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Calabretta E, Guidetti A, Ricci F, Di Trani M, Monfrini C, Magagnoli M, Bramanti S, Maspero D, Morello L, Merli M, Di Rocco A, Graudenzi A, Derenzini E, Antoniotti M, Rossi D, Corradini P, Santoro A, Carlo-Stella C. Chemotherapy after PD-1 inhibitors in relapsed/refractory Hodgkin lymphoma: Outcomes and clonal evolution dynamics. Br J Haematol 2022; 198:82-92. [PMID: 35468225 PMCID: PMC9321573 DOI: 10.1111/bjh.18183] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/27/2022]
Abstract
Checkpoint inhibitors (CPIs) are routinely employed in relapsed/refractory classical Hodgkin lymphoma. Nonetheless, persistent long-term responses are uncommon, and one-third of patients are refractory. Several reports have suggested that treatment with CPIs may re-sensitize patients to chemotherapy, however there is no consensus on the optimal chemotherapy regimen and subsequent consolidation strategy. In this retrospective study we analysed the response to rechallenge with chemotherapy after CPI failure. Furthermore, we exploratively characterized the clonal evolution profile of a small sample of patients (n = 5) by employing the CALDER approach. Among the 28 patients included in the study, 17 (71%) were primary refractory and 26 (92%) were refractory to the last chemotherapy prior to CPIs. Following rechallenge with chemotherapy, response was recorded in 23 (82%) patients experiencing complete remission and 3 (11%) patients experiencing partial remission. The tumour evolution of the patients inferred by CALDER seemingly occurred prior to the first cycle of therapy and was characterized either by linear or branching evolution patterns. Twenty-five patients proceeded to allogeneic stem cell transplantation. At a median follow-up of 21 months, median PFS and OS were not reached. In conclusion, patients who fail CPIs can be effectively rescued by salvage chemotherapy and bridged to allo-SCT/auto-SCT.
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Affiliation(s)
- Eleonora Calabretta
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Anna Guidetti
- Division of Hematology and Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,University of Milano, Milan, Italy
| | - Francesca Ricci
- Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Martina Di Trani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Chiara Monfrini
- Division of Hematology and Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Massimo Magagnoli
- Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Stefania Bramanti
- Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Davide Maspero
- Dipartimento di Informatica, Sistemistica e Comunicazione, Università degli Studi di Milano-Bicocca, Milan, Italy.,Institute of Molecular Bioimaging and Physiology, Consiglio Nazionale delle Ricerche (IBFM-CNR), Segrate, Milan, Italy
| | - Lucia Morello
- Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Michele Merli
- Department of Hematology, University Hospital "Ospedale di Circolo e Fondazione Macchi - ASST Sette Laghi", University of Insubria, Varese, Italy
| | - Alice Di Rocco
- Department of Translational and Precision Medicine, La Sapienza University, Rome, Italy
| | - Alex Graudenzi
- Institute of Molecular Bioimaging and Physiology, Consiglio Nazionale delle Ricerche (IBFM-CNR), Segrate, Milan, Italy.,Bicocca Bioinformatics, Biostatistics and Bioimaging Centre (B4), Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Enrico Derenzini
- IEO European Institute of Oncology IRCCS, Milan, Italy.,Department of Health Sciences, University of Milan, Italy
| | - Marco Antoniotti
- Dipartimento di Informatica, Sistemistica e Comunicazione, Università degli Studi di Milano-Bicocca, Milan, Italy.,Bicocca Bioinformatics, Biostatistics and Bioimaging Centre (B4), Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Davide Rossi
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,Institute of Oncology Research, Bellinzona, Switzerland.,Faculty of Biomedical Sciences, USI, Lugano, Switzerland
| | - Paolo Corradini
- Division of Hematology and Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,University of Milano, Milan, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Carmelo Carlo-Stella
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
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2
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Danilov AV, Magagnoli M, Matasar MJ. Translating the Biology of Diffuse Large B-cell Lymphoma Into Treatment. Oncologist 2022; 27:57-66. [PMID: 35305092 PMCID: PMC8842307 DOI: 10.1093/oncolo/oyab004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/17/2021] [Indexed: 12/16/2022] Open
Abstract
Abstract
Diffuse large B-cell lymphoma (DLBCL) is characterized by clinical and molecular heterogeneity; however, this heterogeneity is rarely taken into account by standard-of-care treatment approaches. While the disease was traditionally classified based on transcriptome signatures purporting the tumor cell of origin, recent classification systems have further differentiated these subtypes into clusters based on molecular and genetic features. Alongside a better understanding of the biology of the disease and the signaling pathways involved, emerging therapeutic agents may be better aimed at attacking distinct disease subsets. It is hoped that molecular subtyping at diagnosis will allow patients to be allocated to the appropriate treatment that targets their specific disease subtype, thus advancing the promise of precision medicine in lymphoma, an approach that is most needed. For high-risk disease subsets, this is particularly important, and much research is still needed to develop agents effective in this population. Here, we review recent advances in DLBCL biology and how they can be translated into clinical care.
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Affiliation(s)
| | - Massimo Magagnoli
- Humanitas Cancer Center, Humanitas Clinical and Research Center – IRCCS, Rozzano, Milan, Italy
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3
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Merryman RW, Castagna L, Giordano L, Ho VT, Corradini P, Guidetti A, Casadei B, Bond DA, Jaglowski S, Spinner MA, Arai S, Lowsky R, Shah GL, Perales MA, De Colella JMS, Blaise D, Herrera AF, Shouse G, Spilleboudt C, Ansell SM, Nieto Y, Badar T, Hamadani M, Feldman TA, Dahncke L, Singh AK, McGuirk JP, Nishihori T, Chavez J, Serritella AV, Kline J, Mohty M, Dulery R, Stamatoulas A, Houot R, Manson G, Moles-Moreau MP, Orvain C, Bouabdallah K, Modi D, Ramchandren R, Lekakis L, Beitinjaneh A, Frigault MJ, Chen YB, Lynch RC, Smith SD, Rao U, Byrne M, Romancik JT, Cohen JB, Nathan S, Phillips T, Joyce RM, Rahimian M, Bashey A, Ballard HJ, Svoboda J, Torri V, Sollini M, De Philippis C, Magagnoli M, Santoro A, Armand P, Zinzani PL, Carlo-Stella C. Allogeneic transplantation after PD-1 blockade for classic Hodgkin lymphoma. Leukemia 2021; 35:2672-2683. [PMID: 33658659 DOI: 10.1038/s41375-021-01193-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [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: 11/18/2020] [Revised: 01/19/2021] [Accepted: 02/08/2021] [Indexed: 12/17/2022]
Abstract
Anti-PD-1 monoclonal antibodies yield high response rates in patients with relapsed/refractory classic Hodgkin lymphoma (cHL), but most patients will eventually progress. Allogeneic hematopoietic cell transplantation (alloHCT) after PD-1 blockade may be associated with increased toxicity, raising challenging questions about the role, timing, and optimal method of transplantation in this setting. To address these questions, we assembled a retrospective cohort of 209 cHL patients who underwent alloHCT after PD-1 blockade. With a median follow-up among survivors of 24 months, the 2-year cumulative incidences (CIs) of non-relapse mortality and relapse were 14 and 18%, respectively; the 2-year graft-versus-host disease (GVHD) and relapse-free survival (GRFS), progression-free survival (PFS), and overall survival were 47%, 69%, and 82%, respectively. The 180-day CI of grade 3-4 acute GVHD was 15%, while the 2-year CI of chronic GVHD was 34%. In multivariable analyses, a longer interval from PD-1 to alloHCT was associated with less frequent severe acute GVHD, while additional treatment between PD-1 and alloHCT was associated with a higher risk of relapse. Notably, post-transplant cyclophosphamide (PTCy)-based GVHD prophylaxis was associated with significant improvements in PFS and GRFS. While awaiting prospective clinical trials, PTCy-based GVHD prophylaxis may be considered the optimal transplantation strategy for this patient population.
