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Hontecillas-Prieto L, García-Domínguez DJ, Palazón-Carrión N, Martín García-Sancho A, Nogales-Fernández E, Jiménez-Cortegana C, Sánchez-León ML, Silva-Romeiro S, Flores-Campos R, Carnicero-González F, Ríos-Herranz E, de la Cruz-Vicente F, Rodríguez-García G, Fernández-Álvarez R, Martínez-Banaclocha N, Gumà-Padrò J, Gómez-Codina J, Salar-Silvestre A, Rodríguez-Abreu D, Gálvez-Carvajal L, Labrador J, Guirado-Risueño M, Provencio-Pulla M, Sánchez-Beato M, Marylene L, Álvaro-Naranjo T, Casanova-Espinosa M, Rueda-Domínguez A, Sánchez-Margalet V, de la Cruz-Merino L. CD8+ NKs as a potential biomarker of complete response and survival with lenalidomide plus R-GDP in the R2-GDP-GOTEL trial in recurrent/refractory diffuse large B cell lymphoma. Front Immunol 2024; 15:1293931. [PMID: 38469299 PMCID: PMC10926187 DOI: 10.3389/fimmu.2024.1293931] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/12/2024] [Indexed: 03/13/2024] Open
Abstract
Background Diffuse large B cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma worldwide. DLBCL is an aggressive disease that can be cured with upfront standard chemoimmunotherapy schedules. However, in approximately 35-40% of the patients DLBCL relapses, and therefore, especially in this setting, the search for new prognostic and predictive biomarkers is an urgent need. Natural killer (NK) are effector cells characterized by playing an important role in antitumor immunity due to their cytotoxic capacity and a subset of circulating NK that express CD8 have a higher cytotoxic function. In this substudy of the R2-GDP-GOTEL trial, we have evaluated blood CD8+ NK cells as a predictor of treatment response and survival in relapsed/refractory (R/R) DLBCL patients. Methods 78 patients received the R2-GDP schedule in the phase II trial. Blood samples were analyzed by flow cytometry. Statistical analyses were carried out in order to identify the prognostic potential of CD8+ NKs at baseline in R/R DLBCL patients. Results Our results showed that the number of circulating CD8+ NKs in R/R DLBCL patients were lower than in healthy donors, and it did not change during and after treatment. Nevertheless, the level of blood CD8+ NKs at baseline was associated with complete responses in patients with R/R DLBCL. In addition, we also demonstrated that CD8+ NKs levels have potential prognostic value in terms of overall survival in R/R DLBCL patients. Conclusion CD8+ NKs represent a new biomarker with prediction and prognosis potential to be considered in the clinical management of patients with R/R DLBCL. Clinical trial registration https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-001620-29 EudraCT, ID:2014-001620-29.
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Affiliation(s)
- Lourdes Hontecillas-Prieto
- Clinical Biochemistry Service, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Institute of Biomedicine of Seville, Virgen Macarena University Hospital, CSIC, University of Seville, Seville, Spain
- Clinical Oncology Service, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain
| | - Daniel J. García-Domínguez
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Institute of Biomedicine of Seville, Virgen Macarena University Hospital, CSIC, University of Seville, Seville, Spain
| | - Natalia Palazón-Carrión
- Clinical Oncology Service, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain
- Department of Medicine, University of Seville, Seville, Spain
| | - Alejandro Martín García-Sancho
- Department of Hematology, Hospital Universitario de Salamanca, IBSAL, CIBERONC, University of Salamanca, Salamanca, Spain
| | - Esteban Nogales-Fernández
- Clinical Oncology Service, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain
- Department of Medicine, University of Seville, Seville, Spain
| | - Carlos Jiménez-Cortegana
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - María L. Sánchez-León
- Clinical Oncology Service, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain
| | - Silvia Silva-Romeiro
- Clinical Oncology Service, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain
| | - Rocío Flores-Campos
- Clinical Oncology Service, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain
| | | | | | | | | | | | - Natividad Martínez-Banaclocha
- Oncology Dept., Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Josep Gumà-Padrò
- Department of Clinical Oncology, Hospital Universitari Sant Joan de Reus URV, IISPV, Reus, Spain
| | - José Gómez-Codina
- Department of Clinical Oncology, Hospital Universitario La Fé, Valencia, Spain
| | | | - Delvys Rodríguez-Abreu
- Department of Clinical Oncology, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| | - Laura Gálvez-Carvajal
- Department of Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Jorge Labrador
- Department of Hematology, Research Unit, Hospital Universitario de Burgos, Burgos, Spain
| | - María Guirado-Risueño
- Department of Clinical Oncology, Hospital General Universitario de Elche, Elche, Spain
| | - Mariano Provencio-Pulla
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, Facultad de Medicina, Universidad Autónoma de Madrid, IDIPHISA, Madrid, Spain
| | - Margarita Sánchez-Beato
- Department of Medical Oncology, Lymphoma Research Group, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, CIBERONC, Madrid, Spain
| | - Lejeune Marylene
- Department of Pathology, Plataforma de Estudios Histológicos, Citológicos y de Digitalización, Hospital de Tortosa Verge de la Cinta, IISPV, URV, Tortosa, Tarragona, Spain
| | - Tomás Álvaro-Naranjo
- Department of Pathology, Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Institut d’Investigació Sanitària Pere Virgili (IISPV), Tortosa, Tarragona, Spain
| | | | | | - Víctor Sánchez-Margalet
- Clinical Biochemistry Service, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Institute of Biomedicine of Seville, Virgen Macarena University Hospital, CSIC, University of Seville, Seville, Spain
| | - Luis de la Cruz-Merino
