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Bhansali RS, Ellin F, Relander T, Cao M, Li W, Long Q, Ganesan N, Stuver RN, Horwitz SM, Wudhikarn K, Hwang SR, Bennani NN, Chavez JC, Sokol L, Saeed H, Duan F, Porcu P, Pullarkat P, Mehta-Shah N, Zain J, Ruiz M, Brammer JE, Prakash R, Padmanabhan Iyer S, Olszewski AJ, Major A, Riedell PA, Smith SM, Goldin C, Haverkos BM, Hu B, Zhuang TZ, Allen PB, Toama W, Janakiram M, Jagadeesh D, Brooks TR, Hariharan N, Goodman AM, Hartmann G, Ghione P, Fayyaz F, Rhodes JM, Chong EA, Gerson JN, Landsburg DJ, Nasta SD, Schuster SJ, Svoboda J, Jerkeman M, Barta SK. The CNS Relapse in T-Cell Lymphoma Index Predicts CNS Relapse in Patients with T- and NK-Cell Lymphomas. Blood Adv 2024:bloodadvances.2024012800. [PMID: 38739715 DOI: 10.1182/bloodadvances.2024012800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 05/16/2024] Open
Abstract
Little is known about risk factors for central nervous system (CNS) relapse in mature T- and NK-cell neoplasms (MTNKN). We aimed to describe the clinical epidemiology of CNS relapse in patients with MTNKN and developed the CNS relapse In T-cell lymphoma Index (CITI) to predict patients at highest risk of CNS relapse. We reviewed data from 135 patients with MTNKN and CNS relapse from 19 North American institutions. After exclusion of leukemic and most cutaneous forms of MTNKN, patients were pooled with non-CNS relapse control patients from a single institution to create a CNS relapse-enriched training set. Using a complete case analysis (N=182), of whom 91 had CNS relapse, we applied a LASSO Cox regression model to select weighted clinicopathologic variables for the CITI score, which we validated in an external cohort from the Swedish Lymphoma Registry (N=566). CNS relapse was most frequently observed in patients with PTCL, NOS (25%). Median time to CNS relapse and median overall survival after CNS relapse was 8.0 months and 4.7 months, respectively. We calculated unique CITI risk scores for individual training set patients and stratified them into risk terciles. Validation set patients with low-risk (N=158) and high-risk (N=188) CITI scores had a 10-year cumulative risk of CNS relapse of 2.2% and 13.4%, respectively (HR 5.24, 95%CI 1.50-18.26, P=0.018). We developed an open-access web-based CITI calculator (https://redcap.link/citicalc) to provide an easy tool for clinical practice. The CITI score is a validated model to predict patients with MTNKN at highest risk of developing CNS relapse.
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Affiliation(s)
| | - Fredrik Ellin
- Department of Internal Medicine, Kalmar County Hospital, Sweden
| | | | - Miao Cao
- Lymphoma Program, Abramson Cancer Center, United States
| | - Wenrui Li
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Qi Long
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Nivetha Ganesan
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Robert N Stuver
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Steven M Horwitz
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | | | | | | | | | - Lubomir Sokol
- Moffitt Cancer Center, Tampa, Florida, United States
| | - Hayder Saeed
- Moffitt Cancer Center, Tampa, Florida, United States
| | - Frank Duan
- Christiana Care, Newark, Delaware, United States
| | - Pierluigi Porcu
- Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania, United States
| | | | - Neha Mehta-Shah
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States
| | | | - Miguel Ruiz
- The Ohio State University James Comprehensive Cancer Center, United States
| | - Jonathan E Brammer
- The Ohio State University James Comprehensive Cancer Center, United States
| | - Rishab Prakash
- The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | | | - Adam J Olszewski
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Ajay Major
- University of Colorado School of Medicine, Denver, Colorado, United States
| | | | | | - Caroline Goldin
- Ochsner MD Anderson Cancer Center, Jefferson, Louisiana, United States
| | | | - Bei Hu
- Atrium Health Levine Cancer Institute, Charlotte, North Carolina, United States
| | | | | | - Wael Toama
- University of Minnesota, Minneapolis, Minnesota, United States
| | | | | | | | | | | | - Gabrielle Hartmann
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
| | - Paola Ghione
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Fatima Fayyaz
- Regional Cancer Care Associates, Marmora, New Jersey, United States
| | - Joanna M Rhodes
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, United States
| | - Elise A Chong
- Lymphoma Program, Abramson Cancer Center, United States
| | | | | | | | - Stephen J Schuster
- University of PennsLymphoma Program, Abramson Cancer Centerylvania, United States
| | - Jakub Svoboda
- Lymphoma Program, Abramson Cancer Center, United States
| | - Mats Jerkeman
- Skane University Hospital and Lund University, Lund, Sweden
| | - Stefan K Barta
- University of PeLymphoma Program, Abramson Cancer Centernnsylvania, United States
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2
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Ghilardi G, Paruzzo L, Patel V, Svoboda J, Chong ER, Fardella E, Chong EA, Gabrielli G, Nasta SD, Landsburg DJ, Carter J, Pajarillo R, Barta SK, White G, Weber E, Napier E, Porter DL, Garfall AL, Schuster SJ, Ruella M. Efficacy and safety of bendamustine for lymphodepletion before lisocabtagene maraleucel. J Hematol Oncol 2024; 17:19. [PMID: 38644469 PMCID: PMC11034069 DOI: 10.1186/s13045-024-01542-9] [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] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/04/2024] [Indexed: 04/23/2024] Open
Abstract
Bendamustine has been retrospectively shown to be an effective and safe lymphodepletion regimen prior to the anti-CD19 chimeric antigen receptor T cell (CART) products tisagenlecleucel and axicabtagene ciloleucel, as well as the anti-BCMA CART products idecabtagene vicleucel and ciltacabtagene autoleucel. However, bendamustine as lymphodepletion prior to lisocabtagene maraleucel (liso-cel), a 4-1BB co-stimulated, fixed CD4:CD8 ratio anti-CD19 CART product, has not been described yet. Thus, we studied a cohort of sequentially-treated patients with large B-cell lymphomas who received bendamustine lymphodepletion before liso-cel at the University of Pennsylvania between 5/2021 and 12/2023 (n = 31). Patients were evaluated for toxicities and responses. Of note, 7 patients (22.6%) would have dnot met the inclusion criteria for the registrational liso-cel clinical trials, mostly due to older age. Overall and complete response rates were 76.9% and 73.1%, respectively. At a median follow-up of 6.3 months, the 6-month progression-free and overall survival were 59.9% and 91.1%, respectively. Rates of cytokine-release syndrome (CRS) and neurotoxicity (ICANS) of any grade were 9.7% and 9.7%, respectively, with no grade ≥ 3 events. No infections were reported during the first 30 days following liso-cel infusion. Neutropenia ≥ grade 3 was observed in 29.0% of patients; thrombocytopenia ≥ grade 3 occurred in 9.7%. In conclusion, bendamustine lymphodepletion before liso-cel appears to be a strategy that can drive tumor responses while ensuring a mild toxicity profile.
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Affiliation(s)
- Guido Ghilardi
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Luca Paruzzo
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Vrutti Patel
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jakub Svoboda
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Emeline R Chong
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Eugenio Fardella
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Elise A Chong
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Giulia Gabrielli
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sunita D Nasta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jordan Carter
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Raymone Pajarillo
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stefan K Barta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Griffin White
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Weber
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ellen Napier
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - David L Porter
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Alfred L Garfall
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Marco Ruella
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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3
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Ghilardi G, Fraietta JA, Gerson JN, Van Deerlin VM, Morrissette JJD, Caponetti GC, Paruzzo L, Harris JC, Chong EA, Susanibar Adaniya SP, Svoboda J, Nasta SD, Ugwuanyi OH, Landsburg DJ, Fardella E, Waxman AJ, Chong ER, Patel V, Pajarillo R, Kulikovskaya I, Lieberman DB, Cohen AD, Levine BL, Stadtmauer EA, Frey NV, Vogl DT, Hexner EO, Barta SK, Porter DL, Garfall AL, Schuster SJ, June CH, Ruella M. T cell lymphoma and secondary primary malignancy risk after commercial CAR T cell therapy. Nat Med 2024; 30:984-989. [PMID: 38266761 DOI: 10.1038/s41591-024-02826-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/22/2024] [Indexed: 01/26/2024]
Abstract
We report a T cell lymphoma (TCL) occurring 3 months after anti-CD19 chimeric antigen receptor (CAR) T cell immunotherapy for non-Hodgkin B cell lymphoma. The TCL was diagnosed from a thoracic lymph node upon surgery for lung cancer. The TCL exhibited CD8+ cytotoxic phenotype and a JAK3 variant, while the CAR transgene was very low. The T cell clone was identified at low levels in the blood before CAR T infusion and in lung cancer. To assess the overall risk of secondary primary malignancy after commercial CAR T (CD19, BCMA), we analyzed 449 patients treated at the University of Pennsylvania. At a median follow-up of 10.3 months, 16 patients (3.6%) had a secondary primary malignancy. The median onset time was 26.4 and 9.7 months for solid and hematological malignancies, respectively. The projected 5-year cumulative incidence is 15.2% for solid and 2.3% for hematological malignancies. Overall, one case of TCL was observed, suggesting a low risk of TCL after CAR T.
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Affiliation(s)
- Guido Ghilardi
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph A Fraietta
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cell Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
| | - James N Gerson
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Vivianna M Van Deerlin
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Center for Personalized Diagnostics, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer J D Morrissette
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Center for Personalized Diagnostics, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gabriel C Caponetti
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Luca Paruzzo
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jaryse C Harris
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Elise A Chong
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sandra P Susanibar Adaniya
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Center for Cell Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
| | - Jakub Svoboda
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sunita D Nasta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ositadimma H Ugwuanyi
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Eugenio Fardella
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Adam J Waxman
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Center for Cell Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
| | - Emeline R Chong
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Vrutti Patel
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Raymone Pajarillo
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Irina Kulikovskaya
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
| | - David B Lieberman
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Center for Personalized Diagnostics, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Adam D Cohen
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Center for Cell Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
| | - Bruce L Levine
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward A Stadtmauer
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Center for Cell Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
| | - Noelle V Frey
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Center for Cell Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
| | - Dan T Vogl
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Center for Cell Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth O Hexner
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Center for Cell Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
| | - Stefan K Barta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - David L Porter
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Center for Cell Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
| | - Alfred L Garfall
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Center for Cell Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Carl H June
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
| | - Marco Ruella
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
- Center for Cell Therapy and Transplant, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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4
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Chong EA, Chong ER, Therwhanger D, Nasta SD, Landsburg DJ, Barta SK, Svoboda J, Gerson JN, Ghilardi G, Paruzzo L, Fraietta JA, Weber E, Stefano N, Porter DL, Frey NV, Garfall AL, Ruella M, Schuster SJ. Bendamustine as Lymphodepletion for Brexucabtagene Autoleucel Therapy of Mantle Cell Lymphoma. Transplant Cell Ther 2024:S2666-6367(24)00288-4. [PMID: 38494076 DOI: 10.1016/j.jtct.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 03/19/2024]
Abstract
Brexucabtagene autoleucel (brexu-cel) is an autologous CD19-directed chimeric antigen receptor (CAR) T-cell therapy approved for treatment of relapsed/refractory mantle cell lymphoma (MCL). During a fludarabine shortage, we used bendamustine as an alternative to standard cyclophosphamide/fludarabine (cy/flu) lymphodepletion (LD) prior to brexu-cel. We assessed MCL patient outcomes as well as CAR T-cell expansion and persistence after brexu-cel following bendamustine or cy/flu LD at our center. This was a retrospective single institution study that utilized prospectively banked blood and tissue samples. Clinical efficacy was assessed by 2014 Lugano guidelines. CAR T-cell expansion and persistence in peripheral blood were assessed on day 7 and at ≥month 6 for patients with available samples. Seventeen patients received bendamustine and 5 received cy/flu. For the bendamustine cohort, 14 (82%) received bridging therapy and 4 (24%) had CNS involvement. Fifteen patients (88%) developed CRS with 4 (24%) ≥grade 3 events. Six (35%) patients developed ICANS with 4 (24%) events ≥grade 3. No patient had ≥grade 3 cytopenias at day 90. Best objective (BOR) and complete response (CRR) rates were 82% and 65%, respectively. At 24.5 months median follow-up, 12-month progression-free survival (PFS) was 45%, 24-month PFS was 25%, and median duration of response was 19 months. Median OS was not reached. BOR was 25% (1/4) for patients with CNS involvement. CAR transgene expansion after bendamustine LD was observed on day 7 in all (4/4) patients tested and persisted at ≥6 months (2/2), regardless of response. Bendamustine LD before brexu-cel for MCL is feasible and safe with a lower frequency and shorter duration of cytopenias than reported for cy/flu. Both CAR T-cell expansion and persistence were observed after bendamustine LD. Outcomes appear comparable to the real world outcomes reported with cy/flu LD.
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Affiliation(s)
- Elise A Chong
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Emeline R Chong
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dylan Therwhanger
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sunita D Nasta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel J Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stefan K Barta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jakub Svoboda
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James N Gerson
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Guido Ghilardi
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Luca Paruzzo
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph A Fraietta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth Weber
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Natalie Stefano
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David L Porter
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noelle V Frey
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alfred L Garfall
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marco Ruella
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
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5
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Chong EA, Kumashie KG, Chong ER, Fabrizio J, Gupta A, Svoboda J, Barta SK, Walsh KM, Napier EB, Lundberg RK, Nasta SD, Gerson JN, Landsburg DJ, Gonzalez J, Gaano A, Weirick ME, McAllister CM, Awofolaju M, John GN, Kammerman SC, Novaceck J, Pajarillo R, Lundgreen KA, Tanenbaum N, Gouma S, Drapeau EM, Adamski S, D'Andrea K, Pattekar A, Hicks A, Korte S, Sharma H, Herring S, Williams JC, Hamilton JT, Bates P, Hensley SE, Prak ETL, Greenplate AR, Wherry EJ, Schuster SJ, Ruella M, Vella LA. Immunologic predictors of vaccine responsiveness in patients with lymphoma and CLL. J Infect Dis 2024:jiae106. [PMID: 38437622 DOI: 10.1093/infdis/jiae106] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024] Open
Abstract
Patients with B-cell lymphomas have altered cellular components of vaccine responses due to malignancy and therapy, and the optimal timing of vaccination relative to therapy remains unknown. SARS-CoV-2 vaccines created an opportunity for new insights in vaccine timing because patients were challenged with a novel antigen across multiple phases of treatment. We studied serologic mRNA vaccine response in retrospective and prospective cohorts with lymphoma and CLL, paired with clinical and research immune parameters. Reduced serologic response was observed more frequently during active therapies, but non-response was also common within observation and post-treatment groups. Total IgA and IgM correlated with successful vaccine response. In individuals treated with CART-19, non-response was associated with reduced B and T follicular helper cells. Predictors of vaccine response varied by disease and therapeutic group, and therefore further studies of immune health during and after cancer therapies are needed to allow individualized vaccine timing.
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Affiliation(s)
- Elise A Chong
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kingsley Gideon Kumashie
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Emeline R Chong
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joseph Fabrizio
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Aditi Gupta
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jakub Svoboda
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Stefan K Barta
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kristy M Walsh
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ellen B Napier
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rachel K Lundberg
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sunita D Nasta
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - James N Gerson
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Daniel J Landsburg
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joyce Gonzalez
- Immune Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Andrew Gaano
- Immune Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Madison E Weirick
- Department of Microbiology, University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Christopher M McAllister
- Department of Microbiology, University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Moses Awofolaju
- Department of Microbiology, University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Gavin N John
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Shane C Kammerman
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Josef Novaceck
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Raymone Pajarillo
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kendall A Lundgreen
- Department of Microbiology, University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Nicole Tanenbaum
- Department of Microbiology, University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Sigrid Gouma
- Department of Microbiology, University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Elizabeth M Drapeau
- Department of Microbiology, University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Sharon Adamski
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kurt D'Andrea
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ajinkya Pattekar
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Amanda Hicks
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Scott Korte
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Harsh Sharma
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sarah Herring
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Justine C Williams
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jacob T Hamilton
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Paul Bates
- Department of Microbiology, University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Scott E Hensley
- Department of Microbiology, University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Eline T Luning Prak
- Immune Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Allison R Greenplate
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - E John Wherry
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Stephen J Schuster
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Marco Ruella
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Laura A Vella
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
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6
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Ghilardi G, Paruzzo L, Svoboda J, Chong EA, Shestov AA, Chen L, Cohen IJ, Gabrielli G, Nasta SD, Porazzi P, Landsburg DJ, Gerson JN, Carter J, Barta SK, Yelton R, Pajarillo R, Patel V, White G, Ballard HJ, Weber E, Napier E, Chong ER, Fraietta JA, Garfall AL, Porter DL, Milone MC, O’Connor R, Schuster SJ, Ruella M. Bendamustine lymphodepletion before axicabtagene ciloleucel is safe and associates with reduced inflammatory cytokines. Blood Adv 2024; 8:653-666. [PMID: 38113468 PMCID: PMC10839610 DOI: 10.1182/bloodadvances.2023011492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023] Open
Abstract
ABSTRACT Lymphodepletion (LD) is an integral component of chimeric antigen receptor T-cell (CART) immunotherapies. In this study, we compared the safety and efficacy of bendamustine (Benda) to standard fludarabine/cyclophosphamide (Flu/Cy) LD before CD19-directed, CD28-costimulated CART axicabtagene ciloleucel (axi-cel) for patients with large B-cell lymphoma (LBCL) and follicular lymphoma (FL). We analyzed 59 patients diagnosed with LBCL (n = 48) and FL (n = 11) consecutively treated with axi-cel at the University of Pennsylvania. We also analyzed serum samples for cytokine levels and metabolomic changes before and after LD. Flu/Cy and Benda demonstrated similar efficacy, with complete remission rates of 51.4% and 50.0% (P = .981), respectively, and similar progression-free and overall survivals. Any-grade cytokine-release syndrome occurred in 91.9% of patients receiving Flu/Cy vs 72.7% of patients receiving Benda (P = .048); any-grade neurotoxicity after Flu/Cy occurred in 45.9% of patients and after Benda in 18.2% of patients (P = .031). In addition, Flu/Cy was associated with a higher incidence of grade ≥3 neutropenia (100% vs 54.5%; P < .001), infections (78.4% vs 27.3%; P < .001), and neutropenic fever (78.4% vs 13.6%; P < .001). These results were confirmed both in patients with LBCL and those with FL. Mechanistically, patients with Flu/Cy had a greater increase in inflammatory cytokines associated with neurotoxicity and reduced levels of metabolites critical for redox balance and biosynthesis. This study suggests that Benda LD may be a safe alternative to Flu/Cy for CD28-based CART CD19-directed immunotherapy with similar efficacy and reduced toxicities. Benda is associated with reduced levels of inflammatory cytokines and increased anabolic metabolites.
