1
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Pleasance E, Bohm A, Williamson LM, Nelson JMT, Shen Y, Bonakdar M, Titmuss E, Csizmok V, Wee K, Hosseinzadeh S, Grisdale CJ, Reisle C, Taylor GA, Lewis E, Jones MR, Bleile D, Sadeghi S, Zhang W, Davies A, Pellegrini B, Wong T, Bowlby R, Chan SK, Mungall KL, Chuah E, Mungall AJ, Moore RA, Zhao Y, Deol B, Fisic A, Fok A, Regier DA, Weymann D, Schaeffer DF, Young S, Yip S, Schrader K, Levasseur N, Taylor SK, Feng X, Tinker A, Savage KJ, Chia S, Gelmon K, Sun S, Lim H, Renouf DJ, Jones SJM, Marra MA, Laskin J. Whole genome and transcriptome analysis enhances precision cancer treatment options. Ann Oncol 2022; 33:939-949. [PMID: 35691590 DOI: 10.1016/j.annonc.2022.05.522] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 12/02/2021] [Revised: 05/03/2022] [Accepted: 05/31/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Recent advances are enabling delivery of precision genomic medicine to cancer clinics. While the majority of approaches profile panels of selected genes or hotspot regions, comprehensive data provided by whole genome and transcriptome sequencing and analysis (WGTA) presents an opportunity to align a much larger proportion of patients to therapies. PATIENTS AND METHODS Samples from 570 patients with advanced or metastatic cancer of diverse types enrolled in the Personalized OncoGenomics (POG) program underwent WGTA. DNA-based data, including mutations, copy number, and mutation signatures, were combined with RNA-based data, including gene expression and fusions, to generate comprehensive WGTA profiles. A multidisciplinary molecular tumour board used WGTA profiles to identify and prioritize clinically actionable alterations and inform therapy. Patient responses to WGTA-informed therapies were collected. RESULTS Clinically actionable targets were identified for 83% of patients, 37% of whom received WGTA-informed treatments. RNA expression data were particularly informative, contributing to 67% of WGTA-informed treatments; 25% of treatments were informed by RNA expression alone. Of a total 248 WGTA-informed treatments, 46% resulted in clinical benefit. RNA expression data were comparable to DNA-based mutation and copy number data in aligning to clinically beneficial treatments. Genome signatures also guided therapeutics including platinum, PARP inhibitors, and immunotherapies. Patients accessed WGTA-informed treatments through clinical trials (19%), off-label use (35%), and as standard therapies (46%) including those which would not otherwise have been the next choice of therapy, demonstrating the utility of genomic information to direct use of chemotherapies as well as targeted therapies. CONCLUSIONS Integrating RNA expression and genome data illuminated treatment options that resulted in 46% of treated patients experiencing positive clinical benefit, supporting the use of comprehensive WGTA profiling in clinical cancer care. CLINICAL TRIAL NUMBER NCT02155621.
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Affiliation(s)
- E Pleasance
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - A Bohm
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver; Department of Medicine, University of British Columbia, Vancouver
| | - L M Williamson
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - J M T Nelson
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - Y Shen
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - M Bonakdar
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - E Titmuss
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - V Csizmok
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - K Wee
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - S Hosseinzadeh
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver; Department of Medicine, University of British Columbia, Vancouver
| | - C J Grisdale
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - C Reisle
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - G A Taylor
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - E Lewis
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - M R Jones
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - D Bleile
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - S Sadeghi
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - W Zhang
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - A Davies
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - B Pellegrini
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - T Wong
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - R Bowlby
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - S K Chan
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - K L Mungall
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - E Chuah
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - A J Mungall
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - R A Moore
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - Y Zhao
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - B Deol
- Department of Medical Oncology, BC Cancer, Vancouver
| | - A Fisic
- Department of Medical Oncology, BC Cancer, Vancouver
| | - A Fok
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver
| | - D A Regier
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver
| | - D Weymann
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver
| | - D F Schaeffer
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver; Pancreas Centre BC, Vancouver
| | - S Young
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver
| | - S Yip
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver
| | - K Schrader
- Hereditary Cancer Program, BC Cancer, Vancouver; Department of Medical Genetics, University of British Columbia, Vancouver
| | - N Levasseur
- Department of Medical Oncology, BC Cancer, Vancouver
| | - S K Taylor
- Department of Medical Oncology, BC Cancer, Kelowna
| | - X Feng
- Department of Medical Oncology, BC Cancer, Victoria
| | - A Tinker
- Department of Medical Oncology, BC Cancer, Vancouver
| | - K J Savage
- Department of Medical Oncology, BC Cancer, Vancouver
| | - S Chia
- Department of Medical Oncology, BC Cancer, Vancouver
| | - K Gelmon
- Department of Medical Oncology, BC Cancer, Vancouver
| | - S Sun
- Department of Medical Oncology, BC Cancer, Vancouver
| | - H Lim
- Department of Medical Oncology, BC Cancer, Vancouver
| | - D J Renouf
- Department of Medical Oncology, BC Cancer, Vancouver; Pancreas Centre BC, Vancouver
| | - S J M Jones
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver; Department of Medical Genetics, University of British Columbia, Vancouver; Department of Molecular Biology and Biochemistry, Simon Fraser University, Vancouver, Canada
| | - M A Marra
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver; Department of Medical Genetics, University of British Columbia, Vancouver
| | - J Laskin
- Department of Medical Oncology, BC Cancer, Vancouver.
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2
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Horwitz S, O'Connor OA, Pro B, Trümper L, Iyer S, Advani R, Bartlett NL, Christensen JH, Morschhauser F, Domingo-Domenech E, Rossi G, Kim WS, Feldman T, Menne T, Belada D, Illés Á, Tobinai K, Tsukasaki K, Yeh SP, Shustov A, Hüttmann A, Savage KJ, Yuen S, Zinzani PL, Miao H, Bunn V, Fenton K, Fanale M, Puhlmann M, Illidge T. The ECHELON-2 Trial: 5-year results of a randomized, phase 3 study of brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma. Ann Oncol 2021; 33:288-298. [PMID: 34921960 PMCID: PMC9447792 DOI: 10.1016/j.annonc.2021.12.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/12/2021] [Accepted: 12/07/2021] [Indexed: 01/18/2023] Open
Abstract
Background: For patients with peripheral T-cell lymphoma (PTCL), outcomes using frontline treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-like therapy are typically poor. The ECHELON-2 study demonstrated that brentuximab vedotin plus cyclophosphamide, doxorubicin, and prednisone (A+CHP) exhibited statistically superior progression-free survival (PFS) per independent central review and improvements in overall survival versus CHOP for the frontline treatment of patients with systemic anaplastic large cell lymphoma or other CD30-positive PTCL. Patients and methods: ECHELON-2 is a double-blind, double-dummy, randomized, placebo-controlled, active-comparator phase III study. We present an exploratory update of the ECHELON-2 study, including an analysis of 5-year PFS per investigator in the intent-to-treat analysis group. Results: A total of 452 patients were randomized (1 : 1) to six or eight cycles of A+CHP (N = 226) or CHOP (N = 226). At median follow-up of 47.6 months, 5-year PFS rates were 51.4% [95% confidence interval (CI): 42.8% to 59.4%] with A+CHP versus 43.0% (95% CI: 35.8% to 50.0%) with CHOP (hazard ratio = 0.70; 95% CI: 0.53–0.91), and 5-year overall survival (OS) rates were 70.1% (95% CI: 63.3% to 75.9%) with A+CHP versus 61.0% (95% CI: 54.0% to 67.3%) with CHOP (hazard ratio = 0.72; 95% CI: 0.53–0.99). Both PFS and OS were generally consistent across key subgroups. Peripheral neuropathy was resolved or improved in 72% (84/117) of patients in the A+CHP arm and 78% (97/124) in the CHOP arm. Among patients who relapsed and subsequently received brentuximab vedotin, the objective response rate was 59% with brentuximab vedotin retreatment after A+CHP and 50% with subsequent brentuximab vedotin after CHOP. Conclusions: In this 5-year update of ECHELON-2, frontline treatment of patients with PTCL with A+CHP continues to provide clinically meaningful improvement in PFS and OS versus CHOP, with a manageable safety profile, including continued resolution or improvement of peripheral neuropathy.
