1
|
Parry H, McIlroy G, Bruton R, Ali M, Stephens C, Damery S, Otter A, McSkeane T, Rolfe H, Faustini S, Wall N, Hillmen P, Pratt G, Paneesha S, Zuo J, Richter A, Moss P. Antibody responses after first and second Covid-19 vaccination in patients with chronic lymphocytic leukaemia. Blood Cancer J 2021; 11:136. [PMID: 34330895 PMCID: PMC8323747 DOI: 10.1038/s41408-021-00528-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 12/15/2022] Open
Abstract
B-cell chronic lymphocytic leukaemia (CLL) is associated with immunosuppression and patients are at increased clinical risk following SARS-CoV-2 infection. Covid-19 vaccines offer the potential for protection against severe infection but relatively little is known regarding the profile of the antibody response following first or second vaccination. We studied spike-specific antibody responses following first and/or second Covid-19 vaccination in 299 patients with CLL compared with healthy donors. 286 patients underwent extended interval (10-12 week) vaccination. 154 patients received the BNT162b2 mRNA vaccine and 145 patients received ChAdOx1. Blood samples were taken either by venepuncture or as dried blood spots on filter paper. Spike-specific antibody responses were detectable in 34% of patients with CLL after one vaccine (n = 267) compared to 94% in healthy donors with antibody titres 104-fold lower in the patient group. Antibody responses increased to 75% after second vaccine (n = 55), compared to 100% in healthy donors, although titres remained lower. Multivariate analysis showed that current treatment with BTK inhibitors or IgA deficiency were independently associated with failure to generate an antibody response after the second vaccine. This work supports the need for optimisation of vaccination strategy in patients with CLL including the potential utility of booster vaccines.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Antibody Formation/drug effects
- BNT162 Vaccine
- COVID-19/blood
- COVID-19/immunology
- COVID-19/prevention & control
- COVID-19 Vaccines/administration & dosage
- COVID-19 Vaccines/immunology
- Female
- Humans
- Immunization, Secondary
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Male
- Middle Aged
Collapse
Affiliation(s)
- H Parry
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - G McIlroy
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - R Bruton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - M Ali
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - C Stephens
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - S Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - A Otter
- National infection Service, Public Health England, Porton Down, Salisbury, SP4 OJG, UK
| | - T McSkeane
- Cancer Research UK Clinical Trials Unit, University of Birmingham, B15 2TT, Birmingham, UK
| | - H Rolfe
- Cancer Research UK Clinical Trials Unit, University of Birmingham, B15 2TT, Birmingham, UK
| | - S Faustini
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - N Wall
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - P Hillmen
- St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - G Pratt
- Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2TH, UK
| | - S Paneesha
- Birmingham Heartlands Hospital, University Hospitals Birmingham, Bordesley Green East, B9 5SS, Birmingham, UK
| | - J Zuo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - A Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - P Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK.
- Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2TH, UK.
| |
Collapse
|
2
|
Hübel K, Scholz CW, Luminari S, Salar A, Wahlin BE, Gopal AK, Bonnet C, Trneny M, Paneesha S, Manzke O, Seguy F, Li D, Sehn LH. INMIND: A PHASE 3 STUDY OF TAFASITAMAB + LENALIDOMIDE AND RITUXIMAB VS PLACEBO + LENALIDOMIDE AND RITUXIMAB FOR RELAPSED/REFRACTORY FOLLICULAR OR MARGINAL ZONE LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.175_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: 11/07/2022]
Affiliation(s)
- K. Hübel
- University Hospital Cologne Department of Internal Medicine I Oncology and Hematology Cologne Germany