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Affiliation(s)
- Guido Ghilardi
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Luca Paruzzo
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
- Department of Oncology, University of Turin, Turin, Italy
| | - Jakub Svoboda
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Eise A. Chong
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Alexander A. Shestov
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Linhui Chen
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ivan J. Cohen
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Giulia Gabrielli
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Sunita D. Nasta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Patrizia Porazzi
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Daniel J. Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - James N. Gerson
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jordan Carter
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Stefan K. Barta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Rebecca Yelton
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Raymone Pajarillo
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Vrutti Patel
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Griffin White
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Hatcher J. Ballard
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Weber
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ellen Napier
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Emeline R. Chong
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Joseph A. Fraietta
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
| | - Alfred L. Garfall
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David L. Porter
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Michael C. Milone
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Roderick O’Connor
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stephen J. Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Marco Ruella
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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7
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Gerson JN, Handorf E, Villa D, Gerrie AS, Chapani P, Li S, Medeiros LJ, Wang M, Cohen JB, Churnetski M, Hill BT, Sawalha Y, Hernandez-Ilizaliturri FJ, Kothari S, Vose JM, Bast M, Fenske T, Rao Gari SN, Maddocks KJ, Bond D, Bachanova V, Kolla B, Chavez J, Shah B, Lansigan F, Burns T, Donovan AM, Wagner-Johnston N, Messmer M, Mehta A, Anderson JK, Reddy N, Kovach AE, Landsburg DJ, Glenn M, Inwards DJ, Ristow K, Karmali R, Kaplan JB, Caimi PF, Rajguru S, Evens A, Klein A, Umyarova E, Pulluri B, Amengual JE, Lue JK, Diefenbach C, Fisher RI, Barta SK. Outcomes of patients with blastoid and pleomorphic variant mantle cell lymphoma. Blood Adv 2023; 7:7393-7401. [PMID: 37874912 PMCID: PMC10758713 DOI: 10.1182/bloodadvances.2023010757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/17/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023] Open
Abstract
Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma; data indicate that blastoid and pleomorphic variants have a poor prognosis. We report characteristics and outcomes of patients with blastoid/pleomorphic variants of MCL. We retrospectively studied adults with newly diagnosed MCL treated from 2000 to 2015. Primary objectives were to describe progression-free survival (PFS) and overall survival (OS). Secondary objectives included characterization of patient characteristics and treatments. Of the 1029 patients with MCL studied, a total of 207 neoplasms were blastoid or pleomorphic variants. Median follow-up period was 82 months (range, 0.1-174 months); median PFS was 38 months (95% confidence interval [CI], 28-66) and OS was 68 months (95% CI, 45-96). Factors associated with PFS were receipt of consolidative autologous hematopoietic transplantation (auto-HCT; hazard ratio [HR], 0.52; 95% CI, 0.31-0.80; P < .05), MCL International Prognostic Index (MIPI) intermediate (HR, 2.3; 95% CI, 1.2-4.3; P < .02) and high (HR, 3.8; 95% CI, 2.0-7.4; P < .01) scores, and complete response to induction (HR, 0.29 (95% CI, 0.17-0.51). Receipt of auto-HCT was not associated with OS (HR, 0.69; 95% CI, 0.41-1.16; P = .16) but was associated with MIPI intermediate (HR, 5.7; 95% CI, 2.5-13.2; P < .01) and high (HR, 10.8; 95% CI, 4.7-24.9; P < .01) scores. We report outcomes in a large cohort of patients with blastoid/pleomorphic variant MCL. For eligible patients, receipt of auto-HCT after induction was associated with improved PFS but not OS. Higher MIPI score and auto-HCT ineligibility were associated with worse survival.
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Affiliation(s)
- James N. Gerson
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Handorf
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Diego Villa
- BC Cancer Centre for Lymphoid Cancer, Vancouver, CA
| | | | - Parv Chapani
- BC Cancer Centre for Lymphoid Cancer, Vancouver, CA
| | | | | | | | - Jonathon B. Cohen
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Michael Churnetski
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | | | | | | | | | | | - Martin Bast
- University of Nebraska Cancer Center, Omaha, NE
| | - Timothy Fenske
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | | | - David Bond
- Division of Hematology, Ohio State University, Columbus, OH
| | - Veronika Bachanova
- Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN
| | - Bhaskar Kolla
- Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN
| | | | | | | | - Timothy Burns
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | - Marcus Messmer
- Hematologic Malignancies Division, Johns Hopkins University, Baltimore, MD
| | | | | | | | | | - Daniel J. Landsburg
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Kay Ristow
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Reem Karmali
- Division of Hematology and Oncology, Northwestern University, Evanston, IL
| | - Jason B. Kaplan
- Division of Hematology and Oncology, Northwestern University, Evanston, IL
| | - Paolo F. Caimi
- Division of Hematology and Oncology, Case Western Reserve University, Cleveland, OH
| | - Saurabh Rajguru
- Division of Hematology, Medical Oncology and Palliative Care, University of Wisconsin, Madison, WI
| | - Andrew Evens
- Division of Hematology/Oncology, Tufts University, Boston, MA
| | - Andreas Klein
- Division of Hematology/Oncology, Tufts University, Boston, MA
| | - Elvira Umyarova
- Division of Hematology and Oncology, University of Vermont, Burlington, VT
| | - Bhargavi Pulluri
- Division of Hematology and Oncology, University of Vermont, Burlington, VT
| | | | - Jennifer K. Lue
- Division of Hematology and Oncology, Columbia University, New York, NY
| | | | - Richard I. Fisher
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Stefan K. Barta
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
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8
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Landsburg DJ, Morrissette JJD, Nasta SD, Barta SK, Schuster SJ, Svoboda J, Chong EA, Bagg A. TP53 mutations predict for poor outcomes in patients with newly diagnosed aggressive B-cell lymphomas in the current era. Blood Adv 2023; 7:7243-7253. [PMID: 37851898 PMCID: PMC10698538 DOI: 10.1182/bloodadvances.2023011384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/20/2023] Open
Abstract
Genetic subgroups of diffuse large B-cell lymphoma (DLBCL) have been identified through comprehensive genomic analysis; however, it is unclear whether this can be applied in clinical practice. We assessed whether mutations detected by clinical laboratory mutation analysis (CLMA) were predictive of outcomes in patients with newly diagnosed DLBCL/high-grade B-cell lymphoma (HGBL). Patients diagnosed from 2018 to 2022 whose biopsy samples were subjected to CLMA and who received rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone or rituximab plus etoposide, prednisolone, vincristine, cyclophosphamide, and doxorubicin were analyzed for overall/complete response rate (ORR/CRR) and estimated progression-free/overall survival (PFS/OS). CLMA was successfully performed in 117 of 122 patient samples (96%), with a median turnaround time of 17 days. Median duration of follow-up was 31.3 months. Of the mutations detected in ≥10% of the samples, only TP53 was associated with both progression and death at 2 years. TP53 mutations were detected in 36% of tumors, and patients with TP53 mutations experienced significantly lower ORR (71% vs 90%; P = .009), CRR (55% vs 77%; P = .01), 2-year PFS (57% vs 77%; P = .006), 2-year OS (70% vs 91%; P = .001), and median OS after relapse (6.1 months vs not yet reached; P = .001) as than those without TP53 mutations. Furthermore, patients with TP53 loss-of-function (LOF) mutations experienced lower rates of 2-year PFS/OS than those with non-LOF mutations and inferior or near-inferior 2-year PFS if harboring high-risk clinicopathologic features. TP53 mutations identified through CLMA can predict for inferior outcomes in patients with newly diagnosed DLBCL/HGBL. Results of CLMA can be used in real time to inform prognosis and/or identify candidates for clinical trials.
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Affiliation(s)
- Daniel J. Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Jennifer JD Morrissette
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sunita D. Nasta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Stefan K. Barta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Stephen J. Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Jakub Svoboda
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Elise A. Chong
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
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9
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Bowers JT, Anna J, Bair SM, Annunzio K, Epperla N, Pullukkara JJ, Gaballa S, Spinner MA, Li S, Messmer MR, Nguyen J, Ayers EC, Wagner CB, Hu B, Di M, Huntington SF, Furqan F, Shah NN, Chen C, Ballard HJ, Hughes ME, Chong EA, Nasta SD, Barta SK, Landsburg DJ, Svoboda J. Brentuximab vedotin plus AVD for Hodgkin lymphoma: incidence and management of peripheral neuropathy in a multisite cohort. Blood Adv 2023; 7:6630-6638. [PMID: 37595053 PMCID: PMC10628810 DOI: 10.1182/bloodadvances.2023010622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/20/2023] Open
Abstract
Brentuximab vedotin (BV) in combination with doxorubicin, vinblastine, and dacarbazine (AVD) is increasingly used for frontline treatment of stage III/IV classical Hodgkin lymphoma (cHL). Peripheral neuropathy (PN) was the most common and treatment-limiting side effect seen in clinical trials but has not been studied in a nontrial setting, in which clinicians may have different strategies for managing it. We conducted a multisite retrospective study to characterize PN in patients who received BV + AVD for newly diagnosed cHL. One hundred fifty-three patients from 10 US institutions were eligible. Thirty-four patients (22%) had at least 1 ineligibility criteria for ECHELON-1, including stage, performance status, and comorbidities. PN was reported by 80% of patients during treatment; 39% experienced grade (G) 1, 31% G2, and 10% G3. In total, BV was modified in 44% of patients because of PN leading to BV discontinuation in 23%, dose reduction in 17%, and temporary hold in 4%. With a median follow-up of 24 months, PN resolution was documented in 36% and improvement in 33% at the last follow-up. Two-year progression-free survival (PFS) for the advanced-stage patients was 82.7% (95% confidence interval [CI], 0.76-0.90) and overall survival was 97.4% (95% CI, 0.94-1.00). Patients who discontinued BV because of PN did not have inferior PFS. In the nontrial setting, BV + AVD was associated with a high incidence of PN. In our cohort, which includes patients who would not have been eligible for the pivotal ECHELON-1 trial, BV discontinuation rates were higher than previously reported, but 2-year outcomes remain comparable.
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Affiliation(s)
- Jackson T. Bowers
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jacob Anna
- Division of Hematology, University of Colorado Denver, Aurora, CO
| | - Steven M. Bair
- Division of Hematology, University of Colorado Denver, Aurora, CO
| | | | | | | | - Sameh Gaballa
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Michael A. Spinner
- Division of Hematology Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Shuning Li
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Marcus R. Messmer
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Joseph Nguyen
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Emily C. Ayers
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Charlotte B. Wagner
- Division of Hematology/Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Boyu Hu
- Division of Hematology/Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Mengyang Di
- Division of Hematology Oncology, Department of Medicine, Yale University, New Haven, CT
| | - Scott F. Huntington
- Division of Hematology Oncology, Department of Medicine, Yale University, New Haven, CT
| | - Fateeha Furqan
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Nirav N. Shah
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Christina Chen
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Hatcher J. Ballard
- Division of Hematology Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mitchell E. Hughes
- Division of Hematology Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elise A. Chong
- Division of Hematology Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sunita D. Nasta
- Division of Hematology Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stefan K. Barta
- Division of Hematology Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Daniel J. Landsburg
- Division of Hematology Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jakub Svoboda
- Division of Hematology Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
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10
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Zayac AS, Landsburg DJ, Hughes ME, Bock AM, Nowakowski GS, Ayers EC, Girton M, Hu M, Beckman AK, Li S, Medeiros LJ, Chang JE, Stepanovic A, Kurt H, Sandoval-Sus J, Ansari-Lari MA, Kothari SK, Kress A, Xu ML, Torka P, Sundaram S, Smith SD, Naresh KN, Karimi YH, Epperla N, Bond DA, Farooq U, Saad M, Evens AM, Pandya K, Naik SG, Kamdar M, Haverkos B, Karmali R, Oh TS, Vose JM, Nutsch H, Rubinstein PG, Chaudhry A, Olszewski AJ. High-grade B-cell lymphoma, not otherwise specified: a multi-institutional retrospective study. Blood Adv 2023; 7:6381-6394. [PMID: 37171397 PMCID: PMC10598493 DOI: 10.1182/bloodadvances.2023009731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023] Open
Abstract
In this multi-institutional retrospective study, we examined the characteristics and outcomes of 160 patients with high-grade B-cell lymphoma, not otherwise specified (HGBL-NOS)-a rare category defined by high-grade morphologic features and lack of MYC rearrangements with BCL2 and/or BCL6 rearrangements ("double hit"). Our results show that HGBL-NOS tumors are heterogeneous: 83% of patients had a germinal center B-cell immunophenotype, 37% a dual-expressor immunophenotype (MYC and BCL2 expression), 28% MYC rearrangement, 13% BCL2 rearrangement, and 11% BCL6 rearrangement. Most patients presented with stage IV disease, a high serum lactate dehydrogenase, and other high-risk clinical factors. Most frequent first-line regimens included dose-adjusted cyclophosphamide, doxorubicin, vincristine, and etoposide, with rituximab and prednisone (DA-EPOCH-R; 43%); rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; 33%); or other intensive chemotherapy programs. We found no significant differences in the rates of complete response (CR), progression-free survival (PFS), or overall survival (OS) between these chemotherapy regimens. CR was attained by 69% of patients. PFS at 2 years was 55.2% and OS was 68.1%. In a multivariable model, the main prognostic factors for PFS and OS were poor performance status, lactate dehydrogenase >3 × upper limit of normal, and a dual-expressor immunophenotype. Age >60 years or presence of MYC rearrangement were not prognostic, but patients with TP53 alterations had a dismal PFS. Presence of MYC rearrangement was not predictive of better PFS in patients treated with DA-EPOCH-R vs R-CHOP. Improvements in the diagnostic criteria and therapeutic approaches beyond dose-intense chemotherapy are needed to overcome the unfavorable prognosis of patients with HGBL-NOS.
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Affiliation(s)
- Adam S. Zayac
- Division of Hematology/Oncology, The Warren Alpert Medical School Medical School of Brown University, Providence, RI
| | | | | | | | | | - Emily C. Ayers
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Mark Girton
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA
| | - Marie Hu
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Amy K. Beckman
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Shaoying Li
- Division of Pathology and Laboratory Medicine, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - L. Jeffrey Medeiros
- Division of Pathology and Laboratory Medicine, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Julie E. Chang
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Adam Stepanovic
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Habibe Kurt
- Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Jose Sandoval-Sus
- Department of Malignant Hematology and Cellular Therapy, Moffitt Cancer Center at Memorial Healthcare System, Pembroke Pines, FL
| | | | - Shalin K. Kothari
- Division of Hematology, Yale University School of Medicine, New Haven, CT
| | - Anna Kress
- Division of Hematology, Yale University School of Medicine, New Haven, CT
| | - Mina L. Xu
- Department of Pathology and Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
| | - Pallawi Torka
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Suchitra Sundaram
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Stephen D. Smith
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, University of Washington, Seattle, WA
| | | | - Yasmin H. Karimi
- Division of Hematology-Oncology, University of Michigan Health, Ann Arbor, MI
| | | | - David A. Bond
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Umar Farooq
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Mahak Saad
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Andrew M. Evens
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Karan Pandya
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Seema G. Naik
- Penn State Cancer Institute, Penn State Hershey Medical Center, Hershey, PA
| | - Manali Kamdar
- Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado, Denver, CO
| | - Bradley Haverkos
- Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado, Denver, CO
| | - Reem Karmali
- Division of Hematology and Oncology, Northwestern University, Chicago, IL
| | - Timothy S. Oh
- Division of Hematology and Oncology, Northwestern University, Chicago, IL
| | - Julie M. Vose
- Department of Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Heather Nutsch
- Department of Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Paul G. Rubinstein
- Department of Medicine, Section of Hematology-Oncology, University of Illinois, Chicago, IL
| | - Amina Chaudhry
- Department of Medicine, Section of Hematology-Oncology, University of Illinois, Chicago, IL
| | - Adam J. Olszewski
- Division of Hematology/Oncology, The Warren Alpert Medical School Medical School of Brown University, Providence, RI
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11
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Lazarow H, Compher C, Ziegler MJ, Gilmar C, Kucharczuk CR, Landsburg DJ. Central Line-Associated Bloodstream Infection in Patients With Hematologic Malignancy Receiving Parenteral Nutrition. JCO Oncol Pract 2023; 19:571-576. [PMID: 37200611 DOI: 10.1200/op.22.00823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/08/2023] [Accepted: 04/12/2023] [Indexed: 05/20/2023] Open
Abstract
PURPOSE Parenteral nutrition (PN) has been shown to be a safe method of feeding in the intensive care unit with modern infection prevention practices, but similar analysis in the hematology-oncology setting is lacking. METHODS A retrospective analysis of 1,617 patients with hematologic malignancies admitted and discharged from the Hospital of the University of Pennsylvania during 3,629 encounters from 2017 to 2019 was undertaken to evaluate the association of PN administration with risk of central line-associated bloodstream infection (CLABSI). Proportions of mucosal barrier injury (MBI)-CLABSI and non-MBI-CLABSI were also compared between groups. RESULTS Risk of CLABSI was associated with cancer type and duration of neutropenia but not with PN administration (odds ratio, 1.015; 95% CI, 0.986 to 1.045; P = .305) in a multivariable analysis. MBI-CLABSI comprised 73% of CLABSI in patients exposed to and 70% in patients not exposed to PN, and there was no significant difference between groups (χ2 = 0.06, P = .800). CONCLUSION PN was not associated with increased risk of CLABSI in a sample of patients with hematologic malignancy with central venous catheters when adjusting for cancer type, duration of neutropenia, and catheter days. The high proportion of MBI-CLABSI highlights the effect of gut permeability within this population.
