1
|
Hall VG, Lim C, Saunders NR, Klimevski E, Nguyen THO, Kedzierski L, Seymour JF, Wadhwa V, Thursky KA, Yong MK, Kedzierska K, Slavin MA, Teh BW. Breakthrough COVID-19 is mild in vaccinated patients with hematological malignancy receiving tixagevimab-cilgavimab as pre-exposure prophylaxis. Leuk Lymphoma 2023; 64:1600-1604. [PMID: 37341732 DOI: 10.1080/10428194.2023.2224472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 06/22/2023]
Affiliation(s)
- V G Hall
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Hematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - C Lim
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - N R Saunders
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - E Klimevski
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - T H O Nguyen
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Australia
| | - L Kedzierski
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Australia
| | - J F Seymour
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Hematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - V Wadhwa
- Department of Ambulatory Services, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - K A Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - M K Yong
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - K Kedzierska
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Australia
| | - M A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - B W Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| |
Collapse
|
2
|
Wu JQ, Seymour JF, Eichhorst B, Hillmen P, Kipps T, Langerak AW, Owen C, Dubois J, Mellink C, van der Kevie‐Kersemaekers A, Chyla B, Jiang Y, Boyer M, Thadani‐Mulero M, Lefebure M, Kater AP. UNFAVORABLE GENETICS IMPACT MRD RESPONSE TO VENETOCLAX+RITUXIMAB RETREATMENT IN RELAPSED OR REFRACTORY CHRONIC LYMPHOCYTIC LEUKEMIA (R/R CLL): PHASE 3 MURANO SUBSTUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.50_2880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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)
- J. Q. Wu
- Genentech, Inc Oncology Biomarker Development South San Francisco USA
| | - J. F. Seymour
- Royal Melbourne Hospital, Peter MacCallum Cancer Centre and University of Melbourne Department of Haematology Melbourne Australia
| | - B. Eichhorst
- University of Cologne Department I of Internal Medicine and Center of Integrated Oncology Aachen Cologne Germany
| | - P. Hillmen
- St. James’s University Hospital Department of Haematology Leeds UK
| | - T. Kipps
- UC San Diego Health, Moores Cancer Center San Diego USA
| | - A. W. Langerak
- University Medical Center Department of Hematology Rotterdam Netherlands
| | - C. Owen
- University of Calgary Departments of Medicine and Oncology Calgary Canada
| | - J. Dubois
- Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam Department of Hematology Amsterdam Netherlands
| | - C. Mellink
- Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam Department of Hematology Amsterdam Netherlands
| | - A. van der Kevie‐Kersemaekers
- Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam Department of Hematology Amsterdam Netherlands
| | - B. Chyla
- AbbVie Inc. Cancer Biomarkers North Chicago USA
| | - Y. Jiang
- Genentech, Inc Oncology Biomarker Development South San Francisco USA
| | - M. Boyer
- Roche Products Limited Clinical Science Welwyn Garden City UK
| | | | - M. Lefebure
- Roche Products Limited Clinical Science Welwyn Garden City UK
| | - A. P. Kater
- Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam Department of Hematology Amsterdam Netherlands
| |
Collapse
|
3
|
Hillmen P, Byrd JC, Ghia P, Kater AP, Chanan‐Khan A, Furman RR, O'Brien S, Yenerel MN, Illes A, Kay N, Garcia‐Marco JA, Mato A, Pinilla‐Ibarz J, Seymour JF, Lepretre S, Stilgenbauer S, Robak T, Patel P, Higgins K, Sohoni S, Jurczak W. FIRST RESULTS OF A HEAD‐TO‐HEAD TRIAL OF ACALABRUTINIB VERSUS IBRUTINIB IN PREVIOUSLY TREATED CHRONIC LYMPHOCYTIC LEUKEMIA. Hematol Oncol 2021. [DOI: 10.1002/hon.33_2879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- P. Hillmen
- St. James’s University Hospital Experimental Haematology, Leeds UK
| | - J. C. Byrd
- The Ohio State University Comprehensive Cancer Center, Hematology Columbus USA
| | - P. Ghia
- Università Vita‐Salute San Raffaele and IRCCS Ospedale San Raffaele Experimental Oncology Milano Italy
| | - A. P. Kater
- Amsterdam University Medical Center Amsterdam, on behalf of Hovon, Hematology, Lymphoma and Myeloma Research Amsterdam Netherlands
| | - A. Chanan‐Khan
- Mayo Clinic Jacksonville Hematology, Oncology, Jacksonville USA
| | - R. R. Furman
- Weill Cornell Medicine New York Presbyterian Hospital, Hematology, Oncology New York USA
| | - S. O'Brien
- Chao Family Comprehensive Cancer Center University of California‐Irvine, Hematology, Oncology Irvine USA
| | - M. N. Yenerel
- Istanbul University, Istanbul Faculty of Medicine, Hematology Istanbul Turkey
| | - A. Illes
- University of Debrecen Historical Auxiliary Sciences Debrecen Hungary
| | - N. Kay
- Mayo Clinic Rochester, Hematology Rochester USA
| | - J. A. Garcia‐Marco
- Hospital Universitario Puerta de Hierro‐Majadahonda "Unidad de Citogenetica Molecular Servicio de Hematologia " Madrid Spain
| | - A. Mato
- University of Pennsylvania, Chronic Lymphocytic Leukemia Philadelphia USA
| | | | - J. F. Seymour
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Haematology Victoria Australia
| | - S. Lepretre
- Centre Henri Becquerel and Normandie University UNIROUEN, Hématologie Rouen France
| | - S. Stilgenbauer
- University of Ulm Internal Medicine III, Haematology, Oncology Rheumatology and Infectious Diseases Ulm Germany
| | - T. Robak
- Medican University of Lodz Hematology Lodz Poland
| | - P. Patel
- AstraZeneca, Clinical Development Hematology R&D Oncology South San Francisco USA
| | - K. Higgins
- AstraZencea, Biostatistics South San Francisco USA
| | - S. Sohoni
- AstraZeneca, Clinical Development Hematology R&D Oncology South San Francisco USA
| | - W. Jurczak
- Maria Sklodowska‐Curie National Research Institute of Oncology Clinical Oncology Krakow Poland
| |
Collapse
|
4
|
Bannerji R, Yuen S, Phillips T, Arthur C, Isufi I, Marlton P, Seymour JF, Corradini P, Molinari A, Gritti G, Emmons R, Hirata J, Musick L, Saha S, Croft B, Flowers C. POLATUZUMAB VEDOTIN + OBINUTUZUMAB + VENETOCLAX IN PATIENTS WITH RELAPSED/REFRACTORY (R/R) FOLLICULAR LYMPHOMA (FL): PRIMARY ANALYSIS OF A PHASE 1B/2 TRIAL. Hematol Oncol 2021. [DOI: 10.1002/hon.23_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)
- R. Bannerji
- Rutgers Cancer Institute of New Jersey Section of Hematologic Malignancies New Brunswick New Jersey USA
| | - S. Yuen
- The Calvary Mater Newcastle Hospital Waratah Australia
| | - T. Phillips
- University of Michigan Medical School, Division of Hematology and Oncology Ann Arbor USA
| | - C. Arthur
- Royal North Shore Hospital Sydney Australia
| | - I. Isufi
- Yale University, Smilow Cancer Hospital Section of Hematology New Haven USA
| | - P. Marlton
- Princess Alexandra Hospital and University of Queensland Department of Haematology Brisbane Australia
| | - J. F. Seymour
- Peter MacCallum Cancer Centre & Royal Melbourne Hospital Department of Haematology Melbourne Australia
| | - P. Corradini
- University of Milan, Istituto Nazionale dei Tumori Medical Oncology and Hematology Department Milan Italy
| | - A. Molinari
- AUSL Romagna Ospedale degli Infirmi Dirigente Medico Ematologia Rimini Italy
| | - G. Gritti
- ASST Papa Giovanni XXIII UOC Ematologia Bergamo Italy
| | - R. Emmons
- James Graham Brown Cancer Center Louisville USA
| | - J. Hirata
- Genentech, Inc. Product Development Oncology South San Francisco USA
| | - L. Musick
- Genentech, Inc. Product Development Oncology South San Francisco USA
| | - S. Saha
- F. Hoffmann‐La Roche Ltd Product Development Biometrics Welwyn Garden City UK
| | - B. Croft
- Genentech, Inc. Product Development Oncology South San Francisco USA
| | - C. Flowers
- M.D. Anderson Cancer Center Department of Lymphoma/Myeloma Houston USA
| |
Collapse
|
5
|
Campbell BA, Lasocki A, Oon SF, Bressel M, Goroncy N, Dwyer M, Wiltshire K, Seymour JF, Mason K, Tange D, Xu M, Wheeler G. Evaluation of the Impact of Magnetic Resonance Imaging with Susceptibility-weighted Imaging for Screening and Surveillance of Radiation-induced Cavernomas in Long-term Survivors of Malignancy. Clin Oncol (R Coll Radiol) 2021; 33:e425-e432. [PMID: 34024699 DOI: 10.1016/j.clon.2021.04.010] [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: 12/28/2020] [Revised: 03/25/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Abstract
AIMS Radiation-induced cavernomas (RIC) are common late toxicities in long-term survivors of malignancy following cerebral irradiation. However, the natural history of RIC is poorly described. We report the first series of long-term surveillance of RIC using modern magnetic resonance imaging (MRI) including highly sensitive susceptibility-weighted imaging (SWI). The aims of this research were to better characterise the natural history of RIC and investigate the utility of MRI-SWI for screening and surveillance. MATERIALS AND METHODS Eligibility required long-term survivors of malignancy with previous exposure to cerebral irradiation and RIC identified on MRI-SWI surveillance. The number and size of RIC were reported on Baseline MRI-SWI and last Follow-up MRI-SWI. RESULTS In total, 113 long-term survivors with RIC underwent MRI-SWI surveillance; 109 (96%) were asymptomatic at the time of RIC diagnosis. The median age at cerebral irradiation was 9.3 years; the median radiotherapy dose was 50.4 Gy. The median time from cerebral irradiation to Baseline MRI-SWI was 17.9 years. On Baseline MRI-SWI, RIC multiplicity was present in 89% of patients; 34% had >10 RIC; 65% had RIC ≥4 mm. The median follow-up from Baseline MRI-SWI was 7.3 years. On Follow-up MRI-SWI, 96% of patients had multiple RIC; 62% had >10 RIC; 72% had RIC ≥4 mm. Of the 109 asymptomatic patients at RIC diagnosis, 96% remained free from RIC-related symptoms at 10 years. Only two required neurosurgical intervention for RIC; there was no RIC-related mortality. CONCLUSIONS RIC are commonly multiple, asymptomatic and typically increase in size and number over time. Our findings suggest that MRI-SWI for screening of RIC is unlikely to influence longer term intervention in asymptomatic cancer survivors. In the absence of neurological symptoms, assessment or monitoring of RIC are insufficient indications for MRI-SWI surveillance for long-term survivors of malignancy with past exposure to cerebral irradiation.
