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Njue A, Colosia A, Trask PC, Olivares R, Khan S, Abbe A, Police R, Wang J, Ruiz-Soto R, Kaye JA, Awan F. Clinical efficacy and safety in relapsed/refractory mantle cell lymphoma: a systematic literature review. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 15:1-12.e7. [PMID: 25052050 DOI: 10.1016/j.clml.2014.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/11/2014] [Accepted: 03/17/2014] [Indexed: 12/14/2022]
Abstract
A systematic literature review was performed to collect and review information on the clinical efficacy and safety of treatments for relapsed/refractory (R/R) mantle cell lymphoma (MCL), with a meta-analysis, if possible. PubMed, Embase, and the Cochrane Library were searched for studies published in English from January 1, 1997, to August 2, 2012. Conference proceedings, bibliographic reference lists of included articles, recent reviews, and ClinicalTrials.gov were searched for phase II to IV studies displaying results. Studies were included if they reported on patients with R/R MCL who were ineligible to receive high-dose chemotherapy with stem cell transplant. Studies of patients with several non-Hodgkin lymphoma subtypes were only included if they reported MCL outcomes separately. We identified 59 studies in R/R MCL. Forty distinct treatment regimens were evaluated. Thirty studies included more than 15 patients with R/R MCL. Six studies were comparative (including 5 randomized controlled trials [RCTs]); 53 were single-arm. There were no common treatments among the RCTs; therefore, a meta-analysis was not feasible. Thirty-one of 59 studies reported baseline data for patients with R/R MCL. Of the 30 studies with > 15 patients with R/R MCL, 30 reported overall response rate data, 14 reported progression-free survival (PFS), and 12 reported overall survival (OS). The small number of RCTs in R/R MCL precludes identifying an optimal treatment. Small sample sizes, infrequent reporting of OS and PFS, and limited information on patient characteristics made a comparison of results difficult. High-quality comparative studies of novel therapies that have the potential to demonstrate OS advantages in R/R MCL are needed.
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Affiliation(s)
- Annete Njue
- RTI Health Solutions, The Pavillion, Towers Business Park, Manchester, United Kingdom.
| | - Ann Colosia
- RTI Health Solutions, Research Triangle Park, NC
| | - Peter C Trask
- Global Evidence and Value Development, Sanofi, Cambridge, MA
| | - Robert Olivares
- Global Evidence and Value Development, Sanofi, Chilly-Mazarin, France
| | - Shahnaz Khan
- RTI Health Solutions, The Pavillion, Towers Business Park, Manchester, United Kingdom
| | - Adeline Abbe
- Global Evidence and Value Development, Sanofi, Chilly-Mazarin, France
| | | | - Jianmin Wang
- RTI Health Solutions, The Pavillion, Towers Business Park, Manchester, United Kingdom
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Fenske TS, Zhang MJ, Carreras J, Ayala E, Burns LJ, Cashen A, Costa LJ, Freytes CO, Gale RP, Hamadani M, Holmberg LA, Inwards DJ, Lazarus HM, Maziarz RT, Munker R, Perales MA, Rizzieri DA, Schouten HC, Smith SM, Waller EK, Wirk BM, Laport GG, Maloney DG, Montoto S, Hari PN. Autologous or reduced-intensity conditioning allogeneic hematopoietic cell transplantation for chemotherapy-sensitive mantle-cell lymphoma: analysis of transplantation timing and modality. J Clin Oncol 2013; 32:273-81. [PMID: 24344210 DOI: 10.1200/jco.2013.49.2454] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To examine the outcomes of patients with chemotherapy-sensitive mantle-cell lymphoma (MCL) following a first hematopoietic stem-cell transplantation (HCT), comparing outcomes with autologous (auto) versus reduced-intensity conditioning allogeneic (RIC allo) HCT and with transplantation applied at different times in the disease course. PATIENTS AND METHODS In all, 519 patients who received transplantations between 1996 and 2007 and were reported to the Center for International Blood and Marrow Transplant Research were analyzed. The early transplantation cohort was defined as those patients in first partial or complete remission with no more than two lines of chemotherapy. The late transplantation cohort was defined as all the remaining patients. RESULTS Auto-HCT and RIC allo-HCT resulted in similar overall survival from transplantation for both the early (at 5 years: 61% auto-HCT v 62% RIC allo-HCT; P = .951) and late cohorts (at 5 years: 44% auto-HCT v 31% RIC allo-HCT; P = .202). In both early and late transplantation cohorts, progression/relapse was lower and nonrelapse mortality was higher in the allo-HCT group. Overall survival and progression-free survival were highest in patients who underwent auto-HCT in first complete response. Multivariate analysis of survival from diagnosis identified a survival benefit favoring early HCT for both auto-HCT and RIC allo-HCT. CONCLUSION For patients with chemotherapy-sensitive MCL, the optimal timing for HCT is early in the disease course. Outcomes are particularly favorable for patients undergoing auto-HCT in first complete remission. For those unable to achieve complete remission after two lines of chemotherapy or those with relapsed disease, either auto-HCT or RIC allo-HCT may be effective, although the chance for long-term remission and survival is lower.
