1
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Desai SH, Mwangi R, Maurer M, King R, Cerhan J, Feldman A, Habermann T, Farooq U, Thompson C, Wang Y, Ansell SM, Witzig TE, Nowakowski GN. DO CELL‐OF‐ORIGIN, DOUBLE EXPRESSER, AND DOUBLE HIT STATUS AFFECT OUTCOMES IN RELAPSED/REFRACTORY DIFFUSE LARGE B CELL LYMPHOMA (R/R DLBCL)? A PROSPECTIVE OBSERVATIONAL STUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.66_2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- S. H. Desai
- Mayo Clinic Division of Hematology, Department of Medicine Rochester Minnesota USA
| | - R. Mwangi
- Mayo Clinic Department of Quantitative Health Sciences Rochester Minnesota USA
| | - M. Maurer
- Mayo Clinic Department of Quantitative Health Sciences Rochester Minnesota USA
| | - R. King
- Mayo Clinic Department of Laboratory Medicine and Pathology Rochester Minnesota USA
| | - J. Cerhan
- Mayo Clinic Department of Quantitative Health Sciences Rochester Minnesota USA
| | - A. Feldman
- Mayo Clinic Division of Hematology, Department of Medicine Rochester Minnesota USA
| | - T. Habermann
- Mayo Clinic Division of Hematology, Department of Medicine Rochester Minnesota USA
| | - U. Farooq
- University of Iowa Hospitals and Clinics Department of Hematology, Oncology and Bone Marrow Transplant, Iowa City Iowa USA
| | - C. Thompson
- Mayo Clinic Division of Hematology, Department of Medicine Rochester Minnesota USA
| | - Y. Wang
- Mayo Clinic Division of Hematology, Department of Medicine Rochester Minnesota USA
| | - S. M. Ansell
- Mayo Clinic Division of Hematology, Department of Medicine Rochester Minnesota USA
| | - T. E. Witzig
- Mayo Clinic Division of Hematology, Department of Medicine Rochester Minnesota USA
| | - G. N. Nowakowski
- Mayo Clinic Division of Hematology, Department of Medicine Rochester Minnesota USA
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2
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Desai S, Laplant B, Macon W, Young J, King R, Wang Y, Inwards D, Micallef I, Johnston PB, Porrata LF, Ansell SM, Habermann TM, Witzig TE, Nowakowski GS. INTERIM PET/CT PREDICTS OUTCOMES OF DIFFUSE LARGE B‐CELL LYMPHOMA (DLBCL) TREATED WITH FRONTLINE LENALIDOMIDE/RCHOP (R2CHOP): LONG‐TERM ANALYSIS OF MC078E. Hematol Oncol 2021. [DOI: 10.1002/hon.83_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: 11/08/2022]
Affiliation(s)
- S. Desai
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - B. Laplant
- Mayo Clinic Department of Quantitative Health Sciences Rochester Minnesota USA
| | - W. Macon
- Mayo Clinic Department of Laboratory Medicine and Pathology Rochester Minnesota USA
| | - J. Young
- Mayo Clinic Division of Nuclear Medicine Department of Radiology Rochester Minnesota USA
| | - R. King
- Mayo Clinic Department of Laboratory Medicine and Pathology Rochester Minnesota USA
| | - Y. Wang
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - D. Inwards
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - I. Micallef
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - P. B. Johnston
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - L. F. Porrata
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - S. M. Ansell
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - T. M. Habermann
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - T. E. Witzig
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - G. S. Nowakowski
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
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3
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Inwards DJ, Fishkin PA, LaPlant BR, Drake MT, Kurtin PJ, Nikcevich DA, Wender DB, Lair BS, Witzig TE. Phase I trial of rituximab, cladribine, and temsirolimus (RCT) for initial therapy of mantle cell lymphoma. Ann Oncol 2019; 30:346. [PMID: 29390098 PMCID: PMC6386023 DOI: 10.1093/annonc/mdx814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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4
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Hu G, Dasari S, Asmann YW, Greipp PT, Knudson RA, Benson HK, Li Y, Eckloff BW, Jen J, Link BK, Jiang L, Sidhu JS, Wellik LE, Witzig TE, Bennani NN, Cerhan JR, Boddicker RL, Feldman AL. Targetable fusions of the FRK tyrosine kinase in ALK-negative anaplastic large cell lymphoma. Leukemia 2017; 32:565-569. [PMID: 29026208 PMCID: PMC5803446 DOI: 10.1038/leu.2017.309] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 12/21/2022]
Affiliation(s)
- G Hu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - S Dasari
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Y W Asmann
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - P T Greipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.,Medical Genome Facility, Mayo Clinic, Rochester, MN, USA
| | - R A Knudson
- Medical Genome Facility, Mayo Clinic, Rochester, MN, USA
| | - H K Benson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Y Li
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - B W Eckloff
- Medical Genome Facility, Mayo Clinic, Rochester, MN, USA
| | - J Jen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - B K Link
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - L Jiang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - J S Sidhu
- Department of Pathology and Laboratory Medicine, United Health Services Hospitals, Johnson City/Binghamton, NY, USA
| | - L E Wellik
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - T E Witzig
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N N Bennani
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - R L Boddicker
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - A L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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5
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Shenoy N, Bhagat T, Nieves E, Stenson M, Lawson J, Choudhary GS, Habermann T, Nowakowski G, Singh R, Wu X, Verma A, Witzig TE. Upregulation of TET activity with ascorbic acid induces epigenetic modulation of lymphoma cells. Blood Cancer J 2017; 7:e587. [PMID: 28731456 PMCID: PMC5549257 DOI: 10.1038/bcj.2017.65] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [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: 06/01/2017] [Accepted: 06/20/2017] [Indexed: 12/20/2022] Open
Abstract
The Ten Eleven Translocation (TET) enzymes have been found to be mutated in both diffuse large B-cell (DLBCL) and peripheral T-cell (PTCL) lymphomas resulting in DNA hypermethylation. Recent studies in embryonal stem cells showed that ascorbic acid (AA) is a cofactor for TET with a binding site at the catalytic domain, and enhances TET activity. We hypothesized that AA could potentially enhance TET activity in lymphoma cells to cause DNA demethylation, reactivate expression of tumor suppressor genes and enhance chemosensitivity. We demonstrate in vitro that AA treatment of DLBCL and PTCL cells using AA concentrations achievable intravenously increased TET activity leading to DNA demethylation. This epigenetic effect is independent of hydrogen peroxide. AA treatment increased the expression of SMAD1, a tumor suppressor gene known to be suppressed by methylation, and increased chemosensitivity of lymphoma cells. Twenty-nine percent (10/34) of unselected lymphoma patients had plasma AA levels that were deficient suggesting an additional clinical mechanism of TET hypofunction. These data indicate that AA has the potential to modify TET function in lymphoma and enhance chemosensitivity. In addition, the AA deficiency seen in some patients may further impair TET function and contribute to resistance. Clinical trials testing intravenous AA with chemotherapy are warranted.
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Affiliation(s)
- N Shenoy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - T Bhagat
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - E Nieves
- Biochemistry and Developmental &Molecular Biology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M Stenson
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J Lawson
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - G S Choudhary
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - T Habermann
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - G Nowakowski
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R Singh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - X Wu
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Verma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - T E Witzig
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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6
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Younes A, Hilden P, Coiffier B, Hagenbeek A, Salles G, Wilson W, Seymour JF, Kelly K, Gribben J, Pfreunschuh M, Morschhauser F, Schoder H, Zelenetz AD, Rademaker J, Advani R, Valente N, Fortpied C, Witzig TE, Sehn LH, Engert A, Fisher RI, Zinzani PL, Federico M, Hutchings M, Bollard C, Trneny M, Elsayed YA, Tobinai K, Abramson JS, Fowler N, Goy A, Smith M, Ansell S, Kuruvilla J, Dreyling M, Thieblemont C, Little RF, Aurer I, Van Oers MHJ, Takeshita K, Gopal A, Rule S, de Vos S, Kloos I, Kaminski MS, Meignan M, Schwartz LH, Leonard JP, Schuster SJ, Seshan VE. International Working Group consensus response evaluation criteria in lymphoma (RECIL 2017). Ann Oncol 2017; 28:1436-1447. [PMID: 28379322 PMCID: PMC5834038 DOI: 10.1093/annonc/mdx097] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [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: 02/24/2017] [Indexed: 12/20/2022] Open
Abstract
In recent years, the number of approved and investigational agents that can be safely administered for the treatment of lymphoma patients for a prolonged period of time has substantially increased. Many of these novel agents are evaluated in early-phase clinical trials in patients with a wide range of malignancies, including solid tumors and lymphoma. Furthermore, with the advances in genome sequencing, new "basket" clinical trial designs have emerged that select patients based on the presence of specific genetic alterations across different types of solid tumors and lymphoma. The standard response criteria currently in use for lymphoma are the Lugano Criteria which are based on [18F]2-fluoro-2-deoxy-D-glucose positron emission tomography or bidimensional tumor measurements on computerized tomography scans. These differ from the RECIST criteria used in solid tumors, which use unidimensional measurements. The RECIL group hypothesized that single-dimension measurement could be used to assess response to therapy in lymphoma patients, producing results similar to the standard criteria. We tested this hypothesis by analyzing 47 828 imaging measurements from 2983 individual adult and pediatric lymphoma patients enrolled on 10 multicenter clinical trials and developed new lymphoma response criteria (RECIL 2017). We demonstrate that assessment of tumor burden in lymphoma clinical trials can use the sum of longest diameters of a maximum of three target lesions. Furthermore, we introduced a new provisional category of a minor response. We also clarified response assessment in patients receiving novel immune therapy and targeted agents that generate unique imaging situations.
