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Torrent A, Morgades M, García-Calduch O, de Llano MPQ, Montesinos P, Navarro I, Hernández-Rivas JM, Bárez-García A, González-Campos J, Oiartzabal I, Valero M, Cervera M, Zudaire T, Albors-Ferreiro M, López-Godino O, Gil-Cortés C, Villalón L, Saldaña R, Ribera JM. Results of the compassionate program of inotuzumab ozogamicin for adult patients with relapsed or refractory acute lymphoblastic leukemia in Spain. Eur J Haematol 2023. [PMID: 37381686 DOI: 10.1111/ejh.14031] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION The prognosis of relapsed B cell precursor acute lymphoblastic leukemia (B-ALL) is poor and few patients can be successfully rescued with conventional therapies. Inotuzumab ozogamicin (IO), an antibody against the CD22 antigen linked to calicheamicin, has been approved as a rescue treatment in relapsed/refractory (R/R) B-ALL. PATIENTS AND METHODS This was an observational, retrospective, multicenter study of adult patients included in the Spanish program of compassionate use of IO in centers from the PETHEMA group (Programa Español de Tratamientos en Hematología). RESULTS Thirty-four patients with a median age of 43 years (range, 19-73) were included. Twenty patients (59%) were refractory to the last treatment, IO treatment was given as ≥3rd salvage treatment in 25 patients (73%) and 20 patients (59%) received allogeneic hematopoietic stem cell transplantation before IO treatment. After a median of 2 cycles of IO, 64% of patients achieved complete response (CR)/complete response with incomplete recovery. The median response duration, progression-free survival and overall survival (OS) were 4.7 (95%CI, 2.4-7.0 months), 3.5 (95%CI, 1.0-5.0 months) and 4 months (95%CI, 1.9-6.1 months) respectively, with better OS for patients with relapsed B-ALL versus refractory disease (10.4 vs. 2.5 months, respectively) (p = .01). There was a trend for better OS for patients with first CR duration >12 months (7.2 months [95%CI, 3.2-11.2] vs. 3 months [95% CI, 1.8-4.2] respectively) (p = .054). There was no sinusoidal obstruction syndrome (SOS) event during IO treatment, but three patients (9%) developed grade 3-4 SOS during alloHSCT after IO treatment. CONCLUSIONS Our study showed slightly inferior outcomes of the pivotal trial probably due to poorer risk factors and late onset of IO therapy of recruited patients. Our results support early use of IO in relapsed/refractory ALL patients.
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Affiliation(s)
- Anna Torrent
- Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute (IJC), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mireia Morgades
- Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute (IJC), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Olga García-Calduch
- Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute (IJC), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Irene Navarro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jesús María Hernández-Rivas
- Departamento de Medicina, Universidad de Salamanca & Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | - Itziar Oiartzabal
- Servicio de Hematología y Hemoterapia, Hospital Universitario de Álava, Vitoria-Gasteiz, Álava, Spain
| | - Marta Valero
- Hematology Department, Hospital Arnau de Vilanova, Valencia, Spain
| | - Marta Cervera
- Hematology Department, Hospital Joan XXIII de Tarragona, Tarragona, Spain
| | - Teresa Zudaire
- Hematology Department, Hospital de Navarra, Navarra, Spain
| | | | - Oriana López-Godino
- Hematology Department, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | | | - Lucía Villalón
- Hematology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Josep-María Ribera
- Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute (IJC), Universitat Autònoma de Barcelona, Barcelona, Spain
