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Robbe P, Ridout KE, Vavoulis DV, Dréau H, Kinnersley B, Denny N, Chubb D, Appleby N, Cutts A, Cornish AJ, Lopez-Pascua L, Clifford R, Burns A, Stamatopoulos B, Cabes M, Alsolami R, Antoniou P, Oates M, Cavalieri D, Gibson J, Prabhu AV, Schwessinger R, Jennings D, James T, Maheswari U, Duran-Ferrer M, Carninci P, Knight SJL, Månsson R, Hughes J, Davies J, Ross M, Bentley D, Strefford JC, Devereux S, Pettitt AR, Hillmen P, Caulfield MJ, Houlston RS, Martín-Subero JI, Schuh A. Whole-genome sequencing of chronic lymphocytic leukemia identifies subgroups with distinct biological and clinical features. Nat Genet 2022; 54:1675-1689. [PMID: 36333502 PMCID: PMC9649442 DOI: 10.1038/s41588-022-01211-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/16/2022] [Indexed: 11/06/2022]
Abstract
The value of genome-wide over targeted driver analyses for predicting clinical outcomes of cancer patients is debated. Here, we report the whole-genome sequencing of 485 chronic lymphocytic leukemia patients enrolled in clinical trials as part of the United Kingdom's 100,000 Genomes Project. We identify an extended catalog of recurrent coding and noncoding genetic mutations that represents a source for future studies and provide the most complete high-resolution map of structural variants, copy number changes and global genome features including telomere length, mutational signatures and genomic complexity. We demonstrate the relationship of these features with clinical outcome and show that integration of 186 distinct recurrent genomic alterations defines five genomic subgroups that associate with response to therapy, refining conventional outcome prediction. While requiring independent validation, our findings highlight the potential of whole-genome sequencing to inform future risk stratification in chronic lymphocytic leukemia.
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Affiliation(s)
- Pauline Robbe
- Department of Oncology, University of Oxford, Oxford, UK
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Kate E Ridout
- Department of Oncology, University of Oxford, Oxford, UK
| | | | - Helene Dréau
- Department of Oncology, University of Oxford, Oxford, UK
| | - Ben Kinnersley
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - Nicholas Denny
- Department of Medicine, Medical Research Council Molecular Haematology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Daniel Chubb
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - Niamh Appleby
- Department of Oncology, University of Oxford, Oxford, UK
| | - Anthony Cutts
- Department of Oncology, University of Oxford, Oxford, UK
| | - Alex J Cornish
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | | | - Ruth Clifford
- Department of Haematology, University Hospital Limerick, Limerick, Ireland
- Limerick Digital Cancer Research Centre, School of Medicine,University of Limerick, Limerick, Ireland
| | - Adam Burns
- Department of Oncology, University of Oxford, Oxford, UK
| | - Basile Stamatopoulos
- Laboratory of Clinical Cell Therapy, Jules Bordet Institute, ULB Cancer Research Center (U-CRC)- Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Maite Cabes
- Oxford Molecular Diagnostics Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Reem Alsolami
- Department of Medical Laboratory Technology, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | | | - Doriane Cavalieri
- Department of Haematology, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Jane Gibson
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anika V Prabhu
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Ron Schwessinger
- Department of Medicine, Medical Research Council Molecular Haematology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Daisy Jennings
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | | | | | - Martí Duran-Ferrer
- Biomedical Epigenomics Group, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Piero Carninci
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Human Technopole, Milan, Italy
| | - Samantha J L Knight
- Oxford University Clinical Academic Graduate School, University of Oxford Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Robert Månsson
- Center for Hematology and Regenerative Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Jim Hughes
- Department of Medicine, Medical Research Council Molecular Haematology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - James Davies
- Department of Medicine, Medical Research Council Molecular Haematology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Mark Ross
- Illumina Cambridge Ltd., Cambridge, UK
| | | | - Jonathan C Strefford
- Cancer Genomics, Cancer Sciences, Faculty of Medicine, Group University of Southampton, Southampton, UK
| | - Stephen Devereux
- King's College Hospital, NHS Foundation Trust, London, UK
- Kings College London, London, UK
| | - Andrew R Pettitt
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | | | - Mark J Caulfield
- Genomics England, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Richard S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - José I Martín-Subero
- Human Technopole, Milan, Italy
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Anna Schuh
- Department of Oncology, University of Oxford, Oxford, UK.
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2
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Byrd JC, Woyach JA, Furman RR, Martin P, O'Brien S, Brown JR, Stephens DM, Barrientos JC, Devereux S, Hillmen P, Pagel JM, Hamdy A, Izumi R, Patel P, Wang MH, Jain N, Wierda WG. Acalabrutinib in treatment-naive chronic lymphocytic leukemia. Blood 2021; 137:3327-3338. [PMID: 33786588 PMCID: PMC8670015 DOI: 10.1182/blood.2020009617] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [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] [Received: 10/28/2020] [Accepted: 02/20/2021] [Indexed: 01/20/2023] Open
Abstract
Acalabrutinib has demonstrated significant efficacy and safety in relapsed chronic lymphocytic leukemia (CLL). Efficacy and safety of acalabrutinib monotherapy were evaluated in a treatment-naive CLL cohort of a single-arm phase 1/2 trial (ACE-CL-001). Adults were eligible for enrollment if chemotherapy was declined or deemed inappropriate due to comorbidities (N = 99). Patients had a median age of 64 years and 47% had Rai stage III/IV disease. Acalabrutinib was administered orally 200 mg once daily, or 100 mg twice daily until progression or intolerance. A total of 99 patients were treated; 57 (62%) had unmutated immunoglobulin heavy-chain variable gene, and 12 (18%) had TP53 aberrations. After median follow-up of 53 months, 85 patients remain on treatment; 14 discontinued treatment, mostly because of adverse events (AEs) (n = 6) or disease progression (n = 3). Overall response rate was 97% (90% partial response; 7% complete response), with similar outcomes among all prognostic subgroups. Because of improved trough BTK occupancy with twice-daily dosing, all patients were transitioned to 100 mg twice daily. Median duration of response (DOR) was not reached; 48-month DOR rate was 97% (95% confidence interval, 90-99). Serious AEs were reported in 38 patients (38%). AEs required discontinuation in 6 patients (6%) because of second primary cancers (n = 4) and infection (n = 2). Grade ≥3 events of special interest included infection (15%), hypertension (11%), bleeding events (3%), and atrial fibrillation (2%). Durable efficacy and long-term safety of acalabrutinib in this trial support its use in clinical management of symptomatic, untreated patients with CLL.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Benzamides/administration & dosage
- Benzamides/adverse effects
- Benzamides/pharmacokinetics
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Mutation
- Neoplasm Staging
- Pyrazines/administration & dosage
- Pyrazines/adverse effects
- Pyrazines/pharmacokinetics
- Tumor Suppressor Protein p53/genetics
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Affiliation(s)
- John C Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Richard R Furman
- Division of Hematology and Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Peter Martin
- Division of Hematology and Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Susan O'Brien
- Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA
| | | | | | | | - Stephen Devereux
- College Hospital, NHS Foundation Trust Denmark Hill, London, United Kingdom
| | - Peter Hillmen
- St James's University Hospital, Leeds, United Kingdom
| | | | | | | | | | | | - Nitin Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William G Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
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3
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Devereux S, Jack M, Worth A, Bridges J. Calcaneotibial screws for immobilisation of the tarsocrural joint of dogs in extension: effect of the angle of screw placement on the force to failure in a canine cadaveric model. N Z Vet J 2021; 69:294-298. [PMID: 34013827 DOI: 10.1080/00480169.2021.1931522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS To compare the force to failure under axial loading of a calcaneotibial screw placed approximately perpendicular to the tibia with that of a screw placed perpendicular to the calcaneus, when used to immobilise the tarsus in an ex vivo canine model. METHODS Twelve pairs of cadaveric hindlimbs from large breed dogs, without orthopaedic or soft tissue disease, were prepared by transecting the limb at the level of the stifle and stripping the limbs of all musculature from the stifle to mid-metatarsus, including removal of the common calcaneal tendon from all limbs. The limbs in each pair were randomly assigned to receive a calcaneotibial screw placed perpendicular to the long axis of either the calcaneus (C group) or the tibia (T group) with the tarsus in full extension. The distal limb was potted in resin and the proximal tibia was pinned to allow biomechanical testing in compressive loading. Testing was performed to apply an axial load using a material testing machine in a proximodistal direction through the tibia, advancing at a rate of 10 mm/second. The force to failure was recorded in kN and compared between groups. RESULTS The median force to failure of the C group was 0.86 (min 0.50; max 1.64) kN which was higher than the T group which had a median force to failure of 0.74 (min 0.26, max1.05) kN (p = 0.004). All modes of failure were by screw pull-out. CONCLUSIONS A calcaneotibial screw placed at an angle approximately perpendicular to the long axis of the calcaneus, has a higher force to failure under axial loading than a calcaneotibial screw that is placed at an angle approximately perpendicular to the tibia, in a canine cadaveric model. CLINICAL RELEVANCE A temporary calcaneotibial screw is a common method of immobilising the tarsus in extension to protect primary repair of a common calcaneal tendon injury. Placing a calcaneotibial screw perpendicular to the calcaneus may be a more reliable option for immobilisation of the tarsus to protect a common calcaneal tendon repair compared to screws placed perpendicular to the tibia. However extrapolation of these results into a clinical setting requires caution.
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Affiliation(s)
- S Devereux
- Massey University Veterinary Teaching Hospital, School of Veterinary science, Massey University, Palmerston North, New Zealand
| | - M Jack
- Cave Veterinary Specialists, Wellington, UK
| | - A Worth
- Massey University Veterinary Teaching Hospital, School of Veterinary science, Massey University, Palmerston North, New Zealand
| | - J Bridges
- Massey University Veterinary Teaching Hospital, School of Veterinary science, Massey University, Palmerston North, New Zealand
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4
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Kennedy E, Coulter E, Halliwell E, Profitos-Peleja N, Walsby E, Clark B, Phillips EH, Burley TA, Mitchell S, Devereux S, Fegan CD, Jones CI, Johnston R, Chevassut T, Schulz R, Seiffert M, Agathanggelou A, Oldreive C, Davies N, Stankovic T, Liloglou T, Pepper C, Pepper AGS. TLR9 expression in chronic lymphocytic leukemia identifies a promigratory subpopulation and novel therapeutic target. Blood 2021; 137:3064-3078. [PMID: 33512408 PMCID: PMC8176769 DOI: 10.1182/blood.2020005964] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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] [Received: 03/26/2020] [Accepted: 12/16/2020] [Indexed: 12/12/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) remains incurable despite B-cell receptor-targeted inhibitors revolutionizing treatment. This suggests that other signaling molecules are involved in disease escape mechanisms and resistance. Toll-like receptor 9 (TLR9) is a promising candidate that is activated by unmethylated cytosine guanine dinucleotide-DNA. Here, we show that plasma from patients with CLL contains significantly more unmethylated DNA than plasma from healthy control subjects (P < .0001) and that cell-free DNA levels correlate with the prognostic markers CD38, β2-microglobulin, and lymphocyte doubling time. Furthermore, elevated cell-free DNA was associated with shorter time to first treatment (hazard ratio, 4.0; P = .003). We also show that TLR9 expression was associated with in vitro CLL cell migration (P < .001), and intracellular endosomal TLR9 strongly correlated with aberrant surface expression (sTLR9; r = 0.9). In addition, lymph node-derived CLL cells exhibited increased sTLR9 (P = .016), and RNA-sequencing of paired sTLR9hi and sTLR9lo CLL cells revealed differential transcription of genes involved in TLR signaling, adhesion, motility, and inflammation in sTLR9hi cells. Mechanistically, a TLR9 agonist, ODN2006, promoted CLL cell migration (P < .001) that was mediated by p65 NF-κB and STAT3 transcription factor activation. Importantly, autologous plasma induced the same effects, which were reversed by a TLR9 antagonist. Furthermore, high TLR9 expression promoted engraftment and rapid disease progression in a NOD/Shi-scid/IL-2Rγnull mouse xenograft model. Finally, we showed that dual targeting of TLR9 and Bruton's tyrosine kinase (BTK) was strongly synergistic (median combination index, 0.2 at half maximal effective dose), which highlights the distinct role for TLR9 signaling in CLL and the potential for combined targeting of TLR9 and BTK as a more effective treatment strategy in this incurable disease.
