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Itchaki G, Jarhovsky O, Castillo JJ, Hassan H, Gatt ML, Leiba M, Raanani P, Gertz MA, Vaxman I. Lymphoplasmacytic lymphoma and multiple myeloma coexisting in the same patient: a case series and literature review. Leuk Lymphoma 2024:1-7. [PMID: 38501758 DOI: 10.1080/10428194.2024.2332499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Abstract
The simultaneous occurrence of Waldenström macroglobulinemia and multiple myeloma in the same patient has been published as case reports. Patients with Waldenström macroglobulinemia often have a small clone of plasma cells. However, the concurrent occurrence of symptomatic myeloma with lytic bone lesions is rare. The diagnosis of this 'hybrid' entity is challenging, and there are no standard therapies. We present six patients from five centers (three in Israel and two in the United States). We describe these patients' unique clinical course and treatment approaches.
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Affiliation(s)
- Gilad Itchaki
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Hematology, Meir Medical Center, Kfar-Saba, Israel
| | - Osnat Jarhovsky
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Hematology, Meir Medical Center, Kfar-Saba, Israel
| | - Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Hamza Hassan
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Moshe L Gatt
- Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Merav Leiba
- Assuta Ashdod University Hospital, Faculty of Health Science, Ben-Gurion University of the Negev, Negev, Israel
| | - Pia Raanani
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikvah, Israel
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Iuliana Vaxman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikvah, Israel
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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2
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Giladi O, Bagnato G, Gentilini M, Shimony S, Pasvolsky O, Berger T, Itchaki G, Raanani P, Lolli G, Stefoni V, Broccoli A, Argnani L, Zinzani PL, Gurion R. Diffuse large B cell lymphoma characteristics and outcomes during the COVID-19 pandemic in two tertiary centers - an Israeli/ Italian study. Ann Hematol 2024; 103:803-811. [PMID: 37950052 DOI: 10.1007/s00277-023-05543-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
The COVID-19 pandemic posed a major challenge in cancer care worldwide which might have an impact on the management of diffuse large B-cell lymphoma (DLBCL). We conducted a retrospective study comparing characteristics, management, and outcomes of DLBCL patients diagnosed during the first year of the COVID-19 pandemic (1/3/2020-28/2/2021) to those diagnosed in the previous year (1/3/2019-28/2/2020) in two tertiary centers in Italy and Israel. 182 patients were diagnosed with DLBCL during the study period. More patients were diagnosed during the pandemic compared to the year before: 60 vs. 29 and 54 vs. 39 in Italy and in Israel, respectively. Trends towards older age and higher transformation rates were shown during the pandemic. The interval between the initiation of symptoms and diagnosis was longer during the pandemic. Five and four patients were diagnosed with COVID-19 during treatment in Italy and in Israel, respectively. there was no difference in dose density and intensity of treatment, before and during the pandemic. The median follow-up during and before the pandemic was 15.2 and 25.5 months, respectively. Progression-free survival (PFS) was slightly shorter during the pandemic compared to the year before (64.9% vs. 70.6%; p = 0.0499). In multivariate analysis, older age and transformed disease were independently related to PFS, while diagnosis of DLBCL during the pandemic was not. Despite the challenges caused by COVID-19 pandemic, the management of DLBCL patients remained unchanged including dose density and intensity. Nevertheless, a shorter PFS during the outbreak might be attributed to differences in patients' characteristics.
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Affiliation(s)
- Odil Giladi
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gianmarco Bagnato
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Marianna Gentilini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Shai Shimony
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Oren Pasvolsky
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Tamar Berger
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Laboratory of Genome Maintenance, The Rockefeller University, New York, NY, USA
| | - Gilad Itchaki
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Hematology Institute, Meir Medical Center, Kfar Saba, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ginerva Lolli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Vittorio Stefoni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Alessandro Broccoli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Lisa Argnani
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Ronit Gurion
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Alfandari A, Moskovich D, Weisz A, Katzav A, Kidron D, Beiner M, Josephy D, Asali A, Hants Y, Yagur Y, Weitzner O, Ellis M, Itchaki G, Ashur-Fabian O. The selenoenzyme type I iodothyronine deiodinase: a new tumor suppressor in ovarian cancer. Mol Oncol 2024. [PMID: 38429887 DOI: 10.1002/1878-0261.13612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/26/2023] [Accepted: 02/05/2024] [Indexed: 03/03/2024] Open
Abstract
The selenoenzyme type I iodothyronine deiodinase (DIO1) catalyzes removal of iodine atoms from thyroid hormones. Although DIO1 action is reported to be disturbed in several malignancies, no work has been conducted in high-grade serous ovarian carcinoma (HGSOC), the most lethal gynecologic cancer. We studied DIO1 expression in HGSOC patients [The Cancer Genome Atlas (TCGA) data and tumor tissues], human cell lines (ES-2 and Kuramochi), normal Chinese hamster ovarian cells (CHO-K1), and normal human fallopian tube cells (FT282 and FT109). To study its functional role, DIO1 was overexpressed, inhibited [by propylthiouracil (PTU)], or knocked down (KD), and cell count, proliferation, apoptosis, cell viability, and proteomics analysis were performed. Lower DIO1 levels were observed in HGSOC compared to normal cells and tissues. TCGA analyses confirmed that low DIO1 mRNA expression correlated with worse survival and therapy resistance in patients. Silencing or inhibiting the enzyme led to enhanced ovarian cancer proliferation, while an opposite effect was shown following DIO1 ectopic expression. Proteomics analysis in DIO1-KD cells revealed global changes in proteins that facilitate tumor metabolism and progression. In conclusion, DIO1 expression and ovarian cancer progression are inversely correlated, highlighting a tumor suppressive role for this enzyme and its potential use as a biomarker in this disease.
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Affiliation(s)
- Adi Alfandari
- Translational Oncology Laboratory, Hematology Institute, Meir Medical Center, Kfar Saba, Israel
- Department of Human Molecular Genetics and Biochemistry, Faculty of Medicine, Tel Aviv University, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Israel
| | - Dotan Moskovich
- Translational Oncology Laboratory, Hematology Institute, Meir Medical Center, Kfar Saba, Israel
- Department of Human Molecular Genetics and Biochemistry, Faculty of Medicine, Tel Aviv University, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Israel
| | - Avivit Weisz
- Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Aviva Katzav
- Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Debora Kidron
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Israel
- Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Mario Beiner
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Israel
- Division of Gynecologic Oncology, Meir Medical Center, Kfar Saba, Israel
| | - Dana Josephy
- Division of Gynecologic Oncology, Meir Medical Center, Kfar Saba, Israel
| | - Aula Asali
- Division of Gynecologic Oncology, Meir Medical Center, Kfar Saba, Israel
| | - Yael Hants
- Division of Gynecologic Oncology, Meir Medical Center, Kfar Saba, Israel
| | - Yael Yagur
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Omer Weitzner
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Martin Ellis
- Translational Oncology Laboratory, Hematology Institute, Meir Medical Center, Kfar Saba, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Israel
| | - Gilad Itchaki
- Translational Oncology Laboratory, Hematology Institute, Meir Medical Center, Kfar Saba, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Israel
| | - Osnat Ashur-Fabian
- Translational Oncology Laboratory, Hematology Institute, Meir Medical Center, Kfar Saba, Israel
- Department of Human Molecular Genetics and Biochemistry, Faculty of Medicine, Tel Aviv University, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Israel
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4
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Durham BH, Hershkovitz-Rokah O, Abdel-Wahab O, Yabe M, Chung YR, Itchaki G, Ben-Sasson M, Asher-Guz VA, Groshar D, Doe-Tetteh SA, Alano T, Solit DB, Shpilberg O, Diamond EL, Mazor RD. Mutant PIK3CA is a targetable driver alteration in histiocytic neoplasms. Blood Adv 2023; 7:7319-7328. [PMID: 37874915 PMCID: PMC10711187 DOI: 10.1182/bloodadvances.2022009349] [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: 11/18/2022] [Revised: 09/21/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplasm characterized by the accumulation of clonal mononuclear phagocyte system cells expressing CD1a and CD207. In the past decade, molecular profiling of LCH as well as other histiocytic neoplasms demonstrated that these diseases are driven by MAPK activating alterations, with somatic BRAFV600E mutations in >50% of patients with LCH, and clinical inhibition of MAPK signaling has demonstrated remarkable clinical efficacy. At the same time, activating alterations in kinase-encoding genes, such as PIK3CA, ALK, RET, and CSF1R, which can activate mitogenic pathways independent from the MAPK pathway, have been reported in a subset of histiocytic neoplasms with anecdotal evidence of successful targeted treatment of histiocytoses harboring driver alterations in RET, ALK, and CSF1R. However, evidence supporting the biological consequences of expression of PIK3CA mutations in hematopoietic cells has been lacking, and whether targeted inhibition of PI3K is clinically efficacious in histiocytic neoplasms is unknown. Here, we provide evidence that activating mutations in PIK3CA can drive histiocytic neoplasms in vivo using a conditional knockin mouse expressing mutant PIK3CAH1047R in monocyte/dendritic cell progenitors. In parallel, we demonstrate successful treatment of PIK3CA-mutated, multisystemic LCH using alpelisib, an inhibitor of the alpha catalytic subunit of PI3K. Alpelisib demonstrated a tolerable safety profile at a dose of 750 mg per week and clinical and metabolic complete remission in a patient with PIK3CA-mutated LCH. These data demonstrate PIK3CA as a targetable noncanonical driver of LCH and underscore the importance of mutational analysis-based personalized treatment in histiocytic neoplasms.
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Affiliation(s)
- Benjamin H. Durham
- Molecular Pharmacology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Oshrat Hershkovitz-Rokah
- Department of Molecular Biology, Faculty of Natural Sciences, Ariel University, Ariel, Israel
- Translational Research Lab, Assuta Medical Centers, Tel Aviv, Israel
| | - Omar Abdel-Wahab
- Molecular Pharmacology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mariko Yabe
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Young Rock Chung
- Molecular Pharmacology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gilad Itchaki
- Department of Hematology, Rabin Medical Center, Petah Tikva, Israel
| | - Maayan Ben-Sasson
- The Institute for Pain Medicine, Rambam Medical Center, Haifa, Israel
- The Rappaport School of Medicine, Technion, Haifa, Israel
- Meuhedet Health Maintenance Organization, Zikhron Ya'akov, Israel
| | - Vered A. Asher-Guz
- Department of Molecular Biology, Faculty of Natural Sciences, Ariel University, Ariel, Israel
- Translational Research Lab, Assuta Medical Centers, Tel Aviv, Israel
| | - David Groshar
- Department of Imaging, Assuta Medical Center, Tel Aviv, Israel
| | - Seyram A. Doe-Tetteh
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tina Alano
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David B. Solit
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ofer Shpilberg
- Translational Research Lab, Assuta Medical Centers, Tel Aviv, Israel
- Clinic of Histiocytic Neoplasms, Institute of Hematology, Assuta Medical Center, Tel Aviv, Israel
- The Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Eli L. Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Roei D. Mazor
- Clinic of Histiocytic Neoplasms, Institute of Hematology, Assuta Medical Center, Tel Aviv, Israel
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5
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Visentin A, Chatzikonstantinou T, Scarfò L, Kapetanakis A, Demosthenous C, Karakatsoulis G, Minga E, Chamou D, Allsup D, Cabrero AA, Andres M, Antic D, Baile M, Baliakas P, Besikli-Dimou S, Bron D, Chatzileontiadou S, Cordoba R, Correa JG, Cuéllar-García C, De Paoli L, De Paolis MR, Delgado J, Dimou M, Donaldson D, Catherwood M, Doubek M, Efstathopoulou M, Eichhorst B, Elashwah S, Enrico A, Espinet B, Farina L, Ferrari A, Foglietta M, Frederiksen H, Fürstenau M, García-Marco JA, García-Serra R, Collado R, Gentile M, Gimeno E, Glenthøj A, da Silva MG, Hakobyan YK, Herishanu Y, Hernández-Rivas JÁ, Herold T, Innocenti I, Itchaki G, Jaksic O, Janssens A, Kalashnikova ОB, Kalicińska E, Kater AP, Kersting S, Labrador J, Lad D, Laurenti L, Levin MD, Lista E, Lopez-Garcia A, Malerba L, Marasca R, Marchetti M, Marquet J, Mattsson M, Mauro FR, Morawska M, Motta M, Munir T, Murru R, Niemann CU, Rodrigues RN, Olivieri J, Orsucci L, Papaioannou M, Pavlovsky MA, Piskunova I, Popov VM, Quaglia FM, Quaresmini G, Qvist K, Rigolin GM, Ruchlemer R, Šimkovič M, Špaček M, Sportoletti P, Stanca O, Tadmor T, Capasso A, Del Poeta G, Gutwein O, Karlsson LK, Milosevic I, Mirás F, Reda G, Saghumyan G, Shrestha A, Te Raa D, Tonino SH, Van Der Spek E, van Gelder M, van Kampen R, Wasik-Szczepanek E, Wróbel T, Segundo LYS, Yassin M, Pocali B, Vandenberghe E, Iyengar S, Varettoni M, Vitale C, Coscia M, Rambaldi A, Montserrat E, Cuneo A, Stavroyianni N, Trentin L, Stamatopoulos K, Ghia P. The evolving landscape of COVID-19 and post-COVID condition in patients with chronic lymphocytic leukemia: A study by ERIC, the European research initiative on CLL. Am J Hematol 2023; 98:1856-1868. [PMID: 37772428 DOI: 10.1002/ajh.27093] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 06/25/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/30/2023]
Abstract
In this retrospective international multicenter study, we describe the clinical characteristics and outcomes of patients with chronic lymphocytic leukemia (CLL) and related disorders (small lymphocytic lymphoma and high-count monoclonal B lymphocytosis) infected by SARS-CoV-2, including the development of post-COVID condition. Data from 1540 patients with CLL infected by SARS-CoV-2 from January 2020 to May 2022 were included in the analysis and assigned to four phases based on cases disposition and SARS-CoV-2 variants emergence. Post-COVID condition was defined according to the WHO criteria. Patients infected during the most recent phases of the pandemic, though carrying a higher comorbidity burden, were less often hospitalized, rarely needed intensive care unit admission, or died compared to patients infected during the initial phases. The 4-month overall survival (OS) improved through the phases, from 68% to 83%, p = .0015. Age, comorbidity, CLL-directed treatment, but not vaccination status, emerged as risk factors for mortality. Among survivors, 6.65% patients had a reinfection, usually milder than the initial one, and 16.5% developed post-COVID condition. The latter was characterized by fatigue, dyspnea, lasting cough, and impaired concentration. Infection severity was the only risk factor for developing post-COVID. The median time to resolution of the post-COVID condition was 4.7 months. OS in patients with CLL improved during the different phases of the pandemic, likely due to the improvement of prophylactic and therapeutic measures against SARS-CoV-2 as well as the emergence of milder variants. However, mortality remained relevant and a significant number of patients developed post-COVID conditions, warranting further investigations.
