Washington, Seattle, WA, US
- Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, US
| | - Kathleen Hutchinson
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, US
| | - Andrew Bryan
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, US
| | - Anu Chaudhary
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, US
| | - Susan L Fink
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, US
| | - Mark H Wener
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, US
- Division of Rheumatology, Department of Medicine, University of Washington, Seattle, WA, US
| | - Chihiro Morishima
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, US
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Banerjee R, Poh C, Hirayama AV, Gauthier J, Cassaday RD, Shadman M, Cowan AJ, Till BG, Green DJ, Kiem HP, Gopal AK, Maloney DG. Answering the "Doctor, can CAR-T therapy cause cancer?" question in clinic. Blood Adv 2024; 8:895-898. [PMID: 38197942 PMCID: PMC10875255 DOI: 10.1182/bloodadvances.2023012336] [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] [Received: 12/04/2023] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- Rahul Banerjee
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Christina Poh
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Alexandre V. Hirayama
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Jordan Gauthier
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Ryan D. Cassaday
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Andrew J. Cowan
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Brian G. Till
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Damian J. Green
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Hans-Peter Kiem
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Ajay K. Gopal
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - David G. Maloney
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
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7
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Banerjee R, Cowan AJ, Ortega M, Missimer C, Carpenter PA, Oshima MU, Salit RB, Vo PT, Lee CJ, Mehta RS, Kuderer NM, Shankaran V, Lee SJ, Su CT. Financial Toxicity, Time Toxicity, and Quality of Life in Multiple Myeloma. Clin Lymphoma Myeloma Leuk 2024:S2152-2650(24)00090-9. [PMID: 38521640 DOI: 10.1016/j.clml.2024.02.013] [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] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/21/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Patients with multiple myeloma (MM) may be on therapy for years, which can lead to financial toxicity (FinTox) or time toxicity (TimeTox). The prevalence, predictors, and quality of life (QOL) impacts of FinTox and TimeTox during different phases of MM treatment have not been characterized. PATIENTS AND METHODS We conducted a single-center cross-sectional survey of patients with MM who had undergone transplantation. FinTox+ was defined as a COST-FACIT score <23, TimeTox+ as MM-related interactions (including phone calls) ≥1x weekly or ≥1x monthly in-person among far-residing patients, QOL using PROMIS Global Health, and functional status using patient-reported Karnofsky performance status (KPS). RESULTS Of 252 patients, 22% and 40% met FinTox+ and TimeTox+ criteria respectively. Respective FinTox+ and TimeTox+ proportions were 22%/37% for patients on maintenance, 22%/82% with active therapy, and 20%/14% with observation. FinTox+ predictors included annual income (P < .01) and out-of-pocket costs (P < .01). TimeTox+ predictors included disease status (P < .001), caregiver status (P = .01), far-residing status (P < .001), and out-of-pocket costs (P = .03). FinTox+ was associated with a clinically meaningful decrease in mental QOL, while TimeTox+ patients were more likely to have KPS ≤ 80. CONCLUSIONS In our large study, monetary status but not disease status predicted FinTox. Over a third of patients on maintenance reported TimeTox. FinTox+ was associated with decreased mental health, while TimeTox+ was associated with worse performance status. These two toxicities may negatively impact patient wellbeing, and studies of strategies to mitigate their impact are in development.
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Affiliation(s)
- Rahul Banerjee
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA.
| | - Andrew J Cowan
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Marivel Ortega
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Masumi Ueda Oshima
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Rachel B Salit
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Phuong T Vo
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Catherine J Lee
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Rohtesh S Mehta
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Veena Shankaran
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Stephanie J Lee
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Christopher T Su
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
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8
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Cowan AJ, Green DJ. Unveiling the link between genetic alterations in gamma secretase and BCMA surface density in multiple myeloma. Br J Haematol 2024; 204:391-392. [PMID: 38014717 DOI: 10.1111/bjh.19222] [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: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
Cattaneo et al. report a unique case of a multiple myeloma patient with elevated B-cell maturation antigen (BCMA) surface density, potentially due to genetic alterations in the gamma-secretase protease complex-responsible for BCMA cleavage from plasma cells. No mutations in the BCMA gene were detected, but there was partial deletion of PSEN1 and amplification of PSEN2 (components of the gamma-secretase complex), which may explain the lack of response to the gamma-secretase inhibitor DAPT. This case, along with recent published literature, underscores the significance of gamma secretase in modulating BCMA density and the potential impact of its genetic alterations. Commentary on: Cattaneo et al. Genetic defects of gamma-secretase genes in a multiple myeloma patient with high and dysregulated BCMA surface density: A case report. Br J Haematol 2024;204:571-575.
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Affiliation(s)
- Andrew J Cowan
- Fred Hutch Cancer Center, UW Medicine, Seattle, Washington, USA
| | - Damian J Green
- Fred Hutch Cancer Center, UW Medicine, Seattle, Washington, USA
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Ho C, Gopal AK, Till BG, Shadman M, Lynch RC, Cowan AJ, Wu QV, Voutsinas J, Rasmussen HA, Blue K, Ujjani CS, Cassaday RD, Fromm JR, Fang M, Smith SD. Pembrolizumab With R-CHOP in Previously Untreated DLBCL: Sustained, High Efficacy, and Safety With Long-Term Follow-Up. Clin Lymphoma Myeloma Leuk 2024; 24:e33-e39.e1. [PMID: 37926672 PMCID: PMC10841534 DOI: 10.1016/j.clml.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/28/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND While generally ineffective in relapsed diffuse large B cell lymphoma (DLBCL), immune checkpoint inhibitors (ICIs) may hold greater promise in untreated, immunocompetent patients. We previously reported safety and early efficacy of pembrolizumab plus rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (PR-CHOP) in a phase I trial of untreated DLBCL, noting responses in 90% of patients (complete response 77%) and a 2-year progression-free survival (PFS) of 83%. We herein report long-term safety and efficacy at 5-year follow up. PATIENTS AND METHODS Adult patients with untreated DLBCL or grade 3b follicular lymphoma, intended to receive 6 cycles of R-CHOP were eligible. Patients (N = 30) were treated with pembrolizumab 200 mg IV and R-CHOP in 21-day cycles for 6 cycles. RESULTS At median follow up of 4.8 years, 5-year PFS was 71% (CI, 54%-94%) and 5-year overall survival was 83% (CI, 71%-98%). Immune-related adverse events (IRAEs) occurred in 7 (23%) patients (10% grade 3/4). Three IRAEs (rash, thyroiditis, rheumatoid arthritis) occurred beyond 3 months of treatment completion. PD-L1 tumor expression was documented in 19 of 23 (83%) tested patients. None of the 19 patients who had any PD-L1 expression have relapsed, whereas 2 out of the 4 patients with no PD-L1 expression have relapsed. CONCLUSION PR-CHOP has led to durable responses in most patients, with the best outcomes in PD-L1-expressing disease. Furthermore, the safety profile was manageable, with no consistent pattern of late events. These data support ongoing strategies incorporating ICIs in frontline DLBCL therapy and confirmation of predictive biomarkers including tumor PD-L1 expression.
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Affiliation(s)
- Carrie Ho
- Department of Internal Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA.
| | - Ajay K Gopal
- Department of Internal Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Brian G Till
- Department of Internal Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Mazyar Shadman
- Department of Internal Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Ryan C Lynch
- Department of Internal Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Andrew J Cowan
- Department of Internal Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Qian V Wu
- Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Heather A Rasmussen
- Department of Internal Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA
| | - Katherine Blue
- Department of Internal Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA
| | - Chaitra S Ujjani
- Department of Internal Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Ryan D Cassaday
- Department of Internal Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Jonathan R Fromm
- Department of Laboratory Medicine, Division of Hematopathology, University of Washington, Seattle, WA
| | - Min Fang
- Fred Hutchinson Cancer Center, Seattle, WA
| | - Stephen D Smith
- Department of Internal Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
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Banerjee R, Hurtado Martínez JA, Flores Pérez PA, Porras N, Hydren J, Ahlstrom JM, Taravati P, Cowan AJ. Association between dexamethasone exposure and visually significant cataracts in multiple myeloma. Am J Hematol 2024; 99:E12-E14. [PMID: 37853832 DOI: 10.1002/ajh.27133] [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] [Received: 09/04/2023] [Revised: 09/21/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Rahul Banerjee
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | | | | | | | | | | | - Parisa Taravati
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Andrew J Cowan
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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11
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Banerjee R, Wang B, Anderson LD, McCaughan G, Mehra N, Cowan AJ, Rajkumar SV, Kaur G. Once-weekly bortezomib as the standard of care in multiple myeloma: results from an international survey of physicians. Blood Cancer J 2023; 13:162. [PMID: 37926718 PMCID: PMC10625982 DOI: 10.1038/s41408-023-00937-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/16/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- Rahul Banerjee
- Department of Medicine, University of Washington, Seattle, WA, USA.
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | - Bo Wang
- Willamette Valley Cancer Institute, Eugene, OR, USA
| | - Larry D Anderson
- Myeloma, Waldenstrom's, and Amyloidosis Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Georgia McCaughan
- Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia
- Garvan Institute of Medical Research, University of New South Wales, Sydney, NSW, Australia
| | - Nikita Mehra
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, India
| | - Andrew J Cowan
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Gurbakhash Kaur
- Myeloma, Waldenstrom's, and Amyloidosis Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
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12
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Banerjee R, Cicero KI, Lee SS, Cowan AJ. Definers and drivers of functional high-risk multiple myeloma: insights from genomic, transcriptomic, and immune profiling. Front Oncol 2023; 13:1240966. [PMID: 37849816 PMCID: PMC10577204 DOI: 10.3389/fonc.2023.1240966] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
Traditional prognostic models for newly diagnosed patients with multiple myeloma (MM), including International Staging System criteria and number of high-risk chromosomal abnormalities, are based on disease characteristics at diagnosis. However, the identification of patients at risk of more rapidly progressive MM is inherently a dynamic assessment. In a subset of patients with MM, adverse disease biology only becomes evident after the failure of first-line therapy. We define this entity as functional high-risk MM (FHRMM), encompassing relapse within 18 months of treatment initiation and/or within 12 months of frontline autologous stem cell transplantation. FHRMM is not adequately captured by traditional prognostic models, and there is a need for better understanding of mechanisms or risk factors for early relapse or progression. In this review, we explore potential definitions of FHRMM before delving into its underlying drivers based on genetic, transcriptomic, and immune cell profiling studies. Emerging data suggest that specific features of both myeloma cells and immune cells can enable the FHRMM phenotype. We conclude our review by discussing ongoing and future studies that seek to identify and intervene upon patients with FHRMM preemptively.
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Affiliation(s)
- Rahul Banerjee
- Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA, United States
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Kara I. Cicero
- Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA, United States
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Sarah S. Lee
- Division of Myeloma, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, CA, United States
| | - Andrew J. Cowan
- Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA, United States
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
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13
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Voorhees PM, Sborov DW, Laubach J, Kaufman JL, Reeves B, Rodriguez C, Chari A, Silbermann R, Costa LJ, Anderson LD, Nathwani N, Shah N, Bumma N, Efebera YA, Holstein SA, Costello C, Jakubowiak A, Wildes TM, Orlowski RZ, Shain KH, Cowan AJ, Dinner S, Pei H, Cortoos A, Patel S, Lin TS, Usmani SZ, Richardson PG. Addition of daratumumab to lenalidomide, bortezomib, and dexamethasone for transplantation-eligible patients with newly diagnosed multiple myeloma (GRIFFIN): final analysis of an open-label, randomised, phase 2 trial. Lancet Haematol 2023; 10:e825-e837. [PMID: 37708911 DOI: 10.1016/s2352-3026(23)00217-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 03/03/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Addition of daratumumab to lenalidomide, bortezomib, and dexamethasone (D-RVd) in the GRIFFIN study improved the stringent complete response rate by the end of consolidation in transplantation-eligible patients with newly diagnosed multiple myeloma. Here, we report the findings of the predefined final analysis. METHODS GRIFFIN was an open-label, randomised, active-controlled, phase 2 trial done in 35 research centres in the USA. Patients had newly diagnosed multiple myeloma with measurable disease by M protein or free light chain, were aged 18-70 years, had an ECOG performance score of 0-2, and were eligible for autologous haematopoietic stem-cell transplantation (HSCT). Patients were randomly assigned (1:1) to four D-RVd or RVd induction cycles, autologous HSCT, two D-RVd or RVd consolidation cycles, and lenalidomide with or without daratumumab maintenance therapy for 2 years. Patients received 21-day cycles of oral lenalidomide (25 mg on days 1-14), subcutaneous bortezomib (1·3 mg/m2 on days 1, 4, 8, and 11), oral dexamethasone (40 mg weekly) with or without intravenous daratumumab (16 mg/kg weekly, cycles 1-4; day 1, cycles 5-6). Maintenance therapy (28-day cycles) was oral lenalidomide (10 mg on days 1-21) with or without daratumumab (16 mg/kg intravenously every 4 or 8 weeks, or 1800 mg subcutaneously monthly). Patients could continue lenalidomide maintenance after study treatment completion. The primary endpoint was stringent complete response rate by the end of consolidation in the response-evaluable population, and has already been reported. Here we report updated stringent complete response rates and secondary outcomes including progression-free survival and overall survival. The trial is registered with ClinicalTrials.gov (NCT02874742) and ended on April 8, 2022. FINDINGS Between Dec 20, 2016, and April 10, 2018, 104 patients were randomly assigned to the D-RVd group and 103 were randomly assigned to the RVd group; most patients were White (85 [82%] in the D-RVd group and 76 [74%] in the RVd group) and male (58 [56%] in the D-RVd group and 60 [58%] in the RVd group). At a median follow-up of 49·6 months (IQR 47·4-52·1), D-RVd improved rates of stringent complete response (67 [67%] of 100] vs 47 [48%] of 98]; odds ratio 2·18 [95% CI 1·22-3·89], p=0·0079), and 4-year progression-free survival was 87·2% (95% CI 77·9-92·8) for D-RVd versus 70·0% (95% CI 55·9-80·3) for RVd, with a hazard ratio (HR) of 0·45 (95% CI 0·21-0·95, p=0·032) for risk of disease progression or death with D-RVd. Median overall survival was not reached for either group (HR 0·90 [95% CI 0·31-2·56], p=0·84). The most common grade 3-4 treatment-emergent adverse events in the D-RVd versus RVd groups were neutropenia (46 [46%] of 99 vs 23 [23%] of 102), lymphopenia (23 [23%] vs 23 [23%]), leukopenia (17 [17%] vs eight [8%]), thrombocytopenia (16 [16%] vs nine [9%]), pneumonia (12 [12%] vs 14 [14%]), and hypophosphataemia (ten [10%] vs 11 [11%]). Serious treatment-emergent adverse events occurred in 46 (46%) of 99 patients in the D-RVd group and in 53 (52%) of 102 patients in the RVd group. One patient in each treatment group reported a treatment-emergent adverse event that resulted in death (bronchopneumonia in the D-RVd group; cause unknown in the RVd group); neither was related to study treatment. No new safety concerns occurred with maintenance therapy. INTERPRETATION Addition of daratumumab to RVd improved the depth of response and progression-free survival in transplantation-eligible patients with newly diagnosed multiple myeloma. These results justify further evaluation in phase 3 studies. FUNDING Janssen Oncology.