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Affiliation(s)
- Emma Kennedy
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Falmer, United Kingdom
| | - Eve Coulter
- Centre for Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
- Department of Haemato-Oncology, Division of Cancer Studies, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Emma Halliwell
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Nuria Profitos-Peleja
- Lymphoma Translational Group, Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - Elisabeth Walsby
- Cardiff CLL Research Group, Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Barnaby Clark
- Molecular Pathology Laboratory, King's College Hospital, London, United Kingdom
| | - Elizabeth H Phillips
- Department of Haemato-Oncology, Division of Cancer Studies, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Thomas A Burley
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Falmer, United Kingdom
| | - Simon Mitchell
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Falmer, United Kingdom
| | - Stephen Devereux
- Department of Haemato-Oncology, Division of Cancer Studies, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Christopher D Fegan
- Cardiff CLL Research Group, Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Christopher I Jones
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, United Kingdom
| | - Rosalynd Johnston
- Department of Haematology, Brighton and Sussex University Hospital Trust, Brighton, United Kingdom
| | - Tim Chevassut
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Falmer, United Kingdom
- Department of Haematology, Brighton and Sussex University Hospital Trust, Brighton, United Kingdom
| | - Ralph Schulz
- German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | | | - Angelo Agathanggelou
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; and
| | - Ceri Oldreive
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; and
| | - Nicholas Davies
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; and
| | - Tatjana Stankovic
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; and
| | - Triantafillos Liloglou
- Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Chris Pepper
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Falmer, United Kingdom
| | - Andrea G S Pepper
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Falmer, United Kingdom
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5
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Coutre SE, Barr PM, Owen C, Robak T, Tedeschi A, Bairey O, Burger JA, Hillmen P, Devereux S, Grosicki S, McCarthy H, Li J, Simpson D, Offner F, Moreno C, Dai S, Szoke A, Dean JP, Kipps TJ, Ghia P. FIRST‐LINE TREATMENT WITH IBRUTINIB FOR PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL): 7‐YEAR RESULTS FROM RESONATE‐2. Hematol Oncol 2021. [DOI: 10.1002/hon.48_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)
- S. E. Coutre
- Stanford Cancer Center, Stanford University School of Medicine, Stanford California USA
| | - P. M. Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Clinical Trials Office Rochester USA
| | - C. Owen
- Tom Baker Cancer Centre, University of Calgary, Medicine and Oncology Calgary Canada
| | - T. Robak
- Medical University of Lodz, Copernicus Memorial Hospital, Hematology Lodz Poland
| | - A. Tedeschi
- ASST Grande Ospedale Metropolitano Niguarda, Hematology Milan Italy
| | - O. Bairey
- Rabin Medical Center, Life and Medicine Sciences Petah Tikva Israel
| | - J. A. Burger
- University of Texas MD Anderson Cancer Center, Leukemia Houston USA
| | - P. Hillmen
- The Leeds Teaching Hospitals, St. James Institute of Oncology, Oncology Leeds UK
| | - S. Devereux
- Kings College Hospital, NHS Foundation Trust, Lymphoma Biology London UK
| | - S. Grosicki
- School of Public Health, Silesian Medical University, Hematology and Cancer Prevention Katowice Poland
| | - H. McCarthy
- Royal Bournemouth General Hospital, Hematology Bournemouth UK
| | - J. Li
- Jiangsu Province Hospital, Hematology Nanjing China
| | - D. Simpson
- North Shore Hospital, Hematology Auckland New Zealand
| | - F. Offner
- Universitair Ziekenhuis Gent, Internal Medicine and Pediatrics Gent Belgium
| | - C. Moreno
- Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Hematology Barcelona Spain
| | - S. Dai
- Pharmacyclics LLC, an AbbVie Company, Biostatistics Sunnyvale USA
| | - A. Szoke
- Pharmacyclics LLC, an AbbVie Company, Oncology Sunnyvale USA
| | - J. P. Dean
- Pharmacyclics LLC, an AbbVie Company, Oncology Sunnyvale USA
| | - T. J. Kipps
- UCSD Moores Cancer Center, Blood Cancer Research Fund San Diego USA
| | - P. Ghia
- Università Vita‐Salute San Raffaele and IRCCS Ospedale San Raffaele, Medical Oncology Milan Italy
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6
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Barr PM, Owen C, Robak T, Tedeschi A, Bairey O, Burger JA, Hillmen P, Coutre SE, Devereux S, Grosicki S, McCarthy H, Li J, Simpson D, Offner FC, Moreno C, Dai S, Szoke A, Dean JP, Kipps TJ, Ghia P. Up to seven years of follow-up in the RESONATE-2 study of first-line ibrutinib treatment for patients with chronic lymphocytic leukemia. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7523] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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
7523 Background: Ibrutinib, a once-daily Bruton’s tyrosine kinase inhibitor, is the only targeted therapy with significant progression-free survival (PFS) and overall survival (OS) benefit in multiple randomized phase 3 studies versus established therapies in patients (pts) with previously untreated chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Extended long-term follow-up data for the RESONATE-2 study of first-line ibrutinib vs chlorambucil in older pts with CLL/SLL are reported. Methods: In the phase 3 RESONATE-2 study, older pts (≥65 years [y]) with previously untreated CLL/SLL and without del(17p) (N=269) were randomly assigned 1:1 to once-daily single-agent ibrutinib 420 mg until disease progression (PD) or unacceptable toxicity (n=136) or chlorambucil 0.5–0.8 mg/kg up to 12 cycles (n=133). Outcomes included PFS, OS, overall response rate (ORR), and safety. Long-term responses were investigator-assessed per 2008 iwCLL criteria. Results: With up to 7y of follow-up (median, 74.9 months; range, 0.1–86.8), significant PFS benefit was sustained for pts treated with ibrutinib vs chlorambucil (hazard ratio [HR] 0.160 [95% confidence interval (CI): 0.111–0.230]). At 6.5y, PFS was 61% in pts treated with ibrutinib vs 9% in pts treated with chlorambucil. This PFS benefit was observed across all subgroups, including in ibrutinib-treated pts with high-risk genomic features of unmutated IGHV (HR 0.109 [95% CI: 0.063–0.189]) or del(11q) (HR 0.033 [95% CI: 0.010–0.107]). OS at 6.5y was 78% with ibrutinib treatment. ORR was 92% for ibrutinib-treated pts with complete response (CR/CRi) rate increasing to 34% with this follow-up. Ongoing rates of grade ≥3 adverse events (AEs) of interest remained low for hypertension (5–6y interval: 5%, n=4; 6–7y: 4%, n=3) and atrial fibrillation (5–6y: 1%, n=1; 6–7y: 1%, n=1); no grade ≥3 major hemorrhage occurred in 5–7y. Dose reductions due to grade ≥3 AEs occurred in 1% (n=1) of pts during the 5–6y and 6–7y intervals. Across full follow-up, 31 pts had dose reductions due to any-grade AEs of whom 22/31 (71%) had resolution or improvement the AE. Primary reason for discontinuations in 5–7y was PD (5–6y: 5%, n=4; 6–7y: 6%, n=4). Any-grade AEs leading to discontinuations were seen in 3% (n=2) of pts from 5–6y and none in 6–7y. With over 7y of follow-up, 47% of pts remain on single-agent ibrutinib. Conclusions: Extended long-term data from RESONATE-2 demonstrate the sustained PFS and OS benefit of first-line ibrutinib treatment for pts with CLL, including for pts with high-risk genomic features. Responses continue to deepen over time. Rates of grade ≥3 AEs of interest continued to be low at up to 7y follow-up and further discontinuations and dose reductions due to AEs were rare; most AEs leading to dose reduction resolved or improved. Ibrutinib remains well tolerated with no new safety signals observed. Clinical trial information: NCT01722487, NCT01724346.
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Affiliation(s)
- Paul M. Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Carolyn Owen
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Tadeusz Robak
- Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | | | | | - Jan Andreas Burger
- University of Texas MD Anderson Cancer Center, Department of Leukemia, Houston, TX
| | - Peter Hillmen
- The Leeds Teaching Hospitals, St. James Institute of Oncology, Leeds, United Kingdom
| | - Steve E. Coutre
- Stanford Cancer Center, Stanford University School of Medicine, Stanford, CA
| | - Stephen Devereux
- Kings College Hospital, NHS Foundation Trust, London, United Kingdom
| | | | - Helen McCarthy
- Royal Bournemouth General Hospital, Bournemouth, United Kingdom
| | | | | | | | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Sandra Dai
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - Anita Szoke
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | | | | | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
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7
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Townsend W, Pasikowska M, Yallop D, Phillips EH, Patten PEM, Salisbury JR, Marcus R, Pepper A, Devereux S. The architecture of neoplastic follicles in follicular lymphoma; analysis of the relationship between the tumor and follicular helper T cells. Haematologica 2020; 105:1593-1603. [PMID: 31537685 PMCID: PMC7271595 DOI: 10.3324/haematol.2019.220160] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 09/18/2019] [Indexed: 12/15/2022] Open
Abstract
CD4+ T-follicular helper cells are essential for the survival, proliferation, and differentiation of germinal center B cells and have been implicated in the pathogenesis of follicular lymphoma (FL). To further define the role of these cells in FL, we used multiparameter confocal microscopy to compare the architecture of normal and neoplastic follicles and next generation sequencing to analyze the T-cell receptor repertoire in FL lymph nodes (LN). Multiparameter analysis of LN showed that the proportion of T-follic-ular helper cells (TFH) in normal and neoplastic follicles is the same and that the previously reported increase in TFH numbers in FL is thus due to an increase in the number and not content of follicles. As in normal germinal centers, TFH were shown to have a close spatial correlation with proliferating B cells in neoplastic follicles, where features of immunological synapse formation were observed. The number of TFH in FL correlate with the rate of B-cell proliferation and TFH co-localized to activation induced cytidine deaminase expressing proliferating B cells. T-cell receptor repertoire analysis of FL LN revealed that follicular areas are significantly more clonal when compared to the rest of the LN. These novel findings show that neoplastic follicles and germinal centers share important structural features and provide further evidence that TFH may play a role in driving B-cell proliferation and genomic evolution in TFH Our results also suggest that targeting this interaction would be an attractive therapeutic option.
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Affiliation(s)
- William Townsend
- Department of Haematological Medicine, Rayne Institute, King's College London, London
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London
| | - Marta Pasikowska
- Department of Haematological Medicine, Rayne Institute, King's College London, London
| | - Deborah Yallop
- Department of Haematological Medicine, Rayne Institute, King's College London, London
- Department of Haematology, King's College Hospital, London
| | - Elizabeth H Phillips
- Department of Haematological Medicine, Rayne Institute, King's College London, London
| | - Piers E M Patten
- Department of Haematological Medicine, Rayne Institute, King's College London, London
- Department of Haematology, King's College Hospital, London
| | | | - Robert Marcus
- Department of Haematology, King's College Hospital, London
| | - Andrea Pepper
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Stephen Devereux
- Department of Haematological Medicine, Rayne Institute, King's College London, London
- Department of Haematology, King's College Hospital, London
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8
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Byrd JC, Woyach JA, Furman RR, Martin P, O'Brien SM, Brown JR, Stephens DM, Barrientos JC, Devereux S, Hillmen P, Pagel JM, Hamdy AM, Izumi R, Patel P, Wang MH, Jain N, Wierda WG. Acalabrutinib in treatment-naïve chronic lymphocytic leukemia: Mature results from phase II study demonstrating durable remissions and long-term tolerability. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.8024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8024 Background: The next-generation Bruton tyrosine kinase inhibitor acalabrutinib was approved in patients (pts) with treatment-naïve (TN) and relapsed/refractory chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) based on two complementary phase 3 studies, ELEVATE-TN and ASCEND. This report of ACE-CL-001 (NCT02029443), the first phase 2 study of acalabrutinib, provides the longest safety and efficacy follow-up to date in symptomatic TN CLL pts. Methods: Adults with TN CLL/SLL were eligible if they met iwCLL 2008 criteria for treatment, were inappropriate for/declined standard chemotherapy and had ECOG performance status 0–2. Pts received acalabrutinib 100 mg BID or 200 mg QD, later switching to 100 mg BID, until progressive disease (PD) or unacceptable toxicity. Primary endpoint was safety. Events of clinical interest (ECI) were based on combined AE terms for infections, bleeding events, hypertension, and second primary malignancies (SPM) excluding non-melanoma skin, and on a single AE term for atrial fibrillation. Additional endpoints included investigator-assessed overall response rate (ORR), duration of response (DOR), time to response (TTR), and event-free survival (EFS). Results: Ninety-nine pts (n = 62 100 mg BID; n = 37 200 mg QD), were treated [median age: 64 years, 47% Rai stage 3–4 disease, 10% del(17p), 62% unmutated IGHV]. At median follow-up of 53 months (range, 1–59), 85 (86%) pts remain on treatment; most discontinuations were due to AEs (n = 6) or PD (n = 3 [n = 1 Richter transformation]). Most common AEs (any grade) were diarrhea (52%), headache (45%), upper respiratory tract infection (44%), arthralgia (42%), and contusion (42%). All-grade and grade ≥3 ECIs included infection (84%, 15%), bleeding events (66%, 3%), and hypertension (22%, 11%). Atrial fibrillation (all grades) occurred in 5% of pts (incidence: 1% in years 1, 2, 4; 3% in year 3). SPMs excluding non-melanoma skin (all grades) occurred in 11%. Serious AEs were reported in 38% of pts; those in > 2 pts were pneumonia (n = 4) and sepsis (n = 3). ORR was 97% (7% complete response; 90% partial response). Median TTR was 3.7 months (range, 2–22). Response rates were similar across high-risk groups. Median DOR and median EFS were not reached; 48-month DOR rate was 97% (95% CI, 90%–99%), and 48-month EFS rate was 90% (95% CI, 82%–94%). Conclusions: Long-term data from ACE-CL-001 further support the favorable results with acalabrutinib in phase 3 studies and demonstrate durable responses with no new long-term safety issues. Clinical trial information: NCT02029443 .
