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Passamonti F, Foran JM, Tandra A, De Stefano V, Fox ML, Mattour AH, McMullin MF, Perkins A, Rodriguez-Macias G, Sibai H, Qin QQ, Potluri J, How JB. Navitoclax plus ruxolitinib in JAK inhibitor-naive patients with myelofibrosis: Preliminary safety and efficacy in a multicenter, open-label phase 2 study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7015] [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
7015 Background: Ruxolitinib (RUX), a Janus kinase (JAK) 1/2 inhibitor, is the current standard of care for patients (pts) with myelofibrosis (MF) that improves splenomegaly and disease symptoms with limited impact on disease biology. Many pts lose response over time, highlighting an unmet need for novel therapies. Navitoclax (NAV) is an oral, small-molecule inhibitor of BCL-XL and BCL-2 that has a synergistic effect when used in combination with JAK inhibitors to enhance apoptosis. This ongoing, open-label, multicenter, phase 2 trial (NCT03222609) is evaluating the efficacy and safety of NAV with/without RUX in pts with MF. Here, we report results from JAK inhibitor-naïve pts treated with NAV+RUX. Methods: Enrolled pts had primary or secondary MF with splenomegaly (DIPSS ≥INT-1) and did not receive prior JAK-2 therapy or bromodomain and extraterminal motif (BET) inhibitors. Pts initiated NAV at 100 mg QD or 200 mg QD if baseline (BL) platelet count was ≤150 × 109/L or >150 × 109/L, respectively. RUX was given BID with starting dose based on BL platelet count per local label. The primary endpoint was spleen volume reduction of ≥35% (SVR35) from BL at wk 24. Key secondary endpoints were ≥50% reduction in total symptom score (TSS50), bone marrow (BM) fibrosis reduction, and anemia response. Adverse events (AEs) were monitored throughout the study. Results: As of Oct 04, 2021, 32 pts received NAV+RUX. Median duration of f/u was 6.1 (range, 1.9 ─ 18.6) mos. 28 (88%) pts received NAV 200 mg and 4 (13%) received 100 mg OD. Median age was 69 (44 ─ 83) yrs, and median spleen volume was 1889.08 cm3 (645.6 ─ 7339.6). Median NAV and RUX exposures were 24.1 (5.1 ─ 80.9) and 20.1 (0.1 ─ 80.1) wks, respectively. 31 (97%) pts reported ≥1 AE (Grade ≥3 AEs, 25 [78%]; serious AEs, 6 [19%]). Most common Grade ≥3 AEs were anemia (34%), thrombocytopenia (31%), and neutropenia (19%). 3 (9%) and 2 (6%) pts reported an AE leading to NAV and RUX discontinuation, respectively, and 2 (6%; 1 PD, 1 cardiac disorder unrelated to NAV) AEs led to death ≤30 days after last NAV dose. SVR35 was achieved by 52% of evaluable pts at wk 24 (SVR35 in INT-2, 50%; HR, 33%) and by 76% at any time on treatment (Table). Median time to first SVR35 was 12.1 (11 ─ 47) wks. Conclusions: The combination of NAV+RUX was well tolerated and demonstrated early and robust reductions in spleen volume, anemia, and BM fibrosis in pts without prior JAK-2 inhibitor exposure. SVR35, TSS50, and BM fibrosis improved over time. Clinical trial information: NCT03222609. [Table: see text]
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Affiliation(s)
| | | | - Anand Tandra
- Indiana Blood and Marrow Transplant, Indianapolis, IN
| | - Valerio De Stefano
- Section of Hematology, Catholic University, Fondazione Policlinico A Gemelli, IRCCS, Rome, Italy
| | - Maria Laura Fox
- Department of Hematology, Hospital Universitari Vall d’Hebron, Experimental Hematology, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Hospital Campus, Barcelona, Spain
| | | | | | - Andrew Perkins
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | | | - Hassan Sibai
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | | | - Jonathan B. How
- Division of Hematology, McGill University Health Center, Montreal, QC, Canada
