1
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Pietka G, De Lord C, Matthias G, Cheung B, Atwal S, Furtado M, Cullis J, Grey-Davies L, Narayanan S, McGregor A, Kilner M, Bosworth J, McMullin MF, Coats T, Parcharidou A, Cavenagh J, Byrne J, Iyengar S, Mohammed K, Cross N, Hubank M, Ribeiro S, Khorashad J, Wren D, O'Connor S, Taussig D. Capture-based targeted sequencing using a T-cell control in myeloid malignancies and idiopathic cytopenias. Br J Haematol 2024; 204:1325-1334. [PMID: 38462984 DOI: 10.1111/bjh.19377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/30/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024]
Abstract
We report on a study of next-generation sequencing in 257 patients undergoing investigations for cytopenias. We sequenced bone marrow aspirates using a target enrichment panel comprising 82 genes and used T cells from paired blood as a control. One hundred and sixty patients had idiopathic cytopenias, 81 had myeloid malignancies and 16 had lymphoid malignancies or other diagnoses. Forty-seven of the 160 patients with idiopathic cytopenias had evidence of somatic pathogenic variants consistent with clonal cytopenias. Only 39 genes of the 82 tested were mutated in the 241 patients with either idiopathic cytopenias or myeloid neoplasms. We confirm that T cells can be used as a control to distinguish between germline and somatic variants. The use of paired analysis with a T-cell control significantly reduced the time molecular scientists spent reporting compared to unpaired analysis. We identified somatic variants of uncertain significance (VUS) in a higher proportion (24%) of patients with myeloid malignancies or clonal cytopenias compared to less than 2% of patients with non-clonal cytopenias. This suggests that somatic VUS are indicators of a clonal process. Lastly, we show that blood depleted of lymphocytes can be used in place of bone marrow as a source of material for sequencing.
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Affiliation(s)
- Grzegorz Pietka
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
- Department of Translational Research, Royal Marsden Hospital NHS Trust, London, UK
| | - Corinne De Lord
- Department of Haematology, St Helier Hospital, London, UK
- Department of Haematology, Royal Marsden Hospital NHS Trust, London, UK
| | - Gwynn Matthias
- Department of Haematology, Queen Alexandra Hospital, Portsmouth, UK
| | - Betty Cheung
- Department of Haematology, Croydon University Hospital, London, UK
| | - Sangeeta Atwal
- Department of Haematology, Kingston Hospital NHS Foundation Trust, London, UK
| | - Michelle Furtado
- Department of Haematology, Royal Cornwall Hospitals NHS Foundation Trust, Cornwall, Truro, UK
| | - Jonathan Cullis
- Department of Haematology, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Liz Grey-Davies
- Department of Haematology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | | | - Andrew McGregor
- Department of Haematology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Mari Kilner
- Department of Haematology, Northumbria Healthcare NHS Foundation Trust, Tyneside, UK
| | - Jenny Bosworth
- Department of Haematology, St Helier Hospital, London, UK
- Department of Haematology, Royal Marsden Hospital NHS Trust, London, UK
| | | | - Thomas Coats
- Department of Haematology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Jamie Cavenagh
- Department of Haematology, St Bartholomew's Hospital, London, UK
| | - Jenny Byrne
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sunil Iyengar
- Department of Haematology, Royal Marsden Hospital NHS Trust, London, UK
| | - Kabir Mohammed
- Department of Statistics, Royal Marsden Hospital NHS Trust, London, UK
| | - Nicholas Cross
- Faculty of Medicine, University of Southampton, Southampton, UK
- Wessex Genomics Laboratory Service, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Mike Hubank
- Department of Translational Research, Royal Marsden Hospital Sutton, London, UK
- Division of Molecular Pathology, Clinical Genomics (Research), Institute of Cancer Research, London, UK
| | - Sara Ribeiro
- Department of Molecular Pathology, Royal Marsden Hospital Sutton, London, UK
| | - Jamshid Khorashad
- Department of Molecular Pathology, Royal Marsden Hospital Sutton, London, UK
| | - Dorte Wren
- Department of Molecular Pathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Simon O'Connor
- Department of Histopathology, Royal Marsden NHS Foundation Trust, London, UK
| | - David Taussig
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
- Department of Haematology, Royal Marsden Hospital NHS Trust, London, UK
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2
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Kulasekararaj A, Cavenagh J, Dokal I, Foukaneli T, Gandhi S, Garg M, Griffin M, Hillmen P, Ireland R, Killick S, Mansour S, Mufti G, Potter V, Snowden J, Stanworth S, Zuha R, Marsh J. Guidelines for the diagnosis and management of adult aplastic anaemia: A British Society for Haematology Guideline. Br J Haematol 2024; 204:784-804. [PMID: 38247114 DOI: 10.1111/bjh.19236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/26/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024]
Abstract
Pancytopenia with hypocellular bone marrow is the hallmark of aplastic anaemia (AA) and the diagnosis is confirmed after careful evaluation, following exclusion of alternate diagnosis including hypoplastic myelodysplastic syndromes. Emerging use of molecular cyto-genomics is helpful in delineating immune mediated AA from inherited bone marrow failures (IBMF). Camitta criteria is used to assess disease severity, which along with age and availability of human leucocyte antigen compatible donor are determinants for therapeutic decisions. Supportive care with blood and platelet transfusion support, along with anti-microbial prophylaxis and prompt management of opportunistic infections remain key throughout the disease course. The standard first-line treatment for newly diagnosed acquired severe/very severe AA patients is horse anti-thymocyte globulin and ciclosporin-based immunosuppressive therapy (IST) with eltrombopag or allogeneic haemopoietic stem cell transplant (HSCT) from a matched sibling donor. Unrelated donor HSCT in adults should be considered after lack of response to IST, and up front for young adults with severe infections and a readily available matched unrelated donor. Management of IBMF, AA in pregnancy and in elderly require special attention. In view of the rarity of AA and complexity of management, appropriate discussion in multidisciplinary meetings and involvement of expert centres is strongly recommended to improve patient outcomes.
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Affiliation(s)
- Austin Kulasekararaj
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
| | - Jamie Cavenagh
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Inderjeet Dokal
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London and Barts Health NHS Trust, London, UK
| | - Theodora Foukaneli
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- NHS Blood and Transplant, Bristol, UK
| | - Shreyans Gandhi
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
| | - Mamta Garg
- Leicester Royal Infirmary, Leicester, UK
- British Society Haematology Task Force Representative, London, UK
| | | | | | - Robin Ireland
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
| | - Sally Killick
- University Hospitals Dorset NHS Foundation Trust, The Royal Bournemouth Hospital, Bournemouth, UK
| | - Sahar Mansour
- St George's Hospital/St George's University of London, London, UK
| | - Ghulam Mufti
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
| | - Victoria Potter
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
| | - John Snowden
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Simon Stanworth
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford and NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Roslin Zuha
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, England
| | - Judith Marsh
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
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3
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de Tute RM, Cook G, Cairns DA, Brown JM, Cavenagh J, Ashcroft AJ, Snowden JA, Yong K, Tholouli E, Jenner M, Hockaday A, Drayson MT, Morris TCM, Rawstron AC, Owen RG. Impact of minimal residual disease (MRD) in salvage autologous stem cell transplantation for relapsed myeloma: results from the NCRI Myeloma X (intensive) trial. Bone Marrow Transplant 2024; 59:431-434. [PMID: 38195983 DOI: 10.1038/s41409-023-02164-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/12/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024]
Affiliation(s)
- Ruth M de Tute
- Haematological Malignancy Diagnostic Service, Leeds Teaching Hospitals Trust, Leeds, UK.
| | - Gordon Cook
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - David A Cairns
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Julia M Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jamie Cavenagh
- Department of Haematology, Barts & The London NHS Trust, London, UK
| | | | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust & Department of Endocrinology & Metabolism, University of Sheffield, Sheffield, UK
| | - Kwee Yong
- Department of Haematology, University College London, London, UK
| | - Eleni Tholouli
- Department of Clinical Haematology, Manchester Royal Infirmary, Manchester Foundation Trust, Manchester, UK
| | - Matthew Jenner
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Anna Hockaday
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy University of Birmingham, Birmingham, UK
| | | | - Andy C Rawstron
- Haematological Malignancy Diagnostic Service, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Roger G Owen
- Haematological Malignancy Diagnostic Service, Leeds Teaching Hospitals Trust, Leeds, UK
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4
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Russell NH, Wilhelm-Benartzi C, Othman J, Dillon R, Knapper S, Batten LM, Canham J, Hinson EL, Betteridge S, Overgaard UM, Gilkes A, Potter N, Mehta P, Kottaridis P, Cavenagh J, Hemmaway C, Arnold C, Freeman SD, Dennis M. Fludarabine, Cytarabine, Granulocyte Colony-Stimulating Factor, and Idarubicin With Gemtuzumab Ozogamicin Improves Event-Free Survival in Younger Patients With Newly Diagnosed AML and Overall Survival in Patients With NPM1 and FLT3 Mutations. J Clin Oncol 2024:JCO2300943. [PMID: 38215358 DOI: 10.1200/jco.23.00943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/07/2023] [Accepted: 10/20/2023] [Indexed: 01/14/2024] Open
Abstract
PURPOSE To determine the optimal induction chemotherapy regimen for younger adults with newly diagnosed AML without known adverse risk cytogenetics. PATIENTS AND METHODS One thousand thirty-three patients were randomly assigned to intensified (fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin [FLAG-Ida]) or standard (daunorubicin and Ara-C [DA]) induction chemotherapy, with one or two doses of gemtuzumab ozogamicin (GO). The primary end point was overall survival (OS). RESULTS There was no difference in remission rate after two courses between FLAG-Ida + GO and DA + GO (complete remission [CR] + CR with incomplete hematologic recovery 93% v 91%) or in day 60 mortality (4.3% v 4.6%). There was no difference in OS (66% v 63%; P = .41); however, the risk of relapse was lower with FLAG-Ida + GO (24% v 41%; P < .001) and 3-year event-free survival was higher (57% v 45%; P < .001). In patients with an NPM1 mutation (30%), 3-year OS was significantly higher with FLAG-Ida + GO (82% v 64%; P = .005). NPM1 measurable residual disease (MRD) clearance was also greater, with 88% versus 77% becoming MRD-negative in peripheral blood after cycle 2 (P = .02). Three-year OS was also higher in patients with a FLT3 mutation (64% v 54%; P = .047). Fewer transplants were performed in patients receiving FLAG-Ida + GO (238 v 278; P = .02). There was no difference in outcome according to the number of GO doses, although NPM1 MRD clearance was higher with two doses in the DA arm. Patients with core binding factor AML treated with DA and one dose of GO had a 3-year OS of 96% with no survival benefit from FLAG-Ida + GO. CONCLUSION Overall, FLAG-Ida + GO significantly reduced relapse without improving OS. However, exploratory analyses show that patients with NPM1 and FLT3 mutations had substantial improvements in OS. By contrast, in patients with core binding factor AML, outcomes were excellent with DA + GO with no FLAG-Ida benefit.