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Affiliation(s)
- Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | | | - Lydia Scarfò
- Università Vita-Salute San Raffaele and IRCC Ospedale San Raffaele, Milan, Italy
| | - Anargyros Kapetanakis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | | | - Georgios Karakatsoulis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
- Department of Mathematics, University of Ioannina, Ioannina, Greece
| | - Eva Minga
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Dimitra Chamou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - David Allsup
- Centre for Biomedicine, Hull York Medical School, Hull, UK
| | - Alejandro Alonso Cabrero
- Spanish Society of Hematology and Hemotherapy (SEHH: Sociedad Española de Hematología y hemoterapia), Madrid, Spain
- Hematology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Martin Andres
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Darko Antic
- University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mónica Baile
- Hospital Clinico Universitario de Salamanca (CAUSA/IBSAL), Salamanca, Spain
| | - Panagiotis Baliakas
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Department of Clinical Genetics, Uppsala University Hospital, Uppsala, Sweden
| | | | | | - Sofia Chatzileontiadou
- Hematology Unit, 1st Dept of Internal Medicine, AUTH, AHEPA Hospital, Thessaloniki, Greece
| | - Raul Cordoba
- Department of Hematology, Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | | | | | - Lorenzo De Paoli
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale Amedeo Avogadro, Azienda Ospedaliero-Universitaria Maggiore della Carità Novara, Novara, Italy
| | | | | | - Maria Dimou
- 1st Internal Medicine Department, Propaedeutic, Hematology Clinical Trial Unit, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Michael Doubek
- Department of Internal Medicine-Hematology and Oncology, University Hospital, Brno, Czech Republic
- Faculty of Medicine, Department of Medical Genetics and Genomics, Masaryk University, Brno, Czech Republic
| | - Maria Efstathopoulou
- Department of Haematology, Athens Medical Center-Psychikon Branch, Athens, Greece
| | - Barbara Eichhorst
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Salma Elashwah
- Medical Oncology Unit, Faculty of Medicine, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | | | | | - Lucia Farina
- Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Angela Ferrari
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | | | | | - Moritz Fürstenau
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Cologne, University of Cologne, Cologne, Germany
| | - José A García-Marco
- Hematology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Rocío García-Serra
- Department of Hematology, Hospital General Universitario, Valencia, Spain
- Fundaci_on de Investigaci_on del Hospital General Universitario, Valencia, Spain
| | - Rosa Collado
- Department of Hematology, Hospital General Universitario, Valencia, Spain
| | - Massimo Gentile
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, Rende, Italy
| | - Eva Gimeno
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Andreas Glenthøj
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Yair Herishanu
- Department of Hematology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Tobias Herold
- Department of Medicine III, Laboratory for Leukemia Diagnostics, University Hospital, Munich, Germany
| | - Idanna Innocenti
- Hematology Unit, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gilad Itchaki
- Meir Medical Center, Kfar-Saba, Israel
- The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ozren Jaksic
- Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
| | - Ann Janssens
- Department of Hematology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Оlga B Kalashnikova
- Federal State Budgetary Educational Institution of Higher Education Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia
| | - Elżbieta Kalicińska
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation Wroclaw Medical University, Wroclaw, Poland
| | - Arnon P Kater
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Sabina Kersting
- Department of Hematology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Jorge Labrador
- Hematology Department, Unit Research, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Deepesh Lad
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Luca Laurenti
- Hematology Unit, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Enrico Lista
- Department of Hematology, Santa Chiara Hospital, Trento, Italy
| | - Alberto Lopez-Garcia
- Department of Hematology, Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - Lara Malerba
- Hematology and Stem Cell Transplant Center, Marche Nord Hospital, Pesaro, Italy
| | - Roberto Marasca
- Department of Medical Sciences, Section of Hematology, University of Modena and Reggio E., Modena, Italy
| | - Monia Marchetti
- Hematology Unit and BM Transplant Center, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Juan Marquet
- Hematology Department, Ram_on y Cajal University Hospital, Madrid, Spain
| | - Mattias Mattsson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Department of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Francesca R Mauro
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Marta Morawska
- Experimental Hematooncology Department, Medical University of Lublin, Lublin, Poland
- Hematology Department, St. John's Cancer Center, Lublin, Poland
| | - Marina Motta
- S.C. Ematologia, ASST Spedali Civili Brescia, Brescia, Italy
| | - Talha Munir
- Consultant Haematologist, St James's Hospital, Leeds, UK
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS "G. Brotzu", Cagliari, Italy
| | - Carsten U Niemann
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Jacopo Olivieri
- Hematology Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Lorella Orsucci
- S.C. Ematologia, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Maria Papaioannou
- Hematology Unit, 1st Dept of Internal Medicine, AUTH, AHEPA Hospital, Thessaloniki, Greece
| | | | - Inga Piskunova
- Consultative Hematology Department with a Day Hospital for Intensive High-Dose Chemotherapy, National Research Center for Hematology, Moscow, Russia
| | - Viola Maria Popov
- HematologyDepartment, Colentina Clinical Hospital, Bucharest, Romania
| | | | - Giulia Quaresmini
- Department of Oncology and Hematology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Bergamo, Bergamo, Italy
| | - Kristian Qvist
- Hematologic Section, Department of Internal Medicine, Hospital Union West, Herning, Denmark
| | | | - Rosa Ruchlemer
- Department of Hematology, Shaare-Zedek Medical Center, Affiliated with the Hebrew University Medical School, Jerusalem, Israel
| | - Martin Šimkovič
- Faculty of Medicine in Hradec Králové, 4th Department of Internal Medicine-Haematology, University Hospital and Charles University in Prague, Hradec Kralove, Czech Republic
| | - Martin Špaček
- First Faculty of Medicine, 1st Department of Medicine-Hematology, Charles University and General Hospital in Prague, Prague, Czech Republic
| | - Paolo Sportoletti
- Department of Medicine and Surgery, Institute of Hematology and Center for Hemato-Oncological Research, University of Perugia, Perugia, Italy
| | - Oana Stanca
- Hematology Department, Coltea Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Tamar Tadmor
- Division of Hematology, Bnai-Zion Medical Center, Haifa, Israel
| | | | - Giovanni Del Poeta
- Department of Biomedicine and Prevention Hematology, University Tor Vergata, Rome, Italy
| | - Odit Gutwein
- Department of Hematology, Shamir Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Ivana Milosevic
- Faculty of Medicine, Clinical Centre of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Fatima Mirás
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Gianluigi Reda
- Hematology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | | | - Amit Shrestha
- Hematology Unit, Nepal Cancer Hospital & Research Centre, Lalitpur, Nepal
| | - Doreen Te Raa
- Department of Hematology, Gelderse Vallei Ede, Ede, the Netherlands
| | - Sanne H Tonino
- Department of Hematology, Lymmcare, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Ellen Van Der Spek
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Michel van Gelder
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Ewa Wasik-Szczepanek
- Department of Hematooncology and Bone Marrow Transplantation, Medical University in Lublin, Lublin, Poland
| | - Tomasz Wróbel
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation Wroclaw Medical University, Wroclaw, Poland
| | - Lucrecia Yáñez San Segundo
- Hematology Department, University Hospital and Research Institute of Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Mohamed Yassin
- Hematology Section, Department of Medical Oncology, National Center for Cancer Care and Research, Doha, Qatar
| | | | | | - Sunil Iyengar
- Haemato-oncology Unit, The Royal Marsden Hospital, UK
| | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Candida Vitale
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Marta Coscia
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Alessandro Rambaldi
- Department of Medicine and Surgery, Institute of Hematology and Center for Hemato-Oncological Research, University of Perugia, Perugia, Italy
| | | | | | - Niki Stavroyianni
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCC Ospedale San Raffaele, Milan, Italy
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6
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Harel R, Itchaki G. COVID-19 in Patients with Chronic Lymphocytic Leukemia: What Have We Learned? Acta Haematol 2023; 147:60-72. [PMID: 37820599 DOI: 10.1159/000534540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) is a prevalent hematological malignancy (HM) characterized by inherent immunodeficiency, which is further pronounced by disease-directed therapy. The COVID-19 pandemic has had devastating outcomes, and although its impact has diminished over time, it continues to be a cause of significant morbidity and mortality, particularly among immunodeficient patients. SUMMARY In this review, we describe mechanisms of immune dysfunction in CLL in relation to COVID-19, provide an overview of the clinical outcomes of the disease in this patient population, and identify risk factors associated with severe morbidity and mortality. Additionally, we acknowledge the influence of the rapidly evolving landscape of new disease variants. The review further delineates the humoral and cellular responses to vaccination and their clinical efficacy in preventing COVID-19 in CLL patients. Moreover, we explore potential approaches to enhance these immune responses. Pre- and post-exposure prophylaxis strategies are discussed, along with description of common agents in the treatment of the disease in both outpatient and inpatient setting. Throughout the review, we emphasize the interplay between novel therapies for CLL and COVID-19 outcomes, prevention, and treatment and describe the impact of COVID-19 on the utilization of these novel agents. This information has the potential to guide clinical decision making in the management CLL patients. KEY MESSAGES CLL patients are at risk for severe COVID-19 infection. Vaccinations and COVID-19 directed therapy have improved outcomes in patients with CLL, yet clinical challenges persist.
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Affiliation(s)
- Reut Harel
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Gilad Itchaki
- Hematology, Meir Medical Center, Kefar Sava, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
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7
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Giladi O, Bagnato G, Gentilini M, Shimony S, Pasvolsky O, Berger T, Itchaki G, Raanani P, Broccoli A, Stefoni VS, Lolli G, Argnani L, Zinzani PL, Gurion R. Poster: ABCL-298 Diffuse Large B-Cell Lymphoma During the Covid-19 Pandemic in Two Tertiary Centers: The Israeli/Italian Study. Clinical Lymphoma Myeloma and Leukemia 2022. [PMCID: PMC9489241 DOI: 10.1016/s2152-2650(22)01037-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Antic D, Milic N, Chatzikonstantinou T, Scarfò L, Otasevic V, Rajovic N, Allsup D, Alonso Cabrero A, Andres M, Baile Gonzales M, Capasso A, Collado R, Cordoba R, Cuéllar-García C, Correa JG, De Paoli L, De Paolis MR, Del Poeta G, Dimou M, Doubek M, Efstathopoulou M, El-Ashwah S, Enrico A, Espinet B, Farina L, Ferrari A, Foglietta M, Lopez-Garcia A, García-Marco JA, García-Serra R, Gentile M, Gimeno E, da Silva MG, Gutwein O, Hakobyan YK, Herishanu Y, Hernández-Rivas JÁ, Herold T, Itchaki G, Jaksic O, Janssens A, Kalashnikova OB, Kalicińska E, Kater AP, Kersting S, Koren-Michowitz M, Labrador J, Lad D, Laurenti L, Fresa A, Levin MD, Mayor Bastida C, Malerba L, Marasca R, Marchetti M, Marquet J, Mihaljevic B, Milosevic I, Mirás F, Morawska M, Motta M, Munir T, Murru R, Nunes R, Olivieri J, Pavlovsky MA, Piskunova I, Popov VM, Quaglia FM, Quaresmini G, Reda G, Rigolin GM, Shrestha A, Šimkovič M, Smirnova S, Špaček M, Sportoletti P, Stanca O, Stavroyianni N, Te Raa D, Tomic K, Tonino S, Trentin L, Van Der Spek E, van Gelder M, Varettoni M, Visentin A, Vitale C, Vukovic V, Wasik-Szczepanek E, Wróbel T, Segundo LYS, Yassin M, Coscia M, Rambaldi A, Montserrat E, Foà R, Cuneo A, Carrier M, Ghia P, Stamatopoulos K. Thrombotic and bleeding complications in patients with chronic lymphocytic leukemia and severe COVID-19: a study of ERIC, the European Research Initiative on CLL. J Hematol Oncol 2022; 15:116. [PMID: 36028857 PMCID: PMC9415249 DOI: 10.1186/s13045-022-01333-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background Patients with chronic lymphocytic leukemia (CLL) may be more susceptible to COVID-19 related poor outcomes, including thrombosis and death, due to the advanced age, the presence of comorbidities, and the disease and treatment-related immune deficiency. The aim of this study was to assess the risk of thrombosis and bleeding in patients with CLL affected by severe COVID-19. Methods This is a retrospective multicenter study conducted by ERIC, the European Research Initiative on CLL, including patients from 79 centers across 22 countries. Data collection was conducted between April and May 2021. The COVID-19 diagnosis was confirmed by the real-time polymerase chain reaction (RT-PCR) assay for SARS-CoV-2 on nasal or pharyngeal swabs. Severe cases of COVID-19 were defined by hospitalization and the need of oxygen or admission into ICU. Development and type of thrombotic events, presence and severity of bleeding complications were reported during treatment for COVID-19. Bleeding events were classified using ISTH definition. STROBE recommendations were used in order to enhance reporting. Results A total of 793 patients from 79 centers were included in the study with 593 being hospitalized (74.8%). Among these, 511 were defined as having severe COVID: 162 were admitted to the ICU while 349 received oxygen supplementation outside the ICU. Most patients (90.5%) were receiving thromboprophylaxis. During COVID-19 treatment, 11.1% developed a thromboembolic event, while 5.0% experienced bleeding. Thrombosis developed in 21.6% of patients who were not receiving thromboprophylaxis, in contrast to 10.6% of patients who were on thromboprophylaxis. Bleeding episodes were more frequent in patients receiving intermediate/therapeutic versus prophylactic doses of low-molecular-weight heparin (LWMH) (8.1% vs. 3.8%, respectively) and in elderly. In multivariate analysis, peak D-dimer level and C-reactive protein to albumin ratio were poor prognostic factors for thrombosis occurrence (OR = 1.022, 95%CI 1.007‒1.038 and OR = 1.025, 95%CI 1.001‒1.051, respectively), while thromboprophylaxis use was protective (OR = 0.199, 95%CI 0.061‒0.645). Age and LMWH intermediate/therapeutic dose administration were prognostic factors in multivariate model for bleeding (OR = 1.062, 95%CI 1.017–1.109 and OR = 2.438, 95%CI 1.023–5.813, respectively). Conclusions Patients with CLL affected by severe COVID-19 are at a high risk of thrombosis if thromboprophylaxis is not used, but also at increased risk of bleeding under the LMWH intermediate/therapeutic dose administration.
