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Bendale YN, Birari‐Gawande P, Patil A, Kadam A. Ayurveda Rasayana Therapy (ART) leads to tumor regression and increased survival in chemo-intolerance high-grade stage IV follicular lymphoma: A case study. Clin Case Rep 2024; 12:e8076. [PMID: 38827936 PMCID: PMC11139640 DOI: 10.1002/ccr3.8076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 06/05/2024] Open
Abstract
Key clinical message Ayurveda Rasayana Therapy (ART) may serve as a safe and effective alternative treatment option for chemo-intolerance high-grade stage IV follicular lymphoma patients for increasing survival and tumor regression. Abstract Follicular lymphoma (FL), also called follicle center lymphoma/nodular lymphoma, observed in the B lymphocytes (B-cells). Available therapeutic options for follicular lymphoma are associated with various side effects and, patients with co-morbidities can seldom tolerate the chemotherapy regimens. Rasayana therapy not only resulted in tumor regression and improved survival but also dealt with the adverse effects of previous chemotherapy drugs. Herein, we present a case of a 74-year-old female diagnosed with Follicular lymphoma who had undergone three cycles of chemotherapy with unresolved disease outcome and serious adverse events. The patient refused to undergo further cycles of chemotherapy. Her family decided to start Ayurveda treatment for her as an alternative therapy for cancer care. On thorough case taking considering the Ayurveda parameters personalized Rasayana therapy as planned for the patient with an aim for improvement in Quality of Life (QoL), increasing survival, and optimizing body's immune response to fight the tumor. After treatment of 8 months, this case demonstrated partial tumor response as evidenced by PET-CT-scan. Quality of Life as evaluated using FACT-G was also seen improved besides significant improvement in physical performance status evaluated using ECOG. The patient showed a survival of 3.5 years after starting Ayurveda Rasayana Therapy (ART). Rasayana therapy was well tolerated by the patient. This case report indicates the potential role of ART as a therapeutic option in geriatric cancer patients who are not eligible for cytotoxic interventions. Case warrants further systematic investigation to evaluate the potential role of ART in the treatment of geriatric cancer patients.
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Saito M, Mori A, Ishio T, Kobayashi M, Tsukamoto S, Kajikawa S, Yokoyama E, Kanaya M, Izumiyama K, Muraki H, Morioka M, Kondo T. Initial Efficacy of the COVID-19 mRNA Vaccine Booster and Subsequent Breakthrough Omicron Variant Infection in Patients with B-Cell Non-Hodgkin's Lymphoma: A Single-Center Cohort Study. Viruses 2024; 16:328. [PMID: 38543695 PMCID: PMC10974858 DOI: 10.3390/v16030328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/17/2024] [Accepted: 02/18/2024] [Indexed: 05/23/2024] Open
Abstract
It has been suggested that the effect of coronavirus disease 2019 (COVID-19) booster vaccination in patients with B-cell non-Hodgkin's lymphoma (B-NHL) is inferior to that in healthy individuals. However, differences according to histological subtype or treatment status are unclear. In addition, there has been less research on patients who subsequently develop breakthrough infections. We investigated the effects of the first COVID-19 booster vaccination for patients with B-NHL and the clinical features of breakthrough infections in the Omicron variant era. In this study, B-NHL was classified into two histological subtypes: aggressive lymphoma and indolent lymphoma. Next, patients were subdivided according to treatment with anticancer drugs at the start of the first vaccination. We also examined the clinical characteristics and outcomes of patients who had breakthrough infections after a booster vaccination. The booster effect of the COVID-19 mRNA vaccine in patients with B-NHL varied considerably depending on treatment status at the initial vaccination. In the patient group at more than 1 year after the last anticancer drug treatment, regardless of the histological subtype, the booster effect was comparable to that in the healthy control group. In contrast, the booster effect was significantly poorer in the other patient groups. However, of the 213 patients who received the booster vaccine, 22 patients (10.3%) were infected with COVID-19, and 18 patients (81.8%) had mild disease; these cases included the patients who remained seronegative. Thus, we believe that booster vaccinations may help in reducing the severity of Omicron variant COVID-19 infection in patients with B-NHL.
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Affiliation(s)
- Makoto Saito
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Takashi Ishio
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Mirei Kobayashi
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Shihori Tsukamoto
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Sayaka Kajikawa
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Emi Yokoyama
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Minoru Kanaya
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Haruna Muraki
- Division of Laboratory, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Masanobu Morioka
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
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Yura Y, Hamada M. Outline of Salivary Gland Pathogenesis of Sjögren's Syndrome and Current Therapeutic Approaches. Int J Mol Sci 2023; 24:11179. [PMID: 37446355 DOI: 10.3390/ijms241311179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Sjögren's syndrome (SS) is an autoimmune disease characterized by the involvement of exocrine glands such as the salivary and lacrimal glands. The minor salivary glands, from which tissue samples may be obtained, are important for the diagnosis, evaluation of therapeutic efficacy, and genetic analyses of SS. In the onset of SS, autoantigens derived from the salivary glands are recognized by antigen-presenting dendritic cells, leading to the activation of T and B cells, cytokine production, autoantibody production by plasma cells, the formation of ectopic germinal centers, and the destruction of salivary gland epithelial cells. A recent therapeutic approach with immune checkpoint inhibitors for malignant tumors enhances the anti-tumor activity of cytotoxic effector T cells, but also induces SS-like autoimmune disease as an adverse event. In the treatment of xerostomia, muscarinic agonists and salivary gland duct cleansing procedure, as well as sialendoscopy, are expected to ameliorate symptoms. Clinical trials on biological therapy to attenuate the hyperresponsiveness of B cells in SS patients with systemic organ involvement have progressed. The efficacy of treatment with mesenchymal stem cells and chimeric antigen receptor T cells for SS has also been investigated. In this review, we will provide an overview of the pathogenesis of salivary gland lesions and recent trends in therapeutic approaches for SS.
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Affiliation(s)
- Yoshiaki Yura
- Department of Oral & Maxillofacial Oncology and Surgery, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan
| | - Masakazu Hamada
- Department of Oral & Maxillofacial Oncology and Surgery, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan
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Ishio T, Tsukamoto S, Yokoyama E, Izumiyama K, Saito M, Muraki H, Kobayashi M, Mori A, Morioka M, Kondo T. Anti-CD20 antibodies and bendamustine attenuate humoral immunity to COVID-19 vaccination in patients with B-cell non-Hodgkin lymphoma. Ann Hematol 2023; 102:1421-1431. [PMID: 37041299 PMCID: PMC10089694 DOI: 10.1007/s00277-023-05204-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
Serologic responses of COVID-19 vaccine are impaired in patients with B-cell lymphoma, especially those who had recently been treated with anti-CD20 monoclonal antibodies. However, it is still unclear whether those patients develop an immune response following vaccination. We investigated the efficacy of vaccination against SARS-CoV-2 in 171 patients with B-cell non-Hodgkin lymphoma (B-NHL) who received two doses of an mRNA-based COVID-19 vaccine and we compared the efficacy of vaccination to that in 166 healthy controls. Antibody titers were measured 3 months after administration of the second vaccine dose. Patients with B-NHL showed a significantly lower seroconversion rate and a lower median antibody titer than those in healthy controls. The antibody titers showed correlations with the period from the last anti-CD20 antibody treatment to vaccination, the period from the last bendamustine treatment to vaccination and serum IgM level. The serologic response rates and median antibody titers were significantly different between diffuse large B-cell lymphoma (DLBCL) patients in whom anti-CD20 antibody treatment was completed within 9 months before vaccination and follicular lymphoma (FL) patients in whom anti-CD20 antibody treatment was completed within 15 months before vaccination. Moreover, the serologic response rates and median antibody titers were significantly different among FL patients in whom bendamustine treatment was completed within 33 months before vaccination. We demonstrated that B-NHL patients who were recently treated with anti-CD20 antibodies and bendamustine had a diminished humoral response to COVID-19 vaccination. UMIN 000,045,267.
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Affiliation(s)
- Takashi Ishio
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan.
| | | | - Emi Yokoyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Makoto Saito
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Haruna Muraki
- Division of Laboratory, Aiiku Hospital, Sapporo, Japan
| | | | - Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | | | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
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5
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Riva N, Molina M, Cornaló BL, Salvador MV, Savransky A, Tenembaum S, Katsicas MM, Monteverde M, Cáceres Guido P, Rousseau M, Staciuk R, González Correas A, Zubizarreta P, Imventarza O, Lagomarsino E, Spitzer E, Tinelli M, Schaiquevich P. Intensive Safety Monitoring of Rituximab (Biosimilar Novex ® and the Innovator) in Pediatric Patients With Complex Diseases. Front Pharmacol 2022; 12:785770. [PMID: 35153748 PMCID: PMC8827405 DOI: 10.3389/fphar.2021.785770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022] Open
Abstract
Although rituximab is widely used off-label for complex pediatric diseases, safety reports are limited. We aimed to report evidence of its use in clinical practice, to describe the incidence of adverse drug reactions (ADR) to rituximab biosimilar Novex® and innovator, and to identify risk factors for the development of ADR in a real-life follow-up cohort of pediatric patients with complex diseases. We conducted a prospective, longitudinal, observational, single-centre study in patients that received rituximab for any complex disease, and as part of an intensive pharmacovigilance program. Demographic, pharmacological, clinical, and drug-related data were collected for all patients. ADR-free survival, including infusion-related reactions (IRR) and delayed ADR (dADR), was estimated using Kaplan-Meier curves. Risk factors were evaluated by multivariable Cox regression models. In total, 77 patients (<19 y.o.) received 187 infusions of rituximab Novex® (n = 155) or innovator rituximab (n = 32) for neurologic (Neu), immune-hematologic-rheumatic (IHR), oncologic (O) diseases, and hematopoietic stem-cell transplantation (HSCT) or solid-organ transplantation (SOT). We recorded 29 IRR and 58 dADR that occurred in 27 (35.1%) and 29 (37.7%) patients, respectively. The respiratory tract was the most affected during IRR (29.6%) and hypogammaglobulinemia (37.9 %) was the most frequent dADR. First versus subsequent infusions (HR 5.4, CI95% 2.4-12.1, p<0.05), sex (boys vs. girls, HR 0.3, CI95% 0.1-0.8, and p<0.05), and diagnosis (Neu-IHR diseases vs. O-HSCT-SOT, HR 2.3, CI95% 1.02-5.4, and p < 0.05) were significantly associated with the development of IRR. For dADR, risk factors were diagnosis (Neu-IHR diseases vs. O-HSCT-SOT, HR 0.4, CI95% 0.2-0.9, and p < 0.05) and cumulative body surface area-normalized dosage (HR 1.0003, CI95% 1.0001-1.0006, and p < 0.05). The present is the largest real-world safety assessment of rituximab in Latin-American children with complex diseases supporting its use based on the overall acceptable safety. Identification of risk factors may contribute to optimization of off-label rituximab treatment in pediatrics.
