1
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Bantilan KS, Smith AN, Maurer MJ, Teruya-Feldstein J, Matasar MJ, Moskowitz AJ, Straus DJ, Noy A, Palomba ML, Horwitz SM, Hamlin PA, Portlock CS, Cerhan JR, Habermann TM, Salles GA, Nowakowski GS, Moskowitz CH, Zelenetz AD. Matched control analysis suggests that R-CHOP followed by (R)-ICE may improve outcome in non-GCB DLBCL compared with R-CHOP. Blood Adv 2024; 8:2172-2181. [PMID: 38271621 PMCID: PMC11068505 DOI: 10.1182/bloodadvances.2023011408] [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: 08/16/2023] [Revised: 11/17/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024] Open
Abstract
ABSTRACT Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is considered the standard-of-care for patients with advanced-stage diffuse large B-cell lymphoma (DLBCL), despite findings that patients with nongerminal center B-cell like (non-GCB) have significantly worse outcome with this regimen. We evaluated the prognostic significance of baseline risk factors, including cell of origin (COO) classified by the Hans algorithm, within an alternative chemoimmunotherapy program. At Memorial Sloan Kettering Cancer Center (MSK), 151 patients with DLBCL received sequential R-CHOP induction and (R)-ICE (rituximab, ifosfamide, carboplatin, and etoposide) consolidation. Outcome analysis based on COO was validated with a propensity score-matched cohort treated with R-CHOP from the Mayo Clinic component of the Molecular Epidemiology Resource (MER). Among the patients with GCB (n = 69) and non-GCB (n = 69) at MSK, event-free survival (EFS) of non-GCB was superior to that of GCB (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.29-0.98). Overall survival (OS) demonstrated an association in the same direction but was not statistically significant (HR, 0.68; 95% CI, 0.33-1.42). Propensity score-matched patients from MSK (n = 108) demonstrated a small attenuation in the HRs for EFS (HR, 0.57; 95% CI, 0.27-1.18) and OS (HR, 0.76; 95% CI, 0.33-1.79) and were no longer statistically significant. In contrast, the matched MER cohort (n = 108) demonstrated an EFS association (HR, 1.17; 95% CI, 0.70-1.95) and OS association (HR, 1.13; 95% CI, 0.64-2.00) in the opposite direction, but were also not statistically significant. R-CHOP induction and (R)-ICE consolidation may overcome the negative prognostic impact of the non-GCB phenotype, per the Hans algorithm, and can be preferentially selected for this population. This trial was registered at www.ClinicalTrials.gov as #NCT00039195 and #NCT00712582.
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Affiliation(s)
- Kurt S. Bantilan
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Matthew J. Matasar
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Alison J. Moskowitz
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - David J. Straus
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ariela Noy
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - M. Lia Palomba
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Steven M. Horwitz
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Paul A. Hamlin
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carol S. Portlock
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James R. Cerhan
- Department of Quantitative Sciences, Mayo Clinic, Rochester, MN
| | | | - Gilles A. Salles
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | | | - Craig H. Moskowitz
- Department of Medicine, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
| | - Andrew D. Zelenetz
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
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2
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Epstein-Peterson ZD, Drill E, Aypar U, Batlevi CL, Caron P, Dogan A, Drullinsky P, Gerecitano J, Hamlin PA, Ho C, Jacob A, Joseph A, Laraque L, Matasar MJ, Moskowitz AJ, Moskowitz CH, Mullins C, Owens C, Salles G, Schöder H, Straus DJ, Younes A, Zelenetz AD, Kumar A. Immunochemotherapy plus lenalidomide for high-risk mantle cell lymphoma with measurable residual disease evaluation. Haematologica 2024; 109:1149-1162. [PMID: 37646671 PMCID: PMC10985438 DOI: 10.3324/haematol.2023.282898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023] Open
Abstract
Chemoimmunotherapy followed by consolidative high-dose therapy with autologous stem cell rescue was a standard upfront treatment for fit patients with mantle cell lymphoma (MCL) in first remission; however, treatment paradigms are evolving in the era of novel therapies. Lenalidomide is an immunomodulatory agent with known efficacy in treating MCL. We conducted a single-center, investigator-initiated, phase II study of immunochemotherapy incorporating lenalidomide, without autologous stem cell transplant consolidation, enriching for patients with high-risk MCL (clinicaltrials gov. Identifier: NCT02633137). Patients received four cycles of lenalidomide-R-CHOP, two cycles of R-HiDAC, and six cycles of R-lenalidomide. The primary endpoint was rate of 3-year progression-free survival. We measured measurable residual disease (MRD) using a next-generation sequencing-based assay after each phase of treatment and at 6 months following end-oftreatment. We enrolled 49 patients of which 47 were response evaluable. By intent-to-treat, rates of overall and complete response were equivalent at 88% (43/49), one patient with stable disease, and two patients had disease progression during study; 3-year progression-free survival was 63% (primary endpoint not met) and differed by TP53 status (78% wild-type vs. 38% ALT; P=0.043). MRD status was prognostic and predicted long-term outcomes following R-HiDAC and at 6 months following end-of-treatment. In a high-dose therapy-sparing, intensive approach, we achieved favorable outcomes in TP53- wild-type MCL, including high-risk cases. We confirmed that sequential MRD assessment is a powerful prognostic tool in patients with MCL.
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Affiliation(s)
- Zachary D Epstein-Peterson
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Esther Drill
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center
| | - Umut Aypar
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | - Connie Lee Batlevi
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Philip Caron
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Ahmet Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | - Pamela Drullinsky
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - John Gerecitano
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Paul A Hamlin
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Caleb Ho
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | | | - Ashlee Joseph
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Leana Laraque
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Matthew J Matasar
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Alison J Moskowitz
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Craig H Moskowitz
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | | | - Colette Owens
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Gilles Salles
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David J Straus
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Anas Younes
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Andrew D Zelenetz
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Anita Kumar
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center.
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3
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Crosswell HE, LaCasce AS, Bartlett NL, Straus DJ, Savage KJ, Zinzani PL, Collins GP, Fanale M, Fenton K, Dong C, Miao H, Grigg AP. Brentuximab vedotin with chemotherapy in adolescents and young adults with stage III or IV classical Hodgkin lymphoma in ECHELON-1. Haematologica 2024; 109:982-987. [PMID: 37794803 PMCID: PMC10905068 DOI: 10.3324/haematol.2023.283303] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Howland E Crosswell
- Bon Secours Hematology and Oncology, Bon Secours, St. Francis Health System, Greenville, SC.
| | - Ann S LaCasce
- Dana-Farber Cancer Institute, Partners Cancer Care, Boston, MA
| | - Nancy L Bartlett
- Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - David J Straus
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Pier Luigi Zinzani
- IRCCS University Hospital of Bologna, Institute of Hematology "Seràgnoli," Bologna, Italy; Department of Specialized Medicine, Diagnostic and Experimental, University of Bologna, Bologna
| | | | | | | | - Cassie Dong
- Takeda Development Center Americas, Inc. (TDCA), Lexington, MA
| | - Harry Miao
- Takeda Development Center Americas, Inc. (TDCA), Lexington, MA
| | - Andrew P Grigg
- Department of Clinical Haematology, Austin Hospital, VIC
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Stuver R, Drill E, Qualls D, Okwali M, Lee Batlevi C, Caron PC, Dogan A, Epstein-Peterson ZD, Falchi L, Hamlin PA, Horwitz SM, Imber BS, Intlekofer AM, Johnson WT, Khan N, Kumar A, Lahoud OB, Lue JK, Matasar MJ, Moskowitz AJ, Noy A, Owens CN, Palomba ML, Schöder H, Vardhana SA, Yahalom J, Zelenetz AD, Salles G, Straus DJ. Retrospective characterization of nodal marginal zone lymphoma. Blood Adv 2023; 7:4838-4847. [PMID: 37307213 PMCID: PMC10469082 DOI: 10.1182/bloodadvances.2022009587] [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: 12/19/2022] [Revised: 05/08/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023] Open
Abstract
Nodal marginal zone lymphoma (NMZL) is a rare non-Hodgkin B-cell lymphoma that has historically been difficult to define, though is now formally recognized by the World Health Organization Classification. To better characterize the clinical outcomes of patients with NMZL, we reviewed a sequential cohort of 187 patients with NMZL to describe baseline characteristics, survival outcomes, and time-to-event data. Initial management strategies were classified into five categories: observation, radiation, anti-CD20 monoclonal antibody therapy, chemoimmunotherapy, or other. Baseline Follicular Lymphoma International Prognostic Index scores were calculated to evaluate prognosis. A total of 187 patients were analyzed. The five-year overall survival was 91% (95% confidence interval [CI], 87-95), with a median follow-up time of 71 months (range, 8-253) among survivors. A total of 139 patients received active treatment at any point, with a median follow-up time of 56 months (range, 13-253) among survivors who were never treated. The probability of remaining untreated at five years was 25% (95% CI, 19-33). For those initially observed, the median time to active treatment was 72 months (95% CI, 49-not reached). For those who received at least one active treatment, the cumulative incidence of receiving a second active treatment at 60 months was 37%. Transformation to large B-cell lymphoma was rare, with a cumulative incidence of 15% at 10 years. In summary, our series is a large cohort of uniformly diagnosed NMZL with detailed analyses of survival and time to event analyses. We showed that NMZL commonly presents as an indolent lymphoma for which initial observation is often a reasonable strategy.
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Affiliation(s)
- Robert Stuver
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Esther Drill
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Qualls
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michelle Okwali
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Connie Lee Batlevi
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Philip C. Caron
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ahmet Dogan
- Department of Pathology and Laboratory Medicine, Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Zachary D. Epstein-Peterson
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Lorenzo Falchi
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Paul A. Hamlin
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Steven M. Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brandon S. Imber
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew M. Intlekofer
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Human Oncology & Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William T. Johnson
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Niloufer Khan
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Anita Kumar
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Oscar B. Lahoud
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jennifer Kimberly Lue
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Matthew J. Matasar
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Alison J. Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ariela Noy
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Colette N. Owens
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M. Lia Palomba
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heiko Schöder
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Santosha A. Vardhana
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Human Oncology & Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joachim Yahalom
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew D. Zelenetz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Gilles Salles
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - David J. Straus
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
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5
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Johnson WT, Ganesan N, Epstein-Peterson ZD, Moskowitz AJ, Stuver RN, Maccaro CR, Galasso N, Chang T, Khan N, Aypar U, Lewis NE, Zelenetz AD, Palomba ML, Matasar MJ, Noy A, Hamilton AM, Hamlin P, Caron PC, Straus DJ, Intlekofer AM, Lee Batlevi C, Kumar A, Owens CN, Sauter CS, Falchi L, Lue JK, Vardhana SA, Salles G, Dogan A, Schultz ND, Arcila ME, Horwitz SM. TP53 mutations identify high-risk events for peripheral T-cell lymphoma treated with CHOP-based chemotherapy. Blood Adv 2023; 7:5172-5186. [PMID: 37078708 PMCID: PMC10480533 DOI: 10.1182/bloodadvances.2023009953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 04/21/2023] Open
Abstract
Nodal peripheral T-cell lymphomas (PTCL), the most common PTCLs, are generally treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-based curative-intent chemotherapy. Recent molecular data have assisted in prognosticating these PTCLs, but most reports lack detailed baseline clinical characteristics and treatment courses. We retrospectively evaluated cases of PTCL treated with CHOP-based chemotherapy that had tumors sequenced by the Memorial Sloan Kettering Integrated Mutational Profiling of Actionable Cancer Targets next-generation sequencing panel to identify variables correlating with inferior survival. We identified 132 patients who met these criteria. Clinical factors correlating with an increased risk of progression (by multivariate analysis) included advanced-stage disease and bone marrow involvement. The only somatic genetic aberrancies correlating with inferior progression-free survival (PFS) were TP53 mutations and TP53/17p deletions. PFS remained inferior when stratifying by TP53 mutation status, with a median PFS of 4.5 months for PTCL with a TP53 mutation (n = 21) vs 10.5 months for PTCL without a TP53 mutation (n = 111). No TP53 aberrancy correlated with inferior overall survival (OS). Although rare (n = 9), CDKN2A-deleted PTCL correlated with inferior OS, with a median of 17.6 months vs 56.7 months for patients without CDKN2A deletions. This retrospective study suggests that patients with PTCL with TP53 mutations experience inferior PFS when treated with curative-intent chemotherapy, warranting prospective confirmation.
