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Durot E, Roosweil D, Chauchet A, Decroocq J, Di Blasi R, Gastinne T, Bensaber H, Cheminant M, Jacquet C, Guidez S, Gros FX, Bachy E, Coste A, Cony-Makhoul P, Treon SP, Delmer AJ, Reshef R, Le Gouill S, Castillo JJ, Houot R. High efficacy of CD19 CAR T-cells in patients with transformed Waldenström macroglobulinemia. Blood 2024:blood.2024024452. [PMID: 38669635 DOI: 10.1182/blood.2024024452] [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: 02/27/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Histological transformation of Waldenström macroglobulinemia (HT-WM) carries a poor prognosis with standard treatments. Here, we report the first series of HT-WM treated with CAR T-cells showing a high efficacy and no unexpected toxicity.
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Affiliation(s)
- Eric Durot
- Hôpital Robert Debré CHU de Reims, Reims cedex, France
| | - Damien Roosweil
- Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Justine Decroocq
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016, F-75014 Paris, France, Paris, France
| | | | | | - Hedi Bensaber
- University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | | | | | | | - Arthur Coste
- Hopital Robert Debre CHU de Reims, Reims cedex, France
| | | | - Steven P Treon
- Dana Farber Cancer Institute, Boston, Massachusetts, United States
| | | | - Ran Reshef
- Columbia University Medical Center, New York, New York, United States
| | | | - Jorge J Castillo
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States
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2
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Treon SP, Sarosiek S, Castillo JJ. How I use genomics and BTK inhibitors in the treatment of Waldenström macroglobulinemia. Blood 2024; 143:1702-1712. [PMID: 38211337 DOI: 10.1182/blood.2022017235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/13/2024] Open
Abstract
ABSTRACT Mutations in MYD88 (95%-97%) and CXCR4 (30%-40%) are common in Waldenström macroglobulinemia (WM). TP53 is altered in 20% to 30% of patients with WM, particularly those previously treated. Mutated MYD88 activates hematopoietic cell kinase that drives Bruton tyrosine kinase (BTK) prosurvival signaling. Both nonsense and frameshift CXCR4 mutations occur in WM. Nonsense variants show greater resistance to BTK inhibitors. Covalent BTK inhibitors (cBTKi) produce major responses in 70% to 80% of patients with WM. MYD88 and CXCR4 mutation status can affect time to major response, depth of response, and/or progression-free survival (PFS) in patients with WM treated with cBTKi. The cBTKi zanubrutinib shows greater response activity and/or improved PFS in patients with WM with wild-type MYD88, mutated CXCR4, or altered TP53. Risks for adverse events, including atrial fibrillation, bleeding diathesis, and neutropenia can differ based on which BTKi is used in WM. Intolerance is also common with cBTKi, and dose reduction or switchover to another cBTKi can be considered. For patients with acquired resistance to cBTKis, newer options include pirtobrutinib or venetoclax. Combinations of BTKis with chemoimmunotherapy, CXCR4, and BCL2 antagonists are discussed. Algorithms for positioning BTKis in treatment naïve or previously treated patients with WM, based on genomics, disease characteristics, and comorbidities, are presented.
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Affiliation(s)
- Steven P Treon
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Shayna Sarosiek
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jorge J Castillo
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
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3
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Tam CS, Opat S, D'Sa S, Jurczak W, Lee HP, Cull G, Owen RG, Marlton P, Wahlin BE, García-Sanz R, McCarthy H, Mulligan S, Tedeschi A, Castillo JJ, Czyż J, Fernández De Larrea C, Belada D, Libby E, Matous J, Motta M, Siddiqi T, Tani M, Trněný M, Minnema MC, Buske C, Leblond V, Treon SP, Trotman J, Wu B, Yu Y, Shen Z, Chan WY, Schneider J, Allewelt H, Cohen A, Dimopoulos MA. Biomarker analysis of the ASPEN study comparing zanubrutinib with ibrutinib for patients with Waldenström macroglobulinemia. Blood Adv 2024; 8:1639-1650. [PMID: 38315878 PMCID: PMC11006814 DOI: 10.1182/bloodadvances.2023010906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 02/07/2024] Open
Abstract
ABSTRACT The phase 3 ASPEN trial (NCT03053440) compared Bruton tyrosine kinase inhibitors (BTKis), zanubrutinib and ibrutinib, in patients with Waldenström macroglobulinemia (WM). Post-hoc biomarker analysis was performed using next-generation sequencing on pretreatment bone marrow samples from 98 patients treated with zanubrutinib and 92 patients treated with ibrutinib with mutated (MUT) MYD88 and 20 patients with wild-type (WT) MYD88 treated with zanubrutinib. Of 329 mutations in 52 genes, mutations in CXCR4 (25.7%), TP53 (24.8%), ARID1A (15.7%), and TERT (9.0%) were most common. TP53MUT, ARID1AMUT, and TERTMUT were associated with higher rates of CXCR4MUT (P < .05). Patients with CXCR4MUT (frameshift or nonsense [NS] mutations) had lower very good partial response (VGPR) and complete response rates (CR; 17.0% vs 37.2%, P = .020) and longer time to response (11.1 vs 8.4 months) than patients with CXCR4WT treated with BTKis. CXCR4NS was associated with inferior progression-free survival (PFS; hazard ratio [HR], 3.39; P = .017) in patients treated with ibrutinib but not in those treated with zanubrutinib (HR, 0.67; P = .598), but VGPR + CR rates were similar between treatment groups (14.3% vs 15.4%). Compared with ibrutinib, patients with CXCR4NS treated with zanubrutinib had a favorable major response rate (MRR; 85.7% vs 53.8%; P = .09) and PFS (HR, 0.30; P = .093). In patients with TP53MUT, significantly lower MRRs were observed for patients treated with ibrutinib (63.6% vs 85.7%; P = .04) but not for those treated with zanubrutinib (80.8% vs 81.9%; P = .978). In TP53MUT, compared with ibrutinib, patients treated with zanubrutinib had higher VGPR and CR (34.6% vs 13.6%; P < .05), numerically improved MRR (80.8% vs 63.6%; P = .11), and longer PFS (not reached vs 44.2 months; HR, 0.66; P = .37). Collectively, patients with WM with CXCR4MUT or TP53MUT had worse prognosis compared with patients with WT alleles, and zanubrutinib led to better clinical outcomes.
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Affiliation(s)
- Constantine S. Tam
- Department of Haematology, Alfred Hospital and Centre for Blood Diseases, Monash University, Melbourne, VIC, Australia
| | - Stephen Opat
- Department of Haematology, Monash Health and Monash University, Clayton, VIC, Australia
| | - Shirley D'Sa
- Centre for Waldenström’s Macroglobulinemia and Associated Disorders, University College London Hospital Foundation Trust, London, United Kingdom
| | - Wojciech Jurczak
- Department of Clinical Oncology, Maria Sklodowska-Curie National Institute of Oncology, Krakow, Poland
| | - Hui-Peng Lee
- Department of Haematology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Gavin Cull
- Department of Haematology, Sir Charles Gairdner Hospital, University of Western Australia, Perth, WA, Australia
| | - Roger G. Owen
- Haematological Malignancy Diagnostic Service, St James University Hospital, Leeds, United Kingdom
| | - Paula Marlton
- Department of Haematology, Princess Alexandra Hospital and University of Queensland, Brisbane, QLD, Australia
| | - Björn E. Wahlin
- Department of Hematology, Karolinska Universitetssjukhuset and Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Ramón García-Sanz
- Department of Hematology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Helen McCarthy
- Department of Haematology, Royal Bournemouth and Christchurch Hospital, Bournemouth, United Kingdom
| | - Stephen Mulligan
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Alessandra Tedeschi
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Jorge J. Castillo
- Bing Center for Waldenstrom Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Jarosław Czyż
- Department of Hematology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | | | - David Belada
- Department of Internal Medicine – Haematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - Edward Libby
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Marina Motta
- Department of Hematology, AO Spedali Civili di Brescia, Lombardia, Italy
| | - Tanya Siddiqi
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Monica Tani
- U.O. Ematologia, Dipartimento Oncologia e Ematologia, Ospedale Civile Santa Maria delle Croci, AUSL Ravenna, Italy
| | - Marek Trněný
- Všeobecná fakultní nemocnice v Praze, Prague, Czechia
| | - Monique C. Minnema
- Department of Hematology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Christian Buske
- Comprehensive Cancer Center Ulm, Universitätsklinikum Ulm, Ulm, Baden-Württemberg, Germany
| | - Véronique Leblond
- Service d'Hématologie Clinique, Sorbonne University, Pitié Salpêtrière Hospital, Paris, France
| | - Steven P. Treon
- Bing Center for Waldenstrom Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Judith Trotman
- Department of Hematology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Binghao Wu
- BeiGene USA, Inc, San Mateo, CA
- BeiGene Co, Ltd, Shanghai, China
| | - Yiling Yu
- BeiGene USA, Inc, San Mateo, CA
- BeiGene Co, Ltd, Shanghai, China
| | - Zhirong Shen
- BeiGene USA, Inc, San Mateo, CA
- BeiGene Co, Ltd, Shanghai, China
| | - Wai Y. Chan
- BeiGene USA, Inc, San Mateo, CA
- BeiGene Co, Ltd, Shanghai, China
| | | | | | - Aileen Cohen
- BeiGene USA, Inc, San Mateo, CA
- BeiGene Co, Ltd, Shanghai, China
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
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4
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Itchaki G, Jarhovsky O, Castillo JJ, Hassan H, Gatt ML, Leiba M, Raanani P, Gertz MA, Vaxman I. Lymphoplasmacytic lymphoma and multiple myeloma coexisting in the same patient: a case series and literature review. Leuk Lymphoma 2024:1-7. [PMID: 38501758 DOI: 10.1080/10428194.2024.2332499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Abstract
The simultaneous occurrence of Waldenström macroglobulinemia and multiple myeloma in the same patient has been published as case reports. Patients with Waldenström macroglobulinemia often have a small clone of plasma cells. However, the concurrent occurrence of symptomatic myeloma with lytic bone lesions is rare. The diagnosis of this 'hybrid' entity is challenging, and there are no standard therapies. We present six patients from five centers (three in Israel and two in the United States). We describe these patients' unique clinical course and treatment approaches.
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Affiliation(s)
- Gilad Itchaki
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Hematology, Meir Medical Center, Kfar-Saba, Israel
| | - Osnat Jarhovsky
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Hematology, Meir Medical Center, Kfar-Saba, Israel
| | - Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Hamza Hassan
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Moshe L Gatt
- Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Merav Leiba
- Assuta Ashdod University Hospital, Faculty of Health Science, Ben-Gurion University of the Negev, Negev, Israel
| | - Pia Raanani
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikvah, Israel
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Iuliana Vaxman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikvah, Israel
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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5
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Castillo JJ, Branagan AR, Sermer D, Flynn CA, Meid K, Little M, Stockman K, White T, Canning A, Guerrera ML, Kofides A, Liu S, Liu X, Richardson K, Tsakmaklis N, Patterson CJ, Hunter ZR, Treon SP, Sarosiek S. Ibrutinib and venetoclax as primary therapy in symptomatic, treatment-naïve Waldenström macroglobulinemia. Blood 2024; 143:582-591. [PMID: 37971194 PMCID: PMC10873534 DOI: 10.1182/blood.2023022420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/29/2023] [Accepted: 10/07/2023] [Indexed: 11/19/2023] Open
Abstract
ABSTRACT Concurrent Bruton tyrosine kinase and BCL2 inhibition has not yet been investigated in Waldenström macroglobulinemia (WM). We performed an investigator-initiated trial of ibrutinib and venetoclax in symptomatic treatment-naïve patients with MYD88-mutated WM. Patients received ibrutinib 420 mg once daily (cycle 1), followed by a ramp-up of venetoclax to 400 mg daily (cycle 2). The combination was then administered for 22 additional 4-week cycles. The attainment of very good partial response (VGPR) was the primary end point. Forty-five patients were enrolled in this study. The median baseline characteristics were as follows: age 67 years, serum IgM 43 g/L, and hemoglobin 102 g/L. Seventeen patients (38%) carried CXCR4 mutations. Nineteen patients (42%) achieved VGPR. Grade 3 or higher adverse events included neutropenia (38%), mucositis (9%), and tumor lysis syndrome (7%). Atrial fibrillation occurred in 3 (9%), and ventricular arrhythmia in 4 (9%) patients that included 2 grade 5 events. With a median follow-up of 24.4 months, the 24-month progression-free survival (PFS) and overall survival (OS) rates were 76% and 96%, respectively, and were not impacted by CXCR4 mutations. The median time on therapy was 10.2 months, and the median time after the end of therapy (EOT) was 13.3 months. Eleven of the 12 progression events occurred after EOT, and the 12-month PFS rates after EOT were 79%; 93% if VGPR was attained, and 69% for other patients (P = .12). Ibrutinib and venetoclax induced high VGPR rates and durable responses after EOT, although they were associated with a higher-than-expected rate of ventricular arrhythmia in patients with WM, leading to early study treatment termination. This trial was registered at www.clinicaltrials.gov as #NCT04273139.