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Affiliation(s)
- Natalia Riva
- Unit of Innovative Treatments, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, Buenos Aires, Argentina
| | - Manuel Molina
- Unit of Innovative Treatments, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina
| | - Berta L Cornaló
- Unit of Innovative Treatments, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina
| | - María V Salvador
- Pharmacy, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina
| | - Andrea Savransky
- Neurology Service, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina
| | - Silvia Tenembaum
- Neurology Service, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina
| | - María M Katsicas
- Immunology and Rheumatology Service, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina
| | - Marta Monteverde
- Nephrology Unit, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina
| | - Paulo Cáceres Guido
- Pharmacy, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina.,Unit of Clinical Pharmacokinetics, Pharmacy, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina
| | - Marcela Rousseau
- Health Technology Assessment Coordination, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina
| | - Raquel Staciuk
- Bone Marrow Transplant Service, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina
| | | | - Pedro Zubizarreta
- Hematology and Oncology Service, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina
| | - Oscar Imventarza
- Liver Transplant Service, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina
| | | | - Eduardo Spitzer
- Laboratorio Elea-Phoenix S.A., Scientific Department, Los Polvorines, Argentina
| | - Marcelo Tinelli
- Laboratorio Elea-Phoenix S.A., Scientific Department, Los Polvorines, Argentina
| | - Paula Schaiquevich
- Unit of Innovative Treatments, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, Buenos Aires, Argentina
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6
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Abstract
PURPOSE Our understanding of thyroid-associated ophthalmopathy (TAO, A.K.A Graves' orbitopathy, thyroid eye disease) has advanced substantially, since one of us (TJS) wrote the 2010 update on TAO, appearing in this journal. METHODS PubMed was searched for relevant articles. RESULTS Recent insights have resulted from important studies conducted by many different laboratory groups around the World. A clearer understanding of autoimmune diseases in general and TAO specifically emerged from the use of improved research methodologies. Several key concepts have matured over the past decade. Among them, those arising from the refinement of mouse models of TAO, early stage investigation into restoring immune tolerance in Graves' disease, and a hard-won acknowledgement that the insulin-like growth factor-I receptor (IGF-IR) might play a critical role in the development of TAO, stand out as important. The therapeutic inhibition of IGF-IR has blossomed into an effective and safe medical treatment. Teprotumumab, a β-arrestin biased agonist monoclonal antibody inhibitor of IGF-IR has been studied in two multicenter, double-masked, placebo-controlled clinical trials demonstrated both effectiveness and a promising safety profile in moderate-to-severe, active TAO. Those studies led to the approval by the US FDA of teprotumumab, currently marketed as Tepezza for TAO. We have also learned far more about the putative role that CD34+ fibrocytes and their derivatives, CD34+ orbital fibroblasts, play in TAO. CONCLUSION The past decade has been filled with substantial scientific advances that should provide the necessary springboard for continually accelerating discovery over the next 10 years and beyond.
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Affiliation(s)
- E J Neag
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, Brehm Tower, 1000 Wall Street, Ann Arbor, MI, 48105, USA
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan Medical School, Ann Arbor, MI, 48105, USA
- Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
| | - T J Smith
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, Brehm Tower, 1000 Wall Street, Ann Arbor, MI, 48105, USA.
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan Medical School, Ann Arbor, MI, 48105, USA.
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7
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Jafarzadeh A, Saffari F. Development of anti-rituximab antibodies in rituximab-treated patients: Related parameters & consequences. Indian J Med Res 2022; 155:335-346. [DOI: 10.4103/ijmr.ijmr_312_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Efficacy of a Third BNT162b2 mRNA COVID-19 Vaccine Dose in Patients with CLL who Failed Standard Two-dose Vaccination. Blood 2021; 139:678-685. [PMID: 34861036 PMCID: PMC8648353 DOI: 10.1182/blood.2021014085] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/18/2021] [Indexed: 11/20/2022] Open
Abstract
Patients with chronic lymphocytic leukemia (CLL) have an impaired antibody response to COVID-19 vaccination. Here, we evaluated the antibody response to a third BNT162b2 mRNA vaccine in patients with CLL/small lymphocytic lymphoma (SLL) who failed to achieve a humoral response after standard two-dose vaccination regimen. Anti-SARS-CoV-2S and neutralizing antibodies were measured 3 weeks after administration of the third dose. In 172 patients with CLL the antibody response rate was 23.8%. Response rate among actively treated patients (12.0%, n=12/100) was lower compared to treatment-naïve patients (40.0%, n=16/40; OR=4.9, 95% CI 1.9-12.9; p<0.001) and patients off-therapy (40.6%, n=13/32; OR=5.0, 95% CI 1.8-14.1; p<0.001), (p<0.001). In those actively treated with BTK inhibitors or venetoclax ± anti-CD20 antibody, response rates were extremely low (15.3%, n=9/59 and 7.7%, n=3/39, respectively). Only one of the 28 patients (3.6%) treated with anti-CD20 antibodies <12 months prior to vaccination responded. The anti-SARS-CoV-2S antibody levels correlated linearly with neutralizing antibody titers (r=0.732, p<0.001). In a multivariate analysis, the independent variables that were associated with response included lack of active therapy (OR=5.6, 95% CI 2.3-13.8; p<0.001) and serum IgA levels ≥80 mg/dL (OR=5.8, 95% CI 2.1-15.9; p<0.001) In conclusion, in patients with CLL/SLL who failed to achieve a humoral response after standard two-dose BNT162b2 mRNA vaccination regimen, close to a quarter responded to the third dose of vaccine. The antibody response rates were lower during active treatment and in patients with a recent exposure (<12 months prior to vaccination) to anti-CD20 therapy.
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Mihályová J, Hradská K, Jelínek T, Motais B, Celichowski P, Hájek R. Promising Immunotherapeutic Modalities for B-Cell Lymphoproliferative Disorders. Int J Mol Sci 2021; 22:ijms222111470. [PMID: 34768899 PMCID: PMC8584080 DOI: 10.3390/ijms222111470] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/17/2021] [Accepted: 10/20/2021] [Indexed: 12/13/2022] Open
Abstract
Over the last few years, treatment principles have been changed towards more targeted therapy for many B-cell lymphoma subtypes and in chronic lymphocytic leukemia (CLL). Immunotherapeutic modalities, namely monoclonal antibodies (mAbs), bispecific antibodies (bsAbs), antibody-drug conjugates (ADCs), and chimeric antigen receptor T (CAR-T) cell therapy, commonly use B-cell-associated antigens (CD19, CD20, CD22, and CD79b) as one of their targets. T-cell engagers (TCEs), a subclass of bsAbs, work on a similar mechanism as CAR-T cell therapy without the need of previous T-cell manipulation. Currently, several anti-CD20xCD3 TCEs have demonstrated promising efficacy across different lymphoma subtypes with slightly better outcomes in the indolent subset. Anti-CD19xCD3 TCEs are being developed as well but only blinatumomab has been evaluated in clinical trials yet. The results are not so impressive as those with anti-CD19 CAR-T cell therapy. Antibody-drug conjugates targeting different B-cell antigens (CD30, CD79b, CD19) seem to be effective in combination with mAbs, standard chemoimmunotherapy, or immune checkpoint inhibitors. Further investigation will show whether immunotherapy alone or in combinatory regimens has potential to replace chemotherapeutic agents from the first line treatment.
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Affiliation(s)
- Jana Mihályová
- Department of Haematooncology, University Hospital Ostrava, 708 52 Ostrava, Czech Republic; (K.H.); (T.J.); (R.H.)
- Faculty of Medicine, University of Ostrava, 708 52 Ostrava, Czech Republic; (B.M.); (P.C.)
- Correspondence:
| | - Katarína Hradská
- Department of Haematooncology, University Hospital Ostrava, 708 52 Ostrava, Czech Republic; (K.H.); (T.J.); (R.H.)
| | - Tomáš Jelínek
- Department of Haematooncology, University Hospital Ostrava, 708 52 Ostrava, Czech Republic; (K.H.); (T.J.); (R.H.)
- Faculty of Medicine, University of Ostrava, 708 52 Ostrava, Czech Republic; (B.M.); (P.C.)
| | - Benjamin Motais
- Faculty of Medicine, University of Ostrava, 708 52 Ostrava, Czech Republic; (B.M.); (P.C.)
| | - Piotr Celichowski
- Faculty of Medicine, University of Ostrava, 708 52 Ostrava, Czech Republic; (B.M.); (P.C.)
| | - Roman Hájek
- Department of Haematooncology, University Hospital Ostrava, 708 52 Ostrava, Czech Republic; (K.H.); (T.J.); (R.H.)
- Faculty of Medicine, University of Ostrava, 708 52 Ostrava, Czech Republic; (B.M.); (P.C.)
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Chowdhury F, Tappuni A, Bombardieri M. Biological Therapy in Primary Sjögren's Syndrome: Effect on Salivary Gland Function and Inflammation. Front Med (Lausanne) 2021; 8:707104. [PMID: 34336905 PMCID: PMC8319401 DOI: 10.3389/fmed.2021.707104] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/07/2021] [Indexed: 12/26/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is a chronic, systemic autoimmune disease. It is the second most common rheumatic autoimmune disorder, affecting 0.7% of European Americans and up to 1% of people globally. pSS is characterized by the impaired secretory function of exocrine glands, including salivary and lachrymal glands. A lymphocytic infiltration of these organs leads to the common and debilitating symptoms of oral and ocular dryness, majorly affecting the quality of life of these patients. Currently, no disease-modifying drug has been approved for the treatment of pSS, with therapies largely aimed at relieving symptoms of dry mouth and dry eyes. In particular, management of oral dryness still represents a major unmet clinical need in pSS and a significant burden for patients with this condition. Recently, several randomized clinical trials in pSS with biological therapies targeting specific mechanistic pathways implicated in the disease pathogenesis, including B-cell hyperactivity, T-cell co-stimulation and the aberrant role of cytokines, have been completed with mixed results. In this review, we summarize evidence from recent clinical trials investigating biological therapy in pSS, specifically highlighting efficacy, or lack thereof, in modulating local inflammation and improving salivary gland function.
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Affiliation(s)
- Farzana Chowdhury
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, London, United Kingdom.,Institute of Dentistry, Barts and the London School of Medicine and Dentistry, London, United Kingdom
| | - Anwar Tappuni
- Institute of Dentistry, Barts and the London School of Medicine and Dentistry, London, United Kingdom
| | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, London, United Kingdom
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Courville J, Nastoupil L, Kaila N, Kelton J, Zhang J, Alcasid A, Nava-Parada P. Factors Influencing Infusion-Related Reactions Following Dosing of Reference Rituximab and PF-05280586, a Rituximab Biosimilar. BioDrugs 2021; 35:459-468. [PMID: 34152584 PMCID: PMC8295162 DOI: 10.1007/s40259-021-00487-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Infusion-related reactions (IRRs) are the most common adverse event (AE) associated with infusion of rituximab, an anti-CD20 monoclonal antibody. OBJECTIVE Our objective was to evaluate the impact of dosing/infusion patterns and certain baseline characteristics on IRR occurrence during the first rituximab infusion administered as the biosimilar PF-05280586 (RTX-PF) or reference rituximab sourced from the EU (RTX-EU, MabThera®) in patients with CD20+ low-tumor-burden follicular lymphoma. PATIENTS AND METHODS Rituximab (RTX-PF, n=196; RTX-EU, n=198) was administered (375 mg/m2) on days 1, 8, 15, and 22 (one cycle), with a follow-up period through 52 weeks. The relationships between infusion rate, drug exposure, and IRR incidence were assessed by logistic regression analysis and pharmacokinetic modeling and simulation. Baseline CD20 level, antidrug antibody (ADA) status, and tumor burden according to IRR occurrence (yes/no) were compared descriptively. RESULTS Median rituximab infusion duration on day 1 was 3.50 h for each of the two groups. There was a positive correlation between infusion rate and all-grade IRRs occurring within 24 h after infusion (p < 0.0001). Patients who developed IRRs had a higher median baseline CD20+ level. IRR incidence was unaffected by baseline ADA status. Drug exposure did not predict IRR incidence. Baseline tumor burden was similar between patients with and without IRRs. CONCLUSIONS Results of this analysis provide a better understanding of IRRs after the first rituximab (RTX-PF or RTX-EU) infusion and demonstrate a potential correlation of infusion rate and other factors with IRR at the individual and population levels. Infusion-rate escalation steps continue to be needed to manage IRRs. TRIAL REGISTRATION (DATE OF REGISTRATION) ClinicalTrials.gov Identifier: NCT02213263 (11 August 2014); and EudraCT: 2014-000132-41 (10 October 2014).