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Affiliation(s)
- William T. Johnson
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Nivetha Ganesan
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zachary D. Epstein-Peterson
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Alison J. Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Robert N. Stuver
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Catherine R. Maccaro
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Natasha Galasso
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tiffany Chang
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Niloufer Khan
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Umut Aypar
- Department of Pathology, Cytogenetics Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Natasha E. Lewis
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew D. Zelenetz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - M. Lia Palomba
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Matthew J. Matasar
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Ariela Noy
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Audrey M. Hamilton
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Paul Hamlin
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Philip C. Caron
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - David J. Straus
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Andrew M. Intlekofer
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Connie Lee Batlevi
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Anita Kumar
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Colette N. Owens
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Craig S. Sauter
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH
| | - Lorenzo Falchi
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Jennifer K. Lue
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Santosha A. Vardhana
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gilles Salles
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Ahmet Dogan
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nikolaus D. Schultz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maria E. Arcila
- Department of Pathology, Molecular Diagnostic Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Steven M. Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
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6
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Roeker LE, Feldman TA, Soumerai JD, Falco V, Panton G, Dorsey C, Zelenetz AD, Falchi L, Park JH, Straus DJ, Pena Velasquez C, Lebowitz S, Fox Y, Battiato K, Laudati C, Thompson MC, McCarthy E, Kdiry S, Martignetti R, Turpuseema T, Purdom M, Paskalis D, Miskin HP, Sportelli P, Leslie LA, Mato AR. Adding Umbralisib and Ublituximab (U2) to Ibrutinib in Patients with CLL: A Phase II Study of an MRD-Driven Approach. Clin Cancer Res 2022; 28:3958-3964. [PMID: 35852793 PMCID: PMC9481719 DOI: 10.1158/1078-0432.ccr-22-0964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/05/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Ibrutinib has transformed the management of chronic lymphocytic leukemia (CLL), though its use is limited by toxicity and resistance. In this study, we utilized an "add on" approach for patients who had been treated with ibrutinib in the front-line or relapsed/refractory settings with detectable MRD. Umbralisib and ublituximab (U2) were added on to ibrutinib, patients were treated until achieving undetectable-MRD (U-MRD), and then they entered a period of treatment-free observation (TFO). PATIENTS AND METHODS Patients were eligible if they received ibrutinib in any line of therapy for at least 6 months and had detectable MRD (flow cytometry, <1 cell in 10-4 cutoff for U-MRD). U2 was added to ibrutinib, and patients were monitored serially for MRD. Once U-MRD was achieved or a total of 24 cycles were administered, patients entered a period of TFO. The primary study objective was rate of U-MRD. Secondary endpoints included safety and durability of clinical benefit after treatment discontinuation. RESULTS Twenty-eight patients were enrolled of whom 27 were evaluable for efficacy. Patients received ibrutinib for a median of 21 months (range 7-67) prior to study enrollment. Fourteen patients (52%) have achieved U-MRD per protocol whereas 78% had at least one U-MRD evaluation. Seventeen patients (63%) have entered TFO after a median of 6.4 months on triplet therapy. Progression-free survival at 12 months was estimated at 95%. Grade ≥3 adverse events were hypertension 7%, diarrhea 4%, and increased ALT/AST 4%. CONCLUSIONS This triplet approach utilizes the addition of U2 to ibrutinib as an MRD-driven time-limited therapy. This therapy was well tolerated and effective. TFO following this therapy appears durable in ongoing follow-up.
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Affiliation(s)
| | - Tatyana A Feldman
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Jacob D Soumerai
- Center for Lymphoma, Massachusetts General Hospital, Boston, Massachusetts
| | - Victoria Falco
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gail Panton
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Colleen Dorsey
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Lorenzo Falchi
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jae H Park
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - David J Straus
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Sonia Lebowitz
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yehudit Fox
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Elizabeth McCarthy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Sabrina Kdiry
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | | | | | | | | | | | | | - Lori A Leslie
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Anthony R Mato
- Memorial Sloan Kettering Cancer Center, New York, New York
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Ansell SM, Radford J, Connors JM, Długosz-Danecka M, Kim WS, Gallamini A, Ramchandren R, Friedberg JW, Advani R, Hutchings M, Evens AM, Smolewski P, Savage KJ, Bartlett NL, Eom HS, Abramson JS, Dong C, Campana F, Fenton K, Puhlmann M, Straus DJ. Overall Survival with Brentuximab Vedotin in Stage III or IV Hodgkin's Lymphoma. N Engl J Med 2022; 387:310-320. [PMID: 35830649 DOI: 10.1056/nejmoa2206125] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Five-year follow-up in a trial involving patients with previously untreated stage III or IV classic Hodgkin's lymphoma showed long-term progression-free survival benefits with first-line therapy with brentuximab vedotin, a CD30-directed antibody-drug conjugate, plus doxorubicin, vinblastine, and dacarbazine (A+AVD), as compared with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). A planned interim analysis indicated a potential benefit with regard to overall survival; data from a median of 6 years of follow-up are now available. METHODS We randomly assigned patients in a 1:1 ratio to receive up to six cycles of A+AVD or ABVD. The primary end point, modified progression-free survival, has been reported previously. The key secondary end point was overall survival in the intention-to-treat population. Safety was also assessed. RESULTS A total of 664 patients were assigned to receive A+AVD and 670 to receive ABVD. At a median follow-up of 73.0 months, 39 patients in the A+AVD group and 64 in the ABVD group had died (hazard ratio, 0.59; 95% confidence interval [CI], 0.40 to 0.88; P = 0.009). The 6-year overall survival estimates were 93.9% (95% CI, 91.6 to 95.5) in the A+AVD group and 89.4% (95% CI, 86.6 to 91.7) in the ABVD group. Progression-free survival was longer with A+AVD than with ABVD (hazard ratio for disease progression or death, 0.68; 95% CI, 0.53 to 0.86). Fewer patients in the A+AVD group than in the ABVD group received subsequent therapy, including transplantation, and fewer second cancers were reported with A+AVD (in 23 vs. 32 patients). Primary prophylaxis with granulocyte colony-stimulating factor was recommended after an increased incidence of febrile neutropenia was observed with A+AVD. More patients had peripheral neuropathy with A+AVD than with ABVD, but most patients in the two groups had resolution or amelioration of the event by the last follow-up. CONCLUSIONS Patients who received A+AVD for the treatment of stage III or IV Hodgkin's lymphoma had a survival advantage over those who received ABVD. (Funded by Takeda Development Center Americas and Seagen; ECHELON-1 ClinicalTrials.gov number, NCT01712490; EudraCT number, 2011-005450-60.).
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Affiliation(s)
- Stephen M Ansell
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - John Radford
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Joseph M Connors
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Monika Długosz-Danecka
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Won-Seog Kim
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Andrea Gallamini
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Radhakrishnan Ramchandren
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Jonathan W Friedberg
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Ranjana Advani
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Martin Hutchings
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Andrew M Evens
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Piotr Smolewski
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Kerry J Savage
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Nancy L Bartlett
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Hyeon-Seok Eom
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Jeremy S Abramson
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Cassie Dong
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Frank Campana
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Keenan Fenton
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Markus Puhlmann
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - David J Straus
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
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Ansell SM, Connors JM, Radford JA, Kim WS, Gallamini A, Ramchandren R, Friedberg JW, Advani RH, Hutchings M, Evens AM, Smolewski P, Savage KJ, Bartlett NL, Eom HS, Abramson JS, Dong C, Campana F, Fenton K, Puhlmann M, Straus DJ. First-line brentuximab vedotin plus chemotherapy to improve overall survival in patients with stage III/IV classical Hodgkin lymphoma: An updated analysis of ECHELON-1. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7503] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7503 Background: To date, an overall survival (OS) benefit from upfront treatment for new treatment combinations over existing approaches has rarely been shown in first-line classical Hodgkin lymphoma (cHL). With the introduction of newer active therapies for relapsed/refractory disease, demonstration of improved OS with first-line therapy has been challenging. In ECHELON-1 (NCT01712490), 5-year follow-up analyses supported the long-term progression-free survival (PFS) benefit with first-line brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A+AVD) vs doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in patients (pts) with stage III/IV cHL, independent of interim positron emission tomography status. A+AVD had a manageable long-term safety profile, with numerically fewer second malignancies and a greater number of pregnancies reported vs ABVD (Connors et al, NEJM 2018; Straus et al, Lancet Haematol 2021). We report a prespecified OS analysis after approximately 6 years’ follow-up (cut-off, June 1, 2021). Methods: Pts were randomized 1:1 to receive up to 6 cycles of A+AVD (n = 664) or ABVD (n = 670) on day 1 and 15 every 28 days. OS was the key secondary endpoint and was an event-driven, pre-specified, alpha-controlled analysis in the intention to treat population. Results: At a median follow-up of 73 months, 39 and 64 OS events occurred in A+AVD and ABVD arms, respectively: OS significantly favored A+AVD vs ABVD (HR 0.590; 95% confidence interval [CI] 0.396–0.879; p = 0.009). Estimated 6-year OS rates (95% CI) were 93.9% (91.6–95.5) vs 89.4% (86.6–91.7) with A+AVD vs ABVD, respectively. There was a consistent OS benefit for A+AVD vs ABVD across prespecified subgroups. The 6-year PFS estimate was 82.3% (79.1–85.0) vs 74.5% (70.8–77.7) with A+AVD vs ABVD, respectively (HR 0.678 [95% CI 0.532–0.863]). Overall, A+AVD had a comparable long-term safety profile to ABVD. Treatment-emergent peripheral neuropathy continued to resolve or improve in both arms, with 86% (379/443) and 87% (249/286) of cases in the A+AVD and ABVD arms either completely resolving (72% vs 79%) or improving (14% vs 8%) by last follow-up. Fewer second malignancies were reported in the A+AVD vs ABVD arm (23 vs 32). More female patients reported pregnancy (49 vs 28) or live births (42 vs 19 in females) in the A+AVD vs the ABVD arm; no stillbirths were reported. No new safety signals were identified. Conclusions: A+AVD treatment resulted in a statistically significant 41% reduction in the risk of death vs ABVD, with a manageable safety profile consistent with prior reports. These outcomes confirm A+AVD as a preferred option for pts with previously untreated stage III/IV cHL. Clinical trial information: NCT01712490.
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Affiliation(s)
| | - Joseph M. Connors
- BC Cancer Centre for Lymphoid Cancer and Department of Medical Oncology, Vancouver, BC, Canada
| | - John A. Radford
- University of Manchester, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Andrea Gallamini
- Research Innovation and Statistics, Antoine-Lacassagne Cancer Centre, Nice, France
| | | | - Jonathan W. Friedberg
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Ranjana H. Advani
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA
| | - Martin Hutchings
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andrew M. Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Piotr Smolewski
- Department of Experimental Hematology, Medical University of Lodz, Lodz, Poland
| | - Kerry J. Savage
- BC Cancer Centre for Lymphoid Cancer and Department of Medical Oncology, Vancouver, BC, Canada
| | - Nancy L. Bartlett
- Washington University School of Medicine Siteman Cancer Center, St. Louis, MO
| | - Hyeon Seok Eom
- Center for Hematologic Malignancy, National Cancer Center, Goyang, South Korea
| | | | - Cassie Dong
- Takeda Development Center Americas, Inc. (TDCA), Lexington, MA
| | - Frank Campana
- Takeda Development Center Americas, Inc. (TDCA), Lexington, MA
| | | | | | - David J. Straus
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
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Buege MJ, Dao PH, Drill E, LeVoir A, Pak T, Peterson TJ, Straus DJ. IVAC With or Without Rituximab for Relapsed or Refractory B-Cell Non-Hodgkin Lymphomas: Real-World Experience in the Modern Era. Clin Lymphoma Myeloma Leuk 2021; 21:873-878. [PMID: 34413005 PMCID: PMC8643303 DOI: 10.1016/j.clml.2021.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Part B of the modified Magrath regimen (IVAC) +/- rituximab (R) is recommended as standalone therapy by national guidelines for management of relapsed/refractory Burkitt lymphoma, and is used in other non-Hodgkin lymphomas (NHL). Activity of IVAC in B-cell NHL, particularly with R, and its toxicity remain incompletely described. PATIENTS AND METHODS We reviewed patients with relapsed/refractory B-cell NHL treated with IVAC +/- R between 2004 and 2019 at Memorial Sloan Kettering Cancer Center to assess efficacy and toxicity. RESULTS Among 54 eligible patients (median 2 prior lines of therapy), 76% had diffuse large B-cell lymphoma; 30% had central nervous system involvement at IVAC initiation. Objective response rate was 48%. At median 22-month follow-up, median progression-free and overall survival were 3.1 months and 4.9 months, respectively. Grade ≥ 3 anemia (93%), neutropenia (94%), and thrombocytopenia (100%; all grade 4) were common. Febrile neutropenia occurred in 65% and did not appear to be influenced by use of antimicrobial or granulocyte colony stimulating factor prophylaxis. Mortality was attributed to treatment in 19% of evaluable patients. CONCLUSION The clinical efficacy and utility of IVAC +/- R remain unclear. However, its profound hematologic toxicity and life-threatening complications despite prophylactic measures warrant careful consideration of alternatives.
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Affiliation(s)
- Michael J Buege
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Phuong H Dao
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Esther Drill
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andréa LeVoir
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Terry Pak
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tim J Peterson
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David J Straus
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Mehta‐Shah N, Lunning MA, Moskowitz AJ, Boruchov AM, Ruan J, Lynch P, Hamlin PA, Leonard J, Matasar MJ, Myskowski PL, Marzouk E, Nair S, Sholklapper T, Minnal V, Palomba ML, Vredenburgh J, Kumar A, Noy A, Straus DJ, Zelenetz AD, Schoder H, Rademaker J, Schaffer W, Galasso N, Ganesan N, Horwitz SM. Romidepsin and lenalidomide-based regimens have efficacy in relapsed/refractory lymphoma: Combined analysis of two phase I studies with expansion cohorts. Am J Hematol 2021; 96:1211-1222. [PMID: 34251048 DOI: 10.1002/ajh.26288] [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] [Received: 04/17/2021] [Revised: 06/06/2021] [Accepted: 07/02/2021] [Indexed: 12/17/2022]
Abstract
Romidepsin (histone deacetylase inhibitor), lenalidomide (immunomodulatory agent), and carfilzomib (proteasome inhibitor), have efficacy and lack cumulative toxicity in relapsed/refractory lymphoma. We performed two investigator initiated sequential phase I studies to evaluate the maximum tolerated dose (MTD) of romidepsin and lenalidomide (regimen A) and romidepsin, lenalidomide, and carfilzomib (regimen B) in relapsed/refractory lymphoma. Cohorts in T-cell lymphoma (TCL), B-cell lymphoma (BCL) were enrolled at the MTD. Forty-nine patients were treated in study A (27 TCL, 17 BCL, 5 Hodgkin lymphoma (HL)) and 27 (16 TCL, 11 BCL) in study B. The MTD of regimen A was romidepsin 14 mg/m2 IV on days 1, 8, and 15 and lenalidomide 25 mg oral on days 1-21 of a 28-day cycle. The MTD of regimen B was romidepsin 8 mg/m2 on days 1 and 8, lenalidomide 10 mg oral on days 1-14 and carfilzomib 36 mg/m2 IV on days 1 and 8 of a 21-day cycle. In study A, 94% had AEs ≥Grade 3, most commonly neutropenia (49%), thrombocytopenia (53%), and electrolyte abnormalities (49%). In study B 59% had AEs ≥Grade 3, including thrombocytopenia (30%) and neutropenia (26%). In study A the ORR was 49% (50% TCL, 47% BCL, 50% HL). In study B the ORR was 48% (50% TCL, 50% BCL). For study A and B the median progression free survival (PFS) was 5.7 months and 3.4 months respectively with 11 patients proceeding to allogeneic transplant. The combinations of romidepsin and lenalidomide and of romidepsin, lenalidomide and carfilzomib showed activity in relapsed/refractory lymphoma with an acceptable safety profile.