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Affiliation(s)
- Jorge J. Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Andrew R. Branagan
- Department of Medicine, Harvard Medical School, Boston, MA
- Center for Multiple Myeloma, Massachusetts General Hospital, Boston, MA
| | - David Sermer
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Catherine A. Flynn
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Kirsten Meid
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Megan Little
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Katherine Stockman
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Timothy White
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Alexa Canning
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Maria L. Guerrera
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Amanda Kofides
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Shirong Liu
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Xia Liu
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Kris Richardson
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Nicholas Tsakmaklis
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | | | - Zachary R. Hunter
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Steven P. Treon
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Shayna Sarosiek
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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6
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AlJabban A, Paik H, Aster JC, Berliner N, Brouillard J, Brown JR, Burns KH, Castillo JJ, Card J, Dal Cin P, DeAngelo DJ, Dorfman DM, Ebert BL, Garcia JS, Jacobson CA, Lakhani H, Laubach JP, Ligon AH, Lindeman NI, Lindsley RC, Lovitch SB, Luskin MR, Morgan EA, Nowak A, Petrides A, Pinkus GS, Pozdnyakova O, Steensma DP, Stone RM, Weinberg OK, Winer ES, Kim AS. Optimization of Advanced Molecular Genetic Testing Utilization in Hematopathology: A Goldilocks Approach to Bone Marrow Testing. JCO Oncol Pract 2024; 20:220-227. [PMID: 37683132 DOI: 10.1200/op.23.00217] [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: 04/10/2023] [Revised: 06/13/2023] [Accepted: 07/10/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE This study investigated the effectiveness of algorithmic testing in hematopathology at the Brigham and Women's Hospital and Dana-Farber Cancer Institute (DFCI). The algorithm was predicated on test selection after an initial pathologic evaluation to maximize cost-effective testing, especially for expensive molecular and cytogenetic assays. MATERIALS AND METHODS Standard ordering protocols (SOPs) for 17 disease categories were developed and encoded in a decision support application. Six months of retrospective data from application beta testing was obtained and compared with actual testing practices during that timeframe. In addition, 2 years of prospective data were also obtained from patients at one community satellite site. RESULTS A total of 460 retrospective cases (before introduction of algorithmic testing) and 109 prospective cases (following introduction) were analyzed. In the retrospective data, 61.7% of tests (509 of 825) were concordant with the SOPs while 38.3% (316 of 825) were overordered and 30.8% (227 of 736) of SOP-recommended tests were omitted. In the prospective data, 98.8% of testing was concordant (244 of 247 total tests) with only 1.2% overordered tests (3 of 247) and 7.6% omitted tests (20 of 264 SOP-recommended tests; overall P < .001). The cost of overordered tests before implementing SOP indicates a potential annualized saving of $1,347,520 in US dollars (USD) in overordered testing at Brigham and Women's Hospital/DFCI. Only two of 316 overordered tests (0.6%) returned any additional information, both for extremely rare clinical circumstances. CONCLUSION Implementation of SOPs dramatically improved test ordering practices, with a just right number of ancillary tests that minimizes cost and has no significant impact on acquiring key informative test results.
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Affiliation(s)
- Ali AlJabban
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Henry Paik
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Enterprise Research IS (ERIS), Digital, Mass General Brigham, Boston, MA
| | - Jon C Aster
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Nancy Berliner
- Harvard Medical School, Boston, MA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
| | | | - Jennifer R Brown
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Kathleen H Burns
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA
| | - Jorge J Castillo
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - James Card
- Department of Quality and Safety, Dana-Farber Cancer Institute, Boston, MA
| | - Paola Dal Cin
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Daniel J DeAngelo
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - David M Dorfman
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Benjamin L Ebert
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Jacqueline S Garcia
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Caron A Jacobson
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Hakim Lakhani
- Department of Quality and Safety, Dana-Farber Cancer Institute, Boston, MA
| | - Jacob P Laubach
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Azra H Ligon
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA
| | - Neal I Lindeman
- Department of Pathology, Weill Cornell Medicine, New York, NY
| | - R Coleman Lindsley
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Scott B Lovitch
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Marlise R Luskin
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Elizabeth A Morgan
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Andrew Nowak
- Department of Performance Improvement, Stanford Medicine Children's Health, Stanford, CA
| | - Athena Petrides
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Enterprise Research IS (ERIS), Digital, Mass General Brigham, Boston, MA
| | - Geraldine S Pinkus
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Olga Pozdnyakova
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - David P Steensma
- Novartis Institutes for BioMedical Research (NIBR), Cambridge, MA
| | - Richard M Stone
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Olga K Weinberg
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX
| | - Eric S Winer
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Annette S Kim
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA
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7
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Richardson K, Castillo JJ, Sarosiek SR, Branagan AR, Flynn CA, Meid K, Gustine JN, Liu X, Kofides A, Liu S, Wolf JL, Kacena KA, Patterson CJ, Guerrera ML, Tsakmaklis N, Treon SP, Hunter ZR. Identification of robust predictors for ibrutinib response by multi-omics in MYD88 mutated Waldenstrom Macroglobulinemia. Blood Adv 2024; 8:bloodadvances.2023012111. [PMID: 38237078 PMCID: PMC11059321 DOI: 10.1182/bloodadvances.2023012111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 05/03/2024] Open
Affiliation(s)
- Kris Richardson
- Bing Center for Waldenstrom’s Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Jorge J. Castillo
- Bing Center for Waldenstrom’s Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Shayna R. Sarosiek
- Bing Center for Waldenstrom’s Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Andrew R. Branagan
- Department of Medicine, Harvard Medical School, Boston, MA
- MGH Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Catherine A. Flynn
- Bing Center for Waldenstrom’s Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA
| | - Kirsten Meid
- Bing Center for Waldenstrom’s Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA
| | - Joshua N. Gustine
- Department of Medicine, Harvard Medical School, Boston, MA
- MGH Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Xia Liu
- Bing Center for Waldenstrom’s Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Amanda Kofides
- Bing Center for Waldenstrom’s Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA
| | - Shirong Liu
- Bing Center for Waldenstrom’s Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | | | | | | | - Maria Luisa Guerrera
- Bing Center for Waldenstrom’s Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Nicholas Tsakmaklis
- Bing Center for Waldenstrom’s Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA
| | - Steven P. Treon
- Bing Center for Waldenstrom’s Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Zachary R. Hunter
- Bing Center for Waldenstrom’s Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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8
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Sarosiek S, Castillo JJ. Waldenström Macroglobulinemia: Targeted Agents Taking Center Stage. Drugs 2024; 84:17-25. [PMID: 38055179 DOI: 10.1007/s40265-023-01974-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 12/07/2023]
Abstract
With the worldwide approval of the oral covalent Bruton tyrosine kinase (BTK) inhibitors ibrutinib and zanubrutinib for treating patients with Waldenström macroglobulinemia (WM), targeted agents have certainly taken center stage in the therapeutic landscape of WM. This review discusses the biological and clinical data supporting current and up-and-coming targeted agents in WM. Bruton tyrosine kinase inhibitors induce fast, deep, and durable responses in patients with WM, comparable to chemoimmunotherapy; however, there is a glaring absence of comparative studies between these regimens. The high response and progression-free survival rate and the ease of administration of BTK inhibitors must be balanced against their specific adverse-event profile with unique toxicity (e.g., bleeding and cardiac arrhythmia) and the indefinite duration of the therapy. Novel targeted agents of interest include BCL2 antagonists (e.g., venetoclax and sonrotoclax) and non-covalent BTK inhibitors (e.g., pirtobrutinib and nemtabrutinib), among others. The therapeutic landscape of patients with WM will benefit from the robust participation of patients in clinical trials.
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Affiliation(s)
- Shayna Sarosiek
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, 450 Brookline Ave, Mayer 221, Boston, MA, 02215, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, 450 Brookline Ave, Mayer 221, Boston, MA, 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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9
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Kumar SK, Callander NS, Adekola K, Anderson LD, Baljevic M, Baz R, Campagnaro E, Castillo JJ, Costello C, D'Angelo C, Derman B, Devarakonda S, Elsedawy N, Garfall A, Godby K, Hillengass J, Holmberg L, Htut M, Huff CA, Hultcrantz M, Kang Y, Larson S, Lee H, Liedtke M, Martin T, Omel J, Robinson T, Rosenberg A, Sborov D, Schroeder MA, Sherbenou D, Suvannasankha A, Valent J, Varshavsky-Yanovsky AN, Snedeker J, Kumar R. Waldenström Macroglobulinemia/Lymphoplasmacytic Lymphoma, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2024; 22:e240001. [PMID: 38244272 DOI: 10.6004/jnccn.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
The treatment of Waldenström macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL) has evolved to include several new options. The NCCN Guidelines for WM/LPL provide a framework on which to base decisions regarding diagnosis, treatment, assessment of response to treatment, and follow-up of both newly diagnosed and previously treated WM/LPL.
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Affiliation(s)
| | | | - Kehinde Adekola
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | | | | | | | - Srinivas Devarakonda
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Noura Elsedawy
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Alfred Garfall
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | | | - Myo Htut
- City of Hope National Medical Center
| | - Carol Ann Huff
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | - Hans Lee
- The University of Texas MD Anderson Cancer Center
| | | | - Thomas Martin
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | - Mark A Schroeder
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Jason Valent
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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10
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Kumar SK, Callander NS, Adekola K, Anderson LD, Baljevic M, Baz R, Campagnaro E, Castillo JJ, Costello C, D'Angelo C, Devarakonda S, Elsedawy N, Garfall A, Godby K, Hillengass J, Holmberg L, Htut M, Huff CA, Hultcrantz M, Kang Y, Larson S, Lee HC, Liedtke M, Martin T, Omel J, Robinson T, Rosenberg A, Sborov D, Schroeder MA, Sherbenou D, Suvannasankha A, Valent J, Varshavsky-Yanovsky AN, Kumar R, Snedeker J. Multiple Myeloma, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2023; 21:1281-1301. [PMID: 38081133 DOI: 10.6004/jnccn.2023.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The treatment of relapsed/refractory multiple myeloma (MM) has evolved to include several new options. These include new combinations with second generation proteasome inhibitors (PI); second generation immunomodulators, monoclonal antibodies, CAR T cells, bispecific antibodies, selinexor, venetoclax, and many others. Most patients with MM undergo several cycles of remissions and relapse, and therefore need multiple lines of combination therapies. Selecting treatment options for relapsed/refractory MM requires consideration of resistance status to specific classes, and patient-specific factors such as age and other comorbidities should be considered. The NCCN Guidelines for MM provide a framework on which to base decisions regarding workup, treatment, and follow-up of newly diagnosed and previously treated MM. This manuscript outlines the recommendations from NCCN Guidelines for MM specific to relapsed/refractory disease.
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Affiliation(s)
| | | | - Kehinde Adekola
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | - Jorge J Castillo
- Dana-Farber/Brigham and Women's Cancer Center | Mass General Cancer Center
| | | | | | - Srinivas Devarakonda
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Noura Elsedawy
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Alfred Garfall
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | | | - Myo Htut
- City of Hope National Medical Center
| | - Carol Ann Huff
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | - Hans C Lee
- The University of Texas MD Anderson Cancer Center
| | | | - Thomas Martin
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | - Mark A Schroeder
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Jason Valent
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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11
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Leung BW, Fay CJ, Said JT, Sheets AR, Lian CG, Brown JR, Castillo JJ, Sarosiek S, Flynn C, LeBoeuf NR. Localized upper extremity edema secondary to Bruton's tyrosine kinase inhibition. Leuk Lymphoma 2023; 64:2047-2050. [PMID: 37671695 DOI: 10.1080/10428194.2023.2245091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/01/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Bonnie W Leung
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christopher J Fay
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jordan T Said
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anthony R Sheets
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Christine G Lian
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jennifer R Brown
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jorge J Castillo
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | - Nicole R LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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12
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Dimopoulos MA, Opat S, D'Sa S, Jurczak W, Lee HP, Cull G, Owen RG, Marlton P, Wahlin BE, Garcia-Sanz R, McCarthy H, Mulligan S, Tedeschi A, Castillo JJ, Czyz J, Fernández de Larrea C, Belada D, Libby E, Matous J, Motta M, Siddiqi T, Tani M, Trněný M, Minnema MC, Buske C, Leblond V, Treon SP, Trotman J, Chan WY, Schneider J, Allewelt H, Patel S, Cohen A, Tam CS. Zanubrutinib Versus Ibrutinib in Symptomatic Waldenström Macroglobulinemia: Final Analysis From the Randomized Phase III ASPEN Study. J Clin Oncol 2023; 41:5099-5106. [PMID: 37478390 PMCID: PMC10666987 DOI: 10.1200/jco.22.02830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/28/2023] [Accepted: 05/08/2023] [Indexed: 07/23/2023] Open
Abstract
The phase III ASPEN study demonstrated the comparable efficacy and improved safety of zanubrutinib versus ibrutinib in patients with Waldenström macroglobulinemia (WM). Here, we report long-term follow-up outcomes from ASPEN. The primary end point was the sum of very good partial response (VGPR) + complete response (CR) rates; secondary and exploratory end points were also reported. Cohort 1 comprised 201 patients (myeloid differentiation primary response 88-mutant WM: 102 receiving zanubrutinib; 99 receiving ibrutinib); cohort 2 comprised 28 patients (myeloid differentiation primary response 88 wild-type WM: 28 zanubrutinib; 26 efficacy evaluable). At 44.4-month median follow-up, VGPR + CR rates were 36.3% with zanubrutinib versus 25.3% with ibrutinib in cohort 1 and 30.8% with one CR in cohort 2. In patients with CXC motif chemokine receptor 4 mutation, VGPR + CR rates were 21.2% with zanubrutinib versus 10.0% with ibrutinib (cohort 1). Median progression-free survival and overall survival were not reached. Any-grade adverse events (AEs) of diarrhea (34.7% v 22.8%), muscle spasms (28.6% v 11.9%), hypertension (25.5% v 14.9%), atrial fibrillation/flutter (23.5% v 7.9%), and pneumonia (18.4% v 5.0%) were more common with ibrutinib versus zanubrutinib; neutropenia (20.4% v 34.7%) was less common with ibrutinib versus zanubrutinib (cohort 1). Zanubrutinib was associated with lower risk of AE-related treatment discontinuation. Overall, these findings confirm the long-term response quality and tolerability associated with zanubrutinib.