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Affiliation(s)
- Darko Antic
- Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia. .,Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Natasa Milic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Thomas Chatzikonstantinou
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece.,Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Lydia Scarfò
- Università Vita-Salute San Raffaele and IRCC Ospedale San Raffaele, Milan, Italy
| | - Vladimir Otasevic
- Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Nina Rajovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - David Allsup
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, Hull, UK
| | | | - Martin Andres
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Rosa Collado
- Department of Hematology, Hospital General Universitario, Valencia, Spain.,Fundación de Investigación del Hospital General Universitario, Valencia, Spain
| | - Raul Cordoba
- Department of Hematology, Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | | | | | - Lorenzo De Paoli
- Division of Internal Medicine, Hematology Unit, ASL Vercelli, Vercelli, Italy
| | | | - Giovanni Del Poeta
- Department of Biomedicine and Prevention Hematology, University Tor Vergata, Rome, Italy
| | - Maria Dimou
- 1st Internal Medicine Department, Propaedeutic, Hematology Clinical Trial Unit, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Doubek
- Department of Internal Medicine - Hematology and Oncology, University Hospital, Brno, Czechia.,Department of Medical Genetics and Genomics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Maria Efstathopoulou
- Department of Haematology Athens Medical Center-Psychikon Branch, Athens, Greece
| | - Shaimaa El-Ashwah
- Clinical Hematology Unit, Oncology Center, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
| | | | - Blanca Espinet
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Lucia Farina
- Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Angela Ferrari
- Hematology Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | | | - Alberto Lopez-Garcia
- Department of Hematology, Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - José A García-Marco
- Hematology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Rocío García-Serra
- Department of Hematology, Hospital General Universitario, Valencia, Spain.,Fundación de Investigación del Hospital General Universitario, Valencia, Spain
| | | | - Eva Gimeno
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Maria Gomes da Silva
- Hematology Department, Portuguese Institute of Oncology Lisbon, Lisbon, Portugal
| | - Odit Gutwein
- Department of Hematology, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Yair Herishanu
- Department of Hematology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Tobias Herold
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Gilad Itchaki
- Division of Hematology, Rabin Medical Center, Petah Tikva, and the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ozren Jaksic
- Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
| | - Ann Janssens
- Department of Hematology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Olga B Kalashnikova
- Federal State Budgetary Educational Institution of Higher Education Academician I.P. Pavlov, First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia
| | - Elżbieta Kalicińska
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Pasteura Street 4, 50-367, Wrocław, Poland
| | - Arnon P Kater
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sabina Kersting
- Department of Hematology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Maya Koren-Michowitz
- Department of Hematology, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jorge Labrador
- Hematology Department, Unit Research, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Deepesh Lad
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Luca Laurenti
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alberto Fresa
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Carlota Mayor Bastida
- Haematology Department, Hospital Universitario de La Princesa, Madrid, Spain.,Spanish Society of Haematology and Hemotherapy (SEHH: Sociedad Española de Hematología y Hemoterapia), Madrid, Spain
| | - Lara Malerba
- Hematology and Stem Cell Transplant Center Marche Nord Hospital, Pesaro, Italy
| | - Roberto Marasca
- Section of Hematology, Department of Medical Sciences, University of Modena and Reggio E., Modena, Italy
| | - Monia Marchetti
- Hematology Unit & TMO Center, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Juan Marquet
- Hematology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Biljana Mihaljevic
- Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Milosevic
- Clinical Centre of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Fatima Mirás
- Hematology Department, Hospital Universitario 12de Octubre, Madrid, Spain
| | - Marta Morawska
- Experimental Hematooncology Department, Medical University of Lublin, Lublin, Poland.,Hematology Department, St. John's Cancer Center, Lublin, Poland
| | - Marina Motta
- S.C. Ematologia ASST Spedali Civili Brescia, Brescia, Italy
| | - Talha Munir
- Consultant Haematologist, St James's Hospital, Leeds, LS9 7TF, UK
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS "G. Brotzu", Cagliari, Italy
| | - Raquel Nunes
- Hematology Department, Portuguese Institute of Oncology Lisbon, Lisbon, Portugal
| | | | | | - Inga Piskunova
- Consultative Hematology Department with a Day Hospital for Intensive High-Dose Chemotherapy, National Research Center for Hematology, Moscow, Russia
| | - Viola Maria Popov
- Hematology Department, Colentina Clinical Hospital, Bucharest, Romania
| | | | | | - Gianluigi Reda
- Hematology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | | | - Amit Shrestha
- Hematology Unit, Nepal Cancer Hospital and Research Center, Lalitpur, Nepal
| | - Martin Šimkovič
- 4th Department of Internal Medicine - Haematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Hradec Kralove, Czech Republic
| | - Svetlana Smirnova
- Consultative Hematology Department with a Day Hospital for Intensive High-Dose Chemotherapy, National Research Center for Hematology, Moscow, Russia
| | - Martin Špaček
- 1st Department of Medicine - Hematology, First Faculty of Medicine, Charles University and General Hospital in Prague, Prague, Czech Republic
| | - Paolo Sportoletti
- Department of Medicine and Surgery, Institute of Hematology and Center for Hemato-Oncological Research, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Oana Stanca
- Hematology Department from Coltea Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Niki Stavroyianni
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Doreen Te Raa
- Department of Hematology, Gelderse Vallei Ede, Ede, The Netherlands
| | - Kristina Tomic
- Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sanne Tonino
- Department of Hematology, Lymmcare, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Ellen Van Der Spek
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Michel van Gelder
- Department Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Candida Vitale
- Division of Hematology, A.O.U. Cittàdella Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Vojin Vukovic
- Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ewa Wasik-Szczepanek
- Department Hematooncology and Bone Marrow Transplantation, Medical University in Lublin, Lublin, Poland
| | - Tomasz Wróbel
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Pasteura Street 4, 50-367, Wrocław, Poland
| | | | - Mohamed Yassin
- Hematology Section, Department of Medical Oncology, National Center for Cancer Care and Research, Doha, Qatar
| | - Marta Coscia
- Division of Hematology, A.O.U. Cittàdella Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | | | | | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, K1H 8L6, Canada
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCC Ospedale San Raffaele, Milan, Italy
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
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9
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Steffanoni S, Calimeri T, Laurenge A, Fox CP, Soussain C, Grommes C, Tisi MC, Boot J, Crosbie N, Visco C, Arcaini L, Chaganti S, Sassone MC, Alencar A, Armiento D, Romano I, Dietrich J, Itchaki G, Bruna R, Fracchiolla NS, Arletti L, Venditti A, Booth S, Musto P, Hoang Xuan K, Batchelor T, Cwynarski K, Ferreri AJM. Impact of severe acute respiratory syndrome coronavirus-2 infection on the outcome of primary central nervous system lymphoma treatment: A study of the International PCNSL Collaborative Group. Br J Haematol 2022; 199:507-519. [PMID: 35945164 PMCID: PMC9538907 DOI: 10.1111/bjh.18396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 01/19/2023]
Abstract
To optimise management of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection identifying high-risk patients and maintaining treatment dose intensity is an important issue in patients with aggressive lymphomas. In the present study, we report on the presentation, management, and outcome of an international series of 91 patients with primary central nervous system lymphoma and SARS-CoV-2 infection. SARS-CoV-2 was diagnosed before/during first-line treatment in 64 patients, during follow-up in 21, and during salvage therapy in six. Among the 64 patients infected before/during first-line chemotherapy, 38 (59%) developed pneumonia and 26 (41%) did not clear the virus. Prolonged exposure to steroids before viral infection and/or treatment with high-dose cytarabine favoured pneumonia development and virus persistence and were associated with poorer survival; 81% of patients who did not clear virus died early from coronavirus disease 2019 (COVID-19). Vaccination was associated with lower pneumonia incidence and in-hospital mortality. Chemotherapy was initiated/resumed in 43 (67%) patients, more commonly among patients who did not develop pneumonia, cleared the virus, or did not receive steroids during infection. Chemotherapy resumption in patients with viral persistence should be indicated cautiously as it was associated with a poorer survival (6-month, 70% and 87%, p = 0.07). None of the 21 patients infected during follow-up died from COVID-19, requiring similar measures as infected subjects in the general population.
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Affiliation(s)
- Sara Steffanoni
- Lymphoma Unit, Department of Onco‐HematologyIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Teresa Calimeri
- Lymphoma Unit, Department of Onco‐HematologyIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Alice Laurenge
- Service de Neurologie 2‐MazarinHôpitaux Universitaires La Pitié Salpêtrière, APHP, Sorbonne UniversitéParisFrance
| | | | - Carole Soussain
- Hôpital René Huguenin‐Institut Curie, Saint‐CloudParisFrance
| | - Christian Grommes
- Department of NeurologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | | | - Jesca Boot
- BarkingHavering and Redbridge University Hospitals NHS TrustLondonUK
| | | | - Carlo Visco
- Department of Medicine, Section of HematologyUniversity of VeronaVeronaItaly
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo and Department of Molecular MedicineUniversity of PaviaPaviaItaly
| | | | - Marianna C. Sassone
- Lymphoma Unit, Department of Onco‐HematologyIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Alvaro Alencar
- Department of Hematology and OncologyUniversity of Miami/Sylvester Comprehensive Cancer CenterMiamiFloridaUSA
| | | | | | - Jorg Dietrich
- Division of Neuro‐OncologyMassachusetts General Hospital Cancer CenterBostonMassachusettsUSA
| | - Gilad Itchaki
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical CenterPetah‐TikvaIsrael
| | | | | | - Laura Arletti
- Division of HematologyAzienda USL‐IRCCS of Reggio EmiliaReggio EmiliaItaly
| | - Adriano Venditti
- Department of Biomedicine and PreventionUniversity Tor VergataRomeItaly
| | - Stephen Booth
- NIHR Oxford Biomedical Research CentreChurchill HospitalOxfordUK
| | - Pellegrino Musto
- Department of Emergency and Organ Transplantation‘Aldo Moro’ University School of Medicine, and Unit of Hematology and Stem Cell Transplantation, AOUC PoliclinicoBariItaly
| | - Khê Hoang Xuan
- Service de Neurologie 2‐MazarinHôpitaux Universitaires La Pitié Salpêtrière, APHP, Sorbonne UniversitéParisFrance
| | - Tracy T. Batchelor
- Department of NeurologyBrigham and Women’s HospitalBostonMassachusettsUSA
| | - Kate Cwynarski
- Department of HaematologyUniversity College London HospitalLondonUK
| | - Andrés J. M. Ferreri
- Lymphoma Unit, Department of Onco‐HematologyIRCCS San Raffaele Scientific InstituteMilanItaly
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10
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Avivi I, Perry C, Segman Y, Amit O, Bar-On Y, Katz OB, Gold R, Ribakovsky E, Avigdor A, Vainstein V, Goldschmidt N, Ringelstein-Harlev S, Horowitz NA, Gutwein O, Gurion R, Itchaki G, Abadi U, Nemets A, Sofer O, Vezker M, Tadmor T, Dally N, Filanovsky K, Leiba M, Sarid N, Benyamini N, Luttwak E, Herishanu Y, Ram R. Polatuzumab-based regimen or CAR T cell for patients with refractory/relapsed DLBCL-a matched cohort analysis. Ann Hematol 2022; 101:755-762. [PMID: 35083525 DOI: 10.1007/s00277-021-04749-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022]
Abstract
Polatuzumab (Pola)-based regimens and chimeric antigen receptor T (CAR T) cells provide superior outcome compared to conventional chemoimmunotherapy in patients with relapsed/refractory diffuse large B cell lymphoma (R/R DLBCL). Choosing between these strategies remains controversial. The efficacy of CAR T versus Pola-rituximab(R) /Pola-bendamustine(B)-R in R/R DLBCL patients after failing ≥2 lines of treatment was compared in a retrospective, 'real-world' study. Propensity score matching, for age, lymphoma category (de-novo/transformed), number of prior lines, Eastern Cooperative Oncology Group performance status and lactate dehydrogenase level, was applied to control for differences in patients' characteristics. Response rate, progression-free survival (PFS) and overall survival (OS) were analyzed. A total of 82 patients, treated with CAR T (n=41) or Pola-based regimens (n=41), were included. No treatment-related deaths occurred with CAR T vs. 3 (7.3%) with Pola. The overall and complete response rates were 83% and 58% with CAR T vs. 66% and 44% with Pola-based-regimens (p=0.077 and p=0.18, respectively). At a median follow-up of 9 months (range 1-19.2) and 16 months (range 0.7-25.3) for the CAR T and Pola arm respectively, the median PFS has not been reached for CAR T vs. 5.6 months for Pola (95% CI 3.6-7.6, p=0.014). Median OS has not been reached for CAR T vs. 10.8 months (95% CI 2.2-19.4) for Pola (p=0.026). To conclude, in a real-world setting, treatment with CAR T achieved superior PFS and OS compared to Pola-based regimens in patients with R/R DLBCL.