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Affiliation(s)
- Heather Lazarow
- Hospital of the University of Pennsylvania, Philadelphia, PA
- Clinical Nutrition Support Services Silverstein 3, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | | | - Cheryl Gilmar
- Hospital of the University of Pennsylvania, Philadelphia, PA
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12
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Landsburg DJ, Nasta SD, Svoboda J, Gerson JN, Schuster SJ, Barta SK, Chong EA, Difilippo H, Weber E, Cunningham K, Catania C, Garfall AL, Stadtmauer EA, Frey NV, Porter DL. Survival outcomes for patients with relapsed/refractory aggressive B cell lymphomas following receipt of high dose chemotherapy/autologous stem transplantation and/or chimeric antigen receptor-modified T cells. Transplant Cell Ther 2023:S2666-6367(23)01294-0. [PMID: 37211154 DOI: 10.1016/j.jtct.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/06/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Patients diagnosed with relapsed/refractory (R/R) diffuse large B cell and high grade B cell lymphomas (DLBCL/HGBL) may achieve prolonged survival following receipt of high dose chemotherapy/autologous stem cell transplantation (HDC/ASCT) or CD19-directed chimeric antigen receptor-modified T cells (CART19). While early results from randomized clinical trials suggest that assignment to CART19 versus salvage immunochemotherapy as second-line therapy results in improved survival, analysis of a large series of patients who actually received HDC/ASCT or CART19 has yet to be performed, and may inform future research efforts to optimize risk-stratification of R/R DLBCL/HGBL patients who are candidates for either therapy. OBJECTIVE To understand clinicopathologic factors which predict for freedom from treatment failure (FFTF) for R/R DLBCL/HGBL patients following receipt of HDC/ASCT or CART19, and compare patterns of TF for R/R DLBCL/HGBL patients receiving either HDC/ASCT or CART19. STUDY DESIGN Patients age ≤75 with R/R DLBCL/HGBL who received HDC/ASCT demonstrating partial or complete metabolic response to salvage immunochemotherapy and/or CART19 in the standard-of-care setting at the University of Pennsylvania from 2013-21 were included. Survival analyses were performed from the time of infusion of either HDC/ASCT or CART19 as well landmark time points post-infusion for patients who achieved FFTF. RESULTS For 100 HDC/ASCT patients with median length of follow-up of 62.7 months, the estimated rate of 36 month FFTF and overall survival were 59% and 81%, respectively. For 109 CART19 patients with median length of follow-up of 37.6 months, the estimated rate of 36 month FFTF and overall survival were 24% and 48%, respectively. HDC/ASCT patients achieved significantly higher rates of estimated 36 month FFTF if achieving actual FFTF at 3, 6, 12 and 24 months. Additionally, the incidence of baseline characteristics that predicted for TF at 36 months for either HDC/ASCT or CART19 patients was either similar or significantly lower at for CART19 as compared to HDC/ASCT patients who achieved actual FFTF at 3, 6, 12 and 24 months. CONCLUSION Patients with R/R DLBCL/HGBL achieving response to salvage immunochemotherapy who receive HDC/ASCT experience a high rate of estimated FFTF regardless of harboring features predictive of resistance to salvage immunochemotherapy, which may be more durable than that of R/R DLBCL/HGBL patients receiving CART19. These findings support further investigation of disease characteristics, such as molecular features, which may predict response to salvage immunochemotherapy in patients fit for HDC/ASCT.
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Affiliation(s)
- Daniel J Landsburg
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA USA.
| | - Sunita D Nasta
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA USA
| | - Jakub Svoboda
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA USA
| | - James N Gerson
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA USA
| | - Stephen J Schuster
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA USA
| | - Stefan K Barta
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA USA
| | - Elise A Chong
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA USA
| | - Heather Difilippo
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA USA
| | - Elizabeth Weber
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA USA
| | | | | | - Alfred L Garfall
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA USA
| | | | - Noelle V Frey
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA USA
| | - David L Porter
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA USA
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13
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Hess BT, Giri A, Park Y, Patel KK, Link BK, Nowakowski GS, Maliske SM, Fortin S, Chavez JC, Saeed H, Hill BT, Mejia Garcia AV, Maddocks KJ, Hanel W, Wagner‐Johnston ND, Messmer MR, Kahl BS, Watkins M, Alderuccio JP, Lossos IS, Nathan S, Orellana‐Noia VM, Portell CA, Landsburg DJ, Ayers EC, Castillo JJ. Outcomes of patients with limited-stage plasmablastic lymphoma: A multi-institutional retrospective study. Am J Hematol 2023; 98:300-308. [PMID: 36588409 PMCID: PMC10107934 DOI: 10.1002/ajh.26784] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 01/03/2023]
Abstract
Plasmablastic lymphoma (PBL) is a rare entity, commonly associated with immunosuppressed states such as human immunodeficiency virus (HIV) infection or solid organ transplant. The clinical course is characterized by high relapse rates and a poor prognosis, leading some clinicians to recommend aggressive frontline therapy. However, a specific review of limited stage (LS) PBL patients is not available to evaluate outcomes and justify treatment recommendations. We performed a retrospective review of LS PBL cases to provide insight into this rare disease. Our cohort consisted of 80 stage I or II PBL patients from 13 US academic centers. With a median follow up of 34 months (1-196), the 3-year progression-free survival (PFS) and overall survival (OS) of the entire cohort were 72% (95% CI 62, 83) and 79% (95% CI 70, 89), respectively. The 3-year PFS and OS of patients treated with frontline chemotherapy alone was 65% (95% CI 50, 84) and 71% (95% CI 56, 89), respectively, compared to 85% (95% CI 72, 100) and 96% (95% CI 89, 100), respectively, in patients treated with combined frontline chemotherapy with radiation consolidation. Our data demonstrate favorable outcomes in LS PBL with no improvements in outcome from aggressive frontline treatment including Hyper-CVAD or auto-SCT consolidation. Multivariate regression analysis (MRA) demonstrated improved PFS for patients receiving EPOCH based frontline therapy versus CHOP (HR: 0.23; p = 0.029). Frontline chemotherapy followed by radiation consolidation versus chemotherapy alone appeared to be associated with improved relapse and survival outcomes but did not show statistical significance in MRA.
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Affiliation(s)
- Brian T. Hess
- Hollings Cancer CenterMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Anshu Giri
- Fox Chase Cancer CenterPhiladelphiaPennsylvaniaUSA
| | - Yeonhee Park
- Hollings Cancer CenterMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Krina K. Patel
- Department of Lymphoma/MyelomaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Brian K. Link
- Division of Hematology, Oncology, and Blood & Marrow TransplantationUniversity of IowaIowa CityIowaUSA
| | | | - Seth M. Maliske
- Roger Maris Cancer Center Sanford HealthFargoNorth DakotaUSA
| | | | - Julio C. Chavez
- Department of Malignant HematologyMoffitt Cancer CenterTampaFloridaUSA
| | - Hayder Saeed
- Department of Malignant HematologyMoffitt Cancer CenterTampaFloridaUSA
| | - Brian T. Hill
- Taussig Cancer Institute, Department of Hematology and Medical OncologyCleveland Clinic FoundationClevelandOhioUSA
| | - Alex V. Mejia Garcia
- Taussig Cancer Institute, Department of Hematology and Medical OncologyCleveland Clinic FoundationClevelandOhioUSA
| | | | - Walter Hanel
- Division of HematologyThe Ohio State UniversityColumbusOhioUSA
| | | | | | - Brad S. Kahl
- Siteman Cancer CenterWashington University School of MedicineSt. LouisMissouriUSA
| | - Marcus Watkins
- Siteman Cancer CenterWashington University School of MedicineSt. LouisMissouriUSA
| | - Juan Pablo Alderuccio
- Sylvester Comprehensive Cancer CenterUniversity of Miami School of MedicineMiamiFloridaUSA
| | - Izidore S. Lossos
- Sylvester Comprehensive Cancer CenterUniversity of Miami School of MedicineMiamiFloridaUSA
| | | | | | - Craig A. Portell
- Division of Hematology/OncologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | | | - Emily C. Ayers
- Division of Hematology/OncologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Jorge J. Castillo
- Department of Medical OncologyDana‐Farber Cancer Institute, Harvard Medical SchoolBostonMassachusettsUSA
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14
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van Besien H, Porter DL, Nasta SD, Svoboda J, Barta SK, Schuster SJ, Chong E, Hollander L, Kucharczuk C, Carulli A, Stadtmauer EA, Garfall AL, Frey NV, Landsburg DJ. Long Term Neurologic Outcomes for Patients Receiving CAR-T Therapy for Non-Hodgkin’s Lymphoma Who Developed Severe Neurotoxicity. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00329-9] [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: 02/07/2023]
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15
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Yegya-Raman N, Wright CM, LaRiviere MJ, Baron JA, Lee DY, Landsburg DJ, Svoboda J, Nasta SD, Gerson JN, Barta SK, Chong EA, Schuster SJ, Maity A, Facciabene A, Paydar I, Plastaras JP. Salvage radiotherapy for relapsed/refractory non-Hodgkin lymphoma following CD19 chimeric antigen receptor T-cell (CART) therapy. Clin Transl Radiat Oncol 2023; 39:100587. [PMID: 36718252 PMCID: PMC9883177 DOI: 10.1016/j.ctro.2023.100587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/18/2022] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Background and purpose CD19-targeting chimeric antigen receptor T-cell (CART) therapy is a promising treatment for relapsed/refractory non-Hodgkin lymphoma, but most patients experience post-CART progression. We describe our institutional experience of salvage radiotherapy (SRT) in this setting. Materials and methods Of 94 patients who received CART therapy from 2018 to 2020, 21 received SRT for post-CART progression. Patients were divided into two groups: locoregional disease (n = 9 [43 %], all disease encompassable within an RT field) and advanced disease (n = 12 [57 %]). Patterns of failure, progression-free survival (PFS), overall survival (OS), and toxicity were assessed. Results Median time from CART infusion to SRT was 4.0 months (range, 0.6-11.5 months). In the locoregional disease group, 8/9 patients (89 %) were treated with comprehensive SRT to a median dose of 37.5 Gy in a median of 15 fractions. In the advanced disease group, all patients (n = 12) were treated with focal SRT to a median dose of 20.8 Gy in a median of 5 fractions. Median follow-up post-SRT was 15.2 months. In-field response was observed in 8/9 (89 %) in the locoregional disease and 8/9 (89 %) evaluable patients in the advanced disease groups. 17/18 evaluable patients (94 %) patients experienced post-SRT progression, all with a distant component. Median OS was 7.4 months; 21 months for locoregional disease versus 2.4 months for advanced disease (p = 0.0002). Median PFS was 1.1 month, and similarly poor regardless of group. No grade ≥ 3 toxicities occurred. Conclusions SRT post-CART therapy appears safe with encouraging in-field response but high rates of out-of-field progression, even for those presenting with locoregional disease, highlighting the need for integration of novel systemic agents.
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Affiliation(s)
- Nikhil Yegya-Raman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Christopher M. Wright
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael J. LaRiviere
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Jonathan A. Baron
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel Y. Lee
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel J. Landsburg
- Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, PA, United States
| | - Jakub Svoboda
- Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, PA, United States
| | - Sunita D. Nasta
- Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, PA, United States
| | - James N. Gerson
- Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, PA, United States
| | - Stefan K. Barta
- Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, PA, United States
| | - Elise A. Chong
- Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, PA, United States
| | - Stephen J. Schuster
- Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, PA, United States
| | - Amit Maity
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Andrea Facciabene
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Ima Paydar
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - John P. Plastaras
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States,Corresponding author at: Department of Radiation Oncology, University of Pennsylvania, PCAM/TRC 4 West, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States.
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16
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Cortese MJ, Wei W, Cerdeña S, Watkins MP, Olson M, Jodon G, Kaiser J, Haverkos B, Hughes ME, Namoglu E, Grover NS, Snow A, Orellana-Noia V, Rainey M, Sohail M, Rudoni J, Portell C, Voorhees T, Landsburg DJ, Kamdar M, Kahl BS, Hill BT. A multi-center analysis of the impact of DA-EPOCH-R dose-adjustment on clinical outcomes of patients with double/triple-hit lymphoma. Leuk Lymphoma 2023; 64:107-118. [PMID: 36323309 DOI: 10.1080/10428194.2022.2140281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patients with double- and triple-hit lymphomas (DHL/THL) have inferior outcomes with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), and higher-intensity regimens such as dose-adjusted (DA)-EPOCH-R are standard. Dose-intensification of DA-EPOCH-R is guided by hematologic toxicity, without conclusive benefit for DHL/THL patients. To determine if cumulative doses of DA-EPOCH-R or compliance with dose adjustment impacts survival, we retrospectively evaluated detailed clinical data from 109 adult (age ≥18 years) patients with DHL/THL treated with ≥4 cycles of induction DA-EPOCH-R from 2014 to 2019 at six centers. A comprehensive multivariate analysis was performed. Survival outcomes for the entire cohort were comparable to historical estimates for DHL/THL treated with this regimen (median follow-up 27.9 months). Overall survival (OS) and progression-free survival (PFS) were not significantly associated with cumulative chemotherapy dose, dose escalation, or compliance with dose adjustment. Heterogeneous dosing practices were observed. Prospective investigation is warranted to evaluate the practice of dose adjustment of R-EPOCH for patients with DHL/THL.
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Affiliation(s)
- Matthew J Cortese
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland, OH, USA
| | - Wei Wei
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Lerner Research Institute, Cleveland, OH, USA
| | - Sebastian Cerdeña
- Barnes-Jewish Hospital, Washington University in St. Louis, St. Louis, MO, USA
| | - Marcus P Watkins
- Barnes-Jewish Hospital, Washington University in St. Louis, St. Louis, MO, USA
| | - Marissa Olson
- Barnes-Jewish Hospital, Washington University in St. Louis, St. Louis, MO, USA
| | - Gray Jodon
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Jeff Kaiser
- University of Colorado Cancer Center, Aurora, CO, USA
| | | | - Mitchell E Hughes
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Esin Namoglu
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Natalie S Grover
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Anson Snow
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Victor Orellana-Noia
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, USA
| | - Magdalena Rainey
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Mohammad Sohail
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Joslyn Rudoni
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
| | - Craig Portell
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, USA
| | - Timothy Voorhees
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel J Landsburg
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Manali Kamdar
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Brad S Kahl
- Barnes-Jewish Hospital, Washington University in St. Louis, St. Louis, MO, USA
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland, OH, USA
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17
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Nasta SD, Hughes ME, Namoglu EC, Garfall A, DiFilippo H, Ballard HJ, Barta SK, Chong EA, Frey NV, Gerson JN, Landsburg DJ, Ruella M, Schuster SJ, Svoboda J, Weber E, Porter DL. Outcomes of Tisagenlecleucel in Lymphoma Patients With Predominant Management in an Ambulatory Setting. Clin Lymphoma Myeloma Leuk 2022; 22:e730-e737. [PMID: 35595619 PMCID: PMC10965010 DOI: 10.1016/j.clml.2022.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/18/2022] [Accepted: 04/03/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Chimeric antigen receptor T-cell therapy (CAR T) is a revolutionary adoptive immunotherapy approach in lymphoma; however, substantial resources are necessary for administration and care of these patients. Our institution has administered tisagenlecleucel primarily in an outpatient setting, and here we report our clinical outcomes. PATIENTS AND METHODS We conducted a single institution, retrospective study investigating outcomes of adult lymphoma patients treated with commercial tisagenlecleucel between 10/2017 and 12/2020. We analyzed patient characteristics and outcomes of efficacy and safety including overall response rate, progression-free survival, overall survival and cytokine-release syndrome, neurotoxicity, and hospitalizations. RESULTS Seventy-two patients with relapsed or refractory non-Hodgkin lymphoma (NHL) who received commercial tisagenlecleucel were identified; 68 (94.4%) patients received outpatient tisagenlecleucel. The overall response rate was 43% with a complete response observed in 25 patients (34.7%). At a median follow-up of 9.1 months, the median progression-free survival was 3.3 months. Grade 3-4 cytokine release syndrome was not observed in the study group and two patients had grade 3-4 neurotoxicity. Twenty-six patients (36.1%) were admitted within 30 days after infusion with a median length of stay of 5 days. Fourteen patients (19.4%) were admitted within 72 hours of infusion. No patient died of CAR T cell-related toxicity. CONCLUSION Our experience affirms treatment with tisagenlecleucel in the outpatient setting is safe and feasible with close supervision and adequate institutional experience. After infusion, adverse events were manageable and the majority of patients did not require hospitalization.
