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Rutherford SC, Yin J, Pederson LD, Blum KA, Martin P, Jung SH, Grant B, Rosenbaum C, Cheson BD, Bartlett NL, Mandrekar SJ, Leonard JP. Impact of imaging frequency on progression-free survival in Alliance trials enrolling patients with follicular lymphoma. Blood Adv 2024; 8:1464-1468. [PMID: 38266151 PMCID: PMC10955638 DOI: 10.1182/bloodadvances.2023012090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/10/2024] [Accepted: 01/14/2024] [Indexed: 01/26/2024] Open
Affiliation(s)
- Sarah C. Rutherford
- Division of Hematology and Medical Oncology, Weill Department of Medicine, Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Jun Yin
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Levi D. Pederson
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Kristie A. Blum
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Peter Martin
- Division of Hematology and Medical Oncology, Weill Department of Medicine, Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Sin-Ho Jung
- Alliance Statistics and Data Management Center, Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University, Durham, NC
| | - Barbara Grant
- Division of Hematology and Oncology, University of Vermont, Burlington, VT
| | - Cara Rosenbaum
- Division of Hematology and Medical Oncology, Weill Department of Medicine, Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | | | - Nancy L. Bartlett
- Division of Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | | | - John P. Leonard
- Division of Hematology and Medical Oncology, Weill Department of Medicine, Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
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2
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Marullo R, Rutherford SC, Revuelta MV, Zamponi N, Culjkovic-Kraljacic B, Kotlov N, Di Siervi N, Lara-Garcia J, Allan JN, Ruan J, Furman RR, Chen Z, Shore TB, Phillips AA, Mayer S, Hsu J, van Besien K, Leonard JP, Borden KL, Inghirami G, Martin P, Cerchietti L. XPO1 Enables Adaptive Regulation of mRNA Export Required for Genotoxic Stress Tolerance in Cancer Cells. Cancer Res 2024; 84:101-117. [PMID: 37801604 PMCID: PMC10758694 DOI: 10.1158/0008-5472.can-23-1992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/08/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023]
Abstract
Exportin-1 (XPO1), the main soluble nuclear export receptor in eukaryotic cells, is frequently overexpressed in diffuse large B-cell lymphoma (DLBCL). A selective XPO1 inhibitor, selinexor, received approval as single agent for relapsed or refractory (R/R) DLBCL. Elucidating the mechanisms by which XPO1 overexpression supports cancer cells could facilitate further clinical development of XPO1 inhibitors. We uncovered here that XPO1 overexpression increases tolerance to genotoxic stress, leading to a poor response to chemoimmunotherapy. Upon DNA damage induced by MYC expression or exogenous compounds, XPO1 bound and exported EIF4E and THOC4 carrying DNA damage repair mRNAs, thereby increasing synthesis of DNA damage repair proteins under conditions of increased turnover. Consequently, XPO1 inhibition decreased the capacity of lymphoma cells to repair DNA damage and ultimately resulted in increased cytotoxicity. In a phase I clinical trial conducted in R/R DLBCL, the combination of selinexor with second-line chemoimmunotherapy was tolerated with early indication of efficacy. Overall, this study reveals that XPO1 overexpression plays a critical role in the increased tolerance of cancer cells to DNA damage while providing new insights to optimize the clinical development of XPO1 inhibitors. SIGNIFICANCE XPO1 regulates the dynamic ribonucleoprotein nuclear export in response to genotoxic stress to support tolerance and can be targeted to enhance the sensitivity of cancer cells to endogenous and exogenous DNA damage. See related commentary by Knittel and Reinhardt, p. 3.
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Affiliation(s)
- Rossella Marullo
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Sarah C. Rutherford
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Maria V. Revuelta
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Nahuel Zamponi
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Biljana Culjkovic-Kraljacic
- Institute for Research in Immunology and Cancer and Department of Pathology and Cell Biology, University of Montreal, Montreal, Canada
| | | | - Nicolás Di Siervi
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Juan Lara-Garcia
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - John N. Allan
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Jia Ruan
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Richard R. Furman
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Zhengming Chen
- Division of Biostatistics, Population Health Sciences Department, Weill Cornell Medicine, New York, New York
| | - Tsiporah B. Shore
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Adrienne A. Phillips
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Sebastian Mayer
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Jingmei Hsu
- New York University Grossman School of Medicine, New York, New York
| | | | - John P. Leonard
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Katherine L.B. Borden
- Institute for Research in Immunology and Cancer and Department of Pathology and Cell Biology, University of Montreal, Montreal, Canada
| | - Giorgio Inghirami
- Pathology and Laboratory Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Peter Martin
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
| | - Leandro Cerchietti
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York
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3
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Qualls DA, Lambert N, Caimi PF, Merrill M, Pullarkat P, Godby RC, Bond DA, Wehmeyer GT, Romancik J, Amoozgar B, Leslie L, Nastoupil LJ, Crombie JL, Abramson JS, Khurana A, Nowakowski GS, Maddocks K, Rutherford SC, Kahl B, Okwali M, Buege MJ, Seshan V, Batlevi CL, Salles G. Tafasitamab and lenalidomide in large B-cell lymphoma: real-world outcomes in a multicenter retrospective study. Blood 2023; 142:2327-2331. [PMID: 37738563 PMCID: PMC10797539 DOI: 10.1182/blood.2023021274] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/15/2023] [Accepted: 08/27/2023] [Indexed: 09/24/2023] Open
Abstract
ABSTRACT In this real-world evaluation of tafasitamab-lenalidomide (TL) in relapsed or refractory LBCL, patients receiving TL had higher rates of comorbidities and high-risk disease characteristics, and substantially lower progression-free survival and overall survival, compared with the L-MIND registration clinical trial for TL.