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Affiliation(s)
- John C. Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Richard R. Furman
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Peter Martin
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Susan Mary O'Brien
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA
| | | | | | | | - Stephen Devereux
- College Hospital, NHS Foundation Trust Denmark Hill, London, United Kingdom
| | - Peter Hillmen
- St. James's University Hospital, Leeds, United Kingdom
| | | | | | | | | | | | - Nitin Jain
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William G. Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
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9
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AJ W, KR F, Devereux S. Use of a Temporary Calcaneotibial Screw to Stabilize the Talocrural Joint in Dogs. Vet Comp Orthop Traumatol 2020. [DOI: 10.1055/s-0040-1712890] [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: 10/24/2022]
Affiliation(s)
- Worth AJ
- Working Dog Centre, Massey University, Palmerston North, New Zealand
| | - Frame KR
- Small Animal Surgery, Veterinary Specialty and Emergency Centre, Philadelphia, Pennsylvania, United States
| | - S Devereux
- Massey University Veterinary Teaching Hospital, School of Veterinary Science, Palmerston North, New Zealand
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10
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Burger JA, Barr PM, Robak T, Owen C, Ghia P, Tedeschi A, Bairey O, Hillmen P, Coutre SE, Devereux S, Grosicki S, McCarthy H, Simpson D, Offner F, Moreno C, Dai S, Lal I, Dean JP, Kipps TJ. Long-term efficacy and safety of first-line ibrutinib treatment for patients with CLL/SLL: 5 years of follow-up from the phase 3 RESONATE-2 study. Leukemia 2020; 34:787-798. [PMID: 31628428 PMCID: PMC7214263 DOI: 10.1038/s41375-019-0602-x] [Citation(s) in RCA: 284] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/08/2019] [Accepted: 08/22/2019] [Indexed: 11/08/2022]
Abstract
RESONATE-2 is a phase 3 study of first-line ibrutinib versus chlorambucil in chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). Patients aged ≥65 years (n = 269) were randomized 1:1 to once-daily ibrutinib 420 mg continuously or chlorambucil 0.5-0.8 mg/kg for ≤12 cycles. With a median (range) follow-up of 60 months (0.1-66), progression-free survival (PFS) and overall survival (OS) benefits for ibrutinib versus chlorambucil were sustained (PFS estimates at 5 years: 70% vs 12%; HR [95% CI]: 0.146 [0.098-0.218]; OS estimates at 5 years: 83% vs 68%; HR [95% CI]: 0.450 [0.266-0.761]). Ibrutinib benefit was also consistent in patients with high prognostic risk (TP53 mutation, 11q deletion, and/or unmutated IGHV) (PFS: HR [95% CI]: 0.083 [0.047-0.145]; OS: HR [95% CI]: 0.366 [0.181-0.736]). Investigator-assessed overall response rate was 92% with ibrutinib (complete response, 30%; 11% at primary analysis). Common grade ≥3 adverse events (AEs) included neutropenia (13%), pneumonia (12%), hypertension (8%), anemia (7%), and hyponatremia (6%); occurrence of most events as well as discontinuations due to AEs decreased over time. Fifty-eight percent of patients continue to receive ibrutinib. Single-agent ibrutinib demonstrated sustained PFS and OS benefit versus chlorambucil and increased depth of response over time.
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Affiliation(s)
- Jan A Burger
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Tadeusz Robak
- Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Carolyn Owen
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Osnat Bairey
- Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Peter Hillmen
- The Leeds Teaching Hospitals, St. James Institute of Oncology, University of Leeds, Leeds, UK
| | - Steven E Coutre
- Stanford Cancer Center, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Sebastian Grosicki
- Department of Hematology and Cancer Prevention, Silesiam Medical University, Katowice, Poland
| | | | | | | | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Sandra Dai
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | - Indu Lal
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | - James P Dean
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
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11
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Hillmen P, Rawstron AC, Brock K, Muñoz-Vicente S, Yates FJ, Bishop R, Boucher R, MacDonald D, Fegan C, McCaig A, Schuh A, Pettitt A, Gribben JG, Patten PE, Devereux S, Bloor A, Fox CP, Forconi F, Munir T. Ibrutinib Plus Venetoclax in Relapsed/Refractory Chronic Lymphocytic Leukemia: The CLARITY Study. J Clin Oncol 2019; 37:2722-2729. [PMID: 31295041 PMCID: PMC6879312 DOI: 10.1200/jco.19.00894] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The treatment of chronic lymphocytic leukemia (CLL) has been revolutionized by targeted therapies that either inhibit proliferation (ibrutinib) or reactivate apoptosis (venetoclax). Both significantly improve survival in CLL and replace chemoimmunotherapy for many patients. However, individually, they rarely lead to eradication of measurable residual disease (MRD) and usually are taken indefinitely or until progression. We present the CLARITY trial that combined ibrutinib with venetoclax to eradicate detectable CLL with the intention of stopping therapy. PATIENTS AND METHODS CLARITY is a phase II trial that combined ibrutinib with venetoclax in patients with relapsed or refractory CLL. The primary end point was eradication of MRD after 12 months of combined therapy. Key secondary end points were response by International Workshop on CLL criteria, safety, and progression-free and overall survival. RESULTS In 53 patients after 12 months of ibrutinib plus venetoclax, MRD negativity (fewer than one CLL cell in 10,000 leukocytes) was achieved in the blood of 28 (53%) and the marrow of 19 (36%). Forty-seven patients (89%) responded, and 27 (51%) achieved a complete remission. After a median follow-up of 21.1 months, one patient progressed, and all patients were alive. A single case of biochemical tumor lysis syndrome was observed. Other adverse effects were mild and/or manageable and most commonly were neutropenia or GI events. CONCLUSION The combination of ibrutinib plus venetoclax was well tolerated in patients with relapsed or refractory CLL. There was a high rate of MRD eradication that led to the cessation of therapy in some patients. The progression-free and overall survival rates are encouraging for relapsed and refractory CLL.
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Affiliation(s)
- Peter Hillmen
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
- St James’s Institute of Oncology, Leeds, United Kingdom
| | | | - Kristian Brock
- Cancer Research UK Clinical Trials Unit, Birmingham, United Kingdom
| | | | | | - Rebecca Bishop
- Cancer Research UK Clinical Trials Unit, Birmingham, United Kingdom
| | - Rebecca Boucher
- Cancer Research UK Clinical Trials Unit, Birmingham, United Kingdom
| | | | - Christopher Fegan
- University Hospital of Wales, Cardiff, United Kingdom
- Vale University Health Board, Cardiff, United Kingdom
| | - Alison McCaig
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Anna Schuh
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | | | - Piers E.M. Patten
- Kings College Hospital NHS Foundation Trust, London, United Kingdom
- King's College London, School of Cancer & Pharmaceutical Sciences, London, United Kingdom
| | - Stephen Devereux
- Kings College Hospital NHS Foundation Trust, London, United Kingdom
| | - Adrian Bloor
- Christie Hospital NHS Trust, Manchester, United Kingdom
| | | | - Francesco Forconi
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Cancer Sciences Unit, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, University of Southampton, Southampton, United Kingdom
| | - Talha Munir
- St James’s Institute of Oncology, Leeds, United Kingdom
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12
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Devereux S, Tavener-Smith L. Seasonal Food Insecurity among Farm Workers in the Northern Cape, South Africa. Nutrients 2019; 11:nu11071535. [PMID: 31284521 PMCID: PMC6683081 DOI: 10.3390/nu11071535] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 06/01/2019] [Revised: 06/26/2019] [Accepted: 06/26/2019] [Indexed: 11/16/2022] Open
Abstract
Very little is known about seasonal hunger in South Africa, or about the food security and nutritional status of farm workers. This article identifies a pathway to seasonal hunger—through intra-annual fluctuations in agricultural employment and income—that is underanalyzed in the literature. We report on findings from a year-long data collection process, comprising baseline and endline surveys and monthly monitoring of three food security indicators, with a sample of 195 female farm workers in the Northern Cape province in South Africa. The three monthly monitoring indicators—the Household Food Insecurity Access Scale (HFIAS), Dietary Diversity Score (DDS), and Coping Strategies Index (CSI)—which measure different aspects of food insecurity, are analyzed to determine whether and to what extent food security fluctuates seasonally in our sample. HFIAS results show unambiguous evidence of seasonal food insecurity, with the highest prevalence (88 percent experiencing severe food insecurity) and severity during the low employment winter period, and lowest prevalence (49 percent) and severity during the summer harvest, which corresponds with relatively higher employment and earnings. The DDS results show evidence of highest dietary diversity during summer and the CSI results reveal the need to employ coping strategies to deal with intensified food insecurity during winter.
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Affiliation(s)
- Stephen Devereux
- Institute of Development Studies, University of Sussex, Brighton, BN1 9RE, UK.
- Institute for Social Development, University of the Western Cape, Cape Town 7535, South Africa.
- Centre of Excellence in Food Security, University of the Western Cape, Cape Town 7535, South Africa.
| | - Lauren Tavener-Smith
- Institute for Social Development, University of the Western Cape, Cape Town 7535, South Africa
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13
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Coutre SE, Byrd JC, Hillmen P, Barrientos JC, Barr PM, Devereux S, Robak T, Kipps TJ, Schuh A, Moreno C, Furman RR, Burger JA, O'Dwyer M, Ghia P, Valentino R, Chang S, Dean JP, James DF, O'Brien SM. Long-term safety of single-agent ibrutinib in patients with chronic lymphocytic leukemia in 3 pivotal studies. Blood Adv 2019; 3:1799-1807. [PMID: 31196847 PMCID: PMC6595265 DOI: 10.1182/bloodadvances.2018028761] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/01/2019] [Indexed: 12/15/2022] Open
Abstract
Ibrutinib, a first-in-class once-daily oral Bruton tyrosine kinase inhibitor indicated for chronic lymphocytic leukemia (CLL), is continued until progressive disease or unacceptable toxicity. We conducted an integrated safety analysis of single-agent ibrutinib from randomized phase 3 studies PCYC-1112 (RESONATE, n = 195) and PCYC-1115/1116 (RESONATE-2, n = 135), and examined longer-term safety separately in the phase 1b/2 PCYC-1102/1103 study (n = 94, 420 mg/d). In the integrated analysis (ibrutinib treatment up to 43 months), the most common adverse events (AEs) were primarily grade 1/2; diarrhea (n = 173, 52% any-grade; n = 15, 5% grade 3) and fatigue (n = 119, 36% any-grade; n = 10, 3% grade 3). The most common grade 3/4 AEs were neutropenia (n = 60, 18%) and pneumonia (n = 38, 12%). Over time, prevalence of AEs of interest (diarrhea, fatigue, grade ≥3 infection, bleeding, and neutropenia) trended down; prevalence of hypertension increased, but incidence decreased after year 1. AEs led to dose reductions in 42 (13%) patients and permanent discontinuations in 37 (11%); dose modifications due to AEs were most common during year 1 and decreased in frequency thereafter. The most common AEs (preferred term) contributing to discontinuation included pneumonia (n = 4), anemia (n = 3), and atrial fibrillation (n = 3). With long-term follow-up on PCYC-1102/1103 (ibrutinib treatment up to 67 months), grade 3/4 AEs were generally similar to those in the integrated analysis. Overall, AEs were primarily grade 1/2 and manageable during prolonged ibrutinib treatment in patients with CLL. These trials were registered at www.clinicaltrials.gov as #NCT01578707, #NCT01722487, #NCT01724346, #NCT01105247, and #NCT01109069.
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Affiliation(s)
| | - John C Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Peter Hillmen
- Leeds Cancer Centre, St. James's Institute of Oncology, Leeds, United Kingdom
| | | | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester Cancer Center, Rochester, NY
| | - Stephen Devereux
- King's College Hospital, National Health Service Foundation Trust, London, United Kingdom
| | | | - Thomas J Kipps
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Anna Schuh
- Oxford National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Richard R Furman
- Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Jan A Burger
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Paolo Ghia
- Università Vita-Salute San Raffaele and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | | | - Stephen Chang
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA; and
| | - James P Dean
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA; and
| | | | - Susan M O'Brien
- Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA
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14
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Phillips E, Pepper A, Townsend W, Coulter E, Salisbury J, Apollonio B, Devereux S, Patten P. PS1304 FOLLICULAR HELPER T-CELLS FORM MUTUALLY SUPPORTIVE INTERACTIONS WITH FOLLICULAR LYMPHOMA B-CELLS THAT MAY SUPPORT TUMOUR GROWTH. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000563496.54236.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Tedeschi A, Burger J, Barr P, Robak T, Owen C, Ghia P, Bairey O, Hillmen P, Coutre S, Devereux S, Grosicki S, McCarthy H, Li J, Simpson D, Offner F, Moreno C, Dai S, Lal I, Dean J, Kipps T. FIVE-YEAR FOLLOW-UP OF FIRST-LINE IBRUTINIB FOR TREATMENT OF PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA//SMALL LYMPHOCYTIC LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.67_2629] [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)
- A. Tedeschi
- Department of Hematology; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - J. Burger
- Department of Leukemia; University of Texas MD Anderson Cancer Center; Houston TX United States
| | - P.M. Barr
- Department of Medicine, Wilmot Cancer Institute; University of Rochester Medical Center; Rochester NY United States
| | - T. Robak
- Department of Hematology, Medical University of Lodz; Copernicus Memorial Hospital; Lodz Poland
| | - C. Owen
- Department of Oncology; Tom Baker Cancer Centre, University of Calgary; Calgary AB Canada
| | - P. Ghia
- Department of Experimental Oncology; Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele; Milan Italy
| | - O. Bairey
- Department of Hematology; Rabin Medical Center; Petah Tikva Israel
| | - P. Hillmen
- Department of Medicine, The Leeds Teaching Hospitals; St. James Institute of Oncology; Leeds United Kingdom
| | - S. Coutre
- Department of Medicine, Stanford Cancer Center; Stanford University School of Medicine; Stanford CA United States
| | - S. Devereux
- Department of Hematology; Kings College Hospital, NHS Foundation Trust; London United Kingdom
| | - S. Grosicki
- Department of Internal Medicine; School of Public Health, Silesian Medical University; Katowice Poland
| | - H. McCarthy
- Department of Hematology; Royal Bournemouth General Hospital; Bournemouth United Kingdom
| | - J. Li
- Department of Medicine; Jiangsu Province Hospital; Nanjing China
| | - D. Simpson
- Department of Hematology; North Shore Hospital; Auckland New Zealand
| | - F. Offner
- Department of Clinical Hematology; Universitair Ziekenhuis Gent; Gent Belgium
| | - C. Moreno
- Department of Hematology; Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona; Barcelona Spain
| | - S. Dai
- Department of Biostatistics; Pharmacyclics LLC, an AbbVie Company; Sunnyvale CA United States
| | - I. Lal
- Department of Clinical Science; Pharmacyclics LLC, an AbbVie Company; Sunnyvale CA United States
| | - J.P. Dean
- Department of Clinical Science; Pharmacyclics LLC, an AbbVie Company; Sunnyvale CA United States
| | - T.J. Kipps
- Department of Medicine; UCSD Moores Cancer Center; La Jolla CA United States
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16
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17
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O'Brien SM, Byrd JC, Hillmen P, Coutre S, Brown JR, Barr PM, Barrientos JC, Devereux S, Robak T, Reddy NM, Kipps TJ, Tedeschi A, Cymbalista F, Ghia P, Chang S, Ninomoto J, James DF, Burger JA. Outcomes with ibrutinib by line of therapy and post-ibrutinib discontinuation in patients with chronic lymphocytic leukemia: Phase 3 analysis. Am J Hematol 2019; 94:554-562. [PMID: 30767298 PMCID: PMC6593416 DOI: 10.1002/ajh.25436] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 10/19/2018] [Revised: 01/02/2019] [Accepted: 02/11/2019] [Indexed: 12/05/2022]
Abstract
The efficacy of ibrutinib has been demonstrated in patients with chronic lymphocytic leukemia (CLL), including as first‐line therapy. However, outcomes after ibrutinib discontinuation have previously been limited to higher‐risk populations with relapsed/refractory (R/R) disease. The objective of this study was to evaluate outcomes of ibrutinib‐treated patients based on prior lines of therapy, including after ibrutinib discontinuation. Data were analyzed from two multicenter phase 3 studies of single‐agent ibrutinib: RESONATE (PCYC‐1112) in patients with R/R CLL and RESONATE‐2 (PCYC‐1115) in patients with treatment‐naive (TN) CLL without del(17p). This integrated analysis included 271 ibrutinib‐treated non‐del(17p) patients with CLL (136 TN and 135 R/R). Median progression‐free survival (PFS) was not reached for subgroups with 0 and 1/2 prior therapies but was 40.6 months for patients with ≥3 therapies (median follow‐up: TN, 36 months; R/R, 44 months). Median overall survival (OS) was not reached in any subgroup. Overall response rate (ORR) was 92% in TN and 92% in R/R, with depth of response increasing over time. Adverse events (AEs) and ibrutinib discontinuation due to AEs were similar between patient groups. Most patients (64%) remain on treatment. OS following discontinuation was 9.3 months in R/R patients (median follow‐up 18 months, n = 51) and was not reached in TN patients (median follow‐up 10 months, n = 30). In this integrated analysis, ibrutinib was associated with favorable PFS and OS, and high ORR regardless of prior therapies in patients with CLL. The best outcomes following ibrutinib discontinuation were for patients receiving ibrutinib in earlier lines of therapy.