Collapse
Affiliation(s)
- B A Campbell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.
| | - A Lasocki
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - S F Oon
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - M Bressel
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - N Goroncy
- Department of Cancer Nursing, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - M Dwyer
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - K Wiltshire
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - J F Seymour
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - K Mason
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia; Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - D Tange
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - M Xu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - G Wheeler
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Dreyling M, Ghielmini M, Rule S, Salles G, Ladetto M, Tonino SH, Herfarth K, Seymour JF, Jerkeman M. Newly diagnosed and relapsed follicular lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2021; 32:298-308. [PMID: 33249059 DOI: 10.1016/j.annonc.2020.11.008] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- M Dreyling
- Department of Medicine III, LMU Hospital Munich, Germany
| | - M Ghielmini
- Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - S Rule
- Haematology, Peninsula School of Medicine, Plymouth, UK
| | - G Salles
- Service d'Hématologie, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Lyon; Université Claude Bernard Lyon-1, Pierre-Benite, France
| | - M Ladetto
- Divisione di Ematologia, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - S H Tonino
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - K Herfarth
- Department of Radiation Oncology, University of Heidelberg, Germany
| | - J F Seymour
- Department of Haematology, Peter McCallum Cancer Center & Royal Melbourne Hospital, Melbourne, University of Melbourne, Parkville, Australia
| | - M Jerkeman
- Department of Oncology, Skåne University Hospital, Lund University, Lund, Sweden
| |
Collapse
|
7
|
Chin CK, Lim KJ, Lewis K, Jain P, Qing Y, Feng L, Cheah CY, Seymour JF, Ritchie D, Burbury K, Tam CS, Fowler NH, Fayad LE, Westin JR, Neelapu SS, Hagemeister FB, Samaniego F, Flowers CR, Nastoupil LJ, Dickinson MJ. Autologous stem cell transplantation for untreated transformed indolent B-cell lymphoma in first remission: an international, multi-centre propensity-score-matched study. Br J Haematol 2020; 191:806-815. [PMID: 33065767 DOI: 10.1111/bjh.17072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/12/2020] [Indexed: 11/30/2022]
Abstract
High-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) are used as consolidation in first remission (CR1) in some centres for untreated, transformed indolent B-cell lymphoma (Tr-iNHL) but the evidence base is weak. A total of 319 patients with untreated Tr-iNHL meeting prespecified transplant eligibility criteria [age <75, LVEF ≥45%, no severe lung disease, CR by positron emission tomography or computed tomography ≥3 months after at least standard cyclophosphamide, doxorubicin, vincristine and prednisolone with rituximab (R-CHOP) intensity front-line chemotherapy] were retrospectively identified. Non-diffuse large B-cell lymphoma transformations were excluded. About 283 (89%) patients had follicular lymphoma, 30 (9%) marginal-zone lymphoma and six (2%) other subtypes. Forty-nine patients underwent HDC/ASCT in CR1, and a 1:2 propensity-score-matched cohort of 98 patients based on age, stage and high-grade B-cell lymphoma with MYC, BCL2 and/or BCL6 rearrangements (HGBL-DH) was generated. After a median follow-up of 3·7 (range 0·1-18·3) years, ASCT was associated with significantly superior progression-free survival [hazard ratio (HR) 0·51, 0·27-0·98; P = 0·043] with a trend towards inferior overall survival (OS; HR 2·36;0·87-6·42; P = 0·1) due to more deaths from progressive disease (8% vs. 4%). Forty (41%) patients experienced relapse in the non-ASCT cohort - 15 underwent HDC/ASCT with seven (47%) ongoing complete remission (CR); 10 chimeric antigen receptor-modified T-cell (CAR-T) therapy with 6 (60%) ongoing CR; 3 allogeneic SCT with 2 (67%) ongoing CR. Although ASCT in CR1 improves initial duration of disease control in untreated Tr-iNHL, the impact on OS is less clear with effective salvage therapies in this era of CAR-T.
Collapse
Affiliation(s)
- C K Chin
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - K J Lim
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - K Lewis
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Australia.,Medical School, University of Western Australia, Nedlands, Australia
| | - P Jain
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y Qing
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Feng
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Australia.,Medical School, University of Western Australia, Nedlands, Australia
| | - J F Seymour
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - D Ritchie
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - K Burbury
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - C S Tam
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia.,St Vincent's Hospital Melbourne, Melbourne, Australia
| | - N H Fowler
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L E Fayad
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J R Westin
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S S Neelapu
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - F B Hagemeister
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - F Samaniego
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C R Flowers
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L J Nastoupil
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M J Dickinson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| |
Collapse
|
8
|
Maurer MJ, Habermann TM, Shi Q, Schmitz N, Cunningham D, Pfreundschuh M, Seymour JF, Jaeger U, Haioun C, Tilly H, Ghesquieres H, Merli F, Ziepert M, Herbrecht R, Flament J, Fu T, Flowers CR, Coiffier B. Progression-free survival at 24 months (PFS24) and subsequent outcome for patients with diffuse large B-cell lymphoma (DLBCL) enrolled on randomized clinical trials. Ann Oncol 2019; 29:1822-1827. [PMID: 29897404 DOI: 10.1093/annonc/mdy203] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Patients with diffuse large B-cell lymphoma treated with first-line anthracycline-based immunochemotherapy and remaining in remission at 2 years have excellent outcomes. This study assessed overall survival (OS) stratified by progression-free survival (PFS) at 24 months (PFS24) using individual patient data from patients with DLBCL enrolled in multi-center, international randomized clinical trials as part of the Surrogate Endpoint for Aggressive Lymphoma (SEAL) Collaboration. Patients and methods PFS24 was defined as being alive and PFS24 after study entry. OS from PFS24 was defined as time from identified PFS24 status until death due to any cause. OS was compared with each patient's age-, sex-, and country-matched general population using expected survival and standardized mortality ratios (SMRs). Results A total of 5853 patients enrolled in trials in the SEAL database received rituximab as part of induction therapy and were included in this analysis. The median age was 62 years (range 18-92), and 56% were greater than 60 years of age. At a median follow-up of 4.4 years, 1337 patients (23%) had disease progression, 1489 (25%) had died, and 5101 had sufficient follow-up to evaluate PFS24. A total of 1423 assessable patients failed to achieve PFS24 with a median OS of 7.2 months (95% CI 6.8-8.1) after progression; 5-year OS after progression was 19% and SMR was 32.1 (95% CI 30.0-34.4). A total of 3678 patients achieved PFS24; SMR after achieving PFS24 was 1.22 (95% CI 1.09-1.37). The observed OS versus expected OS at 3, 5, and 7 years after achieving PFS24 was 93.1% versus 94.4%, 87.6% versus 89.5%, and 80.0% versus 83.7%, respectively. Conclusion Patients treated with rituximab containing anthracycline-based immunochemotherapy on clinical trials who are alive without progression at 24 months from the onset of initial therapy have excellent outcomes with survival that is marginally lower but clinically indistinguishable from the age-, sex-, and country-matched background population for 7 years after achieving PFS24.
Collapse
Affiliation(s)
- M J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA.
| | | | - Q Shi
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - N Schmitz
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Hamburg, Germany
| | - D Cunningham
- Department of Medicine, The Royal Marsden Hospital, Surrey, UK
| | - M Pfreundschuh
- Internal Medicine I, University of the Saarland, Homberg, Germany
| | - J F Seymour
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - U Jaeger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - C Haioun
- Lymphoid Malignancies Unit, AP-HP Hôpital Henri Mondor, Créteil, France
| | - H Tilly
- Henri Becquerel Centre, University of Rouen, Rouen, France
| | - H Ghesquieres
- Department of Hematology, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - F Merli
- Hematology, Azienda Ospedaliera Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - M Ziepert
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - R Herbrecht
- Department of Oncology and Hematology, Hôpital de Hautepierre, Strasbourg, France
| | - J Flament
- Celgene Corporation, Boudry, Switzerland
| | - T Fu
- Celgene Corporation, Summit
| | - C R Flowers
- Department of Bone Marrow and Stem Cell Transplantation, Winship Cancer Institute of Emory University, Atlanta, USA
| | - B Coiffier
- Department of Hematology, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| |
Collapse
|
9
|
Rady K, Blombery P, Westerman DA, Wall M, Curtis M, Campbell LJ, Seymour JF. "Reversible" myelodysplastic syndrome or ineffectual clonal haematopoiesis? - add(6p) myeloid neoplasm with a spontaneous cytogenetic remission. Leuk Res 2018; 73:1-4. [PMID: 30170269 DOI: 10.1016/j.leukres.2018.08.010] [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: 05/11/2018] [Revised: 08/09/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022]
Abstract
Cytotoxic chemotherapy has inherent mutagenic potential and alters the bone marrow microenvironment after therapy. In some cases, this potentiates expansion of an aberrant clone and may lead to a therapy-related myeloid neoplasm if the clone overcomes selective pressure. We present the case of a 43-year-old woman diagnosed with an indolent, therapy-related myeloid neoplasm with an isolated chromosome 6p abnormality following treatment for de novo Acute Myeloid Leukaemia (AML), who manifest a sustained spontaneous cytogenetic remission two years later, possibly due to an ineffectual or non-dominant founding clone. This case reminds us to be mindful of the possibility that clonal haematopoiesis may not always equate to clinically relevant disease, even in the setting of an abnormal clonal karyotype.
