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Karmali R, Galvez C, Hamadani M, Gordon L, Winter J, Ma S, Nelson V, Fenske TS, Shah NN, Jagadeesh D, Klein A, Helenowski I, Chen R, Mi X, Petrich A, Evens AM, Pro B. A phase 1-2 trial of DA-EPOCH-R plus ixazomib for MYC-aberrant lymphoid malignancies: the DACIPHOR regimen. Blood Adv 2024; 8:1612-1620. [PMID: 38237077 PMCID: PMC10987893 DOI: 10.1182/bloodadvances.2023011369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/11/2024] [Indexed: 03/28/2024] Open
Abstract
ABSTRACT MYC-aberrant non-Hodgkin lymphoma (NHL) is associated with poor outcomes with conventional chemotherapy. Ixazomib is an orally bioavailable proteasome inhibitor that targets drivers of MYC expression and has demonstrated preclinical activity in aggressive MYC-aberrant NHL. We conducted a phase 1/2 study evaluating the safety and efficacy of DA-EPOCH-R with adjunctive ixazomib in aggressive MYC-aberrant NHL. For induction, patients received 6 cycles of DA-EPOCH-R with ixazomib administered twice per 21-day cycle; responders continued weekly ixazomib maintenance for up to 1 year. Primary objectives were to determine the maximum tolerated dose in phase 1 and efficacy of DA-EPOCH-R with ixazomib as measured by 12-month progression-free survival (PFS) rate in phase 2. Thirty-six patients were evaluable for response. Median age was 63 years (range, 31-77) and 44% had double-hit lymphoma (DHL)/triple-hit lymphoma (THL). In phase 1, 3 mg of ixazomib was established as recommended phase 2 dose. Twenty-nine (76.3%) patients completed 6 cycles of DA-EPOCH-R and 25 (65.8%) underwent dose escalations. The ORR after induction was 97% (95% confidence interval, 81-100) with a CR rate of 69%. At median follow-up of 18.8 months, the 12-month PFS and overall survival (OS) rates were 78% and 86%, respectively. For DHL/THL vs dual expressor lymphomas (DEL), 12-month PFS rates were 53% vs 95% and 12-month OS rates were 65% vs 100%, respectively. Grade ≥3 toxicities were predominantly hematologic. Twenty-seven (75%) of patients experienced neuropathy, nearly all low-grade. DA-EPOCH-R induction with adjunctive ixazomib is feasible and appears effective in patients with DEL. This trial was registered at www.clinicaltrials.gov as #NCT02481310.
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Affiliation(s)
- Reem Karmali
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Carlos Galvez
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mehdi Hamadani
- Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Leo Gordon
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Jane Winter
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Shuo Ma
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Valerie Nelson
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Timothy S. Fenske
- Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Nirav N. Shah
- Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Deepa Jagadeesh
- Division of Hematology-Oncology, Cleveland Clinic, Cleveland, OH
| | - Andreas Klein
- Division of Hematology-Oncology, Tufts Medical Center, Boston, MA
| | - Irene Helenowski
- Department of Preventative Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ruohui Chen
- Department of Preventative Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Xinlei Mi
- Department of Preventative Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Adam Petrich
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
- Daiichi-Sankyo, Basking Ridge, NJ
| | - Andrew M. Evens
- Division of Hematology-Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Barbara Pro
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
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Karmali R, Machhi R, Epperla N, Shouse G, Romancik JT, Moyo TK, Kenkre VP, Ollila TA, Fitzgerald LA, Hess BT, David KA, Roy I, Zurko JC, Chowdhury SM, Annunzio K, Ferdman R, Bhansali RS, Harris EI, Liu J, Nizamuddin IA, Ma S, Moreira J, Winter JN, Pro B, Stephens DM, Danilov AV, Shah NN, Cohen JB, Barta SK, Torka P, Gordon LI. Impact of Race and Social Determinants of Health on Outcomes in Patients with Aggressive B-cell nHL Treated with CAR-T. Blood Adv 2024:bloodadvances.2023011996. [PMID: 38531057 DOI: 10.1182/bloodadvances.2023011996] [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: 11/13/2023] [Revised: 02/05/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024] Open
Abstract
Healthcare disparities driven by multiple social, economic, and/or environmental factors lead to inequalities in health outcomes. CAR-T cell immunotherapy is an effective therapy for relapsed/refractory B-cell non-Hodgkin lymphoma (r/r B-NHL). However, data are limited on the impact of the convergence of race and social determinants of health on outcomes for patients treated with CAR-T therapy. We examined the impact of interactions between race and insurance type on health care utilization and outcomes in patients treated with CAR-T for aggressive B-NHL. Adult patients with r/r B-NHL treated with CD19 CAR-T were identified between 2015 and 2021 across 13 US academic centers. Insurance type, demographic and clinical data were collected and analyzed via Chi-squared and Kaplan-Meier analysis. Cox multivariable regression (MVA) was used to determine the impact of race/ethnicity and other variables on survival. 466 adult patients were included in our analysis. Median follow-up after CAR-T was 12.7 months. Median progression free survival (mPFS) was longer for Caucasians (11.5 months) than for African Americans (3.5 months, HR 1.56 [1.03-2.4], p=0.04) or Asians (2.7 months, HR 1.7 [1.02-2.67], p=0.04). Differences in median overall survival (mOS) were not significant. For Medicare (n=206) vs Medicaid (n=33) vs private insurance (n=219) vs self-pay (n=7): mPFS was 15.9 vs 4.2 vs 6.0 vs 0.9 months (p<0.001) and mOS was 31.2 vs 12.8 vs 21.5 vs 3.2 months (p<0.001), respectively. Collectively, our multi-center retrospective analysis showed that race and insurance status can impact outcomes for patients treated with CAR-T cell therapy.
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Affiliation(s)
- Reem Karmali
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Rushad Machhi
- Northwestern University, Chicago, Illinois, United States
| | | | - Geoffrey Shouse
- City of Hope National Medical Center, Duarte, California, United States
| | | | - Tamara K Moyo
- Levine Cancer Institute, Atrium Helath, Charlotte, North Carolina, United States
| | | | - Thomas A Ollila
- Brown University/Lifespan Cancer Institute, Providence, Rhode Island, United States
| | | | - Brian T Hess
- The Medical University of South Carolina, Charleston, South Carolina, United States
| | - Kevin A David
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, United States
| | - Ishan Roy
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
| | - Joanna C Zurko
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, United States
| | | | | | - Robert Ferdman
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
| | - Rahul S Bhansali
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Elyse I Harris
- University of Wisconsin, Madison, Wisconsin, United States
| | - Jieqi Liu
- Astera Cancer Care, Jersey City, New Jersey, United States
| | - Imran A Nizamuddin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Shuo Ma
- Northwestern University, Chicago, Illinois, United States
| | - Jonathan Moreira
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Jane N Winter
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Barbara Pro
- Columbia University Medical Center, New York, New York, United States
| | - Deborah M Stephens
- University of North Carolina, Chapel Hill, North Carolina, United States
| | | | - Nirav N Shah
- Medical College of Wisconsin, Wauwatosa, Wisconsin, United States
| | | | - Stefan K Barta
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Pallawi Torka
- Memorial Sloan Kettering Cancer Center, Montvale, New Jersey, United States
| | - Leo I Gordon
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
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Ryu Tiger YK, Jain S, Barta SK, Tolu S, Estrella B, Sawas A, Lue JK, Francescone MM, Pro B, Amengual JE. Phase II study of the novel antifolate agent pralatrexate in combination with the histone deacetylase inhibitor romidepsin for the treatment of patients with mature T-cell lymphoma. Leuk Lymphoma 2024:1-10. [PMID: 38517235 DOI: 10.1080/10428194.2024.2329996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
Previously, we conducted a Phase I study of the combination of pralatrexate and romidepsin in patients with relapsed/refractory (R/R) lymphomas and subsequently conducted a multicenter Phase II study in patients with untreated or R/R mature T cell lymphomas (MTCL). Patients received pralatrexate 25 mg/m2 and romidepsin 12 mg/m2 every 2 weeks. Fourteen patients were evaluable for efficacy. Overall response rate was 35.7% with CR in 14.3% and disease control in 50%. The mDOR was 8.2 months, mPFS was 3.6 months, and mOS was 20.2 months. Gastrointestinal side effects were most common in up to 33%; there was only one hematologic toxicity of grade 3 anemia. Combining results of MTCL patients from the Phase I and II studies (N = 28), the ORR was 53.5% with CR in 21.4%, disease control in67.8%, and DOR of 7.2 months. The combination was safe however does not out-perform other combination strategies.Trial Registration: www.clinicaltrials.gov (NCT01947140).
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Affiliation(s)
- Yun Kyoung Ryu Tiger
- Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Salvia Jain
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute, Cambridge, MA, USA
| | - Stefan K Barta
- Division of Hematology and Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Department of Hematology and Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Seda Tolu
- Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Brian Estrella
- Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ahmed Sawas
- Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Jennifer K Lue
- Division of Hematology and Oncology, Memorial Sloan Kettering, New York, NY, USA
| | - Mark M Francescone
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Barbara Pro
- Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Jennifer E Amengual
- Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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Quaglino P, Pimpinelli N, Zinzani PL, Paulli M, Pileri S, Berti E, Cerroni L, Guitart J, Kim YH, Rupoli S, Santucci M, Simontacchi G, Vermeer M, Hoppe R, Pro B, Swerdlow SH, Barosi G. Identifying and addressing unmet clinical needs in primary cutaneous B-cell lymphoma: A consensus-based paper from an ad-hoc international panel. Hematol Oncol 2024; 42:e3215. [PMID: 37649350 DOI: 10.1002/hon.3215] [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: 06/03/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
Primary cutaneous B-cell lymphomas (PCBCLs) are lymphoproliferative disorders that appear on the skin without evidence of extracutaneous manifestations at the time of diagnosis. There is a lack of evidence-based guidelines for their clinical management due to the availability of very few large scale studies and controlled clinical trials. Here we present and discuss a series of major unmet clinical needs (UCNs) in the management of PCBCLs by a panel of 16 experts involved in research and clinical practice of PCBCL. The Panel produced recommendations on the appropriateness of the clinical decisions concerning the identified clinical needs and proposed research for improving the knowledge needed to solve them. Recommendations and proposals were achieved by multiple-step formalized procedures to reach a consensus after a comprehensive analysis of the scientific literature. Recommendations and proposals lay in the domain of classification uncertainties of PCBCL, optimization of diagnosis, optimization of prognosis, optimization of staging and critical issues on therapeutic strategies with particular focus on new treatments. These recommendations are intended for use not only by experts but above all by dermatologists and hematologists with limited experience in the field of PCBCLs as well as general practitioners.
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Affiliation(s)
- Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy
| | - Nicola Pimpinelli
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna. Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale. Università di Bologna, Bologna, Italy
- Istituto di Ematologia "Seràgnoli", Azienda Ospedaliero-Universitaria di Bologna - IRCCS, Bologna, Italy
| | - Marco Paulli
- Pathology Section, Department of Molecular Medicine, University of Pavia and Fondazione I.R.C.C.S. Policlinico "S.Matteo", Pavia, Italy
| | - Stefano Pileri
- IEO - European Institute of Oncology IRCCS (Milan) & Bologna University School of Medicine, Milano, Italy
| | - Emilio Berti
- Dermatology Unit, La Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Lorenzo Cerroni
- Department of Dermatology, Research Unit Dermatopathology, Medical University of Graz, Graz, Austria
| | - Joan Guitart
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Youn H Kim
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Serena Rupoli
- Clinica di Ematologia, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Marco Santucci
- Pathology Unit, Careggi University Hospital, Florence, Italy
- Department of Health Sciences, Section of Pathological Anatomy, University of Florence, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Maarten Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Richard Hoppe
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Barbara Pro
- Northwestern University, Chicago, Illinois, USA
| | - Steven H Swerdlow
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Giovanni Barosi
- Center for the Study of Myelofibrosis, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
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5
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Vose JM, Fu K, Wang L, Mansoor A, Stewart D, Cheng H, Smith L, Yuan J, Qureishi HN, Link BK, Cessna MH, Barr PM, Kahl BS, Mckinney MS, Khan N, Advani RH, Martin P, Goy AH, Phillips TJ, Mehta A, Kamdar M, Crump M, Pro B, Flowers CR, Jacobson CA, Smith SM, Stephens DM, Bachanova V, Jin Z, Wu S, Hernandez-Ilizaliturri F, Torka P, Anampa-Guzmán A, Kashef F, Li X, Sharma S, Greiner TC, Armitage JO, Lunning M, Weisenburger DD, Bociek RG, Iqbal J, Yu G, Bi C. Integrative analysis of clinicopathological features defines novel prognostic models for mantle cell lymphoma in the immunochemotherapy era: a report from The North American Mantle Cell Lymphoma Consortium. J Hematol Oncol 2023; 16:122. [PMID: 38104096 PMCID: PMC10725579 DOI: 10.1186/s13045-023-01520-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Patients with mantle cell lymphoma (MCL) exhibit a wide variation in clinical presentation and outcome. However, the commonly used prognostic models are outdated and inadequate to address the needs of the current multidisciplinary management of this disease. This study aims to investigate the clinical and pathological features of MCL in the immunochemotherapy era and improve the prognostic models for a more accurate prediction of patient outcomes. METHODS The North American Mantle Cell Lymphoma Project is a multi-institutional collaboration of 23 institutions across North America to evaluate and refine prognosticators for front-line therapy. A total of 586 MCL cases diagnosed between 2000 and 2012 are included in this study. A comprehensive retrospective analysis was performed on the clinicopathological features, treatment approaches, and outcomes of these cases. The establishment of novel prognostic models was based on in-depth examination of baseline parameters, and subsequent validation in an independent cohort of MCL cases. RESULTS In front-line strategies, the use of hematopoietic stem cell transplantation was the most significant parameter affecting outcomes, for both overall survival (OS, p < 0.0001) and progression-free survival (PFS, p < 0.0001). P53 positive expression was the most significant pathological parameter correlating with inferior outcomes (p < 0.0001 for OS and p = 0.0021 for PFS). Based on the baseline risk factor profile, we developed a set of prognostic models incorporating clinical, laboratory, and pathological parameters that are specifically tailored for various applications. These models, when tested in the validation cohort, exhibited strong predictive power for survival and showed a stratification resembling the training cohort. CONCLUSIONS The outcome of patients with MCL has markedly improved over the past two decades, and further enhancement is anticipated with the evolution of clinical management. The innovative prognostic models developed in this study would serve as a valuable tool to guide the selection of more suitable treatment strategies for patients with MCL.
