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Irimia R, Barbu S, Popa C, Badelita S. Evans Syndrome as a Possible Complication of Brentuximab Vedotin Therapy for Peripheral T Cell Lymphoma. Hematol Rep 2023; 15:220-224. [PMID: 36975736 PMCID: PMC10048708 DOI: 10.3390/hematolrep15010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/14/2022] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
Recently, Brentuximab Vedotin (BV) has emerged as an important therapy not only for Hodgkin's Lymphoma, but also for CD30-positive T cell lymphomas. Although anemia and thrombocytopenia are common myelosuppressive side effects, to our knowledge, this is the first described case of Evans Syndrome associated with BV therapy. We present the case of a 64-year-old female, diagnosed with relapsed Peripheral T Cell Lymphoma Not Otherwise Specified (PTCL-NOS), who, after receiving six cycles of BV, developed authentic severe autoimmune hemolytic anemia with strong positive direct anti-globulin (Coombs) test, simultaneously associated with severe immune thrombocytopenia. The patient was unresponsive to systemic corticotherapy, but fully recovered after a course of IV immunoglobulin.
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Affiliation(s)
- Ruxandra Irimia
- School of Medicine, "Carol Davila" University of Medicine and Pharmacy, 4192910 Bucharest, Romania
- Fundeni Clinical Institute, 4192910 Bucharest, Romania
| | - Sinziana Barbu
- School of Medicine, "Carol Davila" University of Medicine and Pharmacy, 4192910 Bucharest, Romania
- Fundeni Clinical Institute, 4192910 Bucharest, Romania
| | - Codruta Popa
- School of Medicine, "Carol Davila" University of Medicine and Pharmacy, 4192910 Bucharest, Romania
- Fundeni Clinical Institute, 4192910 Bucharest, Romania
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Papakonstantinou I, Kosmidou M, Papathanasiou K, Koumpis E, Kapsali E, Milionis H, Vassilakopoulos TP, Papoudou-Bai A, Hatzimichael E. Paraneoplastic Intrahepatic Cholestasis in Supradiaphragmatic Classical Hodgkin Lymphoma Successfully Treated With Brentuximab Vedotin: A Case Report and Review of the Literature. In Vivo 2021; 35:1951-1957. [PMID: 34182468 DOI: 10.21873/invivo.12462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hepatic dysfunction in patients with classical Hodgkin lymphoma (cHL) is of multifactorial aetiology. Prompt evaluation with laboratory tests and imaging methods is sufficient for diagnosis in most cases. Intrahepatic cholestasis and vanishing bile duct syndrome (VBDS) may complicate cHL as rare paraneoplastic phenomena. Liver biopsy provides crucial evidence of cholestasis, and ductopenia, if present, confirms the diagnosis of VBDS. CASE REPORT We report on a cHL patient that presented with jaundice and bulky mediastinal disease and unfold the therapeutic dilemmas we confronted. Marked hyperbilirubinemia was successfully reversed with brentuximab vedotin (BV) at a dose of 1.2 mg/kg and the patient was subsequently treated with doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) at full doses, achieving complete metabolic response. A literature review of intrahepatic cholestasis in cHL is also presented based on currently available data with focus on treatment options and clinicopathologic associations. CONCLUSION VBDS and intrahepatic cholestasis are rare and potentially fatal complications of cHL. Their prompt recognition and appropriate treatment can dramatically affect cHL patients' outcome. BV, used at a reduced dose as a bridging therapy, should be considered as a high-priority treatment plan in these challenging cases.
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Affiliation(s)
- Ioannis Papakonstantinou
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Maria Kosmidou
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantina Papathanasiou
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Epameinondas Koumpis
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleni Kapsali
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Papoudou-Bai
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleftheria Hatzimichael
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece;
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Debliquis A, Baseggio L, Bouyer S, Guy J, Garnache-Ottou F, Genevieve F, Mayeur-Rousse C, Letestu R, Chapuis N, Harrivel V, Bennani H, Lachot S, Loosveld M, Nicolino-Brunet C, Pérès M, Roussel M, Veyrat-Masson R, Jacob MC, Drenou B. Multicentric MFI30 study: Standardization of flow cytometry analysis of CD30 expression in non-Hodgkin lymphoma. Cytometry B Clin Cytom 2020; 100:488-496. [PMID: 32803917 DOI: 10.1002/cyto.b.21940] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/15/2020] [Accepted: 07/15/2020] [Indexed: 02/03/2023]
Abstract
CD30 transmembrane receptor, a member of the tumor necrosis factor receptor family, is expressed in different lymphomas. Brentuximab vedotin (BV), a CD30 monoclonal antibody (Ab)-drug conjugate, is effective in CD30-positive lymphomas. However, the response to BV is not always correlated to CD30 expression detected by immunohistochemistry (IHC). The objectives of this study were to standardize and evaluate CD30 intensity by flow cytometry (FCM) in non-Hodgkin's lymphomas. Twelve centers analyzed 161 cases on standardized cytometers using normalized median fluorescence intensity (nMFI30) of three different Abs, of which one clone can recognize the same epitope as BV. FCM distinguished four groups of cases: negative group (n = 110) which showed no expression with the three clones; high positive group (n = 13) which gave nMFI30 > 5% with all tested clones; dim positive group (n = 17) which showed nMFI30 > 1% with all tested clones and <5% for at least one; discordant group (n = 21) with positive and negative expression of the different clones. In consistency with the literature, CD30 was positive in all anaplastic large cell lymphomas, in some diffuse large B-cell lymphomas (DLBCL), and in other rare lymphomas. FCM results were concordant with those of IHC in 77% of cases. Discrepancies could be explained by clones-related differences, microenvironment, or intracytoplasmic staining. Interestingly, FCM was more sensitive than IHC in 11% of cases, especially in DLBCL. Multicenter standardized FCM of specific CD30 could improve case detection and extend the treatment of BV to various CD30-positive lymphomas.