Collapse
Affiliation(s)
- K Rady
- Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
| | - P Blombery
- Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
| | - D A Westerman
- Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; University of Melbourne, Parkville, VIC, Australia
| | - M Wall
- Victorian Cancer Cytogenetics Service, Fitzroy, VIC, Australia; Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, Australia; St Vincent's Institute of Medical Research, Fitzroy, VIC, Australia
| | - M Curtis
- Victorian Cancer Cytogenetics Service, Fitzroy, VIC, Australia
| | - L J Campbell
- Victorian Cancer Cytogenetics Service, Fitzroy, VIC, Australia
| | - J F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
10
|
Younes A, Hilden P, Coiffier B, Hagenbeek A, Salles G, Wilson W, Seymour JF, Kelly K, Gribben J, Pfreunschuh M, Morschhauser F, Schoder H, Zelenetz AD, Rademaker J, Advani R, Valente N, Fortpied C, Witzig TE, Sehn LH, Engert A, Fisher RI, Zinzani PL, Federico M, Hutchings M, Bollard C, Trneny M, Elsayed YA, Tobinai K, Abramson JS, Fowler N, Goy A, Smith M, Ansell S, Kuruvilla J, Dreyling M, Thieblemont C, Little RF, Aurer I, Van Oers MHJ, Takeshita K, Gopal A, Rule S, de Vos S, Kloos I, Kaminski MS, Meignan M, Schwartz LH, Leonard JP, Schuster SJ, Seshan VE. International Working Group consensus response evaluation criteria in lymphoma (RECIL 2017). Ann Oncol 2017; 28:1436-1447. [PMID: 28379322 PMCID: PMC5834038 DOI: 10.1093/annonc/mdx097] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Indexed: 12/20/2022] Open
Abstract
In recent years, the number of approved and investigational agents that can be safely administered for the treatment of lymphoma patients for a prolonged period of time has substantially increased. Many of these novel agents are evaluated in early-phase clinical trials in patients with a wide range of malignancies, including solid tumors and lymphoma. Furthermore, with the advances in genome sequencing, new "basket" clinical trial designs have emerged that select patients based on the presence of specific genetic alterations across different types of solid tumors and lymphoma. The standard response criteria currently in use for lymphoma are the Lugano Criteria which are based on [18F]2-fluoro-2-deoxy-D-glucose positron emission tomography or bidimensional tumor measurements on computerized tomography scans. These differ from the RECIST criteria used in solid tumors, which use unidimensional measurements. The RECIL group hypothesized that single-dimension measurement could be used to assess response to therapy in lymphoma patients, producing results similar to the standard criteria. We tested this hypothesis by analyzing 47 828 imaging measurements from 2983 individual adult and pediatric lymphoma patients enrolled on 10 multicenter clinical trials and developed new lymphoma response criteria (RECIL 2017). We demonstrate that assessment of tumor burden in lymphoma clinical trials can use the sum of longest diameters of a maximum of three target lesions. Furthermore, we introduced a new provisional category of a minor response. We also clarified response assessment in patients receiving novel immune therapy and targeted agents that generate unique imaging situations.
Collapse
Affiliation(s)
| | - P. Hilden
- Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - B. Coiffier
- Hematology, Université Lyon-1, Lyon-Sud Charles Mérieux, Lyon, France
| | - A. Hagenbeek
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - G. Salles
- Hematology, Université Lyon-1, Lyon-Sud Charles Mérieux, Lyon, France
| | - W. Wilson
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, USA
| | - J. F. Seymour
- Peter MacCallum Cancer Centre and University of Melbourne, Australia
| | - K. Kelly
- Pediatrics Department, Roswell-Park Cancer Institute, Buffalo, USA
| | - J. Gribben
- Department of Haemato-Oncology, Barts Cancer Institute, London, UK
| | - M. Pfreunschuh
- Department of Internal Medicine, Universität des Saarlandes, Homburg, Germany
| | - F. Morschhauser
- Department of Hematology, Université de Lille 2, Lille, France
| | - H. Schoder
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York
| | | | - J. Rademaker
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York
| | - R. Advani
- Department of Oncology, Stanford University, Stanford
| | | | | | | | - L. H. Sehn
- British Columbia Cancer Agency, Vancouver, Canada
| | - A. Engert
- Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | | | - P.-L. Zinzani
- Department of Hematology, University of Bologna, Bologna
| | - M. Federico
- Department of Diagnostic Medicine, University of Modena, Modena, Italy
| | - M. Hutchings
- Department of Hematology, University of Copenhagen, Denmark
| | - C. Bollard
- Children’s National Health System, Washington, USA
| | - M. Trneny
- Lymphoma and Stem Cell Transplantation Program, Charles University, Prague, Czech Republic
| | | | - K. Tobinai
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - J. S. Abramson
- Massachusetts General Hospital, Center for Lymphoma, Boston
| | - N. Fowler
- U.T. M.D.Anderson Cancer Center, Houston
| | - A. Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack
| | - M. Smith
- Cleveland Clinic, Cleveland, USA
| | | | - J. Kuruvilla
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - M. Dreyling
- Medicine Clinic III, Ludwig Maximilian University, Munich, Germany
| | | | - R. F. Little
- Divisions of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - I. Aurer
- Department of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | | | - A. Gopal
- Fred Hutchinson Cancer Research Center, Seattle, USA
| | - S. Rule
- Haematology Department, Plymouth University, UK
| | | | - I. Kloos
- Servier, Neuilly sur Seine, France
| | - M. S. Kaminski
- University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
| | - M. Meignan
- Nuclear Medicine, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - L. H. Schwartz
- Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York
| | - J. P. Leonard
- Weill Cornell Medicine and and New York Presbyterian Hospital, New York
| | - S. J. Schuster
- University of Pennsylvania School of Medicine, Philadelphia, USA
| | - V. E. Seshan
- Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, USA
| |
Collapse
|
11
|
Butler LA, Tam CS, Seymour JF. Dancing partners at the ball: Rational selection of next generation anti-CD20 antibodies for combination therapy of chronic lymphocytic leukemia in the novel agents era. Blood Rev 2017; 31:318-327. [PMID: 28499646 DOI: 10.1016/j.blre.2017.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/02/2017] [Indexed: 02/06/2023]
Abstract
The anti-CD20 antibodies represent a major advancement in the therapeutic options available for chronic lymphocytic leukemia. The addition of rituximab, ofatumumab and obinutuzumab to various chemotherapy regimens has led to considerable improvements in both response and survival. Ocaratuzumab, veltuzumab and ublituximab are currently being explored within the trial setting. We review the current status of these antibodies, and discuss how their mechanisms of action may impact on the choice of combinations with novel small molecule agents.
Collapse
Affiliation(s)
- L A Butler
- Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia; Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia
| | - C S Tam
- Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia; Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia; St. Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC 3065, Australia; Faculty of Medicine, University of Melbourne, Building 181, Grattan Street, Parkville, VIC 3052, Australia
| | - J F Seymour
- Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia; Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia; Faculty of Medicine, University of Melbourne, Building 181, Grattan Street, Parkville, VIC 3052, Australia.
| |
Collapse
|
12
|
Braude MR, Trubiano JA, Heriot A, Dickinson M, Carney D, Seymour JF, Tam CS. Disseminated visceral varicella zoster virus presenting with the constellation of colonic pseudo-obstruction, acalculous cholecystitis and syndrome of inappropriate ADH secretion. Intern Med J 2016; 46:238-9. [DOI: 10.1111/imj.12977] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/09/2015] [Accepted: 08/02/2015] [Indexed: 12/13/2022]
Affiliation(s)
- M. R. Braude
- General Medicine Department; St Vincent's Hospital Melbourne; Victoria Australia
| | - J. A. Trubiano
- Department of Infectious Diseases; Peter MacCallum Cancer Center; Victoria Australia
| | - A. Heriot
- Hematology Department; Peter MacCallum Cancer Center; East Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
| | - M. Dickinson
- Hematology Department; Peter MacCallum Cancer Center; East Melbourne Victoria Australia
| | - D. Carney
- Hematology Department; Peter MacCallum Cancer Center; East Melbourne Victoria Australia
| | - J. F. Seymour
- Hematology Department; Peter MacCallum Cancer Center; East Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
| | - C. S. Tam
- Hematology Department; Peter MacCallum Cancer Center; East Melbourne Victoria Australia
| |
Collapse
|
13
|
Byrne TJ, Riedel B, Ismail HM, Heriot A, Dauer R, Westerman D, Seymour JF, Kenchington K, Burbury K. Fast-track rapid warfarin reversal for elective surgery: extending the efficacy profile to high-risk patients with cancer. Anaesth Intensive Care 2016; 43:712-8. [PMID: 26603795 DOI: 10.1177/0310057x1504300608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/27/2022]
Abstract
Periprocedural management of patients on long-term warfarin therapy remains a common and important clinical issue, with little high-quality data to guide this complex process. The current accepted practice is cessation of warfarin five days preoperatively, but this is not without risk and can be complicated, particularly if bridging is required. An alternative method utilising low-dose intravenous vitamin K the day before surgery has been shown previously to be efficacious, safe and convenient in an elective surgical population receiving chronic warfarin therapy. The efficacy and utility of this 'fast-track' warfarin reversal protocol in surgical patients with cancer, who were at high risk of both thromboembolism and bleeding was investigated in a prospective, single-arm study at a dedicated cancer centre. Seventy-one patients underwent 82 episodes of fast-track warfarin reversal (3 mg intravenous vitamin K 18 to 24 hours before surgery). No patient suffered an adverse reaction to intravenous vitamin K, all but one achieved an International Normalized Ratio =1.5 on the day of surgery, and no surgery was deferred. Assays of vitamin K-dependent factor levels pre- and post-vitamin K demonstrated restoration of functional activity to within an acceptable range for surgical haemostasis. While this alternative method requires further validation in a larger prospective randomised study, we have now extended our use of fast-track warfarin reversal using vitamin K to patients with cancer, on the basis of our experience of its safety, convenience, reliability and efficacy.