| | - C. W. Scholz
- Vivantes Klinikum Am Urban Department of Hematology and Oncology Berlin Germany
| | - S. Luminari
- Azienda USL‐IRCCS di Reggio Emilia Hematology Unit Reggio Emilia Italy
| | - A. Salar
- Hospital del Mar‐IMIM Department of Haematology Barcelona Spain
| | - B. E. Wahlin
- Unit of Hematology Karolinska Institute Department of Medicine Stockholm Sweden
| | - A. K. Gopal
- University of Washington Medicine Division of Medical Oncology Seattle Washington USA
| | - C. Bonnet
- Centre Hospitalier Universitaire University of Liège Clinical Hematology Liège Belgium
| | - M. Trneny
- First Faculty of Medicine Charles University General Hospital First Department of Medicine Prague Czech Republic
| | - S. Paneesha
- University Hospitals Birmingham NHS Foundation Trust Hematology Birmingham UK
| | - O. Manzke
- Incyte Biosciences International Sàrl Clinical Development Morgues Switzerland
| | - F. Seguy
- Incyte Biosciences International Sàrl Clinical Development Morgues Switzerland
| | - D. Li
- Incyte Corporation Biostatistics Wilmington Delaware USA
| | - L. H. Sehn
- BC Cancer Centre for Lymphoid Cancer and The University of British Columbia Division of Medical Oncology Vancouver Canada
| |
Collapse
|
3
|
McMillan AK, Phillips EH, Kirkwood AA, Barrans S, Burton C, Rule S, Patmore R, Pettengell R, Ardeshna KM, Lawrie A, Montoto S, Paneesha S, Clifton-Hadley L, Linch DC. Favourable outcomes for high-risk diffuse large B-cell lymphoma (IPI 3-5) treated with front-line R-CODOX-M/R-IVAC chemotherapy: results of a phase 2 UK NCRI trial. Ann Oncol 2020; 31:1251-1259. [PMID: 32464282 PMCID: PMC7487775 DOI: 10.1016/j.annonc.2020.05.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 12/28/2022] Open
Abstract
Background Outcomes for patients with high-risk diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP chemotherapy are suboptimal but, to date, no alternative regimen has been shown to improve survival rates. This phase 2 trial aimed to assess the efficacy of a Burkitt-like approach for high-risk DLBCL using the dose-intense R-CODOX-M/R-IVAC regimen. Patients and methods Eligible patients were aged 18–65 years with stage II–IV untreated DLBCL and an International Prognostic Index (IPI) score of 3–5. Patients received alternating cycles of CODOX-M (cyclophosphamide, vincristine, doxorubicin and high-dose methotrexate) alternating with IVAC chemotherapy (ifosfamide, etoposide and high-dose cytarabine) plus eight doses of rituximab. Response was assessed by computed tomography after completing all four cycles of chemotherapy. The primary end point was 2-year progression-free survival (PFS). Results A total of 111 eligible patients were registered; median age was 50 years, IPI score was 3 (60.4%) or 4/5 (39.6%), 54% had a performance status ≥2 and 9% had central nervous system involvement. A total of 85 patients (76.6%) completed all four cycles of chemotherapy. There were five treatment-related deaths (4.3%), all in patients with performance status of 3 and aged >50 years. Two-year PFS for the whole cohort was 67.9% [90% confidence interval (CI) 59.9–74.6] and 2-year overall survival was 76.0% (90% CI 68.5–82.0). The ability to tolerate and complete treatment was lower in patients with performance status ≥2 who were aged >50 years, where 2-year PFS was 43.5% (90% CI 27.9–58.0). Conclusions This trial demonstrates that R-CODOX-M/R-IVAC is a feasible and effective regimen for the treatment of younger and/or fit patients with high-risk DLBCL. These encouraging survival rates demonstrate that this regimen warrants further investigation against standard of care. Trial Registration ClinicalTrials.gov (NCT00974792) and EudraCT (2005-003479-19). R-CODOX-M/R-IVAC is an effective regimen for treatment of high-risk DLBCL and high-grade B-cell lymphoma (IPI score 3–5). Treatment was well tolerated in patients aged <50 years, or aged 50–65 with performance status 0 or 1. The 2-year PFS was 67.9% (90% CI: 59.9–74.6) for the whole cohort. This regimen warrants further evaluation against standard of care in high-risk DLBCL.