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Affiliation(s)
- Julie M Vose
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine Fred and Pamela Buffett Cancer Center, 505 S 45Th St, Omaha, NE, 68105, USA
| | - Kai Fu
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lu Wang
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Yantai University, Yantai, China
| | - Adnan Mansoor
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
| | - Douglas Stewart
- Departments of Oncology and Medicine, University of Calgary, Calgary, Canada
| | - Hongxia Cheng
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Lynette Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ji Yuan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Hina Naushad Qureishi
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Brian K Link
- Department of Internal Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Melissa H Cessna
- Department of Pathology, Intermountain Medical Center, Murray, UT, USA
| | - Paul M Barr
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Brad S Kahl
- Department of Medicine, Oncology Division, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Matthew S Mckinney
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Nadia Khan
- Department of Hematology/Oncology, Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Ranjana H Advani
- Division of Oncology, Stanford Cancer Institute, Stanford, CA, USA
| | - Peter Martin
- Division of Hematology and Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Andre H Goy
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | - Tycel J Phillips
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Amitkumar Mehta
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Manali Kamdar
- Division of Hematology, University of Colorado, Denver, CO, USA
| | - Michael Crump
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
| | - Barbara Pro
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Christopher R Flowers
- Division of Cancer Medicine, Department of Lymphoma-Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Caron A Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Sonali M Smith
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Deborah M Stephens
- Huntsman Cancer Institute at University of Utah, Salt Lake City, UT, USA
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Zhaohui Jin
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Shishou Wu
- Department of Pathology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, No.20 Yuhuangding East Road, Yantai, 264000, China
| | | | - Pallawi Torka
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Anampa-Guzmán
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Farshid Kashef
- Department of Pathology, University at Buffalo, Buffalo, NY, USA
| | - Xing Li
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Sunandini Sharma
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Timothy C Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - James O Armitage
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine Fred and Pamela Buffett Cancer Center, 505 S 45Th St, Omaha, NE, 68105, USA
| | - Matthew Lunning
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine Fred and Pamela Buffett Cancer Center, 505 S 45Th St, Omaha, NE, 68105, USA
| | - Dennis D Weisenburger
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Robert G Bociek
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine Fred and Pamela Buffett Cancer Center, 505 S 45Th St, Omaha, NE, 68105, USA
| | - Javeed Iqbal
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Guohua Yu
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA.
- Department of Pathology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, No.20 Yuhuangding East Road, Yantai, 264000, China.
| | - Chengfeng Bi
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine Fred and Pamela Buffett Cancer Center, 505 S 45Th St, Omaha, NE, 68105, USA.
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6
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Karmali R, Abramson JS, Stephens DM, Barnes J, Winter JN, Ma S, Gao J, Kaplan J, Petrich AM, Hochberg E, Takvorian T, Mi X, Nelson V, Gordon LI, Pro B. Ibrutinib maintenance after frontline treatment in patients with mantle cell lymphoma. Blood Adv 2023; 7:7361-7368. [PMID: 37756532 PMCID: PMC10726243 DOI: 10.1182/bloodadvances.2023011271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/19/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Maintenance rituximab in mantle cell lymphoma (MCL) has improved survival and supports exploration of maintenance with novel agents. We evaluated the safety and efficacy of ibrutinib maintenance (I-M) after induction in patients with treatment-naive MCL. Patients with MCL with complete response (CR) or partial response to frontline chemoimmunotherapy ± autologous stem cell transplantation (auto-SCT) received I-M 560 mg daily for up to 4 years. Primary objective was 3-year progression-free survival (PFS) rate from initiation of I-M. Minimal residual disease (MRD) assessments by next-generation sequencing (NGS) on peripheral blood were measured before I-M initiation and at 1, 6, and 18 to 24 months after initiation. Among 36 patients, the median age was 60 years (range, 46-90). For frontline treatment, 18 patients (50%) had consolidation with auto-SCT in CR1 before I-M. At median follow-up of 55.7 months, 17 patients (47%) completed full course I-M (median, 37.5 cycles; range, 2-52). The 3-year PFS and overall survival (OS) rates were 94% and 97%, respectively. With prior auto-SCT, 3-year PFS and OS rates were both 100%. The most common treatment-related adverse event with I-M was infection (n = 31; 86%), typically low grade; the most common grade 3/4 toxicities were hematologic. In 22 patients with MRD assessments, all were MRD negative after induction. Six became MRD positive on I-M, with 2 reverting to MRD-negative status with continued I-M, and all maintain radiographic CR with the exception of 1 with disease progression. I-M is feasible in MCL after frontline chemoimmunotherapy with manageable toxicities although significant. Changes in NGS-MRD were noted in limited patients during maintenance with few progression and survival events. This trial was registered at www.clinicaltrials.gov as #NCT02242097.
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Affiliation(s)
- Reem Karmali
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Jeremy S. Abramson
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Jeffrey Barnes
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jane N. Winter
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Shuo Ma
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Juehua Gao
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jason Kaplan
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Ephraim Hochberg
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Tak Takvorian
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Xinlei Mi
- Department of Preventive Medicine–Biostatistics, Northwestern University, Chicago, IL
| | - Valerie Nelson
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leo I. Gordon
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Barbara Pro
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
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7
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Mellgard G, Stoffel E, Michel A, Iqbal F, Provenzano A, Akpan IJ, Amengual J, Pro B. Hypereosinophilic syndrome with leptomeningeal involvement: a not-so-classical case report of classical Hodgkin Lymphoma. Leuk Lymphoma 2023; 64:2208-2213. [PMID: 37639618 DOI: 10.1080/10428194.2023.2252124] [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: 07/19/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Affiliation(s)
- George Mellgard
- Department of Medicine, NewYork Presbyterian - Columbia University Irving Medical Center, New York, NY, USA
| | - Elina Stoffel
- Department of Medicine, NewYork Presbyterian - Columbia University Irving Medical Center, New York, NY, USA
| | - Alissa Michel
- Department of Hematology and Oncology, NewYork Presbyterian - Columbia University Irving Medical Center, New York, NY, USA
| | - Fatima Iqbal
- Department of Pathology, NewYork Presbyterian - Columbia University Irving Medical Center, New York, NY, USA
| | - Anthony Provenzano
- Department of Hematology and Oncology, NewYork Presbyterian - Columbia University Irving Medical Center, New York, NY, USA
| | - Imo J Akpan
- Department of Hematology and Oncology, NewYork Presbyterian - Columbia University Irving Medical Center, New York, NY, USA
| | - Jennifer Amengual
- Department of Hematology and Oncology, NewYork Presbyterian - Columbia University Irving Medical Center, New York, NY, USA
| | - Barbara Pro
- Department of Hematology and Oncology, NewYork Presbyterian - Columbia University Irving Medical Center, New York, NY, USA
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8
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Amengual JE, Pro B. How I treat posttransplant lymphoproliferative disorder. Blood 2023; 142:1426-1437. [PMID: 37540819 PMCID: PMC10731918 DOI: 10.1182/blood.2023020075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/03/2023] [Accepted: 07/21/2023] [Indexed: 08/06/2023] Open
Abstract
Posttransplant lymphoproliferative disorder (PTLD) is an important and potentially life-threatening complication of solid organ transplant and hematopoietic stem cell transplant (HSCT). Given the heterogeneity of PTLD and the risk of infectious complications in patients with immunosuppression, the treatment of this disease remains challenging. Monomorphic PTLD and lymphoma of B-cell origin account for the majority of cases. Treatment strategies for PTLD consist of response-adapted, risk-stratified methods using immunosuppression reduction, immunotherapy, and/or chemotherapy. With this approach, ∼25% of the patients do not need chemotherapy. Outcomes for patients with high risk or those who do not respond to frontline therapies remain dismal, and novel treatments are needed in this setting. PTLD is associated with Epstein-Barr virus (EBV) infection in 60% to 80% of cases, making EBV-directed therapy an attractive treatment modality. Recently, the introduction of adoptive immunotherapies has become a promising option for refractory cases; hopefully, these treatment strategies can be used as earlier lines of therapy in the future.
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Affiliation(s)
- Jennifer E. Amengual
- Division of Hematology and Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | - Barbara Pro
- Division of Hematology and Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
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9
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Ruan J, Zain J, Palmer B, Jovanovic B, Mi X, Swaroop A, Winter JN, Gordon LI, Karmali R, Moreira J, Petrich AM, Pro B. Multicenter phase 2 study of romidepsin plus lenalidomide for previously untreated peripheral T-cell lymphoma. Blood Adv 2023; 7:5771-5779. [PMID: 37327113 PMCID: PMC10561000 DOI: 10.1182/bloodadvances.2023009767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023] Open
Abstract
Peripheral T-cell lymphomas (PTCLs) are associated with poor prognosis when treated with cytotoxic chemotherapy. We report the findings of a phase 2 study evaluating a chemotherapy-free combination of romidepsin plus lenalidomide as initial treatment for patients with PTCL who were aged >60 years or noncandidates for chemotherapy. Treatment was initiated with romidepsin 10 mg/m2 IV on days 1, 8, and 15 and lenalidomide 25 mg taken orally from days 1 to 21 of 28-day cycle for up to 1 year. The primary objective was overall response rate (ORR). Secondary objectives included safety and survival. The study enrolled 29 patients with a median age of 75 years, including 16 (55%) angioimmunoblastic T-cell lymphoma (AITL), 10 (34%) PTCL- not otherwise specified, 2 ATLL, and 1 EATL. Grade 3 to 4 hematologic toxicities included neutropenia (45%), thrombocytopenia (34%), and anemia (28%). Grade 3 to 4 nonhematologic toxicities included hyponatremia (45%), hypertension (38%), hypoalbuminemia (24%), fatigue (17%), hyperglycemia (14%), hypokalemia (14%), dehydration (10%), and infection (10%). At median follow-up of 15.7 months, 23 patients were evaluable and received a median treatment of 6 cycles. The ORR was 65.2% with complete response (CR) at 26.1%, including 78.6% ORR and 35.7% CR for AITL. Median duration of response was 10.7 months, with 27.1 months for patients achieving CR. The estimated 2-year progression-free survival was 31.5%, and 2-year overall survival was 49.5%. This study provides the first demonstration that the biologic combination of romidepsin and lenalidomide is feasible and effective as initial therapy for PTCL and warrants further evaluation. This trial was registered at www.clinicaltrials.gov as #NCT02232516.
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Affiliation(s)
- Jia Ruan
- Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Jasmine Zain
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Brett Palmer
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Borko Jovanovic
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Xinlei Mi
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alok Swaroop
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jane N. Winter
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leo I. Gordon
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Reem Karmali
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jonathan Moreira
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Hematology and Oncology, Columbia University Irving Medical Center, New York, NY
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10
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Zurko J, Nizamuddin I, Epperla N, David K, Cohen JB, Moyo TK, Ollila T, Hess B, Roy I, Ferdman R, Liu J, Chowdhury SM, Romancik J, Bhansali RS, Harris EI, Sorrell M, Masel R, Kittai AS, Denlinger N, Sigmund AM, Fitzgerald L, Galvez C, Ma S, Winter J, Pro B, Gordon LI, Danilov A, Stephens D, Shah NN, Kenkre V, Barta SK, Torka P, Shouse G, Karmali R. Peri-CAR-T practice patterns and survival predictors for all CAR-T patients and post-CAR-T failure in aggressive B-NHL. Blood Adv 2023; 7:2657-2669. [PMID: 36094847 PMCID: PMC10333741 DOI: 10.1182/bloodadvances.2022008240] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 06/01/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/20/2022] Open
Abstract
Most patients receiving chimeric antigen receptor T-cell therapy (CAR-T) for aggressive B-cell non-Hodgkin lymphoma (B-NHL) do not experience a durable remission. Several novel agents are approved to treat relapsed, refractory aggressive B-NHL; however, it remains unclear how to sequence these therapies pre- and post-CAR-T. We conducted a multicenter retrospective analysis to describe peri-CAR-T practice patterns and survival predictors for patients receiving CD19-directed CAR-T. Patients (n = 514) from 13 centers treated with CAR-T for B-NHL between 2015-2021 were included in the study. Survival curves were constructed using Kaplan-Meier method. Multivariate Cox regression analysis was used to determine the impact of the variables on survival outcomes. For all patients receiving CAR-T, a greater number of lines of therapy pre-CAR-T apheresis and bridging therapy were predictive of inferior progression-free survival (PFS) and overall survival (OS). The median PFS and OS from the time of CAR-T cell infusion were 7.6 and 25.6 months, respectively. From the time of progression post-CAR-T, the median OS was 5.5 months. The median PFS of treatments administered in the first-line post-CAR-T failure was 2.8 months. Patients with refractory disease on day 30 had inferior OS and were less likely to receive subsequent treatment(s) than other patients with CAR-T failure. Allogeneic hematopoietic cell transplantation for selected patients at any time following CAR-T failure led to durable responses in over half of patients at 1 year. These data provide a benchmark for future clinical trials in patients with post-CAR-T cell progression, which remains an unmet clinical need.
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Affiliation(s)
- Joanna Zurko
- Department of Medicine, Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Imran Nizamuddin
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Narendranath Epperla
- Department of Internal Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Kevin David
- Department of Medicine, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Jonathon B. Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | | | - Thomas Ollila
- Department of Medicine, Lifespan Cancer Institute, Brown University, Providence, RI
| | - Brian Hess
- Department of Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Ishan Roy
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert Ferdman
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Jieqi Liu
- Department of Medicine, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Sayan Mullick Chowdhury
- Department of Internal Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Jason Romancik
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Rahul S. Bhansali
- Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Elyse I. Harris
- Department of Medicine, Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Mckenzie Sorrell
- Department of Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Rebecca Masel
- Department of Medicine, Lifespan Cancer Institute, Brown University, Providence, RI
| | - Adam S. Kittai
- Department of Internal Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Nathan Denlinger
- Department of Internal Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Audrey M. Sigmund
- Department of Internal Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Lindsey Fitzgerald
- Department of Internal Medicine, Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | - Carlos Galvez
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shuo Ma
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jane Winter
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Barbara Pro
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leo I. Gordon
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alexey Danilov
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Deborah Stephens
- Department of Internal Medicine, Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | - Nirav N. Shah
- Department of Medicine, MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI
| | - Vaishalee Kenkre
- Department of Medicine, Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Stefan K. Barta
- Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Pallawi Torka
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Geoffrey Shouse
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Reem Karmali
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
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11
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Poon L, de Leval L, Ng SB, Song Y, Pro B, Savage KJ, Ruan J, Mehta-Shah N, Vose JM. Hematological Oncology journal women in lymphoma special issue: Latest updates in nodal peripheral T-cell lymphoma. Hematol Oncol 2023. [PMID: 37309261 DOI: 10.1002/hon.3191] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 05/19/2023] [Indexed: 06/14/2023]
Abstract
In the last decade, there has been increased understanding of the pathologic features and biology of peripheral T cell lymphomas (PTCLs) through development of multi omics and molecular profiling techniques. In addition, international collaborations through multi center trials as well as prospective registry studies have improved our knowledge of host and tumor genomic factors and treatment factors affecting disease outcomes. In our review today, we aim to highlight the current epidemiology, latest advances in classification, disease biology and the evolving treatment landscape for nodal PTCLs.