Collapse
Affiliation(s)
- T J Byrne
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria
| | - B Riedel
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria
| | - H M Ismail
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria
| | - A Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria
| | - R Dauer
- Haematology laboratory, Division of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria
| | - D Westerman
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria
| | - J F Seymour
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria
| | - K Kenchington
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria
| | - K Burbury
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria
| |
Collapse
|
14
|
Jones K, Wockner L, Brennan RM, Keane C, Chattopadhyay PK, Roederer M, Price DA, Cole DK, Hassan B, Beck K, Gottlieb D, Ritchie DS, Seymour JF, Vari F, Crooks P, Burrows SR, Gandhi MK. The impact of HLA class I and EBV latency-II antigen-specific CD8(+) T cells on the pathogenesis of EBV(+) Hodgkin lymphoma. Clin Exp Immunol 2015; 183:206-20. [PMID: 26422112 PMCID: PMC4711160 DOI: 10.1111/cei.12716] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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] [Accepted: 09/22/2015] [Indexed: 12/20/2022] Open
Abstract
In 40% of cases of classical Hodgkin lymphoma (cHL), Epstein–Barr virus (EBV) latency‐II antigens [EBV nuclear antigen 1 (EBNA1)/latent membrane protein (LMP)1/LMP2A] are present (EBV+cHL) in the malignant cells and antigen presentation is intact. Previous studies have shown consistently that HLA‐A*02 is protective in EBV+cHL, yet its role in disease pathogenesis is unknown. To explore the basis for this observation, gene expression was assessed in 33 cHL nodes. Interestingly, CD8 and LMP2A expression were correlated strongly and, for a given LMP2A level, CD8 was elevated markedly in HLA‐A*02–versus HLA‐A*02+ EBV+cHL patients, suggesting that LMP2A‐specific CD8+ T cell anti‐tumoral immunity may be relatively ineffective in HLA‐A*02– EBV+cHL. To ascertain the impact of HLA class I on EBV latency antigen‐specific immunodominance, we used a stepwise functional T cell approach. In newly diagnosed EBV+cHL, the magnitude of ex‐vivo LMP1/2A‐specific CD8+ T cell responses was elevated in HLA‐A*02+ patients. Furthermore, in a controlled in‐vitro assay, LMP2A‐specific CD8+ T cells from healthy HLA‐A*02 heterozygotes expanded to a greater extent with HLA‐A*02‐restricted compared to non‐HLA‐A*02‐restricted cell lines. In an extensive analysis of HLA class I‐restricted immunity, immunodominant EBNA3A/3B/3C‐specific CD8+ T cell responses were stimulated by numerous HLA class I molecules, whereas the subdominant LMP1/2A‐specific responses were confined largely to HLA‐A*02. Our results demonstrate that HLA‐A*02 mediates a modest, but none the less stronger, EBV‐specific CD8+ T cell response than non‐HLA‐A*02 alleles, an effect confined to EBV latency‐II antigens. Thus, the protective effect of HLA‐A*02 against EBV+cHL is not a surrogate association, but reflects the impact of HLA class I on EBV latency‐II antigen‐specific CD8+ T cell hierarchies.
Collapse
Affiliation(s)
- K Jones
- Blood Cancer Research, University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia.,Clinical Immunohaematology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - L Wockner
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - R M Brennan
- Cellular Immunology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - C Keane
- Blood Cancer Research, University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia.,Clinical Immunohaematology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Department of Haematology, Princess Alexandra Hospital, Brisbane, Australia
| | - P K Chattopadhyay
- ImmunoTechnology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - M Roederer
- ImmunoTechnology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - D A Price
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.,Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - D K Cole
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - B Hassan
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - K Beck
- Tissue Engineering and Reparative Dentistry, Cardiff University School of Dentistry, Cardiff, UK
| | - D Gottlieb
- Blood and Marrow Transplant Service, Westmead Hospital, Sydney, Australia
| | - D S Ritchie
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - J F Seymour
- University of Melbourne, Melbourne, Australia
| | - F Vari
- Blood Cancer Research, University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
| | - P Crooks
- Blood Cancer Research, University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
| | - S R Burrows
- Cellular Immunology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - M K Gandhi
- Blood Cancer Research, University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia.,Clinical Immunohaematology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Department of Haematology, Princess Alexandra Hospital, Brisbane, Australia
| |
Collapse
|
15
|
|
16
|
Cheah CY, Chihara D, Romaguera JE, Fowler NH, Seymour JF, Hagemeister FB, Champlin RE, Wang ML. Patients with mantle cell lymphoma failing ibrutinib are unlikely to respond to salvage chemotherapy and have poor outcomes. Ann Oncol 2015; 26:1175-1179. [PMID: 25712454 DOI: 10.1093/annonc/mdv111] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [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: 12/18/2014] [Accepted: 02/18/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although ibrutinib is highly effective in patients with relapsed/refractory mantle cell lymphoma (MCL), a substantial proportion of patients have resistant disease. The subsequent outcomes of such patients are unknown. PATIENTS AND METHODS We carried out a retrospective review of all patients with MCL treated with ibrutinib at MD Anderson Cancer Center between January 2011 and January 2014 using pharmacy and clinical databases. Patients who had discontinued ibrutinib for any reason were included in the study. RESULTS We identified 42 patients with MCL who discontinued therapy due to disease progression on treatment (n = 28), toxicity (n = 6), elective stem-cell transplant in remission (n = 4) or withdrawn consent (n = 4). The median age was 69 years, 35 (83%) were male; the median number of prior treatments was 2 (range 1-8) and the median time from initial diagnosis of MCL to commencing ibrutinib was 3.0 (range 0.5-15.5) years. Patients had received a median of 6.5 (range 1-43) cycles of ibrutinib. Among 31 patients who experienced disease progression following ibrutinib and underwent salvage therapy, the overall and complete response rates were 32% and 19%, respectively. After a median follow-up of 10.7 (range 2.4-38.9) months from discontinuation of ibrutinib, the median overall survival (OS) among patients with disease progression was 8.4 months. By univariate analysis, elevated serum lactate dehydrogenase at progression was associated with inferior OS. CONCLUSION The outcome of patients with MCL who experience disease progression following ibrutinib therapy is poor, with both low response rates to salvage therapy and short duration of responses. Further studies to better understand and overcome ibrutinib resistance are urgently needed.
Collapse
Affiliation(s)
- C Y Cheah
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, USA
| | - D Chihara
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, USA
| | - J E Romaguera
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, USA
| | - N H Fowler
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, USA
| | - J F Seymour
- Department of Haematology, Peter MacCallum Cancer Center, Melbourne; Department of Haematology, University of Melbourne, Melbourne, Australia
| | - F B Hagemeister
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, USA
| | - R E Champlin
- Department of Stem Cell Transplantation, University of Texas MD Anderson Cancer Center, Houston, USA
| | - M L Wang
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, USA.
| |
Collapse
|
17
|
Cheah CY, Herbert KE, O'Rourke K, Kennedy GA, George A, Fedele PL, Gilbertson M, Tan SY, Ritchie DS, Opat SS, Prince HM, Dickinson M, Burbury K, Wolf M, Januszewicz EH, Tam CS, Westerman DA, Carney DA, Harrison SJ, Seymour JF. A multicentre retrospective comparison of central nervous system prophylaxis strategies among patients with high-risk diffuse large B-cell lymphoma. Br J Cancer 2014; 111:1072-9. [PMID: 25072255 PMCID: PMC4453849 DOI: 10.1038/bjc.2014.405] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/04/2014] [Accepted: 06/23/2014] [Indexed: 01/17/2023] Open
Abstract
Background: Central nervous system (CNS) relapse in diffuse large B-cell lymphoma (DLBCL) is a devastating complication; the optimal prophylactic strategy remains unclear. Methods: We performed a multicentre, retrospective analysis of patients with DLBCL with high risk for CNS relapse as defined by two or more of: multiple extranodal sites, elevated serum LDH and B symptoms or involvement of specific high-risk anatomical sites. We compared three different strategies of CNS-directed therapy: intrathecal (IT) methotrexate (MTX) with (R)-CHOP ‘group 1' R-CHOP with IT MTX and two cycles of high-dose intravenous (IV) MTX ‘group 2' dose-intensive systemic antimetabolite-containing chemotherapy (Hyper-CVAD or CODOXM/IVAC) with IT/IV MTX ‘group 3'. Results: Overall, 217 patients were identified (49, 125 and 43 in groups 1–3, respectively). With median follow-up of 3.4 (range 0.2–18.6) years, 23 CNS relapses occurred (12, 10 and 1 in groups 1–3 respectively). The 3-year actuarial rates (95% CI) of CNS relapse were 18.4% (9.5–33.1%), 6.9% (3.5–13.4%) and 2.3% (0.4–15.4%) in groups 1–3, respectively (P=0.009). Conclusions: The addition of high-dose IV MTX and/or cytarabine was associated with lower incidence of CNS relapse compared with IT chemotherapy alone. However, these data are limited by their retrospective nature and warrant confirmation in prospective randomised studies.