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Affiliation(s)
- Peter M Voorhees
- Levine Cancer Institute, Atrium Health Wake Forest University School of Medicine, Charlotte, NC, USA.
| | - Douglas W Sborov
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jacob Laubach
- Dana-Farber/Partners CancerCare, Harvard Medical School, Boston, MA, USA
| | | | - Brandi Reeves
- Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | | | - Ajai Chari
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rebecca Silbermann
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Luciano J Costa
- University of Alabama at Birmingham Hospital, Birmingham, AL, USA
| | - Larry D Anderson
- Myeloma, Waldenstrom's and Amyloidosis Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nitya Nathwani
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Nina Shah
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Naresh Bumma
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Sarah A Holstein
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Caitlin Costello
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | | | - Tanya M Wildes
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Robert Z Orlowski
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kenneth H Shain
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Andrew J Cowan
- Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Shira Dinner
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Huiling Pei
- Janssen Research & Development, Titusville, NJ, USA
| | | | | | | | - Saad Z Usmani
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul G Richardson
- Dana-Farber/Partners CancerCare, Harvard Medical School, Boston, MA, USA
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14
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Cowan AJ, Pont MJ, Sather BD, Turtle CJ, Till BG, Libby EN, Coffey DG, Tuazon SA, Wood B, Gooley T, Wu VQ, Voutsinas J, Song X, Shadman M, Gauthier J, Chapuis AG, Milano F, Maloney DG, Riddell SR, Green DJ. γ-Secretase inhibitor in combination with BCMA chimeric antigen receptor T-cell immunotherapy for individuals with relapsed or refractory multiple myeloma: a phase 1, first-in-human trial. Lancet Oncol 2023; 24:811-822. [PMID: 37414012 PMCID: PMC10783021 DOI: 10.1016/s1470-2045(23)00246-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [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: 12/14/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND γ-Secretase inhibitors (GSIs) increase B cell maturation antigen (BCMA) density on malignant plasma cells and enhance antitumour activity of BCMA chimeric antigen receptor (CAR) T cells in preclinical models. We aimed to evaluate the safety and identify the recommended phase 2 dose of BCMA CAR T cells in combination with crenigacestat (LY3039478) for individuals with relapsed or refractory multiple myeloma. METHODS We conducted a phase 1, first-in-human trial combining crenigacestat with BCMA CAR T-cells at a single cancer centre in Seattle, WA, USA. We included individuals aged 21 years or older with relapsed or refractory multiple myeloma, previous autologous stem-cell transplant or persistent disease after more than four cycles of induction therapy, and Eastern Cooperative Oncology Group performance status of 0-2, regardless of previous BCMA-targeted therapy. To assess the effect of the GSI on BCMA surface density on bone marrow plasma cells, participants received GSI during a pretreatment run-in, consisting of three doses administered 48 h apart. BCMA CAR T cells were infused at doses of 50 × 106 CAR T cells, 150 × 106 CAR T cells, 300 × 106 CAR T cells, and 450 × 106 CAR T cells (total cell dose), in combination with the 25 mg crenigacestat dosed three times a week for up to nine doses. The primary endpoints were the safety and recommended phase 2 dose of BCMA CAR T cells in combination with crenigacestat, an oral GSI. This study is registered with ClinicalTrials.gov, NCT03502577, and has met accrual goals. FINDINGS 19 participants were enrolled between June 1, 2018, and March 1, 2021, and one participant did not proceed with BCMA CAR T-cell infusion. 18 participants (eight [44%] men and ten [56%] women) with multiple myeloma received treatment between July 11, 2018, and April 14, 2021, with a median follow up of 36 months (95% CI 26 to not reached). The most common non-haematological adverse events of grade 3 or higher were hypophosphataemia in 14 (78%) participants, fatigue in 11 (61%), hypocalcaemia in nine (50%), and hypertension in seven (39%). Two deaths reported outside of the 28-day adverse event collection window were related to treatment. Participants were treated at doses up to 450 × 106 CAR+ cells, and the recommended phase 2 dose was not reached. INTERPRETATIONS Combining a GSI with BCMA CAR T cells appears to be well tolerated, and crenigacestat increases target antigen density. Deep responses were observed among heavily pretreated participants with multiple myeloma who had previously received BCMA-targeted therapy and those who were naive to previous BCMA-targeted therapy. Further study of GSIs given with BCMA-targeted therapeutics is warranted in clinical trials. FUNDING Juno Therapeutics-a Bristol Myers Squibb company and the National Institutes of Health.
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Affiliation(s)
- Andrew J Cowan
- Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, USA; Immunotherapy Integrated Research Center, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Margot J Pont
- Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, USA; Immunotherapy Integrated Research Center, Fred Hutch Cancer Center, Seattle, WA, USA
| | | | - Cameron J Turtle
- Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, USA; Immunotherapy Integrated Research Center, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Brian G Till
- Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, USA; Immunotherapy Integrated Research Center, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Edward N Libby
- Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, USA
| | - David G Coffey
- Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, USA; Immunotherapy Integrated Research Center, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Sherilyn A Tuazon
- Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, USA; Immunotherapy Integrated Research Center, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Brent Wood
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Ted Gooley
- Statistics Division, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Vicky Q Wu
- Immunotherapy Integrated Research Center, Fred Hutch Cancer Center, Seattle, WA, USA; Statistics Division, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Jenna Voutsinas
- Immunotherapy Integrated Research Center, Fred Hutch Cancer Center, Seattle, WA, USA; Statistics Division, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Xiaoling Song
- Immunotherapy Integrated Research Center, Fred Hutch Cancer Center, Seattle, WA, USA; Statistics Division, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Mazyar Shadman
- Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, USA; Immunotherapy Integrated Research Center, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Jordan Gauthier
- Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, USA; Immunotherapy Integrated Research Center, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Aude G Chapuis
- Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, USA; Immunotherapy Integrated Research Center, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Filippo Milano
- Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, USA; Immunotherapy Integrated Research Center, Fred Hutch Cancer Center, Seattle, WA, USA
| | - David G Maloney
- Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, USA; Immunotherapy Integrated Research Center, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Stanley R Riddell
- Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, USA; Immunotherapy Integrated Research Center, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Damian J Green
- Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, USA; Immunotherapy Integrated Research Center, Fred Hutch Cancer Center, Seattle, WA, USA.
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15
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Gazeau N, Liang EC, Wu QV, Voutsinas JM, Barba P, Iacoboni G, Kwon M, Ortega JLR, Lopez-Corral L, Hernani R, Ortiz-Maldonado V, Martínez-Cibrian N, Martinez AP, Maziarz RT, Williamson S, Nemecek ER, Shadman M, Cowan AJ, Green DJ, Kimble E, Hirayama AV, Maloney DG, Turtle CJ, Gauthier J. Anakinra for refractory CRS or ICANS after CAR T-cell therapy. Transplant Cell Ther 2023:S2666-6367(23)01233-2. [PMID: 37031746 DOI: 10.1016/j.jtct.2023.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 03/20/2023] [Revised: 04/02/2023] [Accepted: 04/02/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Chimeric antigen receptor-engineered (CAR) T-cell therapy remains limited by significant toxicities such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). The optimal management of severe and/or refractory CRS/ICANS remains ill-defined. Anakinra has emerged as a promising agent based on preclinical data, but its safety and efficacy in CAR T-cell patients remains unknown. OBJECTIVES Our primary objective was to evaluate the safety of anakinra to treat refractory CRS and ICANS after CAR T-cell therapy. Our secondary objective was to evaluate the impact of key treatment, patient, and disease-related variables on time to CRS/ICANS resolution and treatment-related mortality (TRM). STUDY DESIGN We retrospectively analyzed the outcomes of 43 patients with B-cell or plasma cell malignancies treated with anakinra for refractory CRS or ICANS at 9 institutions in the United States and Spain between 2019 and 2022. Cause-specific Cox regression was used to account for competing risks. Multivariable cause-specific Cox regression was used to estimate the effect of the anakinra dose on outcomes while minimizing treatment allocation bias by including age, CAR-T product, prelymphodepletion (pre-LD) ferritin and performance status. RESULTS Indications for anakinra treatment were as follows: grade ≥2 ICANS with worsening or lack of symptom improvement despite treatment with high-dose corticosteroids (n=40), grade ≥2 CRS with worsening symptoms despite treatment with tocilizumab (n=3). Anakinra treatment was feasible and was safe; anakinra discontinuation due to anakinra-related side effects was only reported in 3 patients (7%). The overall response rate (ORR) to CAR T-cell therapy was 77%. The cumulative incidence of TRM in the whole cohort at day-28 and day-60 after CAR T-cell infusion was 7% (95%CI, 2-17) and 23% (95%CI, 11-38), respectively. The cumulative incidence of TRM at day-28 after anakinra initiation was 0% and 47% (95%CI, 20-70) in the high-dose (>200mg/day administered intravenously [IV]) and low-dose (100-200mg/day administered subcutaneously or IV) anakinra patients, respectively. The median cumulative incidence of CRS/ICANS resolution from the time of anakinra initiation was 7 days in patients who received high-dose anakinra and was not reached in patients who received low-dose anakinra due to the high TRM in this group. Univariate Cox modeling suggested shorter time to CRS/ICANS resolution in high-dose anakinra patients (HR, 2.19; 95%CI, 0.94-5.12; p=0.069). In a multivariable Cox model for TRM including age, CAR-T product, pre-LD ferritin and pre-LD KPS, higher anakinra dose remained associated with lower TRM (HR = 0.41 per 1mg/kg/day increase; 95% CI, 0.17-0.96; p=0.039. The only factor independently associated with time to CRS/ICANS resolution in a multivariable Cox model including age, CAR-T product, pre-LD ferritin, and anakinra dose, was higher pre-LD KPS HR = 1.05 per 10% increase; 95%CI, 1.01-1.09; p=0.02). CONCLUSION Anakinra treatment for refractory CRS or ICANS was safe at doses up to 12mg/kg/day IV. We observed an ORR of 77% after CAR T-cell therapy despite anakinra treatment, suggesting limited impact of anakinra on CAR T-cell efficacy. Higher anakinra dose may be associated with faster CRS/ICANS resolution and was independently associated with lower TRM. Prospective comparative studies are needed to confirm our findings.
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Affiliation(s)
- Nicolas Gazeau
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA; Centre Hospitalier Universitaire de Lille, service d'hématologie, Lille, France
| | - Emily C Liang
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA
| | - Qian Vicky Wu
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Jenna M Voutsinas
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Pere Barba
- Hematology Department, Hospital Universitari Vall d'Hebron. Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Gloria Iacoboni
- Hematology Department, Hospital Universitari Vall d'Hebron. Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Mi Kwon
- Department of Hematology, Hospital General Universitario Gregrorio Marañon, Institute of Health Research Gregorio Marañon. Universidad Complutense de Madrid, Madrid, Spain
| | - Juan Luis Reguera Ortega
- Servicio de Hematología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Lucia Lopez-Corral
- Hematology Department, Complejo Asistencial Universitario de Salamanca-IBSAL; Centro de Investigación del Cáncer-IBMCC, Spain
| | - Rafael Hernani
- Hematology Department, Hospital Clinico Universitario, INCLIVA Research Institut, Valencia,Spain
| | | | | | | | - Richard T Maziarz
- Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Staci Williamson
- Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Eneida R Nemecek
- Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA
| | - Andrew J Cowan
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA
| | - Damian J Green
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA
| | - Erik Kimble
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA
| | - Alexandre V Hirayama
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA
| | - David G Maloney
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA
| | - Cameron J Turtle
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA; University of Sydney, NSW, Australia
| | - Jordan Gauthier
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA.