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Affiliation(s)
| | - Stephen Opat
- Monash Health & Monash University, Clayton, VIC, Australia
| | - Shirley D'Sa
- Centre for Waldenström's Macroglobulinemia & Associated Disorders, University College London Hospital Foundation Trust, London, United Kingdom
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Institute of Oncology, Krakow, Poland
| | - Hui-Peng Lee
- Flinders Medical Centre, Adelaide, SA, Australia
| | - Gavin Cull
- Sir Charles Gairdner Hospital, University of Western Australia, Perth, WA, Australia
| | - Roger G Owen
- St James University Hospital, Leeds, United Kingdom
| | - Paula Marlton
- Princess Alexandra Hospital and University of Queensland, Brisbane, QLD, Australia
| | - Björn E Wahlin
- Karolinska Universitetssjukhuset & Karolinska Institutet, Stockholm, Sweden
| | | | - Helen McCarthy
- Royal Bournemouth & Christchurch Hospital, Bournemouth, United Kingdom
| | | | | | | | - Jaroslaw Czyz
- Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | | | | | | | | | | | | | - Monica Tani
- Ospedale Civile Santa Maria delle Croci, AUSL Ravenna, Ravenna, Italy
| | - Marek Trněný
- Všeobecná fakultní nemocnice v Praze, Prague, Czechia
| | | | - Christian Buske
- Institute of Experimental Cancer Research -CCC Ulm-Universitätsklinikum Ulm, Ulm, Baden-Württemberg, Germany
| | | | | | - Judith Trotman
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| | | | | | | | | | | | - Constantine S Tam
- Monash Health & Monash University, Clayton, VIC, Australia
- The Alfred Hospital, Melbourne, VIC, Australia
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13
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Candelaria M, Villela L, Torres-Viera MA, Peña C, Roa M, Zambrano D, Colunga-Pedraza PRR, Robles-Rodríguez A, Pérez-Jacobo F, Oliver AC, Irigoín MV, Baena R, Idrobo H, Paredes SR, Oliday R, Castro D, Montaño-Figueroa E, Perini GF, Fernández-Aguila JD, Malpica LE, Beltran BE, Castillo JJ. Real-world experience in older patients with diffuse large B-cell lymphoma treated in Latin America: A study by the Latin American study group of lymphoproliferative disorders (GELL). J Geriatr Oncol 2023; 14:101565. [PMID: 37419788 DOI: 10.1016/j.jgo.2023.101565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/18/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023]
Affiliation(s)
| | - Luis Villela
- Facultad de Medicina, Universidad Autonoma de Sinaloa, Sinaloa, Mexico; Hospital Fernando Ocaranza ISSSTE y Centro Médico Dr. Ignacio Chávez, ISSSTESON, Hermosillo, Mexico
| | | | - Camila Peña
- Hospital del Salvador, Santiago de Chile, Chile
| | | | | | - Perla R R Colunga-Pedraza
- Hospital Universitario de Nuevo León, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo León, Mexico
| | | | | | | | | | | | - Henry Idrobo
- Hospital Universitario San Jorge, Grupo Ospedale, Suramericana de Salud, Universidad del Valle, Colombia
| | - Sally R Paredes
- Hospital Nacional Edgardo Rebagliati Martins, Centro de Investigación de Medicina de Precisión, Universidad de San Martín de Porres, Lima, Peru
| | - Rosa Oliday
- Hospital Hermanos Ameijeiras, Sociedad Científica de Hematología Cubana, La Habana, Cuba
| | - Denisse Castro
- Hospital Nacional Edgardo Rebagliati Martins, Centro de Investigación de Medicina de Precisión, Universidad de San Martín de Porres, Lima, Peru
| | | | | | | | - Luis E Malpica
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brady E Beltran
- Hospital Nacional Edgardo Rebagliati Martins, Centro de Investigación de Medicina de Precisión, Universidad de San Martín de Porres, Lima, Peru
| | - Jorge J Castillo
- Division of Hematological Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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14
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Sarosiek S, Treon SP, Branagan AR, Castillo JJ. Does Bortezomib-Dexamethasone-Rituximab-Cyclophosphamide Play a Role in the Treatment of Waldenström's Macroglobulinemia? J Clin Oncol 2023; 41:4059-4060. [PMID: 37348023 DOI: 10.1200/jco.23.00649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/26/2023] [Indexed: 06/24/2023] Open
Affiliation(s)
| | - Steven P Treon
- Shayna Sarosiek, MD, and Steven P. Treon, MD, PhD, Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, Department of Medicine, Harvard Medical School, Boston, MA; Andrew R. Branagan, MD, PhD, Department of Medicine, Harvard Medical School, Boston, MA, Center for Multiple Myeloma, Massachusetts General Hospital, Boston, MA; and Jorge J. Castillo, MD, Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, Department of Medicine, Harvard Medical School, Boston, MA
| | - Andrew R Branagan
- Shayna Sarosiek, MD, and Steven P. Treon, MD, PhD, Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, Department of Medicine, Harvard Medical School, Boston, MA; Andrew R. Branagan, MD, PhD, Department of Medicine, Harvard Medical School, Boston, MA, Center for Multiple Myeloma, Massachusetts General Hospital, Boston, MA; and Jorge J. Castillo, MD, Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, Department of Medicine, Harvard Medical School, Boston, MA
| | - Jorge J Castillo
- Shayna Sarosiek, MD, and Steven P. Treon, MD, PhD, Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, Department of Medicine, Harvard Medical School, Boston, MA; Andrew R. Branagan, MD, PhD, Department of Medicine, Harvard Medical School, Boston, MA, Center for Multiple Myeloma, Massachusetts General Hospital, Boston, MA; and Jorge J. Castillo, MD, Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, Department of Medicine, Harvard Medical School, Boston, MA
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15
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Bustoros M, Gribbin C, Castillo JJ, Furman R. Biomarkers of Progression and Risk Stratification in Asymptomatic Waldenström Macroglobulinemia. Hematol Oncol Clin North Am 2023; 37:e1-e13. [PMID: 37574332 DOI: 10.1016/j.hoc.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Waldenström macroglobulinemia is an indolent IgM-secreting B-cell lymphoplasmacytic lymphoma that is preceded by an asymptomatic stage. Clinical and molecular features have been used in risk models to predict progression rates in different asymptomatic subgroups. Risk models used both disease-specific and nonspecific biomarkers for asymptomatic patients. Recently, models that incorporate continuous variables rather than distinct cutoffs have emerged to more accurately predict the risk of progression. Integrating genetic alterations to the clinical models is a promising approach that could improve risk stratification and management of asymptomatic patients.
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Affiliation(s)
- Mark Bustoros
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA.
| | - Caitlin Gribbin
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Richard Furman
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
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16
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Castro D, Valcarcel B, Runciman T, Huerta-Collado Y, Paredes S, Beltran BE, Castillo JJ, Malpica L. The prognostic role of red cell distribution width on all-cause and cause-specific outcomes in peripheral T-cell lymphoma: a retrospective cohort study. Leuk Lymphoma 2023; 64:1225-1233. [PMID: 37132428 DOI: 10.1080/10428194.2023.2205975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 05/04/2023]
Abstract
Readily accessible biomarkers for risk stratification in settings with limited resources are lacking. We evaluated the effect of high red distribution width-coefficient of variation (RDW-CV) values (>14%) on all-cause and lymphoma-specific mortality outcomes among 118 patients with peripheral T-cell lymphoma (PTCL) who received systemic treatment at two tertiary centers between 2010 and 2019. With a median follow-up of 45 months, patients with a high RDW-CV had a lower 4-year overall survival rate (34% vs. 45%, p = 0.015) and higher cumulative incidence of lymphoma mortality (54% vs. 34%, p = 0.007). RDW-CV >14% was associated with all-cause (adjusted Hazard Ratio [aHR] 1.98, 95% confidence interval [CI] 1.10-3.56) and lymphoma-specific mortality (aHR 2.64, 95% CI 1.32-5.29). In our study, RDW-CV emerges as an easily accessible and complementary prognostic biomarker for risk stratification among treated patients with de novo PTCL. Further research should validate the predictive role of RDW-CV in prospective cohorts.
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Affiliation(s)
- Denisse Castro
- Departamento de Oncología y Radioterapia, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
- Centro de Investigación de Medicina de Precisión, Universidad de San Martin de Porres, Lima, Peru
| | - Bryan Valcarcel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Thanya Runciman
- Departamento de Oncología y Radioterapia, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
| | - Yesenia Huerta-Collado
- Departamento de Oncología y Radioterapia, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Sally Paredes
- Departamento de Oncología y Radioterapia, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
- Centro de Investigación de Medicina de Precisión, Universidad de San Martin de Porres, Lima, Peru
| | - Brady E Beltran
- Departamento de Oncología y Radioterapia, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
- Centro de Investigación de Medicina de Precisión, Universidad de San Martin de Porres, Lima, Peru
| | - Jorge J Castillo
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Luis Malpica
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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17
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Talaulikar D, Tomowiak C, Toussaint E, Morel P, Kapoor P, Castillo JJ, Delmer A, Durot E. Evaluation and Management of Disease Transformation in Waldenström Macroglobulinemia. Hematol Oncol Clin North Am 2023:S0889-8588(23)00043-6. [PMID: 37246087 DOI: 10.1016/j.hoc.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Histologic transformation (HT) to diffuse large B-cell lymphoma occurs rarely in Waldenström macroglobulinemia, with higher incidence in MYD88 wild-type patients. HT is suspected clinically when rapidly enlarging lymph nodes, elevated lactate dehydrogenase levels, or extranodal disease occur. Histologic assessment is required for diagnosis. HT carries a worse prognosis compared with nontransformed Waldenström macroglobulinemia. A validated prognostic score based on three adverse risk factors stratifies three risk groups. The most common frontline treatment is chemoimmunotherapy, such as R-CHOP. Central nervous system prophylaxis should be considered if feasible and consolidation with autologous transplant should be discussed in fit patients responding to chemoimmunotherapy.
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Affiliation(s)
- Dipti Talaulikar
- Department of Hematology, Canberra Health Services, Canberra, Australian Capital Territory, Australia; College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia.
| | - Cécile Tomowiak
- Hematology Department and Centre d'Investigations Cliniques (CIC) 1082 INSERM, University Hospital, Poitiers, France
| | - Elise Toussaint
- Department of Hematology, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Pierre Morel
- Department of Hematology, University Hospital of Amiens, Amiens, France
| | - Prashant Kapoor
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Alain Delmer
- Department of Hematology, University Hospital of Reims and UFR Médecine, Reims, France
| | - Eric Durot
- Department of Hematology, University Hospital of Reims and UFR Médecine, Reims, France
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18
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Kapoor P, Castillo JJ. Intercepting the B-T cell tête-à-tête. Blood 2023; 141:2548-2550. [PMID: 37227796 DOI: 10.1182/blood.2023019857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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19
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Castillo JJ, Sarosiek S, Kapoor P. Waldenström Macroglobulinemia: A Myriad of Effective Treatment Options, but Still Work to be Done. Hematol Oncol Clin North Am 2023:S0889-8588(23)00055-2. [PMID: 37211493 DOI: 10.1016/j.hoc.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02115, USA.
| | - Shayna Sarosiek
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02115, USA.
| | - Prashant Kapoor
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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20
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Abstract
Owing to the indolent nature of Waldenström macroglobulinemia, most patients experience a prolonged life expectancy, although many lines of therapy will likely be required to maintain disease control. Despite the currently available therapies, most patients will develop intolerance or resistance to multiple treatments. Therefore, new therapeutic options are being developed with a focus on targeted agents, such as novel Bruton tyrosine kinase (BTK) inhibitors and BTK degraders, as well as C-X-C chemokine receptor type 4, mucosa-associated lymphoid tissue translocation protein 1, and interleukin-1 receptor-associated kinase 4.
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Affiliation(s)
- Shayna Sarosiek
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
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21
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Buske C, Castillo JJ, Abeykoon JP, Advani R, Arulogun SO, Branagan AR, Cao X, D'Sa S, Hou J, Kapoor P, Kastritis E, Kersten MJ, LeBlond V, Leiba M, Matous JV, Paludo J, Qiu L, Tam CS, Tedeschi A, Thomas SK, Tohidi-Esfahani I, Varettoni M, Vos JM, Garcia-Sanz R, San-Miguel J, Dimopoulos MA, Treon SP, Trotman J. Report of consensus panel 1 from the 11 th International Workshop on Waldenstrom's Macroglobulinemia on management of symptomatic, treatment-naïve patients. Semin Hematol 2023; 60:73-79. [PMID: 37099027 DOI: 10.1053/j.seminhematol.2023.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Abstract
Consensus Panel 1 (CP1) of the 11th International Workshop on Waldenstrom's Macroglobulinemia (IWWM-11) was tasked with updating guidelines for the management of symptomatic, treatment-naïve patients with WM. The panel reiterated that watchful waiting remains the gold standard for asymptomatic patients without critically elevated IgM or compromised hematopoietic function. For first-line treatment, chemoimmunotherapy (CIT) regimens such as dexamethasone, cyclophosphamide, rituximab (DRC), or bendamustine, rituximab (Benda-R) continue to play a central role in managing WM, as they are effective, of fixed duration, generally well-tolerated, and affordable. Covalent BTK inhibitors (cBTKi) offer a continuous, generally well-tolerated alternative for the primary treatment of WM patients, particularly those unsuitable for CIT. In a Phase III randomized trial updated at IWWM-11, the second-generation cBTKi, zanubrutinib, was less toxic than ibrutinib and induced deeper remissions, thus categorizing zanubrutinib as a suitable treatment option in WM. While the overall findings of a prospective, randomized trial updated at IWWM-11 did not show superiority of fixed duration rituximab maintenance over observation following attainment of a major response to Benda-R induction, a subset analysis showed benefit in patients >65 years and those with a high IPPSWM score. Whenever possible, the mutational status of MYD88 and CXCR4 should be determined before treatment initiation, as alterations in these 2 genes predict sensitivity towards cBTKi activity. Treatment approaches for WM-associated cryoglobulins, cold agglutinins, AL amyloidosis, Bing-Neel syndrome (BNS), peripheral neuropathy, and hyperviscosity syndrome follow the common principle of reducing tumor and abnormal protein burden rapidly and deeply to improve symptoms. In BNS, ibrutinib can be highly active and produce durable responses. In contrast, cBTKi are not recommended for treating AL amyloidosis. The panel emphasized that continuous improvement of treatment options for symptomatic, treatment-naïve WM patients critically depends on the participation of patients in clinical trials, whenever possible.