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Affiliation(s)
- Susan M. O'Brien
- Department of Medicine, Division of Hematology/OncologyUniversity of California Irvine Irvine California
| | - John C. Byrd
- Department of Internal Medicine, Division of HematologyThe Ohio State University Medical Center Columbus Ohio
| | - Peter Hillmen
- Department of HaematologySt James's University Hospital Leeds United Kingdom
| | - Steven Coutre
- Department of Medicine, Division of HematologyStanford University School of Medicine Stanford California
| | - Jennifer R. Brown
- Department of Medicine, Division of Hematological MalignanciesDana‐Farber Cancer Institute Boston Massachusetts
| | - Paul M. Barr
- Department of MedicineWilmot Cancer Institute, University of Rochester Rochester New York
| | - Jacqueline C. Barrientos
- Department of Medicine, Division of Hematology and Medical OncologyHofstra Northwell School of Medicine Hempstead New York
| | - Stephen Devereux
- Department of Life Sciences and Medicine, Division of Cancer StudiesKings College Hospital London United Kingdom
| | - Tadeusz Robak
- Department of HematologyMedical University of Lodz and Copernicus Memorial Hospital Łódź Poland
| | - Nishitha M. Reddy
- Department of Medicine, Division of Hematology/OncologyVanderbilt University Medical Center Nashville Tennessee
| | - Thomas J. Kipps
- Department of Medicine, Division of Hematology‐OncologyUC San Diego Health, Moores Cancer Center San Diego California
| | | | - Florence Cymbalista
- Service Hematologie BiologiqueHôpital Avicenne, Université Paris 13 Bobigny France
| | - Paolo Ghia
- Strategic Research Program in CLL, Division of Experimental OncologyUniversitè Vita‐Salute San Raffaele and IRCCS Ospedale San Raffaele Milan Italy
| | - Stephen Chang
- BiostatisticsPharmacyclics LLC, an AbbVie Company Sunnyvale California
| | - Joi Ninomoto
- Clinical SciencePharmacyclics LLC, an AbbVie Company Sunnyvale California
| | - Danelle F. James
- Clinical SciencePharmacyclics LLC, an AbbVie Company Sunnyvale California
| | - Jan A. Burger
- Department of Leukemia, Division of Cancer MedicineUniversity of Texas MD Anderson Cancer Center Houston Texas
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18
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Phillips EH, Devereux S, Radford J, Mir N, Adedayo T, Clifton-Hadley L, Johnson R. Toxicity and efficacy of alemtuzumab combined with CHOP for aggressive T-cell lymphoma: a phase 1 dose-escalation trial. Leuk Lymphoma 2019; 60:2291-2294. [DOI: 10.1080/10428194.2019.1576870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - John Radford
- University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Naheed Mir
- Haematology Department, University Hospital Lewisham, London, UK
| | - Toyin Adedayo
- Cancer Research UK and University College London Cancer Trials Centre, London, UK
| | - Laura Clifton-Hadley
- Cancer Research UK and University College London Cancer Trials Centre, London, UK
| | - Rod Johnson
- Department of Haematology, Leeds Cancer Centre, Leeds, UK
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19
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Devereux S, Roelen K, Sabates R, Sabates-Wheeler R, Stoelinga D, Dyevre A. Graduating from food insecurity: evidence from graduation projects in Burundi and Rwanda. Food Secur 2019. [DOI: 10.1007/s12571-019-00887-1] [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: 10/27/2022]
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20
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Robak T, Burger JA, Tedeschi A, Barr PM, Owen C, Bairey O, Hillmen P, Simpson D, Grosicki S, Devereux S, McCarthy H, Coutre SE, Quach H, Gaidano G, Maslyak Z, Stevens DA, Moreno C, Gill DS, Flinn IW, Gribben JG, Mokatrin A, Cheng M, Styles L, James DF, Kipps TJ, Ghia P. Single-agent ibrutinib versus chemoimmunotherapy regimens for treatment-naïve patients with chronic lymphocytic leukemia: A cross-trial comparison of phase 3 studies. Am J Hematol 2018; 93:1402-1410. [PMID: 30129285 PMCID: PMC6221114 DOI: 10.1002/ajh.25259] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 08/01/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 01/03/2023]
Abstract
Chemoimmunotherapy (CIT) and targeted therapy with single‐agent ibrutinib are both recommended first‐line treatments for chronic lymphocytic leukemia (CLL), although their outcomes have not been directly compared. Using ibrutinib data from the RESONATE‐2 (PCYC‐1115/1116) study conducted in patients ≥65 years without del(17p), we performed a cross‐trial comparison with CIT data from published phase 3 studies in first‐line treatment of CLL. Progression‐free survival (PFS), overall survival (OS), and safety data for ibrutinib (median follow‐up 35.7 months) were evaluated alongside available CIT data. CIT regimens included: fludarabine + cyclophosphamide + rituximab (CLL8, CLL10), bendamustine + rituximab (CLL10), obinutuzumab + chlorambucil and rituximab + chlorambucil (CLL11), and ofatumumab + chlorambucil (COMPLEMENT‐1). Median age across studies was 61‐74 years, with older populations receiving ibrutinib, obinutuzumab + chlorambucil, or rituximab + chlorambucil. Median follow‐up varied across studies/regimens (range 14.5‐37.4 months). Among all patients, PFS appeared longer with ibrutinib relative to CIT and OS appeared comparable. Relative to CIT studies that similarly excluded patients with del(17p) (CLL10) or enrolled older/less‐fit patients (CLL11), PFS appeared favorable for ibrutinib in high‐risk subgroups, including advanced disease, bulky lymph nodes, unmutated IGHV status, and presence of del(11q). Grade ≥ 3 infections ranged from 9% (ofatumumab + chlorambucil) to 40% (fludarabine + cyclophosphamide + rituximab), and was 25% with ibrutinib. Grade ≥ 3 neutropenia was 12% for ibrutinib and 26%‐84% for CIT. Although definitive conclusions cannot be made due to inherent limitations of cross‐trial comparisons, this report suggests that ibrutinib has a favorable benefit/risk profile and may potentially eliminate the need for chemotherapy in some patients. Randomized, comparative studies are needed to support these findings.
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Affiliation(s)
- Tadeusz Robak
- Medical University of Lodz, Copernicus Memorial Hospital; Lodz Poland
| | - Jan A. Burger
- The University of Texas MD Anderson Cancer Center; Houston Texas
| | | | - Paul M. Barr
- Wilmot Cancer Institute, University of Rochester Cancer Center; Rochester New York
| | - Carolyn Owen
- Tom Baker Cancer Centre; University of Calgary; Calgary Alberta Canada
| | - Osnat Bairey
- Rabin Medical Center, Beilinson Hospital and Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Peter Hillmen
- The Leeds Teaching Hospitals, St. James's Institute of Oncology; Leeds UK
| | | | | | | | | | | | - Hang Quach
- St. Vincent's Hospital, University of Melbourne; Melbourne Australia
| | - Gianluca Gaidano
- Department of Translational Medicine; Amedeo Avogadro University of Eastern Piedmont; Novara Italy
| | - Zvenyslava Maslyak
- Institute of Blood Pathology and Transfusion Medicine of the Academy of Medical Sciences of Ukraine; Lviv Ukraine
| | | | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | | | - Ian W. Flinn
- Sarah Cannon Research Institute/Tennessee Oncology; Nashville Tennessee
| | - John G. Gribben
- Barts Cancer Institute, Queen Mary University of London; London UK
| | - Ahmad Mokatrin
- Pharmacyclics LLC, an AbbVie Company; Sunnyvale California
| | - Mei Cheng
- Pharmacyclics LLC, an AbbVie Company; Sunnyvale California
| | - Lori Styles
- Pharmacyclics LLC, an AbbVie Company; Sunnyvale California
| | | | - Thomas J. Kipps
- University of California San Diego; Moores Cancer Center; La Jolla California
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele; Milan Italy
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21
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Pratt G, Yap C, Oldreive C, Slade D, Bishop R, Griffiths M, Dyer MJS, Fegan C, Oscier D, Pettitt A, Matutes E, Devereux S, Allsup D, Bloor A, Hillmen P, Follows G, Rule S, Moss P, Stankovic T. A multi-centre phase I trial of the PARP inhibitor olaparib in patients with relapsed chronic lymphocytic leukaemia, T-prolymphocytic leukaemia or mantle cell lymphoma. Br J Haematol 2018; 182:429-433. [PMID: 28643365 DOI: 10.1111/bjh.14793] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
MESH Headings
- Aged
- Ataxia Telangiectasia Mutated Proteins/genetics
- DNA Damage/genetics
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Prolymphocytic, T-Cell/drug therapy
- Leukemia, Prolymphocytic, T-Cell/mortality
- Lymphoma, Mantle-Cell/drug therapy
- Lymphoma, Mantle-Cell/mortality
- Lymphoproliferative Disorders/drug therapy
- Lymphoproliferative Disorders/mortality
- Male
- Maximum Tolerated Dose
- Middle Aged
- Phthalazines/administration & dosage
- Phthalazines/adverse effects
- Phthalazines/therapeutic use
- Piperazines/administration & dosage
- Piperazines/adverse effects
- Piperazines/therapeutic use
- Poly(ADP-ribose) Polymerase Inhibitors/adverse effects
- Poly(ADP-ribose) Polymerase Inhibitors/therapeutic use
- Recurrence
- Survival Analysis
- Tumor Suppressor Protein p53/genetics
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Affiliation(s)
- Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christina Yap
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Ceri Oldreive
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Daniel Slade
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Rebecca Bishop
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Mike Griffiths
- West Midlands Regional Genetics Laboratory, Birmingham, UK
| | - Martin J S Dyer
- Department of Cancer Studies, University of Leicester, Leicester, UK
| | - Chris Fegan
- Cardiff and Vale University Health board, University Hospital of Wales, Cardiff, UK
| | - David Oscier
- Royal Bournemouth and Christchurch NHS Foundation Trust, Bournemouth, UK
| | - Andrew Pettitt
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | | | | | | | - Adrian Bloor
- The Christie NHS Foundation Trust, Manchester, UK
| | - Peter Hillmen
- St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - George Follows
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Simon Rule
- Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Paul Moss
- University of Birmingham, Birmingham, UK
| | - Tatjana Stankovic
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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22
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Mele S, Devereux S, Pepper AG, Infante E, Ridley AJ. Calcium-RasGRP2-Rap1 signaling mediates CD38-induced migration of chronic lymphocytic leukemia cells. Blood Adv 2018; 2:1551-1561. [PMID: 29970392 PMCID: PMC6039665 DOI: 10.1182/bloodadvances.2017014506] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/24/2018] [Indexed: 01/08/2023] Open
Abstract
CD38 is a transmembrane exoenzyme that is associated with poor prognosis in chronic lymphocytic leukemia (CLL). High CD38 levels in CLL cells are linked to increased cell migration, but the molecular basis is unknown. CD38 produces nicotinic acid adenine dinucleotide phosphate and adenosine 5'-diphosphate-ribose, both of which can act to increase intracellular Ca2+ levels. Here we show that CD38 expression increases basal intracellular Ca2+ levels and stimulates CLL cell migration both with and without chemokine stimulation. We find that CD38 acts via intracellular Ca2+ to increase the activity of the Ras family GTPase Rap1, which is in turn regulated by the Ca2+-sensitive Rap1 guanine-nucleotide exchange factor RasGRP2. Both Rap1 and RasGRP2 are required for CLL cell migration, and RasGRP2 is polarized in primary CLL cells with high CD38 levels. These results indicate that CD38 promotes RasGRP2/Rap1-mediated CLL cell adhesion and migration by increasing intracellular Ca2+ levels.