Collapse
Affiliation(s)
- A K McMillan
- Haematology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - E H Phillips
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK; Division of Cancer Sciences, University of Manchester and The Christie Hospital NHS Trust, Manchester, UK
| | - A A Kirkwood
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - S Barrans
- HMDS, St James' University Hospital, Leeds, UK
| | - C Burton
- HMDS, St James' University Hospital, Leeds, UK
| | - S Rule
- Plymouth University Medical School, Plymouth, UK
| | - R Patmore
- Haematology Department, Castle Hill Hospital, Hull, UK
| | - R Pettengell
- Clinical Sciences, St George's University of London, London, UK
| | - K M Ardeshna
- Haematology Department, University College Hospital London, London, UK
| | - A Lawrie
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - S Montoto
- Centre for Haemato-oncology, Barts Health NHS Trust, London, UK
| | - S Paneesha
- Haematology Department, Heart of England NHS Trust, Birmingham, UK
| | - L Clifton-Hadley
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - D C Linch
- Haematology Department, University College Hospital London, London, UK; UCL Cancer Institute, University College London, UK
| |
Collapse
|
4
|
Affiliation(s)
- S Paneesha
- Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, UK.,University of Birmingham, UK
| | - G Pratt
- Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, UK.,University of Birmingham, UK
| | - H Parry
- Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, UK.,University of Birmingham, UK
| | - P Moss
- Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, UK.,University of Birmingham, UK
| |
Collapse
|
5
|
Pettitt A, Barrington S, Kalakonda N, Khan U, Jackson R, Carruthers S, Oates M, Lin K, Ardeshna K, Eyre T, Fox C, Kennedy B, Linton K, Malladi R, Menne T, Okosun J, Paneesha S, Rule S, Johnston A, Trotman J. NCRI PETREA TRIAL: A PHASE 3 EVALUATION OF PET-GUIDED, RESPONSE-ADAPTED THERAPY IN PATIENTS WITH PREVIOUSLY UNTREATED, ADVANCED-STAGE, HIGH-TUMOUR-BURDEN FOLLICULAR LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.35_2629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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)
- A.R. Pettitt
- Department of Molecular and Clinical Cancer Medicine; University of Liverpool, Liverpool Health Partners; Liverpool United Kingdom
| | - S. Barrington
- School of Biomedical Engineering and Imaging Sciences; St Thomas’ Hospital, Kings College London; London United Kingdom
| | - N. Kalakonda
- Department of Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - U.T. Khan
- Department of Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - R. Jackson
- CR-UK Liverpool Cancer Trials Unit; University of Liverpool; Liverpool United Kingdom
| | - S. Carruthers
- CR-UK Liverpool Cancer Trials Unit; University of Liverpool; Liverpool United Kingdom
| | - M. Oates
- Department of Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - K. Lin
- Haemato-Oncology Diagnostic Service; Liverpool Clinical Laboratories; Liverpool United Kingdom
| | - K. Ardeshna
- Department of Haematology; University College London; London United Kingdom
| | - T. Eyre
- Department of Haematology; Churchill Hospital; Oxford United Kingdom
| | - C.P. Fox
- Department of Clinical Haematology; Nottingham University Hospitals NHS Trust; Nottingham United Kingdom
| | - B. Kennedy
- Department of Haematology; University Hospital Leicester NHS Trust; Leicester United Kingdom
| | - K. Linton
- Department of Haemato-oncology; Manchester Cancer Research Centre; Manchester United Kingdom
| | - R. Malladi
- Department of Haematology; Queen Elizabeth Medical Centre; Birmingham United Kingdom
| | - T. Menne
- Department of Haematology; Royal Freeman Hospital; Newcastle Upon Tyne United Kingdom
| | - J. Okosun
- Centre for Haemato-Oncology; Barts Cancer Institute, Queen Mary University of London; London United Kingdom
| | - S. Paneesha
- Department of Haematology; Heartlands Hospital; Birmingham United Kingdom