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Affiliation(s)
- Christian Buske
- University Hospital Ulm, Institute of Experimental Cancer Research, Ulm, Germany.
| | | | | | | | | | | | - Xinxin Cao
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Marie J Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam/LYMMCARE, Amsterdam, Netherlands
| | - Veronique LeBlond
- Groupe Hospitalier Pitié-Salpêtrière, Sorbonne University, Paris France
| | - Merav Leiba
- Faculty of Health Science, Ben- Gurion University of the Negev, Israel Assuta Ashdod University Hospital; Faculty of Health Science, Ben-Gurion University of the Negev, Negev, Israel Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeffrey V Matous
- Colorado Blood Cancer Institute, Sarah Cannon Research Institute, Denver, CO
| | | | - Lugui Qiu
- National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | | | | | | | | | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Josephine M Vos
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam/LYMMCARE, Amsterdam, Netherlands
| | - Ramon Garcia-Sanz
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca, CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
| | - Jesus San-Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Centro de Investigación Biomédica en Red Cáncer, Pamplona, Spain
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Steven P Treon
- Dana Farber Cancer Institute, Harvard Medical School, Boston MA
| | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
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22
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Tam CS, Kapoor P, Castillo JJ, Buske C, Ansell SM, Branagan AR, Kimby E, Li Y, Palomba ML, Qiu L, Shadman M, Abeykoon JP, Sarosiek S, Vos J, Yi S, Stephens D, Roos-Weil D, Roccaro AM, Morel P, Munshi NC, Anderson KC, San-Miguel J, Garcia-Sanz R, Dimopoulos MA, Treon SP, Kersten MJ. Report of consensus panel 7 from the 11th international workshop on Waldenström macroglobulinemia on priorities for novel clinical trials. Semin Hematol 2023; 60:118-124. [PMID: 37099031 DOI: 10.1053/j.seminhematol.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 04/27/2023]
Abstract
Recent advances in the understanding of Waldenström macroglobulinemia (WM) biology have impacted the development of effective novel agents and improved our knowledge of how the genomic background of WM may influence selection of therapy. Consensus Panel 7 (CP7) of the 11th International Workshop on WM was convened to examine the current generation of completed and ongoing clinical trials involving novel agents, consider updated data on WM genomics, and make recommendations on the design and prioritization of future clinical trials. CP7 considers limited duration and novel-novel agent combinations to be the priority for the next generation of clinical trials. Evaluation of MYD88, CXCR4 and TP53 at baseline in the context of clinical trials is crucial. The common chemoimmunotherapy backbones, bendamustine-rituximab (BR) and dexamethasone, rituximab and cyclophosphamide (DRC), may be considered standard-of-care for the frontline comparative studies. Key unanswered questions include the definition of frailty in WM; the importance of attaining a very good partial response or better (≥VGPR), within stipulated time frame, in determining survival outcomes; and the optimal treatment of WM populations with special needs.
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Affiliation(s)
- C S Tam
- Alfred Health, Monash University, Melbourne, Victoria, Australia.
| | | | - J J Castillo
- Harvard Medical School, Dana Farber Cancer Institute, Boston. MA
| | - C Buske
- Institute of Experimental Cancer Research, University Hospital Ulm, Ulm, Germany
| | | | | | - E Kimby
- Karolinska Institut, Stockholm, Sweden
| | - Y Li
- Baylor College of Medicine, Houston, TX
| | - M L Palomba
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - L Qiu
- National National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - M Shadman
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | | | - S Sarosiek
- Harvard Medical School, Dana Farber Cancer Institute, Boston. MA
| | - Jmi Vos
- Department of Hematology, Cancer Center Amsterdam/LYMMCARE, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S Yi
- National National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China; Tianjin Institutes of Health Science, Tianjin 301600, China
| | - D Stephens
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | - D Roos-Weil
- Sorbonne University, Hematology Unit, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | | | - P Morel
- Hematologie Clinique et Therapie Cellulaire, University Hospital Amiens Picardie, University of Picardie Jules Verne, France
| | - N C Munshi
- Institute of Experimental Cancer Research, University Hospital Ulm, Ulm, Germany
| | - K C Anderson
- Institute of Experimental Cancer Research, University Hospital Ulm, Ulm, Germany
| | - J San-Miguel
- Clinica Universidad de Navarra, CCUN, CIMA, IDISNA, CIBERONC, Navarra, Spain
| | - R Garcia-Sanz
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca, CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
| | - M A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - S P Treon
- Institute of Experimental Cancer Research, University Hospital Ulm, Ulm, Germany
| | - M J Kersten
- Tianjin Institutes of Health Science, Tianjin 301600, China
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23
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Jelinek T, Bezdekova R, Zihala D, Sevcikova T, Anilkumar Sithara A, Pospisilova L, Sevcikova S, Polackova P, Stork M, Knechtova Z, Venglar O, Kapustova V, Popkova T, Muronova L, Chyra Z, Hrdinka M, Simicek M, Garcés JJ, Puig N, Cedena MT, Jurczyszyn A, Castillo JJ, Penka M, Radocha J, Mateos MV, San-Miguel JF, Paiva B, Pour L, Rihova L, Hajek R. More Than 2% of Circulating Tumor Plasma Cells Defines Plasma Cell Leukemia-Like Multiple Myeloma. J Clin Oncol 2023; 41:1383-1392. [PMID: 36315921 PMCID: PMC9995102 DOI: 10.1200/jco.22.01226] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Primary plasma cell leukemia (PCL) is the most aggressive monoclonal gammopathy. It was formerly characterized by ≥ 20% circulating plasma cells (CTCs) until 2021, when this threshold was decreased to ≥ 5%. We hypothesized that primary PCL is not a separate clinical entity, but rather that it represents ultra-high-risk multiple myeloma (MM) characterized by elevated CTC levels. METHODS We assessed the levels of CTCs by multiparameter flow cytometry in 395 patients with newly diagnosed transplant-ineligible MM to establish a cutoff for CTCs that identifies the patients with ultra-high-risk PCL-like MM. We tested the cutoff on 185 transplant-eligible patients with MM and further validated on an independent cohort of 280 transplant-ineligible patients treated in the GEM-CLARIDEX trial. The largest published real-world cohort of patients with primary PCL was used for comparison of survival. Finally, we challenged the current 5% threshold for primary PCL diagnosis. RESULTS Newly diagnosed transplant-ineligible patients with MM with 2%-20% CTCs had significantly shorter progression-free survival (3.1 v 15.6 months; P < .001) and overall survival (14.6 v 33.6 months; P = .023) than patients with < 2%. The 2% cutoff proved to be applicable also in transplant-eligible patients with MM and was successfully validated on an independent cohort of patients from the GEM-CLARIDEX trial. Most importantly, patients with 2%-20% CTCs had comparable dismal outcomes with primary PCL. Moreover, after revealing a low mean difference between flow cytometric and morphologic evaluation of CTCs, we showed that patients with 2%-5% CTCs have similar outcomes as those with 5%-20% CTCs. CONCLUSION Our study uncovers that ≥ 2% CTCs is a biomarker of hidden primary PCL and supports the assessment of CTCs by flow cytometry during the diagnostic workup of MM.
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Affiliation(s)
- Tomas Jelinek
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Renata Bezdekova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - David Zihala
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Tereza Sevcikova
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Biology and Ecology, Faculty of Science, University of Ostrava, Ostrava, Czech Republic
| | - Anjana Anilkumar Sithara
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Biology and Ecology, Faculty of Science, University of Ostrava, Ostrava, Czech Republic
| | | | - Sabina Sevcikova
- Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petra Polackova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Martin Stork
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Faculty of Medicine Masaryk University, Czech Republic
| | - Zdenka Knechtova
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Faculty of Medicine Masaryk University, Czech Republic
| | - Ondrej Venglar
- Department of Biology and Ecology, Faculty of Science, University of Ostrava, Ostrava, Czech Republic
| | - Veronika Kapustova
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Tereza Popkova
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ludmila Muronova
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Zuzana Chyra
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Matous Hrdinka
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Michal Simicek
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Juan-Jose Garcés
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CIBER-ONC number CB16/12/00369, Pamplona, Spain
| | - Noemi Puig
- Hospital Universitario de Salamanca, Instituto de Investigacion Biomedica de Salamanca (IBSAL), Centro de Investigación del Cancer (IBMCC-USAL, CSIC), CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | | | - Artur Jurczyszyn
- Plasma Cell Dyscrasia Center, Department of Hematology, Jagiellonian University Medical College, Faculty of Medicine Cracow, Poland
| | - Jorge J Castillo
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Miroslav Penka
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Jakub Radocha
- 4th Department of Internal Medicine-Hematology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Maria Victoria Mateos
- Hospital Universitario de Salamanca, Instituto de Investigacion Biomedica de Salamanca (IBSAL), Centro de Investigación del Cancer (IBMCC-USAL, CSIC), CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - Jesús F San-Miguel
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CIBER-ONC number CB16/12/00369, Pamplona, Spain
| | - Bruno Paiva
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CIBER-ONC number CB16/12/00369, Pamplona, Spain
| | - Ludek Pour
- Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lucie Rihova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Roman Hajek
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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24
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Treon SP, Tedeschi A, San-Miguel J, Garcia-Sanz R, Anderson KC, Kimby E, Minnema MC, Benevolo G, Qiu L, Yi S, Terpos E, Tam CS, Castillo JJ, Morel P, Dimopoulos M, Owen RG. Report of consensus Panel 4 from the 11th International Workshop on Waldenstrom's macroglobulinemia on diagnostic and response criteria. Semin Hematol 2023; 60:97-106. [PMID: 37173155 DOI: 10.1053/j.seminhematol.2023.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 05/15/2023]
Abstract
Consensus Panel 4 (CP4) of the 11th International Workshop on Waldenstrom's Macroglobulinemia (IWWM-11) was tasked with reviewing the current criteria for diagnosis and response assessment. Since the initial consensus reports of the 2nd International Workshop, there have been updates in the understanding of the mutational landscape of IgM related diseases, including the discovery and prevalence of MYD88 and CXCR4 mutations; an improved recognition of disease related morbidities attributed to monoclonal IgM and tumor infiltration; and a better understanding of response assessment based on multiple, prospective trials that have evaluated diverse agents in Waldenstrom's macroglobulinemia. The key recommendations from IWWM-11 CP4 included: (1) reaffirmation of IWWM-2 consensus panel recommendations that arbitrary values for laboratory parameters such as minimal IgM level or bone marrow infiltration should not be used to distinguish Waldenstrom's macroglobulinemia from IgM MGUS; (2) delineation of IgM MGUS into 2 subclasses including a subtype characterized by clonal plasma cells and MYD88 wild-type, and the other by presence of monotypic or monoclonal B cells which may carry the MYD88 mutation; and (3) recognition of "simplified" response assessments that use serum IgM only for determining partial and very good partial responses (simplified IWWM-6/new IWWM-11 response criteria). Guidance on response determination for suspected IgM flare and IgM rebound related to treatment, as well as extramedullary disease assessment was also updated and included in this report.
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Affiliation(s)
- Steven P Treon
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA.
| | | | - Jesus San-Miguel
- Clinica Universidad de Navarra, CCUN, CIMA, IDISNA, CIBERONC, Navarra, Spain
| | | | | | - Eva Kimby
- Division of Hematology, Department of Medicine Huddinge, Karolinska Institute, Stockholm Sweden
| | | | - Giulia Benevolo
- SSD Mieloma Unit e Clinical Trial e S.C. Hematology Univ., Turin Italy
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science...Tianjin 301600, China
| | - Shuhui Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science...Tianjin 301600, China
| | | | | | - Jorge J Castillo
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA
| | - Pierre Morel
- Hematology Department, University Hospital Amiens- Picardie, Amiens, France
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25
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Garcia-Sanz R, Varettoni M, Jiménez C, Ferrero S, Poulain S, San-Miguel JF, Guerrera ML, Drandi D, Bagratuni T, McMaster M, Roccaro AM, Roos-Weil D, Leiba M, Li Y, Qiu L, Hou J, De Larrea CF, Castillo JJ, Dimopoulos M, Owen RG, Treon SP, Hunter ZR. Report of Consensus Panel 3 from the 11th International workshop on Waldenström's Macroglobulinemia: Recommendations for molecular diagnosis in Waldenström's Macroglobulinemia. Semin Hematol 2023; 60:90-96. [PMID: 37099028 DOI: 10.1053/j.seminhematol.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/27/2023]
Abstract
Apart from the MYD88L265P mutation, extensive information exists on the molecular mechanisms in Waldenström's Macroglobulinemia and its potential utility in the diagnosis and treatment tailoring. However, no consensus recommendations are yet available. Consensus Panel 3 (CP3) of the 11th International Workshop on Waldenström's Macroglobulinemia (IWWM-11) was tasked with reviewing the current molecular necessities and best way to access the minimum data required for a correct diagnosis and monitoring. Key recommendations from IWWM-11 CP3 included: (1) molecular studies are warranted for patients in whom therapy is going to be started; such studies should also be done in those whose bone marrow (BM) material is sampled based on clinical issues; (2) molecular studies considered essential for these situations are those that clarify the status of 6q and 17p chromosomes, and MYD88, CXCR4, and TP53 genes. These tests in other situations, and/or other tests, are considered optional; (3) independently of the use of more sensitive and/or specific techniques, the minimum requirements are allele specific polymerase chain reaction for MYD88L265P and CXCR4S338X using whole BM, and fluorescence in situ hybridization for 6q and 17p and sequencing for CXCR4 and TP53 using CD19+ enriched BM; (4) these requirements refer to all patients; therefore, sample should be sent to specialized centers.