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González-Gil C, Morgades M, Lopes T, Fuster-Tormo F, García-Chica J, Zhao R, Montesinos P, Torrent A, Diaz-Beya M, Coll R, Hermosín L, Mercadal S, González-Campos J, Zamora L, Artola T, Vall-Llovera F, Tormo M, Gil-Cortés C, Barba P, Novo A, Ribera J, Bernal T, De Ugarriza PL, Queipo MP, Martínez-Sánchez P, Giménez A, González-Martínez T, Cladera A, Cervera J, Fernández-Martín R, Ardaiz MÁ, Vidal MJ, Baena Á, López-Bigas N, Bigas A, Maciejewski J, Orfao A, Ribera JM, Genescà E. Genomics improves risk stratification of adults with T-cell acute lymphoblastic leukemia patients enrolled in measurable residual disease-oriented trials. Haematologica 2022; 108:969-980. [PMID: 36325893 PMCID: PMC10071117 DOI: 10.3324/haematol.2022.281196] [Citation(s) in RCA: 2] [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: 04/04/2022] [Indexed: 11/06/2022] Open
Abstract
Genetic information has been crucial to understand the pathogenesis of T-cell acute lymphoblastic leukemia (T-ALL) at diagnosis and at relapse, but still nowadays has a limited value in a clinical context. Few genetic markers are associated with the outcome of T-ALL patients, independently of measurable residual disease (MRD) status after therapy. In addition, the prognostic relevance of genetic features may be modulated by the specific treatment used. We analyzed the genetic profile of 145 T-ALL patients by targeted deep sequencing. Genomic information was integrated with the clinical-biological and survival data of a subset of 116 adult patients enrolled in two consecutive MRD-oriented trials of the Spanish PETHEMA (Programa Español de Tratamientos en Hematología) group. Genetic analysis revealed a mutational profile defined by DNMT3A/ N/KRAS/ MSH2/ U2AF1 gene mutations that identified refractory/resistant patients. Mutations in the DMNT3A gene were also found in the nonleukemic cell fraction of patients with T-ALL, revealing a possible mutational-driven clonal hematopoiesis event to prime T-ALL in elderly. The prognostic impact of this adverse genetic profile was independent of MRD status on day +35 of induction therapy. The combined WOG signature and MRD on day +35 allowed risk-stratification of T-ALL into standard or high-risk groups with significantly different 5-year overall survival (OS) (95% confidence interval [CI]) of 52% (37-67 %) and 17% (1-33%), respectively. These results confirm the relevance of the tumor genetic profile in predicting patient outcome in adult T-ALL and highlight the need for novel gene-targeted chemotherapeutic schedules to improve the OS of poor-prognosis T-ALL patients.
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Affiliation(s)
- Celia González-Gil
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Mireia Morgades
- Departament d'Hematologia Clínica, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Thaysa Lopes
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Francisco Fuster-Tormo
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Jesús García-Chica
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Ran Zhao
- Department of Quantitative Health Sciences and Leukemia Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | | | - Anna Torrent
- Departament d'Hematologia Clínica, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Marina Diaz-Beya
- Servei d'Hematologia Clínica, Hospital Clínic de Barcelona, Barcelona
| | - Rosa Coll
- Institut Català d'Oncologia (ICO), Hospital Josep Trueta, Girona
| | - Lourdes Hermosín
- Servicio Hematología Clínica, Hospital de Jerez, Jerez de la Frontera
| | - Santiago Mercadal
- Servei d'Hematologia Clínica, Hospital Duran i Reynals-ICO, Hospitalet del Llobregat
| | | | - Lurdes Zamora
- Departament d'Hematologia Clínica, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Teresa Artola
- Servicio Hematología Clínica, Hospital Universitario de Donostia, Donostia
| | | | - Mar Tormo
- Hospital Clínico Universitario, Instituto de investigación INCLIVA, Valencia
| | | | - Pere Barba
- Servicio Hematología Clínica, Hospital Universitari de la Vall d'Hebron, Barcelona
| | - Andrés Novo
- Servicio Hematología Clínica, Hospital Son Espases, Palma de Mallorca
| | - Jordi Ribera
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Teresa Bernal
- Servicio Hematología Clínica, Hospital Central de Asturias, Instituto de Investigación Sanitario del Principado de Asturias (ISPA), Instituto Oncológico Universitario del Principado de Asturias (IUOPA), Oviedo
| | - Paula López De Ugarriza