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Affiliation(s)
- Nigel H Russell
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Jad Othman
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
| | - Richard Dillon
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
| | - Steven Knapper
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Leona M Batten
- Centre for Trials Research, Cardiff University, Cardiff, United Kindgom
| | - Joanna Canham
- Centre for Trials Research, Cardiff University, Cardiff, United Kindgom
| | - Emily L Hinson
- Centre for Trials Research, Cardiff University, Cardiff, United Kindgom
| | - Sophie Betteridge
- Centre for Trials Research, Cardiff University, Cardiff, United Kindgom
| | | | - Amanda Gilkes
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Nicola Potter
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
| | - Priyanka Mehta
- University Hospitals of Bristol and Weston NHS Trust, Bristol, United Kingdom
| | | | - Jamie Cavenagh
- Department of Haematology, St Bartholomew's Hospital, London, United Kingdom
| | | | | | - Sylvie D Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Mike Dennis
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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5
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Othman J, Wilhelm-Benartzi C, Dillon R, Knapper S, Freeman SD, Batten LM, Canham J, Hinson EL, Wych J, Betteridge S, Villiers W, Kleeman M, Gilkes A, Potter N, Overgaard UM, Mehta P, Kottaridis P, Cavenagh J, Hemmaway C, Arnold C, Dennis M, Russell NH. A randomized comparison of CPX-351 and FLAG-Ida in adverse karyotype AML and high-risk MDS: the UK NCRI AML19 trial. Blood Adv 2023; 7:4539-4549. [PMID: 37171402 PMCID: PMC10425682 DOI: 10.1182/bloodadvances.2023010276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023] Open
Abstract
Liposomal daunorubicin and cytarabine (CPX-351) improved overall survival (OS) compared with 7+3 chemotherapy in older patients with secondary acute myeloid leukemia (AML); to date, there have been no randomized studies in younger patients. The high-risk cohort of the UK NCRI AML19 trial (ISRCTN78449203) compared CPX-351 with FLAG-Ida in younger adults with newly diagnosed adverse cytogenetic AML or high-risk myelodysplastic syndromes (MDS). A total of 189 patients were randomized (median age, 56 years). Per clinical criteria, 49% of patients had de novo AML, 20% had secondary AML, and 30% had high-risk MDS. MDS-related cytogenetics were present in 73% of the patients, with a complex karyotype in 49%. TP53 was the most common mutated gene, in 43%. Myelodysplasia-related gene mutations were present in 75 (44%) patients. The overall response rate (CR + CRi) after course 2 was 64% and 76% for CPX-351 and FLAG-Ida, respectively. There was no difference in OS (13.3 months vs 11.4 months) or event-free survival in multivariable analysis. However, relapse-free survival was significantly longer with CPX-351 (median 22.1 vs 8.35 months). There was no difference between the treatment arms in patients with clinically defined secondary AML or those with MDS-related cytogenetic abnormalities; however, an exploratory subgroup of patients with MDS-related gene mutations had significantly longer OS with CPX-351 (median 38.4 vs 16.3 months). In conclusion, the OS of younger patients with adverse risk AML/MDS was not significantly different between CPX-351 and FLAG-Ida.
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Affiliation(s)
- Jad Othman
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Richard Dillon
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Steve Knapper
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Sylvie D. Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Leona M. Batten
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Joanna Canham
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Emily L. Hinson
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Julie Wych
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Sophie Betteridge
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - William Villiers
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
| | - Michelle Kleeman
- Genomics Facility, NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, United Kingdom
| | - Amanda Gilkes
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Nicola Potter
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
| | | | - Priyanka Mehta
- Bristol Haematology and Oncology Centre, University Hospitals of Bristol and Weston NHS Trust, Bristol, United Kingdom
| | | | - Jamie Cavenagh
- Department of Haemato-Oncology, Barts Health NHS Trust, St Bartholomew’s Hospital, London, United Kingdom
| | - Claire Hemmaway
- Department of Haematology, Auckland Hospital, Auckland, New Zealand
| | - Claire Arnold
- Clinical Haematology, Belfast City Hospital, Belfast, Northern Ireland
| | - Mike Dennis
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Nigel H. Russell
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - UK National Cancer Research Institute Acute Myeloid Leukaemia Working Group
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
- School of Medicine, Cardiff University, Cardiff, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
- Genomics Facility, NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, United Kingdom
- Copenhagen University Hospital, Copenhagen, Denmark
- Bristol Haematology and Oncology Centre, University Hospitals of Bristol and Weston NHS Trust, Bristol, United Kingdom
- Department of Haematology, University College Hospital, London, United Kingdom
- Department of Haemato-Oncology, Barts Health NHS Trust, St Bartholomew’s Hospital, London, United Kingdom
- Department of Haematology, Auckland Hospital, Auckland, New Zealand
- Clinical Haematology, Belfast City Hospital, Belfast, Northern Ireland
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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6
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Chan WY, Counsell N, de Tute R, De-Silva D, Phillips EH, Cavenagh J, Adedayo T, Braganca N, Roddie C, Streetly M, Schey S, Koh MBC, Crowe J, Morris TC, Cook G, Clifton-Hadley L, Rabin N, Owen RG, Popat R, Yong KL. Outcomes of relapse in patients with deferred autologous stem cell transplant after achieving at least very good partial response following bortezomib, adriamycin, dexamethasone chemotherapy for newly diagnosed multiple myeloma in the phase II PADIMAC trial. Br J Haematol 2021; 196:e33-e37. [PMID: 34636043 DOI: 10.1111/bjh.17903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Wei Yee Chan
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Elizabeth H Phillips
- Cancer Research UK & UCL Cancer Trials Centre, London, UK.,Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester, UK
| | | | - Toyin Adedayo
- Cancer Research UK & UCL Cancer Trials Centre, London, UK
| | | | - Claire Roddie
- University College London Hospitals NHS Foundation Trust, London, UK.,UCL Cancer Institute, London, UK
| | | | | | | | | | | | - Gordon Cook
- Leeds Cancer Centre and Leeds Institute of Clinical Trials Research, Leeds, UK
| | | | - Neil Rabin
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Rakesh Popat
- University College London Hospitals NHS Foundation Trust, London, UK.,UCL Cancer Institute, London, UK
| | - Kwee L Yong
- University College London Hospitals NHS Foundation Trust, London, UK.,UCL Cancer Institute, London, UK
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7
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Yong KL, Hinsley S, Auner HW, Bygrave C, Kaiser MF, Ramasamy K, De Tute RM, Sherratt D, Flanagan L, Garg M, Hawkins S, Williams C, Cavenagh J, Rabin NK, Croft J, Morgan G, Davies F, Owen RG, Brown SR. Carfilzomib or bortezomib in combination with cyclophosphamide and dexamethasone followed by carfilzomib maintenance for patients with multiple myeloma after one prior therapy: results from a multi-centre, phase II, randomized, controlled trial (MUK five). Haematologica 2021; 106:2694-2706. [PMID: 33910333 PMCID: PMC8485692 DOI: 10.3324/haematol.2021.278399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Indexed: 11/28/2022] Open
Abstract
The proteasome inhibitors, carfilzomib and bortezomib, are widely used to treat myeloma but head-to-head comparisons have produced conflicting results. We compared the activity of these proteasome inhibitors in combination with cyclophosphamide and dexamethasone (KCd vs. VCd) in second-line treatment using fixed duration therapy and evaluated the efficacy of carfilzomib maintenance. MUKfive was a phase II controlled, parallel group trial that randomized patients (2:1) to KCd (n=201) or VCd (n=99); responding patients on carfilzomib were randomized to maintenance carfilzomib (n=69) or no further treatment (n=72). Primary endpoints were: (i) very good partial response (non-inferiority, odds ratio [OR] 0.8) at 24 weeks, and (ii) progression-free survival. More participants achieved a very good partial response or better with carfilzomib than with bortezomib (40.2% vs. 31.9%, OR=1.48, 90% confidence interval [CI]: 0.95, 2.31; non-inferior), with a trend for particular benefit in patients with adverse-risk disease. KCd was associated with higher overall response (partial response or better, 84.0% vs. 68.1%, OR=2.72, 90% CI: 1.62, 4.55, P=0.001). Neuropathy (grade ≥3 or ≥2 with pain) was more common with bortezomib (19.8% vs. 1.5%, P<0.0001), while grade ≥3 cardiac events and hypertension were only reported in the KCd arm (3.6% each). The median progression-free survival in the KCd arm was 11.7 months vs. 10.2 months in the VCd arm (hazard ratio [HR]=0.95, 80% CI: 0.77, 1.18). Carfilzomib maintenance was associated with longer progression-free survival, median 11.9 months vs. 5.6 months for no maintenance (HR 0.59, 80% CI: 0.46-0.77, P=0.0086). When used as fixed duration therapy in first relapase, KCd is at least as effective as VCd, and carfilzomib is an effective maintenance agent. This trial was registered with International Standard Randomised Controlled Trial Number (ISRCTN) identifier: ISRCTN17354232.
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Affiliation(s)
- Kwee L Yong
- Cancer Institute, University College London, London.
| | - Samantha Hinsley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds
| | - Holger W Auner
- Department of Immunology and Inflammation and The Hugh and Josseline Langmuir Centre for Myeloma Research, Imperial College London, London
| | - Ceri Bygrave
- Cardiff and Vale University Health Board, Cardiff
| | - Martin F Kaiser
- The Institute of Cancer Research, London, UK and The Royal Marsden Hospital NHS Foundation Trust, London
| | - Karthik Ramasamy
- Department of Clinical Haematology, Oxford University Hospitals NHS Trust, Oxford
| | - Ruth M De Tute
- Department of Clinical Haematology, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Debbie Sherratt
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds
| | - Louise Flanagan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds
| | - Mamta Garg
- Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester
| | | | - Catherine Williams
- Centre for Clinical Haematology, Nottingham University Hospitals, Nottingham
| | - Jamie Cavenagh
- Department of Haematology, St Bartholomew's Hospital, London
| | - Neil K Rabin
- Department of Haematology, University College Hospital, London
| | - James Croft
- The Institute of Cancer Research, London, UK and The Royal Marsden Hospital NHS Foundation Trust, London
| | - Gareth Morgan
- Perlmutter Cancer Center, NYU Langone Health, New York
| | - Faith Davies
- Perlmutter Cancer Center, NYU Langone Health, New York
| | - Roger G Owen
- Haematological Malignancy Diagnostic Service (HMDS), St James's University Hospital, Leeds
| | - Sarah R Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds
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8
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Jurgensen-Rauch A, Gibbs S, Farrell M, Aries J, Grantham M, Eccersley L, Gribben J, Hallam S, Oakervee H, Cavenagh J, Davies J, Sive J. Reduced intensity allogeneic hematopoietic stem cell transplantation is a safe and effective treatment option in high-risk myeloma patients - a single centre experience. Br J Haematol 2021; 193:420-423. [PMID: 33713421 DOI: 10.1111/bjh.17379] [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] [Received: 11/08/2020] [Accepted: 02/03/2021] [Indexed: 01/23/2023]
Affiliation(s)
- Amanda Jurgensen-Rauch
- Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Suzanne Gibbs
- Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Maresa Farrell
- Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - James Aries
- Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Marianne Grantham
- Department of Cytogenetics and Molecular Haematology, Barts Health NHS Trust, London, UK
| | - Lydia Eccersley
- Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - John Gribben
- Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Simon Hallam
- Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Heather Oakervee
- Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Jamie Cavenagh
- Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Jeff Davies
- Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Jonathan Sive
- Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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9
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Dillon R, Hills R, Freeman S, Potter N, Jovanovic J, Ivey A, Kanda AS, Runglall M, Foot N, Valganon M, Khwaja A, Cavenagh J, Smith M, Ommen HB, Overgaard UM, Dennis M, Knapper S, Kaur H, Taussig D, Mehta P, Raj K, Novitzky-Basso I, Nikolousis E, Danby R, Krishnamurthy P, Hill K, Finnegan D, Alimam S, Hurst E, Johnson P, Khan A, Salim R, Craddock C, Spearing R, Gilkes A, Gale R, Burnett A, Russell NH, Grimwade D. Molecular MRD status and outcome after transplantation in NPM1-mutated AML. Blood 2020; 135:680-688. [PMID: 31932839 PMCID: PMC7059484 DOI: 10.1182/blood.2019002959] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022] Open
Abstract
Relapse remains the most common cause of treatment failure for patients with acute myeloid leukemia (AML) who undergo allogeneic stem cell transplantation (alloSCT), and carries a grave prognosis. Multiple studies have identified the presence of measurable residual disease (MRD) assessed by flow cytometry before alloSCT as a strong predictor of relapse, but it is not clear how these findings apply to patients who test positive in molecular MRD assays, which have far greater sensitivity. We analyzed pretransplant blood and bone marrow samples by reverse-transcription polymerase chain reaction in 107 patients with NPM1-mutant AML enrolled in the UK National Cancer Research Institute AML17 study. After a median follow-up of 4.9 years, patients with negative, low (<200 copies per 105ABL in the peripheral blood and <1000 copies in the bone marrow aspirate), and high levels of MRD had an estimated 2-year overall survival (2y-OS) of 83%, 63%, and 13%, respectively (P < .0001). Focusing on patients with low-level MRD before alloSCT, those with FLT3 internal tandem duplications(ITDs) had significantly poorer outcome (hazard ratio [HR], 6.14; P = .01). Combining these variables was highly prognostic, dividing patients into 2 groups with 2y-OS of 17% and 82% (HR, 13.2; P < .0001). T-depletion was associated with significantly reduced survival both in the entire cohort (2y-OS, 56% vs 96%; HR, 3.24; P = .0005) and in MRD-positive patients (2y-OS, 34% vs 100%; HR, 3.78; P = .003), but there was no significant effect of either conditioning regimen or donor source on outcome. Registered at ISRCTN (http://www.isrctn.com/ISRCTN55675535).