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Affiliation(s)
- Irit Avivi
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chava Perry
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yafit Segman
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Odelia Amit
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaeli Bar-On
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofrat Beyer Katz
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Gold
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elena Ribakovsky
- Hematology Division, Chaim Sheba Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Abraham Avigdor
- Hematology Division, Chaim Sheba Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Vladimir Vainstein
- Hematology Division, Hadassah Medical Center and the Hebrew Faculty of Medicine, Jerusalem University, Jerusalem, Israel
| | - Neta Goldschmidt
- Hematology Division, Hadassah Medical Center and the Hebrew Faculty of Medicine, Jerusalem University, Jerusalem, Israel
| | | | | | - Odit Gutwein
- Department of Hematology, Assaf Harofeh Medical Center, Tzrifin, Israel
| | - Ronit Gurion
- Institute of Hematology, Rabin Medical Center, Petch Tikva, Israel
| | - Gilad Itchaki
- Institute of Hematology, Rabin Medical Center, Petch Tikva, Israel
| | - Uri Abadi
- Department of Hematology, Meir Medical Center, Kfar Saba, Israel
| | - Anatoly Nemets
- Department of Hematology, Barzilai Medical Center, Ashkelon, Israel
| | - Orit Sofer
- Institute of Hematology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Miri Vezker
- Department of Hematology, Soroka University Medical Center, Negev, Beer Sheva, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Najib Dally
- Hematology Unit, Ziv Medical Center, Zefat, Israel
| | | | - Merav Leiba
- Hematology Institute, Assuta Medical Center, Ashdod, Israel
| | - Nadav Sarid
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Benyamini
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Luttwak
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Herishanu
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Ram
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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11
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Nardi-Agmon I, Hamdan A, Eisen A, Orvin K, Porter A, Vaknin-Assa H, Itchaki G, Molad Y, Kornowski R, Itzhaki Ben Zadok O. Diffused coronary involvement in Takayasu arteritis with concomitant malignancy. Clin Rheumatol 2021; 41:921-928. [PMID: 34839417 DOI: 10.1007/s10067-021-06000-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/10/2021] [Accepted: 11/21/2021] [Indexed: 01/17/2023]
Abstract
Large vessel vasculitis (LVV) is composed of conditions in which inflammation of blood vessel walls affects mainly large arteries, such as the aorta and its main branches, and in some cases the coronary arteries. Coronary artery involvement in systemic vasculitis is associated with significant morbidity and mortality. We present a case of a young patient diagnosed with extensive coronary disease diagnosed as Takayasu arteritis, when whom a concomitant diagnosis of Hodgkin's lymphoma was made. The literature review revealed ten cases of malignancies associated with Takayasu arteritis. We discuss the complexity of the management of concurrent hematological malignancy with TAK and extensive coronary arteritis. This complicated and cross-disciplinary case also represents the pivotal importance of multi-disciplinary team decision in order to achieve the best clinical outcome of both disorders.
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Affiliation(s)
- Inbar Nardi-Agmon
- Cardiology Division, Rabin Medical Center - Beilinson Hospital, 39 Zabotinski st., 4941492, Petach Tikva, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Ashraf Hamdan
- Cardiology Division, Rabin Medical Center - Beilinson Hospital, 39 Zabotinski st., 4941492, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alon Eisen
- Cardiology Division, Rabin Medical Center - Beilinson Hospital, 39 Zabotinski st., 4941492, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Katia Orvin
- Cardiology Division, Rabin Medical Center - Beilinson Hospital, 39 Zabotinski st., 4941492, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avital Porter
- Cardiology Division, Rabin Medical Center - Beilinson Hospital, 39 Zabotinski st., 4941492, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hana Vaknin-Assa
- Cardiology Division, Rabin Medical Center - Beilinson Hospital, 39 Zabotinski st., 4941492, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad Itchaki
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Hematology Division, Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel
| | - Yair Molad
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Rheumatology Division, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel
| | - Ran Kornowski
- Cardiology Division, Rabin Medical Center - Beilinson Hospital, 39 Zabotinski st., 4941492, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Osnat Itzhaki Ben Zadok
- Cardiology Division, Rabin Medical Center - Beilinson Hospital, 39 Zabotinski st., 4941492, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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12
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Durot E, Kanagaratnam L, Zanwar S, Kastritis E, D'Sa S, Garcia-Sanz R, Tomowiak C, Hivert B, Toussaint E, Protin C, Abeykoon JP, Guerrero-Garcia T, Itchaki G, Vos JM, Michallet AS, Godet S, Dupuis J, Leprêtre S, Bomsztyk J, Morel P, Leblond V, Treon SP, Dimopoulos MA, Kapoor P, Delmer A, Castillo JJ. A prognostic index predicting survival in transformed Waldenström macroglobulinemia. Haematologica 2021; 106:2940-2946. [PMID: 33179472 PMCID: PMC8561274 DOI: 10.3324/haematol.2020.262899] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
Histological transformation into diffuse large B-cell lymphoma is a rare complication in patients with Waldenström macroglobulinemia (WM) and is usually associated with a poor prognosis. The objective of this study was to develop and validate a prognostic index for survival of patients with transformed WM. Through this multicenter, international collaborative effort, we developed a scoring system based on data from 133 patients with transformed WM who were evaluated between 1995 and 2016 (training cohort). Univariate and multivariate analyses were used to propose a prognostic index with 2-year survival after transformation as an endpoint. For external validation, a dataset of 67 patients was used to evaluate the performance of the model (validation cohort). By multivariate analysis, three adverse covariates were identified as independent predictors of 2-year survival after transformation: elevated serum lactate dehydrogenase (2 points), platelet count <100x109/L (1 point) and any previous treatment for WM (1 point). Three risk groups were defined: low-risk (0-1 point, 24% of patients), intermediate-risk (2-3 points, 59%; hazard ratio = 3.4) and high-risk (4 points, 17%; hazard ratio = 7.5). Two-year survival rates were 81%, 47%, and 21%, respectively (P<0.0001). This model appeared to be a better discriminant than either the International Prognostic Index or the revised International Prognostic Index. We validated this model in an independent cohort. This easy-to-compute scoring index is a robust tool that may allow identification of groups of transformed WM patients with different outcomes and could be used for improving the development of risk-adapted treatment strategies.
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Affiliation(s)
- Eric Durot
- Department of Hematology, University Hospital of Reims and UFR Médecine, Reims.
| | | | - Saurabh Zanwar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens
| | - Shirley D'Sa
- University College London Hospitals (UCLH) NHS Foundation Trust, London
| | - Ramon Garcia-Sanz
- Department of Hematology, University Hospital of Salamanca, CIBERONC and Research Biomedical Institute of Salamanca (IBSAL), Salamanca
| | - Cécile Tomowiak
- Department of Hematology and CIC U1402, University Hospital of Poitiers, Poitiers
| | | | - Elise Toussaint
- Department of Hematology, University Hospital of Strasbourg, Strasbourg
| | | | - Jithma P Abeykoon
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Gilad Itchaki
- Institute of Hematology, Rabin Medical Center, Sackler Medical School, Tel-Aviv University, Israel
| | - Josephine M Vos
- Amsterdam University Medical Center (UMC) and LYMMCARE, Amsterdam
| | | | - Sophie Godet
- Department of Hematology, University Hospital of Reims and UFR Médecine, Reims
| | - Jehan Dupuis
- Lymphoid Malignancies Unit, Henri Mondor Hospital, Créteil
| | - Stéphane Leprêtre
- Inserm U1245 and Department of Hematology, Henri Becquerel Center and Normandie University UNIROUEN, Rouen
| | - Joshua Bomsztyk
- University College London Hospitals (UCLH) NHS Foundation Trust, London
| | - Pierre Morel
- Department of Hematology, University Hospital of Amiens, Amiens
| | - Véronique Leblond
- Department of Hematology, Pitié-Salpêtrière Hospital and Sorbonne University, UPMC Paris, GRECHY
| | - Steven P Treon
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens
| | - Prashant Kapoor
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Alain Delmer
- Department of Hematology, University Hospital of Reims and UFR Médecine, Reims
| | - Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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13
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Levy I, Lavi A, Zimran E, Grisariu S, Aumann S, Itchaki G, Berger T, Raanani P, Harel R, Aviv A, Lavi N, Zuckerman T, Shvidel L, Jarchowsky O, Ellis M, Herzog Tzarfati K, Koren-Michowitz M, Sherf Y, Levi I, Sofer O, Shpilberg O, Dally N, Suriu C, Braester A, Ben Barouch S, Leiba M, Goldstein D, Sarid N, Yeganeh S, Halloun J, Mittelman M, Tadmor T. COVID-19 among patients with hematological malignancies: a national Israeli retrospective analysis with special emphasis on treatment and outcome. Leuk Lymphoma 2021; 62:3384-3393. [PMID: 34405767 DOI: 10.1080/10428194.2021.1966782] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This national Israeli multicenter retrospective study aimed to characterize the clinical course of COVID-19 infection among patients with hematological malignancies, with special emphasis on treatment efficacy and outcome. Clinical and laboratory data from haemato-oncological patients diagnosed with COVID-19 from 16 medical centers were centrally reported. Multivariate regression analyses were used to determine variables associated with severe disease, hospitalization, and mortality. In total, 313 patients were included: 103 (35.7%) developed severe/critical respiratory infection, 178 (61.4%) were hospitalized, and 60 (20.0%) died. Age > 70 years was associated with severe/critical disease (p = 0.036) and mortality (p = 0.023), hypertension with severe/critical disease (p = 0.046) and hospitalization (p = 0.001), active haemato-oncological treatment with hospitalization (p = 0.009), and remdesivir treatment was associated with decreased mortality (p = 0.021). Convalescent plasma, enoxaparin, and corticosteroids resulted in no clinical benefit. In conclusion, COVID-19 infection seems particularly severe in patients with hematological malignancies, and of all examined therapies, remdesivir appears to be the most effective.
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Affiliation(s)
- Ilana Levy
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel.,Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Avital Lavi
- Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Eran Zimran
- Hematology Department, Hadassah Hospital, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Grisariu
- Hematology Department, Hadassah Hospital, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shlomzion Aumann
- Hematology Department, Hadassah Hospital, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gilad Itchaki
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Berger
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reut Harel
- Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.,Hematology Unit, HaEmek Medical Center, Afula, Israel
| | - Ariel Aviv
- Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.,Hematology Unit, HaEmek Medical Center, Afula, Israel
| | - Noa Lavi
- Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.,Hematology Institute, Rambam Medical Center, Haifa, Israel
| | - Tsila Zuckerman
- Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.,Hematology Institute, Rambam Medical Center, Haifa, Israel
| | - Lev Shvidel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Hematology Unit, Kaplan Medical Center, Rehovot, Israel
| | - Osnat Jarchowsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Hematology Department, Meir Medical Center, Kfar Saba, Israel
| | - Martin Ellis
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Hematology Department, Meir Medical Center, Kfar Saba, Israel
| | - Katrin Herzog Tzarfati
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Hematology Department, Shamir Medical Center, Zerifin, Israel
| | - Maya Koren-Michowitz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Hematology Department, Shamir Medical Center, Zerifin, Israel
| | - Yehonatan Sherf
- Hematology Department, Soroka Medical Center, Beer-Sheva, Israel.,Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itai Levi
- Hematology Department, Soroka Medical Center, Beer-Sheva, Israel.,Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Orit Sofer
- Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.,Hematology Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ofer Shpilberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Hematology Unit, Assuta Ramat Hahayal Medical Center, Tel Aviv, Israel
| | - Nagib Dally
- Hematology Unit, Ziv Medical Center, Safed, Israel.,Faculty of Medicine, Bar Ilan Unifersity, Safed, Israel
| | - Celia Suriu
- Faculty of Medicine, Bar Ilan Unifersity, Safed, Israel.,Hematology Institute, Western Galilee Hospital, Nahariya, Israel
| | - Andrei Braester
- Faculty of Medicine, Bar Ilan Unifersity, Safed, Israel.,Hematology Institute, Western Galilee Hospital, Nahariya, Israel
| | - Sharon Ben Barouch
- Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Hematology Unit, Assuta Ashdod Medical Center, Ashdod, Israel
| | - Merav Leiba
- Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Hematology Unit, Assuta Ashdod Medical Center, Ashdod, Israel
| | - Daniela Goldstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Hematology Unit, Wolfson Medical Center, Holon, Israel
| | - Nadav Sarid
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Hematology Unit, Wolfson Medical Center, Holon, Israel
| | - Shay Yeganeh
- Faculty of Medicine, Bar Ilan Unifersity, Safed, Israel.,Hematology Unit, Baruch Padeh Medical Center, Poriyah, Israel
| | - Jabour Halloun
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Moshe Mittelman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Internal Medicine A Department, Sourasky Medical Center, Tel Aviv, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel.,Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
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14
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Gurion R, Rozovski U, Itchaki G, Gafter-Gvili A, Leibovitch C, Raanani P, Ben-Zvi H, Szwarcwort M, Taylor-Abigadol M, Dann EJ, Horesh N, Inbar T, Tzoran I, Lavi N, Fineman R, Ringelstein-Harlev S, Horowitz NA. Humoral serologic response to the BNT162b2 vaccine is abrogated in lymphoma patients within the first 12 months following treatment with anti-CD2O antibodies. Haematologica 2021; 107:715-720. [PMID: 34320790 PMCID: PMC8883526 DOI: 10.3324/haematol.2021.279216] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Indexed: 11/09/2022] Open
Abstract
Patients with lymphoma, especially those treated with anti-CD20 monoclonal antibodies (MoAb), suffer high COVID-19-associated morbidity and mortality. The goal of this study was to assess the ability of lymphoma patients to generate a sufficient humoral response after two injections of BNT162b2 Pfizer vaccine and to identify factors impacting the response. Antibody titers were measured with the SARS-CoV-2 IgG II Quant (Abbott©) assay in blood samples drawn from lymphoma patients 4±2 weeks after the 2nd vaccine dose. The cutoff for a positive response was set at 50AU/ml. Positive serological responses were observed in 51% of the 162 patients enrolled in this cross-sectional study. In a multivariate analysis, an interval of.