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Affiliation(s)
- Sunita D Nasta
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
| | - Mitchell E Hughes
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Esin C Namoglu
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Alfred Garfall
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Heather DiFilippo
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Hatcher J Ballard
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Stefan K Barta
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Elise A Chong
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Noelle V Frey
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - James N Gerson
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | - Marco Ruella
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | - Jakub Svoboda
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Weber
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - David L Porter
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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18
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Landsburg DJ, Caponetti GC, Bagg A, Schuster SJ, Nasta S, Gerson JM, Frank DM, Barta SK, Svoboda J, Bhattacharyya S, Qualtieri JN, Lim MS, Chong EA, Roth J, Priore SF, Deihimi S, Morrissette JJ. Clinical laboratory mutation analysis performed on aggressive B cell non-Hodgkin lymphoma patient biopsies. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e19561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19561 Background: Results from comprehensive genomic analysis performed on aggressive B cell non-Hodgkin lymphomas (aBNHL) patient (pt) biopsies (bx) have identified mutations (mut) which may be predictive of pt survival. However, results from mut analysis (MA) performed on aBNHL pt bx in clinical laboratories are not well-described. Methods: Bx diagnostic of non-Burkitt aBNHL obtained from 7/2015-2/2021 with MA performed in the Penn Center for Personalized Diagnostics clinical laboratory using 3 consecutive versions of lymphoma sequencing panels were retrospectively analyzed. Mut tested varied by panel. Mut detected with variant allele frequency (VAF) ≥10% were included. Results: MA was performed on 293 aBNHL pt bx with a successful assay for 270 (7.8% failure rate). Request for MA was made by interpreting hematopathologist 93% and treating clinician 7%. Median turnaround time (TAT) from receipt of bx to result report was 18 (range 8-53) days. Notable pt characteristics included prior/concurrent indolent lymphoma (IL) 31% and prior systemic therapy received for IL and/or aBNHL 38%. Notable bx characteristics included bx type paraffin-embedded tissue 85% and bone marrow 12%, histologic classification diffuse large B cell lymphoma 86% and high grade B cell lymphoma 13%, cell of origin (COO) by Hans algorithm non-germinal center B (non-GCB) 51% and GCB 44%, known double expressor lymphoma 30%, known MYC rearrangement 18%, known double hit lymphoma 9% and any mut detected with VAF ≥10% 82%. Number and percentage of mut occurring in ≥10% of bx (minimum tested bx for mut ≥92) with associated COO are listed in the table. Subset analysis of 147 bx obtained from pts with newly-diagnosed aBNHL (15% with previously-untreated IL) had similar bx characteristics to the entire population were analyzed for the presence of mut reported in poor-prognosis COO-associated classifications: Cluster 5 for non-GCB and Cluster 3 for GCB (PMID: 29713087), double-hit signature (DHITsig) for GCB (PMID: 30523716) and molecular high grade (MHG) for GCB (PMID: 30523719). For 77 non-GCB bx, 19% had Cluster 5 mut. For 59 GCB bx, 56% had at least one of Cluster 3, DHITsig or MHG mut. Conclusions: Clinical laboratory MA performed on nearly 300 aBNHL pt bx was highly successful with a short TAT and demonstrated recurrent gene mut associated with aBNHL development. In the subset of bx from previously-untreated pts, MA identified mut associated with poor-prognosis genetic subtypes of aBNHL.[Table: see text]
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Affiliation(s)
- Daniel J Landsburg
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Gabriel C. Caponetti
- Division of Hematopathology, Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Adam Bagg
- Division of Hematopathology, Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Stephen J. Schuster
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Sunita Nasta
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - James M. Gerson
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Dale M. Frank
- Division of Hematopathology, Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Stefan K. Barta
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jakub Svoboda
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Siddharth Bhattacharyya
- Division of Hematopathology, Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Julianne N Qualtieri
- Division of Hematopathology, Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Megan S. Lim
- Division of Hematopathology, Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Elise A. Chong
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jacquelyn Roth
- Division of Precision and Computational Diagnostics, Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Salvatore F. Priore
- Division of Precision and Computational Diagnostics, Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Safoora Deihimi
- Division of Precision and Computational Diagnostics, Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jennifer J. Morrissette
- Division of Precision and Computational Diagnostics, Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA
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19
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Prischak SE, Ballard HJ, Duca AN, Gerson JM, Landsburg DJ, Barta SK, Svoboda J. COVID-19 pandemic experience in patients with Hodgkin lymphoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e19534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19534 Background: Patients (pts) with Hodgkin lymphoma (HL) may be at an increased risk from COVID-19-related complications due to immunosuppression and common therapies with pulmonary toxicities (e.g. bleomycin, radiation). Additionally, they may experience unexpected adverse events (AEs) from the novel SARS-CoV-2 vaccines due to the intrinsic abnormalities in cellular immunity. Exploring their perspective on the COVID-19 pandemic and subjective AEs from the novel vaccines may ultimately allow providers to develop improved services based on needs of this specific population. Methods: We conducted a single-institution, questionnaire-based study in pts treated after 1/1/2015, for diagnosis of HL. Pts were identified through the electronic medical records at our institution. After signing an informed consent, pts answered 19 questions designed to reflect on their COVID-19 pandemic experience. An additional section aimed to determine the percentage of pts with a local or systemic AEs within 7 days of novel SARS-CoV-2 vaccine dose. Results: We enrolled 30 pts with median age 28.5 years (18-66); 16 (53%) were male, and 26 (87%) were on active HL therapy. With data cutoff 1/28/2022, 27 pts (90%) completed the questionnaire. A total of 8 (27%) patients had COVID-19 infection with 75% of those occurring after the vaccination. None required hospitalization and none reported residual pulmonary issues. Eighteen (67%) had a member of their household test positive for COVID-19. Most pts (67%) did not require cancellation of their appointments due to COVID-19-related issues during the pandemic. 85% of pts participated in at least 1 telehealth medical appointment and the majority (72%) were satisfied with their telehealth experience for cancer care. A total of 24 (80%) pts received the novel SARS-CoV-2 vaccines (58% had Pfizer-BioNTech BNT162b2, 38% Moderna mRNA-1273, 4% Ad26.COV2.S) and 23 pts completed the AE section of the questionnaire. The vaccines were generally well-tolerated. Six pts (26%) reported at least one grade 3 AE, but none had grade 4 local or systemic AEs. The most common AE was pain at injection site (65% after dose 1, 55% after dose 2, 69% after dose 3). AEs that occurred in over 25% of pts during any of the injections included redness/swelling/pain at the injection site, fatigue, headache, muscle pain, and fever. Of 23 eligible pts, 13 (57%) received 3rd dose of the vaccine. No unexpected toxicities or autoimmune issues were noted by participants in this study following vaccination with a median follow up of 10 months after the 1st vaccine dose. Conclusions: Based on responses from our study, HL pts adjusted to the challenges of the COVID-19 pandemic with minimal disruptions to their cancer care, showed positive attitudes toward telehealth, and appear without any unexpected toxicities from the novel vaccines.
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Affiliation(s)
- Sara E. Prischak
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | - Adam N. Duca
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - James M. Gerson
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | - Stefan K. Barta
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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20
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Chong EA, Alanio C, Svoboda J, Nasta SD, Landsburg DJ, Lacey SF, Ruella M, Bhattacharyya S, Wherry EJ, Schuster SJ. Pembrolizumab for B-cell lymphomas relapsing after or refractory to CD19-directed CAR T-cell therapy. Blood 2022; 139:1026-1038. [PMID: 34496014 PMCID: PMC9211527 DOI: 10.1182/blood.2021012634] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/26/2021] [Indexed: 01/16/2023] Open
Abstract
CD19-directed chimeric antigen receptor-modified (CAR T) T cells achieve durable remissions in about 30% to 40% of relapsed/refractory large B-cell lymphomas. T-cell exhaustion and/or an immunosuppressive tumor microenvironment may contribute to CAR T-cell failure. Pembrolizumab, an anti-PD1 immune checkpoint inhibitor, may reverse T-cell exhaustion after CAR T-cell therapy. We treated 12 patients with B-cell lymphomas who were either refractory to (n = 9) or relapsed after (n = 3) CD19-directed CAR T-cell (4-1BB-costimulated) therapy with pembrolizumab 200 mg IV every 3 weeks. Median time from CAR T-cell infusion to first pembrolizumab dose was 3.3 months (range, 0.4-42.8 months). Pembrolizumab was well tolerated, and the only grade ≥3 adverse events related to pembrolizumab were neutropenia (n = 3; 25%). Best overall response rate after pembrolizumab was 25% (3 of 12 patients; 1 complete response; 2 partial responses). One (8%) patient had stable disease; thus, 4 of 12 (33%) patients had clinical benefit. After pembrolizumab, 4 patients with clinical benefit had an increase in percentage of CAR T cells by mass cytometry by time of flight (CyTOF); 3 of 4 of these patients also had increases in CAR19 transgene levels by quantitative polymerase chain reaction. Deep immune profiling using CyTOF revealed increased CAR T-cell activation and proliferation and less T-cell exhaustion in clinical responders. Together, PD1 blockade with pembrolizumab after CD19-directed CAR T-cell therapy appears safe and may achieve clinical responses in some patients with B-cell lymphomas refractory to or relapsed after CAR T-cell therapy. This trial was registered at www.clinicaltrials.gove as #NCT02650999.
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MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antigens, CD19/immunology
- Antineoplastic Agents, Immunological/therapeutic use
- Female
- Follow-Up Studies
- Humans
- Immunotherapy, Adoptive/adverse effects
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/immunology
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Prognosis
- Prospective Studies
- Receptors, Chimeric Antigen/immunology
- Salvage Therapy
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Affiliation(s)
| | - Cécile Alanio
- Institute for Immunology, and
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and
- Parker Institute for Cancer Immunotherapy at the University of Pennsylvania
| | | | | | | | - Simon F Lacey
- Center for Cellular Immunotherapies, and
- Department of Pathology & Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Marco Ruella
- Lymphoma Program, Abramson Cancer Center
- Center for Cellular Immunotherapies, and
| | | | - E John Wherry
- Institute for Immunology, and
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and
- Parker Institute for Cancer Immunotherapy at the University of Pennsylvania
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21
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Orellana-Noia VM, Reed DR, McCook AA, Sen JM, Barlow CM, Malecek MK, Watkins M, Kahl BS, Spinner MA, Advani R, Voorhees TJ, Snow A, Grover NS, Ayers A, Romancik J, Liu Y, Huntington SF, Chavez JC, Saeed H, Lazaryan A, Raghunathan V, Spurgeon SE, Ollila TA, Del Prete C, Olszewski A, Ayers EC, Landsburg DJ, Echalier B, Lee J, Kamdar M, Caimi PF, Fu T, Liu J, David KA, Alharthy H, Law J, Karmali R, Shah H, Stephens DM, Major A, Rojek AE, Smith SM, Yellala A, Kallam A, Nakhoda S, Khan N, Sohail MA, Hill BT, Barrett-Campbell O, Lansigan F, Switchenko J, Cohen J, Portell CA. Single-route CNS prophylaxis for aggressive non-Hodgkin lymphomas: real-world outcomes from 21 US academic institutions. Blood 2022; 139:413-423. [PMID: 34570876 PMCID: PMC8777199 DOI: 10.1182/blood.2021012888] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/05/2021] [Indexed: 01/22/2023] Open
Abstract
Prophylaxis is commonly used to prevent central nervous sy stem (CNS) relapse in diffuse large B-cell lymphoma (DLBCL), with no clear standard of care. We retrospectively evaluated 1162 adult patients across 21 US academic centers with DLBCL or similar histologies who received single-route CNS prophylaxis as part of frontline therapy between 2013 and 2019. Prophylaxis was administered intrathecally(IT) in 894 (77%) and using systemic high-dose methotrexate (HD-MTX) in 236 (20%); 32 patients (3%) switched route due to toxicity and were assessed separately. By CNS-International Prognostic Index (IPI), 18% were considered low-risk, 51% moderate, and 30% high. Double-hit lymphoma (DHL) was confirmed in 243 of 866 evaluable patients (21%). Sixty-four patients (5.7%) had CNS relapse after median 7.1 months from diagnosis, including 15 of 64 (23%) within the first 6 months. There was no significant difference in CNS relapse between IT and HD-MTX recipients (5.4% vs 6.8%, P = .4), including after propensity score matching to account for differences between respective recipient groups. Weighting by CNS-IPI, expected vs observed CNS relapse rates were nearly identical (5.8% vs 5.7%). Testicular involvement was associated with high risk of CNS relapse (11.3%) despite most having lower CNS-IPI scores. DHL did not significantly predict for CNS relapse after single-route prophylaxis, including with adjustment for treatment regimen and other factors. This large study of CNS prophylaxis recipients with DLBCL found no significant difference in CNS relapse rates between routes of administration. Relapse rates among high-risk subgroups remain elevated, and reconsideration of prophylaxis strategies in DLBCL is of critical need.
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Affiliation(s)
- Victor Manuel Orellana-Noia
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Daniel R Reed
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
- Comprehensive Cancer Center of Wake Forest University, Section on Hematology and Oncology, Winston-Salem, NC
| | - Ashley Alesia McCook
- Winship Cancer Institute, Department of Biostatistics, Emory University, Atlanta, GA
| | | | - Christian M Barlow
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Mary-Kate Malecek
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Marcus Watkins
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Brad S Kahl
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Michael A Spinner
- Division of Oncology, Stanford University Medical Center, Stanford, CA
| | - Ranjana Advani
- Division of Oncology, Stanford University Medical Center, Stanford, CA
| | - Timothy J Voorhees
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
- Division of Hematology, Ohio State University, Columbus, OH
| | - Anson Snow
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Natalie Sophia Grover
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Amy Ayers
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Jason Romancik
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Yuxin Liu
- Division of Hematology, Yale University, New Haven, CT
| | | | - Julio C Chavez
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Hayder Saeed
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | | | - Vikram Raghunathan
- Division of Hematology and Oncology, Oregon Health Sciences University, Portland, OR
- Division of Medical Oncology, University of Washington, Seattle, WA
| | - Stephen E Spurgeon
- Division of Hematology and Oncology, Oregon Health Sciences University, Portland, OR
| | - Thomas A Ollila
- Division of Hematology/Oncology, Brown University, Providence, RI
| | | | - Adam Olszewski
- Division of Hematology/Oncology, Brown University, Providence, RI
| | - Emily C Ayers
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Daniel J Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | - Jun Lee
- Division of Hematology, University of Colorado, Denver, CO
| | - Manali Kamdar
- Division of Hematology, University of Colorado, Denver, CO
| | - Paolo F Caimi
- Adult Hematologic Malignancies and Stem Cell Transplant Section, University Hospitals Seidman Cancer Center, Cleveland, OH
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Timothy Fu
- Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Jieqi Liu
- Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Kevin A David
- Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Hanan Alharthy
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD
| | - Jennie Law
- Division of Hematology and Oncology, University of Maryland Greenbaum Comprehensive Cancer Center, Baltimore, MD
| | - Reem Karmali
- Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Harsh Shah
- University of Utah/Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Ajay Major
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | | | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Amulya Yellala
- Department of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Avyakta Kallam
- Department of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE
| | | | - Nadia Khan
- Fox Chase Cancer Center, Philadelphia, PA; and
| | - Mohammad Ahsan Sohail
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Frederick Lansigan
- Division of Hematology and Oncology, Dartmouth Geisel School of Medicine, Hanover, NH
| | - Jeffrey Switchenko
- Winship Cancer Institute, Department of Biostatistics, Emory University, Atlanta, GA
| | - Jonathon Cohen
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Craig A Portell
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
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22
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Frosch ZAK, Namoglu EC, Mitra N, Landsburg DJ, Nasta SD, Bekelman JE, Iyengar R, Guerra CE, Schapira MM. Willingness to Travel for Cellular Therapy: The Influence of Follow-Up Care Location, Oncologist Continuity, and Race. JCO Oncol Pract 2022; 18:e193-e203. [PMID: 34524837 PMCID: PMC8757965 DOI: 10.1200/op.21.00312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Patients weigh competing priorities when deciding whether to travel to a cellular therapy center for treatment. We conducted a choice-based conjoint analysis to determine the relative value they place on clinical factors, oncologist continuity, and travel time under different post-treatment follow-up arrangements. We also evaluated for differences in preferences by sociodemographic factors. METHODS We administered a survey in which patients with diffuse large B-cell lymphoma selected treatment plans between pairs of hypothetical options that varied in travel time, follow-up arrangement, oncologist continuity, 2-year overall survival, and intensive care unit admission rate. We determined importance weights (which represent attributes' value to participants) using generalized estimating equations. RESULTS Three hundred and two patients (62%) responded. When all follow-up care was at the center providing treatment, plans requiring longer travel times were less attractive (v 30 minutes, importance weights [95% CI] of -0.54 [-0.80 to -0.27], -0.57 [-0.84 to -0.29], and -0.17 [-0.49 to 0.14] for 60, 90, and 120 minutes). However, the negative impact of travel on treatment plan choice was mitigated by offering shared follow-up (importance weights [95% CI] of 0.63 [0.33 to 0.93], 0.32 [0.08 to 0.57], and 0.26 [0.04 to 0.47] at 60, 90, and 120 minutes). Black participants were less likely to choose plans requiring longer travel, regardless of follow-up arrangement, as indicated by lower value importance weights for longer travel times. CONCLUSION Reducing travel burden through shared follow-up may increase patients' willingness to travel to receive cellular therapies, but additional measures are required to facilitate equitable access.