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Affiliation(s)
- David A. Qualls
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Paolo F. Caimi
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Mwanasha Merrill
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Priyanka Pullarkat
- Division of Hematology-Oncology, Massachusetts General Hospital, Boston, MA
| | - Richard C. Godby
- Hematology Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - David A. Bond
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Graham T. Wehmeyer
- Department of Medicine, Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Jason Romancik
- Department of Hematology and Medical Oncology, Winship Cancer Institute at Emory University, Atlanta, GA
| | - Behzad Amoozgar
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Lori Leslie
- Lymphoma Division, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Loretta J. Nastoupil
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jeremy S. Abramson
- Division of Hematology-Oncology, Massachusetts General Hospital, Boston, MA
| | - Arushi Khurana
- Hematology Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Kami Maddocks
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Sarah C. Rutherford
- Department of Medicine, Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Brad Kahl
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Michelle Okwali
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael J. Buege
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Venkatraman Seshan
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Connie L. Batlevi
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gilles Salles
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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4
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Ruan J, Moskowitz A, Mehta-Shah N, Sokol L, Chen Z, Kotlov N, Nos G, Sorokina M, Maksimov V, Sboner A, Sigouros M, van Besien K, Horwitz S, Rutherford SC, Mulvey E, Revuelta MV, Xiang J, Alonso A, Melnick A, Elemento O, Inghirami G, Leonard JP, Cerchietti L, Martin P. Multicenter phase 2 study of oral azacitidine (CC-486) plus CHOP as initial treatment for PTCL. Blood 2023; 141:2194-2205. [PMID: 36796016 PMCID: PMC10356559 DOI: 10.1182/blood.2022018254] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 10/14/2022] [Revised: 01/25/2023] [Accepted: 02/03/2023] [Indexed: 02/18/2023] Open
Abstract
Peripheral T-cell lymphomas (PTCL) with T-follicular helper phenotype (PTCL-TFH) has recurrent mutations affecting epigenetic regulators, which may contribute to aberrant DNA methylation and chemoresistance. This phase 2 study evaluated oral azacitidine (CC-486) plus cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) as initial treatment for PTCL. CC-486 at 300 mg daily was administered for 7 days before C1 of CHOP, and for 14 days before CHOP C2-6. The primary end point was end-of-treatment complete response (CR). Secondary end points included safety and survival. Correlative studies assessed mutations, gene expression, and methylation in tumor samples. Grade 3 to 4 hematologic toxicities were mostly neutropenia (71%), with febrile neutropenia uncommon (14%). Nonhematologic toxicities included fatigue (14%) and gastrointestinal symptoms (5%). In 20 evaluable patients, CR was 75%, including 88.2% for PTCL-TFH (n = 17). The 2-year progression-free survival (PFS) was 65.8% for all and 69.2% for PTCL-TFH, whereas 2-year overall survival (OS) was 68.4% for all and 76.1% for PTCL-TFH. The frequencies of the TET2, RHOA, DNMT3A, and IDH2 mutations were 76.5%, 41.1%, 23.5%, and 23.5%, respectively, with TET2 mutations significantly associated with CR (P = .007), favorable PFS (P = .004) and OS (P = .015), and DNMT3A mutations associated with adverse PFS (P = .016). CC-486 priming contributed to the reprograming of the tumor microenvironment by upregulation of genes related to apoptosis (P < .01) and inflammation (P < .01). DNA methylation did not show significant shift. This safe and active regimen is being further evaluated in the ALLIANCE randomized study A051902 in CD30-negative PTCL. This trial was registered at www.clinicaltrials.gov as #NCT03542266.
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Affiliation(s)
- Jia Ruan
- Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | | | | | | | - Zhengming Chen
- Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | | | | | | | | | - Andrea Sboner
- Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Michael Sigouros
- Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Koen van Besien
- Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | | | - Sarah C. Rutherford
- Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Erin Mulvey
- Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Maria V. Revuelta
- Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Jenny Xiang
- Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Alicia Alonso
- Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Ari Melnick
- Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Olivier Elemento
- Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Giorgio Inghirami
- Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - John P. Leonard
- Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Leandro Cerchietti
- Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Peter Martin
- Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
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5
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Rutherford SC, Yin J, Pederson L, Perez Burbano G, LaPlant B, Shadman M, Li H, LeBlanc ML, Kenkre VP, Hong F, Blum KA, Dockter T, Martin P, Jung SH, Grant B, Rosenbaum C, Ujjani C, Barr PM, Unger JM, Cheson BD, Bartlett NL, Kahl B, Friedberg JW, Mandrekar SJ, Leonard JP. Relevance of Bone Marrow Biopsies for Response Assessment in US National Cancer Institute National Clinical Trials Network Follicular Lymphoma Clinical Trials. J Clin Oncol 2023; 41:336-342. [PMID: 35787017 PMCID: PMC9839232 DOI: 10.1200/jco.21.02301] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 04/08/2022] [Accepted: 05/16/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Bone marrow biopsies (BMB) are performed before/after therapy to confirm complete response (CR) in patients with lymphoma on clinical trials. We sought to establish whether BMB add value in assessing response or predict progression-free survival (PFS) or overall survival (OS) outcomes in follicular lymphoma (FL) subjects in a large, multicenter, multitrial cohort. METHODS Data were pooled from seven trials of 580 subjects with previously untreated FL through Alliance for Clinical Trials in Oncology (Alliance) and SWOG Cancer Research Network (SWOG) completing enrollment from 2008 to 2016. RESULTS Only 5/580 (0.9%) had positive baseline BMB, CR on imaging, and subsequent positive BMB (P < .0001). Therefore, BMB were irrelevant to response in 99% of subjects. A sensitivity analysis of 385 FL subjects treated on an Eastern Cooperative Oncology Group study was included. In the Eastern Cooperative Oncology Group cohort, 5/385 (1.3%) had BMB that affected response assessment. Since some subjects do not undergo confirmatory BMB, we performed a landmark survival analysis from first radiologic CR with data from 580 subjects from Alliance and SWOG. Of subjects with CR on imaging (n = 187), PFS and OS were not significantly different among those with negative BMB to confirm CR (n = 47) versus those without repeat BMB (n = 140; PFS: adjusted hazard ratio, 1.10, 95% CI, 0.62 to 1.94, log-rank P = .686; OS: hazard ratio, 0.59, 95% CI, 0.23 to 1.53, log-rank P = .276). CONCLUSION We conclude that BMB add little value to response assessment in subjects with FL treated on clinical trials and we recommend eliminating BMB from clinical trial requirements. BMB should also be removed from diagnostic guidelines for FL except in scenarios in which it may change management including confirmation of limited stage and assessment of cytopenias. This would reduce cost, patient discomfort, resource utilization, and potentially remove a barrier to trial enrollment.