Collapse
Affiliation(s)
- C Y Cheah
- 1] Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - K E Herbert
- 1] Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia [3] Cabrini Medical Centre, Malvern, Victoria, Australia
| | - K O'Rourke
- Department of Haematology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - G A Kennedy
- 1] Department of Haematology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia [2] University of Queensland, St Lucia, Queensland, Australia
| | - A George
- Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia
| | - P L Fedele
- Department of Haematology, Monash Health, Clayton, Victoria, Australia
| | - M Gilbertson
- 1] Department of Haematology, Monash Health, Clayton, Victoria, Australia [2] Department of Haematology, Monash University, Clayton, Victoria, Australia
| | - S Y Tan
- Department of Haematology, Monash Health, Clayton, Victoria, Australia
| | - D S Ritchie
- 1] Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - S S Opat
- 1] Department of Haematology, Monash Health, Clayton, Victoria, Australia [2] Department of Haematology, Monash University, Clayton, Victoria, Australia
| | - H M Prince
- 1] Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia [3] Cabrini Medical Centre, Malvern, Victoria, Australia [4] Department of Haematology, Monash University, Clayton, Victoria, Australia
| | - M Dickinson
- 1] Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - K Burbury
- 1] Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - M Wolf
- 1] Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia [3] Cabrini Medical Centre, Malvern, Victoria, Australia
| | - E H Januszewicz
- Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia
| | - C S Tam
- 1] Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - D A Westerman
- 1] Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - D A Carney
- 1] Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - S J Harrison
- 1] Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - J F Seymour
- 1] Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
18
|
Herbert KE, Demosthenous L, Wiesner G, Link E, Westerman DA, Came N, Ritchie DS, Harrison S, Seymour JF, Prince HM. Plerixafor plus pegfilgrastim is a safe, effective mobilization regimen for poor or adequate mobilizers of hematopoietic stem and progenitor cells: a phase I clinical trial. Bone Marrow Transplant 2014; 49:1056-62. [PMID: 24887382 DOI: 10.1038/bmt.2014.112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 03/05/2014] [Accepted: 03/25/2014] [Indexed: 01/18/2023]
Abstract
The safety, kinetics and efficacy of plerixafor+pegfilgrastim for hematopoietic stem and progenitor cell (HSPC) mobilization are poorly understood. We treated 12 study patients (SP; lymphoma n=10 or myeloma n=2) with pegfilgrastim (6 mg SC stat D1) and plerixafor (0.24 mg/kg SC nocte from D3). Six SP were 'predicted poor-mobilizers' and six were 'predicted adequate-mobilizers'. Peripheral blood (PB) CD34(+) monitoring commenced on D3. Apheresis commenced on D4. Comparison was with 22 historical controls (HC; lymphoma n=18, myeloma n=4; poor mobilizers n=4), mobilized with pegfilgrastim alone. Eight (67%) SP had PB CD34(+) count ⩽5 × 10(6)/L D3 post pegfilgrastim; all SP surpassed this threshold the morning after plerixafor. In SP, PBCD34(+) counts peaked D4 6/12 (50%), remaining ⩾5 × 10(6)/L for 4 days in 8/12 (67%). All SP successfully yielded target cell numbers (⩾2 × 10(6)/kg) within four aphereses. After maximum four aphereses, median total CD34+ yield was higher in SP than HC; 8.0 (range 2.4-12.9) vs 4.8 (0.4-14.0) × 10(6)/kg (P=0.04). Seven of twelve (58%) SP achieved target yield after one apheresis. Flow cytometry revealed no tumor cells in PB or apheresis product of SP. Plerixafor+pegfilgrastim was well tolerated with bone pain (n=2), diarrhoea (n=2) and facial paraesthesiae (n=3). Plerixafor+pegfilgrastim is a simple, safe and effective HSPC mobilization regimen in myeloma and lymphoma, in both poor and good mobilizers, and is superior to pegfilgrastim alone.
Collapse
Affiliation(s)
- K E Herbert
- Department of Haematology, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, Australia
| | - L Demosthenous
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - G Wiesner
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - E Link
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - D A Westerman
- Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - N Came
- Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - D S Ritchie
- 1] Department of Haematology, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, Australia [2] Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - S Harrison
- 1] Department of Haematology, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, Australia [2] Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - J F Seymour
- 1] Department of Haematology, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, Australia [2] Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - H M Prince
- 1] Department of Haematology, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, Australia [2] Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
19
|
Kiss N, Seymour JF, Prince HM, Dutu G. Challenges and outcomes of a randomized study of early nutrition support during autologous stem-cell transplantation. ACTA ACUST UNITED AC 2014; 21:e334-9. [PMID: 24764716 DOI: 10.3747/co.21.1820] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients undergoing myeloablative conditioning regimens and autologous stem-cell transplantation (asct) are at high risk of malnutrition. This randomized study aimed to determine if early nutrition support (commenced when oral intake is less than 80% of estimated requirements) compared with usual care (commenced when oral intake is less than 50% of estimated requirements) reduces weight loss in well-nourished patients undergoing high-nutritional-risk conditioning chemotherapy and asct. In the 50 well-nourished patients who were randomized, the outcomes evaluated included changes in weight and lean body mass (mid-upper arm circumference), length of stay, time to hemopoietic engraftment, and quality of life (Memorial Symptom Assessment Scale - Short Form). On secondary analysis, after exclusion of a single extreme outlier, both groups demonstrated significant weight loss over time (p = 0.0005). Weight loss was less in the early nutrition support group at time of discharge (mean: -0.4% ± 2.9% vs. -3.4% ± 2.6% in the usual care group, p = 0.001). This difference in weight was no longer observed at 6 months after discharge (mean: -1.0% ± 6.8% vs. 1.4% ± 6.1%, p = 0.29). In practice, an early start to nutrition support proved difficult because of patient resistance and physician preference, with 8 patients (33%) in the control group and 4 (15%) in the intervention group not commencing nutrition support when stipulated by the study protocol. No significant differences between the groups were found for other outcomes. In well-nourished patients receiving asct, early nutrition support maintained weight during admission, but did not affect other outcomes. Interpretation of results should take into consideration the difficulties encountered with intervention implementation.
Collapse
Affiliation(s)
- N Kiss
- Nutrition Department, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - J F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, Australia. ; University of Melbourne, East Melbourne, Australia
| | - H M Prince
- Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, Australia. ; University of Melbourne, East Melbourne, Australia
| | - G Dutu
- Centre for Biostatistics and Clinical Trials, East Melbourne, Australia
| |
Collapse
|
20
|
Bird RJ, Kenealy M, Forsyth C, Wellwood J, Leahy MF, Seymour JF, To LB. When should iron chelation therapy be considered in patients with myelodysplasia and other bone marrow failure syndromes with iron overload? Intern Med J 2013; 42:450-5. [PMID: 22498118 DOI: 10.1111/j.1445-5994.2012.02734.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite the absence of a robust evidence base, there is growing consensus that effective treatment of iron overload leads to decreased morbidity and premature mortality in patients with good prognosis myelodysplastic syndromes (MDSs). Furthermore, new treatment modalities, including disease-modifying therapies (lenalidamide and azacytidine) and reduced intensity conditioning therapies for allogeneic blood stem cell transplants, are offering the prospect of longer survival for patients with traditionally less favourable prognosis MDS, who might also benefit from iron chelation. This article proposes assessment of patients with MDS and related bone marrow failure syndromes to determine suitability for iron chelation. Iron chelation therapy options and monitoring are discussed.
Collapse
Affiliation(s)
- R J Bird
- Pathology Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
| | | | | | | | | | | | | |
Collapse
|
21
|
Cheah CY, Hofman MS, Dickinson M, Wirth A, Westerman D, Harrison SJ, Burbury K, Wolf M, Januszewicz H, Herbert K, Prince HM, Carney DA, Ritchie DS, Hicks RJ, Seymour JF. Limited role for surveillance PET-CT scanning in patients with diffuse large B-cell lymphoma in complete metabolic remission following primary therapy. Br J Cancer 2013; 109:312-7. [PMID: 23807169 PMCID: PMC3721385 DOI: 10.1038/bjc.2013.338] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [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: 02/27/2013] [Revised: 05/14/2013] [Accepted: 06/10/2013] [Indexed: 11/19/2022] Open
Abstract
Background: The usefulness of positron emission tomography with computed tomography (PET–CT) in the surveillance of patients with diffuse large B-cell lymphoma (DLBCL) in complete metabolic remission after primary therapy is not well studied. Methods: We performed a retrospective review of our database between 2002 and 2009 for patients with de novo DLBCL who underwent surveillance PET–CT after achieving complete metabolic response (CMR) following primary therapy. Results: Four-hundred and fifty scans were performed in 116 patients, with a median follow-up of 53 (range 8–133) months from completion of therapy. Thirteen patients (11%) relapsed: seven were suspected clinically and six were subclinical (all within first 18 months). The positive predictive value in patients with international prognostic index (IPI) <3 was 56% compared with 80% in patients with IPI⩾3. Including indeterminate scans, PET–CT retained high sensitivity 95% and specificity 97% for relapse. Conclusion: Positron emission tomography with computed tomography is not useful in patients for the majority of patients with diffuse large B-cell lymphoma in CMR after primary therapy, with the possible exception of patients with baseline IPI ⩾3 in the 18 months following completion of primary therapy. This issue could be addressed by a prospective clinical trial.