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Affiliation(s)
- S Horwitz
- Memorial Sloan Kettering Cancer Center, New York, New York, USA.
| | - O A O'Connor
- University of Virginia Cancer Center, University of Virginia, Charlottesville, Virginia, USA
| | - B Pro
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - L Trümper
- Universitätsmedizin Göttingen, Göttingen, Germany
| | - S Iyer
- MD Anderson Cancer Center/University of Texas, Houston, Texas, USA
| | - R Advani
- Stanford Cancer Center, Blood and Marrow Transplant Program, Stanford, California, USA
| | - N L Bartlett
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | - E Domingo-Domenech
- Institut Catala D'oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - G Rossi
- Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - W S Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - T Feldman
- John Theurer Cancer Center, Hackensack Meridian Health School of Medicine, Hackensack NJ
| | - T Menne
- Freeman Hospital, Newcastle upon Tyne, England
| | - D Belada
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Králové, Czech Republic and Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic
| | - Á Illés
- Debreceni Egyetem, Debrecen, Hajdu-Bihar, Hungary
| | - K Tobinai
- National Cancer Center Hospital, Tokyo, Japan
| | - K Tsukasaki
- Saitama Medical University International Medical Center, Saitama, Japan
| | - S-P Yeh
- China Medical University Hospital, Taichung, Taiwan
| | - A Shustov
- University of Washington Medical Center, Seattle, Washington, USA
| | - A Hüttmann
- Universitatsklinikum Essen, Essen, Nordrhein-Westfalen, Germany
| | - K J Savage
- Department of Medical Oncology and University of British Columbia, BC Cancer, Vancouver, British Columbia, Canada
| | - S Yuen
- Calvary Mater Newcastle Hospital, Australia
| | - P L Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli"; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italia
| | - H Miao
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, USA, a wholly owned subsidiary of Takeda Pharmaceuticals Limited
| | - V Bunn
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, USA, a wholly owned subsidiary of Takeda Pharmaceuticals Limited
| | - K Fenton
- Seagen Inc., Bothell, Washington, USA
| | - M Fanale
- Seagen Inc., Bothell, Washington, USA
| | | | - T Illidge
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Biomedical Research Centre, Manchester Academic Health Sciences Centre, Christie Hospital NHS Foundation Trust, Manchester, UK
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3
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Ansell SM, Bröckelmann PJ, Keudell G, Lee HJ, Santoro A, Zinzani PL, Collins GP, Cohen JB, Boer JP, Kuruvilla J, Savage KJ, Trneny M, Provencio M, Jaeger U, Willenbacher W, Swanink R, Sacchi M, Shipp MA, Engert A, Armand P. NIVOLUMAB FOR RELAPSED OR REFRACTORY (R/R) CLASSICAL HODGKIN LYMPHOMA (CHL) AFTER AUTOLOGOUS TRANSPLANTATION: 5‐YEAR OVERALL SURVIVAL FROM THE PHASE 2 CHECKMATE 205 STUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.74_2879] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- S. M. Ansell
- Mayo Clinic Division of Hematology Rochester Minnesota USA
| | - P. J. Bröckelmann
- University Hospital of Cologne Department of Internal Medicine Cologne Germany
| | - G. Keudell
- Memorial Sloan Kettering Cancer Center Department of Hematology New York New York USA
| | - H. J. Lee
- University of Texas MD Anderson Cancer Center Department of Lymphoma and Myeloma Houston Texas USA
| | - A. Santoro
- Humanitas University Humanitas Cancer Center Rozzano Milan Italy
| | - P. L. Zinzani
- University of Bologna Institute of Hematology L. e A. Seràgnoli Bologna Italy
| | - G. P. Collins
- Churchill Hospital Oxford Cancer and Haematology Centre Oxford UK
| | - J. B. Cohen
- Emory University Winship Cancer Institute Atlanta Georgia USA
| | - J. P. Boer
- Antoni van Leeuwenhoek Hospital Netherlands Cancer Institute Amsterdam Netherlands
| | - J. Kuruvilla
- University of Toronto and Princess Margaret Cancer Centre Division of Medical Oncology and Hematology Toronto Canada
| | - K. J. Savage
- BC Cancer Department of Medical Oncology Vancouver Canada
| | - M. Trneny
- Charles University in Prague and General University Hospital in Prague Department of Haematology Prague Czech Republic
| | - M. Provencio
- Hospital Universitario Puerta de Hierro Department of Medical Oncology Madrid Spain
| | - U. Jaeger
- Medical University of Vienna Clinical Department for Hematology and Hemostaseology Vienna Austria
| | - W. Willenbacher
- Innsbruck Medical University Department of Internal Medicine V Innsbruck Austria
| | - R. Swanink
- Bristol Myers Squibb Global Biometrics and Data Sciences Braine l’Alleud Belgium
| | - M. Sacchi
- Bristol Myers Squibb, Global Drug Development Princeton New Jersey USA
| | - M. A. Shipp
- Dana‐Farber Cancer Institute Department of Medical Oncology Boston Massachusetts USA
| | - A. Engert
- University Hospital of Cologne Department of Internal Medicine Cologne Germany
| | - P. Armand
- Dana‐Farber Cancer Institute Department of Medical Oncology Boston Massachusetts USA
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4
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Villa D, Hoster E, Hermine O, Klapper W, Szymczyk M, Bosly A, Unterhalt M, Freeman CL, Scott DW, Gerrie AS, Savage KJ, Sehn LH, Dreyling M. RITUXIMAB IN COMBINATION WITH BENDAMUSTINE OR HIGH‐DOSE CYTARABINE‐BASED INDUCTION THERAPY IN TRANSPLANT‐ELIGIBLE PATIENTS WITH MANTLE CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.62_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- D. Villa
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - E. Hoster
- Ludwig‐Maximilians‐Universität München Institute for Medical Information Processing, Biometry, and Epidemiology Munich Germany
| | - O. Hermine
- University of Paris Descartes, Hôpital Necker Assistance Publique Hôpitaux de Paris Paris France
| | - W. Klapper
- Universitätsklinikum Schleswig‐Holstein Institut für Pathologie, Sektion Hämatopathologie und Lymphknotenregister Kiel Germany
| | - M. Szymczyk
- Maria Sklodowska‐Curie National Research Institute of Oncology Department of Lymphoid Malignancies Warsaw Poland
| | - A. Bosly
- CHU UCL Mont‐Godinne‐Dinant Faculty of Medicine and Dentistry Yvoir Belgium
| | - M. Unterhalt
- University of Ulm Department of Internal Medicine Ulm Germany
| | - C. L. Freeman
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - D. W. Scott
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - A. S. Gerrie
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - K. J. Savage
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - L. H. Sehn
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - M. Dreyling
- Ludwig‐Maximilians‐Universität München Medizinische Klinik III Munich Germany
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5
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Collinge BJ, Hilton LK, Wong J, Ben‐Neriah S, Rushton CK, Slack GW, Farinha P, Cook JR, Ott G, Rosenwald A, Campo E, Amador C, Greiner TC, Raess PW, Song JY, Inghirami G, Jaffe ES, Weisenburger DD, Chan WC, Holte H, Beiske K, Fu K, Delabie J, Pittaluga S, Feldman AL, Savage KJ, Mungall AJ, Staudt LM, Steidl C, Rimsza LM, Morin RD, Scott DW. CHARACTERIZATION OF THE GENETIC LANDSCAPE OF HIGH‐GRADE B‐CELL LYMPHOMA, NOS – AN LLMPP PROJECT. Hematol Oncol 2021. [DOI: 10.1002/hon.13_2880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - L. K Hilton
- BC Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - J. Wong
- BC Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - S. Ben‐Neriah
- BC Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - C. K. Rushton
- Simon Fraser University Molecular Biology and Biochemistry Burnaby Canada
| | - G. W. Slack
- BC Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - P. Farinha
- BC Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - J. R. Cook
- Cleveland Clinic Department of Molecular Pathology and Laboratory Medicine Cleveland Ohio USA
| | - G. Ott
- Robert‐Bosch‐Krankenhaus and Dr. Margarete Fischer‐Bosch Institute of Clinical Pharmacology Department of Clinical Pathology Stuttgart Germany
| | - A. Rosenwald
- University of Wuerzburg Institute of Pathology Wuerzburg Germany
| | - E. Campo
- Hospital Clinic of the University of Barcelona Department of Pathology Barcelona Spain
| | - C. Amador
- University of Nebraska Medical Center Department of Pathology and Microbiology Omaha Nebraska USA
| | - T. C. Greiner