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Affiliation(s)
- Agathe Debliquis
- Laboratoire d'Hématologie, Groupe Hospitalier de la région Mulhouse Sud Alsace, Mulhouse, France
| | - Lucile Baseggio
- Laboratoire d'Hématologie Cellulaire, Groupement Hospitalier Sud/Hospices Civils de Lyon, Lyon, France
| | - Sabrina Bouyer
- Service d'Hématologie Biologique, Center Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Julien Guy
- Service d'Hématologie biologique, Center Hospitalier Universitaire de Dijon, Dijon, France
| | | | - Franck Genevieve
- Laboratoire d'Hématologie, Center Hospitalier Universitaire d'Angers, Fédération Hospitalo-Universitaire "Grand Ouest Against Leukemia" (FHU GOAL), Angers, France
| | - Caroline Mayeur-Rousse
- Laboratoire d'Hématologie, Center Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Remi Letestu
- Service d'Hématologie Biologique, Hôpital Avicenne HUPSSD, AP-HP, Bobigny, France
| | - Nicolas Chapuis
- Service d'Hématologie Biologique, Hopital Cochin APHP, Paris, France
| | | | - Hind Bennani
- Laboratoire de biologie, Hopital Foch, Suresnes, France
| | - Sebastien Lachot
- Service d'Hématologie Biologie, Center Hospitalier Universitaire de Tours, Tours, France
| | - Marie Loosveld
- Laboratoire d'Hématologie, Center Hospitalier Universitaire de Marseille, CNRS, INSERM, CIML, Aix Marseille Université, Marseille, France
| | - Corinne Nicolino-Brunet
- Laboratoire d'Hématologie et Biologie Vasculaire du Pr Françoise Dignat George, Center Hospitalier Universitaire La Conception, Marseille, France
| | - Michaël Pérès
- Laboratoire d'Hématologie, IUCT-Oncopole, CHU de Toulouse, Toulouse, France
| | - Mikael Roussel
- Pôle Biologie, Center Hospitalier Universitaire de Rennes, Rennes, France
| | - Richard Veyrat-Masson
- Service d'Hématologie Biologique, Hôpital Estaing, Center Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie-Christine Jacob
- Laboratoire d'Immunologie, Center Hospitalier Universitaire de Grenoble-Alpes, La Tronche, France
| | - Bernard Drenou
- Laboratoire d'Hématologie, Groupe Hospitalier de la région Mulhouse Sud Alsace, Mulhouse, France
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Romano A, Parrinello NL, Chiarenza A, Motta G, Tibullo D, Giallongo C, La Cava P, Camiolo G, Puglisi F, Palumbo GA, Di Raimondo F. Immune off-target effects of Brentuximab Vedotin in relapsed/refractory Hodgkin Lymphoma. Br J Haematol 2019; 185:468-479. [PMID: 30768678 DOI: 10.1111/bjh.15801] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 12/18/2018] [Indexed: 02/04/2023]
Abstract
Hodgkin Lymphoma (HL) is associated with deep microenvironment re-shaping and myeloid dysfunction. Given that only limited data are available regarding the role of Brentuximab Vedotin (BV) as single agent in transplant-naive relapsed/refractory (R/R) patients and its off-target effects on immune system, we evaluated the amount of regulatory T-cells (T-regs), myeloid-derived suppressor cells (MDSC) subpopulations, and their functional marker, serum arginase-1 (s-Arg-1), in peripheral blood of 15 consecutive R/R HL patients. After a median of four BV cycles, the overall response rate (complete response + partial response) was 47%, with 4 (27%) complete metabolic remissions. BV reduced the absolute number of three MDSC subtypes and s-Arg-1 levels. Patients with baseline s-Arg-1 ≥200 ng/ml had inferior progression-free survival at 36 months compared to those with low s-Arg-1. T-regs dysfunction was recovered by BV: absolute T-regs count was increased after treatment with BV, independently of metabolic response achieved, with a significant reduction of CD30+ T-regs. Our data disclose off-target effects of BV in the microenvironment that could explain its deep and durable clinical efficacy.