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Affiliation(s)
| | | | | | - John Kelton
- Pfizer Inc, 219 East 42nd Street, New York, NY, 10017, USA
| | | | | | - Pilar Nava-Parada
- Pfizer Inc, 219 East 42nd Street, New York, NY, 10017, USA.
- Health Advocacy & Medical Exploration Society (HAMES National, Inc), Lawrence Township, NJ, USA.
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12
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Rituximab-induced hypogammaglobulinemia and infection risk in pediatric patients. J Allergy Clin Immunol 2021; 148:523-532.e8. [PMID: 33862010 DOI: 10.1016/j.jaci.2021.03.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Rituximab is a B-cell depleting agent used in B-cell malignancies and autoimmune diseases. A subset of adult patients may develop prolonged and symptomatic hypogammaglobulinemia following rituximab treatment. However, this phenomenon has not been well delineated in the pediatric population. OBJECTIVES This study sought to determine the prevalence, risk factors, and clinical significance of hypogammaglobulinemia following rituximab therapy in children. METHODS This was a multicenter, retrospective cohort study that extracted clinical and immunological data from pediatric patients who received rituximab. RESULTS The cohort comprised 207 patients (median age, 12.0 years). Compared to baseline values, there was a significant increase in hypogammaglobulinemia post-rituximab therapy, with an increase in prevalence of hypo-IgG (28.7%-42.6%; P = .009), hypo-IgA (11.1%-20.4%; P = .02), and hypo-IgM (20.0%-62.0%; P < .0001). Additionally, low IgG levels at any time post-rituximab therapy were associated with a higher risk of serious infections (34.4% vs 18.9%; odds ratio, 2.3; 95% CI, 1.1-4.8; P = .03). Persistent IgG hypogammaglobulinemia was observed in 27 of 101 evaluable patients (26.7%). Significant risk factors for persistent IgG hypogammaglobulinemia included low IgG and IgA levels pre-rituximab therapy. Nine patients (4.3%) within the study were subsequently diagnosed with a primary immunodeficiency, 7 of which received rituximab for autoimmune cytopenias. CONCLUSIONS Hypogammaglobulinemia post-rituximab treatment is frequently diagnosed within the pediatric population. Low IgG levels are associated with a significant increase in serious infections, and underlying primary immunodeficiencies are relatively common in children receiving rituximab, thus highlighting the importance of immunologic monitoring both before and after rituximab therapy.
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13
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Neelapu SS, Adkins S, Ansell SM, Brody J, Cairo MS, Friedberg JW, Kline JP, Levy R, Porter DL, van Besien K, Werner M, Bishop MR. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of lymphoma. J Immunother Cancer 2020; 8:e001235. [PMID: 33361336 PMCID: PMC7768967 DOI: 10.1136/jitc-2020-001235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 02/07/2023] Open
Abstract
The recent development and clinical implementation of novel immunotherapies for the treatment of Hodgkin and non-Hodgkin lymphoma have improved patient outcomes across subgroups. The rapid introduction of immunotherapeutic agents into the clinic, however, has presented significant questions regarding optimal treatment scheduling around existing chemotherapy/radiation options, as well as a need for improved understanding of how to properly manage patients and recognize toxicities. To address these challenges, the Society for Immunotherapy of Cancer (SITC) convened a panel of experts in lymphoma to develop a clinical practice guideline for the education of healthcare professionals on various aspects of immunotherapeutic treatment. The panel discussed subjects including treatment scheduling, immune-related adverse events (irAEs), and the integration of immunotherapy and stem cell transplant to form recommendations to guide healthcare professionals treating patients with lymphoma.
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Affiliation(s)
- Sattva S Neelapu
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sherry Adkins
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen M Ansell
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Cancer Center, Rochester, Minnesota, USA
| | - Joshua Brody
- Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Mitchell S Cairo
- Department of Pediatrics, Medicine, Pathology, Microbiology and Immunology and Cell Biology, New York Medical College At Maria Fareri Children's Hospital, New York City, New York, USA
| | - Jonathan W Friedberg
- Department of Medicine, Hematology-Oncology Division, Wilmot Cancer Institute University of Rochester Medical Center, Rochester, New York, USA
| | - Justin P Kline
- Department of Medicine Section of Hematology/Oncology, University of Chicago, Chicago, Illinois, USA
| | - Ronald Levy
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - David L Porter
- Cell Therapy and Transplant and Division of Hematology Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Koen van Besien
- Division of Hematology/Oncology, Weill Cornell Medical College, New York City, New York, USA
| | | | - Michael R Bishop
- Department of Medicine Section of Hematology/Oncology, University of Chicago, Chicago, Illinois, USA
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14
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Brglez V, Boyer-Suavet S, Zorzi K, Fernandez C, Fontas E, Esnault V, Seitz-Polski B. Personalized Medicine for PLA2R1-Related Membranous Nephropathy: A Multicenter Randomized Control Trial. Front Med (Lausanne) 2020; 7:412. [PMID: 32903623 PMCID: PMC7438577 DOI: 10.3389/fmed.2020.00412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/29/2020] [Indexed: 01/19/2023] Open
Abstract
Background: Membranous Nephropathy (MN) is a rare autoimmune disease related to PLA2R1 antibodies in 70% of cases. One third of patients enter in spontaneous remission. PLA2R1 epitopes in MN have been characterized in four different domains of PLA2R1 and a mechanism of epitope spreading from the immunodominant CysR domain to CTLD1 and/or CTLD7 and/or CTLD8 domains has been associated with poor prognosis. Epitope spreading could predict spontaneous remission (45% in non-spreader patients vs. 0.05% in spreader patients). The comparison of different regimens of rituximab dosing showed that: (i) early remission rate depends on rituximab dosing, (ii) low dose could be enough for patients with anti-PLA2R1 activity restricted to CysR, (iii) high dose may be required for spreader patients. This study aims to evaluate the efficacy of personalized treatment in PLA2R1-related MN depending on the epitope spreading status, in comparison to the established GEMRITUX protocol. Methods: A multicenter, randomized, controlled, prospective clinical trial will be conducted in 22 French hospitals. Sixty-four consecutive patients with PLA2R1-related MN will be randomly assigned to either the control group following the GEMRITUX protocol (symptomatic treatment for 6 months, if the nephrotic syndrome (NS) persists at month-6, two 375 mg/m2 rituximab infusions at 1 week interval) or the personalized treatment group (patients with no epitope spreading at month-0 will be treated with symptomatic treatment for 6 months, if NS persists at month-6, two 375 mg/m2 rituximab infusions at 1 week interval; patients with epitope spreading at month-0 or month-6 with persistent NS will be treated immediately with two 1 g rituximab infusions at 2 week interval). The primary study outcome is the rate of clinical remission at month-12. The secondary outcomes include complete and partial remissions, immunological remissions, relapses, proteinuria, albuminuria, serum creatinine, eGFR, PLA2R1 antibody titers, severe infections, lymphocyte counts and lymphocyte phenotype, residual rituximab levels at month-3 and neutralizing anti-rituximab antibodies at month-6 and month-12 after rituximab treatment. Discussion: The results of this trial will confirm whether personalized treatment of PLA2R1-driven nephrotic MN is more efficient to induce clinical remission than the established GEMRITUX protocol, and may thus contribute to improved remission rates and reduced relapse rates. Trial registration: NCT 03804359 trial number. Registered on 15th January 2019.
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Affiliation(s)
- Vesna Brglez
- Centre de Référence Maladies Rares Syndrome Néphrotique Idiopathique, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.,Unité de Recherche Clinique de la Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Sonia Boyer-Suavet
- Centre de Référence Maladies Rares Syndrome Néphrotique Idiopathique, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.,Unité de Recherche Clinique de la Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Kévin Zorzi
- Centre de Référence Maladies Rares Syndrome Néphrotique Idiopathique, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.,Unité de Recherche Clinique de la Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Céline Fernandez
- Centre de Référence Maladies Rares Syndrome Néphrotique Idiopathique, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.,Unité de Recherche Clinique de la Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Eric Fontas
- Département de Recherche Clinique et Innovation, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Vincent Esnault
- Unité de Recherche Clinique de la Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France.,Service de Néphrologie-Dialyse-Transplantation, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Barbara Seitz-Polski
- Centre de Référence Maladies Rares Syndrome Néphrotique Idiopathique, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.,Unité de Recherche Clinique de la Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France.,Service de Néphrologie-Dialyse-Transplantation, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.,Laboratoire d'Immunologie, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
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15
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Juárez-Salcedo LM, Conde-Royo D, Quiroz-Cervantes K, Dalia S. Use of anti-CD20 therapy in follicular and marginal zone lymphoma: a review of the literature. Drugs Context 2020; 9:2019-9-3. [PMID: 32426017 PMCID: PMC7216786 DOI: 10.7573/dic.2019-9-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/13/2020] [Accepted: 03/27/2020] [Indexed: 12/12/2022] Open
Abstract
The identification of the CD20 antigen in 1979 was the first step in what would become a therapeutic milestone opening the use of immunotherapy in hematological diseases. This protein is expressed on the surface of developing B cells, but not the early progenitors or mature plasma cells. In 1997, rituximab was approved by the Food and Drug Administration, and since then it has revolutionized the treatment of B-cell malignancies. It is used as a monotherapy and in combination, at induction, at relapsed, and also in maintenance. Indolent non-Hodgkin lymphomas are characterized by a long and non-aggressive course. In this group of lymphomas, rituximab represented a great therapeutic improvement, achieving lasting responses with few adverse effects. Nowadays, second-generation molecules are emerging that may have important advantages compared to rituximab, as well as biosimilars that represent an important cost-effective option.