- University of Nebraska Medical Center Department of Pathology and Microbiology Omaha Nebraska USA
| | - P. W. Raess
- Oregon Health & Science University Department of Pathology Portland Oregon USA
| | - J. Y. Song
- City of Hope National Medical Center Department of Pathology Duarte California USA
| | - G. Inghirami
- Weill Cornell Medicine Pathology and Laboratory Medicine New York New York USA
| | - E. S. Jaffe
- National Cancer Institute Laboratory of Pathology Bethesda Maryland USA
| | - D. D. Weisenburger
- City of Hope National Medical Center Department of Pathology Duarte California USA
| | - W. C. Chan
- City of Hope National Medical Center Department of Pathology Duarte California USA
| | - H. Holte
- Oslo University Hospital Department of Oncology Oslo Norway
| | - K. Beiske
- Oslo University Hospital Department of Pathology Oslo Norway
| | - K. Fu
- Roswell Park Cancer Institute Department of Pathology & Laboratory Medicine Buffalo New York USA
| | - J. Delabie
- University Health Network and University of Toronto Department of Laboratory Medicine and Pathobiology Toronto Canada
| | - S. Pittaluga
- National Cancer Institute Laboratory of Pathology Bethesda Maryland USA
| | - A. L. Feldman
- Mayo Clinic College of Medicine Laboratory Medicine and Pathology Rochester Minnesota USA
| | - K. J. Savage
- BC Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - A. J. Mungall
- BC Cancer Canada’s Michael Smith Genome Sciences Centre Vancouver Canada
| | - L. M. Staudt
- National Cancer Institute Center for Cancer Research Bethesda Maryland USA
| | - C. Steidl
- BC Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - L. M. Rimsza
- Mayo Clinic Department of Laboratory Medicine and Pathology Scottsdale Arizona USA
| | - R. D. Morin
- Simon Fraser University Molecular Biology and Biochemistry Burnaby Canada
| | - D. W. Scott
- BC Cancer Centre for Lymphoid Cancer Vancouver Canada
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6
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Collinge BJ, Hilton LK, Wong J, Ben‐Neriah S, Alduaij W, Rushton CK, Slack GW, Farinha P, Miyata‐Takata T, Cook JR, Ott G, Rosenwald A, Campo E, Amador C, Greiner TC, Raess PW, Song JY, Inghirami G, Jaffe ES, Weisenburger DD, Chan WC, Holte H, Beiske K, Fu K, Delabie J, Pittaluga S, Feldman AL, Sehn LH, Savage KJ, Mungall AJ, Staudt LM, Steidl C, Rimsza LM, Morin RD, Scott DW. THE MUTATIONAL LANDSCAPE OF DOUBLE/TRIPLE‐HIT HIGH‐GRADE B‐CELL LYMPHOMA WITH
BCL2
REARRANGEMENT (DH/TH‐
BCL2
) – AN LLMPP PROJECT. Hematol Oncol 2021. [DOI: 10.1002/hon.65_2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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7
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Zinzani PL, Carlo‐Stella C, Hamadani M, Herrera AF, Ansell SM, Radford J, Maddocks K, Kline J, Savage KJ, Bartlett NL, Caimi PF, Negievich Y, Cruz HG, Wang L, Wuerthner J, Collins GP. CAMIDANLUMAB TESIRINE EFFICACY AND SAFETY IN AN OPEN‐LABEL, MULTICENTER, PHASE 2 STUDY OF PATIENTS (PTS) WITH RELAPSED OR REFRACTORY CLASSICAL HODGKIN LYMPHOMA (R/R CHL). Hematol Oncol 2021. [DOI: 10.1002/hon.75_2879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- P. L. Zinzani
- IRCCS Azienda Ospedaliero‐Universitaria di Bologna Istituto di Ematologia "Seràgnoli" and Dipartimento di Medicina Specialistica Diagnostica e Sperimentale Università di Bologna Bologna Italy
| | - C. Carlo‐Stella
- Humanitas Clinical and Research Center – IRCCS, and Humanitas University Department of Oncology and Hematology Rozzano Milan Italy
| | - M. Hamadani
- Medical College of Wisconsin BMT & Cellular Therapy Program Department of Medicine Milwaukee Wisconsin USA
| | - A. F. Herrera
- City of Hope Comprehensive Cancer Center Department of Hematology & Hematopoietic Cell Transplantation Duarte California USA
| | - S. M. Ansell
- Mayo Clinic Division of Hematology Rochester Minnesota USA
| | - J. Radford
- NIHR Manchester Clinical Research Facility The Christie NHS Foundation Trust and University of Manchester Manchester Academic Health Science Centre Manchester UK
| | - K. Maddocks
- Ohio State University Medical Center Division of Hematology Columbus Ohio USA
| | - J. Kline
- The University of Chicago Department of Medicine Chicago Illinois USA
| | - K. J. Savage
- BC Cancer and University of British Columbia Department of Medical Oncology Vancouver BC Canada
| | - N. L. Bartlett
- Washington University School of Medicine in St Louis Division of Oncology St Louis Montana USA
| | - P. F. Caimi
- University Hospitals Cleveland Medical Center/Case Western Reserve University Department of Medicine Cleveland Ohio USA
| | - Y. Negievich
- ADC Therapeutics SA Clinical Development Epalinges Switzerland
| | - H. G. Cruz
- ADC Therapeutics SA Clinical Development Epalinges Switzerland
| | - L. Wang
- ADC Therapeutics America, Inc, Clinical Development Murray Hill New Jersey USA
| | - J. Wuerthner
- ADC Therapeutics SA Clinical Development Epalinges Switzerland
| | - G. P. Collins
- Churchill Hospital NIHR Oxford Biomedical Research Centre Oxford Cancer and Haematology Centre Oxford UK
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8
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Hilton LK, Collinge B, Ben‐Neriah S, Grande BM, Slack GW, Farinha P, Miyata‐Takata T, Cook JR, Ott G, Rosenwald A, Campo E, Amador C, Greiner TC, Raess PW, Song JY, Inghirami G, Jaffe ES, Weisenburger DD, Chan WC, Holte H, Beiske K, Fu K, Delabie J, Pittaluga S, Feldman AL, Sehn LH, Savage KJ, Mungall AJ, Staudt LM, Steidl C, Rimsza LM, Morin RD, Scott DW. THE TOPOLOGY OF
MYC
REARRANGEMENTS IN DOUBLE‐HIT LYMPHOMA IS CONSTRAINED BY THE PRECEDING IGH
‐BCL2
REARRANGEMENT – AN LLMPP PROJECT. Hematol Oncol 2021. [DOI: 10.1002/hon.64_2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- L. K. Hilton
- BC Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - B. Collinge
- BC Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - S. Ben‐Neriah
- BC Cancer Centre for Lymphoid Cancer Vancouver Canada
| | | | - G. W. Slack
- BC Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - P. Farinha
- BC Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - T. Miyata‐Takata
- Niigata University Graduate School of Medical and Dental Sciences Division of Molecular and Cellular Pathology Niigata Japan
| | - J. R. Cook
- Cleveland Clinic Department of Molecular Pathology and Laboratory Medicine Cleveland Ohio USA
| | - G. Ott
- Robert‐Bosch‐Krankenhaus and Dr. Margarete Fischer‐Bosch Institute of Clinical Pharmacology Department of Clinical Pathology Stuttgart Germany
| | - A. Rosenwald
- University of Wuerzburg, Institute of Pathology Wuerzburg Germany
| | - E. Campo
- Hospital Clinic Department of Pathology Barcelona Spain
| | - C. Amador
- University of Nebraska Medical Center Department of Pathology and Microbiology Omaha Nebraska USA
| | - T. C. Greiner
- University of Nebraska Medical Center Department of Pathology and Microbiology Omaha Nebraska USA
| | - P. W. Raess
- Oregon Health & Science University Department of Pathology Portland Oregon USA
| | - J. Y. Song
- City of Hope National Medical Center Department of Pathology Duarte California USA
| | - G. Inghirami
- Weill Cornell Medicine Pathology and Laboratory Medicine, New York New York USA
| | - E. S. Jaffe
- National Cancer Institute Laboratory of Pathology Bethesda Maryland USA
| | - D. D. Weisenburger
- City of Hope National Medical Center Department of Pathology Duarte California USA
| | - W. C. Chan
- City of Hope National Medical Center Department of Pathology Duarte California USA
| | - H. Holte
- Oslo University Hospital Department of Oncology Oslo Norway
| | - K. Beiske
- Oslo University Hospital Department of Pathology Oslo Norway
| | - K. Fu
- Roswell Park Cancer Institute Department of Pathology & Laboratory Medicine Buffalo New York USA
| | - J. Delabie
- University Health Network and University of Toronto Department of Laboratory Medicine and Pathobiology Toronto Canada
| | - S. Pittaluga
- National Cancer Institute Laboratory of Pathology Bethesda Maryland USA
| | - A. L. Feldman
- Mayo Clinic College of Medicine Laboratory Medicine and Pathology Rochester Minnesota USA
| | - L. H. Sehn
- BC Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - K. J. Savage
- BC Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - A. J. Mungall
- Canada's Michael Smith Genome Sciences Centre BC Cancer Research Institute Vancouver Canada
| | - L. M. Staudt
- National Cancer Institute Center for Cancer Research Bethesda Maryland USA
| | - C. Steidl
- BC Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - L. M. Rimsza