- Servicio Hematología Clínica, Hospital Central de Asturias, Instituto de Investigación Sanitario del Principado de Asturias (ISPA), Instituto Oncológico Universitario del Principado de Asturias (IUOPA), Oviedo
| | - María-Paz Queipo
- Servicio Hematología Clínica, Hospital Virgen de la Victoria, Málaga
| | | | - Alicia Giménez
- Servicio Hematología Clínica, Hospital 12 de Octubre, Madrid
| | | | - Antonia Cladera
- Servicio Hematología Clínica, Hospital Son LLátzer, Palma de Mallorca
| | - José Cervera
- Hospital Universitari i Politècnic La Fe, Valencia
| | - Rosa Fernández-Martín
- Servicio Hematología Clínica, Hospital Insular de Gran Canarias, Las Palmas de Gran Canaria
| | | | | | - Ángela Baena
- Servicio Hematología Clínica, Complejo Hospitalario de Jaén, Jaén
| | - Nuria López-Bigas
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona Institute of Science and Technology, Barcelona
| | - Anna Bigas
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Program in Cancer Research, Institut-Hospital del Mar d'Investigacions Mèdiques, CIBERONC, Barcelona
| | - Jaroslaw Maciejewski
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Alberto Orfao
- Centro de Investigación del Cáncer (IBMCC-CSIC/USAL), Departamento de Medicina, Universidad de Salamanca, Instituto Biosanitario de Salamanca, CIBERONC, Salamanca
| | - Josep Maria Ribera
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Departament d'Hematologia Clínica, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Eulalia Genescà
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona.
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Rodríguez-Arbolí E, Martínez-Cuadrón D, Rodríguez-Veiga R, Carrillo-Cruz E, Gil-Cortés C, Serrano-López J, Bernal Del Castillo T, Martínez-Sánchez MDP, Rodríguez-Medina C, Vidriales B, Bergua JM, Benavente C, García-Boyero R, Herrera-Puente P, Algarra L, Sayas-Lloris MJ, Fernández R, Labrador J, Lavilla-Rubira E, Barrios-García M, Tormo M, Serrano-Maestro A, Sossa-Melo CL, García-Belmonte D, Vives S, Rodríguez-Gutiérrez JI, Albo-López C, Garrastazul-Sánchez MP, Colorado-Araujo M, Mariz J, Sanz MÁ, Pérez-Simón JA, Montesinos P. Long-Term Outcomes After Autologous Versus Allogeneic Stem Cell Transplantation in Molecularly-Stratified Patients With Intermediate Cytogenetic Risk Acute Myeloid Leukemia: A PETHEMA Study. Transplant Cell Ther 2021; 27:311.e1-311.e10. [PMID: 33836871 DOI: 10.1016/j.jtct.2020.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/20/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022]
Abstract
Acute myeloid leukemia (AML) with intermediate risk cytogenetics (IRcyto) comprises a variety of biological entities with distinct mutational landscapes that translate into differential risks of relapse and prognosis. Optimal postremission therapy choice in this heterogeneous patient population is currently unsettled. In the current study, we compared outcomes in IRcyto AML recipients of autologous (autoSCT) (n = 312) or allogeneic stem cell transplantation (alloSCT) (n = 279) in first complete remission (CR1). Molecular risk was defined based on CEBPA, NPM1, and FLT3-ITD mutational status, per European LeukemiaNet 2017 criteria. Five-year overall survival (OS) in patients with favorable molecular risk (FRmol) was 62% (95% confidence interval [CI], 50-72) after autoSCT and 66% (95% CI, 41-83) after matched sibling donor (MSD) alloSCT (P = .68). For patients of intermediate molecular risk (IRmol), MSD alloSCT was associated with lower cumulative incidence of relapse (P < .001), as well as with increased nonrelapse mortality (P = .01), as compared to autoSCT. The 5-year OS was 47% (95% CI, 34-58) after autoSCT and 70% (95% CI, 59-79) after MSD alloSCT (P = .02) in this patient subgroup. In a propensity-score matched IRmol subcohort (n = 106), MSD alloSCT was associated with superior leukemia-free survival (hazard ratio [HR] 0.33, P = .004) and increased OS in patients alive 1 year after transplantation (HR 0.20, P = .004). These results indicate that, within IRcyto AML in CR1, autoSCT may be a valid option for FRmol patients, whereas MSD alloSCT should be the preferred postremission strategy in IRmol patients.
