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Vargas-Blanco DA, Hepworth OW, Basham KJ, Simaku P, Crossen AJ, Timmer KD, Hopke A, Brown Harding H, Vandal SR, Jensen KN, Floyd DJ, Reedy JL, Reardon C, Mansour MK, Ward RA, Irimia D, Abramson JS, Vyas JM. BTK inhibitor-induced defects in human neutrophil effector activity against Aspergillus fumigatus are restored by TNFα. JCI Insight 2024:e176162. [PMID: 38713531 DOI: 10.1172/jci.insight.176162] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2024] Open
Abstract
Inhibition of Bruton's tyrosine kinase (BTK) through covalent modifications of its active site (e.g., ibrutinib [IBT]) is a preferred treatment for multiple B cell malignancies. However, IBT-treated patients are more susceptible to invasive fungal infections, although the mechanism is poorly understood. Neutrophils are the primary line of defense against these infections; therefore, we examined the impact of IBT on primary human neutrophil effector activity against Aspergillus fumigatus. IBT significantly impaired the ability of neutrophils to kill A. fumigatus and potently inhibited reactive oxygen species (ROS) production, chemotaxis, and phagocytosis. Importantly, exogenous TNFα fully compensated for defects imposed by IBT and newer-generation BTK inhibitors and restored the ability of neutrophils to contain A. fumigatus hyphal growth. Blocking TNFα did not impact ROS production in healthy neutrophils but prevented exogenous TNFα from rescuing the phenotype of IBT-treated neutrophils. The restorative capacity of TNFα was independent of transcription. Moreover, the addition of TNFα immediately rescued ROS production in IBT-treated neutrophils indicating that TNFα worked through a BTK-independent signaling pathway. Finally, TNFα restored effector activity of primary neutrophils from patients on IBT therapy. Altogether, our data indicate that TNFα rescues the antifungal immunity block imposed by inhibition of BTK in primary human neutrophils.
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Affiliation(s)
- Diego A Vargas-Blanco
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Olivia W Hepworth
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Kyle J Basham
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Patricia Simaku
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Arianne J Crossen
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Kyle D Timmer
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Alex Hopke
- Harvard Medical School, Boston, United States of America
| | - Hannah Brown Harding
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Steven R Vandal
- Beth Israel Deaconess Medical Center, Boston, United States of America
| | - Kirstine N Jensen
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Daniel J Floyd
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Jennifer L Reedy
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Christopher Reardon
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Michael K Mansour
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Rebecca A Ward
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
| | - Daniel Irimia
- Harvard Medical School, Boston, United States of America
| | - Jeremy S Abramson
- Center for Lymphoma, Mass General Cancer Center, Boston, United States of America
| | - Jatin M Vyas
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America
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2
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Lei MM, Sorial MN, Lou U, Yu M, Medrano A, Ford J, Nemec RA, Abramson JS, Soumerai JD. Real-world evidence of obinutuzumab and venetoclax in previously treated patients with chronic lymphocytic leukemia or small lymphocytic lymphoma. Leuk Lymphoma 2024; 65:653-659. [PMID: 38293753 PMCID: PMC11097209 DOI: 10.1080/10428194.2024.2310144] [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: 11/27/2023] [Accepted: 01/21/2024] [Indexed: 02/01/2024]
Abstract
Venetoclax-obinutuzumab (Ven-O) is frequently administered off-label in relapsed/refractory (r/r) CLL/SLL where venetoclax-rituximab is the approved regimen. We conducted this retrospective, real-world study to evaluate Ven-O in r/r CLL/SLL. Between 7/2019 and 6/2022, 40 patients with r/r CLL/SLL on Ven-O were included. The median age was 72, 28.2% had TP53 mutation and/or 17p deletion, median number of prior therapies was 1 (range, 1-6), and 55% had prior BTK inhibitor exposure. The overall response rate was 90% (complete response [CR] or CR with incomplete marrow recovery in 27.5% and partial response in 62.5%) of patients, and the 2-year progression-free survival was 81.2% (95% CI, 69.5-94.8). Therapy was well tolerated. No laboratory or clinical TLS occurred with venetoclax (Howard criteria). One (3%) patient experienced laboratory TLS with obinutuzumab initiation. In summary, this retrospective cohort study demonstrated that Ven-O achieves frequent, durable responses and can be safely administered in r/r CLL/SLL.
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MESH Headings
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Sulfonamides/administration & dosage
- Sulfonamides/therapeutic use
- Sulfonamides/adverse effects
- Bridged Bicyclo Compounds, Heterocyclic/therapeutic use
- Bridged Bicyclo Compounds, Heterocyclic/administration & dosage
- Bridged Bicyclo Compounds, Heterocyclic/adverse effects
- Aged
- Female
- Male
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/adverse effects
- Middle Aged
- Retrospective Studies
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Aged, 80 and over
- Treatment Outcome
- Adult
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Affiliation(s)
- Matthew M. Lei
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Mark N. Sorial
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Uvette Lou
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Michelle Yu
- School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Andrea Medrano
- School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Josie Ford
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Ronald A. Nemec
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Jeremy S. Abramson
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Jacob D. Soumerai
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA, USA
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3
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Crombie JL, Graff T, Falchi L, Karimi YH, Bannerji R, Nastoupil L, Thieblemont C, Ursu R, Bartlett N, Nachar V, Weiss J, Osterson J, Patel K, Brody J, Abramson JS, Lunning M, Shah NN, Ayed A, Kamdar M, Parsons B, Caimi P, Flinn I, Herrera A, Sharman J, McKenna M, Armand P, Kahl B, Smith S, Zelenetz A, Budde LE, Hutchings M, Phillips T, Dickinson M. Consensus recommendations on the management of toxicity associated with CD3×CD20 bispecific antibody therapy. Blood 2024; 143:1565-1575. [PMID: 38252906 DOI: 10.1182/blood.2023022432] [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: 09/12/2023] [Revised: 12/19/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
ABSTRACT Bispecific antibodies (BsAb) that target CD3 and CD20 represent a new milestone in the treatment of patients with B-cell non-Hodgkin lymphoma. These drugs have demonstrated remarkable single-agent activity in patients with heavily pretreated disease, and 3 drugs have so far received regulatory approvals in various countries. However, BsAbs can potentially lead to severe toxicity associated with T-cell activation, particularly cytokine release syndrome (CRS). The anticipated widespread use of these off-the-shelf products poses challenges for implementation and highlights the need for guidance in anticipating, mitigating, and managing adverse events. In clinical trials, guidance for the evaluation and treatment of CRS and neurotoxicity associated with BsAb therapy has been modeled after algorithms originally created for chimeric antigen receptor (CAR) T-cell therapies and other immune effector therapies, yet notable differences in timing, quality, and severity exist between the toxicities of BsAbs and CAR T-cell therapies. We therefore convened an international panel of academic and community practice physicians, advanced practitioners, registered nurses, and pharmacists with experience using CD3×CD20 BsAbs in clinical trial and off-trial settings to provide comprehensive, consensus-based recommendations specific to the assessment and management of CD3×CD20 BsAb-related toxicities.
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Affiliation(s)
| | - Tara Graff
- Mission Cancer and Blood, Des Moines, IA
| | - Lorenzo Falchi
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yasmin H Karimi
- Hematology Clinic, Rogel Cancer Center, University of Michigan Health System, Ann Arbor, MI
| | - Rajat Bannerji
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Catherine Thieblemont
- Department of Hemato-oncology, Assistance Publique Hôpitaux de Paris, INSERM U1153, Hôpital Saint Louis, Paris, France
| | - Renata Ursu
- Department of Neurology, Assistance Publique Hôpitaux de Paris, Hôpital Saint Louis, Paris, France
| | | | - Victoria Nachar
- Hematology Clinic, Rogel Cancer Center, University of Michigan Health System, Ann Arbor, MI
| | - Jonathan Weiss
- Hematology Clinic, Rogel Cancer Center, University of Michigan Health System, Ann Arbor, MI
| | | | - Krish Patel
- Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute, Seattle, WA
| | - Joshua Brody
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeremy S Abramson
- Center for Lymphoma, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Matthew Lunning
- Division of Oncology and Hematology, University of Nebraska, Omaha, NE
| | | | - Ayed Ayed
- Cancer Specialists of North Florida, Jacksonville, FL
| | - Manali Kamdar
- Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado Cancer Center, Aurora, CO
| | - Benjamin Parsons
- Department of Hematology and Oncology, Gundersen Lutheran Health System, La Crosse, WI
| | - Paolo Caimi
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Ian Flinn
- Tennessee Oncology and OneOncology, Nashville, TN
| | | | - Jeffrey Sharman
- Department of Medical Oncology, Willamette Valley Cancer Institute and Research Center/US Oncology Research, Eugene, OR
| | | | | | - Brad Kahl
- Washington University in St. Louis, St. Louis, MO
| | - Sonali Smith
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Andrew Zelenetz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Martin Hutchings
- Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Tycel Phillips
- Hematology Clinic, Rogel Cancer Center, University of Michigan Health System, Ann Arbor, MI
| | - Michael Dickinson
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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4
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Woyach JA, Perez Burbano G, Ruppert AS, Miller C, Heerema NA, Zhao W, Wall A, Ding W, Bartlett NL, Brander DM, Barr PM, Rogers KA, Parikh SA, Stephens DM, Brown JR, Lozanski G, Blachly J, Nattam S, Larson RA, Erba H, Litzow M, Luger S, Owen C, Kuzma C, Abramson JS, Little RF, Dinner S, Stone RM, Uy G, Stock W, Mandrekar SJ, Byrd JC. Follow-up from the A041202 study shows continued efficacy of ibrutinib regimens for older adults with CLL. Blood 2024; 143:1616-1627. [PMID: 38215395 DOI: 10.1182/blood.2023021959] [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: 07/24/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024] Open
Abstract
ABSTRACT A041202 (NCT01886872) is a phase 3 study comparing bendamustine plus rituximab (BR) with ibrutinib and the combination of ibrutinib plus rituximab (IR) in previously untreated older patients with chronic lymphocytic leukemia (CLL). The initial results showed that ibrutinib-containing regimens had superior progression-free survival (PFS) and rituximab did not add additional benefits. Here we present an updated analysis. With a median follow-up of 55 months, the median PFS was 44 months (95% confidence interval [CI], 38-54) for BR and not yet reached in either ibrutinib-containing arm. The 48-month PFS estimates were 47%, 76%, and 76% for BR, ibrutinib, and IR, respectively. The benefit of ibrutinib regimens over chemoimmunotherapy was consistent across subgroups of patients defined by TP53 abnormalities, del(11q), complex karyotype, and immunoglobulin heavy chain variable region (IGHV). No significant interaction effects were observed between the treatment arm and del(11q), the complex karyotype, or IGHV. However, a greater difference in PFS was observed among the patients with TP53 abnormalities. There was no difference in the overall survival. Notable adverse events with ibrutinib included atrial fibrillation (afib) and hypertension. Afib was observed in 11 patients (pts) on BR (3%) and 67 pts on ibrutinib (18%). All-grade hypertension was observed in 95 pts on BR (27%) and 263 pts on ibrutinib (55%). These data show that ibrutinib regimens prolong PFS compared with BR for older patients with treatment-naïve CLL. These benefits were observed across subgroups, including high-risk groups. Strikingly, within the ibrutinib arms, there was no inferior PFS for patients with abnormalities in TP53, the highest risk feature observed in CLL. These data continue to demonstrate the efficacy of ibrutinib in treatment-naïve CLL.
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Affiliation(s)
| | | | - Amy S Ruppert
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Cecelia Miller
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Nyla A Heerema
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Weiqiang Zhao
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Anna Wall
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Wei Ding
- Department of Hematology, Mayo Clinic, Rochester, MN
| | - Nancy L Bartlett
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | | | - Paul M Barr
- University of Rochester Medical Center, Rochester, NY
| | - Kerry A Rogers
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | - Gerard Lozanski
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - James Blachly
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Harry Erba
- Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Mark Litzow
- Department of Hematology, Mayo Clinic, Rochester, MN
| | - Selina Luger
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Carolyn Owen
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Charles Kuzma
- First Health of the Carolinas Cancer Center, Southeast Clinical Oncology Research Consortium, Winston-Salem, NC
| | | | - Richard F Little
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Shira Dinner
- Division of Hematology and Oncology, Northwestern University, Chicago, IL
| | | | - Geoffrey Uy
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Wendy Stock
- University of Chicago Comprehensive Cancer Center, Chicago, IL
| | - Sumithra J Mandrekar
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - John C Byrd
- University of Cincinnati Cancer Center, Cincinnati, OH
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5
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Wierda WG, Brown J, Abramson JS, Awan F, Bilgrami SF, Bociek G, Brander D, Cortese M, Cripe L, Davis RS, Eradat H, Fakhri B, Fletcher CD, Gaballa S, Hamid MS, Hill B, Kaesberg P, Kahl B, Kamdar M, Kipps TJ, Ma S, Mosse C, Nakhoda S, Parikh S, Schorr A, Schuster S, Seshadri M, Siddiqi T, Stephens DM, Thompson M, Ujjani C, Valdez R, Wagner-Johnston N, Woyach JA, Sundar H, Dwyer M. Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma, Version 2.2024. J Natl Compr Canc Netw 2024; 22:175-204. [PMID: 38626800 DOI: 10.6004/jnccn.2024.0018] [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] [Indexed: 04/19/2024]
Abstract
Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are essentially different manifestations of the same disease that are similarly managed. A number of molecular and cytogenetic variables with prognostic implications have been identified. Undetectable minimal residual disease at the end of treatment with chemoimmunotherapy or venetoclax-based combination regimens is an independent predictor of improved survival among patients with previously untreated or relapsed/refractory CLL/SLL. The selection of treatment is based on the disease stage, presence or absence of del(17p) or TP53 mutation, immunoglobulin heavy chain variable region mutation status, patient age, performance status, comorbid conditions, and the agent's toxicity profile. This manuscript discusses the recommendations outlined in the NCCN Guidelines for the diagnosis and management of patients with CLL/SLL.
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Affiliation(s)
| | | | | | - Farrukh Awan
- 4UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | | | - Larry Cripe
- 9Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | | | | | | | | | | | - Muhammad Saad Hamid
- 15St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Brian Hill
- 16Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Brad Kahl
- 18Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Shuo Ma
- 21Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jennifer A Woyach
- 34The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
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6
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Wang M, Siddiqi T, Gordon LI, Kamdar M, Lunning M, Hirayama AV, Abramson JS, Arnason J, Ghosh N, Mehta A, Andreadis C, Solomon SR, Kostic A, Dehner C, Espinola R, Peng L, Ogasawara K, Chattin A, Eliason L, Palomba ML. Lisocabtagene Maraleucel in Relapsed/Refractory Mantle Cell Lymphoma: Primary Analysis of the Mantle Cell Lymphoma Cohort From TRANSCEND NHL 001, a Phase I Multicenter Seamless Design Study. J Clin Oncol 2024; 42:1146-1157. [PMID: 38072625 DOI: 10.1200/jco.23.02214] [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: 10/10/2023] [Revised: 11/02/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To report the primary analysis results from the mantle cell lymphoma (MCL) cohort of the phase I seamless design TRANSCEND NHL 001 (ClinicalTrials.gov identifier: NCT02631044) study. METHODS Patients with relapsed/refractory (R/R) MCL after ≥two lines of previous therapy, including a Bruton tyrosine kinase inhibitor (BTKi), an alkylating agent, and a CD20-targeted agent, received lisocabtagene maraleucel (liso-cel) at a target dose level (DL) of 50 × 106 (DL1) or 100 × 106 (DL2) chimeric antigen receptor-positive T cells. Primary end points were adverse events (AEs), dose-limiting toxicities, and objective response rate (ORR) by independent review committee per Lugano criteria. RESULTS Of 104 leukapheresed patients, liso-cel was infused into 88. Median (range) number of previous lines of therapy was three (1-11) with 30% receiving ≥five previous lines of therapy, 73% of patients were age 65 years and older, 69% had refractory disease, 53% had BTKi refractory disease, 23% had TP53 mutation, and 8% had secondary CNS lymphoma. Median (range) on-study follow-up was 16.1 months (0.4-60.5). In the efficacy set (n = 83; DL1 + DL2), ORR was 83.1% (95% CI, 73.3 to 90.5) and complete response (CR) rate was 72.3% (95% CI, 61.4 to 81.6). Median duration of response was 15.7 months (95% CI, 6.2 to 24.0) and progression-free survival was 15.3 months (95% CI, 6.6 to 24.9). Most common grade ≥3 treatment-emergent AEs were neutropenia (56%), anemia (37.5%), and thrombocytopenia (25%). Cytokine release syndrome (CRS) was reported in 61% of patients (grade 3/4, 1%; grade 5, 0), neurologic events (NEs) in 31% (grade 3/4, 9%; grade 5, 0), grade ≥3 infections in 15%, and prolonged cytopenia in 40%. CONCLUSION Liso-cel demonstrated high CR rate and deep, durable responses with low incidence of grade ≥3 CRS, NE, and infections in patients with heavily pretreated R/R MCL, including those with high-risk, aggressive disease.
