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Saito T, Matsuo-Tezuka Y, Sugitani Y, Tajima T, Fukao-Washino J, Sakai S, Iwagami M. Effect of the COVID-19 pandemic on outpatient care and rehabilitation in neuromuscular clinical practice in Japan: a health insurance claims database analysis. BMJ Open 2023; 13:e070818. [PMID: 37380210 PMCID: PMC10410968 DOI: 10.1136/bmjopen-2022-070818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/08/2023] [Indexed: 06/30/2023] Open
Abstract
OBJECTIVES To evaluate the impact of the COVID-19 pandemic on outpatient care in Japanese patients with neuromuscular diseases (NMDs). DESIGN This retrospective cohort study included patients between January 2018 and February 2019; the follow-up period was divided into 'before COVID-19' (March 2019-February 2020) and 'during COVID-19' (March 2020-February 2021). SETTING JMDC claims database study. PARTICIPANTS Of the 10 655 557 patients identified, we included patients with spinal muscular atrophy (SMA; n=82), neuromyelitis optica (NMO; n=342), myasthenia gravis (MG; n=1347), Guillain-Barré syndrome (GBS; n=442) or autoimmune encephalitis/encephalopathy (AIE; n=133). Patients were required to have ≥1 month of data available, have a diagnosis of NMD during the enrolment period and be available for follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES We estimated the proportion of patients with >30% change in outpatient consultation and rehabilitation visits before versus during the COVID-19 pandemic. RESULTS Small reductions in the proportion of patients with outpatient consultation/rehabilitation visits were observed before versus during the pandemic. Compared with before the pandemic, 30.4%, 27.8%, 28.7%, 49.4% and 50.0% of patients showed a >30% decrease in outpatient consultation visits and 58.6%, 75.0%, 50.0%, 76.3% and 84.6% showed a >30% decrease in outpatient rehabilitation visits during the pandemic for SMA, NMO, MG, GBS and AIE, respectively. The median change in the number of outpatient consultation visits per year before versus during pandemic was -1.0 day for all NMDs, and that in outpatient rehabilitation visits per year was -6.0, -5.5, -1.5, -6.5 and -9.0 days for SMA, NMO, MG, GBS and AIE, respectively. The reduction in outpatient rehabilitation visits was greater in the absence versus presence of a neurology specialist. CONCLUSIONS Outpatient consultation and rehabilitation visits during the COVID-19 pandemic were affected in Japanese patients with NMDs. Longer-term evaluations are required to understand if these reductions in outpatient care would affect patient prognosis.
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Affiliation(s)
- Toshio Saito
- Division of Child Neurology, Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Osaka, Japan
| | | | - Yasuo Sugitani
- Biometrics Department, Chugai Pharmaceutical Co, Ltd, Tokyo, Japan
| | - Takumi Tajima
- Real World Evidence Division, Pharmaceutical Business Unit, JMDC Inc, Tokyo, Japan
| | | | - Sadaoki Sakai
- Medical Information Department, Chugai Pharmaceutical Co, Ltd, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Shima M, Takedani H, Kitsukawa K, Taki M, Ishiguro A, Nagao A, Yamaguchi-Suita H, Kyogoku Y, Yoshida S, Nogami K. AOZORA: long-term safety and joint health in paediatric persons with haemophilia A without factor VIII inhibitors receiving emicizumab - protocol for a multicentre, open-label, phase IV clinical study. BMJ Open 2022; 12:e059667. [PMID: 35697445 PMCID: PMC9196178 DOI: 10.1136/bmjopen-2021-059667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Persons with haemophilia A (PwHA) commonly experience regular bleeding into joints, which may result in joint damage and complications such as degenerative arthritis. Emicizumab has previously demonstrated efficacy in reducing the occurrence of joint bleeds and target joints, along with having a favourable safety profile; however, data on the long-term effects on joint health are lacking. The AOZORA study will evaluate the long-term safety and joint health of paediatric PwHA without factor (F)VIII inhibitors taking emicizumab; here, we report the details of the study protocol and baseline data. METHODS AND ANALYSIS AOZORA is a multicentre, open-label, phase IV clinical study in Japan that aims to enrol approximately 30 PwHA aged <12 years without FVIII inhibitors. The primary endpoints include a long-term safety evaluation of adverse events, laboratory test abnormalities and FVIII inhibitor development; and a long-term joint health assessment using MRI and the Hemophilia Joint Health Score. Exploratory endpoints include characterising participants' physical activities and the number of activity-related bleeds requiring coagulation factor treatment. Currently, 30 participants have been enrolled, including 20 emicizumab-naïve participants and 10 who transferred from HOHOEMI, a previous study in paediatric PwHA. ETHICS AND DISSEMINATION The AOZORA study was approved by the Institutional Review Boards of Nara Medical University and the St Marianna University Group. The study will be conducted in compliance with the Declaration of Helsinki, the standards stipulated in paragraph 3 of Article 14 and Article 80-2 of the Pharmaceuticals, Medical Devices and Other Therapeutic Products Act, the Ministerial Ordinance on Good Clinical Practice and the Ministerial Ordinance on Good Post-marketing Study Practice. Data will be published in peer-reviewed journals and presented at Global congresses. TRIAL REGISTRATION NUMBER JapicCTI-194701.