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Affiliation(s)
- Reid W Merryman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Luca Castagna
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | - Laura Giordano
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | - Vincent T Ho
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Paolo Corradini
- Division of Hematology and Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milano, Milano, Italy
| | - Anna Guidetti
- Division of Hematology and Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milano, Milano, Italy
| | - Beatrice Casadei
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università Degli Studi, Bologna, Italia
| | - David A Bond
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | | | - Michael A Spinner
- Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Sally Arai
- Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Robert Lowsky
- Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Gunjan L Shah
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jean Marc Schiano De Colella
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Didier Blaise
- Institut Paoli-Calmettes, Aix Marseille University, CNRS, INSERM, CRCM, Marseille, France
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Geoffrey Shouse
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | | | | | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Talha Badar
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tatyana A Feldman
- John Theurer Cancer Center at HMH, Hackensack Meridian Health School of Medicine, Hackensack, NJ, USA
| | - Lori Dahncke
- John Theurer Cancer Center at HMH, Hackensack Meridian Health School of Medicine, Hackensack, NJ, USA
| | - Anurag K Singh
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS, USA
| | - Joseph P McGuirk
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS, USA
| | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Julio Chavez
- Department of Blood & Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Anthony V Serritella
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Justin Kline
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Mohamad Mohty
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hospital Saint Antoine, Sorbonne University, Paris, France
| | - Remy Dulery
- Department of Hematology, Centre Henri Becquerel, Rouen, France
| | | | - Roch Houot
- Department of Hematology, CHU Rennes, University of Rennes, Inserm U1236, Rennes, France
| | - Guillaume Manson
- Department of Hematology, CHU Rennes, University of Rennes, Inserm U1236, Rennes, France
| | | | | | | | - Dipenkumar Modi
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA
| | | | - Lazaros Lekakis
- Division of Transplantation and Cellular Therapy, University of Miami/Sylvester Cancer Center, Miami, FL, USA
| | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami/Sylvester Cancer Center, Miami, FL, USA
| | - Matthew J Frigault
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA, USA
| | - Yi-Bin Chen
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA, USA
| | - Ryan C Lynch
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Stephen D Smith
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Uttam Rao
- Department of Medicine, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Byrne
- Department of Medicine, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Sunita Nathan
- Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Tycel Phillips
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Robin M Joyce
- Division of Hematologic Malignancy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Maryam Rahimian
- Division of Hematologic Malignancy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Hatcher J Ballard
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jakub Svoboda
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Valter Torri
- Laboratory of Methodology of Clinical Research, Oncology Department. IRCCS Mario Negri Institute, Milano, Italy
| | - Martina Sollini
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Chiara De Philippis
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | - Massimo Magagnoli
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | - Armando Santoro
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | - Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Pier Luigi Zinzani
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università Degli Studi, Bologna, Italia
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Carmelo Carlo-Stella
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano-Milan, Italy
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Moreno V, Vieito Villar M, Sepulveda Sanchez J, Galvao V, Hernández Guerrero T, Doger B, Saavedra O, Carlo Stella C, Michot JM, Italiano A, Magagnoli M, Carpio C, Sarmiento R, Amoroso B, Aronchik I, Filvaroff E, Hanna B, Pinto A, Nikolova Z, Braña I. 8MO CC-90010, a reversible, potent oral bromodomain and extraterminal inhibitor (BETi) in patients (pts) with advanced solid tumours (aSTs) and relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL): Longer follow-up from parts A & B and first reporting of part C of a phase I study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.01.021] [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: 10/22/2022] Open
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Balzarotti M, Magagnoli M, Canales MÁ, Corradini P, Grande C, Sancho JM, Zaja F, Quinson AM, Belsack V, Maier D, Carlo-Stella C. A phase Ib, open-label, dose-escalation trial of the anti-CD37 monoclonal antibody, BI 836826, in combination with gemcitabine and oxaliplatin in patients with relapsed/refractory diffuse large B-cell lymphoma. Invest New Drugs 2021; 39:1028-1035. [PMID: 33523334 PMCID: PMC8279964 DOI: 10.1007/s10637-020-01054-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/16/2020] [Indexed: 11/25/2022]
Abstract
Background BI 836826 is a chimeric mouse–human monoclonal antibody directed against human CD37, a transmembrane protein expressed on mature B lymphocytes. This open-label, phase I dose-escalation trial (NCT02624492) was conducted to determine the maximum tolerated dose (MTD), safety/tolerability, and preliminary efficacy of BI 836826 in combination with gemcitabine and oxaliplatin in patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL). Methods Eligible patients received intravenous infusions of BI 836826 on day 8 and gemcitabine 1000 mg/m2 plus oxaliplatin 100 mg/m2 on day 1, for up to six 14-day treatment cycles. Dose escalation followed the standard 3 + 3 design. Results Of 21 treated patients, 17 had relapsed/refractory DLBCL and four had follicular lymphoma transformed to DLBCL. BI 836826 dosing started at 25 mg and proceeded through 50 mg and 100 mg. Two dose-limiting toxicities (DLTs) occurred during cycle 1, both grade 4 thrombocytopenia lasting > 7 days, affecting 1/6 evaluable patients (17%) in both the 50 mg and 100 mg cohorts. Due to early termination of the study, the MTD was not determined. The most common adverse events related to BI 836826 treatment were neutropenia (52%), thrombocytopenia (48%), and anemia (48%). Eight patients (38%) experienced BI 836826-related infusion-related reactions (two grade 3). Overall objective response rate was 38%, including two patients (10%) with complete remission and six patients (29%) with partial remission. Conclusions BI 836826 in combination with GemOx was generally well tolerated but did not exceed the MTD at doses up to 100 mg given every 14 days.
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Affiliation(s)
- Monica Balzarotti
- Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milano, Italy
| | - Massimo Magagnoli
- Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milano, Italy
| | | | - Paolo Corradini
- University of Milan, Milan, Italy
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Juan-Manuel Sancho
- Clinical Hematology Department, ICO-IJC-Hospital Germans Trias i Pujol, Badalona, Spain
| | - Francesco Zaja
- University of Trieste, Ospedale Maggiore, Piazza dell'Ospitale 1, Trieste, Italy
| | | | | | - Daniela Maier
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riß, Germany
| | - Carmelo Carlo-Stella
- Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milano, Italy.
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
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Abstract
INTRODUCTION Follicular lymphoma (FL) is the second most common histotype of lymphoma and is considered an incurable disease. The need for new treatment options has led to the development of innovative targeted agents, including inhibitors of the phosphatidylinositol-3-kinase (PI3K) pathway. AREAS COVERED Copanlisib, an intravenous pan-class I PI3K inhibitor, has been approved by the US Food and Drug Administration (FDA) for the treatment of relapsed FL in patients who have received at least two prior systemic therapies. In this article, we critically review the mechanism of action, clinical efficacy, safety, dosage, administration, and role of copanlisib in the treatment of relapsed FL. EXPERT OPINION Treatment with copanlisib results in clinically relevant and durable responses in heavily pretreated patients with relapsed or refractory FL. In addition, copanlisib has a manageable safety profile in this population, with low rates of severe hepatic transaminitis, diarrhea, colitis, and noninfectious pneumonitis. Further investigations of copanlisib within combination regimens will potentially allow to move copanlisib to an earlier line of therapy for FL. However, results of the CHRONOS-4 clinical trial evaluating copanlisib with standard chemoimmunotherapy (rituximab with bendamustine or CHOP) are not yet available.
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Affiliation(s)
- Massimo Magagnoli
- Department of Oncology and Hematology, Humanitas Clinical and Research Center - IRCCS , Rozzano, Milan, Italy
| | - Carmelo Carlo-Stella
- Department of Oncology and Hematology, Humanitas Clinical and Research Center - IRCCS , Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University , Pieve Emanuele, Milan, Italy
| | - Armando Santoro
- Department of Oncology and Hematology, Humanitas Clinical and Research Center - IRCCS , Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University , Pieve Emanuele, Milan, Italy
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Matasar MJ, Luminari S, Barr PM, Barta SK, Danilov AV, Hill BT, Phillips TJ, Jerkeman M, Magagnoli M, Nastoupil LJ, Persky DO, Okosun J. Follicular Lymphoma: Recent and Emerging Therapies, Treatment Strategies, and Remaining Unmet Needs. Oncologist 2019; 24:e1236-e1250. [PMID: 31346132 PMCID: PMC6853118 DOI: 10.1634/theoncologist.2019-0138] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/13/2019] [Indexed: 12/18/2022] Open
Abstract
Follicular lymphoma (FL) is a heterogeneous disease with varying prognosis owing to differences in clinical, laboratory, and disease parameters. Although generally considered incurable, prognosis for early- and advanced-stage disease has improved because of therapeutic advances, several of which have resulted from elucidation of the biologic and molecular basis of the disease. The choice of treatment for FL is highly dependent on patient and disease characteristics. Several tools are available for risk stratification, although limitations in their routine clinical use exist. For limited disease, treatment options include radiotherapy, rituximab monotherapy or combination regimens, and surveillance. Treatment of advanced disease is often determined by tumor burden, with surveillance or rituximab considered for low tumor burden and chemoimmunotherapy for high tumor burden disease. Treatment for relapsed or refractory disease is influenced by initial first-line therapy and the duration and quality of the response. Presently, there is no consensus for treatment of patients with early or multiply relapsed disease; however, numerous agents, combination regimens, and transplant options have demonstrated efficacy. Although the number of therapies available to treat FL has increased together with an improved understanding of the underlying biologic basis of disease, the best approach to select the most appropriate treatment strategy for an individual patient at a particular time continues to be elucidated. This review considers prognostication and the evolving treatment landscape of FL, including recent and emergent therapies as well as remaining unmet needs. IMPLICATIONS FOR PRACTICE: In follicular lymphoma, a personalized approach to management based on disease biology, patient characteristics, and other factors continues to emerge. However, application of current management requires an understanding of the available therapeutic options for first-line treatment and knowledge of current development in therapies for previously untreated and for relapsed or refractory disease. Thus, this work reviews for clinicians the contemporary data in follicular lymphoma, from advances in characterizing disease biology to current treatments and emerging novel therapies.
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Affiliation(s)
- Matthew J Matasar
- Memorial Sloan Kettering Cancer Center and New York Presbyterian, New York New York, USA
| | - Stefano Luminari
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Paul M Barr
- University of Rochester Medical Center, Rochester, New York, USA
| | - Stefan K Barta
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Brian T Hill
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | | | | | - Massimo Magagnoli
- Humanitas Cancer Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | - Jessica Okosun
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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Carlo-Stella C, Delarue R, Scarfo L, Barde PJ, Nair A, Locatelli SL, Morello L, Magagnoli M, Vakkalanka S, Viswanadha S, Ferreri AJM. A First-in-human Study of Tenalisib (RP6530), a Dual PI3K δ/γ Inhibitor, in Patients With Relapsed/Refractory Hematologic Malignancies: Results From the European Study. Clin Lymphoma Myeloma Leuk 2019; 20:78-86. [PMID: 31761713 DOI: 10.1016/j.clml.2019.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tenalisib (RP6530) is a novel, highly specific, dual phosphoinositide-3 kinases (PI3K) δ/γ inhibitor with nano-molar potency. MATERIAL AND METHODS This was a phase I, open-label, 3 + 3 dose escalation, maximum tolerated dose determination study to evaluate the safety, pharmacokinetics, and efficacy of tenalisib in patients with relapsed/refractory hematologic malignancies. Tenalisib was administered orally twice/thrice daily in 28-day cycles with starting dose of 25 mg twice daily. RESULTS Thirty-five patients were enrolled across 11 dose levels. No dose limiting toxicity was reported at any of the dose levels. The most common treatment-emergent adverse events irrespective of causality were asthenia and cough in 15 (43%) patients and pyrexia in 13 (37%) patients. The most frequently reported related treatment-emergent adverse events were diarrhea, nausea, and vomiting. Related grade 3/4 adverse events were limited to events of hypertriglyceridemia, neutropenia, and diarrhea. Pharmacokinetics showed rapid absorption. Based on maximum plasma concentration and area under the plasma-concentration time curve, dose proportionality was observed up to 400 mg dose. Of 31 patients included in the efficacy analysis, complete response was seen in 2 (7%) patients and partial response in 4 (13%) patients, with an overall response rate of 19% and a disease-control rate of 61%. The median duration of response was 5.7 months. Responders demonstrated a marked downregulation of phospho-AKT on C1D8. CONCLUSION Tenalisib demonstrated acceptable safety up to 1200 mg twice a day with no dose-limiting toxicities. Consistent clinical response was seen at doses 200 mg BID and above. Pharmacodynamics correlated well with clinical outcome. Further phase I/II studies are being undertaken to evaluate efficacy across different histologies.
