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Eyre TA, Phillips EH, Linton KM, Arumainathan A, Kassam S, Gibb A, Allibone S, Radford J, Peggs K, Burton C, Stewart G, LeDieu R, Booth C, Osborne WL, Miall F, Eyre DW, Ardeshna KM, Collins GP. Results of a multicentre UK-wide retrospective study evaluating the efficacy of brentuximab vedotin in relapsed, refractory classical Hodgkin lymphoma in the transplant naive setting. Br J Haematol 2017; 179:471-479. [PMID: 28857136 DOI: 10.1111/bjh.14898] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 07/18/2017] [Indexed: 11/29/2022]
Abstract
Relapsed or refractory classical Hodgkin lymphoma (cHL) is associated with a poor outcome when standard chemotherapy fails. Brentuximab vedotin (BV) is an anti-CD30 monoclonal antibody-drug conjugate licensed for use at relapse after autologous stem cell transplant (ASCT) or following two prior therapies in those unsuitable for ASCT. There are limited data assessing the ability of BV to enable curative SCT. We performed a UK-wide retrospective study of 99 SCT-naïve relapsed/refractory cHL. All had received 2 prior lines and were deemed fit for transplant but had an insufficient remission to proceed. The median age was 32 years. Most had nodular sclerosis subtype, Eastern Cooperative Oncology Group performance status 0-1 and advanced stage disease. The median progression-free survival (PFS) was 5·6 months and median overall survival (OS) was 37·2 months. The overall response rate was 56% (29% complete response; 27% partial response). 61% reached SCT: 34% immediately post-BV and 27% following an inadequate BV response but were salvaged and underwent deferred SCT. Patients consolidated with SCT had a superior PFS and OS to those not receiving SCT (P < 0·001). BV is an effective, non-toxic bridge to immediate SCT in 34% and deferred SCT in 27%. 39% never reached SCT with a PFS of 3·0 months, demonstrating the unmet need to improve outcomes in those unsuitable for SCT post-BV.
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Affiliation(s)
- Toby A Eyre
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Elizabeth H Phillips
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kim M Linton
- Department of Medical Oncology, The Christie Hospital NHS Trust, Manchester, UK
| | | | - Shireen Kassam
- Department of Haematology, Kings College London Hospitals NHS Foundation Trust Denmark Hill, London, UK
| | - Adam Gibb
- Department of Medical Oncology, The Christie Hospital NHS Trust, Manchester, UK
| | - Suzanne Allibone
- Department of Medical Oncology, The Christie Hospital NHS Trust, Manchester, UK
| | - John Radford
- Department of Medical Oncology, The Christie Hospital NHS Trust, Manchester, UK
| | - Karl Peggs
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Cathy Burton
- Department of Haematology, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Gillian Stewart
- Department of Haematology, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Rifca LeDieu
- Department of Haematology, St Bartholomew's Hospital, London, UK
| | - Catherine Booth
- Department of Haematology, St Bartholomew's Hospital, London, UK
| | - Wendy L Osborne
- Department of Haematology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Fiona Miall
- Department of Haematology University Hospitals of Leicester NHS Trust, Leicester, UK
| | - David W Eyre
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kirit M Ardeshna
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Graham P Collins