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Affiliation(s)
| | - P. Hilden
- Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - B. Coiffier
- Hematology, Université Lyon-1, Lyon-Sud Charles Mérieux, Lyon, France
| | - A. Hagenbeek
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - G. Salles
- Hematology, Université Lyon-1, Lyon-Sud Charles Mérieux, Lyon, France
| | - W. Wilson
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, USA
| | - J. F. Seymour
- Peter MacCallum Cancer Centre and University of Melbourne, Australia
| | - K. Kelly
- Pediatrics Department, Roswell-Park Cancer Institute, Buffalo, USA
| | - J. Gribben
- Department of Haemato-Oncology, Barts Cancer Institute, London, UK
| | - M. Pfreunschuh
- Department of Internal Medicine, Universität des Saarlandes, Homburg, Germany
| | - F. Morschhauser
- Department of Hematology, Université de Lille 2, Lille, France
| | - H. Schoder
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York
| | | | - J. Rademaker
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York
| | - R. Advani
- Department of Oncology, Stanford University, Stanford
| | | | | | | | - L. H. Sehn
- British Columbia Cancer Agency, Vancouver, Canada
| | - A. Engert
- Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | | | - P.-L. Zinzani
- Department of Hematology, University of Bologna, Bologna
| | - M. Federico
- Department of Diagnostic Medicine, University of Modena, Modena, Italy
| | - M. Hutchings
- Department of Hematology, University of Copenhagen, Denmark
| | - C. Bollard
- Children’s National Health System, Washington, USA
| | - M. Trneny
- Lymphoma and Stem Cell Transplantation Program, Charles University, Prague, Czech Republic
| | | | - K. Tobinai
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - J. S. Abramson
- Massachusetts General Hospital, Center for Lymphoma, Boston
| | - N. Fowler
- U.T. M.D.Anderson Cancer Center, Houston
| | - A. Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack
| | - M. Smith
- Cleveland Clinic, Cleveland, USA
| | | | - J. Kuruvilla
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - M. Dreyling
- Medicine Clinic III, Ludwig Maximilian University, Munich, Germany
| | | | - R. F. Little
- Divisions of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - I. Aurer
- Department of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | | | - A. Gopal
- Fred Hutchinson Cancer Research Center, Seattle, USA
| | - S. Rule
- Haematology Department, Plymouth University, UK
| | | | - I. Kloos
- Servier, Neuilly sur Seine, France
| | - M. S. Kaminski
- University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
| | - M. Meignan
- Nuclear Medicine, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - L. H. Schwartz
- Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York
| | - J. P. Leonard
- Weill Cornell Medicine and and New York Presbyterian Hospital, New York
| | - S. J. Schuster
- University of Pennsylvania School of Medicine, Philadelphia, USA
| | - V. E. Seshan
- Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, USA
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7
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Witzig TE, LaPlant B, Habermann TM, McPhail E, Inwards DJ, Micallef IN, Colgan JP, Nowakowski GS, Ansell SM, Johnston PB. High rate of event-free survival at 24 months with everolimus/RCHOP for untreated diffuse large B-cell lymphoma: updated results from NCCTG N1085 (Alliance). Blood Cancer J 2017. [PMID: 28649983 PMCID: PMC5520404 DOI: 10.1038/bcj.2017.57] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 12/22/2022] Open
Affiliation(s)
- T E Witzig
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - B LaPlant
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - T M Habermann
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - E McPhail
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - D J Inwards
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - I N Micallef
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - J P Colgan
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - G S Nowakowski
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - S M Ansell
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - P B Johnston
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
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8
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Manso BA, Wenzl K, Asmann YW, Maurer MJ, Manske M, Yang ZZ, Slager SL, Nowakowski GS, Ansell SM, Witzig TE, Feldman AL, Rimsza L, Link B, Cerhan JR, Novak AJ. Whole-exome analysis reveals novel somatic genomic alterations associated with cell of origin in diffuse large B-cell lymphoma. Blood Cancer J 2017; 7:e553. [PMID: 28430174 PMCID: PMC5436076 DOI: 10.1038/bcj.2017.33] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 02/06/2023] Open
Affiliation(s)
- B A Manso
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - K Wenzl
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Y W Asmann
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - M J Maurer
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - M Manske
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Z-Z Yang
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S L Slager
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - S M Ansell
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - T E Witzig
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - L Rimsza
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | - B Link
- Department of Hematology, Oncology and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA, USA
| | - J R Cerhan
- Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - A J Novak
- Department of Immunology, Mayo Clinic, Rochester, MN, USA.,Division of Hematology, Mayo Clinic, Rochester, MN, USA
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9
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Church AK, VanDerMeid KR, Baig NA, Baran AM, Witzig TE, Nowakowski GS, Zent CS. Anti-CD20 monoclonal antibody-dependent phagocytosis of chronic lymphocytic leukaemia cells by autologous macrophages. Clin Exp Immunol 2015; 183:90-101. [PMID: 26307241 DOI: 10.1111/cei.12697] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 08/20/2015] [Indexed: 01/01/2023] Open
Abstract
Unconjugated monoclonal antibodies (mAbs) are an important component of effective combination therapies for chronic lymphocytic leukaemia (CLL). Antibody-dependent phagocytosis (ADP) is a major mediator of mAb cytotoxicity, but there is limited knowledge of the determinants of ADP efficacy. We used macrophages derived in vitro from autologous circulating monocytes to test the effects of mAb structure and concentration, target : effector cell ratio, duration of co-incubation and CLL cell CD20 expression on ADP. Next-generation anti-CD20 mAbs (ofatumumab, ublituximab, obinutuzumab, ocaratuzumab) were significantly more effective at inducing ADP compared to rituximab, but none were as effective as the anti-CD52 mAb alemtuzumab. Ofatumumab (10 μg/ml) used as a representative next-generation anti-CD20 mAb achieved an ADP plateau at 3 h co-incubation with a target : effector ratio of 10 : 1 (mean = 2.1 CLL cells/macrophage, range = 1.5-3.5). At 0.156 μg/ml (the lowest concentration tested) ofatumumab ADP was significantly higher than alemtuzumab. However, ofatumumab-induced ADP did not increase significantly at higher mAb concentrations. We show that anti-CD20 mAb ADP efficacy is determined by the mAb characteristics, target : effector ratio and incubation time. We suggest that preclinical evaluation of anti-CD20 mAbs to understand the determinants of ADP could be useful in designing future combination therapies for CLL.
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Affiliation(s)
- A K Church
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - K R VanDerMeid
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - N A Baig
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - A M Baran
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - T E Witzig
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - C S Zent
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
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10
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Gupta M, Stenson M, O'Byrne M, Maurer MJ, Habermann T, Cerhan JR, Weiner GW, Witzig TE. Comprehensive serum cytokine analysis identifies IL-1RA and soluble IL-2Rα as predictors of event-free survival in T-cell lymphoma. Ann Oncol 2015; 27:165-72. [PMID: 26487586 DOI: 10.1093/annonc/mdv486] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 02/16/2015] [Accepted: 09/30/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND T-cell malignancies are heterogeneous in their clinical presentation and pathology, and have a poor prognosis. New biomarkers are needed to predict prognosis and to provide insights into signal pathways used by these cells. The goal of this study was to evaluate pretreatment serum cytokines in patients with newly diagnosed T-cell neoplasms and correlate with clinical outcome. PATIENTS AND METHODS We evaluated 30 cytokines in pretreatment serum from 68 untreated patients and 14 normal controls. Significantly elevated cytokines were correlated with patterns of abnormalities, event-free survival (EFS) and overall survival (OS). RESULTS Our data demonstrated significantly elevated levels (versus controls) of seven cytokines-epidermal growth factor (EGF), IL-6, IL-12, interferon gamma-induced protein (IP)-10, soluble interleukin (sIL)-2Rα, monokine induced by gamma interferon (MIG), and IL-1RA-in all T-cell neoplasms (P < 0.05). In the angioimmunoblastic subset, all seven cytokines except IP-10 and in the peripheral T-cell lymphoma (TCL)-not otherwise specified subset, only IP-10, sIL-2Rα, MIG, and IL-8 were statistically elevated compared with control. Of these, elevated cytokines all but EGF were predictive of an inferior EFS; IL-1RA, sIL-2Rα, and MIG predicted an inferior OS. In a multivariate analysis, sIL-2Rα [hazard ratio (HR) = 3.95; 95% confidence interval (CI) 1.61-8.38] and IL-1RA (HR = 3.28; 95% CI 1.47-7.29) levels remained independent predictors of inferior EFS. TCL cell lines secreted high levels of sIL-2Rα and expressed the IL-2Rα surface receptor. CONCLUSIONS This report describes the cytokines relevant to prognosis in patients with untreated TCL and provides the rationale to include serum IL-1RA and sIL-2Rα as biomarkers in future trials. Inhibition of these cytokines may also be of therapeutic benefit.