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Affiliation(s)
- Carmelo Carlo-Stella
- Department of Hematology and Oncology, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milano, Italy.
| | - Richard Delarue
- Hematology Department, Necker University Hospital, Paris, France
| | - Lydia Scarfo
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milano, Italy; Strategic Research Program on CLL, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Prajak J Barde
- Rhizen Pharmaceuticals SA, La Chaux-de-Fonds, Switzerland
| | - Ajit Nair
- Rhizen Pharmaceuticals SA, La Chaux-de-Fonds, Switzerland
| | - Silvia L Locatelli
- Department of Hematology and Oncology, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Lucia Morello
- Department of Hematology and Oncology, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Massimo Magagnoli
- Department of Hematology and Oncology, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | | | | | - Andrés J M Ferreri
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milano, Italy
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9
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Dreyling M, Santoro A, Leppä S, Demeter J, Follows G, Lenz G, Kim W, Mollica L, Nagler A, Phipps Diong C, Provencio M, Magagnoli M, Munoz J, Hiemeyer F, Liu L, Miriyala A, Rodrigues L, Garcia-Vargas J, Childs B, Zinzani P. EFFICACY AND SAFETY IN HIGH-RISK RELAPSED OR REFRACTORY INDOLENT FOLLICULAR LYMPHOMA PATIENTS TREATED WITH COPANLISIB. Hematol Oncol 2019. [DOI: 10.1002/hon.57_2631] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M. Dreyling
- Department of Medicine III; University Hospital (LMU); Munich Germany
| | - A. Santoro
- Cancer Center; Humanitas Clinical and Research Center; Rozzano Italy
| | - S. Leppä
- Comprehensive Cancer Center; Helsinki University Hospital; Helsinki Finland
| | - J. Demeter
- First Department of Internal Medicine; Semmelweis University; Budapest Hungary
| | - G.A. Follows
- Haematology; Cambridge University Hospitals NHS Foundation Trust; Cambridge United Kingdom
| | - G. Lenz
- Translational Oncology; University Hospital Münster; Münster Germany
| | - W.S. Kim
- Hematology and Oncology; Sungkyunkwan University School of Medicine, Samsung Medical Center; Seoul Republic of Korea
| | - L. Mollica
- Clinical Research in Hematology and Clinical Oncology; Maisonneuve-Rosemont Hospital Research Centre; Montréal Quebec Canada
| | - A. Nagler
- Chaim Sheba Medical Center; Tel Aviv University; Tel HaShomer Israel
| | - C. Phipps Diong
- Department of Haematology; Singapore General Hospital; Bukit Merah Singapore
| | - M. Provencio
- Medical Oncology; Health Research Institute, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid; Madrid Spain
| | - M. Magagnoli
- Cancer Center; Humanitas Clinical and Research Center; Rozzano Italy
| | - J. Munoz
- Hematology and Oncology; Banner MD Anderson Cancer Center Clinic; Gilbert United States
| | - F. Hiemeyer
- Pharmaceutical Division; Bayer AG; Berlin Germany
| | - L. Liu
- Oncology; Bayer HealthCare Pharmaceuticals, Inc.; Whippany United States
| | - A. Miriyala
- Oncology; Bayer HealthCare Pharmaceuticals, Inc.; Whippany United States
| | | | - J. Garcia-Vargas
- Oncology; Bayer HealthCare Pharmaceuticals, Inc.; Whippany United States
| | - B.H. Childs
- Oncology; Bayer HealthCare Pharmaceuticals, Inc.; Whippany United States
| | - P.L. Zinzani
- Institute of Hematology “Seràgnoli”; University of Bologna; Bologna Italy
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10
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Zinzani P, Santoro A, Leppä S, Demeter J, Follows G, Lenz G, Kim W, Mollica L, Nagler A, Phipps Diong C, Provencio M, Magagnoli M, Munoz J, Miriyala A, Liu L, Zhang M, Garcia-Vargas J, Childs B, Dreyling M. SAFETY ANALYSIS OF PATIENTS WITH A MEDICAL HISTORY OF RESPIRATORY DISORDERS TREATED WITH COPANLISIB FROM THE CHRONOS-1 STUDY IN RELAPSED OR REFRACTORY INDOLENT B-CELL LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.58_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- P.L. Zinzani
- Institute of Hematology “Seràgnoli”; University of Bologna; Bologna Italy
| | - A. Santoro
- Cancer Center; Humanitas Clinical and Research Center; Rozzano Italy
| | - S. Leppä
- Comprehensive Cancer Center; Helsinki University Hospital; Helsinki Finland
| | - J. Demeter
- First Department of Internal Medicine; Semmelweis University; Budapest Hungary
| | - G.A. Follows
- Haematology; Cambridge University Hospitals NHS Foundation Trust; Cambridge United Kingdom
| | - G. Lenz
- Translational Oncology; University Hospital Münster; Münster Germany
| | - W.S. Kim
- Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - L. Mollica
- Clinical Research in Hematology and Clinical Oncology; Maisonneuve-Rosemont Hospital Research Centre; Montréal, Quebec Canada
| | - A. Nagler
- Chaim Sheba Medical Center; Tel Aviv University; Tel HaShomer Israel
| | - C. Phipps Diong
- Department of Haematology; Singapore General Hospital; Bukit Merah Singapore
| | - M. Provencio
- Health Research Institute; Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid; Madrid Spain
| | - M. Magagnoli
- Cancer Center; Humanitas Clinical and Research Center; Rozzano Italy
| | - J. Munoz
- Hematology and Oncology; Banner MD Anderson Cancer Center Clinic; Gilbert United States
| | - A. Miriyala
- Oncology; Bayer HealthCare Pharmaceuticals, Inc.; Whippany United States
| | - L. Liu
- Oncology; Bayer HealthCare Pharmaceuticals, Inc.; Whippany United States
| | - M. Zhang
- Oncology; Bayer HealthCare Pharmaceuticals, Inc.; Whippany United States
| | - J. Garcia-Vargas
- Oncology; Bayer HealthCare Pharmaceuticals, Inc.; Whippany United States
| | - B.H. Childs
- Oncology; Bayer HealthCare Pharmaceuticals, Inc.; Whippany United States
| | - M. Dreyling
- Department of Medicine III; University Hospital (LMU); Munich Germany
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11
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Masci G, Magagnoli M, Grimaldi A, Covini G, Carnaghi C, Rimassa L, Santoro A. Metastasis of Hepatocellular Carcinoma to the Heart: A Case Report and Review of the Literature. Tumori 2018; 90:345-7. [PMID: 15315319 DOI: 10.1177/030089160409000317] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 11/16/2022]
Abstract
Hepatocellular carcinoma (HCC) with extension or metastasis to the right atrium is an uncommon form of cardiac malignancy. This report describes a rare case of right intraventricular metastasis from HCC in a patient who had undergone a partial hepatectomy for HCC more than two years earlier. Open heart surgery was performed and the mass was partially excised. Symptoms (dyspnea, edema of the lower extremities, palpitations) improved after surgery. Two months later a recurrence of the ventricular mass was observed. Systemic chemotherapy with cisplatin and doxorubicin resulted in significant tumor reduction. The patient died of progressive hepatic failure six months later. In addition to this case report, a review of the literature on heart involvement from HCC is presented.
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Affiliation(s)
- Giovanna Masci
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
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12
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Fracchiolla NS, Artuso S, Cortelezzi A, Pelizzari AM, Tozzi P, Bonfichi M, Bocchio F, Gargantini L, De Rosa E, Vighi GD, Prestini L, Sammassimo S, Frungillo N, Pasquini MC, Ragazzi A, Boghi D, Pastore A, Lanzi E, Gritti G, Quaresmini G, Voltolini S, Gaiardoni R, Corti C, Vilardo MC, La Targia ML, Berini G, Magagnoli M, Bacci C, Consonni D, Rivolta AL, Muti G. FarmaREL: An Italian pharmacovigilance project to monitor and evaluate adverse drug reactions in haematologic patients. Hematol Oncol 2017; 36:299-306. [DOI: 10.1002/hon.2451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Nicola S. Fracchiolla
- UOC Oncoematologia; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico; Milan Italy
| | - Silvia Artuso
- UOC Oncoematologia; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico; Milan Italy
| | - Agostino Cortelezzi
- UOC Oncoematologia; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico; Milan Italy
| | | | - Paola Tozzi
- UO Ematologia; Spedali Civili; Brescia Italy
| | | | - Federica Bocchio
- SC Ematologia; Fondazione IRCCS Policlinico S Matteo; Pavia Italy
| | - Livio Gargantini
- SC Ematologia; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Elisa De Rosa
- SC Ematologia; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Giuseppe D. Vighi
- SS Farmacovigilanza e Farmacologia clinica; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Lucia Prestini
- SS Farmacovigilanza e Farmacologia clinica; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Simona Sammassimo
- Divisione di Oncoematologia; Istituto Europeo di Oncologia; Milan Italy
| | - Niccolò Frungillo
- Divisione di Oncoematologia; Istituto Europeo di Oncologia; Milan Italy
| | | | | | - Daniele Boghi
- UO Oncologia; Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | - Alessia Pastore
- UO Oncologia; Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | | | | | | | | | | | - Consuelo Corti
- UO di Ematologia e Trapianto di Midollo; IRCCS Ospedale San Raffaele; Milan Italy
| | | | | | - Giacomo Berini
- UO Oncologia Medica; AO Ospedale di Circolo; Busto Arsizio Italy
| | - Massimo Magagnoli
- Dipartimento di Ematologia ed Oncologia; Humanitas Cancer Center, Rozzano; Milan Italy
| | | | - Dario Consonni
- UO Epidemiologia; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico; Milan Italy
| | | | - Giuliana Muti
- Commissione Qualità e Risk Management REL; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
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13
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Carlo-Stella C, Barde P, Delarue R, Scarfò L, Viswanadha S, Locatelli S, Gandolfi S, Pittari V, Morello L, Magagnoli M, Pilipow K, De Paoli F, Lugli E, Santoro A, Ferreri A. SAFETY AND CLINICAL ACTIVITY OF RP6530, A DUAL PI3Kδ/γ INHIBITOR, IN PATIENTS WITH ADVANCED HEMATOLOGIC MALIGNANCIES: FINAL ANALYSIS OF A PHASE 1 MULTI-CENTER STUDY. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- C. Carlo-Stella
- Department of Biomedical Sciences, Department of Oncology and Hematology; Humanitas University, Humanitas Clinical and Research Hospital; Milan Italy
| | - P. Barde
- Clinical Research; Rhizen Pharmaceuticals SA; La Chaux-de-Fonds Switzerland
| | - R. Delarue
- Department of Hematology; AP-HP Hopital universitaire Necker-Enfants malades; Paris France