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Oarbeascoa G, Rodriguez-Macias G, Guzman-de-Villoria JA, Fernandez-Garcia P, Churruca J, Diez-Martin JL, Bastos-Oreiro M. Methotrexate-Induced Subacute Neurotoxicity Surrounding an Ommaya Reservoir in a Patient with Lymphoma. Am J Case Rep 2019; 20:1002-1005. [PMID: 31295228 PMCID: PMC6640172 DOI: 10.12659/ajcr.915632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/03/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intraventricular administration of methotrexate (MTX) using an Ommaya reservoir is a useful therapeutic maneuver for malignant CNS involvement in patients with hematological malignancies. MTX-induced subacute neurotoxicity is a rare complication that typically progresses with involvement of the basal ganglia. Local toxicity due to misplaced catheters has been described, although the impact of normally positioned catheters on toxicity is not clear. CASE REPORT We report the case of a 21-year-old man diagnosed with stage IV diffuse large B-cell lymphoma who experienced a central nervous system relapse. While receiving intraventricular MTX using an Ommaya reservoir and systemic MTX, he experienced sudden left-side hemiparesis. All diagnostic tests were negative except for altered MRI findings with FLAIR hyperintensity in the basal ganglia and restricted diffusion in the same location that followed the track of the Ommaya catheter. The syndrome resolved after administration of high-dose steroids, and the patient received subsequent MTX courses without recurrence. CONCLUSIONS MTX-induced neurotoxicity is a rare adverse event related to systemic and intrathecal administration of the drug. Many cases of Ommaya-related CNS symptoms have been described, although most were related to misplaced or malfunctioning catheters. Here we present a case of subacute MTX toxicity affecting the area around a correctly positioned catheter, suggesting that the catheter track could be more susceptible to MTX-induced toxicity.
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Affiliation(s)
- Gillen Oarbeascoa
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gabriela Rodriguez-Macias
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Juan Adan Guzman-de-Villoria
- Department of Radiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Center for Biomedical Research in Mental Health Network, Madrid, Spain
| | - Pilar Fernandez-Garcia
- Department of Radiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Center for Biomedical Research in Mental Health Network, Madrid, Spain
| | - Juan Churruca
- Department of Hematology, Infanta Leonor University Hospital, Madrid, Spain
| | - Jose Luis Diez-Martin
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
| | - Mariana Bastos-Oreiro
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
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Bastos-Oreiro M, Rodriguez-Macias G, Pradillo V, Martinez S, O'Hara K, Champ D, Font P, Vidan M, Ortiz J, Menarguez J, Serra J, Diéz-Martín J. A PROSPECTIVE STUDY TO EVALUATE THE UTILITY OF GERIATRIC ASSESSMENT AND INTERVENTION IN PATIENTS WITH LYMPHOPROLIFERATIVE DISORDERS IN A TERTIARY HOSPITAL. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- M. Bastos-Oreiro
- Hematology; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | | | - V. Pradillo
- Hematology; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | - S. Martinez
- Geriatry; Hospital General Universitario Gregorio Marañón, Madrid; Spain
| | - K. O'Hara
- Geriatry; Hospital General Universitario Gregorio Marañón, Madrid; Spain
| | - D. Champ
- Hematology; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | - P. Font
- Hematology; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | - M. Vidan
- Geriatry; Hospital General Universitario Gregorio Marañón, Madrid; Spain
| | - J. Ortiz
- Geriatry; Hospital General Universitario Gregorio Marañón, Madrid; Spain
| | - J. Menarguez
- Pathology; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | - J. Serra
- Geriatry; Hospital General Universitario Gregorio Marañón, Madrid; Spain
| | - J. Diéz-Martín
- Hematology; Hospital General Universitario Gregorio Marañón; Madrid Spain
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Ballesteros J, Montesinos P, Martinez Cuadron D, Martinez J, Serrano J, Perez de Oteyza J, Fernandez P, Rodriguez-Macias G, Vidriales MB, Herrera P, Tormo M, Bergua JM, Garcia-Boyero R, Vives S, Fernandez MA, Villoria J, Moscardo F, Troconiz IF, Sanz MA. An ex vivo native environment precision medicine AML test and the correlation with responses to 1st line treatment. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e18510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Pau Montesinos