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Affiliation(s)
- Alessandra Romano
- Section of Haematology, Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Nunziatina L Parrinello
- Section of Haematology, Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | | | - Giovanna Motta
- Division of Haematology, Azienda Policlinico-OVE, Catania, Italy
| | - Daniele Tibullo
- Division of Haematology, Azienda Policlinico-OVE, Catania, Italy.,Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | | | - Piera La Cava
- Division of Haematology, Azienda Policlinico-OVE, Catania, Italy
| | | | - Fabrizio Puglisi
- Division of Haematology, Azienda Policlinico-OVE, Catania, Italy
| | | | - Francesco Di Raimondo
- Section of Haematology, Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.,Division of Haematology, Azienda Policlinico-OVE, Catania, Italy
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Li C, Agarwal P, Gibiansky E, Jin JY, Dent S, Gonçalves A, Nijem I, Strasak A, Harle-Yge ML, Chernyukhin N, LoRusso P, Girish S. A Phase I Pharmacokinetic Study of Trastuzumab Emtansine (T-DM1) in Patients with Human Epidermal Growth Factor Receptor 2-Positive Metastatic Breast Cancer and Normal or Reduced Hepatic Function. Clin Pharmacokinet 2018; 56:1069-1080. [PMID: 27995530 DOI: 10.1007/s40262-016-0496-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the pharmacokinetics (PK) of trastuzumab emtansine (T-DM1) and relevant analytes in patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer and hepatic impairment. METHODS Patients were enrolled in three independent parallel cohorts based on hepatic function per Child-Pugh criteria: normal hepatic function, mild hepatic impairment, and moderate hepatic impairment. Patients received T-DM1 3.6 mg/kg intravenously every 3 weeks. PK samples were collected during cycles 1 and 3, and the PK of T-DM1 and relevant analytes were characterized and compared across cohorts. RESULTS Compared with patients with normal hepatic function (n = 10), T-DM1 clearance at cycle 1 was 1.8- and 4.0-fold faster in the mild (n = 10) and moderate (n = 8) cohorts, respectively. The trend of faster clearance was less apparent in cycle 3, with similar T-DM1 clearance across cohorts (mean ± standard deviation 8.16 ± 3.27 [n = 9], 9.74 ± 3.62 [n = 7], and 8.99 and 10.2 [individual values, n = 2] mL/day/kg for the normal, mild, and moderate cohorts, respectively). T-DM1 clearance at cycle 1 correlated significantly with baseline albumin, aspartate aminotransferase, and HER2 extracellular domain concentrations (p < 0.05). Plasma concentrations of DM1 and DM1-containing catabolites were low and were comparable across cohorts. CONCLUSIONS No increase in systemic DM1 concentration was observed in patients with mild or moderate hepatic impairment versus those with normal hepatic function. The faster T-DM1 clearance observed at cycle 1 in patients with hepatic impairment appeared to be transient. After repeated dosing (three cycles), T-DM1 exposure in patients with mild and moderate hepatic impairment was within the range seen in those with normal hepatic function.
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Affiliation(s)
- Chunze Li
- Genentech, Inc, 1 DNA Way, South San Francisco, CA, 94080, USA.
| | - Priya Agarwal
- Genentech, Inc, 1 DNA Way, South San Francisco, CA, 94080, USA
| | | | - Jin Yan Jin
- Genentech, Inc, 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Susan Dent
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | | | - Ihsan Nijem
- Genentech, Inc, 1 DNA Way, South San Francisco, CA, 94080, USA
| | | | | | | | - Pat LoRusso
- Yale Cancer Center, Yale University, New Haven, CT, USA
| | - Sandhya Girish
- Genentech, Inc, 1 DNA Way, South San Francisco, CA, 94080, USA
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Alig SK, Dreyling M, Seppi B, Aulinger B, Witkowski L, Rieger CT. Severe cytokine release syndrome after the first dose of Brentuximab Vedotin in a patient with relapsed systemic anaplastic large cell lymphoma (sALCL): a case report and review of literature. Eur J Haematol 2014; 94:554-7. [PMID: 24913471 DOI: 10.1111/ejh.12396] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2014] [Indexed: 12/31/2022]
Abstract
Brentuximab Vedotin is an antibody - drug conjugate targeting CD30. We report a case of severe cytokine release syndrome (CRS) after administration of the first dose of Brentuximab Vedotin in a 64-yr-old patient with relapsed systemic anaplastic large cell lymphoma (sALCL). To our knowledge, this is the first case of CRS to Brentuximab Vedotin described in the literature. However, CRS to Brentuximab Vedotin might be underestimated, as the drug has not been tested in large phase III trials yet.
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Affiliation(s)
- Stefan K Alig
- Department of Medicine III, Medical Centre of the University of Munich, Munich, Germany
| | - Martin Dreyling
- Department of Medicine III, Medical Centre of the University of Munich, Munich, Germany
| | - Bettina Seppi
- Department of Medicine III, Medical Centre of the University of Munich, Munich, Germany
| | - Benedikt Aulinger
- Department of Medicine II, Medical Centre of the University of Munich, Munich, Germany
| | - Lukas Witkowski
- Department of Medicine III, Medical Centre of the University of Munich, Munich, Germany
| | - Christina T Rieger
- Department of Medicine III, Medical Centre of the University of Munich, Munich, Germany
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