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Affiliation(s)
| | - Diego Conde-Royo
- Hematology Department, Principe de Asturias General Hospital, Madrid, Spain
| | | | - Samir Dalia
- Hematology/Oncology Department, Mercy Clinic Oncology and Hematology – Joplin, Missouri, United States
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16
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Zeng C, Cheng J, Li T, Huang J, Li C, Jiang L, Wang J, Chen L, Mao X, Zhu L, Lou Y, Zhou J, Zhou X. Efficacy and toxicity for CD22/CD19 chimeric antigen receptor T-cell therapy in patients with relapsed/refractory aggressive B-cell lymphoma involving the gastrointestinal tract. Cytotherapy 2020; 22:166-171. [PMID: 32063474 DOI: 10.1016/j.jcyt.2020.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 12/15/2022]
Abstract
Gastrointestinal (GI) tract is the most common site of extranodal involvement in non-Hodgkin lymphoma. Life-threatening complications of GI may occur because of tumor or chemotherapy. Chimeric antigen receptor (CAR) T-cell therapy has been successfully used to treat refractory/relapse B-cell lymphoma, however, little is known about the efficacy and safety of CAR-T cell therapy for GI lymphoma. Here, we reported the efficacy and safety of CAR-T cell therapy in 14 patients with relapsed/refractory aggressive B-cell lymphoma involving the GI tract. After a sequential anti-CD22/anti-CD19 CAR-T therapy, 10 patients achieved an objective response, and seven patients achieved a complete response. CAR transgene and B-cell aplasia persisted in the majority of patients irrespective of response status. Six patients with partial response or stable disease developed progressive disease; two patients lost target antigens. Cytokine release syndrome (CRS) and GI adverse events were generally mild and manageable. The most common GI adverse events were diarrhea (4/14), vomiting (3/14) and hemorrhage (2/14). No perforation occurred during follow-up. Infection is a severe complication in GI lymphoma. Two patients were infected with bacteria that are able to colonize at GI; one died of sepsis early after CAR-T cells infusion. In conclusion, our study showed promising efficacy and safety of CAR-T cell therapy in refractory/relapsed B-cell lymphoma involving the GI tract. However, the characteristics of CAR-T-related infection in GI lymphoma should be further clarified to prevent and control infection.
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Affiliation(s)
- Chen Zeng
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiali Cheng
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tongjuan Li
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Huang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunrui Li
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lijun Jiang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jue Wang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liting Chen
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xia Mao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Zhu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaoyao Lou
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianfeng Zhou
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoxi Zhou
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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17
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Taylor PN, Zhang L, Lee RWJ, Muller I, Ezra DG, Dayan CM, Kahaly GJ, Ludgate M. New insights into the pathogenesis and nonsurgical management of Graves orbitopathy. Nat Rev Endocrinol 2020; 16:104-116. [PMID: 31889140 DOI: 10.1038/s41574-019-0305-4] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2019] [Indexed: 12/13/2022]
Abstract
Graves orbitopathy, also known as thyroid eye disease or thyroid-associated orbitopathy, is visually disabling, cosmetically disfiguring and has a substantial negative impact on a patient's quality of life. There is increasing awareness of the need for early diagnosis and rapid specialist input from endocrinologists and ophthalmologists. Glucocorticoids are the mainstay of treatment; however, recurrence occurs frequently once these are withdrawn. Furthermore, in >60% of cases, normal orbital anatomy is not restored, and skilled rehabilitative surgery is required. Clinical trials have shown that considerable benefit can be derived from the addition of antiproliferative agents (such as mycophenolate or azathioprine) in preventing deterioration after steroid cessation. In addition, targeted biologic therapies have shown promise, including teprotumumab, which reduces proptosis, rituximab (anti-CD20), which reduces inflammation, and tocilizumab, which potentially benefits both of these parameters. Other strategies such as orbital radiotherapy have had their widespread role in combination therapy called into question. The pathophysiology of Graves orbitopathy has also been revised with identification of new potential therapeutic targets. In this Review we provide an up-to-date overview of the field, outline the optimal management of Graves orbitopathy and summarize the research developments in this area to highlight future research questions and direct future clinical trials.
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Affiliation(s)
- Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK.
| | - Lei Zhang
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Richard W J Lee
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- University of Bristol, Bristol, UK
| | - Ilaria Muller
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
- Fondazione IRRCS Ca' Granda Ospedale Maggiore Policinico, Department of Endocrinology, Milan, Italy
| | - Daniel G Ezra
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Colin M Dayan
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - George J Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Marian Ludgate
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
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18
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Kaplan B, Bonagura VR. Secondary Hypogammaglobulinemia: An Increasingly Recognized Complication of Treatment with Immunomodulators and After Solid Organ Transplantation. Immunol Allergy Clin North Am 2019; 39:31-47. [PMID: 30466771 DOI: 10.1016/j.iac.2018.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Secondary hypogammaglobulinemia is a common development in patients treated with immunomodulatory agents for autoimmune, connective tissue, and malignant diseases. It has been observed in the medical management of patients undergoing hematopoietic stem cell and solid organ transplantation. Some patients have preexisting immunodeficiency associated with these illnesses; immunosuppressive treatment magnifies their immune defect. This article reviews immunosuppressive medications, including biological treatments that cause secondary hypogammaglobulinemia. It summarizes risk factors for rituximab-induced hypogammaglobulinemia, such as preexisting low immunoglobulin G levels, CD19 levels, host factors, and additive effect of all immunomodulatory drugs used. The evaluation and management of secondary hypogammaglobulinemia are discussed.
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Affiliation(s)
- Blanka Kaplan
- Division of Allergy and Immunology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Steven and Alexandra Cohen Medical Center of New York, 865 Northern Boulevard, Suite 101, Great Neck, NY 11021, USA.
| | - Vincent R Bonagura
- Division of Allergy and Immunology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Steven and Alexandra Cohen Medical Center of New York, 865 Northern Boulevard, Suite 101, Great Neck, NY 11021, USA
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19
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Yogurtcu ON, Sauna ZE, McGill JR, Tegenge MA, Yang H. TCPro: an In Silico Risk Assessment Tool for Biotherapeutic Protein Immunogenicity. AAPS JOURNAL 2019; 21:96. [PMID: 31376048 DOI: 10.1208/s12248-019-0368-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/16/2019] [Indexed: 12/21/2022]
Abstract
Most immune responses to biotherapeutic proteins involve the development of anti-drug antibodies (ADAs). New drugs must undergo immunogenicity assessments to identify potential risks at early stages in the drug development process. This immune response is T cell-dependent. Ex vivo assays that monitor T cell proliferation often are used to assess immunogenicity risk. Such assays can be expensive and time-consuming to carry out. Furthermore, T cell proliferation requires presentation of the immunogenic epitope by major histocompatibility complex class II (MHCII) proteins on antigen-presenting cells. The MHC proteins are the most diverse in the human genome. Thus, obtaining cells from subjects that reflect the distribution of the different MHCII proteins in the human population can be challenging. The allelic frequencies of MHCII proteins differ among subpopulations, and understanding the potential immunogenicity risks would thus require generation of datasets for specific subpopulations involving complex subject recruitment. We developed TCPro, a computational tool that predicts the temporal dynamics of T cell counts in common ex vivo assays for drug immunogenicity. Using TCPro, we can test virtual pools of subjects based on MHCII frequencies and estimate immunogenicity risks for different populations. It also provides rapid and inexpensive initial screens for new biotherapeutics and can be used to determine the potential immunogenicity risk of new sequences introduced while bioengineering proteins. We validated TCPro using an experimental immunogenicity dataset, making predictions on the population-based immunogenicity risk of 15 protein-based biotherapeutics. Immunogenicity rankings generated using TCPro are consistent with the reported clinical experience with these therapeutics.
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Affiliation(s)
- Osman N Yogurtcu
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US FDA, 10903 New Hampshire Ave, Silver Spring, 20993, Maryland, USA
| | - Zuben E Sauna
- Office of Tissues and Advanced Therapy, Center for Biologics Evaluation and Research, US FDA, 10903 New Hampshire Ave, Silver Spring, 20993, Maryland, USA
| | - Joseph R McGill
- Office of Tissues and Advanced Therapy, Center for Biologics Evaluation and Research, US FDA, 10903 New Hampshire Ave, Silver Spring, 20993, Maryland, USA
| | - Million A Tegenge
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US FDA, 10903 New Hampshire Ave, Silver Spring, 20993, Maryland, USA
| | - Hong Yang
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US FDA, 10903 New Hampshire Ave, Silver Spring, 20993, Maryland, USA.
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20
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Seitz-Polski B, Dahan K, Debiec H, Rousseau A, Andreani M, Zaghrini C, Ticchioni M, Rosenthal A, Benzaken S, Bernard G, Lambeau G, Ronco P, Esnault VLM. High-Dose Rituximab and Early Remission in PLA2R1-Related Membranous Nephropathy. Clin J Am Soc Nephrol 2019; 14:1173-1182. [PMID: 31340979 PMCID: PMC6682825 DOI: 10.2215/cjn.11791018] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 06/17/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Different rituximab protocols are used to treat membranous nephropathy. We compared two rituximab protocols in patients with membranous nephropathy. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Twenty-eight participants from the NICE cohort received two infusions of 1-g rituximab at 2-week intervals, whereas 27 participants from the Prospective Randomized Multicentric Open Label Study to Evaluate Rituximab Treatment for Membranous Nephropathy (GEMRITUX) cohort received two infusions of 375 mg/m2 at 1-week interval. We measured serum rituximab levels and compared remission at month 6 and before any treatment modification and analyzed factors associated with remission and relapses. RESULTS Remissions occurred in 18 (64%) versus eight (30%) from the NICE and GEMRITUX cohort (P=0.02) at month 6, respectively, and in 24 (86%) versus 18 (67%) participants (P=0.12) before treatment modification, respectively. Median time to remission was 3 [interquartile range (IQR), 3-9] and 9 [IQR, 6-12] months for NICE and GEMRITUX cohorts respectively (P=0.01). Participants from the NICE cohort had higher circulating level of rituximab and lower CD19 counts (3.3 µg/L [IQR, 0.0-10.8] versus 0.0 [IQR, 0.0-0.0] P<0.001 and 0.0 [IQR, 0.0-2.0] versus 16.5 [IQR, 2.5-31.0] P<0.001) at month 3, lower level of anti-PLA2R1 antibodies at month 6 (0.0 [IQR, 0.0-8.0] versus 8.3 [IQR, 0.0-73.5] P=0.03). In the combined study population, lower epitope spreading at diagnosis and higher rituximab levels at month 3 were associated with remissions at month 6 (13/26 (50%) versus 22/29 (76%) P=0.05 and 2.2 µg/ml [IQR, 0.0-10.9] versus 0.0 µg/ml [IQR, 0.0-0.0] P<0.001 respectively). All non-spreaders entered into remission whatever the protocol. Eight of the 41 participants who reached remission had relapses. Epitope spreading at diagnosis (8/8 (100%) versus 16/33 (48%) P=0.01) and incomplete depletion of anti-PLA2R1 antibodies at month 6 (4/8 (50%) versus 5/33 (9%) P=0.05) were associated with relapses. CONCLUSIONS Our work suggests that higher dose rituximab protocol is more effective on depletion of B-cells and lack of epitope spreading is associated with remission of membranous nephropathy.