- Hospital Universitari i Politecnic La Fe de Valencia, Valencia, Spain
| | | | | | | | | | | | | | | | | | - Mar Tormo
- Hospital Clínico Universitario, Valencia, Valencia, Spain
| | - Juan M Bergua
- Hospital Universitario San Pedro de Alcántara, Cáceres, Cáceres, Spain
| | | | - Susana Vives
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | | | - Inaki F Troconiz
- Department of Pharmacy, School of Pharmacy, University of Navarra, Pamplona, Spain
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Bennett TA, Montesinos P, Moscardo F, Martinez-Cuadron D, Martinez J, Sierra J, García R, de Oteyza JP, Fernandez P, Serrano J, Fernandez A, Herrera P, Gonzalez A, Bethancourt C, Rodriguez-Macias G, Alonso A, Vera JA, Navas B, Lavilla E, Lopez JA, Jimenez S, Simiele A, Vidriales B, Gonzalez BJ, Burgaleta C, Hernandez Rivas JA, Mascuñano RC, Bautista G, Perez Simon JA, Fuente ADL, Rayón C, Troconiz IF, Janda A, Bosanquet AG, Hernandez-Campo P, Primo D, Lopez R, Liebana B, Rojas JL, Gorrochategui J, Sanz MA, Ballesteros J. Pharmacological Profiles of Acute Myeloid Leukemia Treatments in Patient Samples by Automated Flow Cytometry: A Bridge to Individualized Medicine. Clinical Lymphoma Myeloma and Leukemia 2014; 14:305-18. [DOI: 10.1016/j.clml.2013.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 10/29/2013] [Accepted: 11/05/2013] [Indexed: 01/26/2023]
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Serrano D, Miralles P, Balsalobre P, Kwon M, Rodriguez-Macias G, Gayoso J, Anguita J, Buño I, Berenguer J, Díez-Martín JL. Graft-versus-tumor effect after allogeneic stem cell transplantation in HIV-positive patients with high-risk hematologic malignancies. AIDS Res Hum Retroviruses 2013; 29:1340-5. [PMID: 23800257 DOI: 10.1089/aid.2013.0001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is a well-established therapeutic option for hematological malignancies. Combination antiretroviral therapy (cART) has enabled the treatment of medical conditions in patients infected with the human immunodeficiency virus (HIV) in the same way as in the general population. Moreover, improvements in supportive care have allowed HIV-infected patients with life-threatening hematological disorders to be treated with Allo-HSCT. We report on four HIV-infected patients with hematological malignancies receiving an Allo-HSCT in our institution, and on the use of donor lymphocyte infusions to successfully treat post-Allo-HSCT relapse. Of note, one of them is the first HIV(+) patient to receive a "dual transplant" (unrelated umbilical cord blood stem cells combined with mobilized T cell-depleted CD34(+) stem cells from a mismatched third party donor). cART drugs interactions were satisfactorily managed. This approach provided long-term control of the hematological disease. Nevertheless, despite adequate immune reconstitution, infections were the main cause of morbidity and mortality after Allo-HSCT.
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Affiliation(s)
- David Serrano
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Pilar Miralles
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
- Infectious Diseases Unit, H.G.U. Gregorio Marañón, Madrid, Spain
| | - Pascual Balsalobre
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Mi Kwon
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Gabriela Rodriguez-Macias
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Jorge Gayoso
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Javier Anguita
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Ismael Buño
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Juan Berenguer
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
- Infectious Diseases Unit, H.G.U. Gregorio Marañón, Madrid, Spain
| | - José L. Díez-Martín
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
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