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Affiliation(s)
- Neha Mehta‐Shah
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
- Washington University School of Medicine in St. Louis St. Louis Missouri USA
| | - Matthew A. Lunning
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
- Department of Medicine University of Nebraska Medical Center Omaha Nebraska USA
| | - Alison J. Moskowitz
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Adam M. Boruchov
- Department of Medicine St. Francis Medical Center Hartford Connecticut USA
| | - Jia Ruan
- Department of Medicine Weill Cornell Medical Center New York New York USA
| | - Peggy Lynch
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Paul A. Hamlin
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - John Leonard
- Department of Medicine Weill Cornell Medical Center New York New York USA
| | - Matthew J. Matasar
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Patricia L. Myskowski
- Dermatology Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Evan Marzouk
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Sumithra Nair
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Tamir Sholklapper
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Veena Minnal
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Maria L. Palomba
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - James Vredenburgh
- Department of Medicine St. Francis Medical Center Hartford Connecticut USA
| | - Anita Kumar
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Ariela Noy
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - David J. Straus
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Andrew D. Zelenetz
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Heiko Schoder
- Department of Radiology Memorial Sloan Kettering Cancer Center New York New York USA
| | - Jurgen Rademaker
- Department of Radiology Memorial Sloan Kettering Cancer Center New York New York USA
| | - Wendy Schaffer
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Natasha Galasso
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Nivetha Ganesan
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Steven M. Horwitz
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
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Moskowitz AJ, Shah G, Schöder H, Ganesan N, Drill E, Hancock H, Davey T, Perez L, Ryu S, Sohail S, Santarosa A, Galasso N, Neuman R, Liotta B, Blouin W, Kumar A, Lahoud O, Batlevi CL, Hamlin P, Straus DJ, Rodriguez-Rivera I, Owens C, Caron P, Intlekofer AM, Hamilton A, Horwitz SM, Falchi L, Joffe E, Johnson W, Lee C, Palomba ML, Noy A, Matasar MJ, Pongas G, Salles G, Vardhana S, Sanin BW, von Keudell G, Yahalom J, Dogan A, Zelenetz AD, Moskowitz CH. Phase II Trial of Pembrolizumab Plus Gemcitabine, Vinorelbine, and Liposomal Doxorubicin as Second-Line Therapy for Relapsed or Refractory Classical Hodgkin Lymphoma. J Clin Oncol 2021; 39:3109-3117. [PMID: 34170745 PMCID: PMC9851707 DOI: 10.1200/jco.21.01056] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE We conducted a phase II study evaluating pembrolizumab plus gemcitabine, vinorelbine, and liposomal doxorubicin (pembro-GVD) as second-line therapy for relapsed or refractory (rel/ref) classical Hodgkin lymphoma (cHL) (ClinicalTrials.gov identifier: NCT03618550). METHODS Transplant eligible patients with rel/ref cHL following first-line therapy were treated with two to four cycles of pembrolizumab (200 mg intravenous [IV], day 1), gemcitabine (1,000 mg/m2 IV, days 1 and 8), vinorelbine (20 mg/m2 IV, days 1 and 8), and liposomal doxorubicin (15 mg/m2, days 1 and 8), given on 21-day cycles. The primary end point was complete response (CR) following up to four cycles of pembro-GVD. Patients who achieved CR by labeled fluorodeoxyglucose-positron emission tomography (Deauville ≤ 3) after two or four cycles proceeded to high-dose therapy and autologous hematopoietic cell transplantation (HDT/AHCT). HDT/AHCT was carried out according to institutional standards, and brentuximab vedotin maintenance was allowed following HDT/AHCT. RESULTS Of 39 patients enrolled, 41% had primary ref disease and 38% relapsed within 1 year of frontline treatment. 31 patients received two cycles of pembro-GVD, and eight received four cycles. Most adverse events were grade 1 or two, whereas few were grade 3 and included transaminitis (n = 4), neutropenia (n = 4), mucositis (n = 2), thyroiditis (n = 1), and rash (n = 1). Of 38 evaluable patients, overall and CR rates after pembro-GVD were 100% and 95%, respectively. Thirty-six (95%) patients proceeded to HDT/AHCT, two received pre-HDT/AHCT involved site radiation, and 13 (33%) received post-HDT/AHCT brentuximab vedotin maintenance. All 36 transplanted patients are in remission at a median post-transplant follow-up of 13.5 months (range: 2.66-27.06 months). CONCLUSION Second-line therapy with pembro-GVD is a highly effective and well-tolerated regimen that can efficiently bridge patients with rel/ref cHL to HDT/AHCT.
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Affiliation(s)
- Alison J. Moskowitz
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY,Alison J. Moskowitz, MD, Memorial Sloan Kettering Cancer Center, 530 East 74th St, New York, NY 10021; e-mail:
| | - Gunjan Shah
- Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heiko Schöder
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nivetha Ganesan
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Esther Drill
- Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Helen Hancock
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Theresa Davey
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leslie Perez
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sunyoung Ryu
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samia Sohail
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alayna Santarosa
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Natasha Galasso
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rachel Neuman
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brielle Liotta
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William Blouin
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anita Kumar
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Oscar Lahoud
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Connie L. Batlevi
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Hamlin
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David J. Straus
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Colette Owens
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Philip Caron
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew M. Intlekofer
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Audrey Hamilton
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Steven M. Horwitz
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lorenzo Falchi
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Erel Joffe
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William Johnson
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christina Lee
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M. Lia Palomba
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ariela Noy
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew J. Matasar
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Georgios Pongas
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL
| | - Gilles Salles
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Santosha Vardhana
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Beatriz Wills Sanin
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gottfried von Keudell
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joachim Yahalom
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ahmet Dogan
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew D. Zelenetz
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Craig H. Moskowitz
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL
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12
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Straus DJ, Długosz-Danecka M, Connors JM, Alekseev S, Illés Á, Picardi M, Lech-Maranda E, Feldman T, Smolewski P, Savage KJ, Bartlett NL, Walewski J, Ramchandren R, Zinzani PL, Hutchings M, Munoz J, Lee HJ, Kim WS, Advani R, Ansell SM, Younes A, Gallamini A, Liu R, Little M, Fenton K, Fanale M, Radford J. Brentuximab vedotin with chemotherapy for stage III or IV classical Hodgkin lymphoma (ECHELON-1): 5-year update of an international, open-label, randomised, phase 3 trial. Lancet Haematol 2021; 8:e410-e421. [PMID: 34048680 DOI: 10.1016/s2352-3026(21)00102-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite advances in the treatment of Hodgkin lymphoma with the introduction of PET-adapted regimens, practical challenges prevent more widespread use of these approaches. The ECHELON-1 study assessed the safety and efficacy of front-line A+AVD (brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine) versus ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in patients with stage III or IV classical Hodgkin lymphoma. The primary analysis showed improved modified progression-free survival with A+AVD. We present an updated analysis of ECHELON-1 at 5 years, an important landmark for this patient population. METHODS ECHELON-1 was an international, open-label, randomised, phase 3 trial done at 218 clinical sites, including hospitals, cancer centres, and community clinics, in 21 countries. Previously untreated patients (≥18 years with an Eastern Cooperative Oncology Group performance status of ≤2) with stage III or IV classical Hodgkin lymphoma were randomly assigned (1:1) to receive A+AVD (brentuximab vedotin, 1·2 mg/kg of bodyweight, doxorubicin 25 mg/m2 of body surface area, vinblastine 6 mg/m2, and dacarbazine 375 mg/m2) or ABVD (doxorubicin 25 mg/m2, bleomycin 10 U/m2, vinblastine 6 mg/m2, and dacarbazine 375 mg/m2) intravenously on days 1 and 15 of each 28-day cycle for up to six cycles. Stratification factors included region (Americas vs Europe vs Asia) and International Prognostic Score risk group (low, intermediate, or high risk). The primary endpoint was modified progression-free survival; this 5-year update includes analysis of progression-free survival as per investigator assessment in the intention-to-treat population, which was an exploratory endpoint, although the 5-year analysis was not prespecified in the protocol. This trial is registered with ClinicalTrials.gov (NCT01712490) and EudraCT (2011-005450-60), and is ongoing. FINDINGS Between Nov 19, 2012, and Jan 13, 2016, 1334 patients were randomly assigned to receive A+AVD (n=664) or ABVD (n=670). At a median follow-up of 60·9 months (IQR 52·2-67·3), 5-year progression-free survival was 82·2% (95% CI 79·0-85·0) with A+AVD and 75·3% (71·7-78·5) with ABVD (hazard ratio [HR] 0·68 [95% CI 0·53-0·87]; p=0·0017). Among PET-2-negative patients, 5-year progression-free survival was higher with A+AVD than with ABVD (84·9% [95% CI 81·7-87·6] vs 78·9% [75·2-82·1]; HR 0·66 [95% CI 0·50-0·88]; p=0·0035). 5-year progression-free survival for PET-2-positive patients was 60·6% (95% CI 45·0-73·1) with A+AVD versus 45·9% (32·7-58·2) with ABVD (HR 0·70 [95% CI 0·39-1·26]; p=0·23). Peripheral neuropathy continued to improve or resolve over time with both A+AVD (375 [85%] of 443 patients) and ABVD (245 [86%] of 286 patients); more patients had ongoing peripheral neuropathy in the A+AVD group (127 [19%] of 662) than in the ABVD group (59 [9%] of 659). Fewer secondary malignancies were reported with A+AVD (19 [3%] of 662) than with ABVD (29 [4%] of 659). More livebirths were reported in the A+AVD group (n=75) than in the ABVD group (n=50). INTERPRETATION With 5 years of follow-up, A+AVD showed robust and durable improvement in progression-free survival versus ABVD, regardless of PET-2 status, and a consistent safety profile. On the basis of these findings, A+AVD should be preferred over ABVD for patients with previously untreated stage III or IV classical Hodgkin lymphoma. FUNDING Millennium Pharmaceuticals (a wholly owned subsidiary of Takeda Pharmaceutical Company), and Seagen.
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Affiliation(s)
- David J Straus
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Monika Długosz-Danecka
- Department of Clinical Oncology, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Joseph M Connors
- Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Sergey Alekseev
- Petrov Research Institute of Oncology, St Petersburg, Russia
| | | | - Marco Picardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Ewa Lech-Maranda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Tatyana Feldman
- John Theurer Cancer Center, Hackensack Meridian Health School of Medicine, Hackensack, NJ, USA
| | | | - Kerry J Savage
- Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Nancy L Bartlett
- Washington University School of Medicine Siteman Cancer Center, St Louis, MO, USA
| | - Jan Walewski
- Maria Sklodowska-Curie National Research Institute of Oncology, European Reference Network, Warszawa, Poland
| | | | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia Seràgnoli, Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italy
| | - Martin Hutchings
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Javier Munoz
- Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Hun Ju Lee
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ranjana Advani
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
| | | | - Anas Younes
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; AstraZeneca Pharmaceuticals, LP Wilmington, DE, USA
| | - Andrea Gallamini
- Research Innovation and Statistics, Antoine-Lacassagne Cancer Centre, Nice, France
| | - Rachael Liu
- Millennium Pharmaceuticals, a wholly owned subsidiary of Takeda Pharmaceuticals, Cambridge, MA, USA
| | - Meredith Little
- Millennium Pharmaceuticals, a wholly owned subsidiary of Takeda Pharmaceuticals, Cambridge, MA, USA
| | | | | | - John Radford
- University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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13
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Crosswell HE, LaCasce AS, Bartlett NL, Straus DJ, Savage KJ, Zinzani PL, Collins GP, Fanale MA, Fenton K, Dong C, Miao HH, Grigg A. Brentuximab vedotin with chemotherapy in adolescents and young adults (AYAs) with stage III or IV Hodgkin lymphoma: A subgroup analysis from the phase 3 Echelon-1 study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7528] [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
7528 Background: Hodgkin lymphoma (HL) is a rare disease that commonly occurs in adolescents and young adults (AYAs) which is typically defined as 15 to 39 years. Given their young age at presentation, key factors in treatment selection include a high cure rate and limiting long-term toxicities. Brentuximab vedotin (Adcetris®; A) is a CD30-directed ADC approved in combination with doxorubicin, vinblastine, and dacarbazine chemotherapy (A+AVD) for adults with previously untreated stage III/IV cHL based on results from the phase 3 ECHELON-1 trial. Recent 5-year data demonstrated a significantly improved PFS per investigator (INV) vs doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) (HR, 0.69; 95% CI, 0.54–0.9; P = 0.003) (Straus 2020). Here we describe key efficacy and safety results for AYA pts enrolled in ECHELON-1. Methods: ECHELON-1 (N = 1334) is a global, open-label, multicenter, randomized trial of pts with previously untreated stage III/IV cHL. A total of 771 AYAs (57.8%) received either A+AVD (n = 396) or ABVD (n = 375) with a PET scan after cycle 2 (PET2). An analysis of PFS (time from randomization to progression or death from any cause) per INV was conducted. Results: After a median follow-up of 60.7 months (95% CI, 60.4-61.0), there was a 36% reduction in the risk of progression or death in AYAs receiving A+AVD vs ABVD (HR 0.64; 95% CI, 0.45-0.92; P = 0.013) with a 5-year PFS of 86.3% vs 79.4%, respectively, similar to the ITT population. The PFS benefit of A+AVD vs ABVD was independent of PET2 status; PET2 positivity (Deauville 4-5) was 6% and 8%, respectively. On the A+AVD arm, 81 AYAs (20%) had at least 1 subsequent anticancer therapy vs 96 AYAs (26%) on the ABVD arm; 26 AYAs (7%) received subsequent high dose chemotherapy and autologous stem cell transplant vs 32 AYAs (9%) on the A+AVD and ABVD arms, respectively. Resolution or improvement of peripheral neuropathy (PN) were similar in both arms; 224 AYAs (88%) on the A+AVD had resolution or improvement of PN vs 133 AYAs (89%) on the ABVD arm. Ongoing PN was predominantly Gr 1 (62%) and Gr 2 (26%), with 8 AYAs (13%) on the A+AVD arm and 1 AYA (5%) on the ABVD arm reporting ongoing Gr 3 PN. Finally, 7 AYAs (1.8%) and 5 AYAs (1.4%) on the A+AVD and ABVD arms, respectively, reported a secondary malignancy. Subsequent pregnancies were reported in female pts (44 A+AVD; 26 ABVD) and partners of male pts (31 A+AVD; 30 ABVD). No stillbirths were reported. All but 1 pt in each arm was < 40. Conclusions: Consistent with the ITT population, AYAs treated with A+AVD compared to ABVD had a durable PFS benefit at this significant 5-year milestone. No impact on the rate of secondary malignancies and a numerically greater number of pregnancies were observed, outcomes of interest to AYAs. Additionally, the majority of PN events improved or resolved over time. A+AVD should be considered a treatment option for AYAs with stage III/IV cHL. Clinical trial information: NCT01712490.