| | - S. Rule
- Department of Haematology; Derriford Hospital; Plymouth United Kingdom
| | - A. Johnston
- School of Medicine & Department of Haematology; University of Tasmania & Royal Hobart Hospital; Hobart Australia
| | - J. Trotman
- University of Sydney; Concord Repatriation General Hospital; Concord New South Wales Australia
| |
Collapse
|
6
|
Pettitt A, Kalakonda N, Cicconi S, Murphy C, Menon G, Coupland S, Oates M, Lin K, Pocock C, Jenkins S, Schuh A, Wandroo F, Rassam S, Duncombe A, Cervi P, Paneesha S, Aldouri M, Fox C, Knechtli C, Hamblin M, Turner D, Hillmen P. BRIEF CO-ADMINISTRATION OF IDELALISIB MAY IMPROVE THE LONG-TERM EFFICACY OF FRONTLINE CHEMOIMMUNOTHERAPY IN CHRONIC LYMPHOCYTIC LEUKAEMIA: 3-YEAR FOLLOW-UP FROM THE RIALTO TRIAL. Hematol Oncol 2019. [DOI: 10.1002/hon.32_2630] [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: 11/06/2022]
Affiliation(s)
- A. Pettitt
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - N. Kalakonda
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - S. Cicconi
- CR-UK Liverpool Cancer Trials Unit; University of Liverpool; Liverpool United Kingdom
| | - C. Murphy
- CR-UK Liverpool Cancer Trials Unit; University of Liverpool; Liverpool United Kingdom
| | - G. Menon
- Liverpool Clinical Laboratories; Haemato-Oncology Diagnostic Service; Liverpool United Kingdom
| | - S.E. Coupland
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - M. Oates
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - K. Lin
- Liverpool Clinical Laboratories; Department of Blood Sciences; Liverpool United Kingdom
| | - C. Pocock
- Department of Haematology; Kent & Canterbury Hospital; Canterbury United Kingdom
| | - S. Jenkins
- Russells Hall Hospital; Haematology Unit; Dudley United Kingdom
| | - A. Schuh
- Department of Oncology; University of Oxford; Oxford United Kingdom
| | - F. Wandroo
- Department of Haematology; Sandwell Hospital; Birmingham United Kingdom
| | - S. Rassam
- Department of Haematology; Maidstone Hospital; Maidstone United Kingdom
| | - A.S. Duncombe
- Department of Haematology; University Hospital Southampton; Southampton United Kingdom
| | - P. Cervi
- Department of Haematology & Blood Transfusion; Southend Hospital; Southend United Kingdom
| | - S. Paneesha
- Department of Haematology; Heartlands Hospital; Birmingham United Kingdom
| | - M. Aldouri
- Department of Haematology; Medway Maritime Hospital; Gillingham United Kingdom
| | - C. Fox
- Department of Clinical Haematology; Nottingham University Hospitals NHS Trust; Nottingham United Kingdom
| | - C. Knechtli
- Department of Clinical Haematology; Royal United Hospital; Bath United Kingdom
| | - M. Hamblin
- Department of Haematology; Colchester General Hospital; Colchester United Kingdom
| | - D. Turner
- Oncology Unit; Torbay Hospital; Torquay United Kingdom
| | - P. Hillmen
- Faculty of Medicine and Health; University of Leeds; Leeds United Kingdom
| |
Collapse
|
7
|
Jayalathike D, Stevens A, Paneesha S, Chaganti S, Hassan Y, Zarkar A. Treatment outcomes using involved field and involved site radiotherapy for NHL and HL: Retrospective analysis from a large UK Radiotherapy centre. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- D.M. Jayalathike
- Department of Oncology; University Hospital Birmingham; Birmingham UK
| | - A. Stevens
- Department of Oncology; University Hospital Birmingham; Birmingham UK
| | - S. Paneesha
- Department of Haematology; Birmingham Heartlands Hospital; Birmingham UK
| | - S. Chaganti
- Department of Oncology; University Hospital Birmingham; Birmingham UK
| | - Y. Hassan
- Department of Haematology, City Hospital; Birmingham UK
| | - A.M. Zarkar
- Department of Oncology; University Hospital Birmingham; Birmingham UK
| |
Collapse
|
8
|