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Tokaz MC, Baldomero H, Cowan AJ, Saber W, Greinix H, Koh MBC, Kröger N, Mohty M, Galeano S, Okamoto S, Chaudhri N, Karduss AJ, Ciceri F, Colturato VAR, Corbacioglu S, Elhaddad A, Force LM, Frutos C, León AGD, Hamad N, Hamerschlak N, He N, Ho A, Huang XJ, Jacobs B, Kim HJ, Iida M, Lehmann L, de Latour RP, Percival MEM, Perdomo M, Rasheed W, Schultz KR, Seber A, Ko BS, Simione AJ, Srivastava A, Szer J, Wood WA, Kodera Y, Nagler A, Snowden JA, Weisdorf D, Passweg J, Pasquini MC, Sureda A, Atsuta Y, Aljurf M, Niederwieser D. An Analysis of the Worldwide Utilization of Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia. Transplant Cell Ther 2023; 29:279.e1-279.e10. [PMID: 36572384 DOI: 10.1016/j.jtct.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022]
Abstract
Acute myeloid leukemia (AML) has an aggressive course and a historically dismal prognosis. For many patients, hematopoietic stem cell transplantation (HSCT) represents the best option for cure, but access, utilization, and health inequities on a global scale remain poorly elucidated. We wanted to describe patterns of global HSCT use in AML for a better understanding of global access, practices, and unmet needs internationally. Estimates of AML incident cases in 2016 were obtained from the Global Burden of Disease 2019 study. HSCT activities were collected from 2009 to 2016 by the Worldwide Network for Blood and Marrow Transplantation through its member organizations. The primary endpoint was global and regional use (number of HSCT) and utilization of HSCT (number of HSCT/number of incident cases) for AML. Secondary outcomes included trends from 2009 to 2016 in donor type, stem cell source, and remission status at time of HSCT. Global AML incidence has steadily increased, from 102,000 (95% uncertainty interval: 90,200-108,000) in 2009 to 118,000 (104,000-126,000) in 2016 (16.2%). Over the same period, a 54.9% increase from 9659 to 14,965 HSCT/yr was observed globally, driven by an increase in allogeneic (64.9%) with a reduction in autologous (-34.9%) HSCT. Although the highest numbers of HSCT continue to be performed in high-resource regions, the largest increases were seen in resource-constrained regions (94.6% in Africa/East Mediterranean Region [AFR/EMR]; 34.7% in America-Nord Region [AMR-N]). HSCT utilization was skewed toward high-resource regions (in 2016: AMR-N 18.4%, Europe [EUR] 17.9%, South-East Asia/Western Pacific Region [SEAR/WPR] 11.7%, America-South Region [AMR-S] 4.5%, and AFR/EMR 2.8%). For patients <70 years of age, this difference in utilization was widened; AMR-N had the highest allogeneic utilization rate, increasing from 2009 to 2016 (30.6% to 39.9%) with continued low utilization observed in AFR/EMR (1.7% to 2.9%) and AMR-S (3.5% to 5.4%). Across all regions, total HSCT for AML in first complete remission (CR1) increased (from 44.1% to 59.0%). Patterns of donor stem cell source from related versus unrelated donors varied widely by geographic region. SEAR/WPR had a 130.2% increase in related donors from 2009 to 2016, and >95% HSCT donors in AFR/EMR were related; in comparison, AMR-N and EUR have a predilection for unrelated HSCT. Globally, the allogeneic HSCT stem cell source was predominantly peripheral blood (69.7% of total HSCT in 2009 increased to 78.6% in 2016). Autologous HSCT decreased in all regions from 2009 to 2016 except in SEAR/WPR (18.9%). HSCT remains a central curative treatment modality in AML. Allogeneic HSCT for AML is rising globally, but there are marked variations in regional utilization and practices, including types of graft source. Resource-constrained regions have the largest growth in HSCT use, but utilization rates remain low, with a predilection for familial-related donor sources and are typically offered in CR1. Further studies are necessary to elucidate the reasons, including economic factors, to understand and address these health inequalities and improve discrepancies in use of HSCT as a potentially curative treatment globally.
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Affiliation(s)
- Molly C Tokaz
- Division of Medical Oncology, University of Washington, Seattle, Washington; Division of Hematology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington.
| | - Helen Baldomero
- University Hospital Basel, Center for International Blood and Marrow Transplant Research, Switzerland
| | - Andrew J Cowan
- Division of Medical Oncology, University of Washington, Seattle, Washington; Division of Hematology, University of Washington, Seattle, Washington
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Mickey B C Koh
- Infection and Immunity Clinical Academic Group, St George's Hospital and Medical School, London, United Kingdom; Academic Cell Therapy Facility and Programme Health Sciences Authority, Singapore
| | | | - Mohamad Mohty
- Sorbonne University, Hospital Saint Antoine, Paris, France
| | - Sebastian Galeano
- Latin American Blood and Marrow Transplantation Group - LABMT Hospital Británico, Montevideo, Uruguay
| | - Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naeem Chaudhri
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Amado J Karduss
- Clínica Las Américas, Latin AmericanBlood and Marrow Transplantation Group- LABMT, Medellín, Colombia
| | - Fabio Ciceri
- University Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | | | - Alaa Elhaddad
- African Blood and Marrow Transplantation Group - AfBMT; Department of Pediatric Oncology and Stem Cell Transplantation Unit, Cairo University, Cairo, Egypt
| | - Lisa M Force
- Division of Pediatric Hematology-Oncology, Department of Pediatrics and Department of Health Metrics Sciences, University of Washington, Seattle, Washington
| | | | | | - Nada Hamad
- Department of Haematology, St. Vincent's Hospital Sydney, School of Clinical Medicine, Faculty of Medicine and Health, UNSW, School of Medicine, University of Notre Dame Australia, Sydney, Australia
| | | | - Naya He
- University Hospital Basel, Center for International Blood and Marrow Transplant Research, Switzerland
| | - Aloysius Ho
- Department of Haematology, Singapore General Hospital, Singapore
| | - Xiao-Jun Huang
- Department of Hematology, Peking University Institute of Hematology, Beijing, China
| | - Ben Jacobs
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hee-Je Kim
- Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Minako Iida
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Leslie Lehmann
- Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | | | - Mary-Elizabeth M Percival
- Division of Hematology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Walid Rasheed
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Kirk R Schultz
- BC Children's Hospital/UBC, Vancouver, British Columbia, Canada
| | - Adriana Seber
- Latin American Blood and Marrow Transplantation Group-LABMT, Bern, Switzerland; Hospital Samaritano - Americas, Sao Paulo Brazil and Pediatric Oncology Institute-Graacc-Unifesp, São Paulo, Brazil
| | - Bor-Sheng Ko
- Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | | | | | - Jeff Szer
- Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), St. Vincent ́s Hospital Sydney, Sydney, New South Wales, Australia; Peter MacCallum Cancer Center and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - William A Wood
- CIBMTR, University of North Carolina, Chapel Hill, North Carolina
| | - Yoshihisa Kodera
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Arnon Nagler
- The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - John A Snowden
- Department of Hematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Daniel Weisdorf
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota
| | - Jakob Passweg
- University Hospital Basel, Center for International Blood and Marrow Transplant Research, Switzerland
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anna Sureda
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Dietger Niederwieser
- University Leipzig, Leipzig, Germany; Japanese Data Center for Hematopoietic Cell Transplantation, Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan; KaunoKlinikos University of Health Sciences, Kaunas, Lithuania
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17
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Kourelis T, Bansal R, Berdeja J, Siegel D, Patel K, Mailankody S, Htut M, Shah N, Wong SW, Sidana S, Cowan AJ, Alsina M, Cohen A, Holstein SA, Bergsagel L, Ailawadhi S, Raje N, Dhakal B, Rossi A, Lin Y. Ethical Challenges with Multiple Myeloma BCMA Chimeric Antigen Receptor T Cell Slot Allocation: A Multi-Institution Experience. Transplant Cell Ther 2023; 29:255-258. [PMID: 36681151 PMCID: PMC10040426 DOI: 10.1016/j.jtct.2023.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [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: 11/25/2022] [Revised: 01/04/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023]
Abstract
Chimeric antigen receptor T cell (CAR-T) therapies are Food and Drug Administration (FDA)-approved for patients with triple refractory multiple myeloma (MM). Real-world access to CAR-T therapy remains challenging owing to supply chain limitations impacting manufacturing. The goal of this study was to evaluate the extent of this issue and how major centers are handling the challenges of CAR-T manufacturing slot allocation. MM CAR-T physician leaders at each CAR-T treatment center across the United States were surveyed. We received responses from 17 of 20 centers. A median of 1 slot is allocated per month per center, and the median number of patients per center on the waitlist since the FDA's approval of idecabtagene vicleucel is 20 (range, 5 to 100). As a result, patients remain on the waitlist for a median of 6 months (range, 2 to 8 months) prior to leukapheresis. For patient selection, all centers reported using a committee of experienced CAR-T physicians to ensure consistency. To ensure transparency, 15 centers make selection criteria, selection timelines, and priority scores readily available for CAR-T providers. Centers also reported using ethical values for selection: (1) equal treatment: time spent on waiting list (n = 12); (2) priority to the worst-off: limited therapeutic options (n = 14), MM burden (n = 11), high Hematopoietic Cell Transplantation Comorbidity Index (n = 5); (3) maximize benefit: most likely to complete apheresis (n = 13) or infusion (n = 13) or to achieve response (n = 8); and (4) social value: younger patients (n = 3). Maximizing benefit was considered the most important criterion by 10 centers. This study is the first attempt to evaluate existing issues with CAR-T access for patients with MM and the variability and challenges in patient selection. Integrating ethical resource allocation strategies, similar to those described here, into formal institutional policies would help streamline access to CAR-T therapy and protect the needs of both current and future patients and physicians.
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Affiliation(s)
| | - Radhika Bansal
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - David Siegel
- Department of Hematology/Oncology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Krina Patel
- Department of Lymphoma - Myeloma, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sham Mailankody
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer, New York, NY
| | - Myo Htut
- Division of Myeloma, Department of Hematology and Hematopietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Nina Shah
- Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
| | - Sandy W Wong
- Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
| | - Surbhi Sidana
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, California
| | - Andrew J Cowan
- Division of Medical Oncology, University of Washington Fred Hutchinson Cancer Center, Seattle, Washington
| | - Melissa Alsina
- Department of Malignant Hematology, H. L. Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Adam Cohen
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah A Holstein
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Leif Bergsagel
- Department of Hematology/Oncology,Mayo Clinic, Phoenix, Arizona
| | | | - Noopur Raje
- Center for Multiple Myeloma, Massachusetts General Hospital, Boston, MA
| | - Binod Dhakal
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Adriana Rossi
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
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18
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Chhabra S, Callander N, Watts NL, Costa LJ, Thapa B, Kaufman JL, Laubach J, Sborov DW, Reeves B, Rodriguez C, Chari A, Silbermann R, Anderson LD, Bal S, Dhakal B, Nathwani N, Shah N, Medvedova E, Bumma N, Holstein SA, Costello C, Jakubowiak A, Wildes TM, Schmidt T, Orlowski RZ, Shain KH, Cowan AJ, Dholaria B, Cornell RF, Jerkins JH, Pei H, Cortoos A, Patel S, Lin TS, Usmani SZ, Richardson PG, Voorhees PM. Stem Cell Mobilization Yields with Daratumumab- and Lenalidomide-Containing Quadruplet Induction Therapy in Newly Diagnosed Multiple Myeloma: Findings from the MASTER and GRIFFIN Trials. Transplant Cell Ther 2023; 29:174.e1-174.e10. [PMID: 36494017 DOI: 10.1016/j.jtct.2022.11.029] [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: 08/29/2022] [Revised: 10/31/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
For eligible patients with newly diagnosed multiple myeloma (NDMM), standard of care includes induction therapy followed by autologous stem cell transplantation (ASCT). Daratumumab as monotherapy and in combination treatment is approved across multiple lines of therapy for multiple myeloma (MM), and lenalidomide is an effective and commonly used agent for induction and maintenance therapy in MM. However, there is concern that lenalidomide and daratumumab given as induction therapy might impair mobilization of stem cells for ASCT. Therefore, we assessed stem cell mobilization in patients following frontline induction therapy in the MASTER and GRIFFIN phase 2 clinical studies by examining stem cell mobilization yields, apheresis attempts, and engraftment outcomes for patients from each study. Adult transplantation-eligible patients with NDMM received induction therapy consisting of daratumumab plus carfilzomib/lenalidomide/dexamethasone (D-KRd) for four 28-day cycles in the single-arm MASTER trial or lenalidomide/bortezomib/dexamethasone (RVd) with or without daratumumab (D) for four 21-day cycles in the randomized GRIFFIN trial, followed by stem cell mobilization and ASCT in both studies. Institutional practice differed regarding plerixafor use for stem cell mobilization; the strategies were upfront (ie, planned plerixafor use) or rescue (ie, plerixafor use only after mobilization parameters indicated failure with granulocyte colony-stimulating factor [G-CSF] alone). Descriptive analyses were used to summarize patient characteristics, stem cell mobilization yields, and engraftment outcomes. In MASTER, 116 D-KRd recipients underwent stem cell mobilization and collection at a median of 24 days after completing induction therapy. In GRIFFIN, 175 patients (D-RVd, n = 95; RVd, n = 80) underwent mobilization at a median of 27 days after completing D-RVd induction therapy and 24 days after completing RVd induction therapy. Among those who underwent mobilization and collection, 7% (8 of 116) of D-KRd recipients, 2% (2 of 95) of D-RVd recipients, and 6% (5 of 80) of RVd recipients did not meet the center-specific minimally required CD34+ cell yield in the first mobilization attempt; however, nearly all collected sufficient stem cells for ASCT on remobilization. Among patients who underwent mobilization, plerixafor use, either upfront or as a rescue strategy, was higher in patients receiving D-KRd (97%; 112 of 116) and D-RVd (72%; 68 of 95) compared with those receiving RVd (55%; 44 of 80). The median total CD34+ cell collection was 6.0 × 106/kg (range, 2.2 to 13.9 × 106/kg) after D-KRd induction, 8.3 × 106/kg (range, 2.6 to 33.0 × 106/kg) after D-RVd induction, and 9.4 × 106/kg (range, 4.1 to 28.7 × 106/kg) after RVd induction; the median days for collection were 2, 2, and 1, respectively. Among patients who underwent mobilization, 98% (114 of 116) of D-KRd patients, 99% (94 of 95) of D-RVd patients, and 98% (78 of 80) of RVd patients underwent ASCT using median CD34+ cell doses of 3.2 × 106/kg, 4.2 × 106/kg, and 4.8 × 106/kg, respectively. The median time to neutrophil recovery was 12 days in all 3 treatment groups across the 2 trials. Because both trials used different criteria to define platelet recovery, data on platelet engraftment using the same criteria are not available. Four cycles of daratumumab- and lenalidomide-based quadruplet induction therapy had a minimal impact on stem cell mobilization and allowed predictable stem cell harvesting and engraftment in all patients who underwent ASCT. Upfront plerixafor strategy may be considered, but many patients were successfully collected with the use of G-CSF alone or rescue plerixafor.