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Affiliation(s)
- Limei Poon
- Department of Hematology/Oncology, National University Cancer Institute, Singapore, Singapore
| | - Laurence de Leval
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Siok Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yuqin Song
- Department of Lymphoma, Peking University Cancer Hospital & Institute (Beijing Cancer Hospital), Beijing, China
| | - Barbara Pro
- Division of Hematology and Oncology, Columbia University and New York Presbyterian Hospital, New York, New York, USA
| | - Kerry J Savage
- Division of Medical Oncology, Centre for Lymphoid Cancer, University of British Columbia, BC Cancer, Vancouver, British Columbia, Canada
| | - Jia Ruan
- Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA
| | - Neha Mehta-Shah
- Division of Oncology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Julie M Vose
- Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
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12
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Bryan LJ, Casulo C, Allen PB, Smith SE, Savas H, Dillehay GL, Karmali R, Pro B, Kane KL, Bazzi LA, Chmiel JS, Palmer BA, Mehta J, Gordon LI, Winter JN. Pembrolizumab Added to Ifosfamide, Carboplatin, and Etoposide Chemotherapy for Relapsed or Refractory Classic Hodgkin Lymphoma: A Multi-institutional Phase 2 Investigator-Initiated Nonrandomized Clinical Trial. JAMA Oncol 2023; 9:683-691. [PMID: 36928527 PMCID: PMC10020934 DOI: 10.1001/jamaoncol.2022.7975] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 09/15/2022] [Accepted: 12/08/2022] [Indexed: 03/17/2023]
Abstract
Importance To our knowledge, this is the first clinical trial designed to investigate concurrent treatment with a checkpoint inhibitor and conventional chemotherapy in relapsed or refractory classic Hodgkin lymphoma in patients destined for an autologous stem cell transplant. Objective To evaluate the complete response rate as assessed by 18F-fluorodeoxyglucose-positron emission tomography with computed tomography (FDG-PET/CT) after salvage therapy for patients with relapsed or refractory classic Hodgkin lymphoma. Design, Setting, and Participants A single-group, phase 2, multi-institutional nonrandomized clinical trial to evaluate the addition of pembrolizumab to ifosfamide, carboplatin, and etoposide (ICE) chemotherapy was conducted from April 20, 2017, to October 29, 2020, at 5 US sites. The 42 patients were aged 18 years or older, with an Eastern Cooperative Oncology Group Performance Status Scale score of 0 or 1 and biopsy-proven relapsed or refractory classic Hodgkin lymphoma after 1 or 2 prior lines of chemotherapy. Patients were required to be appropriate candidates for transplant, with measurable lesions detected by FDG-PET/CT. Interventions Two cycles of pembrolizumab (200 mg intravenously on day 1) with ICE chemotherapy every 21 days, followed by stem cell mobilization and collection, and then 1 cycle of pembrolizumab monotherapy followed by FDG-PET/CT response assessment. Main Outcomes and Measures The primary end point was complete response rate detected by FDG-PET/CT, defined as a Deauville score of 3 or lower. Patients with a complete response proceeded to an autologous stem cell transplant. Secondary end points included progression-free survival, overall survival, stem cell mobilization, and neutrophil and platelet engraftment. Adverse events were monitored to assess safety. Results Forty-two patients were enrolled, with 37 evaluable for the primary end point. The median age was 34 years (range, 19-70 years), 25 patients were female (68%), 6 were African American (16%), and 26 were White (70%). The complete response rate for the 37 patients assessed by FDG-PET/CT imaging was 86.5% (95% CI, 71.2%-95.5%); the overall response rate was 97.3% (36 patients), with 10.8% partial responses (4 patients). New areas of FDG-PET positivity in 2 patients were biopsied, showing noncaseating granuloma in 1 case and a reactive lymph node in a second. Progression-free survival and overall survival 2-year estimates were 87.2% (32 patients; 95% CI, 77.3%-98.3%) and 95.1% (95% CI, 88.8%-100%), respectively. The addition of pembrolizumab to ICE chemotherapy did not negatively affect stem cell mobilization or collection or engraftment, similar to prior experience in this patient population and setting. Conclusions and Relevance Results suggest that the addition of pembrolizumab to ICE chemotherapy was well tolerated and highly effective in comparison with prior reports of chemotherapy-only regimens, supporting further investigation in patients with relapsed or refractory classic Hodgkin lymphoma eligible for an autologous stem cell transplant. Trial Registration ClinicalTrials.gov Identifier: NCT03077828.
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Affiliation(s)
- Locke J. Bryan
- Division of Hematology and Oncology, Georgia Cancer Center at Augusta University, Augusta
| | - Carla Casulo
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Pamela B. Allen
- Division of Hematology and Oncology, Emory University, Atlanta, Georgia
| | - Scott E. Smith
- Division of Hematology and Oncology, Loyola University Medical Center, Maywood, Illinois
| | - Hatice Savas
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Gary L. Dillehay
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Reem Karmali
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kaitlyn L. Kane
- Robert H. Lurie Comprehensive Cancer Center, Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Latifa A. Bazzi
- Robert H. Lurie Comprehensive Cancer Center, Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joan S. Chmiel
- Robert H. Lurie Comprehensive Cancer Center, Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Brett A. Palmer
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jayesh Mehta
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Leo I. Gordon
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jane N. Winter
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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13
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Karmali R, St‐Pierre F, Ma S, Foster KD, Kaplan J, Mi X, Pro B, Winter JN, Gordon LI. Phase I study of novel SYK inhibitor TAK-659 (mivavotinib) in combination with R-CHOP for front-line treatment of high-risk diffuse large B-cell lymphoma. EJHaem 2023; 4:108-114. [PMID: 36819145 PMCID: PMC9928783 DOI: 10.1002/jha2.625] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/12/2022] [Accepted: 11/17/2022] [Indexed: 05/20/2023]
Abstract
Background: TAK-659, a novel oral SYK inhibitor, has demonstrated efficacy in heavily pretreated diffuse large B-cell lymphoma (DLBCL). We report results of a phase I single-institution escalation study of front-line treatment with R-CHOP and TAK-659 in treatment-naïve high-risk DLBCL. Methods: Patients with high-risk DLBCL were treated with R-CHOP for 1 cycle, followed by combined R-CHOP and TAK-659 for an additional five cycles, with TAK-659 dosing escalated from 60 mg, to 80 mg, to 100 mg daily, based on a 3 + 3 design. The primary objective was to determine the safety and establish the maximum tolerated dose (MTD) of TAK-659 in this setting. Results: Twelve patients were enrolled. Dose level 3 (100 mg) was established as the MTD. Dose level 1 (60 mg) maintained a similar area under the curve (AUC) to the MTD. With a median follow-up of 21 months, 92% of patients achieved complete response (CR). The most common treatment-emergent adverse events were lymphopenia (100%), infection (50%, n = 3 opportunistic), aspartate aminotransferase elevation (100%), and alanine aminotransferase elevation (83%). Conclusion: A TAK-659 dose of 60 mg was well tolerated, did not require dose modifications, and maintained a similar AUC to the MTD. The combination of R-CHOP and TAK-659 in patients with newly diagnosed high-risk DLBCL produces promising CR rates.
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Affiliation(s)
- Reem Karmali
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology/Oncology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Division of Hematology/OncologyNorthwestern UniversityChicagoIllinoisUSA
| | - Frederique St‐Pierre
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology/Oncology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Shuo Ma
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology/Oncology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Division of Hematology/OncologyNorthwestern UniversityChicagoIllinoisUSA
| | - Kelly D. Foster
- Northwestern Medicine Lake Forest HospitalLake ForestIllinoisUSA
| | - Jason Kaplan
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology/Oncology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Division of Hematology/OncologyNorthwestern UniversityChicagoIllinoisUSA
| | - Xinlei Mi
- Department of Preventative Medicine ‐ Biostatistics, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology/Oncology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Division of Hematology/OncologyNorthwestern UniversityChicagoIllinoisUSA
| | - Jane N. Winter
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology/Oncology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Division of Hematology/OncologyNorthwestern UniversityChicagoIllinoisUSA
| | - Leo I. Gordon
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology/Oncology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Division of Hematology/OncologyNorthwestern UniversityChicagoIllinoisUSA
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14
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Campo E, Jaffe ES, Cook JR, Quintanilla-Martinez L, Swerdlow SH, Anderson KC, Brousset P, Cerroni L, de Leval L, Dirnhofer S, Dogan A, Feldman AL, Fend F, Friedberg JW, Gaulard P, Ghia P, Horwitz SM, King RL, Salles G, San-Miguel J, Seymour JF, Treon SP, Vose JM, Zucca E, Advani R, Ansell S, Au WY, Barrionuevo C, Bergsagel L, Chan WC, Cohen JI, d'Amore F, Davies A, Falini B, Ghobrial IM, Goodlad JR, Gribben JG, Hsi ED, Kahl BS, Kim WS, Kumar S, LaCasce AS, Laurent C, Lenz G, Leonard JP, Link MP, Lopez-Guillermo A, Mateos MV, Macintyre E, Melnick AM, Morschhauser F, Nakamura S, Narbaitz M, Pavlovsky A, Pileri SA, Piris M, Pro B, Rajkumar V, Rosen ST, Sander B, Sehn L, Shipp MA, Smith SM, Staudt LM, Thieblemont C, Tousseyn T, Wilson WH, Yoshino T, Zinzani PL, Dreyling M, Scott DW, Winter JN, Zelenetz AD. The International Consensus Classification of Mature Lymphoid Neoplasms: a report from the Clinical Advisory Committee. Blood 2022; 140:1229-1253. [PMID: 35653592 PMCID: PMC9479027 DOI: 10.1182/blood.2022015851] [Citation(s) in RCA: 450] [Impact Index Per Article: 225.0] [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: 04/14/2022] [Accepted: 05/18/2022] [Indexed: 11/20/2022] Open
Abstract
Since the publication of the Revised European-American Classification of Lymphoid Neoplasms in 1994, subsequent updates of the classification of lymphoid neoplasms have been generated through iterative international efforts to achieve broad consensus among hematopathologists, geneticists, molecular scientists, and clinicians. Significant progress has recently been made in the characterization of malignancies of the immune system, with many new insights provided by genomic studies. They have led to this proposal. We have followed the same process that was successfully used for the third and fourth editions of the World Health Organization Classification of Hematologic Neoplasms. The definition, recommended studies, and criteria for the diagnosis of many entities have been extensively refined. Some categories considered provisional have now been upgraded to definite entities. Terminology for some diseases has been revised to adapt nomenclature to the current knowledge of their biology, but these modifications have been restricted to well-justified situations. Major findings from recent genomic studies have impacted the conceptual framework and diagnostic criteria for many disease entities. These changes will have an impact on optimal clinical management. The conclusions of this work are summarized in this report as the proposed International Consensus Classification of mature lymphoid, histiocytic, and dendritic cell tumors.
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Affiliation(s)
- Elias Campo
- Haematopathology Section, Hospital Clínic of Barcelona, Institut d'Investigaciones Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Barcelona, Spain
| | - Elaine S Jaffe
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - James R Cook
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Steven H Swerdlow
- Department of Pathology, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Pierre Brousset
- Department of Pathology, Institut Universitaire du Cancer de Toulouse-Oncopole, and Laboratoire d'Excellence Toulouse Cancer, Toulouse, France
| | - Lorenzo Cerroni
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ahmet Dogan
- Laboratory of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Falko Fend
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | | | - Philippe Gaulard
- Department of Pathology, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
- Mondor Institute for Biomedical Research, INSERM U955, Faculty of Medicine, University of Paris-Est Créteil, Créteil, France
| | - Paolo Ghia
- Strategic Research Program on Chronic Lymphocytic Leukemia, Division of Experimental Oncology, IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Steven M Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rebecca L King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Gilles Salles
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jesus San-Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, CIBERONC, Pamplona, Spain
| | - John F Seymour
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Julie M Vose
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, University of Nebraska, Omaha, NE
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, and Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Ranjana Advani
- Stanford Cancer Center, Blood and Marrow Transplant Program, Stanford University, Stanford, CA
| | - Stephen Ansell
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Wing-Yan Au
- Blood-Med Clinic, Hong Kong, People's Republic of China
| | - Carlos Barrionuevo
- Department of Pathology, Instituto Nacional de Enfermedades Neoplásicas, Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Leif Bergsagel
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ
| | - Wing C Chan
- Department of Pathology, City of Hope National Medical Center, Duarte, CA
| | - Jeffrey I Cohen
- Medical Virology Section, Laboratory of Infectious Diseases, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Francesco d'Amore
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Andrew Davies
- Cancer Research UK Centre, Centre for Cancer Immunology, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| | - Brunangelo Falini
- Institute of Hematology and Center for Hemato-Oncology Research, Hospital of Perugia, University of Perugia , Perugia, Italy
| | - Irene M Ghobrial
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Harvard University, Boston, MA
| | - John R Goodlad
- National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - John G Gribben
- Department of Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Eric D Hsi
- Department of Pathology, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Brad S Kahl
- Oncology Division, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Won-Seog Kim
- Hematology and Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Shaji Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Camille Laurent
- Department of Pathology, Institut Universitaire du Cancer de Toulouse-Oncopole, and Laboratoire d'Excellence Toulouse Cancer, Toulouse, France
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - John P Leonard
- Weill Department of Medicine, Weill Medical College, Cornell University, New York, NY
| | - Michael P Link
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Armando Lopez-Guillermo
- Department of Hematology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Maria Victoria Mateos
- Department of Hematology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cancer, Universidad de Salamanca, Salamanca, Spain
| | - Elizabeth Macintyre
- Laboratoire d'Onco-Hématologie, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris Cité and Institut Necker-Enfants Malades, Paris, France
| | - Ari M Melnick
- Division of Hematology and Oncology, Weill Medical College, Cornell University, New York, NY
| | - Franck Morschhauser
- Department of Hematology, Centre Hospitalier Universitaire de Lille, University Lille, Lille, France
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Marina Narbaitz
- Department of Pathology, Instituto de Investigaciones Hematológicas, Academia Nacional de Medicina and Fundacion para combatir la leucemia (FUNDALEU), Buenos Aires, Argentina
| | - Astrid Pavlovsky
- Fundación para Combatir la Leucemia (FUNDALEU), Centro de Hematología Pavlovsky, Buenos Aires, Argentina
| | - Stefano A Pileri
- Haematopathology Division, IRCCS, Istituto Europeo di Oncologia, Milan, Italy
| | - Miguel Piris
- Jiménez Díaz Foundation University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Barbara Pro
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Vincent Rajkumar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Steven T Rosen
- Beckman Research Institute, and Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Birgitta Sander
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Laurie Sehn
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Louis M Staudt
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Catherine Thieblemont
- Service Hémato-Oncologie, AP-HP, Hôpital Saint-Louis, Paris, France
- DMU-DHI, Université de Paris-Paris Diderot, Paris, France
| | - Thomas Tousseyn
- Department of Pathology, Universitair Ziekenhuis Leuven Hospitals, Leuven, Belgium
| | - Wyndham H Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Tadashi Yoshino
- Department of Pathology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Pier-Luigi Zinzani
- Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seragnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Martin Dreyling
- Department of Medicine III, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - David W Scott
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Jane N Winter
- Feinberg School of Medicine, Northwestern University, Chicago, IL; and
| | - Andrew D Zelenetz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Medical College, Cornell University, New York, NY
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15
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Roy I, Smilnak G, Burkart M, Hamilton E, Thorp K, Miyata S, Ma S, Pro B, Winter J, Gordon L, Karmali R. Cachexia is a risk factor for negative clinical and functional outcomes in patients receiving chimeric antigen receptor T-cell therapy for B-cell non-Hodgkin lymphoma. Br J Haematol 2022; 197:71-75. [PMID: 35141891 DOI: 10.1111/bjh.18054] [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: 10/06/2021] [Revised: 12/21/2021] [Accepted: 01/10/2022] [Indexed: 11/30/2022]
Abstract
Cachexia is a muscle-wasting syndrome that is known to impact the clinical course of several cancer populations but has not been specifically investigated in patients receiving chimeric antigen receptor T (CAR-T) cell therapy. In this study, we investigated the relationship between cachexia markers and several cancer and functional outcomes in a pilot population of aggressive B-cell non-Hodgkin lymphoma patients receiving CAR-T. We found that the prognostic nutritional index was linked to progression-free survival, overall survival, and disability-free survival, while several additional weight and serum-based markers of cachexia were also associated with negative outcomes. These data prompt further investigation of cachexia markers in populations receiving CAR-T cell therapy.