Collapse
Affiliation(s)
- C Y Cheah
- Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Herbert KE, Gambell P, Link EK, Mouminoglu A, Wall DM, Harrison SJ, Ritchie DS, Seymour JF, Prince HM. Pegfilgrastim compared with filgrastim for cytokine-alone mobilization of autologous haematopoietic stem and progenitor cells. Bone Marrow Transplant 2012; 48:351-6. [PMID: 22858510 DOI: 10.1038/bmt.2012.145] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Haematopoietic stem and progenitor cells (HSPC) mobilization, using cytokine-alone, is a well-tolerated regimen with predictable mobilization kinetics. Single-dose pegfilgrastim mobilizes HSPC efficiently; however, there is surprisingly little comparative data on its use without chemotherapy for HSPC mobilization. Pegfilgrastim-alone and filgrastim-alone mobilization regimens were compared in 52 patients with haematological malignancy. Pegfilgrastim 12 mg (n=20) or 6 mg (n=2) was administered Day 1 (D1) in 22 patients (lymphoma n=17; myeloma n=5). Thirty historical controls (lymphoma n=18; myeloma n=12) received filgrastim 10 mcg/kg daily from D1. Peripheral blood (PB) CD34(+) counts reached threshold (5 × 10(6)/L) and apheresis commenced on D4(4-5) and D4(4-6). Median PB CD34(+) cell count on D1 of apheresis was similar (26.0 × 10(6)/L (2.5-125.0 × 10(6)/L) and 16.2 × 10(6)/L (2.6-50.7 × 10(6)/L); P=0.06), for pegfilgrastim and filgrastim groups, respectively. Target yield (2 × 10(6) per kg CD34(+) cells) was collected in 20/22 (91%) pegfilgrastim patients and 24/30 (80%) in the filgrastim group (P=0.44), in a similar median number of aphereses (3(1-4) versus 3(2-6), respectively; P=0.85). A higher proportion of pegfilgrastim patients tended to yield 4 × 10(6) per kg CD34(+) cells; 16/22 (73%) versus 14/30 (47%) filgrastim patients (P=0.09). One pegfilgrastim patient developed hyperleukocytosis that resolved without incident. Pegfilgrastim-alone is a simple, well-tolerated, and attractive option for outpatient-based HSPC mobilization with similar mobilization kinetics and efficacy to regular filgrastim.
Collapse
Affiliation(s)
- K E Herbert
- Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Cheah CY, Carney DA, Lim SM, Januszewicz H, Scarlett J, Seymour JF. Local experience with the novel human anti-CD20 antibody, ofatumumab, as salvage treatment for patients with heavily pretreated chronic lymphocytic leukaemia. Intern Med J 2012; 42:846-8. [PMID: 22805693 DOI: 10.1111/j.1445-5994.2012.02827.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
MESH Headings
- Aged
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antigens, CD20/immunology
- Diagnosis, Differential
- Disease-Free Survival
- Erythrocyte Transfusion
- Female
- Follow-Up Studies
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Lymphocytosis/drug therapy
- Lymphocytosis/immunology
- Male
- Middle Aged
- Salvage Therapy/methods
Collapse
|
24
|
Campbell BA, Hornby C, Cunninghame J, Burns M, MacManus M, Ryan G, Lau E, Seymour JF, Wirth A. Minimising critical organ irradiation in limited stage Hodgkin lymphoma: a dosimetric study of the benefit of involved node radiotherapy. Ann Oncol 2012; 23:1259-1266. [PMID: 21980193 DOI: 10.1093/annonc/mdr439] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Chemotherapy plus radiotherapy is the standard of care for patients with limited stage Hodgkin lymphoma (HL). Radiotherapy is evolving from involved field radiotherapy (IFRT) to involved node radiotherapy (INRT) to decrease radiotherapy-related morbidity. In the absence of long-term toxicity data, dose-volume metrics of organs at risk (OAR) provide a surrogate measure of toxicity risk. PATIENTS AND METHODS Ten female patients with stage I-IIA supradiaphragmatic HL were randomly selected. All patients had pre-chemotherapy computerised tomography (CT) and CT-positron emission tomography staging. Using CT planning, three radiotherapy plans were produced per patient: (i) IFRT, (ii) INRT using parallel-opposed beams and (iii) INRT using volumetric modulated arc therapy (VMAT). Radiotherapy dose was 30.6 Gy in 1.8 Gy fractions. OAR evaluated were lungs, breasts, thyroid, heart and coronary arteries. RESULTS Compared with IFRT, INRT significantly reduced mean doses to lungs (P < 0.01), breasts (P < 0.01), thyroid (P < 0.01) and heart (P < 0.01), on Wilcoxon testing. Compared with conventional INRT, VMAT improved dose conformality but increased low-dose radiation exposure to lungs and breasts. VMAT reduced the heart volume receiving 30 Gy (V30) by 85%. CONCLUSIONS Reduction from IFRT to INRT decreased the volumes of lungs, breasts and thyroid receiving high-dose radiation, suggesting the potential to reduce long-term second malignancy risks. VMAT may be useful for patients with pre-existing heart disease by minimising further cardiac toxicity risks.
Collapse
Affiliation(s)
- B A Campbell
- Department of Radiation Oncology and Cancer Imaging.
| | | | | | | | - M MacManus
- Department of Radiation Oncology and Cancer Imaging
| | - G Ryan
- Department of Radiation Oncology and Cancer Imaging
| | - E Lau
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne; Department of Radiology, University of Melbourne, Parkville
| | - J F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne; Department of Medicine, University of Melbourne, Parkville, Australia
| | - A Wirth
- Department of Radiation Oncology and Cancer Imaging
| |
Collapse
|
25
|
van der Jagt A, Muirhead J, Seymour JF, Bradstock KF, Paul E, Wei A. Risk factors for early death after high-dose cytosine arabinoside (HiDAC)-based chemotherapy for adult AML. Leukemia 2011; 26:362-5. [DOI: 10.1038/leu.2011.201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
26
|
Lee RJ, Leung C, Lim EJ, Angus PW, Bhathal PS, Crowley P, Gonzales M, Stella D, Seymour JF, Speer AG. Liver transplantation in an adult with sclerosing cholangitis due to multisystem Langerhans cell histiocytosis. Am J Transplant 2011; 11:1755-6. [PMID: 21797977 DOI: 10.1111/j.1600-6143.2011.03661.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
27
|
Lingaratnam S, Slavin MA, Mileshkin L, Solomon B, Burbury K, Seymour JF, Sharma R, Koczwara B, Kirsa SW, Davis ID, Prince M, Szer J, Underhill C, Morrissey O, Thursky KA. An Australian survey of clinical practices in management of neutropenic fever in adult cancer patients 2009. Intern Med J 2011; 41:110-20. [DOI: 10.1111/j.1445-5994.2010.02342.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
28
|
Lingaratnam S, Slavin MA, Koczwara B, Seymour JF, Szer J, Underhill C, Prince M, Mileshkin L, O'Reilly M, Kirsa SW, Bennett CA, Davis ID, Morrissey O, Thursky KA. Introduction to the Australian consensus guidelines for the management of neutropenic fever in adult cancer patients, 2010/2011. Intern Med J 2011; 41:75-81. [DOI: 10.1111/j.1445-5994.2010.02338.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
29
|
Carney DA, Westerman DA, Tam CS, Milner A, Prince HM, Kenealy M, Wolf M, Januszewicz EH, Ritchie D, Came N, Seymour JF. Therapy-related myelodysplastic syndrome and acute myeloid leukemia following fludarabine combination chemotherapy. Leukemia 2010; 24:2056-62. [DOI: 10.1038/leu.2010.218] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
30
|
Hallek M, Fischer K, Fingerle-Rowson G, Fink AM, Busch R, Mayer J, Hensel M, Hopfinger G, Hess G, von Grünhagen U, Bergmann M, Catalano J, Zinzani PL, Caligaris-Cappio F, Seymour JF, Berrebi A, Jäger U, Cazin B, Trneny M, Westermann A, Wendtner CM, Eichhorst BF, Staib P, Bühler A, Winkler D, Zenz T, Böttcher S, Ritgen M, Mendila M, Kneba M, Döhner H, Stilgenbauer S. Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open-label, phase 3 trial. Lancet 2010; 376:1164-74. [PMID: 20888994 DOI: 10.1016/s0140-6736(10)61381-5] [Citation(s) in RCA: 1269] [Impact Index Per Article: 90.6] [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: 01/19/2023]
Abstract
BACKGROUND On the basis of promising results that were reported in several phase 2 trials, we investigated whether the addition of the monoclonal antibody rituximab to first-line chemotherapy with fludarabine and cyclophosphamide would improve the outcome of patients with chronic lymphocytic leukaemia. METHODS Treatment-naive, physically fit patients (aged 30-81 years) with CD20-positive chronic lymphocytic leukaemia were randomly assigned in a one-to-one ratio to receive six courses of intravenous fludarabine (25 mg/m(2) per day) and cyclophosphamide (250 mg/m(2) per day) for the first 3 days of each 28-day treatment course with or without rituximab (375 mg/m(2) on day 0 of first course, and 500 mg/m(2) on day 1 of second to sixth courses) in 190 centres in 11 countries. Investigators and patients were not masked to the computer-generated treatment assignment. The primary endpoint was progression-free survival (PFS). Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00281918. FINDINGS 408 patients were assigned to fludarabine, cyclophosphamide, and rituximab (chemoimmunotherapy group) and 409 to fludarabine and cyclophosphamide (chemotherapy group); all patients were analysed. At 3 years after randomisation, 65% of patients in the chemoimmunotherapy group were free of progression compared with 45% in the chemotherapy group (hazard ratio 0·56 [95% CI 0·46-0·69], p<0·0001); 87% were alive versus 83%, respectively (0·67 [0·48-0·92]; p=0·01). Chemoimmunotherapy was more frequently associated with grade 3 and 4 neutropenia (136 [34%] of 404 vs 83 [21%] of 396; p<0·0001) and leucocytopenia (97 [24%] vs 48 [12%]; p<0·0001). Other side-effects, including severe infections, were not increased. There were eight (2%) treatment-related deaths in the chemoimmunotherapy group compared with ten (3%) in the chemotherapy group. INTERPRETATION Chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab improves progression-free survival and overall survival in patients with chronic lymphocytic leukaemia. Moreover, the results suggest that the choice of a specific first-line treatment changes the natural course of chronic lymphocytic leukaemia. FUNDING F Hoffmann-La Roche.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Disease Progression