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Affiliation(s)
- Ramón Garcia-Sanz
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain.
| | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Italy
| | - Cristina Jiménez
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
| | - Simone Ferrero
- Unit of Hematology, Department of Biotechnology & Health Sciences, University of Torino, Torino, Italy
| | - Stephanie Poulain
- Laboratory of Hematology, Biology and Pathology Center, CHU of Lille, UMR9020 CNRS-U1277 INSERM, University of Lille, and ONCOLILLE Cancer Institute, CANTHER Laboratory, Lille, France
| | - Jesus F San-Miguel
- Laboratory of Hematology, Biology and Pathology Center, CHU of Lille, Lille, France
| | - Maria L Guerrera
- Hematology department, Clínica Universidad de Navarra, CIMA, IDISNA, CIBERONC, Pamplona, Spain
| | - Daniela Drandi
- Unit of Hematology, Department of Biotechnology & Health Sciences, University of Torino, Torino, Italy
| | - Tina Bagratuni
- Bing Center for Waldenström's Macroglobulinemia, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Mary McMaster
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aldo M Roccaro
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Damien Roos-Weil
- Clinical Trial Center, Translational Research and Phase I Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Merav Leiba
- Sorbonne Université, Hematology Unit, Pitié-Salpêtrière Hospital, Assitance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Yong Li
- Assuta Ashdod University Hospital, Faculty of Health Science, Ben-Gurion University of the Negev, Negev, Israel
| | - Luigi Qiu
- Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Jian Hou
- National Clinical Research Center for Blood Diseases, Blood Disease Hospital and Institute of Hematology), Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | | | - Jorge J Castillo
- Hematology department, Clínica Universidad de Navarra, CIMA, IDISNA, CIBERONC, Pamplona, Spain
| | - M Dimopoulos
- Bing Center for Waldenström's Macroglobulinemia, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - R G Owen
- Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S P Treon
- Hematology department, Clínica Universidad de Navarra, CIMA, IDISNA, CIBERONC, Pamplona, Spain
| | - Z R Hunter
- Hematology department, Clínica Universidad de Navarra, CIMA, IDISNA, CIBERONC, Pamplona, Spain
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26
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D'Sa S, Matous JV, Advani R, Buske C, Castillo JJ, Gatt M, Kapoor P, Kersten MJ, Leblond V, Leiba M, Palomba ML, Paludo J, Qiu L, Sarosiek S, Shadman M, Talaulikar D, Tam CS, Tedeschi A, Thomas SK, Tohidi-Esfahani I, Trotman J, Varettoni M, Vos J, Garcia-Sanz R, San-Miguel J, Dimopoulos MA, Treon SP, Kastritis E. Report of consensus panel 2 from the 11th international workshop on Waldenström's macroglobulinemia on the management of relapsed or refractory WM patients. Semin Hematol 2023; 60:80-89. [PMID: 37147252 DOI: 10.1053/j.seminhematol.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
The consensus panel 2 (CP2) of the 11th International Workshop on Waldenström's macroglobulinemia (IWWM-11) has reviewed and incorporated current data to update the recommendations for treatment approaches in patients with relapsed or refractory WM (RRWM). The key recommendations from IWWM-11 CP2 include: (1) Chemoimmunotherapy (CIT) and/or a covalent Bruton tyrosine kinase (cBTKi) strategies are important options; their use should reflect the prior upfront strategy and are subject to their availability. (2) In selecting treatment, biological age, co-morbidities and fitness are important; nature of relapse, disease phenotype and WM-related complications, patient preferences and hematopoietic reserve are also critical factors while the composition of the BM disease and mutational status (MYD88, CXCR4, TP53) should also be noted. (3) The trigger for initiating treatment in RRWM should utilize knowledge of patients' prior disease characteristics to avoid unnecessary delays. (4) Risk factors for cBTKi related toxicities (cardiovascular dysfunction, bleeding risk and concurrent medication) should be addressed when choosing cBTKi. Mutational status (MYD88, CXCR4) may influence the cBTKi efficacy, and the role of TP53 disruptions requires further study) in the event of cBTKi failure dose intensity could be up titrated subject to toxicities. Options after BTKi failure include CIT with a non-cross-reactive regimen to one previously used CIT, addition of anti-CD20 antibody to BTKi, switching to a newer cBTKi or non-covalent BTKi, proteasome inhibitors, BCL-2 inhibitors, and new anti-CD20 combinations are additional options. Clinical trial participation should be encouraged for all patients with RRWM.
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Affiliation(s)
- S D'Sa
- UCLH Centre for Waldenström Macroglobulinaemia and Related Conditions, University College London Hospitals NHS Foundation Trust, London, UK.
| | - J V Matous
- Colorado Blood Cancer Institute, Sarah Cannon Research Institute, Denver, CO
| | - R Advani
- Stanford University Medical Center, Stanford, CA
| | - C Buske
- University Hospital Ulm, Ulm, Germany
| | - J J Castillo
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - M Gatt
- Hadassah University Medical Center, Jerusalem, Israel
| | | | - M J Kersten
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Cancer Center Amsterdam/LYMMCARE, Amsterdam, Netherlands
| | - V Leblond
- Groupe Hospitalier Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - M Leiba
- Assuta Ashdod University Hospital; Faculty of Health Science, Ben-Gurion University of the Negev, Negev, Israel Memorial Sloan Kettering Cancer Center, New York, NY
| | - M L Palomba
- Memorial Sloan Kettering Cancer Center, New York NY US
| | | | - L Qiu
- National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - S Sarosiek
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - D Talaulikar
- ANU College of Health and Medicine, Canberra, Australia
| | - C S Tam
- Alfred Health, Monash University, Melbourne, Australia
| | - A Tedeschi
- A. O. Ospedale Niguarda Ca' Granda, Milan, Italy
| | - S K Thomas
- University of Texas, MD Anderson Cancer Center, Houston TX USA
| | - I Tohidi-Esfahani
- Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
| | - J Trotman
- Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
| | - M Varettoni
- Division of Hematology, Fondazione iRCCS Policlinico, San Matteo, Italy
| | - Jmi Vos
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Cancer Center Amsterdam/LYMMCARE, Amsterdam, Netherlands
| | - R Garcia-Sanz
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca, CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
| | - J San-Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Centro de Investigación Biomédica en Red Cáncer, Pamplona, Spain
| | - M A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - S P Treon
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - E Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
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27
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Castillo JJ, Buske C, Trotman J, Sarosiek S, Treon SP. Bruton tyrosine kinase inhibitors in the management of Waldenström macroglobulinemia. Am J Hematol 2023; 98:338-347. [PMID: 36415104 PMCID: PMC10107762 DOI: 10.1002/ajh.26788] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022]
Abstract
Bruton tyrosine kinase (BTK) inhibitors have taken a central role in the management of patients with Waldenström macroglobulinemia and are the only agents approved by the Food and Drug Administration (FDA) to treat these patients. Although associated with high rates of durable responses, unmet needs with BTK inhibitor therapy include indefinite duration therapy, high cost, scarcity of complete responses, and lower rates and shorter duration of response in patients with CXCR4 mutations. Herein, we review the data supporting the use of covalent BTK inhibitors, selected management issues, clinical trials with covalent BTK inhibitor combination regimens, and up-and-coming non-covalent BTK inhibitors.
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Affiliation(s)
- Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Buske
- Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, University Hospital Ulm, Ulm, Germany
| | - Judith Trotman
- Department of Haematology, Concord Repatriation General Hospital, Faculty of Medicine, University of Sydney, Concord, Australia
| | - Shayna Sarosiek
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven P Treon
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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28
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Hess BT, Giri A, Park Y, Patel KK, Link BK, Nowakowski GS, Maliske SM, Fortin S, Chavez JC, Saeed H, Hill BT, Mejia Garcia AV, Maddocks KJ, Hanel W, Wagner‐Johnston ND, Messmer MR, Kahl BS, Watkins M, Alderuccio JP, Lossos IS, Nathan S, Orellana‐Noia VM, Portell CA, Landsburg DJ, Ayers EC, Castillo JJ. Outcomes of patients with limited-stage plasmablastic lymphoma: A multi-institutional retrospective study. Am J Hematol 2023; 98:300-308. [PMID: 36588409 PMCID: PMC10107934 DOI: 10.1002/ajh.26784] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 06/05/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 01/03/2023]
Abstract
Plasmablastic lymphoma (PBL) is a rare entity, commonly associated with immunosuppressed states such as human immunodeficiency virus (HIV) infection or solid organ transplant. The clinical course is characterized by high relapse rates and a poor prognosis, leading some clinicians to recommend aggressive frontline therapy. However, a specific review of limited stage (LS) PBL patients is not available to evaluate outcomes and justify treatment recommendations. We performed a retrospective review of LS PBL cases to provide insight into this rare disease. Our cohort consisted of 80 stage I or II PBL patients from 13 US academic centers. With a median follow up of 34 months (1-196), the 3-year progression-free survival (PFS) and overall survival (OS) of the entire cohort were 72% (95% CI 62, 83) and 79% (95% CI 70, 89), respectively. The 3-year PFS and OS of patients treated with frontline chemotherapy alone was 65% (95% CI 50, 84) and 71% (95% CI 56, 89), respectively, compared to 85% (95% CI 72, 100) and 96% (95% CI 89, 100), respectively, in patients treated with combined frontline chemotherapy with radiation consolidation. Our data demonstrate favorable outcomes in LS PBL with no improvements in outcome from aggressive frontline treatment including Hyper-CVAD or auto-SCT consolidation. Multivariate regression analysis (MRA) demonstrated improved PFS for patients receiving EPOCH based frontline therapy versus CHOP (HR: 0.23; p = 0.029). Frontline chemotherapy followed by radiation consolidation versus chemotherapy alone appeared to be associated with improved relapse and survival outcomes but did not show statistical significance in MRA.
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Affiliation(s)
- Brian T. Hess
- Hollings Cancer CenterMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Anshu Giri
- Fox Chase Cancer CenterPhiladelphiaPennsylvaniaUSA
| | - Yeonhee Park
- Hollings Cancer CenterMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Krina K. Patel
- Department of Lymphoma/MyelomaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Brian K. Link
- Division of Hematology, Oncology, and Blood & Marrow TransplantationUniversity of IowaIowa CityIowaUSA
| | | | - Seth M. Maliske
- Roger Maris Cancer Center Sanford HealthFargoNorth DakotaUSA
| | | | - Julio C. Chavez
- Department of Malignant HematologyMoffitt Cancer CenterTampaFloridaUSA
| | - Hayder Saeed
- Department of Malignant HematologyMoffitt Cancer CenterTampaFloridaUSA
| | - Brian T. Hill
- Taussig Cancer Institute, Department of Hematology and Medical OncologyCleveland Clinic FoundationClevelandOhioUSA
| | - Alex V. Mejia Garcia
- Taussig Cancer Institute, Department of Hematology and Medical OncologyCleveland Clinic FoundationClevelandOhioUSA
| | | | - Walter Hanel
- Division of HematologyThe Ohio State UniversityColumbusOhioUSA
| | | | | | - Brad S. Kahl
- Siteman Cancer CenterWashington University School of MedicineSt. LouisMissouriUSA
| | - Marcus Watkins
- Siteman Cancer CenterWashington University School of MedicineSt. LouisMissouriUSA
| | - Juan Pablo Alderuccio
- Sylvester Comprehensive Cancer CenterUniversity of Miami School of MedicineMiamiFloridaUSA
| | - Izidore S. Lossos
- Sylvester Comprehensive Cancer CenterUniversity of Miami School of MedicineMiamiFloridaUSA
| | | | | | - Craig A. Portell
- Division of Hematology/OncologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | | | - Emily C. Ayers
- Division of Hematology/OncologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Jorge J. Castillo
- Department of Medical OncologyDana‐Farber Cancer Institute, Harvard Medical SchoolBostonMassachusettsUSA
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29
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Muñoz J, Sarosiek S, Castillo JJ. Managing Ibrutinib-Intolerant Patients With B-Cell Malignancies. Oncologist 2023; 28:309-318. [PMID: 36723874 PMCID: PMC10078910 DOI: 10.1093/oncolo/oyac260] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/21/2022] [Indexed: 02/02/2023] Open
Abstract
Ibrutinib is a first-generation inhibitor of Bruton tyrosine kinase (BTK) that is currently approved to treat patients with B-cell malignancies, including Waldenström macroglobulinemia (WM), relapsed/refractory (R/R) mantle cell lymphoma (MCL), R/R marginal zone lymphoma (MZL), and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Off-target adverse effects, such as atrial fibrillation, hypertension, and bleeding, have been observed and may limit a patient's tolerance for treatment. Currently, there is no well-established treatment regimen for patients who cannot tolerate ibrutinib. Approaches to address such patients include managing ibrutinib side effects with supportive care or dose reductions, switching to an alternative covalent BTK inhibitor, or abandoning covalent BTK inhibitors for alternative forms of treatment. Here we review the literature and provide guidance on treating ibrutinib-intolerant patients with B-cell malignancies.