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Affiliation(s)
- Barbara Seitz-Polski
- Department of Immunology, Hôpital l'Archet, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France; .,Department of Nephrology-Dialysis-Transplantation, Hôpital Pasteur, CHU de Nice, Université Côte d'Azur, Nice, France.,Institut de Pharmacologie Moléculaire et Cellulaire, Centre National de la Recherche Scientifique, Université Côte d'Azur, Nice, France
| | - Karine Dahan
- Department of Nephrology and Dialysis, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Hanna Debiec
- Unité Mixte de Recherche_S 1155, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Sorbonne Université, Université Pierre et Marie Curie University Paris 06, Paris, France; and
| | - Alexandra Rousseau
- Department of Clinical Pharmacology and Clinical Research, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Marine Andreani
- Department of Nephrology-Dialysis-Transplantation, Hôpital Pasteur, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Christelle Zaghrini
- Institut de Pharmacologie Moléculaire et Cellulaire, Centre National de la Recherche Scientifique, Université Côte d'Azur, Nice, France
| | - Michel Ticchioni
- Department of Immunology, Hôpital l'Archet, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Alessandra Rosenthal
- Department of Immunology, Hôpital l'Archet, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Sylvia Benzaken
- Department of Immunology, Hôpital l'Archet, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Ghislaine Bernard
- Department of Immunology, Hôpital l'Archet, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Gérard Lambeau
- Institut de Pharmacologie Moléculaire et Cellulaire, Centre National de la Recherche Scientifique, Université Côte d'Azur, Nice, France
| | - Pierre Ronco
- Department of Nephrology and Dialysis, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France.,Unité Mixte de Recherche_S 1155, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Sorbonne Université, Université Pierre et Marie Curie University Paris 06, Paris, France; and
| | - Vincent L M Esnault
- Department of Nephrology-Dialysis-Transplantation, Hôpital Pasteur, CHU de Nice, Université Côte d'Azur, Nice, France
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21
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He Y, Helfrich W, Bremer E. Development of Bispecific Antibody Derivatives for Cancer Immunotherapy. Methods Mol Biol 2019; 1884:335-347. [PMID: 30465214 DOI: 10.1007/978-1-4939-8885-3_23] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Development of antibody-based immunotherapeutics has progressed from direct tumor-targeting, with antibodies such as rituximab, to blocking of immune checkpoints to reactivate antitumor immunity. In addition, bispecific antibodies/antibody fragments are also of great interest in cancer therapy, as these constructs have the ability to redirect immune effector cells to cancer targets and, thereby, enhance therapeutic efficacy. A number of bispecific antibody formats have been reported, with the first FDA-approved bispecific antibody being blinatumomab, a so-called bispecific T cell engager (BiTE), which redirects and potently activates T cell immune responses. Recently, we described an additional novel bispecific antibody derivative, termed RTX-CD47, which was designed to inhibit the innate immune checkpoint CD47-SIRPα only on -positive cancer cells. RTX-CD47 contains two antibody fragments in tandem and has monovalent binding specificity for CD47 and . Only upon dual binding to and CD47 RTX-CD47 blocks CD47 "Don't eat me" signaling. Here, we provide a detailed protocol for the construction and functional evaluation of such a bispecific antibody derivative.
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MESH Headings
- Animals
- Antibodies, Bispecific/pharmacology
- Antibodies, Bispecific/therapeutic use
- Antigens, Differentiation/genetics
- Antigens, Differentiation/immunology
- Antigens, Differentiation/metabolism
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Biological Assay/instrumentation
- Biological Assay/methods
- CD47 Antigen/genetics
- CD47 Antigen/immunology
- CD47 Antigen/metabolism
- CHO Cells
- Cell Culture Techniques/instrumentation
- Cell Culture Techniques/methods
- Cell Separation/instrumentation
- Cell Separation/methods
- Chromatography, Affinity/instrumentation
- Chromatography, Affinity/methods
- Cricetulus
- Drug Evaluation, Preclinical/instrumentation
- Drug Evaluation, Preclinical/methods
- HEK293 Cells
- Humans
- Immunotherapy/methods
- Neoplasms/drug therapy
- Neoplasms/immunology
- Neoplasms/pathology
- Receptors, Immunologic/genetics
- Receptors, Immunologic/immunology
- Receptors, Immunologic/metabolism
- Recombinant Fusion Proteins/genetics
- Recombinant Fusion Proteins/immunology
- Recombinant Fusion Proteins/metabolism
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
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Affiliation(s)
- Yuan He
- Department of Hematology, Section Immunohematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wijnand Helfrich
- Department of Surgery, Translational Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Edwin Bremer
- Department of Hematology, Section Immunohematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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22
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Immunogenicity of Rituximab, Trastuzumab, and Bevacizumab Monoclonal Antibodies in Patients with Malignant Diseases. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2018. [DOI: 10.5812/ijcm.64983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Casan JML, Wong J, Northcott MJ, Opat S. Anti-CD20 monoclonal antibodies: reviewing a revolution. Hum Vaccin Immunother 2018; 14:2820-2841. [PMID: 30096012 PMCID: PMC6343614 DOI: 10.1080/21645515.2018.1508624] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/14/2018] [Accepted: 08/02/2018] [Indexed: 12/23/2022] Open
Abstract
Since the inception of rituximab in the 1990s, anti-CD20 monoclonal antibodies have revolutionised the treatment of B cell hematological malignancies and have become a cornerstone of modern gold-standard practice. Additionally, the potent efficacy of these agents in depleting the B cell compartment has been used in the management of a broad array of autoimmune diseases. Multiple iterations of these agents have been investigated and are routinely used in clinical practice. In this review, we will discuss the physiology of CD20 and its attractiveness as a therapeutic target, as well as the pharmacology, pre-clinical and clinical data for the major anti-CD20 monoclonal antibodies: rituximab, obinutuzumab and ofatumumab.
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Affiliation(s)
- J. M. L. Casan
- Haematology Department, Monash Health, Melbourne Australia
| | - J. Wong
- Haematology Department, Monash Health, Melbourne Australia
| | - M. J. Northcott
- Rheumatology Department, Monash Health, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | - S. Opat
- Haematology Department, Monash Health, Melbourne Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
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24
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Laudati C, Clark C, Knezevic A, Zhang Z, Barton-Burke M. Hypersensitivity Reactions: Priming Practice Change to Reduce Incidence in First-Dose Rituximab Treatment. Clin J Oncol Nurs 2018; 22:407-414. [DOI: 10.1188/18.cjon.407-414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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25
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Kamei K, Ogura M, Sato M, Ito S, Ishikura K. Infusion reactions associated with rituximab treatment for childhood-onset complicated nephrotic syndrome. Pediatr Nephrol 2018; 33:1013-1018. [PMID: 29426974 DOI: 10.1007/s00467-018-3900-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/21/2018] [Accepted: 01/23/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Infusion reaction (IR) is defined as an adverse event within 24 h after monoclonal antibody infusion. In non-Hodgkin lymphoma, IR incidence following rituximab treatment is high (77-80%), but there are no data in complicated nephrotic syndrome. METHODS Records of rituximab infusions in patients with complicated nephrotic syndrome between February 2006 and December 2014 at the National Center for Child Health and Development were reviewed. Rituximab was administered at doses of 375 mg/m2. The severity of IR was evaluated using the Common Terminology Criteria for Adverse Events ver. 4.0. RESULTS For 309 rituximab infusions in 159 patients (male, 110; median age, 12 years), IR was observed in 165 infusions (53.4%). Respiratory symptoms were most common (66% of all events). Ninety-five percent of the IR was observed within 3 h after rituximab infusion initiation. Sixty-eight percent of the events were classified as grade 1 and others classified as grade 2. Only 18% required medical intervention. CD20 cell count in patients with IR was significantly higher than in patients without IR. Incidence of IR was similar in subsequent rituximab treatment after B-cell recovery. Patients who experienced IR at first rituximab treatment were more likely to experience recurrent IR with subsequent treatments compared to those not having IR at initial treatment (odds ratio 3.64; p < 0.001). CONCLUSIONS In patients with complicated nephrotic syndrome, respiratory symptoms were the major type of IR, mostly observed within 3 h of infusion. Incidence of IR was lower and its severity milder in patients with complicated nephrotic syndrome than those with lymphoma.
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Affiliation(s)
- Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Shuichi Ito
- Department of Pediatrics, Yokohama City University Graduate School pf Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Kenji Ishikura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
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26
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Sacco KA, Abraham RS. Consequences of B-cell-depleting therapy: hypogammaglobulinemia and impaired B-cell reconstitution. Immunotherapy 2018; 10:713-728. [PMID: 29569510 DOI: 10.2217/imt-2017-0178] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Rituximab is a chimeric monoclonal antibody used to treat hematologic and autoimmune diseases by depleting CD20-expressing B cells. Patients may develop hypogammaglobulinemia following treatment, with some demonstrating failure of B-cell recovery. The true frequency of hypogammaglobulinemia and/or impaired B-cell reconstitution post rituximab is unknown due to the lack of prospective studies in different patient cohorts. The clinical significance remains controversial; some patients have recurrent infections while others are relatively asymptomatic. The aim of this review is to describe the prevalence of hypogammaglobulinemia and the associated risk for developing severe infection, in patients with differing underlying clinical conditions treated with rituximab. This may facilitate classification and prognostication of patients who develop these conditions and identify patients who may be at high risk of developing these complications, including those who may benefit from immunoglobulin replacement therapy.
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Affiliation(s)
- Keith A Sacco
- Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Roshini S Abraham
- Department of Laboratory Medicine & Pathology & Medicine, Mayo Clinic, Rochester, MN 55905, USA
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27
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Gribben JG. Clinical Manifestations, Staging, and Treatment of Follicular Lymphoma. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00080-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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28
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Gu JJ, Singh A, Xue K, Mavis C, Barth M, Yanamadala V, Lenz P, Grau M, Lenz G, Czuczman MS, Hernandez-Ilizaliturri FJ. Up-regulation of hexokinase II contributes to rituximab-chemotherapy resistance and is a clinically relevant target for therapeutic development. Oncotarget 2017; 9:4020-4033. [PMID: 29423101 PMCID: PMC5790518 DOI: 10.18632/oncotarget.23425] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 11/26/2017] [Indexed: 02/07/2023] Open
Abstract
In order to identify cellular pathways associated with therapy-resistant aggressive lymphoma, we generated rituximab-resistant cell lines (RRCL) and found that the acquirement of rituximab resistance was associated with a deregulation in glucose metabolism and an increase in the apoptotic threshold leading to chemotherapy resistance. Hexokinase II (HKII), the predominant isoform overexpressed in cancer cells, has dual functions of promoting glycolysis as well as inhibiting mitochondrial-mediated apoptosis. We found that RRCL demonstrated higher HKII levels. Targeting HKII resulted in decreased mitochondrial membrane potential, ATP production, cell viability; and re-sensitization to chemotherapy agents. Analyzed gene expression profiling data from diffuse large B-cell lymphoma patients, high-HKII levels were associated with a shorter progression free survival (PFS) and/or overall survival (OS). Our data suggest that over-expression of HKII is associated with resistance to rituximab and chemotherapy agents in aggressive lymphoma and identifies this enzyme isoform as a potential therapeutic target.