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Affiliation(s)
- Zachary A. K. Frosch
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA,Zachary A. K. Frosch, MD, MSHP, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111; e-mail:
| | - Esin C. Namoglu
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Nandita Mitra
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Daniel J. Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Sunita D. Nasta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Justin E. Bekelman
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Raghuram Iyengar
- Marketing Department, The Wharton School, University of Pennsylvania, Philadelphia, PA
| | - Carmen E. Guerra
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Marilyn M. Schapira
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA,Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA
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23
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Lewis DJ, Haun PL, Samimi SS, Vittorio CC, Villasenor-Park J, Barta SK, Landsburg DJ, Svoboda J, Nasta SD, Schuster SJ, Rook AH, Kim EJ. Brentuximab Vedotin for Relapsed or Refractory Sézary Syndrome. JAMA Dermatol 2021; 157:317-321. [PMID: 33377934 DOI: 10.1001/jamadermatol.2020.4901] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Treatment options for Sézary syndrome (SS) are limited and associated with low response rates. Brentuximab vedotin is a CD30-directed antibody-drug conjugate approved for refractory CD30-positive cutaneous T-cell lymphoma. However, limited data exist on its efficacy in SS, including in the pivotal phase 3 ALCANZA (A Phase 3 Trial of Brentuximab Vedotin (SGN-35) Versus Physician's Choice [Methotrexate or Bexarotene] in Participants With CD30-Positive Cutaneous T-Cell Lymphoma) trial. Objective To assess the preliminary efficacy and tolerability of brentuximab vedotin for SS. Design, Setting, and Participants From January 1, 2017, to July 31, 2020, a total of 13 patients with SS received brentuximab vedotin and were analyzed as part of a retrospective case series. Median follow-up was 10.4 months (range, 1.4-34.6 months). All patients were 18 years or older with a diagnosis of SS and with B2 blood involvement at the time brentuximab vedotin therapy was initiated. This single-center study was conducted at a major academic referral center. Interventions Intravenous brentuximab vedotin administration approximately every 3 weeks. Main Outcomes and Measures The primary end point was the global response rate. Outcomes were assessed in the skin and lymph nodes per the 2011 European Organization for Research and Treatment of Cancer-International Society of Cutaneous Lymphoma response criteria and in the blood per the 2018 Prospective Cutaneous Lymphoma International Prognostic Index revised blood response criteria. Results The study included 13 patients (8 [62%] male; mean [SD] age, 68.2 [8.6] years). Of these 13 patients, 5 (38%) achieved a global response after a median of 6 cycles, including 1 complete response. Response rates by disease compartment were 38% in the skin, 63% in the blood, and 50% in the lymph nodes. Three of 11 patients (27%) with pruritus reported improvement. Skin CD30 positivity (>10%) was detected in 9 patients but was not associated with responses. Among responders, the median time to response was 6 weeks (range, 6-9 weeks), and the median duration of response was 5.5 months (range, 2.5-28.9 months). The median time to next treatment was 3.2 months (range, 1.5-36.7 months). Peripheral neuropathy occurred in 4 patients but resolved in 2 patients. Grade 2 adverse events were neuropathy (n = 2), constipation (n = 1), and hand-foot syndrome (n = 1). Conclusions and Relevance In this case series, brentuximab vedotin use was associated with some efficacy in SS across multiple disease compartments and in the setting of refractory disease or low CD30 skin expression. Brentuximab vedotin may offer a manageable treatment schedule and low incidence of significant toxic effects.
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Affiliation(s)
- Daniel J Lewis
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Paul L Haun
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Sara S Samimi
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Carmela C Vittorio
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jennifer Villasenor-Park
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Stefan K Barta
- Abramson Cancer Center, Department of Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Daniel J Landsburg
- Abramson Cancer Center, Department of Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jakub Svoboda
- Abramson Cancer Center, Department of Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Sunita D Nasta
- Abramson Cancer Center, Department of Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Stephen J Schuster
- Abramson Cancer Center, Department of Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alain H Rook
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Ellen J Kim
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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24
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Landsburg DJ, Nasta SD, Gerson JN, Svoboda J, Chong EA, Schuster SJ, Barta SK, Robinson KW, Hughes ME. Time-to-response for patients with relapsed/refractory diffuse large B cell and high grade B cell lymphoma treated with polatuzumab-based therapy. Leuk Lymphoma 2021; 63:243-246. [PMID: 34435548 DOI: 10.1080/10428194.2021.1971224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Daniel J Landsburg
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Sunita D Nasta
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - James N Gerson
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jakub Svoboda
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Elise A Chong
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen J Schuster
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Stefan K Barta
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Kyle W Robinson
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Mitchell E Hughes
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
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25
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Landsburg DJ, Barta SK, Ramchandren R, Batlevi C, Iyer S, Kelly K, Micallef IN, Smith SM, Stevens DA, Alvarez M, Califano A, Shen Y, Bosker G, Parker J, Soikes R, Martinez E, von Roemeling R, Martell RE, Oki Y. Fimepinostat (CUDC-907) in patients with relapsed/refractory diffuse large B cell and high-grade B-cell lymphoma: report of a phase 2 trial and exploratory biomarker analyses. Br J Haematol 2021; 195:201-209. [PMID: 34341990 DOI: 10.1111/bjh.17730] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/13/2021] [Indexed: 12/28/2022]
Abstract
Fimepinostat (CUDC-907), a first-in-class oral small-molecule inhibitor of histone deacetylase and phosphatidylinositol 3-kinase, demonstrated efficacy in a phase 1 study of patients with relapsed/refractory (R/R) diffuse large and high-grade B-cell lymphomas (DLBCL/HGBL), particularly those with increased MYC protein expression and/or MYC gene rearrangement/copy number gain (MYC-altered disease). Therefore, a phase 2 study of fimepinostat was conducted in this patient population with 66 eligible patients treated. The primary end-point of overall response (OR) rate for patients with MYC-IHC ≥40% (n = 46) was 15%. Subsequently, exploratory pooled analyses were performed including patients treated on both the phase 1 and 2 studies based upon the presence of MYC-altered disease as well as a biomarker identified by Virtual Inference of Protein activity by Enriched Regulon analysis (VIPER). For these patients with MYC-altered disease (n = 63), the overall response (OR) rate was 22% with seven responding patients remaining on treatment for approximately two years or longer, and VIPER yielded a three-protein biomarker classification with positive and negative predictive values of ≥85%. Prolonged durations of response were achieved by patients with MYC-altered R/R DLBCL/HGBL treated with single-agent fimepinostat. Combination therapies and/or biomarker-based patient selection strategies may lead to higher response rates in future clinical trials.
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Affiliation(s)
| | - Stefan K Barta
- University of Pennsylvania, Philadelphia, PA, USA.,Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - Connie Batlevi
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Swaminathan Iyer
- MD Anderson Cancer Center, Houston, TX, USA.,Houston Methodist Hospital, Houston, TX, USA
| | - Kevin Kelly
- University of Southern California, Los Angeles, CA, USA
| | | | | | | | | | | | - Yao Shen
- DarwinHealth, Inc, New York, NY, USA
| | | | | | | | | | | | | | - Yasuhiro Oki
- MD Anderson Cancer Center, Houston, TX, USA.,Genentech, San Francisco, CA, USA
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26
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Svoboda J, Bair SM, Landsburg DJ, Dwivedy Nasta S, Nagle SJ, Barta SK, Khan N, Filicko-O'Hara J, Gaballa S, Strelec L, Chong E, Mitnick S, Waite TS, King C, Ballard H, Youngman M, Gerson J, Plastaras JP, Maity A, Bogusz AM, Hung SS, Nakamura H, Nejati R, Steidl C, Lim M, Ruella M, Schuster SJ. Brentuximab vedotin in combination with rituximab, cyclophosphamide, doxorubicin, and prednisone as frontline treatment for patients with CD30-positive B-cell lymphomas. Haematologica 2021; 106:1705-1713. [PMID: 32414850 PMCID: PMC8168499 DOI: 10.3324/haematol.2019.238675] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 09/19/2019] [Indexed: 12/14/2022] Open
Abstract
We conducted a phase I/II multicenter trial using six cycles of brentuximab vedotin (BV) in combination with rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHP) for treatment of patients with CD30-positive B-cell lymphomas. Thirty-one patients were evaluable for toxicity and 29 for efficacy including 22 with primary mediastinal B-cell lymphoma, five with diffuse large B-cell lymphoma, and two with gray zone lymphoma. There were no treatmentrelated deaths; 32% of patients had non-hematologic grade 3/4 toxicities. The overall response rate was 100% (95% confidence interval [95% CI]: 88-100) with 86% (95% CI: 68-96) of patients achieving complete response at the end of systemic treatment. Consolidative radiation following end-of-treatment response assessment was permissible and used in 52% of all patients including 59% of the patients with primary mediastinal B-cell lymphoma. With a median follow-up of 30 months, the 2- year progression-free survival and overall survival rates were 85% (95% CI: 66-94) and 100%, respectively. In the cohort with primary mediastinal B-cell lymphoma, the 2-year progression-free survival rate was 86% (95% CI: 62-95). In summary, BV-R-CHP with or without consolidative radiation is a feasible and active frontline regimen for CD30-positive Bcell lymphomas (ClinicalTrials.gov identifier: NCT01994850).
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Affiliation(s)
| | | | | | | | - Sarah J Nagle
- Oregon Health and Science University, Portland, OR, USA
| | | | - Nadia Khan
- Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | | | | | - Elise Chong
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Cara King
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - James Gerson
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Amit Maity
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Stacy S Hung
- Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | | | - Reza Nejati
- Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - Megan Lim
- University of Pennsylvania, Philadelphia, PA, USA
| | - Marco Ruella
- University of Pennsylvania, Philadelphia, PA, USA
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27
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Landsburg DJ, Koike A, Nasta SD, Svoboda J, Schuster SJ, Wasik MA, Caponetti GC. Patterns of immune checkpoint protein expression in MYC-overexpressing aggressive B-cell non-Hodgkin lymphomas. Cancer Immunol Immunother 2020; 70:869-874. [PMID: 32857184 DOI: 10.1007/s00262-020-02708-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/19/2020] [Indexed: 12/16/2022]
Abstract
Given the poor prognosis of MYC-overexpressing diffuse large B cell lymphoma (DLBCL) and B cell lymphoma unclassifiable with features intermediate between DLBCL and Burkitt lymphoma/high grade B cell lymphoma (BCLU/HGBL), and preclinical data suggesting that MYC may regulate the antitumor immune response, we sought to characterize expression of immune checkpoint proteins on tumor tissue from patients diagnosed with these lymphomas. Immunohistochemical staining for immune checkpoint protein expression was applied to 56 cases of MYC-overexpressing DLBCL and BCLU/HGBL, 35 of which also harbored MYC rearrangement (MYC-R). Analysis revealed both frequent overexpression of immune checkpoint proteins as well as differences in overexpression patterns based upon MYC-R status, with MYC-R cases more likely to overexpress PD-L1 and PD-1 in the tumor microenvironment (50 vs. 15%, p = 0.02 and 32 vs. 5%, p = 0.02, respectively) but less likely to overexpress CTLA-4 and CD80 on tumor cells (34 vs. 71%, p = 0.01 and 34 vs. 81%, p = 0.001, respectively), as compared to cases without MYC-R. These data may suggest a biologic rationale for investigation of the effect of checkpoint inhibitor therapies in these subgroups of MYC-overexpressing DLBCL and BCLU/HGBL.
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Affiliation(s)
| | - Alexa Koike
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Mariusz A Wasik
- Fox Chase Cancer Center and University of Pennsylvania, Philadelphia, USA
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28
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Lazarow H, Singer R, Compher C, Gilmar C, Kucharczuk CR, Mangan P, Salam K, Cunningham K, Stadtmauer EA, Landsburg DJ. Effect of malnutrition-driven nutritional support protocol on clinical outcomes in autologous stem cell transplantation patients. Support Care Cancer 2020; 29:997-1003. [PMID: 32556621 DOI: 10.1007/s00520-020-05571-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/11/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE Poor nutrition status in patients receiving high-dose chemotherapy and autologous stem cell transplant (ASCT) has been associated with inferior clinical outcomes. We aim to determine whether a malnutrition-driven nutritional support protocol can improve these outcomes. METHODS In this prospective cohort study, we assessed adults for malnutrition who were consecutively admitted for ASCT between October 2017 and March 2019 (n = 251), and provided enteral or parenteral nutrition (EN/PN) to patients who were malnourished early in the transplantation admission. We compared their clinical outcomes with those of a historical cohort admitted between May 2016 and October 2017 (n = 257) for whom nutrition assessment and initiation of EN/PN were not protocol-driven. RESULTS Patients receiving ASCT during the intervention period experienced decreased odds of prolonged hospital stay (p = 0.023), central line-associated bloodstream infection (p = 0.015), mucosal barrier injury (p = 0.037), and high weight loss (p = 0.002), in a multivariate analysis as compared with those receiving ASCT during the control period. Outcomes for ICU transfer, deconditioning on discharge, time to platelet engraftment, and unplanned 30-day hospital readmission did not differ significantly between groups. CONCLUSION A malnutrition-driven nutritional support protocol may improve outcomes for ASCT patients.
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Affiliation(s)
- Heather Lazarow
- Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Ryan Singer
- Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Charlene Compher
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Cheryl Gilmar
- Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania, Philadelphia, PA, USA
| | - Colleen R Kucharczuk
- Department of Advanced Practice, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Patricia Mangan
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly Salam
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathleen Cunningham
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward A Stadtmauer
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Landsburg
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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29
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Wright CM, LaRiviere MJ, Baron JA, Uche C, Xiao Y, Arscott WT, Anstadt EJ, Barsky AR, Miller D, LaRose MI, Landsburg DJ, Svoboda J, Nasta SD, Gerson JN, Barta SK, Chong EA, Schuster SJ, Paydar I, Maity A, Plastaras JP. Bridging Radiation Therapy Before Commercial Chimeric Antigen Receptor T-Cell Therapy for Relapsed or Refractory Aggressive B-Cell Lymphoma. Int J Radiat Oncol Biol Phys 2020; 108:178-188. [PMID: 32446950 DOI: 10.1016/j.ijrobp.2020.05.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/30/2020] [Accepted: 05/11/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE CD19-targeting chimeric antigen receptor T-cell (CART) therapy has emerged as a promising treatment for relapsed/refractory aggressive B-cell lymphoma (r/rABL), culminating in 2 US Food and Drug Administration-approved therapies: tisagenlecleucel (tisa-cel) and axicabtagene ciloleucel (axi-cel). Following leukapheresis and in preparation for CART infusion, contemporary bridging and lymphodepletion regimens rely mostly on cytotoxic chemotherapy. Here, in a cohort of patients treated with commercial tisa-cel and axi-cel, we show that bridging-RT may offer a supplemental approach. METHODS AND MATERIALS Thirty-one patients receiving commercial tisa-cel (n = 13) or axi-cel (n = 18) between August 2018 and February 2019 for r/rABL were retrospectively reviewed. Patients were categorized into 2 groups: (1) bridging-RT within 30 days of CART infusion or (2) nonbridging-RT (NBRT), in which patients received either remote RT greater than 30 days before CART infusion or no prior RT. RESULTS Five patients received bridging-RT within 30 days of CART infusion. Median bridging-RT dose was 37.5 Gy and was completed a median of 13 days before infusion. No grade 3 (G3) or higher RT-toxicities occurred. No patients in the bridging-RT group experienced G3 or higher CART-related toxicities (CRS or neurotoxicity), and 23% (n = 6) and 15% (n = 4) experienced G3-5 CRS and G3-5 neurotoxicity in the NBRT group, respectively. Overall treatment response in the bridging-RT and NBRT groups was 80% and 64%, respectively. The axi-cel CART product was associated with CRS (odds ratio [OR] = 26.67, P = .001) and CRS correlated with neurotoxicity (OR = 12.22, P = .028). There was a trend toward an association for CRS with metabolic tumor volume (OR = 1.06/mL, P = .141) and TLG (OR = 1.01/mL x standard uptake value, P = .099). CONCLUSIONS Bridging-RT before commercial CART does not appear to increase the risk for CART-related toxicities or negatively affect outcomes in r/rABL patients. No G3 or higher RT-toxicities occurred in this series. Pretreatment metabolic tumor burden may be associated with CART-associated CRS; however, larger patient numbers are required to elucidate significant associations. Future work to prospectively assess the value of bridging-RT is warranted.