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Affiliation(s)
| | | | - Nicole L Watts
- University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Luciano J Costa
- University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Bicky Thapa
- Medical College of Wisconsin, Division of Hematology/Oncology, Department of Medicine, Milwaukee, Wisconsin
| | | | - Jacob Laubach
- Dana-Farber/Partners CancerCare, Harvard Medical School, Boston, Massachusetts
| | - Douglas W Sborov
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Brandi Reeves
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Ajai Chari
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rebecca Silbermann
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Larry D Anderson
- Myeloma, Waldenstrom's and Amyloidosis Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Susan Bal
- University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Binod Dhakal
- Medical College of Wisconsin, Division of Hematology/Oncology, Department of Medicine, Milwaukee, Wisconsin
| | - Nitya Nathwani
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Nina Shah
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Eva Medvedova
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Naresh Bumma
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Sarah A Holstein
- Division of Oncology & Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Caitlin Costello
- Moores Cancer Center, University of California San Diego, La Jolla, California
| | | | - Tanya M Wildes
- Division of Oncology & Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Timothy Schmidt
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Robert Z Orlowski
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kenneth H Shain
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Andrew J Cowan
- Division of Medical Oncology, University of Washington, Seattle, Washington
| | | | | | - James H Jerkins
- Medical College of Wisconsin, Division of Hematology/Oncology, Department of Medicine, Milwaukee, Wisconsin
| | - Huiling Pei
- Janssen Research & Development, LLC, Titusville, New Jersey
| | | | | | - Thomas S Lin
- Janssen Scientific Affairs, LLC, Horsham, Pennsylvania
| | - Saad Z Usmani
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul G Richardson
- Dana-Farber/Partners CancerCare, Harvard Medical School, Boston, Massachusetts
| | - Peter M Voorhees
- Levine Cancer Institute, Atrium Health/Wake Forest Baptist, Charlotte, North Carolina
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Banerjee R, Lee SS, Cowan AJ. Innovation in BCMA CAR-T therapy: Building beyond the Model T. Front Oncol 2022; 12:1070353. [PMID: 36505779 PMCID: PMC9729952 DOI: 10.3389/fonc.2022.1070353] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
Autologous chimeric antigen receptor T-cell (CAR-T) therapies targeting B-cell maturation antigen (BCMA) have revolutionized the field of multiple myeloma in the same way that the Ford Model T revolutionized the original CAR world a century ago. However, we are only beginning to understand how to improve the efficacy and usability of these cellular therapies. In this review, we explore three automotive analogies for innovation with BCMA CAR-T therapies: stronger engines, better mileage, and hassle-free delivery. Firstly, we can build stronger engines in terms of BCMA targeting: improved antigen binding, tools to modulate antigen density, and armoring to better reach the antigen itself. Secondly, we can improve "mileage" in terms of response durability through ex vivo CAR design and in vivo immune manipulation. Thirdly, we can implement hassle-free delivery through rapid manufacturing protocols and off-the-shelf products. Just as the Model T set a benchmark for car manufacturing over 100 years ago, idecabtagene vicleucel and ciltacabtagene autoleucel have now set the starting point for BCMA CAR-T therapy with their approvals. As with any emerging technology, whether automotive or cellular, the best in innovation and optimization is yet to come.
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Affiliation(s)
- Rahul Banerjee
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, United States
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Sarah S. Lee
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, United States
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Andrew J. Cowan
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, United States
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
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Kosydar S, Gulhane A, Libby E, Cowan AJ, Kwok M, Lee SS, Green DJ, Coffey D, Holmberg LA, Chen DL, Tseng YD. Radiographic Response of Solitary Plasmacytomas After Conformal Radiotherapy May Be Delayed: Outcomes in the 3D Era. Am J Clin Oncol 2022; 45:443-449. [PMID: 36346953 DOI: 10.1097/coc.0000000000000948] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Although recurrence rates after radiotherapy for solitary plasmacytoma (SP) are well established, little is known about how SP responds radiographically, as most historical patients were treated in the 2D era. We evaluated the response to radiotherapy among SP patients staged and treated with 3D techniques, including proton therapy, which has not yet been previously reported. METHODS AND MATERIALS Between 2007 and 2021, 15 SP patients (4 extramedullary, 11 bone) staged with 3D imaging and bone marrow evaluation were consecutively treated with definitive radiotherapy. The best response was categorized in 9 evaluable patients according to response evaluation criteria in solid tumors (RECIST) and positron emission tomography response criteria in solid tumors (PERCIST). RESULTS With a median follow-up of 34 months, 4 patients relapsed. The median time to the best response was ~2 years (26.6 mo RECIST, 25.4 mo PERCIST). Response rates differed based on response assessment criteria. PERCIST was associated with higher rates of complete (85.7%) or partial response (14.3%) compared with RECIST (16.7% complete, 33.3% partial). Two-year and 4-year PFS for extramedullary SP were 100% and 75%, compared with 91% and 55% for bone ( P =0.75). Patients treated with proton therapy (n=5) did not appear to have different patterns of relapse (1 marginal, 1 distant) compared with those treated with photons or electrons (n=10; 2 distant). CONCLUSIONS More conformal dose distribution with proton therapy does not appear to alter patterns of recurrence. Although response rates differ based on criteria by both RECIST and PERCIST assessments, the radiographic response may be slow and requires validation in other cohorts.
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Affiliation(s)
| | - Avanti Gulhane
- University of Washington School of Medicine
- Department of Radiology, University of Washington, Seattle, WA
| | - Edward Libby
- University of Washington School of Medicine
- Clinical Research Division, Fred Hutchinson Cancer Center
- Division of Medical Oncology
| | - Andrew J Cowan
- University of Washington School of Medicine
- Clinical Research Division, Fred Hutchinson Cancer Center
- Division of Medical Oncology
| | - Mary Kwok
- University of Washington School of Medicine
- Division of Hematology, University of Washington
| | - Sarah S Lee
- University of Washington School of Medicine
- Clinical Research Division, Fred Hutchinson Cancer Center
- Division of Medical Oncology
| | - Damian J Green
- University of Washington School of Medicine
- Clinical Research Division, Fred Hutchinson Cancer Center
- Division of Medical Oncology
| | - David Coffey
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Leona A Holmberg
- University of Washington School of Medicine
- Clinical Research Division, Fred Hutchinson Cancer Center
- Division of Medical Oncology
| | - Delphine L Chen
- University of Washington School of Medicine
- Department of Radiology, University of Washington, Seattle, WA
| | - Yolanda D Tseng
- University of Washington School of Medicine
- Clinical Research Division, Fred Hutchinson Cancer Center
- Department of Radiation Oncology
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21
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Josyula S, Pont MJ, Dasgupta S, Song X, Thomas S, Pepper G, Keane-Candib J, Stevens-Ayers TL, Ochs HD, Boeckh MJ, Riddell SR, Cowan AJ, Krantz EM, Green DJ, Hill JA. Pathogen-specific humoral immunity and infections in BCMA-directed chimeric antigen receptor T-cell therapy recipients with multiple myeloma. Transplant Cell Ther 2022; 28:304.e1-304.e9. [DOI: 10.1016/j.jtct.2022.03.005] [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] [Received: 11/13/2021] [Revised: 01/30/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
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22
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Gazeau N, Barba P, Iacoboni G, Kwon M, Bailen R, Reguera JL, López-Corral L, Hernani R, Ortiz-Maldonado V, Pérez-Martínez A, Maziarz RT, Williamson S, Myers J, Dwinal AH, Nemecek ER, Shadman M, Cowan AJ, Green DJ, Chow VA, Hirayama AV, Maloney DG, Turtle CJ, Gauthier J. Safety and Efficacy Comparison of Two Anakinra Dose Regimens for Refractory CRS or Neurotoxicity after CAR T-Cell Therapy. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00389-x] [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: 11/29/2022]
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23
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Shadman M, Yeung CCS, Redman M, Lee SY, Lee DH, Ra S, Ujjani CS, Dezube BJ, Poh C, Warren EH, Chapuis AG, Green DJ, Cowan AJ, Cassaday RD, Kiem HP, Gauthier J, Turtle CJ, Lynch RC, Smith SD, Gopal AK, Maloney DG, Till BG. High Efficacy and Low Toxicity of MB-106, a Third Generation CD20 Targeted CAR-T for Treatment of Relapsed/Refractory B-NHL and CLL. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00386-4] [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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Abstract
IMPORTANCE Multiple myeloma is a hematologic malignancy characterized by presence of abnormal clonal plasma cells in the bone marrow, with potential for uncontrolled growth causing destructive bone lesions, kidney injury, anemia, and hypercalcemia. Multiple myeloma is diagnosed in an estimated 34 920 people in the US and in approximately 588 161 people worldwide each year. OBSERVATIONS Among patients with multiple myeloma, approximately 73% have anemia, 79% have osteolytic bone disease, and 19% have acute kidney injury at the time of presentation. Evaluation of patients with possible multiple myeloma includes measurement of hemoglobin, serum creatinine, serum calcium, and serum free light chain levels; serum protein electrophoresis with immunofixation; 24-hour urine protein electrophoresis; and full-body skeletal imaging with computed tomography, positron emission tomography, or magnetic resonance imaging. The Revised International Staging System combines data from the serum biomarkers β2 microglobulin, albumin, and lactate dehydrogenase in conjunction with malignant plasma cell genomic features found on fluorescence in situ hybridization-t(4;14), del(17p), and t(14;16)-to assess estimated progression-free survival and overall survival. At diagnosis, 28% of patients are classified as having Revised International Staging stage I multiple myeloma, and these patients have a median 5-year survival of 82%. Among all patients with multiple myeloma, standard first-line (induction) therapy consists of a combination of an injectable proteasome inhibitor (ie, bortezomib), an oral immunomodulatory agent (ie, lenalidomide), and dexamethasone and is associated with median progression-free survival of 41 months, compared with historical reports of 8.5 months without therapy. This induction therapy combined with autologous hematopoietic stem cell transplantation followed by maintenance lenalidomide is standard of care for eligible patients. CONCLUSIONS AND RELEVANCE Approximately 34 920 people in the US and 155 688 people worldwide are diagnosed with multiple myeloma each year. Induction therapy with an injectable proteasome inhibitor, an oral immunomodulatory agent and dexamethasone followed by treatment with autologous hematopoietic stem cell transplantation, and maintenance therapy with lenalidomide are among the treatments considered standard care for eligible patients.
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Affiliation(s)
- Andrew J Cowan
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Seattle Cancer Care Alliance, Seattle, Washington
| | - Damian J Green
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Seattle Cancer Care Alliance, Seattle, Washington
| | - Mary Kwok
- Seattle Cancer Care Alliance, Seattle, Washington
- Division of Hematology, Department of Medicine, University of Washington, Seattle
| | - Sarah Lee
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Seattle Cancer Care Alliance, Seattle, Washington
| | - David G Coffey
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida
| | - Leona A Holmberg
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Seattle Cancer Care Alliance, Seattle, Washington
| | - Sherilyn Tuazon
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Now with Bristol Myers Squibb, Seattle, Washington
| | - Ajay K Gopal
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Seattle Cancer Care Alliance, Seattle, Washington
| | - Edward N Libby
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Seattle Cancer Care Alliance, Seattle, Washington
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25
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Heldman MR, Ma J, Gauthier J, O’Hara RA, Cowan AJ, Yoke LM, So L, Gulleen E, Duke ER, Liu C, Turtle CJ, Hill JA. CMV and HSV Pneumonia After Immunosuppressive Agents for Treatment of Cytokine Release Syndrome Due to Chimeric Antigen Receptor-modified T (CAR-T)-Cell Immunotherapy. J Immunother 2021; 44:351-354. [PMID: 34369454 PMCID: PMC8497421 DOI: 10.1097/cji.0000000000000388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/01/2021] [Accepted: 07/15/2021] [Indexed: 11/25/2022]
Abstract
Pneumonia due to cytomegalovirus and herpes simplex virus-1 caused substantial morbidity after hematopoietic cell transplantation before the institution of preventative approaches. End-organ disease from herpesviruses is poorly described after chimeric antigen receptor-modified T-cell immunotherapy. We report 2 cases of cytomegalovirus pneumonia and 1 case of herpes simplex virus-1 gingivostomatitis, esophagitis, and pneumonia after chimeric antigen receptor-modified T-cell immunotherapy for the treatment of hematologic malignancies.
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Affiliation(s)
- Madeleine R. Heldman
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jimmy Ma
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Jordan Gauthier
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Riley A. O’Hara
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Andrew J. Cowan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Leah M. Yoke
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lisa So
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Elizabeth Gulleen
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Elizabeth R. Duke
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Catherine Liu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Cameron J. Turtle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Joshua A. Hill
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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Walti CS, Loes AN, Shuey K, Krantz EM, Boonyaratanakornkit J, Keane-Candib J, Loeffelholz T, Wolf CR, Taylor JJ, Gardner RA, Green DJ, Cowan AJ, Maloney DG, Turtle CJ, Pergam SA, Chu HY, Bloom JD, Hill JA. Humoral immunogenicity of the seasonal influenza vaccine before and after CAR-T-cell therapy: a prospective observational study. J Immunother Cancer 2021; 9:jitc-2021-003428. [PMID: 34702753 PMCID: PMC8549667 DOI: 10.1136/jitc-2021-003428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/23/2022] Open
Abstract
Recipients of chimeric antigen receptor-modified T (CAR-T) cell therapies for B cell malignancies have profound and prolonged immunodeficiencies and are at risk for serious infections, including respiratory virus infections. Vaccination may be important for infection prevention, but there are limited data on vaccine immunogenicity in this population. We conducted a prospective observational study of the humoral immunogenicity of commercially available 2019-2020 inactivated influenza vaccines in adults immediately prior to or while in durable remission after CD19-, CD20-, or B cell maturation antigen-targeted CAR-T-cell therapy, as well as controls. We tested for antibodies to all four vaccine strains using neutralization and hemagglutination inhibition (HAI) assays. Antibody responses were defined as at least fourfold titer increases from baseline. Seroprotection was defined as a HAI titer ≥40. Enrolled CAR-T-cell recipients were vaccinated 14-29 days prior to (n=5) or 13-57 months following therapy (n=13), and the majority had hypogammaglobulinemia and cellular immunodeficiencies prevaccination. Eight non-immunocompromised adults served as controls. Antibody responses to ≥1 vaccine strain occurred in 2 (40%) individuals before CAR-T-cell therapy and in 4 (31%) individuals vaccinated after CAR-T-cell therapy. An additional 1 (20%) and 6 (46%) individuals had at least twofold increases, respectively. One individual vaccinated prior to CAR-T-cell therapy maintained a response for >3 months following therapy. Across all tested vaccine strains, seroprotection was less frequent in CAR-T-cell recipients than in controls. There was evidence of immunogenicity even among individuals with low immunoglobulin, CD19+ B cell, and CD4+ T-cell counts. These data support consideration for vaccination before and after CAR-T-cell therapy for influenza and other relevant pathogens such as SARS-CoV-2, irrespective of hypogammaglobulinemia or B cell aplasia. However, relatively impaired humoral vaccine immunogenicity indicates the need for additional infection-prevention strategies. Larger studies are needed to refine our understanding of potential correlates of vaccine immunogenicity, and durability of immune responses, in CAR-T-cell therapy recipients.