- Mayo Clinic Arizona Department of Laboratory Medicine and Pathology Scottsdale Arizona USA
| | - R. D. Morin
- Simon Fraser University Molecular Biology and Biochemistry Burnaby Canada
| | - D. W. Scott
- BC Cancer Centre for Lymphoid Cancer Vancouver Canada
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9
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Hogg D, Monzon JG, Ernst S, Song X, McWhirter E, Savage KJ, Skinn B, Romeyer F, Smylie M. Canadian cohort expanded-access program of nivolumab plus ipilimumab in advanced melanoma. Curr Oncol 2020; 27:204-214. [PMID: 32905202 PMCID: PMC7467793 DOI: 10.3747/co.27.5985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background The combination of nivolumab and ipilimumab is approved in several jurisdictions (United States, European Union, Canada) for the first-line treatment of patients with advanced melanoma. CheckMate 218 is a North American expanded-access program (eap) of nivolumab plus ipilimumab in patients with advanced melanoma. Here, we report safety and survival outcomes for the Canadian cohort in the eap. Methods Eligible patients were those 18 years of age or older with unresectable stage iii or iv melanoma, an Eastern Cooperative Oncology Group performance status of 0 or 1, and no prior anti-PD-1 or anti-ctla-4 therapy. Patients were treated with nivolumab 1 mg/kg and ipilimumab 3 mg/kg every 3 weeks for 4 cycles (induction phase); they then continued with nivolumab 3 mg/kg every 2 weeks (maintenance phase) until progression, unacceptable toxicity, or a maximum of 48 weeks, whichever occurred first. Safety and overall survival (os) data were collected. Results Of 194 patients enrolled, 174 were treated, and 51% continued on nivolumab maintenance. Median follow-up was 12.9 months. All-grade and grades 3-4 treatment-related adverse events were reported in 98% and 60% of patients respectively and led to treatment discontinuation in 40% and 28% of patients. Two treatment-related deaths were reported. The 12- and 18-month os rates were 80% [95% confidence interval (ci): 73% to 86%] and 76% (95% ci: 67% to 82%) respectively. Conclusions In this Canadian population, nivolumab plus ipilimumab demonstrated a safety profile and survival outcomes consistent with phase ii and iii clinical trial data.
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Affiliation(s)
- D Hogg
- Princess Margaret Cancer Centre, Toronto, ON
| | | | - S Ernst
- Children's Hospital, London Health Sciences Centre, London, ON
| | - X Song
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - E McWhirter
- Juravinski Cancer Centre, McMaster University, Hamilton, ON
| | - K J Savage
- Department of Medical Oncology, BC Cancer, Vancouver, BC
| | - B Skinn
- Bristol Myers Squibb, Princeton, NJ, U.S.A
| | - F Romeyer
- Bristol Myers Squibb, Saint-Laurent, QC
| | - M Smylie
- Cross Cancer Institute, Edmonton, AB
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Marr KC, Connors JM, Savage KJ, Goddard KJ, Deyell RJ. ABVD chemotherapy with reduced radiation therapy rates in children, adolescents and young adults with all stages of Hodgkin lymphoma. Ann Oncol 2017; 28:849-854. [PMID: 28327925 DOI: 10.1093/annonc/mdx005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Indexed: 11/13/2022] Open
Abstract
Background We adopted ABVD chemotherapy with risk-adapted radiation therapy (RT) as first-line therapy for children, adolescents and young adults with Hodgkin lymphoma (HL) in British Columbia in 2004. Patients and methods Patients ≤ 25 years diagnosed from 2004 to 2013 with all stages of HL who received ABVD as initial therapy were included. Results Among 55 children (age < 18 year) and 154 young adults (18-25 year), there were no significant differences among age groups for sex, histologic subtype, tumour bulk, B symptoms, prognostic risk groups or treatment received. The rates of complete response, partial response and progressive disease were 84%, 7% and 10% for children and 95%, 4% and 1% for young adults (P=0.01), respectively. Treatment failures in children all occurred within one year of completion, while 8/21 (38%) relapses in young adults occurred later (P=0.04). With a median follow-up of 66 months the 5-year progression-free (PFS) and overall survival (OS) were 85 ± 3% and 97 ± 1%, respectively. For limited stage disease, PFS was 90 ± 7% for children and 93 ± 3% for young adults (P=0.65); OS was 100% for both. For advanced stage patients, PFS and OS were also similar for the children and young adults (77 ± 7% versus 81 ± 4%; P=0.38 and OS 90 ± 6% versus 97 ± 2%; P=0.17). The rate of consolidative RT was low (21%) and did not differ between age groups. Conclusion ABVD is an effective treatment in children, adolescents and young adults with HL. Children were less likely to achieve complete response and demonstrated earlier relapses compared to young adults. RT may be omitted for the majority of patients while maintaining excellent 5-year OS.
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Affiliation(s)
- K C Marr
- Division of Paediatric Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children's Hospital
| | - J M Connors
- British Columbia Cancer Agency, Centre for Lymphoid Cancer
| | - K J Savage
- British Columbia Cancer Agency, Centre for Lymphoid Cancer
| | - K J Goddard
- British Columbia Cancer Agency, Department of Radiation Oncology, University of British Columbia, Vancouver, Canada
| | - R J Deyell
- Division of Paediatric Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children's Hospital
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11
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Long GV, Atkinson V, Ascierto PA, Robert C, Hassel JC, Rutkowski P, Savage KJ, Taylor F, Coon C, Gilloteau I, Dastani HB, Waxman IM, Abernethy AP. Effect of nivolumab on health-related quality of life in patients with treatment-naïve advanced melanoma: results from the phase III CheckMate 066 study. Ann Oncol 2016; 27:1940-6. [PMID: 27405322 PMCID: PMC5035785 DOI: 10.1093/annonc/mdw265] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/29/2016] [Indexed: 01/14/2023] Open
Abstract
In patients with advanced melanoma in the CheckMate 066 study, baseline health-related quality of life (HRQoL) with nivolumab was maintained over time, with statistically significant and clinically meaningful improvements in some exploratory analyses, and no HRQoL improvements with dacarbazine. Added to the survival benefit of nivolumab, the benefit-to-risk ratio favors nivolumab over dacarbazine. Background Nivolumab has shown significant survival benefit and a favorable safety profile compared with dacarbazine chemotherapy among treatment-naïve patients with metastatic melanoma in the CheckMate 066 phase III study. Results from the health-related quality of life (HRQoL) analyses from CheckMate 066 are presented. Patients and methods HRQoL was evaluated at baseline and every 6 weeks while on treatment using the European Organisation for Research and Treatment of Care (EORTC) Core Quality of Life Questionnaire (QLQ-C30) and the EuroQoL Five Dimensions Questionnaire (EQ-5D). Via a multi-step statistical plan, data were analyzed descriptively, cross-sectionally, and longitudinally, adjusting for baseline covariates, in patients having baseline plus ≥1 post-baseline assessment. Results Baseline-adjusted completion rates for all HRQoL questionnaires across treatment arms were 65% and 70% for dacarbazine and nivolumab, respectively, and remained similar throughout treatment. The mean baseline HRQoL scores were similar for patients treated with nivolumab and dacarbazine. Baseline HRQoL levels with nivolumab were maintained over time. This exploratory analysis showed a between-arm difference in favor of nivolumab on the EQ-5D utility index and clinically meaningful EQ-5D improvements from baseline at several time points for patients receiving nivolumab. Patients treated with nivolumab did not show increased symptom burden as assessed by the EORTC QLQ-C30. No HRQoL change was noted with dacarbazine patients up to week 43, although the high attrition rate after week 13 did not allow any meaningful analyses. Patients receiving nivolumab deteriorated significantly later than those receiving dacarbazine on several EORTC QLQ-C30 scales and the EQ-5D utility index. Conclusions In addition to prolonged survival, these exploratory HRQoL results show that nivolumab maintains baseline HRQoL levels to provide long-term quality of survival benefit, compared with dacarbazine in patients with advanced melanoma.