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Affiliation(s)
- Ishan Roy
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Gordon Smilnak
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Madelyn Burkart
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | | | | | - Sarah Miyata
- Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Shuo Ma
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Barbara Pro
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Jane Winter
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Leo Gordon
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Reem Karmali
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
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16
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Horwitz S, O'Connor OA, Pro B, Trümper L, Iyer S, Advani R, Bartlett NL, Christensen JH, Morschhauser F, Domingo-Domenech E, Rossi G, Kim WS, Feldman T, Menne T, Belada D, Illés Á, Tobinai K, Tsukasaki K, Yeh SP, Shustov A, Hüttmann A, Savage KJ, Yuen S, Zinzani PL, Miao H, Bunn V, Fenton K, Fanale M, Puhlmann M, Illidge T. The ECHELON-2 Trial: 5-year results of a randomized, phase 3 study of brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma. Ann Oncol 2021; 33:288-298. [PMID: 34921960 PMCID: PMC9447792 DOI: 10.1016/j.annonc.2021.12.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [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: 08/26/2021] [Revised: 11/12/2021] [Accepted: 12/07/2021] [Indexed: 01/18/2023] Open
Abstract
Background: For patients with peripheral T-cell lymphoma (PTCL), outcomes using frontline treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-like therapy are typically poor. The ECHELON-2 study demonstrated that brentuximab vedotin plus cyclophosphamide, doxorubicin, and prednisone (A+CHP) exhibited statistically superior progression-free survival (PFS) per independent central review and improvements in overall survival versus CHOP for the frontline treatment of patients with systemic anaplastic large cell lymphoma or other CD30-positive PTCL. Patients and methods: ECHELON-2 is a double-blind, double-dummy, randomized, placebo-controlled, active-comparator phase III study. We present an exploratory update of the ECHELON-2 study, including an analysis of 5-year PFS per investigator in the intent-to-treat analysis group. Results: A total of 452 patients were randomized (1 : 1) to six or eight cycles of A+CHP (N = 226) or CHOP (N = 226). At median follow-up of 47.6 months, 5-year PFS rates were 51.4% [95% confidence interval (CI): 42.8% to 59.4%] with A+CHP versus 43.0% (95% CI: 35.8% to 50.0%) with CHOP (hazard ratio = 0.70; 95% CI: 0.53–0.91), and 5-year overall survival (OS) rates were 70.1% (95% CI: 63.3% to 75.9%) with A+CHP versus 61.0% (95% CI: 54.0% to 67.3%) with CHOP (hazard ratio = 0.72; 95% CI: 0.53–0.99). Both PFS and OS were generally consistent across key subgroups. Peripheral neuropathy was resolved or improved in 72% (84/117) of patients in the A+CHP arm and 78% (97/124) in the CHOP arm. Among patients who relapsed and subsequently received brentuximab vedotin, the objective response rate was 59% with brentuximab vedotin retreatment after A+CHP and 50% with subsequent brentuximab vedotin after CHOP. Conclusions: In this 5-year update of ECHELON-2, frontline treatment of patients with PTCL with A+CHP continues to provide clinically meaningful improvement in PFS and OS versus CHOP, with a manageable safety profile, including continued resolution or improvement of peripheral neuropathy.
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Affiliation(s)
- S Horwitz
- Memorial Sloan Kettering Cancer Center, New York, New York, USA.
| | - O A O'Connor
- University of Virginia Cancer Center, University of Virginia, Charlottesville, Virginia, USA
| | - B Pro
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - L Trümper
- Universitätsmedizin Göttingen, Göttingen, Germany
| | - S Iyer
- MD Anderson Cancer Center/University of Texas, Houston, Texas, USA
| | - R Advani
- Stanford Cancer Center, Blood and Marrow Transplant Program, Stanford, California, USA
| | - N L Bartlett
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | - E Domingo-Domenech
- Institut Catala D'oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - G Rossi
- Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - W S Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - T Feldman
- John Theurer Cancer Center, Hackensack Meridian Health School of Medicine, Hackensack NJ
| | - T Menne
- Freeman Hospital, Newcastle upon Tyne, England
| | - D Belada
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Králové, Czech Republic and Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic
| | - Á Illés
- Debreceni Egyetem, Debrecen, Hajdu-Bihar, Hungary
| | - K Tobinai
- National Cancer Center Hospital, Tokyo, Japan
| | - K Tsukasaki
- Saitama Medical University International Medical Center, Saitama, Japan
| | - S-P Yeh
- China Medical University Hospital, Taichung, Taiwan
| | - A Shustov
- University of Washington Medical Center, Seattle, Washington, USA
| | - A Hüttmann
- Universitatsklinikum Essen, Essen, Nordrhein-Westfalen, Germany
| | - K J Savage
- Department of Medical Oncology and University of British Columbia, BC Cancer, Vancouver, British Columbia, Canada
| | - S Yuen
- Calvary Mater Newcastle Hospital, Australia
| | - P L Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli"; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italia
| | - H Miao
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, USA, a wholly owned subsidiary of Takeda Pharmaceuticals Limited
| | - V Bunn
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, USA, a wholly owned subsidiary of Takeda Pharmaceuticals Limited
| | - K Fenton
- Seagen Inc., Bothell, Washington, USA
| | - M Fanale
- Seagen Inc., Bothell, Washington, USA
| | | | - T Illidge
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Biomedical Research Centre, Manchester Academic Health Sciences Centre, Christie Hospital NHS Foundation Trust, Manchester, UK
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17
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Park J, Daniels J, Wartewig T, Ringbloom KG, Martinez-Escala ME, Choi S, Thomas JJ, Doukas PG, Yang J, Snowden C, Law C, Lee Y, Lee K, Zhang Y, Conran C, Tegtmeyer K, Mo SH, Pease DR, Jothishankar B, Kwok PY, Abdulla FR, Pro B, Louissaint A, Boggon TJ, Sosman J, Guitart J, Rao D, Ruland J, Choi J. Integrated genomic analyses of cutaneous T-cell lymphomas reveal the molecular bases for disease heterogeneity. Blood 2021; 138:1225-1236. [PMID: 34115827 PMCID: PMC8499046 DOI: 10.1182/blood.2020009655] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 10/22/2020] [Accepted: 05/20/2021] [Indexed: 11/20/2022] Open
Abstract
Cutaneous T-cell lymphomas (CTCLs) are a clinically heterogeneous collection of lymphomas of the skin-homing T cell. To identify molecular drivers of disease phenotypes, we assembled representative samples of CTCLs from patients with diverse disease subtypes and stages. Via DNA/RNA-sequencing, immunophenotyping, and ex vivo functional assays, we identified the landscape of putative driver genes, elucidated genetic relationships between CTCLs across disease stages, and inferred molecular subtypes in patients with stage-matched leukemic disease. Collectively, our analysis identified 86 putative driver genes, including 19 genes not previously implicated in this disease. Two mutations have never been described in any cancer. Functionally, multiple mutations augment T-cell receptor-dependent proliferation, highlighting the importance of this pathway in lymphomagenesis. To identify putative genetic causes of disease heterogeneity, we examined the distribution of driver genes across clinical cohorts. There are broad similarities across disease stages. Many driver genes are shared by mycosis fungoides (MF) and Sezary syndrome (SS). However, there are significantly more structural variants in leukemic disease, leading to highly recurrent deletions of putative tumor suppressors that are uncommon in early-stage skin-centered MF. For example, TP53 is deleted in 7% and 87% of MF and SS, respectively. In both human and mouse samples, PD1 mutations drive aggressive behavior. PD1 wild-type lymphomas show features of T-cell exhaustion. PD1 deletions are sufficient to reverse the exhaustion phenotype, promote a FOXM1-driven transcriptional signature, and predict significantly worse survival. Collectively, our findings clarify CTCL genetics and provide novel insights into pathways that drive diverse disease phenotypes.
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Affiliation(s)
- Joonhee Park
- Department of Dermatology, and
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jay Daniels
- Department of Dermatology, and
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tim Wartewig
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
- Center for Translational Cancer Research (TranslaTUM), Munich, Germany
| | - Kimberly G Ringbloom
- Department of Dermatology, and
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | - Jane J Thomas
- Department of Dermatology, and
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Jingyi Yang
- Department of Dermatology, and
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Caroline Snowden
- Department of Dermatology, and
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Calvin Law
- Department of Dermatology, and
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Yujin Lee
- Department of Dermatology, and
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Katie Lee
- Department of Dermatology, and
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Yancong Zhang
- Department of Dermatology, and
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Kyle Tegtmeyer
- Department of Dermatology, and
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Samuel H Mo
- Department of Dermatology, and
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Balaji Jothishankar
- Department of Medicine, Section of Dermatology, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Pui-Yan Kwok
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA
| | - Farah R Abdulla
- Division of Dermatology, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Barbara Pro
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Abner Louissaint
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Titus J Boggon
- Department of Pharmacology and
- Department of Molecular Biology and Biophysics, Yale University School of Medicine, New Haven, CT
| | - Jeffrey Sosman
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | | | - Deepak Rao
- Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jürgen Ruland
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
- Center for Translational Cancer Research (TranslaTUM), Munich, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany; and
- German Center for Infection Research (DZIF), Munich, Germany
| | - Jaehyuk Choi
- Department of Dermatology, and
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
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18
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Daniels J, Park J, Wartewig T, Martinez-Escala ME, Pro B, Sosman J, Guitart J, Rao D, Ruland J, Choi J. PD1 regulates T cell exhaustion phenotypes and disease aggressiveness in CTCL. Eur J Cancer 2021. [DOI: 10.1016/s0959-8049(21)00629-8] [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: 11/30/2022]
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19
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Park J, Daniels J, Ringbloom K, Martinez-Escala ME, Yang J, Snowden C, Zhang Y, Mo S, Pro B, Sosman J, Guitart J, Choi J. Subtype-specific differences in the genomic landscape of cutaneous T cell lymphomas. Eur J Cancer 2021. [DOI: 10.1016/s0959-8049(21)00628-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Pearse WB, Petrich AM, Gordon LI, Karmali R, Winter JN, Ma S, Kaplan JB, Behdad A, Klein A, Jovanovic B, Helenowski I, Smith SM, Evens AM, Pro B. A phase I/II trial of brentuximab vedotin plus rituximab as frontline therapy for patients with immunosuppression-associated CD30+ and/or EBV + lymphomas. Leuk Lymphoma 2021; 62:3493-3500. [PMID: 34338127 DOI: 10.1080/10428194.2021.1957867] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Treatment strategies for post-transplant lymphoproliferative disorders (PTLD) consist of response-adapted risk-stratified methods using immunosuppression reduction, immunotherapy, and chemotherapy. We investigated the efficacy of Brentuximab vedotin given concurrently with Rituximab (BV + R) once weekly for four weeks, followed by optional consolidation, and up to one year of maintenance. Among 20 assessable patients, BV + R therapy resulted in an overall response rate of 75% (95% CI 51 to 91, p = 0.044) with 60% achieving a complete response. Median time to best response was 28 days. Two-year progression-free survival and overall survival rates were 75 and 90%, respectively. Most common severe grade 3/4 treatment-related toxicities included neutropenia (40%), hypertension (30%), infection (25%), and peripheral neuropathy (15%). BV + R is a novel and effective therapeutic strategy that achieved rapid and durable remissions in previously untreated PTLD patients; however, this treatment platform requires further modification due to the high rates of treatment-related toxicity.Key pointsBrentuximab vedotin + Rituximab showed ORR and CR rates of 75 and 60% in patients with immunosuppression-associated lymphoid malignanciesHigh rates of treatment delay were attributed to treatment-related toxicity; further dosing optimization of this regimen is required.
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Affiliation(s)
- William B Pearse
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Adam M Petrich
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Leo I Gordon
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Reem Karmali
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane N Winter
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shuo Ma
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jason B Kaplan
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amir Behdad
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andreas Klein
- Department of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
| | - Borko Jovanovic
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Irene Helenowski
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Barbara Pro
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Mehta-Shah N, Horwitz SM, Ansell S, Ai WZ, Barnes J, Barta SK, Clemens MW, Dogan A, Fisher K, Goodman AM, Goyal G, Guitart J, Halwani A, Haverkos BM, Hoppe RT, Jacobsen E, Jagadeesh D, Lunning MA, Mehta A, Olsen EA, Pro B, Rajguru SA, Shanbhag S, Shaver A, Shustov A, Sokol L, Torka P, Torres-Cabala C, Wilcox R, William BM, Zain J, Dwyer MA, Sundar H, Kim YH. NCCN Guidelines Insights: Primary Cutaneous Lymphomas, Version 2.2020. J Natl Compr Canc Netw 2021; 18:522-536. [PMID: 32380458 DOI: 10.6004/jnccn.2020.0022] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma (CTCL), and Sézary syndrome (SS) is a rare erythrodermic and leukemic subtype of CTCL characterized by significant blood involvement. Although early-stage disease can be effectively treated predominantly with skin-directed therapies, systemic therapy is often necessary for the treatment of advanced-stage disease. Systemic therapy options have evolved in recent years with the approval of novel agents such as romidepsin, brentuximab vedotin, and mogamulizumab. These NCCN Guidelines Insights discuss the diagnosis and management of MF and SS (with a focus on systemic therapy).