Pettitt A, Kalakonda N, Polydoros F, Bickerstaff M, Menon G, Coupland S, Oates M, Lin K, Pocock C, Jenkins S, Schuh A, Wandroo F, Rassam S, Duncombe A, Jenner M, Cervi P, Paneesha S, Aldouri M, Fox C, Knechtli C, Hamblin M, Turner D, Hillmen P. EFFECT OF ADDING IDELALISIB TO FRONTLINE OFATUMUMAB PLUS EITHER CHLORAMBUCIL OR BENDAMUSTINE IN LESS FIT PATIENTS WITH CLL: PRELIMINARY RESULTS FROM THE NCRI RIALTO TRIAL. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_77] [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: 11/06/2022]
Affiliation(s)
- A.R. Pettitt
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool UK
| | - N. Kalakonda
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool UK
| | - F. Polydoros
- CRUK Liverpool Cancer Trials Unit; University of Liverpool; Liverpool UK
| | - M. Bickerstaff
- CRUK Liverpool Cancer Trials Unit; University of Liverpool; Liverpool UK
| | - G. Menon
- Haemato-Oncology Diagnostic Service; Liverpool Clinical Laboratories; Liverpool UK
| | - S.E. Coupland
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool UK
| | - M. Oates
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool UK
| | - K. Lin
- Blood Sciences; Liverpool Clinical Laboratories; Liverpool UK
| | - C. Pocock
- Department of Haematology; Kent & Canterbury Hospital; Canterbury UK
| | - S. Jenkins
- Haematology Unit; Russells Hall Hospital; Dudley UK
| | - A. Schuh
- Oncology; University of Oxford; Oxford UK
| | - F. Wandroo
- Haematology; Sandwell Hospital; Birmingham UK
| | - S. Rassam
- Haematology; Maidstone Hospital; Maidstone UK
| | - A.S. Duncombe
- Haematology; University Hospital Southampton; Southampton UK
| | - M. Jenner
- Haematology; University Hospital Southampton; Southampton UK
| | - P. Cervi
- Haematology & Blood Transfusion; Southend Hospital, Westcliff-on-Sea; UK
| | - S. Paneesha
- Haematology; Heartlands Hospital; Birmingham UK
| | - M. Aldouri
- Haematology; Medway Maritime Hospital; Gillingham UK
| | - C.P. Fox
- Clinical Haematology; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - C. Knechtli
- Clinical Haematology; Royal United Hospital; Bath UK
| | - M. Hamblin
- Haematology; Colchester General Hospital; Colchester UK
| | - D. Turner
- Oncology Unit; Torbay Hospital; Torquay UK
| | - P. Hillmen
- Medicine and Health; University of Leeds; Leeds UK
| |
Collapse
|
9
|
Nikolousis E, Robinson S, Nagra S, Brookes C, Kinsella F, Tauro S, Jeffries S, Griffiths M, Mahendra P, Cook M, Paneesha S, Lovell R, Kishore B, Chaganti S, Malladi R, Raghavan M, Moss P, Milligan D, Craddock C. Post-transplant T cell chimerism predicts graft versus host disease but not disease relapse in patients undergoing an alemtuzumab based reduced intensity conditioned allogeneic transplant. Leuk Res 2013; 37:561-5. [PMID: 23395505 DOI: 10.1016/j.leukres.2013.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 01/12/2013] [Accepted: 01/13/2013] [Indexed: 11/18/2022]
Abstract
In this multicentre retrospective study we have studied the impact of T cell chimerism on the outcome of 133 patients undergoing an alemtuzumab based reduced intensity conditioning allograft (RIC). The median age of the patients was 50 years (range 42-55 years). 77 patients were transplanted using an HLA identical sibling donor while 56 patients received a fully matched volunteer unrelated donor graft. 64 patients had a lymphoid malignancy and 69 were transplanted for a myeloid malignancy. 38 patients (29%) relapsed with no significant difference in risk of relapse between patients developing full donor and mixed donor chimerism in the T-cell compartment on D+90 and D+180 post transplant. Day 90 full donor T cell chimerism correlated with an increased incidence of acute GVHD according to NIH criteria (p=0.0004) and the subsequent development of chronic GVHD. Consistent with previous observations, our results confirmed a correlation between the establishment of T cell full donor chimerism and acute GVHD in T deplete RIC allografts. However our study failed to identify any correlation between T cell chimerism and relapse risk and challenge the use of pre-emptive donor lymphocyte infusions (DLI) in patients with mixed T cell chimerism transplanted using an alemtuzumab based RIC regimen.