| | - L. Scarfò
- Department of Hematology; Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele; Milan Italy
| | - S. Viswanadha
- Drug Discovery; Incozen Therapeutics Pvt Ltd; Hyderabad India
| | - S. Locatelli
- Department of Oncology and Hematology; Humanitas Research Hospital; Milan Italy
| | - S. Gandolfi
- Department of Oncology and Hematology; Humanitas Research Hospital; Milan Italy
| | - V. Pittari
- Department of Oncology and Hematology; Humanitas Research Hospital; Milan Italy
| | - L. Morello
- Department of Oncology and Hematology; Humanitas Research Hospital; Milan Italy
| | - M. Magagnoli
- Department of Oncology and Hematology; Humanitas Research Hospital; Milan Italy
| | - K. Pilipow
- Laboratory of Translational Immunology; Humanitas Clinical and Research Center; Milan Italy
| | - F. De Paoli
- Laboratory of Translational Immunology; Humanitas Clinical and Research Center; Milan Italy
| | - E. Lugli
- Laboratory of Translational Immunology; Humanitas Clinical and Research Center; Milan Italy
| | - A. Santoro
- Department of Biomedical Sciences, Department of Oncology and Hematology; Humanitas University, Humanitas Clinical and Research Hospital; Milan Italy
| | - A. Ferreri
- Unit of Lymphoid Malignancies; IRCCS San Raffaele Scientific Institute; Milan Italy
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14
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Dreyling MH, Santoro A, Leppa S, Demeter J, Follows G, Lenz G, Kim WS, Mollica L, Nagler A, Diong CP, Provencio M, Stevens DA, Trevarthen D, Magagnoli M, Cupit L, Yin S, Hiemeyer F, Garcia-Vargas JE, Childs BH, Zinzani PL. Copanlisib in patients with relapsed or refractory follicular lymphoma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.7535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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
7535 Background: Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma (iNHL) subtype, yet treatment options in the relapsed/refractory (r/r) setting are limited. Copanlisib is a pan-Class I phosphatidylinositol 3-kinase (PI3K) inhibitor with predominant PI3K-α and PI3K-δ activity. We report results from the FL subset of a large phase II study (n=141) in iNHL patients (pts) (NCT01660451, part B). Methods: A total of 104 pts with indolent FL (grade 1-3a) relapsed/refractory to ≥2 prior lines of treatment were treated with copanlisib (60 mg IV infusion) administered on days 1, 8 and 15 of a 28-day cycle. The primary endpoint was objective tumor response rate (ORR) per independent radiologic review (Cheson et al., JCO 20:579, 2007). Results: Of the 104 pts treated, 62% were refractory; median prior lines 3 (range 2-8), median time from progression 8 wks (range 1-73 wks). 52% were male, 83% white, median age 62 yrs, and 62% ECOG 0. At the time of primary analysis the ORR was 58.7%, comprising 15 pts (14.4%) with complete response (CR) and 46 (44.2%) with partial response. Stable disease was observed in 35 (33.7%) pts and progression of disease as best response in 2 pts. The median duration of response was 370 days (range 0-687), with 43 responders censored at data cut-off. Median duration of treatment was 22 wks (range 1-105); 33 (32%) pts remained on treatment. For all pts, the most common treatment-emergent AEs occurring in >25% of pts included (all grade/grade 3+): diarrhea (34%/5%), reduced neutrophil count (30%/24%), fatigue (30%/2%), and fever (25%/4%). Hyperglycemia (50%/41%) and hypertension (30%/24%) were transient. The incidence of pneumonitis (8%/1.4%), hepatic enzymopathy (AST 28%/1.4%; ALT 23%/1.4%), opportunistic infection (1.4%) and colitis (0.7%) were low. Six deaths were observed, 3 of which were attributed to copanlisib: one lung infection, one respiratory failure, and one thromboembolic event. Conclusions: Copanlisib was highly active as a single agent in heavily pretreated r/r FL pts and resulted in durable responses in the majority of pts. Toxicities were manageable, with a low incidence of severe AEs associated with other PI3K inhibitors, especially hepatic enzymopathy, opportunistic infections, and colitis. Clinical trial information: NCT01660451.
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Affiliation(s)
| | - Armando Santoro
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Sirpa Leppa
- Helsinki University Central Hospital Cancer Center, Helsinki, Finland
| | - Judit Demeter
- Semmelweis University, First Department of Internal Medicine, Division of Haematology, Budapest, Hungary
| | - George Follows
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - Georg Lenz
- Translational Oncology Medical Clinic, Münster University Clinic, Münster, Germany
| | - Won Seog Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Division of Hematology and Oncology, Seoul, Republic of Korea
| | | | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Colin Phipps Diong
- Singapore General Hospital, Department of Haematology, Singapore, Singapore
| | - Mariano Provencio
- Health Research Institute, Hospital Universitario Puerta de Hierro, Universidad Autonoma de Madrid, Madrid, Spain
| | | | - David Trevarthen
- Comprehensive Cancer Care and Research Institute of Colorado, Englewood, CO
| | - Massimo Magagnoli
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Lisa Cupit
- Bayer HealthCare Pharmaceuticals Inc., Whippany, NJ
| | - Shuxin Yin
- Bayer HealthCare Pharmaceuticals Inc., Whippany, NJ
| | | | | | | | - Pier Luigi Zinzani
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
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15
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Balzarotti M, Brusamolino E, Angelucci E, Carella AM, Vitolo U, Russo E, Congiu A, Gotti M, Massidda S, Botto B, Annechini G, Spina M, Re A, Zilioli VR, Merli F, Salvi F, Stelitano C, Bonfichi M, Rodari M, Murru R, Magagnoli M, Anastasia A, Mazza R, Giordano L, Santoro A. B-IGEV (bortezomib plus IGEV) versus IGEV before high-dose chemotherapy followed by autologous stem cell transplantation in relapsed or refractory Hodgkin lymphoma: a randomized, phase II trial of the Fondazione Italiana Linfomi (FIL). Leuk Lymphoma 2016; 57:2375-81. [PMID: 26879066 DOI: 10.3109/10428194.2016.1140161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This randomized, multicenter study evaluates the addition of bortezomib (13 mg/m(2)) to IGEV (B-IGEV) in patients with relapsed/refractory Hodgkin Lymphoma (HL). Patients received either four courses of IGEV alone (n = 40) or B-IGEV (n = 40). The primary endpoint was the complete response (CR) proportion, evaluated by FDG-PET, after induction chemotherapy. CR proportion was 39% with B-IGEV and 53% with IGEV. PFS and OS were similar between the two groups (two-year PFS: 58% vs 56%; two-year OS: 93% vs 81%). The PET-negative status after treatment was the only variable favorably influencing both PFS (two-year PFS: 77% vs 40%; p = 0.002) and OS (two-year OS: 100% vs 76%; p < 0.001). Toxicity was overall similar with the two regimens. The addition of bortezomib to IGEV does not improve response in relapsed/refractory HL patients. However, its favorable therapeutic and safety profile, and the prognostic role of pre-transplant PET negativity in patients receiving IGEV-based regimens are confirmed.
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Affiliation(s)
| | - Ercole Brusamolino
- a Humanitas Cancer Center , Rozzano , Milan , Italy ;,b San Matteo Hospital , Pavia , Italy
| | - Emanuele Angelucci
- c U.O. Ematologia E Centro Trapianti Midollo Osseo. "Armando Businco" Hospital , Cagliari , Italy
| | | | | | - Eleonora Russo
- f Department of Biotechnology and Hematology, University La Sapienza , Rome , Italy
| | | | | | - Stefania Massidda
- c U.O. Ematologia E Centro Trapianti Midollo Osseo. "Armando Businco" Hospital , Cagliari , Italy
| | - Barbara Botto
- e AO Città Della Salute E Della Scienza , Turin , Italy
| | - Giorgia Annechini
- f Department of Biotechnology and Hematology, University La Sapienza , Rome , Italy
| | | | | | | | - Francesco Merli
- j Arcispedale S. Maria Nuova Hospital , Reggio Emilia , Italy
| | - Flavia Salvi
- k SS Antonio E Biagio E Cesare Arrigo Hospital , Alessandria , Italy
| | | | | | | | - Roberta Murru
- c U.O. Ematologia E Centro Trapianti Midollo Osseo. "Armando Businco" Hospital , Cagliari , Italy
| | | | - Antonella Anastasia
- a Humanitas Cancer Center , Rozzano , Milan , Italy ;,h Spedali Civili , Brescia , Italy
| | - Rita Mazza
- a Humanitas Cancer Center , Rozzano , Milan , Italy
| | | | - Armando Santoro
- a Humanitas Cancer Center , Rozzano , Milan , Italy ;,m Humanitas University , Rozzano , Milan , Italy
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16
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Castagna L, Crocchiolo R, Giordano L, Bramanti S, Carlo-Stella C, Sarina B, Chiti A, Mauro E, Gandolfi S, Todisco E, Balzarotti M, Anastasia A, Magagnoli M, Brusamolino E, Santoro A. High-dose melphalan with autologous stem cell support in refractory Hodgkin lymphoma patients as a bridge to second transplant. Bone Marrow Transplant 2015; 50:499-504. [PMID: 25621797 DOI: 10.1038/bmt.2014.304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 10/27/2014] [Accepted: 10/31/2014] [Indexed: 11/09/2022]
Abstract
Persistence of disease after salvage therapy among relapsed or refractory Hodgkin lymphoma (HL) patients predicts poor outcome. Here, we report on 41 HL patients with active disease after salvage therapy and who received high-dose melphalan (HD-PAM) and auto-SCT as a bridge to a second autologous or an allogeneic transplantation between 2002 and 2013 at our center. Disease response was based on 18-fluoro-deoxyglucose-positron emission tomography results in all patients. Overall response rate after HD-PAM was 78% and it did not differ among PR or stable/progressive disease patients (P=1.00). Response was associated with better OS: hazard ratio=0.32 (95% confidence interval: 0.13-0.77, P=0.01) irrespective of disease status before HD-PAM. Thirty-three patients (80%) were able to complete the planned treatment, intended as tandem autologous or auto-allo transplant. Hematological and extrahematological toxicity of HD-PAM was manageable, without any treatment-related death. In conclusion, HD-PAM is a valuable therapeutic option in relapsed/refractory HL patients with active disease after salvage therapy, with an impressive 78% overall response rate and 80% rate of proceeding to further transplantation. The present data may be integrated with the growing literature on new drugs in the field of relapsed/refractory HL.