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Affiliation(s)
- Sarah C. Rutherford
- Weill Department of Medicine, Division of Hematology and Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY
| | | | | | | | | | | | - Hongli Li
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | | | | | - Peter Martin
- Weill Department of Medicine, Division of Hematology and Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY
| | | | | | - Cara Rosenbaum
- Weill Department of Medicine, Division of Hematology and Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY
| | | | - Paul M. Barr
- University of Rochester, Wilmot Cancer Institute, Rochester, NY
| | | | - Bruce D. Cheson
- Scientific Advisor, Lymphoma Research Foundation, New York, NY
| | - Nancy L. Bartlett
- Washington University School of Medicine, Siteman Cancer Center, St Louis, MO
| | - Brad Kahl
- Washington University School of Medicine, Siteman Cancer Center, St Louis, MO
| | | | | | - John P. Leonard
- Weill Department of Medicine, Division of Hematology and Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY
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6
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Hamid MS, Rutherford SC, Jang H, Kim S, Patel K, Bartlett NL, Malecek MK, Watkins MP, Maddocks KJ, Bond DA, Feldman TA, Magarelli G, Advani RH, Spinner MA, Evens AM, Shah M, Ahmed S, Stephens DM, Allen P, Tees MT, Karmali R, Cheson BD, Yazdy MS, Strouse C, Bailey NA, Pagel JM, Ramchandren R. Outcomes Among Classical Hodgkin Lymphoma Patients After an Interim PET Scan: A Real-World Experience. Clin Lymphoma Myeloma Leuk 2022; 22:e435-e442. [PMID: 35093285 DOI: 10.1016/j.clml.2021.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/17/2021] [Accepted: 12/18/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The utility of dose escalation after positive positron emission tomography following 2 cycles of ABVD (PET2) for Hodgkin Lymphoma (HL) remains controversial. We describe the United States real-world practice patterns for PET2 positive patients. PATIENTS AND METHODS Data was collected from 15 sites on PET2 positive HL patients after receiving frontline treatment between January, 2015 and June, 2019. Descriptive analyses between those with therapy change and those continuing initial therapy were assessed. RESULTS A total of 129 patients were identified; 111 (86%) were treated with ABVD therapy and 18 (14%) with an alternate regimen. At PET2 assessment, 74.4% (96/129) had Deauville score (DS) 4 and 25.6% (33/129) had DS 5. Of the 66 limited stage (LS) patients with PET2 DS score of 4/5, 77.3% (51/66) continued initial therapy and 22.7% (15/66) changed to escalated therapy. The 12-month progression-free survival (PFS) for DS 4/5 LS patients was 67.0% (95% CI; 54.9-81.7) for patients without escalation compared with 51.4% (95% CI; 30.8-85.8) for those who escalated. Of the 63 DS 4/5 patients with advanced stage (AS) disease, 76.2% (48/63) continued initial therapy and 23.8% (15/63) changed to escalated therapy. The 12-month PFS for DS 4/5 AS patients was 38.3% (95% CI: 26.3%-55.7%) for patients without escalation compared with 57.1% (95% CI: 36.3-89.9) for those with escalation. CONCLUSION A minority of PET2 positive HL patients undergo therapy escalation and outcomes remain overall suboptimal. Improved prognostics markers and better therapeutics are required to improve outcomes for high-risk PET2 positive HL patients.
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Affiliation(s)
| | | | | | | | | | - Nancy L Bartlett
- Washington University Medical University at St. Louis, St. Louis, MO
| | - Mary-Kate Malecek
- Washington University Medical University at St. Louis, St. Louis, MO
| | - Marcus P Watkins
- Washington University Medical University at St. Louis, St. Louis, MO
| | - Kami J Maddocks
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - David A Bond
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Tatyana A Feldman
- John Theurer Cancer Center at Hackensack Meridian Health, Hackensack, NJ
| | - Gabriela Magarelli
- John Theurer Cancer Center at Hackensack Meridian Health, Hackensack, NJ
| | | | | | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Mansi Shah
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | | | - Pamela Allen
- Winship Cancer Institute at Emory University, Atlanta, GA
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7
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Abstract
CONTEXT Existing research on psychological distress and mental health service utilization has focused on common types of solid tumor cancers, leaving significant gaps in our understanding of patients experiencing rare forms of hematologic cancers. OBJECTIVE To examine distress, quality of life, and mental health service utilization among patients with aggressive, refractory B-cell lymphomas. METHOD Patients (n = 26) with B-cell lymphomas that relapsed after first- or second-line treatment completed self-report measures of distress (Hospital Anxiety and Depression Scale) and quality of life (Short-Form Health Survey, SF-12). Patients also reported whether they had utilized mental health treatment since their cancer diagnosis. RESULTS Approximately 42% (n = 11) of patients reported elevated levels of psychological distress. Of patients with elevated distress, only one quarter (27.2%; n = 3) received mental health treatment, while more than half did not receive mental health treatment (54.5%; n = 6), and 18.1% (n = 2) did not want treatment. Patients with elevated distress reported lower mental quality of life than patients without elevated distress [F (1, 25) = 15.32, p = 0.001]. SIGNIFICANCE OF THE RESULTS A significant proportion of patients with advanced, progressive, B-cell lymphomas may experience elevated levels of distress. Yet, few of these distressed patients receive mental health treatment. Findings highlight the need to better identify and address barriers to mental health service utilization among patients with B-cell lymphoma, including among distressed patients who decline treatment.
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Affiliation(s)
| | | | | | | | - Peter Martin
- Weill Cornell Medicine, New York, NY
- New York Presbyterian, New York, NY
| | - John P Leonard
- Weill Cornell Medicine, New York, NY
- New York Presbyterian, New York, NY
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8
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Rutherford SC, Abramson JS, Bartlett NL, Barta SK, Khan N, Joyce R, Maddocks K, Ali-Shaw T, Senese S, Yuan Y, Westin J, Leonard JP. Venetoclax with dose-adjusted EPOCH-R as initial therapy for patients with aggressive B-cell lymphoma: a single-arm, multicentre, phase 1 study. Lancet Haematol 2021; 8:e818-e827. [PMID: 34634256 DOI: 10.1016/s2352-3026(21)00273-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) is a front-line treatment for patients with aggressive B-cell lymphomas. Bcl-2 is associated with chemoresistance due to BCL2 gene rearrangement or protein overexpression and is antagonised by venetoclax. We aimed to assess the safety of venetoclax with dose-adjusted EPOCH-R as initial therapy in aggressive B-cell lymphoma. METHODS We conducted a single-arm, phase 1 study across seven treatment centres in the USA. Eligible patients were aged 18-80 years with histologically confirmed, previously untreated diffuse large B-cell lymphoma, transformed indolent non-Hodgkin lymphoma, high-grade B-cell lymphoma with double-hit or not otherwise specified, or primary mediastinal B-cell lymphoma, with Ann Arbor stage II-IV and Eastern Cooperative Oncology Group performance status of 0-2. Participants received six cycles of oral venetoclax 400 mg, 600 mg, or 800 mg once daily for 10 days per cycle with dose-adjusted EPOCH-R (one cycle every 3 weeks; baseline doses were intravenous rituximab 375 mg/m2 on day 1, intravenous etoposide 50 mg/m2 on days 1-4, oral prednisone 60 mg/m2 twice daily on days 1-5, intravenous vincristine 0·4 mg/m2 on days 1-4, intravenous cyclophosphamide 750 mg/m2 on day 5, and intravenous doxorubicin 10 mg/m2 on days 1-4). A subsequent cohort received venetoclax 600 mg once daily for 5 days per cycle. The primary endpoints were the maximum tolerated dose, dose-limiting toxicities, and the recommended phase 2 dose of venetoclax. Analyses were done per protocol. This trial is registered with ClinicalTrials.gov, NCT03036904, and enrolment is now closed. FINDINGS Between Feb 3, 2017, and June 4, 2019, 34 patients were assessed for eligibility, and 30 were enrolled and received venetoclax with dose-adjusted EPOCH-R. The median patient age was 64·0 years (IQR 51·6-69·4). The maximum tolerated dose was 800 mg for 10 days and the established recommended phase 2 dose was 600 mg for 5 days due to tolerability for treatment duration. One (3%) of 30 patients had a dose-limiting toxicity in cycle one (grade 4 thrombocytopenia with 800 mg dose). The most common grade 3-4 adverse events were cytopenias (28 [93%] of 30 patients); febrile neutropenia occurred in 19 (63%) patients. Grade 3-4 non-haematological adverse events included hypophosphataemia (n=10), hypokalaemia (n=7), and hyperglycaemia (n=5). Serious adverse events included infection (n=7) and gastrointestinal toxicities including abdominal pain (n=3), colonic perforation (n=1), and small intestinal obstruction (n=1). There was one treatment-related death (sepsis). Overall response rate was 96·7% (95% CI 82·8-99·9); 28 (93·3% [77·9-99·2]) of 30 patients had complete response and one (3·3% [0·1-17·2]) had a partial response. INTERPRETATION Venetoclax with dose-adjusted EPOCH-R showed an acceptable safety profile at the recommended phase 2 dose and had encouraging preliminary activity in this population at high risk of adverse outcomes, and is worthy of further study. The combination is being investigated in Alliance 051701 (NCT03984448). FUNDING Genentech.