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Affiliation(s)
- Javier Muñoz
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Shayna Sarosiek
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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30
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Eichhorst B, Dunleavy K, Tiacci E, Buske C, Jain N, Castillo JJ, Rossi D, Woolven K, Masouleh BK, Peng W, Schuberth PC, Domper N, Wolthers BO, Palomba ML. Zuma-25: A Phase 2 Study of Brexucabtagene Autoleucel (KTE-X19) Chimeric Antigen Receptor T-Cell Therapy in Adult Patients with Relapsed/Refractory Rare B-Cell Malignancies. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00589-4] [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: 02/07/2023]
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31
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Mendoza R, Quiñones MP, Beltrán BE, Castro D, Paredes S, Miranda RN, Moisés C, Sánchez G, Castillo JJ, Torres-Cabala C. Primary cutaneous Epstein-Barr virus-positive B-cell lymphoid proliferation with features of diffuse large B-cell lymphoma and mucocutaneous ulcer: a diagnostic dilemma. Int J Dermatol 2023; 62:e87-e90. [PMID: 35064673 DOI: 10.1111/ijd.16040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/11/2021] [Accepted: 12/08/2021] [Indexed: 01/20/2023]
Affiliation(s)
- Ronald Mendoza
- Department of Pathology, Hospital Edgardo Rebagliati Martins, Lima, Peru
| | - M Pilar Quiñones
- Department of Pathology, Hospital Edgardo Rebagliati Martins, Lima, Peru
| | - Brady E Beltrán
- Department of Oncology and Radiotherapy, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru.,Centro de Investigación de Medicina de Precision, Universidad de San Martin de Porres, Lima, Peru
| | - Denisse Castro
- Department of Oncology and Radiotherapy, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru.,Centro de Investigación de Medicina de Precision, Universidad de San Martin de Porres, Lima, Peru
| | - Sally Paredes
- Department of Oncology and Radiotherapy, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru.,Centro de Investigación de Medicina de Precision, Universidad de San Martin de Porres, Lima, Peru
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Celia Moisés
- Department of Dermatology, Hospital Edgardo Rebagliati Martins, Lima, Peru
| | - Gadwyn Sánchez
- Department of Dermatology, Hospital Edgardo Rebagliati Martins, Lima, Peru
| | - Jorge J Castillo
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Carlos Torres-Cabala
- Departments of Pathology and Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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32
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Castillo JJ, Kingsley EC, Narang M, Yimer HA, Dasanu CA, Melear JM, Coleman M, Farber CM, Shulman J, Mantovani EH, Zhang X, Cohen A, Huang J. Zanubrutinib in patients with treatment-naïve or relapsed/refractory Waldenström macroglobulinemia: An expanded-access study of 50 patients in the United States. EJHaem 2023; 4:301-304. [PMID: 36819162 PMCID: PMC9928654 DOI: 10.1002/jha2.619] [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] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 01/13/2023]
Affiliation(s)
| | | | - Mohit Narang
- US Oncology ResearchMaryland Hematology OncologyColumbiaMarylandUSA
| | | | | | - Jason M Melear
- US Oncology ResearchTexas Oncology, Austin MidtownAustinTexasUSA
| | - Morton Coleman
- Clinical Research AllianceWeill Cornell MedicineNew YorkNew YorkUSA
| | - Charles M Farber
- Atlantic Hematology OncologyMorristown Medical CenterMorristownNew JerseyUSA
| | - Jonah Shulman
- Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Emily H Mantovani
- BeiGene (Beijing) Co. Ltd. BeijingChina and BeiGene IncSan MateoCaliforniaUSA
| | - Xiaowei Zhang
- BeiGene (Beijing) Co. Ltd. BeijingChina and BeiGene IncSan MateoCaliforniaUSA
| | - Aileen Cohen
- BeiGene (Beijing) Co. Ltd. BeijingChina and BeiGene IncSan MateoCaliforniaUSA
| | - Jane Huang
- BeiGene (Beijing) Co. Ltd. BeijingChina and BeiGene IncSan MateoCaliforniaUSA
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33
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Sarosiek S, Gustine JN, Flynn CA, Leventoff C, Little M, White T, Meid K, Treon SP, Castillo JJ. Dose reductions in patients with Waldenström macroglobulinaemia treated with ibrutinib. Br J Haematol 2023; 201:897-904. [PMID: 36626914 DOI: 10.1111/bjh.18643] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023]
Abstract
Waldenström macroglobulinaemia (WM) is characterized by the presence of a MYD88L265P mutation. This mutation promotes growth and survival of malignant cells through Bruton tyrosine kinase (BTK) activation. Ibrutinib was the first BTK inhibitor approved for WM. Intolerance to ibrutinib frequently leads to dose reductions, though the impact of reducing ibrutinib dosing has not been systematically studied. We performed a retrospective study to determine the frequency and impact of reducing ibrutinib dosing in WM patients. With a median treatment time of 64 months, 96 (27%) of 353 WM patients required a dose reduction due to adverse events such as musculoskeletal symptoms, cardiac events, dermatologic symptoms, cytopenias, and gastrointestinal symptoms. The median time to initial dose reduction was 9.3 months (range, 0.5-74). Dose reductions were more common in those 65 years of age or older versus under 65 [hazard ratio (HR) 2.46, 95% confidence interval (CI) 1.55-3.90; p < 0.001], and in females versus males (HR 2.20, 95% CI 1.41-3.28, p < 0.001). Most patients (65%) had improvement or resolution of adverse effects after initial dose reduction. With a median follow-up of three years from dose reduction, hematologic response sustained or deepened in 79% of patients. These data suggest that dose reduction of ibrutinib is a reasonable treatment approach for patients with intolerable side effects.
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Affiliation(s)
- Shayna Sarosiek
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua N Gustine
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Catherine A Flynn
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Carly Leventoff
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Megan Little
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Timothy White
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kirsten Meid
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Steven P Treon
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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34
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Kumar SK, Callander NS, Adekola K, Anderson LD, Baljevic M, Campagnaro E, Castillo JJ, Costello C, D'Angelo C, Devarakonda S, Elsedawy N, Garfall A, Godby K, Hillengass J, Holmberg L, Htut M, Huff CA, Hultcrantz M, Kang Y, Larson S, Lee HC, Liedtke M, Martin T, Omel J, Rosenberg A, Sborov D, Valent J, Berardi R, Kumar R. Systemic Light Chain Amyloidosis, Version 2.2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2023; 21:67-81. [PMID: 36652935 DOI: 10.6004/jnccn.2023.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Primary systemic light chain amyloidosis (SLCA) is characterized by production of light chains that get converted to amyloid fibrils with an affinity for visceral organs and causing organ dysfunction. The therapy for SLCA is directed to recovering the function of the affected organs by targeting the abnormal plasma cell clone and slowing deposition of amyloid fibrils. The NCCN Guidelines for SLCA provide recommendations for workup, diagnosis, and treatment of primary as well as previously treated SLCA.
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Affiliation(s)
| | | | - Kehinde Adekola
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Jorge J Castillo
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | | | | | - Srinivas Devarakonda
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Noura Elsedawy
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Alfred Garfall
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | - Leona Holmberg
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Myo Htut
- City of Hope National Medical Center
| | - Carol Ann Huff
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | - Hans C Lee
- The University of Texas MD Anderson Cancer Center
| | | | - Thomas Martin
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | - Jason Valent
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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35
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Cabrera ME, Peña C, Leon P, Lois V, Rojas H, Vega V, Pizarro A, Calderon S, Rojas C, Aspillaga A, Gonzalez ML, Intriago M, Rojas B, Hales C, Oliva J, Romero M, Capurro M, Castillo JJ. Diffuse Large B-Cell Lymphoma in Chile: The Impact of Combined CHOP Plus Rituximab in the Public Health System. JCO Glob Oncol 2022; 8:e2200165. [PMID: 36351213 PMCID: PMC10166504 DOI: 10.1200/go.22.00165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma subtype. The purpose of this study was to evaluate the clinical features, prognostic factors, and results of DLBCL that was treated in the cancer centers of the public health system in Chile and compare cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). PATIENTS AND METHODS Patients age > 15 years who were treated in 18 cancer centers in the country between 2001 and 2017 were included. The Kaplan-Meier method was used to calculate overall survival (OS), and Cox proportional hazard regression modeling was used to evaluate the effect of the addition of rituximab to CHOP on OS. RESULTS A total of 1,807 patients were evaluated. The median age at diagnosis was 62 (range, 15-95) years, with a female predominance (53%). Half of the patients were age ≥ 60 years. Serology for HIV infection was positive in 5% of cases (96 cases). International Prognostic Index scores were available for 90% of patients, of which 45% had low-risk, 25% low-intermediate-risk, 18% high-intermediate-risk, and 11% high-risk scores. CHOP was administered to 986 patients (55%; median follow-up, 13.2 years) and R-CHOP to 821 patients (45%; median follow-up, 8.4 years). R-CHOP was associated with superior OS compared with CHOP (5-year 66% v 48%, and 10-year 53% v 35%; P < .001). CONCLUSION Rituximab improved the survival of patients with DLBCL diagnosed and treated in Chile. The benefit was sustained over time, with curative rates of > 50%. This intervention shows that the inclusion of this biological drug justified the expenses incurred by the Ministry of Health in the National Lymphoma Protocols in Chile.
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Affiliation(s)
- María Elena Cabrera
- Hospital del Salvador, Titular Professor of Medicine, Universidad de Chile, Santiago, Chile
| | | | - Pilar Leon
- Hospital Carlos van Buren, Valparaiso, Chile
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jorge J Castillo
- Division of Hematological Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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36
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Sermer D, Sarosiek S, Branagan AR, Treon SP, Castillo JJ. SOHO State of the Art Updates and Next Questions: Targeted therapies and emerging novel treatment approaches for Waldenström Macroglobulinemia. Clin Lymphoma Myeloma Leuk 2022; 22:547-556. [PMID: 35339405 DOI: 10.1016/j.clml.2022.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
Waldenström Macroglobulinemia (WM) is a rare hematologic malignancy characterized by the presence of lymphoplasmacytic lymphoma cells involving the bone marrow and production of a monoclonal IgM paraprotein. Recurrent somatic mutations in MYD88L265P and CXCR4 have been reported in 90% to 95% and 30% to 40% of patients with WM, respectively. Standard treatment regimens combine the anti-CD20 antibody rituximab with alkylating agents (eg, bendamustine, cyclophosphamide), nucleoside analogs (eg, fludarabine, cladribine), or proteasome inhibitors (eg, bortezomib, carfilzomib, and ixazomib). Covalent BTK inhibitors (eg, ibrutinib, acalabrutinib, zanubrutinib) have shown to be safe and highly effective in patients with WM. Novel and promising agents in this disease include next-generation covalent BTK inhibitors (eg, tirabrutinib, orelabrutinib), non-covalent BTK inhibitors (eg, pirtobrutinib, ARQ531), BCL-2 antagonists (eg, venetoclax), and CXCR4-targeted agents (eg, mavorixafor, ulocuplumab), among others. Future studies will focus on developing fixed-duration combinations regimens with these novel agents aimed at increasing durable responses while minimizing toxicity and cost.
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Affiliation(s)
- David Sermer
- Division of Hematology and Hematologic Malignancies, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA
| | - Shayna Sarosiek
- Department of Medicine, Harvard Medical School, Boston, MA; Bing Center for Waldenstrom Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Andrew R Branagan
- Department of Medicine, Harvard Medical School, Boston, MA; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA
| | - Steven P Treon
- Department of Medicine, Harvard Medical School, Boston, MA; Bing Center for Waldenstrom Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Jorge J Castillo
- Department of Medicine, Harvard Medical School, Boston, MA; Bing Center for Waldenstrom Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA.
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Moreno DF, de Larrea CF, Castillo JJ. New treatment strategies for Waldenström macroglobulinemia. Clin Adv Hematol Oncol 2022; 20:506-515. [PMID: 36125957] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The development of high-throughput technologies has allowed us to characterize the molecular landscape of hematologic neoplasms and identify somatic mutations. As a result, we can now use these technologies to screen for and diagnose neoplastic disease, model risk factors for progression, make treatment decisions, track response to treatment, and design clinical trials. Waldenström macroglobulinemia (WM), which is a lymphoplasmacytic lymphoma, serves as a good example of how genomic data collected at the bench can be applied at the bedside. MYD88 L265P and CXCR4 nonsense and frameshift mutations are the most common recurrent variants observed in patients who have WM, with detection rates of 90% and 40%, respectively. Knowing about these mutations has made it possible to develop agents that target the underlying signaling pathways. In this review, we describe the various treatment strategies for WM and detail the genotype of the malignant WM cell.
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Affiliation(s)
- David F Moreno
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Carlos Fernández de Larrea
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Castillo JJ, Sarosiek S, Flynn CA, Leventoff C, Little M, White T, Meid K, Treon SP. A pilot study on dasatinib in patients with Waldenström macroglobulinemia progressing on ibrutinib. eJHaem 2022; 3:927-929. [PMID: 36051045 PMCID: PMC9421949 DOI: 10.1002/jha2.493] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/24/2022]
Abstract
The hematopoietic cell kinase (HCK) regulates BTK activation and represents a potential therapeutic target in Waldenstrom macroglobulinemia (WM). We investigated dasatinib, a potent HCK inhibitor, in patients with WM progressing on ibrutinib. Study treatment consisted of dasatinib administered at 100 mg by mouth once daily in four‐week cycles for up to 24 cycles. This study was registered under ClinicalTrials.Gov ID NCT04115059. Three participants were enrolled and received at least one cycle of dasatinib. The best response was stable disease. Two patients received 5 months and one patient received 1 month of therapy. The dose of dasatinib was decreased in one participant due to volume overload. Based on the lack of responses observed, the study was terminated. Dasatinib might not be effective in patients with WM progressing on ibrutinib.
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Affiliation(s)
- Jorge J. Castillo
- Bing Center for Waldenström Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
| | - Shayna Sarosiek
- Bing Center for Waldenström Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
| | - Catherine A. Flynn
- Bing Center for Waldenström Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Carly Leventoff
- Bing Center for Waldenström Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Megan Little
- Bing Center for Waldenström Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Timothy White
- Bing Center for Waldenström Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Kirsten Meid
- Bing Center for Waldenström Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Steven P. Treon
- Bing Center for Waldenström Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
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Riva E, Duarte PJ, Valcárcel B, Remaggi G, Murrieta I, Corzo A, del Carpio D, Peña C, Vásquez J, Bove V, Teixeira L, Fleury-Perini G, Yantorno S, Samánez C, Lopresti S, Altamirano M, Villela L, Ruiz-Arguelles GJ, Ruiz-Delgado GJ, Montaño E, Verri V, Zamora Pérez E, Pérez Jacobo F, Idrobo H, Martínez-Cordero H, Beltran BE, Ramírez J, Castillo JJ, Malpica Castillo LE. Treatment and Survival Outcomes of Waldenstrom Macroglobulinemia in Latin American Patients: A Multinational Retrospective Cohort Study. JCO Glob Oncol 2022; 8:e2100380. [PMID: 35939775 PMCID: PMC9470138 DOI: 10.1200/go.21.00380] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Waldenstrom Macroglobulinemia (WM) is a rare lymphoma with distinct clinical features, and data from Latin American patients are lacking. Therefore, we aim to investigate the clinical, therapy, and outcome patterns of WM in Latin America. Waldenstrom Macroglobulinemia (WM) is a rare lymphoma with distinct clinical features. Data from Latin American WM patients are lacking. In this article, we report, for the first time, the results of a retrospective analysis focused on the clinical, therapy, and outcome patterns of WM in Latin America. Moreover, we have validated the IPSSWM score as a prognostic factor for mortality and disease progression. Despite the limitations we acknowledge, this is the first study to provide novel real-world data on WM in Latin America.