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Affiliation(s)
- Carla S Walti
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Andrea N Loes
- Basic Sciences Division and Computational Biology Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Howard Hughes Medical Institute, Seattle, Washington, USA
| | - Kiel Shuey
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Elizabeth M Krantz
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jim Boonyaratanakornkit
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jacob Keane-Candib
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Tillie Loeffelholz
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Caitlin R Wolf
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Justin J Taylor
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Rebecca A Gardner
- Division of Hematology-Oncology, Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Damian J Green
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Andrew J Cowan
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - David G Maloney
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Cameron J Turtle
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Steven A Pergam
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Helen Y Chu
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jesse D Bloom
- Howard Hughes Medical Institute, Seattle, Washington, USA
- Basic Sciences Division, Computational Biology Program, and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Joshua A Hill
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Gowin K, Skerget S, Keats JJ, Mikhael J, Cowan AJ. Plasma cell leukemia: A review of the molecular classification, diagnosis, and evidenced-based treatment. Leuk Res 2021; 111:106687. [PMID: 34425325 DOI: 10.1016/j.leukres.2021.106687] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 05/10/2021] [Revised: 07/22/2021] [Accepted: 08/15/2021] [Indexed: 12/11/2022]
Abstract
Plasma cell leukemia is a rare and aggressive plasma cell dyscrasia associated with dismal outcomes. It may arise de novo, primary plasma cell leukemia, or evolve from an antecedent diagnosis of multiple myeloma, secondary plasma cell leukemia. Despite highly effective therapeutics, survival for plasma cell leukemia patients remains poor. Molecular knowledge of plasma cell leukemia has recently expanded with use of gene expression profiling and whole exome sequencing, lending new insights into prognosis and therapeutic development. In this review, we describe the molecular knowledge, clinical characteristics, evidenced-based therapeutic approaches and treatment outcomes of plasma cell leukemia.
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Affiliation(s)
- Krisstina Gowin
- University of Arizona, Department of Bone Marrow Transplant and Cellular Therapy, Tucson, AZ, United States.
| | - Sheri Skerget
- Translational Genomics Research Institute (TGen), Integrated Cancer Genomics Division, Phoenix, AZ, United States
| | - Jonathan J Keats
- Translational Genomics Research Institute (TGen), Integrated Cancer Genomics Division, Phoenix, AZ, United States
| | - Joseph Mikhael
- Translational Genomics Research Institute (TGen), Applied Cancer Research and Drug Discovery Division, Phoenix, AZ, United States
| | - Andrew J Cowan
- University of Washington, Department of Hematology Oncology, Seattle, WA, United States
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28
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Lynch RC, Cassaday RD, Smith SD, Fromm JR, Cowan AJ, Warren EH, Shadman MS, Shustov A, Till BG, Ujjani CS, Libby EN, Philip M, Coye H, Martino CN, Bhark SL, Morris K, Rasmussen H, Behnia S, Voutsinas J, Gopal AK. Dose-dense brentuximab vedotin plus ifosfamide, carboplatin, and etoposide for second-line treatment of relapsed or refractory classical Hodgkin lymphoma: a single centre, phase 1/2 study. Lancet Haematol 2021; 8:e562-e571. [PMID: 34329577 DOI: 10.1016/s2352-3026(21)00170-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Relapsed or refractory classical Hodgkin lymphoma could be treated with multiagent salvage chemotherapy followed by autologous haematopoietic stem-cell transplantation. The aim of this study is to establish the safety and activity of dose-dense brentuximab vedotin combined with ifosfamide, carboplatin, and etoposide (BV-ICE) chemotherapy in second-line treatment of classical Hodgkin lymphoma. METHODS We conducted a single-arm, open-label, phase 1/2 study of dose-dense BV-ICE at the Seattle Cancer Care Alliance, University of Washington (Seattle, WA, USA). Eligibility criteria were age 18 years or older; diagnosis of first relapse, primary refractory classical Hodgkin lymphoma after one previous line of therapy; measurable disease of at least 1 cm in the longest axis, CT of chest, abdomen, and pelvis with PET within the past 28 days; Eastern Cooperative Oncology Group performance status of 0-1; and adequate organ function. A 3 + 3 dose escalation study was done for the phase 1 part of the trial to establish the maximum tolerated dose to be used for the phase 2 study. Brentuximab vedotin was delivered on days 1 and 8 at either 1·2 mg/kg (dose level 1) or 1·5 mg/kg (dose level 2) intravenously (capped at 150 mg) with standard dosing of ICE on days 1-3 (ifosfamide 5 g/m2 plus mesna 5 g/m2 intravenously over 24 h on day 2, carboplatin area under the curve 5 on day 2 in one intravenous injection, and etoposide 100 mg/m2 on days 1-3 in one intravenous injection per day) for two 21-day cycles. The primary endpoint was to establish the recommended phase 2 dose (phase 1 part) and complete response rate after two cycles, with a prespecified target of 78% (phase 2 part). Safety analysis was done in all enrolled participants and the primary activity analysis was done in all patients with evaluable response data. This study is registered with ClinicalTrials.gov (NCT02227199); enrolment and study treatment are complete. FINDINGS Between Oct 16, 2014, and Feb 10, 2020, we enrolled 45 patients with a median age of 31 years (IQR 28-45). The recommended phase 2 dose of brentuximab vedotin was established to be 1·5 mg/kg. After a median follow-up of 3·1 years (IQR 1·7-4·1), 32 (74%; 95% CI 58·8-86·5) of 43 evaluable patients had complete responses after two cycles of treatment. Grade 3-4 haematological toxic effects were common, including neutropenia (33 [73%]), anaemia (six [13%]), and thrombocytopenia (36 [80%]). The most common grade 3-4 non-haematological toxic effects were febrile neutropenia (four [9%]), sepsis (six [13%]), increased alanine aminotransferase (five [11%]), hyperglycaemia (three [7%]), pulmonary embolism (two [4%]), and increased aspartate aminotransferase (two [4%]). There was one (2%) on-treatment death due to multisystem organ failure that was considered treatment related. Serious adverse events occurred in 13 (29%) patients. INTERPRETATION Our data suggest that dose-dense BV-ICE is a rapidly administered and active salvage regimen for patients with relapsed or refractory classical Hodgkin lymphoma despite a complete response in this trial lower than the prespecified phase 2 target. Although cross-trial comparisons should be made with caution, activity results seem to be similar to previously presented brentuximab vedotin chemotherapy salvage combinations delivered over much longer durations and can be considered in young (<60 years), transplantation-eligible patients for second-line therapy. FUNDING Seagen, Lymphoma Research Foundation, National Institutes of Health/National Cancer Institute, and generous philanthropic donations to the University of Washington from numerous individuals and families in support of lymphoma research.
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Affiliation(s)
- Ryan C Lynch
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ryan D Cassaday
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Stephen D Smith
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jonathan R Fromm
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Andrew J Cowan
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Edus H Warren
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mazyar S Shadman
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Andrei Shustov
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Brian G Till
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Chaitra S Ujjani
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Edward N Libby
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mary Philip
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hilary Coye
- Seattle Cancer Care Alliance, Seattle, WA, USA
| | | | | | - Karolyn Morris
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Heather Rasmussen
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Sanaz Behnia
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Jenna Voutsinas
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ajay K Gopal
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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Shah N, Perales MA, Turtle CJ, Cairo MS, Cowan AJ, Saeed H, Budde LE, Tan A, Lee Z, Kai K, Marcondes MQ, Zalevsky J, Tagliaferri MA, Patel KK. Phase I study protocol: NKTR-255 as monotherapy or combined with daratumumab or rituximab in hematologic malignancies. Future Oncol 2021; 17:3549-3560. [PMID: 34154392 DOI: 10.2217/fon-2021-0576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/25/2022] Open
Abstract
NKTR-255 is an investigational polyethylene glycol-modified recombinant human IL-15 (rhIL-15) receptor agonist, designed to improve the immunotherapeutic and anti-cancer benefit observed with rhIL-15 while circumventing the toxicities associated with this therapy. In preclinical studies, NKTR-255 has demonstrated enhanced proliferation and function of CD8+ T cells and natural killer cells, as well as enhanced anti-tumor activity and survival both as monotherapy and in combination with monoclonal antibodies in multiple cancer models. Here, we describe the rationale and design of the first-in-human Phase I, dose-escalation and dose-expansion study of NKTR-255 alone and in combination with daratumumab or rituximab in adults with relapsed/refractory multiple myeloma or non-Hodgkin's lymphoma that will determine the maximum tolerated dose and recommended Phase II dose for NKTR-255.
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Affiliation(s)
- Nina Shah
- Department of Medicine University of California San Francisco, San Francisco, CA 94158, USA
| | - Miguel-Angel Perales
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Centre, New York, NY 10065, USA
| | - Cameron J Turtle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.,Division of Medical Oncology, University of Washington, Seattle, WA 98195, USA
| | - Mitchell S Cairo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, New York Medical College, Valhalla, NY 10595, USA
| | - Andrew J Cowan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.,Division of Medical Oncology, University of Washington, Seattle, WA 98195, USA
| | - Hayder Saeed
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Lihua E Budde
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Alan Tan
- Division of Hematology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Zachary Lee
- Clinical Development, Nektar Therapeutics, San Francisco, CA 94158, USA
| | - Kazuharu Kai
- Clinical Development, Nektar Therapeutics, San Francisco, CA 94158, USA
| | - Mario Q Marcondes
- Clinical Development, Nektar Therapeutics, San Francisco, CA 94158, USA
| | - Jonathan Zalevsky
- Research & Development, Nektar Therapeutics, San Francisco, CA 94158, USA
| | | | - Krina K Patel
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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30
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Walti CS, Krantz EM, Maalouf J, Boonyaratanakornkit J, Keane-Candib J, Joncas-Schronce L, Stevens-Ayers T, Dasgupta S, Taylor JJ, Hirayama AV, Bar M, Gardner RA, Cowan AJ, Green DJ, Boeckh MJ, Maloney DG, Turtle CJ, Hill JA. Antibodies against vaccine-preventable infections after CAR-T cell therapy for B cell malignancies. JCI Insight 2021; 6:146743. [PMID: 33914708 PMCID: PMC8262349 DOI: 10.1172/jci.insight.146743] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 12/14/2020] [Accepted: 04/28/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Little is known about pathogen-specific humoral immunity after chimeric antigen receptor–modified T (CAR-T) cell therapy for B cell malignancies. METHODS We conducted a prospective cross-sectional study of CD19-targeted or B cell maturation antigen–targeted (BCMA-targeted) CAR-T cell therapy recipients at least 6 months posttreatment and in remission. We measured pathogen-specific IgG against 12 vaccine-preventable infections and the number of viral and bacterial epitopes to which IgG was detected (“epitope hits”) using a serological profiling assay. The primary outcome was the proportion of participants with IgG levels above a threshold correlated with seroprotection for vaccine-preventable infections. RESULTS We enrolled 65 children and adults a median of 20 months after CD19- (n = 54) or BCMA- (n = 11) CAR-T cell therapy. Among 30 adults without IgG replacement therapy (IGRT) in the prior 16 weeks, 27 (90%) had hypogammaglobulinemia. These individuals had seroprotection to a median of 67% (IQR, 59%–73%) of tested infections. Proportions of participants with seroprotection per pathogen were comparable to population-based studies, but most individuals lacked seroprotection to specific pathogens. Compared with CD19-CAR-T cell recipients, BCMA-CAR-T cell recipients were half as likely to have seroprotection (prevalence ratio, 0.47; 95% CI, 0.18–1.25) and had fewer pathogen-specific epitope hits (mean difference, –90 epitope hits; 95% CI, –157 to –22). CONCLUSION Seroprotection for vaccine-preventable infections in adult CD19-CAR-T cell recipients was comparable to the general population. BCMA-CAR-T cell recipients had fewer pathogen-specific antibodies. Deficits in both groups support the need for vaccine and immunoglobulin replacement therapy studies. FUNDING Swiss National Science Foundation (Early Postdoc Mobility grant P2BSP3_188162), NIH/National Cancer Institute (NIH/NCI) (U01CA247548 and P01CA018029), NIH/NCI Cancer Center Support Grants (P30CA0087-48 and P30CA015704-44), American Society for Transplantation and Cellular Therapy, and Juno Therapeutics/BMS. In this prospective study, we investigated antibodies against vaccine-preventable infections and other pathogen-specific antibodies in individuals with remission after CAR-T cell therapy for B lineage malignancies.