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Affiliation(s)
- Howland E. Crosswell
- Bon Secours Hematology Oncology, Bon Secours, St. Francis Health System, Greenville, SC
| | - Ann S. LaCasce
- Dana-Farber Cancer Institute, Partners CancerCare, Boston, MA
| | - Nancy L. Bartlett
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - David J. Straus
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Pier Luigi Zinzani
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna, Italy
| | | | | | | | | | | | - Andrew Grigg
- Department of Clinical Haematology, Austin Hospital, Austin, VIC, Australia
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14
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Khan N, Khimani F, Shustov AR, Shadman M, Ruan J, Moskowitz AJ, Straus DJ, Kumar A, Sauter CS, Zelenetz AD, Noy A, Shah GL, Matasar MJ, Drullinsky P, Hamilton AM, Drill EN, Van Besien K, Giralt S, Horwitz SM, Dahi P. Update of a phase II, multicenter study of high-dose chemotherapy with autologous stem cell transplant followed by maintenance romidepsin for T-cell lymphoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7533] [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
7533 Background: Peripheral T-cell lymphomas (PTCL) have suboptimal outcomes with conventional chemotherapy. Autologous hematopoietic stem cell transplant (AHCT) is a therapeutic strategy for patients in first complete or partial remission (CR1 or PR1), with median progression-free survival (PFS) after AHCT of 36-48% by intent to treat (d’Amore et al JCO 2012, Reimer et al JCO 2009). Romidepsin (romi) is a histone deacetylase inhibitor approved for treatment of relapsed/refractory T-cell lymphoma. We present updated data of the first multicenter study to evaluate PFS of patients (pts) receiving maintenance therapy with romi after AHCT. Methods: This was a phase 2, open-label, investigator-initiated study (expected PFS 45%, desired PFS 70%; success achieved if 15 or more pts out of 25 were progression-free at 2 years post-AHCT). 26 pts transplanted in CR1 or PR1 were evaluable for the primary endpoint of 2-year PFS (Cohort 1, Table). An exploratory cohort (Cohort 2, n=7) enrolled pts either transplanted ≥ CR/PR2 (n=5) or with high risk histologies (n=2). Pts underwent AHCT with carmustine, etoposide, cytarabine and melphalan (BEAM) conditioning. Maintenance romi 14 mg/m2 started days 42-80 post AHCT; every other week through 6 mon, every 3 weeks through 1 year and every 4 weeks through 2 years post AHCT. PFS was estimated by Kaplan-Meier. Results: 47 pts consented; 13 did not receive romi (no AHCT, n=2; relapse before romi, n=3; cardiac comorbidity, n=3, patient declined, n=5). 1 consented pt did not have PTCL. 15 out of the first 25 pts in Cohort 1 were progression free after 2 years; median follow up of 31 mon (21 - 36 mon). Estimated 2-year PFS was 62% (45-83%, 95% CI); median PFS 30 mon (12.0- NA, 95% CI). In Cohort 2, estimated 2-year PFS was 43% (18 – 100, 95% CI); median follow up of 30 mon (range, 24 – 37 mon); median PFS 14 mon (5 – NA, 95% CI). Across cohorts, 5 pts required dose reduction. The most common toxicities (≥10% of pts, all grades) were fatigue (n=24, 73%), decreased platelets (n=16, 48%) and anemia (n=16, 48%). Conclusions: While the study did not meet its desired primary efficacy endpoint, maintenance romi was well-tolerated with an estimated 2-year PFS of 62%, greater than historical data. A larger, randomized study would be needed to determine the superiority of this approach. Clinical trial information: NCT01908777. [Table: see text]
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Affiliation(s)
- Niloufer Khan
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Farhad Khimani
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | | | - Jia Ruan
- Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | | | | | - Anita Kumar
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Ariela Noy
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Parastoo Dahi
- Memorial Sloan Kettering Cancer Center, New York, NY
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15
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Kumar A, Casulo C, Advani RH, Budde E, Barr PM, Batlevi CL, Caron P, Constine LS, Dandapani SV, Drill E, Drullinsky P, Friedberg JW, Grieve C, Hamilton A, Hamlin PA, Hoppe RT, Horwitz SM, Joseph A, Khan N, Laraque L, Matasar MJ, Moskowitz AJ, Noy A, Palomba ML, Schöder H, Straus DJ, Vemuri S, Yang J, Younes A, Zelenetz AD, Yahalom J, Moskowitz CH. Brentuximab Vedotin Combined With Chemotherapy in Patients With Newly Diagnosed Early-Stage, Unfavorable-Risk Hodgkin Lymphoma. J Clin Oncol 2021; 39:2257-2265. [PMID: 33909449 DOI: 10.1200/jco.21.00108] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To improve curability and limit long-term adverse effects for newly diagnosed early-stage (ES), unfavorable-risk Hodgkin lymphoma. METHODS In this multicenter study with four sequential cohorts, patients received four cycles of brentuximab vedotin (BV) and doxorubicin, vinblastine, and dacarbazine (AVD). If positron emission tomography (PET)-4-negative, patients received 30-Gy involved-site radiotherapy in cohort 1, 20-Gy involved-site radiotherapy in cohort 2, 30-Gy consolidation-volume radiotherapy in cohort 3, and no radiotherapy in cohort 4. Eligible patients had ES, unfavorable-risk disease. Bulk disease defined by Memorial Sloan Kettering criteria (> 7 cm in maximal transverse or coronal diameter on computed tomography) was not required for cohorts 1 and 2 but was for cohorts 3 and 4. The primary end point was to evaluate safety for cohort 1 and to evaluate complete response rate by PET for cohorts 2-4. RESULTS Of the 117 patients enrolled, 116 completed chemotherapy, with the median age of 32 years: 50% men, 98% stage II, 86% Memorial Sloan Kettering-defined disease bulk, 27% traditional bulk (> 10 cm), 52% elevated erythrocyte sedimentation rate, 21% extranodal involvement, and 56% > 2 involved lymph node sites. The complete response rate in cohorts 1-4 was 93%, 100%, 93%, and 97%, respectively. With median follow-up of 3.8 years (5.9, 4.5, 2.5, and 2.2 years for cohorts 1-4), the overall 2-year progression-free and overall survival were 94% and 99%, respectively. In cohorts 1-4, the 2-year progression-free survival was 93%, 97%, 90%, and 97%, respectively. Adverse events included neutropenia (44%), febrile neutropenia (8%), and peripheral neuropathy (54%), which was largely reversible. CONCLUSION BV + AVD × four cycles is a highly active and well-tolerated treatment program for ES, unfavorable-risk Hodgkin lymphoma, including bulky disease. The efficacy of BV + AVD supports the safe reduction or elimination of consolidative radiation among PET-4-negative patients.
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Affiliation(s)
- Anita Kumar
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carla Casulo
- Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | | | | | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | | | - Philip Caron
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Esther Drill
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Clare Grieve
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Paul A Hamlin
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard T Hoppe
- Stanford Cancer Institute, Stanford University, Stanford, CA
| | | | - Ashlee Joseph
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Niloufer Khan
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leana Laraque
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Ariela Noy
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Heiko Schöder
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Shreya Vemuri
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joanna Yang
- University of California San Francisco, San Francisco, CA
| | | | | | | | - Craig H Moskowitz
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
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16
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Abstract
Not available.
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17
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Mondello P, Musolino C, Dogliotti I, Bohn J, Cavallo F, Ferrero S, Botto B, Cerchione C, Nappi D, De Lorenzo S, Martinelli G, Wolf D, Schmitt C, Loseto G, Cuzzocrea S, Willenbacher W, Mian M, Straus DJ. ABVD vs BEACOPP escalated in advanced-stage Hodgkin's lymphoma: Results from a multicenter European study. Am J Hematol 2020; 95:1030-1037. [PMID: 32419224 DOI: 10.1002/ajh.25871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 11/05/2022]
Abstract
The optimal first-line treatment for advanced-stage Hodgkin's lymphoma (HL) is still a matter of debate. While ABVD is less toxic and as effective as other, more intensive chemotherapy regimens, escalated BEACOPP (BEACOPPesc) is superior to ABVD for initial disease control and prolonged time-to-relapse. However, this advantage is associated with higher rate of early and late toxicities. As most of these data have been accumulated from clinical trials, a retrospective analysis was conducted in a large database of patients treated outside clinical trials to investigate the advantages and disadvantages of these regimes in a real-world setting. From October 2009 to October 2018, 397 advanced-stage HL patients treated with either ABVD or BEACOPPesc were retrospectively assessed in 7 European cancer centers (2 Austrian and 5 Italian centers). Complete metabolic remission (CMR) by PET was achieved in 76% and 85% of patients in the ABVD and BEACOPPesc groups, respectively (p = .01). Severe adverse events occurred more frequently with BEACOPPesc than ABVD. At a median follow-up of 8 years, 9% of the patients who achieved CMR after BEACOPPesc relapsed compared to 16.6% in the ABVD group (p = .043). No statistical difference in progression free survival (PFS) was observed between the two cohorts overall (p = .11), but there was a trend towards a superior PFS in high-risk patients treated with BEACOPPesc (p = .074). Nevertheless, overall survival was similar between the two groups (p = .94). In conclusion, we confirm that ABVD is an effective and less toxic therapeutic option for advanced-stage HL. Although BEACOPP results in better initial tumor control, the long-term outcome remains similar between the two regimens.
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Affiliation(s)
- Patrizia Mondello
- Department of Medicine Memorial Sloan Kettering Cancer Center New York NY
- Department of Human Pathology University of Messina Messina Italy
| | | | - Irene Dogliotti
- Hematology Division I, Department of Molecular Biotechnologies and Health Sciences University of Turin/AOU “Città della Salute e della Scienza di Torino” Turin Italy
| | - Jan‐Paul Bohn
- Department of Internal Medicine V Medical University of Innsbruck Innsbruck Austria
| | - Federica Cavallo
- Hematology Division I, Department of Molecular Biotechnologies and Health Sciences University of Turin/AOU “Città della Salute e della Scienza di Torino” Turin Italy
| | - Simone Ferrero
- Hematology Division I, Department of Molecular Biotechnologies and Health Sciences University of Turin/AOU “Città della Salute e della Scienza di Torino” Turin Italy
| | - Barbara Botto
- Department of Hematology “Città della Salute e della Scienza Torino” Turin Italy
| | - Claudio Cerchione
- Hematology Unit Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS Meldola Italy
| | - Davide Nappi
- Department of Medicine and Surgery Hematology and Hematopoietic Stem Cell Transplant Center, University of Naples Federico II Naples Italy
| | | | - Giovanni Martinelli
- Hematology Unit Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS Meldola Italy
| | - Dominik Wolf
- Department of Internal Medicine V Medical University of Innsbruck Innsbruck Austria
- Medical Clinic 3 University Hospital Bonn Bonn Germany
| | | | - Giacomo Loseto
- Hematology and Cell Therapy Unit IRCCS Cancer Institute "Giovanni Paolo II" Bari Italy
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences University of Messina Messina Italy
| | - Wolfgang Willenbacher
- Department of Internal Medicine V Medical University of Innsbruck Innsbruck Austria
- Oncotyrol Center for Personalized Cancer Medicine Innsbruck Austria
| | - Michael Mian
- Department of Haematology & CBMT Central Hospital of Bolzano (SABES‐ASDAA) Bolzano‐Bozen Italy
| | - David J Straus
- Department of Medicine Memorial Sloan Kettering Cancer Center New York NY
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18
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Affiliation(s)
- David J Straus
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, 1275 York Avenue, New York, NY 10065, USA.
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19
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Straus DJ. Next Questions - Classical Hodgkin Lymphoma (cHL). Clin Lymphoma Myeloma Leuk 2020; 20 Suppl 1:S103-S104. [PMID: 32862849 DOI: 10.1016/s2152-2650(20)30478-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- David J Straus
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, 1275 York Avenue, New York, NY 10065, USA.