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Affiliation(s)
- G V Long
- Melanoma Institute Australia, The University of Sydney, and Mater Hospital, Sydney, Australia
| | - V Atkinson
- Gallipoli Medical Research Foundation and Princess Alexandra Hospital, Greenslopes, Australia
| | - P A Ascierto
- Istituto Nazionale Tumori Fondazione Pascale, Napoli, Italy
| | | | - J C Hassel
- University Hospital Heidelberg and National Center for Tumor Diseases, Heidelberg, Germany
| | - P Rutkowski
- Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - K J Savage
- BC Cancer Agency, University of British Columbia, Vancouver, Canada
| | | | - C Coon
- Adelphi Values, Boston, MA, USA
| | | | | | - I M Waxman
- Bristol-Myers Squibb, Princeton, NJ, USA
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Alzahrani M, El-Galaly TC, Hutchings M, Hansen JW, Loft A, Johnsen HE, Iyer V, Wilson D, Sehn LH, Savage KJ, Connors JM, Gascoyne RD, Johansen P, Clasen-Linde E, Brown P, Villa D. The value of routine bone marrow biopsy in patients with diffuse large B-cell lymphoma staged with PET/CT: a Danish-Canadian study. Ann Oncol 2016; 27:1095-1099. [PMID: 27002106 DOI: 10.1093/annonc/mdw137] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 03/10/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The added diagnostic and prognostic value of routine bone marrow biopsy (BMB) in patients with diffuse large B-cell lymphoma (DLBCL) undergoing positron emission tomography combined with computed tomography (PET/CT) staging is controversial. PATIENTS AND METHODS Patients with newly diagnosed DLBCL who underwent both staging PET/CT and BMB were retrospectively identified in British Columbia, Aalborg, and Copenhagen. Original written PET/CT and pathology reports were retrospectively reviewed to determine Ann Arbor stage and outcomes, with and without the contribution of BMB. RESULTS A total of 530 patients were identified: 146 (28%) had focal bone marrow (BM) lesions on PET/CT and 87 (16%) had positive BMB. Fifty-two of 146 patients (36%) with positive PET/CT had a positive BMB [39 DLBCL, 13 indolent non-Hodgkin lymphoma (iNHL)], while 35 of 384 patients (9%) with negative PET/CT had positive BMB (12 DLBCL, 23 iNHL). BMB upstaged 12/209 (6%) of stage I/II patients to stage IV, although this was the case for only 3 (1%) patients with DLBCL in the BMB. PET/CT identified BM involvement by BMB with sensitivity 60%, specificity 79%, positive predictive value 36%, and negative predictive value 91%. Concordant histological involvement of the BM by DLBCL was associated with worse overall survival and progression-free survival than discordant or no involvement in univariate and multivariate analyses. CONCLUSIONS In patients with DLBCL, staging PET/CT can miss BM involvement with concordant DLBCL (less common) or discordant iNHL (more common). Routine BMB does not add relevant diagnostic or prognostic value over PET/CT alone in the majority of patients with DLBCL.
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Affiliation(s)
- M Alzahrani
- Department of Hematology, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - T C El-Galaly
- Department of Hematology and Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg
| | | | | | - A Loft
- Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen
| | - H E Johnsen
- Department of Hematology and Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg
| | - V Iyer
- Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - D Wilson
- Department of Functional Imaging, British Columbia Cancer Agency and the University of British Columbia, Vancouver
| | | | | | | | - R D Gascoyne
- Department of Pathology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, Vancouver, Canada
| | - P Johansen
- Department of Pathology, Aalborg University Hospital, Aalborg
| | - E Clasen-Linde
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - D Villa
- Division of Medical Oncology.
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13
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Hitz F, Connors JM, Gascoyne RD, Hoskins P, Moccia A, Savage KJ, Sehn LH, Shenkier T, Villa D, Klasa R. Outcome of patients with primary refractory diffuse large B cell lymphoma after R-CHOP treatment. Ann Hematol 2015; 94:1839-43. [PMID: 26246466 DOI: 10.1007/s00277-015-2467-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
Primary refractory diffuse large B cell lymphoma (DLBCL) following R-CHOP chemotherapy is a major concern. We identified 1126 patients with DLBCL treated with R-CHOP from 2000 to 2009, of whom 166 (15 %) had primary refractory disease. Of the 75/166 (45 %) who were age <70 years and had been planned for stage-directed curative therapy, 43 (57 %) were primary nonresponders and 32 (43 %) relapsed within 3 months of completing R-CHOP. Thirty of 75 (40 %) patients had serious comorbidity and organ dysfunction precluding intensive treatment and had palliative treatment only. Twelve of 45 (27 %) patients responded to second-line treatment and underwent ASCT. The median overall survival for the 75 patients was 10 months with only seven patients alive without evidence of disease at follow-up ranging from 14 to 106 months. Primary refractory DLBCL after R-CHOP has a very poor outcome with only anecdotal survivors independent of the intended treatment approach.
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Affiliation(s)
- Felicitas Hitz
- Medical Oncology, Oncology/Haematology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland. .,British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada. .,Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland.
| | - J M Connors
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - R D Gascoyne
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada.,Division of Pathology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada
| | - P Hoskins
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - A Moccia
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada.,Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - K J Savage
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - L H Sehn
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - T Shenkier
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - D Villa
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - R Klasa
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
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14
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Bains P, Al Tourah A, Campbell BA, Pickles T, Gascoyne RD, Connors JM, Savage KJ. Incidence of transformation to aggressive lymphoma in limited-stage follicular lymphoma treated with radiotherapy. Ann Oncol 2013; 24:428-432. [PMID: 23035152 DOI: 10.1093/annonc/mds433] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The established treatment of limited-stage follicular lymphoma is radiotherapy (RT). There is an inherent risk of transformation of follicular lymphoma to aggressive lymphoma; however, the frequency and impact on the outcome are unknown in limited-stage patients. MATERIALS AND METHODS We identified 237 patients with limited-stage follicular lymphoma treated with curative intent RT. Cases were reviewed to determine the frequency of transformation and subsequent survival. RESULTS With a median follow-up of 7.4 years, the 10-year risk of transformation was 18.5%. With a median follow-up after transformation of 4.7 years, the 3-year post-transformation progression-free survival (PFS) and overall survival (OS) were 42% and 44%, respectively. The addition of rituximab improved the 3-year post-transformation PFS and OS compared with combination chemotherapy alone (78% versus 15%, P < 0.00001) and (87% versus 38.5%, P < 0.00001), respectively. In multivariate analysis, only rituximab was associated with OS [HR 0.07 (95% CI 0.015-0.312, P = 0.001)] and PFS [HR 0.19 (95% CI 0.55-0.626, P = 0.007)] following transformation. CONCLUSIONS There is a moderate risk of transformation in limited-stage follicular lymphoma treated with curative intent RT, and it substantially impacts outcome in these patients. Treatment with rituximab at the time of transformation appears to improve survival in this otherwise poor-risk population.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Cell Transformation, Neoplastic
- Combined Modality Therapy
- Disease-Free Survival
- Female
- Humans
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/radiotherapy
- Male
- Middle Aged
- Rituximab
- Survival
- Treatment Outcome
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Affiliation(s)
- P Bains
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver; Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - A Al Tourah
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver; Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - B A Campbell
- Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - T Pickles
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver
| | - R D Gascoyne
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver; Department of Pathology and the Centre for Lymphoid Cancer, British Columbia Cancer Agency Vancouver, Canada
| | - J M Connors
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - K J Savage
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver; Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada.