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Affiliation(s)
- M Gupta
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester
| | - M Stenson
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester
| | - M O'Byrne
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - M J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - T Habermann
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester
| | - J R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - G W Weiner
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, USA
| | - T E Witzig
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester
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11
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Khosroshahi A, Wallace ZS, Crowe JL, Akamizu T, Azumi A, Carruthers MN, Chari ST, Della-Torre E, Frulloni L, Goto H, Hart PA, Kamisawa T, Kawa S, Kawano M, Kim MH, Kodama Y, Kubota K, Lerch MM, Löhr M, Masaki Y, Matsui S, Mimori T, Nakamura S, Nakazawa T, Ohara H, Okazaki K, Ryu JH, Saeki T, Schleinitz N, Shimatsu A, Shimosegawa T, Takahashi H, Takahira M, Tanaka A, Topazian M, Umehara H, Webster GJ, Witzig TE, Yamamoto M, Zhang W, Chiba T, Stone JH. International Consensus Guidance Statement on the Management and Treatment of IgG4-Related Disease. Arthritis Rheumatol 2015; 67:1688-99. [PMID: 25809420 DOI: 10.1002/art.39132] [Citation(s) in RCA: 589] [Impact Index Per Article: 65.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/19/2015] [Indexed: 02/06/2023]
Affiliation(s)
- A Khosroshahi
- Emory University School of Medicine, Atlanta, Georgia
| | | | - J L Crowe
- University of Tennessee College of Medicine, Chattanooga
| | - T Akamizu
- Wakayama Medical University, Tokyo, Japan
| | - A Azumi
- Kobe Kaisei Hospital, Kobe, Japan
| | - M N Carruthers
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - H Goto
- Tokyo Medical University, Tokyo, Japan
| | - P A Hart
- The Ohio State University Medical College and The Ohio State University Wexner Medical Center, Columbus
| | - T Kamisawa
- Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - S Kawa
- Shinshu University, Matsumoto, Japan
| | - M Kawano
- Kanazawa University Graduate School of Medical Sciences and Kanazawa University Hospital, Kanazawa, Japan
| | - M H Kim
- University of Ulsan College of Medicine and Asan Medical Center, Ulsan, Republic of Korea
| | - Y Kodama
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Kubota
- Yokohama City University and Yokohama City University Hospital, Yokohama, Japan
| | - M M Lerch
- University of Greifswald Medical School, Greifswald, Germany
| | - M Löhr
- Karolinska Institutet, Stockholm, Sweden
| | - Y Masaki
- Kanazawa Medical University, Kanazawa, Japan
| | - S Matsui
- University of Toyama, Toyama, Japan
| | - T Mimori
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - S Nakamura
- Kyushu University and Kyushu University Dental Hospital, Fukuoka, Japan
| | - T Nakazawa
- Nagoya City University Graduate School of Medicine, Nagoya, Japan
| | - H Ohara
- Nagoya City University Graduate School of Medicine, Nagoya, Japan
| | - K Okazaki
- Kansai Medical University, Hirakata, Japan
| | - J H Ryu
- Mayo Clinic, Rochester, Minnesota
| | - T Saeki
- Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - N Schleinitz
- Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - A Shimatsu
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | | - H Takahashi
- Sapporo Medical University School of Medicine, Sapporo, Japan
| | - M Takahira
- Kanazawa University Graduate School of Medical Sciences and Kanazawa University Hospital, Kanazawa, Japan
| | - A Tanaka
- Teikyo University School of Medicine, Tokyo, Japan
| | | | - H Umehara
- Kanazawa Medical University, Kanazawa, Japan
| | - G J Webster
- University College London and University College London Hospitals, London, UK
| | | | - M Yamamoto
- Sapporo Medical University School of Medicine, Sapporo, Japan
| | - W Zhang
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - T Chiba
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - J H Stone
- Massachusetts General Hospital, Boston
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- Japanese Ministry of Health, Labor, and Welfare, Amgen, and Genetech
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12
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Novak AJ, Asmann YW, Maurer MJ, Wang C, Slager SL, Hodge LS, Manske M, Price-Troska T, Yang ZZ, Zimmermann MT, Nowakowski GS, Ansell SM, Witzig TE, McPhail E, Ketterling R, Feldman AL, Dogan A, Link BK, Habermann TM, Cerhan JR. Whole-exome analysis reveals novel somatic genomic alterations associated with outcome in immunochemotherapy-treated diffuse large B-cell lymphoma. Blood Cancer J 2015; 5:e346. [PMID: 26314988 PMCID: PMC4558593 DOI: 10.1038/bcj.2015.69] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [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: 07/06/2015] [Accepted: 07/21/2015] [Indexed: 01/14/2023] Open
Abstract
Lack of remission or early relapse remains a major clinical issue in diffuse large B-cell lymphoma (DLBCL), with 30% of patients failing standard of care. Although clinical factors and molecular signatures can partially predict DLBCL outcome, additional information is needed to identify high-risk patients, particularly biologic factors that might ultimately be amenable to intervention. Using whole-exome sequencing data from 51 newly diagnosed and immunochemotherapy-treated DLBCL patients, we evaluated the association of somatic genomic alterations with patient outcome, defined as failure to achieve event-free survival at 24 months after diagnosis (EFS24). We identified 16 genes with mutations, 374 with copy number gains and 151 with copy number losses that were associated with failure to achieve EFS24 (P<0.05). Except for FOXO1 and CIITA, known driver mutations did not correlate with EFS24. Gene losses were localized to 6q21-6q24.2, and gains to 3q13.12-3q29, 11q23.1-11q23.3 and 19q13.12-19q13.43. Globally, the number of gains was highly associated with poor outcome (P=7.4 × 10−12) and when combined with FOXO1 mutations identified 77% of cases that failed to achieve EFS24. One gene (SLC22A16) at 6q21, a doxorubicin transporter, was lost in 54% of EFS24 failures and our findings suggest it functions as a doxorubicin transporter in DLBCL cells.
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Affiliation(s)
- A J Novak
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Y W Asmann
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - M J Maurer
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - C Wang
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - S L Slager
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - L S Hodge
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Manske
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Z-Z Yang
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M T Zimmermann
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - S M Ansell
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - T E Witzig
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - E McPhail
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - R Ketterling
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - A L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - A Dogan
- Departments of Pathology and Laboratory Medicine, Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - B K Link
- Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - T M Habermann
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J R Cerhan
- Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
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13
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Vaidya R, Witzig TE. Prognostic factors for diffuse large B-cell lymphoma in the R(X)CHOP era. Ann Oncol 2014; 25:2124-2133. [PMID: 24625454 PMCID: PMC4288137 DOI: 10.1093/annonc/mdu109] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [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: 11/08/2013] [Revised: 01/27/2014] [Accepted: 03/03/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The introduction of rituximab (R) to conventional CHOP chemotherapy for newly diagnosed diffuse large B-cell lymphoma (DLBCL) led to an unequivocal improvement in survival, establishing RCHOP as the standard of care. Still, nearly 40% of DLBCL patients will eventually die of relapsed disease. Efforts to improve outcomes by addition of new biologic agents (X) to the RCHOP backbone are underway. In this era of R(X)CHOP, it is imperative to develop prognostic and predictive markers, not only to identify patients who will suffer a particularly aggressive course, but also to accurately select patients for clinical trials from which they will most benefit. DESIGN The following review was undertaken to describe prognostic factors in DLBCL, with emphasis on markers that are accurate, relatively available, and clinically applicable in 2014. RESULTS The International Prognostic Index retains its validity in the era of RCHOP, although with limited ability to predict those with <50% chance of long-term survival. Gene expression profiling has provided novel insights into the biology of DLBCL and led to the development of immunohistochemistry (IHC) algorithms that are in routine practice. Identification of a 'double-hit' (DH) lymphoma by fluorescent in situ hybridization with aberrations involving MYC and/or BCL2 and BCL6 genes has important implications due to its extremely dismal prognosis with RCHOP. Other markers such as the absolute lymphocyte count (ALC), serum immunoglobulin free light chains, vitamin D levels, serum cytokines/chemokines, and imaging with positron emission tomography (PET) have all shown promise as future predictive/prognostic tests. CONCLUSIONS The future for new treatment options in DLBCL is promising with current clinical trials testing novel targeted agents such as bortezomib, lenalidomide, and ibrutinib as the 'X' in R(X)CHOP. Predictive factors are required to select and randomize patients appropriately for these trials. We envision the day when 'X' will be chosen based on the biological characteristics of the tumor.
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MESH Headings
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Clinical Trials as Topic
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Doxorubicin/analogs & derivatives
- Humans
- Immunoglobulin Light Chains/blood
- In Situ Hybridization, Fluorescence
- Lymphocyte Count
- Lymphoma, Large B-Cell, Diffuse/blood
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Monocytes/pathology
- Prednisone/administration & dosage
- Prognosis
- Proto-Oncogene Proteins c-bcl-2/biosynthesis
- Proto-Oncogene Proteins c-myc/biosynthesis
- Rituximab
- Treatment Outcome
- Vincristine/administration & dosage
- Vitamin D/blood
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Affiliation(s)
- R Vaidya
- Department of Internal Medicine, Division of Hematology, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, USA
| | - T E Witzig
- Department of Internal Medicine, Division of Hematology, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, USA.
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14
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Inwards DJ, Fishkin PA, LaPlant BR, Drake MT, Kurtin PJ, Nikcevich DA, Wender DB, Lair BS, Witzig TE. Phase I trial of rituximab, cladribine, and temsirolimus (RCT) for initial therapy of mantle cell lymphoma. Ann Oncol 2014; 25:2020-2024. [PMID: 25057177 DOI: 10.1093/annonc/mdu273] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We conducted this trial to determine the maximum tolerated dose (MTD) of temsirolimus added to an established regimen comprised of rituximab and cladribine for the initial treatment of mantle cell lymphoma. PATIENTS AND METHODS A standard phase I cohort of three study design was utilized. The fixed doses of rituximab and cladribine were 375 mg/m(2) i.v. day 1 and 5 mg/m(2)/day i.v. days 1-5 of a 28-day cycle, respectively. There were five planned temsirolimus i.v. dose levels: 15 mg day 1; 25 mg day 1; 25 mg days 1 and 15; 25 mg days 1, 8 and 15; and 25 mg days 1, 8, 15, and 22. RESULTS Seventeen patients were treated: three each at levels 1-4 and five at dose level 5. The median age was 75 years (52-86 years). Mantle Cell International Prognostic Index (MIPI) scores were low in 6% (1), intermediate in 59% (10), and high in 35% (6) of patients. Five patients were treated at level 5 without dose limiting toxicity. Hematologic toxicity was frequent: grade 3 anemia in 12%, grade 3 thrombocytopenia in 41%, grade 4 thrombocytopenia in 24%, grade 3 neutropenia in 6%, and grade 4 neutropenia in 18% of patients. The overall response rate (ORR) was 94% with 53% complete response and 41% partial response. The median progression-free survival was 18.7 months. CONCLUSIONS Temsirolimus 25 mg i.v. weekly may be safely added to rituximab and cladribine at 375 mg/m(2) i.v. day 1 and 5 mg/m(2)/day i.v. days 1-5 of a 28-day cycle, respectively. This regimen had promising preliminary activity in an elderly cohort of patients with mantle cell lymphoma. CLINICALTRIALSGOV IDENTIFIER NCT00787969.