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Affiliation(s)
- Carla S Walti
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Elizabeth M Krantz
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Joyce Maalouf
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jim Boonyaratanakornkit
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jacob Keane-Candib
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Laurel Joncas-Schronce
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Terry Stevens-Ayers
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Sayan Dasgupta
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Justin J Taylor
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Alexandre V Hirayama
- Clinical Research Division, and.,Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Merav Bar
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, and.,Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Rebecca A Gardner
- Clinical Research Division, and.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Andrew J Cowan
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, and.,Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Damian J Green
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, and.,Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Michael J Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, and.,Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - David G Maloney
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, and.,Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Cameron J Turtle
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, and.,Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, and.,Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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31
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Walti CS, Loes AN, Shuey K, Krantz EM, Boonyaratanakornkit J, Keane-Candib J, Loeffelholz T, Wolf CR, Taylor JJ, Gardner RA, Green DJ, Cowan AJ, Maloney DG, Turtle CJ, Pergam SA, Chu HY, Bloom JD, Hill JA. Humoral immunogenicity of the seasonal influenza vaccine before and after CAR-T-cell therapy. medRxiv 2021. [PMID: 34013294 PMCID: PMC8132269 DOI: 10.1101/2021.05.10.21256634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recipients of chimeric antigen receptor-modified T (CAR-T) cell therapies for B-cell malignancies are immunocompromised and at risk for serious infections. Vaccine immunogenicity is unknown in this population. We conducted a prospective observational study of the humoral immunogenicity of 2019-2020 inactivated influenza vaccines (IIV) in children and adults immediately prior to (n=7) or 13-57 months after (n=15) CD19-, CD20-, or BCMA-targeted CAR-T-cell therapy, as well as controls (n=8). Individuals post-CAR-T-cell therapy were in remission. We tested for antibodies to 4 vaccine strains at baseline and ≥1 time point after IIV using neutralization and hemagglutination inhibition assays. An antibody response was defined as a ≥4-fold titer increase from baseline at the first post-vaccine time point. Baseline A(H1N1) titers in the CAR-T cohorts were significantly lower compared to controls. Antibody responses to ≥1 vaccine strain occurred in 2 (29%) individuals before CAR-T-cell therapy; one individual maintained a response for >3 months post-CAR-T-cell therapy. Antibody responses to ≥1 vaccine strain occurred in 6 (40%) individuals vaccinated after CAR-T-cell therapy. An additional 2 (29%) and 6 (40%) individuals had ≥2-fold increases (at any time) in the pre- and post-CAR-T cohorts, respectively. There were no identified clinical or immunologic predictors of antibody responses. Neither severe hypogammaglobulinemia nor B-cell aplasia precluded antibody responses. These data support consideration for vaccination before and after CAR-T-cell therapy for influenza and other relevant pathogens such as SARS-CoV-2, irrespective of hypogammaglobulinemia or B-cell aplasia. Larger studies are needed to determine correlates of vaccine immunogenicity and durability in CAR-T-cell therapy recipients. Key Points Influenza vaccination was immunogenic pre- and post-CAR-T-cell therapy, despite hypogammaglobulinemia and B-cell aplasia.Vaccination with inactivated vaccines can be considered before CAR-T-cell therapy and in individuals with remission after therapy.
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32
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Coffey DG, Cowan AJ, DeGraaff B, Martins TJ, Curley N, Green DJ, Libby EN, Silbermann R, Chien S, Dai J, Morales A, Gooley TA, Warren EH, Becker PS. High-Throughput Drug Screening and Multi-Omic Analysis to Guide Individualized Treatment for Multiple Myeloma. JCO Precis Oncol 2021; 5:PO.20.00442. [PMID: 34250400 PMCID: PMC8232547 DOI: 10.1200/po.20.00442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/03/2020] [Revised: 01/14/2021] [Accepted: 02/24/2021] [Indexed: 11/20/2022] Open
Abstract
Multiple myeloma (MM) is a genetically heterogeneous malignancy characterized by variable treatment responses. Although numerous drugs have been approved in recent years, the ability to predict treatment response and tailor individual therapy is limited by the absence of robust predictive biomarkers. The goal of this clinical trial was to use ex vivo, high-throughput screening (HTS) of 170 compounds to predict response among patients with relapsed or refractory MM and inform the next treatment decisions. Additionally, we integrated HTS with multi-omic analysis to uncover novel associations between in vitro drug sensitivity and gene expression and mutation profiles. MATERIALS AND METHODS Twenty-five patients with relapsed or refractory MM underwent a screening bone marrow or soft tissue biopsy. Sixteen patients were found to have sufficient plasma cells for HTS. Targeted next-generation sequencing was performed on plasma cell-free DNA from all patients who underwent HTS. RNA and whole-exome sequencing of bone marrow plasma cells were performed on eight and seven patients, respectively. RESULTS Results of HTS testing were made available to treating physicians within a median of 5 days from the biopsy. An actionable treatment result was identified in all 16 patients examined. Among the 13 patients who received assay-guided therapy, 92% achieved stable disease or better. The expression of 105 genes and mutations in 12 genes correlated with in vitro cytotoxicity. CONCLUSION In patients with relapsed or refractory MM, we demonstrate the feasibility of ex vivo drug sensitivity testing on isolated plasma cells from patient bone marrow biopsies or extramedullary plasmacytomas to inform the next line of therapy.
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Affiliation(s)
- David G. Coffey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Brotman Baty Institute for Precision Medicine, Seattle, WA
| | - Andrew J. Cowan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Bret DeGraaff
- Department of Medicine, University of Washington, Seattle, WA
| | - Timothy J. Martins
- Quellos High Throughput Screening Core, Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA
| | - Niall Curley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Damian J. Green
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Edward N. Libby
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Rebecca Silbermann
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Sylvia Chien
- Department of Medicine, University of Washington, Seattle, WA
| | - Jin Dai
- Department of Medicine, University of Washington, Seattle, WA
| | - Alicia Morales
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ted A. Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Edus H. Warren
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Brotman Baty Institute for Precision Medicine, Seattle, WA
| | - Pamela S. Becker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Brotman Baty Institute for Precision Medicine, Seattle, WA
- Quellos High Throughput Screening Core, Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA
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33
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Rubinstein SM, Yang PC, Cowan AJ, Warner JL. Standardizing Chemotherapy Regimen Nomenclature: A Proposal and Evaluation of the HemOnc and National Cancer Institute Thesaurus Regimen Content. JCO Clin Cancer Inform 2021; 4:60-70. [PMID: 31990580 PMCID: PMC7000232 DOI: 10.1200/cci.19.00122] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Due to decades of nonstandardized approaches to the naming of chemotherapy regimens, representation in electronic health records and secondary systems is highly variable. This hampers efforts to understand patterns of chemotherapy usage at the population level. In this article, we describe a proposal for rules to standardize the nomenclature of chemotherapy regimens and illustrate applications of these rules. METHODS Through our experience with building HemOnc.org, which has been under construction since 2011, we formulated a set of guidelines and recommendations for the standard representation of chemotherapy regimen names. We then performed a mapping between the HemOnc and National Cancer Institute Thesaurus vocabulary’s regimens and evaluated conformance with the naming conventions. Finally, we assembled a database of acronyms and names for multiple myeloma regimens to illustrate the scope of the problem. RESULTS For the first use case, 242 of 527 (45.1%) of the regimen names differed. The schema was able to allocate a preferred source for 217 (89.4%) of these regimens. For the second use case, we expanded 130 multiple myeloma regimens to 1,138 unique regimen names and demonstrate ways in which the schema can collapse these into disambiguated, but abbreviated, regimen names. CONCLUSION To our knowledge, this is the first proposal to normalize chemotherapy regimen nomenclature. If our recommendations are adopted, we expect that the uniformity of treatment exposure representation in hematology/oncology will increase, which will enable large-scale efforts such as ASCO’s CancerLinQ to achieve better standardization.
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Affiliation(s)
- Samuel M Rubinstein
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Peter C Yang
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Andrew J Cowan
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Jeremy L Warner
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
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34
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Josyula S, Pont MJ, Keane-Candib J, Song X, Thomas S, Pepper G, Krantz E, Riddell SR, Cowan AJ, Green DJ, Hill JA. Infectious Complications and Humoral Immunity after BCMA-Directed Chimeric Antigen Receptor T-Cell Therapy in Adults with Multiple Myeloma. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00444-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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35
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Okello CD, Mulumba Y, Omoding A, Ddungu H, Welch K, Thompson CL, Cowan AJ, Cooney MM, Orem J. Characteristics and outcomes of patients with multiple myeloma at the Uganda Cancer Institute. Afr Health Sci 2021; 21:67-74. [PMID: 34394283 PMCID: PMC8356586 DOI: 10.4314/ahs.v21i1.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Data on multiple myeloma (MM) in sub-Sahara Africa is scarce. In Uganda, there is a progressively increasing incidence of MM over the years. METHODS We performed a retrospective study on 217 patients with MM at the UCI using purposive sampling method. The objectives of the study were to determine the clinical characteristics, treatment outcomes, 5 year overall survival and predictors of survival of patients with MM at the UCI from 01 January 2008 to 31 December 2012. RESULTS There were 119 (54.8%) males; the mean(SD) age of the study population at presentation was 59(12.8) years; 183(84.3%) patients presented with bone pain, and 135 (61.9%) had skeletal pathology; 186(85.3%) were HIV negative, and 152(70%) had Durie-Salmon stage III. The median overall survival was 2.5 years, (95% CI, 0.393-0.595); factors significantly associated with worse survival were Durie-Salmon stage III disease, HR=5.9, 95% CI (1.61 - 21.74; P=0.007) and LDH >225 U/L HR=3.3, 95% CI (0.57 - 5.92; P=0.029). CONCLUSION Most patients with multiple myeloma at the UCI were diagnosed at a relatively young age, presented with late stage disease and bone pain, and had a shorter survival time. Factors associated with worse survival were Durie-Salmon stage III and LDH >225 U/L.
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36
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Gauthier J, Bezerra ED, Hirayama AV, Fiorenza S, Sheih A, Chou CK, Kimble EL, Pender BS, Hawkins RM, Vakil A, Phi TD, Steinmetz RN, Jamieson AW, Bar M, Cassaday RD, Chapuis AG, Cowan AJ, Green DJ, Kiem HP, Milano F, Shadman M, Till BG, Riddell SR, Maloney DG, Turtle CJ. Factors associated with outcomes after a second CD19-targeted CAR T-cell infusion for refractory B-cell malignancies. Blood 2021; 137:323-335. [PMID: 32967009 PMCID: PMC7819764 DOI: 10.1182/blood.2020006770] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [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: 05/01/2020] [Accepted: 09/09/2020] [Indexed: 01/04/2023] Open
Abstract
CD19-targeted chimeric antigen receptor-engineered (CD19 CAR) T-cell therapy has shown significant efficacy for relapsed or refractory (R/R) B-cell malignancies. Yet, CD19 CAR T cells fail to induce durable responses in most patients. Second infusions of CD19 CAR T cells (CART2) have been considered as a possible approach to improve outcomes. We analyzed data from 44 patients with R/R B-cell malignancies (acute lymphoblastic leukemia [ALL], n = 14; chronic lymphocytic leukemia [CLL], n = 9; non-Hodgkin lymphoma [NHL], n = 21) who received CART2 on a phase 1/2 trial (NCT01865617) at our institution. Despite a CART2 dose increase in 82% of patients, we observed a low incidence of severe toxicity after CART2 (grade ≥3 cytokine release syndrome, 9%; grade ≥3 neurotoxicity, 11%). After CART2, complete response (CR) was achieved in 22% of CLL, 19% of NHL, and 21% of ALL patients. The median durations of response after CART2 in CLL, NHL, and ALL patients were 33, 6, and 4 months, respectively. Addition of fludarabine to cyclophosphamide-based lymphodepletion before the first CAR T-cell infusion (CART1) and an increase in the CART2 dose compared with CART1 were independently associated with higher overall response rates and longer progression-free survival after CART2. We observed durable CAR T-cell persistence after CART2 in patients who received cyclophosphamide and fludarabine (Cy-Flu) lymphodepletion before CART1 and a higher CART2 compared with CART1 cell dose. The identification of 2 modifiable pretreatment factors independently associated with better outcomes after CART2 suggests strategies to improve in vivo CAR T-cell kinetics and responses after repeat CAR T-cell infusions, and has implications for the design of trials of novel CAR T-cell products after failure of prior CAR T-cell immunotherapies.
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MESH Headings
- Adult
- Aged
- Antigens, CD19/metabolism
- Cell Proliferation
- Cyclophosphamide/therapeutic use
- Cytokine Release Syndrome/complications
- Female
- Humans
- Immunotherapy, Adoptive
- Leukemia, B-Cell/immunology
- Leukemia, B-Cell/therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Lymphoma, Non-Hodgkin/immunology
- Lymphoma, Non-Hodgkin/therapy
- Male
- Middle Aged
- Multivariate Analysis
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Progression-Free Survival
- T-Lymphocytes/immunology
- Treatment Outcome
- Vidarabine/analogs & derivatives
- Vidarabine/therapeutic use
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Affiliation(s)
- Jordan Gauthier
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | | | | | | | | | - Cassie K Chou
- Clinical Research Division and
- Department of Pediatrics, University of Washington, Seattle, WA
| | | | | | | | | | | | | | | | - Merav Bar
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | | | - Aude G Chapuis
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - Andrew J Cowan
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - Damian J Green
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - Hans-Peter Kiem
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - Filippo Milano
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - Mazyar Shadman
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - Brian G Till
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - Stanley R Riddell
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - David G Maloney
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - Cameron J Turtle
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
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37
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Leedy DJ, Vasbinder A, Huang HD, Fernandes R, Cowan AJ, Gopal AK, Kirkpatrick JN, Libby EN, Cheng RK. Assessment of Left Ventricular, Right Ventricular, and Left Atrial Strain in Light-Chain Amyloidosis. JACC CardioOncol 2020; 2:647-649. [PMID: 33511354 PMCID: PMC7839948 DOI: 10.1016/j.jaccao.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Richard K Cheng
- Department of Medicine, Division of Cardiology and Department of Radiology, University of Washington Medical Center, PO Box 356422, Seattle, Washington 98195
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38
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Li X, Sigworth EA, Wu AH, Behrens J, Etemad SA, Nagpal S, Go RS, Wuichet K, Chen EJ, Rubinstein SM, Venepalli NK, Tillman BF, Cowan AJ, Schoen MW, Malty A, Greer JP, Fernandes HD, Seifter A, Chen Q, Chowdhery RA, Mohan SR, Dewdney SB, Osterman T, Ambinder EP, Buchbinder EI, Schwartz C, Abraham I, Rioth MJ, Singh N, Sharma S, Gibson MK, Yang PC, Warner JL. Seven decades of chemotherapy clinical trials: a pan-cancer social network analysis. Sci Rep 2020; 10:17536. [PMID: 33067482 PMCID: PMC7568560 DOI: 10.1038/s41598-020-73466-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 09/17/2020] [Indexed: 11/09/2022] Open
Abstract
Clinical trials establish the standard of cancer care, yet the evolution and characteristics of the social dynamics between the people conducting this work remain understudied. We performed a social network analysis of authors publishing chemotherapy-based prospective trials from 1946 to 2018 to understand how social influences, including the role of gender, have influenced the growth and development of this network, which has expanded exponentially from fewer than 50 authors in 1946 to 29,197 in 2018. While 99.4% of authors were directly or indirectly connected by 2018, our results indicate a tendency to predominantly connect with others in the same or similar fields, as well as an increasing disparity in author impact and number of connections. Scale-free effects were evident, with small numbers of individuals having disproportionate impact. Women were under-represented and likelier to have lower impact, shorter productive periods (P < 0.001 for both comparisons), less centrality, and a greater proportion of co-authors in their same subspecialty. The past 30 years were characterized by a trend towards increased authorship by women, with new author parity anticipated in 2032. The network of cancer clinical trialists is best characterized as strategic or mixed-motive, with cooperative and competitive elements influencing its appearance. Network effects such as low centrality, which may limit access to high-profile individuals, likely contribute to the observed disparities.