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MESH Headings
- Adolescent
- Adult
- Aged
- Female
- Hematopoietic Stem Cell Transplantation/mortality
- Humans
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/mortality
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/genetics
- Nuclear Proteins/genetics
- Nucleophosmin
- Recurrence
- Young Adult
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Affiliation(s)
- Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | - Robert Hills
- Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Sylvie Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Nicola Potter
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Jelena Jovanovic
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Adam Ivey
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Anju Shankar Kanda
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Manohursingh Runglall
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Nicola Foot
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Mikel Valganon
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Asim Khwaja
- Department of Haematology, University College, London, United Kingdom
| | | | | | | | | | - Mike Dennis
- Christie Hospital, Manchester, United Kingdom
| | - Steven Knapper
- Department of Haematology, Cardiff University, Cardiff, United Kingdom
| | - Harpreet Kaur
- Royal Hallamshire Hospital, Sheffield, United Kingdom
| | | | - Priyanka Mehta
- Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | - Kavita Raj
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | | | | | | | | | - Kate Hill
- University Hospital, Southampton, United Kingdom
| | | | - Samah Alimam
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | - Erin Hurst
- Royal Victoria Infirmary, Newcastle, United Kingdom
| | | | - Anjum Khan
- St James' Hospital, Leeds, United Kingdom
| | - Rahuman Salim
- Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | | | | | - Amanda Gilkes
- Department of Haematology, Cardiff University, Cardiff, United Kingdom
| | - Rosemary Gale
- Department of Haematology, University College, London, United Kingdom
| | - Alan Burnett
- Blackwaterfoot, Isle of Arran, United Kingdom; and
| | - Nigel H Russell
- Department of Haematology, Guy's Hospital, London, United Kingdom
- Nottingham University Hospital, Nottingham, United Kingdom
| | - David Grimwade
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
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10
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Phillips E, Wilson W, Benjamin R, Popat R, Braganza N, Clifton-Hadley L, Bygrave C, Cavenagh J, Chapman M, Owen R, Ramasamy K, Sive J, Streetly M, Nador G, Arnott S, Hassan S, Kishore B, Moore S, Virchis A, Willis F, Yong K. PF599 EFFICACY OF BORTEZOMIB, THALIDOMIDE AND DEXAMETHASONE FOR TREATMENT OF PATIENTS WITH CARFILZOMIB-REFRACTORY MYELOMA IN THE UK NCRI CARDAMON TRIAL. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000560684.31002.b1] [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: 11/25/2022] Open
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11
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Plesner T, Arkenau HT, Gay F, Minnema MC, Boccadoro M, Moreau P, Cavenagh J, Perrot A, Laubach JP, Krejcik J, Ahmadi T, de Boer C, Chen D, Chiu C, Schecter JM, Richardson PG. Enduring efficacy and tolerability of daratumumab in combination with lenalidomide and dexamethasone in patients with relapsed or relapsed/refractory multiple myeloma (GEN503): final results of an open-label, phase 1/2 study. Br J Haematol 2019; 186:e35-e39. [PMID: 30931524 DOI: 10.1111/bjh.15879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Torben Plesner
- Vejle Hospital and University of Southern Denmark, Vejle, Denmark
| | - Hendrik-Tobias Arkenau
- Sarah Cannon Research Institute, University College London Cancer Institute, London, United Kingdom
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, University of Torino, Torino, Italy
| | - Monique C Minnema
- Department of Hematology, UMC Utrecht Cancer Centre, Utrecht, The Netherlands
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Torino, Italy
| | - Philippe Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
| | - Jamie Cavenagh
- Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Aurore Perrot
- Hematology Department, University Hospital, Vandoeuvre Les Nancy, France
| | - Jacob P Laubach
- The LeBow Institute for Myeloma Therapeutics and Jerome Lipper Myeloma Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jakub Krejcik
- Vejle Hospital and University of Southern Denmark, Vejle, Denmark
| | | | | | - Diana Chen
- Janssen Research & Development, Shanghai, China
| | | | | | - Paul G Richardson
- The LeBow Institute for Myeloma Therapeutics and Jerome Lipper Myeloma Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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12
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Craddock C, Slade D, De Santo C, Wheat R, Ferguson P, Hodgkinson A, Brock K, Cavenagh J, Ingram W, Dennis M, Malladi R, Siddique S, Mussai F, Yap C. Combination Lenalidomide and Azacitidine: A Novel Salvage Therapy in Patients Who Relapse After Allogeneic Stem-Cell Transplantation for Acute Myeloid Leukemia. J Clin Oncol 2019; 37:580-588. [PMID: 30653424 PMCID: PMC6494237 DOI: 10.1200/jco.18.00889] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Salvage options for patients who relapse after allogeneic stem-cell transplantation (allo-SCT) for acute myeloid leukemia (AML) and myelodysplasia (MDS) remain limited, and novel treatment strategies are required. Both lenalidomide (LEN) and azacitidine (AZA) possess significant antitumor activity effect in AML. Administration of LEN post-transplantation is associated with excessive rates of graft-versus-host disease (GVHD), but AZA has been shown to ameliorate GVHD in murine transplantation models. We therefore examined the tolerability and activity of combined LEN/AZA administration in post-transplantation relapse. PATIENTS AND METHODS Twenty-nine patients who had relapsed after allo-SCT for AML (n = 24) or MDS (n = 5) were treated with sequential AZA (75 mg/m2 for 7 days) followed by escalating doses of LEN on days 10 to 30. Dose allocation and maximum tolerated dose (MTD) estimation were guided by a modified Bayesian continuous reassessment method (CRM). RESULTS Sequential AZA and LEN therapy was well tolerated. The MTD of post-transplantation LEN, in combination with AZA, was determined as 25 mg daily. Three patients developed grade 2 to 4 GVHD. There was no GVHD-related mortality. Seven of 15 (47%) patients achieved a major clinical response after LEN/AZA therapy. CD8+ T cells demonstrated impaired interferon-γ/tumor necrosis factor-α production at relapse, which was not reversed during LEN/AZA administration. CONCLUSION We conclude LEN can be administered safely post-allograft in conjunction with AZA, and this combination demonstrates clinical activity in relapsed AML/MDS without reversing biologic features of T-cell exhaustion. The use of a CRM model delivered improved efficiency in MTD assessment and provided additional flexibility. Combined LEN/AZA therapy represents a novel and active salvage therapy in patients who had relapsed post-allograft.
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Affiliation(s)
- Charles Craddock
- 1 Queen Elizabeth Hospital, Birmingham, United Kingdom.,2 University of Birmingham, Birmingham, United Kingdom
| | - Daniel Slade
- 2 University of Birmingham, Birmingham, United Kingdom
| | | | - Rachel Wheat
- 2 University of Birmingham, Birmingham, United Kingdom
| | - Paul Ferguson
- 3 University Hospital North Staffordshire, Stoke-on-Trent, United Kingdom
| | | | | | | | - Wendy Ingram
- 5 University College Hospital, Cardiff, United Kingdom
| | - Mike Dennis
- 6 The Christie Hospital, Manchester, United Kingdom
| | - Ram Malladi
- 1 Queen Elizabeth Hospital, Birmingham, United Kingdom
| | | | | | - Christina Yap
- 2 University of Birmingham, Birmingham, United Kingdom
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13
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Cross NCP, Hoade Y, Tapper WJ, Carreno-Tarragona G, Fanelli T, Jawhar M, Naumann N, Pieniak I, Lübke J, Ali S, Bhuller K, Burgstaller S, Cargo C, Cavenagh J, Duncombe AS, Das-Gupta E, Evans P, Forsyth P, George P, Grimley C, Jack F, Munro L, Mehra V, Patel K, Rismani A, Sciuccati G, Thomas-Dewing R, Thornton P, Virchis A, Watt S, Wallis L, Whiteway A, Zegocki K, Bain BJ, Reiter A, Chase A. Recurrent activating STAT5B N642H mutation in myeloid neoplasms with eosinophilia. Leukemia 2018; 33:415-425. [PMID: 30573779 PMCID: PMC6365490 DOI: 10.1038/s41375-018-0342-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 01/16/2023]
Abstract
Determining the underlying cause of persistent eosinophilia is important for effective clinical management but remains a diagnostic challenge in many cases. We identified STAT5B N642H, an established oncogenic mutation, in 27/1715 (1.6%) cases referred for investigation of eosinophilia. Of the 27 mutated cases, a working diagnosis of hypereosinophilic syndrome (HES; n = 7) or a myeloid neoplasm with eosinophilia (n = 20) had been made prior to the detection of STAT5B N642H. Myeloid panel analysis identified a median of 2 additional mutated genes (range 0–4) with 4 cases having STAT5B N642H as a sole abnormality. STAT5B N642H was absent in cultured T cells of 4/4 positive cases. Individuals with SF3B1 mutations (9/27; 33%) or STAT5B N642H as a sole abnormality had a markedly better overall survival compared to cases with other additional mutations (median 65 months vs. 14 months; hazard ratio = 8.1; P < 0.001). The overall survival of STAT5B-mutated HES cases was only 30 months, suggesting that these cases should be reclassified as chronic eosinophilic leukemia, not otherwise specified (CEL-NOS). The finding of STAT5B N642H as a recurrent mutation in myeloid neoplasia with eosinophilia provides a new diagnostic and prognostic marker as well as a potential target for therapy.