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Affiliation(s)
| | - Jeremy S Abramson
- Department of Haematology and Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Nancy L Bartlett
- Washington University School of Medicine, Siteman Cancer Center, St Louis, MO, USA
| | - Stefan K Barta
- Division of Haematology and Oncology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA, USA
| | - Nadia Khan
- Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Robin Joyce
- Beth-Israel Deaconess Medical Center, Boston, MA, USA
| | - Kami Maddocks
- James Cancer Hospital, Ohio State University, Columbus, OH, USA
| | - Trisha Ali-Shaw
- Weill Cornell Medicine, Meyer Cancer Center, New York, NY, USA
| | - Silvia Senese
- Weill Cornell Medicine, Meyer Cancer Center, New York, NY, USA
| | - Ying Yuan
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason Westin
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John P Leonard
- Weill Cornell Medicine, Meyer Cancer Center, New York, NY, USA
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9
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Orfali N, Jhanwar Y, Koo C, Pasciolla M, Baldo M, Cuvilly E, Furman R, Gergis U, Greenberg J, Guarneri D, Hsu JM, Leonard JP, Mark T, Mayer S, Maignan K, Martin P, Opong A, Pearse R, Phillips A, Rossi A, Ruan J, Rutherford SC, Ryan J, Suhu G, Van Besien K, Shore T. Sequential intensive chemotherapy followed by autologous or allogeneic transplantation for refractory lymphoma. Leuk Lymphoma 2021; 62:1629-1638. [PMID: 33586581 DOI: 10.1080/10428194.2021.1881516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We evaluate the safety of bendamustine as a bridge to stem cell transplantation (SCT) in patients with relapsed/refractory lymphoma and residual disease after salvage therapy. Thirty-four subjects without complete responses (CR) received bendamustine 200 mg/m2/day for 2 days followed 14 days later by SCT. Sixteen subjects in partial remission (PR) with maximal FDG-PET SUVs ≤8 prior to bendamustine received autologous SCT, while 13 with suboptimal responses were allografted. Five subjects did not proceed to transplant. No bendamustine toxicities precluded transplantation and no detrimental effect on engraftment or early treatment-related mortality (TRM) was attributable to bendamustine. At 1 year, 75% of auto-recipients and 31% of allo-recipients were alive with CR. Two subjects in the autologous arm developed therapy-related myeloid neoplasia (t-MN). In conclusion, a bendamustine bridge to SCT can be administered without early toxicity to patients with suboptimal responses to salvage chemotherapy. However this approach may increase the risk of t-MN. (NCT02059239).Supplemental data for this article is available online at here.
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Affiliation(s)
- Nina Orfali
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Yuliya Jhanwar
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Calvin Koo
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Michelle Pasciolla
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Maria Baldo
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Edwidge Cuvilly
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Richard Furman
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Usama Gergis
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - June Greenberg
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Danielle Guarneri
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Jing-Mei Hsu
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - John P Leonard
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Tomer Mark
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Sebastian Mayer
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Kathleen Maignan
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Peter Martin
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Adomah Opong
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Roger Pearse
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Adrienne Phillips
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Adriana Rossi
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Jia Ruan
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Sarah C Rutherford
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Jessy Ryan
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Grace Suhu
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Koen Van Besien
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Tsiporah Shore
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
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10
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Magid Diefenbach CS, Cohen JB, Harb WA, Ansell SM, Nastoupil LJ, Abramson JS, Lakhani NJ, Schreeder MT, Sher T, Patel-Donnelly D, Aboulafia DM, Fuchs CA, Nix D, Landrette S, Graham PS, King LB, Young PL, Miller LL, Lichenstein H, Rutherford SC. Results of a completed phase I study of LAM-002 (apilimod dimesylate), a first-in-class phosphatidylinositol-3-phosphate 5 kinase (PIKfyve) inhibitor, administered as monotherapy or with rituximab or atezolizumab to patients with previously treated follicular lymphoma or other B-cell cancers. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.8017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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
8017 Background: LAM-002 is a selective inhibitor of PIKfyve that disrupts lysosomal homeostasis, inducing cytotoxicity in B-cell lymphoma models as monotherapy or with anti-CD20 or anti-PDL1 antibodies (Gayle et al., Blood 2017;129(13):1768). Methods: In this study, patients received LAM-002 orally 2-3 times per day (BID or TID) in a 3+3 escalation. Additional patients received LAM-002 125 mg BID as monotherapy; with rituximab 375 mg/m2 intravenously (IV) and or subcutaneously weekly (Q1W) x 4 → Q8W x 4; or atezolizumab 1200 mg IV Q3W until disease progression or unacceptable toxicity. Pharmacokinetics (PK) were assessed for 8 hours postdose on Days 1 and 8. Efficacy was evaluated Q6-12W. Results: The study enrolled 62 patients (M:F n = 32/30); median [range] age = 69 [46-89] years; with diagnoses (n) of diffuse large B-cell lymphoma (25), follicular lymphoma (19), marginal zone lymphoma (8), mantle cell lymphoma (5), or chronic lymphocytic leukemia (5) to receive LAM-002 alone (n) at 50 mg BID (3), 100 mg BID (8), 150 mg BID (8), 75 mg TID (4), or 125 mg BID (20); LAM-002/rituximab (12); or LAM-002/atezolizumab (7). During LAM-002 dose-ranging (50 mg BID → 100 mg BID → 150 mg BID → 75 mg TID → 125 mg BID) transient, reversible nausea and/or diarrhea occurred at 150 mg BID and 75 mg TID, resulting in a LAM-002 recommended Phase 2 dosing regimen (RP2DR) of 125 mg BID. Among 39 patients receiving LAM-002, 125 mg BID, alone or in combination for up to 22 cycles (1.9 years), adverse events were typically low-grade. LAM-002 PK showed rapid absorption, dose proportionality, minimal accumulation, and no substantive changes with rituximab or atezolizumab coadministration. In patients with follicular lymphoma and median [range] prior therapies = 3 [1-9] treated with the RP2DR, objective response rates were 2/7 (29%; 1 complete response [CR], 1 partial response [PR]) with LAM-002, 5/8 (63%; 1 CR, 4 PRs) with LAM-002/rituximab, and 2/2 (100%; 2 PRs) with LAM-002/atezolizumab. Conclusions: LAM-002, the first clinical PIKfyve inhibitor, is safe alone or with full-dose anti-CD20 or anti-PD-L1 inhibition. LAM-002 does not cause the myelosuppressive or immune adverse events associated with lenalidomide or PI3K inhibitors. Promising efficacy supports registration-directed Phase 2/3 testing of LAM-002 monotherapy and combination therapy for patients with previously treated follicular lymphoma. Clinical trial information: NCT02594384 .