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Affiliation(s)
- Xuanyi Li
- Vanderbilt University, Nashville, TN, USA
| | | | | | | | | | | | | | - Kristin Wuichet
- Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 777, Nashville, TN, 37232, USA
| | - Eddy J Chen
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Samuel M Rubinstein
- Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 777, Nashville, TN, 37232, USA
| | | | - Benjamin F Tillman
- Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 777, Nashville, TN, 37232, USA
| | | | | | | | - John P Greer
- Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 777, Nashville, TN, 37232, USA
| | | | - Ari Seifter
- University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Sanjay R Mohan
- Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 777, Nashville, TN, 37232, USA
| | | | - Travis Osterman
- Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 777, Nashville, TN, 37232, USA
| | | | | | | | - Ivy Abraham
- University of Illinois at Chicago, Chicago, IL, USA
| | | | - Naina Singh
- University of Illinois at Chicago, Chicago, IL, USA
| | | | - Michael K Gibson
- Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 777, Nashville, TN, 37232, USA
| | - Peter C Yang
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeremy L Warner
- Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 777, Nashville, TN, 37232, USA.
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Percival MEM, Lynch RC, Halpern AB, Shadman M, Cassaday RD, Ujjani C, Shustov A, Tseng YD, Liu C, Pergam S, Libby EN, Scott BL, Smith SD, Green DJ, Gopal AK, Cowan AJ. Considerations for Managing Patients With Hematologic Malignancy During the COVID-19 Pandemic: The Seattle Strategy. JCO Oncol Pract 2020; 16:571-578. [PMID: 32369409 PMCID: PMC7489485 DOI: 10.1200/op.20.00241] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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] [Accepted: 04/13/2020] [Indexed: 02/07/2023] Open
Abstract
In January 2020, the first documented patient in the United States infected with severe acute respiratory syndrome coronavirus 2 was diagnosed in Washington State. Since that time, community spread of coronavirus disease 2019 (COVID-19) in the state has changed the practice of oncologic care at our comprehensive cancer center in Seattle. At the Seattle Cancer Care Alliance, the primary oncology clinic for the University of Washington/Fred Hutchinson Cancer Consortium, our specialists who manage adult patients with hematologic malignancies have rapidly adjusted clinical practices to mitigate the potential risks of COVID-19 to our patients. We suggest that our general management decisions and modifications in Seattle are broadly applicable to patients with hematologic malignancies. Despite a rapidly changing environment that necessitates opinion-based care, we provide recommendations that are based on best available data from clinical trials and collective knowledge of disease states.
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Affiliation(s)
- Mary-Elizabeth M. Percival
- Seattle Cancer Care Alliance, Seattle, WA
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ryan C. Lynch
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Anna B. Halpern
- Seattle Cancer Care Alliance, Seattle, WA
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mazyar Shadman
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Ryan D. Cassaday
- Seattle Cancer Care Alliance, Seattle, WA
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Chaitra Ujjani
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Andrei Shustov
- Seattle Cancer Care Alliance, Seattle, WA
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Yolanda D. Tseng
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Catherine Liu
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Steven Pergam
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Edward N. Libby
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Bart L. Scott
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Stephen D. Smith
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Damian J. Green
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Ajay K. Gopal
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Andrew J. Cowan
- Seattle Cancer Care Alliance, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
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40
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Cowan AJ, Green DJ, Karami M, Becker PS, Tuazon S, Coffey DG, Hyun TS, Libby EN, Gopal AK, Holmberg LA. KRD-PACE Mobilization for Multiple Myeloma Patients With Significant Residual Disease Before Autologous Stem-Cell Transplantation. Clin Lymphoma Myeloma Leuk 2020; 20:602-609. [PMID: 32457024 DOI: 10.1016/j.clml.2020.04.002] [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] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/11/2020] [Accepted: 04/03/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Bortezomib has been incorporated into thalidomide and dexamethasone provided with cisplatin, doxorubicin, cyclophosphamide, and etoposide (PACE) as an intensive regimen before autologous stem-cell transplantation for multiple myeloma (MM). We examined MM patients at our center who received chemomobilization with a regimen that substituted carfilzomib and lenalidomide for bortezomib and thalidomide (KRD-PACE). PATIENTS AND METHODS This was a retrospective study of 27 MM patients who received KRD-PACE for chemomobilization. Our analysis included patients who had circulating plasma cells (CPCs) by flow cytometry, ≥ 10% bone marrow plasma cells (BMPC), a monoclonal protein ≥ 1 g/dL, or an involved serum free light chain ≥ 10 mg/dL. RESULTS The most common indication for KRD-PACE was BMPC ≥ 10% in 16 patients (60%), followed by CPCs in 11 (41%). The median (range) age was 61 (35-69) years, and the median (range) BMPC before treatment was 10% (5%-47%). The overall response rate was 43%, and a median (range) of 20.24 (8.08-69.88) × 106 CD34+ cells/kg were collected. CPC clearance rate was 50%, and the median reduction in BMPC was 75%. Two patients had sinus bradycardia and 5 (19%) had neutropenic fever. CONCLUSION KRD-PACE is an effective therapy to mobilize peripheral blood stem cells in MM patients with residual disease burden. This regimen was successful at clearing CPCs and reducing BMPC burden, with an overall response rate of 43%. Despite theoretical concern regarding the combination of 3 cardiotoxic agents, we observed a low frequency of cardiac issues.
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Affiliation(s)
- Andrew J Cowan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - Damian J Green
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - Mehdi Karami
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - Pamela S Becker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
| | - Sherilyn Tuazon
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - David G Coffey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - Teresa S Hyun
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Pathology, University of Washington, Seattle, WA
| | - Edward N Libby
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - Ajay K Gopal
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - Leona A Holmberg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA.
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41
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Smith SD, Till BG, Shadman MS, Lynch RC, Cowan AJ, Wu QV, Voutsinas J, Rasmussen HA, Blue K, Ujjani CS, Shustov A, Cassaday RD, Fromm JR, Gopal AK. Pembrolizumab with R‐CHOP in previously untreated diffuse large B‐cell lymphoma: potential for biomarker driven therapy. Br J Haematol 2020; 189:1119-1126. [DOI: 10.1111/bjh.16494] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/24/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Stephen D. Smith
- Division of Medical Oncology Department of Internal Medicine University of Washington Seattle WA USA
- Clinical Research Division Fred Hutchinson Cancer Research Center Seattle WA USA
| | - Brian G. Till
- Clinical Research Division Fred Hutchinson Cancer Research Center Seattle WA USA
| | - Mazyar S. Shadman
- Clinical Research Division Fred Hutchinson Cancer Research Center Seattle WA USA
| | - Ryan C. Lynch
- Division of Medical Oncology Department of Internal Medicine University of Washington Seattle WA USA
- Clinical Research Division Fred Hutchinson Cancer Research Center Seattle WA USA
| | - Andrew J. Cowan
- Division of Medical Oncology Department of Internal Medicine University of Washington Seattle WA USA
- Clinical Research Division Fred Hutchinson Cancer Research Center Seattle WA USA
| | - Qian V. Wu
- Clinical Research Division Fred Hutchinson Cancer Research Center Seattle WA USA
| | - Jenna Voutsinas
- Clinical Research Division Fred Hutchinson Cancer Research Center Seattle WA USA
| | - Heather A. Rasmussen
- Division of Medical Oncology Department of Internal Medicine University of Washington Seattle WA USA
| | - Katherine Blue
- Division of Medical Oncology Department of Internal Medicine University of Washington Seattle WA USA
| | - Chaitra S. Ujjani
- Division of Medical Oncology Department of Internal Medicine University of Washington Seattle WA USA
- Clinical Research Division Fred Hutchinson Cancer Research Center Seattle WA USA
| | - Andrei Shustov
- Clinical Research Division Fred Hutchinson Cancer Research Center Seattle WA USA
- Division of Hematology Department of Internal Medicine University of Washington Seattle WA USA
| | - Ryan D. Cassaday
- Clinical Research Division Fred Hutchinson Cancer Research Center Seattle WA USA
- Division of Hematology Department of Internal Medicine University of Washington Seattle WA USA
| | - Jonathan R. Fromm
- Division of Hematopathology Department of Laboratory Medicine University of Washington Seattle WA USA
| | - Ajay K. Gopal
- Division of Medical Oncology Department of Internal Medicine University of Washington Seattle WA USA
- Clinical Research Division Fred Hutchinson Cancer Research Center Seattle WA USA
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42
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Cowan AJ, Allen C, Barac A, Basaleem H, Bensenor I, Curado MP, Foreman K, Gupta R, Harvey J, Hosgood HD, Jakovljevic M, Khader Y, Linn S, Lad D, Mantovani L, Nong VM, Mokdad A, Naghavi M, Postma M, Roshandel G, Shackelford K, Sisay M, Nguyen CT, Tran TT, Xuan BT, Ukwaja KN, Vollset SE, Weiderpass E, Libby EN, Fitzmaurice C. Global Burden of Multiple Myeloma: A Systematic Analysis for the Global Burden of Disease Study 2016. JAMA Oncol 2019; 4:1221-1227. [PMID: 29800065 PMCID: PMC6143021 DOI: 10.1001/jamaoncol.2018.2128] [Citation(s) in RCA: 348] [Impact Index Per Article: 69.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Question What is the burden of multiple myeloma globally and by country, how has it changed over time, and how widely available are treatments for this disease? Findings Myeloma incident cases and deaths increased from 1990 to 2016, with middle-income countries contributing the most to this increase. Treatment availability is very limited in countries with low socioeconomic development. Meaning Marked variation in myeloma incidence and mortality across countries highlights the need to improve access to diagnosis and effective therapy and to expand research on etiological determinants of myeloma. Introduction Multiple myeloma (MM) is a plasma cell neoplasm with substantial morbidity and mortality. A comprehensive description of the global burden of MM is needed to help direct health policy, resource allocation, research, and patient care. Objective To describe the burden of MM and the availability of effective therapies for 21 world regions and 195 countries and territories from 1990 to 2016. Design and Setting We report incidence, mortality, and disability-adjusted life-year (DALY) estimates from the Global Burden of Disease 2016 study. Data sources include vital registration system, cancer registry, drug availability, and survey data for stem cell transplant rates. We analyzed the contribution of aging, population growth, and changes in incidence rates to the overall change in incident cases from 1990 to 2016 globally, by sociodemographic index (SDI) and by region. We collected data on approval of lenalidomide and bortezomib worldwide. Main Outcomes and Measures Multiple myeloma mortality; incidence; years lived with disabilities; years of life lost; and DALYs by age, sex, country, and year. Results Worldwide in 2016 there were 138 509 (95% uncertainty interval [UI], 121 000-155 480) incident cases of MM with an age-standardized incidence rate (ASIR) of 2.1 per 100 000 persons (95% UI, 1.8-2.3). Incident cases from 1990 to 2016 increased by 126% globally and by 106% to 192% for all SDI quintiles. The 3 world regions with the highest ASIR of MM were Australasia, North America, and Western Europe. Multiple myeloma caused 2.1 million (95% UI, 1.9-2.3 million) DALYs globally in 2016. Stem cell transplantation is routinely available in higher-income countries but is lacking in sub-Saharan Africa and parts of the Middle East. In 2016, lenalidomide and bortezomib had been approved in 73 and 103 countries, respectively. Conclusions and Relevance Incidence of MM is highly variable among countries but has increased uniformly since 1990, with the largest increase in middle and low-middle SDI countries. Access to effective care is very limited in many countries of low socioeconomic development, particularly in sub-Saharan Africa. Global health policy priorities for MM are to improve diagnostic and treatment capacity in low and middle income countries and to ensure affordability of effective medications for every patient. Research priorities are to elucidate underlying etiological factors explaining the heterogeneity in myeloma incidence.
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Affiliation(s)
- Andrew J Cowan
- Division of Medical Oncology, University of Washington, Seattle
| | - Christine Allen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | | | - Maria Paula Curado
- Accamargo Cancer Center, São Paolo, Brazil.,International Prevention Research Institute, Ecully, France
| | - Kyle Foreman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Rahul Gupta
- West Virginia Bureau for Public Health, Charleston
| | - James Harvey
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Mihajlo Jakovljevic
- University of Kragujevac, Kragujevac, Serbia.,Center for Health Trends and Forecasts, University of Washington, Seattle
| | - Yousef Khader
- Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Deepesh Lad
- Postgraduate Institute of Medical Education and Research, Candigarh, India
| | | | - Vuong Minh Nong
- Institute for Global Health Innovations, Duy Tan University, Danang, Vietnam
| | - Ali Mokdad
- International Prevention Research Institute, Ecully, France
| | - Mohsen Naghavi
- International Prevention Research Institute, Ecully, France
| | | | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.,Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Katya Shackelford
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Danang, Vietnam
| | - Tung Thanh Tran
- Institute for Global Health Innovations, Duy Tan University, Danang, Vietnam
| | - Bach Tran Xuan
- Haramaya University, Haramaya, Ethiopia.,Johns Hopkins University, Baltimore, Maryland.,Hanoi Medical University, Hanoi, Vietnam
| | | | | | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo
| | - Edward N Libby
- Division of Medical Oncology, University of Washington, Seattle
| | - Christina Fitzmaurice
- Institute for Health Metrics and Evaluation, University of Washington, Seattle.,Division of Hematology, University of Washington, Seattle
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43
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Kopmar NE, Tseng YD, Holmberg LA, Becker PS, Green DJ, Tuazon S, Libby EN, Coffey DG, Gopal AK, Cowan AJ. Safety and Toxicities of Radiotherapy As Consolidation or Cytoreduction Around the Time of Autologous Stem Cell Transplantation for Multiple Myeloma Patients: A Single Center Retrospective Report. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.833] [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: 10/27/2022]
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44
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Cowan AJ, Fitzmaurice C. Burden of Multiple Myeloma in Taiwan—Reply. JAMA Oncol 2019; 5:116. [DOI: 10.1001/jamaoncol.2018.5533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andrew J. Cowan
- Division of Medical Oncology, University of Washington, Seattle
| | - Christina Fitzmaurice
- Division of Hematology, University of Washington, Institute for Health Metrics and Evaluation, Seattle
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45
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Cowan AJ, Johnson CK, Libby EN. Plasma cell diseases and organ transplant: A comprehensive review. Am J Transplant 2018; 18:1046-1058. [PMID: 29524307 DOI: 10.1111/ajt.14731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 09/22/2017] [Revised: 02/28/2018] [Accepted: 03/04/2018] [Indexed: 01/25/2023]
Abstract
Plasma cell diseases are a class of hematologic diseases that are sometimes present as preexisting diagnoses prior to organ transplantation, causative factors leading to a need for organ transplantation, or may occur posttransplant as part of the spectrum of posttransplant lymphoproliferative disorders. Herein, we review the most common plasma cell diseases, both as coexisting with other causes of organ failure, but also as a primary underlying cause for organ failure. In many cases, treatment of the underlying clonal disease may be indicated before proceeding with organ transplant. This review aims to provide current and relevant data regarding the management of these conditions in the organ transplant patient, for transplant providers, and those who take care of these patients.