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15
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Bestawros A, Foltz L, Srour N, Savage KJ, Connors JM. Patients' and physicians' roles in detecting recurrent Hodgkin lymphoma following complete remission. Ann Oncol 2012; 24:1359-63. [PMID: 23230136 DOI: 10.1093/annonc/mds606] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Optimal post-treatment surveillance for patients with Hodgkin lymphoma in first complete remission (CR) is unknown. Guidelines are based on consensus rather than high-quality evidence. It is unknown if routine screening leads to earlier relapse detection or translates into better outcomes. PATIENTS AND METHODS We identified 258 patients with relapse after CR and determined whether the recurrence was detected as a result of patient-detected symptoms (PT group) or through exams or tests ordered by the physician in the absence of symptoms (MD group). RESULTS Of 258 recurrences, 182 (71%) were in the PT group. The median time to diagnosis of recurrence was similar in both groups (PT group = 1.65 years; MD group = 1.95 years; P = 0.69). Neither the postrelapse progression-free (PFS, P = 0.26) nor overall survival (OS, P = 0.40) differed significantly between the groups. CONCLUSION Patients are much more likely to detect recurrence than their physicians employing routine follow-up testing. There is no difference in PFS or OS between patients whose recurrence is self-diagnosed versus those whose recurrence is diagnosed by physician through routine screening. We found no benefit for detection of HL recurrence in asymptomatic patients and thus cannot support the routine use of costly, anxiety-provoking or potentially harmful tests in the absence of symptoms.
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Affiliation(s)
- A Bestawros
- Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada.
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16
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Savage KJ, Connors JM, Klasa RJ, Hoskins P, Shenkier TN, Gascoyne RD, Bhimji S, Pickles T, Benard F, Wilson D, Sehn LH. The use of FDG-PET to guide consolidative radiotherapy in patients with advanced-stage Hodgkin lymphoma with residual abnormalities on CT scan following ABVD chemotherapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Chen RW, Gopal AK, Smith SE, Ansell SM, Rosenblatt JD, Savage KJ, Connors JM, Engert A, Larsen EK, Kennedy DA, Sievers EL, Younes A. Results from a pivotal phase II study of brentuximab vedotin (SGN-35) in patients with relapsed or refractory Hodgkin lymphoma (HL). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Bains P, Al-Tourah AJ, Campbell BA, Pickles T, Gascoyne RD, Connors JM, Savage KJ. Incidence of transformation to aggressive lymphoma in limited-stage follicular lymphoma (FL) treated with radiotherapy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Petrella TM, Tozer R, Belanger K, Savage KJ, Wong R, Kamel-Reid S, Tron V, Chen B, Hunder NN, Eisenhauer EA. Interleukin-21 (IL-21) activity in patients (pts) with metastatic melanoma (MM). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Kim C, Lee CW, Klasa R, Shah A, Savage KJ. Long-term survival of patients with metastatic melanoma (MM) treated with dacarbazine (DTIC) or temozolomide (TMZ). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9054] [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
9054 Background: Patients with metastatic melanoma (MM) generally have a poor prognosis, with a median survival of 6 to 9 months. There is a small proportion of patients who achieve long term survival (LTS), however, it is unclear whether LTS reflects sensitivity to systemic therapy, indolent tumor biology or host immune factors. Dacarbazine (DTIC) is the only approved chemotherapy for the treatment of MM, although temozolomide (TMZ) has similar efficacy. There is limited information as to the frequency of complete response (CR) following DTIC or TMZ, duration of response and whether LTS occurs only in patients who achieve a CR. We sought to identify all patients with MM treated with either DTIC (alone or in combinations) or TMZ at the BC Cancer Agency (BCCA) who achieved LTS defined as survival ≥ 18 months from the time of administration of chemotherapy. Methods: All patients with MM treated with either DTIC or TMZ from January 1, 1988 to February 1, 2006 were identified in the BCCA pharmacy database. The BCCA surveillance and outcomes unit (SAO) was utilized to identify cases of LTS. CR was defined as disappearance of all disease by diagnostic imaging. Given the retrospective nature of the analysis, progressive disease (PD) was defined as any tumor growth, and partial response or stable disease (PR/SD) were combined. Results: In the 18-year period reviewed, 397 patients with MM were treated with DTIC (n= 349) or TMZ (n=48). Of these, 45 patients met the criterion of LTS and had the following characteristics: median age 53 (range 22–86); male 67 %; ocular primary 7%; non-pulmonary visceral metastases 38%; DTIC 11.7% (41/349), TMZ 8.3% (4/48). The best response to DTIC or TMZ documented was: CR 18%, PR/SD 67%, PD 13%. The 5-year overall and progression-free survival rates were 33% and 12%, respectively. Eleven patients survived > 5 years (range 5–27.5), and 6 patients remain in remission (5 CR, 1 PR). Disease progression occurred in 5 patients in < 1 year however, they remain alive for at least 5 years (range 5.2–17.9). Conclusions: LTS occurs in patients with MM treated with either DTIC or TMZ. However, a minority have a sustained response following chemotherapy, and most cases of LTS are likely the result of indolent disease or host biology. No significant financial relationships to disclose.
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Affiliation(s)
- C. Kim
- University of British Columbia, Vancouver, BC, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - C. W. Lee
- University of British Columbia, Vancouver, BC, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - R. Klasa
- University of British Columbia, Vancouver, BC, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - A. Shah
- University of British Columbia, Vancouver, BC, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - K. J. Savage
- University of British Columbia, Vancouver, BC, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada
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Proctor BR, Hui D, Donaldson J, Savage KJ, Shenkier TN, Hoskins PJ, Klasa R, Randy G, Joseph C, Sehn LH. Prognostic significance of primary extranodal diffuse large B-cell lymphoma (DLBCL) in patients treated with R-CHOP. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Fontaine A, Gelmon KA, Connors JM, Savage KJ. Secondary breast cancer in patients treated for Hodgkin lymphoma: Adherence to screening recommendations in a high-risk population. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.1540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Almansour MM, Connors JM, Gascoyne RD, Skinnider B, Savage KJ. Frequency of transformation to diffuse large B-cell lymphoma in nodular lymphocyte predominant hodgkin lymphoma: The BCCA Experience. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lim HJ, Gill S, Hay J, Savage KJ. A comparison of capecitabine versus infusional 5-FU used concurrently with preoperative radiation for rectal cancer: A population-based study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Villa D, Connors JM, Sehn LH, Savage KJ. Diffuse large B-cell lymphoma with renal involvement: Outcome and risk of central nervous system relapse. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Villa D, Savage KJ, Sehn LH, Connors J. Incidence and risk factors for central nervous system relapse in patients with diffuse large B-cell lymphoma: The impact of the addition of rituximab to CHOP chemotherapy. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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
8037 Background: The addition of rituximab to CHOP (CHOP-R) chemotherapy improves outcome in patients with diffuse large B- cell lymphoma (DLBCL). However, limited data suggests that it may not impact the risk of central nervous system (CNS) relapse. We evaluated the risk of CNS relapse and associated predictive factors in a large population-based cohort of patients with DLBCL. Methods: All patients with DLBCL diagnosed from September 1, 1999 to January 14, 2005 at the British Columbia Cancer Agency were identified, including those from a recently published report (Sehn, J Clin Onc. 2005). Patients were included if they were ≥16 years old with advanced stage (stage III /IV, or stage I /II with B symptoms or bulky disease (≥10 cm)), or limited stage with testicular involvement and excluded if HIV-positive or known to have CNS involvement at diagnosis. From Sept 1999 to Feb 2001 patients were treated with CHOP- type chemotherapy. After March 1, 2001 patients received CHOP-R. Results: A total of 435 patients with DLBCL were identified; 125 (29%) were treated with CHOP and 310 (71%) with CHOP-R. There were 28 CNS relapses with no significant difference in frequency between CHOP-treated (11 (9%)) or CHOP-R-treated (17 (5%)) patients (p=0.202). The median time to CNS relapse (8.1 mos vs 6.7 mos) and median survival after CNS relapse (2.7 mos vs 3.8 mos, p=0.665) were similar in the CHOP and CHOP-R treated patients, respectively. In univariate analysis, testicular involvement, renal involvement, advanced stage, and LDH ≥2x ULN were associated with increased risk of CNS relapse. In a multivariate analysis, testicular (OR 7.44, p=0.013) or renal (OR 6.23, p=0.012) involvement, and stage IV disease (OR 4.43, p=0.034) were independent predictors of CNS relapse. Conclusions: Consistent with prior reports, the addition of rituximab does not appear to significantly influence the risk of CNS relapse in patients with DLBCL, possibly due to poor CNS penetration. Risk factors for CNS relapse in the rituximab era are similar to those noted in prior reports based on anthracycline-treated patients. The overall survival of patients with CNS relapse is dismal and new strategies to reduce its incidence warrant further evaluation. No significant financial relationships to disclose.
