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Barrett A, Appleby N, Dreau H, Fox CP, Munir T, Eyre TA. Richter's transformation: Transforming the clinical landscape. Blood Rev 2024; 64:101163. [PMID: 38097488 DOI: 10.1016/j.blre.2023.101163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/22/2023] [Accepted: 12/08/2023] [Indexed: 03/12/2024]
Abstract
Richter transformation (RT) represents an aggressive histological transformation from chronic lymphocytic leukaemia, most often to a large B cell lymphoma. It is characterised by chemo-resistance and subsequent short survival. Drug development has struggled over recent years in light of the aggressive kinetics of the disease, lack of pivotal registrational trials and relative rarity of the phenomenon. In this review we will highlight the diagnostic and therapeutic challenges of managing patients with RT as well as taking a look to the future therapeutic landscape. Highly active therapies developed across B cell malignancies are starting to impact this field, with T-cell activation therapies (CAR-T, bispecific antibodies), antibody-drug conjugates, and novel small molecule inhibitor combinations (e.g. BTKi-BCL2i) being actively studied. We will highlight the data supporting these developments and look to the studies to come to provide hope for patients suffering from this devastating disease.
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MESH Headings
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/therapy
- Cell Transformation, Neoplastic
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Affiliation(s)
- A Barrett
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - N Appleby
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - H Dreau
- Oxford Molecular Diagnostic Centre, Oxford, United Kingdom
| | - C P Fox
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - T Munir
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - T A Eyre
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
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Hounsome L, Eyre TA, Ireland R, Hodson A, Walewska R, Ardeshna K, Chaganti S, McKay P, Davies A, Fox CP, Kalakonda N, Fields PA. Diffuse large B cell lymphoma (DLBCL) in patients older than 65 years: analysis of 3 year Real World data of practice patterns and outcomes in England. Br J Cancer 2022; 126:134-143. [PMID: 34611308 PMCID: PMC8727618 DOI: 10.1038/s41416-021-01525-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/10/2021] [Accepted: 08/11/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND We wished to examine treatment and outcome patterns in older diffuse large B-cell lymphoma (DLBCL) patients, with a focus on the effect of route-to-diagnosis to outcome. METHODS Data were extracted from Public Health England's National Cancer Registration and Analysis Service between 2013 and 2015 included route-to-diagnosis, disease characteristics and survival for 9186 patients ≥65 years. Systemic Anti-Cancer Therapy data identified front-line regimens, cycles and doses. RESULTS Route-to-diagnosis were emergency (34%), NHS urgent cancer pathway (rapid haemato-oncologist review <2 weeks), (29%) and standard GP referral (25%). The most common regimen was R-CHOP (n = 4392). 313 patients received R-miniCHOP (7% of R-CHOP). For all patients, 3-year overall survival (OS) for 65-79 years was 57% and for ≥80 years was 32%. Three-year OS for R-CHOP-treated patients diagnosed via emergency presentation was 54% (adjusted hazard ratio (HR) 1.63, p < 0.01) and 75% (adjusted HR 0.81, p < 0.01) on the NHS urgent cancer pathway (reference HR:1.00: GP referrals). 3-year OS was 54% for both R-miniCHOP and R-CHOP in ≥80 years. CONCLUSIONS Our comprehensive population analysis is the first to show that the NHS urgent cancer pathway is associated with a superior survival after adjusting for multiple confounders. Equivalent survival for R-CHOP and R-mini-CHOP was demonstrated in those ≥80 years.