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Affiliation(s)
- Midori Shima
- Department of Pediatrics, Nara Medical University, Kashihara, Japan
| | - Hideyuki Takedani
- Department of Joint Surgery, IMSUT Hospital, The University of Tokyo, Tokyo, Japan
| | - Kaoru Kitsukawa
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masashi Taki
- Department of Pediatrics, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Akira Ishiguro
- Division of Hematology, National Center for Child Health and Development, Tokyo, Japan
| | - Azusa Nagao
- Department of Blood Coagulation, Ogikubo Hospital, Tokyo, Japan
| | | | - Yui Kyogoku
- Medical Affairs Division, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Seitaro Yoshida
- Clinical Development Division, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, Kashihara, Japan
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Ohe Y, Yamazaki N, Yamamoto N, Murakami H, Yoh K, Kitano S, Hashimoto H, Murayama A, Nakane S, Gemma A. The real-world safety of atezolizumab as second-line or later treatment in Japanese patients with non-small-cell lung cancer: a post-marketing surveillance study. Jpn J Clin Oncol 2022; 52:623-632. [PMID: 35325169 PMCID: PMC9157296 DOI: 10.1093/jjco/hyac024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/23/2021] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We conducted a post-marketing surveillance study to evaluate the clinical tolerability and safety of atezolizumab in Japanese patients with non-small-cell lung cancer (NSCLC). METHODS This prospective, observational post-marketing cohort study was conducted in NSCLC patients who received atezolizumab 1200 mg every 3 weeks at 770 facilities in Japan between April 18, 2018, and March 31, 2020 (study number UMIN000031978). Case report forms were completed, recording patient characteristics, treatment details, adverse events, adverse drug reactions (ADRs), their severity, onset and outcomes. Follow-up was for 12 months or until atezolizumab discontinuation. RESULTS Overall, 2570 patients were included, median age was 69.0 years, and 69.9% were males. ADRs were reported in 29.1% of patients, most commonly pyrexia (4.2%). Grade ≥ 3 ADRs occurred in 9.7% of patients aged <75 and 9.7% of those aged ≥75 years. The incidence of Grade ≥ 3 ADRs was not affected by the number of lines of previous treatment or the presence or history of an autoimmune disorder. Immune-related ADRs of interest that occurred in >1% of patients were interstitial lung disease (ILD; 4.4%), endocrine disorder (4.3%), and hepatic dysfunction (2.8%). ILD was significantly more common in patients with a history of, or concurrent, ILD versus those without (P ≤ 0.001). Risk factors of Grade ≥ 3 ADRs were a history of, or concurrent, ILD. Grade 5 ADRs occurred in 35 patients, 11 of whom had concurrent ILD. CONCLUSIONS This large cohort study confirmed the clinical tolerability of atezolizumab in a real-world group of Japanese patients with NSCLC.