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Affiliation(s)
- Michael Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Leo I Gordon
- Northwestern University, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | | | | | | | - Jeremy S Abramson
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Jon Arnason
- Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | | | - M Lia Palomba
- Memorial Sloan Kettering Cancer Center, New York, NY
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7
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Abramson JS, Solomon SR, Arnason J, Johnston PB, Glass B, Bachanova V, Ibrahimi S, Mielke S, Mutsaers P, Hernandez-Ilizaliturri F, Izutsu K, Morschhauser F, Lunning M, Crotta A, Montheard S, Previtali A, Ogasawara K, Kamdar M. Plain language summary of the TRANSFORM study primary analysis results: lisocabtagene maraleucel as a second treatment regimen for large B-cell lymphoma following failure of the first treatment regimen. Future Oncol 2024. [PMID: 38547003 DOI: 10.2217/fon-2023-0898] [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: 04/04/2024] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? People diagnosed with a disease called large B-cell lymphoma (LBCL) may experience return, or early relapse, of their disease within the first year after receiving and responding to their first (first-line) treatment regimen. Others may have primary refractory disease, meaning that the disease either did not respond to first-line treatment at all or only responded for a very brief period. Second (second-line) treatment includes immunotherapy followed by high-dose chemotherapy and ASCT, which has the potential to cure LBCL. However, if the disease does not respond to immunotherapy, people cannot receive ASCT, and less than 30% of people are cured. Therefore, new second-line treatment options are required, such as CAR T cell therapy, which uses a person's own genetically engineered lymphocytes, also called T cells, to fight their lymphoma. In this article, we summarize the key results of the phase 3 TRANSFORM clinical study that tested if liso-cel, a CAR T cell treatment, can safely and effectively be used as a second-line treatment for people with early relapsed or primary refractory (relapsed/refractory) LBCL. A total of 184 adults with relapsed/refractory LBCL who were able to receive ASCT were randomly treated with either liso-cel or standard of care (SOC) as second-line treatment. SOC included immunochemotherapy followed by high-dose chemotherapy and ASCT. WHAT WERE THE KEY TAKEAWAYS? Almost all (97%) people in the liso-cel group completed treatment, whereas 53% of people in the SOC group did not complete treatment, mostly due to their disease not responding or relapsing, and therefore they were not able to receive ASCT. People who received liso-cel as a second-line treatment lived longer without the occurrence of an unfavorable medical event or worsening of the disease and had a better response to treatment than those who received SOC as second-line treatment. People who received liso-cel reported side effects that researchers considered to be manageable, and that were known to occur with CAR T cell treatment. WHAT WERE THE MAIN CONCLUSIONS REPORTED BY THE RESEARCHERS? Results from the TRANSFORM study support the use of liso-cel as a more effective second-line treatment compared with SOC that is safe for people with relapsed/refractory LBCL. Clinical Trial Registration: NCT03575351 (TRANSFORM study) (ClinicalTrials.gov).
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Affiliation(s)
- Jeremy S Abramson
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Scott R Solomon
- Transplant & Cellular Immunotherapy Program, Northside Hospital Cancer Institute, Atlanta, GA, USA
| | - Jon Arnason
- Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Bertram Glass
- Department of Hematology & Cell Therapy, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Veronika Bachanova
- Division of Hematology, Oncology & Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Sami Ibrahimi
- Transplant & Cellular Therapy Clinic, University of Oklahoma Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Stephan Mielke
- Departments of Laboratory Medicine & Medicine at Huddinge, Center of Allogeneic Stem Cell Transplantation & Cellular Therapy, Karolinska Institutet & University Hospital, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Pim Mutsaers
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Franck Morschhauser
- Centre Hospitalier Universitaire de Lille, Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Matthew Lunning
- Hematology/Oncology Division, University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | | | | | - Manali Kamdar
- Division of Hematology, Hematologic Malignancies & Stem Cell Transplantation, University of Colorado Cancer Center, Aurora, CO, USA
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8
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Ahn IE, Brander DM, Ren Y, Zhou Y, Tyekucheva S, Walker HA, Black R, Montegaard J, Alencar A, Shune L, Omaira M, Jacobson CA, Armand P, Ng SY, Crombie J, Fisher DC, LaCasce AS, Arnason J, Hochberg EP, Takvorian RW, Abramson JS, Brown JR, Davids MS. Five-year follow-up of a phase 2 study of ibrutinib plus fludarabine, cyclophosphamide, and rituximab as initial therapy in CLL. Blood Adv 2024; 8:832-841. [PMID: 38163317 PMCID: PMC10874751 DOI: 10.1182/bloodadvances.2023011574] [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: 09/01/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024] Open
Abstract
ABSTRACT We previously reported high rates of undetectable minimal residual disease <10-4 (uMRD4) with ibrutinib plus fludarabine, cyclophosphamide, and rituximab (iFCR) followed by 2-year ibrutinib maintenance (I-M) in treatment-naïve chronic lymphocytic leukemia (CLL). Here, we report updated data from this phase 2 study with a median follow-up of 63 months. Of 85 patients enrolled, including 5 (6%) with deletion 17p or TP53 mutation, 91% completed iFCR and 2-year I-M. Five-year progression-free survival (PFS) and overall survival were 94% (95% confidence interval [CI], 89%-100%) and 99% (95% CI, 96%-100%), respectively. No additional deaths have occurred with this extended follow-up. No difference in PFS was observed by immunoglobulin heavy-chain variable region gene status or duration of I-M. High rates of peripheral blood (PB) uMRD4 were maintained (72% at the end of iFCR, 66% at the end of 2-year I-M, and 44% at 4.5 years from treatment initiation). Thirteen patients developed MRD conversion without clinical progression, mostly (77%) after stopping ibrutinib. None had Bruton tyrosine kinase (BTK) mutations. One patient had PLCG2 mutation. Six of these patients underwent ibrutinib retreatment per protocol. Median time on ibrutinib retreatment was 34 months. The cumulative incidence of atrial fibrillation was 8%. Second malignancy or nonmalignant hematologic disease occurred in 13%, mostly nonmelanoma skin cancer. Overall, iFCR with 2-year I-M achieved durably deep responses in patients with diverse CLL genetic markers. Re-emergent clones lacked BTK mutation and retained sensitivity to ibrutinib upon retreatment. This trial is registered at www.clinicaltrials.gov as #NCT02251548.
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Affiliation(s)
- Inhye E. Ahn
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Yue Ren
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - Yinglu Zhou
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | | | - Heather A. Walker
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Robert Black
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Josie Montegaard
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Alvaro Alencar
- Division of Hematology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
| | - Leyla Shune
- Department of Hematologic Malignancies, University of Kansas Cancer Center, Westwood, KS
| | - Mohammad Omaira
- Department of Medical Oncology, West Michigan Cancer Center, Kalamazoo, MI
| | - Caron A. Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Samuel Y. Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jennifer Crombie
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - David C. Fisher
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ann S. LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jon Arnason
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Ephraim P. Hochberg
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA
| | - Ronald W. Takvorian
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA
| | - Jeremy S. Abramson
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA
| | - Jennifer R. Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Matthew S. Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
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9
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Nemec R, Scherrer-Crosbie M, Abramson JS, Redd R, Gilman HK, Ho T, Wu J, Heemelaar J, Neuberg D, Hochberg EP, Barnes JA, Armand P, Jacobsen ED, Jacobson CA, Kim AI, Friedman RS, LaCasce AS, Neilan TG, Soumerai JD. Effect of atorvastatin versus placebo on efficacy in patients with diffuse large B-cell lymphoma receiving R-CHOP. Leuk Lymphoma 2024:1-6. [PMID: 38380861 DOI: 10.1080/10428194.2024.2317343] [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: 10/18/2023] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
STOP-CA was a multicenter, double-blind, randomized, placebo-controlled trial comparing atorvastatin to placebo in treatment-naïve lymphoma patients receiving anthracycline-based chemotherapy. We performed a preplanned subgroup to analyze the impact of atorvastatin on efficacy in patients with diffuse large B-cell lymphoma (DLBCL). Patients received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) at standard doses for six 21-day cycles and were randomly assigned to receive atorvastatin 40 mg daily (n = 55) or placebo (n = 47) for 12 months. The complete response (CR) rate was numerically higher in the atorvastatin arm (95% [52/55] vs. 85% [40/47], p = .18), but this was not statistically significant. Adverse event rates were similar between the atorvastatin and placebo arms. In summary, atorvastatin did not result in a statistically significant improvement in the CR rate or progression-free survival, but both were numerically improved in the atorvastatin arm. These data warrant further investigation into the potential therapeutic role of atorvastatin added to anthracycline-based chemotherapies.
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Affiliation(s)
- Ronald Nemec
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | - Jeremy S Abramson
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Robert Redd
- Department of Data Science, Dana Farber Cancer Institute, Boston, MA, USA
| | - Hannah K Gilman
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Terry Ho
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jessica Wu
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Julius Heemelaar
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Donna Neuberg
- Department of Data Science, Dana Farber Cancer Institute, Boston, MA, USA
| | - Ephraim P Hochberg
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Jeffrey A Barnes
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Eric D Jacobsen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Caron A Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Austin I Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Robb S Friedman
- Division of Medical Oncology, Newton-Wellesley Hospital, Newton, MA, USA
| | - Ann S LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tomas G Neilan
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jacob D Soumerai
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA, USA
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10
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Abramson JS, Palomba ML, Gordon LI, Lunning M, Wang M, Arnason J, Purev E, Maloney DG, Andreadis C, Sehgal A, Solomon SR, Ghosh N, Dehner C, Kim Y, Ogasawara K, Kostic A, Siddiqi T. Two-year follow-up of lisocabtagene maraleucel in relapsed or refractory large B-cell lymphoma in TRANSCEND NHL 001. Blood 2024; 143:404-416. [PMID: 37890149 DOI: 10.1182/blood.2023020854] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
ABSTRACT Lisocabtagene maraleucel (liso-cel) demonstrated significant efficacy with a manageable safety profile as third-line or later treatment for patients with relapsed or refractory (R/R) large B-cell lymphoma (LBCL) in the TRANSCEND NHL 001 study. Primary end points were adverse events (AEs), dose-limiting toxicities, and objective response rate (ORR) per independent review committee. Key secondary end points were complete response (CR) rate, duration of response (DOR), progression-free survival (PFS), and overall survival (OS). After 2-year follow-up, patients could enroll in a separate study assessing long-term (≤15 years) safety and OS. Liso-cel-treated patients (N = 270) had a median age of 63 years (range, 18-86 years) and a median of 3 prior lines (range, 1-8) of systemic therapy, and 181 of them (67%) had chemotherapy-refractory LBCL. Median follow-up was 19.9 months. In efficacy-evaluable patients (N = 257), the ORR was 73% and CR rate was 53%. The median (95% confidence interval) DOR, PFS, and OS were 23.1 (8.6 to not reached), 6.8 (3.3-12.7), and 27.3 months (16.2-45.6), respectively. Estimated 2-year DOR, PFS, and OS rates were 49.5%, 40.6%, and 50.5%, respectively. In the 90-day treatment-emergent period (N = 270), grade 3 to 4 cytokine release syndrome and neurological events occurred in 2% and 10% of patients, respectively. The most common grade ≥3 AEs in treatment-emergent and posttreatment-emergent periods, respectively, were neutropenia (60% and 7%) and anemia (37% and 6%). Liso-cel demonstrated durable remissions and a manageable safety profile with no new safety signals during the 2-year follow-up in patients with R/R LBCL. These trials were registered at www.ClinicalTrials.gov as #NCT02631044 and #NCT03435796.
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Affiliation(s)
- Jeremy S Abramson
- Lymphoma Program, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - M Lia Palomba
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leo I Gordon
- Department of Hematology/Oncology, Northwestern University, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Matthew Lunning
- Hematology/Oncology Division, University of Nebraska Medical Center, Omaha, NE
| | - Michael Wang
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jon Arnason
- Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - David G Maloney
- Clinical Research Division Medicine and Oncology, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Alison Sehgal
- University of Pittsburgh Medical Center: Hillman Cancer Center, Pittsburgh, PA
| | - Scott R Solomon
- Transplant and Cellular Immunotherapy Program, Northside Hospital Cancer Institute, Atlanta, GA
| | - Nilanjan Ghosh
- Department of Hematologic Oncology and Blood Disorders, Atrium Health, Levine Cancer Institute, Charlotte, NC
| | | | | | | | | | - Tanya Siddiqi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
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11
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Choe JH, Yu T, Abramson JS, Abou-el-Enein M. Cost-effectiveness of second-line lisocabtagene maraleucel in relapsed or refractory diffuse large B-cell lymphoma. Blood Adv 2024; 8:484-496. [PMID: 38153350 PMCID: PMC10837180 DOI: 10.1182/bloodadvances.2023011793] [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: 09/26/2023] [Revised: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 12/29/2023] Open
Abstract
ABSTRACT Lisocabtagene maraleucel (liso-cel), a chimeric antigen receptor (CAR) T-cell therapy, received the US Food and Drug Administration approval in 2022 for second-line treatment of diffuse large B-cell lymphoma (DLBCL) for patients with refractory disease or early relapse after first-line chemoimmunotherapy. This decision was based on the TRANSFORM study demonstrating improvements in event-free survival with liso-cel compared with standard care. Given the high costs of CAR T-cell therapies, particularly as they transition to second-line treatment, a cost-effectiveness analysis is essential to determine their economic viability. The study used a partitioned survival model with standard parametric functions to evaluate the cost-effectiveness of liso-cel aganist platinum-based chemotherapy followed by high-dose chemotherapy and autologous hematopoietic stem cell transplantation over a lifetime horizon The analysis relied on data from the TRANSFORM and TRANSCEND trials, established literature, and public data sets to calculate the incremental cost-effectiveness ratio (ICER). For a representative cohort of US adults aged 60 years, ICER of liso-cel was $99 669 per quality-adjusted life-year (QALY) from a health care sector perspective and $68 212 per QALY from a societal perspective, confirming its cost-effectiveness at the $100 000 per QALY threshold. Nonetheless, under certain scenarios, liso-cel surpasses this benchmark but remains within the US acceptable range of $150 000 per QALY. A key finding underlines the importance of incorporating productivity losses into such analyses to capture the broader societal values of novel therapies. Although these therapies offer substantial clinical benefits, their high acquisition costs and limited long-term data critically challenge their economic sustainability.