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Affiliation(s)
- Christopher M Wright
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Michael J LaRiviere
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan A Baron
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chibueze Uche
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - W Tristram Arscott
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily J Anstadt
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew R Barsky
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Miller
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Meredith I LaRose
- Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel J Landsburg
- Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jakub Svoboda
- Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sunita D Nasta
- Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James N Gerson
- Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stefan K Barta
- Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elise A Chong
- Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen J Schuster
- Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ima Paydar
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amit Maity
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P Plastaras
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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30
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Ayers EC, Margolis D, Landsburg DJ. Real World Outcomes in Patients With Relapsed/Refractory Diffuse Large B-cell Lymphoma Receiving Palliative Intent Therapies. Clin Lymphoma Myeloma Leuk 2020; 20:661-667. [PMID: 32576502 DOI: 10.1016/j.clml.2020.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/04/2020] [Accepted: 05/10/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Outcomes in patients with relapsed/refractory (R/R) diffuse large b-cell lymphoma (DLBCL) who are ineligible for and/or fail high-dose chemotherapy and autologous stem cell transplantation in the second line are poor. There is no preferred palliative-intent treatment for patients in this setting. PATIENTS AND METHODS A retrospective cohort study was performed using the nationwide de-identified electronic health record-derived Flatiron Health database. Event-free survival (EFS) and overall survival (OS) was evaluated for patients with R/R DLBCL who were ineligible for and/or failed autologous stem cell transplantation in the second line and received bendamustine, gemcitabine, or lenalidomide. RESULTS Three hundred eighty-three patients were included. Therapy received was bendamustine in 158 patients, gemcitabine in 142 patients, and lenalidomide in 83 patients. The median EFS and OS for all patients was 4.1 months and 8.7 months, respectively. Compared with patients receiving bendamustine or gemcitabine, those receiving lenalidomide demonstrated significantly longer median EFS (6.8 vs. 3.8 months; P = .006) and median OS (15.4 vs. 7.7 months; P = .045). Survival outcomes were also improved for lenalidomide-treated patients specifically in the second- as well as third- or fourth-line settings. CONCLUSION Use of lenalidomide resulted in prolonged EFS and OS as compared with bendamustine or gemcitabine in this cohort of patients with R/R DLBCL receiving palliative therapy. This first large-scale analysis of real-world outcomes for this patient population may guide current clinical management as well as serve as a benchmark for survival outcomes in the standard-of-care setting, which may aid in the design of future clinical trials.
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Affiliation(s)
- Emily C Ayers
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA.
| | - David Margolis
- Department of Biostatistics, Epidemiology and Informatics, Perlman School of Medicine, Philadelphia, PA
| | - Daniel J Landsburg
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA
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Frey NV, Gill S, Hexner EO, Schuster S, Nasta S, Loren A, Svoboda J, Stadtmauer E, Landsburg DJ, Mato A, Levine BL, Lacey SF, Melenhorst JJ, Veloso E, Gaymon A, Pequignot E, Shan X, Hwang WT, June CH, Porter DL. Long-Term Outcomes From a Randomized Dose Optimization Study of Chimeric Antigen Receptor Modified T Cells in Relapsed Chronic Lymphocytic Leukemia. J Clin Oncol 2020; 38:2862-2871. [PMID: 32298202 DOI: 10.1200/jco.19.03237] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [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] Open
Abstract
PURPOSE To describe long-term outcomes of anti-CD19 chimeric antigen receptor T (CART) cells in patients with relapsed or refractory chronic lymphocytic leukemia (CLL). METHODS Between January 2013 and June 2016, 42 patients with relapsed or refractory CLL were enrolled in this study and 38 were infused with anti-CD19 CART cells (CART-19). Of these, 28 patients were initially randomly assigned to receive a low (5 × 107) or high (5 × 108) dose of CART-19, and 24 were evaluable for response assessment. After an interim analysis, 10 additional patients received the selected (high) dose and of these, eight were evaluable for response. Patients were followed for a median 31.5 months (range, 2 to 75 months). RESULTS At 4 weeks, the complete and overall responses for the 32 evaluable patients were 28% (90% CI, 16% to 44%) and 44% (90% CI, 29% to 60%), respectively. The median overall survival (OS) for all patients was 64 months; there was no statistically significant difference between low- and high-dose groups (P = .84). Regardless of dose, prolonged survival was observed in patients who achieved a CR versus those who did not (P = .035), with median OS not reached in patients with CR versus 64 months in those without CR. The median progression-free survival was 40.2 months in patients with CR and 1 month in those without a CR (P < .0001). Toxicity was comparable in both dose groups. CONCLUSION In patients with advanced CLL, a 5 × 108 dose of CART-19 may be more effective than 5 × 107 CART-19 at inducing CR without excessive toxicity. Attainment of a CR after CART-19 infusion, regardless of cell dose, is associated with longer OS and progression-free survival in patients with relapsed CLL.
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Affiliation(s)
- Noelle V Frey
- Cell Therapy and Transplant Program, Division of Hematology-Oncology, Department of Medicine, Philadelphia, PA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Saar Gill
- Cell Therapy and Transplant Program, Division of Hematology-Oncology, Department of Medicine, Philadelphia, PA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.,Center for Cellular Immunotherapies, Department of Pathology and Laboratory Medicine, Philadelphia, PA
| | - Elizabeth O Hexner
- Cell Therapy and Transplant Program, Division of Hematology-Oncology, Department of Medicine, Philadelphia, PA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Stephen Schuster
- Cell Therapy and Transplant Program, Division of Hematology-Oncology, Department of Medicine, Philadelphia, PA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Sunita Nasta
- Cell Therapy and Transplant Program, Division of Hematology-Oncology, Department of Medicine, Philadelphia, PA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Alison Loren
- Cell Therapy and Transplant Program, Division of Hematology-Oncology, Department of Medicine, Philadelphia, PA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Jakub Svoboda
- Cell Therapy and Transplant Program, Division of Hematology-Oncology, Department of Medicine, Philadelphia, PA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Edward Stadtmauer
- Cell Therapy and Transplant Program, Division of Hematology-Oncology, Department of Medicine, Philadelphia, PA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Daniel J Landsburg
- Cell Therapy and Transplant Program, Division of Hematology-Oncology, Department of Medicine, Philadelphia, PA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Anthony Mato
- Cell Therapy and Transplant Program, Division of Hematology-Oncology, Department of Medicine, Philadelphia, PA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Bruce L Levine
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.,Center for Cellular Immunotherapies, Department of Pathology and Laboratory Medicine, Philadelphia, PA
| | - Simon F Lacey
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.,Center for Cellular Immunotherapies, Department of Pathology and Laboratory Medicine, Philadelphia, PA
| | - Jan Joseph Melenhorst
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.,Center for Cellular Immunotherapies, Department of Pathology and Laboratory Medicine, Philadelphia, PA
| | - Elizabeth Veloso
- Center for Cellular Immunotherapies, Department of Pathology and Laboratory Medicine, Philadelphia, PA
| | - Avery Gaymon
- Center for Cellular Immunotherapies, Department of Pathology and Laboratory Medicine, Philadelphia, PA
| | - Edward Pequignot
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.,Center for Cellular Immunotherapies, Department of Pathology and Laboratory Medicine, Philadelphia, PA
| | - Xinhe Shan
- Cell Therapy and Transplant Program, Division of Hematology-Oncology, Department of Medicine, Philadelphia, PA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Wei-Ting Hwang
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.,Center for Cellular Immunotherapies, Department of Pathology and Laboratory Medicine, Philadelphia, PA
| | - Carl H June
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.,Center for Cellular Immunotherapies, Department of Pathology and Laboratory Medicine, Philadelphia, PA
| | - David L Porter
- Cell Therapy and Transplant Program, Division of Hematology-Oncology, Department of Medicine, Philadelphia, PA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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Affiliation(s)
- Zachary A K Frosch
- Division of Hematology/Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Daniel J Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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Qian L, Soderquist C, Schrank‐Hacker A, Strauser H, Dupoux V, Tang CN, Smith JR, Sun A, Majumdar S, Nguyen T, Widura S, Landsburg DJ, Schuster SJ, Baxter RHG, Bogusz AM. Deletion 20q12 is associated with histological transformation of nodal marginal zone lymphoma to diffuse large B-cell lymphoma. Am J Hematol 2020; 95:238-244. [PMID: 31804739 DOI: 10.1002/ajh.25694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/26/2019] [Accepted: 11/29/2019] [Indexed: 11/06/2022]
Abstract
The genetic and molecular abnormalities underlying histological transformation (HT) of nodal marginal zone lymphoma (NMZL) to diffuse large B-cell lymphoma (DLBCL) are not well known. While del(20q12) is commonly deleted in myelodysplastic syndrome it has not previously been associated with DLBCL. We recently described a case of DLBCL harboring del(20q12) in a patient with a history of MZL involving lymph nodes and skin. Here we report eight matched cases of transformed MZL(tMZL): six from nodal MZL (tNMZL) and two from splenic MZL (tSMZL). We found >20% del(20q12) in 4/6 tNMZL, but not in tSMZL, nor in unmatched DLBCL, MZL with increased large cells (MZL-ILC), or MZL cases. To examine whether transformation is associated with a specific gene signature, the matched cases were analyzed for multiplexed gene expression using the Nanostring PanCancer Pathways panel. The differential gene expression signature revealed enrichment of inflammatory markers, as previously observed in MZL. Also, tMZL and de novo DLBCL were enriched for extracellular matrix proteins such as collagen and fibronectin, vascular development protein PDGFRβ, DNA repair protein RAD51, and oncogenic secrete protein Wnt11. A subset of genes is expressed differentially in del(20q12) tMZL cases vs non-del(20q12) tMZL cases. These results suggest a specific pathway is involved in the histological transformation of NMZL, which could serve as an indicator of aggressive clinical course in this otherwise indolent neoplasm.
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Affiliation(s)
- Lei Qian
- Department of Medical Genetics & Molecular Biochemistry, Lewis Katz School of MedicineTemple University Philadelphia Pennsylvania
| | - Craig Soderquist
- Department of Pathology and Cell BiologyColumbia University Medical Center New York Pennsylvania
| | - April Schrank‐Hacker
- Department of Pathology and Laboratory MedicineHospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Honore Strauser
- Department of Pathology and Laboratory MedicineHospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Vanessa Dupoux
- Department of Pathology and Laboratory MedicineHospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Chi Ngong Tang
- Department of Pathology and Laboratory MedicineHospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Jennifer R. Smith
- Department of Pathology and Laboratory MedicineHospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Ang Sun
- Department of BiologyTemple University Philadelphia Pennsylvania
| | - Sonali Majumdar
- Wistar Genomics Shared ResourceThe Wistar Institute Philadelphia Pennsylvania
| | - Tran Nguyen
- Wistar Genomics Shared ResourceThe Wistar Institute Philadelphia Pennsylvania
| | - Sandy Widura
- Wistar Genomics Shared ResourceThe Wistar Institute Philadelphia Pennsylvania
| | - Daniel J. Landsburg
- Department of Medicine, Perelman School of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania
- Lymphoma Program, Abramson Cancer CenterUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Stephen J. Schuster
- Department of Medicine, Perelman School of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania
- Lymphoma Program, Abramson Cancer CenterUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Richard H. G. Baxter
- Department of Medical Genetics & Molecular Biochemistry, Lewis Katz School of MedicineTemple University Philadelphia Pennsylvania
| | - Agata M. Bogusz
- Department of Pathology and Laboratory MedicineHospital of the University of Pennsylvania Philadelphia Pennsylvania
- Lymphoma Program, Abramson Cancer CenterUniversity of Pennsylvania Philadelphia Pennsylvania
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Rhodes JM, LoRe VA, Mato AR, Chong EA, Barrientos JC, Gerson JN, Barta SK, Landsburg DJ, Nasta SD, Svoboda J, Loren AW, Schuster SJ. Ibrutinib-associated Arthralgias/Myalgias in Patients With Chronic Lymphocytic Leukemia: Incidence and Impact on Clinical Outcomes. Clin Lymphoma Myeloma Leuk 2020; 20:438-444.e1. [PMID: 32197990 DOI: 10.1016/j.clml.2020.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 01/26/2023]
Abstract
INTRODUCTION The Bruton's tyrosine kinase (BTK) inhibitor ibrutinib has transformed the treatment of chronic lymphocytic leukemia (CLL), leading to unprecedented improvements in progression-free and overall survival for all patients, including those with poor prognostic features. The side effect profile of ibrutinib is unique compared with chemoimmunotherapy and includes atrial fibrillation, increased bleeding risk, and arthralgias/myalgias. Although common, arthralgias/myalgias and their management are poorly described. PATIENTS AND METHODS We identified 214 patients with CLL treated with ibrutinib (as a single agent or in combination) from 2011 to 2018 at the University of Pennsylvania. RESULTS In this cohort, 36% (76/214) of patients developed arthralgias/myalgias during follow-up with a median onset of 34.5 months. Most (79%) events were grade 1 or 2. Risk factors for developing arthralgias/myalgias included younger age at start of ibrutinib, female gender, and ibrutinib use as first treatment. Twenty-eight percent of patients with grade 1 or 2 toxicity continued ibrutinib and had resolution of symptoms. Dose holds were frequently used to manage this toxicity, and this strategy was more successful than dose reduction. Sixty-two percent of patients with grade 3 toxicity ultimately discontinued ibrutinib. Supportive care measures such as discontinuing statins or use of non-steroidal anti-inflammatory drugs, acetaminophen, or corticosteroids were not used frequently enough in this cohort to evaluate their efficacy. CONCLUSIONS Additional studies to determine the mechanism of ibrutinib-related arthralgias/myalgias are needed to develop optimal management strategies.
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Affiliation(s)
- Joanna M Rhodes
- Division of Hematology/Oncology, Northwell Health Cancer Institute, New Hyde Park, NY; Division of Hematology/Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.
| | - Vincent A LoRe
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Anthony R Mato
- Chronic Lymphocytic Leukemia Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elise A Chong
- Division of Hematology/Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | | | - James N Gerson
- Division of Hematology/Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Stefan K Barta
- Division of Hematology/Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Daniel J Landsburg
- Division of Hematology/Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Sunita Dwivedy Nasta
- Division of Hematology/Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Jakub Svoboda
- Division of Hematology/Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Alison W Loren
- Division of Hematology/Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Stephen J Schuster
- Division of Hematology/Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
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Namoglu EC, Hughes ME, Plastaras JP, Landsburg DJ, Maity A, Nasta SD. Management and outcomes of sinus histiocytosis with massive lymphadenopathy (Rosai Dorfman Disease). Leuk Lymphoma 2019; 61:905-911. [PMID: 31876204 DOI: 10.1080/10428194.2019.1703971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/08/2023]
Abstract
Sinus histiocytosis with massive lymphadenopathy (Rosai Dorfman Disease [RDD]), is a rare, benign but clinically heterogeneous histiocytic disorder. Our aims were to analyze the clinical characteristics of the disease and explore the outcomes of patients with RDD followed at our institution. Between January 2000 and February 2019, there were 15 patients with a pathologically confirmed diagnosis of RDD. Median age at diagnosis was 48 years old (range 26-78). The majority (87%, n = 13) of the patients had extranodal disease. Frontline approaches included surgical intervention/complete excision (n = 5, 33%), rituximab monotherapy (n = 5, 33%), observation (n = 3, 20%), and radiation (n = 2, 13%). Two of the five patients underwent surgical excision and were subsequently treated with rituximab. Of the 7 patients who were given rituximab, 64% remained progression free 24 months after the initial rituximab administration. Our review parallels previous reports and highlights rituximab as a favorable option for therapy if ineligible for surgery or radiation.
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Affiliation(s)
- Esin C Namoglu
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mitchell E Hughes
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - John P Plastaras
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Landsburg
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Amit Maity
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Sunita D Nasta
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, PA, USA
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36
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Landsburg DJ, Ayers EC, Bond DA, Maddocks KJ, Karmali R, Behdad A, Curry M, Wagner‐Johnston ND, Modi D, Ramchandren R, Assouline SE, Faramand R, Chavez JC, Torka P, Mier Hicks A, Medeiros LJ, Li S. Poor outcomes for double‐hit lymphoma patients treated with curative‐intent second‐line immunochemotherapy following failure of intensive front‐line immunochemotherapy. Br J Haematol 2019; 189:313-317. [DOI: 10.1111/bjh.16319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 09/25/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center Buffalo NY USA
| | | | | | - Shaoying Li
- The University of Texas MD Anderson Cancer Center Houston TX USA
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37
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Ayers EC, Li S, Medeiros LJ, Bond DA, Maddocks KJ, Torka P, Mier Hicks A, Curry M, Wagner-Johnston ND, Karmali R, Behdad A, Fakhri B, Kahl BS, Churnetski MC, Cohen JB, Reddy NM, Modi D, Ramchandren R, Howlett C, Leslie LA, Cytryn S, Diefenbach CS, Faramand R, Chavez JC, Olszewski AJ, Liu Y, Barta SK, Mukhija D, Hill BT, Ma H, Amengual JE, Nathan S, Assouline SE, Orellana-Noia VM, Portell CA, Chandar A, David KA, Giri A, Hess BT, Landsburg DJ. Outcomes in patients with aggressive B-cell non-Hodgkin lymphoma after intensive frontline treatment failure. Cancer 2019; 126:293-303. [PMID: 31568564 DOI: 10.1002/cncr.32526] [Citation(s) in RCA: 14] [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: 03/07/2019] [Revised: 06/19/2019] [Accepted: 07/12/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Salvage immunochemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation is the standard-of-care second-line treatment for patients with relapsed/refractory diffuse large B-cell lymphoma after first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Outcomes after receipt of second-line immunochemotherapy in patients with aggressive B-cell lymphomas who relapse or are refractory to intensive first-line immunochemotherapy regimens (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab [R-EPOCH], rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and cytarabine [R-HyperCVAD], rituximab, cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate alternating with ifosfamide, etoposide, and cytarabine [R-CODOX-M/IVAC]) remain unknown. METHODS Outcomes of patients with non-Burkitt, aggressive B-cell lymphomas and relapsed/refractory disease after first-line treatment with intensive immunochemotherapy regimens who received platinum-based second-line immunochemotherapy were reviewed retrospectively. Analyses were performed to determine progression-free survival (PFS) and overall survival (OS) from the time of receipt of second-line immunochemotherapy. RESULTS In total, 195 patients from 19 academic centers were included in the study. The overall response rate to second-line immunochemotherapy was 44%, with a median PFS of 3 months and a median OS of 8 months. Patients with early treatment failure (primary refractory or relapse <12 months from completion of first-line therapy) experienced inferior median PFS (2.8 vs 23 months; P < .001) and OS (6 months vs not reached; P < .001) compared with patients with late treatment failure. Although the 17% of patients with early failure who achieved a complete response to second-line immunochemotherapy experienced prolonged survival, this outcome could not be predicted by clinicopathologic features at the start of second-line immunochemotherapy. CONCLUSIONS Patients with early treatment failure after intensive first-line immunochemotherapy experience poor outcomes after receiving standard second-line immunochemotherapy. The use of standard-of-care or experimental therapies currently available in the third-line setting and beyond should be investigated in the second-line setting for these patients.