- Disease-Free Survival
- Drug Administration Schedule
- Female
- Humans
- Immunologic Factors/administration & dosage
- Incidence
- Kaplan-Meier Estimate
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukopenia/chemically induced
- Male
- Middle Aged
- Neutropenia/chemically induced
- Rituximab
- Severity of Illness Index
- Treatment Outcome
- Vidarabine/administration & dosage
- Vidarabine/analogs & derivatives
Collapse
Affiliation(s)
- M Hallek
- Department I of Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Gore S, Fenaux P, Santini V, Bennett JM, Silverman LR, Seymour JF, Hellstrom-Lindberg E, Swern AS, Beach CL, List AF. Time-dependent decision analysis: Stable disease in azacitidine (AZA)-treated patients (pts) with higher-risk MDS. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
32
|
Salles GA, Seymour JF, Feugier P, Offner F, Lopez-Guillermo A, Bouabdallah R, Pedersen LM, Brice P, Belada D, Xerri L. Rituximab maintenance for 2 years in patients with untreated high tumor burden follicular lymphoma after response to immunochemotherapy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
33
|
Mufti GJ, Herman JG, Gore S, Seymour JF, Santini V, Hagemeijer AM, Skikne B, MacBeth KJ, Lucy LM, Beach CL. Gene methylation and cytogenetic abnormalities in patients (pts) with higher-risk myelodysplastic syndromes. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
34
|
Martinelli G, Ryan G, Seymour JF, Nassi L, Steffanoni S, Alietti A, Calabrese L, Pruneri G, Santoro L, Kuper-Hommel M, Tsang R, Zinzani PL, Taghian A, Zucca E, Cavalli F. Primary follicular and marginal-zone lymphoma of the breast: clinical features, prognostic factors and outcome: a study by the International Extranodal Lymphoma Study Group. Ann Oncol 2009; 20:1993-9. [PMID: 19570964 DOI: 10.1093/annonc/mdp238] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
MESH Headings
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Breast Neoplasms, Male/diagnosis
- Breast Neoplasms, Male/pathology
- Breast Neoplasms, Male/therapy
- Female
- Humans
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Male
- Prognosis
- Treatment Outcome
Collapse
Affiliation(s)
- G Martinelli
- Division of Haematology, European Institute of Oncology, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Grigg AP, Bashford J, Seymour JF, Shuttleworth P, Norris D, Hertzberg M, Gill D, Waugh M, Saal R, Marlton P. Autografting followed by rituximab for chemosensitive mantle cell lymphoma: A pilot study and literature review. Leuk Lymphoma 2009; 46:851-60. [PMID: 16019529 DOI: 10.1080/10428190500052461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Mantle cell lymphoma (MCL) is rarely cured with either conventional-dose chemotherapy or autografting. Recent evidence suggests that anti-CD20 monoclonal antibody therapy (rituximab) in combination with chemotherapy may improve the response rate. We report a pilot study of autografting using busulfan-melphalan conditioning followed by rituximab in 9 patients (median age 52 years) with chemosensitive MCL. Rituximab was given for 4 doses of 375 mg/m(2) between 4 and 10 weeks post-transplant. Three of 5 patients autografted after induction therapy remain alive in clinical and molecular complete remission at 33-50 months post-transplant. Only 1 of 4 patients autografted after relapse remains in complete remission. Two of the 3 patients with persistent marrow molecular positivity post-autograft became negative after rituximab therapy. Molecular negativity was first observed in 2 patients only after rituximab therapy. Overall, 2 patients have relapsed and the remaining 3 died of late-onset respiratory failure, probably reflecting infection and/or aggressive conditioning in an older patient population. These preliminary results, together with a review of the literature, suggest that the combination of autografting and rituximab may lead to durable molecular remissions in patients with chemosensitive MCL. Further studies are required to clarify whether the administration of rituximab: (1) is optimal pre- or post-autograft and (2) impacts on the incidence of infection and idiopathic pneumonitis in this context.
Collapse
Affiliation(s)
- A P Grigg
- Department of Clinical Haematology and Medical Oncology, Royal Melbourne Hospital, Victoria, Australia.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Mason KD, Khaw SL, Rayeroux KC, Chew E, Lee EF, Fairlie WD, Grigg AP, Seymour JF, Szer J, Huang DCS, Roberts AW. The BH3 mimetic compound, ABT-737, synergizes with a range of cytotoxic chemotherapy agents in chronic lymphocytic leukemia. Leukemia 2009; 23:2034-41. [DOI: 10.1038/leu.2009.151] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
37
|
Gill S, Carney D, Ritchie D, Wolf M, Westerman D, Prince HM, Januszewicz H, Seymour JF. The frequency, manifestations, and duration of prolonged cytopenias after first-line fludarabine combination chemotherapy. Ann Oncol 2009; 21:331-334. [PMID: 19625344 DOI: 10.1093/annonc/mdp297] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fludarabine-based chemoimmunotherapy has well-recognised efficacy and short-term toxicity in the treatment of lymphoid malignancies. However, the presence and significance of prolonged cytopenias after completion of treatment have not been thoroughly quantified. METHODS Sixty-one patients receiving initial therapy with fludarabine-based regimens were categorised according to the presence of post-treatment cytopenias (haemoglobin <110-130 g/l depending on sex and age, neutrophils <2.0 x 10(9)/l, or platelets <140 x 10(9)/l) lasting >3 months. RESULTS Persistent cytopenias unrelated to persistent disease were found in 43% of patients. Cytopenias were associated with clinically important rates of infection and transfusion requirement (P = 0.03) and predicted for worse overall survival (61% versus 96% at 60 months, P = 0.05). Increasing age predicted for persistent cytopenias (P = 0.02), but the presence of pretreatment cytopenias and delivered dose intensity were not predictive. The median times to resolution of anaemia, neutropenia, and thrombocytopenia were 7, 9, and 10 months, respectively. CONCLUSIONS Cytopenias often persist >3 months after first-line fludarabine combination therapy and can lead to important clinical sequelae. Although cytopenias generally resolve over time, treating physicians should be aware of these factors when considering fludarabine combination chemotherapy and when documenting treatment response status in chronic lymphocytic leukaemia.
Collapse
Affiliation(s)
- S Gill
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre
| | - D Carney
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre
| | - D Ritchie
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - M Wolf
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre
| | - D Westerman
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre
| | - H M Prince
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - H Januszewicz
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre
| | - J F Seymour
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
| |
Collapse
|
38
|
Biagi JJ, Herbert KE, Smith C, Abdi E, Leahy M, Falkson C, Wolf M, Januszewicz H, Seymour JF, Richards K, Matthews JP, Dale B, Prince HM. A phase II study of dexamethasone, ifosfamide, cisplatin and etoposide (DICE) as salvage chemotherapy for patients with relapsed and refractory lymphoma. Leuk Lymphoma 2009; 46:197-206. [PMID: 15621802 DOI: 10.1080/10428190400014884] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The 4-day combination of dexamethasone, ifosfamide, cisplatin, and etoposide (DICE) is a salvage regimen for lymphoma. We report a prospective phase II multi-center trial of a modified DICE regimen in relapsed or refractory Hodgkin (HL) or non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL), constituting a single day of intravenous administration followed by 3 days of oral administration, aimed at reducing inpatient days without losing efficacy. Forty patients (median age 56, range 25 - 79) were included: 28 (70%) NHL, 9 (23%) HL and 3 (8%) CLL. Fifty-three per cent had received 2 prior treatment regimens. International Prognostic Index (IPI) was 2 in 75% of NHL patients. Patients aged 55 and those with previous autologous stem cell transplantation (ASCT) started on a lower-dose regimen, with dose escalation possible in 2 patients. Overall response rate was 41%. Thirty-eight per cent of patients had stable disease. With a median of 3.1 years of follow-up, estimated progression-free survival (PFS) and overall survival (OS) rates at 3 years were 15% and 43% respectively. OS was longer in the < 55 compared to the 55 age cohort (P = 0.0091), longer for HL than NHL (P = 0.59 and 0.039 respectively) and longer for Low/Low-Int IPI than High/High-Int IPI (P = 0.0074 and 0.0009 respectively). Median duration of inpatient stay was 3 days. There were no treatment-related deaths. In conclusion, this modification of DICE is an effective and well tolerated salvage regimen, even in this poor prognosis group of patients. Further clinical studies of DICE in first relapse and in older patients, possibly with the addition of rituximab, are warranted.