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Affiliation(s)
- Jee H. Choe
- Department of Pharmaceutical and Health Economics, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA
| | - Tianzhou Yu
- Department of Pharmaceutical and Health Economics, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA
| | - Jeremy S. Abramson
- Center for Lymphoma, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mohamed Abou-el-Enein
- Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine, University of Southern California and Children’s Hospital of Los Angeles, Los Angeles, CA
- USC/CHLA Cell Therapy Program, University of Southern California and Children’s Hospital of Los Angeles, Los Angeles, CA
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12
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Ababneh HS, Ng AK, Abramson JS, Soumerai JD, Takvorian RW, Frigault MJ, Patel CG. Metabolic parameters predict survival and toxicity in chimeric antigen receptor T-cell therapy-treated relapsed/refractory large B-cell lymphoma. Hematol Oncol 2024; 42:e3231. [PMID: 37795759 DOI: 10.1002/hon.3231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
CD19-targeted chimeric antigen receptor (CAR) T-cell therapy has revolutionized treatment for patients with relapsed/refractory large B-cell lymphoma (LBCL). However, data available concerning the impact of the prognostic value of quantitative 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) parameters on the CAR T-related outcomes and toxicities are limited. Therefore, we aimed to evaluate the predictive value of pre- and post-CAR T metabolic parameters on survival and toxicities following CAR T-cell therapy. Fifty-nine patients with PET/CT scans done pre-and post-CAR T infusion were retrospectively identified and analyzed in a single institution database of LBCL patients treated with commercial CD19-targeted CAR T-cell therapy. The median follow-up was 10.7 months [interquartile range (IQR): 2.6-25.5 months]. The overall response (complete response-CR and partial response) and CR rates post-CAR T were 76% (n = 45) and 53% (n = 31), respectively. On univariate analysis, low pre-CAR T total lesion glycolysis (TLG) and metabolic tumor volume (MTV) predicted improved overall response post-CAR T (OR = 4.7, p = 0.01, OR = 9.5, p = 0.03, respectively) and CR post-CAR T (OR = 12.4, p = 0.0004, OR = 10.9, p = 0.0001, respectively). High TLG pre-CAR T was correlated with cytokine release syndrome (CRS, OR = 3.25, p = 0.04). High MTV pre-CAR T was correlated with developing immune effector cell neurotoxicity syndrome (ICANS) events (OR = 4.3, p = 0.01), and high SUV pre-CAR T was associated with grade 3-4 neurological events (OR = 12, p = 0.01). High MTV/TLG/SUVmax post-CAR T were significantly associated with inferior Overall survival (OS). On multivariate analysis, high TLG pre-CAR T (HR = 2.4, p = 0.03), age ≥60 (HR = 2.7, p = 0.03), and bulky disease (≥5 cm) at the time of apheresis (HR = 2.5, p = 0.02) were identified to be independent prognostic factors for inferior PFS. High MTV post-CAR T was identified as the most prognostic factor associated with inferior OS.
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Affiliation(s)
- Hazim S Ababneh
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy S Abramson
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob D Soumerai
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ronald W Takvorian
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew J Frigault
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chirayu G Patel
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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13
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Qualls DA, Lambert N, Caimi PF, Merrill M, Pullarkat P, Godby RC, Bond DA, Wehmeyer GT, Romancik J, Amoozgar B, Leslie L, Nastoupil LJ, Crombie JL, Abramson JS, Khurana A, Nowakowski GS, Maddocks K, Rutherford SC, Kahl B, Okwali M, Buege MJ, Seshan V, Batlevi CL, Salles G. Tafasitamab and lenalidomide in large B-cell lymphoma: real-world outcomes in a multicenter retrospective study. Blood 2023; 142:2327-2331. [PMID: 37738563 PMCID: PMC10797539 DOI: 10.1182/blood.2023021274] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 06/08/2023] [Revised: 08/15/2023] [Accepted: 08/27/2023] [Indexed: 09/24/2023] Open
Abstract
ABSTRACT In this real-world evaluation of tafasitamab-lenalidomide (TL) in relapsed or refractory LBCL, patients receiving TL had higher rates of comorbidities and high-risk disease characteristics, and substantially lower progression-free survival and overall survival, compared with the L-MIND registration clinical trial for TL.
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Affiliation(s)
- David A. Qualls
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Paolo F. Caimi
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Mwanasha Merrill
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Priyanka Pullarkat
- Division of Hematology-Oncology, Massachusetts General Hospital, Boston, MA
| | - Richard C. Godby
- Hematology Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - David A. Bond
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Graham T. Wehmeyer
- Department of Medicine, Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Jason Romancik
- Department of Hematology and Medical Oncology, Winship Cancer Institute at Emory University, Atlanta, GA
| | - Behzad Amoozgar
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Lori Leslie
- Lymphoma Division, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Loretta J. Nastoupil
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jeremy S. Abramson
- Division of Hematology-Oncology, Massachusetts General Hospital, Boston, MA
| | - Arushi Khurana
- Hematology Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Kami Maddocks
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Sarah C. Rutherford
- Department of Medicine, Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Brad Kahl
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Michelle Okwali
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael J. Buege
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Venkatraman Seshan
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Connie L. Batlevi
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gilles Salles
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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14
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Karmali R, Abramson JS, Stephens DM, Barnes J, Winter JN, Ma S, Gao J, Kaplan J, Petrich AM, Hochberg E, Takvorian T, Mi X, Nelson V, Gordon LI, Pro B. Ibrutinib maintenance after frontline treatment in patients with mantle cell lymphoma. Blood Adv 2023; 7:7361-7368. [PMID: 37756532 PMCID: PMC10726243 DOI: 10.1182/bloodadvances.2023011271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/19/2023] [Revised: 08/19/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Maintenance rituximab in mantle cell lymphoma (MCL) has improved survival and supports exploration of maintenance with novel agents. We evaluated the safety and efficacy of ibrutinib maintenance (I-M) after induction in patients with treatment-naive MCL. Patients with MCL with complete response (CR) or partial response to frontline chemoimmunotherapy ± autologous stem cell transplantation (auto-SCT) received I-M 560 mg daily for up to 4 years. Primary objective was 3-year progression-free survival (PFS) rate from initiation of I-M. Minimal residual disease (MRD) assessments by next-generation sequencing (NGS) on peripheral blood were measured before I-M initiation and at 1, 6, and 18 to 24 months after initiation. Among 36 patients, the median age was 60 years (range, 46-90). For frontline treatment, 18 patients (50%) had consolidation with auto-SCT in CR1 before I-M. At median follow-up of 55.7 months, 17 patients (47%) completed full course I-M (median, 37.5 cycles; range, 2-52). The 3-year PFS and overall survival (OS) rates were 94% and 97%, respectively. With prior auto-SCT, 3-year PFS and OS rates were both 100%. The most common treatment-related adverse event with I-M was infection (n = 31; 86%), typically low grade; the most common grade 3/4 toxicities were hematologic. In 22 patients with MRD assessments, all were MRD negative after induction. Six became MRD positive on I-M, with 2 reverting to MRD-negative status with continued I-M, and all maintain radiographic CR with the exception of 1 with disease progression. I-M is feasible in MCL after frontline chemoimmunotherapy with manageable toxicities although significant. Changes in NGS-MRD were noted in limited patients during maintenance with few progression and survival events. This trial was registered at www.clinicaltrials.gov as #NCT02242097.
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Affiliation(s)
- Reem Karmali
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Jeremy S. Abramson
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Jeffrey Barnes
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jane N. Winter
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Shuo Ma
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Juehua Gao
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jason Kaplan
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Ephraim Hochberg
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Tak Takvorian
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Xinlei Mi
- Department of Preventive Medicine–Biostatistics, Northwestern University, Chicago, IL
| | - Valerie Nelson
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leo I. Gordon
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Barbara Pro
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
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15
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Karschnia P, Arrillaga-Romany IC, Eichler A, Forst DA, Gerstner E, Jordan JT, Ly I, Plotkin SR, Wang N, Martinez-Lage M, Winter SF, Tonn JC, Rejeski K, von Baumgarten L, Cahill DP, Nahed BV, Shankar GM, Abramson JS, Barnes JA, El-Jawahri A, Hochberg EP, Johnson PC, Soumerai JD, Takvorian RW, Chen YB, Frigault MJ, Dietrich J. Neurotoxicity and management of primary and secondary central nervous system lymphoma after adoptive immunotherapy with CD19-directed chimeric antigen receptor T-cells. Neuro Oncol 2023; 25:2239-2249. [PMID: 37402650 PMCID: PMC10708936 DOI: 10.1093/neuonc/noad118] [Citation(s) in RCA: 1] [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: 06/05/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Chimeric antigen receptor (CAR) T-cells targeting CD19 have been established as a leading engineered T-cell therapy for B-cell lymphomas; however, data for patients with central nervous system (CNS) involvement are limited. METHODS We retrospectively report on CNS-specific toxicities, management, and CNS response of 45 consecutive CAR T-cell transfusions for patients with active CNS lymphoma at the Massachusetts General Hospital over a 5-year period. RESULTS Our cohort includes 17 patients with primary CNS lymphoma (PCNSL; 1 patient with 2 CAR T-cell transfusions) and 27 patients with secondary CNS lymphoma (SCNSL). Mild ICANS (grade 1-2) was observed after 19/45 transfusions (42.2%) and severe immune effector cell-associated neurotoxicity syndrome (ICANS) (grade 3-4) after 7/45 transfusions (15.6%). A larger increase in C-reactive protein (CRP) levels and higher rates of ICANS were detected in SCNSL. Early fever and baseline C-reactive protein levels were associated with ICANS occurrence. CNS response was seen in 31 cases (68.9%), including a complete response of CNS disease in 18 cases (40.0%) which lasted for a median of 11.4 ± 4.5 months. Dexamethasone dose at time of lymphodepletion (but not at or after CAR T-cell transfusion) was associated with an increased risk for CNS progression (hazard ratios [HR] per mg/d: 1.16, P = .031). If bridging therapy was warranted, the use of ibrutinib translated into favorable CNS-progression-free survival (5 vs. 1 month, HR 0.28, CI 0.1-0.7; P = .010). CONCLUSIONS CAR T-cells exhibit promising antitumor effects and a favorable safety profile in CNS lymphoma. Further evaluation of the role of bridging regimens and corticosteroids is warranted.
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Affiliation(s)
- Philipp Karschnia
- Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, Section for Neuro-Oncology, Ludwig-Maximilians-University, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Isabel C Arrillaga-Romany
- Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - April Eichler
- Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Deborah A Forst
- Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth Gerstner
- Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin T Jordan
- Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ina Ly
- Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Scott R Plotkin
- Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Wang
- Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Martinez-Lage
- Department of Pathology, Division of Neuropathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sebastian F Winter
- Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Section for Neuro-Oncology, Ludwig-Maximilians-University, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Kai Rejeski
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
- Department of Medicine III, Section for Cellular Immunotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Louisa von Baumgarten
- Department of Neurosurgery, Section for Neuro-Oncology, Ludwig-Maximilians-University, Munich, Germany
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy S Abramson
- Department of Medicine, Hematology, and Oncology Division, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey A Barnes
- Department of Medicine, Hematology, and Oncology Division, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Department of Medicine, Hematology, and Oncology Division, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ephraim P Hochberg
- Department of Medicine, Hematology, and Oncology Division, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - P Connor Johnson
- Department of Medicine, Hematology, and Oncology Division, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob D Soumerai
- Department of Medicine, Hematology, and Oncology Division, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ronald W Takvorian
- Department of Medicine, Hematology, and Oncology Division, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Yi-Bin Chen
- Department of Medicine, Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew J Frigault
- Department of Medicine, Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorg Dietrich
- Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
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Redd RA, Ford J, Lei M, Abramson JS, Soumerai JD. Combined analysis of the impact of second-generation BTK inhibitors on patient outcomes. Leuk Lymphoma 2023; 64:2296-2305. [PMID: 37798861 DOI: 10.1080/10428194.2023.2254876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/28/2023] [Indexed: 10/07/2023]
Abstract
BTK inhibitors (BTKi) are highly effective in B-cell malignancies. Acalabrutinib and zanubrutinib have exhibited favorable safety profiles when compared with ibrutinib. We identified all published/presented randomized trials comparing a second-generation BTKi with ibrutinib and reconstructed individual patient-level, censored time-to-event data for adverse events to evaluate the impact of second-generation BTKi on safety outcomes including atrial fibrillation/flutter [AF], hypertension, bleeding, diarrhea, and infection. 1386 pts from ELEVATE-RR (n = 533), ALPINE (n = 652), and ASPEN (n = 201) trials were included in the analyses. Acalabrutinib or zanubrutinib were associated with significant reductions in cumulative event rates of AF (HR 0.28, 95% CI 0.18-0.42, p < 0.001), bleeding (HR 0.65, 95% CI 0.52-0.81, p < 0.001), diarrhea (HR 0.61, 95% CI 0.47-0.78, p < 0.001), hypertension (HR 0.40, 95% CI 0.27-0.61, p < 0.001), and infections (HR 0.83, 95% CI 0.70-0.98, p = 0.032). In summary, zanubrutinib and acalabrutinib have a favorable safety profile among pts with r/r B-cell malignancies. These data support use of acalabrutinib or zanubrutinib as preferred BTK inhibitors for approved indications.
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Affiliation(s)
- Robert A Redd
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Josie Ford
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Matthew Lei
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Jeremy S Abramson
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Jacob D Soumerai
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA, USA
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17
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Zelenetz AD, Gordon LI, Abramson JS, Advani RH, Andreadis B, Bartlett NL, Budde LE, Caimi PF, Chang JE, Christian B, DeVos S, Dholaria B, Fayad LE, Habermann TM, Hamid MS, Hernandez-Ilizaliturri F, Hu B, Kaminski MS, Karimi Y, Kelsey CR, King R, Krivacic S, LaCasce AS, Lim M, Messmer M, Narkhede M, Rabinovitch R, Ramakrishnan P, Reid E, Roberts KB, Saeed H, Smith SD, Svoboda J, Swinnen LJ, Tuscano J, Vose JM, Dwyer MA, Sundar H. NCCN Guidelines® Insights: B-Cell Lymphomas, Version 6.2023. J Natl Compr Canc Netw 2023; 21:1118-1131. [PMID: 37935098 DOI: 10.6004/jnccn.2023.0057] [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] [Indexed: 11/09/2023]
Abstract
Novel targeted therapies (small molecule inhibitors, antibody-drug conjugates, and CD19-directed therapies) have changed the treatment landscape of relapsed/refractory B-cell lymphomas. Bruton's tyrosine kinase (BTK) inhibitors continue to evolve in the management of mantle cell lymphoma (MCL), in both the relapsed/refractory and the frontline setting. Anti-CD19 CAR T-cell therapies are now effective and approved treatment options for relapsed/refractory follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), and MCL. Bispecific T-cell engagers represent a novel immunotherapeutic approach for relapsed FL and DLBCL after multiple lines of therapies, including prior CAR T-cell therapy. These NCCN Guideline Insights highlight the significant updates to the NCCN Guidelines for B-Cell Lymphomas for the treatment of FL, DLBCL, and MCL.