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Affiliation(s)
- D J Inwards
- Division of Hematology, Mayo Clinic, Rochester.
| | - P A Fishkin
- Illinois Oncology Research Association, Peoria
| | - B R LaPlant
- Division of Endocrinology, Mayo Clinic, Rochester
| | - M T Drake
- Division of Endocrinology, Mayo Clinic, Rochester
| | - P J Kurtin
- Division of Hematopathology, Mayo Clinic, Rochester
| | - D A Nikcevich
- Department of Medical Oncology, Essentia Duluth Clinic, Duluth
| | - D B Wender
- Department of Oncology, Siouxland Hematology-Oncology Associates, Sioux City
| | - B S Lair
- Department of Oncology, Iowa Oncology Research Association, Des Moines, USA
| | - T E Witzig
- Division of Hematology, Mayo Clinic, Rochester
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15
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Affiliation(s)
- R Vaidya
- Department of Internal Medicine, Division of Hematology, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, USA
| | - T E Witzig
- Department of Internal Medicine, Division of Hematology, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, USA
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16
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Tiegs-Heiden CA, Eckel LJ, Hunt CH, Diehn FE, Schwartz KM, Kallmes DF, Salomão DR, Witzig TE, Garrity JA. Immunoglobulin G4-related disease of the orbit: imaging features in 27 patients. AJNR Am J Neuroradiol 2014; 35:1393-7. [PMID: 24627453 DOI: 10.3174/ajnr.a3865] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Immunoglobulin G4-related disease is a systemic fibroinflammatory process of unknown etiology, characterized by tissue infiltration by immunoglobulin G4 plasma cells. The purpose of this study was to retrospectively identify the spectrum of imaging features seen in immunoglobulin G4-related disease of the orbit. MATERIALS AND METHODS This study included 27 patients with biopsy-proved immunoglobulin G4-related disease of the orbit and either a CT or MR imaging of the orbits. These CT or MR imaging examinations were evaluated for the following: extraocular muscle size, extraocular muscle tendon enlargement, lacrimal gland enlargement, infiltrative process in the orbital fat (increased attenuation on CT or abnormal signal on MR imaging), infraorbital nerve enlargement, mucosal thickening in the paranasal sinuses, and extension of orbital findings intracranially. RESULTS Extraocular muscles were enlarged in 24 of 27 (89%) patients, 21 (88%) bilaterally. In 32 of 45 (71%) affected orbits, the lateral rectus was the most enlarged muscle. In 26 (96%) patients, the tendons of the extraocular muscles were spared. Nineteen (70%) patients had lacrimal gland enlargement. Twelve (44%) patients had an infiltrative process within the orbital fat. Infraorbital nerve enlargement was seen in 8 (30%) patients. Twenty-four (89%) patients had sinus disease. Cavernous sinus or Meckel cave extension was seen in 3 (11%) patients. CONCLUSIONS In patients with extraocular muscle enlargement, particularly when the tendons are spared and the lateral rectus is the most enlarged, and even more so when other noted findings are present, immunoglobulin G4-related disease should be a leading differential consideration, even over more commonly known etiologies of extraocular muscle enlargement.
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Affiliation(s)
- C A Tiegs-Heiden
- From the Departments of Radiology (C.A.T.-H., L.J.E., C.H.H., F.E.D., K.M.S., D.F.K.)
| | - L J Eckel
- From the Departments of Radiology (C.A.T.-H., L.J.E., C.H.H., F.E.D., K.M.S., D.F.K.)
| | - C H Hunt
- From the Departments of Radiology (C.A.T.-H., L.J.E., C.H.H., F.E.D., K.M.S., D.F.K.)
| | - F E Diehn
- From the Departments of Radiology (C.A.T.-H., L.J.E., C.H.H., F.E.D., K.M.S., D.F.K.)
| | - K M Schwartz
- From the Departments of Radiology (C.A.T.-H., L.J.E., C.H.H., F.E.D., K.M.S., D.F.K.)
| | - D F Kallmes
- From the Departments of Radiology (C.A.T.-H., L.J.E., C.H.H., F.E.D., K.M.S., D.F.K.)
| | - D R Salomão
- Pathology (D.R.S.)Ophthalmology (D.R.S., J.A.G.), Mayo Clinic, Rochester, Minnesota
| | | | - J A Garrity
- Ophthalmology (D.R.S., J.A.G.), Mayo Clinic, Rochester, Minnesota
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17
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Zinzani PL, Vose JM, Czuczman MS, Reeder CB, Haioun C, Polikoff J, Tilly H, Zhang L, Prandi K, Li J, Witzig TE. Long-term follow-up of lenalidomide in relapsed/refractory mantle cell lymphoma: subset analysis of the NHL-003 study. Ann Oncol 2013; 24:2892-7. [PMID: 24030098 PMCID: PMC3811905 DOI: 10.1093/annonc/mdt366] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [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: 02/06/2013] [Revised: 07/20/2013] [Accepted: 07/23/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Mantle cell lymphoma (MCL) is an uncommon type of non-Hodgkin lymphoma with poor overall prognosis, requiring the development of new therapies. Lenalidomide is an immunomodulatory agent demonstrating antitumor and antiproliferative effects in MCL. We report results from a long-term subset analysis of 57 patients with relapsed/refractory MCL from the NHL-003 phase II multicenter study of single-agent lenalidomide in patients with aggressive lymphoma DESIGN Lenalidomide was administered orally 25 mg daily on days 1-21 every 28 days until progressive disease (PD) or intolerability. The primary end point was overall response rate (ORR). RESULTS Fifty-seven patients with relapsed/refractory, advanced-stage MCL had a median of three prior therapies. The ORR was 35% [complete response (CR)/CR unconfirmed (CRu) 12%], with a median duration of response (DOR) of 16.3 months (not yet reached in patients with CR/CRu) by blinded independent central review. The median time to first response was 1.9 months. Median progression-free survival was 8.8 months, and overall survival had not yet been reached. The most common grade 3/4 adverse events (AEs) were neutropenia (46%), thrombocytopenia (30%), and anemia (13%). CONCLUSIONS These results show the activity of lenalidomide in heavily pretreated, relapsed/refractory MCL. Responders had a durable response with manageable side-effects. Clinical trial number posted on www.clinicaltrials.gov NCT00413036.
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Affiliation(s)
- P. L. Zinzani
- Institute of Hematology ‘Seràgnoli’, University of Bologna, Bologna, Italy
| | - J. M. Vose
- Section of Hematology/Oncology, Nebraska Medical Center, Omaha, USA
| | - M. S. Czuczman
- Department of Medicine, Lymphoma/Myeloma Service, Roswell Park Cancer Institute, Buffalo, USA
| | - C. B. Reeder
- Department of Medicine, Division of Hematology, Mayo Clinic Arizona, Scottsdale, USA
| | - C. Haioun
- Lymphoid Blood Diseases Unit, Hôpital Henri Mondor, Créteil, France
| | - J. Polikoff
- Department of Hematology/Oncology, Southern California Kaiser Permanente, San Diego, USA
| | - H. Tilly
- Hematology Service, Centre Henri Becquerel, Rouen, France
| | - L. Zhang
- Celgene Corporation, Summit, USA
| | | | - J. Li
- Celgene Corporation, Summit, USA
| | - T. E. Witzig
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, USA
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18
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Witzig TE, Hu G, Offer SM, Wellik LE, Han JJ, Stenson MJ, Dogan A, Diasio RB, Gupta M. Epigenetic mechanisms of protein tyrosine phosphatase 6 suppression in diffuse large B-cell lymphoma: implications for epigenetic therapy. Leukemia 2013; 28:147-54. [PMID: 23979523 DOI: 10.1038/leu.2013.251] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/07/2013] [Accepted: 08/16/2013] [Indexed: 11/09/2022]
Abstract
Protein tyrosine phosphatases such as PTPN6 can be downregulated in various neoplasms. PTPN6 expression by immunohistochemistry in 40 diffuse large B-cell lymphoma (DLBCL) tumors was lost or suppressed in 53% (21/40). To elucidate the molecular mechanisms of PTPN6 suppression, we performed a comprehensive epigenetic analysis of PTPN6 promoter 2 (P2). None of the DLBCL primary tumors (0/37) had PTPN6 hypermethylation on the CpG1 island using methylation-specific PCR, pyrosequencing, and high-resolution melting assays. However, hypermethylation in 57% (21/37) of cases was found in a novel CpG island (CpG2) in P2. PTPN6 gene suppression was reversed by 5-aza-deoxycytidine (5-Aza), a DNA methyltransferase inhibitor, and the histone deacetylase inhibitor (HDACi) LBH589. LBH589 and 5-Aza in combination inhibited DLBCL survival and PTPN6 hypermethylation at CpG2. The role of histone modifications was investigated with a chromatin-immunoprecipitation assay demonstrating that PTPN6 P2 is associated with silencing histone marks H3K27me3 and H3K9me3 in DLBCL cells but not normal B cells. 3-Deazaneplanocin A, a histone methyltransferase inhibitor, decreased the H3K27me3 mark, whereas HDACi LBH589 increased the H3K9Ac mark within P2 resulting in re-expression of PTPN6. These studies have uncovered novel epigenetic mechanisms of PTPN6 suppression and suggest that PTPN6 may be a potential target of epigenetic therapy in DLBCL.