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Affiliation(s)
- L. Hounsome
- grid.271308.f0000 0004 5909 016XPublic Health England, London, UK
| | - T. A. Eyre
- grid.410556.30000 0001 0440 1440Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R. Ireland
- grid.13097.3c0000 0001 2322 6764Department of Haematology, Kings College London Hospitals, London, UK
| | - A. Hodson
- grid.414810.80000 0004 0399 2412Department of Haematology, Ipswich Hospital, Ipswich, UK
| | - R. Walewska
- Department of Haematology, University Hospitals Dorset, Bournemouth, UK
| | - K. Ardeshna
- grid.52996.310000 0000 8937 2257Department of Haematology, UCLH, London, UK
| | - S. Chaganti
- grid.412563.70000 0004 0376 6589Department of Haematology, University Hospitals Birmingham, Birmingham, UK
| | - P. McKay
- Department of Haematology, Beatson Cancer Centre, Glasgow, UK
| | - A. Davies
- grid.123047.30000000103590315Department of Medical Oncology, Southampton General Hospital, Southampton, UK
| | - C. P. Fox
- grid.240404.60000 0001 0440 1889Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - N. Kalakonda
- grid.10025.360000 0004 1936 8470Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - P. A. Fields
- grid.425213.3Department of Haematology, Guys and St Thomas’ Hospital, London, UK
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Jurczak W, Shah NN, Lamanna N, Eyre TA, Woyach J, Lech‐Maranda E, Wierda WG, Lewis D, Thompson MC, Wang D, Yin M, Balbas M, Nair BC, Zhu EY, Tsai DE, Ku NC, Coombs CC, Mato AR. PIRTOBRUTINIB (LOXO‐305), A NEXT GENERATION HIGHLY SELECTIVE NON‐COVALENT BTK INHIBITOR IN PREVIOUSLY TREATED RICHTER TRANSFORMATION: RESULTS FROM THE PHASE 1/2 BRUIN STUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.41_2880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- W. Jurczak
- Maria Sklodowska‐Curie National Research Institute of Oncology Clinical Oncology Krakow Poland
| | - N. N. Shah
- Medical College of Wisconsin Hematology and Oncology Brookfield USA
| | - N. Lamanna
- Herbert Irving Comprehensive Cancer Center Columbia University, Medicine New York USA
| | - T. A. Eyre
- Oxford University Hospitals NHS Foundation Trust Churchill Cancer Center Haematology Oxford UK
| | - J. Woyach
- The Ohio State University Comprehensive Cancer Center Internal Medicine Columbus USA
| | - E. Lech‐Maranda
- Institute of Hematology and Transfusion Medicine Hematology Warsaw Poland
| | | | - D. Lewis
- Plymouth Hospitals NHS Trust ‐ Derriford Hospital Haematology Plymouth UK
| | - M. C. Thompson
- Memorial Sloan Kettering Cancer Center Medicine New York USA
| | - D. Wang
- Loxo Oncology at Lilly Statistics Stamford USA
| | - M. Yin
- Loxo Oncology at Lilly Statistics Stamford USA
| | - M. Balbas
- Loxo Oncology at Lilly, Clinical Stamford CT USA
| | - B. C. Nair
- Loxo Oncology at Lilly, Clinical Stamford CT USA
| | - E. Y. Zhu
- Loxo Oncology at Lilly, Clinical Stamford CT USA
| | - D. E. Tsai
- Loxo Oncology at Lilly, Medical Stamford CT USA
| | - N. C. Ku
- Loxo Oncology at Lilly, Medical Stamford CT USA
| | - C. C. Coombs
- University of North Carolina at Chapel Hill Medicine Chapel Hill USA
| | - A. R. Mato
- Memorial Sloan Kettering Cancer Center Medicine New York USA
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Sharpley FA, Neffa P, Panitsas F, Eyre TA, Kothari J, Subesinghe M, Cutter D, Szor RS, Martinez GA, Rocha V, Ramasamy K. Correction: Long-term clinical outcomes in a cohort of patients with solitary plasmacytoma treated in the modern era. PLoS One 2019; 14:e0225184. [PMID: 31697780 PMCID: PMC6837372 DOI: 10.1371/journal.pone.0225184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0219857.].