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Affiliation(s)
| | - Leo I Gordon
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Nancy L Bartlett
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | - Paolo F Caimi
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Beth Christian
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Sven DeVos
- UCLA Jonsson Comprehensive Cancer Center
| | | | - Luis E Fayad
- The University of Texas MD Anderson Cancer Center
| | | | - Muhammad Saad Hamid
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Boyu Hu
- Huntsman Cancer Institute at the University of Utah
| | | | | | | | | | | | | | - Megan Lim
- Memorial Sloan Kettering Cancer Center
| | | | | | | | | | | | | | | | | | - Jakub Svoboda
- Abramson Cancer Center at the University of Pennsylvania
| | - Lode J Swinnen
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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18
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Ababneh HS, Ng AK, Frigault MJ, Abramson JS, Johnson PC, Jacobson CA, Patel CG. Salvage radiotherapy in relapsed/refractory large B-cell lymphoma after failure of CAR T-cell therapy. Haematologica 2023; 108:2972-2981. [PMID: 37317884 PMCID: PMC10620597 DOI: 10.3324/haematol.2023.282804] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023] Open
Abstract
Despite the success of CD19-targeted chimeric antigen receptor (CAR T)-cell therapy in patients with relapsed/refractory large B-cell lymphoma (LBCL), there is a need for effective salvage strategies post-CAR T-cell therapy failure. We conducted a multi-institutional retrospective study of patients who relapsed following CAR T-cell therapy (axicabtagene ciloleucel [axi-cel] or tisagenlecleucel [tisa-cel]) and received salvage therapies (radiation therapy [RT] alone, systemic therapy alone, or combined modality therapy [CMT]). A total of 120 patients with post-CAR T relapsed LBCL received salvage therapies (RT alone, 25 patients; CMT, 15 patients; systemic therapy alone, 80 patients). The median follow-up from CAR T-cell infusion was 10.2 months (interquartile range, 5.2-20.9 months). Failure occurred in previously involved sites prior to CAR T-cell therapy in 78% of patients (n=93). A total of 93 sites were irradiated in 54 patients who received any salvage RT post-CAR T failure. The median dose/fractionation were 30 Gy (range, 4-50.4 Gy) and 10 fractions (range, 1-28 fractions). The 1-year local control rate for the 81 assessable sites was 84%. On univariate analysis, the median overall survival (OS) from the start date of RT was significantly higher among patients who received comprehensive RT versus focal RT (19.1 months vs. 3.0 months; P=<0.001). Twenty-three of 29 patients who received comprehensive RT had limited-stage disease. Among these, there was no difference in median OS among the patients who received RT alone versus those who received RT followed by additional therapies (log-rank P=0.2). On multivariate survival analysis, achieving PR or CR post-CAR T (hazard ratio =0.5; 95% confidence interval: 0.3-0.9; P=0.01) was independently associated with superior OS. Our findings suggest that RT can provide local control for LBCL relapsed post-CAR T-cell therapy, particularly in patients with limited-stage relapsed disease treated with comprehensive RT.
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Affiliation(s)
- Hazim S Ababneh
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Andrea K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston
| | - Matthew J Frigault
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jeremy S Abramson
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Patrick Connor Johnson
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Caron A Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Chirayu G Patel
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston.
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19
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Abramson JS. Tips on choosing a CAR T-cell therapy in DLBCL. Clin Adv Hematol Oncol 2023; 21:592-596. [PMID: 37948595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Jeremy S Abramson
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
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20
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Lakhotia R, Dunleavy K, Abramson JS, Link BK, Powell BL, Melani C, Lucas AN, Steinberg SM, Friedberg JW, Kahl BS, Little RF, Bartlett NL, Noy A, Wilson WH, Roschewski M. Prognostic factors for adult patients with Burkitt lymphoma treated with dose-adjusted EPOCH-R. Blood Adv 2023; 7:5320-5324. [PMID: 37389844 PMCID: PMC10506053 DOI: 10.1182/bloodadvances.2023010223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/15/2023] [Accepted: 06/04/2023] [Indexed: 07/01/2023] Open
Affiliation(s)
- Rahul Lakhotia
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Kieron Dunleavy
- Department of Hematology-Oncology, Georgetown University, Washington, DC
| | - Jeremy S. Abramson
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Brian K. Link
- Department of Medicine, University of Iowa, Iowa City, IA
| | - Bayard L. Powell
- Department of Internal Medicine-Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Christopher Melani
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Andrea N. Lucas
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Seth M. Steinberg
- Biostatistics and Data Management Section, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Brad S. Kahl
- Lymphoma Program, Washington University School of Medicine Siteman Cancer Center, St. Louis, MO
| | | | - Nancy L. Bartlett
- Lymphoma Program, Washington University School of Medicine Siteman Cancer Center, St. Louis, MO
| | - Ariela Noy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Wyndham H. Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Mark Roschewski
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
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21
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Musimar Z, Mpetani M, Abramson JS, Chabner BA, Mohamed Z. Diffuse Large B-Cell Lymphoma Treated With R-CHOP in a Resource-Limited Setting in South Africa: A Real-World Study. Oncologist 2023; 28:e756-e764. [PMID: 37053476 PMCID: PMC10485283 DOI: 10.1093/oncolo/oyad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/24/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin's lymphoma worldwide and particularly in Africa, where the incidence of HIV is the highest in the world. R-CHOP is the standard of care regimen for DLBCL, but access to rituximab is limited in developing countries. METHODS This is a retrospective cohort study that included all HIV-negative patients with DLBCL who received R-CHOP at a single institution from January 2012 to December 2017. Clinical and demographic data were collected to assess factors that influenced survival. RESULTS Seventy-three patients were included. Median age was 55 (17-76), 67.1% of patients were younger than 60 years, and 60.3% were female. Most presented with stages III/IV disease (53.5%) but with good performance status (56.% PS 0 and 1). Progression-free survival at 3 and 5 years was 75% and 69%, and overall survival at 3 and 5 years was 77% and 74%, respectively. Median survival had not been reached with a median follow-up of 3.5 years(0.13-7.9). Overall survival was significantly affected by performance status (P = .04), but not by IPI or age. Survival was significantly associated with response to chemotherapy after 4-5 cycles of R-CHOP (P = 0.005). CONCLUSIONS Treatment of DLBCL with R-CHOP is feasible and can achieve good outcomes in resource-limited settings with rituximab-based chemotherapy. Poor performance status was the most important adverse prognostic factor in this cohort of HIV-negative patients.
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Affiliation(s)
- Zola Musimar
- Radiation Oncology Department, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, Republic of South Africa
| | - Mtonga Mpetani
- Radiation Oncology Department, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, Republic of South Africa
| | - Jeremy S Abramson
- Massachusetts General Hospital Cancer Center and the POETIC Fellowship Exchange Program, Dana Faber, Harvard Cancer Center, Boston, MA, USA
| | - Bruce A Chabner
- Massachusetts General Hospital Cancer Center and the POETIC Fellowship Exchange Program, Dana Faber, Harvard Cancer Center, Boston, MA, USA
| | - Zainab Mohamed
- Radiation Oncology Department, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, Republic of South Africa
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22
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Neilan TG, Quinaglia T, Onoue T, Mahmood SS, Drobni ZD, Gilman HK, Smith A, Heemelaar JC, Brahmbhatt P, Ho JS, Sama S, Svoboda J, Neuberg DS, Abramson JS, Hochberg EP, Barnes JA, Armand P, Jacobsen ED, Jacobson CA, Kim AI, Soumerai JD, Han Y, Friedman RS, Lacasce AS, Ky B, Landsburg D, Nasta S, Kwong RY, Jerosch-Herold M, Redd RA, Hua L, Januzzi JL, Asnani A, Mousavi N, Scherrer-Crosbie M. Atorvastatin for Anthracycline-Associated Cardiac Dysfunction: The STOP-CA Randomized Clinical Trial. JAMA 2023; 330:528-536. [PMID: 37552303 PMCID: PMC10410476 DOI: 10.1001/jama.2023.11887] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/12/2023] [Indexed: 08/09/2023]
Abstract
Importance Anthracyclines treat a broad range of cancers. Basic and retrospective clinical data have suggested that use of atorvastatin may be associated with a reduction in cardiac dysfunction due to anthracycline use. Objective To test whether atorvastatin is associated with a reduction in the proportion of patients with lymphoma receiving anthracyclines who develop cardiac dysfunction. Design, Setting, and Participants Double-blind randomized clinical trial conducted at 9 academic medical centers in the US and Canada among 300 patients with lymphoma who were scheduled to receive anthracycline-based chemotherapy. Enrollment occurred between January 25, 2017, and September 10, 2021, with final follow-up on October 10, 2022. Interventions Participants were randomized to receive atorvastatin, 40 mg/d (n = 150), or placebo (n = 150) for 12 months. Main Outcomes and Measures The primary outcome was the proportion of participants with an absolute decline in left ventricular ejection fraction (LVEF) of ≥10% from prior to chemotherapy to a final value of <55% over 12 months. A secondary outcome was the proportion of participants with an absolute decline in LVEF of ≥5% from prior to chemotherapy to a final value of <55% over 12 months. Results Of the 300 participants randomized (mean age, 50 [SD, 17] years; 142 women [47%]), 286 (95%) completed the trial. Among the entire cohort, the baseline mean LVEF was 63% (SD, 4.6%) and the follow-up LVEF was 58% (SD, 5.7%). Study drug adherence was noted in 91% of participants. At 12-month follow-up, 46 (15%) had a decline in LVEF of 10% or greater from prior to chemotherapy to a final value of less than 55%. The incidence of the primary end point was 9% (13/150) in the atorvastatin group and 22% (33/150) in the placebo group (P = .002). The odds of a 10% or greater decline in LVEF to a final value of less than 55% after anthracycline treatment was almost 3 times greater for participants randomized to placebo compared with those randomized to atorvastatin (odds ratio, 2.9; 95% CI, 1.4-6.4). Compared with placebo, atorvastatin also reduced the incidence of the secondary end point (13% vs 29%; P = .001). There were 13 adjudicated heart failure events (4%) over 24 months of follow-up. There was no difference in the rates of incident heart failure between study groups (3% with atorvastatin, 6% with placebo; P = .26). The number of serious related adverse events was low and similar between groups. Conclusions and Relevance Among patients with lymphoma treated with anthracycline-based chemotherapy, atorvastatin reduced the incidence of cardiac dysfunction. This finding may support the use of atorvastatin in patients with lymphoma at high risk of cardiac dysfunction due to anthracycline use. Trial Registration ClinicalTrials.gov Identifier: NCT02943590.
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Affiliation(s)
- Tomas G. Neilan
- Cardiovascular Imaging Research Center, Division of Cardiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Thiago Quinaglia
- Cardiovascular Imaging Research Center, Division of Cardiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Takeshi Onoue
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Syed S. Mahmood
- Cardiovascular Imaging Research Center, Division of Cardiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Zsofia D. Drobni
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Hannah K. Gilman
- Cardiovascular Imaging Research Center, Division of Cardiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Amanda Smith
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Julius C. Heemelaar
- Cardiovascular Imaging Research Center, Division of Cardiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Priya Brahmbhatt
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Jor Sam Ho
- Cardiovascular Imaging Research Center, Division of Cardiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Supraja Sama
- Cardiovascular Imaging Research Center, Division of Cardiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jakub Svoboda
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia
| | - Donna S. Neuberg
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jeremy S. Abramson
- Division of Hematology-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ephraim P. Hochberg
- Division of Hematology-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jefferey A. Barnes
- Division of Hematology-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eric D. Jacobsen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Caron A. Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Austin I. Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jacob D. Soumerai
- Division of Hematology-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Yuchi Han
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Robb S. Friedman
- Division of Hematology-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ann S. Lacasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Bonnie Ky
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Dan Landsburg
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia
| | - Sunita Nasta
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia
| | - Raymond Y. Kwong
- Cardiology Division, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Robert A. Redd
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lanqi Hua
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston
| | - James L. Januzzi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
- Heart Failure Trials, Baim Institute for Clinical Research, Boston, Massachusetts
| | - Aarti Asnani
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Negareh Mousavi
- Division of Cardiology, McGill University Hospital, Montreal, Quebec, Canada
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Abramson JS. A new CAR takes a test drive in DLBCL. Blood 2023; 141:2410-2411. [PMID: 37200062 DOI: 10.1182/blood.2023020131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
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24
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Fitzpatrick MJ, Sundaram V, Ly A, Abramson JS, Balassanian R, Cheung MC, Cook SL, Falchi L, Frank AK, Gupta S, Hasserjian RP, Lin O, Long SR, Menke JR, Mou E, Reed DR, Ruiz-Cordero R, Volaric AK, Wang L, Wen KW, Xie Y, Zadeh SL, Gratzinger D. Small volume biopsy diagnostic yield at initial diagnosis versus recurrence/transformation of follicular lymphoma: A retrospective Cyto-Heme Interinstitutional Collaborative study. Cancer Cytopathol 2023; 131:279-288. [PMID: 36573933 PMCID: PMC10557381 DOI: 10.1002/cncy.22676] [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: 06/29/2022] [Revised: 09/28/2022] [Accepted: 11/01/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Few studies have evaluated diagnostic yield of small volume biopsies (SVB) for the diagnosis and management of follicular lymphoma (FL). METHODS The authors performed a multi-institutional retrospective analysis of SVBs including fine-needle aspiration (FNA) and needle core biopsy (NCB) for initial FL diagnosis and suspected recurrence or transformation of FL. A total of 676 workups beginning with SVB were assessed for the mean number of biopsies per workup, the proportion of workups requiring multiple biopsies, and the proportion with a complete diagnosis including grade, on initial biopsy. RESULTS Compared to workups performed for question transformation/recurrence, those done for initial FL diagnosis were significantly more likely to require multiple biopsies (p < .01), had a higher mean number of biopsies per workup (1.7 vs. 1.1, absolute standardized difference = 1.1), and a lower complete diagnosis rate at initial biopsy (39% vs. 56%). At initial FL diagnosis, NCB +/- FNA was associated with fewer biopsies per workup compared to FNA +/- CB (1.2 vs. 1.9), fewer workups requiring multiple biopsies (23% vs. 83%), and a higher complete diagnosis rate (71% vs. 18%). In contrast, during assessment for transformation/recurrence, NCB and FNA showed a similar mean number of biopsies per workup (1.2 vs. 1.2) and few workups required multiple biopsies (6% vs. 19%). CONCLUSIONS SVB at initial FL diagnosis often required additional biopsies to establish a complete diagnosis. In contrast, when assessing for transformed/recurrent FL, additional biopsies were generally not obtained regardless of SVB type, suggesting that in these clinical settings SVB may be sufficient for clinical decision-making.
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Affiliation(s)
- Megan J Fitzpatrick
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vandana Sundaram
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeremy S Abramson
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ronald Balassanian
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Matthew C Cheung
- Division of Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stephen L Cook
- Department of Laboratory Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Lorenzo Falchi
- Department of Hematology/Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Annabel K Frank
- Department of Hematology/Oncology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Srishti Gupta
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Steven R Long
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Joshua R Menke
- Department of Pathology, Stanford University Hospital, Stanford, California, USA
| | - Eric Mou
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, The University of Iowa, Iowa City, Iowa, USA
| | - Daniel R Reed
- Section on Hematology/Oncology, Wake Forest Baptist Health Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
| | - Roberto Ruiz-Cordero
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Ashley K Volaric
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
- Department of Pathology, Stanford University Hospital, Stanford, California, USA
| | - Linlin Wang
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Kwun Wah Wen
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Yi Xie
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Sara L Zadeh
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Dita Gratzinger
- Department of Pathology, Stanford University Hospital, Stanford, California, USA
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25
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Abramson JS, Solomon SR, Arnason J, Johnston PB, Glass B, Bachanova V, Ibrahimi S, Mielke S, Mutsaers P, Hernandez-Ilizaliturri F, Izutsu K, Morschhauser F, Lunning M, Crotta A, Montheard S, Previtali A, Ogasawara K, Kamdar M. Lisocabtagene maraleucel as second-line therapy for large B-cell lymphoma: primary analysis of the phase 3 TRANSFORM study. Blood 2023; 141:1675-1684. [PMID: 36542826 PMCID: PMC10646768 DOI: 10.1182/blood.2022018730] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [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: 10/24/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
This global phase 3 study compared lisocabtagene maraleucel (liso-cel) with a standard of care (SOC) as second-line therapy for primary refractory or early relapsed (≤12 months) large B-cell lymphoma (LBCL). Adults eligible for autologous stem cell transplantation (ASCT; N = 184) were randomly assigned in a 1:1 ratio to liso-cel (100 × 106 chimeric antigen receptor-positive T cells) or SOC (3 cycles of platinum-based immunochemotherapy followed by high-dose chemotherapy and ASCT in responders). The primary end point was event-free survival (EFS). In this primary analysis with a 17.5-month median follow-up, median EFS was not reached (NR) for liso-cel vs 2.4 months for SOC. Complete response (CR) rate was 74% for liso-cel vs 43% for SOC (P < .0001) and median progression-free survival (PFS) was NR for liso-cel vs 6.2 months for SOC (hazard ratio [HR] = 0.400; P < .0001). Median overall survival (OS) was NR for liso-cel vs 29.9 months for SOC (HR = 0.724; P = .0987). When adjusted for crossover from SOC to liso-cel, 18-month OS rates were 73% for liso-cel and 54% for SOC (HR = 0.415). Grade 3 cytokine release syndrome and neurological events occurred in 1% and 4% of patients in the liso-cel arm, respectively (no grade 4 or 5 events). These data show significant improvements in EFS, CR rate, and PFS for liso-cel compared with SOC and support liso-cel as a preferred second-line treatment compared with SOC in patients with primary refractory or early relapsed LBCL. This trial was registered at www.clinicaltrials.gov as #NCT03575351.