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Affiliation(s)
- Timothy S Fenske
- Timothy S. Fenske and Mehdi Hamadani, Medical College of Wisconsin; Mei-Jie Zhang, Jeanette Carreras, and Parameswaran N. Hari, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Ernesto Ayala, H. Lee Moffitt Cancer Center and Research Institute, Tampa; Baldeep M. Wirk, Shands Healthcare and University of Florida, Gainesville, FL; Linda J. Burns, University of Minnesota Medical Center, Fairview, Minneapolis; David J. Inwards, Mayo Clinic Rochester, Rochester, MN; Amanda Cashen, Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, MO; Luciano J. Costa, Medical University of South Carolina, Charleston, SC; César O. Freytes, South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, TX; Robert P. Gale, Imperial College; Silvia Montoto, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Leona A. Holmberg and David G. Maloney, Fred Hutchinson Cancer Research Center, Seattle, WA; Hillard M. Lazarus, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH; Richard T. Maziarz, Oregon Health and Science University, Portland, OR; Reinhold Munker, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA; Miguel-Angel Perales, Memorial Sloan-Kettering Cancer Center, New York, NY; David A. Rizzieri, Duke University Medical Center, Durham, NC; Harry C. Schouten, Academische Ziekenhuis Maastricht, Maastricht, the Netherlands; Sonali M. Smith, University of Chicago Hospitals, Chicago, IL; Edmund K. Waller, Emory University Hospital, Atlanta, GA; and Ginna G. Laport, Stanford Hospital and Clinics, Stanford, CA
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Lamm W, Drach J, Kiesewetter B, Zielinksi CC, Mayerhöfer ME, Müllauer L, Raderer M. Rituximab, Ara-C, dexamethasone and oxaliplatin (R-ADOx) is effective for treatment of elderly patients with relapsed mantle cell lymphoma. J Cancer Res Clin Oncol 2013; 139:1771-5. [DOI: 10.1007/s00432-013-1475-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
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Affiliation(s)
- Peter H Wiernik
- Continuum Cancer Centers of New York, St. Lukes – Roosevelt and Beth Israel Medical Center, Leukemia Program,
1000 10th Ave, Ste. 11C-02, New York, NY 10019, USA ;
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Renner C, Zinzani PL, Gressin R, Klingbiel D, Dietrich PY, Hitz F, Bargetzi M, Mingrone W, Martinelli G, Trojan A, Bouabdallah K, Lohri A, Gyan E, Biaggi C, Cogliatti S, Bertoni F, Ghielmini M, Brauchli P, Ketterer N. A multicenter phase II trial (SAKK 36/06) of single-agent everolimus (RAD001) in patients with relapsed or refractory mantle cell lymphoma. Haematologica 2012; 97:1085-91. [PMID: 22315486 DOI: 10.3324/haematol.2011.053173] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mantle cell lymphoma accounts for 6% of all B-cell lymphomas and is generally incurable. It is characterized by the translocation t(11;14) leading to cyclin D1 over-expression. Cyclin D1 is downstream of the mammalian target of rapamycin threonine kinase and can be effectively blocked by mammalian target of rapamycin inhibitors. We set out to examine the single agent activity of the orally available mammalian target of rapamycin inhibitor everolimus in a prospective, multicenter trial in patients with relapsed or refractory mantle cell lymphoma (NCT00516412). DESIGN AND METHODS Eligible patients who had received a maximum of three prior lines of chemotherapy were given everolimus 10 mg for 28 days (one cycle) for a total of six cycles or until disease progression. The primary endpoint was the best objective response. Adverse reactions, progression-free survival and molecular response were secondary endpoints. RESULTS Thirty-six patients (35 evaluable) were enrolled and treatment was generally well tolerated with Common Terminology Criteria grade ≥ 3 adverse events (>5%) including anemia (11%), thrombocytopenia (11%) and neutropenia (8%). The overall response rate was 20% (95% CI: 8-37%) with two complete remissions and five partial responses; 49% of the patients had stable disease. At a median follow-up of 6 months, the median progression-free survival was 5.5 months (95% CI: 2.8-8.2) overall and 17.0 (6.4-23.3) months for 18 patients who received six or more cycles of treatment. Three patients achieved a lasting complete molecular response, as assessed by polymerase chain reaction analysis of peripheral blood. CONCLUSIONS Everolimus as a single agent is well tolerated and has anti-lymphoma activity in relapsed or refractory mantle cell lymphoma. Further studies of everolimus in combination with chemotherapy or as a single agent for maintenance treatment are warranted.
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Affiliation(s)
- Christoph Renner
- Division of Oncology, University Hospital Zürich, Rämistrasse 100 8091 Zürich, Switzerland.
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HDM-2 inhibition suppresses expression of ribonucleotide reductase subunit M2, and synergistically enhances gemcitabine-induced cytotoxicity in mantle cell lymphoma. Blood 2011; 118:4140-9. [PMID: 21844567 DOI: 10.1182/blood-2011-03-340323] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Mantle cell lymphoma (MCL) usually responds well to initial therapy but is prone to relapses with chemoresistant disease, indicating the need for novel therapeutic approaches. Inhibition of the p53 E3 ligase human homolog of the murine double minute protein-2 (HDM-2) with MI-63 has been validated as one such strategy in wild-type (wt) p53 models, and our genomic and proteomic analyses demonstrated that MI-63 suppressed the expression of the ribonucleotide reductase (RNR) subunit M2 (RRM2). This effect occurred in association with induction of p21 and cell-cycle arrest at G(1)/S and prompted us to examine combinations with the RNR inhibitor 2',2'-difluoro-2'-deoxycytidine (gemcitabine). The regimen of MI-63-gemcitabine induced enhanced, synergistic antiproliferative, and proapoptotic effects in wtp53 MCL cell lines. Addition of exogenous dNTPs reversed this effect, whereas shRNA-mediated inhibition of RRM2 was sufficient to induce synergy with gemcitabine. Combination therapy of MCL murine xenografts with gemcitabine and MI-219, the in vivo analog of MI-63, resulted in enhanced antitumor activity. Finally, synergy was seen with MI-63-gemcitabine in primary patient samples that were found to express high levels of RRM2 compared with MCL cell lines. These findings provide a framework for translation of the rational combination of an HDM-2 and RNR inhibitor to the clinic for patients with relapsed wtp53 MCL.
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Geisler C. Mantle cell lymphoma: are current therapies changing the course of disease? Curr Oncol Rep 2010; 11:371-7. [PMID: 19679012 DOI: 10.1007/s11912-009-0050-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Mantle cell lymphoma (MCL) is a rare entity of non-Hodgkin's lymphoma, although it seems to be increasing in incidence and severity. There is no accepted standard therapy; however, one controlled clinical trial demonstrated that intensive induction immunochemotherapy followed by high-dose radiochemotherapy and autologous stem cell transplantation was superior to conventional treatment. Moreover, uncontrolled studies of intensive immunochemotherapy followed by autologous stem cell transplantation now suggest that MCL may be cured. Insight into the biology of MCL is expanding, opening new avenues of treatment with well-defined molecular targets, including CD20, mammalian target of rapamycin, and proteasomes.
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Affiliation(s)
- Christian Geisler
- Department of Hematology 4042, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
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