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20
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Zheng S, Gupta K, Goyal P, Nakajima R, Michaud L, Batlevi CL, Hamlin PA, Horwitz SM, Kumar A, Matasar MJ, Moskowitz AJ, Moskowitz CH, Noy A, Palomba ML, Straus DJ, Schöder H, Yahalom J, Zelenetz AD, Younes A, Joffe E. Impact of interim PET on Hodgkin lymphoma treatment outcome and survival in clinical practice. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e20017] [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
e20017 Background: FDG avidity above liver on interim PET (PET2) during frontline ABVD is considered a marker of impending treatment failure and an indication to switch to an intensified regimen. However, in clinical practice the utility of PET2 for treatment decisions is less clear. We describe outcomes of patients with positive PET2 who continued treatment with ABVD in the clinical setting. Methods: A retrospective study of all patients with newly diagnosed advanced-stage Hodgkin lymphoma treated with frontline ABVD at Memorial Sloan Kettering Cancer Center between 2008-2017. Eligibility criteria were set to correspond with the RATHL inclusion criteria (stage IIB - IV, or IIA bulky or ≥ 3 involved sites). We identified all PET2 reports indicating suspected residual uptake. All positive PET2 images were then reviewed by a single study radiologist. To increase reproducibility and avoid selection of borderline cases, we defined as PET2 positive only those cases with a lesion-to-liver (mean) SUV ratio ≥ 1.3. We also used a recently published stringent criterion of lesion-to-liver (max) ratio ≥ 1.4 (mPET2+). Progression-free and overall survival (PFS, OS) were calculated from the date of initial treatment until progression or death of any cause. Consolidative radiation was not considered a PFS event, and all progressions were verified by biopsy. Results: We identified 227 patients fitting RATHL inclusion criteria treated with ABVD. Median age was 34, with 25% (58) ≥ 45 years, 12% (26) had an IPS ≥ 4; 28% (64) stage II (5% II-X) and 38% (87) with extranodal involvement. 57 (25%) patients had a PET2 report indicating suspected residual lymphoma (PET2+), however, only 32 (14%) met the more stringent mPET2+ criterion. Most patients with PET2+ continued ABVD (84%, 48), and 9 switched to escBEACOPP (this subset of patients had substantially worse disease and are not the focus of this analysis). 21 (9%) patients received consolidative radiation. With a median follow-up of 47 months (42-54m), PET2+ patients who continued ABVD had a 3yPFS of 70% (58-85%, n = 48); mPET+ had a 3yPFS of 71% (55-92%, n = 24). Overall survival was excellent regardless of PET2 status (5yOS 97%). Conclusions: The outcome of PET2+ patients in this analysis was better than previously reported and the continuation of ABVD was appropriate for most patients. Use of a confirmatory biopsy is important for identifying true progressions. Patients with PET2+ had an excellent OS. Evaluation of the superiority of alternative regimens in PET2+ patients requires an ABVD comparator arm.
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Affiliation(s)
- Serena Zheng
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kanika Gupta
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Piyush Goyal
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Laure Michaud
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Anita Kumar
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Ariela Noy
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Heiko Schöder
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Anas Younes
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Erel Joffe
- Memorial Sloan Kettering Cancer Center, New York, NY
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21
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Ghione P, Joffe E, De Paola N, Mainardi T, Noor SJ, Bobillo S, Myskowski PL, Palomba ML, Moskowitz AJ, Mato AR, Sha F, Von Keudell G, Straus DJ, Noy A, Younes A, Hamlin PA, Brentjens RJ, Tejedor-Alonso MA, Horwitz SM, Zelenetz AD. Alternative anti-CD20 antibody versus desensitization for lymphoma patients with drug hypersensitivity reactions requiring discontinuation of rituximab, obinutuzumab, or ofatumumab. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.8062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8062 Background: Immunotherapy with anti CD20 is often associated with mild easily manageable infusion reactions. In rare cases, patients experience severe drug hypersensitivity reactions (DHR) serum sickness or anaphylaxis. These in turn may lead to discontinuation of the drug. In our experience, switching to a different anti-CD20 agent is a feasible alternative to discontinuation or desensitization protocols. Methods: From our pharmacology database we identified all the patients that received rituximab and/or obinutuzumab, and/or ofatumumab, and/or all the patients who received a flat dose of less than 50 mL of the same drugs and were followed at our institution. From the medical record, we identified all the cases where the anti-CD20 antibody was changed due to allergy, serum sickness or other types of DHR, and all those who received minimal doses of anti-CD20 in the context of a desensitization protocol. DHRs were evaluated either by an allergist, or by retrospective review following the World Allergy Organization guidelines. Our primary comparison, was to assess the proportion of pts able to completed planned infusion of abs using either approach (Fisher’s exact Test). Results: Among 343 patients receiving at least two different anti-CD20 antibodies or a flat dose of < 50 mL, we identified 44 patients experiencing severe DHRs needing intervention. At the time of the reaction, 16 (36%) received the anti-CD20 as single agent, 24 (54%) in combination with chemotherapy, 4 (9%) in combination with ibrutinib or lenalidomide. In 9 (20%) patients the reaction was defined as anaphylactoid (8 rituximab; 1 obinutuzumab) and in 8 (18%) patients, all receiving rituximab, as serum sickness. Episodes of DHR were addressed with either desensitization (n = 29) or change of anti-CD20 agent (n = 25), 9 patients received both of these approaches, one patient switched anti-CD20 antibodies twice. Overall, 21 desensitizations were successful (72.4%), 8 failed; 23 changes of anti-CD20 were successful (92%) and 2 failed (p = 0.09). Conclusions: In patients with DHR use of an alternative anti-CD20 antibody is safe and is an alternative or complementary approach to anti-CD20 desensitization.
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Affiliation(s)
- Paola Ghione
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Erel Joffe
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Timothy Mainardi
- Allergy and Immunology, New York Presbyterian Hospital, New York, NY
| | - Sarah J. Noor
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Anthony R. Mato
- Center for CLL, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fushen Sha
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Ariela Noy
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anas Younes
- Memorial Sloan Kettering Cancer Center, New York, NY
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22
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Straus DJ. Highlights in Hodgkin lymphoma from the 61st American Society of Hematology Annual Meeting: commentary. Clin Adv Hematol Oncol 2020; 18 Suppl 6:20-23. [PMID: 33843910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- David J Straus
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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23
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Sarlo KM, Dixon BN, Ni A, Straus DJ. Incidence of infectious complications with the combination of bendamustine and an anti-CD20 monoclonal antibody .. Leuk Lymphoma 2019; 61:364-369. [PMID: 31603363 DOI: 10.1080/10428194.2019.1666378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Combination of bendamustine (B) and rituximab (R) has been associated with opportunistic infections (OI) in case reports. This retrospective analysis evaluated the incidence, risk factors, and types of infectious complications (IC) in adults with CD20+ non-Hodgkin lymphoma who received ≥2 cycles of B and either R or ofatumumab. Infection data were collected up to 1-year post-B-based treatment. Potential risk factors for IC were assessed using univariate analysis with Fisher's exact test. Four-hundred and sixteen patients were included. Incidence of IC and OI was 20 and 6%, respectively. Viral (n = 19), fungal (n = 1), and Pneumocystis jiroveci pneumonia (n = 5) infections occurred. OI was associated with lack of antimicrobial prophylaxis analysis (p = .048). The incidences of IC and OI with B and anti-CD20 antibody combination at our institution appear lower than those previously reported, possibly due to antimicrobial prophylaxis and G-CSF use.
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Affiliation(s)
- Kristen M Sarlo
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Pharmaceutical Company, Daiichi Sankyo, Basking Ridge, NJ, USA
| | - Brianne N Dixon
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ai Ni
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David J Straus
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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24
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Stephens DM, Li H, Schöder H, Straus DJ, Moskowitz CH, LeBlanc M, Rimsza LM, Bartlett NL, Evens AM, LaCasce AS, Barr PM, Knopp MV, Hsi ED, Leonard JP, Kahl BS, Smith SM, Friedberg JW. Five-year follow-up of SWOG S0816: limitations and values of a PET-adapted approach with stage III/IV Hodgkin lymphoma. Blood 2019; 134:1238-1246. [PMID: 31331918 PMCID: PMC6788007 DOI: 10.1182/blood.2019000719] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [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: 03/21/2019] [Accepted: 07/03/2019] [Indexed: 01/16/2023] Open
Abstract
Patients with advanced-stage Hodgkin lymphoma (HL) demonstrated excellent 2-year progression-free survival (PFS) after receiving positron emission tomography (PET)-adapted therapy on SWOG S0816. Patients received 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Patients achieving complete response (CR) on PET scan following cycle 2 of ABVD (PET2) continued 4 additional cycles of ABVD. Patients not achieving CR on PET2 were switched to escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) for 6 cycles. After a median follow-up of 5.9 years, a subset of 331 eligible patients with central review of PET2 was analyzed. PET2 was negative in 82% and positive in 18%. For all patients, the estimated 5-year PFS and OS was 74% (95% confidence interval [CI], 69%-79%) and 94% (95% CI, 91%-96%), respectively. For PET2- and PET2+ patients, the 5-year PFS was 76% (95% CI, 70%-81%) and 66% (95% CI, 52%-76%), respectively. Seven (14%) and 6 (2%) patients reported second cancers after treatment with eBEACOPP and ABVD, respectively (P = .001). Long-term OS of HL patients treated on S0816 remains high. Nearly 25% of PET2- patients experienced relapse events, demonstrating limitations ABVD therapy and of the negative predictive value of PET2. In PET2+ patients who received eBEACOPP, PFS was favorable, but was associated with a high rate of second malignancies compared with historical controls. Our results emphasize the importance of long-term follow-up, and the need for more efficacious and less toxic therapeutic approaches for advanced-stage HL patients. This trial was registered at www.clinicaltrials.gov as #NCT00822120.
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Affiliation(s)
- Deborah M Stephens
- Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, UT
| | - Hongli Li
- SWOG Statistical Center, Seattle, WA
| | - Heiko Schöder
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Nancy L Bartlett
- Oncology Division, Washington University in St. Louis, St. Louis, MO
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Paul M Barr
- Division of Hematology/Oncology, University of Rochester, Rochester NY
| | - Michael V Knopp
- Division of Hematology, The Ohio State University, Columbus, OH
| | | | | | - Brad S Kahl
- Oncology Division, Washington University in St. Louis, St. Louis, MO
| | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
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25
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Straus DJ, Długosz-Danecka M, Alekseev S, Illés Á, Picardi M, Lech-Maranda E, Feldman T, Savage KJ, Smolewski P, Bartlett NL, Gallamini A, Walewski JA, Ramchandren R, Zinzani PL, Connors JM, Jolin H, Liu R, Fenton K, Fanale M, Radford JA. Brentuximab vedotin with chemotherapy for stage 3/4 classical Hodgkin lymphoma: Three-year update of the ECHELON-1 study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.7532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7532 Background: The phase 3 ECHELON-1 study demonstrated that BV with AVD (A+AVD) was superior to ABVD for the frontline treatment of Stage 3/4 cHL. Maturing data from RATHL and SWOG S0816 show limitations to PET2-adapted strategies, including short and long-term toxicities in PET2+ patients (pts) switched to BEACOPP and still frequent relapse in PET2- pts. Pts in the RATHL trial with Stage 3/4 disease ≤60 yrs had a 3-yr PFS of 79.8% (82.1% PET2-); SWOG S0816 reported a 5-yr PFS of 74% (76% PET2-) in the same population. As an alternative to PET-adapted therapy, here we present a 3-year update of the ECHELON-1 study, including ITT PFS and outcomes by PET status. Methods: Pts with Stage 3/4 cHL were randomized 1:1 to receive up to six cycles of A+AVD (n=664) or ABVD (n=670). Interim PET scan after cycle 2 was conducted. All analyses of PFS are exploratory and per investigator assessment. Results: At a median follow-up of 37 months, analysis of PFS in the ITT population favors the A+AVD treatment arm (Table), with a 3-yr PFS of 83.1% for A+AVD vs 76.0% for ABVD; the 3-yr PFS for PET2- pts <60 yrs was 87.2% vs 81.0%, respectively. Trend toward benefit for PET2+ pts <60 yrs treated with A+AVD was also observed, with a 3-yr PFS of 69.2% vs 54.7% with ABVD. Data from prespecified subgroups and safety follow-up, including peripheral neuropathy, will be presented. Conclusions: Follow-up at 3-yrs demonstrates that frontline treatment of Stage 3/4 cHL with A+AVD provides a durable treatment benefit vs ABVD that is independent of PET2 status. While direct comparisons cannot be made, A+AVD compares favorably to PET-adapted strategies without requiring interim PET assessment, escalation of therapy, or bleomycin. Clinical trial information: NCT01712490. [Table: see text]
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Affiliation(s)
| | | | - Sergiy Alekseev
- N.N. Petrov Scientific Reserch Institute of Oncology, St. Petersburg, Russia
| | - Árpád Illés
- University of Debrecen, Medical and Health Science Center, Debrecen, Hungary
| | - Marco Picardi
- Department of Advanced Biomedical Science, Napoli, Italy
| | - Ewa Lech-Maranda
- Institute of Hematology and Transfusion Medicine, Department of Hematology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Kerry J. Savage
- British Columbia Cancer Agency, Center for Lymphoid Cancer, Vancouver, BC, Canada
| | | | - Nancy L. Bartlett
- Washington University School of Medicine in St. Louis and Siteman Cancer Center, St. Louis, MO
| | - Andrea Gallamini
- Research Innovation and Statistics, Antoine-Lacassagne Cancer Centre, Nice, France
| | | | | | - Pier Luigi Zinzani
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna, Italy
| | - Joseph M. Connors
- British Columbia Cancer Agency Center for Lymphoid Cancer, Vancouver, BC, Canada
| | - Hina Jolin
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
| | - Rachael Liu
- Millenium Pharmaceutics, a wholly owned Subsidiary of Takeda Pharmaceuticals, Inc., Cambridge, MA
| | | | | | - John A. Radford
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
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26
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Kumar A, Sha F, Toure A, Dogan A, Ni A, Batlevi CL, Palomba MLM, Portlock C, Straus DJ, Noy A, Horwitz SM, Moskowitz A, Hamlin P, Moskowitz CH, Matasar MJ, Zelenetz AD, Younes A. Patterns of survival in patients with recurrent mantle cell lymphoma in the modern era: progressive shortening in response duration and survival after each relapse. Blood Cancer J 2019; 9:50. [PMID: 31110172 PMCID: PMC6527702 DOI: 10.1038/s41408-019-0209-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/27/2019] [Accepted: 04/03/2019] [Indexed: 01/29/2023] Open
Abstract
As the survival of patients with mantle cell lymphoma (MCL) continues to improve, patients are increasingly being treated with multiple regimens. However, outcome after each line remains poorly characterized in the modern era. To address this knowledge gap, we retrospectively studied 404 consecutive MCL patients who were managed between 2000 and 2014 at Memorial Sloan Kettering Cancer Center. Histologic diagnosis was centrally confirmed, and patients were followed longitudinally from diagnosis throughout their disease course. Progression-free survival (PFS) and overall survival (OS) were determined by Kaplan–Meier method. The median OS and PFS after first-line treatment were 9.7 and 4.0 years, respectively. After second-line therapy, the median OS and PFS were 41.1 and 14.0 months, third line were 25.2 and 6.5 months, and fourth line were 14.4 and 5.0 months. In patients less than 65 years, stem cell transplant (SCT)-based frontline regimens were associated with improved PFS compared with non-SCT regimens (median PFS: 86.2 versus 40.0 months; P < 0.01), with a trend toward longer OS (median OS: 165.0 versus 120.0 months; P = 0.06). Early treatment failure after first-line regimens was associated with worse OS (5.9 versus 2.5 years; P < 0.01). Our study should facilitate establishing proper endpoints for future clinical trials using novel treatment approaches.