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Affiliation(s)
- Jeremy S. Abramson
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Harvard University, Boston, MA
| | - Scott R. Solomon
- Transplant and Cellular Immunotherapy Program, Northside Hospital Cancer Institute, Atlanta, GA
| | - Jon Arnason
- Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Bertram Glass
- Department of Hematology and Cell Therapy, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Sami Ibrahimi
- Transplant and Cellular Therapy Clinic, University of Oklahoma Stephenson Cancer Center, Oklahoma City, OK
| | - Stephan Mielke
- Departments of Laboratory Medicine and Medicine at Huddinge, Center of Allogeneic Stem Cell Transplantation and Cellular Therapy, Karolinska Institutet and University Hospital, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Pim Mutsaers
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Franck Morschhauser
- Centre Hospitalier Universitaire de Lille, Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Matthew Lunning
- Hematology/Oncology Division, University of Nebraska Medical Center, Omaha, NE
| | | | | | | | | | - Manali Kamdar
- Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado Cancer Center, Aurora, CO
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26
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Olson NE, Ragan SP, Reiss DJ, Thorpe J, Kim Y, Abramson JS, McCoy C, Newhall KJ, Fox BA. Exploration of Tumor Biopsy Gene Signatures to Understand the Role of the Tumor Microenvironment in Outcomes to Lisocabtagene Maraleucel. Mol Cancer Ther 2023; 22:406-418. [PMID: 36595660 PMCID: PMC9978882 DOI: 10.1158/1535-7163.mct-21-0506] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 12/17/2021] [Accepted: 12/21/2022] [Indexed: 01/05/2023]
Abstract
In the TRANSCEND NHL 001 study, 53% of patients with relapsed/refractory large B-cell lymphoma (LBCL) treated with lisocabtagene maraleucel (liso-cel) achieved a complete response (CR). To determine characteristics of patients who did and did not achieve a CR, we examined the tumor biology and microenvironment from lymph node tumor biopsies. LBCL biopsies from liso-cel-treated patients were taken pretreatment and ∼11 days posttreatment for RNA sequencing (RNA-seq) and multiplex immunofluorescence (mIF). We analyzed gene expression data from pretreatment biopsies (N = 78) to identify gene sets enriched in patients who achieved a CR to those with progressive disease. Pretreatment biopsies from month-3 CR patients displayed higher expression levels of T-cell and stroma-associated genes, and lower expression of cell-cycle genes. To interpret whether LBCL samples were "follicular lymphoma (FL)-like," we constructed an independent gene expression signature and found that patients with a higher "FL-like" gene expression score had longer progression-free survival (PFS). Cell of origin was not associated with response or PFS, but double-hit gene expression was associated with shorter PFS. The day 11 posttreatment samples (RNA-seq, N = 73; mIF, N = 53) had higher levels of chimeric antigen receptor (CAR) T-cell densities and CAR gene expression, general immune infiltration, and immune activation in patients with CR. Further, the majority of T cells in the day 11 samples were endogenous. Gene expression signatures in liso-cel-treated patients with LBCL can inform the development of combination therapies and next-generation CAR T-cell therapies.
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Affiliation(s)
| | | | | | | | | | - Jeremy S Abramson
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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27
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Thomas N, Dreval K, Gerhard DS, Hilton LK, Abramson JS, Ambinder RF, Barta S, Bartlett NL, Bethony J, Bhatia K, Bowen J, Bryan AC, Cesarman E, Casper C, Chadburn A, Cruz M, Dittmer DP, Dyer MA, Farinha P, Gastier-Foster JM, Gerrie AS, Grande BM, Greiner T, Griner NB, Gross TG, Harris NL, Irvin JD, Jaffe ES, Henry D, Huppi R, Leal FE, Lee MS, Martin JP, Martin MR, Mbulaiteye SM, Mitsuyasu R, Morris V, Mullighan CG, Mungall AJ, Mungall K, Mutyaba I, Nokta M, Namirembe C, Noy A, Ogwang MD, Omoding A, Orem J, Ott G, Petrello H, Pittaluga S, Phelan JD, Ramos JC, Ratner L, Reynolds SJ, Rubinstein PG, Sissolak G, Slack G, Soudi S, Swerdlow SH, Traverse-Glehen A, Wilson WH, Wong J, Yarchoan R, ZenKlusen JC, Marra MA, Staudt LM, Scott DW, Morin RD. Genetic subgroups inform on pathobiology in adult and pediatric Burkitt lymphoma. Blood 2023; 141:904-916. [PMID: 36201743 PMCID: PMC10023728 DOI: 10.1182/blood.2022016534] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [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: 03/31/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/20/2022] Open
Abstract
Burkitt lymphoma (BL) accounts for most pediatric non-Hodgkin lymphomas, being less common but significantly more lethal when diagnosed in adults. Much of the knowledge of the genetics of BL thus far has originated from the study of pediatric BL (pBL), leaving its relationship to adult BL (aBL) and other adult lymphomas not fully explored. We sought to more thoroughly identify the somatic changes that underlie lymphomagenesis in aBL and any molecular features that associate with clinical disparities within and between pBL and aBL. Through comprehensive whole-genome sequencing of 230 BL and 295 diffuse large B-cell lymphoma (DLBCL) tumors, we identified additional significantly mutated genes, including more genetic features that associate with tumor Epstein-Barr virus status, and unraveled new distinct subgroupings within BL and DLBCL with 3 predominantly comprising BLs: DGG-BL (DDX3X, GNA13, and GNAI2), IC-BL (ID3 and CCND3), and Q53-BL (quiet TP53). Each BL subgroup is characterized by combinations of common driver and noncoding mutations caused by aberrant somatic hypermutation. The largest subgroups of BL cases, IC-BL and DGG-BL, are further characterized by distinct biological and gene expression differences. IC-BL and DGG-BL and their prototypical genetic features (ID3 and TP53) had significant associations with patient outcomes that were different among aBL and pBL cohorts. These findings highlight shared pathogenesis between aBL and pBL, and establish genetic subtypes within BL that serve to delineate tumors with distinct molecular features, providing a new framework for epidemiologic, diagnostic, and therapeutic strategies.
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Affiliation(s)
- Nicole Thomas
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Kostiantyn Dreval
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Daniela S. Gerhard
- Office of Cancer Genomics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Laura K. Hilton
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Jeremy S. Abramson
- Center for Lymphoma, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Richard F. Ambinder
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stefan Barta
- University of Pennsylvania Hospital, Philadelphia, PA
| | - Nancy L. Bartlett
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey Bethony
- Department of Microbiology, Immunology, and Tropical Medicine, George Washington University, Washington, DC
| | | | - Jay Bowen
- Biopathology Center, Nationwide Children's Hospital, Columbus, OH
| | - Anthony C. Bryan
- Biopathology Center, Nationwide Children's Hospital, Columbus, OH
| | - Ethel Cesarman
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, Cornell University, New York, NY
| | - Corey Casper
- Infectious Disease Research Institute, Seattle, WA
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Manuela Cruz
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Dirk P. Dittmer
- Lineberger Comprehensive Cancer Center and Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Maureen A. Dyer
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD
| | - Pedro Farinha
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Julie M. Gastier-Foster
- Biopathology Center, Nationwide Children's Hospital, Columbus, OH
- Departments of Pathology and Pediatrics, The Ohio State University, Columbus, OH
| | - Alina S. Gerrie
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | | | - Timothy Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Nicholas B. Griner
- Office of Cancer Genomics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Thomas G. Gross
- Center for Global Health, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Nancy L. Harris
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - John D. Irvin
- Foundation for Burkitt Lymphoma Research, Geneva, Switzerland
| | - Elaine S. Jaffe
- Laboratory of Pathology, Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - David Henry
- University of Pennsylvania Hospital, Philadelphia, PA
| | - Rebecca Huppi
- Office of HIV/AIDS Malignancies, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Fabio E. Leal
- Programa de Oncovirologia, Instituto Nacional de Cancer Jose de Alencar, Rio de Janeiro, Brazil
| | - Michael S. Lee
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Sam M. Mbulaiteye
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Ronald Mitsuyasu
- Center for Clinical AIDS Research and Education, University of California Los Angeles, Los Angeles, CA
| | - Vivian Morris
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | | | - Andrew J. Mungall
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Karen Mungall
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | | | - Mostafa Nokta
- Office of HIV/AIDS Malignancies, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Ariela Noy
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | | | | | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus and Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - Hilary Petrello
- Biopathology Center, Nationwide Children's Hospital, Columbus, OH
| | - Stefania Pittaluga
- Laboratory of Pathology, Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - James D. Phelan
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Juan Carlos Ramos
- Department of Medicine, Division of Hematology, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Lee Ratner
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Steven J. Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Paul G. Rubinstein
- Section of Hematology/Oncology, John H. Stroger Jr Hospital of Cook County, Chicago, IL
| | - Gerhard Sissolak
- Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa
| | - Graham Slack
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Shaghayegh Soudi
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Steven H. Swerdlow
- Division of Hematopathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Alexandra Traverse-Glehen
- Hospices Civils de Lyon, Université Lyon 1, Service d'Anatomie Pathologique, Hopital Lyon Sud France
| | - Wyndham H. Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Jasper Wong
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Robert Yarchoan
- Office of HIV/AIDS Malignancies, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jean C. ZenKlusen
- The Cancer Genome Atlas, Center for Cancer Genomics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Marco A. Marra
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Louis M. Staudt
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - David W. Scott
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Ryan D. Morin
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
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28
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Ryan CE, Brander DM, Barr PM, Tyekucheva S, Hackett LR, Collins MC, Fernandes SM, Ren Y, Zhou Y, McDonough MM, Walker HA, McEwan MR, Abramson JS, Jacobsen ED, LaCasce AS, Fisher DC, Brown JR, Davids MS. A phase 1b study of ibrutinib in combination with obinutuzumab in patients with relapsed or refractory chronic lymphocytic leukemia. Leukemia 2023; 37:835-842. [PMID: 36717653 DOI: 10.1038/s41375-023-01830-2] [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: 09/06/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/31/2023]
Abstract
This study investigated ibrutinib plus obinutuzumab in relapsed/refractory CLL, evaluating tolerability of 3 sequencing regimens as well as overall safety and efficacy. Fifty-two patients were initially randomized 1:1:1 to receive either obinutuzumab 1 month before ibrutinib initiation, ibrutinib 1 month prior to obinutuzumab initiation, or to start both drugs concomitantly. Higher rates of infusion-related reactions were observed with the first sequence, and only the latter 2 cohorts were expanded. Grade 4 hematologic toxicity was uncommon, and notable all-grade non-hematologic toxicities included bruising (58%), hypertension (46%), arthralgia (38%), diarrhea (37%), transaminitis (35%), atrial fibrillation (21%), and serious infection (17%). Best overall response rate was 96% (including 40% CR and 56% PR). Best rates of undetectable minimal residual disease in peripheral blood and bone marrow were 27% and 19%, respectively. With a median follow-up of 41.5 months, four-year progression-free and overall survival rates are 74% and 93%, respectively. Correlative studies demonstrated that serum CCL4 and CXCL13 levels were associated with clinical response, and BH3 profiling revealed increased BCL-2 and BCL-xL dependence in CLL cells from patients on treatment. Overall, ibrutinib plus obinutuzumab was highly active, with a manageable safety profile, supporting further investigation of this type of approach in relapsed/refractory CLL.
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Affiliation(s)
- Christine E Ryan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Danielle M Brander
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA
| | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Liam R Hackett
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mary C Collins
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Stacey M Fernandes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yue Ren
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yinglu Zhou
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mikaela M McDonough
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Heather A Walker
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Monica R McEwan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jeremy S Abramson
- Center for Lymphoma, Massachusetts General Hospital, Boston, MA, USA
| | - Eric D Jacobsen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ann S LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - David C Fisher
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer R Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Matthew S Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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29
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Sermer D, Elavalakanar P, Abramson JS, Palomba ML, Salles G, Arnason J. Targeting CD19 for diffuse large B cell lymphoma in the era of CARs: Other modes of transportation. Blood Rev 2023; 57:101002. [PMID: 35989138 DOI: 10.1016/j.blre.2022.101002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 01/28/2023]
Abstract
CD19 is nearly ubiquitously expressed on B-lymphocytes and in B-cell malignancies. Although CD19-directed CAR T cells have greatly improved outcomes in B-cell malignancies, there are significant limitations with this therapy. CD19 can also be effectively targeted by other drug classes, such as monoclonal antibodies, antibody-drug conjugates, and bispecific T cell engagers or antibodies. However, the optimal patient selection and sequencing of these novel therapies has not yet been established. In this review, we discuss the utilization of CD19 as a target for the treatment of DLBCL, focusing on tafasitamab, loncastuximab tesirine, and blinatumomab. We provide a comprehensive review of the pivotal clinical trials, discussing the strength and limitations of the data for each agent. We explore the emerging evidence that CD19 expression is retained following exposure to these agents and that patients can be successfully re-challenged with anti-CD19 therapies of a different drug class upon disease relapse post-CAR T cells. Finally, we discuss how these drugs potentially fit into the most current treatment paradigm for DLBCL.