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Affiliation(s)
- Eloísa Riva
- Hematology Department, Hospital Británico & Hospital de Clinicas, Montevideo, Uruguay
| | | | - Bryan Valcárcel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | | | | | - Ariel Corzo
- Hospital de Clínicas de Buenos Aires, Buenos Aires, Argentina
| | | | - Camila Peña
- Hospital del Salvador, Santiago de Chile, Chile
| | - Jule Vásquez
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Virginia Bove
- Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | | | | | | | | | - Sergio Lopresti
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | | | - Luis Villela
- Centro Médico Dr Ignacio Chavez, Hospital Fernando Ocaranza, Universidad del Valle, Mexico City, Mexico
| | | | | | | | - Verónica Verri
- Instituto de Investigaciones Médicas Alfredo Lanari, Buenos Aires, Argentina
| | | | | | | | | | | | | | - Jorge J. Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA
| | - Luis E. Malpica Castillo
- Division of Cancer Medicine, Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
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Giuliani F, Pavlovsky MA, Giere I, Fernandez I, Sackmann F, Pavlovsky A, Remaggi G, Castillo JJ. First Latin America report on the diagnostic utility of the study of the MYD88 L265P gene mutation in patients with Waldenström Macroglobulinemia. Ann Hematol 2022; 101:2365-2367. [PMID: 35794278 DOI: 10.1007/s00277-022-04910-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- F Giuliani
- Fundaleu, Haematology Service, Buenos Aires, Argentina. .,Centro de Hematologia Pavlovsky, Buenos Aires, Argentina.
| | - M A Pavlovsky
- Fundaleu, Haematology Service, Buenos Aires, Argentina.,Centro de Hematologia Pavlovsky, Buenos Aires, Argentina
| | - I Giere
- Fundaleu, Haematology Service, Buenos Aires, Argentina
| | - I Fernandez
- Fundaleu, Haematology Service, Buenos Aires, Argentina.,Centro de Hematologia Pavlovsky, Buenos Aires, Argentina
| | - F Sackmann
- Fundaleu, Haematology Service, Buenos Aires, Argentina.,Centro de Hematologia Pavlovsky, Buenos Aires, Argentina
| | - A Pavlovsky
- Fundaleu, Haematology Service, Buenos Aires, Argentina.,Centro de Hematologia Pavlovsky, Buenos Aires, Argentina
| | - G Remaggi
- Fundaleu, Haematology Service, Buenos Aires, Argentina.,Centro de Hematologia Pavlovsky, Buenos Aires, Argentina
| | - J J Castillo
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Malpica L, Marques‐Piubelli ML, Beltran BE, Chavez JC, Miranda RN, Castillo JJ. EBV-positive diffuse large B-cell lymphoma, not otherwise specified: 2022 update on diagnosis, risk-stratification, and management. Am J Hematol 2022; 97:951-965. [PMID: 35472248 DOI: 10.1002/ajh.26579] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/12/2022] [Accepted: 04/16/2022] [Indexed: 01/04/2023]
Abstract
DISEASE OVERVIEW Epstein Barr virus-positive (EBV+) diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS) is an entity included in the WHO classification of lymphoid neoplasms since 2016. EBV+ DLBCL, NOS, is an aggressive B-cell lymphoma associated with EBV infection, and a poor prognosis with standard chemotherapeutic approaches. DIAGNOSIS The diagnosis is made through a careful pathological evaluation. Detection of EBV-encoded RNA (EBER) is considered standard for diagnosis; however, a clear cutoff for percentage of positive cells has not been defined. The differential diagnosis includes plasmablastic lymphoma (PBL), DLBCL associated with chronic inflammation, primary effusion lymphoma (PEL), among others. RISK-STRATIFICATION The International Prognostic Index (IPI) and the Oyama score can be used for risk-stratification. The Oyama score includes age >70 years and presence of B symptoms. The expression of CD30 and PD-1/PD-L1 are emerging as potential adverse but targetable biomarkers. MANAGEMENT Patients with EBV+ DLBCL, NOS, should be staged and managed following similar guidelines than patients with EBV-negative DLBCL. EBV+ DLBCL, NOS, however, might have a worse prognosis than EBV-negative DLBCL in the era of chemoimmunotherapy. Therefore, the inclusion of patients in clinical trials when available is recommended. There is an opportunity to study and develop targeted therapy in the management of patients with EBV+ DLBCL, NOS.
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Affiliation(s)
- Luis Malpica
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Mario L. Marques‐Piubelli
- Department of Translational Molecular Pathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Brady E. Beltran
- Department of Oncology and Radiotherapy Hospital Nacional Edgardo Rebagliati Martins Lima Peru
- Instituto de Ciencias Biomédicas Universidad Ricardo Palma Lima Peru
| | - Julio C. Chavez
- Department of Malignant Hematology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Roberto N. Miranda
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Jorge J. Castillo
- Division of Hematologic Malignancies, Dana‐Farber Cancer Institute Harvard Medical School Boston Massachusetts USA
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Abeykoon JP, Kumar S, Castillo JJ, D'Sa S, Kastritis E, Durot E, Uppal E, Morel P, Paludo J, Tawfiq R, Sarosiek S, Ogunbiyi MO, Cornillet-Lefebvre P, Kyle RA, Delmer A, Gertz MA, Dimopoulos MA, Treon SP, Ansell SM, Kapoor P. Bendamustine rituximab (BR) versus ibrutinib (Ibr) as primary therapy for Waldenström macroglobulinemia (WM): An international collaborative study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7566 Background: Parenteral limited-duration BR chemoimmunotherapy and continuous orally administered Ibr, a Bruton tyrosine kinase inhibitor, dominate the treatment landscape of WM, a rare B cell lymphoma. No trials have assessed the comparative effectiveness of these 2 vastly different approaches. We conducted a multiinstitutional, international, collaborative study to compare BR and single-agent Ibr in patients (pts) with treatment naïve (TN) WM. Methods: Data from 347 pts with active TN WM, seen between 2011 and 2021 in the US and Europe, were analyzed. The pts on rituximab maintenance were excluded. The modified IWWM-6 criteria (based on IgM alone) were used for response assessment. All time-to-event analyses were performed from the frontline therapy initiation, using the Kaplan-Meier method. Results: The median age of the pts treated with BR (n=208) and Ibr (n=139) was 66 (range 40-86) years (y) and 69 (39-97) y, respectively, (p=0.005). With a median follow up of 4.2 y (95% CI 3.8-4.5), the 4-y progression free survival (PFS) was 73% in each group, p=0.6, and 4-y overall survival (OS) was 94% (95% CI 91-98) in the BR group versus ( v) 82% (95% CI 75-90) in the Ibr group, p=0.01. In a bivariate analysis adjusting for age and the treatment type, only age emerged as a predictor for OS (HR 7.2, p=0.0001). Therefore, a 1:1 age-matched analysis of 246 pts who received Ibr (n=123) or BR (n=123) was performed. Pts with a known MYD88WT status who had received Ibr and their age matched controls on BR were excluded. The international prognostic scoring system (IPSS) WM was comparable between the 2 groups (Table). A higher proportion of pts on BR attained very good partial or deeper response (≥VGPR) as the best response in comparison to the pts on Ibr (Table). The 4-y PFS for the BR and Ibr groups was similar [72% (95% CI 63-82) v 78% (95% CI 70-87), p=0.14] and 4-y OS was 95% (95% CI 91-99) with BR v 86% (95% CI 80-93) with Ibr (p=0.3). Premature discontinuation, during active treatment, due to adverse effects (AEs) or lack of response was noted in 13% and 33% of pts on BR and Ibr, respectively. A detailed assessment of the AEs will be presented at the meeting. Conclusions: Both BR and Ibr lead to comparable outcomes in pts with TN WM, although deeper responses are attained with BR. These findings require confirmation in prospective studies. For pts who harbor MYD 88L265P mutation, selection between the 2 approaches should be dictated by their potential toxicities, pt comorbidities, pt/clinician preference (parenteral fixed-duration v continuous oral) and access to therapies. [Table: see text]
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Affiliation(s)
| | | | - Jorge J. Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Shirley D'Sa
- Centre for Waldenström’s Macroglobulinemia and Associated Disorders, University College London Hospital Foundation Trust, London, United Kingdom
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Eric Durot
- CHU De Reims - Hematology Clinique, Reims, France
| | - Encarl Uppal
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Shayna Sarosiek
- Section of Hematology and Oncology, Boston University Medical Center, Boston, MA
| | - M Olabisi Ogunbiyi
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | | - Steven P. Treon
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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Castillo JJ, Kingsley E, Narang M, Yimer HA, Dasanu CA, Melear JM, Coleman M, Farber CM, Gupta M, Shulman J, Mantovani EH, Zhang X, Cohen A, Huang J. A phase 2 expanded access study of zanubrutinib (ZANU) in patients (pts) with Waldenström Macroglobulinemia (WM). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e19522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19522 Background: Bruton tyrosine kinase (BTK) inhibition is an emerging standard of care for WM. The next-generation BTK inhibitor ZANU (BGB-3111), designed to maximize BTK occupancy and minimize off-target inhibition of other kinases, is approved by the United States (US) Food and Drug Administration, Health Canada, and the European Union at a dose of 320 mg once daily (QD) or 160 mg twice daily (BID) for adult pts with WM. BGB-3111-216 is a single-arm expanded access study of ZANU in treatment-naïve (TN) pts who were unsuitable for standard chemoimmunotherapy or pts with relapsed refractory (R/R) WM. This study provides real-world experience with ZANU in pts with WM. Methods: Eligible pts with TN or R/R WM received ZANU 320 mg QD or 160 mg BID orally. Primary endpoint was the number of pts enrolled/treated and enrolling sites. Secondary endpoints included treatment-emergent adverse events (TEAEs) of special interest, disease response rate, progression-free survival (PFS), and overall survival (OS). Response was evaluated by investigator assessment according to the 6th International Workshop on WM ( Br J Haematol. 2013;160(2):171-6) every 6 mo at minimum. The study was closed by the sponsor in July 2021 and active pts were transitioned to commercial ZANU via a patient assistance program. Results: Fifty pts with WM (17, TN; 33, R/R) were enrolled between December 2019 and June 2021 across 10 academic and community medical centers in the US. Median age was 72 years, 54% had intermediate-, 40% had high-risk disease, and the median number of prior therapies for R/R pts was 2. Median treatment exposure was 9.2 mo (range, 1.4-20.0). Thirty-eight (76%) pts had ≥1 TEAE, and 36 (72%) had ≥1 TEAE of special interest. Grade ≥3 TEAEs of special interest were hypertension (8%), infection (8%), atrial fibrillation/flutter (2%), neutropenia (2%), and second primary malignancy (2%). No new safety signals were observed. In pts with ≥1 response evaluation, 39% achieved a best overall response (BOR) of very good partial response. Overall response rate was 85.4% and major response rate was 73.2% (Table). Of the 4 pts with BOR of progressive disease, 3 had IgM values that met partial response criteria before the 6-mo response assessment. PFS and OS were immature due to short follow-up, and the median was not met. Conclusions: These real-world expanded access study results were consistent with the established ZANU profile in WM or other B-cell malignancies when administered as oral monotherapy at 160 mg BID or 320 mg QD in pts with intermediate or high-risk R/R or TN WM. Clinical trial information: NCT04052854. [Table: see text]
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Affiliation(s)
- Jorge J. Castillo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Ed Kingsley
- Department of Medical Oncology, Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | - Mohit Narang
- Department of Hematology and Medical Oncology, US Oncology Research, Maryland Hematology Oncology, Columbia, MD
| | - Habte Aragaw Yimer
- Department of Medical Hematology/Oncology, Texas Oncology-Tyler, US Oncology Research, Tyler, TX
| | | | | | - Morton Coleman
- Department of Hematology, Clinical Research Alliance Inc., New York, NY
| | | | - Mukul Gupta
- Department of Medical Oncology, Ridley-Tree Cancer Center at Sansum Clinic, Santa Barbara, CA
| | - Jonah Shulman
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | - Jane Huang
- BeiGene Co., Ltd.; BeiGene, Inc., San Mateo, CA
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Tam CSL, Garcia-Sanz R, Opat S, D'Sa S, Jurczak W, Lee HP, Cull G, Owen RG, Marlton P, Wahlin BE, Tedeschi A, Castillo JJ, Siddiqi T, Buske C, Leblond V, Chan WY, Schneider J, Cohen A, Huang J, Dimopoulos MA. ASPEN: Long-term follow-up results of a phase 3 randomized trial of zanubrutinib (ZANU) versus ibrutinib (IBR) in patients with Waldenström macroglobulinemia (WM). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7521 Background: ASPEN is a randomized, open-label, phase 3 study comparing ZANU, a potent and selective Bruton tyrosine kinase inhibitor (BTKi), with the first-generation BTKi IBR in patients with WM. We present data with a median follow-up of 43 months. Methods: Patients with MYD88 mutations were assigned to cohort 1 and randomized 1:1 to receive ZANU 160 mg twice daily or IBR 420 mg once daily. Randomization was stratified by CXCR4 mutational status and lines of prior therapy (0 vs 1-3 vs > 3). Patients without MYD88 mutations were assigned to cohort 2 and received ZANU 160 mg twice daily. The primary endpoint was proportion of patients achieving complete response or very good partial response (CR+VGPR). Results: A total of 201 patients (ZANU arm, n = 102; IBR arm, n = 99) were enrolled in cohort 1 and 28 patients were enrolled in cohort 2. A larger proportion of patients in the ZANU arm of cohort 1 vs IBR had CXCR4 mutations by next-generation sequencing (32% vs 20%, or 33 of 98 vs 20 of 92 with data available) and were aged > 75 years (33% vs 22%). Median duration of treatment was 42 months (ZANU) and 41 months (IBR), with 67% and 58% remaining on treatment, respectively. The CR+VGPR rate by investigator was 36% with ZANU vs 22% with IBR ( p= 0.02) in cohort 1, and 31% in cohort 2. One patient achieved CR (cohort 2). In patients with wild type or mutant CXCR4 from cohort 1, CR+VGPR rates with ZANU vs IBR were 45% vs 28% ( p= 0.04) and 21% vs 5% ( p= 0.15) , respectively. Median progression-free survival and overall survival were not yet reached. Rates of atrial fibrillation, diarrhea, hypertension, localized infection, hemorrhage, muscle spasms, pneumonia, and adverse events leading to discontinuation or death were lower with ZANU vs IBR (Table). Exposure-adjusted incidence rates of atrial fibrillation/flutter and hypertension were lower with ZANU vs IBR (0.2 vs 0.8 and 0.5 vs 1.0 persons per 100 person-months, respectively; p< 0.05). Rate of neutropenia was higher and rate of grade ≥3 infection was lower with ZANU vs IBR. Safety outcomes of ZANU were similar between cohorts 1 and 2. Conclusions: ASPEN is the largest phase 3 trial with head-to-head BTKi comparison in WM. At a median follow-up of 43 months, ZANU was associated with higher CR+VGPR rate and demonstrated clinically meaningful advantages in long-term safety and tolerability vs IBR. Clinical trial information: NCT03053440. [Table: see text]