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Affiliation(s)
- Silvia Mele
- Randall Centre for Cell and Molecular Biophysics, and
- School of Cancer Sciences, King's College London, London, United Kingdom
| | - Stephen Devereux
- School of Cancer Sciences, King's College London, London, United Kingdom
| | - Andrea G Pepper
- School of Cancer Sciences, King's College London, London, United Kingdom
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom; and
| | | | - Anne J Ridley
- Randall Centre for Cell and Molecular Biophysics, and
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
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23
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Barr PM, Robak T, Owen C, Tedeschi A, Bairey O, Bartlett NL, Burger JA, Hillmen P, Coutre S, Devereux S, Grosicki S, McCarthy H, Li J, Simpson D, Offner F, Moreno C, Zhou C, Styles L, James D, Kipps TJ, Ghia P. Sustained efficacy and detailed clinical follow-up of first-line ibrutinib treatment in older patients with chronic lymphocytic leukemia: extended phase 3 results from RESONATE-2. Haematologica 2018; 103:1502-1510. [PMID: 29880603 PMCID: PMC6119145 DOI: 10.3324/haematol.2018.192328] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/04/2018] [Indexed: 12/15/2022] Open
Abstract
Results of RESONATE-2 (PCYC-1115/1116) supported approval of ibrutinib for first-line treatment of chronic lymphocytic leukemia. Extended analysis of RESONATE-2 was conducted to determine long-term efficacy and safety of ibrutinib in older patients with chronic lymphocytic leukemia. A total of 269 patients aged ≥65 years with previously untreated chronic lymphocytic leukemia without del(17p) were randomized 1:1 to ibrutinib (n=136) or chlorambucil (n=133) on days 1 and 15 of a 28-day cycle for 12 cycles. Median ibrutinib treatment duration was 28.5 months. Ibrutinib significantly prolonged progression-free survival versus chlorambucil (median, not reached vs. 15 months; hazard ratio, 0.12; 95% confidence interval, 0.07-0.20; P<0.0001). The 24-month progression-free survival was 89% with ibrutinib (97% and 89% in patients with del[11q] and unmutated immunoglobulin heavy chain variable region gene, respectively). Progression-free survival rates at 24 months were also similar regardless of age (<75 years [88%], ≥75 years [89%]). Overall response rate was 92% (125/136). Rate of complete response increased substantially from 7% at 12 months to 18% with extended follow up. Greater quality of life improvements occurred with ibrutinib versus chlorambucil in Functional Assessment of Chronic Illness Therapy-Fatigue (P=0.0013). The most frequent grade ≥3 adverse events were neutropenia (12%), anemia (7%), and hypertension (5%). Rate of discontinuations due to adverse events was 12%. Results demonstrated that first-line ibrutinib for elderly patients with chronic lymphocytic leukemia provides sustained response and progression-free survival benefits over chemotherapy, with depth of response improving over time without new toxicity concerns. This trial was registered at clinicaltrials.gov identifier 01722487 and 01724346.
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Affiliation(s)
| | | | | | | | - Osnat Bairey
- Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | - Jan A Burger
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Hillmen
- The Leeds Teaching Hospitals, St. James Institute of Oncology, UK
| | | | | | | | | | | | | | | | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cathy Zhou
- Pharmacyclics, LLC, an AbbVie Company, Sunnyvale, CA, USA
| | - Lori Styles
- Pharmacyclics, LLC, an AbbVie Company, Sunnyvale, CA, USA
| | - Danelle James
- Pharmacyclics, LLC, an AbbVie Company, Sunnyvale, CA, USA
| | - Thomas J Kipps
- University of California, San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele, Milan, Italy
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24
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Wierda WG, Brown JR, Stilgenbauer S, Coutre S, Byrd JC, Mato AR, Tam C, Barrientos JC, Jäger U, Devereux S, Cymbalista F, Barr PM, Dearden C, Montillo M, Moreno C, Liu EY, Szoke A, Dean JP, O'Brien SM. Prognostic role of beta-2 microglobulin (B2M) in relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL) patients (pts) treated with ibrutinib (ibr). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7521] [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: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - John C. Byrd
- The Ohio State University, Division of Hematology, Columbus, OH
| | - Anthony R. Mato
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Constantine Tam
- Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, Australia
| | | | - Ulrich Jäger
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Vienna General Hospital – Medical University of Vienna, Vienna, Austria
| | | | | | - Paul M. Barr
- University of Rochester Medical Center, Rochester, NY
| | - Claire Dearden
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Emily Y. Liu
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - Anita Szoke
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
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25
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Coulter EM, Pepper A, Mele S, Folarin N, Townsend W, Cuthill K, Phillips EH, Patten PEM, Devereux S. In vitro and in vivo evidence for uncoupling of B-cell receptor internalization and signaling in chronic lymphocytic leukemia. Haematologica 2017; 103:497-505. [PMID: 29242301 PMCID: PMC5830387 DOI: 10.3324/haematol.2017.176164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/12/2017] [Indexed: 12/24/2022] Open
Abstract
B-cell receptor activation, occurring within lymph nodes, plays a key role in the pathogenesis of chronic lymphocytic leukemia and is linked to prognosis. As well as activation of downstream signaling, receptor ligation triggers internalization, transit to acidified endosomes and degradation of ligand-receptor complexes. Herein, we investigated the relationship between these two processes in normal and leukemic B cells. We found that leukemic B cells, particularly anergic cases lacking the capacity to initiate downstream signaling, internalize and accumulate ligand in acidified endosomes more efficiently than normal B cells. Furthermore, ligation of either surface CD79B, a B-cell receptor component required for downstream signaling, or surface Immunoglobulin M (IgM) by cognate agonistic antibody, showed that the two molecules internalize independently of each other in leukemic but not normal B cells. Since association with surface CD79B is required for surface retention of IgM, this suggests that uncoupling of B-cell receptor internalization from signaling may be due to the dissociation of these two molecules in leukemic cells. A comparison of lymph node with peripheral blood cells from chronic lymphocytic leukemia patients showed that, despite recent B-cell receptor activation, lymph node B cells expressed higher levels of surface IgM. This surprising finding suggests that the B-cell receptors of lymph node- and peripheral blood-derived leukemic cells might be functionally distinct. Finally, long-term therapy with the Bruton’s tyrosine kinase inhibitors ibrutinib or acalabrutinib resulted in a switch to an anergic pattern of B-cell receptor function with reduced signaling capacity, surface IgM expression and more efficient internalization.
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Affiliation(s)
- Eve M Coulter
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London
| | - Andrea Pepper
- Brighton and Sussex Medical School, Medical research Building, University of Sussex, Brighton
| | - Silvia Mele
- St John's Institute of Dermatology, Department of Genetics and Molecular Medicine, King's College London
| | | | - William Townsend
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London
| | - Kirsty Cuthill
- Department of Haematological Medicine, Kings College Hospital, London, UK
| | - Elizabeth H Phillips
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London
| | - Piers E M Patten
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London.,Department of Haematological Medicine, Kings College Hospital, London, UK
| | - Stephen Devereux
- Department of Haematological Medicine, Kings College Hospital, London, UK
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26
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Devereux S. Response to the Clinical Commentary on electrical nerve stimulation for the management of equine trigeminal mediated headshaking by Dr K. J. Pickles. EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12875] [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: 11/26/2022]
Affiliation(s)
- S. Devereux
- Equine Acupuncture and Chiropractic Referrals Meadow Rise Salisbury Wiltshire UK
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27
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Marsilio S, Khiabanian H, Fabbri G, Vergani S, Scuoppo C, Montserrat E, Shpall EJ, Hadigol M, Marin P, Rai KR, Rabadan R, Devereux S, Pasqualucci L, Chiorazzi N. Somatic CLL mutations occur at multiple distinct hematopoietic maturation stages: documentation and cautionary note regarding cell fraction purity. Leukemia 2017; 32:1041-1044. [PMID: 29203856 PMCID: PMC5886053 DOI: 10.1038/leu.2017.343] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- S Marsilio
- Karches Center for Oncology Research, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - H Khiabanian
- Center for Systems and Computational Biology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - G Fabbri
- Institute for Cancer Genetics, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - S Vergani
- Karches Center for Oncology Research, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - C Scuoppo
- Institute for Cancer Genetics, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - E Montserrat
- Institute of Hematology and Oncology, Department of Hematology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - E J Shpall
- Department of Stem Cell Transplantation and Cell Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Hadigol
- Center for Systems and Computational Biology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - P Marin
- Institute of Hematology and Oncology, Department of Hematology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - K R Rai
- Karches Center for Oncology Research, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - R Rabadan
- Department of Systems Biology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - S Devereux
- Kings College Hospital, NHS Foundation Trust, London, UK
| | - L Pasqualucci
- Institute for Cancer Genetics, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - N Chiorazzi
- Karches Center for Oncology Research, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
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28
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Fararjeh FA, Mahmood S, Tachtatzis P, Yallop D, Devereux S, Patten P, Agrawal K, Suddle A, O'Grady J, Heaton N, Marcus R, Kassam S. A retrospective analysis of post-transplant lymphoproliferative disorder following liver transplantation. Eur J Haematol 2017; 100:98-103. [PMID: 29094407 DOI: 10.1111/ejh.12988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate response rates and survival in adults developing post-transplant lymphoproliferative disorder (PTLD) following liver transplantation. METHODS Patients were identified retrospectively and data collected through local liver and haematology electronic databases and pharmacy records. RESULTS Forty-five patients were identified. The median age at first transplant and at development of PTLD was 48 and 54 years, respectively, with the median time from transplant to PTLD diagnosis of 56 months. The majority of cases (76%) were monomorphic B-cell lymphomas, and 36% of tumours were EBV positive. Treatment involved reduction in immune-suppression (RIS) in 30 (67%) with RIS the only treatment in 3. Ten (22%) patients were treated with rituximab alone, 13 (29%) with chemotherapy alone and 14 (31%) patients were treated with rituximab and chemotherapy. Twenty-six (58%) patients achieved a complete response (CR). At a median follow-up of 27 months, the median overall survival (OS) was 50 months. Response and OS were not associated with clinical factors or the use of rituximab. CONCLUSION Outcomes reported in this study are favourable and comparable to those reported previously. The addition of rituximab did not appear to have improved outcomes in this series, although a significant proportion of patients were able to avoid chemotherapy.
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Affiliation(s)
- Feras Al Fararjeh
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, UK
| | - Shameem Mahmood
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, UK
| | - Phaedra Tachtatzis
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, UK
| | - Deborah Yallop
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, UK
| | - Stephen Devereux
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, UK
| | - Piers Patten
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, UK
| | - Kosh Agrawal
- Department of Hepatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Abid Suddle
- Department of Hepatology, King's College Hospital NHS Foundation Trust, London, UK
| | - John O'Grady
- Department of Hepatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Nigel Heaton
- Department of Hepatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Robert Marcus
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, UK
| | - Shireen Kassam
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, UK
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29
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Vidler J, Rogers C, Yallop D, Devereux S, Wellving E, Stewart O, Cox A, Hunt KF, Kassam S. Outpatient management of steroid-induced hyperglycaemia and steroid-induced diabetes in people with lymphoproliferative disorders treated with intermittent high dose steroids. J Clin Transl Endocrinol 2017; 9:18-20. [PMID: 29067264 PMCID: PMC5651285 DOI: 10.1016/j.jcte.2017.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/04/2017] [Revised: 06/18/2017] [Accepted: 06/21/2017] [Indexed: 11/28/2022] Open
Abstract
High dose steroids (HDS) are used in the treatment of haematological malignancies. The reported risk of steroid-induced diabetes (SID) is high. However, screening is not consistently performed. We implemented a protocol for detection and management of SID and steroid-induced hyperglycamia (SIH) in haematology outpatients receiving HDS. Eighty-three people were diagnosed with a lymphoproliferative disorder, of whom 6 had known Type 2 diabetes. Fifty-three people without known diabetes were screened by HbA1c and random venous plasma glucose. All patients (n = 34) subsequently prescribed HDS checked capillary blood glucose (CBG) pre-breakfast and pre-evening meal. Treatment algorithms used initiation and/or dose titration of gliclazide or human NPH insulin, aiming for pre-meal CBG 5-11 mmol/l. Type 2 diabetes was identified in 4/53 people screened (7.5%). Of 34 people treated with HDS, 17 (44%) developed SIH/SID. All 7 people with Type 2 diabetes developed SIH and 3 required insulin. Of 27 people without known diabetes, 8 (30%) developed SID and 1 required insulin. Pre-treatment HbA1c was higher in people who developed SID compared to those that did not (p = 0.002). This is the first report of a SID/SIH detection and treatment protocol for use in people with lymphoproliferative disorders receiving intermittent HDS, demonstrating its feasibility and safety.
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Affiliation(s)
- Jennifer Vidler
- Department of Haematology, King’s College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Charlotte Rogers
- Department of Haematology, King’s College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Deborah Yallop
- Department of Haematology, King’s College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Stephen Devereux
- Department of Haematology, King’s College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Ellinor Wellving
- Department of Haematology, King’s College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Orla Stewart
- Department of Haematology, King’s College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Alison Cox
- Department of Diabetes, King’s College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Katharine F. Hunt
- Department of Diabetes, King’s College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Shireen Kassam
- Department of Haematology, King’s College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
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30
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Affiliation(s)
- S. Devereux
- Equine Acupuncture and Chiropractic Referrals Meadow Rise Farley Salisbury Wiltshire UK
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Kipps TJ, Fraser G, Coutre S, Brown JR, Barrientos JC, Barr PM, Byrd JC, O'Brien SM, Dilhuydy MS, Devereux S, Jaeger U, Moreno C, Cramer P, Stilgenbauer S, Chanan-Khan AA, Mahler M, Salman M, Cheng M, Londhe A, Ninomoto J, Howes A, James D, Hallek M. Abstract CT158: Unmutated IGHV is not an adverse predictor of outcome to therapy with ibrutinib in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-ct158] [Citation(s) in RCA: 2] [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: 11/16/2022]
Abstract
Abstract
Background: Patients (pts) with CLL/SLL who use unmutated IGHV (u-CLL) have a less favorable outcome with standard chemotherapy than pts who use mutated IGHV (m-CLL). Ibrutinib (ibr) inhibits B-cell receptor signaling through Bruton’s tyrosine kinase and has robust clinical activity against CLL. This integrated analysis of 3 phase 3 studies examined the impact of IGHV status on ibr- and comparator (comp)-treated pts.