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Affiliation(s)
- David Sermer
- Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | | | - Jeremy S Abramson
- Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - M Lia Palomba
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Weill-Cornell Medical College, New York, NY, USA
| | - Gilles Salles
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Weill-Cornell Medical College, New York, NY, USA
| | - Jon Arnason
- Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Soumerai JD, Rosenthal A, Harkins S, Duffy J, Mecca C, Wang Y, Grewal RK, El-Jawahri AR, Liu H, Menard C, Dogan A, Yang L, Rimsza LM, Bantilan K, Martin H, Lei M, Mohr S, Kurilovich A, Kudryashova O, Postovalova E, Nardi V, Abramson JS, Chiarle R, Zelenetz AD, Louissaint A. Next-generation ALK inhibitors are highly active in ALK-positive large B-cell lymphoma. Blood 2022; 140:1822-1826. [PMID: 35802834 PMCID: PMC9837428 DOI: 10.1182/blood.2022015443] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/29/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
| | | | | | - Jessica Duffy
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | - Yingbing Wang
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | | | - Huiyun Liu
- Dana Farber Cancer Institute, Boston, MA
| | - Cedric Menard
- Massachusetts General Hospital Cancer Center, Boston, MA
| | - Ahmet Dogan
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Lei Yang
- Dana Farber Cancer Institute, Boston, MA
| | | | - Kurt Bantilan
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Haley Martin
- Massachusetts General Hospital Cancer Center, Boston, MA
| | - Matthew Lei
- Massachusetts General Hospital Cancer Center, Boston, MA
| | - Sydney Mohr
- Massachusetts General Hospital Cancer Center, Boston, MA
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Soumerai JD, Takvorian RW, Sohani AR, Abramson JS, Ferry JA. Venetoclax activity in a patient with central nervous system involvement by chronic lymphocytic leukaemia. Lancet Haematol 2022; 9:e796. [PMID: 36174642 DOI: 10.1016/s2352-3026(22)00098-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/09/2022] [Accepted: 03/14/2022] [Indexed: 06/16/2023]
Affiliation(s)
| | | | - Aliyah R Sohani
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | - Judith A Ferry
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
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Abramson JS. Choosing a CAR for Relapsed/Refractory Large B-cell Lymphoma. Transplant Cell Ther 2022; 28:621-622. [DOI: 10.1016/j.jtct.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gongora CA, Drobni ZD, Quinaglia Araujo Costa Silva T, Zafar A, Gong J, Zlotoff DA, Gilman HK, Hartmann SE, Sama S, Nikolaidou S, Suero-Abreu GA, Jacobsen E, Abramson JS, Hochberg E, Barnes J, Armand P, Thavendiranathan P, Nohria A, Neilan TG. Sodium-Glucose Co-Transporter-2 Inhibitors and Cardiac Outcomes Among Patients Treated With Anthracyclines. JACC Heart Fail 2022; 10:559-567. [PMID: 35902159 PMCID: PMC9638993 DOI: 10.1016/j.jchf.2022.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [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: 12/08/2021] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 05/15/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors improve outcomes among patients with established heart failure. Despite supportive basic science studies, there are no data on the value of SGLT2 inhibitors among patients treated with anthracyclines. OBJECTIVES This study sought to test the cardiac efficacy and overall safety of SGLT2 inhibitors in patients treated with anthracyclines. METHODS This study identified 3,033 patients with diabetes mellitus (DM) and cancer who were treated with anthracyclines. Cases were patients with cancer and DM who were on SGLT2 inhibitor therapy during anthracycline treatment (n = 32). Control participants (n = 96) were patients with cancer and DM who were also treated with anthracyclines, but were not on an SGLT2 inhibitor. The primary cardiac outcome was a composite of cardiac events (heart failure incidence, heart failure admissions, new cardiomyopathy [>10% decline in ejection fraction to <53%], and clinically significant arrhythmias). The primary safety outcome was overall mortality. RESULTS Age, sex, ethnicity, cancer type, cancer stage, and other cardiac risk factors were similar between groups. There were 20 cardiac events over a median follow-up period of 1.5 years. The cardiac event incidence was lower among case patients in comparison to control participants (3% vs 20%; P = 0.025). Case patients also experienced lower overall mortality when compared with control participants (9% vs 43%; P < 0.001) and a lower composite of sepsis and neutropenic fever (16% vs 40%; P = 0.013). CONCLUSIONS SGLT2 inhibitors were associated with lower rate of cardiac events among patients with cancer and DM who were treated with anthracyclines. Additionally, SGLT2 inhibitors appeared to be safe. These data support the conducting of a randomized clinical trial testing SGLT2 inhibitors in patients at high cardiac risk treated with anthracyclines.
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Affiliation(s)
- Carlos A Gongora
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zsofia D Drobni
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Amna Zafar
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jingyi Gong
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel A Zlotoff
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hannah K Gilman
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah E Hartmann
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Supraja Sama
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sofia Nikolaidou
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Eric Jacobsen
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jeremy S Abramson
- Center for Lymphoma, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ephraim Hochberg
- Center for Lymphoma, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey Barnes
- Center for Lymphoma, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Philippe Armand
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Anju Nohria
- Department of Cardiology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tomas G Neilan
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Blum KA, Supko JG, Maris MB, Flinn IW, Goy A, Younes A, Bobba S, Senderowicz AM, Efuni S, Rippley R, Colak G, Trojer P, Abramson JS. A Phase I Study of Pelabresib (CPI-0610), a Small-Molecule Inhibitor of BET Proteins, in Patients with Relapsed or Refractory Lymphoma. Cancer Res Commun 2022; 2:795-805. [PMID: 36923307 PMCID: PMC10010313 DOI: 10.1158/2767-9764.crc-22-0060] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/15/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022]
Abstract
Purpose NF-κB, a transcription factor essential for inflammatory responses, is constitutively activated in many lymphomas. In preclinical studies, pelabresib (CPI-0610), an investigational (BET) bromodomain inhibitor, downregulated NF-κB signaling and demonstrated antitumor activity in vitro. Here we report the safety, pharmacokinetics, pharmacodynamics, and preliminary clinical activity from the first-in-human phase I study of pelabresib in patients with relapsed/refractory lymphomas (NCT01949883). Experimental Design Sixty-four patients with relapsed/refractory lymphoma (median of 4 prior lines of therapy) were treated with either capsule (6, 12, 24, 48, 80, 120, 170, 230, 300 mg) or tablet (125, 225 mg) doses of pelabresib orally once daily on a 14 days on, 7 days off schedule. Results The MTD was determined as the 225 mg tablet daily. The most frequent adverse events were fatigue, nausea, and decreased appetite. Thrombocytopenia, a class effect for all BET inhibitors, was dose-dependent, reversible, and noncumulative. Pelabresib exhibited dose-proportional increases in systemic exposure, rapid absorption, and a half-life of approximately 15 hours (supporting once daily dosing). The bioavailability of the tablet formulation was 60% greater than the capsules. Pelabresib suppressed IL8 and CCR1 mRNA at doses above 120 and 170 mg, respectively. Four patients (6.2%) had an objective response (2 complete response and 2 partial response) and 5 patients had prolonged stable disease. Conclusions/Discussion Pelabresib is capable of BET target gene suppression in an exposure-dependent manner with an acceptable safety profile leading to the recommended phase II dose of the 125 mg tablet once daily. Significance BET proteins inhibition can potentially modify the pathogenic pathways which contribute to many diseases including malignancies. Pelabresib (CPI-0610), a potent and selective small molecule BET proteins inhibitor, has a MTD of 225 mg once daily for 14 days with a 7-day break, clear pharmacokinetic/pharmacodynamic relationship, and manageable clinical safety profile. These findings are part of the foundation for the ongoing pivotal study of pelabresib in patients with myelofibrosis.
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Affiliation(s)
| | | | | | - Ian W Flinn
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, Tennessee
| | - Andre Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Anas Younes
- Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Suresh Bobba
- Constellation Pharmaceuticals (a Morphosys Company), Boston, Massachusetts
| | | | - Sergey Efuni
- Constellation Pharmaceuticals (a Morphosys Company), Boston, Massachusetts
| | - Ronda Rippley
- Constellation Pharmaceuticals (a Morphosys Company), Boston, Massachusetts
| | - Gozde Colak
- Constellation Pharmaceuticals (a Morphosys Company), Boston, Massachusetts
| | - Patrick Trojer
- Constellation Pharmaceuticals (a Morphosys Company), Boston, Massachusetts
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Ansell SM, Radford J, Connors JM, Długosz-Danecka M, Kim WS, Gallamini A, Ramchandren R, Friedberg JW, Advani R, Hutchings M, Evens AM, Smolewski P, Savage KJ, Bartlett NL, Eom HS, Abramson JS, Dong C, Campana F, Fenton K, Puhlmann M, Straus DJ. Overall Survival with Brentuximab Vedotin in Stage III or IV Hodgkin's Lymphoma. N Engl J Med 2022; 387:310-320. [PMID: 35830649 DOI: 10.1056/nejmoa2206125] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Five-year follow-up in a trial involving patients with previously untreated stage III or IV classic Hodgkin's lymphoma showed long-term progression-free survival benefits with first-line therapy with brentuximab vedotin, a CD30-directed antibody-drug conjugate, plus doxorubicin, vinblastine, and dacarbazine (A+AVD), as compared with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). A planned interim analysis indicated a potential benefit with regard to overall survival; data from a median of 6 years of follow-up are now available. METHODS We randomly assigned patients in a 1:1 ratio to receive up to six cycles of A+AVD or ABVD. The primary end point, modified progression-free survival, has been reported previously. The key secondary end point was overall survival in the intention-to-treat population. Safety was also assessed. RESULTS A total of 664 patients were assigned to receive A+AVD and 670 to receive ABVD. At a median follow-up of 73.0 months, 39 patients in the A+AVD group and 64 in the ABVD group had died (hazard ratio, 0.59; 95% confidence interval [CI], 0.40 to 0.88; P = 0.009). The 6-year overall survival estimates were 93.9% (95% CI, 91.6 to 95.5) in the A+AVD group and 89.4% (95% CI, 86.6 to 91.7) in the ABVD group. Progression-free survival was longer with A+AVD than with ABVD (hazard ratio for disease progression or death, 0.68; 95% CI, 0.53 to 0.86). Fewer patients in the A+AVD group than in the ABVD group received subsequent therapy, including transplantation, and fewer second cancers were reported with A+AVD (in 23 vs. 32 patients). Primary prophylaxis with granulocyte colony-stimulating factor was recommended after an increased incidence of febrile neutropenia was observed with A+AVD. More patients had peripheral neuropathy with A+AVD than with ABVD, but most patients in the two groups had resolution or amelioration of the event by the last follow-up. CONCLUSIONS Patients who received A+AVD for the treatment of stage III or IV Hodgkin's lymphoma had a survival advantage over those who received ABVD. (Funded by Takeda Development Center Americas and Seagen; ECHELON-1 ClinicalTrials.gov number, NCT01712490; EudraCT number, 2011-005450-60.).
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Affiliation(s)
- Stephen M Ansell
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - John Radford
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Joseph M Connors
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Monika Długosz-Danecka
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Won-Seog Kim
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Andrea Gallamini
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Radhakrishnan Ramchandren
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Jonathan W Friedberg
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Ranjana Advani
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Martin Hutchings
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Andrew M Evens
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Piotr Smolewski
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Kerry J Savage
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Nancy L Bartlett
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Hyeon-Seok Eom
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Jeremy S Abramson
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Cassie Dong
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Frank Campana
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Keenan Fenton
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - Markus Puhlmann
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
| | - David J Straus
- From the Division of Hematology, Mayo Clinic, Rochester, MN (S.M.A.); the University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (J.R.); BC Cancer Centre for Lymphoid Cancer, Vancouver (J.M.C., K.J.S.); Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (M.D.-D.), and the Department of Experimental Hematology, Medical University of Lodz, Lodz (P.S.) - both in Poland; the Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (W.-S.K.), and the Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang (H.-S.E.) - both in South Korea; Research and Innovation Department, Antoine-Lacassagne Cancer Center, Nice, France (A.G.); the University of Tennessee Graduate School of Medicine, Knoxville (R.R.); Wilmot Cancer Institute, University of Rochester, Rochester (J.W.F.), and the Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York (D.J.S.) - both in New York; the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (R.A.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (M.H.); the Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick (A.M.E.); Washington University School of Medicine Siteman Cancer Center, St. Louis (N.L.B.); Massachusetts General Hospital, Boston (J.S.A.), and Takeda Development Center Americas, Lexington (C.D., F.C.) - both in Massachusetts; and Seagen, Bothell, WA (K.F., M.P.)
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Erika Haydu J, Abramson JS. CAR T-cells in relapsed Burkitt lymphoma – a promising test drive in a rare disease. Leuk Lymphoma 2022; 63:2263-2264. [DOI: 10.1080/10428194.2022.2102625] [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: 10/17/2022]
Affiliation(s)
- J. Erika Haydu
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Jeremy S. Abramson
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
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Kamdar M, Solomon SR, Arnason J, Johnston PB, Glass B, Bachanova V, Ibrahimi S, Mielke S, Mutsaers P, Hernandez-Ilizaliturri F, Izutsu K, Morschhauser F, Lunning M, Maloney DG, Crotta A, Montheard S, Previtali A, Stepan L, Ogasawara K, Mack T, Abramson JS. Lisocabtagene maraleucel versus standard of care with salvage chemotherapy followed by autologous stem cell transplantation as second-line treatment in patients with relapsed or refractory large B-cell lymphoma (TRANSFORM): results from an interim analysis of an open-label, randomised, phase 3 trial. Lancet 2022; 399:2294-2308. [PMID: 35717989 DOI: 10.1016/s0140-6736(22)00662-6] [Citation(s) in RCA: 243] [Impact Index Per Article: 121.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/29/2022] [Accepted: 04/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with large B-cell lymphoma (LBCL) primary refractory to or relapsed within 12 months of first-line therapy are at high risk for poor outcomes with current standard of care, platinum-based salvage immunochemotherapy and autologous haematopoietic stem cell transplantation (HSCT). Lisocabtagene maraleucel (liso-cel), an autologous, CD19-directed chimeric antigen receptor (CAR) T-cell therapy, has previously demonstrated efficacy and manageable safety in third-line or later LBCL. In this Article, we report a prespecified interim analysis of liso-cel versus standard of care as second-line treatment for primary refractory or early relapsed (within 12 months after response to initial therapy) LBCL. METHODS TRANSFORM is a global, phase 3 study, conducted in 47 sites in the USA, Europe, and Japan, comparing liso-cel with standard of care as second-line therapy in patients with primary refractory or early (≤12 months) relapsed LBCL. Adults aged 18-75 years, Eastern Cooperative Oncology Group performance status score of 1 or less, adequate organ function, PET-positive disease per Lugano 2014 criteria, and candidates for autologous HSCT were randomly assigned (1:1), by use of interactive response technology, to liso-cel (100 × 106 CAR+ T cells intravenously) or standard of care. Standard of care consisted of three cycles of salvage immunochemotherapy delivered intravenously-R-DHAP (rituximab 375 mg/m2 on day 1, dexamethasone 40 mg on days 1-4, two infusions of cytarabine 2000 mg/m2 on day 2, and cisplatin 100 mg/m2 on day 1), R-ICE (rituximab 375 mg/m2 on day 1, ifosfamide 5000 mg/m2 on day 2, etoposide 100 mg/m2 on days 1-3, and carboplatin area under the curve 5 [maximum dose of 800 mg] on day 2), or R-GDP (rituximab 375 mg/m2 on day 1, dexamethasone 40 mg on days 1-4, gemcitabine 1000 mg/m2 on days 1 and 8, and cisplatin 75 mg/m2 on day 1)-followed by high-dose chemotherapy and autologous HSCT in responders. Primary endpoint was event-free survival, with response assessments by an independent review committee per Lugano 2014 criteria. Efficacy was assessed per intention-to-treat (ie, all randomly assigned patients) and safety in patients who received any treatment. This trial is registered with ClinicalTrials.gov, NCT03575351, and is ongoing. FINDINGS Between Oct 23, 2018, and Dec 8, 2020, 232 patients were screened and 184 were assigned to the liso-cel (n=92) or standard of care (n=92) groups. At the data cutoff for this interim analysis, March 8, 2021, the median follow-up was 6·2 months (IQR 4·4-11·5). Median event-free survival was significantly improved in the liso-cel group (10·1 months [95% CI 6·1-not reached]) compared with the standard-of-care group (2·3 months [2·2-4·3]; stratified hazard ratio 0·35; 95% CI 0·23-0·53; stratified Cox proportional hazards model one-sided p<0·0001). The most common grade 3 or worse adverse events were neutropenia (74 [80%] of 92 patients in the liso-cel group vs 46 [51%] of 91 patients in the standard-of-care group), anaemia (45 [49%] vs 45 [49%]), thrombocytopenia (45 [49%] vs 58 [64%]), and prolonged cytopenia (40 [43%] vs three [3%]). Grade 3 cytokine release syndrome and neurological events, which are associated with CAR T-cell therapy, occurred in one (1%) and four (4%) of 92 patients in the liso-cel group, respectively (no grade 4 or 5 events). Serious treatment-emergent adverse events were reported in 44 (48%) patients in the liso-cel group and 44 (48%) in the standard-of-care group. No new liso-cel safety concerns were identified in the second-line setting. There were no treatment-related deaths in the liso-cel group and one treatment-related death due to sepsis in the standard-of-care group. INTERPRETATION These results support liso-cel as a new second-line treatment recommendation in patients with early relapsed or refractory LBCL. FUNDING Celgene, a Bristol-Myers Squibb Company.