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Affiliation(s)
- Neha Mehta-Shah
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Weiyun Z Ai
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Stefan K Barta
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | - Kristopher Fisher
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Joan Guitart
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | - Deepa Jagadeesh
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Satish Shanbhag
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Andrei Shustov
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | | | - Basem M William
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
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22
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Ruan J, Zain JM, Palmer B, Jovanovic BB, Mi X, Swaroop A, Winter J, Gordon LI, Karmali R, Pro B. MULTI‐CENTER PHASE II STUDY OF ROMIDEPSIN PLUS LENALIDOMIDE FOR PATIENTS WITH PREVIOUSLY UNTREATED PERIPHERAL T‐CELL LYMPHOMA (PTCL). Hematol Oncol 2021. [DOI: 10.1002/hon.55_2879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J. Ruan
- Weill Cornell Medicine New York Presbyterian Hospital Medicine Hematology‐Oncology New York City, New York USA
| | - J. M Zain
- City of Hope Comprehensive Cancer Center, Medicine Duarte USA
| | - B. Palmer
- Robert H. Lurie Comprehensive Cancer Center Northwestern University Feinberg School of Medicine, Medicine Chicago USA
| | - B. Borko Jovanovic
- Northwestern University Feinberg School of Medicine Department of Preventive Medicine Chicago USA
| | - X. Mi
- Northwestern University Feinberg School of Medicine Department of Preventive Medicine Chicago USA
| | - A. Swaroop
- Northwestern University Feinberg School of Medicine Department of Medicine Chicago USA
| | - J. Winter
- Robert H. Lurie Comprehensive Cancer Center Northwestern University Feinberg School of Medicine, Medicine Chicago USA
| | - L. I Gordon
- Robert H. Lurie Comprehensive Cancer Center Northwestern University Feinberg School of Medicine, Medicine Chicago USA
| | - R. Karmali
- Robert H. Lurie Comprehensive Cancer Center Northwestern University Feinberg School of Medicine, Medicine Chicago USA
| | - B. Pro
- Robert H. Lurie Comprehensive Cancer Center Northwestern University Feinberg School of Medicine, Medicine Chicago USA
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23
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Conconi A, Vannata B, Janikova A, Ramirez A, Bodoni CL, Nowakowski G, Mian M, Ferreri AJ, Ryan G, Pangalis GA, Cabrera ME, Luminari S, Montoto S, Tsang R, Aurer I, Visco C, Mazzucchelli L, Trneny M, Gaidano G, Federico M, Lopez‐Guillermo A, Pro B, Zucca E. PRIMARY EXTRANODAL FOLLICULAR LYMPHOMA IN A LARGE RETROSPECTIVE SURVEY OF THE INTERNATIONAL EXTRANODAL LYMPHOMA STUDY GROUP (IELSG31). Hematol Oncol 2021. [DOI: 10.1002/hon.78_2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A. Conconi
- Azienda sanitaria locale Biella Ospedale degli Infermi ‐ Ematologia Biella Italy
| | - B. Vannata
- Oncology Institute of Southern Switzerland Medical Oncology Clinic Bellinzona Switzerland
| | - A. Janikova
- University Hospital Brno Department of Hematology and Oncology Brno Czech Republic
| | - A. Ramirez
- Instituto Nacional de Cancerologia Hematology Department Mexico City Mexico
| | - C. Lobetti Bodoni
- Oncology Institute of Southern Switzerland Medical Oncology Clinic Bellinzona Switzerland
| | - G. Nowakowski
- Mayo Clinic Division of Hematology Rochester Minnesota USA
| | - M. Mian
- Ospedale di Bolzano Ematologia e Centro Trapianto Midollo Osseo Bolzano Italy
| | - Andrés J.M. Ferreri
- IRCCS San Raffaele Scientific Institute Unità Operativa di Oncologia Medica Milano Italy
| | - G. Ryan
- Peter MacCallum Cancer Institute Deptment of Radiation Oncology Melbourne Australia
| | - G. A. Pangalis
- Athens Medical Center‐Psychikon Branch Hematology Department Athens Greece
| | - M. E. Cabrera
- Hospital del Salvador Facultad de Medicina Santiago Chile
| | - S. Luminari
- Arcispedale Santa Maria Nuova Servizio di Ematologia Reggio Emilia Italy
| | - S. Montoto
- St. Bartholomew’s Hospital Department of Medical Oncology London UK
| | - R. Tsang
- University Health Network Princess Margaret Hospital Toronto Canada
| | - I. Aurer
- University Hospital Centre Zagreb Division of Hematology Zagreb Croatia
| | - C. Visco
- University of Verona Departmento of Medicine ‐ Section of Hematology Verona Italy
| | | | - M. Trneny
- Charles University General Hospital Prague First Faculty of Medicine Prague Czech Republic
| | - G. Gaidano
- Azienda Ospedaliera "Maggiore della Carità" Ematologia Novara Italy
| | - M. Federico
- Università degli Studi di Modena e Reggio Emilia Centro Oncologico Modenese Modena Italy
| | | | - B. Pro
- Northwestern Medicine Hematology and Medical Oncology Chicago Illinois USA
| | - E. Zucca
- Foundation for the Institute of Oncology Research (IOR) International Extranodal Lymphoma Study Group Oncology Institute of Southern Switzerland Medical Oncology Clinic Bellinzona Switzerland
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Ruan J, Zain JM, Palmer B, Jovanovic B, Mi X, Swaroop A, Winter J, Gordon LI, Karmali R, Pro B. Multicenter phase II study of romidepsin plus lenalidomide for patients with previously untreated peripheral T-cell lymphoma (PTCL). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7514 Background: PTCL are aggressive malignancies associated with poor prognosis when treated with cytotoxic chemotherapy. Novel agents, such as HDAC inhibitor romidepsin and immunomodulatory agent lenalidomide, have shown clinical activities as single agents and in combination in R/R PTCL. We hypothesize that upfront treatment with these agents is an effective and well-tolerated option to defer chemotherapy, particularly in patients who are not candidates for intensive approach. We report the findings of the first chemo-free combination of romidepsin plus lenalidomide as initial treatment for PTCL (ClinicalTrials.gov-NCT02232516). Methods: Patients with untreated PTCL who were over 60 or noncandidates for chemotherapy based on comorbidity CIRS score were eligible. Treatment was initiated with romidepsin 10 mg/m2 IV on d 1, 8, 15, and lenalidomide 25 mg PO on d 1-21 of 28-day cycle for up to 1 year, unless discontinued prior due to POD, toxicities, or withdrawal of consent. The primary objective was to evaluate ORR per Cheson criteria. Secondary objectives included safety, PFS, OS, DOR, and delay to chemotherapy. The sample size was 20 evaluable patients, which allows to estimate the underlying true response rate with the margin of error of an approximate 95% confidence interval equal to 0.22, assuming the true ORR = 0.5. Results: The study enrolled 29 subjects at 3 US centers, including 16 (55%) AITL, 11 (38%) PTCL-NOS, 1 ATLL and 1 EATCL. The median age was 75 (range 49-84), and M:F ratio was 1:1. Nineteen (66%) had stage III/IV disease, 23 (79%) had elevated LDH, and 9 (31%) had IPI 3-5. Treatment was well tolerated with expected side effects. Grade 3-4 hematologic toxicities included neutropenia (45%), thrombocytopenia (34%) and anemia (28%). Grade 3-4 non-hematologic toxicities included hyponatremia (45%), hypertension (38%), hypoalbuminemia (24%), fatigue (17%), hyperglycemia (14%), hypokalemia (14%), dehydration (10%), lung infection (10%) and sepsis (10%). At a median follow-up of 8 months, 20 subjects were evaluable with at least one response assessment, and received a median treatment of 6 cycles. The ORR was 75% (95%CI: 50.9%, 91.3%) with CR at 30% (11.9%, 54.3%). For AITL, the ORR was 85% (54.6%, 98.1%) with CR at 38% (13.9%, 68.4%). Median DOR was 4.2 months for all responders, and 14.3 months for CR patients. The estimated 1-yr PFS was 54.3% with 3-yr PFS at 36.2%, and the estimated 1-yr OS was 76.0% with 3-yr OS at 51.3%. Two subjects moved onto consolidative ASCT in remission, and 4 received additional cytotoxic chemotherapy after progression. Conclusions: This study provides the first demonstration that chemo-free biologic combination of romidepsin and lenalidomide is feasible and effective as initial therapy for PTCL patients who are not candidates for cytotoxic chemotherapy. These data justify further evaluation of such novel agents as a frontline strategy. Clinical trial information: NCT02232516.
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Affiliation(s)
- Jia Ruan
- Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | | | - Brett Palmer
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Borko Jovanovic
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Xinlei Mi
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alok Swaroop
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jane Winter
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leo I. Gordon
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Reem Karmali
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
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25
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Roy I, Smilnak GJ, Burkart M, Williams C, Hamilton E, Miyata S, Thorp K, Ma S, Winter JN, Pro B, Gordon LI, Karmali R. Cachexia is an independent factor for negative clinical and functional outcomes in lymphoma patients receiving CART therapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e19504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19504 Background: Cachexia is a known independent factor for negative outcomes in several cancer populations at early and late stages, but has not been in investigated in cancer patients receiving Chimeric Antigen Receptor T-cell therapy (CART). Our objective was to evaluate the relationship between cachexia and clinical and functional outcomes in patients with lymphoma receiving CART. Methods: Design: Retrospective cohort study including 70 adult patients with aggressive B-cell lymphomas (Diffuse Large B-cell or Mantle Cell Lymphoma) who received CART. Cachexia markers: body weight loss (BWL), BMI, albumin, creatinine, and neutrophil-to-lymphocyte ratio (NLR) – each captured at diagnosis, pre-collection, CART initiation, and through day 360 post-CART. Outcome measures: Primary outcomes: Disease relapse after CART and 90-day mortality. Secondary outcome: Need for rehabilitation services post-acute care (inpatient rehabilitation or home physical therapy). Statistical analyses: Linear regression modeling, area under the curve analysis, and multivariate modeling (any univariates with p < 0.25). Co-variates: age, ECOG PS, IPI, cell of origin, MYC status, number of prior cancer therapies, time from diagnosis to CART, and need for bridging / steroid pre-CART. Results: In longitudinal modeling from diagnosis to day 360, CART patients who relapsed had linear associations over time with BWL since diagnosis (p < 0.01), NLR (p < 0.0001), creatinine (p = 0.045), and albumin (p < 0.001). In univariate analyses (see table): at pre-collection, high NLR and BWL increased odds of relapse; at treatment, high NLR and CRP increased odds of mortality; and at D30, and BWL and high NLR increased odds of relapse and mortality, respectively. In multivariate analyses (see table, # = independent association), BWL and high NLR independently associated with relapse and mortality, respectively. Significant covariates included need for bridging (p = 0.02), steroid therapy pre-CART (p < 0.01), and time from diagnosis to CART (p = 0.02). Secondarily, BWL and low albumin pre-CART increased odds of needing rehabilitation services, with BWL independently associating in multivariate models (OR = infinity, p < 0.001). Conclusions: Cachexia markers, such as BWL from diagnosis and NLR, are candidate predictors of relapse and mortality after CART. Specific markers could also assign patients to neo/adjuvant rehabilitative and medical therapies targeted towards cachexia. Overall, this study suggests that cachexia may alter the clinical and functional trajectory of lymphoma patients receiving CART.[Table: see text]
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Affiliation(s)
- Ishan Roy
- Shirley Ryan AbilityLab, Chicago, IL
| | | | | | | | | | - Sarah Miyata
- Robert H Lurie Comprehensive Cancer Center, Chicago, IL
| | | | - Shuo Ma
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jane N. Winter
- Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leo I. Gordon
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
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Allen PB, Savas H, Evens AM, Advani RH, Palmer B, Pro B, Karmali R, Mou E, Bearden J, Dillehay G, Bayer RA, Eisner RM, Chmiel JS, O'Shea K, Gordon LI, Winter JN. Pembrolizumab followed by AVD in untreated early unfavorable and advanced-stage classical Hodgkin lymphoma. Blood 2021; 137:1318-1326. [PMID: 32992341 PMCID: PMC7955404 DOI: 10.1182/blood.2020007400] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [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: 06/05/2020] [Accepted: 09/20/2020] [Indexed: 02/06/2023] Open
Abstract
Pembrolizumab, a humanized IgG4 monoclonal antibody targeting programmed death-1 protein, has demonstrated efficacy in relapsed/refractory classical Hodgkin lymphoma (cHL). To assess the complete metabolic response (CMR) rate and safety of pembrolizumab monotherapy in newly diagnosed cHL, we conducted a multicenter, single-arm, phase 2 investigator-initiated trial of sequential pembrolizumab and doxorubicin, vinblastine, and dacarbazine (AVD) chemotherapy. Patients ≥18 years of age with untreated, early, unfavorable, or advanced-stage disease were eligible for treatment. Thirty patients (early unfavorable stage, n = 12; advanced stage, n = 18) were treated with 3 cycles of pembrolizumab monotherapy followed by AVD for 4 to 6 cycles, depending on stage and bulk. Twelve had either large mediastinal masses or bulky disease (>10 cm). After pembrolizumab monotherapy, 11 patients (37%) demonstrated CMRs, and an additional 7 of 28 (25%) patients with quantifiable positron emission tomography computed tomography scans had >90% reduction in metabolic tumor volume. All patients achieved CMR after 2 cycles of AVD and maintained their responses at the end of treatment. With a median follow-up of 22.5 months (range, 14.2-30.6) there were no changes in therapy, progressions, or deaths. No patients received consolidation radiotherapy, including those with bulky disease. Therapy was well tolerated. The most common immune-related adverse events were grade 1 rash (n = 6) and grade 2 infusion reactions (n = 4). One patient had reversible grade 4 transaminitis and a second had reversible Bell's palsy. Brief pembrolizumab monotherapy followed by AVD was both highly effective and safe in patients with newly diagnosed cHL, including those with bulky disease. This trial was registered at www.clinicaltrials.gov as #NCT03226249.
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Affiliation(s)
| | - Hatice Savas
- Department of Radiology and
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Brett Palmer
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Reem Karmali
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Eric Mou
- Stanford Cancer Institute, Palo Alto, CA; and
| | - Jeffrey Bearden
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gary Dillehay
- Department of Radiology and
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Robert A Bayer
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Robert M Eisner
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Joan S Chmiel
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kaitlyn O'Shea
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Leo I Gordon
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jane N Winter
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
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27
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Nizamuddin I, Galvez C, Pro B. Management of ALCL and other CD30+ peripheral T-cell lymphomas with a focus on Brentuximab vedotin. Semin Hematol 2021; 58:85-94. [PMID: 33906726 DOI: 10.1053/j.seminhematol.2021.02.006] [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] [Received: 01/13/2021] [Revised: 02/23/2021] [Accepted: 02/27/2021] [Indexed: 02/07/2023]
Abstract
Peripheral T-cell lymphomas (PTCL) are rare lymphoproliferative disorders with poor outcomes and high rates of relapse. Incidence varies although the most common subtypes include PTCL-not-otherwise specified, anaplastic large cell lymphoma, and angioimmunoblastic T-cell lymphoma. Anaplastic large cell lymphoma is characterized by near-universal CD30 expression and serves as a prototypic model for other CD30-expressing lymphomas. Historically, these neoplasms have been treated with regimens used in the treatment of aggressive B-cell lymphomas. Over the last decade, brentuximab vedotin, an antibody-drug conjugate, has been investigated to treat peripheral T-cell lymphomas expressing CD30. While first studied in the relapsed and refractory setting, it was later studied in the frontline setting in the ECHELON-2 trial with positive results and is now an approved treatment for CD30-expressing peripheral T-cell lymphomas. Other treatment options in the relapsed and refractory setting include histone deacetylase inhibitors, pralatrexate, and salvage multiagent chemotherapy regimens. Current research is underway regarding combination therapies and the use of other novel agents.
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Affiliation(s)
- Imran Nizamuddin
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Carlos Galvez
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine and Robert H Lurie Comprehensive Cancer Center, Chicago, IL
| | - Barbara Pro
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine and Robert H Lurie Comprehensive Cancer Center, Chicago, IL.
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28
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Walker CJ, Espinosa ML, Mehta-Shah N, Pro B, Guitart J, Kuzel T. Clinical Trial of High-Dose Pegylated-Interferon-Alfa-2b Combined With Phototherapy in Advanced Stage Mycosis Fungoides. J Drugs Dermatol 2021; 20:349-350. [PMID: 33683074 DOI: 10.36849/jdd.5756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The combination of Interferon-α-2b (IFN-α-2b) and phototherapy is highly effective in treating mycosis fungoides (MF) but side effects often lead to discontinuation of therapy.1.
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29
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Walker CJ, Donnelly ED, Moreira J, Mehta J, Mittal BB, Choi J, Zhou XA, Guitart J, Pro B. Pembrolizumab and palliative radiotherapy in 2 cases of refractory mycosis fungoides. JAAD Case Rep 2020; 7:87-90. [PMID: 33344742 PMCID: PMC7736700 DOI: 10.1016/j.jdcr.2020.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Christina J Walker
- Department of Dermatology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Eric D Donnelly
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jonathan Moreira
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jayesh Mehta
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Bharat B Mittal
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jaehyuk Choi
- Department of Dermatology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Xiaolong Alan Zhou
- Department of Dermatology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Joan Guitart
- Department of Dermatology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Barbara Pro
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
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Pan J, Ghimire S, Alpdogan SO, Chapman A, Carabasi M, DiMeglio M, Gong J, Martinez-Outschoorn U, Rose L, Ramirez M, Wagner JL, Weiss M, Flomenberg N, Pro B, Porcu P, Filicko-OHara J, Gaballa S. Phase I/II study of bendamustine in combination with ofatumumab, carboplatin, etoposide (BOCE) for relapsed or refractory aggressive B-cell non-Hodgkin lymphoma. Leuk Lymphoma 2020; 62:590-597. [PMID: 33146052 DOI: 10.1080/10428194.2020.1842400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We developed an outpatient salvage chemotherapy regimen using bendamustine, ofatumumab, carboplatin and etoposide (BOCE) to treat relapsed/refractory non-Hodgkin lymphoma (RR NHL) in a single-center phase I/II study. Primary objectives were safety, tolerability and overall response rate (ORR). Thirty-five RR NHL patients (57% de novo large cell [DLBCL] or grade 3B follicular [FL], 26% transformed DLBCL, 9% grade 3A FL, 3% mantle cell; median age = 62, median prior therapies = 1) were treated. Median follow-up was 24.1 months. ORR was 69% (CR = 49%, PR = 20% [ORR = 70%, CR = 50%, PR = 20% in the de novo DLBCL/grade 3B FL subgroup]). Median progression-free survival was 5.1 months and overall-survival 26.2 months. Twelve patients subsequently underwent stem cell transplantation. The most common non-hematologic grade 3-4 toxicities were neutropenic fever and hypophosphatemia. There were no treatment-related deaths. In conclusion, BOCE is a safe and effective outpatient salvage regimen for patients with RR NHL and serves as an effective bridge to stem cell transplantation.