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Affiliation(s)
| | | | | | | | - Loretta J. Nastoupil
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma/Myeloma, Houston, TX
| | - Jeremy S. Abramson
- Massachusetts General Hospital Cancer Center; Harvard Medical School, Boston, MA
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11
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Rutherford SC, Yin J, Pederson L, LaPlant B, Shadman M, Li H, LeBlanc ML, Blum KA, Dockter T, Martin P, Jung SH, Grant BW, Rosenbaum CA, Ujjani CS, Barr PM, Unger JM, Cheson BD, Bartlett NL, Friedberg JW, Leonard JP. Relevance of bone marrow biopsies for response assessment in NCTN follicular lymphoma clinical trials. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.8038] [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
8038 Background: Bone marrow biopsies (BMB) are performed pre/post therapy to confirm complete response (CR) in patients (pts) with lymphoma on clinical trials. We evaluated 2 prior data sets and concluded that BMB impact response assessment in a minority of pts with follicular lymphoma (FL) (Rutherford BJH 2017; Rutherford ASH abstract 1605, 2018). We sought to establish if BMB add value in assessing response or identify distinct progression free (PFS) or overall survival (OS) outcomes in a large, multicenter, multi-trial cohort. Methods: Data were pooled from 7 trials of 580 pts with untreated FL conducted through the Alliance for Clinical Trials in Oncology and SWOG from 2002-2016. The proportion of pts with positive (+) baseline BMB, CR on imaging after treatment, and (+) repeat BMB was calculated using total pts enrolled as the denominator. We tested against the null hypothesis that the proportion was = 10%, the threshold below which BMB would be considered irrelevant for response assessment, versus (vs) the alternative hypothesis that this proportion was < 10%, using 1-sided exact binomial test. Response criteria were CT-based. Imaging was not used to assess BM involvement. Because confirmatory BMB were not completed in all indicated pts, landmark survival analyses compared PFS/OS of pts with CR on imaging and negative (-) BMB vs pts with CR on imaging without repeat BMB. Pts with CR on imaging were categorized as having (-) repeat BMB or no repeat BMB within 60 days of first CR on imaging. PFS and OS were calculated from time of first CR and estimated using Kaplan-Meier and Cox models adjusting for age, sex, stage, Follicular Lymphoma International Prognostic Index (FLIPI) score, and treatment type (targeted vs chemotherapy plus targeted therapy), and stratified by treatment arm. Results: Median age was 55 with 51% male, 96% stage III-IV, and 88% grade I-II. FLIPI scores were 113 low, 265 intermediate, and 199 high risk. 67% received chemotherapy-based regimens. Baseline BMB was (+) in 321 (55%). Only 5/580 (0.8%) had (+) baseline BMB, CR on imaging, and subsequent (+) BMB (p < 0.0001). Of pts with CR on imaging, PFS and OS were not different among pts with (-) BMB vs pts without repeat BMB (PFS: HR = 1.08, 95%CI 0.61-1.93, p = 0.783; OS: HR = 0.52, 95%CI 0.20-1.40, p = 0.199). Conclusions: BMB requirements may discourage pt participation in trials and add pain, expense and time without providing necessary information. We recommend eliminating BMB for response assessment from FL clinical trials. Clinical trial information: NCT00553501, NCT01145495, NCT01190449, NCT01286272, NCT01829568, NCT00822120, and NCT00770224 .