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Affiliation(s)
- Manali Kamdar
- Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado Cancer Center, Aurora, CO, USA.
| | - Scott R Solomon
- Transplant and Cellular Immunotherapy Program, Northside Hospital Cancer Institute, Atlanta, GA, USA
| | - Jon Arnason
- Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Bertram Glass
- Department of Hematology and Cell Therapy, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Sami Ibrahimi
- Transplant and Cellular Therapy Clinic, University of Oklahoma Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Stephan Mielke
- Departments of Laboratory Medicine and Medicine at Huddinge, Center of Allogeneic Stem Cell Transplantation and Cellular Therapy (CAST), Karolinska Institutet and University Hospital, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Pim Mutsaers
- Department of Hematology, Erasmus University Medical Center, Rotterdam, Netherlands, on behalf of HOVON/LLPC
| | | | - Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Franck Morschhauser
- Département d'Hématologie, Université de Lille, Centre Hospitalier Universitaire de Lille, Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Matthew Lunning
- Hematology/Oncology Division, University of Nebraska Medical Center, Omaha, NE, USA
| | - David G Maloney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | | | - Lara Stepan
- Bristol Myers Squibb, Lawrence Township, NJ, USA
| | | | - Timothy Mack
- Bristol Myers Squibb, Lawrence Township, NJ, USA
| | - Jeremy S Abramson
- Lymphoma Program, Massachusetts General Hospital Cancer Center, Boston, MA, USA
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Ansell SM, Connors JM, Radford JA, Kim WS, Gallamini A, Ramchandren R, Friedberg JW, Advani RH, Hutchings M, Evens AM, Smolewski P, Savage KJ, Bartlett NL, Eom HS, Abramson JS, Dong C, Campana F, Fenton K, Puhlmann M, Straus DJ. First-line brentuximab vedotin plus chemotherapy to improve overall survival in patients with stage III/IV classical Hodgkin lymphoma: An updated analysis of ECHELON-1. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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
7503 Background: To date, an overall survival (OS) benefit from upfront treatment for new treatment combinations over existing approaches has rarely been shown in first-line classical Hodgkin lymphoma (cHL). With the introduction of newer active therapies for relapsed/refractory disease, demonstration of improved OS with first-line therapy has been challenging. In ECHELON-1 (NCT01712490), 5-year follow-up analyses supported the long-term progression-free survival (PFS) benefit with first-line brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A+AVD) vs doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in patients (pts) with stage III/IV cHL, independent of interim positron emission tomography status. A+AVD had a manageable long-term safety profile, with numerically fewer second malignancies and a greater number of pregnancies reported vs ABVD (Connors et al, NEJM 2018; Straus et al, Lancet Haematol 2021). We report a prespecified OS analysis after approximately 6 years’ follow-up (cut-off, June 1, 2021). Methods: Pts were randomized 1:1 to receive up to 6 cycles of A+AVD (n = 664) or ABVD (n = 670) on day 1 and 15 every 28 days. OS was the key secondary endpoint and was an event-driven, pre-specified, alpha-controlled analysis in the intention to treat population. Results: At a median follow-up of 73 months, 39 and 64 OS events occurred in A+AVD and ABVD arms, respectively: OS significantly favored A+AVD vs ABVD (HR 0.590; 95% confidence interval [CI] 0.396–0.879; p = 0.009). Estimated 6-year OS rates (95% CI) were 93.9% (91.6–95.5) vs 89.4% (86.6–91.7) with A+AVD vs ABVD, respectively. There was a consistent OS benefit for A+AVD vs ABVD across prespecified subgroups. The 6-year PFS estimate was 82.3% (79.1–85.0) vs 74.5% (70.8–77.7) with A+AVD vs ABVD, respectively (HR 0.678 [95% CI 0.532–0.863]). Overall, A+AVD had a comparable long-term safety profile to ABVD. Treatment-emergent peripheral neuropathy continued to resolve or improve in both arms, with 86% (379/443) and 87% (249/286) of cases in the A+AVD and ABVD arms either completely resolving (72% vs 79%) or improving (14% vs 8%) by last follow-up. Fewer second malignancies were reported in the A+AVD vs ABVD arm (23 vs 32). More female patients reported pregnancy (49 vs 28) or live births (42 vs 19 in females) in the A+AVD vs the ABVD arm; no stillbirths were reported. No new safety signals were identified. Conclusions: A+AVD treatment resulted in a statistically significant 41% reduction in the risk of death vs ABVD, with a manageable safety profile consistent with prior reports. These outcomes confirm A+AVD as a preferred option for pts with previously untreated stage III/IV cHL. Clinical trial information: NCT01712490.
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Affiliation(s)
| | - Joseph M. Connors
- BC Cancer Centre for Lymphoid Cancer and Department of Medical Oncology, Vancouver, BC, Canada
| | - John A. Radford
- University of Manchester, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Andrea Gallamini
- Research Innovation and Statistics, Antoine-Lacassagne Cancer Centre, Nice, France
| | | | - Jonathan W. Friedberg
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Ranjana H. Advani
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA
| | - Martin Hutchings
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andrew M. Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Piotr Smolewski
- Department of Experimental Hematology, Medical University of Lodz, Lodz, Poland
| | - Kerry J. Savage
- BC Cancer Centre for Lymphoid Cancer and Department of Medical Oncology, Vancouver, BC, Canada
| | - Nancy L. Bartlett
- Washington University School of Medicine Siteman Cancer Center, St. Louis, MO
| | - Hyeon Seok Eom
- Center for Hematologic Malignancy, National Cancer Center, Goyang, South Korea
| | | | - Cassie Dong
- Takeda Development Center Americas, Inc. (TDCA), Lexington, MA
| | - Frank Campana
- Takeda Development Center Americas, Inc. (TDCA), Lexington, MA
| | | | | | - David J. Straus
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
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Wierda WG, Brown J, Abramson JS, Awan F, Bilgrami SF, Bociek G, Brander D, Chanan-Khan AA, Coutre SE, Davis RS, Eradat H, Fletcher CD, Gaballa S, Ghobadi A, Hamid MS, Hernandez-Ilizaliturri F, Hill B, Kaesberg P, Kamdar M, Kaplan LD, Khan N, Kipps TJ, Ma S, Mato A, Mosse C, Schuster S, Siddiqi T, Stephens DM, Ujjani C, Wagner-Johnston N, Woyach JA, Ye JC, Dwyer MA, Sundar H. NCCN Guidelines® Insights: Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma, Version 3.2022. J Natl Compr Canc Netw 2022; 20:622-634. [PMID: 35714675 DOI: 10.6004/jnccn.2022.0031] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The treatment landscape of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) has significantly evolved in recent years. Targeted therapy with Bruton's tyrosine kinase (BTK) inhibitors and BCL-2 inhibitors has emerged as an effective chemotherapy-free option for patients with previously untreated or relapsed/refractory CLL/SLL. Undetectable minimal residual disease after the end of treatment is emerging as an important predictor of progression-free and overall survival for patients treated with fixed-duration BCL-2 inhibitor-based treatment. These NCCN Guidelines Insights discuss the updates to the NCCN Guidelines for CLL/SLL specific to the use of chemotherapy-free treatment options for patients with treatment-naïve and relapsed/refractory disease.
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Affiliation(s)
| | | | | | - Farrukh Awan
- UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | | | | | | | | | | | | | - Armin Ghobadi
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Muhammad Saad Hamid
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Brian Hill
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | - Shuo Ma
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | - Chaitra Ujjani
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Jennifer A Woyach
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
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Dougan M, Anderson MA, Abramson JS, Fitzpatrick MJ. Case 14-2022: A 57-Year-Old Man with Chylous Ascites. N Engl J Med 2022; 386:1834-1844. [PMID: 35544390 DOI: 10.1056/nejmcpc2115856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Michael Dougan
- From the Departments of Medicine (M.D., J.S.A.), Radiology (M.A.A.), and Pathology (M.J.F.), Massachusetts General Hospital, and the Departments of Medicine (M.D., J.S.A.), Radiology (M.A.A.), and Pathology (M.J.F.), Harvard Medical School - both in Boston
| | - Mark A Anderson
- From the Departments of Medicine (M.D., J.S.A.), Radiology (M.A.A.), and Pathology (M.J.F.), Massachusetts General Hospital, and the Departments of Medicine (M.D., J.S.A.), Radiology (M.A.A.), and Pathology (M.J.F.), Harvard Medical School - both in Boston
| | - Jeremy S Abramson
- From the Departments of Medicine (M.D., J.S.A.), Radiology (M.A.A.), and Pathology (M.J.F.), Massachusetts General Hospital, and the Departments of Medicine (M.D., J.S.A.), Radiology (M.A.A.), and Pathology (M.J.F.), Harvard Medical School - both in Boston
| | - Megan J Fitzpatrick
- From the Departments of Medicine (M.D., J.S.A.), Radiology (M.A.A.), and Pathology (M.J.F.), Massachusetts General Hospital, and the Departments of Medicine (M.D., J.S.A.), Radiology (M.A.A.), and Pathology (M.J.F.), Harvard Medical School - both in Boston
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Bennani NN, Tun AM, Carson KR, Geiger JL, Maeda LS, Savage KJ, Rose J, Pinter-Brown L, Lunning MA, Abramson JS, Bartlett NL, Vose JM, Evens AM, Smith SM, Horwitz SM, Ansell SM, Advani RH. Characteristics and Outcome of Extranodal NK/T-cell Lymphoma in North America: A Retrospective Multi-Institutional Experience. Clin Lymphoma Myeloma Leuk 2022; 22:e300-e309. [PMID: 34848181 DOI: 10.1016/j.clml.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Extranodal natural killer/T-cell lymphoma (ENKTL) is rare and clinical data from non-Asian countries are lacking. It is unclear whether outcomes and disease natural history is similar to reported Asian series. We assessed characteristics and outcomes of patients with ENKTL from major North American centers. PATIENTS AND METHODS We retrospectively identified patients with newly-diagnosed CD56 + ENKTL and studied disease characteristics and clinical outcomes. RESULTS One hundred and twenty-one patients with ENKTL diagnosed between June 1990 and November 2012 were identified. Eighty-three patients (69%) had stage I/II disease and were treated with combined modality therapy (CMT) (n = 53), chemotherapy alone (CT) (n = 14) or radiotherapy alone (RT) (n = 16). Thirty-eight patients (31%) had stage III/IV disease and were treated with CMT (n = 12), CT (n = 23), or RT (n = 3). The median follow-up for the entire cohort was 51 months. Patients with stage I/II disease, compared to those with stage III/IV disease, had superior 2-year progression free survival (PFS) 43% vs 19% (P = .03) and overall survival (OS) 59% vs. 29% (P= .004). Outcomes were similar for stage I/II patients who received CMT vs. RT alone with 2-year PFS (53% vs. 47%; P= .91) and OS (67% vs. 67%; P= .58). No significant differences in outcomes were noted based on race/ethnicity. CONCLUSIONS This series represents a large experience of ENKTL treated at several major North American academic centers. Our data are consistent with Asian studies: (1) majority of patients present with early-stage disease; (2) overall poor outcome regardless of race/ethnicity; (3) CMT likely yields favorable outcomes for suitable candidates with early-stage disease.
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Affiliation(s)
| | - Aung M Tun
- Division of Hematology, Mayo Clinic, Rochester, MN; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Kansas City, KS
| | - Kenneth R Carson
- Research Service, St Louis Veterans Affairs Medical Center, St. Louis, MO; Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | | | | | - Kerry J Savage
- Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC
| | - Jim Rose
- Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC
| | | | - Matthew A Lunning
- Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Jeremy S Abramson
- Divisions of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Nancy L Bartlett
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Julie M Vose
- Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | | | - Sonali M Smith
- Divisions of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Steven M Horwitz
- Division of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
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Kamdar M, Solomon SR, Arnason JE, Johnston PB, Glass B, Bachanova V, Ibrahimi S, Mielke S, Mutsaers P, Hernandez-Ilizaliturri FJ, Izutsu K, Morschhauser F, Lunning M, Maloney DG, Crotta A, Montheard S, Previtali A, Stepan L, Ogasawara K, Mack T, Abramson JS. Lisocabtagene Maraleucel (liso-cel), a CD19-Directed Chimeric Antigen Receptor (CAR) T Cell Therapy, Versus Standard of Care (SOC) with Salvage Chemotherapy (CT) Followed By Autologous Stem Cell Transplantation (ASCT) As Second-Line (2L) Therapy in Patients (Pts) with Relapsed or Refractory (R/R) Large B-Cell Lymphoma (LBCL): Results from the Randomized Phase 3 Transform Study. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00227-5] [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: 10/18/2022]
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Abramson JS, Palomba ML, Gordon LI, Lunning M, Wang M, Arnason JE, Purev E, Maloney DG, Andreadis C, Sehgal AR, Solomon SR, Ghosh N, Kostic A, Kim Y, Ogasawara K, Dehner C, Siddiqi T. Two-Year (yr) Follow-up (FU) of Transcend NHL 001, a Multicenter Phase 1 Study of Lisocabtagene Maraleucel (liso-cel) in Relapsed or Refractory (R/R) Large B-Cell Lymphomas (LBCL). Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00226-3] [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: 10/18/2022]
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Soumerai JD, Mato AR, Dogan A, Seshan VE, Joffe E, Flaherty K, Carter J, Hochberg E, Barnes JA, Hamilton AM, Abramson JS, Batlevi CL, Matasar MJ, Noy A, Owens CN, Palomba ML, Kumar A, Takvorian T, Ni A, Choma M, Friedman C, Chadha P, Simkins E, Ruiters J, Sechio S, Portman D, Ramos L, Nolet N, Mahajan N, Martignetti R, Mi J, Scorsune K, Lynch J, McGree B, Hughes S, Grieve C, Roeker LE, Thompson M, Johnson PC, Roshal M, Huang J, Biondo J, Wu Q, Jacob A, Abdel-Wahab O, Zelenetz AD. Zanubrutinib, obinutuzumab, and venetoclax with minimal residual disease-driven discontinuation in previously untreated patients with chronic lymphocytic leukaemia or small lymphocytic lymphoma: a multicentre, single-arm, phase 2 trial. Lancet Haematol 2021; 8:e879-e890. [DOI: 10.1016/s2352-3026(21)00307-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 10/19/2022]
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Zelenetz AD, Gordon LI, Chang JE, Christian B, Abramson JS, Advani RH, Bartlett NL, Budde LE, Caimi PF, De Vos S, Dholaria B, Fakhri B, Fayad LE, Glenn MJ, Habermann TM, Hernandez-Ilizaliturri F, Hsi E, Hu B, Kaminski MS, Kelsey CR, Khan N, Krivacic S, LaCasce AS, Lim M, Narkhede M, Rabinovitch R, Ramakrishnan P, Reid E, Roberts KB, Saeed H, Smith SD, Svoboda J, Swinnen LJ, Tuscano J, Vose JM, Dwyer MA, Sundar H. NCCN Guidelines® Insights: B-Cell Lymphomas, Version 5.2021. J Natl Compr Canc Netw 2021; 19:1218-1230. [PMID: 34781267 DOI: 10.6004/jnccn.2021.0054] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In the last decade, a better understanding of the molecular pathogenesis of B-cell non-Hodgkin lymphomas has resulted in the development of novel targeted therapies, such as small molecule inhibitors of select kinases in the B-cell receptor pathway, antibody-drug conjugates, and small molecules that target a variety of proteins (eg, CD-19, EZH2, and XPO-1-mediated nuclear export). Anti-CD19 CAR T-cell therapy, first approved for relapsed/refractory (R/R) diffuse large B-cell lymphoma, has also emerged as a novel treatment option for R/R follicular lymphoma and mantle cell lymphoma. These NCCN Guideline Insights highlight the new targeted therapy options included in the NCCN Guidelines for B-Cell Lymphomas for the treatment of R/R disease.