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Affiliation(s)
- Ronit Gurion
- Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler School of Medicine, Aviv University, Aviv, Israel
| | - Uri Rozovski
- Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler School of Medicine, Aviv University, Aviv, Israel
| | - Gilad Itchaki
- Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler School of Medicine, Aviv University, Aviv, Israel
| | - Anat Gafter-Gvili
- Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler School of Medicine, Aviv University, Aviv, Israel; Medicine A, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Chiya Leibovitch
- Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler School of Medicine, Aviv University, Aviv, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler School of Medicine, Aviv University, Aviv, Israel
| | - Haim Ben-Zvi
- Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | | | | | - Eldad J Dann
- Department of Hematology, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Nurit Horesh
- Department of Hematology, Rambam Health Care Campus, Haifa, Israel
| | - Tsofia Inbar
- Department of Hematology, Rambam Health Care Campus, Haifa, Israel
| | - Inna Tzoran
- Department of Hematology, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Noa Lavi
- Department of Hematology, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Riva Fineman
- Department of Hematology, Rambam Health Care Campus, Haifa, Israel
| | - Shimrit Ringelstein-Harlev
- Department of Hematology, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Netanel A Horowitz
- Department of Hematology, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
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15
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Benjamini O, Rokach L, Itchaki G, Braester A, Shvidel L, Goldschmidt N, Shapira S, Dally N, Avigdor A, Rahav G, Lustig Y, Ben David SS, Fineman R, Paz A, Bairey O, Polliack A, Levy I, Tadmor T. Safety and efficacy of BNT162b mRNA Covid19 Vaccine in patients with chronic lymphocytic leukemia. Haematologica 2021; 107:625-634. [PMID: 34320789 PMCID: PMC8883569 DOI: 10.3324/haematol.2021.279196] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [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: 05/11/2021] [Indexed: 11/09/2022] Open
Abstract
Patients with chronic lymphocytic leukemia (CLL) have a suboptimal humoral response to vaccination. Recently, BNT162b2, an mRNA COVID-19 vaccine with a high efficacy of 95% in immunocompetent individuals, was introduced. We investigated the safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine in patients with CLL from nine medical centers in Israel, Overall 400 patients were included, of whom 373 were found to be eligible for the analysis of antibody response. The vaccine appeared to be safe and only grade 1-2 adverse events were seen in 50% of the patients. Following the second dose, an antibody response was detected in 43% of the cohort. Among these CLL patients, 61% of the treatment-naïve patients responded to the vaccine, while responses developed in only 18% of those with ongoing disease, 37% of those previously treated with a BTK inhibitor and 5% of those recently given an anti-CD20 antibody. Among patients treated with BCL2 as monotherapy or in combination with anti-CD20, 62% and 14%, respectively, developed an immune response. There was a high concordance between neutralizing antibodies and positive serological response to spike protein. Based on our findings we developed a simple seven-factor score including timing of any treatment with anti-CD20, age, treatment status, and IgG, IgA, IgM and hemoglobin levels. The sum of all the above parameters can serve as a possible estimate to predict whether a given CLL patient will develop sufficient antibodies. In conclusion, the BNT162b2 mRNA COVID-19 vaccine was found to be safe in patients with CLL, but its efficacy is limited, particularly in treated patients.
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Affiliation(s)
- Ohad Benjamini
- Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Lior Rokach
- Department of Software and Information Systems Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gilad Itchaki
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Andrei Braester
- Department of Hematology Galilee Medical Center, Nahariya, Israel
| | - Lev Shvidel
- Hematology Institute, Kaplan Medical Center, Rehovot, Israel
| | | | | | - Najib Dally
- Division of Hematology, Ziv Medical Center, Safed, Israel
| | - Abraham Avigdor
- Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Galia Rahav
- The Infectious Disease Unit, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Yaniv Lustig
- Central Virology Laboratory, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Riva Fineman
- Department of Hematology and BMT, Rambam Health Care Campus, Haifa, Israel
| | - Alona Paz
- Infectious Disease Unit, Bnai Zion Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Osnat Bairey
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | | | - Ilana Levy
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Tamar Tadmor
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Hematology Unit, Bnai Zion Medical Center, Haifa, Israel.
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16
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Shapira S, Kazanov D, Mdah F, Yaakobi H, Herishanu Y, Perry C, Avivi I, Itchaki G, Shacham-Abulafia A, Raanani P, Hay-Levy M, Aiger G, Mashiah J, Lev-Ari S, Arber N. Feasibly of CD24/CD11b as a Screening Test for Hematological Malignancies. J Pers Med 2021; 11:724. [PMID: 34442367 PMCID: PMC8399145 DOI: 10.3390/jpm11080724] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/17/2022] Open
Abstract
An estimated 1.24 million blood cancer cases occur annually worldwide, accounting for approximately 6% of all cancer cases. Currently, there are no standardized hematology cancer screening tests that are recommended for the general population. CD24 is a mucin-like cell surface molecule and P-selectin ligand, which plays a significant role in the maturation of B-lymphocytes and was found to be overexpressed in a number of hematological malignancies. Our primary aim was to assess the sensitivity and specificity of the CD24/CD11b-based blood test for the detection of hematological malignancies. Our cohort included 488 subjects with positive hematological cancer diagnosis (n = 122) and healthy subjects (n = 366). CD24/CD11b expression in peripheral blood leukocytes (PBLs) obtained from blood samples of participants was analyzed by flow cytometry. Our results demonstrated that the average levels of CD24/CD11b in healthy patients (21.7 ± 9.0) were statistically significantly lower compared to levels of CD24/CD11b in cancer patients (29.5 ± 18.7, p < 0.001). The highest levels of CD24/CD11b were found in multiple myeloma (39.1 ± 23.6), followed by chronic myeloid leukemia (33.0 ± 13.7) and non-Hodgkin lymphoma (32.3 ± 13.3). The test had an overall sensitivity for hematologic cancers of 78.5% (95% CI, 70.7-86.3%) and specificity of 80.2% (95% CI, 76.1-84.3%). In conclusion, our findings indicate the feasibility of a CD24/CD11b-based blood test as a screening test of hematological malignancies.
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Affiliation(s)
- Shiran Shapira
- Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv 6423906, Israel; (S.S.); (D.K.); (F.M.); (H.Y.); (M.H.-L.); (G.A.); (S.L.-A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6423906, Israel; (Y.H.); (C.P.); (I.A.); (G.I.); (A.S.-A.); (P.R.)
| | - Dina Kazanov
- Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv 6423906, Israel; (S.S.); (D.K.); (F.M.); (H.Y.); (M.H.-L.); (G.A.); (S.L.-A.)
| | - Fatin Mdah
- Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv 6423906, Israel; (S.S.); (D.K.); (F.M.); (H.Y.); (M.H.-L.); (G.A.); (S.L.-A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6423906, Israel; (Y.H.); (C.P.); (I.A.); (G.I.); (A.S.-A.); (P.R.)
| | - Hadas Yaakobi
- Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv 6423906, Israel; (S.S.); (D.K.); (F.M.); (H.Y.); (M.H.-L.); (G.A.); (S.L.-A.)
| | - Yair Herishanu
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6423906, Israel; (Y.H.); (C.P.); (I.A.); (G.I.); (A.S.-A.); (P.R.)
- Tel Aviv Medical Center, Department of Hematology, Tel Aviv 6423906, Israel
| | - Chava Perry
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6423906, Israel; (Y.H.); (C.P.); (I.A.); (G.I.); (A.S.-A.); (P.R.)
- Tel Aviv Medical Center, Department of Hematology, Tel Aviv 6423906, Israel
| | - Irit Avivi
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6423906, Israel; (Y.H.); (C.P.); (I.A.); (G.I.); (A.S.-A.); (P.R.)
- Tel Aviv Medical Center, Department of Hematology, Tel Aviv 6423906, Israel
| | - Gilad Itchaki
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6423906, Israel; (Y.H.); (C.P.); (I.A.); (G.I.); (A.S.-A.); (P.R.)
- Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Petah Tikva 49100, Israel
| | - Adi Shacham-Abulafia
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6423906, Israel; (Y.H.); (C.P.); (I.A.); (G.I.); (A.S.-A.); (P.R.)
- Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Petah Tikva 49100, Israel
| | - Pia Raanani
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6423906, Israel; (Y.H.); (C.P.); (I.A.); (G.I.); (A.S.-A.); (P.R.)
- Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Petah Tikva 49100, Israel
| | - Mori Hay-Levy
- Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv 6423906, Israel; (S.S.); (D.K.); (F.M.); (H.Y.); (M.H.-L.); (G.A.); (S.L.-A.)
| | - Gal Aiger
- Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv 6423906, Israel; (S.S.); (D.K.); (F.M.); (H.Y.); (M.H.-L.); (G.A.); (S.L.-A.)
| | - Jacob Mashiah
- Tel Aviv Medical Center, The Pediatric Dermatology Unit, Tel Aviv 6423906, Israel;
| | - Shahar Lev-Ari
- Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv 6423906, Israel; (S.S.); (D.K.); (F.M.); (H.Y.); (M.H.-L.); (G.A.); (S.L.-A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6423906, Israel; (Y.H.); (C.P.); (I.A.); (G.I.); (A.S.-A.); (P.R.)
| | - Nadir Arber
- Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv 6423906, Israel; (S.S.); (D.K.); (F.M.); (H.Y.); (M.H.-L.); (G.A.); (S.L.-A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6423906, Israel; (Y.H.); (C.P.); (I.A.); (G.I.); (A.S.-A.); (P.R.)
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17
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Shimony S, Bar-Sever E, Berger T, Itchaki G, Gurion R, Yeshurun M, Lahav M, Raanani P, Wolach O. Late onset neutropenia after rituximab and obinutuzumab treatment - characteristics of a class-effect toxicity. Leuk Lymphoma 2021; 62:2921-2927. [PMID: 34284690 DOI: 10.1080/10428194.2021.1948037] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Late onset neutropenia (LON) after rituximab is a previously described complication. We aimed to assess and characterize LON after obinutuzumab, a novel anti-CD20 antibody, in the real-world setting and compare it to LON after rituximab therapy. We retrospectively analyzed 330 consecutive patients with lymphoproliferative neoplasms (rituximab-treated n = 283; obinutuzumab-treated n = 47). LON occurred in 23% patients with similar incidence in rituximab (n = 66, 23%) or obinutuzumab (n = 10, 21%) groups (p = 0.853). Patients treated for CLL and post-transplantation lymphoproliferative disease (PTLD) were at higher risk to develop LON (multivariate analysis: HR for CLL - 6.62 CI 95% 1.33-32.92; HR for PTLD 15.82 CI 95% 2.04-122.4). Febrile neutropenia was uncommon during LON and occurred in 15 patients (4.5%; rituximab (n = 14) and obinutuzumab (n = 1).These data suggest that LON after obinutuzumab treatment is as common as with rituximab. The similarities in LON after rituximab and obinutuzumab argue for a possible class effect for anti-CD20 monoclonal antibodies.