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Affiliation(s)
- Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Kiyotaka Yoh
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shigehisa Kitano
- Division of Cancer Immunotherapy Development, Advanced Medical Development Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hideyuki Hashimoto
- Real World Data Science Department, Drug Safety Division, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Ayako Murayama
- Real World Data Science Department, Drug Safety Division, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Sayuri Nakane
- Real World Data Science Department, Drug Safety Division, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Matsushita T, Suzuki N, Nagao A, Nagae C, Yamaguchi-Suita H, Kyogoku Y, Ioka A, Nogami K. AKATSUKI study: a prospective, multicentre, phase IV study evaluating the safety of emicizumab under and immediately after immune tolerance induction therapy in persons with congenital haemophilia A with factor VIII inhibitors. BMJ Open 2022; 12:e057018. [PMID: 35288393 PMCID: PMC8921931 DOI: 10.1136/bmjopen-2021-057018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION For persons with haemophilia A with factor (F) VIII inhibitors (PwHAwI), immune tolerance induction (ITI) therapy is indicated for inhibitor eradication; however, since PwHAwI on ITI were excluded from the emicizumab clinical development programme, there are limited safety data for emicizumab treatment under/immediately after ITI in PwHAwI. Accordingly, there is a need to collect safety and efficacy data on this concomitant treatment strategy. The AKATSUKI study aims to evaluate the safety of emicizumab under/immediately after ITI in PwHAwI; here we report details of the study protocol. METHODS AND ANALYSIS AKATSUKI is an open-label, non-randomised, interventional, multicentre study. Twenty participants with congenital HA with FVIII inhibitors will be enrolled from 17 sites across Japan. Emicizumab will be administered subcutaneously, with an initial loading dose of 3 mg/kg once per week (QW) for the first 4 weeks, followed by a maintenance dose of 1.5 mg/kg QW, 3 mg/kg once every 2 weeks or 6 mg/kg once every 4 weeks. For ITI therapy, 50 IU/kg FVIII will be administered three times per week. For extended half-life FVIII, a dosing frequency of twice per week will be permitted. The primary endpoint is a comprehensive safety evaluation of adverse events (mainly thromboembolic events) and abnormal laboratory values over time. Secondary endpoints are the number of bleeds requiring coagulation factor treatment, the number of participants achieving a partially successful ITI response, FVIII inhibitor titres under/immediately after ITI, quality of life and time to achieve a negative FVIII inhibitor result (<0.6 BU/mL) and partial success in PwHAwI starting ITI after study enrolment. CONCLUSIONS AKATSUKI will evaluate the safety of emicizumab administered under/immediately after ITI, providing reference data to inform treatment strategies in PwHAwI. ETHICS AND DISSEMINATION The results of this study will be published in a peer-reviewed international journal and presented at national and/or international medical scientific conferences; the major findings of this study will be published on the jRCT registry website (https://jrct.niph.go.jp). TRIAL REGISTRATION NUMBER jRCTs041200037.
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Affiliation(s)
| | | | | | - Chiai Nagae
- St Marianna University School of Medicine, Kawasaki, Japan
| | | | | | - Akiko Ioka
- Chugai Pharmaceutical Co Ltd, Tokyo, Japan
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Iwai T, Sugimoto M, Patel H, Yorozu K, Kurasawa M, Kondoh O. Anti-VEGF Antibody Protects against Alveolar Exudate Leakage Caused by Vascular Hyperpermeability, Resulting in Mitigation of Pneumonitis Induced by Immunotherapy. Mol Cancer Ther 2021; 20:2519-2526. [PMID: 34552009 PMCID: PMC9306403 DOI: 10.1158/1535-7163.mct-21-0031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/26/2021] [Accepted: 09/16/2021] [Indexed: 01/07/2023]
Abstract
Immune-related pneumonitis is an important toxicity associated with checkpoint inhibitor therapy with anti-PD-1 or anti-PD-L1 antibodies, often necessitating discontinuation of treatment. Development of methods to mitigate checkpoint inhibitor-related pneumonitis is required.The contributions of PD-L1, PD-L2, and VEGF to the pathogenesis of pneumonitis were examined in an IL2- plus IL18-induced mouse pneumonitis model (IL pneumonitis model). Furthermore, the incidences of pneumonitis were retrospectively examined in patients with non-small cell lung cancer treated with the anti-PD-L1 mAb atezolizumab plus chemotherapy, with or without the anti-VEGF mAb bevacizumab, in the phase III IMpower150 trial. PD-1 signal blockade by anti-PD-L1 and anti-PD-L2 antibodies aggravated pneumonitis in the IL pneumonitis model. An anti-VEGF antibody prevented PD-1 signal blockade from aggravating pneumonitis in this model. PD-1 signal blockade induced interstitial T-cell infiltration in the lungs, but VEGF blockade did not affect this T-cell infiltration. The anti-VEGF antibody protected against vascular-to-alveolar leakage of protein and fluid due to PD-1 signal blockade in a murine model. In the IMpower150 trial, incidence rates of pneumonitis of any grade were 4.3% in the group without bevacizumab and 2.8% in the group with bevacizumab. In patients with pneumonitis, outcomes of "Not recovered/Not resolved" were reported for 29.4% in the group without bevacizumab compared with 9.1% in the group with bevacizumab. Our findings suggest that anti-VEGF antibodies in combination with checkpoint inhibitors may be a treatment method that can control checkpoint inhibitor-related pneumonitis.