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Affiliation(s)
- Nicholas C P Cross
- Faculty of Medicine, University of Southampton, Southampton, UK. .,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK.
| | - Yvette Hoade
- Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK
| | | | - Gonzalo Carreno-Tarragona
- Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Tiziana Fanelli
- Center Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Firenze, Italy
| | - Mohamad Jawhar
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicole Naumann
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Iwo Pieniak
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Johannes Lübke
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Sahra Ali
- Hull & East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Kaljit Bhuller
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | | | | | - Emma Das-Gupta
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Paul Evans
- HMDS, St. James's University Hospital, Leeds, UK
| | | | - Philip George
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | | | | | - Kavita Patel
- Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Ali Rismani
- Whittington Health & University College London Hospitals, London, UK
| | | | | | | | - Andres Virchis
- Royal Free London, Barnet Hospital, Wellhouse Lane, Barnet, UK
| | - Simon Watt
- Manchester University NHS FT, Manchester, UK
| | | | | | | | | | - Andreas Reiter
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Andrew Chase
- Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK
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14
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Popat R, Brown SR, Flanagan L, Hall A, Gregory W, Kishore B, Streetly M, Oakervee H, Yong K, Cook G, Low E, Cavenagh J. Extended follow-up and the feasibility of Panobinostat maintenance for patients with Relapsed Multiple Myeloma treated with Bortezomib, Thalidomide, Dexamethasone plus Panobinostat (MUK six open label, multi-centre phase I/II Clinical Trial). Br J Haematol 2018; 185:573-578. [PMID: 30125960 DOI: 10.1111/bjh.15551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Rakesh Popat
- NIHR/UCLH Clinical Research Facility, University College London Hospitals, London, UK
| | - Sarah R Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Louise Flanagan
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Andrew Hall
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Walter Gregory
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | | | | | - Kwee Yong
- NIHR/UCLH Clinical Research Facility, University College London Hospitals, London, UK
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15
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Killick SB, Bown N, Cavenagh J, Dokal I, Foukaneli T, Hillmen P, Ireland R, Kulasekararaj A, Mufti G, Snowden JA, Samarasinghe S, Wood A, Marsh JCW. British Committee for Standards in Haematology guidelines for aplastic anemia: Single centre retrospective review finds no compelling evidence for the recommended higher platelet count threshold of 20 × 10 9 /L - RESPONSE to Yan et al. Br J Haematol 2018; 182:286-287. [PMID: 28542907 DOI: 10.1111/bjh.14766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sally B Killick
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Nick Bown
- Northern Genetics Service, Newcastle upon Tyne, UK
| | - Jamie Cavenagh
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Inderjeet Dokal
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London and Barts Health NHS Trust, London, UK
| | | | | | - Robin Ireland
- Kings College Hospital NHS Foundation Trust, London, UK
| | | | - Ghulam Mufti
- Kings College Hospital NHS Foundation Trust, London, UK
| | - John A Snowden
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Anna Wood
- West Hertfordshire NHS Trust, Watford, UK
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16
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Striha A, Ashcroft AJ, Hockaday A, Cairns DA, Boardman K, Jacques G, Williams C, Snowden JA, Garg M, Cavenagh J, Yong K, Drayson MT, Owen R, Cook M, Cook G. The role of ixazomib as an augmented conditioning therapy in salvage autologous stem cell transplant (ASCT) and as a post-ASCT consolidation and maintenance strategy in patients with relapsed multiple myeloma (ACCoRd [UK-MRA Myeloma XII] trial): study protocol for a Phase III randomised controlled trial. Trials 2018; 19:169. [PMID: 29514706 PMCID: PMC5842589 DOI: 10.1186/s13063-018-2524-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 12/18/2017] [Accepted: 01/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple myeloma (MM) is a plasma cell tumour with an approximate annual incidence of 4500 in the UK. Therapeutic options for patients with MM have changed in the last decade with the arrival of proteasome inhibitors and immunomodulatory drugs. Despite these options, almost all patients will relapse post first-line autologous stem cell transplantation (ASCT). First relapse management (second-line treatment) has evolved in recent years with an expanding portfolio of novel agents, driving response rates influencing the durability of response. A second ASCT, as part of relapsed disease management (salvage ASCT), has been shown to prolong the progression-free survival and overall survival following a proteasome inhibitor-containing re-induction regimen, in the Cancer Research UK-funded National Cancer Research Institute Myeloma X (Intensive) study. It is now recommended that salvage ASCT be considered for suitable patients by the International Myeloma Working Group and the National Institute for Health and Care Excellence NG35 guidance. METHODS/DESIGN ACCoRd (Myeloma XII) is a UK-nationwide, individually randomised, multi-centre, multiple randomisation, open-label phase III trial with an initial single intervention registration phase aimed at relapsing MM patients who have received ASCT in first-line treatment. We will register 406 participants into the trial to allow 284 and 248 participants to be randomised at the first and second randomisations, respectively. All participants will receive re-induction therapy until maximal response (four to six cycles of ixazomib, thalidomide and dexamethasone). Participants who achieve at least stable disease will be randomised (1:1) to receive either ASCTCon, using high-dose melphalan, or ASCTAug, using high-dose melphalan with ixazomib. All participants achieving or maintaining a minimal response or better, following salvage ASCT, will undergo a second randomisation (1:1) to consolidation and maintenance or observation. Participants randomised to consolidation and maintenance will receive consolidation with two cycles of ixazomib, thalidomide and dexamethasone, and maintenance with ixazomib until disease progression. DISCUSSION The question of how best to maximise the durability of response to salvage ASCT warrants clinical investigation. Given the expanding scope of oral therapeutic agents, patient engagement with long-term maintenance strategies is a real opportunity. This study will provide evidence to better define post-relapse treatment in MM. TRIAL REGISTRATION ISRCTN, ISRCTN10038996 . Registered on 15 December 2016.
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Affiliation(s)
- Alina Striha
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - A. John Ashcroft
- Department of Haematology, Pinderfields General Hospital, Wakefield, UK
| | - Anna Hockaday
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - David A. Cairns
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Karen Boardman
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Gwen Jacques
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Cathy Williams
- Centre for Clinical Haematology, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - John A. Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mamta Garg
- Leicester Royal Infirmary, Leicester, UK
| | - Jamie Cavenagh
- Department of Haematology, St Bartholomew’s Hospital, London, UK
| | - Kwee Yong
- Department of Haematology, University College Hospital, London, UK
| | - Mark T. Drayson
- Myeloma Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Roger Owen
- HMDS, St James’s University Hospital, Leeds, UK
| | - Mark Cook
- Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Birmingham, UK
| | - Gordon Cook
- Leeds Institute of Cancer & Pathology, University of Leeds, St James’s University Hospital, Leeds, UK
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17
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Cavenagh J, Oakervee H, Baetiong-Caguioa P, Davies F, Gharibo M, Rabin N, Kurman M, Novak B, Shiraishi N, Nakashima D, Akinaga S, Yong K. A phase I/II study of KW-2478, an Hsp90 inhibitor, in combination with bortezomib in patients with relapsed/refractory multiple myeloma. Br J Cancer 2017; 117:1295-1302. [PMID: 28873084 PMCID: PMC5672925 DOI: 10.1038/bjc.2017.302] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 03/03/2017] [Revised: 06/07/2017] [Accepted: 08/08/2017] [Indexed: 01/17/2023] Open
Abstract
Background: KW-2478 is a novel non-ansamycin Hsp90 inhibitor with modest single-agent activity in relapsed/refractory myeloma but which shows synergistic antimyeloma activity with bortezomib (BTZ) in preclinical studies. This study determined the safety, preliminary clinical activity, and pharmacokinetics of KW-2478, an Hsp90 inhibitor, in combination with BTZ in patients with relapsed/refractory multiple myeloma (MM). Methods: Phase I dose escalation determined the recommended phase II dose (RP2D) of KW-2478 plus BTZ, which was then used during phase II. Results: The maximum tolerated dose was not reached during phase I and the RP2D was KW-2478 175 mg m−2 plus BTZ 1.3 mg m−2 on days 1, 4, 8, and 11 every 3 weeks. In the efficacy evaluable phase I/II population treated at the RP2D (n=79), the objective response rate was 39.2% (95% confidence interval: 28.4–50.9%), clinical benefit rate 51.9% (40.4–63.3%), median progression-free survival 6.7 (5.9-not reached (NR)) months, and median duration of response 5.5 (4.9-NR) months. In the phase I/II safety population (n=95), the most frequently observed treatment-related grade 3/4 adverse events were diarrhoea, fatigue, and neutropenia (each in 7.4% of patients), and nausea and thrombocytopenia (each in 5.3%). Conclusions: KW-2478 plus BTZ was well tolerated with no apparent overlapping toxicity in patients with relapsed/refractory MM. The antimyeloma activity of KW-2478 in combination with BTZ as scheduled in this trial appeared relatively modest; however, the good tolerability of the combination would support further exploration of alternate dosing schedules and combinations.
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Affiliation(s)
- J Cavenagh
- Department of Haematology, St Bartholomew's Hospital, West Smithfield, London SE24 9LG, UK
| | - H Oakervee
- Department of Haematology, St Bartholomew's Hospital, West Smithfield, London SE24 9LG, UK
| | - P Baetiong-Caguioa
- Benavides Cancer Institute, University of Santo Tomas Hospital, Manila and St Luke's Medical Center, Quezon City, The Philippines
| | - F Davies
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - M Gharibo
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers, State University of New Jersey, New Brunswick, NJ 08901, USA
| | - N Rabin
- UCL Cancer Institute, University College London, Gower Street, London WC1E 6BT, UK
| | - M Kurman
- Kyowa Kirin Pharmaceutical Development, Inc., Princeton, NJ 08540, USA
| | - B Novak
- Kyowa Kirin Pharmaceutical Development, Inc., Princeton, NJ 08540, USA
| | - N Shiraishi
- R&D Division, Kyowa Hakko Kirin Co. Ltd., Tokyo 100-0004, Japan
| | - D Nakashima
- R&D Division, Kyowa Hakko Kirin Co. Ltd., Tokyo 100-0004, Japan
| | - S Akinaga
- R&D Division, Kyowa Hakko Kirin Co. Ltd., Tokyo 100-0004, Japan
| | - K Yong
- UCL Cancer Institute, University College London, Gower Street, London WC1E 6BT, UK
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18
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Subramanian J, Cavenagh J, Desai B, Jacobs I. Rituximab in the treatment of follicular lymphoma: the future of biosimilars in the evolving therapeutic landscape. Cancer Manag Res 2017; 9:131-140. [PMID: 28479860 PMCID: PMC5411111 DOI: 10.2147/cmar.s120589] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Follicular lymphoma (FL) is the second most common type of non-Hodgkin’s lymphoma. FL is an incurable disease with treatment options ranging from a “watch-and-wait” approach to localized therapy with radiation or systemic therapy with rituximab in combination with chemotherapy regimens. This review summarizes the role of rituximab across the spectrum of FL treatment and the evolving therapeutic landscape with the emergence of novel agents currently in clinical development. Despite the prospect of new agents on the horizon, it is widely accepted that rituximab will remain as the cornerstone of therapy because of its established long-term efficacy. Many biologics, including rituximab, have lost exclusivity of composition-of-matter patent or will do so in the next few years, which is a concern for patients and physicians alike. Moreover, access to rituximab is challenging, particularly in countries with restricted resources. Together, these concerns have fueled the development of safe and effective biosimilars. The term “biosimilar” refers to a biologic product that is highly similar to an approved reference (or originator) product, notwithstanding minor differences in clinically inactive components, and for which there are no clinically meaningful differences in purity, potency, or safety. Biosimilars are developed to treat the same condition(s) using the same treatment regimens as an approved reference biologic, and have the potential to increase access to more affordable treatment of FL. Herein, we also discuss the potential benefits of eagerly awaited rituximab biosimilars, which may mitigate the impact of the lack of access to rituximab.