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Affiliation(s)
| | | | | | | | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - Hongli Li
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - Michael Leo LeBlanc
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | | | | | | | - Sin-Ho Jung
- Duke University School of Medicine, Durham, NC
| | | | | | | | - Paul M. Barr
- University of Rochester Medical Center, Rochester, NY
| | - Joseph M. Unger
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | | | - Nancy L. Bartlett
- Washington University School of Medicine, Siteman Cancer Center, St. Louis, MO
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12
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Rutherford SC, Abramson JS, Bartlett NL, Barta SK, Khan N, Joyce R, Maddocks KJ, Yuan Y, Ali-Shaw T, Senese S, Westin J, Leonard JP. Phase I study of the Bcl-2 inhibitor venetoclax with DA-EPOCH-R as initial therapy for aggressive B-cell lymphomas. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.8003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8003 Background: Dose-adjusted (DA) EPOCH-R is a frontline treatment for aggressive B-cell lymphomas. Bcl-2 is associated with chemoresistance due to BCL2 gene rearrangement or protein overexpression in lymphomas and is antagonized by BH3 mimetic venetoclax (ven). We conducted a phase I study combining ven with DA-EPOCH-R in aggressive B-cell lymphomas. Methods: This phase 1 study used Bayesian optimal interval design with dose expansion. Eligible patients (pts) were 18 years with newly diagnosed diffuse large B-cell (DLBCL), primary mediastinal, and high grade B-cell lymphoma (HGBCL) with double hit (DHL) or not otherwise specified (NOS). Ven was dosed at 400 mg (DL1), 600 mg (DL2), and 800 mg (DL3) daily for 10 days with 6 cycles of DA-EPOCH-R. A subsequent cohort received ven 600 mg daily for 5 days (DL2B). Toxicities were graded by CTCAE v4.0 and response assessed by Lugano criteria. Dose limiting toxicity (DLT) period was cycle 1 and primarily included grade (gr) ≥3 neutropenia on cycle 2 day 1, gr ≥4 febrile neutropenia/thrombocytopenia, and gr ≥3 nausea, vomiting, diarrhea despite supportive care. Results: 30 pts enrolled with median age 64 (24-79), and 50% female. Ann Arbor stage was III-IV in 23. IPI was high risk in > 50%. Diagnosis was DHL (15), DLBCL NOS (13), and HGBCL NOS (2). 18 had MYC and 14 had BCL2 rearrangements. Bcl-2 was expressed ≥50% by IHC in 21/26 with data. There were no DLTs in DL1 (3 pts) or DL2 (9 pts). 1/6 had DLT in DL3 (gr 4 thrombocytopenia). Ven dose reductions occurred in subsequent cycles in 4 (2 in DL2; 2 in DL3). Of 18 in DL1-3, EPOCH was escalated above level 1 in 1 and de-escalated below level 1 in 7. Because of delays and ven dose reductions in DL2-3 due in part to cytopenias, infections and GI toxicities, we accrued DL2B. In DL2B, 0/12 pts had DLTs or ven dose reductions. EPOCH was escalated above level 1 in 4 and de-escalated below level 1 in 3. 1 died of sepsis during cycle 3. Most common gr 3-4 toxicities across all dose levels were cytopenias; febrile neutropenia occurred in 57%. Most common non-hematologic toxicities of all grades were hypocalcemia, nausea, diarrhea, hypokalemia and fatigue. ORR (N = 30) ITT was 97% with 27 (90%) complete and 2 (7%) partial responses; 1 was not evaluable. Follow up is ongoing. Of 15 DHL, ORR and CRR were 93% and 80%. Conclusions: We identified ven 600 mg for 5 days per cycle as RP2D with DA-EPOCH-R. DL2B was well tolerated and required no ven dose reductions. Further efficacy and safety is being evaluated in Alliance 51701, DA-EPOCH-R/R-CHOP in DH/double expressor lymphomas, using the dosing regimen defined by this study. Clinical trial information: NCT03036904 .
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Affiliation(s)
| | - Jeremy S. Abramson
- Massachusetts General Hospital Cancer Center; Harvard Medical School, Boston, MA
| | - Nancy L. Bartlett
- Washington University School of Medicine, Siteman Cancer Center, St. Louis, MO
| | | | - Nadia Khan
- Fox Chase Cancer Center, Philadelphia, PA
| | - Robin Joyce
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Kami J. Maddocks
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ying Yuan
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Jason Westin
- University of Texas MD Anderson Cancer Center, Houston, TX
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13
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Castellino SM, LeBlanc ML, Herrera AF, Parsons SK, Punnett A, Hodgson DC, Rutherford SC, Khan N, Constine LS, Davison K, Prica AA, Friedberg JW, Kelly KM. An intergroup collaboration for advanced stage classical Hodgkin lymphoma (cHL) in adolescents and young adults (AYA): SWOG S1826. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps8067] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS8067 Background: Treatment for pediatric cHL varies considerably from that in adult cHL. Hence there are gaps in risk prediction and optimal therapy for de-novo advanced stage disease across the adolescent and young adult (AYA) age spectrum. Early access to novel agents for AYA could be facilitated via collaboration with adult research groups through the U.S. National Cancer Institute’s National Clinical Trials Network (NCTN). The PD-1 inhibitor Nivolumab (Nivo) has safety and efficacy in relapsed and refractory disease in children and adults, but has not been evaluated in de-novo disease to date. Methods: North American cooperative group lymphoma chairs, Cancer Therapy Evaluation Program (CTEP) representatives and patient advocates met to establish consensus on the comparison arms and study design, based on recent historical approaches across adult and pediatric groups. Study champions were identified across North American cooperative groups and include expertise in imaging, radiation oncology, biology and patient-reported outcomes. A therapeutic study was designed with the primary aim being to compare progression-free survival with novel targeted agents in advanced stage cHL. S1826 (NCT03907488), led by SWOG Cancer Research Network, opened to accrual in July 2019. Eligibility criteria include age > 12 years, and Stage III or IV cHL. Patients are randomized (1:1) to 6 cycles of either Nivo-Adriamycin, Vinblastine, Dacarbazine (AVD) or Brentuximab vedotin (Bv)-AVD. Enrollment is stratified by age, baseline International Prognostic Score, and provider intent to use involved site radiation therapy (ISRT). Protocol-prescribed ISRT is response-adapted, based on end of therapy imaging. The primary endpoint is a comparison of progression-free survival between arms. Secondary clinical endpoints include comparison of: overall survival, metabolic response at the end of therapy, physician-reported adverse events, patient-reported adverse events, and health-related quality of life (overall, and specific to fatigue and neuropathy). This unique intergroup collaboration demonstrates the process and the feasibility of consensus study designs toward early adoption of targeted therapies and harmonization of treatment approaches for AYA populations. Clinical trial information: NCT03907488 .
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Affiliation(s)
- Sharon M. Castellino
- Emory University, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | | | | | | | | | | | | | - Nadia Khan
- Fox Chase Cancer Center, Philadelphia, PA
| | | | | | - Anca A. Prica
- Sunnybrook Health Science Centre/Odette Cancer Centre, Toronto, ON, Canada
| | | | - Kara M. Kelly
- Department of Pediatric Oncology, Roswell Park Cancer Institute and Oishei Children's Hospital, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY
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14
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Trevino KM, Rutherford SC, Marte C, Ouyang DJ, Martin P, Prigerson HG, Leonard JP. Illness Understanding and Advance Care Planning in Patients with Advanced Lymphoma. J Palliat Med 2019; 23:832-837. [PMID: 31633432 PMCID: PMC7249459 DOI: 10.1089/jpm.2019.0311] [Citation(s) in RCA: 3] [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: 01/15/2023] Open
Abstract
Background: The prognosis of an aggressive lymphoma can change dramatically following failure of first-line treatment. This sudden shift is challenging for the promotion of illness understanding and advance care planning (ACP). Yet, little is known about illness understanding and ACP in patients with aggressive lymphomas. Objective: To examine illness understanding, rates of engagement in ACP, and reasons for lack of ACP engagement in patients with advanced B cell lymphomas. Design: Cross-sectional observational study. Setting/Subjects: Patients (n = 27) with aggressive B cell lymphomas that relapsed after first- or second-line treatment treated at a single urban academic medical center. Measurements: Participants were administered structured surveys by trained staff to obtain self-report measures of illness understanding (i.e., aggressiveness, terminality, curability) and ACP (i.e., discussions of care preferences, completion of advance directives). Results: The majority of patients reported discussing curability (92.6%), prognosis (77.8%), and treatment goals (88.9%) with their medical team. Yet, less than one-third of patients reported being terminally ill (29.6%) and having incurable disease (22.2%). Most patients had a health care proxy (81.5%) and had decided about do-not-resuscitate status (63%), but the majority had not completed a living will (65.4%) or discussed their care preferences with others (55.6%). Conclusions: The accuracy of lymphoma patients' illness understanding following first-line treatment is difficult to determine due to the potential for cure following transplant. However, this study suggests that a large proportion of patients with advanced B cell lymphomas may underestimate the severity of their illness, despite discussing illness severity with their medical team. Providing patients with information on prognosis, and the ACP process may increase engagement in ACP.