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Affiliation(s)
- Juan J Gu
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Anil Singh
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Kai Xue
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Cory Mavis
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Matthew Barth
- Department of Pediatric Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Vivek Yanamadala
- Department of Immunology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Peter Lenz
- Department of Physics, Philipps-University, Marburg, Germany
| | - Michael Grau
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany.,Cluster of Excellence EXC 1003, Cells in Motion, Münster, Germany
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany.,Cluster of Excellence EXC 1003, Cells in Motion, Münster, Germany
| | | | - Francisco J Hernandez-Ilizaliturri
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA.,Department of Immunology, Roswell Park Cancer Institute, Buffalo, New York, USA
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29
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Graf J, Leussink VI, Dehmel T, Ringelstein M, Goebels N, Adams O, MacKenzie CR, Warnke C, Feldt T, Lammerskitten A, Klotz L, Meuth S, Wiendl H, Hartung HP, Aktas O, Albrecht P. Infectious risk stratification in multiple sclerosis patients receiving immunotherapy. Ann Clin Transl Neurol 2017; 4:909-914. [PMID: 29296620 PMCID: PMC5740259 DOI: 10.1002/acn3.491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/11/2017] [Accepted: 09/18/2017] [Indexed: 01/26/2023] Open
Abstract
The increasing number of potent treatments for multiple sclerosis warrants screening for infections. To investigate the prevalence of infections in two independent German patient cohorts with multiple sclerosis/neuromyelitis optica spectrum disorders (NMOSD), we performed a retrospective chart review study of multiple sclerosis/NMOSD patients who underwent testing for infections between 2014 and 2016. We show that 6 out of 80 tested patients (Düsseldorf cohort) and 2 out of 97 tested patients (Münster cohort) had a latent tuberculosis infection; total 3.95%, 95% CI: 2-8%. Our findings suggest that latent tuberculosis infection is frequent (>1%). Screening should be performed before embarking on immunomodulatory therapies to allow treatment and mitigation of the risk of a reactivation.
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Affiliation(s)
- Jonas Graf
- Department of Neurology University Hospital Medical Faculty Heinrich-Heine-University Düsseldorf Germany
| | - Verena I Leussink
- Department of Neurology University Hospital Medical Faculty Heinrich-Heine-University Düsseldorf Germany
| | | | - Marius Ringelstein
- Department of Neurology University Hospital Medical Faculty Heinrich-Heine-University Düsseldorf Germany
| | - Norbert Goebels
- Department of Neurology University Hospital Medical Faculty Heinrich-Heine-University Düsseldorf Germany
| | - Ortwin Adams
- Institute of Virology University Hospital Heinrich-Heine-University Düsseldorf Germany
| | - Colin R MacKenzie
- Institute of Medical Microbiology and Hospital Hygiene University Hospital Heinrich-Heine-University Düsseldorf Germany
| | - Clemens Warnke
- Department of Neurology University Hospital Medical Faculty Heinrich-Heine-University Düsseldorf Germany.,Department of Neurology University Hospital of Cologne Cologne Germany
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases University Hospital Heinrich-Heine-University Düsseldorf Germany
| | | | - Luisa Klotz
- Department of Neurology University Hospital of Münster Münster Germany
| | - Sven Meuth
- Department of Neurology University Hospital of Münster Münster Germany
| | - Heinz Wiendl
- Department of Neurology University Hospital of Münster Münster Germany
| | - Hans-Peter Hartung
- Department of Neurology University Hospital Medical Faculty Heinrich-Heine-University Düsseldorf Germany
| | - Orhan Aktas
- Department of Neurology University Hospital Medical Faculty Heinrich-Heine-University Düsseldorf Germany
| | - Philipp Albrecht
- Department of Neurology University Hospital Medical Faculty Heinrich-Heine-University Düsseldorf Germany
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30
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Torka P, Patel P, Tan W, Wilding G, Bhat SA, Czuczman MS, Lee KP, Deeb G, Neppalli V, Mavis C, Wallace P, Hernandez-Ilizaliturri FJ. A Phase II Trial of Rituximab Combined With Pegfilgrastim in Patients With Indolent B-cell Non-Hodgkin Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 18:e51-e60. [PMID: 29233743 DOI: 10.1016/j.clml.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 09/11/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND To explore the role of augmenting neutrophil function in B-cell lymphoma, we conducted a phase II study evaluating the safety and clinical efficacy of pegfilgrastim and rituximab in low-grade CD20+ B-cell non-Hodgkin lymphoma (B-NHL). PATIENTS AND METHODS Twenty patients with indolent B-NHL were treated with rituximab (375 mg/m2) every other week for 4 doses, followed by every 2 months for 4 additional doses. Pegfilgrastim was administered subcutaneously 3 days before each dose of rituximab. Clinical activity and tolerability were assessed using standard criteria. Biologic monitoring included phenotype characteristics of the host neutrophils, changes in oxidative burst, and functional assays. RESULTS The patient demographics included median age of 64 years, 70% were male, 70% had follicular lymphoma, and 90% had stage III-IV disease. The median number of previous therapies was 2 (range, 0-5); 90% had received previous anti-CD20 monoclonal antibody therapy. The addition of pegfilgrastim to rituximab did not increase rituximab-related toxicities. The overall response rate was 60% (12 of 20), with a complete response (CR) rate of 35% (7 of 20). The median progression-free survival (PFS) duration was 17.9 months (95% confidence interval, 9.9-27.6 months); the median overall survival was not reached. A shorter time-to-peak oxidative burst after the first dose of pegfilgrastim was associated with greater CR rates (P = .04) and longer PFS (P = .03). CONCLUSION The pegfilgrastim-rituximab combination was well tolerated, with favorable outcomes compared with historical controls. A shorter time-to-peak oxidative burst was associated with higher CR rates and longer PFS. Our results support further evaluation of strategies that enhance the innate immune system to improve rituximab activity in B-NHL.
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Affiliation(s)
- Pallawi Torka
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY.
| | - Priyank Patel
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | - Wei Tan
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY
| | - Gregory Wilding
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY
| | - Seema A Bhat
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | - Myron S Czuczman
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | - Kelvin P Lee
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY; Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY
| | - George Deeb
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY
| | - Vishala Neppalli
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY
| | - Cory Mavis
- Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY
| | - Paul Wallace
- Department of Flow Cytometry, Roswell Park Cancer Institute, Buffalo, NY
| | - Francisco J Hernandez-Ilizaliturri
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY; Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY
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31
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Salles G, Barrett M, Foà R, Maurer J, O'Brien S, Valente N, Wenger M, Maloney DG. Rituximab in B-Cell Hematologic Malignancies: A Review of 20 Years of Clinical Experience. Adv Ther 2017; 34:2232-2273. [PMID: 28983798 PMCID: PMC5656728 DOI: 10.1007/s12325-017-0612-x] [Citation(s) in RCA: 353] [Impact Index Per Article: 50.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Indexed: 10/31/2022]
Abstract
Rituximab is a human/murine, chimeric anti-CD20 monoclonal antibody with established efficacy, and a favorable and well-defined safety profile in patients with various CD20-expressing lymphoid malignancies, including indolent and aggressive forms of B-cell non-Hodgkin lymphoma. Since its first approval 20 years ago, intravenously administered rituximab has revolutionized the treatment of B-cell malignancies and has become a standard component of care for follicular lymphoma, diffuse large B-cell lymphoma, chronic lymphocytic leukemia, and mantle cell lymphoma. For all of these diseases, clinical trials have demonstrated that rituximab not only prolongs the time to disease progression but also extends overall survival. Efficacy benefits have also been shown in patients with marginal zone lymphoma and in more aggressive diseases such as Burkitt lymphoma. Although the proven clinical efficacy and success of rituximab has led to the development of other anti-CD20 monoclonal antibodies in recent years (e.g., obinutuzumab, ofatumumab, veltuzumab, and ocrelizumab), rituximab is likely to maintain a position within the therapeutic armamentarium because it is well established with a long history of successful clinical use. Furthermore, a subcutaneous formulation of the drug has been approved both in the EU and in the USA for the treatment of B-cell malignancies. Using the wealth of data published on rituximab during the last two decades, we review the preclinical development of rituximab and the clinical experience gained in the treatment of hematologic B-cell malignancies, with a focus on the well-established intravenous route of administration. This article is a companion paper to A. Davies, et al., which is also published in this issue. FUNDING F. Hoffmann-La Roche Ltd., Basel, Switzerland.
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Affiliation(s)
- Gilles Salles
- Hématologie, Hospices Civils de Lyon and Université de Lyon, Pierre-Bénite, Lyon, France.
| | | | - Robin Foà
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | | | - Susan O'Brien
- Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange, CA, USA
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32
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Battella S, Cox MC, La Scaleia R, Di Napoli A, Di Landro F, Porzia A, Franchitti L, Mainiero F, Ruco L, Monarca B, Santoni A, Palmieri G. Peripheral blood T cell alterations in newly diagnosed diffuse large B cell lymphoma patients and their long-term dynamics upon rituximab-based chemoimmunotherapy. Cancer Immunol Immunother 2017; 66:1295-1306. [PMID: 28555258 PMCID: PMC11028700 DOI: 10.1007/s00262-017-2026-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/24/2017] [Indexed: 12/17/2022]
Abstract
The importance of T cell-dependent immune responses in achieving long-term cure of chemoimmunotherapy-treated cancer patients is underscored by the recently described "vaccinal effect" exerted by therapeutic mAbs. In accordance, pre- and post-therapy peripheral blood lymphopenia represents a well-established negative prognostic factor in DLBCL. We analyzed the phenotypic and functional (IFNγ production, and Granzyme B (GrzB) cytotoxic granule marker expression) profile of peripheral blood T lymphocyte subsets ("conventional" CD4+ and CD8+, FOXP3+CD25bright Treg, and "innate-like" CD56+) in DLBCL patients at diagnosis, and assessed the long-term impact of R-CHOP chemoimmunotherapy, in a prospective study. At diagnosis, DLBCL patients showed lower lymphocyte counts, due to selective decrement of CD4+ T (including Treg) and B lymphocytes. While all T cell subsets transiently decreased during therapy, CD4+ T cell and Treg remained significantly lower than controls, up to 1 year after R-CHOP. Phenotypically skewed profile of CD4+ and CD8+ T cell subsets associated with higher frequencies of IFNγ+ and GrzB+ cells at diagnosis, that transiently decreased during therapy, and re-attained persistently elevated levels, till up to 1 year after therapy. Differently, the pre-therapy elevated levels of circulating monocytes, and of plasma IL-6 and IL-10 rapidly normalized upon R-CHOP. In sum, we describe a quantitatively and functionally altered status of the peripheral blood T cell compartment in DLBCL patients at diagnosis, that persists long-term after tumor eradication, and it is only transiently perturbed by R-CHOP chemoimmunotherapy. Moreover, data suggest the association of selected T cell functional features with DLBCL phenotype, and with therapy outcome.
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Affiliation(s)
- Simone Battella
- Department of Molecular Medicine, University La Sapienza, Rome, Italy
| | - M Christina Cox
- Hematology Unit, AO Sant'Andrea, University La Sapienza, Via di Grottarossa 1035/1039, 00189, Rome, Italy.
| | - Raffaella La Scaleia
- Department of Experimental Medicine, University La Sapienza, Viale Regina Elena 324, 00161, Rome, Italy
| | - Arianna Di Napoli
- Neuromed, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, IS, Italy
| | - Francesca Di Landro
- Hematology Unit, AO Sant'Andrea, University La Sapienza, Via di Grottarossa 1035/1039, 00189, Rome, Italy
| | - Alessandra Porzia
- Neuromed, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, IS, Italy
| | - Lavinia Franchitti
- Department of Experimental Medicine, University La Sapienza, Viale Regina Elena 324, 00161, Rome, Italy
| | - Fabrizio Mainiero
- Department of Experimental Medicine, University La Sapienza, Viale Regina Elena 324, 00161, Rome, Italy
| | - Luigi Ruco
- Department of Clinical and Molecular Medicine, University La Sapienza, Rome, Italy
| | - Bruno Monarca
- Department of Clinical and Molecular Medicine, University La Sapienza, Rome, Italy
| | - Angela Santoni
- Department of Molecular Medicine, University La Sapienza, Rome, Italy
- Istituto Pasteur-Fondazione Cenci Bolognetti, University La Sapienza, Rome, Italy
| | - Gabriella Palmieri
- Department of Experimental Medicine, University La Sapienza, Viale Regina Elena 324, 00161, Rome, Italy.