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Affiliation(s)
- Toshiki Iwai
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., Kanagawa, Japan.
| | - Masamichi Sugimoto
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., Kanagawa, Japan
| | - Hina Patel
- Safety Science Oncology, Genentech, Inc., South San Francisco, California
| | - Keigo Yorozu
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., Kanagawa, Japan
| | - Mitsue Kurasawa
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., Kanagawa, Japan
| | - Osamu Kondoh
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., Kanagawa, Japan
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Kurogi K, Ikegami K, Eguchi H, Tsuji M, Tateishi S, Nagata T, Matsuda S, Fujino Y, Ogami A. A cross-sectional study on perceived workplace health support and health-related quality of life. J Occup Health 2021; 63:e12302. [PMID: 34877733 PMCID: PMC8652405 DOI: 10.1002/1348-9585.12302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/13/2021] [Revised: 11/04/2021] [Accepted: 11/25/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Many companies in Japan have been increasingly interested in "health and productivity management (H&PM)." In terms of H&PM, we hypothesized that companies can enhance their employees' perceived workplace health support (PWHS) by supporting workers' lively working and healthy living. This could then improve their health-related quality of life (HRQOL) by increasing PWHS. Consequently, this study explored the relationship between PWHS and HRQOL. METHODS In December 2020, during the COVID-19 pandemic, we conducted an Internet-based nationwide health survey of Japanese workers (CORoNaWork study). A database of 27 036 participants was created. The intensity of PWHS was measured using a four-point Likert scale. We used multilevel ordered logistic regression to analyze the relationship between PWHS intensity and the four domains of the Centers for Disease Control's HRQOL-4 (self-rated health, number of poor physical health days, number of poor mental health days, and activity limitation days during the past 30 days). RESULTS In the sex- and age-adjusted and multivariate models, the intensity of PWHS significantly affected self-rated health and the three domains of unhealthy days (physical, mental, and activity limitation). There was also a trend toward worse HRQOL scores as the PWHS decreased. CONCLUSIONS We found that the higher the PWHS of Japanese workers, the higher their self-rated health and the fewer their unhealthy days. Companies need to assess workers' PWHS and HRQOL and promote H&PM. H&PM is also necessary to maintain and promote the health of workers during the COVID-19 pandemic.
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Affiliation(s)
- Kazushirou Kurogi
- Department of Work Systems and HealthInstitute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Kazunori Ikegami
- Department of Work Systems and HealthInstitute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Hisashi Eguchi
- Department of Mental HealthInstitute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Mayumi Tsuji
- Department of Environmental HealthSchool of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Seiichiro Tateishi
- Department of Occupational MedicineSchool of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Tomohisa Nagata
- Department of Occupational Health Practice and ManagementInstitute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Shinya Matsuda
- Department of Public HealthSchool of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Yoshihisa Fujino
- Department of Environmental EpidemiologyInstitute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Akira Ogami
- Department of Work Systems and HealthInstitute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuJapan
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Tobinai K, Klein C, Oya N, Fingerle-Rowson G. A Review of Obinutuzumab (GA101), a Novel Type II Anti-CD20 Monoclonal Antibody, for the Treatment of Patients with B-Cell Malignancies. Adv Ther 2017; 34:324-356. [PMID: 28004361 PMCID: PMC5331088 DOI: 10.1007/s12325-016-0451-1] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [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: 09/08/2016] [Indexed: 12/26/2022]
Abstract
Obinutuzumab (GA101) is a novel, type II, glycoengineered, humanized anti-CD20 monoclonal antibody that has been developed to address the need for new therapeutics with improved efficacy in patients with lymphocytic leukemia and lymphoma of B-cell origin. Obinutuzumab has a distinct mode of action relative to type I anti-CD20 antibodies, such as rituximab, working primarily by inducing direct cell death and antibody-dependent cell-mediated cytotoxicity. Obinutuzumab is under investigation in a wide-ranging program of clinical trials in patients with B-cell malignancies. Efficacy as monotherapy has been reported in patients with relapsed/refractory indolent and aggressive non-Hodgkin lymphoma (NHL) and in chronic lymphocytic leukemia (CLL) of B-cell origin. Improved outcomes have also been noted when obinutuzumab is added to chemotherapy in patients with B-cell NHL, and superiority over rituximab has been reported with combination therapy in patients with CLL. Ongoing research is focusing on developing options for chemotherapy-free treatment and on new combinations of obinutuzumab with novel targeted agents.
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MESH Headings
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal, Humanized/pharmacology
- Antigens, CD20/immunology
- Antineoplastic Agents/pharmacology
- B-Lymphocytes/immunology
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/immunology
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Affiliation(s)
- Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan.
| | - Christian Klein
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Zurich, Schlieren, Switzerland
| | - Naoko Oya
- Oncology Lifecycle Management Department, Chugai Pharmaceutical Co. Ltd, Tokyo, Japan
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