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Affiliation(s)
- Emily C Ayers
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shaoying Li
- Department of Hematopathology, The University of Texas MD Anderson Cancer, Houston, Texas
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer, Houston, Texas
| | - David A Bond
- Department of Internal Medicine, The Ohio State University Cancer Center, Columbus, Ohio
| | - Kami J Maddocks
- Department of Hematology, The Ohio State University Cancer Center, Columbus, Ohio
| | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Madeira Curry
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | | | - Reem Karmali
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg.,School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Amir Behdad
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bita Fakhri
- Washington University School of Medicine, St. Louis, Missouri
| | - Brad S Kahl
- Washington University School of Medicine, St. Louis, Missouri
| | - Michael C Churnetski
- Department of Hematology, Winship Cancer Institute, Emory University, Atlanta, Georgia.,Department of Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jonathon B Cohen
- Department of Hematology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Nishitha M Reddy
- Department of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dipenkumar Modi
- Karmanos Cancer Institute/Wayne State University, Detroit, Michigan
| | | | - Christina Howlett
- Deparrment of Pharmacy and Clinical Services, John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, New Jersey
| | - Lori A Leslie
- John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, New Jersey
| | - Samuel Cytryn
- New York University Perlmutter Cancer Center, New York, New York
| | | | - Rawan Faramand
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Julio C Chavez
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Adam J Olszewski
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island
| | - Yang Liu
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Stefan K Barta
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.,Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - Brian T Hill
- Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Helen Ma
- Center for Lymphoid Malignancies, Department of Medicine, and Department of Pathology and Cell Biology, Columbia University Medical Center , New York
| | - Jennifer E Amengual
- Division of Hematology and Oncology, Department of Medicine, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York
| | | | - Sarit E Assouline
- Medicine and Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Craig A Portell
- Hematology and Oncology, University of Virginia, Charlottesville, Virginia
| | - Ashwin Chandar
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | | | - Anshu Giri
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Brian T Hess
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel J Landsburg
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
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Hughes ME, Landsburg DJ, Rubin DJ, Schuster SJ, Svoboda J, Gerson JN, Namoglu E, Nasta SD. Treatment of Patients With Relapsed/Refractory Non-Hodgkin Lymphoma With Venetoclax: A Single-Center Evaluation of Off-Label Use. Clin Lymphoma Myeloma Leuk 2019; 19:791-798. [PMID: 31648953 DOI: 10.1016/j.clml.2019.09.612] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/03/2019] [Accepted: 09/21/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Venetoclax is a highly effective agent in chronic lymphocytic leukemia and acute myeloid leukemia. Phase I/II clinical trials have shown it to be safe and effective in non-Hodgkin lymphoma (NHL). Adverse events were consistent with package labeling despite escalation to high doses. To the best of our knowledge, venetoclax use outside the setting of a clinical trial of NHL has not been reported. PATIENTS AND METHODS We conducted a single-center, retrospective study of 34 adult patients who had been treated off-label with venetoclax-containing regimens from 2016 to 2018. RESULTS Of the 34 patients with NHL treated with venetoclax therapy, 13 had had high-grade B-cell lymphoma/diffuse large B-cell lymphoma, 10 mantle cell lymphoma, 5 transformed follicular lymphoma, 2 Richter transformation, 2 marginal zone lymphoma, 1 follicular lymphoma, and 1 post-transplant lymphoproliferative disorder. The patients had received a median of 4 previous therapies. The overall response rate was 26% (3% with a complete response and 35% with stable disease). The median venetoclax dose achieved was 400 mg. Of those receiving combination therapy, 18% had undergone radiation and 62% had received other systemic antineoplastic therapy. The median progression-free and overall survival for the cohort was 2 and 4.5 months, respectively. Adverse events occurred in 76% of the patients during venetoclax therapy. The adverse events included neutropenia, thrombocytopenia, tumor lysis syndrome, infection, neutropenic fever, diarrhea, and 1 opportunistic infection. CONCLUSION Venetoclax therapy in a real-world cohort offered modest benefits in heavily pretreated patients. Adverse events were observed at a greater incidence than in the clinical trials. A wide heterogeneity of venetoclax dose escalation, multiagent combinations, and timing of initiation were identified and require investigation in subsequent clinical trials.
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Affiliation(s)
- Mitchell E Hughes
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
| | - Daniel J Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Daniel J Rubin
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Jakub Svoboda
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - James N Gerson
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Esin Namoglu
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Sunita D Nasta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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39
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Behdad A, Boddy CS, Fought AJ, Taxter T, Falkiewicz MK, Ayers E, Chen QC, Chen YH, Karmali R, Pro B, Winter JN, Landsburg DJ, Gordon LI, Kaplan JB. Survival outcomes of diffuse large B-cell lymphoma by association with concurrent or antecedent follicular lymphoma and double hit status. Leuk Lymphoma 2019; 60:3266-3271. [PMID: 31225766 DOI: 10.1080/10428194.2019.1622099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) transformed from follicular lymphoma (FL) (tDLBCL) has been traditionally associated with an aggressive course, but more recent studies have shown longer survivals. The clinical significance of concurrent FL at the time of diagnosis of DLBCL (cDLBCL/FL) is less clear. We compared outcomes of tDLBCL, cDLBCL/FL, and de novo DLBCL (dDLBCL) and then evaluated the impact of double hit (DH) rearrangements (MYC with BCL2 and/or BCL6) in these subgroups' outcomes. The progression free survival (PFS) and overall survival (OS) were not significantly different among the three groups (dDLBCL, tDLBCL, and cDLBCL/FL). The effect of DH on survival was then analyzed in two subgroups: (1) dDLBCL and (2) tDLBCL + cDLBCL/FL. PFS and OS were significantly shorter in lymphomas with DH in each of these two subgroups. We conclude that DH status drives outcomes in all DLBCLs, regardless of their transformation status.
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Affiliation(s)
- Amir Behdad
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Craig S Boddy
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Angela J Fought
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Timothy Taxter
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marissa K Falkiewicz
- Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Ayers
- Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Qing C Chen
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yi-Hua Chen
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Reem Karmali
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Barbara Pro
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Jane N Winter
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Daniel J Landsburg
- Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Leo I Gordon
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Jason B Kaplan
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
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Lazarow H, Nicolo M, Compher C, Kucharczuk CR, Stadtmauer EA, Landsburg DJ. Nutrition-Related Outcomes for Autologous Stem Cell Transplantation Patients. Clin Lymphoma Myeloma Leuk 2019; 19:e393-e398. [PMID: 31053549 DOI: 10.1016/j.clml.2019.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/21/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Autologous stem cell transplantation (ASCT) patients are at risk for malnutrition before transplantation admission as well as malnutrition acquired during their transplantation admission. PATIENTS AND METHODS In this retrospective, observational study we examined data related to consecutive adults (n = 330) admitted for ASCT between 2014 and 2016 at the Hospital of the University of Pennsylvania. Malnutrition risk on admission (identified by the Malnutrition Screening Tool) and transplantation-associated weight loss were analyzed for independent associations with hospital length of stay, nosocomial infection, intensive care unit transfer, deconditioning, time to platelet and neutrophil engraftment, 30-day readmission, and 1-year mortality. RESULTS Adults with high malnutrition risk (n = 60) had a longer median hospital stay (P = .004), longer median time to platelet engraftment (P = .022), increased nosocomial infections (P = .047), and increased 1-year mortality (P = .036). Adults with high transplantation-associated weight loss (n = 100) experienced longer hospital stays (P < .001) and more intensive care unit transfers (P = .001). Outcomes for deconditioning, time to neutrophil engraftment, and 30-day readmission did not differ significantly on the basis of nutrition risk or weight loss. CONCLUSION Further research is needed to determine whether early nutrition intervention would improve these outcomes.
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Affiliation(s)
- Heather Lazarow
- Hospital of the University of Pennsylvania, Philadelphia, PA.
| | | | | | | | - Edward A Stadtmauer
- Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Daniel J Landsburg
- Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, PA
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Gerson JN, Handorf E, Villa D, Gerrie AS, Chapani P, Li S, Medeiros LJ, Wang MI, Cohen JB, Calzada O, Churnetski MC, Hill BT, Sawalha Y, Hernandez-Ilizaliturri FJ, Kothari S, Vose JM, Bast MA, Fenske TS, Narayana Rao Gari S, Maddocks KJ, Bond D, Bachanova V, Kolla B, Chavez J, Shah B, Lansigan F, Burns TF, Donovan AM, Wagner-Johnston N, Messmer M, Mehta A, Anderson JK, Reddy N, Kovach AE, Landsburg DJ, Glenn M, Inwards DJ, Karmali R, Kaplan JB, Caimi PF, Rajguru S, Evens A, Klein A, Umyarova E, Pulluri B, Amengual JE, Lue JK, Diefenbach C, Fisher RI, Barta SK. Survival Outcomes of Younger Patients With Mantle Cell Lymphoma Treated in the Rituximab Era. J Clin Oncol 2019; 37:471-480. [PMID: 30615550 DOI: 10.1200/jco.18.00690] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Mantle cell lymphoma (MCL) is a B-cell lymphoma characterized by cyclin D1 expression. Autologous hematopoietic cell transplantation (AHCT) consolidation after induction chemotherapy is often used for eligible patients; however, the benefit remains uncertain in the rituximab era. Herein we retrospectively assessed the impact of AHCT consolidation on survival in a large cohort of transplantation-eligible patients age 65 years or younger. PATIENTS AND METHODS We retrospectively studied transplantation-eligible adults age 65 years or younger with newly diagnosed MCL treated between 2000 and 2015. The primary objective was to assess for improved progression-free survival (PFS) with AHCT consolidation and secondarily to assess for improved overall survival (OS). Cox multivariable regression analysis and propensity score-weighted (PSW) analysis were performed. RESULTS Data were collected from 25 medical centers for 1,254 patients; 1,029 met inclusion criteria. Median follow-up for the cohort was 76 months. Median PFS and OS were 62 and 139 months, respectively. On unadjusted analysis, AHCT was associated with improved PFS (75 v 44 months with v without AHCT, respectively; P < .01) and OS (147 v 115 months with v without AHCT, respectively; P < .05). On multivariable regression analysis, AHCT was associated with improved PFS (hazard ratio [HR], 0.54; 95% CI, 0.44 to 0.66; P < .01) and a trend toward improved OS (HR, 0.77; 95% CI, 0.59 to 1.01; P = .06). After PSW analysis, AHCT remained associated with improved PFS (HR, 0.70; 95% CI, 0.59 to 0.84; P < .05) but not improved OS (HR, 0.87; 95% CI, 0.69 to 1.1; P = .2). CONCLUSION In this large cohort of younger, transplantation-eligible patients with MCL, AHCT consolidation after induction was associated with significantly improved PFS but not OS after PSW analysis. Within the limitations of a retrospective analysis, our findings suggest that in younger, fit patients, AHCT consolidation may improve PFS.
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Affiliation(s)
| | | | - Diego Villa
- 2 BC Cancer, Vancouver, British Columbia, Canada
| | | | - Parv Chapani
- 2 BC Cancer, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Julie M Vose
- 7 University of Nebraska Cancer Center, Omaha, NE
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Martha Glenn
- 17 Huntsman Cancer Institute, Salt Lake City, UT
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Bair SM, Strelec LE, Feldman TA, Ahmed G, Armand P, Shah NN, Singavi AN, Reddy N, Khan N, Andreadis C, Vu K, Huntington SF, Giri S, Ujjani C, Howlett C, Faheem M, Youngman MR, Nasta SD, Landsburg DJ, Schuster SJ, Svoboda J. Outcomes and Toxicities of Programmed Death-1 (PD-1) Inhibitors in Hodgkin Lymphoma Patients in the United States: A Real-World, Multicenter Retrospective Analysis. Oncologist 2018; 24:955-962. [PMID: 30568021 DOI: 10.1634/theoncologist.2018-0538] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/07/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Although classical Hodgkin lymphoma (cHL) is highly curable, 20%-30% of patients will not be cured with conventional treatments. The programmed death-1 (PD-1) inhibitors (PD-1i) nivolumab and pembrolizumab have been Food and Drug Administration-approved for relapsed/refractory (R/R) cHL. There is limited data on the real-world experience with PD-1i in cHL and it is unknown whether fewer selected patients treated with PD-1i derive benefits similar to those observed in published trials. MATERIALS AND METHODS We performed a multicenter, retrospective analysis of R/R cHL patients treated with PD-1i in the nontrial setting. The primary objective was to describe progression-free survival (PFS) and overall survival (OS) in this population. Secondary objectives were to characterize response rates, toxicities, discontinuation patterns, and post-PD-1i therapies. RESULTS The study included 53 patients from nine U.S. centers. Overall response rate (ORR), complete response (CR), and partial response (PR) to PD-1i were 68%, 45%, and 23%, respectively. Twelve-month OS and PFS were 89% and 75%, respectively; median PFS was 29 months. Ninety-six percent of patients with CR continue to respond at a median follow-up of 20 months. Toxicities were similar to those previously described. Seventy percent of patients treated with systemic therapy after PD-1i demonstrated objective responses. CONCLUSION To our knowledge, this analysis is the first describing real-world experience with PD-1i in cHL patients in the U.S. Here, we demonstrate similar response rates compared to prior studies. The toxicity profile of PD-1i was similar to that seen in previous studies; we further describe toxicity patterns in those with prior autoimmune disease or allogeneic transplant. Post-PD-1i systemic therapies appear active. These results support the effectiveness and tolerability of PD-1i therapy in R/R cHL in a real-world setting. IMPLICATIONS FOR PRACTICE Two PD-1 inhibitors have recently been approved for patients with relapsed/refractory classical Hodgkin lymphoma based on results from nonrandomized clinical trials. However, to date, there have been no studies evaluating the effectiveness and toxicity profile of these drugs in the real-world setting in the U.S. The present study demonstrates that patients treated in a real-world context experience similar rates of overall effectiveness compared with published clinical trials. Patients who discontinue PD-1 inhibitors may experience clinical responses to subsequent treatment with systemic chemotherapy or targeted therapy. This study provides clinicians with further insight into the effectiveness and tolerability of PD-1 inhibitors and suggests that when patients progress while on these drugs, conventional systemic chemotherapy may be an effective treatment option.
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Affiliation(s)
- Steven M Bair
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lauren E Strelec
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Gulrayz Ahmed
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Nirav N Shah
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Nadia Khan
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | | | - Khoan Vu
- University of California, San Francisco, San Francisco, California, USA
| | | | - Smith Giri
- Yale University, New Haven, Connecticut, USA
| | | | - Christina Howlett
- Hackensack Medical Center, Hackensack, New Jersey, USA
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Malik Faheem
- Hackensack Medical Center, Hackensack, New Jersey, USA
| | - Matthew R Youngman
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sunita D Nasta
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel J Landsburg
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen J Schuster
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jakub Svoboda
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Landsburg DJ, Kahl BS. Can We Exploit the Molecular Heterogeneity of Aggressive B Cell Lymphomas Into Effective New Therapies? Clin Lymphoma Myeloma Leuk 2018; 19:65-67. [PMID: 30555036 DOI: 10.1016/j.clml.2018.11.017] [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] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/18/2018] [Indexed: 10/27/2022]
Affiliation(s)
| | - Brad S Kahl
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
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45
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Cherng HJJ, Sargent RL, Nasta SD, Svoboda J, Schuster SJ, Mato AR, Schrank-Hacker A, Morrissette JJD, Landsburg DJ. Interim PET/CT Result Is Not Predictive of Survival in Patients With MYC-rearranged Non-Burkitt Aggressive B-cell Lymphoma. Clin Lymphoma Myeloma Leuk 2018; 18:673-678. [PMID: 30033208 DOI: 10.1016/j.clml.2018.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/03/2018] [Accepted: 06/11/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with a diagnosis of MYC-rearranged non-Burkitt aggressive B-cell lymphoma (MYC-R), including those with double hit lymphoma, are at high risk of developing relapsed/refractory disease, even if treated with intensive front-line immunochemotherapy. It is common in clinical practice and clinical trials to perform an interim positron emission tomography (PET)/computed tomography (CT) scan (iPET) during front-line therapy for diffuse large B-cell lymphoma. However, the utility of the iPET result for MYC-R patients for predicting outcomes is unclear. PATIENTS AND METHODS We performed a single-center retrospective study with centralized pathologic review and PET/CT image acquisition and interpretation for 28 MYC-R patients. The patients received front-line therapy with R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin [doxorubicin], Oncovin [vincristine], prednisone) or intensive immunochemotherapy. RESULTS Eight patients had iPET-positive (iPET+) and 20 patients had iPET-negative (iPET-) results using the Deauville visual assessment criteria. At a median follow-up length of 30.4 months, progression-free survival was 65% and overall survival was 76%, neither of which differed significantly between the iPET- and iPET+ patients. The positive predictive value of iPET for progression at 30 months was 25%, and the negative predictive value was 65%. CONCLUSION Although patients with MYC-R lymphoma have been reported to be at high risk of primary treatment failure, this was not predicted by iPET+ results. Thus, the iPET result should not be used to guide changes in front-line or consolidative therapy for these patients.