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Affiliation(s)
- T E Witzig
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - G Hu
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - S M Offer
- Department of Molecular and Experimental Therapeutics, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - L E Wellik
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - J J Han
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - M J Stenson
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - A Dogan
- Department of Pathology, Memorial Sloan-Kettering Cancer, New York, NY, USA
| | - R B Diasio
- Department of Molecular and Experimental Therapeutics, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - M Gupta
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, College of Medicine, Rochester, MN, USA
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19
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Vaidya R, Habermann TM, Donohue JH, Ristow KM, Maurer MJ, Macon WR, Colgan JP, Inwards DJ, Ansell SM, Porrata LF, Micallef IN, Johnston PB, Markovic SN, Thompson CA, Nowakowski GS, Witzig TE. Bowel perforation in intestinal lymphoma: incidence and clinical features. Ann Oncol 2013; 24:2439-43. [PMID: 23704194 DOI: 10.1093/annonc/mdt188] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Perforation is a serious life-threatening complication of lymphomas involving the gastrointestinal (GI) tract. Although some perforations occur as the initial presentation of GI lymphoma, others occur after initiation of chemotherapy. To define the location and timing of perforation, a single-center study was carried out of all patients with GI lymphoma. PATIENTS AND METHODS Between 1975 and 2012, 1062 patients were identified with biopsy-proven GI involvement with lymphoma. A retrospective chart review was undertaken to identify patients with gut perforation and to determine their clinicopathologic features. RESULTS Nine percent (92 of 1062) of patients developed a perforation, of which 55% (51 of 92) occurred after chemotherapy. The median day of perforation after initiation of chemotherapy was 46 days (mean, 83 days; range, 2-298) and 44% of perforations occurred within the first 4 weeks of treatment. Diffuse large B-cell lymphoma (DLBCL) was the most common lymphoma associated with perforation (59%, 55 of 92). Compared with indolent B-cell lymphomas, the risk of perforation was higher with aggressive B-cell lymphomas (hazard ratio, HR = 6.31, P < 0.0001) or T-cell/other types (HR = 12.40, P < 0.0001). The small intestine was the most common site of perforation (59%). CONCLUSION Perforation remains a significant complication of GI lymphomas and is more frequently associated with aggressive than indolent lymphomas. Supported in part by University of Iowa/Mayo Clinic SPORE CA97274 and the Predolin Foundation.
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Affiliation(s)
- R Vaidya
- Department of Internal Medicine, Division of Hematology, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN 55905, USA
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20
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Bianchi G, Kyle RA, Larson DR, Witzig TE, Kumar S, Dispenzieri A, Morice WG, Rajkumar SV. High levels of peripheral blood circulating plasma cells as a specific risk factor for progression of smoldering multiple myeloma. Leukemia 2012; 27:680-5. [PMID: 22902364 PMCID: PMC3597230 DOI: 10.1038/leu.2012.237] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [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] [Indexed: 02/03/2023]
Abstract
Smoldering multiple myeloma (SMM) carries a 50% risk of progression to multiple myeloma (MM) or related malignancy within the first 5 years following diagnosis. The goal of this study was to determine if high levels of circulating plasma cells (PCs) are predictive of SMM transformation within the first 2–3 years from diagnosis. Ninety-one patients diagnosed with SMM at Mayo Clinic from January 1994 through January 2007 who had testing for circulating PCs using an immunofluorescent assay and adequate follow up to ascertain disease progression, were studied. High level of circulating PCs was defined as absolute peripheral blood PCs >5000 ×106/L and/or > 5% cytoplasmic immunoglobulin (Ig) positive PCs per 100 peripheral blood mononuclear cells. Patients with high circulating PCs (14 of 91 patients, 15%) were significantly more likely to progress to active disease within 2 years compared with patients without high circulating PCs, 71% versus 25%, respectively, P=0.001. Corresponding rates for progression within 3 years were 86% versus 35%, respectively, P<0.001. Overall survival (OS) after both SMM diagnosis and MM diagnosis was also significantly different. High levels of circulating PCs identify SMM patients with an elevated risk of progression within the first 2 to 3 years following diagnosis.
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Affiliation(s)
- G Bianchi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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21
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Witzig TE, Laumann KM, Lacy MQ, Hayman SR, Dispenzieri A, Kumar S, Reeder CB, Roy V, Lust JA, Gertz MA, Greipp PR, Hassoun H, Mandrekar SJ, Rajkumar SV. A phase III randomized trial of thalidomide plus zoledronic acid versus zoledronic acid alone in patients with asymptomatic multiple myeloma. Leukemia 2012; 27:220-5. [PMID: 22902362 DOI: 10.1038/leu.2012.236] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patients with asymptomatic (smoldering) multiple myeloma (AMM) have a high risk of transformation to active multiple myeloma (MM). Bisphosphonates such as zoledronic acid (ZLD) reduce skeletal events in MM and the immunomodulatory agent thalidomide (Thal) has proven effectiveness in active MM. We hypothesized that treatment with Thal and ZLD would prolong the time to progression (TTP) to MM over ZLD alone. Eligible patients had asymptomatic MM and all patients received ZLD 4 mg intravenous monthly; the treatment arm also received Thal 200 mg per day. The TTP was superior for Thal/ZLD (n=35) patients compared with ZLD alone (n=33); median TTP of 2.4 years (95% confidence interval (CI): 1.4-3.6) versus 1.2 years (95% CI: 0.7-2.5) (hazard ratio (HR), 2.05; 95% CI: 1.1-3.8; P-value: 0.02). At 1 year, 86% of Thal/ZLD patients were progression free compared with 55% on ZLD alone (P=0.0048). The overall response rate after year 1 was 37% for Thal/ZLD with a median duration of response of 3.3 years (95% CI: 1.1-NA); there were no confirmed responses to ZLD alone (P=0.0004). The addition of Thal to standard ZLD produces anti-tumor responses whereas ZLD alone does not. Thal/ZLD also prolongs TTP from AMM to MM. This study provides the rationale for further studies in patients with AMM to delay chemotherapy.
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Affiliation(s)
- T E Witzig
- Division of Hematology, Department of Medicine, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
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22
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Gupta M, Han JJ, Stenson M, Wellik L, Witzig TE. Regulation of STAT3 by histone deacetylase-3 in diffuse large B-cell lymphoma: implications for therapy. Leukemia 2011; 26:1356-64. [PMID: 22116549 DOI: 10.1038/leu.2011.340] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) with an activated B-cell (ABC) gene-expression profile has been shown to have a poorer prognosis compared with tumors with a germinal center B-cell type. ABC cell lines have constitutive activation of STAT3; however, the mechanisms regulating STAT3 signaling in lymphoma are unknown. In studies of class-I histone deacetylase (HDAC) expression, we found overexpression of HDAC3 in phospho STAT3-positive DLBCL and the HDAC3 was found to be complexed with STAT3. Inhibition of HDAC activity by panobinostat (LBH589) increased p300-mediated STAT3(Lys685) acetylation with increased nuclear export of STAT3 to the cytoplasm. HDAC inhibition abolished STAT3(Tyr705) phosphorylation with minimal effect on STAT3(Ser727) and JAK2 tyrosine activity. pSTAT3(Tyr705)-positive DLBCLs were more sensitive to HDAC inhibition with LBH589 compared with pSTAT3(Tyr705)-negative DLBCLs. This cytotoxicity was associated with downregulation of the direct STAT3 target Mcl-1. HDAC3 knockdown upregulated STAT3(Lys685) acetylation but prevented STAT3(Tyr705) phosphorylation and inhibited survival of pSTAT3-positive DLBCL cells. These studies provide the rationale for targeting STAT3-positive DLBCL tumors with HDAC inhibitors.
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Affiliation(s)
- M Gupta
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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23
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Ansell SM, Tang H, Kurtin PJ, Koenig PA, Nowakowski GS, Nikcevich DA, Nelson GD, Yang Z, Grote DM, Ziesmer SC, Silberstein PT, Erlichman C, Witzig TE. Denileukin diftitox in combination with rituximab for previously untreated follicular B-cell non-Hodgkin's lymphoma. Leukemia 2011; 26:1046-52. [PMID: 22015775 PMCID: PMC3266999 DOI: 10.1038/leu.2011.297] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [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] [Indexed: 11/18/2022]
Abstract
Follicular lymphoma exhibits intratumoral infiltration by non-malignant T lymphocytes inluding CD4+CD25+ regulatory T (Treg) cells. We combined denileukin diftitox with rituximab in previously untreated, advanced-stage follicular lymphoma patients anticipating that denileukin diftitox would deplete CD25+ Treg cells while rituximab would deplete malignant B-cells. Patients received rituximab 375 mg/m2 weekly for 4 weeks and denileukin diftitox 18 mcg/kg/day for 5 days every 3 weeks for 4 cycles; neither agent was given as maintenance therapy. Between August 2008 and March 2010, 24 patients were enrolled. One patient died before treatment was given and was not included in the analysis. Eleven of 23 patients (48%; 95% CI: 27–69%) responded; 2 (9%) had complete responses and 9 (39%) had partial responses. The progression-free rate at 2 years was 55% (95%CI: 37–82%). Thirteen patients (57%) experienced grade ≥3 adverse events and 1 patient (4%) died. In correlative studies, soluble CD25 and the number of CD25+ T-cells decreased after treatment, however there was a compensatory increase in IL-15 and IP-10. We conclude that while the addition of denileukin diftitox to rituximab decreased the number of CD25+ T-cells, denileukin diftitox contributed to the toxicity of the combination without an improvement in response rate or time to progression.
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Affiliation(s)
- S M Ansell
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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24
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Nowakowski GS, LaPlant B, Habermann TM, Rivera CE, Macon WR, Inwards DJ, Micallef IN, Johnston PB, Porrata LF, Ansell SM, Klebig RR, Reeder CB, Witzig TE. Lenalidomide can be safely combined with R-CHOP (R2CHOP) in the initial chemotherapy for aggressive B-cell lymphomas: phase I study. Leukemia 2011; 25:1877-81. [PMID: 21720383 DOI: 10.1038/leu.2011.165] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lenalidomide was shown to have significant single-agent activity in relapsed aggressive non-Hodgkin's lymphoma (NHL). We conducted a phase I trial to establish the maximum tolerated dose of lenalidomide that could be combined with R-CHOP (rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone). Eligible patients were adults with newly diagnosed, untreated CD20 positive diffuse large cell or follicular grade III NHL. Patients received oral lenalidomide on days 1-10 with standard dose R-CHOP every 21 days. All patients received pegfilgrastim on day 2 of the cycle and aspirin prophylaxis. The lenalidomide dose levels tested were 15, 20 and 25 mg. A total of 24 patients were enrolled. The median age was 65 (35-82) years and 54% were over 60 years. Three patients received 15 mg, 3 received 20 mg and 18 received 25 mg of lenalidomide. No dose limiting toxicity was found, and 25 mg on days 1-10 is the recommended dose for phase II. The incidence of grade IV neutropenia and thrombocytopenia was 67% and 21%, respectively. Febrile neutropenia was rare (4%) and there were no toxic deaths. The overall response rate was 100% with a complete response rate of 77%. Lenalidomide at the dose of 25 mg/day administered on days 1 to 10 of 21-day cycle can be safely combined with R-CHOP in the initial chemotherapy of aggressive B-cell lymphoma.