Collapse
Affiliation(s)
- E Nikolousis
- Department of Haematology, Heart of England NHS Foundation Trust, Birmingham, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Knowlson L, Bacchu S, Paneesha S, McManus A, Randall K, Rose P. Elevated D-dimers are also a marker of underlying malignancy and increased mortality in the absence of venous thromboembolism. J Clin Pathol 2010; 63:818-22. [DOI: 10.1136/jcp.2010.076349] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
11
|
|
12
|
Paneesha S, McManus A, Arya R, Scriven N, Farren T, Nokes T, Bacon S, Nieland A, Cooper D, Smith H, O'Shaughnessy D, Rose P. Frequency, demographics and risk (according to tumour type or site) of cancer-associated thrombosis among patients seen at outpatient DVT clinics. Thromb Haemost 2009; 103:338-43. [PMID: 20024496 DOI: 10.1160/th09-06-0397] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 10/26/2009] [Indexed: 11/05/2022]
Abstract
Venous thromboembolism (VTE) is a clinically important complication for both hospitalised and ambulatory cancer patients. In the current study, the frequency, demographics and risk (according to tumour site) of VTE were examined among patients seen at outpatient DVT (deep-vein thrombosis) clinics. Of 10,015 VTE cases, 1,361 were diagnosed with cancer, for an overall rate of cancer-associated VTE of 13.6% in this outpatient population. Patients with cancer-associated VTE were significantly older than cancer-free VTE cases (66.4 +/- 12.7 vs. 58.8 +/- 18.5 years; p<0.0001). The frequency of cancer-associated VTE peaked earlier among females than males, occurring in the sixth (137/639, 21.4% vs. 98/851, 11.3%; p<0.001) and seventh decades (213/980, 21.7% vs. 197/1096, 18%; p=0.036). VTE was described most frequently in common cancers - breast, prostate, colorectal and lung (56.1% of cases). The risk of VTE varied widely across 17 cancer types. Calculating odds ratios (OR) to assess the effect size of cancer type on VTE risk, the highest odds were observed for patients with pancreatic cancer (OR 9.65, 95% confidence interval [CI] (5.51-16.91). Tumours of the head and neck had higher odds than previously reported (OR 8.24, 95% CI 5.06-13.42). Reduced risk estimates were observed for skin cancers (melanoma and non-melanoma: OR 0.89, 95% CI 0.42-1.87; OR 0.74, 95% CI, 0.32-1.69, respectively). We conclude that outpatients have a similar rate of cancer-associated VTE as VTE patient populations previously reported, that cancer-associated VTE occurs in an older age group and earlier in females and that outpatients exhibit distinct tumour site-specific risk from that described among hospitalised cancer patients.
Collapse
Affiliation(s)
- S Paneesha
- Consultant Haematologist, Department of Haematology, Warwick Hospital, Warwick, CV34 5BW, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Pemberton NC, Paneesha S, Hiller L, Starczynski J, Hooper L, Pepper C, Pratt G, Fegan C. The SDF-1 G > A polymorphism at position 801 plays no role in multiple myeloma but may contribute to an inferior cause-specific survival in chronic lymphocytic leukemia. Leuk Lymphoma 2009; 47:1239-44. [PMID: 16923552 DOI: 10.1080/10428190600562112] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [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: 10/23/2022]
Abstract
The growth and circulation of B lymphocytes is largely under the control of bone marrow stromal cells, cytokines and chemokines. The gene responsible for the pivotal B cell growth factor, stromal derived factor-1 (SDF-1), has recently been shown to contain a single nucleotide polymorphism G > A at position 801 which leads to higher SDF-1 secretion. This polymorphism is common in the normal population and has been shown to play a potential role in the development of both HIV and non-HIV related non-Hodgkin's lymphoma. We therefore undertook a large single-centre study to ascertain its role in the pathogenesis of two other common B-cell malignancies, notably chronic lymphocytic leukemia (CLL- 197 patients) and multiple myeloma (126 patients). We show that the 801 G > A polymorphism plays no role in the incidence of multiple myeloma or CLL nor the outcome in multiple myeloma. By contrast, it trends towards an inferior cause-specific survival in CLL.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Cell Line, Tumor