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Affiliation(s)
- Shai Shimony
- Rabin Medical Center, Institute of Hematology, Davidoff Cancer Centre, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Einat Bar-Sever
- Rabin Medical Center, Institute of Hematology, Davidoff Cancer Centre, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Tamar Berger
- Rabin Medical Center, Institute of Hematology, Davidoff Cancer Centre, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Gilad Itchaki
- Rabin Medical Center, Institute of Hematology, Davidoff Cancer Centre, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Ronit Gurion
- Rabin Medical Center, Institute of Hematology, Davidoff Cancer Centre, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Moshe Yeshurun
- Rabin Medical Center, Institute of Hematology, Davidoff Cancer Centre, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Meir Lahav
- Rabin Medical Center, Institute of Hematology, Davidoff Cancer Centre, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Pia Raanani
- Rabin Medical Center, Institute of Hematology, Davidoff Cancer Centre, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Ofir Wolach
- Rabin Medical Center, Institute of Hematology, Davidoff Cancer Centre, Beilinson Hospital, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
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18
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Ferreri AJM, Steffanoni S, Calimeri T, Laurenge A, Fox CP, Soussain C, Grommes C, Sassone MC, Touat M, Boot J, Crosbie N, Chaganti S, Dietrich J, Alencar A, Itchaki G, Hoang Xuan K, Batchelor T, Cwynarski K. SARS‐COV‐2 INFECTION IN 50 PATIENTS WITH PRIMARY CNS LYMPHOMA: PRESENTATION, EFFECTS ON TUMOR TREATMENT AND OUTCOME IN A SERIES OF THE INTERNATIONAL PCNSL COLLABORATIVE GROUP. Hematol Oncol 2021. [DOI: 10.1002/hon.68_2880] [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: 11/11/2022]
Affiliation(s)
| | - S. Steffanoni
- IRCCS San Raffaele Lymphoma Unit Hematology Milan Italy
| | - T. Calimeri
- IRCCS San Raffaele Lymphoma Unit Hematology Milan Italy
| | - A. Laurenge
- Hôpitaux Universitaires La Pitié Salpêtrière Service de Neurologie 2‐Mazarin Paris France
| | - C. P. Fox
- University Hospitals NHS Trust hematology Nottingham UK
| | - C. Soussain
- Hôpital René Huguenin‐Institut Curie Saint‐Cloud Hematology Paris France
| | - C. Grommes
- Memorial Sloan Kettering Cancer Center Department of Neurology New York USA
| | - M. C. Sassone
- IRCCS San Raffaele Lymphoma Unit Hematology Milan Italy
| | - M. Touat
- Hôpitaux Universitaires La Pitié Salpêtrière Service de Neurologie 2‐Mazarin Paris France
| | - J. Boot
- Barking Havering and Redbridge University Hospitals NHS Trust Hematology London UK
| | - N. Crosbie
- Derriford Hospital Hematology Plymouth UK
| | - S. Chaganti
- Queen Elizabeth Hospital Haematology Birmingham UK
| | - J. Dietrich
- Massachusetts General Hospital Cancer Center Neuro‐Oncology Boston USA
| | - A. Alencar
- University of Miami/Sylvester Comprehensive Cancer Center Department of Hematology and Oncology Miami USA
| | - G. Itchaki
- Davidoff Cancer Center Rabin Medical Center Hematology Petah‐Tikva Israel
| | - K. Hoang Xuan
- Hôpitaux Universitaires La Pitié Salpêtrière Service de Neurologie 2‐Mazarin Paris France
| | - T. Batchelor
- Brigham and Women’s Hospital Neurology, Boston, Massachusetts USA 13 University College London Hospital Haematology London UK
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19
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Luttwak E, Hagin D, Perry C, Wolach O, Itchaki G, Amit O, Bar-On Y, Freund T, Kay S, Eshel R, Avivi I, Ram R. Anti-CD19 CAR-T therapy for EBV-negative posttransplantation lymphoproliferative disease-a single center case series. Bone Marrow Transplant 2020; 56:1031-1037. [PMID: 33230187 DOI: 10.1038/s41409-020-01145-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/19/2020] [Accepted: 11/09/2020] [Indexed: 11/09/2022]
Abstract
Posttransplantation lymphoproliferative disease (PTLD) is a potentially fatal disorder arising after solid organ or hematopoietic cell transplantation. Survival rates of PTLD with diffuse large B-cell lymphoma (DLBCL) phenotype have improved due to the introduction of rituximab, however, reports on curative management of refractory PTLD are scarce. Here, we describe successful management of three patients with refractory EBV-negative PTLD with chimeric antigen receptor T-cell (CAR-T) therapy. All patients continued calcineurin inhibitors throughout the whole course of treatment. T-cell immunophenotyping was performed on both the apheresed cells and CAR-T product to investigate the T-cell compartment subpopulations. All three patients responded to a single infusion of tisagenlecleucel and two of them achieved CR. Toxicity profile was similar to other patients with non-PTLD DLBCL treated with CAR-T. No transplanted graft dysfunction was observed during the course of therapy. To our knowledge, this is the first report demonstrating that patients with EBV-negative refractory PTLD may benefit from CAR-T therapy, similarly to other patients with relapse/refractory DLBCL. A larger cohort of patients is needed to further establish proof-of-concept.
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Affiliation(s)
- Efrat Luttwak
- BMT Unit, Tel Aviv (Sourasky) Medical Center, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - David Hagin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Immunology Unit, Tel Aviv (Sourasky) Medical Center, Tel Aviv, Israel
| | - Chava Perry
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology, Tel Aviv (Sourasky) Medical Center, Tel Aviv, Israel
| | - Ofir Wolach
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Gilad Itchaki
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Odelia Amit
- BMT Unit, Tel Aviv (Sourasky) Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Bar-On
- BMT Unit, Tel Aviv (Sourasky) Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Freund
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Immunology Unit, Tel Aviv (Sourasky) Medical Center, Tel Aviv, Israel
| | - Sigi Kay
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology, Tel Aviv (Sourasky) Medical Center, Tel Aviv, Israel
| | - Rinat Eshel
- BMT Unit, Tel Aviv (Sourasky) Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Avivi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology, Tel Aviv (Sourasky) Medical Center, Tel Aviv, Israel
| | - Ron Ram
- BMT Unit, Tel Aviv (Sourasky) Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Segman Y, Ribakovsky E, Avigdor A, Goldhecht Y, Vainstein V, Goldschmidt N, Harlev S, Horwitz N, Gutwein O, Gurion R, Itchaki G, Abadi U, Nemets A, Sofer O, Zektser M, Tadmor T, Dally N, Filanovsky K, Leiba M, Sarid N, Benyamini N, Herishanu Y, Ram R, Perry C, Avivi I. Outcome of relapsed/refractory diffuse large B-cell lymphoma patients treated with polatuzumab vedotin-based therapy: real-life experience. Leuk Lymphoma 2020; 62:118-124. [PMID: 32981410 DOI: 10.1080/10428194.2020.1824069] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The efficacy of polatuzumab vedotin in relapsed/refractory diffuse large B-cell lymphoma outside clinical study are undetermined. This retrospective study examined the efficacy and safety of polatuzumab vedotin administered in real life settings. Forty-seven patients, 31 with de-novo DLBCL and 16 with transformed lymphoma, treated with polatuzumab-based regimen in 14 Israeli centers between June 2018 and November 2019, were included. Median age was 66.1 years (60.4-78.8) and median number of prior lines was 3 (2-7). The overall response rate was 61% (n = 29), including 40% complete responses (n = 19) and 21% (n = 10) partial responses. The median overall survival and progression-free survival were 8.3 months and 5.6 months, respectively. An ECOG PS ≥2 predicted a decreased overall survival (p = 0.045). Primary refractory vs relapsed disease (p = 0.005) and transformed vs de-novo DLBCL (p = 0.039) were associated with shorter PFS (p = 0.027). Our data show that polatuzumab-based regimen is an effective and tolerable treatment in relapsed/refractory DLBCL.
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Affiliation(s)
- Yafit Segman
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elena Ribakovsky
- Hematology Division, Chaim Sheba Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Abraham Avigdor
- Hematology Division, Chaim Sheba Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Yair Goldhecht
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vladimir Vainstein
- Hematology Division, Hadassah Medical Center and the Hebrew University Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Neta Goldschmidt
- Hematology Division, Hadassah Medical Center and the Hebrew University Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Shimrit Harlev
- Department of Hematology, Rambam Healthcare Campus, Haifa and the Rappaport Faculty of medicine of the Technion, Haifa, Israel
| | - Netanel Horwitz
- Department of Hematology, Rambam Healthcare Campus, Haifa and the Rappaport Faculty of medicine of the Technion, Haifa, Israel
| | - Odit Gutwein
- Department of Hematology, Assaf Harofeh Medical Center, Tzrifin, Israel
| | - Ronit Gurion
- Institute of Hematology, Rabin Medical Center, Petch Tikvah, Israel
| | - Gilad Itchaki
- Institute of Hematology, Rabin Medical Center, Petch Tikvah, Israel
| | - Uri Abadi
- Department of Hematology, Meir Medical Center, Kfar Saba, Israel
| | - Anatoly Nemets
- Department of Hematology, Barzilai Medical Center, Ashkelon, Israel
| | - Orit Sofer
- Institute of Hematology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Miri Zektser
- Department of Hematology, Soroka University Medical Center, Negev Beer Sheva, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Nagib Dally
- Hematology Unit, Ziv Medical Center, Zefat, Israel
| | | | - Merav Leiba
- Assuta Medical Center, Hematology Institute, Ashdod, Israel
| | - Nadav Sarid
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Benyamini
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Herishanu
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Ram
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chava Perry
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Avivi
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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21
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Herishanu Y, Shaulov A, Fineman R, Bašić‐Kinda S, Aviv A, Wasik‐Szczepanek E, Jaksic O, Zdrenghea M, Greenbaum U, Mandac I, Simkovic M, Morawska M, Benjamini O, Spacek M, Nemets A, Bairey O, Trentin L, Ruchlemer R, Laurenti L, Stanca Ciocan O, Doubek M, Shvidel L, Dali N, Mirás F, De Meûter A, Dimou M, Mauro FR, Coscia M, Bumbea H, Szász R, Tadmor T, Gutwein O, Gentile M, Scarfò L, Tedeschi A, Sportoletti P, Gimeno Vázquez E, Marquet J, Assouline S, Papaioannou M, Braester A, Levato L, Gregor M, Rigolin GM, Loscertales J, Medina Perez A, Nijziel MR, Popov VM, Collado R, Slavutsky I, Itchaki G, Ringelstein S, Goldschmidt N, Perry C, Levi S, Polliack A, Ghia P. Frontline treatment with the combination obinutuzumab ± chlorambucil for chronic lymphocytic leukemia outside clinical trials: Results of a multinational, multicenter study by ERIC and the Israeli CLL study group. Am J Hematol 2020; 95:604-611. [PMID: 32096887 DOI: 10.1002/ajh.25766] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/14/2022]
Abstract
In recent years, considerable progress has been made in frontline therapy for elderly/physically unfit patients with CLL. The combination of obinutuzumab and chlorambucil (O-Clb) has been shown to prolong progression free survival (PFS, median PFS-31.5 months) and overall survival (OS) compared to chlorambucil alone. More recently, obinutuzumab given in combination with either ibrutinib or venetoclax improved PFS but not OS when compared to O-Clb. In this retrospective multinational, multicenter co-operative study, we evaluated the efficacy and safety of frontline treatment with O ± Clb in unfit patients with CLL, in a "real-world" setting. Patients with documented del (17p13.1)/TP53 mutation were excluded. A total of 437 patients (median age, 75.9 years; median CIRS score, 8; median creatinine clearance, 61.1 mL/min) were included. The clinical overall response rate was 80.3% (clinical complete and partial responses in 38.7% and 41.6% of patients, respectively). Median observation time was 14.1 months and estimated median PFS was 27.6 months (95% CI, 24.2-31.0). In a multivariate analysis, high-risk disease [del (11q22.3) and/or IGHV-unmutated], lymph nodes of diameter > 5 cm, obinutuzumab monotherapy and reduced cumulative dose of obinutuzumab, were all independently associated with shorter PFS. The median OS has not yet been reached and estimated 2-year OS is 88%. In conclusion, in a "real-world" setting, frontline treatment with O-Clb achieves PFS comparable to that reported in clinical trials. Inferior outcomes were noted in patients with del (11q22.3) and/or unmutated IGHV and those treated with obinutuzumab-monotherapy. Thus, O-Clb can be still considered as legitimate frontline therapy for unfit CLL patients with low-risk disease.