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Affiliation(s)
- G S Nowakowski
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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25
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Hodge LS, Elsawa SF, Grote DM, Price-Troska TL, Asmann YW, Fonseca R, Gertz MA, Witzig TE, Novak AJ, Ansell SM. MicroRNA expression in tumor cells from Waldenstrom's macroglobulinemia reflects both their normal and malignant cell counterparts. Blood Cancer J 2011; 1:e24. [PMID: 22829168 PMCID: PMC3255267 DOI: 10.1038/bcj.2011.25] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [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: 02/15/2011] [Revised: 04/11/2011] [Accepted: 05/12/2011] [Indexed: 12/12/2022] Open
Abstract
MicroRNAs (miRNAs) are involved in the regulation of many cellular processes including hematopoiesis, with the aberrant expression of differentiation-stage specific miRNA associated with lymphomagenesis. miRNA profiling has been essential for understanding the underlying biology of many hematological malignancies; however the miRNA signature of the diverse tumor clone associated with Waldenstrom's macroglobulinemia (WM), consisting of B lymphocytes, plasmacytes and lymphoplasmacytic cells, has not been characterized. We have investigated the expression of over 13 000 known and candidate miRNAs in both CD19(+) and CD138(+) WM tumor cells, as well as in their malignant and non-malignant counterparts. Although neither CD19(+) nor CD138(+) WM cells were defined by a distinct miRNA profile, the combination of all WM cells revealed a unique miRNA transcriptome characterized by the dysregulation of many miRNAs previously identified as crucial for normal B-cell lineage differentiation. Specifically, miRNA-9(*)/152/182 were underexpressed in WM, whereas the expression of miRNA-21/125b/181a/193b/223/363 were notably increased (analysis of variance; P<0.0001). Future studies focusing on the effects of these dysregulated miRNAs will provide further insight into the mechanisms responsible for the pathogenesis of WM.
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Affiliation(s)
- L S Hodge
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S F Elsawa
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - D M Grote
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - T L Price-Troska
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Y W Asmann
- Division of Biomedical Informatics, Mayo Clinic, Rochester, MN, USA
| | - R Fonseca
- Comprehensive Cancer Center, Mayo Clinic, Scottsdale, AZ, USA
| | - M A Gertz
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - T E Witzig
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - A J Novak
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S M Ansell
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
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26
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Wilcox RA, Ristow K, Habermann TM, Inwards DJ, Micallef INM, Johnston PB, Colgan JP, Nowakowski GS, Ansell SM, Witzig TE, Markovic SN, Porrata L. The absolute monocyte and lymphocyte prognostic score predicts survival and identifies high-risk patients in diffuse large-B-cell lymphoma. Leukemia 2011; 25:1502-9. [PMID: 21606957 DOI: 10.1038/leu.2011.112] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite the use of modern immunochemotherapy regimens, almost 50% of patients with diffuse large-B-cell lymphoma will relapse. Current prognostic models, including the International Prognostic Index, incorporate patient and tumor characteristics. In contrast, recent observations show that variables related to host adaptive immunity and the tumor microenvironment are significant prognostic variables in non-Hodgkin lymphoma. Therefore, we retrospectively examined the absolute monocyte and lymphocyte counts as prognostic variables in a cohort of 366 diffuse large-B-cell lymphoma patients who were treated between 1993 and 2007 and followed at a single institution. The absolute monocyte and lymphocyte counts in univariate analysis predicted progression-free and overall survival when analyzed as continuous and dichotomized variables. On multivariate analysis performed with factors included in the IPI, the absolute monocyte and lymphocyte counts remained independent predictors of progression-free and overall survival. Therefore, the absolute monocyte and lymphocyte counts were combined to generate a prognostic score that identified patients with an especially poor overall survival. This prognostic score was independent of the IPI and added to its ability to identify high-risk patients.
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Affiliation(s)
- R A Wilcox
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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27
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Buadi F, Lacy M, Dispenzieri A, LaPlant B, Laumann KM, Nowakowski GS, Hayman SR, Detweiler Short K, Dingli D, Gertz MA, Greipp PR, Lust JA, Witzig TE, Zeldenrust SR, Russell SJ, Rajkumar V, Kumar S. Single-agent lenalidomide for newly diagnosed myeloma with on-demand dexamethasone: A phase II trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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28
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Nowakowski GS, Reeder CB, LaPlant B, Habermann TM, Rivera C, Macon WR, Inwards DJ, Micallef INM, Johnston PB, Porrata LF, Ansell SM, Witzig TE. Combination of lenalidomide with R-CHOP (R2CHOP) as an initial therapy for aggressive B-cell lymphomas: A phase I/II study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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29
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Kylstra JW, Witzig TE, Huang M, Emmanouilides CE, Hagenbeek A, Tidmarsh GF. Discriminatory power of the 111-indium scan (111-In) in the prediction of altered biodistribution of radio-immunoconjugate in the 90-yttrium ibritumomab tiuxetan therapeutic regimen: Meta-analysis of five clinical trials and 9 years of post-approval safety data. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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30
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Kapoor P, Kumar S, Mandrekar SJ, Laumann KM, Dispenzieri A, Lacy MQ, Dingli D, Gertz MA, Kyle RA, Greipp PR, Rajkumar SV, Witzig TE. Efficacy of thalidomide- or lenalidomide-based therapy in proliferative multiple myeloma. Leukemia 2011; 25:1195-7. [PMID: 21468037 DOI: 10.1038/leu.2011.54] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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31
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Witzig TE, Vose JM, Zinzani PL, Reeder CB, Buckstein R, Polikoff JA, Bouabdallah R, Haioun C, Tilly H, Guo P, Pietronigro D, Ervin-Haynes AL, Czuczman MS. An international phase II trial of single-agent lenalidomide for relapsed or refractory aggressive B-cell non-Hodgkin's lymphoma. Ann Oncol 2011; 22:1622-1627. [PMID: 21228334 DOI: 10.1093/annonc/mdq626] [Citation(s) in RCA: 325] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Lenalidomide is an immunomodulatory agent with antitumor activity in B-cell malignancies. This phase II trial aimed to demonstrate the safety and efficacy of lenalidomide in patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma (MCL), follicular grade 3 lymphoma (FL-III), or transformed lymphoma (TL). METHODS Patients received oral lenalidomide 25 mg on days 1-21 every 28 days as tolerated or until progression. The primary end point was overall response rate (ORR). RESULTS Two hundred and seventeen patients enrolled and received lenalidomide. The ORR was 35% (77/217), with 13% (29/217) complete remission (CR), 22% (48/217) partial remission, and 21% (45/217) with stable disease. The ORR for DLBCL was 28% (30/108), 42% (24/57) for MCL, 42% (8/19) for FL-III, and 45% (15/33) for TL. Median progression-free survival for all 217 patients was 3.7 months [95% confidence interval (CI) 2.7-5.1]. For 77 responders, the median response duration lasted 10.6 months (95% CI 7.0-NR). Median response duration was not reached in 29 patients who achieved a CR and in responding patients with FL-III or MCL. The most common adverse event was myelosuppression with grade 4 neutropenia and thrombocytopenia in 17% and 6%, respectively. CONCLUSION Lenalidomide is well tolerated and produces durable responses in patients with relapsed or refractory aggressive non-Hodgkin's lymphoma.
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Affiliation(s)
- T E Witzig
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester.
| | - J M Vose
- Section of Hematology/Oncology, University of Nebraska, Omaha, USA
| | - P L Zinzani
- Institute of Hematology and Oncology Seragnoli, University of Bologna, Bologna, Italy
| | - C B Reeder
- Department of Medicine, Division of Hematology, Mayo Clinic, Scottsdale, USA
| | - R Buckstein
- Department of Hematology, Sunnybrook Odette Cancer Center, Toronto, Canada
| | - J A Polikoff
- Department of Hematology/Oncology, Kaiser Permanente Medical Group, San Diego, USA
| | - R Bouabdallah
- Department of Hematology, Institut Paoli Calmettes, Marseilles
| | - C Haioun
- Department of Hôpital Henri Mondor-AP-HP, Créteil
| | - H Tilly
- Department of Centre Henri Becquerel, Rouen, France
| | - P Guo
- Department of Celgene Corporation, Summit
| | | | | | - M S Czuczman
- Department of Medicine, Lymphoma/Myeloma Service, Roswell Park Cancer Institute, Buffalo, USA
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32
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Witzig TE, Reeder CB, LaPlant BR, Gupta M, Johnston PB, Micallef IN, Porrata LF, Ansell SM, Colgan JP, Jacobsen ED, Ghobrial IM, Habermann TM. A phase II trial of the oral mTOR inhibitor everolimus in relapsed aggressive lymphoma. Leukemia 2010; 25:341-7. [PMID: 21135857 PMCID: PMC3049870 DOI: 10.1038/leu.2010.226] [Citation(s) in RCA: 257] [Impact Index Per Article: 18.4] [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] [Indexed: 12/12/2022]
Abstract
The phosphatidylinositol 3-kinase signal transduction pathway members are often activated in tumor samples from patients with non-Hodgkin's lymphoma (NHL). Everolimus is an oral agent that targets the raptor mammalian target of rapamycin (mTORC1). The goal of this trial was to learn the antitumor activity and toxicity of single-agent everolimus in patients with relapsed/refractory aggressive NHL. Patients received everolimus 10 mg PO daily. Response was assessed after two and six cycles, and then every three cycles until progression. A total of 77 patients with a median age of 70 years were enrolled. Patients had received a median of three previous therapies and 32% had undergone previous transplant. The overall response rate (ORR) was 30% (95% confidence interval: 20-41%), with 20 patients achieving a partial remission and 3 a complete remission unconfirmed. The ORR in diffuse large B cell was 30% (14/47), 32% (6/19) in mantle cell and 38% (3/8) in follicular grade 3. The median duration of response was 5.7 months. Grade 3 or 4 anemia, neutropenia and thrombocytopenia occurred in 14, 18 and 38% of patients, respectively. Everolimus has single-agent activity in relapsed/refractory aggressive NHL and provides proof-of-concept that targeting the mTOR pathway is clinically relevant.