Collapse
Affiliation(s)
- J J Biagi
- Department of Hematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
This study describes a case of extra-nodal marginal zone lymphoma presenting in skeletal muscle and recurring on multiple occasions in the same tissue at other sites. In this case, 18F-fluoro-deoxy-glucose positron emission tomography scanning was the most useful surveillance modality.
Collapse
Affiliation(s)
- S I Gill
- Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | | | | | | |
Collapse
|
40
|
Fenaux P, Mufti GJ, Hellström-Lindberg E, Santini V, Gattermann N, Sanz G, List AF, Gore SD, Seymour JF, Backstrom J, Zimmerman L, McKenzie D, Beach CL, Silverman LB. Azacitidine prolongs overall survival and reduces infections and hospitalizations in patients with WHO-defined acute myeloid leukaemia compared with conventional care regimens: an update. Ecancermedicalscience 2008; 2:121. [PMID: 22275991 PMCID: PMC3234073 DOI: 10.3332/ecancer.2008.121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 11/01/2008] [Indexed: 11/26/2022] Open
Abstract
Azacitidine (AZA), as demonstrated in the phase III trial (AZA-001), is the first MDS treatment to significantly prolong overall survival (OS) in higher risk MDS pts ((2007) Blood110 817). Approximately, one-third of the patients (pts) enrolled in AZA-001 were FAB RAEB-T (≥20–30% blasts) and now meet the WHO criteria for acute myeloid leukaemia (AML) ((1999) Blood17 3835). Considering the poor prognosis (median survival <1 year) and the poor response to chemotherapy in these pts, this sub-group analysis evaluated the effects of AZA versus conventional care regimens (CCR) on OS and on response rates in pts with WHO AML.
Collapse
Affiliation(s)
- P Fenaux
- Hôpital Avicenne, Université Paris 13, Bobigny, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Silverman LR, Fenaux P, Mufti GJ, Santini V, Hellström-Lindberg E, Gattermann N, Sanz G, List AF, Gore SD, Seymour JF, Backstrom J, McKenzie D, Beach CL. The effects of continued azacitidine treatment cycles on response in higher risk patients with myelodysplastic syndromes: an update. Ecancermedicalscience 2008; 2:118. [PMID: 22275990 PMCID: PMC3234059 DOI: 10.3332/ecancer.2008.118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Indexed: 12/02/2022] Open
Abstract
The international, phase III, multi-centre AZA-001 trial demonstrated azacitidine (AZA) is the first treatment to significantly extend overall survival (OS) in higher risk myelodysplastic syndromes (MDS) patients (Fenaux (2007) Blood110 817). The current treatment paradigm, which is based on a relationship between complete remission (CR) and survival, is increasingly being questioned (Cheson (2006) Blood108 419). Results of AZA-001 show CR is sufficient but not necessary to prolong OS (List (2008) Clin Oncol26 7006). Indeed, the AZA CR rate in AZA-001 was modest (17%), while partial remission (PR, 12%) and haematological improvement (HI, 49%) were also predictive of prolonged survival. This analysis was conducted to assess the median number of AZA treatment cycles associated with achievement of first response, as measured by IWG 2000-defined CR, PR or HI (major + minor). The number of treatment cycles from first response to best response was also measured.
Collapse
Affiliation(s)
- L R Silverman
- Division of Hematology, Mount Sinai School of Medicine, New York, NY, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Dickinson M, Prince HM, Kirsa S, Zannettino A, Gibbs SDJ, Mileshkin L, O'Grady J, Seymour JF, Szer J, Horvath N, Joshua DE. Osteonecrosis of the jaw complicating bisphosphonate treatment for bone disease in multiple myeloma: an overview with recommendations for prevention and treatment. Intern Med J 2008; 39:304-16. [PMID: 19220531 DOI: 10.1111/j.1445-5994.2008.01824.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Osteonecrosis of the Jaw (ONJ) is a recently recognised and potentially highly morbid complication of bisphosphonate therapy in the setting of metastatic malignancy, including myeloma. Members of the Medical and Scientific Advisory Group of the Myeloma Foundation of Australia formulated guidelines for the management of bisphosphonates around the issue of ONJ, based on the best available evidence in June 2008. Prior to commencement of therapy, patients should have an oral health assessment and be educated about the risks of ONJ. Dental assessment should occur 6 monthly during therapy. If tooth extraction is required, sufficient time should be allowed for complete healing to occur prior to commencement of bisphosphonate. As the risk of ONJ increases with duration of bisphosphonate therapy, we recommend annual assessment of dose with modification to 3 monthly i.v. therapy or to oral therapy with clodronate for those with all but the highest risk of skeletal-related event. Established ONJ should be managed conservatively; a bisphosphonate "drug holiday" is usually indicated and invasive surgery should generally be avoided. These recommendations will assist with clinical decision making for myeloma patients who are at risk of bisphosphonate-associated ONJ.
Collapse
Affiliation(s)
- M Dickinson
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Thursky KA, Playford EG, Seymour JF, Sorrell TC, Ellis DH, Guy SD, Gilroy N, Chu J, Shaw DR. Recommendations for the treatment of established fungal infections. Intern Med J 2008; 38:496-520. [PMID: 18588522 DOI: 10.1111/j.1445-5994.2008.01725.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Evidence-based guidelines for the treatment of established fungal infections in the adult haematology/oncology setting were developed by a national consensus working group representing clinicians, pharmacists and microbiologists. These updated guidelines replace the previous guidelines published in the Internal Medicine Journal by Slavin et al. in 2004. The guidelines are pathogen-specific and cover the treatment of the most common fungal infections including candidiasis, aspergillosis, cryptococcosis, zygomycosis, fusariosis, scedosporiosis, and dermatophytosis. Recommendations are provided for management of refractory disease or salvage therapies, and special sites of infections such as the cerebral nervous system and the eye. Because of the widespread use newer broad-spectrum triazoles in prophylaxis and empiric therapy, these guidelines should be implemented in concert with the updated prophylaxis and empiric therapy guidelines published by this group.
Collapse
Affiliation(s)
- K A Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre and St Vincent's Hospital, Melbourne, VIC.
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Santini V, Fenaux P, Mufti GJ, Hellström-Lindberg E, List AF, Silverman LR, Seymour JF, Backstrom J, McKenzie D, Beach CL. Patient outcome measures during prolonged survival in patients (Pts) with high-risk myelodysplastic syndromes (MDS) treated with azacitidine (AZA). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.7028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
45
|
Mufti GJ, Fenaux P, Hellstrom-Lindberg E, Santini V, List AF, Gore S, Seymour JF, Silverman LR, Backstrom J, Beach CL. Treatment of high-risk MDS patients (pts) with -7/del(7q) with azacitidine (AZA) versus conventional care regimens (CCR): Effects on overall survival (OS). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.7033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
46
|
Westerman DA, Burbury KL, Gambell P, Came N, Seymour JF, Prince HM. Immunophenotyping by flow-cyotmetry in MDS and its potential role in remission assessment post treatment. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.18008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
47
|
Carson KR, Evens AM, Gordon LI, Seymour JF, Rosen ST, Gottardi-Littell N, Muro K, Richey E, Bennett CL. Rituximab and progressive multifocal leukoencephalopathy: A report of 35 cases. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
48
|
Hellstrom-Lindberg E, Fenaux P, Mufti GJ, List AF, Santini V, Gore S, Seymour JF, Backstrom J, McKenzie D, Beach CL. Relationship of progression to acute myeloid leukemia (AML) from myelodysplastic syndrome (MDS) and cytogenetic status. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.7089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
49
|
Bishton MJ, Hicks RJ, Westerman DA, Prince MH, Wolf M, Seymour JF. A prospective study of the separate predictive capabilities of 18[F]-FDG-PET and molecular response in patients with relapsed indolent non-Hodgkin's lymphoma following treatment with iodine-131-rituximab radio-immunotherapy. Haematologica 2008; 93:789-90. [DOI: 10.3324/haematol.12253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
50
|
Ryan G, Martinelli G, Kuper-Hommel M, Tsang R, Pruneri G, Yuen K, Roos D, Lennard A, Devizzi L, Crabb S, Hossfeld D, Pratt G, Dell'Olio M, Choo SP, Bociek RG, Radford J, Lade S, Gianni AM, Zucca E, Cavalli F, Seymour JF. Primary diffuse large B-cell lymphoma of the breast: prognostic factors and outcomes of a study by the International Extranodal Lymphoma Study Group. Ann Oncol 2007; 19:233-41. [PMID: 17932394 DOI: 10.1093/annonc/mdm471] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary diffuse large B-cell lymphoma (DLBCL) of breast is rare. We aimed to define clinical features, prognostic factors, patterns of failure, and treatment outcomes. PATIENTS AND METHODS A retrospective international study of 204 eligible patients presenting to the International Extranodal Lymphoma Study Group-affiliated institutions from 1980 to 2003. RESULTS Median age was 64 years, with 95% of patients presenting with unilateral disease. Median overall survival (OS) was 8.0 years, and median progression-free survival 5.5 years. In multifactor analysis, favourable International Prognostic Index score, anthracycline-containing chemotherapy, and radiotherapy (RT) were significantly associated with longer OS (each P < or = 0.03). There was no benefit from mastectomy, as opposed to biopsy or lumpectomy only. At a median follow-up time of 5.5 years, 37% of patients had progressed--16% in the same or contralateral breast, 5% in the central nervous system, and 14% in other extranodal sites. CONCLUSIONS The combination of limited surgery, anthracycline-containing chemotherapy, and involved-field RT produced the best outcome in the pre-rituximab era. A prospective trial on the basis of these results should be pursued to confirm these observations and to determine whether the impact of rituximab on the patterns of relapse and outcome parallels that of DLBCL presenting at other sites.
Collapse
Affiliation(s)
- G Ryan
- Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|