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Affiliation(s)
- Yair Herishanu
- Department of HematologyTel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of MedicineTel Aviv University Tel‐Aviv Israel
| | - Adir Shaulov
- Hadassah Hebrew University Medical Center Jerusalem Israel
| | - Riva Fineman
- Department of HematologyRambam Health Care Campus Haifa Israel
| | | | - Ariel Aviv
- Department of HematologyHaEmek Medical Center Afula Israel
- Faculty of MedicineTechnion Israel Institute of Technology Haifa Israel
| | - Ewa Wasik‐Szczepanek
- Department of Hematooncologyand Bone Marrow Transplantation Medical University Lublin Poland
| | | | - Mihnea Zdrenghea
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj‐Napoca Romania
| | - Uri Greenbaum
- Ben‐Gurion University, Soroka University Medical Center Beer Sheva Israel
| | | | - Martin Simkovic
- University Hospital and Medical School Hradec Kralove Hradec Kralove Czech Republic
| | | | - Ohad Benjamini
- Sackler Faculty of MedicineTel Aviv University Tel‐Aviv Israel
- Hematology DivisionChaim Sheba Medical Center Ramat Gan Israel
| | - Martin Spacek
- Charles University and General Hospital in Prague Prague Czech Republic
| | | | - Osnat Bairey
- Rabin Medical Center, Beilinson Hospital; Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
| | | | - Rosa Ruchlemer
- Department of HematologyShaare Zedek Medical Center Jerusalem Israel
| | - Luca Laurenti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | | | - Michael Doubek
- Department of Internal Medicine‐Hematology and OncologyMedical Faculty of Masaryk University and University Hospital Brno Brno Czech Republic
| | - Lev Shvidel
- Department of HematologyKaplan Medical Center Rehovot Israel
- Hebrew University of Jerusalem Jerusalem Israel
| | | | | | | | - Maria Dimou
- Hematology Section ‐ 1st Department Of Propaedeutic Internal MedicineLaikon Hospital Athens Greece
| | - Francesca R. Mauro
- Hematology, Department of Translational and Precision MedicineSapienza University, Policlinico Umberto I Rome Italy
| | - Marta Coscia
- Department of Molecular Biotechnology and Health SciencesUniversity of Torino Torino Italy
| | - Horia Bumbea
- Emergency University Clinical Hospital Bucharest Romania
| | - Róbert Szász
- Division of Hematology, Department of Internal Medicine, Faculty of MedicineUniversity of Debrecen Debrecen Hungary
| | | | | | - Massimo Gentile
- Hematology Unit and Biotechnology Research Unit, A.O. of Cosenza Cosenza Italy
| | - Lydia Scarfò
- Division of Experimental OncologyIRCCS Ospedale San Raffaele Milan Italy
- Università Vita‐Salute San Raffaele Milan Italy
| | - Alessandra Tedeschi
- Department of Haematology, Niguarda Cancer CenterASST Grande Ospedale Metropolitano Niguarda Milan Italy
| | - Paolo Sportoletti
- Institute of Hematology and Center for Hemato‐Oncological Research, Ospedale S. Maria della Misericordia, University of Perugia Perugia Italy
| | | | - Juan Marquet
- Hematology and HemotherapyHospital Universitario Ramón y Cajal Madrid Spain
| | - Sarit Assouline
- Division of HematologyJewish General Hospital, Montreal Quebec Canada
| | - Maria Papaioannou
- First Department of Internal Medicine, Division of HaematologyAHEPA University Hospital, Aristotle University of Thessaloniki Thessaloniki Greece
| | | | - Luciano Levato
- Department Hematology‐OncologyAzienda Ospedaliera Pugliese‐Ciaccio Catanzaro Italy
| | - Michael Gregor
- Division of HematologyCantonal Hospital of Lucerne Lucerne Switzerland
| | - Gian M. Rigolin
- Hematology Section, Department of Medical SciencesUniversity of Ferrara‐Azienda Ospedaliera‐Universitaria di Ferrara, University of Ferrara Ferrara Italy
| | | | | | | | | | | | | | - Gilad Itchaki
- Rabin Medical Center, Beilinson Hospital; Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
| | | | | | - Chava Perry
- Department of HematologyTel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of MedicineTel Aviv University Tel‐Aviv Israel
| | - Shai Levi
- Department of HematologyTel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Aaron Polliack
- Hadassah Hebrew University Medical Center Jerusalem Israel
| | - Paolo Ghia
- Division of Experimental OncologyIRCCS Ospedale San Raffaele Milan Italy
- Università Vita‐Salute San Raffaele Milan Italy
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22
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Castillo JJ, Itchaki G, Gustine JN, Meid K, Flynn CA, Demos MG, Guerrera ML, Jimenez C, Kofides A, Liu X, Munshi M, Tsakmaklis N, Patterson CJ, Xu L, Yang G, Hunter ZR, Treon SP. A matched case-control study comparing features, treatment and outcomes between patients with non-IgM lymphoplasmacytic lymphoma and Waldenström macroglobulinemia. Leuk Lymphoma 2020; 61:1388-1394. [PMID: 31992103 DOI: 10.1080/10428194.2020.1719100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cases of non-IgM lymphoplasmacytic lymphoma (LPL) are rare. We performed a case-control study comparing features and outcomes of 31 non-IgM LPL cases and 93 Waldenström macroglobulinemia (WM) controls matched by age, sex, and year of diagnosis. Odds of MYD88 mutations were lower (odds ratio (OR) 0.22, p = .05), and median time to treatment was shorter in cases than in controls (4 vs. 32 months; p < .001). Odds of extramedullary disease were higher (OR 4.20, p = .01), while odds of neuropathy (OR 0.22, p = .25), and hyperviscosity (OR 0.26, p = .26) were lower in cases than in controls. Odds of using chemoimmunotherapy were higher (OR 2.62, p = .11) while odds of using proteasome inhibitors (OR 0.35, p = .15) and BTK inhibitors (OR 0.17, p = .21) were lower in cases than in controls. There were no differences in response and overall survival (OS) between cases and controls. Despite clinicopathological differences, response, and survival outcomes are similar between non-IgM LPL cases and WM controls.
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Affiliation(s)
- Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Gilad Itchaki
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA.,Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel
| | - Joshua N Gustine
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kirsten Meid
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Catherine A Flynn
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Maria G Demos
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Maria L Guerrera
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Cristina Jimenez
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Amanda Kofides
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Xia Liu
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Manit Munshi
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nicholas Tsakmaklis
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christopher J Patterson
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lian Xu
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Guang Yang
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Zachary R Hunter
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Steven P Treon
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
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23
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Castillo J, Itchaki G, Paludo J, Varettoni M, Buske C, Eyre T, Chavez J, Shain K, Issa S, Palomba L, Pasvolsky O, Simpson D, Talaulikar D, Tam C, Tedeschi A, Ansell S, Nayak L, Treon S. IBRUTINIB FOR THE TREATMENT OF BING-NEEL SYNDROME: A RETROSPECTIVE, MULTICENTER STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.140_2629] [Citation(s) in RCA: 1] [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: 11/12/2022]
Affiliation(s)
- J. Castillo
- Bing Center for Waldenstrom Macroglobulinemia; Dana-Farber Cancer Institute; Boston United States
| | - G. Itchaki
- Hematology; Rabin Medical Center; Petah Tikva Israel
| | - J. Paludo
- Hematology and Oncology; Mayo Clinic; Rochester United States
| | - M. Varettoni
- Hematology; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - C. Buske
- Comprehensive Cancer Center; University Hospital Ulm; Ulm Germany
| | - T. Eyre
- Hematology; Churchill Hospital; Oxford United Kingdom
| | - J. Chavez
- Malignant Hematology; Moffitt Cancer Institute; Tampa United States
| | - K. Shain
- Malignant Hematology; Moffitt Cancer Institute; Tampa United States
| | - S. Issa
- Hematology; Middlemore Hospital; Auckland New Zealand
| | - L. Palomba
- Hematology and Oncology; Memorial Sloan Kettering Cancer Center; New York United States
| | - O. Pasvolsky
- Hematology; Rabin Medical Center; Petah Tikva Israel
| | - D. Simpson
- Hematology; North Shore Hospital; Auckland New Zealand
| | | | - C. Tam
- Hematology; Peter MacCallum Cancer Centre; Melbourne Australia
| | | | - S. Ansell
- Hematology and Oncology; Mayo Clinic; Rochester United States
| | - L. Nayak
- Center for CNS Lymphoma; Dana-Farber Cancer Institute; Boston United States
| | - S. Treon
- Bing Center for Waldenstrom Macroglobulinemia; Dana-Farber Cancer Institute; Boston United States
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24
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Durot E, Kanagaratnam L, D'sa S, Tomowiak C, Hivert B, Toussaint E, Guerrero-Garcia T, Itchaki G, Vos J, Michallet A, Godet S, Bomsztyk J, Morel P, Leblond V, Treon S, Delmer A, Castillo J. A PROGNOSTIC SCORE FOR TRANSFORMED WALDENSTRÖM MACROGLOBULINEMIA. Hematol Oncol 2019. [DOI: 10.1002/hon.71_2631] [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: 11/08/2022]
Affiliation(s)
- E. Durot
- Department of Hematology; University Hospital of Reims; Reims France
| | - L. Kanagaratnam
- Department of Research and Innovation; University Hospital of Reims; Reims France
| | - S. D'sa
- Department of Hematology; University College London Hospitals (UCLH) NHS Foundation Trust; London United Kingdom
| | - C. Tomowiak
- Department of Hematology; University Hospital of Poitiers; Poitiers France
| | - B. Hivert
- Department of Hematology; Hospital of Lens; Lens France
| | - E. Toussaint
- Department of Hematology; University Hospital of Strasbourg; Strasbourg France
| | - T. Guerrero-Garcia
- Department of Hematology; Dana-Farber Cancer Institute, Harvard Medical School; Boston United States
| | - G. Itchaki
- Department of Hematology; Dana-Farber Cancer Institute, Harvard Medical School; Boston United States
| | - J. Vos
- Department of Hematology; Academical Medical Center; Amsterdam Netherlands
| | - A. Michallet
- Department of Hematology; Centre Léon Bérard; Lyon France
| | - S. Godet
- Department of Hematology; University Hospital of Reims; Reims France
| | - J. Bomsztyk
- Department of Hematology; University College London Hospitals (UCLH) NHS Foundation Trust; London United Kingdom
| | - P. Morel
- Department of Hematology; University Hospital of Amiens; Amiens France
| | - V. Leblond
- Department of Hematology; Pitié-Salpêtrière Hospital; Paris France
| | - S.P. Treon
- Department of Hematology; Dana-Farber Cancer Institute, Harvard Medical School; Boston United States
| | - A. Delmer
- Department of Hematology; University Hospital of Reims; Reims France
| | - J.J. Castillo
- Department of Hematology; Dana-Farber Cancer Institute, Harvard Medical School; Boston United States
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25
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Itchaki G, Brown JR. Experience with ibrutinib for first-line use in patients with chronic lymphocytic leukemia. Ther Adv Hematol 2018; 9:3-19. [PMID: 29317997 PMCID: PMC5753924 DOI: 10.1177/2040620717741861] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 10/17/2017] [Indexed: 01/17/2023] Open
Abstract
Ibrutinib is the first in-class, orally administered, Bruton's tyrosine kinase (BTK) inhibitor that abrogates the critical signaling downstream of the B-cell receptor (BCR). This signaling is required for B-cell survival, proliferation and interaction with the microenvironment. Ibrutinib proved active in preclinical models of lymphoproliferative diseases and achieved impressive response rates in heavily pretreated relapsed and refractory (R/R) patients with chronic lymphocytic leukemia (CLL). Ibrutinib prolonged survival compared to standard therapy and mitigated the effect of most poor prognostic factors in CLL, thus becoming the main therapeutic option in high-risk populations. Moreover, compared with standard chemoimmunotherapy (CIT) for adults, ibrutinib causes fewer cytopenias and infections, while having its own unique toxicity profile. Its efficacy in relapsed patients as well as its tolerability have led to its increased use in previously untreated patients, especially in those with poor prognostic markers and/or the elderly. This review elaborates on ibrutinib's unique toxicity profile and the mechanisms of acquired resistance leading to progression on ibrutinib, since both are critical for understanding the obstacles to its first-line use. We will further evaluate the data from ongoing clinical trials in this setting and explore future options for combination therapy.
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Abstract
INTRODUCTION Lenalidomide is an immunomodulatory drug (IMiD) with a unique mode of action (MOA) that may vary across disease-type. It is currently approved in multiple myeloma (MM), myelodysplastic syndrome (MDS) and mantle cell lymphoma (MCL), yet is also clinically active in a host of lymphoproliferative diseases, including chronic lymphocytic leukemia (CLL). Due to its protean effects on the immune system, lenalidomide may be particularly appealing in CLL, which is distinct in its ability to evade immune recognition and cause immunosuppression. Areas covered: This review recaps the biological mechanisms of lenalidomide specific for CLL, and summarizes the clinical data in previously untreated and relapsed/refractory (R/R) CLL patients, with emphasis on toxicity. Moreover, lenalidomide treatment is put into the context of the highly effective targeted agents that are drastically changing the therapeutic approach in CLL. Expert opinion: Lenalidomide is a potent drug in CLL, both in first line and relapse. However, in comparison to other newly available agents, lenalidomide has slow onset of efficacy and notable toxicity profile that limits both its single agent use and combinations with chemotherapy. Future trials will hopefully direct our ability to harness lenalidomide MOA to best incorporate it in the rapidly evolving landscape of CLL treatment.
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Affiliation(s)
- Gilad Itchaki
- a Department of Medical Oncology , Dana Farber Cancer Institute , Boston , MA , USA
| | - Jennifer R Brown
- a Department of Medical Oncology , Dana Farber Cancer Institute , Boston , MA , USA
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Abstract
Venetoclax (VEN, ABT-199/GDC-0199) is an orally bioavailable BH3-mimetic that specifically inhibits the anti-apoptotic B-cell lymphoma/leukemia 2 (BCL2) protein. Although BCL2 overexpression is not genetically driven in chronic lymphocytic leukemia (CLL), it is nearly universal and represents a highly important and prevalent mechanism of apoptosis evasion, making it an attractive therapeutic target. This review summarizes the role of BCL2 in CLL pathogenesis, the development path targeting its inhibition prior to VEN, and the preclinical and clinical data regarding the effectiveness and safety of VEN. We further strive to contextualize VEN in the current CLL treatment landscape and discuss potential mechanisms of resistance.