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Affiliation(s)
- T E Witzig
- Division of Hematology, Department of Medicine, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN 55905, USA.
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Hussain S, Foreman O, Perkins SL, Witzig TE, Miles RR, van Deursen J, Galardy PJ. The de-ubiquitinase UCH-L1 is an oncogene that drives the development of lymphoma in vivo by deregulating PHLPP1 and Akt signaling. Leukemia 2010; 24:1641-55. [PMID: 20574456 DOI: 10.1038/leu.2010.138] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
De-ubiquitinating enzymes (DUBs) can reverse the modifications catalyzed by ubiquitin ligases and as such are believed to be important regulators of a variety of cellular processes. Several members of this protein family have been associated with human cancers; however, there is little evidence for a direct link between deregulated de-ubiquitination and neoplastic transformation. Ubiquitin C-terminal hydrolase (UCH)-L1 is a DUB of unknown function that is overexpressed in several human cancers, but whether it has oncogenic properties has not been established. To address this issue, we generated mice that overexpress UCH-L1 under the control of a ubiquitous promoter. Here, we show that UCH-L1 transgenic mice are prone to malignancy, primarily lymphomas and lung tumors. Furthermore, UCH-L1 overexpression strongly accelerated lymphomagenesis in Emu-myc transgenic mice. Aberrantly expressed UCH-L1 boosts signaling through the Akt pathway by downregulating the antagonistic phosphatase PHLPP1, an event that requires its de-ubiquitinase activity. These data provide the first in vivo evidence for DUB-driven oncogenesis and suggest that UCH-L1 hyperactivity deregulates normal Akt signaling.
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Affiliation(s)
- S Hussain
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN 55906, USA
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34
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Porrata LF, Ristow K, Inwards DJ, Ansell SM, Micallef IN, Johnston PB, Habermann TM, Witzig TE, Colgan J, Markovic S. Use of lymphopenia assessed during routine follow-up after immunochemotherapy (R-CHOP) to predict relapse in patients with diffuse large B-cell lymphoma (DLBCL). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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35
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Hernandez-Ilizaliturri FJ, Deeb G, Zinzani PL, Pileri SA, Malik F, Macon WR, Witzig TE, Goy A, Czuczman MS. Response of relapsed/refractory diffuse large B-cell lymphoma (DLBCL) with nongerminal center B-cell phenotype to lenalidomide (L) alone or in combination with rituximab (R). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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36
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Reeder CB, Vose J, Witzig TE, Zinzani PL, Buckstein R, Polikoff J, Li J, Pietronigro D, Ervin-Haynes AL, Czuczman MS. Lenalidomide (LEN) in patients with transformed lymphoma: Results from a large international phase II study (NHL-003). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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37
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Wilcox RA, Frigola Baro X, Porrata LF, Kwon ED, Maurer MJ, Micallef IN, Witzig TE, Ansell SM. Association of serum B7-H1 level and lymphopenia in diffuse large B-cell non-Hodgkin lymphoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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38
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Ramakrishnan V, Timm M, Haug JL, Kimlinger TK, Wellik LE, Witzig TE, Rajkumar SV, Adjei AA, Kumar S. Sorafenib, a dual Raf kinase/vascular endothelial growth factor receptor inhibitor has significant anti-myeloma activity and synergizes with common anti-myeloma drugs. Oncogene 2009; 29:1190-202. [PMID: 19935717 DOI: 10.1038/onc.2009.403] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Multiple myeloma is characterized by increased bone marrow neovascularization driven in part by vascular endothelial growth factor (VEGF). In addition, the Ras/Raf/MEK/ERK pathway is critical for the proliferation of myeloma cells and is often upregulated. Sorafenib (Nexavar) is a novel multi-kinase inhibitor that acts predominantly through inhibition of Raf-kinase and VEGF receptor 2, offering the potential for targeting two important aspects of disease biology. In in vitro studies, sorafenib-induced cytotoxicity in MM cell lines as well as freshly isolated patient myeloma cells. It retained its activity against MM cells in co-culture with stromal cells or with interleukin-6, VEGF or IGF; conditions mimicking tumor microenvironment. Examination of cellular signaling pathways showed downregulation of Mcl1 as well as decreased phosphorylation of the STAT3 and MEK/ERK, as potential mechanisms of its anti-tumor effect. Sorafenib induces reciprocal upregulation of Akt phosphorylation; and simultaneous inhibition of downstream mTOR with rapamycin leads to synergistic effects. Sorafenib also synergizes with drugs such as proteasome inhibitors and steroids. In a human in vitro angiogenesis assay, sorafenib showed potent anti-angiogenic activity. Sorafenib, through multiple mechanisms exerts potent anti-myeloma activity and these results favor further clinical evaluation and development of novel sorafenib combinations.
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Affiliation(s)
- V Ramakrishnan
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA
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39
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Micallef IN, Maurer MJ, Nikcevich DA, Cannon MW, Schaefer EW, Moore DF, Kurtin P, Witzig TE. Final results of NCCTG N0489: Epratuzumab and rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy (ER-CHOP) in patients with previously untreated diffuse large B-cell lymphoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8508] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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
8508 Background: A prior pilot study of epratuzumab (Immunomedics) and rituximab in combination with CHOP chemotherapy (ER-CHOP) in untreated patients with diffuse large B-cell lymphoma demonstrated feasibility and safety. This multicenter NCCTG phase II study was carried out to assess efficacy. Methods: Patients received immunochemotherapy on the following schedule: epratuzumab 360 mg/m2, rituximab 375 mg/m2, and standard dose CHOP every 3 weeks for 6 cycles. Weekly blood counts were obtained to monitor hematological toxicity. Primary endpoint was 12 month event free survival (EFS12). Secondary endpoints were response rate, progression free survival, functional CR (PET negative) and toxicity. Results: 107 patients were accrued from Feb 2006 to Aug 2007. 29 patients were ineligible resulting in 78 eligible patients. Baseline patient characteristics for the eligible patients included median age 61 (range 21–82); 59% were male. 81% had advanced stage; IPI was 0–1 in 17 pts (22%), 2 in 22 pts (28%), 3 in 29 pts (37%) and 4–5 in 10 pts (13%). Based on the revised IPI (R-IPI) 50% were poor/high risk (IPI 3–5). 71% had an elevated LDH. Performance score was 0–1 in 69 pts and 2–3 in 9 pts. The ORR was 95% (CR/CRu: 73%). For the low risk IPI (0–2), ORR was 95% (CR/CRu: 74%) and for the high risk IPI (3–5), ORR was 95% (CR/CRu: 72%). The EFS at 12 months was 80%. The 12 month progression free survival (PFS12) and overall survival (OS12) is 82% and 88% respectively. EFS12, PFS12 and OS12 by IPI risk category is shown ( Table ). Conclusions: ER-CHOP every 21 days is feasible and safe. The ORR, EFS and PFS compare favorably to studies using R-CHOP especially in the high-intermediate and high risk IPI subgroups. A randomized phase III trial of R-CHOP vs ER-CHOP is needed to prove that dual antibody targeting in combination with CHOP is better. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- I. N. Micallef
- Mayo Clinic, Rochester, MN; St. Mary's Duluth Clinic, Duluth, MN; Cancer Center of Kansas PA, Wichita, KS
| | - M. J. Maurer
- Mayo Clinic, Rochester, MN; St. Mary's Duluth Clinic, Duluth, MN; Cancer Center of Kansas PA, Wichita, KS
| | - D. A. Nikcevich
- Mayo Clinic, Rochester, MN; St. Mary's Duluth Clinic, Duluth, MN; Cancer Center of Kansas PA, Wichita, KS
| | - M. W. Cannon
- Mayo Clinic, Rochester, MN; St. Mary's Duluth Clinic, Duluth, MN; Cancer Center of Kansas PA, Wichita, KS
| | - E. W. Schaefer
- Mayo Clinic, Rochester, MN; St. Mary's Duluth Clinic, Duluth, MN; Cancer Center of Kansas PA, Wichita, KS
| | - D. F. Moore
- Mayo Clinic, Rochester, MN; St. Mary's Duluth Clinic, Duluth, MN; Cancer Center of Kansas PA, Wichita, KS
| | - P. Kurtin
- Mayo Clinic, Rochester, MN; St. Mary's Duluth Clinic, Duluth, MN; Cancer Center of Kansas PA, Wichita, KS
| | - T. E. Witzig
- Mayo Clinic, Rochester, MN; St. Mary's Duluth Clinic, Duluth, MN; Cancer Center of Kansas PA, Wichita, KS
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Reeder CB, Witzig TE, Zinzani PL, Vose JM, Buckstein R, Haioun C, Bouabdallah R, Polikoff J, Pietronigro D, Czuczman MS. Efficacy and safety of lenalidomide oral monotherapy in patients with relapsed or refractory mantle-cell lymphoma: Results from an international study (NHL-003). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8569] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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
8569 Introduction: Relapsed or refractory MCL patients demonstrated a promising overall response rate (ORR) of 53% with a median duration of response (DR) of 13.7 months to single-agent lenalidomide when analyzed as a subset in a recent a phase II study (NHL-002). A supporting international phase II trial (NHL-003) of single-agent lenalidomide was initiated for patients with relapsed or refractory aggressive NHL. In this report, we analyze the current results from the MCL patients enrolled in this trial. Methods: Patients with relapsed or refractory MCL and measurable disease 2 cm after at least 1 prior treatment regimen were eligible. Patients received 25 mg of lenalidomide orally once daily on days 1–21 of every 28-day cycle. Patients continued therapy until disease progression or toxicity. The 1999 IWLRC methodology was used to assess response and progression. Results: Fifty-four MCL patients were enrolled and were evaluable for response assessment. Median age was 69 years (33–82) and 40 patients (74%) were male. Median time from diagnosis was 3.2 years (0.4–10.4), patients had received a median of 3 prior treatments (1–8), 17 of the patients (32%) had received prior bortezomib therapy (MCL-bortezomib), and 14 (26%) had received a prior stem cell transplant (MCL-stem cell). Response rates are shown in the Table. The most common grade 3 or 4 adverse events were neutropenia (43%), thrombocytopenia (22%) and anemia (11%). Conclusions: This is the second study to demonstrate that lenalidomide oral monotherapy is effective in the treatment of patients with relapsed or refractory MCL, with manageable side effects. [Table: see text] [Table: see text]