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Affiliation(s)
- Andrew J Cowan
- Division of Medical Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Edward N Libby
- Division of Medical Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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46
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Burke FJT, Crisp RJ, Cowan AJ, Raybould L, Redfearn P, Sands P, Thompson O, Ravaghi V. A Randomised Controlled Trial of a Universal Bonding Agent at Three Years: Self Etch vs Total Etch. Eur J Prosthodont Restor Dent 2017; 25:220-227. [PMID: 29182212 DOI: 10.1922/ejprd_01692burke08] [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] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/19/2017] [Indexed: 11/11/2022]
Abstract
General dental practice is increasingly being recognised as the ideal situation for the conduct of clinical trials into the longevity of restorations. The aim of this study was to investigate the survival of 64 nanofilled resin composite (Filtek Supreme XTE) restorations placed principally in loadbearing cavities using a Universal dentine bonding agent (Scotchbond Universal), in five UK dental practices by members of the UK-based practice-based research group, the PREP Panel. A split mouth design was used, comprising patients who required two restorations, with one of the restorations receiving a total etch approach using phosphoric acid and the other being placed using a self-etch approach. The results indicated good performance of the restorations examined, with no difference, in terms of marginal characteristics, between the restorations which received total etching and those which did not.
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Affiliation(s)
| | | | - A J Cowan
- General Dental Practitioner, Buxton, England
| | - L Raybould
- General Dental Practitioner, Wendover, England
| | - P Redfearn
- General Dental Practitioner, Hamilton, Scotland
| | - P Sands
- General Dental Practitioner, Abingdon, England, University of Birmingham College of Medical and Dental Sciences
| | - O Thompson
- General Dental Practitioner, Coleraine, N Ireland
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47
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Fanola CL, Mooney D, Cowan AJ, Ko D, Sisson EK, Henault LE, Tripodis Y, Hylek EM. Incidence of severe renal dysfunction among individuals taking warfarin and implications for non-vitamin K oral anticoagulants. Am Heart J 2017; 184:150-155. [PMID: 28224930 DOI: 10.1016/j.ahj.2016.08.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 08/22/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study is to assess incidence and risk factors for severe renal dysfunction in patients requiring oral anticoagulation to help guide initial drug choice and provide a rational basis for interval monitoring of renal function for patients prescribed non-vitamin K oral anticoagulants. METHODS Patients on warfarin for atrial fibrillation or venous thromboembolism were consecutively enrolled from January 2007 to December 2010. Baseline kidney function was assessed, and patients were followed to their first decline of kidney function to creatinine clearance<30 mL/min. Multivariate regression assessed independent risk factors for the primary outcome. Severe renal impairment based on baseline kidney function was assessed by Kaplan-Meier analyses. RESULTS Of 787 patients identified, 34 were excluded for baseline CrCl <30 mL/min. The mean age was 71 years, and 74% and 31% had hypertension and diabetes mellitus, respectively. At baseline, 23% (n=174) had moderate chronic kidney disease (CKD) (CrCl 30-59mL/min), whereas 31% had mild CKD (CrCl 60-89mL/min). Severe renal impairment occurred in 92 patients (12%), 25% of which was seen within 5.3 months. Of those with baseline stage 3 CKD, 37% developed severe renal impairment. Stage 3 CKD conferred a 14-fold increased risk in the development of severe renal dysfunction (odds ratio 14.5, 95% CI 6.7-31.3, P<.001). Coronary artery disease was also associated with severe renal impairment (odds ratio 2.2, 95% CI 1.3-3.8, P=.004). CONCLUSIONS Acute and chronic renal dysfunction is common among individuals requiring long-term anticoagulant therapy. Patients with moderate chronic kidney disease and coronary artery disease are at the highest short-term risk of developing severe renal impairment. More frequent monitoring of these patients is warranted.
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48
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Cowan AJ, Stevenson PA, Gooley TA, Frayo SL, Oliveira GR, Smith SD, Green DJ, Roden JE, Pagel JM, Wood BL, Press OW, Gopal AK. Results of a phase I-II study of fenretinide and rituximab for patients with indolent B-cell lymphoma and mantle cell lymphoma. Br J Haematol 2017; 176:583-590. [PMID: 28055107 DOI: 10.1111/bjh.14451] [Citation(s) in RCA: 7] [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] [Received: 08/09/2016] [Accepted: 09/12/2016] [Indexed: 11/29/2022]
Abstract
Fenretinide, a synthetic retinoid, induces apoptotic cell death in B-cell non-Hodgkin lymphoma (B-NHL) and acts synergistically with rituximab in preclinical models. We report results from a phase I-II study of fenretinide with rituximab for B-NHLs. Eligible diagnoses included indolent B-NHL or mantle cell lymphoma. The phase I design de-escalated from fenretinide at 900 mg/m2 PO BID for days 1-5 of a 7-day cycle. The phase II portion added 375 mg/m2 IV rituximab weekly on weeks 5-9 then every 3 months. Fenretinide was continued until progression or intolerance. Thirty-two patients were treated: 7 in phase I, and 25 in phase II of the trial. No dose-limiting toxicities were observed. The phase II component utilized fenretinide 900 mg/m2 twice daily with rituximab. The most common treatment-related adverse events of grade 3 or higher were rash (n = 3) and neutropenia (n = 3). Responses were seen in 6 (24%) patients on the phase II study, with a median duration of response of 47 months (95% confidence interval, 2-56). The combination of fenretinide and rituximab was well tolerated, yielded a modest overall response rate, but with prolonged remission durations. Further study should focus on identifying the responsive subset of B-NHL.
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Affiliation(s)
- Andrew J Cowan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Phillip A Stevenson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ted A Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Shani L Frayo
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - George R Oliveira
- Department of Radiology, Harvard Medical School, MGH Hospital, Boston, MA, USA
| | - Stephen D Smith
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Damian J Green
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jennifer E Roden
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Brent L Wood
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Hematopathology, Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Oliver W Press
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ajay K Gopal
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
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Cowan AJ, Klippel ZK, Stevenson PA, Hyun TS, Tuazon S, Becker PS, Green DJ, Holmberg LA, Coffey DG, Gopal AK, Libby EN. Pre-transplantation novel agent induction predicts progression-free survival for patients with immunoglobulin light-chain amyloidosis undergoing high-dose melphalan and autologous stem cell transplantation. Amyloid 2016; 23:254-259. [PMID: 27879147 PMCID: PMC5189710 DOI: 10.1080/13506129.2016.1258356] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION High-dose melphalan and autologous stem cell transplantation (HDM/SCT) is an effective treatment modality for immunoglobulin light-chain (AL) amyloidosis; however, its application remains restricted to patients with good performance status and limited organ involvement. In recent years, the paradigm for AL amyloidosis has changed with the introduction of novel agents such as immunomodulatory drugs (IMiDs) and proteasome inhibitors (PIs). We hypothesized that use of novel agent induction regimens has improved outcomes for patients with AL amyloidosis undergoing HDM/SCT at our center. METHODS All patients with AL amyloidosis, age ≥18 years who underwent HDM/SCT between 2001 and 2014 at the Fred Hutchinson Cancer Research Center and University of Washington Medical Center were included in this study. Any regimen administered within 6 months prior to HDM/SCT including an IMiD or a PI was considered a novel induction regimen. Use of induction regimen was evaluated in a Cox proportional hazard model for association with progression-free survival (PFS) and overall survival (OS). RESULTS Forty-five patients with AL amyloidosis underwent HDM/SCT. The median age was 57.2 years (range 39-74.4), 15 (33.3%) were women. The median number of organs involved was 2 (range 1-5), with 20 patients having only 1 (44.4%), 10 patients having 2 (22.2%), and 15 patients (33.3%) having ≥ 3 organs involved. Novel agent induction regimens were used prior to HDM/SCT in 21 patients (46.7%); these comprised PI in 13/21 (57.1%), IMiD alone in 6/21 (28.6%), PI and cyclophosphamide (CyBorD) in 3/21 (14.3%), and IMiD and PI in 3/21 (14.3%). Use of a novel agent induction regimen was associated with improved, but not OS. The 3-year PFS for patients who received a novel agent induction was 79%, while for those who did not was 53% (hazard ratio [HR] = 0.317, p = 0.048). The 3-year OS for patients who received novel agent induction regimens was 95%, while for those who did not was 71% (HR = 0.454, p = 0.247). DISCUSSION Our data suggest that use of a novel agent induction regimen including an IMiD or PI prior to HDM/SCT for patients with AL amyloidosis could improve outcomes, with improvement in PFS. Although these results are limited by sample size and lack of randomization, these results support possible further investigation of novel agent induction regimens in the context of a prospective clinical trial.
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Affiliation(s)
- Andrew J Cowan
- a Division of Medical Oncology , University of Washington , Seattle , WA , USA.,b Clinical Research Division, Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | | | - Philip A Stevenson
- b Clinical Research Division, Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | - Teresa S Hyun
- b Clinical Research Division, Fred Hutchinson Cancer Research Center , Seattle , WA , USA.,d Department of Pathology , University of Washington , Seattle , WA , USA , and
| | - Sherilyn Tuazon
- a Division of Medical Oncology , University of Washington , Seattle , WA , USA.,b Clinical Research Division, Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | - Pamela S Becker
- b Clinical Research Division, Fred Hutchinson Cancer Research Center , Seattle , WA , USA.,e Division of Hematology , Department of Medicine, University of Washington , Seattle , WA , USA
| | - Damian J Green
- a Division of Medical Oncology , University of Washington , Seattle , WA , USA.,b Clinical Research Division, Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | - Leona A Holmberg
- a Division of Medical Oncology , University of Washington , Seattle , WA , USA.,b Clinical Research Division, Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | - David G Coffey
- a Division of Medical Oncology , University of Washington , Seattle , WA , USA.,b Clinical Research Division, Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | - Ajay K Gopal
- a Division of Medical Oncology , University of Washington , Seattle , WA , USA.,b Clinical Research Division, Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | - Edward N Libby
- a Division of Medical Oncology , University of Washington , Seattle , WA , USA.,b Clinical Research Division, Fred Hutchinson Cancer Research Center , Seattle , WA , USA
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Cowan AJ, Stevenson PA, Cassaday RD, Graf SA, Fromm JR, Wu D, Holmberg LA, Till BG, Chauncey TR, Smith SD, Philip M, Orozco JJ, Shustov AR, Green DJ, Libby EN, Bensinger WI, Shadman M, Maloney DG, Press OW, Gopal AK. Pretransplantation Minimal Residual Disease Predicts Survival in Patients with Mantle Cell Lymphoma Undergoing Autologous Stem Cell Transplantation in Complete Remission. Biol Blood Marrow Transplant 2015; 22:380-385. [PMID: 26348890 DOI: 10.1016/j.bbmt.2015.08.035] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 06/25/2015] [Accepted: 08/31/2015] [Indexed: 01/22/2023]
Abstract
Autologous stem cell transplantation (ASCT) is standard therapy for mantle cell lymphoma (MCL) in remission after induction chemotherapy, with the best results for patients in complete remission (CR). We hypothesized that evaluation of minimal residual disease (MRD) before ASCT could further stratify outcomes for these patients. Patients with MCL who underwent ASCT in clinical CR between 1996 and 2011 with pretransplantation MRD testing were eligible. Presence of a clonal IgH rearrangement, t(11; 14) by PCR or positive flow cytometry from blood or bone marrow, was considered positive. An adjusted proportional hazards model for associations with progression-free (PFS) and overall survival (OS) was performed. Of 75 MCL patients in CR, 8 (11%) were MRD positive. MRD positivity was associated with shorter OS and PFS. The median OS for MRD-negative patients was not reached, with 82% survival at 5 years, whereas for the MRD-positive patients, median OS was 3.01 years (hazard ratio [HR], 4.04; P = .009), with a median follow-up of 5.1 years. The median PFS for MRD-negative patients was not reached with 75% PFS at 5 years, whereas for MRD-positive patients, it was 2.38 years (HR, 3.69; P = .002). MRD positivity is independently associated with poor outcomes after ASCT for MCL patients in CR.
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Affiliation(s)
- Andrew J Cowan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Philip A Stevenson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Ryan D Cassaday
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Solomon A Graf
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Jonathan R Fromm
- Marrow Transplant Unit, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - David Wu
- Marrow Transplant Unit, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Leona A Holmberg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Brian G Till
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Thomas R Chauncey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington; VA Puget Sound Health Care System, Seattle, Washington
| | - Stephen D Smith
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Mary Philip
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Johnnie J Orozco
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Andrei R Shustov
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Damian J Green
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Edward N Libby
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington
| | - William I Bensinger
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - David G Maloney
- Transplantation Biology Department, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Oliver W Press
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Ajay K Gopal
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
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