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Affiliation(s)
- Anita Kumar
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Fushen Sha
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmed Toure
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmet Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andy Ni
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Connie L Batlevi
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Carol Portlock
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David J Straus
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ariela Noy
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steven M Horwitz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alison Moskowitz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Hamlin
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Craig H Moskowitz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew J Matasar
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew D Zelenetz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anas Younes
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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27
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Ramchandren R, Advani RH, Ansell SM, Bartlett NL, Chen R, Connors JM, Feldman T, Forero-Torres A, Friedberg JW, Gopal AK, Gordon LI, Kuruvilla J, Savage KJ, Younes A, Engley G, Manley TJ, Fenton K, Straus DJ. Brentuximab Vedotin plus Chemotherapy in North American Subjects with Newly Diagnosed Stage III or IV Hodgkin Lymphoma. Clin Cancer Res 2019; 25:1718-1726. [PMID: 30617130 DOI: 10.1158/1078-0432.ccr-18-2435] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/12/2018] [Accepted: 01/04/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate safety and efficacy outcomes for subjects on the ECHELON-1 study treated in North America (NA). PATIENTS AND METHODS ECHELON-1 is a global, open-label, randomized phase III study comparing doxorubicin, vinblastine, and dacarbazine in combination with brentuximab vedotin (A+AVD) versus ABVD (AVD + bleomycin) as first-line therapy in subjects with stage III or IV classical Hodgkin lymphoma (cHL; NCT01712490). Subjects were randomized 1:1 to receive A+AVD or ABVD intravenously on days 1 and 15 of each 28-day cycle for up to 6 cycles. RESULTS The NA subgroup consisted of 497 subjects in the A+AVD (n = 250) and ABVD (n = 247) arms. Similar to the primary analysis based on the intent-to-treat population, the primary endpoint [modified progression-free survival (PFS) per independent review] demonstrated an improvement among subjects who received A+AVD compared with ABVD (HR = 0.60; P = 0.012). For PFS, the risk of progression or death was also reduced (HR = 0.50; P = 0.002). Subsequent anticancer therapies were lower in the A+AVD arm. Grade 3 or 4 adverse events (AEs) were more common, but there were fewer study discontinuations due to AEs in the A+AVD arm as compared with ABVD. Noted differences between arms included higher rates of febrile neutropenia (20% vs. 9%) and peripheral neuropathy (80% vs. 56%), but lower rates of pulmonary toxicity (3% vs. 10%) in subjects treated with A+AVD versus ABVD. CONCLUSIONS The efficacy benefit and manageable toxicity profile observed in the NA subgroup of ECHELON-1 support A+AVD as a frontline treatment option for patients with stage III or IV cHL.
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Affiliation(s)
| | - Ranjana H Advani
- Department of Medicine, Stanford University, Palo Alto, California
| | | | - Nancy L Bartlett
- Division of Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Robert Chen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Joseph M Connors
- University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Tatyana Feldman
- John Theurer Cancer Centre, Hackensack University Medical Center, Hackensack, New Jersey
| | - Andres Forero-Torres
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jonathan W Friedberg
- James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Ajay K Gopal
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Leo I Gordon
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - John Kuruvilla
- Division of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Kerry J Savage
- University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Anas Younes
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - David J Straus
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Bonafede M, Feliciano J, Cai Q, Noxon V, Princic N, Richhariya A, Straus DJ. Real-world analysis of cost, health care resource utilization, and supportive care in Hodgkin lymphoma patients with frontline failure. Clinicoecon Outcomes Res 2018; 10:629-641. [PMID: 30410373 PMCID: PMC6198880 DOI: 10.2147/ceor.s178649] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose The purpose of this study was to evaluate the economic burden of frontline failure (FLF) among classical Hodgkin lymphoma (HL) patients during and after treatment. Patients and methods The population consisted of adult HL patients identified from January 2010 through September 2015 without any other primary cancer prior to HL diagnosis, who also had a frontline (FL) regimen indicative of curative intent. Patients were characterized as FLF (those who restart, switch to any chemotherapy; had a hematopoietic stem cell transplant; or newly initiated radiation therapy [RT] after discontinuing FL) or non-FLF (those not considered as FLF). Direct health care utilization and expenditures were measured over both fixed and variable length follow-up periods and during FL therapy. Results There were 77 FLF and 602 non-FLF patients who met the final inclusion criteria. FLF and non-FLF patients were demographically similar with mean age 38.5 years and 47.5% females. Average per patient per month (PPPM) costs were significantly higher for FLF patients during all follow-up (US$20,266 vs US$7,772, P<0.05). Annual total expenditures were significantly higher among FLF patients (US$198,388) vs non-FLF patients (US$37,549). FLF (vs non-FLF) patients had a significantly shorter duration of FL therapy (116 vs 131 days, P=0.024) and higher total PPPM expenditures during FL (US$29,040 vs US$16,369, P<0.05). Annual cost varied by failure type with those who failed due to restart incurring the highest cost (US$269,189) and those who switched incurring the lowest cost (US$46,951). FLF patients had a significantly greater utilization in every health care resource category during follow-up. Conclusion FLF (vs non-FLF) patients utilized substantially more health care resources and incurred a substantially higher economic burden. Over 5 years, FLF patients with at least two lines of treatment were projected to incur US$535,846 of health care costs. Further research is needed to determine optimal treatment that could reduce the risk of progression, need for treatment after FL, and enhance long-term clinical and economic outcomes.
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Affiliation(s)
| | | | - Qian Cai
- IBM Watson Health, Cambridge, MA, USA,
| | | | | | | | - David J Straus
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,John P Leonard Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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Ramchandren R, Advani RH, Ansell SM, Bartlett NL, Chen RW, Feldman T, Forero-Torres A, Friedberg JW, Gopal AK, Gordon LI, Kuruvilla J, Savage KJ, Straus DJ, Younes A, Fenton K, Manley TJ, Engley G, Connors JM. Brentuximab vedotin (BV) plus chemotherapy in patients with newly diagnosed advanced stage Hodgkin lymphoma (HL): North American results. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Nancy L. Bartlett
- Washington University School of Medicine in St. Louis and Siteman Cancer Center, St. Louis, MO
| | | | | | | | | | - Ajay K. Gopal
- Medical Oncology Division, University of Washington School of Medicine, Seattle, WA
| | - Leo I. Gordon
- Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | - Kerry J. Savage
- British Columbia Cancer Agency, Center for Lymphoid Cancer, Vancouver, BC, Canada
| | | | - Anas Younes
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Joseph M. Connors
- British Columbia Cancer Agency Center for Lymphoid Cancer, Vancouver, BC, Canada
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30
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Batlevi CL, De Frank S, Stewart C, Hamlin PA, Matasar MJ, Gerecitano JF, Moskowitz AJ, Hamilton AM, Zelenetz AD, Drullinsky P, Straus DJ, Kumar A, Moskowitz CH, Dicostanzo J, Callan D, Tsui D, Rademaker J, Schöder H, Ni A, Younes A. Phase I/II clinical trial of ibrutinib and buparlisib in relapsed/refractory diffuse large B-cell lymphoma, mantle cell lymphoma, and follicular lymphoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Anita Kumar
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Devin Callan
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dana Tsui
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Heiko Schöder
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ai Ni
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anas Younes
- Memorial Sloan Kettering Cancer Center, New York, NY
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31
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Straus DJ, Collins GP, Walewski JA, Zinzani PL, Grigg A, Sureda AM, Illés Á, Kim TM, Alekseev S, Specht L, Buccheri V, Younes A, Connors JM, Gautam A, Purevjal I, Fenton K, Engley G, Gallamini A. Improving outcomes with brentuximab vedotin (BV) plus chemotherapy in patients with newly diagnosed advanced stage Hodgkin lymphoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Graham P. Collins
- Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford, United Kingdom
| | | | - Pier Luigi Zinzani
- Institute of Hematology Seràgnoli, University of Bologna, Bologna, Italy
| | | | - Anna M. Sureda
- Servei d'Hematologia, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | | | - Tae Min Kim
- Seoul National University Hospital, Seoul, Korea, Republic of (South)
| | - Sergiy Alekseev
- N.N. Petrov Scientific Reserch Institute of Oncology, St. Petersburg, Russia
| | - Lena Specht
- Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Valeria Buccheri
- Hematology Service, University of São Paulo Medical School, São Paulo, Brazil
| | - Anas Younes
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph M. Connors
- British Columbia Cancer Agency Center for Lymphoid Cancer, Vancouver, BC, Canada
| | - Ashish Gautam
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
| | - Indra Purevjal
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Deerfield, IL
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32
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Connors JM, Jurczak W, Straus DJ, Ansell SM, Kim WS, Gallamini A, Younes A, Alekseev S, Illés Á, Picardi M, Lech-Maranda E, Oki Y, Feldman T, Smolewski P, Savage KJ, Bartlett NL, Walewski J, Chen R, Ramchandren R, Zinzani PL, Cunningham D, Rosta A, Josephson NC, Song E, Sachs J, Liu R, Jolin HA, Huebner D, Radford J. Brentuximab Vedotin with Chemotherapy for Stage III or IV Hodgkin's Lymphoma. N Engl J Med 2018; 378:331-344. [PMID: 29224502 PMCID: PMC5819601 DOI: 10.1056/nejmoa1708984] [Citation(s) in RCA: 464] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Brentuximab vedotin is an anti-CD30 antibody-drug conjugate that has been approved for relapsed and refractory Hodgkin's lymphoma. METHODS We conducted an open-label, multicenter, randomized phase 3 trial involving patients with previously untreated stage III or IV classic Hodgkin's lymphoma, in which 664 were assigned to receive brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A+AVD) and 670 were assigned to receive doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). The primary end point was modified progression-free survival (the time to progression, death, or noncomplete response and use of subsequent anticancer therapy) as adjudicated by an independent review committee. The key secondary end point was overall survival. RESULTS At a median follow-up of 24.6 months, 2-year modified progression-free survival rates in the A+AVD and ABVD groups were 82.1% (95% confidence interval [CI], 78.8 to 85.0) and 77.2% (95% CI, 73.7 to 80.4), respectively, a difference of 4.9 percentage points (hazard ratio for an event of progression, death, or modified progression, 0.77; 95% CI, 0.60 to 0.98; P=0.04). There were 28 deaths with A+AVD and 39 with ABVD (hazard ratio for interim overall survival, 0.73 [95% CI, 0.45 to 1.18]; P=0.20) [corrected]. All secondary efficacy end points trended in favor of A+AVD. Neutropenia occurred in 58% of the patients receiving A+AVD and in 45% of those receiving ABVD; in the A+AVD group, the rate of febrile neutropenia was lower among the 83 patients who received primary prophylaxis with granulocyte colony-stimulating factor than among those who did not (11% vs. 21%). Peripheral neuropathy occurred in 67% of patients in the A+AVD group and in 43% of patients in the ABVD group; 67% of patients in the A+AVD group who had peripheral neuropathy had resolution or improvement at the last follow-up visit. Pulmonary toxicity of grade 3 or higher was reported in less than 1% of patients receiving A+AVD and in 3% of those receiving ABVD. Among the deaths that occurred during treatment, 7 of 9 in the A+AVD group were associated with neutropenia and 11 of 13 in the ABVD group were associated with pulmonary-related toxicity. CONCLUSIONS A+AVD had superior efficacy to ABVD in the treatment of patients with advanced-stage Hodgkin's lymphoma, with a 4.9 percentage-point lower combined risk of progression, death, or noncomplete response and use of subsequent anticancer therapy at 2 years. (Funded by Millennium Pharmaceuticals and Seattle Genetics; ECHELON-1 ClinicalTrials.gov number, NCT01712490 ; EudraCT number, 2011-005450-60 .).