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Affiliation(s)
- C. B. Reeder
- Mayo Clinic Arizona, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Institute of Hematology and Medical Oncology, Bologna, Italy; University of Nebraska, Omaha, NE; Toronto Sunnybrook, Toronto, ON, Canada; Henri Mondor Hospital, Creteil, France; Cancer Center Institute Paoli-Calmettes, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Roswell Park Cancer Institute, Buffalo, NY
| | - T. E. Witzig
- Mayo Clinic Arizona, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Institute of Hematology and Medical Oncology, Bologna, Italy; University of Nebraska, Omaha, NE; Toronto Sunnybrook, Toronto, ON, Canada; Henri Mondor Hospital, Creteil, France; Cancer Center Institute Paoli-Calmettes, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Roswell Park Cancer Institute, Buffalo, NY
| | - P. L. Zinzani
- Mayo Clinic Arizona, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Institute of Hematology and Medical Oncology, Bologna, Italy; University of Nebraska, Omaha, NE; Toronto Sunnybrook, Toronto, ON, Canada; Henri Mondor Hospital, Creteil, France; Cancer Center Institute Paoli-Calmettes, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Roswell Park Cancer Institute, Buffalo, NY
| | - J. M. Vose
- Mayo Clinic Arizona, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Institute of Hematology and Medical Oncology, Bologna, Italy; University of Nebraska, Omaha, NE; Toronto Sunnybrook, Toronto, ON, Canada; Henri Mondor Hospital, Creteil, France; Cancer Center Institute Paoli-Calmettes, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Roswell Park Cancer Institute, Buffalo, NY
| | - R. Buckstein
- Mayo Clinic Arizona, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Institute of Hematology and Medical Oncology, Bologna, Italy; University of Nebraska, Omaha, NE; Toronto Sunnybrook, Toronto, ON, Canada; Henri Mondor Hospital, Creteil, France; Cancer Center Institute Paoli-Calmettes, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Roswell Park Cancer Institute, Buffalo, NY
| | - C. Haioun
- Mayo Clinic Arizona, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Institute of Hematology and Medical Oncology, Bologna, Italy; University of Nebraska, Omaha, NE; Toronto Sunnybrook, Toronto, ON, Canada; Henri Mondor Hospital, Creteil, France; Cancer Center Institute Paoli-Calmettes, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Roswell Park Cancer Institute, Buffalo, NY
| | - R. Bouabdallah
- Mayo Clinic Arizona, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Institute of Hematology and Medical Oncology, Bologna, Italy; University of Nebraska, Omaha, NE; Toronto Sunnybrook, Toronto, ON, Canada; Henri Mondor Hospital, Creteil, France; Cancer Center Institute Paoli-Calmettes, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Roswell Park Cancer Institute, Buffalo, NY
| | - J. Polikoff
- Mayo Clinic Arizona, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Institute of Hematology and Medical Oncology, Bologna, Italy; University of Nebraska, Omaha, NE; Toronto Sunnybrook, Toronto, ON, Canada; Henri Mondor Hospital, Creteil, France; Cancer Center Institute Paoli-Calmettes, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Roswell Park Cancer Institute, Buffalo, NY
| | - D. Pietronigro
- Mayo Clinic Arizona, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Institute of Hematology and Medical Oncology, Bologna, Italy; University of Nebraska, Omaha, NE; Toronto Sunnybrook, Toronto, ON, Canada; Henri Mondor Hospital, Creteil, France; Cancer Center Institute Paoli-Calmettes, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Roswell Park Cancer Institute, Buffalo, NY
| | - M. S. Czuczman
- Mayo Clinic Arizona, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Institute of Hematology and Medical Oncology, Bologna, Italy; University of Nebraska, Omaha, NE; Toronto Sunnybrook, Toronto, ON, Canada; Henri Mondor Hospital, Creteil, France; Cancer Center Institute Paoli-Calmettes, Marseille, France; Kaiser Permanente Medical Group, Southern California, CA; Celgene Corporation, Summit, NJ; Roswell Park Cancer Institute, Buffalo, NY
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Witzig TE, Wiernik PH, Moore T, Reeder C, Cole C, Justice G, Kaplan H, Voralia M, Pietronigro D, Vose JM. Efficacy of lenalidomide oral monotherapy in relapsed or refractory indolent non-Hodgkin's lymphoma: Final results of NHL-001. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8560] [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
8560 Background: Lenalidomide has shown activity in a wide range of hematological malignancies. We conducted a phase II trial of single-agent lenalidomide in indolent non-Hodgkin's lymphoma (NHL). Methods: Patients with relapsed or refractory indolent NHL were eligible, with no limit on the number of previous therapies. Oral lenalidomide 25 mg was self-administered once-daily on days 1–21 of every 28-day cycle for up to 52 weeks as tolerated, or until disease progression. The primary endpoint was overall response rate (ORR), with secondary endpoints of response duration, progression-free survival (PFS), and safety. Results: Forty-three patients were enrolled and were evaluable for response and safety. Patients had received a median of 3 prior systemic therapies (1–17) and half of all patients were refractory to their last therapy. The ORR was 23% (10/43), including a complete response (CR) or unconfirmed CR (CRu) rate of 7%. The median time to first response was 3.6 months (1.7–4.2) and the median time to CR or CRu was 4.2 months (1.9–11.1). Twenty-seven percent (6/22) of patients with follicular lymphoma grade 1 or 2, and 22% (4/18) of patients with small lymphocytic lymphoma responded to therapy. The median duration of response has not reached, but is longer than 16.5 months with 7 of 10 responses ongoing at 15–28 months. Median PFS was 4.4 months (2.5–10.4). Adverse events were consistent with the known safety profile of lenalidomide and manageable; the most common grade 3 or 4 adverse events were neutropenia (30% and 16%, respectively) and thrombocytopenia (14% and 5%, respectively). Conclusions: Oral lenalidomide monotherapy produces durable responses with manageable side effects in relapsed or refractory indolent NHL and warrants further investigation in the treatment of indolent NHL. [Table: see text]
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Affiliation(s)
- T. E. Witzig
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - P. H. Wiernik
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - T. Moore
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - C. Reeder
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - C. Cole
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - G. Justice
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - H. Kaplan
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - M. Voralia
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - D. Pietronigro
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
| | - J. M. Vose
- Mayo Clinic Stabile 628, Rochester, MN; Montefiore Medical Center-North Division, Valhalla, NY; Mid Ohio Oncology/Hematology, Inc., Columbus, OH; Mayo Clinic, Scottsdale, AZ; Gundersen Clinic, La Crosse, WI; Pacific Coast Hematology/Oncology, Fountain Valley, CA; Swedish Cancer Institute, Seattle, WA; Saskatoon Cancer Center, Saskatoon, SK, Canada; Celgene Corporation, Summit, NJ; University of Nebraska, Omaha, NE
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Gertz MA, Leung N, Lacy MQ, Dispenzieri A, Zeldenrust SR, Hayman SR, Buadi FK, Dingli D, Greipp PR, Kumar SK, Lust JA, Rajkumar SV, Russell SJ, Witzig TE. Clinical outcome of immunoglobulin light chain amyloidosis affecting the kidney. Nephrol Dial Transplant 2009; 24:3132-7. [DOI: 10.1093/ndt/gfp201] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gertz MA, Lacy MQ, Lust JA, Greipp PR, Witzig TE, Kyle RA. Long-term risk of myelodysplasia in melphalan-treated patients with immunoglobulin light-chain amyloidosis. Haematologica 2008; 93:1402-6. [DOI: 10.3324/haematol.12982] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Habermann TM, Witzig TE, Lossos IS, Vose JM, Wiernik PH, Weiss L, Ervin-Haynes A, Pietronigro D, Zeldis JB, Czuczman M. Safety of lenalidomide monotherapy in patients with relapsed or refractory aggressive non-Hodgkin’s lymphom. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kapoor P, Snozek C, Colby CL, Larson DR, Katzmann JA, Witzig TE, Rajkumar SV, Greipp PR. Incorporation of the plasma cell labeling index into the international staging system of multiple myeloma: Impact on prognostic value. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gertz MA, Lacy MQ, Lust J, Greipp PR, Witzig TE, Kyle RA. Long-term risk of myelodysplasia in melphalan-treated patients with immunoglobulin light chain amyloidosis. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Witzig TE, Vose JM, Justice G, Kaplan HG, Reeder CB, Pietronigro D, Takeshita K, Ervin-Haynes A, Zeldis JB, Wiernik PH. Lenalidomide oral monotherapy in relapsed/refractory small lymphocytic non-Hodgkin’s lymphoma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Czuczman MS, Reeder CB, Polikoff J, Chowhan NM, Esseessee I, Greenberg R, Ervin-Haynes A, Pietronigro D, Zeldis JB, Witzig TE. International study of lenalidomide in relapsed/refractory aggressive non-Hodgkin’s lymphoma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Micallef IN, Maurer MJ, Nikcevich DA, Cannon M, Moore DF, Kurtin P, Witzig TE. A phase II study of epratuzumab and rituximab in combination with cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy (ER-CHOP) in patients with previously untreated diffuse large B-cell lymphoma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Greipp PT, Kapoor P, Morice WG, Witzig TE, Greipp PR. Reply to ‘Rituximab in CD20 positive multiple myeloma’ by P Moreau et al. Leukemia 2007; 22:214-5. [DOI: 10.1038/sj.leu.2404972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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