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Affiliation(s)
- L Castagna
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - R Crocchiolo
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - L Giordano
- Statistic Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - S Bramanti
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - C Carlo-Stella
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - B Sarina
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - A Chiti
- Nuclear Medicine Department, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - E Mauro
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - S Gandolfi
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - E Todisco
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - M Balzarotti
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - A Anastasia
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - M Magagnoli
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - E Brusamolino
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - A Santoro
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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17
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Conconi A, Raderer M, Franceschetti S, Devizzi L, Ferreri AJM, Magagnoli M, Arcaini L, Zinzani PL, Martinelli G, Vitolo U, Kiesewetter B, Porro E, Stathis A, Gaidano G, Cavalli F, Zucca E. Clinical activity of everolimus in relapsed/refractory marginal zone B-cell lymphomas: results of a phase II study of the International Extranodal Lymphoma Study Group. Br J Haematol 2014; 166:69-76. [DOI: 10.1111/bjh.12845] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/27/2014] [Indexed: 12/29/2022]
Affiliation(s)
- Annarita Conconi
- Division of Haematology; Department of Translational Medicine; Amedeo Avogadro University of Eastern Piedmont; AOU Maggiore della Carità; Novara Italy
- Haematology Unit; Department of Internal Medicine; Ospedale degli Infermi; Biella Italy
| | - Markus Raderer
- Division of Oncology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - Silvia Franceschetti
- Division of Haematology; Department of Translational Medicine; Amedeo Avogadro University of Eastern Piedmont; AOU Maggiore della Carità; Novara Italy
| | - Liliana Devizzi
- Medical Oncology; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
| | - Andrés J. M. Ferreri
- Unit of Lymphoid Malignancies; Department of Onco-Haematology; San Raffaele Scientific Institute; Milan Italy
| | - Massimo Magagnoli
- Department of Medical Oncology and Haematology; Istituto Clinico Humanitas; Rozzano Milan Italy
| | - Luca Arcaini
- Department of Molecular Medicine; University of Pavia; Pavia Italy
- Department of Haematology Oncology; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - Pier Luigi Zinzani
- Institute of Haematology “L. e A. Seràgnoli”; University of Bologna; Bologna Italy
| | | | - Umberto Vitolo
- Haematology 2; San Giovanni Battista Hospital and University; Torino Italy
| | - Barbara Kiesewetter
- Division of Oncology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - Elena Porro
- Lymphoma Unit; IOSI - Oncology Institute of Southern Switzerland; Ospedale San Giovanni; Bellinzona Switzerland
| | - Anastasios Stathis
- Lymphoma Unit; IOSI - Oncology Institute of Southern Switzerland; Ospedale San Giovanni; Bellinzona Switzerland
| | - Gianluca Gaidano
- Division of Haematology; Department of Translational Medicine; Amedeo Avogadro University of Eastern Piedmont; AOU Maggiore della Carità; Novara Italy
| | - Franco Cavalli
- Lymphoma Unit; IOSI - Oncology Institute of Southern Switzerland; Ospedale San Giovanni; Bellinzona Switzerland
| | - Emanuele Zucca
- Lymphoma Unit; IOSI - Oncology Institute of Southern Switzerland; Ospedale San Giovanni; Bellinzona Switzerland
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18
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Spina M, Balzarotti M, Uziel L, Ferreri AJM, Fratino L, Magagnoli M, Talamini R, Giacalone A, Ravaioli E, Chimienti E, Berretta M, Lleshi A, Santoro A, Tirelli U. Modulated chemotherapy according to modified comprehensive geriatric assessment in 100 consecutive elderly patients with diffuse large B-cell lymphoma. Oncologist 2012; 17:838-46. [PMID: 22610154 PMCID: PMC3380883 DOI: 10.1634/theoncologist.2011-0417] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [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: 11/30/2011] [Accepted: 04/24/2012] [Indexed: 11/17/2022] Open
Abstract
Chemotherapy is associated with toxicity in elderly patients with potentially curable malignancies, posing the dilemma of whether to intensify therapy, thereby improving the cure rate, or de-escalate therapy, thereby reducing toxicity, with consequent risks for under- or overtreatment. Adequate tools to define doses and combinations have not been identified for lymphoma patients. We conducted a prospective trial aimed to evaluate the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment (CGA) in elderly (aged ≥70 years) patients with diffuse large B-cell lymphoma (DLBCL). In June 2000 to March 2006, 100 patients were stratified using a CGA into three groups (fit, unfit, and frail), and they received a rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone modulated in dose and drugs according to comorbidities and activities of daily living (ADL) and instrumental ADL scores. Treatment was associated with a complete response rate of 81% and mild toxicity: grade 4 neutropenia in 14%, anemia in 1%, and neurological and cardiac toxicity in 2% of patients. At a median follow-up of 64 months, 51 patients were alive, with 5-year disease-free, overall, and cause-specific survival rates of 80%, 60%, and 74%, respectively. Chemoimmunotherapy adjustments based on a CGA are associated with manageable toxicity and excellent outcomes in elderly patients with DLBCL. Wide use of this CGA-driven treatment may result in better cure rates, especially in fit and unfit patients.
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Affiliation(s)
- Michele Spina
- Division of Medical Oncology A, National Cancer Institute, Via Franco Gallini 2, Aviano, PN, Italy.
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19
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Saber W, Moua T, Williams EC, Verso M, Agnelli G, Couban S, Young A, De Cicco M, Biffi R, van Rooden CJ, Huisman MV, Fagnani D, Cimminiello C, Moia M, Magagnoli M, Povoski SP, Malak SF, Lee AY. Risk factors for catheter-related thrombosis (CRT) in cancer patients: a patient-level data (IPD) meta-analysis of clinical trials and prospective studies. J Thromb Haemost 2011; 9:312-9. [PMID: 21040443 PMCID: PMC4282796 DOI: 10.1111/j.1538-7836.2010.04126.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [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] [Indexed: 11/29/2022]
Abstract
BACKGROUND Knowledge of independent, baseline risk factors for catheter-related thrombosis (CRT) may help select adult cancer patients who are at high risk to receive thromboprophylaxis. OBJECTIVES We conducted a meta-analysis of individual patient-level data to identify these baseline risk factors. PATIENTS/METHODS MEDLINE, EMBASE, CINAHL, CENTRAL, DARE and the Grey literature databases were searched in all languages from 1995 to 2008. Prospective studies and randomized controlled trials (RCTs) were eligible. Studies were included if original patient-level data were provided by the investigators and if CRT was objectively confirmed with valid imaging. Multivariate logistic regression analysis of 17 prespecified baseline characteristics was conducted. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. RESULTS A total sample of 5636 subjects from five RCTs and seven prospective studies was included in the analysis. Among these subjects, 425 CRT events were observed. In multivariate logistic regression, the use of implanted ports as compared with peripherally implanted central venous catheters (PICCs), decreased CRT risk (OR, 0.43; 95% CI, 0.23-0.80), whereas past history of deep vein thrombosis (DVT) (OR, 2.03; 95% CI, 1.05-3.92), subclavian venipuncture insertion technique (OR, 2.16; 95% CI, 1.07-4.34) and improper catheter tip location (OR, 1.92; 95% CI, 1.22-3.02), increased CRT risk. CONCLUSIONS CRT risk is increased with use of PICCs, previous history of DVT, subclavian venipuncture insertion technique and improper positioning of the catheter tip. These factors may be useful for risk stratifying patients to select those for thromboprophylaxis. Prospective studies are needed to validate these findings.
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Affiliation(s)
- W Saber
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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20
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Anastasia A, Mazza R, Giordano L, Balzarotti M, Magagnoli M, Castagna L, Spina M, Michieli M, Tirelli U, Santoro A. Complete response (CR) to ifosfamide, gemcitabine, and vinorelbine (IGEV) and outcome in relapsed/refractory Hodgkin's lymphoma (HL) patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8568 Background: High dose chemotherapy with autologous stem cells transplant (ASCT) is the gold standard in patients with relapsed/refractory HL. Response to induction chemotherapy (chemosensitive patients) plays a major role in prognosis, however the role of CR status after induction therapy has not been established. Methods: One hundred twenty one patients with relapsed/refractory HL received 4 courses of IGEV followed by single (N=59) or tandem (N=19) ASCT (Santoro et al., Haematologica 92, 2007). Response to IGEV was evaluated by Cheson criteria (1999).The aim of this study was to evaluate the role of CR versus no-CR to IGEV induction therapy on the outcome in terms of progression free survival (PSF) and overall survival (OS). Statistical analysis was performed by using the Kaplan-Meier method and Cox proportional hazard model. Results: IGEV induced an overall response rate of 75% with 46% of CR. In the univariate analysis favourable factors for outcome were CR vs no-CR to IGEV (PFS: p <0.001, OS: p 0.002), A vs B symptoms (PFS: p 0.003; OS: p 0.05), limited vs advanced stage (PFS: p 0.03; OS: p 0.03), and 1 vs≥2 previous chemotherapy lines (PFS: p 0.03, OS: p 0.02); response to last therapy (relapsed vs refractory) influenced PFS (p 0.03) but not OS (p 0.70). The multivariate analysis confirmed the favourable prognostic role of CR to IGEV (PFS HR: 2.5, CI 95%:1.3; 4.6 - OS HR 2.3, CI 95%:1.1;4.8) and of the number of previous chemotherapy lines (PFS HR:1.8, CI 95%:1.0;3.2 - OS HR 2.1, CI 95%:1.1;3.9). Conclusions: According to our data, we conclude that: 1. CR to IGEV is the strongest indicator of outcome in relapsed/refractory HL. 2. Achievement of CR to IGEV overcomes the role of initial disease status. 3. Efforts are warranted to increase the CR rate by induction therapy. No significant financial relationships to disclose.
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Affiliation(s)
- A. Anastasia
- Istituto Clinico Humanitas, Rozzano, Italy; Medical Oncology, Centro di Riferimento Oncologico, Aviano (Pordenone), Italy
| | - R. Mazza
- Istituto Clinico Humanitas, Rozzano, Italy; Medical Oncology, Centro di Riferimento Oncologico, Aviano (Pordenone), Italy
| | - L. Giordano
- Istituto Clinico Humanitas, Rozzano, Italy; Medical Oncology, Centro di Riferimento Oncologico, Aviano (Pordenone), Italy
| | - M. Balzarotti
- Istituto Clinico Humanitas, Rozzano, Italy; Medical Oncology, Centro di Riferimento Oncologico, Aviano (Pordenone), Italy
| | - M. Magagnoli
- Istituto Clinico Humanitas, Rozzano, Italy; Medical Oncology, Centro di Riferimento Oncologico, Aviano (Pordenone), Italy
| | - L. Castagna
- Istituto Clinico Humanitas, Rozzano, Italy; Medical Oncology, Centro di Riferimento Oncologico, Aviano (Pordenone), Italy
| | - M. Spina
- Istituto Clinico Humanitas, Rozzano, Italy; Medical Oncology, Centro di Riferimento Oncologico, Aviano (Pordenone), Italy
| | - M. Michieli
- Istituto Clinico Humanitas, Rozzano, Italy; Medical Oncology, Centro di Riferimento Oncologico, Aviano (Pordenone), Italy
| | - U. Tirelli
- Istituto Clinico Humanitas, Rozzano, Italy; Medical Oncology, Centro di Riferimento Oncologico, Aviano (Pordenone), Italy
| | - A. Santoro
- Istituto Clinico Humanitas, Rozzano, Italy; Medical Oncology, Centro di Riferimento Oncologico, Aviano (Pordenone), Italy
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21
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Castagna L, Bramanti S, Balzarotti M, Sarina B, Todisco E, Anastasia A, Magagnoli M, Mazza R, Nozza A, Giordano L, Rodari M, Rinifilo E, Chiti A, Santoro A. Predictive value of early 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) during salvage chemotherapy in relapsing/refractory Hodgkin lymphoma (HL) treated with high-dose chemotherapy. Br J Haematol 2009; 145:369-72. [PMID: 19344403 DOI: 10.1111/j.1365-2141.2009.07645.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This retrospective study evaluated whether early 2-[fluorine-18]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) after two cycles of salvage chemotherapy (PET2) could predict survival after high-dose chemotherapy (HDC). Twenty-four Hodgkin lymphoma (HL) patients were included. PET2 was negative in 58% and positive in 42% of patients. Ninety per cent of patients (9/10) with positive PET2 relapsed after HDC while all but one patient with negative PET2 maintained a complete remission. The 2-year progression-free survival was 93% vs. 10% for patients with negative and positive PET2, respectively (P < 0.001). This study shows that interim PET can predict the outcome after high-dose chemotherapy in HL patients.