Methods: Pooled data from 3 studies of ibr (420 mg/d) in CLL/SLL pts (RESONATE: relapsed/refractory [R/R] pts, ibr vs ≤ 24 weeks ofatumumab; RESONATE-2: treatment-naïve [TN] pts ≥ 65 yrs of age [no del17p], ibr vs ≤ 12 cycles chlorambucil; HELIOS: R/R pts [no del17p], ≤ 6 cycles bendamustine-rituximab with ibr vs placebo) were analyzed by IGHV status. Analyses included Kaplan-Meier method (overall survival [OS]; progression-free survival [PFS]); log-rank test (group comparisons); and Cox multivariate analysis (prognostic factors; Table).
Results: For 491 ibr- (366 u-CLL, 125 m-CLL) and 494 comp-treated (351 u-CLL, 143 m-CLL) pts with IGHV data, baseline characteristics were similar for u-CLL vs m-CLL, except for the proportions of pts who were TN (17 vs 31%), had bulky disease (60 vs 37%), or had CLL cells with del11q (32 vs 16%). Median follow up was 21.4 mos for ibr and 20.6 mos for comp. PFS and OS were similar for u-CLL and m-CLL ibr-treated pts; u-CLL had poorer outcomes than m-CLL in comp-treated pts, which remained after adjustment for prognostic factors (Table). Ibr treatment was more effective than comp regardless of IGHV status. Incidence of adverse events (AEs) was similar between groups. For ibr vs comp pts (u-CLL/m-CLL): serious AEs: 49% (50%/47%) vs 36.5% (37%/35%); AEs that led to discontinuation: 12% (11%/15%) vs 13% (13%/14%); death within 30 days of last dose: 5% (6%/3%) vs 5% (6%/2%).
Conclusions: U-CLL was an adverse predictor of outcome for comp-treated, but not for ibr-treated pts.
Table.Efficacy Outcomes in Ibr- and Comparator-Treated Patients by IGHV Mutation StatusIbrutinib (N=491)Comparator (N =494)u-CLL (n=717)m-CLL (n=268)u-CLL(n=366): m-CLL(n=125)u-CLL(n=351): m-CLL(n=143)Ibr(n=366): Comp(n=351)Ibr (n=125): Comp (n=143)PFS24-month rate HR78%:81%10%:32%78%:10%81%:32%0.93a1.99a0.12b0.21bp = 0.78p < 0.0001p < 0.0001p <0.0001Adjusted HRc1.02a1.94a0.11b0.17bp = 0.93p < 0.0001p < 0.0001p < 0.0001OS24-month rate HR88%:89%78%:87%88%:78%89%:87%0.95a1.96a0.49b0.85b,ep = 0.86p = 0.02p < 0.01p = 0.66Adjusted HRc1.21a2.10a0.49bNAp =0.57p = 0.01p < 0.001Response ratesu-CLLm-CLLu-CLLm-CLLIbrCompIbrCompORR, %d8990475189479051p = 0.96p = 0.36p < 0.0001p < 0.0001CR, %d221546224156p = 0.10p = 0.44p < 0.0001p = 0.01CI, confidence interval; CR, complete response; HR, hazard ratio; ORR, overall response rate; NA, not applicable. aHR < 1 favors unmutated. bHR < 1 favors ibrutinib. cMultivariate Cox model adjusted for age, sex, current Rai stage, baseline ECOG performance status score, del11q, del17p, number of prior therapies, and cytopenias. dp value is from a Cochran-Mantel-Haenszel chi-square test. eInsufficient number of events prevents meaningful analysis, only 13 and 16 events observed in ibr and comp groups, respectively, and 46 (32%) pts in comp arm crossed over to ibr arm; interpret results with caution.
Citation Format: Thomas J. Kipps, Graeme Fraser, Steven Coutre, Jennifer R. Brown, Jacqueline C. Barrientos, Paul M. Barr, John C. Byrd, Susan M. O'Brien, Marie-Sarah Dilhuydy, Stephen Devereux, Ulrich Jaeger, Carol Moreno, Paula Cramer, Stephan Stilgenbauer, Asher A. Chanan-Khan, Michelle Mahler, Mariya Salman, Mei Cheng, Anil Londhe, Joi Ninomoto, Angela Howes, Danelle James, Michael Hallek. Unmutated IGHV is not an adverse predictor of outcome to therapy with ibrutinib in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr CT158. doi:10.1158/1538-7445.AM2017-CT158
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Affiliation(s)
| | - Graeme Fraser
- 2Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Steven Coutre
- 3Stanford Cancer Center, Stanford University School of Medicine, Stanford, CA
| | | | | | - Paul M. Barr
- 6Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
| | - John C. Byrd
- 7Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Stephen Devereux
- 10Kings College Hospital, NHS Foundation Trust, London, United Kingdom
| | - Ulrich Jaeger
- 11Division of Hematology and Hemostaseology, Medical University of Vienna, Wien, Austria
| | - Carol Moreno
- 12Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Paula Cramer
- 13Department of Internal Medicine and German CLL Study Group, University of Cologne, Cologne, Germany
| | - Stephan Stilgenbauer
- 14Department of Internal Medicine, Division of Hematology, University of Ulm, Ulm, Germany
| | | | | | | | - Mei Cheng
- 17Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - Anil Londhe
- 16Janssen Research and Development, Raritan, NJ
| | - Joi Ninomoto
- 17Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - Angela Howes
- 18Janssen Research and Development, High Wycombe, United Kingdom
| | - Danelle James
- 17Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - Michael Hallek
- 13Department of Internal Medicine and German CLL Study Group, University of Cologne, Cologne, Germany
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Dhanapal V, Gunasekara M, Lianwea C, Marcus R, De Lord C, Bowcock S, Devereux S, Patten P, Yallop D, Wrench D, Fields P, Kassam S. Outcome for patients with relapsed/refractory aggressive lymphoma treated with gemcitabine and oxaliplatin with or without rituximab; a retrospective, multicentre study. Leuk Lymphoma 2017; 58:1-9. [DOI: 10.1080/10428194.2016.1276288] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Vijay Dhanapal
- Department of Haematology, Medway Maritime Hospital, London, UK
| | | | - Chia Lianwea
- Department of Haematology, Medway Maritime Hospital, London, UK
| | - Robert Marcus
- Department of Haematology, King’s College Hospital, London, UK
| | - Corinne De Lord
- Department of Haematology, King’s College Hospital, London, UK
| | - Stella Bowcock
- Department of Haematology, King’s College Hospital, London, UK
| | | | - Piers Patten
- Department of Haematology, King’s College Hospital, London, UK
| | - Deborah Yallop
- Department of Haematology, King’s College Hospital, London, UK
| | - David Wrench
- Department of Haematology, Guy’s & St Thomas’ Hospital, London, UK
| | - Paul Fields
- Department of Haematology, Guy’s & St Thomas’ Hospital, London, UK
| | - Shireen Kassam
- Department of Haematology, King’s College Hospital, London, UK
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Eyre TA, Clifford R, Bloor A, Boyle L, Roberts C, Cabes M, Collins GP, Devereux S, Follows G, Fox CP, Gribben J, Hillmen P, Hatton CS, Littlewood TJ, McCarthy H, Murray J, Pettitt AR, Soilleux E, Stamatopoulos B, Love SB, Wotherspoon A, Schuh A. NCRI phase II study of CHOP in combination with ofatumumab in induction and maintenance in newly diagnosed Richter syndrome. Br J Haematol 2016; 175:43-54. [PMID: 27378086 DOI: 10.1111/bjh.14177] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/15/2016] [Indexed: 01/21/2023]
Abstract
Richter syndrome (RS) is associated with chemotherapy resistance and a poor historical median overall survival (OS) of 8-10 months. We conducted a phase II trial of standard CHOP-21 (cyclophosphamide, doxorubicin, vincristine, prednisolone every 21 d) with ofatumumab induction (Cycle 1: 300 mg day 1, 1000 mg day 8, 1000 mg day 15; Cycles 2-6: 1000 mg day 1) (CHOP-O) followed by 12 months ofatumumab maintenance (1000 mg given 8-weekly for up to six cycles). Forty-three patients were recruited of whom 37 were evaluable. Seventy-three per cent were aged >60 years. Over half of the patients received a fludarabine and cyclophosphamide-based regimen as prior CLL treatment. The overall response rate was 46% (complete response 27%, partial response 19%) at six cycles. The median progression-free survival was 6·2 months (95% confidence interval [CI] 4·9-14·0 months) and median OS was 11·4 months (95% CI 6·4-25·6 months). Treatment-naïve and TP53-intact patients had improved outcomes. Fifteen episodes of neutropenic fever and 46 non-neutropenic infections were observed. There were no treatment-related deaths. Seven patients received platinum-containing salvage at progression, with only one patient obtaining an adequate response to proceed to allogeneic transplantation. CHOP-O with ofatumumab maintenance provides minimal benefit beyond CHOP plus rutuximab. Standard immunochemotherapy for RS remains wholly inadequate for unselected RS. Multinational trials incorporating novel agents are urgently needed.
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Affiliation(s)
- Toby A Eyre
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Ruth Clifford
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- NIHR BRC Oxford Molecular Diagnostic Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Adrian Bloor
- Department of Haematology, The Christie Hospital NHS Trust, Wimslow Road, Manchester, UK
| | - Lucy Boyle
- OCTO - Oncology Clinical Trials Office, Department of Oncology, University of Oxford, Oxford, UK
| | - Corran Roberts
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Maite Cabes
- NIHR BRC Oxford Molecular Diagnostic Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Graham P Collins
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | | | - George Follows
- Department of Haematology, Addenbrooke's Hospital NHS Trust, Cambridge, UK
| | - Christopher P Fox
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - John Gribben
- Institute of Cancer, Barts & the London School of Medicine & Dentistry, London, UK
| | - Peter Hillmen
- St James's Institute of Oncology; Dena Cohen, University of Leeds, Leeds, UK
| | - Chris S Hatton
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Tim J Littlewood
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Helen McCarthy
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Jim Murray
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Andrew R Pettitt
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, Merseyside, UK
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Elizabeth Soilleux
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Basile Stamatopoulos
- NIHR BRC Oxford Molecular Diagnostic Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Sharon B Love
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Wotherspoon
- Laboratory of Clinical Cell Therapy, Jules Bordet Institute, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Anna Schuh
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK.
- NIHR BRC Oxford Molecular Diagnostic Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.
- Department of Histopathology, The Royal Marsden Hospital, London, UK.
- Department of Oncology, University of Oxford, Oxford, UK.
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Mehra V, Pomplum S, Ireland R, Yallop D, Devereux S, Marcus R, Shah C, Patten P, Kassam S. ALK-positive large B-cell lymphoma with strong CD30 expression; a diagnostic pitfall and resistance to brentuximab and crizotinib. Histopathology 2016; 69:880-882. [DOI: 10.1111/his.13002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Varun Mehra
- Department of Haematology; King's College Hospital; London UK
| | - Sabine Pomplum
- Department of Histopathology; University College Hospital; London UK
| | - Robin Ireland
- Department of Haematology; King's College Hospital; London UK
| | - Deborah Yallop
- Department of Haematology; King's College Hospital; London UK
| | | | - Robert Marcus
- Department of Haematology; King's College Hospital; London UK
| | - Chirag Shah
- Department of Histopathology; King's College Hospital; London UK
| | - Piers Patten
- Department of Haematology; King's College Hospital; London UK
| | - Shireen Kassam
- Department of Haematology; King's College Hospital; London UK
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O'Brien SM, Byrd JC, Hillmen P, Coutre S, Brown JR, Barr PM, Barrientos JC, Devereux S, Robak T, Reddy NM, Kipps TJ, Tedeschi A, Cymbalista F, Ghia P, Chang S, Ninomoto JS, James DF, Burger JA. Outcomes with ibrutinib by line of therapy in patients with CLL: Analyses from phase III data. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7520] [Citation(s) in RCA: 8] [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: 11/20/2022] Open
Affiliation(s)
| | - John C. Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Peter Hillmen
- St. James's University Hospital, Leeds, United Kingdom
| | | | | | - Paul M. Barr
- Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | | | | | - Tadeusz Robak
- Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland
| | | | - Thomas J. Kipps
- University of California San Diego/Moores Cancer Center, La Jolla, CA
| | | | | | - Paolo Ghia
- Universita Vita-Salute San Raffaele and IRCCS Instituto Scientifico San Raffaele, Milano, Italy
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Burger JA, Tedeschi A, Barr PM, Robak T, Owen C, Ghia P, Bairey O, Hillmen P, Bartlett NL, Li J, Simpson D, Grosicki S, Devereux S, McCarthy H, Coutre S, Quach H, Gaidano G, Maslyak Z, Stevens DA, Janssens A, Offner F, Mayer J, O'Dwyer M, Hellmann A, Schuh A, Siddiqi T, Polliack A, Tam CS, Suri D, Cheng M, Clow F, Styles L, James DF, Kipps TJ. Ibrutinib as Initial Therapy for Patients with Chronic Lymphocytic Leukemia. N Engl J Med 2015; 373:2425-37. [PMID: 26639149 PMCID: PMC4722809 DOI: 10.1056/nejmoa1509388] [Citation(s) in RCA: 1092] [Impact Index Per Article: 121.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) primarily affects older persons who often have coexisting conditions in addition to disease-related immunosuppression and myelosuppression. We conducted an international, open-label, randomized phase 3 trial to compare two oral agents, ibrutinib and chlorambucil, in previously untreated older patients with CLL or small lymphocytic lymphoma. METHODS We randomly assigned 269 previously untreated patients who were 65 years of age or older and had CLL or small lymphocytic lymphoma to receive ibrutinib or chlorambucil. The primary end point was progression-free survival as assessed by an independent review committee. RESULTS The median age of the patients was 73 years. During a median follow-up period of 18.4 months, ibrutinib resulted in significantly longer progression-free survival than did chlorambucil (median, not reached vs. 18.9 months), with a risk of progression or death that was 84% lower with ibrutinib than that with chlorambucil (hazard ratio, 0.16; P<0.001). Ibrutinib significantly prolonged overall survival; the estimated survival rate at 24 months was 98% with ibrutinib versus 85% with chlorambucil, with a relative risk of death that was 84% lower in the ibrutinib group than in the chlorambucil group (hazard ratio, 0.16; P=0.001). The overall response rate was higher with ibrutinib than with chlorambucil (86% vs. 35%, P<0.001). The rates of sustained increases from baseline values in the hemoglobin and platelet levels were higher with ibrutinib. Adverse events of any grade that occurred in at least 20% of the patients receiving ibrutinib included diarrhea, fatigue, cough, and nausea; adverse events occurring in at least 20% of those receiving chlorambucil included nausea, fatigue, neutropenia, anemia, and vomiting. In the ibrutinib group, four patients had a grade 3 hemorrhage and one had a grade 4 hemorrhage. A total of 87% of the patients in the ibrutinib group are continuing to take ibrutinib. CONCLUSIONS Ibrutinib was superior to chlorambucil in previously untreated patients with CLL or small lymphocytic lymphoma, as assessed by progression-free survival, overall survival, response rate, and improvement in hematologic variables. (Funded by Pharmacyclics and others; RESONATE-2 ClinicalTrials.gov number, NCT01722487.).