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Affiliation(s)
- Gilad Itchaki
- Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Jennifer R. Brown
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
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28
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Muchtar E, Magen H, Itchaki G, Cohen A, Rosenfeld R, Shochat T, Kornowski R, Iakobishvili Z, Raanani P. Uninvolved immunoglobulins predicting hematological response in newly diagnosed AL amyloidosis. Leuk Res 2016; 41:56-61. [DOI: 10.1016/j.leukres.2015.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/30/2015] [Accepted: 11/19/2015] [Indexed: 12/11/2022]
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Shacham-Abulafia A, Itchaki G, Yeshurun M, Paul M, Peck A, Leader A, Shpilberg O, Ram R, Raanani P. High-Intensity Induction Chemotherapy Is Feasible for Elderly Patients with Acute Myeloid Leukemia. Acta Haematol 2015; 135:55-64. [PMID: 26443995 DOI: 10.1159/000437131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/23/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prognosis of elderly patients with acute myeloid leukemia (AML) is poor, and the best treatment is controversial. Since the majority of AML patients are older than 60 years, identification of those who might benefit from intensive treatment is essential. METHODS Data from electronic charts of consecutive AML patients treated in our center were analyzed. Eligibility criteria included newly diagnosed de novo or secondary AML, an age of 60 years or older, and intensive induction treatment. RESULTS Sixty-two patients were included in the analysis. Forty-six patients (74%) achieved complete remission (CR) after 1-2 intensive induction courses. Twenty of them received consolidation with conventional chemotherapy, 20 proceeded to allogeneic hematopoietic cell transplantation (allo-HCT), and 6 were ineligible for further treatment. The projected overall survival (OS) at 2 and 3 years was 28 and 23%, respectively. A normal karyotype, CR achievement, and allo-HCT were associated with improved OS, while an Eastern Cooperative Oncology Group performance status of 0-1 was borderline associated. The median survival and disease-free survival at 2 years was 18.7 months and 49%, respectively, for patients who underwent allo-HCT in CR1, compared to 12.8 months and 25%, respectively, for those who did not. CONCLUSION Based on our data, selected eligible elderly AML patients might benefit from intensive treatment.
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Affiliation(s)
- Adi Shacham-Abulafia
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva, Israel
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30
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Wolach O, Itchaki G, Bar-Natan M, Yeshurun M, Ram R, Herscovici C, Shpilberg O, Douer D, Tallman MS, Raanani P. High-dose cytarabine as salvage therapy for relapsed or refractory acute myeloid leukemia--is more better or more of the same? Hematol Oncol 2015; 34:28-35. [PMID: 25689584 DOI: 10.1002/hon.2191] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 12/22/2014] [Indexed: 11/07/2022]
Abstract
Cytarabine is the backbone of most chemotherapeutic regimens for acute myeloid leukemia (AML), yet the optimal dose for salvage therapy of refractory or relapsed AML (RR-AML) has not been established. Very high dose single-agent cytarabine at 36 g/m(2) (ARA-36) was previously shown to be effective and tolerable in RR-AML. In this retrospective analysis, we aim to describe the toxicity and efficacy of ARA-36 as salvage therapy for patients with AML who are primary refractory to intensive daunorubicin-containing induction or those relapsing after allogeneic stem cell transplant (alloSCT). Fifteen patients, median age 53 years, were included in the analysis. Six patients were treated for induction failure, one had resistant APL, and eight relapsed after alloSCT. Complete remission was achieved in 60% of patients. Surviving patients were followed for a median of 8.5 months. One-year overall survival was 54% (95% CI 30%-86%), and relapse rate from remission (n = 9) was 56%. Grade III/IV pulmonary, infectious, ocular and gastrointestinal toxicities occurred in 26%, 20%, 20% and 20% of patients respectively. Salvage therapy with ARA-36 regimen for RR-AML has considerable efficacy with manageable toxicity in patients with induction failure or post-transplant relapse. Overall survival in these high-risk patients still remains poor.
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MESH Headings
- Adolescent
- Adult
- Allografts
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/adverse effects
- Antimetabolites, Antineoplastic/therapeutic use
- Combined Modality Therapy
- Cytarabine/administration & dosage
- Cytarabine/adverse effects
- Cytarabine/therapeutic use
- Dose-Response Relationship, Drug
- Drug Resistance, Neoplasm
- Dyspnea/chemically induced
- Female
- Gastrointestinal Diseases/chemically induced
- Hematopoietic Stem Cell Transplantation
- Humans
- Infections/etiology
- Kaplan-Meier Estimate
- Keratitis/chemically induced
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Recurrence
- Remission Induction
- Retrospective Studies
- Salvage Therapy
- Treatment Outcome
- Xerophthalmia/chemically induced
- Young Adult
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Affiliation(s)
- Ofir Wolach
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Itchaki
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Bar-Natan
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Yeshurun
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Ram
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Corina Herscovici
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Shpilberg
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Douer
- Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin S Tallman
- Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Paul M, Ram R, Kugler E, Farbman L, Peck A, Leibovici L, Lahav M, Yeshurun M, Shpilberg O, Herscovici C, Wolach O, Itchaki G, Bar-Natan M, Vidal L, Gafter-Gvili A, Raanani P. Subcutaneous versus intravenous granulocyte colony stimulating factor for the treatment of neutropenia in hospitalized hemato-oncological patients: randomized controlled trial. Am J Hematol 2014; 89:243-8. [PMID: 24178750 DOI: 10.1002/ajh.23622] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 09/14/2013] [Accepted: 10/28/2013] [Indexed: 01/22/2023]
Abstract
Intravenous (IV) granulocyte colony stimulating factor (G-CSF) might be safer and more convenient than subcutaneous (SC) administration to hospitalized hemato-oncological patients receiving chemotherapy. To compare IV vs. SC G-CSF administration, we conducted a randomized, open-label trial. We included inpatients receiving chemotherapy for acute myeloid leukemia, acute lymphoblastic leukemia, lymphoma or multiple myeloma, and allogeneic or autologous hematopoietic cell transplantation (HCT). Patients were randomized to 5 mcg/kg single daily dose of IV bolus versus SC filgrastim given for its clinical indications. Patients were crossed-over to the alternate study arm on the subsequent chemotherapy course. The primary outcomes were time from initiation of filgrastim to recovery of stable neutrophil count of >500 cells/µL and a composite clinical outcome of infection or death assessed for the first course post-randomization. The study was stopped on the second interim analysis. Of 120 patients randomized, 118 were evaluated in the first treatment course. The mean time to neutropenia resolution was longer with IV G-CSF [7.9 days, 95% confidence interval (CI) 6.6-9.1] compared with SC G-CSF (5.4 days, 95% CI 4.6-6.2), log-rank P = 0.001. Longer neutropenia duration was observed in all patient subgroups, except for patients undergoing autologous HCT. There was no significant difference between groups in the occurrence of infection or death, but more deaths were observed with IV (4/57, 7%) versus SC (1/61, 1.6%) G-CSF administration, P = 0.196. Similar results were observed when all 158 courses following cross-over were analyzed. Patients reported similar pain and satisfaction scores in both groups. Bolus IV administration of G-CSF results in longer neutropenia duration than SC administration, with no difference in clinical or quality-of-life measures.
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Affiliation(s)
- Mical Paul
- Unit of Infectious Diseases; Rabin Medical Center, Beilinson Hospital; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel-Aviv University; Ramat-Aviv Israel
| | - Ron Ram
- Sackler Faculty of Medicine; Tel-Aviv University; Ramat-Aviv Israel
- Institute of Hematology; Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center; Petach Tikva Israel
| | - Eitan Kugler
- Unit of Infectious Diseases; Rabin Medical Center, Beilinson Hospital; Petach Tikva Israel
| | - Laura Farbman
- Sackler Faculty of Medicine; Tel-Aviv University; Ramat-Aviv Israel
- Medicine E, Rabin Medical Center; Beilinson Hospital; Petach Tikva Israel
| | - Anat Peck
- Institute of Hematology; Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center; Petach Tikva Israel
| | - Leonard Leibovici
- Sackler Faculty of Medicine; Tel-Aviv University; Ramat-Aviv Israel
- Medicine E, Rabin Medical Center; Beilinson Hospital; Petach Tikva Israel
| | - Meir Lahav
- Sackler Faculty of Medicine; Tel-Aviv University; Ramat-Aviv Israel
- Institute of Hematology; Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center; Petach Tikva Israel
- Medicine A, Rabin Medical Center; Beilinson Hospital; Petach Tikva Israel
| | - Moshe Yeshurun
- Sackler Faculty of Medicine; Tel-Aviv University; Ramat-Aviv Israel
- Institute of Hematology; Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center; Petach Tikva Israel
| | - Ofer Shpilberg
- Sackler Faculty of Medicine; Tel-Aviv University; Ramat-Aviv Israel
- Institute of Hematology; Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center; Petach Tikva Israel
| | - Corina Herscovici
- Sackler Faculty of Medicine; Tel-Aviv University; Ramat-Aviv Israel
- Institute of Hematology; Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center; Petach Tikva Israel
| | - Ofir Wolach
- Sackler Faculty of Medicine; Tel-Aviv University; Ramat-Aviv Israel
- Institute of Hematology; Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center; Petach Tikva Israel
| | - Gilad Itchaki
- Sackler Faculty of Medicine; Tel-Aviv University; Ramat-Aviv Israel
- Institute of Hematology; Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center; Petach Tikva Israel
| | - Michal Bar-Natan
- Sackler Faculty of Medicine; Tel-Aviv University; Ramat-Aviv Israel
- Institute of Hematology; Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center; Petach Tikva Israel
| | - Liat Vidal
- Sackler Faculty of Medicine; Tel-Aviv University; Ramat-Aviv Israel
- Institute of Hematology; Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center; Petach Tikva Israel
| | - Anat Gafter-Gvili
- Sackler Faculty of Medicine; Tel-Aviv University; Ramat-Aviv Israel
- Institute of Hematology; Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center; Petach Tikva Israel
- Medicine E, Rabin Medical Center; Beilinson Hospital; Petach Tikva Israel
| | - Pia Raanani
- Sackler Faculty of Medicine; Tel-Aviv University; Ramat-Aviv Israel
- Institute of Hematology; Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center; Petach Tikva Israel
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Shepshelovich D, Shpilberg O, Lahav M, Itchaki G, Yakimov M, Raanani P, Cohen A. Hodgkin lymphoma and hypothermia: case report and review of the literature. Acta Haematol 2013; 131:227-30. [PMID: 24335335 DOI: 10.1159/000355262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 05/28/2013] [Accepted: 08/22/2013] [Indexed: 11/19/2022]
Abstract
We report the development of hypothermia in a patient with Hodgkin lymphoma which resolved with chemotherapy administration. A review of the literature revealed 16 previous reports of hypothermia in patients with Hodgkin lymphoma. Overall prognosis seems to be unfavorable. To the best of our knowledge this is the first report of hypothermia in a patient with Hodgkin lymphoma transforming from chronic lymphocytic leukemia (Richter's syndrome). A possible pathophysiology could be paraneoplastic autonomic neuropathy. Physicians should be aware that Hodgkin lymphoma can present with hypothermia and should carefully monitor newly diagnosed patients with advanced disease for this complication. Likewise, patients with Hodgkin lymphoma who develop hypothermia should be screened for signs of autonomic neuropathy.
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Affiliation(s)
- Daniel Shepshelovich
- Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
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Itchaki G, Gafter-Gvili A, Lahav M, Vidal L, Raanani P, Shpilberg O, Paul M. Anthracycline-containing regimens for treatment of follicular lymphoma in adults. Cochrane Database Syst Rev 2013:CD008909. [PMID: 23832787 DOI: 10.1002/14651858.cd008909.pub2] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Anthracycline-containing regimens (ACR) are the most prevalent regimens in the management of patients with advanced follicular lymphoma (FL). However, there is no proof that they are superior to non-anthracycline-containing regimens (non-ACR). OBJECTIVES To compare the efficacy of ACRs to other chemotherapy regimens, in the treatment of FL. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 3), MEDLINE (January 1966 to April 2013), smaller databases, relevant conference proceedings (2004 to 2012) and the National Medical Library (April 2013). SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing ACR with non-ACR for adult patients with FL. We excluded trials in which immunotherapy, radiotherapy alone or stem-cell transplantation were used in one arm alone. Our primary outcome was overall survival (OS). Secondary outcomes included disease control, as measured by progression-free survival (PFS) or remission duration (RD). DATA COLLECTION AND ANALYSIS Two review authors assessed the quality of trials and extracted data. We contacted study authors for additional information. We analyzed trials separately according to resemblance of the chemotherapeutic regimens in study arms, other than the addition of anthracyclines ('same' versus 'different' chemotherapy). Hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals (CI) were estimated and pooled using the fixed-effect model. MAIN RESULTS Eight RCTs, conducted between 1974 and 2011, and involving 2636 patients were included in this meta-analysis. All trials included therapy-naive patients. Rituximab was used in one trial only. Follow-up was between three and five years in most trials (range three to 18 years). All trials were published in peer-reviewed journals.Five trials compared similar chemotherapeutic regimens, except for the anthracycline. In three studies reporting overall survival specifically in FL patients, there was no statistically significant difference between ACR and non-ACR arms (HR 0.99; 95% CI 0.77 to 1.29; I(2) = 0%). ACR significantly improved disease control (HR 0.65; 95% CI 0.52 to 0.81; four trials). Progression or relapse at three years were reduced (RR 0.73; 95% CI 0.63 to 0.85). Anthracyclines did not significantly increase rates of complete response (RR 1.05; 95% CI 0.94 to 1.18) or overall response (RR 1.06; 95% CI 1.00 to 1.12), but heterogeneity was substantial.Overall, ACR were more often associated with cytopenias, but not with serious infections or death related to chemotherapy. Cardiotoxicity, albeit rare, was associated with anthracycline use (RR 4.55; 95% CI 0.92 to 22.49; four trials).Three trials added anthracycline to one arm of two different regimens. None showed benefit to ACR regarding OS, yet there was a trend in favor of anthracyclines for disease control. Results were heterogeneous.We judged the overall quality of these trials as moderate as all are unblinded, some are outdated and are not uniform in outcome definitions. AUTHORS' CONCLUSIONS The use of anthracyclines in patients with FL has no demonstrable benefit on overall survival, although it may have been mitigated by the more intense regimens given in the control arms of three of five trials. ACR improved disease control, as measured by PFS and RD with an increased risk for side effects, notably cardiotoxicity. The current evidence on the added value of ACR in the management of FL is limited. Further studies involving immunotherapy during induction and maintenance may change conclusion.
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Affiliation(s)
- Gilad Itchaki
- Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel. .
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