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Affiliation(s)
| | - Jamie Cavenagh
- Department of Haematology, St. Bartholomew's Hospital, London, UK
| | | | - Ira Jacobs
- Global Established Pharma, Pfizer Inc., New York, NY, USA
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19
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Abstract
Myeloma is a haematological malignancy which typically follows a relapsing-remitting course. While treatment can control the myeloma and improve quality of life for given periods of time, remissions generally become progressively shorter with subsequent relapses, and patients ultimately enter a final refractory phase. To help control symptoms and enhance quality of life, some patients use complementary therapies as an adjunct to their conventional therapy. Here, we describe a myeloma patient who started a daily dietary supplement of curcumin when approaching her third relapse. In the absence of further antimyeloma treatment, the patient plateaued and has remained stable for the last 5 years with good quality of life.
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Affiliation(s)
- Abbas Zaidi
- Department of Haematology, Barts Health NHS Trust, London, UK
| | | | - Jamie Cavenagh
- Department of Haematology, Barts Health NHS Trust, London, UK
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20
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Hunt BJ, Tueger S, Pattison J, Cavenagh J, D'Cruz DP. Microangiopathic haemolytic anaemia secondary to lupus nephritis: an important differential diagnosis of thrombotic thrombocytopenic purpura. Lupus 2016; 16:358-62. [PMID: 17576739 DOI: 10.1177/0961203307077151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 11/15/2022]
Abstract
Systemic lupus erythematosus (SLE) has been described as a cause of microangiopathic haemolytic anaemia (MAHA), however there is little literature to support this assertion. We report on three patients presenting with SLE and MAHA with a clinical picture indistinguishable from thrombotic thrombocytopenic purpura (TTP), who had underlying lupus nephritis. They all had significant proteinuria and normal Von Willebrand Factor cleaving protease (vWF-CP) levels. Their MAHA fitted better for haemolytic syndrome (HUS) and their cerebral signs were explained either by malignant hypertension or cerebral lupus. Their MAHA only improved when the appropriate treatment for lupus nephritis was given.We propose that the previously described association between SLE and MAHA, in actuality relates to the underlying presence of lupus nephritis causing haemolytic uraemic syndrome, not TTP. Significant proteinuria was present in all cases of MAHA due to lupus nephritis, so may be a useful discriminatory sign. Furthermore the demonstration of a normal vWF-CP assay aided in the distinction between TTP and MAHA due to lupus nephritis. All our patients responded to mycophenolate mofetil suggesting this may be useful in other cases of lupus nephritis causing HUS. Lupus (2007) 16, 358—362.
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Affiliation(s)
- B J Hunt
- Department of Haematology, Guy's & St Thomas Trust, London, UK. Beverley.hunt@ gstt.nhs.uk
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21
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Burnett A, Cavenagh J, Russell N, Hills R, Kell J, Jones G, Nielsen OJ, Khwaja A, Thomas I, Clark R. Defining the dose of gemtuzumab ozogamicin in combination with induction chemotherapy in acute myeloid leukemia: a comparison of 3 mg/m2 with 6 mg/m2 in the NCRI AML17 Trial. Haematologica 2016; 101:724-31. [PMID: 26921360 PMCID: PMC5013968 DOI: 10.3324/haematol.2016.141937] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/23/2016] [Indexed: 11/09/2022] Open
Abstract
Arecent source data meta-analysis of randomized trials in adults assessing the immunoconjugate gemtuzumab ozogamicin combined with standard chemotherapy in acute myeloid leukemia showed a significant survival benefit in patients without an adverse karyotype. It is not clear whether the optimal dose should be 3 mg/m(2) or 6 mg/m(2) In this study, we randomized 788 patients to a single dose of gemtuzumab ozogamicin 3 mg/m(2) or 6 mg/m(2) with the first course of induction therapy. We found that the rate of complete remission was higher with 3 mg/m(2) [82% vs 76%; odds ratio 1.46 (1.04-2.06); P=0.03], but this was balanced by a higher rate of complete remission with incomplete peripheral blood count recovery in the 6 mg/m(2) treatment (10% vs 7%) resulting in similar overall response rate [89% vs 86%; hazard ratio 1.34 (0.88-2.04); P=0.17]. There was no overall difference in relapse or survival at four years between the arms: 46% vs 54%; hazard ratio 1.17 (0.94-1.45), P=0.5, and 50% versus 47%; hazard ratio 1.10 (0.90-1.34), P=0.3, respectively. The 30- and 60-day mortality was significantly higher in the 6 mg/m(2) recipients: 7% versus 3%; hazard ratio 2.07 (1.11-3.87), P=0.02, and 9% versus 5%; hazard ratio 1.99 (1.17-3.39), P=0.01, respectively, which in addition was associated with a higher rate of veno-occlusive disease (5.6% vs 0.5%; P<0.0001). Our conclusion from this trial is that there is no advantage in using a single dose of 6 mg/m(2) of gemtuzumab ozogamicin in combination with induction chemotherapy when compared with a 3 mg/m(2) dose, with respect to response, disease-free and overall survival, either overall, or in any disease subgroup. (AML17 was registered as ISRCTN55675535).
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MESH Headings
- Adolescent
- Adult
- Aged
- Aminoglycosides/administration & dosage
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child
- Child, Preschool
- Female
- Gemtuzumab
- Humans
- Infant
- Infant, Newborn
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/mortality
- Male
- Middle Aged
- Odds Ratio
- Recurrence
- Remission Induction
- Survival Analysis
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Alan Burnett
- Department of Haematology, Cardiff University School of Medicine, UK
| | - Jamie Cavenagh
- Department of Haematology, St Bartholomew's Hospital, West Smithfield, London UK
| | - Nigel Russell
- Department of Haematology, Nottingham University Hospital NHS Trust, UK
| | - Robert Hills
- Department of Haematology, Cardiff University School of Medicine, UK
| | - Jonathan Kell
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - Gail Jones
- Department of Haematology, Newcastle Teaching Hospitals NHS Trust, UK
| | | | - Asim Khwaja
- Department of Haematology, University College, London Cancer Institute, UK
| | - Ian Thomas
- Department of Haematology, Cardiff University School of Medicine, UK
| | - Richard Clark
- Department of Haematology, Royal Liverpool University Hospital, UK
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22
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Parrish C, Morris CT, Williams CD, Cairns DA, Cavenagh J, Snowden JA, Ashcroft J, Cavet J, Hunter H, Bird JM, Chalmers A, Brown JM, Yong K, Schey S, Chown S, Cook G. Stem Cell Harvesting after Bortezomib-Based Reinduction for Myeloma Relapsing after Autologous Transplantation: Results from the British Society of Blood and Marrow Transplantation/United Kingdom Myeloma Forum Myeloma X (Intensive) Trial. Biol Blood Marrow Transplant 2016; 22:1009-1016. [DOI: 10.1016/j.bbmt.2016.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/11/2016] [Indexed: 12/20/2022]
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23
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Brown S, Hinsley S, Ballesteros M, Bourne S, McGarry P, Sherratt D, Flanagan L, Gregory W, Cavenagh J, Owen R, Williams C, Kaiser M, Low E, Yong K. The MUK five protocol: a phase II randomised, controlled, parallel group, multi-centre trial of carfilzomib, cyclophosphamide and dexamethasone (CCD) vs. cyclophosphamide, bortezomib (Velcade) and dexamethasone (CVD) for first relapse and primary refractory multiple myeloma. BMC Hematol 2016; 16:14. [PMID: 27190631 PMCID: PMC4869302 DOI: 10.1186/s12878-016-0053-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 05/11/2016] [Indexed: 12/04/2022]
Abstract
Background Multiple myeloma is a plasma cell tumour with an annual incidence in the UK of approximately 40–50 per million i.e. about 4500 new cases per annum. The triple combination cyclophosphamide, bortezomib (Velcade®) and dexamethasone (CVD) is an effective regimen at relapse and has emerged in recent years as the standard therapy at first relapse in the UK. Carfilzomib has good activity as a single agent in the relapsed setting, and it is expected that efficacy will be improved when used in combination with dexamethasone and cyclophosphamide. Methods MUK Five is a phase II open label, randomised, controlled, parallel group, multi-centre trial that will compare the activity of carfilzomib, cyclophosphamide and dexamethasone (CCD) with that of CVD, given over an equivalent treatment period (24 weeks), in participants with multiple myeloma at first relapse, or refractory to no more than 1 line of treatment. In addition, the study also aims to assess the utility of a maintenance schedule of carfilzomib in these participants. The primary objective of the trial is to assess whether CCD provides non-inferior activity in terms of ≥ VGPR rates at 24 weeks, and whether the addition of maintenance treatment with carfilzomib to CCD provides superior activity in terms of progression-free survival, as compared to CCD with no maintenance. Secondary objectives include comparing toxicity profiles, further summarizing and comparing the activity of the different treatment arms and analysis of the effect of each treatment arm on minimal residual disease status. Discussion The development of carfilzomib offers the opportunity to further explore the anti-tumour efficacy of proteasome inhibition and, based on the available evidence, it is important and timely to obtain data on the activity, toxicity and tolerability of this drug. In contrast to ongoing phase III trials, this phase II trial has a unique subset of participants diagnosed with multiple myeloma at first relapse or refractory to no more than 1 line of treatment and will also evaluate the utility of maintenance with carfilzomib for up to 18 months and investigate minimal residual disease status to provide information on depth of response and the prognostic impact thereof. Trial registration The trial is registered under ISRCTN17354232, December 2012.
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Affiliation(s)
- Sarah Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Samantha Hinsley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Mónica Ballesteros
- Methodology of Biomedical Research and Public Health Programme, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sue Bourne
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Paul McGarry
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Debbie Sherratt
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Louise Flanagan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Walter Gregory
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jamie Cavenagh
- Department of Haematology, St Bartholomew's Hospital, London, UK
| | - Roger Owen
- HMDS Laboratory, St James's University Hospital, Leeds, UK
| | - Cathy Williams
- Centre for Clinical Haematology, Nottingham University Hospitals, Nottingham, UK
| | | | | | - Kwee Yong
- UCL Cancer Institute, 72 Huntley Street, WC1E 6BT London, UK
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24
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Yong K, Cavet J, Johnson P, Morgan G, Williams C, Nakashima D, Akinaga S, Oakervee H, Cavenagh J. Phase I study of KW-2478, a novel Hsp90 inhibitor, in patients with B-cell malignancies. Br J Cancer 2015; 114:7-13. [PMID: 26695442 PMCID: PMC4716540 DOI: 10.1038/bjc.2015.422] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/12/2015] [Accepted: 10/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND KW-2478 is a novel, non-ansamycin, non-purine heat-shock protein 90 (Hsp90) inhibitor. METHODS In this phase I, multicentre study, KW-2478 was administered intravenously over 1 h at doses ranging from 14 to 176 mg m(-2) once daily on days 1-5 of a 14-day cycle in a standard 3+3 design in 27 patients (22 with multiple myeloma and 5 with non-Hodgkin lymphoma). Patients enrolled had relapsed/refractory disease previously treated with ⩾2 regimens. RESULTS There were no dose-limiting toxicities, thus the maximum-tolerated dose was not reached. KW-2478 was well tolerated and did not manifest significant retinal or ocular toxicity. The most common treatment-related adverse events were diarrhoea (33.3%), fatigue (29.6%), headache (25.9%), hypertension (22.2%), nausea (14.8%), vomiting (7.4%), and dizziness (7.4%). Plasma concentrations peaked at the end of infusion and decayed in a biphasic manner with a terminal half-life of ∼6 h. Target inhibition was inferred from the increase in Hsp70 levels in peripheral blood mononuclear cells at doses ⩾71 mg m(-2). Twenty-four of 25 (96%) evaluable patients showed stable disease, with five being free of disease progression for ⩾6 months. CONCLUSIONS Preliminary clinical response data were encouraging and warrant further investigation of KW-2478 in combination regimens for relapsed/refractory B-cell malignancies.