- Institute of Biomedicine of Seville, Virgen Macarena University Hospital, CSIC, University of Seville, Seville, Spain
- Clinical Oncology Service, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain
- Department of Medicine, University of Seville, Seville, Spain
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Palazón-Carrión N, Martín García-Sancho A, Nogales-Fernández E, Jiménez-Cortegana C, Carnicero-González F, Ríos-Herranz E, de la Cruz-Vicente F, Rodríguez-García G, Fernández-Álvarez R, Martínez-Banaclocha N, Gumà-Padrò J, Gómez-Codina J, Salar-Silvestre A, Rodríguez-Abreu D, Gálvez-Carvajal L, Labrador J, Guirado-Risueño M, García-Domínguez DJ, Hontecillas-Prieto L, Espejo-García P, Fernández-Román I, Provencio-Pulla M, Sánchez-Beato M, Navarro M, Marylene L, Álvaro-Naranjo T, Casanova-Espinosa M, Sánchez-Margalet V, Rueda-Domínguez A, de la Cruz-Merino L. Lenalidomide plus R-GDP (R2-GDP) in Relapsed/Refractory Diffuse Large B-Cell Lymphoma: Final Results of the R2-GDP-GOTEL Trial and Immune Biomarker Subanalysis. Clin Cancer Res 2022; 28:3658-3668. [PMID: 35727601 PMCID: PMC9433956 DOI: 10.1158/1078-0432.ccr-22-0588] [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] [Received: 02/21/2022] [Revised: 05/06/2022] [Accepted: 06/17/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE New therapeutic options are needed in relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL). Lenalidomide-based schedules can reverse rituximab refractoriness in lymphoma. PATIENTS AND METHODS In the phase II R2-GDP trial, 78 patients unsuitable for autologous stem cell transplant received treatment with the following schedule: lenalidomide 10 mg Days (D)1-14, rituximab 375 mg/m2 D1, cisplatin 60 mg/m2 D1, gemcitabine 750 mg/m2 D1 and D8, and dexamethasone 20 mg D1-3, up to 6 cycles (induction phase), followed by lenalidomide 10 mg (or last lenalidomide dose received) D1-21 every 28 days (maintenance phase). Primary endpoint was overall response rate (ORR). Secondary endpoints included progression-free survival (PFS), overall survival (OS), safety, and monitorization of key circulating immune biomarkers (EU Clinical Trials Register number: EudraCT 2014-001620-29). RESULTS After a median follow-up of 37 months, ORR was 60.2% [37.1% complete responses (CR) and 23.1% partial responses (PR)]. Median OS was 12 months (47 vs. 6 months in CR vs. no CR); median PFS was 9 months (34 vs. 5 months in CR vs. no CR). In the primary refractory population, ORR was 45.5% (21.2% CR and 24.3% PR). Most common grade 3-4 adverse events were thrombocytopenia (60.2%), neutropenia (60.2%), anemia (26.9%), infections (15.3%), and febrile neutropenia (14.1%). Complete responses were associated with a sharp decrease in circulating myeloid-derived suppressor cells and regulatory T cells. CONCLUSIONS R2-GDP schedule is feasible and highly active in R/R DLBCL, including the primary refractory population. Immune biomarkers showed differences in responders versus progressors.
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Affiliation(s)
- Natalia Palazón-Carrión
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain
| | | | - Esteban Nogales-Fernández
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain
| | - Carlos Jiménez-Cortegana
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | | | | | | | | | | | - Josep Gumà-Padrò
- Department of Clinical Oncology, Hospital Universitari Sant Joan de Reus URV, IISPV, Reus, Spain
| | - José Gómez-Codina
- Department of Clinical Oncology, Hospital Universitario La Fé, Valencia, Spain
| | | | - Delvys Rodríguez-Abreu
- Department of Clinical Oncology, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| | - Laura Gálvez-Carvajal
- Department of Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Jorge Labrador
- Department of Hematology, Research Unit, Hospital Universitario de Burgos, Burgos, Spain
| | - María Guirado-Risueño
- Department of Clinical Oncology, Hospital General Universitario de Elche, Elche, Spain
| | - Daniel J. García-Domínguez
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain.,Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Lourdes Hontecillas-Prieto
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain.,Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Pablo Espejo-García
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain
| | | | - Mariano Provencio-Pulla
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, Facultad de Medicina, Universidad Autónoma de Madrid, IDIPHISA, Madrid, Spain
| | - Margarita Sánchez-Beato
- Department of Medical Oncology, Lymphoma Research Group, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, CIBERONC, Madrid, Spain
| | - Marta Navarro
- Department of Medical Oncology, Lymphoma Research Group, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, Madrid, Spain
| | - Lejeune Marylene
- Department of Pathology, Plataforma de Estudios Histológicos, Citológicos y de Digitalización, Hospital de Tortosa Verge de la Cinta, IISPV, URV, Tortosa, Tarragona, Spain
| | - Tomás Álvaro-Naranjo
- Department of Pathology, Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Institut d'Investigació Sanitària Pere Virgili (IISPV), Tortosa, Tarragona, Spain
| | | | - Victor Sánchez-Margalet
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Antonio Rueda-Domínguez
- Department of Hematology/Clinical Oncology, Hospital Costa del Sol, Marbella, Spain.,Corresponding Authors: Luis de la Cruz-Merino, Hospital Universitario Virgen Macarena and University of Seville, Avenue Doctor Fedriani, 41009 Seville, Spain. Phone: 346-7790-2681; E-mail: ; and Antonio Rueda-Domínguez,
| | - Luis de la Cruz-Merino
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain.,Corresponding Authors: Luis de la Cruz-Merino, Hospital Universitario Virgen Macarena and University of Seville, Avenue Doctor Fedriani, 41009 Seville, Spain. Phone: 346-7790-2681; E-mail: ; and Antonio Rueda-Domínguez,
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