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Affiliation(s)
- Luca Castagna
- Oncology and Haematology Department, Istituto Clinico Humanitas, Rozzano (MI), Italy.
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22
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Castagna L, Sarina B, Todisco E, Magagnoli M, Balzarotti M, Bramanti S, Mazza R, Anastasia A, Bacigalupo A, Aversa F, Soligo D, Giordano L, Santoro A. Allogeneic stem cell transplantation compared with chemotherapy for poor-risk Hodgkin lymphoma. Biol Blood Marrow Transplant 2009; 15:432-8. [PMID: 19285630 DOI: 10.1016/j.bbmt.2008.12.506] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [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: 09/04/2008] [Accepted: 12/22/2008] [Indexed: 11/19/2022]
Abstract
The aim of this study was to assess the role of allogeneic hematopoietic stem cell transplantation (HSCT) in patients with poor-risk Hodgkin's disease (HD) compared to chemotherapy. A donor was identified in 26 patients (14 HLA identical siblings and 10 alternative donors), and 24 received a transplant (Allo group). Twenty patients without a donor received different chemotherapy regimens and radiotherapy (CHEMO group). After a median follow-up of 28 months (range: 1-110), the 2-year overall survival (OS) was 71% in the ALLO group compared to 50% in the CHEMO group (P = .031). In the Allo group, the 2-year progression-free survival (PFS) was 47%. The 1-year nonrelapse mortality (NRM) in the ALLO group was 8% versus 0% in the CHEMO group. This study, suggests that allogeneic transplantation may prolong the survival in patients with a poor-risk HD.
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Affiliation(s)
- Luca Castagna
- Hematology Oncology Department, Istituto Clinico Humanitas, Rozzano, Milano, Italy.
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23
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Magagnoli M, Balzarotti M, Castagna L, Demarco M, Santoro A. What is the best option to cure patients with resistant/relapsing Hodgkin's disease? Curr Stem Cell Res Ther 2008; 1:419-24. [PMID: 18220885 DOI: 10.2174/157488806778226786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Nearly 80% of patients with Hodgkin's disease (HD) are cured with chemotherapy with or without radiotherapy. However, in patients with primary refractory or relapsed disease, high-dose therapy (HDT) and autologous or peripheral-blood stem-cell transplantation (ASCT or PBSCT) represents the best curative option. Several prognostic factors to identify patients at high risk for relapse or progression have been analyzed. However, in almost all analyzed series, disease status before high-dose chemotherapy with PBSC support remains the most important factor predicting the outcome of these patients. Nonetheless, the benefit of cytoreduction before HDT has yet to be fully determined and efforts to identify the best active regimen, combining therapeutic activity and CD34+ stem-cell mobilizing potential, represent a challenging issue for these patients. Furthermore new approaches like myeloablative and non-myeloablative allogeneic transplants have been assessed to improve long-term in such patients. In this review we analyzed the results of the most important salvage chemotherapy combinations as well as allogeneic transplantations to clarify the optimal treatment options for patients with resistant/relapsing HD.
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Affiliation(s)
- Massimo Magagnoli
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
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24
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Magagnoli M, Spina M, Balzarotti M, Timofeeva I, Isa L, Michieli M, Capizzuto R, Morenghi E, Castagna L, Tirelli U, Santoro A. IGEV regimen and a fixed dose of lenograstim: an effective mobilization regimen in pretreated Hodgkin's lymphoma patients. Bone Marrow Transplant 2007; 40:1019-25. [PMID: 17906705 DOI: 10.1038/sj.bmt.1705862] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We explored the efficacy of the IGEV regimen (ifosfamide, gemcitabine, vinorelbine and prednisone) combined with a fixed dose of lenograstim (263 mug/day) to mobilize peripheral blood stem cells (PBSCs) in 90 Hodgkin's lymphoma patients. The median total CD34+ cells/mul peak, colony-forming units granulocyte-macrophage and white blood cells for all individual collection sets were 85/mul, 12 x 10(4)/kg and 20 700/mul, respectively. An adequate number of CD34+ cells (more than 3 x 10(6) or 6 x 10(6) CD34+ cells/kg depending on whether single or tandem high-dose chemotherapy was used) were collected in 89 out of 90 (98.7%) mobilized patients, whereas the only failure reached 2.3 x 10(6) CD34+ cells/kg. The median CD34+ cell collections were 11 x 10(6)/kg (range 2.3-39 x 10(6)/kg) and 10 x 10(6)/kg (range 6-22.0 x 10(6)/kg) with a median of 1 and 2 leukaphereses for patients eligible for single high-dose treatment and for candidates for tandem transplant, respectively. Target yields were reached in 71.43 and 49.09% and additionally in 17.14 and 43.64% of cases after the first and second apheresis procedures, respectively. Hematological and non-hematological side effects were acceptable, and no toxic deaths occurred. Thirty-four patients received a single and 47 received tandem transplantation with rapid engraftment. These results confirm that the IGEV regimen with lenograstim support can be used successfully and safely to mobilize PBSCs.
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Affiliation(s)
- M Magagnoli
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
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25
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Masci G, Magagnoli M, Gullo G, Morenghi E, Garassino I, Simonelli M, Santoro A. Herpes infections in breast cancer patients treated with adjuvant chemotherapy. Oncology 2007; 71:164-7. [PMID: 17641534 DOI: 10.1159/000106065] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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: 11/14/2006] [Accepted: 03/10/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE There is little information on Herpes zoster infection in breast cancer patients as a complication during adjuvant chemotherapy. The aim of this study is to evaluate the incidence of Herpes zoster and simplex infections in this patients setting. METHODS We analyzed 623 early-stage breast cancer patients in our Institute over a period of 7 years (1998-2005). Four-hundred and sixty-one patients were treated with anthracycline-based chemotherapy, 116 with CMF and 46 with taxane-containing regimens. RESULTS Twelve (1.9%) developed herpes zoster; 9 patients, receiving anthracycline-based chemotherapy, two taxane-containing regimens, and one CMF regimen. Herpes zoster infection required treatment delay in 6 patients. Adjuvant chemotherapy was delayed for 1 week in 2 patients, while in 4 patients with more severe symptoms chemotherapy was delayed for 2 weeks. One patient, despite i.v. acyclovir, had severe postherpetic motor neuropathy with a permanent ambulation impairment, and chemotherapy was stopped. In our study, herpes zoster occurred in 55/1,000 cases/year. The reported incidence in the general population varies between 2.2 and 4.1 per 1,000 patients/year; therefore, the risk of developing herpes zoster in these patients may be 13- to 25-fold higher compared to the incidence in the general population. In addition, 13 of 623 patients developed herpes simplex. CONCLUSION Our findings suggest that adjuvant chemotherapy can facilitate reactivation of herpes infection.
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Affiliation(s)
- Giovanna Masci
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Milan, Italy.
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27
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Di Ieva A, Di Lieva A, Aimar E, Tancioni F, Levi D, Debernardi A, Pisano P, Rahal D, Nozza A, Magagnoli M, Gaetani P. Focal extra-axial hemorrahagic mass with subdural hemorrhage secondare to extramedullary hematopoiesis in idiopathic myelodysplastic sindrome. J Neurosurg Sci 2007; 51:29-32. [PMID: 17369789] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Idiopathic myelodysplastic syndrome is a disease characterized by a clonal stem cell disorder in which megacaryocitic and granulocytic lineages are mainly involved; extramedullary myeloid metaplasia is due to abnormal location of myeloid tissue in other organs than bone marrow. Rarely the central nervous system is involved. When it happens, it is typical to find masses around the brain and pachymeningeal thickening, but it is very rare to find it associated with subdural haemorrhage, as in the case we describe in the present article. Considering our case and the literature we can suggest that radiological images associated with the clinical history of the patient suggestive for extramedullary hematopoiesis can be sufficient for a correct diagnosis and for a radiotherapy treatment, demanding surgery in the case of diagnostic doubts, massive hemorrahages or neurological decifits caused by the focal lesions.
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Affiliation(s)
- A Di Ieva
- Department of Neurosurgery, Istituto Clinico HUMANITAS IRCCS, Rozzano (Milan), Italy.
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Castagna L, Magagnoli M, Balzarotti M, Sarina B, Siracusano L, Nozza A, Todisco E, Bramanti S, Mazza R, Russo F, Timofeeva I, Santoro A. Tandem high-dose chemotherapy and autologous stem cell transplantation in refractory/relapsed Hodgkin's lymphoma: a monocenter prospective study. Am J Hematol 2007; 82:122-7. [PMID: 17019686 DOI: 10.1002/ajh.20790] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [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: 12/25/2022]
Abstract
We designed a prospective study to evaluate the feasibility and efficacy of tandem high-dose chemotherapy (HDCT) in the treatment of refractory or relapsed Hodgkin's lymphoma (HL). Thirty-two patients were treated with salvage chemotherapy (IGEV, ifosfamide, gemcitabine, and vinorelbine) and chemo-sensitive patients received a first HDCT course with melphalan 200 mg/m(2) (MEL200) and a second BEAM course. The median time interval between the two HDCT courses was 66 days. The median number of reinfused CD34(+) cells was 4.7 x 10(6)/kg after MEL200 and 5.8 x 10(6)/kg after BEAM. The hematological reconstitution after both HDCT courses did not differ. No grade III or IV renal, hepatic, lung, cardiac, and neurological toxicity was observed. Severe (grade III and IV) oral mucositis was the most prominent complication affecting 60 and 50% of patients after MEL200 and BEAM, respectively. Fever of unknown origin occurred in 65 and 70% of patients after MEL200 and BEAM, respectively. One patient died from septic shock during the aplasia period following BEAM. In an intention-to-treat analysis, the overall response rate increased after each stage of protocol, ranging from 47% to 65% and 75% after IGEV, MEL200, and BEAM, respectively. Tandem HDCT is feasible and effective in patients with relapsed or refractory HL.