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Eyre TA, Osborne WL, Gallop-Evans E, Ardeshna KM, Kassam S, Sadullah S, Sidra G, Culligan D, Arumainathan A, Shankara P, Bowles KM, Eyre DW, Peng YY, Pettengell R, Bloor A, Vandenberghe E, Collins GP. Results of a multicentre UK-wide compassionate use programme evaluating the efficacy of idelalisib monotherapy in relapsed, refractory follicular lymphoma. Br J Haematol 2017; 181:555-559. [DOI: 10.1111/bjh.14665] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Toby A. Eyre
- Department of Haematology; Churchill Hospital; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - Wendy L. Osborne
- Department of Haematology; Newcastle upon Tyne NHS Foundation Trust; Newcastle upon Tyne UK
| | | | - Kirit M. Ardeshna
- Department of Haematology; University College London Hospitals NHS Foundation Trust; London UK
| | - Shireen Kassam
- Department of Haematology; Kings College London Hospitals NHS Foundation Trust Denmark Hill; London UK
| | - Shalal Sadullah
- Department of Haematology; James Paget University Hospitals NHS Foundation Trust; Great Yarmouth UK
| | - Gamal Sidra
- Department of Haematology; Lincoln County Hospital; Lincoln UK
| | - Dominic Culligan
- Department of Haematology; Aberdeen Royal Infirmary; Aberdeen UK
| | - Arvind Arumainathan
- Department of Haematology; Royal Liverpool University Hospital NHS Trust; Liverpool UK
| | - Paneesha Shankara
- Department of Haematology & Stem Cell Transplantation; Birmingham Heartlands Hospital; Birmingham UK
| | - Kristian M. Bowles
- Department of Haematology; Norfolk and Norwich University Hospital; Norwich UK
| | - David W. Eyre
- Nuffield Department of Medicine; University of Oxford; Oxford UK
| | - Ying Y. Peng
- Department of Haematology; St George's Hospital; Oxford UK
| | | | - Adrian Bloor
- Department of Haematology; The Christie Hospital NHS Trust; Manchester UK
| | | | - Graham P. Collins
- Department of Haematology; Churchill Hospital; Oxford University Hospitals NHS Foundation Trust; Oxford UK
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Eyre TA, Linton KM, Rohman P, Kothari J, Cwynarski K, Ardeshna K, Bailey C, Osborne WL, Rowntree C, Eden D, Shankara P, Eyre DW, Jasani P, Chaidos A, Collins GP, Hatton CS. Results of a multicentre UK-wide retrospective study evaluating the efficacy of pixantrone in relapsed, refractory diffuse large B cell lymphoma. Br J Haematol 2016; 173:896-904. [PMID: 26956150 DOI: 10.1111/bjh.14021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 11/23/2015] [Accepted: 01/12/2016] [Indexed: 11/29/2022]
Abstract
Relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) in those unfit or ineligible for autologous stem cell transplantation is associated with a poor outcome and new treatment approaches are needed. Pixantrone is a novel aza-anthracenedione which is structurally similar to anthracyclines and is licenced in R/R DLBCL and National Institute for Health and Care Excellence (NICE)-approved following the PIX301 trial. No data exist post-NICE approval. We performed a UK-wide retrospective multi-centre study of 92 R/R DLBCL who received pixantrone. Eighty-five per cent had refractory disease and 72% had an international prognostic index (IPI) 3-5 at commencement of pixantrone. The median progression-free survival (PFS) was 2·0 months (95% confidence interval (CI) 1·5-2·4) and the median overall survival was 3·4 months (95% CI 2·7-4·5). The overall response rate was 24% (complete response 10%; partial response 14%). We demonstrate that pixantrone has limited activity in a cohort of high risk, predominantly refractory DLBCL. Multivariate Cox regression revealed that patients who relapsed >12 months after first line treatment, those with fewer prior lines of therapy and relapsed (non-refractory) DLBCL had improved PFS. The major population of unmet need are those with refractory DLBCL who are poorly represented within trials and in whom pixantrone appears less efficacious compared to relapsed DLBCL.