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Affiliation(s)
- Jonathan Pan
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sushil Ghimire
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - S Onder Alpdogan
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Andrew Chapman
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Matthew Carabasi
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Martina DiMeglio
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jerald Gong
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Lewis Rose
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Michael Ramirez
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - John L Wagner
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mark Weiss
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Neal Flomenberg
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Barbara Pro
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.,Robert H. Lurie Comprehensive Cancer Center, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pierluigi Porcu
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Joanne Filicko-OHara
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sameh Gaballa
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.,Division of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
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Horwitz SM, Ansell S, Ai WZ, Barnes J, Barta SK, Clemens MW, Dogan A, Goodman AM, Goyal G, Guitart J, Halwani A, Haverkos BM, Hoppe RT, Jacobsen E, Jagadeesh D, Jones A, Kim YH, Mehta-Shah N, Olsen EA, Pro B, Rajguru SA, Rozati S, Said J, Shaver A, Shustov A, Sokol L, Torka P, Torres-Cabala C, Wilcox R, William BM, Zain J, Dwyer MA, Sundar H. NCCN Guidelines Insights: T-Cell Lymphomas, Version 1.2021. J Natl Compr Canc Netw 2020; 18:1460-1467. [DOI: 10.6004/jnccn.2020.0053] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hepatosplenic T-cell lymphoma (HSTCL) is a rare subtype of T-cell lymphoma associated with an aggressive clinical course and a worse prognosis. HSTCL develops in the setting of chronic immune suppression or immune dysregulation in up to 20% of cases and is most often characterized by spleen, liver, and bone marrow involvement. Diagnosis and management of HSTCL pose significant challenges given the rarity of the disease along with the absence of lymphadenopathy and poor outcome with conventional chemotherapy regimens. These Guidelines Insights focus on the diagnosis and treatment of HSTCL as outlined in the NCCN Guidelines for T-Cell Lymphomas.
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Affiliation(s)
| | | | - Weiyun Z. Ai
- 3UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | | | | | - Joan Guitart
- 9Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Ahmad Halwani
- 10Huntsman Cancer Institute at the University of Utah
| | | | | | | | - Deepa Jagadeesh
- 14Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Allison Jones
- 15St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Neha Mehta-Shah
- 16Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | - Barbara Pro
- 9Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Sima Rozati
- 19The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | - Andrei Shustov
- 22Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | - Ryan Wilcox
- 25University of Michigan Rogel Cancer Center
| | - Basem M. William
- 26The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
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Samaniego F, McLaughlin P, Neelapu SS, Feng L, Fanale M, Nastoupil L, Rodriguez MA, Pro B, Taylor E, Hagemeister FB, Fowler N. Initial report of a phase II study with R-FND followed by ibritumomab tiuxetan radioimmunotherapy and rituximab maintenance in patients with untreated high-risk follicular lymphoma. Leuk Lymphoma 2020; 62:58-67. [PMID: 32924687 DOI: 10.1080/10428194.2020.1821005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
R-FND (rituximab, fludarabine, mitoxantrone, and dexamethasone) can induce molecular remissions in indolent lymphoma. The addition of 90yttrium ibritumomab tiuxetan (90YIT) radioimmunotherapy following first-line induction treatment in patients with advanced follicular lymphoma (FL) may improve remission rates. We now report 10-year follow-up results from our sequential treatment approach with an abbreviated regimen of R-FND followed by 90YIT consolidation and rituximab maintenance. Forty-nine patients were enrolled; 47 received treatment. Patients had high-risk (FLIPI score ≥3) FL of grade 1-3A and stage III/IV with adequate hematologic function. Following R-FND, the complete and partial response rates were 91% and 8.5%, respectively. After 90YIT consolidation, the CR rate increased to 97%. The 10-year PFS rate was 49%. The most common non-hematologic, grade 3 or 4 adverse events were fatigue, dyspnea, and myalgia. Five developed myelodysplastic syndrome (MDS). This treatment approach is most appropriate in FLIPI-based high-risk patients whose outlook with standard therapy is inadequate.
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Affiliation(s)
- Felipe Samaniego
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peter McLaughlin
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sattva S Neelapu
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lei Feng
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle Fanale
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Barbara Pro
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Erin Taylor
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Nathan Fowler
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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Lansigan F, Horwitz SM, Pinter-Brown LC, Carson KR, Shustov AR, Rosen ST, Pro B, Hsi ED, Federico M, Gisselbrecht C, Schwartz M, Bellm LA, Acosta M, Foss FM. Outcomes of Patients with Transformed Mycosis Fungoides: Analysis from a Prospective Multicenter US Cohort Study. Clin Lymphoma Myeloma Leuk 2020; 20:744-748. [PMID: 32532611 DOI: 10.1016/j.clml.2020.05.001] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/26/2020] [Accepted: 05/03/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We examined patient characteristics, treatments, and outcomes of patients with transformed mycosis fungoides (tMF) from COMPLETE: a large, multicenter, prospective cohort study of peripheral T-cell lymphoma patients in the United States. METHODS Patients with tMF were enrolled in COMPLETE at the time of transformation. For this analysis, we identified patients with tMF with completed baseline, treatment, and follow-up records. Median survival was assessed using Kaplan-Meier methodology. RESULTS Of the 499 patients enrolled in COMPLETE, 17 had tMF. Median age was 61; 53% were male, 9 had elevated lactate dehydrogenase, and 9 had lymph node involvement. Approximately one-quarter of the patients were African American and 47% had CD30+ disease. Median time to transformation was 53 months. All patients received systemic therapy, with 19% receiving concomitant radiotherapy. Most patients (87%) received single agents, including liposomal doxorubicin, pralatrexate, and gemcitabine. Eight patients (50%) had reported responses to therapy. Median survival was 18 months. One- and 2-year survival rates were 56% and 44%, respectively. CONCLUSIONS tMF often expresses CD30 and presents with lymph node involvement. Responses have been seen with single agents, but survival remains poor. Novel treatment approaches are urgently needed to improve outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
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Abstract
PURPOSE OF REVIEW Peripheral T cell lymphomas (PTCLs) are a heterogeneous group of non-Hodgkin lymphomas with inferior prognosis compared with their B cell counterparts characterized by frequent relapses, resulting in a median 5-year survival of approximately 30%. Their diverse clinicopathologic features challenge existing treatment paradigms that treat all patients uniformly. Here we review recent advances in the treatment of these diseases. RECENT FINDINGS While current treatment still relies largely on combination chemotherapy, the introduction of more effective novel and targeted therapies has improved outcomes in certain subtypes. Increasing understanding of the underlying biology of PTCL has prompted further subclassification by genetic and molecular subgroups. Overall, the most significant advances in PTCL management have resulted from improved understanding and classification of the biology of PTCL. Ongoing development of subtype-specific targeted therapies will be essential to improve long-term outcomes of patients with these diseases.
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Affiliation(s)
- Pamela B Allen
- Winship Institute of Emory University, 1365 Clifton Rd NE, Suite 4400, Atlanta, GA, USA
| | - Barbara Pro
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair Street, Suite 850, Chicago, IL, 60611, USA.
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35
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Daniels J, Doukas PG, Escala MEM, Ringbloom KG, Shih DJH, Yang J, Tegtmeyer K, Park J, Thomas JJ, Selli ME, Altunbulakli C, Gowthaman R, Mo SH, Jothishankar B, Pease DR, Pro B, Abdulla FR, Shea C, Sahni N, Gru AA, Pierce BG, Louissaint A, Guitart J, Choi J. Cellular origins and genetic landscape of cutaneous gamma delta T cell lymphomas. Nat Commun 2020; 11:1806. [PMID: 32286303 PMCID: PMC7156460 DOI: 10.1038/s41467-020-15572-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 03/10/2020] [Indexed: 12/14/2022] Open
Abstract
Primary cutaneous γδ T cell lymphomas (PCGDTLs) represent a heterogeneous group of uncommon but aggressive cancers. Herein, we perform genome-wide DNA, RNA, and T cell receptor (TCR) sequencing on 29 cutaneous γδ lymphomas. We find that PCGDTLs are not uniformly derived from Vδ2 cells. Instead, the cell-of-origin depends on the tissue compartment from which the lymphomas are derived. Lymphomas arising from the outer layer of skin are derived from Vδ1 cells, the predominant γδ cell in the epidermis and dermis. In contrast, panniculitic lymphomas arise from Vδ2 cells, the predominant γδ T cell in the fat. We also show that TCR chain usage is non-random, suggesting common antigens for Vδ1 and Vδ2 lymphomas respectively. In addition, Vδ1 and Vδ2 PCGDTLs harbor similar genomic landscapes with potentially targetable oncogenic mutations in the JAK/STAT, MAPK, MYC, and chromatin modification pathways. Collectively, these findings suggest a paradigm for classifying, staging, and treating these diseases.
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MESH Headings
- Amino Acid Sequence
- Antigens, CD1d/metabolism
- Chromatin Assembly and Disassembly
- Epitopes/immunology
- Genome, Human
- HEK293 Cells
- Humans
- Lymph Nodes/pathology
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/pathology
- Models, Biological
- Mutation/genetics
- Phenotype
- Principal Component Analysis
- Receptors, Antigen, T-Cell, gamma-delta/metabolism
- Signal Transduction
- Skin/pathology
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
- Transcription, Genetic
- Transcriptome/genetics
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Affiliation(s)
- Jay Daniels
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Peter G Doukas
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maria E Martinez Escala
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kimberly G Ringbloom
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David J H Shih
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jingyi Yang
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kyle Tegtmeyer
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joonhee Park
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jane J Thomas
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mehmet E Selli
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Can Altunbulakli
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ragul Gowthaman
- University of Maryland Institute for Bioscience and Biotechnology Research, Rockville, MD, USA
- Department of Cell Biology and Molecular Genetics, University of Maryland, College Park, MD, USA
| | - Samuel H Mo
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Balaji Jothishankar
- Department of Medicine, Section of Dermatology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - David R Pease
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Barbara Pro
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Farah R Abdulla
- Division of Dermatology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Christopher Shea
- Department of Medicine, Section of Dermatology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Nidhi Sahni
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Epigenetics and Molecular Carcinogenesis, The University of Texas MD Anderson Cancer Center, Smithville, TX, USA
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Program in Quantitative and Computational Biosciences, Baylor College of Medicine, Houston, TX, USA
| | - Alejandro A Gru
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
- Department of Dermatology, University of Virginia Health System, Charlottesville, VA, USA
| | - Brian G Pierce
- University of Maryland Institute for Bioscience and Biotechnology Research, Rockville, MD, USA
- Department of Cell Biology and Molecular Genetics, University of Maryland, College Park, MD, USA
| | - Abner Louissaint
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
| | - Joan Guitart
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Jaehyuk Choi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Center for Genetic Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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36
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Espinosa ML, Nguyen MT, Aguirre AS, Martinez-Escala ME, Kim J, Walker CJ, Pontes DS, Silverberg JI, Choi J, Pro B, Pincus LB, Guitart J, Zhou XA. Progression of cutaneous T-cell lymphoma after dupilumab: Case review of 7 patients. J Am Acad Dermatol 2020; 83:197-199. [PMID: 32229275 DOI: 10.1016/j.jaad.2020.03.050] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Maria L Espinosa
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Morgan T Nguyen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amaia Saenz Aguirre
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Jane Kim
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Christina J Walker
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David S Pontes
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jaehyuk Choi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois; Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Barbara Pro
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Laura B Pincus
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Joan Guitart
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xiaolong A Zhou
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Chowdhary M, Chowdhary A, Royce TJ, Patel KR, Chhabra AM, Jain S, Knoll MA, Vapiwala N, Pro B, Marwaha G. Women's Representation in Leadership Positions in Academic Medical Oncology, Radiation Oncology, and Surgical Oncology Programs. JAMA Netw Open 2020; 3:e200708. [PMID: 32159809 PMCID: PMC7066474 DOI: 10.1001/jamanetworkopen.2020.0708] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Women are underrepresented in medical leadership positions; however, representation of women among academic oncology leadership is unknown. OBJECTIVES To evaluate representation of women overall and in leadership positions in academic medical oncology (MO), radiation oncology (RO), and surgical oncology (SO) programs and to examine the association of women leadership with overall faculty representation of women per program. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, MO, RO, and SO training program websites were queried from October 2018 through June 2019. All faculty from 265 of 273 accredited MO, RO, and SO training programs (97.1%) were included. EXPOSURE Gender. MAIN OUTCOMES AND MEASURES Observed proportions of women in leadership positions compared with the expected proportion of overall women faculty in MO, RO, and SO were assessed. Rates of representation of women across each MO, RO, and SO program's faculty based on the presence or absence of a woman in a leadership position were compared. RESULTS Of 6030 total faculty, only 2164 (35.9%) were women. Total representation of women among MO, RO, and SO faculty was 37.1% (1563 of 4215), 30.7% (389 of 1269), and 38.8% (212 of 546), respectively. Women composed only 21.7% (30 of 138), 11.7% (11 of 94), and 3.8% (1 of 26) of MO, RO, and SO chair positions, respectively. The observed proportion of women in chair positions was significantly lower than the expected proportion for MO, RO, and SO. In all, 47.9%, 33%, and 18.5% of MO, RO, and SO programs, respectively, had at least 1 woman in a leadership position (program director or chair). Programs with 1 or more women in a leadership position were associated with a higher mean (SD) percentage of women faculty than those without at least 1 woman leader in MO (40.7% [12.5%] vs 33.1% [11.0%]; P < .001) and RO (36.2% [13.3%] vs 23.4% [12.3%]; P < .001) but not SO (40.2% [15.4%] vs 31.4% [16.9%]; P = .29). CONCLUSIONS AND RELEVANCE Gender disparity exists in academic MO, RO, and SO faculty, which is magnified at the chair level. Programs in MO and RO with a woman physician in a leadership position were associated with a higher percentage of women faculty, but this was not true for SO. These data will serve as a benchmark to monitor progress toward a more balanced workforce.