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33
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Kim WS, Buske C, Ogura M, Jurczak W, Sancho JM, Zhavrid E, Kim JS, Hernández-Rivas JÁ, Prokharau A, Vasilica M, Nagarkar R, Osmanov D, Kwak LW, Lee SJ, Lee SY, Bae YJ, Coiffier B. Efficacy, pharmacokinetics, and safety of the biosimilar CT-P10 compared with rituximab in patients with previously untreated advanced-stage follicular lymphoma: a randomised, double-blind, parallel-group, non-inferiority phase 3 trial. LANCET HAEMATOLOGY 2017; 4:e362-e373. [PMID: 28712940 DOI: 10.1016/s2352-3026(17)30120-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Studies in patients with rheumatoid arthritis have shown that the rituximab biosimilar CT-P10 (Celltrion, Incheon, South Korea) has equivalent efficacy and pharmacokinetics to rituximab. In this phase 3 study, we aimed to assess the non-inferior efficacy and pharmacokinetic equivalence of CT-P10 compared with rituximab, when used in combination with cyclophosphamide, vincristine, and prednisone (CVP) in patients with newly diagnosed advanced-stage follicular lymphoma. METHODS In this ongoing, randomised, double-blind, parallel-group, active-controlled study, patients aged 18 years or older with Ann Arbor stage III-IV follicular lymphoma were assigned 1:1 to CVP plus intravenous infusions of 375 mg/m2 CT-P10 or rituximab on day 1 of eight 21-day cycles. Randomisation was done by the investigators using an interactive web or voice response system and a computer-generated randomisation schedule, prepared by a clinical research organisation. Randomisation was balanced using permuted blocks and was stratified by country, gender, and Follicular Lymphoma International Prognostic Index score (0-2 vs 3-5). Study teams from the sponsor and clinical research organisation, investigators, and patients were masked to treatment assignment. The study was divided into two parts: part 1 assessing equivalence of pharmacokinetics (in the pharmacokinetics subset), and part 2 assessing efficacy in all randomised patients (patients from the pharmacokinetics subset plus additional patients enrolled in part 2). Equivalence of pharmacokinetics was shown if the 90% CIs for the geometric mean ratio of CT-P10 to rituximab in AUCτ and CmaxSS were within the bounds of the equivalence margin of 80% and 125%. Non-inferiority of response was shown if the one-sided 97·5% CI lay on the positive side of the -7% margin, using a one-sided test done at the 2·5% significance level. The primary efficacy endpoint was the proportion of patients who had an overall response over eight cycles and was assessed in the efficacy population (all randomised patients). The primary pharmacokinetic endpoints were area under the serum concentration-time curve at steady state (AUCτ) and maximum serum concentration at steady state (CmaxSS) at cycle 4, assessed in the pharmokinetic population. This trial is registered with ClinicalTrials.gov, number NCT02162771. FINDINGS Between July 28, 2014, and Dec 29, 2015, 140 patients were enrolled. Here we report data for the eight-cycle induction period, up to week 24. The proportion of patients with an overall response in the efficacy population was 64 (97·0%) of 66 patients in the CT-P10 treatment group and 63 (92·6%) of 68 patients in the rituximab treatment group (4·3%; one-sided 97·5% CI -4·25), which lay on the positive side of the predefined non-inferiority margin. The ratio of geometric least squares means (CT-P10/rituximab) was 102·25% (90% CI 94·05-111·17) for AUCτ and 100·67% (93·84-108·00) for CmaxSS, with all CIs within the bioequivalence margin of 80-125%. Treatment-emergent adverse events were reported for 58 (83%) of 70 patients in the CT-P10 treatment group and 56 (80%) of 70 in the rituximab treatment group. The most common grade 3 or 4 treatment-emergent adverse event in each treatment group was neutropenia (grade 3, 15 [21%] of 70 patients in the CT-P10 group and seven [10%] of 70 patients in the rituximab group). The proportion of patients who experienced at least one treatment-emergent serious adverse event was 16 (23%) of 70 patients in the CT-P10 group and nine (13%) of 70 patients in the rituximab group. INTERPRETATION In this study, we show that CT-P10 exhibits non-inferior efficacy and pharmacokinetic equivalence to rituximab. The safety profile of CT-P10 was comparable to that of rituximab. CT-P10 might represent a new therapeutic option for advanced-stage follicular lymphoma. FUNDING Celltrion, Inc.
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Affiliation(s)
- Won Seog Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Christian Buske
- Comprehensive Cancer Center Ulm, University Hospital of Ulm, Ulm, Germany
| | - Michinori Ogura
- Department of Haematology, Tokai Central Hospital, Kakamigahara, Gifu, Japan
| | - Wojciech Jurczak
- Department of Haematology, Jagiellonian University, Kraków, Poland
| | - Juan-Manuel Sancho
- Hematology Department, ICO-IJC-Hospital Germans Trias i Pujol, Badalona, Spain
| | - Edvard Zhavrid
- N N Alexandrov Republican Scientific and Practical Centre of Oncology and Medical Radiology, Minsk, Belarus
| | - Jin Seok Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | | | | | - Mariana Vasilica
- Hematology Department, Fundeni Clinical Institute, Bucharest, Romania
| | | | | | - Larry W Kwak
- Toni Stephenson Lymphoma Center and Department of Haematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
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Abstract
In patients with membranous nephropathy, alkylating agents (cyclophosphamide or chlorambucil) alone or in combination with steroids achieve remission of nephrotic syndrome more effectively than conservative treatment or steroids alone, but can cause myelotoxicity, infections, and cancer. Calcineurin inhibitors can improve proteinuria, but are nephrotoxic. Most patients relapse after treatment withdrawal and can become treatment dependent, which increases the risk of nephrotoxicity. The discovery of nephritogenic autoantibodies against podocyte M-type phospholipase A2 receptor (PLA2R) and thrombospondin type-1 domain- containing protein 7A (THSD7A) antigens provides a clear pathophysiological rationale for interventions that specifically target B-cell lineages to prevent antibody production and subepithelial deposition. The anti-CD20 monoclonal antibody rituximab is safe and achieves remission of proteinuria in approximately two-thirds of patients with membranous nephropathy. In those with PLA2R-related disease, remission can be predicted by anti-PLA2R antibody depletion and relapse by antibody re-emergence into the circulation. Thus, integrated evaluation of serology and proteinuria could guide identification of affected patients and treatment with individually tailored protocols. Nonspecific and toxic immunosuppressive regimens will fall out of use. B-cell modulation by rituximab and second-generation anti-CD20 antibodies (or plasma cell-targeted therapy in anti-CD20 resistant forms of disease) will lead to a novel therapeutic paradigm for patients with membranous nephropathy.
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Schultz HS, Reedtz-Runge SL, Bäckström BT, Lamberth K, Pedersen CR, Kvarnhammar AM. Quantitative analysis of the CD4+ T cell response to therapeutic antibodies in healthy donors using a novel T cell:PBMC assay. PLoS One 2017; 12:e0178544. [PMID: 28562666 PMCID: PMC5451071 DOI: 10.1371/journal.pone.0178544] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 05/15/2017] [Indexed: 12/22/2022] Open
Abstract
Many biopharmaceuticals (BPs) are known to be immunogenic in the clinic, which can result in modified pharmacokinetics, reduced efficacy, allergic reactions and anaphylaxis. During recent years, several technologies to predict immunogenicity have been introduced, but the predictive value is still considered low. Thus, there is an unmet medical need for optimization of such technologies. The generation of T cell dependent high affinity anti-drug antibodies plays a key role in clinical immunogenicity. This study aimed at developing and evaluating a novel in vitro T cell:PBMC assay for prediction of the immunogenicity potential of BPs. To this end, we assessed the ability of infliximab (anti-TNF-α), rituximab (anti-CD20), adalimumab (anti-TNF-α) and natalizumab (anti-α4-integrin), all showing immunogenicity in the clinic, to induce a CD4+ T cells response. Keyhole limpet hemocyanin (KLH) and cytomegalovirus pp65 protein (CMV) were included as neo-antigen and recall antigen positive controls, respectively. By analyzing 26 healthy donors having HLA-DRB1 alleles matching the European population, we calculated the frequency of responding donors, the magnitude of the response, and the frequency of BP-specific T cells, as measured by 3[H]-thymidine incorporation and ELISpot IL-2 secretion. KLH and CMV demonstrated a strong T cell response in all the donors analyzed. The frequency of responding donors to the BPs was 4% for infliximab, 8% for adalimumab, 19% for rituximab and 27% for natalizumab, which is compared to and discussed with their respective observed clinical immunogenicity. This study further complements predictive immunogenicity testing by quantifying the in vitro CD4+ T cell responses to different BPs. Even though the data generated using this modified method does not directly translate to the clinical situation, a high sensitivity and immunogenic potential of most BPs is demonstrated.
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Affiliation(s)
- Heidi S. Schultz
- Immunogenicity Prediction and Tolerance, Global Research, Novo Nordisk A/S, Måløv, Denmark
- * E-mail:
| | | | - B. Thomas Bäckström
- Immunogenicity Prediction and Tolerance, Global Research, Novo Nordisk A/S, Måløv, Denmark
| | - Kasper Lamberth
- Immunogenicity Prediction and Tolerance, Global Research, Novo Nordisk A/S, Måløv, Denmark
| | | | - Anne M. Kvarnhammar
- Immunogenicity Prediction and Tolerance, Global Research, Novo Nordisk A/S, Måløv, Denmark
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Nagai H, Shimomura T, Takeuchi M, Hanada S, Komeno T, Sunami K, Hidaka M, Yano T, Kitano K, Yoshida I, Inoue N, Saito A, Horibe K, Motitani S, Ichihara S, Watanabe T, Sawamura M. Phase II study of intensified rituximab induction and maintenance for low grade B cell lymphoma. Leuk Lymphoma 2017; 58:2845-2851. [PMID: 28509595 DOI: 10.1080/10428194.2017.1319054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Rituximab has markedly improved the outcomes of B cell lymphoma, and its maintenance has been shown to be beneficial in low grade B cell lymphoma (LGBCL). We conducted a multicenter, phase II trial of intensive rituximab induction and maintenance therapy for LGBCL to optimize the rituximab monotherapy. Patients with newly diagnosed or rituximab naïve relapsed LGBCL received 8 weekly rituximab as induction, then continued maintenance therapy with rituximab for 4 weeks at 6-month intervals. The primary endpoint was the overall response rate (ORR). Forty-five patients were enrolled from 2005 to 2009 and 36 were eligible. The ORR was 83.3% (30/36) with a complete response rate of 72.2% (26/36). The 3-year progression-free survival (PFS) was 76.7% with a median follow-up of 43.0 months. Five grade three toxicities were observed (no grade 4). Our findings suggest that this regimen demonstrates high activity with durable PFS and minimal toxicity in LGBCL patients.