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Affiliation(s)
- Jan A Burger
- From the University of Texas MD Anderson Cancer Center, Houston (J.A.B.); Azienda Ospedaliera Niguarda Cà Granda (A.T.) and Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele (P.G.), Milan, and the Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara (G.G.) - all in Italy; Wilmot Cancer Institute, University of Rochester, Rochester, NY (P.M.B.); Medical University of Lodz and Copernicus Memorial Hospital, Lodz (T.R.), the Department of Cancer Prevention, School of Public Health, Medical University of Silesia, Katowice (S.G.), and the Department of Hematology, University Clinical Center of Medical University of Gdansk, Gdansk (A.H.) - all in Poland; Tom Baker Cancer Centre, Calgary, AB, Canada (C.O.); Rabin Medical Center, Beilinson Hospital and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (O.B.), and Hadassah University Hospital, Hebrew University Medical School, Jerusalem (A.P.) - both in Israel; Leeds Teaching Hospitals, St. James Institute of Oncology, Leeds (P.H.), Kings College Hospital, London (S.D.), Royal Bournemouth Hospital, Bournemouth (H.M.), and University of Oxford, Oxford (A.S.) - all in the United Kingdom; Washington University School of Medicine, St. Louis (N.L.B.); Jiangsu Province Hospital, Nanjing, China (J.L.); North Shore Hospital, Auckland, New Zealand (D. Simpson); Stanford University School of Medicine, Stanford (S.C.), City of Hope National Medical Center, Duarte (T.S.), Pharmacyclics, Sunnyvale (D. Suri, M.C., F.C., L.S., D.F.J.), and Moores Cancer Center, University of California, San Diego, San Diego (T.J.K.) - all in California; St. Vincent's Hospital, University of Melbourne (H.Q.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital (C.S.T.), Melbourne, VIC, Australia; Institute of Blood Pathology and Transfusion Medicine, National Academy of Medical Sciences of Ukraine, Lviv, Ukraine (Z.M.); Norton Cancer Institute, Louisville, KY (D.A.S.)
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Bürgler S, Gimeno A, Parente-Ribes A, Wang D, Os A, Devereux S, Jebsen P, Bogen B, Tjønnfjord GE, Munthe LA. Chronic lymphocytic leukemia cells express CD38 in response to Th1 cell-derived IFN-γ by a T-bet-dependent mechanism. J Immunol 2014; 194:827-35. [PMID: 25505279 DOI: 10.4049/jimmunol.1401350] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is a B cell malignancy associated with increased levels of inflammatory cytokines. Similarly, expression of CD38 on CLL cells correlates with CLL cell survival and proliferation, but the mechanisms that regulate CD38 expression and inflammatory cytokines remain unclear. We have recently demonstrated that patients have CLL-specific Th cells that support CLL proliferation. In this article, we show that CLL cells attract such Th cells, thereby establishing an Ag-dependent collaboration. Blocking experiments performed in vitro as wells as in vivo, using a xenograft model, revealed that secretion of IFN-γ was a major mechanism by which CLL-specific Th cells increased CD38 on CLL cells. The expression of the transcription factor T-bet in peripheral blood CLL cells significantly correlated with CD38 expression, and transient transfection of CLL cells with T-bet resulted in T-bet(hi)CD38(hi) cells. Finally, chromatin immunoprecipitation experiments revealed that T-bet can bind to regulatory regions of the CD38 gene. These data suggest that CLL cells attract CLL-specific Th cells and initiate a positive feedback loop with upregulation of T-bet, CD38, and type 1 chemokines allowing further recruitment of Th cells and increased type 1 cytokine secretion. This insight provides a cellular and molecular mechanism that links the inflammatory signature observed in CLL pathogenesis with CD38 expression and aggressive disease and suggests that targeting the IFN-γ/IFN-γR/JAK/STAT/T-bet/CD38 pathway could play a role in the therapy of CLL.
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Affiliation(s)
- Simone Bürgler
- Centre for Immune Regulation, Department of Immunology, University of Oslo, Oslo University Hospital, NO-0424 Oslo, Norway; Department of Hematology, Oslo University Hospital, NO-0424 Oslo, Norway; Experimental Infectious Diseases and Cancer Research, University Children's Hospital Zürich, University of Zürich, CH-8008 Zurich, Switzerland;
| | - Aleix Gimeno
- Centre for Immune Regulation, Department of Immunology, University of Oslo, Oslo University Hospital, NO-0424 Oslo, Norway; Department of Hematology, Oslo University Hospital, NO-0424 Oslo, Norway
| | - Anna Parente-Ribes
- Centre for Immune Regulation, Department of Immunology, University of Oslo, Oslo University Hospital, NO-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, NO-0424 Oslo, Norway
| | - Dong Wang
- Centre for Immune Regulation, Department of Immunology, University of Oslo, Oslo University Hospital, NO-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, NO-0424 Oslo, Norway
| | - Audun Os
- Centre for Immune Regulation, Department of Immunology, University of Oslo, Oslo University Hospital, NO-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, NO-0424 Oslo, Norway
| | - Stephen Devereux
- Department of Hematological Medicine, King's College London, London SE5 9RS, United Kingdom
| | - Peter Jebsen
- Department of Pathology, Oslo University Hospital, NO-0424 Oslo, Norway; and
| | - Bjarne Bogen
- Centre for Immune Regulation, Department of Immunology, University of Oslo, Oslo University Hospital, NO-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, NO-0424 Oslo, Norway; K. G. Jebsen Centre for Influenza Vaccine Research, Department of Immunology, Oslo University Hospital, University of Oslo, NO-0424 Oslo, Norway
| | - Geir E Tjønnfjord
- Department of Hematology, Oslo University Hospital, NO-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, NO-0424 Oslo, Norway;
| | - Ludvig A Munthe
- Centre for Immune Regulation, Department of Immunology, University of Oslo, Oslo University Hospital, NO-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, NO-0424 Oslo, Norway;
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38
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Pepper C, Buggins AGS, Jones CH, Walsby EJ, Forconi F, Pratt G, Devereux S, Stevenson FK, Fegan C. Phenotypic heterogeneity in IGHV-mutated CLL patients has prognostic impact and identifies a subset with increased sensitivity to BTK and PI3Kδ inhibition. Leukemia 2014; 29:744-7. [PMID: 25349153 PMCID: PMC4360209 DOI: 10.1038/leu.2014.308] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- C Pepper
- Cardiff CLL Research Group, Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - A G S Buggins
- Department of Haematology, King's College London, London, UK
| | - C H Jones
- Cardiff CLL Research Group, Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - E J Walsby
- Cardiff CLL Research Group, Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - F Forconi
- Cancer Sciences Unit, CRUK Clinical Centre, University of Southampton, Southampton, UK
| | - G Pratt
- CRUK Institute for Cancer Studies, University of Birmingham, Birmingham, UK
| | - S Devereux
- Department of Haematology, King's College London, London, UK
| | - F K Stevenson
- Cancer Sciences Unit, CRUK Clinical Centre, University of Southampton, Southampton, UK
| | - C Fegan
- Cardiff CLL Research Group, Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
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39
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Wang M, Wang W, Abeywardane A, Adikarama M, McLornan D, Raj K, de Lavallade H, Devereux S, Mufti GJ, Pagliuca A, Potter VT, Mijovic A. Autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation: analysis of 533 adult patients who underwent transplantation at King's College Hospital. Biol Blood Marrow Transplant 2014; 21:60-6. [PMID: 25262883 DOI: 10.1016/j.bbmt.2014.09.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/15/2014] [Indexed: 01/08/2023]
Abstract
Autoimmune hemolytic anemia (AIHA) is a recognized complication of hematopoietic stem cell transplantation (HSCT); it is often refractory to treatment and carries a high mortality. To improve understanding of the incidence, risk factors, and clinical outcome of post-transplantation AIHA, we analyzed 533 patients who received allogeneic HSCT, and we identified 19 cases of AIHA after HSCT (overall incidence, 3.6%). The median time to onset, from HSCT to AIHA, was 202 days. AIHA was associated with HSCT from unrelated donors (hazard ratio [HR], 5.28; 95% confidence interval [CI], 1.22 to 22.9; P = .026). In the majority (14 of 19; 74%) of AIHA patients, multiple agents for treatment were required, with only 9 of 19 (47%) patients achieving complete resolution of AIHA. Patients with post-transplantation AIHA had a higher overall mortality (HR, 2.48; 95% CI, 1.33 to 4.63; P = .004), with 36% (4 of 11 cases) of deaths attributable to AIHA.
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Affiliation(s)
- Meng Wang
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom.
| | - Wenjia Wang
- School of Computing Sciences, University of East Anglia, Norwich, United Kingdom
| | - Ayesha Abeywardane
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom
| | - Malinthi Adikarama
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom
| | - Donal McLornan
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom
| | - Kavita Raj
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom
| | - Hugues de Lavallade
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom
| | - Stephen Devereux
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom
| | - Ghulam J Mufti
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom
| | - Antonio Pagliuca
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom
| | - Victoria T Potter
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom
| | - Aleksandar Mijovic
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom
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40
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Abstract
Chronic lymphocytic leukemia (CLL) cells proliferate predominantly in niches in the lymph nodes, where signaling from the B cell receptor (BCR) and the surrounding microenvironment are critical for disease progression. In addition, leukemic cells traffic constantly from the bloodstream into the lymph nodes, migrate within lymphatic tissues and egress back to the bloodstream. These processes are driven by chemokines and their receptors, and depend on changes in cell migration and integrin-mediated adhesion. Here we describe how Rho and Rap guanosine triphosphatases (GTPases) contribute to both BCR signaling and chemokine receptor signaling, particularly by regulating cytoskeletal dynamics and integrin activity. We propose that new inhibitors of BCR-activated kinases are likely to affect CLL cell trafficking via Rho and Rap GTPases, and that upstream regulators or downstream effectors could be good targets for therapeutic intervention in CLL.
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Affiliation(s)
- Silvia Mele
- Randall Division of Cell and Molecular Biophysics, King's College London , London , UK
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41
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Noriega V, Kaur H, Devereux S, Byrne J, Marcus R, Haynes A, Yallop D, McMillan A, Ingram W, Khan A, Kenyon M, Potter V, Russell N, Mufti GJ, Pagliuca A. Long term follow-up of BEAM-autologous and BEAM-alemtuzumab allogeneic stem cell transplantation in relapsed advanced stage follicular lymphoma. Leuk Res 2014; 38:737-43. [PMID: 24787231 DOI: 10.1016/j.leukres.2014.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/17/2014] [Accepted: 03/09/2014] [Indexed: 10/25/2022]
Abstract
This is an analysis in 171 patients comparing BEAM-Auto and BEAM-Allo (alemtuzumab)-hematopoietic stem cell transplantation in relapsed follicular lymphoma. BEAM-Allo group had a lower 10 years cumulative incidence of relapse(31.4% vs 55.1%, p=0.042), a trend to a plateau in survival but no statistical differences in OS or DFS, and a TRM of 24%. When transplanted in CR BEAM-Allo patients had better OS and DFS. Incidence of acute and chronic GVHD was 16.6% and 22%. 29% of BEAM-Allo patients received DLI (all but two remain in CR and alive). Our data supports Allo-HSCT as a potential curative treatment for selected patients with FL.