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Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Akansha Chowdhary
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Medical Oncology, Northwestern University, Chicago, Illinois
| | - Trevor J. Royce
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill
| | - Kirtesh R. Patel
- Department of Radiation Oncology, Kaiser Permanente, Atlanta, Georgia
| | - Arpit M. Chhabra
- Department of Radiation Oncology, New York Proton Center, New York
| | - Shikha Jain
- Division of Hematology, Oncology and Stem Cell Transplant, Rush University Medical Center, Chicago, Illinois
| | - Miriam A. Knoll
- John Theurer Cancer Center, Department of Radiation Oncology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia
| | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Medical Oncology, Northwestern University, Chicago, Illinois
| | - Gaurav Marwaha
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
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38
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Horwitz SM, Ansell SM, Ai WZ, Barnes J, Barta SK, Choi M, Clemens MW, Dogan A, Greer JP, Halwani A, Haverkos BM, Hoppe RT, Jacobsen E, Jagadeesh D, Kim YH, Lunning MA, Mehta A, Mehta-Shah N, Oki Y, Olsen EA, Pro B, Rajguru SA, Shanbhag S, Shustov A, Sokol L, Torka P, Wilcox R, William B, Zain J, Dwyer MA, Sundar H. NCCN Guidelines Insights: T-Cell Lymphomas, Version 2.2018. J Natl Compr Canc Netw 2019; 16:123-135. [PMID: 29439173 DOI: 10.6004/jnccn.2018.0007] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Natural killer (NK)/T-cell lymphomas are a rare and distinct subtype of non-Hodgkin's lymphomas. NK/T-cell lymphomas are predominantly extranodal and most of these are nasal type, often localized to the upper aerodigestive tract. Because extranodal NK/T-cell lymphomas (ENKL) are rare malignancies, randomized trials comparing different regimens have not been conducted to date and standard therapy has not yet been established for these patients. These NCCN Guidelines Insights discuss the recommendations for the diagnosis and management of patients with ENKL as outlined in the NCCN Guidelines for T-Cell Lymphomas.
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39
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Lee DE, Martinez-Escala ME, Serrano LM, Zhou XA, Kaplan JB, Pro B, Choi J, Guitart J. Hemophagocytic Lymphohistiocytosis in Cutaneous T-Cell Lymphoma. JAMA Dermatol 2019; 154:828-831. [PMID: 29874360 DOI: 10.1001/jamadermatol.2018.1264] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Importance Hemophagocytic lymphohistiocytosis (HLH) has been reported as a serious complication of cutaneous T-cell lymphoma (CTCL). Despite available diagnostic guidelines, it remains a diagnostic and therapeutic challenge in this patient population. Objectives To examine the characteristics of CTCL associated with HLH and analyze the presenting signs and symptoms, therapeutic options, and outcome. Design, Setting, and Participants In this case series, patients diagnosed with CTCL and HLH who were treated at a single institution from January 1, 2014, through December 31, 2017, were studied. Exposures The HLH-2004 trial criteria, HScore, and various clinical and histopathologic variables were applied to and analyzed in the cohort. Main Outcomes and Measures Subtype of CTCL, treatment administered for HLH, and patient outcome were assessed. Results Seven patients (4 men and 3 women; median age, 50 years; range, 34-77 years) were identified from the database and included in the study. Cytotoxic subtypes of CTCL that involve the deep dermis and subcutaneous tissue were most commonly associated with HLH. Four patients met 5 or more HLH-2004 trial criteria, and 5 had an HScore probability greater than 85% at presentation. Common presenting HLH symptoms were fever and malaise. Cyclosporine, polychemotherapy, and systemic corticosteroids were the most common treatments. Patients receiving allogeneic stem cell transplants had the best outcomes, with all 3 of these patients alive and in complete remission. Conclusions and Relevance Hemophagocytic lymphohistiocytosis is a life-threatening complication of CTCL associated with rare cytotoxic CTCL subtypes that primarily involve the subcutaneous tissue. Because these cases may resemble a granulomatous or infectious condition, the diagnosis and appropriate management are often delayed. The results of this study demonstrate the need for high awareness of HLH in patients with panniculitic lymphomas and indicate that allogeneic stem cell transplantation may be the best option for a sustained remission.
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Affiliation(s)
- Dylan E Lee
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - M Estela Martinez-Escala
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Linda M Serrano
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xiaolong A Zhou
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jason B Kaplan
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Barbara Pro
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jaehyuk Choi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joan Guitart
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Lansigan F, Horwitz SM, Pinter-Brown LC, Rosen ST, Pro B, Hsi ED, Federico M, Gisselbrecht C, Schwartz M, Bellm LA, Acosta M, Shustov AR, Advani RH, Feldman T, Lechowicz MJ, Smith SM, Tulpule A, Craig MD, Greer JP, Kahl BS, Leach JW, Morganstein N, Casulo C, Park SI, Foss FM. Outcomes for Relapsed and Refractory Peripheral T-Cell Lymphoma Patients after Front-Line Therapy from the COMPLETE Registry. Acta Haematol 2019; 143:40-50. [PMID: 31315113 DOI: 10.1159/000500666] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 04/05/2019] [Accepted: 04/29/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Outcomes for patients with peripheral T-cell lymphoma (PTCL) who fail to achieve complete response (CR) or relapse after front-line therapy are poor with lack of prospective outcomes data. OBJECTIVES COMPLETE is a prospective registry of 499 patients enrolled at academic and community sites in the United States detailing patient demographics, treatment and outcomes for patients with aggressive T cell lymphomas. We report results for patients with primary refractory and relapsed disease. METHODS Primary refractory disease was defined as an evaluable best response to initial treatment (induction ± maintenance or consolidation/transplant) other than CR, and included a partial response, progressive disease, or no response/stable disease. Relapsed disease was defined as an evaluable best response to initial treatment of CR, followed by disease progression at a later date, irrespective of time to progression. Patients were included in the analysis if initial treatment began within 30 days of enrollment and treatment duration was ≥4 days. RESULTS Of 420 evaluable patients, 97 met the definition for primary refractory and 58 with relapsed disease. In the second-line setting, relapsed patients received single-agent therapies more often than refractory patients (52 vs. 28%; p = 0.01) and were more likely to receive single-agent regimens (74 vs. 53%; p = 0.03). The objective response rate to second-line therapy was higher in relapsed patients (61 vs. 40%; p = 0.04) as was the proportion achieving a CR (41 vs. 14%; p = 0.002). Further, relapsed patients had longer overall survival (OS) compared to refractory patients, with a median OS of 29.1 versus 12.3 months. CONCLUSIONS Despite the availability of newer active single agents, refractory patients were less likely to receive these therapies and continue to have inferior outcomes compared to those with relapsed disease. PTCL in the real world remains an unmet medical need, and improvements in front-line therapies are needed.
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Affiliation(s)
| | | | | | | | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | | | | | | | | | | | - Mark Acosta
- Spectrum Pharmaceuticals Inc., Irvine, California, USA
| | - Andrei R Shustov
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Tatyana Feldman
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | | | | | - Anil Tulpule
- University of Southern California, Los Angeles, California, USA
| | | | - John P Greer
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brad S Kahl
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joseph W Leach
- Virginia Piper Cancer Institute, Minneapolis, Minnesota, USA
| | | | - Carla Casulo
- University of Rochester, Rochester, New York, USA
| | - Steven I Park
- Levine Cancer Institute, Chapel Hill, North Carolina, USA
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Behdad A, Boddy CS, Fought AJ, Taxter T, Falkiewicz MK, Ayers E, Chen QC, Chen YH, Karmali R, Pro B, Winter JN, Landsburg DJ, Gordon LI, Kaplan JB. Survival outcomes of diffuse large B-cell lymphoma by association with concurrent or antecedent follicular lymphoma and double hit status. Leuk Lymphoma 2019; 60:3266-3271. [PMID: 31225766 DOI: 10.1080/10428194.2019.1622099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) transformed from follicular lymphoma (FL) (tDLBCL) has been traditionally associated with an aggressive course, but more recent studies have shown longer survivals. The clinical significance of concurrent FL at the time of diagnosis of DLBCL (cDLBCL/FL) is less clear. We compared outcomes of tDLBCL, cDLBCL/FL, and de novo DLBCL (dDLBCL) and then evaluated the impact of double hit (DH) rearrangements (MYC with BCL2 and/or BCL6) in these subgroups' outcomes. The progression free survival (PFS) and overall survival (OS) were not significantly different among the three groups (dDLBCL, tDLBCL, and cDLBCL/FL). The effect of DH on survival was then analyzed in two subgroups: (1) dDLBCL and (2) tDLBCL + cDLBCL/FL. PFS and OS were significantly shorter in lymphomas with DH in each of these two subgroups. We conclude that DH status drives outcomes in all DLBCLs, regardless of their transformation status.
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Affiliation(s)
- Amir Behdad
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Craig S Boddy
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Angela J Fought
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Timothy Taxter
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marissa K Falkiewicz
- Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Ayers
- Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Qing C Chen
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yi-Hua Chen
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Reem Karmali
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Barbara Pro
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Jane N Winter
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Daniel J Landsburg
- Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Leo I Gordon
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Jason B Kaplan
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
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Kim Y, Ortiz-Romero P, Pro B, Sokol L, Scarisbrick J, Musiek A, Vermeer M, Dummer R, Halwani A, Fierro M, Moriya J, Leoni M, Bagot M. TIME TO NEXT TREATMENT IN PATIENTS WITH PREVIOUSLY TREATED CUTANEOUS T-CELL LYMPHOMA (CTCL) RECEIVING MOGAMULIZUMAB OR VORINOSTAT: A POST-HOC ANALYSIS OF THE MAVORIC STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.95_2630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Y.H. Kim
- Dermatology; Stanford University School of Medicine; Stanford United States
| | - P.L. Ortiz-Romero
- Dermatología; Institute i+12, Hospital Universitario 12 de Octubre, Universidad Complutense; Madrid Spain
| | - B. Pro
- Oncology; Northwestern University; Chicago United States
| | - L. Sokol
- Hematology/Oncology; H. Lee Moffitt Cancer Center; Tampa United States
| | - J. Scarisbrick
- Lymphoma Service; University Hospitals Birmingham; Birmingham United Kingdom
| | - A. Musiek
- Dermatology; Washington University; St. Louis United States
| | - M. Vermeer
- Dermatology; Leiden University Medical Center; Leiden Netherlands
| | - R. Dummer
- Dermatology; UniversitatsSpital Zurich; Zurich Switzerland
| | - A. Halwani
- Hematology; University of Utah; Salt Lake City United States
| | - M. Fierro
- Scienze Mediche; Università di Torino; Torino Italy
| | - J. Moriya
- Biostatistics; Kyowa Kirin Pharmaceutical Development, Inc.; Princeton United States
| | - M. Leoni
- Medical Sciences; Kyowa Kirin Pharmaceutical Development, Inc.; Princeton United States
| | - M. Bagot
- Service de Dermatologie; Hôpital Saint Louis, APHP, Inserm U976, Université Paris 7; Paris France
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Stuver RN, Khan N, Schwartz M, Acosta M, Federico M, Gisselbrecht C, Horwitz SM, Lansigan F, Pinter‐Brown LC, Pro B, Shustov AR, Foss FM, Jain S. Single agents vs combination chemotherapy in relapsed and refractory peripheral T-cell lymphoma: Results from the comprehensive oncology measures for peripheral T-cell lymphoma treatment (COMPLETE) registry. Am J Hematol 2019; 94:641-649. [PMID: 30896890 DOI: 10.1002/ajh.25463] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/18/2019] [Accepted: 03/12/2019] [Indexed: 11/11/2022]
Abstract
Single agents have demonstrated activity in relapsed and refractory (R/R) peripheral T-cell lymphoma (PTCL). Their benefit relative to combination chemotherapy remains undefined. Patients with histologically confirmed PTCL were enrolled in the Comprehensive Oncology Measures for Peripheral T-cell Lymphoma Treatment (COMPLETE) registry. Eligibility criteria included those with R/R disease who had received one prior systemic therapy and were given either a single agent or combination chemotherapy as first retreatment. Treatment results for those with R/R disease who received single agents were compared to those who received combination chemotherapy. The primary endpoint was best response to retreatment. Fifty-seven patients met eligibility criteria. At first retreatment, 46% (26/57) received combination therapy and 54.5% (31/57) received single agents. At median follow up of 2 years, a trend was seen towards increased complete response rate for single agents versus combination therapy (41% vs 19%; P = .02). There was also increased median overall survival (38.9 vs 17.1 months; P = .02) and progression-free survival (11.2 vs 6.7 months; P = .02). More patients receiving single agents received hematopoietic stem-cell transplantation (25.8% vs 7.7%, P = .07). Adverse events of grade 3 or 4 occurred more frequently in those receiving combination therapy, although this was not statistically significant. The data confirm the unmet need for better treatment in R/R PTCL. Despite a small sample, the analysis shows greater response and survival in those treated with single agents as first retreatment in R/R setting, while maintaining the ability to achieve transplantation. Large, randomized trials are needed to identify the best strategy.