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Affiliation(s)
| | | | - Stephen Opat
- Monash Health, Monash University, Clayton, Victoria, Australia
| | - Shirley D'Sa
- Centre for Waldenström’s Macroglobulinemia and Associated Disorders, University College London Hospital Foundation Trust, London, United Kingdom
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland
| | - Hui-Peng Lee
- Flinders Medical Centre, Adelaide, SA, Australia
| | - Gavin Cull
- Sir Charles Gairdner Hospital and University of Western Australia, Perth, Australia
| | - Roger G. Owen
- HMDS Laboratory, St. James’ Institute of Oncology, Leeds, United Kingdom
| | - Paula Marlton
- Princess Alexandra Hospital, University of Queensland Brisbane, Brisbane, Australia
| | - Bjorn E. Wahlin
- Karolinska Universitetssjukhuset and Karolinska Institutet, Stockholm, Sweden
| | | | - Jorge J. Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - Christian Buske
- CCC Ulm-Universitätsklinikum Ulm, Baden-Württemberg, Germany
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Gómez XE, Castillo JJ, Gómez MA. Bone marrow aspiration in a patient with systemic microsporidium. Clin Case Rep 2022; 10:e05845. [PMID: 35600011 PMCID: PMC9109649 DOI: 10.1002/ccr3.5845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/01/2022] [Accepted: 04/05/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ximena E. Gómez
- General Medicine Japanese Peruvian Centennial Clinic Lima Perú
| | - Jorge J. Castillo
- Division of Hematologic Malignancies Dana‐Farber Cancer Institute Harvard Medical School Boston Massachusetts USA
| | - Marco A. Gómez
- Division of Hematology Japanese Peruvian Centennial Clinic Lima Perú
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Dittus C, Miller JA, Wehbie R, Castillo JJ. Daratumumab with ifosfamide, carboplatin and etoposide for the treatment of relapsed plasmablastic lymphoma. Br J Haematol 2022; 198:e32-e34. [PMID: 35506301 DOI: 10.1111/bjh.18228] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/11/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Christopher Dittus
- Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jordan A Miller
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Robert Wehbie
- UNC REX Cancer Center of Wakefield, University of North Carolina at Chapel Hill, Raleigh, North Carolina, USA
| | - Jorge J Castillo
- Hematologic Oncology Treatment Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Jurczyszyn A, Castillo JJ, Olszewska-Szopa M, Kumar L, Thibaud S, Richter J, Flicker K, Fiala M, Vij R, Yi S, Xu F, Silbermann R, Gaisan CM, Ocio EM, Waszczuk-Gajda A, Crusoe EDQ, Salomon-Perzyński A, Hus I, Valls JD, Gozzetti A, Czepiel J, Krzanowska K, Chappell A, Chellapuram SK, Suska A, Vesole DH. POEMS Syndrome: Real World Experience in Diagnosis and Systemic Therapy - 108 Patients Multicenter Analysis. Clin Lymphoma Myeloma Leuk 2022; 22:297-304. [PMID: 34844892 DOI: 10.1016/j.clml.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/03/2021] [Accepted: 10/13/2021] [Indexed: 10/19/2022]
Abstract
POEMS syndrome, a rare plasma cell disorder, is challenging both in the diagnostic and therapeutic management. We present real word retrospective analysis of 108 cases analyzing clinical features and therapeutic modes. We compare our results with the available literature. This is the first description with such wide use of proteasome inhibitors in first line treatment. POEMS (Polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes) syndrome is a rare and challenging plasma cell disorder, both in the diagnostic and therapeutic management of the disease. Currently, the literature on POEMS is sparse with most evidence being case reports and small case studies. We present a retrospective real world experience of 108 patients with POEMS. We analyzed the clinical features and therapeutic interventions. Regarding clinical features, our findings demonstrated that skin lesions, thrombocythemia and polycythemia were present less frequently than reported previously. Regarding clinical interventions, this is one of the largest analyses of front line treatment in POEMS and the first one to include frequent utilization of proteasome inhibitors (37%). Bortezomib monotherapy was the most effective therapy achieving complete remission/very good partial remissions (CR/VGPR) in 69% of patients. Thirty percent of patients proceeded to planned autologous stem cell transplant (ASCT) as part of the front-line treatment resulting in statistically superior progression-free (PFS) and overall survival (OS) compared to non-ASCT treated patients (P= .003). In multivariate analysis, anemia, thrombocytopenia, and as age over 60 were associated with a negative impact on patient outcomes.
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Affiliation(s)
- Artur Jurczyszyn
- Plasma Cell Dyscrasia Center, Department of Hematology Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland.
| | - Jorge J Castillo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Magdalena Olszewska-Szopa
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Mark Fiala
- Division of Oncology, Section of Bone Marrow Transplant & Leukemia, Washington University School of Medicine, Saint Louis, MO
| | - Ravi Vij
- Division of Oncology, Section of Bone Marrow Transplant & Leukemia, Washington University School of Medicine, Saint Louis, MO
| | - Shuhua Yi
- State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood Diseases Institute of Hematology and Blood Disease Hospital Chinese, Academy of Medical Sciences and Peking Union Medical College Tianjin China
| | - Fang Xu
- Department of Hematology, Mianyang Central Hospital, Mianyang, Sichuan, People's Republic of China
| | - Rebecca Silbermann
- Division of Hematology and Medical Oncology, Oregon Health and Sciences University, Knight Cancer Institute, Portland
| | - Carmen Montes Gaisan
- University Hospital Marques de Valdecilla (IDIVAL), University of Cantabria, Santander, Spain
| | - Enrique M Ocio
- University Hospital Marques de Valdecilla (IDIVAL), University of Cantabria, Santander, Spain
| | - Anna Waszczuk-Gajda
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Poland
| | - Edvan De Queiroz Crusoe
- Universidade Federal da Bahia (UFBA), Hospital Universitário Professor Edgard Santos, Salvador, BA, Brazil
| | | | - Iwona Hus
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Alessandro Gozzetti
- Division of Hematology, Department of Medical Science, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Jacek Czepiel
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna Krzanowska
- Department of Nephrology, Jagiellonian University Medical College, Kraków, Poland
| | - Aimee Chappell
- Department of Hematology/Oncology, Georgetown University Hospital, Washington, DC
| | - S K Chellapuram
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Anna Suska
- Plasma Cell Dyscrasia Center, Department of Hematology Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - David H Vesole
- Department of Hematology/Oncology, Georgetown University Hospital, Washington, DC; John Theurer Cancer Center at Hackensack Meridian School of Medicine, Hackensack, NJ
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Alderuccio JP, Arcaini L, Watkins MP, Beaven AW, Shouse G, Epperla N, Spina M, Stefanovic A, Sandoval-Sus J, Torka P, Alpert AB, Olszewski AJ, Kim SH, Hess B, Gaballa S, Ayyappan S, Castillo JJ, Argnani L, Voorhees TJ, Saba R, Chowdhury SM, Vargas F, Reis IM, Kwon D, Alexander JS, Zhao W, Edwards D, Martin P, Cencini E, Kamdar M, Link BK, Logothetis CN, Herrera AF, Friedberg JW, Kahl BS, Luminari S, Zinzani PL, Lossos IS. An international analysis evaluating frontline bendamustine with rituximab in extranodal marginal zone lymphoma. Blood Adv 2022; 6:2035-2044. [PMID: 35196377 PMCID: PMC9006265 DOI: 10.1182/bloodadvances.2021006844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/13/2022] [Indexed: 11/20/2022] Open
Abstract
Extranodal marginal zone lymphoma (EMZL) is a heterogeneous non-Hodgkin lymphoma. No consensus exists regarding the standard-of-care in patients with advanced-stage disease. Current recommendations are largely adapted from follicular lymphoma, for which bendamustine with rituximab (BR) is an established approach. We analyzed the safety and efficacy of frontline BR in EMZL using a large international consortium. We included 237 patients with a median age of 63 years (range, 21-85). Most patients presented with Eastern Cooperative Oncology Group (ECOG) performance status 0 to 1 (n = 228; 96.2%), stage III/IV (n = 179; 75.5%), and intermediate (49.8%) or high (33.3%) Mucosa Associated Lymphoid Tissue International Prognosis Index (MALT-IPI). Patients received a median of 6 (range, 1-8) cycles of BR, and 20.3% (n = 48) received rituximab maintenance. Thirteen percent experienced infectious complications during BR therapy; herpes zoster (4%) was the most common. Overall response rate was 93.2% with 81% complete responses. Estimated 5-year progression-free survival (PFS) and overall survival (OS) were 80.5% (95% CI, 73.1% to 86%) and 89.6% (95% CI, 83.1% to 93.6%), respectively. MALT-IPI failed to predict outcomes. In the multivariable model, the presence of B symptoms was associated with shorter PFS. Rituximab maintenance was associated with longer PFS (hazard ratio = 0.16; 95% CI, 0.04-0.71; P = .016) but did not impact OS. BR is a highly effective upfront regimen in EMZL, providing durable remissions and overcoming known adverse prognosis factors. This regimen is associated with occurrence of herpes zoster; thus, prophylactic treatment may be considered.
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Affiliation(s)
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS San Mateo and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Anne W. Beaven
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | | | - Michele Spina
- Medical Oncology Division, Centro Riferimento Oncologico, Aviano, Italy
| | | | - Jose Sandoval-Sus
- Moffitt Cancer Center at Memorial Healthcare System, Pembroke Pines, FL
| | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Ash B. Alpert
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI
| | | | - Seo-Hyun Kim
- Division of Hematology/Oncology, Rush University Medical Center, Chicago, IL
| | - Brian Hess
- Hollings Cancer Center at Medical University of South Carolina, Charleston, SC
| | | | - Sabarish Ayyappan
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | | | - Lisa Argnani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia “Seràgnoli”
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
| | - Timothy J. Voorhees
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Raya Saba
- Washington University in St. Louis, St. Louis, MO
| | | | - Fernando Vargas
- Moffitt Cancer Center at Memorial Healthcare System, Pembroke Pines, FL
| | | | - Deukwoo Kwon
- Sylvester Comprehensive Cancer Center, Miami, FL
| | | | - Wei Zhao
- Sylvester Comprehensive Cancer Center, Miami, FL
| | - Dali Edwards
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Peter Martin
- Division of Hematology/Oncology, Weill Cornell Medicine, New York, NY
| | - Emanuele Cencini
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena SI, Italy
| | | | - Brian K. Link
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | | | | | | | - Brad S. Kahl
- Washington University in St. Louis, St. Louis, MO
| | - Stefano Luminari
- CHIMOMO Department University of Modena and Reggio Emilia, Reggio Emilia, Italy; and
- Department of Hematology, Azienda USL IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia “Seràgnoli”
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
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Sarosiek S, Sermer D, Branagan AR, Treon SP, Castillo JJ. Zanubrutinib for the treatment of adults with Waldenstrom macroglobulinemia. Expert Rev Anticancer Ther 2022; 22:471-478. [PMID: 35404729 DOI: 10.1080/14737140.2022.2064849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The development of Bruton tyrosine kinase (BTK) inhibitors has significantly changed the treatment landscape for patients with Waldenström macroglobulinemia (WM). Ibrutinib was the first BTK inhibitor to receive FDA approval for this disease, but in recent years additional more selective BTK inhibitors have become available. Zanubrutinib, the most recently FDA-approved therapy for WM, has demonstrated comparable efficacy regarding hematologic response, but with an improved side effect profile compared to other BTK inhibitors. AREAS COVERED In this review, we highlight the pivotal studies that have formed the foundation for the use of zanubrutinib in WM, including safety and efficacy data from prospective clinical trials of the currently available BTK inhibitors. EXPERT OPINION BTK inhibitors are very effective in WM and have an overall response rate higher than 90%. The side effect profile of these medications is manageable, but does include a risk of atrial fibrillation, infection, and bleeding. The newer BTK inhibitors, such as acalabrutinib and zanubrutinib, are known to have less off-target effects and are potential treatment options. BTK inhibitors should be considered as a treatment option in treatment-naïve and previously treated disease depending on the individual patient preferences, comorbidities, and molecular profile.
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Affiliation(s)
- Shayna Sarosiek
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - David Sermer
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andrew R Branagan
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Steven P Treon
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
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50
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Derman B, Castillo JJ, Sarosiek S, Beksac M. When a Monoclonal Gammopathy Is Not Multiple Myeloma. Am Soc Clin Oncol Educ Book 2022; 42:1-10. [PMID: 35394823 DOI: 10.1200/edbk_349643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Our knowledge of monoclonal gammopathies is continuously evolving. Once accepted as a possible precursor condition to multiple myeloma, monoclonal gammopathies as an entity are now associated with many renal, neurologic, and dermatologic disorders of clinical significance. This change has created a challenge for patients and clinicians, as a monoclonal gammopathy may be a harbinger not of multiple myeloma but of other lymphoproliferative disorders such as light-chain amyloidosis and Waldenström macroglobulinemia. Early recognition of monoclonal gammopathies along with a careful workup are essential in determining the next steps in the care of a given patient. Recognition has become all the more important as we understand how to triage the 4% to 9% of patients with monoclonal gammopathies depending on age, with the goal of limiting overdiagnosis and misdiagnosis. In this review, we focus on treatment strategies for patients with monoclonal gammopathies that are not multiple myeloma, including smoldering multiple myeloma, light-chain amyloidosis, and Waldenström macroglobulinemia.
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Affiliation(s)
| | - Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Shayna Sarosiek
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Meral Beksac
- Department of Hematology, Cebeci Hospital, Ankara University Dikimevi, Ankara, Turkey
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