- Chemokine CXCL12
- Chemokines, CXC/genetics
- Cohort Studies
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Middle Aged
- Multiple Myeloma/genetics
- Multiple Myeloma/mortality
- Polymorphism, Genetic
- Prognosis
- Receptors, CXCR4/genetics
- Treatment Outcome
Collapse
Affiliation(s)
- N C Pemberton
- Department of Haematology, Heartlands and Solihull NHS Trust, Bordesley Green East, Birmingham, UK
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Paneesha S, Zhang W, Parsons N, Kesteven P, Marr H, Borg A, Rose P. PO-45 Do all patients with venous thrombosis require screening for malignancy? A predictive model to identify patients with VTE at minimal risk of malignancy. Thromb Res 2007. [DOI: 10.1016/s0049-3848(07)70198-6] [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: 11/29/2022]
|
15
|
Paneesha S, Cheyne E, French K, Bacchu S, Borg A, Rose P. High D-dimer levels at presentation in patients with venous thromboembolism is a marker of adverse clinical outcomes. Br J Haematol 2006; 135:85-90. [PMID: 16925794 DOI: 10.1111/j.1365-2141.2006.06260.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Qualitative D-dimer results, together with clinical probability scores, are well established in the diagnosis of venous thromboembolism (VTE). The predictive value of quantitative D-dimer levels for various clinical outcomes in VTE patients is not fully understood. D-dimer levels obtained at presentation were analysed in 699 (360 men; 339 women) VTE patients for survival and occurrence of malignancy. Patients were followed for a median of 23 months. 17.2% patients had a D-dimer level >8000 ng FEU/mlat presentation, which was associated with decreased overall survival (OS) (P < 0.001) and event-free survival (EFS) (P < 0.001). 25.4% patients had malignancy and 4% subsequently developed malignancy following VTE. 29.9% of patients with VTE and malignancy had a D-dimer level >8 mg/l when compared with 13.4% of patients with VTE without malignancy (P < 0.001). 50% of patients who developed subsequent malignancy following VTE had a presentation D-dimer >8000 ng FEU/mlas compared with 13.3% of patients with VTE with out malignancy (P = 0.009). In conclusion, D-dimer >8000 ng FEU/ml at presentation in patients with VTE is a marker of poor OS, EFS and underlying malignancy. Consideration of screening for malignancy is recommended in patients with VTE with a presentation D-dimer >8000 ng FEU/ml and age >60 years.
Collapse
Affiliation(s)
- S Paneesha
- Department of Haematology, Warwick Hospital, Warwick, UK
| | | | | | | | | | | |
Collapse
|
16
|
Narayan H, Bandyopadhyay D, Schmidt K, Chachlani N, Hughes M, Paneesha S, Rose P, Borg A. Successful treatment of a patient with chronic lymphocytic leukaemia (CLL) presenting with bony metastases with aggressive antibody and chemotherapy. ACTA ACUST UNITED AC 2005; 27:405-8. [PMID: 16307545 DOI: 10.1111/j.1365-2257.2005.00733.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 11/28/2022]
Abstract
Osteolytic lesions are rare in chronic lymphocytic leukaemia (CLL) and thought to result from Richter's transformation or metastatic disease from nonlymphoid malignancies. We report a patient who presented with a large femoral metastatic lesion and hypercalcaemia caused by CLL itself. Complete remission of CLL with resolution of the osteolytic lesion was achieved with rituximab and cyclophosphamide, adriamycin, oncovin and prednisolone [CHOP (R-CHOP)] combination chemotherapy.