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Affiliation(s)
- D. Villa
- University of British Columbia, Vancouver, BC, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - K. J. Savage
- University of British Columbia, Vancouver, BC, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - L. H. Sehn
- University of British Columbia, Vancouver, BC, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - J. Connors
- University of British Columbia, Vancouver, BC, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada
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Al-Tourah AJ, Gill KK, Hoskins PJ, Klasa RJ, Savage KJ, Sehn LH, Shenkier TN, Gascoyne RD, Voss NJ, Connors JM. The impact of initial treatment of advanced stage indolent lymphoma on the risk of transformation. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7510 Background: The impact of initial treatment of indolent non-Hodgkin’s lymphoma (NHL) on the risk of transformation (TR) to aggressive NHL is unknown. High LDH and advanced stage at diagnosis have been shown to be predictive for TR; however, the effect of initial treatment is difficult to estimate as most series included heterogenous patient (pts) populations. Methods: As part of a large retrospective analysis examining TR (n = 698), we identified pts from 2 consecutive phase II studies conducted at the British Columbia Cancer Agency. Both studies had identical inclusion criteria: diagnosis of indolent NHL, no prior treatment, age16–60 y and advanced stage disease (III/ IV or I/ II with B symptoms or bulky disease ≥10cm). The first study included use of BPVACOP (bleomycin, cisplatin, etoposide, doxorubicin, cyclophosphamide,vincristine and prednisone, followed by involved field irradiation (RT) to original nodal sites of lymphoma. The second used combination alkylator-purine analogue (cyclophosphamide- cladrabine or fludaribine and prednisone). The definition of TR was based on either histological confirmation (HIST) or clinical features (CLIN), defined as one or more of the following: rapid discordant nodal or extranodal growth; sudden rise in LDH to > 2 x previous baseline; involvement of unusual extranodal sites; or hypercalcemia. Results: 260 pts were identified. BPVACOP+RT (n = 140), alkylator-purine analogue (n = 120). Median age 46 y (19–60). Follicular histology in 133 (94%) and 105 (87%), respectively. The majority were stage III/IV (89%) with equal proportions in each cohort. With a median follow-up (FU) for living pts of 90 months (1–225), 26 (18%) pts treated with BPVACOP+RT developed TR, 16 of which were confirmed with biopsy, versus 32 (27%) in the alkylator-purine group, of which 18 had biopsy confirmation. The 5 y risk of TR for BPVACOP+RT was 9% compared to 24% for the alkylator-purine analogue group (p < 0.0095). The annual risk of TR through 10 y of FU was 1.5% and 3.0%, respectively. The post-TR 5 y OS of all 58 pts with TR was 19%. Pts with TR based on CLIN vs HIST criteria did not differ in their outcome. Conclusions: The use of an anthracycline-based regimen as initial treatment for advanced stage indolent NHL is associated with a marked reduction in the risk of future TR. No significant financial relationships to disclose.
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Affiliation(s)
- A. J. Al-Tourah
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - K. K. Gill
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - P. J. Hoskins
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - R. J. Klasa
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - K. J. Savage
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - L. H. Sehn
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - T. N. Shenkier
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - R. D. Gascoyne
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - N. J. Voss
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - J. M. Connors
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
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Savage KJ, Al-Rajhi N, Voss N, Paltiel C, Klasa R, Gascoyne RD, Connors JM. Favorable outcome of primary mediastinal large B-cell lymphoma in a single institution: the British Columbia experience. Ann Oncol 2006; 17:123-30. [PMID: 16236753 DOI: 10.1093/annonc/mdj030] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Primary mediastinal large B-cell lymphoma (PMBCL) is a distinct clinico-pathological subtype of diffuse large B-cell lymphoma (DLBCL). The optimal treatment is unknown, with some studies suggesting a superior outcome with dose-intensive chemotherapy regimens, and the role of radiotherapy remains ill-defined. PATIENTS AND METHODS The British Columbia Cancer Agency lymphoma database was searched and records reviewed to identify those patients presenting with a prominent mediastinal mass and considered to be PMBCL based on the current REAL/WHO classifications. Patients were treated based on era-specific BCCA guidelines (1980-1992 MACOPB/VACOPB; 1992-2001 CHOP-type; 2001-present CHOP-R). Beginning in January 1998 involved-field radiotherapy was recommended to be routinely administered following chemotherapy. Prior to this, use of radiotherapy was individualized in advanced disease. RESULTS In total, 153 patients with newly diagnosed PMBCL were identified between 28 July 1980 and 30 June 2003. The median age was 37 years (range 13-82) and the majority had stage I/II (74%), bulky mediastinal disease (75%). Overall (OS) and progression-free (PFS) survival at 5 years for the entire cohort were 75% and 69%, respectively. In direct comparison with a cohort of patients with DLBCL (n = 1273), OS (P = 10(-4)) and PFS (P = 0.0001) favored PMBCL. The age-adjusted International Prognostic Index (aaIPI) was not predictive of survival (P = 0.18). Five-year OS in patients < 65 years old treated with MACOPB/VACOPB, CHOP-R and CHOP-type was 87%, 81% and 71% respectively (P = 0.048). In pair-wise survival comparisons, only MACOPB/VACOPB and CHOP-type treated patients were significantly different (P = 0.016). In Cox multiple regression analysis, poor performance status remained the only predictor of survival, with treatment received demonstrating a trend to worse outcome for patients treated with CHOP-type regimens (P = 0.09). In an intention-to-treat analysis comparing the era before radiotherapy was routinely administered with after, there was no significant difference in 5-year PFS (74% versus 62%; P = 0.09) or OS (78% versus 69%; P = 0.14). CONCLUSIONS In this single institution, population-based retrospective study, we found that PMBCL patients have excellent survival rates and a distinct plateau is observed in PFS, in striking comparison to DLBCL. The aaIPI was not predictive of survival in this population, suggesting that other prognostic models may be better suited for risk stratification. Dose-intensified chemotherapy with MACOPB or VACOPB demonstrated a trend to superior outcome over CHOP-type chemotherapy. However, further randomized studies are needed and the impact of rituximab on these comparisons must be considered. Finally, the routine addition of radiotherapy does not improve survival.
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Affiliation(s)
- K J Savage
- University of British Columbia and the British Columbia Cancer Agency, Vancouver, BC, Canada.