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Affiliation(s)
- Joseph M Connors
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Wojciech Jurczak
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - David J Straus
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Stephen M Ansell
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Won S Kim
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Andrea Gallamini
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Anas Younes
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Sergey Alekseev
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Árpád Illés
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Marco Picardi
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Ewa Lech-Maranda
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Yasuhiro Oki
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Tatyana Feldman
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Piotr Smolewski
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Kerry J Savage
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Nancy L Bartlett
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Jan Walewski
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Robert Chen
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Radhakrishnan Ramchandren
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Pier L Zinzani
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - David Cunningham
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Andras Rosta
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Neil C Josephson
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Eric Song
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Jessica Sachs
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Rachael Liu
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Hina A Jolin
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - Dirk Huebner
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
| | - John Radford
- From the University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada (J.M.C., K.J.S.); the Department of Hematology, Jagiellonian University, Krakow (W.J.), the Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), the Department of Hematology and Transfusion Medicine, Center of Postgraduate Medical Education, Warsaw (E.L.-M.), the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.), and the Department of Lymphoid Malignancy, the Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw (J.W.) - all in Poland; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (D.J.S., A.Y.); the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea (W.S.K.); Research Innovation and Statistics, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); Petrov Research Institute of Oncology, St. Petersburg, Russia (S.A.); the Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen (Á.I.), and the Department of Hematology, National Institute of Oncology, Budapest (A.R.) - both in Hungary; the Department of Advanced Biomedical Science, Federico II University Hospital, Naples (M.P.), and the Institute of Hematology Seràgnoli, University of Bologna, Bologna (P.L.Z.) - both in Italy; the Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston (Y.O.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (T.F.); the Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis (N.L.B.); the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA (R.C.); the Department of Hematology-Oncology, Barbara Ann Karmanos Cancer Center, Detroit (R.R.); Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton (D.C.), and the Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester (J.R.) - both in the United Kingdom; the Department of Clinical Development, Seattle Genetics, Bothell, WA (N.C.J., E.S.); and Oncology Clinical Research (J.S., H.A.J., D.H.) and Global Biostatistics (R.L.), Millennium Pharmaceuticals, Cambridge, MA
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Batlevi CL, Hamlin PA, Matasar MJ, Horwitz SM, Gerecitano JF, Moskowitz CH, Straus DJ, Zelenetz AD, Drullinsky P, Copeland A, Ahsanuddin S, Callan D, Freidin B, Porzio R, Dang TO, Ni A, Rademaker J, Schöder H, Dogan A, Younes A. Phase I dose escalation of ibrutinib and buparlisib in relapsed/refractory diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma (MCL), and follicular lymphoma (FL). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.7544] [Citation(s) in RCA: 3] [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
7544 Background: In vitro studies of BTK and PI3K inhibitors demonstrate synergy in non-Hodgkin lymphoma (NHL). We embarked on a phase I/Ib investigator-initiated clinical trial evaluating the combination of ibrutinib (BTK inhibitor) and buparlisib (pan-PI3K inhibitor) in relapsed/refractory (R/R) NHL. The completed dose escalation is reported. Methods: Patients (pts) were eligible if they had R/R DLBCL, MCL, or FL with ECOG≤2 and adequate organ function. Ibrutinib and buparlisib were given daily by mouth on a 28-day cycle. Dose reductions were permitted after cycle 1. Tumor response was based on Lugano Classification however CR required both PET resolution and ≥ PR by CT. Results: As of Dec 16, 2016, 13 pts were enrolled and evaluated for toxicity (DLBCL 5, FL 2, MCL 6). Dose levels and DLT per table. Six pts discontinued treatment for disease progression (DLBCL 4, FL 2). Hematologic AE ≥ grade 3 are anemia (2), leukocytosis (2), and leukopenia (4). Relevant non-hematologic AEs of any grade ≥ 20% across all pts were fatigue (77%), diarrhea (62%), anorexia (54%), rash (46%), hyperbilirubinemia (46%), gastric reflux (46%), CMV reactivation (31%), mood change (31%), and hypertension (23%). Most common related grade 3/4 toxicity is rash (N = 3). No grade 5 toxicities noted. Serious adverse events (SAE) include: grade 2 pleural effusion and grade 2 nausea (N = 1), grade 1 fever with hospitalization (N = 1), grade 2 confusion and grade 4 hyponatremia (N = 1) were unrelated to therapy. Responses noted in 13 pts: MCL (N = 6: CR 4, PR 2), FL (N = 2: SD 2), DLBCL (N = 5: SD 1). One CR was a MCL pt with CR after 2 cycles on combination therapy and continues in remission on ibrutinib alone because of buparlisib toxicity. Conclusions: Combination of ibrutinib and buparlisib while generally well tolerated has predicted toxicities of both BTK and PI3K inhibitors. The recommended phase 2 dose is ibrutinib 560 mg and buparlisib 100 mg though dose reductions for tolerability may be needed for long term oral therapies. Promising efficacy is observed in MCL. Clinical trial information: NCT02756247. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Devin Callan
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Robert Porzio
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Thu Oanh Dang
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Ai Ni
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Heiko Schöder
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Ahmet Dogan
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Anas Younes
- Memorial Sloan-Kettering Cancer Center, New York, NY
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Soumerai JD, Zelenetz AD, Moskowitz CH, Palomba ML, Hamlin PA, Noy A, Straus DJ, Moskowitz AJ, Younes A, Matasar MJ, Horwitz SM, Portlock CS, Konner JA, Gounder MM, Hyman DM, Voss MH, Fury MG, Gajria D, Carvajal RD, Ho AL, Beumer JH, Kiesel B, Zhang Z, Chen A, Little RF, Jarjies C, Dang TO, France F, Mishra N, Gerecitano JF. The PARP Inhibitor Veliparib Can Be Safely Added to Bendamustine and Rituximab and Has Preliminary Evidence of Activity in B-Cell Lymphoma. Clin Cancer Res 2017; 23:4119-4126. [PMID: 28314788 DOI: 10.1158/1078-0432.ccr-16-3068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/06/2017] [Accepted: 03/08/2017] [Indexed: 11/16/2022]
Abstract
Purpose: The PARP inhibitor veliparib enhances the cytotoxicity of alkylating agents. This phase I study evaluated veliparib with the bifunctional alkylator bendamustine (VB) in patients with relapsed/refractory lymphoma, multiple myeloma, and solid malignancies, with a cohort expansion of VB with rituximab (VBR) in patients with B-cell lymphomas.Experimental Design: This dose-escalation study evaluated safety, pharmacokinetics, and preliminary efficacy of veliparib (20-400 mg twice a day, days 1-7 of 28-day cycle) and bendamustine (70 and 90 mg/m2 intravenously, days 1 and 2). A cohort expansion was conducted, which combined veliparib and bendamustine at the maximum tolerated dose (MTD) with rituximab (375 mg/m2, day 1) in patients with B-cell lymphomas. Thirty-four patients were treated in seven dose-escalation cohorts and seven patients in the dose-expansion cohort.Results: The MTD was veliparib 300 mg twice daily plus bendamustine 90 mg/m2 Dose-limiting toxicities (DLT) were anemia, nausea, hypertension, and hyperhidrosis. Grade ≥3 toxicities included lymphopenia (87.8%), anemia (19.5%), neutropenia (12.2%), thrombocytopenia (9.8%), leukopenia (9.8%), nausea (7.3%), and hypophosphatemia (7.3%). Apparent veliparib clearance was slightly lower than previously reported. Of 14 patients with lymphoma evaluable for response, five of seven (71%) on VB and six of seven (86%) on VBR achieved objective response. One patient with multiple myeloma achieved partial response.Conclusions: VB and VBR were generally well-tolerated. VBR had preliminary clinical activity in patients with B-cell lymphoma, which warrants further investigation in a phase II trial. This trial was registered at www.clinicaltrials.gov as NCT01326702 Clin Cancer Res; 23(15); 4119-26. ©2017 AACR.
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Affiliation(s)
- Jacob D Soumerai
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Andrew D Zelenetz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Craig H Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - M Lia Palomba
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul A Hamlin
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ariela Noy
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David J Straus
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison J Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anas Younes
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew J Matasar
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Steven M Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carol S Portlock
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jason A Konner
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mrinal M Gounder
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David M Hyman
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martin H Voss
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew G Fury
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Devika Gajria
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard D Carvajal
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alan L Ho
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jan H Beumer
- Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.,Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Brian Kiesel
- Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Zhigang Zhang
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alice Chen
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, Maryland
| | - Richard F Little
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, Maryland
| | | | - Thu O Dang
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Fallon France
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nishant Mishra
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - John F Gerecitano
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
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Press OW, Li H, Schöder H, Straus DJ, Moskowitz CH, LeBlanc M, Rimsza LM, Bartlett NL, Evens AM, Mittra ES, LaCasce AS, Sweetenham JW, Barr PM, Fanale MA, Knopp MV, Noy A, Hsi ED, Cook JR, Lechowicz MJ, Gascoyne RD, Leonard JP, Kahl BS, Cheson BD, Fisher RI, Friedberg JW. US Intergroup Trial of Response-Adapted Therapy for Stage III to IV Hodgkin Lymphoma Using Early Interim Fluorodeoxyglucose-Positron Emission Tomography Imaging: Southwest Oncology Group S0816. J Clin Oncol 2016; 34:2020-7. [PMID: 27069074 DOI: 10.1200/jco.2015.63.1119] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Four US National Clinical Trials Network components (Southwest Oncology Group, Cancer and Leukemia Group B/Alliance, Eastern Cooperative Oncology Group, and the AIDS Malignancy Consortium) conducted a phase II Intergroup clinical trial that used early interim fluorodeoxyglucose positron emission tomography (FDG-PET) imaging to determine the utility of response-adapted therapy for stage III to IV classic Hodgkin lymphoma. PATIENTS AND METHODS The Southwest Oncology Group S0816 (Fludeoxyglucose F 18-PET/CT Imaging and Combination Chemotherapy With or Without Additional Chemotherapy and G-CSF in Treating Patients With Stage III or Stage IV Hodgkin Lymphoma) trial enrolled 358 HIV-negative patients between July 1, 2009, and December 2, 2012. A PET scan was performed after two initial cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and was labeled PET2. PET2-negative patients (Deauville score 1 to 3) received an additional four cycles of ABVD, whereas PET2-positive patients (Deauville score 4 to 5) were switched to escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) for six cycles. Among 336 eligible and evaluable patients, the median age was 32 years (range, 18 to 60 years), with 52% stage III, 48% stage IV, 49% International Prognostic Score 0 to 2, and 51% score 3 to 7. RESULTS Three hundred thirty-six of the enrolled patients were evaluable. Central review of the interim PET2 scan was performed in 331 evaluable patients, with 271 (82%) PET2-negative and 60 (18%) PET2-positive. Of 60 eligible PET2-positive patients, 49 switched to eBEACOPP as planned and 11 declined. With a median follow-up of 39.7 months, the Kaplan-Meier estimate for 2-year overall survival was 98% (95% CI, 95% to 99%), and the 2-year estimate for progression-free survival (PFS) was 79% (95% CI, 74% to 83%). The 2-year estimate for PFS in the subset of patients who were PET2-positive after two cycles of ABVD was 64% (95% CI, 50% to 75%). Both nonhematologic and hematologic toxicities were greater in the eBEACOPP arm than in the continued ABVD arm. CONCLUSION Response-adapted therapy based on interim PET imaging after two cycles of ABVD seems promising with a 2-year PFS of 64% for PET2-positive patients, which is much higher than the expected 2-year PFS of 15% to 30%.
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Affiliation(s)
- Oliver W Press
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA.
| | - Hongli Li
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Heiko Schöder
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - David J Straus
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Craig H Moskowitz
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Michael LeBlanc
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Lisa M Rimsza
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Nancy L Bartlett
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Andrew M Evens
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Erik S Mittra
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Ann S LaCasce
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - John W Sweetenham
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Paul M Barr
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Michelle A Fanale
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Michael V Knopp
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Ariela Noy
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Eric D Hsi
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - James R Cook
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Mary Jo Lechowicz
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Randy D Gascoyne
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - John P Leonard
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Brad S Kahl
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Bruce D Cheson
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Richard I Fisher
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Jonathan W Friedberg
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
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Affiliation(s)
- David J. Straus
- Lymphoma Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York
| | - Oren Cahlon
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York
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Owens CN, Iannotta A, Gerecitano JF, Matasar MJ, Noy A, Moskowitz CH, Drullinsky P, Palomba ML, Straus DJ, Horwitz SM, Zelenetz AD, Portlock CS, Kumar A, Hamlin PA. Effect of prednisone and rituximab prephase on early toxicity in older DLBCL patients (pts) receiving RCHOP within a NHL specific comprehensive geriatric assessment (CGA) trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Ariela Noy
- Memorial Sloan Kettering Cancer Center, Englewood, NJ
| | | | | | | | | | | | | | | | - Anita Kumar
- Memorial Sloan Kettering Cancer Center, New York, NY
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Mehta-Shah N, Lunning MA, Boruchov AM, Ruan J, Nair S, Lynch P, Byrne R, Moskowitz AJ, Matasar MJ, Gerecitano JF, Hamlin PA, Leonard J, Moskowitz CH, Myskowski PL, Querfeld C, Nolan P, Palomba ML, Straus DJ, Zelenetz AD, Horwitz SM. A phase I/II trial of the combination of romidepsin and lenalidomide in patients with relapsed/refractory lymphoma and myeloma: Activity in T-cell lymphoma. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8521] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Jia Ruan
- New York Presbyterian Hosp Cornell Campus, New York, NY
| | - Sumithra Nair
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peggy Lynch
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Regina Byrne
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - John Leonard
- Weill Cornell Medical College - New York Presbyterian Hospital, New York, NY
| | | | | | | | - Patrick Nolan
- Memorial Sloan Kettering Cancer Center, New York, NY
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Matasar MJ, Ford JS, Riedel ER, Salz T, Oeffinger KC, Straus DJ. Late morbidity and mortality in patients with Hodgkin's lymphoma treated during adulthood. J Natl Cancer Inst 2015; 107:djv018. [PMID: 25717170 DOI: 10.1093/jnci/djv018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Survivors of Hodgkin's lymphoma (HL) treated as adults are at risk for late effects of therapy. However, the burden of late morbidity and mortality among adults treated for HL remains incompletely characterized. METHODS Vital status and, for deceased, cause of death were determined for 746 adults treated on a first-line trial at a single center from 1975 to 2000. Survivors completed a detailed survey describing their physical and mental health. A severity score (grades 1-4, ranging from mild to life-threatening or disabling) was assigned to self-reported conditions. RESULTS At a median follow-up of 22 years, 227 of patients (30.4%) had died, 107 (47.1%) from HL, 120 (52.9%) from other causes, including second primary malignancies (SPMs) (n = 52) and cardiovascular disease (n = 27). Across the duration of follow-up, all-cause and SPM-specific risk of death remained higher than predicted by normative data. Among survivors, late morbidity survey data are available for 238 patients (45.9%). Ninety-four-point-one percent of respondents reported at least one morbidity, and 47.5% reported at least one grade 3 or 4 morbidity; 20.2% reported two or more grade 3 morbidities. Commonly reported morbidities included cardiovascular (54.6%), endocrine (68.5%), pulmonary disease (21.4%), and nonfatal second malignancy (23.1%). Anxiety, depression, and fear of recurrence were frequently reported. CONCLUSIONS Among a large cohort of patients treated for HL with extensive follow-up, risk of late mortality from causes other than HL and prevalence of late medical morbidity are high. Guidelines for prevention, screening, and management of late effects in adult survivors of HL are needed.