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Affiliation(s)
- Kelly M Trevino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sarah C Rutherford
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,Department of Medicine, NewYork Presbyterian Hospital, New York, New York, USA
| | - Chrystal Marte
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Daniel Jie Ouyang
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,Department of Medicine, NewYork Presbyterian Hospital, New York, New York, USA
| | - Peter Martin
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,Department of Medicine, NewYork Presbyterian Hospital, New York, New York, USA
| | - Holly G Prigerson
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,Department of Medicine, NewYork Presbyterian Hospital, New York, New York, USA
| | - John P Leonard
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,Department of Medicine, NewYork Presbyterian Hospital, New York, New York, USA
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15
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Loh KP, Baran A, Lee CY, Alshaibani A, Rutherford SC, Hu J, Casulo C, Barr PM, Friedberg JW, Reagan PM. Patients with diffuse large B-cell lymphoma requiring urgent treatment: its implication on trial design and interpretation. Leuk Lymphoma 2019; 60:3569-3572. [DOI: 10.1080/10428194.2019.1639172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Center, Division of Hematology and Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Andrea Baran
- James P. Wilmot Cancer Center, Division of Hematology and Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Christina Y. Lee
- Meyer Cancer Center, Weill Cornell Medicine and New York-Presbyterian Hospital, Department of Medicine, New York, NY, USA
| | - Alfadel Alshaibani
- Meyer Cancer Center, Weill Cornell Medicine and New York-Presbyterian Hospital, Department of Medicine, New York, NY, USA
| | - Sarah C. Rutherford
- Meyer Cancer Center, Weill Cornell Medicine and New York-Presbyterian Hospital, Department of Medicine, New York, NY, USA
| | - John Hu
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Carla Casulo
- James P. Wilmot Cancer Center, Division of Hematology and Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Paul M. Barr
- James P. Wilmot Cancer Center, Division of Hematology and Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jonathan W. Friedberg
- James P. Wilmot Cancer Center, Division of Hematology and Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Patrick M. Reagan
- James P. Wilmot Cancer Center, Division of Hematology and Oncology, University of Rochester Medical Center, Rochester, NY, USA
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Rutherford SC. Surveillance scanning in lymphoma. Clin Adv Hematol Oncol 2019; 17:352-359. [PMID: 31437139] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Although the role of imaging in the management of most lymphomas is well established at baseline, during treatment, and following treatment, surveillance imaging after complete response remains controversial despite the numerous studies that have investigated follow-up computed tomography, positron emission tomography, and magnetic resonance imaging over the past 20 years. Although robust data do not support an impact of this strategy on survival in Hodgkin lymphoma, diffuse large B-cell lymphoma, or follicular lymphoma, many patients continue to undergo serial imaging studies. The role of imaging following treatment in peripheral T-cell lymphoma (PTCL) and mantle cell lymphoma (MCL) is poorly investigated, although the available literature questions the utility of scanning patients with PTCL or MCL in first remission. Of clear significance in all lymphoma subtypes is the effect of such imaging on patient anxiety, secondary cancers, and health care costs. Novel monitoring strategies, such as minimal residual disease detection with circulating tumor DNA, are being examined in lymphoma and may provide a more accurate method by which to survey patients. Here I review the current literature on follow-up imaging in lymphoma patients by subtype.
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Affiliation(s)
- Sarah C Rutherford
- Meyer Cancer Center, New York-Presbyterian/Weill Cornell Medicine, New York, New York
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17
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Rutherford SC. PET beyond Deauville in diffuse large B-cell lymphoma. Leuk Lymphoma 2019; 60:1851-1852. [PMID: 31106623 DOI: 10.1080/10428194.2019.1599115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sarah C Rutherford
- a Weill Department of Medicine Division of Hematology and Medical Oncology , Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital , New York , NY, USA
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18
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Rutherford SC, Leonard JP. DLBCL Cell of Origin: What Role Should It Play in Care Today? Oncology (Williston Park) 2018; 32:445-449. [PMID: 30248164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is curable in about two-thirds of patients. Research has focused on determining which patients have less favorable prognoses so that they can be considered for novel targeted-treatment strategies. In 2000, gene expression profiling was used to define two principal DLBCL molecular subtypes, germinal center B-cell-like (GCB) and activated B-cell-like (ABC). Patients with GCB DLBCL have more favorable outcomes than those with ABC DLBCL when treated with standard immunochemotherapy. Alternate strategies to characterize molecular subtype include approximation with immunohistochemistry algorithms, and more recently the NanoString gene expression platform. Numerous studies have investigated novel agents in DLBCL with respect to GCB and ABC (or non-GCB) subtypes, but R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) remains the standard of care for most patients. Here we review the methods of determining cell of origin (COO); use of COO in clinical practice; clinical trials in DLBCL according to COO; and future directions of tailoring treatment, including alternate categorization of genetic subtypes or clusters in DLBCL.