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Affiliation(s)
- Luca Castagna
- Department of Hematology and Medical Oncology, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
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Santoro A, Magagnoli M, Spina M, Pinotti G, Siracusano L, Michieli M, Nozza A, Sarina B, Morenghi E, Castagna L, Tirelli U, Balzarotti M. Ifosfamide, gemcitabine, and vinorelbine: a new induction regimen for refractory and relapsed Hodgkin's lymphoma. Haematologica 2007; 92:35-41. [PMID: 17229633 DOI: 10.3324/haematol.10661] [Citation(s) in RCA: 183] [Impact Index Per Article: 10.8] [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: 11/09/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Response to pre-transplant salvage chemotherapy remains the most important prognostic factor for outcome in refractory or relapsed Hodgkin's lymphoma. Results of a new induction regimen are reported in terms of response rates, toxicity, and stem cell mobilization. DESIGN AND METHODS Ninety-one patients with refractory or relapsed Hodgkin's lymphoma were treated prospectively with a salvage regimen consisting of ifosfamide 2000 mg/m2 on days 1 to 4, gemcitabine 800 mg/m2 on days 1 and 4, vinorelbine 20 mg/m2 on day 1, and prednisolone 100 mg on days 1 to 4 (IGEV). RESULTS Forty-nine patients (53.8%) achieved a complete remission and 25 (27.5%) a partial response for an overall response rate of 81.3%. In the multivariate analysis response to the last chemotherapy (p<0.0001) and involvement of > or =3 sites (p<0.049) were the most important prognostic factors for response. Adequate CD34+ cell collection was achieved in 78 out of 79 (98.7%) mobilized patients. So far, no treatment-related death has been documented. Thirteen (4.2%) and 27 (8.6%) out of 313 evaluated cycles had to be delayed or reduced, respectively, mainly because of neutropenia and thrombocytopenia. No grade 4 non-hematologic toxicity was observed, except for one episode of mucositis. INTERPRETATION AND CONCLUSIONS The high response rate, in particular the complete remission rate, the low toxicity profile, and the very high mobilizing potential of the IGEV regimen strongly suggest that patients with relapsed/refractory Hodgkin's lymphoma may benefit from the use of this salvage induction regimen.
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Affiliation(s)
- Armando Santoro
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, via Manzoni 56, 20089 Rozzano, Milan, Italy.
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Todisco E, Castagna L, Sarina B, Mazza R, Magagnoli M, Balzarotti M, Nozza A, Siracusano L, Timofeeva I, Anastasia A, Demarco M, Santoro A. CD34+ dose-driven administration of granulocyte colony-stimulating factor after high-dose chemotherapy in lymphoma patients. Eur J Haematol 2007; 78:111-6. [PMID: 17313558 DOI: 10.1111/j.1600-0609.2006.00793.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 11/29/2022]
Abstract
Our goal was to optimize use of granulocyte colony-stimulating factor (G-CSF) after high-dose chemotherapy and autologous peripheral blood stem-cell transplantation in lymphoma patients, limiting G-CSF administration to patients infusing a suboptimal CD34(+) cell number. Of 124 consecutive patients with histologically proven Hodgkin's and non-Hodgkin's lymphoma from January 2001 to June 2004, 60 patients (group 1) given > or = 5 x 10(6)/kg CD34(+) cells received no G-CSF; 64 patients (group 2) given < or = 5 x 10(6)/kg CD34(+) cells received G-CSF from day +5 after stem-cell reinfusion. The median times to reach 0.5 x 10(9)/L and 1.0 x 10(9)/L neutrophils were, respectively, 3 and 4 d shorter in G-CSF group and this difference was statistically significant (P = 0.0014; P = 0.0001). In terms of antibiotic and antimycotic requirements, gastrointestinal toxicity, days of hospitalization, and transfusion requirements, no differences were demonstrated between the two groups. No statistically significant difference was demonstrated for the total number of febrile episodes (52 for group 1; 53 for group 2; P = 0.623) and the median number of febrile days (2 d for both groups). Myeloid reconstitution values for both groups agree with published results for autotransplanted patients treated with G-CSF from 7 to 14 d. Also, major clinical events, antibiotic, antimycotic, and transfusion requirements, and hospital stay were similar to published findings. Our data suggest that G-CSF administration can be safely optimized, used only for patients infused with a suboptimal CD34(+) cell dose.
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Affiliation(s)
- Elisabetta Todisco
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano, Milano, Italy.
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Magagnoli M, Balzarotti M, Siracusano LV, Spina M, Isa L, Morenghi E, Tirelli U, Santoro A. High relapse rate after a brief chemotherapy course and involved-field radiotherapy in early-stage Hodgkin lymphoma. Leuk Lymphoma 2007; 48:2444-6. [DOI: 10.1080/10428190701684492] [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: 10/22/2022]
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Masci G, Magagnoli M, Pedicini V, Poretti D, Castagna L, Carnaghi C, Morenghi E, Del Vecchio A, Finotto R, Brambilla G, Santoro A. Long-term, tunneled, noncuffed central venous catheter in cancer patients (Vygon): safety, efficacy, and complications. Support Care Cancer 2006; 14:1141-6. [PMID: 16622649 DOI: 10.1007/s00520-006-0065-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Accepted: 03/09/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Totally implantable or partially cuffed central venous catheters (CVC) are commonly used in cancer patients, but they are often expensive and may produce complications. To minimize costs, we have been using a low-cost, partially tunneled, silicone elastomer catheter with no Dacron cuff or antireflux valve (Vygon) since 2001. This study is a retrospective investigation of our experience using the Vygon catheter as a long-term CVC in patients with malignancy. MATERIALS AND METHODS A total of 458 Vygon catheters (Nutricath, Vygon) were percutaneously inserted by an interventional radiologist in 302 cancer patients. The median duration of catheter use was 93 days, mean 164.3 days (range 1-789). Main patient characteristics were as follows: number of male/female patients, 166/136; median age, 51 years; hematological/nonhematological patients, 189/113. RESULTS Early complications were pneumothorax in six and hematoma in twelve of 458 implants, respectively. Thirteen out of 302 patients developed a catheter-related thrombosis. One hundred and thirty-five of 458 Vygon catheters required removal because of catheter-related complications: 68 accidental losses, 37 cases of febrile neutropenia suspected to be catheter-related, ten catheter dislodgements, ten catheter malfunctions, four local infections, three thromboses, two catheter ruptures, and one allergic reaction. CONCLUSION Vygon catheters do not seem to induce more early and late complications as compared with other more expensive devices, except for disadvantage of the high incidence rate of accidental losses.
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Affiliation(s)
- Giovanna Masci
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
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Magagnoli M, Masci G, Castagna L, Pedicini V, Poretti D, Morenghi E, Brambilla G, Santoro A. Prophylaxis of central venous catheter-related thrombosis with minidose warfarin in patients treated with high-dose chemotherapy and peripheral-blood stem-cell transplantation: retrospective analysis of 228 cancer patients. Am J Hematol 2006; 81:1-4. [PMID: 16369969 DOI: 10.1002/ajh.20512] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [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: 11/11/2022]
Abstract
Patients with a central venous catheter (CVC) undergoing high-dose chemotherapy (HDC) followed by peripheral-blood stem-cell transplantation (PBSCT) for malignancies are at high risk of thrombosis, but the use of anti-coagulant prophylaxis remains debatable in this setting of patients. We analyzed the efficacy and the safety of minidose warfarin in 228 patients in whom CVCs had been placed and who had received 292 HDC courses of therapy. The catheters remained in place for a mean of 173 (range 40-298) days. All patients received prophylactic oral warfarin in the fixed dose of 1 mg/day starting on the day of CVC insertion. Prophylaxis was interrupted during aplasia when platelet counts fell below 50,000/dL. There were no toxic deaths related to the prophylaxis. Overall there were 4 thrombotic events. Three occurrences were directly related to the catheter, while the remaining event was a deep saphenous-vein thrombosis. A number of potential predictive factors were analyzed for their impact on thrombotic events without finding any significant correlation. Four episodes of bleeding occurred, with each of these individuals having a normal INR but a platelet count below 50,000/dL. Minidose warfarin is effective and safe to use for preventing thrombotic events in this setting of patients.
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Affiliation(s)
- Massimo Magagnoli
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
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Magagnoli M, Masci G, Castagna L, Morenghi E, Santoro A. High incidence of INR alteration in gastrointestinal cancer patients treated with mini-dose warfarin and 5-fluorouracil-based regimens. Ann Oncol 2006; 17:174-6. [PMID: 16100233 DOI: 10.1093/annonc/mdj002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Magagnoli M, Masci G, Castagna L, Bramanti S, Morenghi E, Carnaghi C, Santoro A. High incidence of haemostatic interference in cancer patients treated with FOLFOX regimen and concomitant minidose of warfarin. Br J Haematol 2005; 129:709-10. [PMID: 15916696 DOI: 10.1111/j.1365-2141.2005.05523.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Magagnoli M, Masci G, Castagna L, Zucali PA, Morenghi E, Pedicini V, Santoro A. Prophylaxis of central venous catheter-related thrombosis with minidose warfarin: analysis of its use in 427 cancer patients. Anticancer Res 2005; 25:3143-7. [PMID: 16080578] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND In the past few years, several studies have been performed to evaluate thrombosis prophylaxis with warfarin in cancer patients with central venous catheters (CVC), but the analysis of these studies does not allow firm conclusions to be drawn. PATIENTS AND METHODS Four hundred and twenty-seven cancer patients were evaluated. Each received warfarin at a dose of 1 mg/daily as prophylaxis, starting the day after CVC positioning until its removal. RESULTS The catheters were monitored for a mean of 168 days (range 22-706). There were 9 thrombotic events (1.8%). Overall, International Normalised Ratio (INR) elevation occurred in 55 (12.8%) patients. Bleeding was observed in 15 (3.5%) patients, 10 of whom had elevated INR levels. Of these, all were treated with continuous-infusion 5-Fluorouracil (5-FU)-based regimens. CONCLUSION Minidose warfarin can protect from clinical thrombosis, but can induce an alteration in INR values and/or haemorrhagic symptoms in patients being treated with 5-FU-based regimens.