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Affiliation(s)
- Eduardo Rodríguez-Arbolí
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), University of Seville, Seville, Spain
| | | | | | - Estrella Carrillo-Cruz
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), University of Seville, Seville, Spain
| | - Cristina Gil-Cortés
- Department of Hematology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Josefina Serrano-López
- Department of Hematology, Reina Sofía University Hospital/Maimónides Biomedical Research Institute of Córdoba (IMIBIC)/University of Córdoba, Córdoba, Spain
| | | | | | - Carlos Rodríguez-Medina
- Department of Hematology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Belén Vidriales
- Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), CIBERONC- CB16/12/00233 and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Juan Miguel Bergua
- Department of Hematology, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Celina Benavente
- Department of Hematology, Hospital Clínico San Carlos, Madrid, Spain
| | - Raimundo García-Boyero
- Department of Hematology, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | | | - Lorenzo Algarra
- Department of Hematology, Hospital General de Albacete, Albacete, Spain
| | | | - Rosa Fernández
- Department of Hematology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Jorge Labrador
- Department of Hematology and Research Unit, Hospital Universitario de Burgos, Burgos, Spain
| | | | | | - Mar Tormo
- Deparment of Hematology, Hospital Clínico Universitario de Valencia, Instituto de Investigación INCLIVA, Valencia, Spain
| | | | | | | | - Susana Vives
- Department of Hematology - ICO Hospital Germans Trias i Pujol , Josep Carreras Leukemia Research Institute, Badalona , Spain
| | | | - Carmen Albo-López
- Department of Hematology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | - José Mariz
- Department of Hematology, Instituto Português de Oncologia do Porto FG, Porto, Portugal
| | - Miguel Ángel Sanz
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain
| | - José Antonio Pérez-Simón
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), University of Seville, Seville, Spain.
| | - Pau Montesinos
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain
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Barba P, Martino R, Martinez-Cuadron D, Olga G, Esquirol A, Gil-Cortés C, Gonzalez J, Fernandez-Avilés F, Valcárcel D, Guardia R, Duarte RF, Hernandez-Rivas JM, Abella E, Montesinos P, Ribera JM. Impact of transplant eligibility and availability of a human leukocyte antigen-identical matched related donor on outcome of older patients with acute lymphoblastic leukemia. Leuk Lymphoma 2015; 56:2812-8. [DOI: 10.3109/10428194.2015.1014365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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García-Escrivá A, López-Hernández N, Gil-Cortés C. [Treatment of neuropathic pain with lacosamide]. Rev Neurol 2012; 54:167-172. [PMID: 22278893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Lacosamide is a new antiepileptic drug with a novel mechanism of action, as it selectively promotes the slow inactivation of voltage-dependent sodium channels without affecting fast inactivation. There are studies in the literature regarding its effectiveness in controlling neuropathic pain. CASE REPORTS We describe the use of intravenous lacosamide in the treatment of three patients with neuropathic pain: a woman with neuropathic pain in the first branch of the right trigeminal nerve during the acute phase of herpes zoster, a woman with central pain secondary to Dejerine-Roussy syndrome due to a malignant brain tumour, and a man with facial pain due to infiltration of the trigeminal nerve by a secondary lymphoma of the central nervous system. In the three cases, the administration of intravenous lacosamide has led to a considerable improvement in pain. The lacosamide dose has been 200 mg/day with excellent tolerability. CONCLUSION Lacosamide can be an effective and well-tolerated alternative in the treatment of neuropathic pain and, moreover, its intravenous use can achieve pain control faster or be suitable when it is not tolerated orally.
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