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Affiliation(s)
- Hua-Jay J Cherng
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
| | - Rachel Lynn Sargent
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sunita Dwivedy Nasta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Jakub Svoboda
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Anthony R Mato
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - April Schrank-Hacker
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Daniel J Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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Alonso C, Dutta SW, Mitra N, Landsburg DJ, Zaorsky NG, Grover S, Peterson J, Trifiletti DM. Adult nodular lymphocyte-predominant Hodgkin lymphoma: treatment modality utilization and survival. Cancer Med 2018; 7:1118-1126. [PMID: 29479868 PMCID: PMC5911587 DOI: 10.1002/cam4.1383] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 01/10/2023] Open
Abstract
Early-stage nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is associated with a favorable prognosis. Our aim was to evaluate the patterns of care of radiotherapy utilization in this disease and to define the relationship between treatment modality and survival. The National Cancer Database was queried for patients with stages I-II NLPHL diagnosed from 2004 to 2012. Patients were compared based on primary therapy into four categories: radiotherapy, chemotherapy, both, or neither. Covariate-adjusted and propensity score-weighted (PS) Cox proportional hazards models were used, adjusting for potential factors confounding survival. After exclusions, 1420 patients were evaluated, 571 (40%) received radiotherapy alone, 318 (22%) received chemotherapy alone, 351 (25%) received both, and 180 (13%) received neither. Younger patient age (P = 0.001), female gender (P = 0.019), and chemotherapy use (P < 0.001) were associated with decreased radiotherapy utilization. On PS, radiation alone (HR = 0.298, P < 0.001) and chemoradiotherapy (HR = 0.258, P < 0.001) were associated with improved survival compared to no upfront therapy, but the use of chemotherapy alone did not statistically differ compared to no initial therapy (HR = 0.784, P = 0.078). In this large database analysis, over one-third of patients with early-stage NLPHL did not receive radiotherapy as a component of initial therapy. The omission of upfront radiotherapy was associated with inferior survival.
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Affiliation(s)
- Clayton Alonso
- Department of Radiation OncologyUniversity of VirginiaCharlottesvilleVirginia
| | - Sunil W. Dutta
- Department of Radiation OncologyUniversity of VirginiaCharlottesvilleVirginia
| | - Nandita Mitra
- Department of BiostatisticsUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Daniel J. Landsburg
- Division of Hematology/OncologyDepartment of MedicineHospital of the University of PennsylvaniaPhiladelphiaPennsylvania
| | - Nicholas G. Zaorsky
- Department of Radiation OncologyPennsylvania State UniversityState ParkPennsylvania
| | - Surbhi Grover
- Department of Radiation OncologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvania
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Nagle SJ, Shah NN, Ganetsky A, Landsburg DJ, Nasta SD, Mato A, Schuster SJ, Reshef R, Tsai DE, Svoboda J. Long-term outcomes of rituximab, temozolomide and high-dose methotrexate without consolidation therapy for lymphoma involving the CNS. Int J Hematol Oncol 2018; 6:113-121. [PMID: 30302232 PMCID: PMC6171986 DOI: 10.2217/ijh-2017-0020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 06/22/2017] [Accepted: 10/16/2017] [Indexed: 11/21/2022] Open
Abstract
Aim To describe the long-term outcomes of patients with lymphoma in the CNS treated with rituximab, temozolomide and high-dose methotrexate without consolidation therapy. Patients & methods A retrospective cohort study of 46 consecutive patients with primary CNS lymphoma (PCNSL, 27 patients) or secondary CNS involvement of diffuse large B-cell lymphoma (DLBCL, 19 patients) who were treated with rituximab on day 1 in combination with high-dose methotrexate (days 1 and 15) and temozolomide (days 1-5) in 28-day cycles without further consolidation. Results Median follow-up was 21.2 months. Patients received a median of five cycles (range 1-15). Median overall survival (OS) was 26 months and median progression-free survival was 8.6 months. At 3 years, 37% of patients were alive and without evidence of disease. The patients with PCNSL had a significantly higher response rates (ORR 81 vs 47%; p = 0.015) and longer median OS (55.3 vs 4.8 months; p < 0.01) than those with secondary CNS DLBCL. Toxicities were mild and manageable. Conclusion The rituximab, temozolomide and methotrexate regimen is an effective therapy for patients with PCNSL without the toxicities typically associated with consolidation therapy.
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Affiliation(s)
- Sarah J Nagle
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, 2 West Pavilion, Philadelphia, PA 19104, USA.,Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, 2 West Pavilion, Philadelphia, PA 19104, USA
| | - Nirav N Shah
- Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226, USA.,Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226, USA
| | - Alex Ganetsky
- Department of Pharmacy, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.,Department of Pharmacy, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Daniel J Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, 2 West Pavilion, Philadelphia, PA 19104, USA.,Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, 2 West Pavilion, Philadelphia, PA 19104, USA
| | - Sunita D Nasta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, 2 West Pavilion, Philadelphia, PA 19104, USA.,Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, 2 West Pavilion, Philadelphia, PA 19104, USA
| | - Anthony Mato
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, 2 West Pavilion, Philadelphia, PA 19104, USA.,Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, 2 West Pavilion, Philadelphia, PA 19104, USA
| | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, 2 West Pavilion, Philadelphia, PA 19104, USA.,Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, 2 West Pavilion, Philadelphia, PA 19104, USA
| | - Ran Reshef
- Division of Hematology/Oncology & the Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA.,Division of Hematology/Oncology & the Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA
| | - Donald E Tsai
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, 2 West Pavilion, Philadelphia, PA 19104, USA.,Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, 2 West Pavilion, Philadelphia, PA 19104, USA
| | - Jakub Svoboda
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, 2 West Pavilion, Philadelphia, PA 19104, USA.,Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, 2 West Pavilion, Philadelphia, PA 19104, USA
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Bair SM, Strelec L, Nagle SJ, Nasta SD, Landsburg DJ, Mato AR, Loren AW, Schuster SJ, Stadtmauer EA, Svoboda J. Outcomes of patients with relapsed/refractory Hodgkin lymphoma progressing after autologous stem cell transplant in the current era of novel therapeutics: A retrospective analysis. Am J Hematol 2017; 92:879-884. [PMID: 28512788 DOI: 10.1002/ajh.24792] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 04/20/2017] [Accepted: 05/09/2017] [Indexed: 12/20/2022]
Abstract
Patients with relapsed/refractory Hodgkin lymphoma (RR-HL) who progress or relapse following autologous stem cell transplantation (ASCT) have historically had a poor prognosis. Several novel agents, particularly brentuximab vedotin, have shown efficacy in this setting. However, there remains a paucity of data characterizing outcomes outside of clinical trials and how these novel agents have impacted prognosis in general population of patients with RR-HL. Here, we conducted a retrospective analysis to evaluate outcomes in 87 patients with RR-HL with relapse post-ASCT. Treatment with novel agents (including brentuximab vedotin) was associated with significant improvement in median overall survival (OS) compared to patients who did not receive novel agents (85.6 vs 17.1 months; P < .001). Additional factors associated with improved OS in univariate analysis include treatment with radiation therapy post-ASCT (34.1 vs 17.0 months; P = .015), chemosensitivity (i.e., relapsed compared to primary refractory disease; 51.8 vs 25.6 months; p = 0.013), initial response to ASCT (i.e., CR/PR compared to SD/PD; 46.1 vs 20.4 months; P = .011), and transplantation in 2010 and later compared to prior to 2010 (not reached vs 24.5 months; P = .025). The current study demonstrates markedly improved OS in RR-HL patients treated with novel therapeutics and lends "real world" credence to the role of these agents in improving outcomes in the current era.
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Affiliation(s)
- Steven M. Bair
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Lauren Strelec
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Sarah J. Nagle
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Sunita D. Nasta
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Daniel J. Landsburg
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Anthony R. Mato
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Alison W. Loren
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Stephen J. Schuster
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Edward A. Stadtmauer
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Jakub Svoboda
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
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Landsburg DJ, Falkiewicz MK, Maly J, Blum KA, Howlett C, Feldman T, Mato AR, Hill BT, Li S, Medeiros LJ, Torka P, Hernandez-Ilizaliturri F, Reddy NM, Singavi A, Fenske TS, Chavez JC, Kaplan JB, Behdad A, Petrich AM, Bast MA, Vose JM, Olszewski AJ, Costa C, Lansigan F, Gerson JN, Barta SK, Calzada O, Cohen JB, Lue JK, Amengual JE, Rivera X, Persky DO, Peace DJ, Nathan S, Cassaday RD. Outcomes of Patients With Double-Hit Lymphoma Who Achieve First Complete Remission. J Clin Oncol 2017; 35:2260-2267. [PMID: 28475457 DOI: 10.1200/jco.2017.72.2157] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose Patients with double-hit lymphoma (DHL) rarely achieve long-term survival following disease relapse. Some patients with DHL undergo consolidative autologous stem-cell transplantation (autoSCT) to reduce the risk of relapse, although the benefit of this treatment strategy is unclear. Methods Patients with DHL who achieved first complete remission following completion of front-line therapy with either rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or intensive front-line therapy, and deemed fit for autoSCT, were included. A landmark analysis was performed, with time zero defined as 3 months after completion of front-line therapy. Patients who experienced relapse before or who were not followed until that time were excluded. Results Relapse-free survival (RFS) and overall survival (OS) rates at 3 years were 80% and 87%, respectively, for all patients (n = 159). Three-year RFS and OS rates did not differ significantly for autoSCT (n = 62) versus non-autoSCT patients (n = 97), but 3-year RFS was inferior in patients who received R-CHOP compared with intensive therapy (56% v 88%; P = .002). Three-year RFS and OS did not differ significantly for patients in the R-CHOP or intensive therapy cohorts when analyzed by receipt of autoSCT. The median OS following relapse was 8.6 months. Conclusion In the largest reported series, to our knowledge, of patients with DHL to achieve first complete remission, consolidative autoSCT was not associated with improved 3-year RFS or OS. In addition, patients treated with R-CHOP experienced inferior 3-year RFS compared with those who received intensive front-line therapy. When considered in conjunction with reports of patients with newly diagnosed DHL, which demonstrate lower rates of disease response to R-CHOP compared with intensive front-line therapy, our findings further support the use of intensive front-line therapy for this patient population.
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Affiliation(s)
- Daniel J Landsburg
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Marissa K Falkiewicz
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Joseph Maly
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Kristie A Blum
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Christina Howlett
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Tatyana Feldman
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Anthony R Mato
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Brian T Hill
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Shaoying Li
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - L Jeffrey Medeiros
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Pallawi Torka
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Francisco Hernandez-Ilizaliturri
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Nishitha M Reddy
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Arun Singavi
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Timothy S Fenske
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Julio C Chavez
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Jason B Kaplan
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Amir Behdad
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Adam M Petrich
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Martin A Bast
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Julie M Vose
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Adam J Olszewski
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Cristiana Costa
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Frederick Lansigan
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - James N Gerson
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Stefan K Barta
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Oscar Calzada
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Jonathon B Cohen
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Jennifer K Lue
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Jennifer E Amengual
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Xavier Rivera
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Daniel O Persky
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - David J Peace
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Sunita Nathan
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
| | - Ryan D Cassaday
- Daniel J. Landsburg and Anthony R. Mato, University of Pennsylvania; James N. Gerson and Stefan K. Barta, Temple University, Philadelphia, PA; Marissa K. Falkiewicz, Robert Wood Johnson Medical School, New Brunswick; Christina Howlett, Tatyana Feldman, and Anthony R. Mato, Hackensack University Medical Center, Hackensack, NJ; Joseph Maly and Kristie A. Blum, Ohio State University, Columbus; Brian T. Hill, Cleveland Clinic, Cleveland, OH; Shaoying Li and L. Jeffrey Medeiros, MD Anderson Cancer Center, Houston, TX; Pallawi Torka and Francisco Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Jennifer K. Lue and Jennifer E. Amengual, Columbia University, New York, NY; Nishitha M. Reddy, Vanderbilt University, Nashville, TN; Arun Singavi and Timothy S. Fenske, Medical College of Wisconsin, Milwaukee, WI; Julio C. Chavez, Moffitt Cancer Center, Tampa, FL; Jason B. Kaplan, Amir Behdad, and Adam M. Petrich, Northwestern University, Evanston; Adam M. Petrich, AbbVie, North Chicago; David J. Peace, University of Illinois, Urbana; Sunita Nathan, Rush University, Chicago, IL; Martin A. Bast and Julie M. Vose, University of Nebraska, Lincoln, NE; Adam J. Olszewski, Brown University, Providence, RI; Cristiana Costa and Frederick Lansigan, Dartmouth College, Hanover, NH; Oscar Calzada and Jonathon B. Cohen, Emory University, Atlanta, GA; Xavier Rivera and Daniel O. Persky, University of Arizona, Tucson, AZ; and Ryan D. Cassaday, University of Washington, Seattle, WA
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Landsburg DJ, Falkiewicz MK, Petrich AM, Chu BA, Behdad A, Li S, Medeiros LJ, Cassaday RD, Reddy NM, Bast MA, Vose JM, Kruczek KR, Smith SE, Patel P, Hernandez-Ilizaliturri F, Karmali R, Rajguru S, Yang DT, Maly JJ, Blum KA, Zhao W, Vanslambrouck C, Nabhan C. Sole rearrangement but not amplification of MYC is associated with a poor prognosis in patients with diffuse large B cell lymphoma and B cell lymphoma unclassifiable. Br J Haematol 2016; 175:631-640. [PMID: 27469075 DOI: 10.1111/bjh.14282] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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: 05/25/2016] [Accepted: 06/22/2016] [Indexed: 01/06/2023]
Abstract
Rearrangement of MYC is associated with a poor prognosis in patients with diffuse large B cell lymphoma (DLBCL) and B cell lymphoma unclassifiable (BCLU), particularly in the setting of double hit lymphoma (DHL). However, little is known about outcomes of patients who demonstrate MYC rearrangement without evidence of BCL2 or BCL6 rearrangement (single hit) or amplification (>4 copies) of MYC. We identified 87 patients with single hit lymphoma (SHL), 22 patients with MYC-amplified lymphoma (MYC amp) as well as 127 DLBCL patients without MYC rearrangement or amplification (MYC normal) and 45 patients with DHL, all treated with either R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) or intensive induction therapy. For SHL and MYC amp patients, the 2-year progression-free survival rate (PFS) was 49% and 48% and 2-year overall survival rate (OS) was 59% and 71%, respectively. SHL patients receiving intensive induction experienced higher 2-year PFS (59% vs. 23%, P = 0·006) but similar 2-year OS as compared with SHL patients receiving R-CHOP. SHL DLBCL patients treated with R-CHOP, but not intensive induction, experienced significantly lower 2-year PFS and OS (P < 0·001 for both) when compared with MYC normal patients. SHL patients appear to have a poor prognosis, which may be improved with receipt of intensive induction.
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Affiliation(s)
- Daniel J Landsburg
- Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Adam M Petrich
- Division of Hematology/Oncology, Northwestern University, Chicago, IL, USA.,AbbVie, Chicago, IL, USA
| | - Benjamin A Chu
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amir Behdad
- Department of Pathology, Northwestern University, Chicago, IL, USA
| | - Shaoying Li
- Department of Hematopathology, MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, MD Anderson Cancer Center, Houston, TX, USA
| | - Ryan D Cassaday
- Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - Nishitha M Reddy
- Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, USA
| | - Martin A Bast
- Lymphoma Study Group, University of Nebraska Medical Center, Omaha, NE, USA
| | - Julie M Vose
- Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kimberly R Kruczek
- Division of Hematology/Oncology, Loyola University Chicago, Chicago, IL, USA
| | - Scott E Smith
- Division of Hematology/Oncology, Loyola University Chicago, Chicago, IL, USA
| | - Priyank Patel
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - Reem Karmali
- Rush University Cancer Center, Rush University, Chicago, IL, USA
| | - Saurabh Rajguru
- Division of Hematology/Oncology, University of Wisconsin, Madison, WI, USA
| | - David T Yang
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI, USA
| | - Joseph J Maly
- Division of Hematology/Oncology, Ohio State University, Columbus, OH, USA
| | - Kristie A Blum
- Division of Hematology, Ohio State University, Columbus, OH, USA
| | - Weiqiang Zhao
- Department of Pathology, Ohio State University, Columbus, OH, USA
| | | | - Chadi Nabhan
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
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