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Affiliation(s)
- Massimo Magagnoli
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
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Siracusano L, Balzarotti M, Magagnoli M, Castagna L, Rahal D, Santoro A. Primary mediastinal B-cell lymphoma with sclerosis: report of 11 cases treated with intensified-CHOP plus radiotherapy. Am J Hematol 2005; 78:312-3. [PMID: 15795908 DOI: 10.1002/ajh.20301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/07/2022]
Abstract
Primary mediastinal B-cell lymphoma (PMBCL) is a clinicopathological entity with aggressive behavior. Retrospective evaluation suggests the need for intensive chemotherapy programs. From 1997 to February 2003, a total of 11 cases of previously untreated PMBCL with sclerosis were treated at our institution with 5 courses of intensified CHOP (ICHOP) regimen and mediastinal irradiation. Three patients were submitted to high-dose chemotherapy with peripheral-blood stem-cell support, followed by radiotherapy, because of intermediate-risk age-adjusted International Prognostic Index at diagnosis. After a median follow up of 30 months, all patients but one are in continuous complete remission (CR), and overall survival is 100%.
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Affiliation(s)
- Licia Siracusano
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
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Santoro A, Castagna L, Magagnoli M. Lymphomas. Cancer Chemother Biol Response Modif 2005; 22:391-9. [PMID: 16110621] [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] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Armando Santoro
- Department of Medical Oncology and Hematology, Istituto Clnico Humanitas, Milano, Italy.
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Magagnoli M, Castagna L, Bramanti S, Balzarotti M, Santoro A. Single-agent high-dose melphalan followed by peripheral blood stem cell (PBSC) in lymphoma patients: an effective, and well-tolerated conditioning regimen. Bone Marrow Transplant 2004; 33:1067-8. [PMID: 15129236 DOI: 10.1038/sj.bmt.1704492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Magagnoli M, Castagna L, Masci G, Santoro A. Low‐Dose Warfarin Prophylaxis for Catheter‐Associated Thrombosis in Cancer Patients. Can It Be Safely Associated with 5‐Fluorouracil‐Based Chemotherapy? Oncologist 2004; 9:594-5; author reply 596. [PMID: 15477645 DOI: 10.1634/theoncologist.9-5-594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Magagnoli M, Masci G, Castagna L, Zucali PA, Pedicini V, Bramanti S, Balzarotti M, Morenghi E, Santoro A. Retrospective analysis of central venous catheter-related thrombosis in 427 cancer patients prophylaxed with low-dose warfarin. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Magagnoli
- Istituto Clinico Humanitas, Rozzano-Milano, Italy
| | - G. Masci
- Istituto Clinico Humanitas, Rozzano-Milano, Italy
| | - L. Castagna
- Istituto Clinico Humanitas, Rozzano-Milano, Italy
| | - P. A. Zucali
- Istituto Clinico Humanitas, Rozzano-Milano, Italy
| | - V. Pedicini
- Istituto Clinico Humanitas, Rozzano-Milano, Italy
| | - S. Bramanti
- Istituto Clinico Humanitas, Rozzano-Milano, Italy
| | | | - E. Morenghi
- Istituto Clinico Humanitas, Rozzano-Milano, Italy
| | - A. Santoro
- Istituto Clinico Humanitas, Rozzano-Milano, Italy
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Affiliation(s)
- Massimo Magagnoli
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
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Magagnoli M, Masci G, Castagna L, Rimassa L, Bramanti S, Santoro A. Intermediate-dose melphalan with stem-cell support in platinum-refractory ovarian cancer. Bone Marrow Transplant 2004; 33:1261-2. [PMID: 15107813 DOI: 10.1038/sj.bmt.1704527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bertuzzi A, Castagna L, Quagliuolo V, Ginanni V, Compasso S, Magagnoli M, Balzarotti M, Nozza A, Siracusano L, Timofeeva I, Sarina B, Parra HS, Santoro A. Prospective study of high-dose chemotherapy and autologous peripheral stem cell transplantation in adult patients with advanced desmoplastic small round-cell tumour. Br J Cancer 2003; 89:1159-61. [PMID: 14520438 PMCID: PMC2394317 DOI: 10.1038/sj.bjc.6601304] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A total of 10 desmoplastic small round-cell tumour patients were treated by high-dose chemotherapy with stem cell support. After high-dose chemotherapy, no complete response conversion was obtained and EWS-WT1 fusion transcript detection was positive in the peripheral blood during follow-up in all patients. High-dose chemotherapy did not seem to change the results in desmoplastic small round-cell tumour.
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Affiliation(s)
- A Bertuzzi
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - L Castagna
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, Milan 20089, Italy
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, Milan 20089, Italy. E-mail:
| | - V Quagliuolo
- Department of General Surgery, Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - V Ginanni
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - S Compasso
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - M Magagnoli
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - M Balzarotti
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - A Nozza
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - L Siracusano
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - I Timofeeva
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - B Sarina
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - H Soto Parra
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - A Santoro
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, Milan 20089, Italy
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Magagnoli M, Balzarotti M, Castagna L, Rahal D, Siracusano L, Nozza A, Santoro A. Idiopathic thrombocytopenic purpura and splenic marginal-zone B-cell lymphoma: a casual correlation? Leuk Lymphoma 2003; 44:1639-40. [PMID: 14565674 DOI: 10.3109/10428190309178794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Magagnoli M, Castagna L, Timofeeva I, Balzarotti M, Santoro A. High-dose chemotherapy supported by peripheral blood stem cell transplantation in elderly versus younger lymphoma patients: a matched analysis. Leuk Lymphoma 2003; 44:1439-40. [PMID: 12952242 DOI: 10.1080/1042819031000083299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Magagnoli M, Castagna L, Balzarotti M, Sarina B, Timofeeva I, Bertuzzi A, Compasso S, Nozza A, Siracusano L, Santoro A. Feasibility and toxicity of high-dose therapy (HDT) supported by peripheral blood stem cells in elderly patients with multiple myeloma and non-Hodgkin's lymphoma: survey from a single institution. Am J Hematol 2003; 73:267-72. [PMID: 12879431 DOI: 10.1002/ajh.10384] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 12/22/2022]
Abstract
The aim of this retrospective study was to investigate the feasibility of high-dose therapy (HDT) followed by peripheral blood stem cell transplantation (PBSCT) in elderly patients with hematological malignancies. From April 1998 to November 2001, 40 elderly patients (defined as > or =60 years) with non-Hodgkin's lymphoma (12 patients) and multiple myeloma (28 patients) were evaluated. Seven lymphoma and one myeloma patients were in complete remission (CR), 27 in partial remission (PR), two had stable disease (SD), and three progressive disease (PD). The median age was 65 years (range 60-71). Thirty-nine patients were mobilized with chemotherapy plus granulocyte-colony stimulating factor (G-CSF) and one with G-CSF alone. Patients received HDT including melphalan alone in 32 cases or combined with other drugs in six and BEAM in two. The median number of collected CD34(+) cells was 12.4 x 10(6)/kg (range 2.0-68.9). The median number of re-infused CD34(+) cells was 9.9 x 10(6)/kg (range 2.0-68.9). All patients engrafted after PBSC and the median time to neutrophil recovery (N > 500/micro l) and platelet recovery (PLT > 20,000/micro l) was 8 days (range 5-18) and 6 days (range 5-18), respectively. Nonhematological toxicity was mild and no patient died from transplant-related toxicity (TRM). Median duration of hospitalization was 18 days (range 12-24). To date, 32 patients are alive and eight died from disease progression at a median follow-up interval of 24 months. HDT supported by PBSC is a feasible procedure in selected elderly patients, and an age of more than 60 years should not be considered a contraindication for HDT.
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Affiliation(s)
- Massimo Magagnoli
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano-Milan, Italy.
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Balzarotti M, Magagnoli M, Santoro A. Early restaging positron emission tomography with 18F-fluorodeoxyglucose in aggressive non-Hodgkin's lymphomas: is it too easy to be true? Ann Oncol 2003; 14:1155-6. [PMID: 12853364 DOI: 10.1093/annonc/mdg283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Magagnoli M, Masci G, Carnaghi C, Zucali PA, Castagna L, Morenghi E, Santoro A. Minidose warfarin is associated with a high incidence of International Normalized Ratio elevation during chemotherapy with FOLFOX regimen. Ann Oncol 2003; 14:959-60. [PMID: 12796035 DOI: 10.1093/annonc/mdg238] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Masci G, Magagnoli M, Zucali PA, Castagna L, Carnaghi C, Sarina B, Pedicini V, Fallini M, Santoro A. Minidose warfarin prophylaxis for catheter-associated thrombosis in cancer patients: can it be safely associated with fluorouracil-based chemotherapy? J Clin Oncol 2003; 21:736-9. [PMID: 12586814 DOI: 10.1200/jco.2003.02.042] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [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: 12/18/2022] Open
Abstract
PURPOSE The use of prophylactic low-dose oral warfarin in cancer patients with a central venous catheter (CVC) in place has an established role in the prevention of thrombotic complications and is associated with a low hemorrhagic risk. Despite the literature indicating an adverse interaction between warfarin and fluorouracil (FU), the frequency of this interaction and whether it occurs when minidose warfarin is used is unknown. We analyzed the incidence of alterations in the International Normalized Ratio (INR) and bleeding in cancer patients given minidose warfarin during treatment with continuous-infusion FU-based regimens. PATIENTS AND METHODS Between July 1999 and August 2001, 95 cancer patients were evaluated. Forty-one patients (43%) had liver metastases. Seventy-nine patients (83%) had a Groshong CVC (Bard Access System, Salt Lake City, UT), and 16 (17%) had a Port-a-Cath device (Bard Access System). All patients received oral warfarin at a dose of 1 mg/daily as prophylaxis beginning the day after the catheter was positioned. An INR of more than 1.5 was considered significantly elevated. RESULTS INR elevation occurred in 31 patients (33%), with 18 patients (19%) having an INR more than 3.0. Twelve (39%) of the 31 patients had liver metastases. Bleeding was observed in eight patients (8%); seven of these patients had elevated INR levels. We observed INR elevations in 12 of 21 patients treated with a FU, folinic acid, and oxaliplatin (FOLFOX) regimen, 11 of 40 treated with a de Gramont regimen (FU and folinic acid), and five of 19 treated with a FU, folinic acid, and irinotecan (FOLFIRI) regimen. CONCLUSION A high incidence of INR abnormalities was observed in our cohort of patients, especially those treated with FOLFOX regimen. Clinicians should be aware of this interaction and should regularly monitor the prothrombin time in patients receiving warfarin and FU.
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Affiliation(s)
- Giovanna Masci
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, 20089 Rozzano, Milan, Italy.
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