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Affiliation(s)
- Toby A Eyre
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kim M Linton
- Department of Medical Oncology, the Christie NHS Foundation Trust, Manchester, UK
| | - Phillipa Rohman
- Imperial College London Centre for Haematology, Hammersmith Hospital, London, UK.,Department of Haematology, Royal Free Hospital, London, UK
| | - Jaimal Kothari
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kate Cwynarski
- Department of Haematology, Royal Free Hospital, London, UK
| | - Kirit Ardeshna
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Chris Bailey
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Wendy L Osborne
- Department of Haematology, Newcastle upon Tyne NHS Foundation Trust, London, UK
| | - Clare Rowntree
- Department of Haematology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Dewi Eden
- Department of Haematology & Stem Cell Transplantation, Birmingham Heartlands Hospital, Birmingham, UK
| | - Paneesha Shankara
- Department of Haematology & Stem Cell Transplantation, Birmingham Heartlands Hospital, Birmingham, UK
| | - David W Eyre
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Parag Jasani
- Department of Haematology, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK
| | - Aristeidis Chaidos
- Imperial College London Centre for Haematology, Hammersmith Hospital, London, UK
| | - Graham P Collins
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Chris S Hatton
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Jackson GH, Morgan GJ, Davies FE, Wu P, Gregory WM, Bell SE, Szubert AJ, Navarro Coy N, Drayson MT, Owen RG, Feyler S, Ashcroft AJ, Ross FM, Byrne J, Roddie H, Rudin C, Boyd KD, Osborne WL, Cook G, Child JA. Osteonecrosis of the jaw and renal safety in patients with newly diagnosed multiple myeloma: Medical Research Council Myeloma IX Study results. Br J Haematol 2014; 166:109-17. [PMID: 24673708 DOI: 10.1111/bjh.12861] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 01/22/2014] [Indexed: 11/28/2022]
Abstract
Bisphosphonates are recommended in patients with osteolytic lesions secondary to multiple myeloma. We report on the safety of bisphosphonate therapy with long-term follow-up in the Medical Research Council Myeloma IX study. Patients with newly diagnosed multiple myeloma were randomised to zoledronic acid (ZOL; 4 mg intravenously every 21-28 d) or clodronate (CLO; 1600 mg/d orally) plus chemotherapy. Among 1960 patients (5.9-year median follow-up), both bisphosphonates were well tolerated. Acute renal failure events were similar between groups (ZOL 5.2% vs. CLO 5.8% at 2 years; incidence plateaued thereafter). The overall incidence of confirmed osteonecrosis of the jaw (ONJ) was low, but higher with ZOL (ZOL 3.7% vs. CLO 0.5%; P < 0.0001). ONJ events were generally low grade and most occurred between 8 and 30 months (median time to ONJ, 23.7 months). Among 10 patients with ONJ recovery data, four patients in the ZOL group completely recovered, two patients improved, and three patients experienced no improvement; one CLO patient experienced no improvement. Dental surgery or trauma preceded ONJ in six ZOL patients. The incidence of renal adverse events was similar for ZOL and CLO. ONJ incidence remained low and was lower with CLO compared to ZOL. We have seen no further ONJ cases to date.
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Abstract
We discuss a case with significant progressive peripheral neurological deterioration following administration of both fludarabine and cytarabine as part of the FLA (fludarabine and cytarabine) regime. Of particular interest is that toxicity only occurred during the second course of FLA and sixth course of Ara-C containing chemotherapy. At this point, a new antifungal agent had been commenced, suggesting a possible drug interaction enhancing the risk of known neurological toxicity with this regime.
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Affiliation(s)
- W L Osborne
- Bone Marrow Transplant Unit and Department of Haematology, Glasgow Royal Infirmary, Glasgow, UK
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DeVaney S, Hughey AW, Osborne WL. Comparative effects of exercise reduction and relaxation training on mood states and Type A scores in habitual aerobic exercisers. Percept Mot Skills 1994; 79:1635-44. [PMID: 7870559 DOI: 10.2466/pms.1994.79.3f.1635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The comparative effects of exercise reduction and relaxation training on dysphoric mood states and Type A scores in persons who exercise beyond the American College of Sports Medicine's recommended guidelines for cardiovascular fitness were investigated. Using their scores on the Profile of Mood States and the Jenkins Activity Survey, 57 subjects were randomly divided into 3 matched groups based on age, gender, and exercise regimen. Subjects assigned to the control group maintained their current exercise regimen, those in the second group reduced their exercise regimen to include no more than 5 hours of aerobic activity per week, and those in the third group maintained their current exercise regimen and attended 5 1 1/2-hr. relaxation training sessions. Both inventories were administered again after 10 weeks. Multivariate analysis of covariance showed no statistically significant differences among group means on the dependent variables. Further research on the use of aerobic exercise and relaxation training as auxiliary treatments for anxiety and depression is recommended.
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Affiliation(s)
- S DeVaney
- Department of Educational Leadership, Western Kentucky University, Bowling Green 42101
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Osborne WL, Courts NF. Better communications make more compassionate hospitals. Nurs Manag (Harrow) 1991; 22:31-2. [PMID: 1870791 DOI: 10.1097/00006247-199108000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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