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Affiliation(s)
- K Yong
- UCL Cancer Institute, University College London, Huntley Street, London WC1E 6DD, UK
| | - J Cavet
- Department of Haematology, Christie Hospital/University of Manchester, Wilmslow Road, Manchester M20 4BX, UK
| | - P Johnson
- Cancer Research UK Clinical Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - G Morgan
- Myeloma Institute for Research and Therapy, West Markham Street, Little Rock, AR 72205, USA
| | - C Williams
- Centre for Clinical Haematology, Nottingham University Hospital, Hucknall Road, Nottingham NG5 1PB, UK
| | - D Nakashima
- Kyowa Hakko Kirin Pharma Inc., Princeton, NJ, USA
| | - S Akinaga
- Kyowa Hakko Kirin Co. Ltd, Tokyo Research Triangle Park, Tokyo 194-8533, Japan
| | - H Oakervee
- Department of Haematology, St. Bartholomew's Hospital, West Smithfield, London SE24 9LG, UK
| | - J Cavenagh
- Department of Haematology, St. Bartholomew's Hospital, West Smithfield, London SE24 9LG, UK
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25
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Killick SB, Bown N, Cavenagh J, Dokal I, Foukaneli T, Hill A, Hillmen P, Ireland R, Kulasekararaj A, Mufti G, Snowden JA, Samarasinghe S, Wood A, Marsh JCW. Guidelines for the diagnosis and management of adult aplastic anaemia. Br J Haematol 2015; 172:187-207. [PMID: 26568159 DOI: 10.1111/bjh.13853] [Citation(s) in RCA: 457] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sally B Killick
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Nick Bown
- Northern Genetics Service, Newcastle upon Tyne, UK
| | - Jamie Cavenagh
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Inderjeet Dokal
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London and Barts Health NHS Trust, London, UK
| | | | | | | | - Robin Ireland
- Kings College Hospital NHS Foundation Trust, London, UK
| | | | - Ghulam Mufti
- Kings College Hospital NHS Foundation Trust, London, UK
| | - John A Snowden
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Anna Wood
- West Hertfordshire NHS Trust, Watford, UK
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26
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Abstract
The presence of fever in malignancy usually indicates infection, though transfusion, thrombosis and drugs are also culprits. However, particularly in some tumour types, fever can also be a paraneoplastic syndrome, caused by the malignancy itself. This can be a difficult diagnosis to establish and presents a therapeutic challenge to the physician when the underlying malignancy is not easily treated.
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Affiliation(s)
| | - Jamie Cavenagh
- professor of haematology, St Bartholomew's Hospital, London, UK
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27
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Schey S, Brown SR, Tillotson AL, Yong K, Williams C, Davies F, Morgan G, Cavenagh J, Cook G, Cook M, Orti G, Morris C, Sherratt D, Flanagan L, Gregory W, Cavet J. Bendamustine, thalidomide and dexamethasone combination therapy for relapsed/refractory myeloma patients: results of the MUKone randomized dose selection trial. Br J Haematol 2015; 170:336-48. [PMID: 25891006 DOI: 10.1111/bjh.13435] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 12/01/2014] [Accepted: 02/16/2015] [Indexed: 11/27/2022]
Abstract
There is a significant unmet need in effective therapy for relapsed myeloma patients once they become refractory to bortezomib and lenalidomide. While data from the front line setting suggest bendamustine is superior to melphalan, there is no information defining optimal bendamustine dose in multiply-treated patients. We report a multi-centre randomized two-stage phase 2 trial simultaneously assessing deliverability and activity of two doses of bendamustine (60 mg/m2 vs. 100 mg/m2) days 1 and 8, thalidomide (100 mg) days 1-21 and low dose dexamethasone (20 mg) days 1, 8, 15 and 22 of a 28-d cycle. Ninety-four relapsing patients were treated on trial, with a median three prior treatment lines. A pre-planned interim deliverability and activity assessment led to closure of the 100 mg/m2 arm due to excess cytopenias, and led to amendment of entry criteria for cytopenias. Non-haematological toxicities including thromboembolism and neurotoxicity were infrequent. In the 60 mg/m2 arm, treatment was deliverable in 61.1% subjects and the partial response rate was 46.3% in the study eligible population, with 7.5 months progression-free survival. This study demonstrates bendamustine at 60 mg/m2 twice per month with thalidomide and dexamethasone is deliverable for repeated cycles in heavily pre-treated myeloma patients and has substantial clinical activity.
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Affiliation(s)
- Steve Schey
- Department of Haematology, King's College Hospital, London, UK
| | - Sarah R Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Avie-Lee Tillotson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Kwee Yong
- University College London Cancer Institute, London, UK
| | - Cathy Williams
- Centre for Clinical Haematology, Nottingham University Hospitals, Nottingham, UK
| | - Faith Davies
- Haemato-Oncology Unit, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Gareth Morgan
- Haemato-Oncology Unit, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Jamie Cavenagh
- Department of Haematology, St Bartholomew's Hospital, London, UK
| | - Gordon Cook
- Department of Haematology, St James's University Hospital, Leeds, UK
| | - Mark Cook
- Queen Elizabeth Hospital, Birmingham, UK
| | - Guillermo Orti
- Department of Haematology, King's College Hospital, London, UK
| | | | - Debbie Sherratt
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Louise Flanagan
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Walter Gregory
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - James Cavet
- Haematology and Transplant Unit, Christie NHS Foundation Trust, Manchester, UK
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28
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Gillmore JD, Wechalekar A, Bird J, Cavenagh J, Hawkins S, Kazmi M, Lachmann HJ, Hawkins PN, Pratt G. Guidelines on the diagnosis and investigation of AL amyloidosis. Br J Haematol 2014; 168:207-18. [PMID: 25312307 DOI: 10.1111/bjh.13156] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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29
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Wechalekar AD, Gillmore JD, Bird J, Cavenagh J, Hawkins S, Kazmi M, Lachmann HJ, Hawkins PN, Pratt G. Guidelines on the management of AL amyloidosis. Br J Haematol 2014; 168:186-206. [PMID: 25303672 DOI: 10.1111/bjh.13155] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Benboubker L, Dimopoulos MA, Dispenzieri A, Catalano J, Belch AR, Cavo M, Pinto A, Weisel K, Ludwig H, Bahlis N, Banos A, Tiab M, Delforge M, Cavenagh J, Geraldes C, Lee JJ, Chen C, Oriol A, de la Rubia J, Qiu L, White DJ, Binder D, Anderson K, Fermand JP, Moreau P, Attal M, Knight R, Chen G, Van Oostendorp J, Jacques C, Ervin-Haynes A, Avet-Loiseau H, Hulin C, Facon T. Lenalidomide and dexamethasone in transplant-ineligible patients with myeloma. N Engl J Med 2014; 371:906-17. [PMID: 25184863 DOI: 10.1056/nejmoa1402551] [Citation(s) in RCA: 583] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The combination melphalan-prednisone-thalidomide (MPT) is considered a standard therapy for patients with myeloma who are ineligible for stem-cell transplantation. However, emerging data on the use of lenalidomide and low-dose dexamethasone warrant a prospective comparison of the two approaches. METHODS We randomly assigned 1623 patients to lenalidomide and dexamethasone in 28-day cycles until disease progression (535 patients), to the same combination for 72 weeks (18 cycles; 541 patients), or to MPT for 72 weeks (547 patients). The primary end point was progression-free survival with continuous lenalidomide-dexamethasone versus MPT. RESULTS The median progression-free survival was 25.5 months with continuous lenalidomide-dexamethasone, 20.7 months with 18 cycles of lenalidomide-dexamethasone, and 21.2 months with MPT (hazard ratio for the risk of progression or death, 0.72 for continuous lenalidomide-dexamethasone vs. MPT and 0.70 for continuous lenalidomide-dexamethasone vs. 18 cycles of lenalidomide-dexamethasone; P<0.001 for both comparisons). Continuous lenalidomide-dexamethasone was superior to MPT for all secondary efficacy end points, including overall survival (at the interim analysis). Overall survival at 4 years was 59% with continuous lenalidomide-dexamethasone, 56% with 18 cycles of lenalidomide-dexamethasone, and 51% with MPT. Grade 3 or 4 adverse events were somewhat less frequent with continuous lenalidomide-dexamethasone than with MPT (70% vs. 78%). As compared with MPT, continuous lenalidomide-dexamethasone was associated with fewer hematologic and neurologic toxic events, a moderate increase in infections, and fewer second primary hematologic cancers. CONCLUSIONS As compared with MPT, continuous lenalidomide-dexamethasone given until disease progression was associated with a significant improvement in progression-free survival, with an overall survival benefit at the interim analysis, among patients with newly diagnosed multiple myeloma who were ineligible for stem-cell transplantation. (Funded by Intergroupe, Francophone du Myélome and Celgene; FIRST ClinicalTrials.gov number, NCT00689936; European Union Drug Regulating Authorities Clinical Trials number, 2007-004823-39.).