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Affiliation(s)
- Matthew J Matasar
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO).
| | - Jennifer S Ford
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO)
| | - Elyn R Riedel
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO)
| | - Talya Salz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO)
| | - Kevin C Oeffinger
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO)
| | - David J Straus
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO)
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Straus DJ, Hamlin PA, Matasar MJ, Lia Palomba M, Drullinsky PR, Zelenetz AD, Gerecitano JF, Noy A, Hamilton AM, Elstrom R, Wegner B, Wortman K, Cella D. Phase I/II trial of vorinostat with rituximab, cyclophosphamide, etoposide and prednisone as palliative treatment for elderly patients with relapsed or refractory diffuse large B-cell lymphoma not eligible for autologous stem cell transplantation. Br J Haematol 2014; 168:663-70. [PMID: 25316653 DOI: 10.1111/bjh.13195] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 06/10/2014] [Accepted: 08/27/2014] [Indexed: 12/20/2022]
Abstract
The standard treatment of relapsed/refractory diffuse large B-cell lymphoma (DLBCL) in frail elderly patients has not been established. A variation was made on rituximab (R), cyclophosphamide (C), etoposide (E), procarbazine and prednisone (P), substituting vorinostat (V) for procarbazine. Patients ≥aged 60 years with relapsed/refractory DLBCL, not candidates for autologous stem cell transplantation, were treated R-CVEP [R 375 mg/m(2) intravenously (IV), day 1; C 600 mg/m(2) IV days 1, 8: E 70 mg/m(2) IV day 1, 140 mg/m(2) days 2, 3 orally (PO); V (300 vs. 400 mg) PO and P 60 mg/m(2) PO days 1-10] every 28 d for six cycles. Quality of life (QoL) was assessed in addition to response. Thirty patients (median age 76 years, 69-88) were enrolled (one died before treatment). Maximum tolerated dose (MTD) for V was 300 mg. For 23 patients at MTD (six phase I + 17 phase II), two were discontinued for toxicity, one withdrew consent, eight achieved complete response (35%), five achieved partial response (22%) and seven progressed (25%). Median overall survival was 17·5 months. Median progression-free survival was 9·2 months. Nine patients are alive. QoL declined during treatment but improved above baseline for patients who completed treatment. In conclusion, R-CVEP was tolerated at MTD and produced durable responses with improved QoL.
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Affiliation(s)
- David J Straus
- Memorial Sloan-Kettering Cancer Center, Division of Hematologic Oncology, Lymphoma Service, New York, NY, USA
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Lunning MA, Ruan J, Nair S, Boruchov AM, Byrne R, Gerecitano JF, Hamlin PA, Inserra B, Leonard J, Lynch P, Matasar MJ, Moskowitz AJ, Moskowitz C, Myskowski PL, Nolan P, Palomba ML, Quefeld C, Straus DJ, Zelenetz AD, Horwitz SM. A phase I/II trial of the combination of romidepsin and lenalidomide in patients with relapsed/refractory lymphoma and myeloma: Phase I results. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8582] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jia Ruan
- Weill Cornell Medical College, New York, NY
| | - Sumithra Nair
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Regina Byrne
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | - Beth Inserra
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Peggy Lynch
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | | | - Patrick Nolan
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Maria Lia Palomba
- Lymphoma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
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Straus DJ. Radiotherapy should be omitted in most patients. Clin Adv Hematol Oncol 2014; 12:247-249. [PMID: 25134171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
Since its initial description in 1958, Burkitt lymphoma has become a prototype for our understanding of the pathogenesis and optimal treatment of aggressive lymphomas. The evolution of the treatment of this disease is explored and current therapeutic approaches evaluated. Special issues in the treatment of Burkitt lymphoma will also be discussed, including considerations in patients infected with HIV and current views on prophylactic measures and treatment of tumor lysis syndrome.
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Affiliation(s)
- John Gerecitano
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. gerecitj@@mskcc.org
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Straus DJ, Duvic M, Horwitz SM, Hymes K, Goy A, Hernandez-Ilizaliturri FJ, Feldman T, Wegner B, Myskowski PL. Final results of phase II trial of doxorubicin HCl liposome injection followed by bexarotene in advanced cutaneous T-cell lymphoma. Ann Oncol 2013; 25:206-10. [PMID: 24285015 DOI: 10.1093/annonc/mdt480] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND High response rates for doxorubicin HCl liposome injection (DLI) in cutaneous T-cell lymphoma (CTCL) have been reported with vague criteria until recently. Approximately 50% of CTCL patients respond to bexarotene (Bex). PATIENTS AND METHODS A phase II trial was carried out to clarify the true overall response rate (ORR) for DLI and to assess the role of sequential Bex. Patients were treated with DLI 20 mg/m(2) i.v. every 2 weeks for 16 weeks (8 doses) followed by 16 weeks with Bex 300 mg/m(2) orally. Response assessments were carried out after 16 (DLI) and 32 weeks (Bex). Skin responses were measured by the modified Severity-Weighted Assessment Tool (mSWAT) and the Composite Assessment of Index Lesion Severity (CA). RESULTS Thirty-seven patients were treated: stage IV (22, 8 with Sézary syndrome), IIB (10), earlier stage refractory to skin-directed therapies or radiation therapy (5). For 34 assessable patients: ORR 14/34 [41%: partial response (PR) 12, clinical complete response (CCR) 2]. Maximum responses were all seen after 16 weeks DLI. Median progression-free survival (PFS) was 5 months. There were 22 deaths: 21 of disease and 1 of heart failure. Twenty-seven grade 3 and 5 grade 4 toxic events were observed. CONCLUSION(S) With strict criteria, DLI ORR is among the highest reported for single agents in CTCL. Sequential Bex did not increase the response rate or duration.
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Affiliation(s)
- D J Straus
- Department of Medicine, Division of Hematologic Oncology, Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York
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Abstract
There have been an increasing number of survivors of successful treatment of Hodgkin lymphoma (HL) over the past 30 years. Although these survivors may be cured of their HL, long-term morbidity and mortality are associated with late toxicities of treatment. Identification of these late complications will lead to strategies to manage them when they occur and hopefully to decrease the risk of their development. Second malignancies followed by cardiovascular disease are the leading causes of late morbidity and mortality. Musculoskeletal difficulties, endocrine abnormalities including sterility and thyroid disease, heart and lung damage, persistent fatigue and psychosocial distress have also been seen. The subjects of this review are the late complications of primary treatment of HL and autologous stem cell transplantation, usually for relapsed disease.
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Moskowitz AJ, Hamlin PA, Perales MA, Gerecitano J, Horwitz SM, Matasar MJ, Noy A, Palomba ML, Portlock CS, Straus DJ, Graustein T, Zelenetz AD, Moskowitz CH. Phase II study of bendamustine in relapsed and refractory Hodgkin lymphoma. J Clin Oncol 2013; 31:456-60. [PMID: 23248254 PMCID: PMC3862960 DOI: 10.1200/jco.2012.45.3308] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [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] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Limited data exist regarding the activity of bendamustine in Hodgkin lymphoma (HL). This phase II study evaluated the efficacy of bendamustine in relapsed and refractory HL. PATIENTS AND METHODS Patients with relapsed and refractory HL who were ineligible for autologous stem-cell transplantation (ASCT), or for whom this treatment failed, received bendamustine 120 mg/m(2) as a 30-minute infusion on days 1 and 2 every 28 days with growth factor support. The primary end point was overall response rate (ORR). A secondary end point was referral rate to allogeneic stem-cell transplantation (alloSCT) for patients deemed eligible for alloSCT at the time of enrollment. RESULTS Of the 36 patients enrolled, 34 were evaluable for response. Patients had received a median of four prior treatments, and 75% had relapsed after ASCT. The ORR by intent-to-treat analysis was 53%, including 12 complete responses (33%) and seven partial responses (19%). The response rate among evaluable patients was 56%. Responses were seen in patients with prior refractory disease, prior ASCT, and prior alloSCT; however, no responses were seen in patients who relapsed within 3 months of ASCT. The median response duration was 5 months. Five patients (20% of those eligible) proceeded to alloSCT after treatment with bendamustine. Grade ≥ 3 adverse events were infrequent and most commonly included thrombocytopenia (20%), anemia (14%), and infection (14%). CONCLUSION This study confirms the efficacy of bendamustine in heavily pretreated patients with HL. These results support current and future studies evaluating bendamustine combinations in relapsed and refractory HL.
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Kostakoglu L, Schöder H, Johnson JL, Hall NC, Schwartz LH, Straus DJ, LaCasce AS, Jung SH, Bartlett NL, Canellos GP, Cheson BD. Interim [(18)F]fluorodeoxyglucose positron emission tomography imaging in stage I-II non-bulky Hodgkin lymphoma: would using combined positron emission tomography and computed tomography criteria better predict response than each test alone? Leuk Lymphoma 2012; 53:2143-50. [PMID: 22421007 DOI: 10.3109/10428194.2012.676173] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our objective was to validate the International Harmonization Project (IHP) positron emission tomography (PET) response criteria and correlate with the Deauville criteria and diagnostic computed tomography-based (dCT) lesion size changes. All patients were recruited prospectively to the Cancer and Leukemia Group B (CALGB) 50203 trial for the treatment of stage I-II, non-bulky Hodgkin lymphoma (HL). [(18)F]Fluorodeoxyglucose (FDG) PET and dCT were performed at baseline and after two doxorubicin, vinblastine and gemcitabine (AVG) cycles (PET-2, dCT-2) in 88 patients. IHP and Deauville criteria and percent decrease in the sum of the products of the perpendicular diameters (%SPPD) after two cycles were correlated with progression-free survival (PFS). After a median follow-up of 3.3 years, 23.9% of patients relapsed/progressed (3-year PFS 77%). By IHP, the 2-year PFS was 88% and 54% for PET-2 negative and positive groups, respectively (p = 0.0009). Similar results were obtained for Deauville criteria. In a univariate analysis, PET-2 predicted PFS better than %SPPD, and in a combinatorial analysis, in the PET-2 positive group, a negative dCT-2 increased PFS by 27-35%. However, some confidence intervals were large due to small sample sizes. In conclusion, IHP and Deauville criteria-based interpretation of PET-2 was strongly associated with 2-year PFS. The combined analysis of PET-2 with dCT-2 suggested a better predictive value for PFS compared to either test alone. Further studies are under way to confirm these findings.
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Cooper RA, Straus DJ. Clinical guidelines, the politics of value, and the practice of medicine: physicians at the crossroads. J Oncol Pract 2012; 8:233-5. [PMID: 23180988 PMCID: PMC3396820 DOI: 10.1200/jop.2011.000500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2012] [Indexed: 11/20/2022] Open
Abstract
Best practice guidelines are being used to an increasing degree, not only by physicians to improve the level of care, but also by bureaucrats to constrain reimbursement and guide the pathways of care.
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Affiliation(s)
- Richard A Cooper
- Center for the Future of the Healthcare Workforce, New York Institute of Technology, New York, NY 10022, USA.
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Straus DJ, Hamlin PA, Matasar MJ, Palomba ML, Drullinsky P, Zelenetz AD, Gerecitano JF, Noy A, Hamilton AM, Wegner B, Zhang Z, Elstrom RL, Cella D. Final results of phase I/II trial of vorinostat in combination with cyclophosphamide, etoposide, prednisone, and rituximab (R-CVEP) for elderly patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.8054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8054 Background: Standard treatment of relapsed/refractory DLBCL in elderly patients who are not candidates for autologous stem cell transplantation (auSCT) has not been established. Cyclophosphamide (C), etoposide (E), prednisone (P) and procarbazine (CEPP) has been used by many clinicians based on limited data (Blood 76: 1293-98, 1990). Vorinostat (V) is a histone deacetylase inhibitor that is approved for relapsed cutaneous T-cell lymphoma and has activity in B-cell lymphomas. This trial defined the maximum tolerated dose (MTD) of V added to standard therapy and determined the response rate of this combination. Methods: Patients ≥age 60 with relapsed/refractory DLBCL not candidates for auSCT were enrolled on R-CVEP (R 375mg/m2 IV, d1; C 600mg/m2 d1 and 8, E 70mg/m2 IV d1, 140mg/m2 d2 and 3; V PO and Pred 60mg/m2 PO d1-10) every 28 days for 6 cycles. In the phase I component V was administered at doses of 300mg/d or 400mg/d for 10 days. The phase I was a 3 + 3 design and the phase II a two stage design requiring 8/20 complete responses (CR) for expansion. Assessment of response utilized end-of-treatment positron emission tomography (PET) (JCO 25: 579-86, 2007). Quality of life (QOL) was measured with the FACT-Lym v.4. Results: 27 pts. were enrolled. 1 died before treatment. For 26 pts: median age 76 yrs. (69-88), 14 females and 12 males, baseline PS (ECOG) 1 (0-2). Median follow-up for survivors: 9.2 mo. Phase I: 6 pts. at 300mg/d (no dose-limiting toxicity-DLT), 6 pts. at 400mg/d (2 grade 3 neutropenia = DLT). MTD 300mg/d x 10d. For 20 pts. at V 300mg/m2 (6 phase I + 14 phase II): 2 off study for toxicity, 1 withdrew consent, 6 CR (30%), 5 partial response (PR) (25%), 6 progressed (30%). Phenotypic overall responses (OR): germinal center (GC) 4/8 (2 CR), non-GC 6/10 (3 CR), transformed CLL 1/2 (1 CR). Median progression-free survival: 10 mo. QOL results will be presented. Conclusions: OR rate for V added to conventional chemotherapy and R was 55% (CR 30%, PR 25%) in relapsed/refractory DLBCL in elderly pts. not candidates for auSCT. This could provide a baseline for comparison with future clinical trials in this understudied population.
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Affiliation(s)
| | | | | | | | | | | | | | - Ariela Noy
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Brett Wegner
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Zhigang Zhang
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - David Cella
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
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