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Affiliation(s)
- Sarah C Rutherford
- Meyer Cancer Center, Division of Hematology and Medical Oncology, Weill Department of Medicine, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - John P Leonard
- Meyer Cancer Center, Division of Hematology and Medical Oncology, Weill Department of Medicine, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York
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Rutherford SC, Leonard JP. Bone marrow biopsies not indicated for response assessment in follicular lymphoma trials regardless of type of imaging study - Response to Adams and Kwee. Br J Haematol 2018; 184:466-467. [PMID: 29377067 DOI: 10.1111/bjh.15113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah C Rutherford
- Department of Medicine, Division of Hematology and Oncology, Meyer Cancer Center, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY, USA
| | - John P Leonard
- Department of Medicine, Division of Hematology and Oncology, Meyer Cancer Center, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY, USA
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Rutherford SC, Li V, Ghione P, Chen Z, Martin P, Leonard JP. Bone marrow biopsies do not impact response assessment for follicular lymphoma patients treated on clinical trials. Br J Haematol 2017; 179:242-245. [DOI: 10.1111/bjh.14839] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 05/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Sarah C. Rutherford
- Department of Medicine; Division of Hematology and Oncology; Meyer Cancer Center; Weill Cornell Medical College and New York-Presbyterian Hospital; New York NY USA
| | - Valery Li
- Department of Medicine; Division of Hematology and Oncology; Meyer Cancer Center; Weill Cornell Medical College and New York-Presbyterian Hospital; New York NY USA
| | - Paola Ghione
- Department of Medicine; Division of Hematology and Oncology; Meyer Cancer Center; Weill Cornell Medical College and New York-Presbyterian Hospital; New York NY USA
| | - Zhengming Chen
- Department of Healthcare Policy and Research; Division of Biostatistics and Epidemiology; Weill Cornell Medical College; New York NY USA
| | - Peter Martin
- Department of Medicine; Division of Hematology and Oncology; Meyer Cancer Center; Weill Cornell Medical College and New York-Presbyterian Hospital; New York NY USA
| | - John P. Leonard
- Department of Medicine; Division of Hematology and Oncology; Meyer Cancer Center; Weill Cornell Medical College and New York-Presbyterian Hospital; New York NY USA
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22
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Rutherford SC, Stewart EN, Chen Z, Chadburn A, Wehrli NE, van Besien K, Martin P, Furman RR, Leonard JP, Cerchietti L. The eIF4E inhibitor ribavirin as a potential antilymphoma therapeutic: early clinical data<sup/>. Leuk Lymphoma 2017; 59:256-258. [PMID: 28573908 DOI: 10.1080/10428194.2017.1323270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sarah C Rutherford
- a Department of Medicine, Division of Hematology and Oncology , Meyer Cancer Center, Weill Cornell Medicine and New York-Presbyterian Hospital , New York , NY , USA
| | - Eric N Stewart
- a Department of Medicine, Division of Hematology and Oncology , Meyer Cancer Center, Weill Cornell Medicine and New York-Presbyterian Hospital , New York , NY , USA
| | - Zhengming Chen
- b Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology , Weill Cornell Medical College , New York , NY , USA
| | - Amy Chadburn
- c Department of Pathology and Laboratory Medicine, Division of Hematopathology , Weill Cornell Medical College , New York , NY , USA
| | - Natasha E Wehrli
- d Department of Radiology , Weill Cornell Medical College , New York , NY , USA
| | - Koen van Besien
- a Department of Medicine, Division of Hematology and Oncology , Meyer Cancer Center, Weill Cornell Medicine and New York-Presbyterian Hospital , New York , NY , USA
| | - Peter Martin
- a Department of Medicine, Division of Hematology and Oncology , Meyer Cancer Center, Weill Cornell Medicine and New York-Presbyterian Hospital , New York , NY , USA
| | - Richard R Furman
- a Department of Medicine, Division of Hematology and Oncology , Meyer Cancer Center, Weill Cornell Medicine and New York-Presbyterian Hospital , New York , NY , USA
| | - John P Leonard
- a Department of Medicine, Division of Hematology and Oncology , Meyer Cancer Center, Weill Cornell Medicine and New York-Presbyterian Hospital , New York , NY , USA
| | - Leandro Cerchietti
- a Department of Medicine, Division of Hematology and Oncology , Meyer Cancer Center, Weill Cornell Medicine and New York-Presbyterian Hospital , New York , NY , USA
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Rutherford SC, Leonard JP. The Uncertainties of Rituximab and Related Therapies, 20 Years After Approval. Oncology (Williston Park) 2017; 31:412-414. [PMID: 28516440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Marullo R, Rutherford SC, Leonard JP, Cerchietti L. Therapeutic implication of concomitant chromosomal aberrations in patients with aggressive B-cell lymphomas. Cell Cycle 2016; 15:2241-7. [PMID: 27419806 DOI: 10.1080/15384101.2016.1207839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A subset of diffuse large B-cell lymphomas (DLBCL) harbors concomitant rearrangements of MYC, BCL2 and BCL6 and is characterized by clinical aggressiveness and intrinsic refractoriness to standard chemo-immunotherapy. Commonly identified as "double or triple hit" lymphomas, these diseases represent a therapeutic challenge to chemotherapy-based regimens and likely require a more targeted approach. Herein we summarize the unique biological behavior of double and triple hit lymphomas focusing on the coordinated network of pathways that enable cancer cells to tolerate the oncogenic stress imposed by the co-expression of MYC, BCL2 and BCL6. We discuss how these enabling pathways contribute to the chemo-refractoriness of these tumors. We propose to exploit lymphoma cells' addiction to these oncogenic networks to design combinatorial treatments for this aggressive disease based on the modulation of epigenetically-silenced pathways and decreasing expression and activity of these oncogenic drivers.
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Affiliation(s)
- Rossella Marullo
- a Division of Hematology and Medical Oncology, Department of Medicine and Meyer Cancer Center, Weill Cornell Medicine , New York , NY , USA
| | - Sarah C Rutherford
- a Division of Hematology and Medical Oncology, Department of Medicine and Meyer Cancer Center, Weill Cornell Medicine , New York , NY , USA
| | - John P Leonard
- a Division of Hematology and Medical Oncology, Department of Medicine and Meyer Cancer Center, Weill Cornell Medicine , New York , NY , USA
| | - Leandro Cerchietti
- a Division of Hematology and Medical Oncology, Department of Medicine and Meyer Cancer Center, Weill Cornell Medicine , New York , NY , USA
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Rutherford SC, Martin P, Chapin J. Management strategies in patients with diffuse large B-cell lymphoma and severe haemophilia. Haemophilia 2015; 21:e445-7. [PMID: 26178703 DOI: 10.1111/hae.12741] [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] [Accepted: 05/11/2015] [Indexed: 12/18/2022]
Affiliation(s)
- S C Rutherford
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - P Martin
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - J Chapin
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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Rutherford SC, Andemariam B, Philips SM, Elstrom RL, Chadburn A, Furman RR, Niesvizky R, Martin P, Fahey TJ, Coleman M, Goldsmith SJ, Leonard JP. FDG-PET in prediction of splenectomy findings in patients with known or suspected lymphoma. Leuk Lymphoma 2009; 49:719-26. [DOI: 10.1080/10428190801927387] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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