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Savage KJ, Chhanabhai M, Gascoyne RD, Connors JM. Characterization of peripheral T-cell lymphomas in a single North American institution by the WHO classification. Ann Oncol 2005; 15:1467-75. [PMID: 15367405 DOI: 10.1093/annonc/mdh392] [Citation(s) in RCA: 271] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND All peripheral T-cell lymphomas (PTCLs) diagnosed at a single institution were evaluated to determine the unique clinical features and outcome of specific entities and test the predictive validity of the International Prognostic Index (IPI). PATIENTS AND METHODS Cases of PTCL seen at the British Columbia Cancer Agency between 1981 and 2000 were identified. Pathologic material was re-assessed and classified according to the WHO classification, and patients were staged and treated uniformly according to era-specific guidelines. In total, there were 199 patients with PTCL and the most common subtypes were peripheral T-cell lymphoma unspecified (PTCL-US) (59%), anaplastic large-cell lymphoma, systemic type (ALCL) (17%) and extranodal NK/T-cell lymphoma, nasal and nasal-type (NASAL) (9%). Most patients were treated with CHOP-type chemotherapy. RESULTS Three distinct prognostic subgroups were notable on survival analysis: favorable (cutaneous ALCL), 5-year overall survival (OS) 78%; intermediate [PTCL, ALCL and angioimmunoblastic lymphoma (AILT)], 5-year OS 35-43%; unfavorable [NASAL and enteropathy-type T-cell lymphoma (ETTL)], 5-year OS 22-24%. Furthermore, in PTCL-US and ALCL clinical separation of patients into good risk (IPI 0,1) and poor risk (IPI > or =2) subsets was demonstrated. CONCLUSIONS A large proportion of PTCL patients have poor risk disease and/or a histologically aggressive subtype with frequent relapse and unfavorable outcome. For these patients, treatment with CHOP chemotherapy is only minimally effective and new strategies need to be developed, an effort that will require a multi-institution international collaboration due to the rarity of most subtypes.
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Affiliation(s)
- K J Savage
- Division of Medical Oncology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, BC, Canada.
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Savage KJ, Wells PS, Schulz V, Goudie D, Morrow B, Cruickshank M, Kovacs MJ. Outpatient use of low molecular weight heparin (Dalteparin) for the treatment of deep vein thrombosis of the upper extremity. Thromb Haemost 1999; 82:1008-10. [PMID: 10494754] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Upper extremity deep vein thrombosis (DVT) is now recognized as a major cause of morbidity and mortality. There is little information regarding the most effective treatment of this condition. We report a prospective cohort study of the use of low molecular weight heparin (LMWH) in the outpatient management of upper extremity DVT. Forty-six patients were managed as outpatients for objectively documented upper extremity DVT with dalteparin (200 aXa u/kg), for a minimum of five days. Warfarin was usually initiated on the first day with a target INR of 2.0-3.0. Most patients had an underlying malignancy or a history of a central line. All patients were followed for 12 weeks from diagnosis. Only one patient had a major bleed. No patients developed pulmonary emboli. One patient had a recurrence of DVT during the treatment with LMWH with extension of the existing thrombus. Seven patients died, all due to their underlying disease. This study supports the safety and effectiveness of dalteparin in the treatment of upper extremity DVT. Given that these patients were treated as outpatients, there is a potential for huge cost savings.
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Affiliation(s)
- K J Savage
- University of Western Ontario, Ottawa, Canada
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Mason AB, Tam BM, Woodworth RC, Oliver RW, Green BN, Lin LN, Brandts JF, Savage KJ, Lineback JA, MacGillivray RT. Receptor recognition sites reside in both lobes of human serum transferrin. Biochem J 1997; 326 ( Pt 1):77-85. [PMID: 9337853 PMCID: PMC1218639 DOI: 10.1042/bj3260077] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The binding of iron by transferrin leads to a significant conformational change in each lobe of the protein. Numerous studies have shown that the transferrin receptor discriminates between iron-saturated and iron-free transferrin and that it modulates the release of iron. Given these observations, it seems likely that there is contact between each lobe of transferrin and the receptor. This is the case with chicken transferrin, in which it has been demonstrated unambiguously that both lobes are required for binding and iron donation to occur [Brown-Mason and Woodworth (1984) J. Biol. Chem. 259, 1866-1873]. Further support to this contention is added by the ability of both N- and C-domain-specific monoclonal antibodies to block the binding of a solution containing both lobes [Mason, Brown and Church (1987) J. Biol. Chem. 262, 9011-9015]. In the present study a similar conclusion is reached for the binding of human serum transferrin to the transferrin receptor. With the use of recombinant N- and C-lobes of human transferrin produced in a mammalian expression system, we show that both lobes are required to achieve full binding. (Production of recombinant C-lobe in the baby hamster kidney cell system is reported here for the first time.) Each lobe is able to donate iron to transferrin receptors on HeLa S3 cells in the presence of the contralateral lobe. The results are not identical with the chicken system, because the C-lobe alone shows a limited ability to bind to receptors and to donate iron. Further complications arise from the relatively weak re-association between the two lobes of human transferrin compared with the re-association of the ovotransferrin lobes. However, domain-specific monoclonal antibodies to either lobe block the binding of N- and C-lobe mixtures in the human system, thus substantiating the need for both.
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Affiliation(s)
- A B Mason
- Department of Biochemistry, University of Vermont, College of Medicine, Burlington 05405, USA
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Mason AB, Woodworth RC, Oliver RW, Green BN, Lin LN, Brandts JF, Savage KJ, Tam BM, MacGillivray RT. Association of the two lobes of ovotransferrin is a prerequisite for receptor recognition. Studies with recombinant ovotransferrins. Biochem J 1996; 319 ( Pt 2):361-8. [PMID: 8912668 PMCID: PMC1217777 DOI: 10.1042/bj3190361] [Citation(s) in RCA: 29] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Different recombinant N-lobes of chicken ovotransferrin (oTF/2N) have been isolated from the tissue-culture medium of baby hamster kidney cells transfected with the plasmid pNUT containing the relevant DNA coding sequence. Levels of up to 40, 55 and 30 mg/1 oTF/2N were obtained for constructs defining residues 1-319, 1-332 and 1-337-(Ala)3 respectively. In addition, a full-length non-glycosylated oTF was expressed at a maximum of 80 mg/1 and a foreshortened oTF consisting of residues 1-682 was expressed at a level of 95 mg/l. These preparations were then used to produce, proteolytically, two different C-lobes (oTF/2C) comprising residues 342-686 and 342-682. The purified recombinant N-lobes (oTF/2N) are similar to the proteolytically derived half-molecule with regard to immunoreactivity and spectral properties; they show some interesting differences in thermal stability. A sequence analysis of the cDNA revealed six changes at the nucleotide level that led to six differences in the amino acid sequence compared with that reported by Jeltsch and Chambon [(1982) Eur. J. Biochem. 122, 291-295]. Electrospray mass spectrometry gives results consistent with these six changes. Interaction between the various N- and C-lobes was measured by titration calorimetry. Studies show that only those lobes that associate in solution are able to bind to the receptors on chick embryo red blood cells. These findings do not support a previous report by Oratore et al.
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Affiliation(s)
- A B Mason
- Department of Biochemistry, University of Vermont, Burlington 05405, USA
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Mason AB, Miller MK, Funk WD, Banfield DK, Savage KJ, Oliver RW, Green BN, MacGillivray RT, Woodworth RC. Expression of glycosylated and nonglycosylated human transferrin in mammalian cells. Characterization of the recombinant proteins with comparison to three commercially available transferrins. Biochemistry 1993; 32:5472-9. [PMID: 8499451 DOI: 10.1021/bi00071a025] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The coding sequence for human serum transferrin was assembled from restriction fragments derived from a full-length cDNA clone isolated from a human liver cDNA library. The assembled clone was inserted into the expression vector pNUT and stably transfected into transformed baby hamster kidney (BHK) cells, leading to secretion of up to 125 mg/L recombinant protein into the tissue culture medium. As judged by mobility on NaDodSO4-PAGE, immunoreactivity, spectral properties (indicative of correct folding and iron binding), and the ability to bind to receptors on a human cell line, initial studies showed that the recombinant transferrin, is identical to three commercial human serum transferrin samples. Electrospray mass spectrometry (ESMS), anion-exchange chromatography, and urea gel analysis showed that the recombinant protein has an extremely complex carbohydrate pattern with 16 separate masses ranging from 78,833 to 80,802 daltons. Mutation of the two asparagine carbohydrate linkage sites to aspartic acid residues led to the expression and secretion of up to 25 mg/L nonglycosylated transferrin. ESMS, anion-exchange chromatography, and urea gel analysis showed a single molecular species that was consistent with the expected theoretical mass of 75,143 daltons. In equilibrium binding experiments, the nonglycosylated mutant bound to HeLa S3 cells with the same avidity and to the same extent as the glycosylated protein and the three commercial samples. These studies demonstrate conclusively that carbohydrate has no role in this function.
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Affiliation(s)
- A B Mason
- Department of Biochemistry, University of Vermont College of Medicine, Burlington 05405
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