Collapse
MESH Headings
- Aged, 80 and over
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Neoplasms/drug therapy
- Bone Neoplasms/secondary
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Femur
- Humans
- Hypercalcemia/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Prednisolone/therapeutic use
- Remission Induction/methods
- Rituximab
- Vincristine/therapeutic use
Collapse
Affiliation(s)
- H Narayan
- Department of Haematology, Warwick Hospital, Warwick, UK
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Paneesha S, Cheyne E, French K, Delgado J, Borg A, Rose P. High D-dimer level at presentation in patients with venous thrombosis is a marker for malignancy. Haematologica 2005; 90:ELT08. [PMID: 16464765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
|
18
|
Abstract
Early results of autologous stem cell transplantation (ASCT) in chronic lymphocytic leukaemia (CLL) suggested a significant proportion of patients remained disease-free for years, raising the possibility of cure. More recent studies have shown no evidence of a plateau in the survival curves indicating that, at best, ASCT may only prolong disease-free survival. Problems remain over progenitor cell mobilization and one study has raised anxieties about post-transplant myelodysplasia. The impact of ASCT in CLL will only be properly ascertained in a randomized clinical trial and this in underway in Europe. Initial results of conventional allogeneic transplantation (allo-SCT) were very disappointing, with an unacceptably high mortality, but did show that cure was possible in some patients. The introduction of reduced intensity conditioning has limited the early transplant-related mortality but it remains too early to determine what proportion of patients will be cured. In view of these uncertainties, is important that reduced intensity allo-SCT for CLL is conducted in the context of a clinical trial. Finally, CLL is very heterogeneous condition and great deal more is becoming understood about the prognostic factors. These will become important in allowing patients and their physicians a choice in balancing the risks of various treatment options.
Collapse
MESH Headings
- Disease-Free Survival
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/surgery
- Stem Cell Transplantation/methods
- T-Lymphocytes/immunology
- Transplantation Conditioning
- Transplantation, Autologous
- Transplantation, Homologous
Collapse
Affiliation(s)
- S Paneesha
- Specialist Registrar in Haematology, Department of Haematology, Birmingham Heartlands Hospital, Birmingham, UK
| | | |
Collapse
|
19
|
Peggs KS, Paneesha S, Kottaridis PD, Chakraverty RK, Tobias G, Reilly M, Mahendra P, Yong K. Peripheral blood stem cell transplantation for POEMS syndrome. Bone Marrow Transplant 2002; 30:401-4. [PMID: 12235526 DOI: 10.1038/sj.bmt.1703670] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2001] [Accepted: 05/17/2002] [Indexed: 11/09/2022]
Abstract
In common with other plasma cell dyscrasias in which a small tumour burden is associated with severe clinical symptoms (notably systemic AL amyloidosis) the possible benefits of dose intensification are yet to be fully explored in POEMS syndrome. One important issue is whether the toxicity of the procedure is significantly increased in this group. We report two cases of POEMS syndrome with solitary asymptomatic bone lesions treated with high-dose melphalan (200 mg/m(2)) and peripheral blood stem cell (PBSC) rescue. In both cases there was minimal peri-transplant morbidity and a subsequent substantial and maintained improvement in the peripheral neuropathy.
Collapse
Affiliation(s)
- K S Peggs
- Department of Haematology, University College London Hospitals, UK
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
Burkitt's lymphoma is a rare aggressive lymphoma, which responds poorly to standard chemotherapy regimens used to treat high-grade non-Hodgkin's lymphoma (NHL). The use of intensive chemotherapy protocols using alkylating agents and intensive CNS prophylaxis has dramatically altered prognosis. We have treated eight patients with Burkitt's lymphoma with a modified BFM protocol. The dose of methotrexate was reduced from 5 g/m2 to 1.5 g/m2 with the aim of reducing toxicity. Seven patients received a total of six cycles of chemotherapy each and one patient received five cycles of chemotherapy. Each cycle included high-dose methotrexate, an alkylating agent (ifosphamide or cyclophosphamide) and two triple intrathecal injections of chemotherapy. Two patients with bulky abdominal disease in addition received an autologous stem cell transplant. The regimen was well tolerated with minimal toxicity. At a median follow-up of 16 months (range 10-28), six of the eight patients (75%) were alive and in complete remission. Two patients relapsed, one 24 months post-BFM chemotherapy and the other 1-month post-autologous stem cell transplantation and 2 months post-BFM chemotherapy.
Collapse
Affiliation(s)
- E Harris
- Department of Haematology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | | | | | | | | |
Collapse
|