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Affiliation(s)
- Victor Noriega
- Department of Haematological Medicine, King's College London and Kings College Hospital, London, UK.
| | - Harpreet Kaur
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, UK
| | - Stephen Devereux
- Department of Haematological Medicine, King's College London and Kings College Hospital, London, UK
| | - Jennifer Byrne
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, UK
| | - Robert Marcus
- Department of Haematological Medicine, King's College London and Kings College Hospital, London, UK
| | - Andrew Haynes
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, UK
| | - Deborah Yallop
- Department of Haematological Medicine, King's College London and Kings College Hospital, London, UK
| | - Andrew McMillan
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, UK
| | - Wendy Ingram
- Department of Haematological Medicine, King's College London and Kings College Hospital, London, UK
| | - Anjum Khan
- Department of Haematological Medicine, King's College London and Kings College Hospital, London, UK
| | - Michelle Kenyon
- Department of Haematological Medicine, King's College London and Kings College Hospital, London, UK
| | - Victoria Potter
- Department of Haematological Medicine, King's College London and Kings College Hospital, London, UK
| | - Nigel Russell
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, UK
| | - Ghulam J Mufti
- Department of Haematological Medicine, King's College London and Kings College Hospital, London, UK
| | - Antonio Pagliuca
- Department of Haematological Medicine, King's College London and Kings College Hospital, London, UK
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42
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Cutino-Moguel T, Lauinger IL, Srivastava S, Zuckerman M, Tong CYW, Devereux S. Analysis of a potential cluster of rhinovirus infections in patients and staff on two haemato-oncology wards. J Clin Virol 2014; 60:57-9. [PMID: 24630953 DOI: 10.1016/j.jcv.2014.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/24/2013] [Accepted: 02/07/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Human rhinoviruses (HRV) cause the common cold, increased mortality in patients attending elderly care facilities and significant morbidity as well as mortality in the post-transplantation setting. OBJECTIVES The aim of the study was to determine if there had been a breakdown in infection control practice in a large haemato-oncology centre. Molecular techniques had detected increased numbers of HRV in respiratory samples from patients and staff over a 6-week period. Typing was performed to investigate the possibility of transmission between individuals. STUDY DESIGN This was a retrospective study having detected HRV RNA in combined nose and throat swab samples that were collected from 13 individuals: 8 patients and 5 staff members, in the haemato-oncology wards of a tertiary referral centre in January and February 2011. The 5'NTR and the VP4/VP2 region were used for HRV typing. RESULTS All 3 HRV species were detected with 7 HRV-A, 1 HRV-B, 4 HRV-C and 1 untyped. None of the individuals were infected by the same HRV serotype. Three individuals had multiple samples collected: 1 patient had an HRV-B infection over a 4-week period, 1 patient had an HRV-A infection over 3 months and 1 staff member had an HRV-C infection over 1 week, each shedding an unchanged serotype throughout the whole period. CONCLUSION Nucleotide sequence analysis confirmed that there was no breakdown in infection control measures. No transmission incidents had occurred between patients and/or between staff and patients.
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Affiliation(s)
- T Cutino-Moguel
- South London Specialist Virology Centre, King's College Hospital NHS Foundation Trust, Denmark Hill SE5 9RS
| | - I L Lauinger
- Department of Infectious Diseases, King's College London School of Medicine, London SE1 7EH, UK; Department of Infectious Diseases and Centre for Clinical Infection and Diagnostics Research (CIDR), Guy's and St. Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - S Srivastava
- South London Specialist Virology Centre, King's College Hospital NHS Foundation Trust, Denmark Hill SE5 9RS
| | - M Zuckerman
- South London Specialist Virology Centre, King's College Hospital NHS Foundation Trust, Denmark Hill SE5 9RS.
| | - C Y W Tong
- Department of Infectious Diseases, King's College London School of Medicine, London SE1 7EH, UK; Department of Infectious Diseases and Centre for Clinical Infection and Diagnostics Research (CIDR), Guy's and St. Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - S Devereux
- King's College Hospital NHS Foundation Trust, Haematological Medicine, Denmark Hill SE5 9RS
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43
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Potter VT, Krishnamurthy P, Barber LD, Lim Z, Kenyon M, Ireland RM, de Lavallade H, Dhouri A, Marsh JCW, Marcus R, Devereux S, Ho A, Pagliuca A, Mufti GJ. Long-term outcomes of alemtuzumab-based reduced-intensity conditioned hematopoietic stem cell transplantation for myelodysplastic syndrome and acute myelogenous leukemia secondary to myelodysplastic syndrome. Biol Blood Marrow Transplant 2013; 20:111-7. [PMID: 24216184 DOI: 10.1016/j.bbmt.2013.10.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 10/22/2013] [Indexed: 12/01/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) with reduced-intensity conditioning (RIC) offers a potential cure for patients with myelodysplastic syndrome (MDS) who are ineligible for standard-intensity regimens. Previously published data from our institution suggest excellent outcomes at 1 yr using a uniform fludarabine, busulfan, and alemtuzumab-based regimen. Here we report long-term follow-up of 192 patients with MDS and acute myelogenous leukemia (AML) secondary to MDS (MDS-AML) transplanted with this protocol, using sibling (n = 45) or matched unrelated (n = 147) donors. The median age of the cohort was 57 yr (range, 21 to 72 yr), and median follow-up was 4.5 yr (range, 0.1 to 10.6 yr). The 5-yr overall survival (OS), event-free survival, and nonrelapse mortality were 44%, 33%, and 26% respectively. The incidence of de novo chronic graft-versus-host disease (GVHD) was low at 19%, illustrating the efficacy of alemtuzumab for GVHD prophylaxis. Conversely, the 5-yr relapse rate was 51%. For younger patients (age <50 yr), the 5-yr OS and relapse rates were 58% and 39%, respectively. On multivariate analysis, advanced age predicted significantly worse outcomes, with patients age >60 yr having a 5-yr OS of 15% and relapse rate of 66%. Patients receiving preemptive donor lymphocyte infusions had an impressive 5-yr OS of 67%, suggesting that this protocol may lend itself to the incorporation of immunotherapeutic strategies. Overall, these data demonstrate good 5-yr OS for patients with MDS and MDS-AML undergoing alemtuzumab-based RIC-HSCT. The low rate of chronic GVHD is encouraging, and comparative studies with other RIC protocols are warranted.
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Affiliation(s)
- Victoria T Potter
- Department of Haematological Medicine, King's College Hospital, London, UK
| | | | - Linda D Barber
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Ziyi Lim
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Michelle Kenyon
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Robin M Ireland
- Department of Haematological Medicine, King's College Hospital, London, UK
| | | | - Abdel Dhouri
- Department of Statistics, King's College, London, UK
| | - Judith C W Marsh
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Robert Marcus
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Stephen Devereux
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Aloysius Ho
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Antonio Pagliuca
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Ghulam J Mufti
- Department of Haematological Medicine, King's College Hospital, London, UK.
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44
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Cuthill K, Devereux S. How I treat patients with relapsed chronic lymphocytic leukaemia. Br J Haematol 2013; 163:423-35. [DOI: 10.1111/bjh.12549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/29/2013] [Indexed: 01/29/2023]
Affiliation(s)
- Kirsty Cuthill
- Department of Haematological Medicine; Kings College; London UK
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45
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Byrd JC, Barrientos JC, Devereux S, Brown JR, Kay NE, Reddy NM, O'Brien SM, Kipps TJ, Furman RR, Schuster SJ, Bloor A, Gill DS, Thornton P, Dearden CE, Jäger U, Barker C, Lin J, Kunkel LA, James DF, Hillmen P. A randomized, multicenter, open-label, phase III study of the Bruton tyrosine kinase (BTK) inhibitor ibrutinib (PCI-32765) versus ofatumumab in patients (pts) with relapsed or refractory (RR) chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL): RESONATE. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.tps8619] [Citation(s) in RCA: 1] [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
TPS8619 Background: Chemoimmunotherapy (CIT) treatment approaches such as FCR have markedly improved outcomes for CLL pts when administered as initial or second-line therapy. Despite this progress, virtually all pts relapse and effective salvage regimens that induce durable remissions or can be administered safely to elderly pts or those with comorbidities are lacking. BTK, an essential mediator of B-cell receptor signaling, is a novel target in CLL. Ibrutinib, a first-in class inhibitor of BTK, promotes apoptosis and inhibits proliferation, migration and adhesion in CLL cells. Phase II data of ibrutinib monotherapy in RR CLL demonstrated an estimated PFS and OS of 75% and 83% respectively at 26 months (Byrd Abst #189 ASH 2012). These findings confirmed BTK as an important target in CLL and supported initiation of a pivotal phase III study in pts with RR CLL/SLL. Methods: PCYC-1112-CA is an ongoing international Phase 3 randomized controlled study of ibrutinib versus ofatumumab for treatment of pts with RR CLL/SLL. The study is enrolling 350 planned pts in 9 countries. Pts are randomized 1:1 to receive ibrutinib 420 mg orally once daily or ofatumumab per the package insert at 300 mg for the first dose, then 2000 mg for a total of 12 doses over 24 weeks. Pts are stratified based on del 17p and disease refractory to purine analogs. Key inclusion criteria include RR CLL/SLL with >= 1 prior line of therapy including pts who experienced a short remission duration to purine analog based CIT, pts who are older or have comorbidities, and pts with del 17p. Pts must have active disease meeting criterion for requiring therapy and measurable nodal disease by CT. Key exclusion criteria include Richter’s transformation, stem cell transplantation within 6 months, GVHD or immunosuppression, platelet count <30,000 cells/ul or use of warfarin The primary objective of the study is PFS evaluated by an IRC. Other outcomes include ORR, OS, hematologic improvement, and safety. An independent DMC is monitoring the study. Clinical trial information: NCT01744691.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Adrian Bloor
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Claire E. Dearden
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | | - Peter Hillmen
- St James’s University Hospital, Leeds, United Kingdom
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46
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Béné C, Devereux S, Sabates-Wheeler R. Shocks and social protection in the Horn of Africa: analysis from the Productive Safety Net programme in Ethiopia. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/j.2040-0209.2012.00395.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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47
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Krishnamurthy P, Potter VT, Barber LD, Kulasekararaj AG, Lim ZY, Pearce RM, de Lavallade H, Kenyon M, Ireland RM, Marsh JCW, Devereux S, Pagliuca A, Mufti GJ. Outcome of donor lymphocyte infusion after T cell-depleted allogeneic hematopoietic stem cell transplantation for acute myelogenous leukemia and myelodysplastic syndromes. Biol Blood Marrow Transplant 2012; 19:562-8. [PMID: 23266740 DOI: 10.1016/j.bbmt.2012.12.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 12/14/2012] [Indexed: 11/24/2022]
Abstract
Relapse occurs in 30%-50% of recipients of T cell-depleted (TCD) reduced-intensity conditioned (RIC) hematopoietic stem cell transplantation (HSCT) for acute myelogenous leukemia (AML) and myelodysplastic syndromes (MDS). Despite limited published supportive data, donor lymphocyte infusion (DLI) is used preemptively (pDLI) to improve donor chimerism and prevent relapse, and therapeutically (tDLI) after disease recurrence. We evaluated the efficacy and toxicity of pDLI and tDLI in 113 patients after TCD (alemtuzumab, n = 99; antithymocyte globulin, n = 14) RIC HSCT for AML or MDS. Recipients of pDLI (n = 62) had an estimated 5-year overall survival (OS) of 80% and an event-free survival of 65%. More than one-half (52%; n = 32) of the patients received pDLI within 6 months post-HSCT; despite this, the 5-year incidence of graft-versus-host disease was only 31% (95% confidence interval [CI], 19%-43%). Recipients of tDLI (n = 51) had an estimated 5-year OS of 40% and a 5-year relapse/progression rate of 69% (95% CI, 54%-81%). Recipients of tDLI at >6 months post-HSCT had a significantly superior 5-year OS after tDLI compared with those treated earlier (P = .008). The cumulative incidence of graft-versus-host disease at 5 years after tDLI was 45% (95% CI, 23%-65%). We demonstrate that pDLI safely promotes durable remission after TCD RIC HSCT for AML or MDS, and that tDLI salvages patients after late relapse with greater efficacy.
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48
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Haan N, Devereux S, Maxwell D. Global implications of Somalia 2011 for famine prevention, mitigation and response. Global Food Security 2012. [DOI: 10.1016/j.gfs.2012.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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49
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Winchester SA, Tedder RS, Pomplun S, Sudhanva M, Zuckerman M, Poulton M, Devereux S, Schey S. Lymphadenopathy and splenomegaly in an HIV-infected man. J Clin Virol 2012; 56:181-4. [PMID: 22939364 DOI: 10.1016/j.jcv.2012.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 08/03/2012] [Indexed: 11/16/2022]
Affiliation(s)
- S A Winchester
- South London Specialist Virology Centre, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
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50
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Hamilton E, Pearce L, Morgan L, Robinson S, Ware V, Brennan P, Thomas NSB, Yallop D, Devereux S, Fegan C, Buggins AGS, Pepper C. Mimicking the tumour microenvironment: three different co-culture systems induce a similar phenotype but distinct proliferative signals in primary chronic lymphocytic leukaemia cells. Br J Haematol 2012; 158:589-99. [DOI: 10.1111/j.1365-2141.2012.09191.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 05/04/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Emma Hamilton
- Department of Haematology; King's College London; London; UK
| | - Laurence Pearce
- Department of Medical Genetics, Haematology and Pathology; School of Medicine; Cardiff University; Cardiff; UK
| | - Liam Morgan
- Department of Medical Genetics, Haematology and Pathology; School of Medicine; Cardiff University; Cardiff; UK
| | - Sophie Robinson
- Department of Medical Genetics, Haematology and Pathology; School of Medicine; Cardiff University; Cardiff; UK
| | - Vicki Ware
- Department of Medical Genetics, Haematology and Pathology; School of Medicine; Cardiff University; Cardiff; UK
| | - Paul Brennan
- Department of Medical Genetics, Haematology and Pathology; School of Medicine; Cardiff University; Cardiff; UK
| | | | - Deborah Yallop
- Department of Haematology; King's College London; London; UK
| | | | - Chris Fegan
- Department of Medical Genetics, Haematology and Pathology; School of Medicine; Cardiff University; Cardiff; UK
| | | | - Chris Pepper
- Department of Medical Genetics, Haematology and Pathology; School of Medicine; Cardiff University; Cardiff; UK
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