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31
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Pratt G, Jenner M, Owen R, Snowden JA, Ashcroft J, Yong K, Feyler S, Morgan G, Cavenagh J, Cook G, Low E, Stern S, Behrens J, Davies F, Bird J. Updates to the guidelines for the diagnosis and management of multiple myeloma. Br J Haematol 2014; 167:131-3. [DOI: 10.1111/bjh.12926] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Guy Pratt
- School of Cancer Studies; University of Birmingham; Birmingham UK
- Department of Haematology; Heart of England NHS Foundation Trust; Birmingham UK
| | - Matthew Jenner
- Department of Haematology; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Roger Owen
- Department of Haematology; Leeds Teaching Hospitals NHS Trust; Leeds UK
| | - John A. Snowden
- Department of Haematology; Royal Hallamshire Hospital; Sheffield UK
| | - John Ashcroft
- Department of Haematology; Leeds Teaching Hospitals NHS Trust; Leeds UK
| | - Kwee Yong
- Department of Haematology; University College London Hospitals; London UK
| | - Sylvia Feyler
- Department of Haematology; Leeds Teaching Hospitals NHS Trust; Leeds UK
| | - Gareth Morgan
- Section of Haemato-Oncology; Institute of Cancer Research; London UK
| | - Jamie Cavenagh
- Department of Haematology; Barts Health NHS Trust; London UK
| | - Gordon Cook
- Department of Haematology; Leeds Teaching Hospitals NHS Trust; Leeds UK
| | | | - Simon Stern
- Department of Haematology; Epsom and St Heliers University Hospitals; London UK
| | - Judith Behrens
- Department of Haematology; Epsom and St Heliers University Hospitals; London UK
| | - Faith Davies
- Section of Haemato-Oncology; Institute of Cancer Research; London UK
| | - Jennifer Bird
- Department of Haematology; University Hospitals Bristol NHS Foundation Trust; Bristol UK
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32
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Renaudon-Smith E, Kaur M, Haroon A, Cavenagh J, Butler T. Intravascular haemolysis secondary to Clostridium perfringens in a patient with acute myeloid leukaemia undergoing allogeneic stem cell transplantation. Br J Haematol 2014; 165:743. [PMID: 24446867 DOI: 10.1111/bjh.12745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ed Renaudon-Smith
- Department of Haemato-Oncology, St Bartholomew's Hospital, London, UK
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33
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Zdenkowski N, Cavenagh J, Ku YC, Bisquera A, Bonaventura A. Administration of chemotherapy with palliative intent in the last 30 days of life: the balance between palliation and chemotherapy. Intern Med J 2013; 43:1191-8. [DOI: 10.1111/imj.12245] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 07/05/2013] [Indexed: 11/27/2022]
Affiliation(s)
- N. Zdenkowski
- Department of Medical Oncology; Mercy Hospice; Calvary Mater Newcastle; Newcastle New South Wales Australia
- Hunter Cancer Research Alliance; Hunter Medical Research Institute; Newcastle New South Wales Australia
| | - J. Cavenagh
- Department of Palliative Care; Mercy Hospice; Calvary Mater Newcastle; Newcastle New South Wales Australia
- Hunter Cancer Research Alliance; Hunter Medical Research Institute; Newcastle New South Wales Australia
| | - Y. C. Ku
- Hunter Cancer Research Alliance; Hunter Medical Research Institute; Newcastle New South Wales Australia
- Clinical Systems Team; Information Technology and Telecommunication Department; Hunter New England Local Health District; Newcastle New South Wales Australia
| | - A. Bisquera
- Hunter Cancer Research Alliance; Hunter Medical Research Institute; Newcastle New South Wales Australia
- Clinical Research Design, IT and Statistical Support; Hunter Medical Research Institute; Newcastle New South Wales Australia
| | - A. Bonaventura
- Department of Medical Oncology; Mercy Hospice; Calvary Mater Newcastle; Newcastle New South Wales Australia
- Hunter Cancer Research Alliance; Hunter Medical Research Institute; Newcastle New South Wales Australia
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34
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Smith D, Stevens J, Quinn J, Cavenagh J, Ingram W, Yong K. Myeloma presenting during pregnancy. Hematol Oncol 2013; 32:52-5. [DOI: 10.1002/hon.2088] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 06/09/2013] [Accepted: 06/24/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Dean Smith
- Clinical Haematology; University College Hospital; London UK
| | | | - John Quinn
- Haematology; Beaumont Hospital; Dublin Ireland
| | | | - Wendy Ingram
- Haematology; University Hospital of Wales; Cardiff Wales UK
| | - Kwee Yong
- Clinical Haematology; University College Hospital; London UK
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35
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Morris TCM, Williams C, Bell S, Fletcher M, Szubert A, Cavenagh J, Snowden J, Ashcroft J, Yong K, Cavet J, Brown J, Cook G. Patient perceptions of second transplants in myeloma: impact on recruitment in the British Society of Blood and Marrow Transplantation/UK Myeloma Forum Myeloma X Relapse (Intensive) Trial. Br J Haematol 2013; 163:541-3. [DOI: 10.1111/bjh.12513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Cathy Williams
- Centre for Clinical Haematology; University Hospitals Nottingham; Nottingham UK
| | - Sue Bell
- Clinical Trials Research Unit; University of Leeds; Leeds UK
| | - Marie Fletcher
- Clinical Trials Research Unit; University of Leeds; Leeds UK
| | | | - Jamie Cavenagh
- Department of Haematology; Barts and The London Hospitals Trust; London UK
| | - John Snowden
- Department of Haematology; Royal Hallamshire Hospital; Sheffield UK
| | - John Ashcroft
- Department of Haematology; Mid-Yorks Trust; Wakefield UK
| | - Kwee Yong
- Department of Haematology; University College Hospital; London UK
| | - James Cavet
- Department of Haematology; The Christie and University of Manchester; Manchester UK
| | - Julia Brown
- Clinical Trials Research Unit; University of Leeds; Leeds UK
| | - Gordon Cook
- Department of Haematology; Leeds Teaching Hospitals Trust; Leeds UK
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36
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Maharaj L, Marson CM, Middleton BJ, Rioja AS, Perry J, Oakervee H, Cavenagh J, Joel SP, Popat R. The histone deacetylase inhibitor UCL67022 has potent activity in multiple myeloma and non-Hodgkin lymphoma pre-clinical models. Br J Haematol 2013; 163:135-9. [DOI: 10.1111/bjh.12456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Alf S. Rioja
- Department of Chemistry; University College London; London; UK
| | - Jackie Perry
- Barts Cancer Institute; Queen Mary University of London; London; UK
| | | | | | - Simon P. Joel
- Barts Cancer Institute; Queen Mary University of London; London; UK
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37
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Islam A, Rafiq S, Kirwan M, Walne A, Cavenagh J, Vulliamy T, Dokal I. Haematological recovery in dyskeratosis congenita patients treated with danazol. Br J Haematol 2013; 162:854-6. [PMID: 23782100 DOI: 10.1111/bjh.12432] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Pratt G, Bowcock S, Lai M, Bell S, Bird J, D'Sa S, Cavenagh J, Cook G, Morgan G, Owen R, Snowden JA, Yong K, Davies F. United Kingdom Myeloma Forum (UKMF) position statement on the use of bendamustine in myeloma. Int J Lab Hematol 2013; 36:20-8. [PMID: 23615178 DOI: 10.1111/ijlh.12097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/25/2013] [Indexed: 11/29/2022]
Abstract
Bendamustine is a unique bifunctional alkylating agent with promising activity in myeloma. Despite the increasing number of studies demonstrating its efficacy in both the upfront and relapse settings, including patients with renal insufficiency, the optimal use of bendamustine, in terms of dosage, schedule and combination with other agents, has yet to be defined. It is currently licensed for use as frontline treatment with prednisolone for patients with myeloma who are unsuitable for transplantation and who are contraindicated for thalidomide and bortezomib. Studies in relapsed/refractory patients are currently ongoing with other combinations. Given the increasing data to date, the UK Myeloma Forum believes that bendamustine with steroids alone or in combination with a novel agent could be considered for patients with multiply relapsed myeloma. This document provides guidance for the use of bendamustine for patients with myeloma until the results of definitive studies are available.
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Affiliation(s)
- G Pratt
- Haematology, Heart of England NHS Trust, Institute for Cancer Studies, University of Birmingham, Birmingham, UK
| | - S Bowcock
- Haematology, South London Healthcare NHS Trust, Haematology Kent, Kent, UK
| | - M Lai
- Myeloma UK, Edinburgh, UK
| | - S Bell
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - J Bird
- Avon Haematology Unit, Bristol Haematology and Oncology Centre, Bristol, UK
| | - S D'Sa
- Department of Haematology, University College Hospital, London, UK
| | - J Cavenagh
- Department of Haematology, St. Bartholomew's Hospital, London, UK
| | - G Cook
- Department of Haematology, St. James's Institute of Oncology, Leeds, UK
| | - G Morgan
- Haemato-Oncology Unit, Royal Marsden Hospital, Sutton, UK
| | - R Owen
- Haematological Malignancy Diagnostic Service Laboratory, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J A Snowden
- Department of Haematology, Royal Hallamshire Hospital, Sheffield, UK
| | - K Yong
- Department of Haematology, University College Hospital, London, UK
| | - F Davies
- Haemato-Oncology Unit, Royal Marsden Hospital, Sutton, UK
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39
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Popat R, Plesner T, Davies F, Cook G, Cook M, Elliott P, Jacobson E, Gumbleton T, Oakervee H, Cavenagh J. A phase 2 study of SRT501 (resveratrol) with bortezomib for patients with relapsed and or refractory multiple myeloma. Br J Haematol 2012. [DOI: 10.1111/bjh.12154] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | | | | | | | - Mark Cook
- Queen Elizabeth Hospital; Birmingham; UK
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40
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Craddock C, Quek L, Goardon N, Freeman S, Siddique S, Raghavan M, Aztberger A, Schuh A, Grimwade D, Ivey A, Virgo P, Hills R, McSkeane T, Arrazi J, Knapper S, Brookes C, Davies B, Price A, Wall K, Griffiths M, Cavenagh J, Majeti R, Weissman I, Burnett A, Vyas P. Azacitidine fails to eradicate leukemic stem/progenitor cell populations in patients with acute myeloid leukemia and myelodysplasia. Leukemia 2012; 27:1028-36. [PMID: 23223186 DOI: 10.1038/leu.2012.312] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Epigenetic therapies demonstrate significant clinical activity in acute myeloid leukemia (AML) and myelodysplasia (MDS) and constitute an important new class of therapeutic agents. However hematological responses are not durable and disease relapse appears inevitable. Experimentally, leukemic stem/progenitor cells (LSC) propagate disease in animal models of AML and it has been postulated that their relative chemo-resistance contributes to disease relapse. We serially measured LSC numbers in patients with high-risk AML and MDS treated with 5'-azacitidine and sodium valproate (VAL-AZA). Fifteen out of seventy-nine patients achieved a complete remission (CR) or complete remission with incomplete blood count recovery (CRi) with VAL-AZA therapy. There was no significant reduction in the size of the LSC-containing population in non-responders. While the LSC-containing population was substantially reduced in all patients achieving a CR/CRi it was never eradicated and expansion of this population antedated morphological relapse. Similar studies were performed in seven patients with newly diagnosed AML treated with induction chemotherapy. Eradication of the LSC-containing population was observed in three patients all of whom achieved a durable CR in contrast to patients with resistant disease where LSC persistence was observed. LSC quantitation provides a novel biomarker of disease response and relapse in patients with AML treated with epigenetic therapies. New drugs that target this cellular population in vivo are required.
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Affiliation(s)
- C Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK.
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41
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Popat R, Maharaj L, Oakervee H, Cavenagh J, Joel S. Schedule dependent cytotoxicity of bortezomib and melphalan in multiple myeloma. Br J Haematol 2012; 160:111-4. [PMID: 23078038 DOI: 10.1111/bjh.12089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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42
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Ludwig H, Avet-Loiseau H, Bladé J, Boccadoro M, Cavenagh J, Cavo M, Davies F, de la Rubia J, Delimpasi S, Dimopoulos M, Drach J, Einsele H, Facon T, Goldschmidt H, Hess U, Mellqvist UH, Moreau P, San-Miguel J, Sondergeld P, Sonneveld P, Udvardy M, Palumbo A. European perspective on multiple myeloma treatment strategies: update following recent congresses. Oncologist 2012; 17:592-606. [PMID: 22573721 DOI: 10.1634/theoncologist.2011-0391] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The management of multiple myeloma has undergone profound changes over the recent past as a result of advances in our understanding of the disease biology as well as improvements in treatment and supportive care strategies. Notably, recent years have seen a surge in studies incorporating the novel agents thalidomide, bortezomib, and lenalidomide into treatment for different disease stages and across different patient groups. This article presents an update to a previous review of European treatment practices and is based on discussions during an expert meeting that was convened to review novel agent data published or presented at medical meetings until the end of 2011 and to assess their impact on treatment strategies.