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Affiliation(s)
- Robert N. Stuver
- Division of Hematologic Malignancies and and Bone Marrow Transplantation, Beth Israel Deaconess Medical Center Boston Massachusetts
| | - Niloufer Khan
- Memorial Sloan Kettering Cancer Center New York New York
| | | | - Mark Acosta
- Spectrum Pharmaceuticals, Inc. Irvine California
| | | | | | | | | | | | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center Chicago Illinois
| | | | | | - Salvia Jain
- Division of Hematologic Malignancies and and Bone Marrow Transplantation, Beth Israel Deaconess Medical Center Boston Massachusetts
- Harvard Medical School Boston Massachusetts
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Karmali R, Abramson JS, Stephens DM, Barnes JA, Kaplan JB, Winter JN, Ma S, Petrich AM, Hochberg EP, Takvorian T, Nelson V, Gordon LI, Pro B. Ibrutinib maintenance following induction for untreated mantle cell lymphoma (MCL): Initial safety report. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.7542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7542 Background: Maintenance rituximab in MCL has improved survival, though the optimal approach is not yet defined. Ibrutinib, a selective BTK inhibitor, has profound activity in R/R MCL. Ibrutinib maintenance (I-M) following induction for treatment-naive MCL has not been explored. We report preliminary results of a multicenter phase II trial assessing efficacy and safety of I-M for MCL after frontline induction. Methods: Patients with MCL with CR/PR to frontline chemo-immunotherapy (+/- autoSCT) received I-M 560 mg daily for up to 4 years. Primary objective was 3 year PFS rate. Secondary objectives were PR to CR conversions, median OS at 4 years and toxicity with MRD assessments planned. Results: Accrual is complete with 36 patients, median age of 60 (range 46-90), 28 males, 28 with advanced stage and 9 with extranodal disease. 18 (50%), 7 (19%) and 11 (31%) had low vs intermediate vs high risk MIPI respectively. 8/24 patients had a Ki-67 > / = 30%. For induction, 17 (47%) received BR, 18 (50%) a cytarabine-based regimen, 1 (3%) R-CHOP. 18 (50%) had autoSCT in CR1 prior to enrollment. 33 (92%) and 3 (8%) had CR and PR with induction respectively with 1 PR to CR conversion on I-M. At median follow-up of 19 mos, 24/36 (67%) patients remain on I-M (median 15 cycles, range 1-49) with 1 PD and 1 death. TRAEs led to dose reductions/interruptions in 25 (69%) patients, including permanent dose reductions in 7 (19%) and treatment discontinuation in 9 (25%; Table). 3 additional patients discontinued I-M, 1 for endometrial adenocarcinoma, 1 PD, 1 death, cause unknown. Conclusions: Ibrutinib maintenance is feasible in MCL patients who respond to frontline chemo-immunotherapy +/- autoSCT with manageable toxicities consistent with prior reports of ibrutinib. Additional follow-up and MRD status correlations with PFS and OS will provide insight on clinical relevance for this approach. Clinical trial information: NCT02242097. [Table: see text]
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Affiliation(s)
- Reem Karmali
- Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Jeremy S. Abramson
- Massachusetts General Hospital Cancer Center/Harvard Medical School, Boston, MA
| | | | - Jeffrey A. Barnes
- Massachusetts General Hospital Cancer Center; Harvard Medical School, Boston, MA
| | - Jason B. Kaplan
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jane N. Winter
- Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Shuo Ma
- Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | - Ephraim P. Hochberg
- Massachusetts General Hospital Cancer Center; Harvard Medical School, Boston, MA
| | - Tak Takvorian
- Massachusetts General Hospital Cancer Center; Harvard Medical School, Boston, MA
| | | | - Leo I. Gordon
- Northwestern University, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
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Pro B, Kim YH, Ortiz-Romero PL, Sokol L, Scarisbrick J, Musiek A, Vermeer M, Dummer R, Halwani AS, Fierro MT, Moriya J, Leoni M, Bagot M. Time to next treatment in patients with previously treated cutaneous T-cell lymphoma (CTCL) receiving mogamulizumab or vorinostat: A MAVORIC post-hoc analysis. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.7539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7539 Background: CTCLs are chronic skin malignancies, characterized by relapsing/remitting behavior and progressive resistance to treatments, with a reported median time to next treatment (TTNT; ie, systemic treatment excluding topical steroids) in mycosis fungoides (MF) and Sezary syndrome (SS) of 5.4 months (mo) (Hughes et al. Blood, 2015). The phase 3 MAVORIC study demonstrated mogamulizumab (MOGA) was superior to vorinostat (VORI) in progression-free survival (median 7.7 vs 3.1 mo, P<0.0001) and confirmed overall response rates (28% vs 4.8%, P<0.0001) in previously treated patients with MF/SS (Kim et al. Lancet Oncol 2018). This post-hoc analysis examines TTNT to further explore the patient clinical experience. Methods: Patients with MF/SS who were treated with ≥1 prior systemic therapy were randomized 1:1 to receive MOGA (1.0 mg/kg, administered once weekly for the first 28-day cycle, then on Days 1 and 15 of subsequent cycles) or oral VORI (400 mg daily). Patients on VORI were permitted to crossover to MOGA upon approval. TTNT was defined as time to any therapy excluding topical steroids or focal radiation. The length of TTNT was assessed overall and by disease stage grouping (IB/II and III/IV) and disease type (MF and SS). Results: Median TTNT for the full ITT population was longer with MOGA at 11 mo (95% CI, 8.8-12.6) compared to VORI at 3.5 mo and consistently longer for MOGA vs VORI across disease stage grouping or by disease type (Table). Conclusions: TTNT in MF/SS represents an additional measure of clinical benefit and disease control in patients who may have progressed based on strict protocol definitions of progression. This post hoc analysis showing a prolonged TTNT across disease stages and types supports a clinical benefit for MF and SS patients who receive MOGA. Clinical trial information: NCT01728805. [Table: see text]
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Affiliation(s)
| | | | - Pablo L. Ortiz-Romero
- Institute i+12, Hospital 12 de Octubre Medical School, University Complutense, Madrid, Spain
| | | | | | | | | | - Reinhard Dummer
- Department of Dermatology, University Hospital Zürich Skin Cancer Center, Zürich, Switzerland
| | | | | | - Junji Moriya
- Kyowa Kirin Pharmaceutical Development, Inc., Princeton, NJ
| | - Mollie Leoni
- Kyowa Kirin Pharmaceutical Development, Inc., Princeton, NJ
| | - Martine Bagot
- Hôpital Saint Louis, APHP, Inserm U976, Université Paris, Paris, France
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Chowdhary M, Chowdhary A, Patel KR, Royce TJ, Sen N, Barry PN, Jain S, Rao RD, Levy MA, Knoll M, Vapiwala N, Wang D, Pro B, Marwaha G. It starts at the top: An analysis of female representation in academic medical oncology (MO), radiation oncology (RO), and surgical oncology (SO) program leadership positions. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10520 Background: Female underrepresentation in academic medicine leadership is well-documented; however, oncology specific data are scarce. This study evaluates female leadership representation in academic medical oncology (MO), radiation oncology (RO) and surgical oncology (SO) programs. Furthermore, we examine the impact of female leadership on overall female faculty representation. Methods: A total of 264 (96%) Accreditation Council for Graduate Medical Education actively accredited MO [144 of 153], RO [93 of 94] and SO [27 of 27] training programs were included. The gender of overall faculty and those in leadership positions (program director and departmental chair/division chief) of each program was determined using hospital websites from 10/01/18 to 01/27/19. The chi-squared goodness-of-fit test was used to examine whether the observed proportion of females in leadership positions deviates significantly from the expected proportion based on the actual proportion of overall female faculty in MO, RO and SO. Two-sample t-tests were used to compare rates of female faculty representation across each program based on the presence/absence of female in a leadership position for MO, RO and SO. Results: Female faculty representation in MO, RO and SO was 37.1% (1,554/4,191), 30.7% (389/1,269) and 38.8% (212/546), respectively. Female representation in leadership positions was 31.5% (82/260), 17.4% (31/178) and 11.1% (5/45), respectively. The observed proportion of females in leadership positions was significantly lower than the expected proportion of females in leadership positions for RO (17.4% vs. 30.7%, p = .0001) and SO (11.1% vs. 38.8%, p = .0001), and demonstrated a trend towards significance for MO (31.5% vs. 37.1%, p = .063). 47.9%, 33% and 18.5% of MO, RO and SO programs had ≥1 female in a leadership position, respectively. Programs that had a female in a leadership position had a higher mean percentage of overall female faculty than those that did not: 41.0% vs 35.0% (p = .0006), 36.0% vs 26.0% (p = .0002) and 39.0% vs 32.0% (p = .348) for MO, RO and SO, respectively. Conclusions: Gender disparity exists in academic MO, RO and SO faculty and is magnified at the leadership level. Programs with a female physician in a leadership position are associated with a higher percentage of female faculty.
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Affiliation(s)
| | - Akansha Chowdhary
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | - Trevor J. Royce
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | | | | | | | - Miriam Knoll
- Hackensack University Medical Center, Hackensack, NJ
| | | | - Dian Wang
- Rush University Medical Center, Chicago, IL
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Mina AA, Vakkalagadda C, Pro B. Novel Therapies and Approaches to Relapsed/Refractory HL Beyond Chemotherapy. Cancers (Basel) 2019; 11:cancers11030421. [PMID: 30934568 PMCID: PMC6468730 DOI: 10.3390/cancers11030421] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/20/2019] [Accepted: 03/12/2019] [Indexed: 11/16/2022] Open
Abstract
Although Hodgkin lymphoma (HL) is highly curable with first-line therapy, relapses occur in approximately 10–20% of patients with early stage disease and 30–40% of patients with advanced stage disease. The standard approach for relapsed or refractory disease is salvage therapy, followed by consolidation with high dose therapy and autologous stem cell transplant (ASCT). Patients who achieve a complete response to salvage therapy prior to ASCT have better outcomes, thus recent studies have focused on incorporating newer agents in this setting. Major challenges in the management of relapsed patients remain how to choose and sequence the many salvage therapies that are currently available and how to best incorporate novel agents in the current treatment paradigms. In this article, we will summarize the most recent advances in the management of patients with recurrent HL and will mainly focus on the role of new agents approved and under investigation. Aside from brentuximab vedotin and checkpoint inhibitors, other novel agents and therapies are showing promising early results. However, at least with some of the newest targeted strategies, it is important to recognize that we are facing new challenges in terms of toxicities, which require very close monitoring and education of both the patient and treating physician.
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Affiliation(s)
- Alain Antoine Mina
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine Chicago Illinois, Chicago, IL 60611, USA.
| | - Chetan Vakkalagadda
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine Chicago Illinois, Chicago, IL 60611, USA.
| | - Barbara Pro
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine Chicago Illinois, Chicago, IL 60611, USA.
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Hossain C, Jennings T, Duffy R, Knoblauch K, Gochoco A, Chervoneva I, Shi W, Alpdogan SO, Porcu P, Pro B, Sahu J. The histological prevalence and clinical implications of folliculotropism and syringotropism in mycosis fungoides. Chin Clin Oncol 2019; 8:6. [PMID: 30818957 DOI: 10.21037/cco.2018.10.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/29/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Mycosis fungoides (MF), the most common form of cutaneous T-cell lymphoma, remains a challenge for clinicians to stage and manage. Classically, MF is determined through histopathologic evidence of a neoplastic infiltrate within the epidermis. In certain patients, however, the infiltrate extends into the hair follicles and sweat glands. The objective of this study is to determine the utility of expanding the analysis of histopathology reports to include the reporting of folliculotropism and syringotropism. METHODS This is a prospective, observational study conducted in a single facility from 2012-2018. All patients with MF, excluding those treated at this facility for less than six months with the exception of those with incomplete pruritus documentation, or absence of initial biopsy analysis were studied. Modified severity weighted assessment tool (mSWAT) quantified body surface area and treatments attempted per patient were continuously charted. Patients were surveyed for presence and degree of pruritus and pain. Evaluation of these parameters were charted at the initial patient visit and correlated with their primary biopsy for presence or absence of folliculotropism and syringotropism. RESULTS Of the 87 patients examined, 70 patients (80%) exhibited syringotropism in their original biopsy and 68 patients (78%) exhibited folliculotropism. Presence of both findings concurrently was present in 56 patients (64.4%), while neither finding was present in 5 patients (5.8%). The singular finding of folliculotropism was found in 12 patients (13.8%), while the singular finding of syringotropism was exhibited in 14 patients (16.1%). A significant association between the presence of folliculotropism and pruritus was established (P=0.043, α=0.05). The general trend towards increase in mSWAT score and pruritus in patients in regard to the mean and median values suggest that increasing the sample population of the study might yield a significant value in the future. CONCLUSIONS These presentations are more prevalent than previously recognized and have findings indicative of more severe disease. We propose that MF histopathology reports document the presence of folliculotropism and syringotropism and that these findings be added to the NCCN guidelines as they may aid in predicting severity and progression risk.
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Affiliation(s)
- Claudia Hossain
- Department of Dermatology and Cutaneous Biology, Jefferson University Hospital, Philadelphia, PA, USA
| | - Tara Jennings
- Department of Dermatology and Cutaneous Biology, Jefferson University Hospital, Philadelphia, PA, USA
| | - Robert Duffy
- Department of Dermatology and Cutaneous Biology, Jefferson University Hospital, Philadelphia, PA, USA
| | - Kelly Knoblauch
- Department of Dermatology and Cutaneous Biology, Jefferson University Hospital, Philadelphia, PA, USA
| | - Ashley Gochoco
- Department of Dermatology and Cutaneous Biology, Jefferson University Hospital, Philadelphia, PA, USA
| | - Inna Chervoneva
- Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Wenyin Shi
- Department of Radiation Oncology, Jefferson University Hospital, Philadelphia, PA, USA
| | - S Onder Alpdogan
- Department of Medical Oncology, Jefferson University Hospital, Philadelphia, PA, USA
| | - Pierluigi Porcu
- Department of Medical Oncology, Jefferson University Hospital, Philadelphia, PA, USA
| | - Barbara Pro
- Department of Medical Oncology, Jefferson University Hospital, Philadelphia, PA, USA
| | - Joya Sahu
- Department of Dermatology and Cutaneous Biology, Jefferson University Hospital, Philadelphia, PA, USA.
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49
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Khashab T, Hagemeister F, Romaguera JE, Fanale MA, Pro B, McLaughlin P, Rodriguez MA, Neelapu SS, Fayad L, Younes A, Feng L, Vega F, Kwak LW, Samaniego F. Long‐term overall‐ and progression‐free survival after pentostatin, cyclophosphamide and rituximab therapy for indolent non‐Hodgkin lymphoma. Br J Haematol 2019; 185:670-678. [DOI: 10.1111/bjh.15814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/18/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Tamer Khashab
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
- Department of Internal Medicine Lankenau Medical Center Wynnewood PAUSA
| | - Fredrick Hagemeister
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Jorge E. Romaguera
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Michelle A. Fanale
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
- Seattle Genetics, Inc. Bothell WAUSA
| | - Barbara Pro
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
- Robert H Lurie Medical Research Center Chicago ILUSA
| | - Peter McLaughlin
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - M. Alma Rodriguez
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Sattva S. Neelapu
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Luis Fayad
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Anas Younes
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
- Memorial Sloan Kettering Cancer Center New York NYUSA
| | - Lei Feng
- Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Francisco Vega
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
- University of Miami Sylvester Comprehensive Cancer Center Miami FL USA
| | - Larry W. Kwak
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
- City of Hope Hospital Duarte CA USA
| | - Felipe Samaniego
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
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50
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Park SI, Horwitz SM, Foss FM, Pinter-Brown LC, Carson KR, Rosen ST, Pro B, Hsi ED, Federico M, Gisselbrecht C, Schwartz M, Bellm LA, Acosta M, Advani RH, Feldman T, Lechowicz MJ, Smith SM, Lansigan F, Tulpule A, Craig MD, Greer JP, Kahl BS, Leach JW, Morganstein N, Casulo C, Shustov AR. The role of autologous stem cell transplantation in patients with nodal peripheral T-cell lymphomas in first complete remission: Report from COMPLETE, a prospective, multicenter cohort study. Cancer 2019; 125:1507-1517. [PMID: 30694529 DOI: 10.1002/cncr.31861] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [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: 06/29/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The role of autologous stem cell transplantation (ASCT) in the first complete remission (CR1) of peripheral T-cell lymphomas (PTCLs) is not well defined. This study analyzed the impact of ASCT on the clinical outcomes of patients with newly diagnosed PTCL in CR1. METHODS Patients with newly diagnosed, histologically confirmed, aggressive PTCL were prospectively enrolled into the Comprehensive Oncology Measures for Peripheral T-Cell Lymphoma Treatment (COMPLETE) study, and those in CR1 were included in this analysis. RESULTS Two hundred thirteen patients with PTCL achieved CR1, and 119 patients with nodal PTCL, defined as anaplastic lymphoma kinase-negative anaplastic large cell lymphoma, angioimmunoblastic T-cell lymphoma (AITL), or PTCL not otherwise specified, were identified. Eighty-three patients did not undergo ASCT, whereas 36 underwent consolidative ASCT in CR1. At the median follow-up of 2.8 years, the median overall survival was not reached for the entire cohort of patients who underwent ASCT, whereas it was 57.6 months for those not receiving ASCT (P = .06). ASCT was associated with superior survival for patients with advanced-stage disease or intermediate-to-high International Prognostic Index scores. ASCT significantly improved overall and progression-free survival for patients with AITL but not for patients with other PTCL subtypes. In a multivariable analysis, ASCT was independently associated with improved survival (hazard ratio, 0.37; 95% confidence interval, 0.15-0.89). CONCLUSIONS This is the first large prospective cohort study directly comparing the survival outcomes of patients with nodal PTCL in CR1 with or without consolidative ASCT. ASCT may provide a benefit in specific clinical scenarios, but the broader applicability of this strategy should be determined in prospective, randomized trials. These results provide a platform for designing future studies of previously untreated PTCL.
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Affiliation(s)
| | | | | | | | | | | | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | | | | | | | | | | | - Mark Acosta
- Spectrum Pharmaceuticals, Inc, Irvine, California
| | | | - Tatyana Feldman
- Hackensack University Medical Center, Hackensack, New Jersey
| | | | | | - Frederick Lansigan
- Massachusetts General Hospital, Harvard University School of Medicine, Boston, Massachusetts
| | - Anil Tulpule
- University of Southern California, Los Angeles, California
| | | | | | - Brad S Kahl
- Washington University School of Medicine, St. Louis, Missouri
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