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Affiliation(s)
| | - Leo I Gordon
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Beth Christian
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Nancy L Bartlett
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | - Paolo F Caimi
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | - Bita Fakhri
- UCSF Helen Diller Family Comprehensive Cancer Center
| | - Luis E Fayad
- The University of Texas MD Anderson Cancer Center
| | | | | | | | - Eric Hsi
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Boyu Hu
- Huntsman Cancer Institute at the University of Utah
| | | | | | | | | | | | - Megan Lim
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | | | | | | | | | - Stephen D Smith
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Jakub Svoboda
- Abramson Cancer Center at the University of Pennsylvania
| | - Lode J Swinnen
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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Bennani NN, Tun AM, Carson KR, Geiger JL, Maeda LS, Savage KJ, Rose J, Pinter-Brown L, Lunning MA, Abramson JS, Bartlett NL, Vose JM, Evens AM, Smith SM, Horwitz SM, Ansell SM, Advani RH. Characteristics and Outcome of Extranodal NK/T-Cell Lymphoma in North America: A Retrospective Multi-Institutional Experience. Clin Lymphoma Myeloma Leuk 2021; 22:e250-e260. [PMID: 34794912 DOI: 10.1016/j.clml.2021.10.004] [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] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Extranodal natural killer/T-cell lymphoma (ENKTL) is rare and clinicaldata from non-Asian countries are lacking. It is unclear whether outcomes and diseasenatural history is similar to reported Asian series. We assessed characteristics and outcomes of patients with ENKTL from major North American centers. PATIENTS AND METHODS We retrospectively identified patients with newly-diagnosedCD56 + ENKTL and studied disease characteristics and clinical outcomes. RESULTS 121 patients with ENKTL diagnosed between June 1990 and November 2012 were identified. Eighty-three patients (69%) had stage I/II disease and were treatedwith combined modality therapy (CMT) (n=53), chemotherapy alone (CT) (n=14) orradiotherapy alone (RT) (n=16). Thirty-eight patients (31%) had stage III/IV diseaseand were treated with CMT (n=12), CT (n=23), or RT (n=3). The median follow-up forthe entire cohort was 51 months. Patients with stage I/II disease, compared to thosewith stage III/IV disease, had superior 2-year progression free survival (PFS) 43% vs19% (p=0.03) and overall survival (OS) 59% vs 29% (p=0.004). Outcomes were similarfor stage I/II patients who received CMT vs RT alone with 2-year PFS (53% vs 47%;p=0.91) and OS (67% vs 67%; p=0.58). No significant differences in outcomes werenoted based on race/ethnicity. CONCLUSIONS This series represents a large experience of ENKTL treated at several major North American academic centers. OUR DATA ARE CONSISTENT WITH ASIAN STUDIES 1) majority of patients present with early-stage disease; 2) overall poor outcome regardless of race/ethnicity; 3) CMT likely yields favorable outcomes for suitable candidates with early-stage disease.
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Affiliation(s)
| | - Aung M Tun
- Division of Hematology, Mayo Clinic, Rochester, MN; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Kansas City, KS
| | - Kenneth R Carson
- Research Service, St Louis Veterans Affairs Medical Center, St Louis, MO; Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | | | - Lauren S Maeda
- Division of Oncology, Stanford Cancer Institute, Stanford, CA
| | - Kerry J Savage
- Department of Medical Oncology, Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Jim Rose
- Department of Medical Oncology, Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | | | - Matthew A Lunning
- Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Jeremy S Abramson
- Divisions of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Nancy L Bartlett
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Julie M Vose
- Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | | | - Sonali M Smith
- Divisions of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Steven M Horwitz
- Division of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
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Rutherford SC, Abramson JS, Bartlett NL, Barta SK, Khan N, Joyce R, Maddocks K, Ali-Shaw T, Senese S, Yuan Y, Westin J, Leonard JP. Venetoclax with dose-adjusted EPOCH-R as initial therapy for patients with aggressive B-cell lymphoma: a single-arm, multicentre, phase 1 study. Lancet Haematol 2021; 8:e818-e827. [PMID: 34634256 DOI: 10.1016/s2352-3026(21)00273-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) is a front-line treatment for patients with aggressive B-cell lymphomas. Bcl-2 is associated with chemoresistance due to BCL2 gene rearrangement or protein overexpression and is antagonised by venetoclax. We aimed to assess the safety of venetoclax with dose-adjusted EPOCH-R as initial therapy in aggressive B-cell lymphoma. METHODS We conducted a single-arm, phase 1 study across seven treatment centres in the USA. Eligible patients were aged 18-80 years with histologically confirmed, previously untreated diffuse large B-cell lymphoma, transformed indolent non-Hodgkin lymphoma, high-grade B-cell lymphoma with double-hit or not otherwise specified, or primary mediastinal B-cell lymphoma, with Ann Arbor stage II-IV and Eastern Cooperative Oncology Group performance status of 0-2. Participants received six cycles of oral venetoclax 400 mg, 600 mg, or 800 mg once daily for 10 days per cycle with dose-adjusted EPOCH-R (one cycle every 3 weeks; baseline doses were intravenous rituximab 375 mg/m2 on day 1, intravenous etoposide 50 mg/m2 on days 1-4, oral prednisone 60 mg/m2 twice daily on days 1-5, intravenous vincristine 0·4 mg/m2 on days 1-4, intravenous cyclophosphamide 750 mg/m2 on day 5, and intravenous doxorubicin 10 mg/m2 on days 1-4). A subsequent cohort received venetoclax 600 mg once daily for 5 days per cycle. The primary endpoints were the maximum tolerated dose, dose-limiting toxicities, and the recommended phase 2 dose of venetoclax. Analyses were done per protocol. This trial is registered with ClinicalTrials.gov, NCT03036904, and enrolment is now closed. FINDINGS Between Feb 3, 2017, and June 4, 2019, 34 patients were assessed for eligibility, and 30 were enrolled and received venetoclax with dose-adjusted EPOCH-R. The median patient age was 64·0 years (IQR 51·6-69·4). The maximum tolerated dose was 800 mg for 10 days and the established recommended phase 2 dose was 600 mg for 5 days due to tolerability for treatment duration. One (3%) of 30 patients had a dose-limiting toxicity in cycle one (grade 4 thrombocytopenia with 800 mg dose). The most common grade 3-4 adverse events were cytopenias (28 [93%] of 30 patients); febrile neutropenia occurred in 19 (63%) patients. Grade 3-4 non-haematological adverse events included hypophosphataemia (n=10), hypokalaemia (n=7), and hyperglycaemia (n=5). Serious adverse events included infection (n=7) and gastrointestinal toxicities including abdominal pain (n=3), colonic perforation (n=1), and small intestinal obstruction (n=1). There was one treatment-related death (sepsis). Overall response rate was 96·7% (95% CI 82·8-99·9); 28 (93·3% [77·9-99·2]) of 30 patients had complete response and one (3·3% [0·1-17·2]) had a partial response. INTERPRETATION Venetoclax with dose-adjusted EPOCH-R showed an acceptable safety profile at the recommended phase 2 dose and had encouraging preliminary activity in this population at high risk of adverse outcomes, and is worthy of further study. The combination is being investigated in Alliance 051701 (NCT03984448). FUNDING Genentech.
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Affiliation(s)
| | - Jeremy S Abramson
- Department of Haematology and Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Nancy L Bartlett
- Washington University School of Medicine, Siteman Cancer Center, St Louis, MO, USA
| | - Stefan K Barta
- Division of Haematology and Oncology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA, USA
| | - Nadia Khan
- Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Robin Joyce
- Beth-Israel Deaconess Medical Center, Boston, MA, USA
| | - Kami Maddocks
- James Cancer Hospital, Ohio State University, Columbus, OH, USA
| | - Trisha Ali-Shaw
- Weill Cornell Medicine, Meyer Cancer Center, New York, NY, USA
| | - Silvia Senese
- Weill Cornell Medicine, Meyer Cancer Center, New York, NY, USA
| | - Ying Yuan
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason Westin
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John P Leonard
- Weill Cornell Medicine, Meyer Cancer Center, New York, NY, USA
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Ruppert AS, Booth AM, Ding W, Bartlett NL, Brander DM, Coutre S, Brown JR, Nattam S, Larson RA, Erba H, Litzow M, Owen C, Kuzma CS, Abramson JS, Little RF, Smith SE, Stone RM, Byrd JC, Mandrekar SJ, Woyach JA. Adverse event burden in older patients with CLL receiving bendamustine plus rituximab or ibrutinib regimens: Alliance A041202. Leukemia 2021; 35:2854-2861. [PMID: 34274940 PMCID: PMC8744070 DOI: 10.1038/s41375-021-01342-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023]
Abstract
Ibrutinib has superior progression-free survival compared with bendamustine plus rituximab (BR) in older CLL patients, however, differences in treatment duration, six monthly BR cycles versus continuous ibrutinib, complicate adverse event (AE) comparisons. We introduce the AE burden score (AEsc) to compare AEs, calculated for each patient by summing over products of reporting period length and grade for each all-cause grade 1-4 AE and dividing by the length of time over which AEs are assessed. A total of 176 patients received BR and 361 ibrutinib alone or with six cycles of rituximab. At 38 months median follow-up, 64% remained on ibrutinib. Median AEsc was higher with BR versus ibrutinib in the first six cycles (7.2 versus 4.9, p < 0.0001). Within ibrutinib arms, median AEsc decreased significantly to 3.7 after six cycles (p < 0.0001). 10% and 14% of BR and ibrutinib patients discontinued treatment for AEs. In ibrutinib arms, cumulative incidence of grade 3 or higher atrial fibrillation, hypertension, and infection (AEs of clinical interest) at 12 months was 4.5%, 17.5%, and 12.8%, respectively, and increased more slowly thereafter to 7.7%, 25.4%, and 20.5% at 36 months. Analytical tools including the AEsc and cumulative incidence of AEs can help to better characterize AE burden over time. ClinicalTrials.gov identifier: NCT01886872.
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Affiliation(s)
- Amy S. Ruppert
- Division of Hematology, the Ohio State University, Columbus, OH, USA,Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Allison M. Booth
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Steven Coutre
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | - Harry Erba
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Carolyn Owen
- University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | | | | | | | | | | | - John C. Byrd
- Division of Hematology, the Ohio State University, Columbus, OH, USA
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49
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Westin JR, Kersten MJ, Salles G, Abramson JS, Schuster SJ, Locke FL, Andreadis C. Efficacy and safety of CD19-directed CAR-T cell therapies in patients with relapsed/refractory aggressive B-cell lymphomas: Observations from the JULIET, ZUMA-1, and TRANSCEND trials. Am J Hematol 2021; 96:1295-1312. [PMID: 34310745 PMCID: PMC9290945 DOI: 10.1002/ajh.26301] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/25/2021] [Accepted: 07/22/2021] [Indexed: 01/16/2023]
Abstract
Chimeric antigen receptor (CAR)‐T cell therapies have improved the outcome for many patients with relapsed or refractory aggressive B‐cell lymphomas. In 2017, axicabtagene ciloleucel and soon after tisagenlecleucel became the first approved CAR‐T cell products for patients with high‐grade B‐cell lymphomas or diffuse large B‐cell lymphoma (DLBCL) who are relapsed or refractory to ≥ 2 prior lines of therapy; lisocabtagene maraleucel was approved in 2021. Safety and efficacy outcomes from the pivotal trials of each CAR‐T cell therapy have been reported. Despite addressing a common unmet need in the large B‐cell lymphoma population and utilizing similar CAR technologies, there are differences between CAR‐T cell products in manufacturing, pivotal clinical trial designs, and data reporting. Early reports of commercial use of axicabtagene ciloleucel and tisagenlecleucel provide the first opportunities to validate the impact of patient characteristics on the efficacy and safety of these CAR‐T cell therapies in the real world. Going forward, caring for patients after CAR‐T cell therapy will require strategies to monitor patients for sustained responses and potential long‐term side effects. In this review, product attributes, protocol designs, and clinical outcomes of the key clinical trials are presented. We discuss recent data on patient characteristics, efficacy, and safety of patients treated with axicabtagene ciloleucel or tisagenlecleucel in the real world. Finally, we discuss postinfusion management and preview upcoming clinical trials of CAR‐T cell therapies.
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Affiliation(s)
- Jason R. Westin
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Marie José Kersten
- Department of Hematology Amsterdam UMC, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam) Amsterdam The Netherlands
| | - Gilles Salles
- Memorial Sloan Kettering Cancer Center New York New York USA
| | - Jeremy S. Abramson
- Center for Lymphoma Massachusetts General Hospital Cancer Center Boston Massachusetts USA
| | - Stephen J. Schuster
- Lymphoma Program Abramson Cancer Center, University of Pennsylvania Philadelphia Pennsylvania USA
| | - Frederick L. Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy Moffitt Cancer Center Tampa Florida USA
| | - Charalambos Andreadis
- Helen Diller Family Comprehensive Cancer Center University of California San Francisco San Francisco California USA
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50
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Mou E, Falchi L, Sundaram V, Abramson JS, Balassanian R, Beygi S, Fitzpatrick MJ, Frank AK, Gupta S, Lin O, Long SR, Menke JR, Reed DR, Ruiz-Cordero R, Volaric AK, Xie Y, Wang L, Wen KW, Zadeh SL, Natkunam Y, Cheung MC, Gratzinger D. Impact of initial biopsy type on the time to final diagnostic biopsy in patients with follicular lymphoma and suspected histologic transformation. Leuk Lymphoma 2021; 62:2864-2872. [PMID: 34176413 DOI: 10.1080/10428194.2021.1941936] [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: 10/21/2022]
Abstract
Diagnosis of histologic transformation (HT) of follicular lymphoma (FL) requires tissue biopsy. While surgical biopsy represents the gold standard, less invasive procedures such as fine-needle aspiration biopsy (FNAB) and core needle biopsy (CNB) are frequently performed. In this retrospective multi-institutional study including 269 patients with FL and suspected HT, the median time from initial clinical suspicion to final diagnostic biopsy was similar whether the workup began with FNAB, CNB, or surgical biopsy (4, 9, and 6 days, respectively; p=.27), despite more subsequent biopsies performed following initial FNAB. Periprocedural complications were uniformly minimal. Biopsy-proven HT was more common in the initial surgery group and in workups including positron emission tomography/computed tomography (PET/CT). Our findings, derived from US academic centers with specialized procedural and pathology expertise, suggest that FNAB, CNB, and surgical biopsy are all viable initial diagnostic procedures that can inform clinical decision-making in select FL patients with suspected HT.
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Affiliation(s)
- Eric Mou
- Department of Internal Medicine, Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA, USA.,Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lorenzo Falchi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vandana Sundaram
- Quantitative Science Unit, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Ronald Balassanian
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Sara Beygi
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Annabel Kate Frank
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Srishti Gupta
- Department of Pathology, University of Virginia, Charlottesville, VA, USA.,Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Steven R Long
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA.,Department of Pathology, Stanford University, Stanford, CA, USA
| | - Joshua R Menke
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Daniel R Reed
- Section of Hematology and Oncology, Wake Forest Baptist Medical Comprehensive Cancer Center.,Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA
| | - Roberto Ruiz-Cordero
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Ashley K Volaric
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Yi Xie
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Linlin Wang
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kwun Wah Wen
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Sara L Zadeh
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | | | - Matthew C Cheung
- Division of Hematology, Sunnybrook Odette Cancer Centre, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Dita Gratzinger
- Department of Pathology, Stanford University, Stanford, CA, USA.,Department of Pathology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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