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Affiliation(s)
- Heinz Ludwig
- Department of Medicine I, Center of Oncology and Hematology, Wilhelminenspital, Vienna, Austria.
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43
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Ishii T, Seike T, Nakashima T, Juliger S, Maharaj L, Soga S, Akinaga S, Cavenagh J, Joel S, Shiotsu Y. Anti-tumor activity against multiple myeloma by combination of KW-2478, an Hsp90 inhibitor, with bortezomib. Blood Cancer J 2012; 2:e68. [PMID: 22829970 PMCID: PMC3346683 DOI: 10.1038/bcj.2012.13] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 03/16/2012] [Accepted: 03/23/2012] [Indexed: 11/09/2022] Open
Abstract
Heat shock protein 90 (Hsp90) is a promising target for anti-tumor therapy. We previously reported the anti-tumor activity of a novel Hsp90 inhibitor, KW-2478, in multiple myeloma (MM) as a single agent. In this study, we examined the combinational effect of KW-2478 and bortezomib, a proteasome inhibitor, in vitro and in vivo. In vitro, KW-2478 enhanced bortezomib-induced cell growth inhibition, both in MM cell lines and primary patient MM cells. The combination of KW-2478 and bortezomib also induced caspase activation in MM cell lines. Interestingly, the combination synergistically enhanced the expression of Hsp70B, a homolog of Hsp70, in human MM cells and peripheral blood mononuclear cells, indicating Hsp70B could be a surrogate biomarker for the combination of Hsp90 and proteasome inhibitors. In vivo, the combination of KW-2478 with bortezomib showed synergistic anti-tumor activity without significant body weight loss in a subcutaneously inoculated human myeloma model. Furthermore, the combination also showed synergistic reduction of tumor burden in bone marrow in an orthotopic myeloma model. Our results strongly suggest that combination of KW-2478 with bortezomib could exhibit enhanced anti-tumor activity against human myeloma.
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44
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Bödör C, Renneville A, Smith M, Charazac A, Iqbal S, Etancelin P, Cavenagh J, Barnett MJ, Kramarzová K, Krishnan B, Matolcsy A, Preudhomme C, Fitzgibbon J, Owen C. Germ-line GATA2 p.THR354MET mutation in familial myelodysplastic syndrome with acquired monosomy 7 and ASXL1 mutation demonstrating rapid onset and poor survival. Haematologica 2012; 97:890-4. [PMID: 22271902 DOI: 10.3324/haematol.2011.054361] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
While most myelodysplastic syndrome/acute myeloid leukemia cases are sporadic, rare familial cases occur and provide some insight into leukemogenesis. The most clearly defined familial cases result from inherited mutations in RUNX1 or CEBPA. Recently, novel germline mutations in GATA2 have been reported. We, therefore, investigated individuals from families with one or more first-degree relatives with myelodysplastic syndrome/acute myeloid leukemia with wild-type RUNX1 and CEBPA, for GATA2 mutations. Screening for other recurrent mutations was also performed. A GATA2 p.Thr354Met mutation was observed in a pedigree in which 2 first-degree cousins developed high-risk myelodys-plastic syndrome with monosomy 7. They were also observed to have acquired identical somatic ASXL1 mutations and both died despite stem cell transplantation. These findings confirm that germline GATA2 mutations predispose to familial myelodysplastic syndrome/acute myeloid leukemia, and that monosomy 7 and ASXL1 mutations may be recurrent secondary genetic abnormalities triggering overt malignancy in these families.
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Affiliation(s)
- Csaba Bödör
- Centre of Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
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45
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Vargaftig J, Taussig DC, Griessinger E, Anjos-Afonso F, Lister TA, Cavenagh J, Oakervee H, Gribben J, Bonnet D. Frequency of leukemic initiating cells does not depend on the xenotransplantation model used. Leukemia 2011; 26:858-60. [PMID: 21926966 PMCID: PMC3272414 DOI: 10.1038/leu.2011.250] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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46
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Scully M, McDonald V, Cavenagh J, Hunt BJ, Longair I, Cohen H, Machin SJ. A phase 2 study of the safety and efficacy of rituximab with plasma exchange in acute acquired thrombotic thrombocytopenic purpura. Blood 2011; 118:1746-53. [PMID: 21636861 DOI: 10.1182/blood-2011-03-341131] [Citation(s) in RCA: 272] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The safety and efficacy of weekly rituximab 375 mg/m(2) (×4), given within 3 days of acute TTP admission, with standard therapy (PEX and steroids) was evaluated. Clinical outcomes were compared to historical controls (n = 40) who had not received rituximab. Within the trial group, 15 of 40 required ICU admission and 15% of all cases with the highest troponin T levels on admission were ventilated. Before the second rituximab infusion, 68% of cases had a platelet count > 50 × 10(9)/L and 38% > 150 × 10(9)/L. Fewer PEX were required in whites compared to nonwhite in the rituximab group (mean 14 vs 21, P = .0095). Inpatient stay was reduced by 7 days in the non-ICU trial cases compared to historical controls (P = .04), especially in whites, with a mean reduction of 7 days (P = .05). Ten percent of trial cases relapsed, median, 27 months (17-31 months), compared to 57% in historical controls, median 18 months (3-60 months; P = .0011). There were no excess infections or serious adverse events with rituximab. In conclusion, rituximab appears a safe and effective therapy. Inpatient stay and relapse are significantly reduced in the rituximab cohort. Rituximab should be considered in conjunction with standard therapy on acute presentation of TTP. This study was registered at www.clinicaltrials.gov as NCT009-3713.
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MESH Headings
- ADAM Proteins/immunology
- ADAMTS13 Protein
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/immunology
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antigens, CD19/immunology
- Female
- Humans
- Immunologic Factors/adverse effects
- Immunologic Factors/immunology
- Immunologic Factors/therapeutic use
- Male
- Middle Aged
- Plasma Exchange
- Purpura, Thrombotic Thrombocytopenic/drug therapy
- Purpura, Thrombotic Thrombocytopenic/immunology
- Purpura, Thrombotic Thrombocytopenic/prevention & control
- Purpura, Thrombotic Thrombocytopenic/therapy
- Recurrence
- Rituximab
- Young Adult
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Affiliation(s)
- Marie Scully
- Department of Haematology, University College London Hospital, London, United Kingdom.
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47
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Bird JM, Owen RG, D'Sa S, Snowden JA, Pratt G, Ashcroft J, Yong K, Cook G, Feyler S, Davies F, Morgan G, Cavenagh J, Low E, Behrens J. Guidelines for the diagnosis and management of multiple myeloma 2011. Br J Haematol 2011; 154:32-75. [PMID: 21569004 DOI: 10.1111/j.1365-2141.2011.08573.x] [Citation(s) in RCA: 227] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Jennifer M Bird
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
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48
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Ludwig H, Beksac M, Bladé J, Cavenagh J, Cavo M, Delforge M, Dimopoulos M, Drach J, Einsele H, Facon T, Goldschmidt H, Harousseau JL, Hess U, Kropff M, Leal da Costa F, Louw V, Magen-Nativ H, Mendeleeva L, Nahi H, Plesner T, San-Miguel J, Sonneveld P, Udvardy M, Sondergeld P, Palumbo A. Multiple myeloma treatment strategies with novel agents in 2011: a European perspective. Oncologist 2011; 16:388-403. [PMID: 21441574 PMCID: PMC3228121 DOI: 10.1634/theoncologist.2010-0386] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 02/11/2011] [Indexed: 11/17/2022] Open
Abstract
The arrival of the novel agents thalidomide, bortezomib, and lenalidomide has significantly changed our approach to the management of multiple myeloma and, importantly, patient outcomes have improved. These agents have been investigated intensively in different treatment settings, providing us with data to make evidence-based decisions regarding the optimal management of patients. This review is an update to a previous summary of European treatment practices that examines new data that have been published or presented at congresses up to the end of 2010 and assesses their impact on treatment practices.
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Affiliation(s)
- Heinz Ludwig
- Department of Medicine I, Center of Oncology and Hematology, Wilhelminenspital, Montleartstr. 37, 1160 Vienna, Austria.
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49
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Morris C, Cook G, Streetly M, Kettle P, Drake M, Quinn M, Cavet J, Tighe J, Kazmi M, Ashcroft J, Cook M, Snowden J, Olujohungbe A, Marshall S, Conn J, Oakervee H, Popat R, Cavenagh J. Re-transplantation after bortezomib-based therapy. Br J Haematol 2011; 153:666-8. [DOI: 10.1111/j.1365-2141.2010.08521.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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50
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Goardon N, Marchi E, Atzberger A, Quek L, Schuh A, Soneji S, Woll P, Mead A, Alford KA, Rout R, Chaudhury S, Gilkes A, Knapper S, Beldjord K, Begum S, Rose S, Geddes N, Griffiths M, Standen G, Sternberg A, Cavenagh J, Hunter H, Bowen D, Killick S, Robinson L, Price A, Macintyre E, Virgo P, Burnett A, Craddock C, Enver T, Jacobsen SEW, Porcher C, Vyas P. Coexistence of LMPP-like and GMP-like leukemia stem cells in acute myeloid leukemia. Cancer Cell 2011; 19:138-52. [PMID: 21251617 DOI: 10.1016/j.ccr.2010.12.012] [Citation(s) in RCA: 456] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 10/23/2010] [Accepted: 12/15/2010] [Indexed: 12/13/2022]
Abstract
The relationships between normal and leukemic stem/progenitor cells are unclear. We show that in ∼80% of primary human CD34+ acute myeloid leukemia (AML), two expanded populations with hemopoietic progenitor immunophenotype coexist in most patients. Both populations have leukemic stem cell (LSC) activity and are hierarchically ordered; one LSC population gives rise to the other. Global gene expression profiling shows the LSC populations are molecularly distinct and resemble normal progenitors but not stem cells. The more mature LSC population most closely mirrors normal granulocyte-macrophage progenitors (GMP) and the immature LSC population a previously uncharacterized progenitor functionally similar to lymphoid-primed multipotential progenitors (LMPPs). This suggests that in most cases primary CD34+ AML is a progenitor disease where LSCs acquire abnormal self-renewal potential.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Animals
- Antigens, CD/metabolism
- Antigens, CD34/metabolism
- Cell Differentiation/physiology
- Cell Lineage/physiology
- Gene Expression Profiling
- Graft Survival
- Granulocyte-Macrophage Progenitor Cells/cytology
- Granulocyte-Macrophage Progenitor Cells/metabolism
- Hematopoietic Stem Cells/cytology
- Hematopoietic Stem Cells/metabolism
- Humans
- Immunophenotyping
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/pathology
- Leukocyte Common Antigens/metabolism
- Lymphoid Progenitor Cells/cytology
- Lymphoid Progenitor Cells/metabolism
- Mice
- Mice, Inbred NOD
- Mice, SCID
- Middle Aged
- Neoplastic Stem Cells/metabolism
- Neoplastic Stem Cells/pathology
- Neoplastic Stem Cells/transplantation
- Transplantation, Heterologous/pathology
- Young Adult
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