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Eyre TA, Martinez-Calle N, Hildyard C, Eyre DW, Plaschkes H, Griffith J, Wolf J, Fields P, Gunawan A, Oliver R, Djebbari F, Booth S, McMillan A, Fox CP, Bishton MJ, Collins GP, Hatton CSR. Impact of intended and relative dose intensity of R-CHOP in a large, consecutive cohort of elderly diffuse large B-cell lymphoma patients treated with curative intent: no difference in cumulative incidence of relapse comparing patients by age. J Intern Med 2019; 285:681-692. [PMID: 30811713 DOI: 10.1111/joim.12889] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The increasing incidence of diffuse large B-cell lymphoma (DLBCL) in ageing populations places a significant burden on healthcare systems. Co-morbidity, frailty, and reduced organ and physiological reserve contribute to treatment-related complications. The optimal dose intensity of R-CHOP to optimize outcome across different ages with variable frailty and comorbidity burden is unclear. OBJECTIVES AND METHODS We examined the influence of intended (IDI) and relative (RDI) dose intensity of the combination of cyclophosphamide and doxorubicin, age and comorbidity on outcomes for DLBCL patients ≥70 years in a representative, consecutive cohort across eight UK centres (2009-2018). We determined predictors of survival using multivariable Cox regression, and predictors of recurrence before death using competing risks regression. RESULTS Porgression-free survival (PFS) and overall survival (OS) were significantly inferior in patients ≥80 vs. 70-79 years (P < 0.001). In contrast, 2-year cumulative relapse incidence, when accounting for non-relapse mortality as a competing risk, was no different between 70-79 vs. ≥80 years (P = 0.27) or comorbidity status (CIRS-G: 0-6 vs. >6) (P = 0.27). In 70-79 years, patients with an IDI ≥80% had a significantly improved PFS and OS (P < 0.001) compared to IDI < 80%. Conversely, in patients ≥80 years, there was no difference in PFS (P = 0.88) or OS (P = 0.75) according to IDI <80% vs. ≥80%. On multivariable analysis, when comparing by age, there was a significantly higher cumulative relapse rate for patients aged 70-79 years with an IDI <80% (vs. >80%) (P = 0.04) but not for patients ≥80 years comparing IDI (P = 0.32). CONCLUSION 'R-mini-CHOP' provides adequate lymphoma-specific disease control and represents a reasonable treatment option in elderly patients ≥80 years aiming for cure.
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Affiliation(s)
- T A Eyre
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - N Martinez-Calle
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C Hildyard
- Department of Haematology, Milton Keynes Hospital, Milton Keynes, UK
| | - D W Eyre
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Big Data Institute, University of Oxford, Oxford, UK
| | - H Plaschkes
- Oxford University Medical School, Oxford, UK
| | - J Griffith
- Department of Haematology, Great Western Hospital, Swindon, UK
| | - J Wolf
- Department of Haematology, Great Western Hospital, Swindon, UK
| | - P Fields
- Department of Haematology, Guys and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - A Gunawan
- Department of Haematology, Guys and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - R Oliver
- Department of Haematology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - F Djebbari
- Department of Cancer Pharmacy, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Booth
- Department of Haematology, Royal Berkshire Hospital NHS Foundation Trust, Reading, UK
| | - A McMillan
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C P Fox
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M J Bishton
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - G P Collins
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C S R Hatton
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Abstract
The management of peripheral T-cell lymphoma (PTCL) remains a big challenge. PTCL exists as a collection of subentities, which are all rare. Each subtype described has its own unique pathogenesis, etiological associations and presentation. In general, PTCL is a relatively resistant disorder that exhibits extranodal features, B symptoms and paraneoplastic phenomena. This condition is prone to relapse, with a disappointing overall survival at 5 years of approximately 30%. This review will discuss the differences in the tumor biology of PTCL subentities, their associated targeted therapies, options for first-line treatment and the role of stem cell transplantation in first-line and relapsed settings. The authors then discuss new agents being used in early phase trials in relapsed/refractory disease and discuss the urgent need for collaborative randomized controlled trials in this resistant and biologically aggressive disease group.
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Affiliation(s)
- T A Eyre
- Department of Hematology, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, U.K.
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