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Affiliation(s)
- Hirokazu Nagai
- a Department of Hematology , National Hospital Organization Naogoya Medical Center , Nagoya , Japan.,b Clinical Research Center , National Hospital Organization Naogoya Medical Center , Nagoya , Japan
| | - Takeshi Shimomura
- c Department of Hematology , National Hospital Organization Hiroshima-nishi Medical Center , Otake , Japan
| | - Makoto Takeuchi
- d Department of Hematology , National Hospital Organization Minami-Okayama Medical Center , Tsukubo , Japan
| | - Shuichi Hanada
- e Department of Hematology , National Hospital Organization Kagoshima Medical Center , Kagoshima , Japan
| | - Takuya Komeno
- f Department of Hematology , National Hospital Organization Mito Medical Center , Mito , Japan
| | - Kazutaka Sunami
- g Department of Hematology , National Hospital Organization Okayama Medical Center , Okayama , Japan
| | - Michihiro Hidaka
- h Department of Hematology , National Hospital Organization Kumamoto Medical Center , Kumamoto , Japan
| | - Takahiro Yano
- i Department of Hematology , National Hospital Organization Tokyo Medical Center , Tokyo , Japan
| | - Kiyoshi Kitano
- j Department of Hematology , National Hospital Organization Matsumoto Medical Center , Matsumoto , Japan
| | - Isao Yoshida
- k Department of Hematology , National Hospital Organization Shikoku Cancer Center , Matsuyama , Japan
| | - Nobumasa Inoue
- l Department of Hematology , National Hospital Organization Osaka Medical Center , Osaka , Japan
| | - Akiko Saito
- b Clinical Research Center , National Hospital Organization Naogoya Medical Center , Nagoya , Japan
| | - Keizo Horibe
- b Clinical Research Center , National Hospital Organization Naogoya Medical Center , Nagoya , Japan
| | - Suzuko Motitani
- m Department of Pathology , National Hospital Organization Naogoya Medical Center , Nagoya , Japan
| | - Shu Ichihara
- m Department of Pathology , National Hospital Organization Naogoya Medical Center , Nagoya , Japan
| | - Tomoyuki Watanabe
- b Clinical Research Center , National Hospital Organization Naogoya Medical Center , Nagoya , Japan.,n Department of Nutritional Science , Aichi Gakuin University , Nisshin , Japan
| | - Morio Sawamura
- o Department of Hematology , National Hospital Organization Shibukawa Medical Center , Shibukawa , Japan
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Efficacy and Tolerability of a 2-Year Rituximab Maintenance Therapy in Patients with Advanced Follicular Lymphoma after Induction of Response with Rituximab-Containing First Line-Regimens (HUSOM Study). Pathol Oncol Res 2017; 24:199-205. [PMID: 28432650 DOI: 10.1007/s12253-017-0234-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/06/2017] [Indexed: 10/19/2022]
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Pavanello F, Zucca E, Ghielmini M. Rituximab: 13 open questions after 20years of clinical use. Cancer Treat Rev 2017; 53:38-46. [DOI: 10.1016/j.ctrv.2016.11.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/20/2016] [Accepted: 11/29/2016] [Indexed: 12/26/2022]
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Uzun S, Bilgiç Temel A, Akman Karakaş A, Ergün E, Özkesici B, Eskiocak AH, Erat A, Uğurlu N, Nazlım B, Koç S, Bozkurt S, Dicle Ö, Alpsoy E, Yılmaz E. Efficacy and safety of rituximab therapy in patients with pemphigus vulgaris: first report from Turkey. Int J Dermatol 2016; 55:1362-1368. [DOI: 10.1111/ijd.13400] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/03/2016] [Accepted: 05/19/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Soner Uzun
- Department of Dermatology and Venereology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Aslı Bilgiç Temel
- Department of Dermatology and Venereology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Ayşe Akman Karakaş
- Department of Dermatology and Venereology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Erkan Ergün
- Department of Dermatology and Venereology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Birgül Özkesici
- Department of Dermatology and Venereology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Ali Haydar Eskiocak
- Department of Dermatology and Venereology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Ayşegül Erat
- Department of Dermatology and Venereology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Nilay Uğurlu
- Department of Dermatology and Venereology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Berna Nazlım
- Department of Dermatology and Venereology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Saliha Koç
- Department of Dermatology and Venereology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Selen Bozkurt
- Department of Biostatistics and Medical Informatics; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Özlem Dicle
- Department of Dermatology and Venereology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Erkan Alpsoy
- Department of Dermatology and Venereology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Ertan Yılmaz
- Department of Dermatology and Venereology; Faculty of Medicine; Akdeniz University; Antalya Turkey
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Chemotherapy-sparing treatment strategies for follicular lymphoma: current options and future directions. Curr Opin Hematol 2016; 23:371-6. [PMID: 27213499 DOI: 10.1097/moh.0000000000000263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The accelerating development of targeted therapy offers the possibility of avoiding the many toxic side-effects of cytotoxic chemotherapy often experienced during treatment of patients with malignancies. As a currently incurable disease that typically follows an indolent course, follicular lymphoma is a disease for which chemotherapy-free treatment may offer substantial benefit. RECENT FINDINGS We review chemotherapy-free treatment regimens, including those targeting cell-surface proteins and intracellular signaling pathways currently in use for the treatment of follicular lymphoma, paying particular attention to the unique toxicity profiles of these agents. Additionally, the safety profiles and efficacy of selected novel-targeted therapies in earlier phase studies, including immunotherapeutics, will be explored. SUMMARY Novel-targeted therapies are rapidly changing the landscape of follicular lymphoma and decreasing reliance upon traditional chemotherapeutics. Although the toxicities of chemotherapy are well known to clinicians, the unique adverse events associated with novel agents may be less familiar, and requires attention to identification, management, and prophylaxis of toxicity associated with emerging chemotherapy-sparing treatments.
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Aguiar-Bujanda D, Blanco-Sánchez MJ, Hernández-Sosa M, Galván-Ruíz S, Hernández-Sarmiento S. Critical appraisal of rituximab in the maintenance treatment of advanced follicular lymphoma. Cancer Manag Res 2015; 7:319-30. [PMID: 26604821 PMCID: PMC4629955 DOI: 10.2147/cmar.s69145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Rituximab is an IgG1, chimeric monoclonal antibody specifically designed to recognize the CD20 antigen expressed on the surface of normal and malignant B-lymphocytes, from the B-cell precursor to the mature B-cells of the germinal center, and by most neoplasms derived from B-cells. After 2 decades of use, rituximab is firmly positioned in the treatment of follicular lymphoma (FL), both in the front line and in the relapsing disease, improving previous results by including it in classical chemotherapy regimens. However, the pharmacology of rituximab continues to generate controversial issues especially regarding the mechanisms of action in vivo. The contribution of rituximab as a maintenance treatment in FL has been significant progress in the management of this disease without an increase in side effects or a decrease in the quality of life of patients. With the widespread use of rituximab, there are new security alerts and side effects not previously detected in the pivotal trials that clinicians should learn to recognize and manage. In this article, we will review the pharmacokinetics and pharmacodynamics of rituximab, the management issues in the treatment of advanced FL focusing on maintenance rituximab, its long-term efficacy and safety profile, and its effect on the quality of life.
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Affiliation(s)
- David Aguiar-Bujanda
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - María Jesús Blanco-Sánchez
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - María Hernández-Sosa
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Saray Galván-Ruíz
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Samuel Hernández-Sarmiento
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
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A phase 2 study of idelalisib plus rituximab in treatment-naïve older patients with chronic lymphocytic leukemia. Blood 2015; 126:2686-94. [PMID: 26472751 DOI: 10.1182/blood-2015-03-630947] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 09/08/2015] [Indexed: 01/19/2023] Open
Abstract
Idelalisib is a first-in-class oral inhibitor of PI3Kδ that has shown substantial activity in patients with relapsed/refractory chronic lymphocytic leukemia (CLL). To evaluate idelalisib as initial therapy, 64 treatment-naïve older patients with CLL or small lymphocytic leukemia (median age, 71 years; range, 65-90) were treated with rituximab 375 mg/m(2) weekly ×8 and idelalisib 150 mg twice daily continuously for 48 weeks. Patients completing 48 weeks without progression could continue to receive idelalisib on an extension study. The median time on treatment was 22.4 months (range, 0.8-45.8+). The overall response rate (ORR) was 97%, including 19% complete responses. The ORR was 100% in patients with del(17p)/TP53 mutations and 97% in those with unmutated IGHV. Progression-free survival was 83% at 36 months. The most frequent (>30%) adverse events (any grade) were diarrhea (including colitis) (64%), rash (58%), pyrexia (42%), nausea (38%), chills (36%), cough (33%), and fatigue (31%). Elevated alanine transaminase/aspartate transaminase was seen in 67% of patients (23% grade ≥3). The combination of idelalisib and rituximab was highly active, resulting in durable disease control in treatment-naïve older patients with CLL. These results support the further development of idelalisib as initial treatment of CLL. This study is registered at ClinicalTrials.gov as #NCT01203930.
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Sehn LH, Goy A, Offner FC, Martinelli G, Caballero MD, Gadeberg O, Baetz T, Zelenetz AD, Gaidano G, Fayad LE, Buckstein R, Friedberg JW, Crump M, Jaksic B, Zinzani PL, Padmanabhan Iyer S, Sahin D, Chai A, Fingerle-Rowson G, Press OW. Randomized Phase II Trial Comparing Obinutuzumab (GA101) With Rituximab in Patients With Relapsed CD20+ Indolent B-Cell Non-Hodgkin Lymphoma: Final Analysis of the GAUSS Study. J Clin Oncol 2015; 33:3467-74. [PMID: 26282650 DOI: 10.1200/jco.2014.59.2139] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Obinutuzumab (GA101), a novel glycoengineered type II anti-CD20 monoclonal antibody, demonstrated responses in single-arm studies of patients with relapsed/refractory non-Hodgkin lymphoma. This is the first prospective, randomized study comparing safety and efficacy of obinutuzumab with rituximab in relapsed indolent lymphoma. The primary end point of this study was the overall response rate (ORR) in patients with follicular lymphoma after induction and safety in patients with indolent lymphoma. PATIENTS AND METHODS A total of 175 patients with relapsed CD20(+) indolent lymphoma requiring therapy and with previous response to a rituximab-containing regimen were randomly assigned (1:1) to four once-per-week infusions of either obinutuzumab (1,000 mg) or rituximab (375 mg/m(2)). Patients without evidence of disease progression after induction therapy received obinutuzumab or rituximab maintenance therapy every 2 months for up to 2 years. RESULTS Among patients with follicular lymphoma (n = 149), ORR seemed higher for obinutuzumab than rituximab (44.6% v 33.3%; P = .08). This observation was also demonstrated by a blinded independent review panel that measured a higher ORR for obinutuzumab (44.6% v 26.7%; P = .01). However, this difference did not translate into an improvement in progression-free survival. No new safety signals were observed for obinutuzumab, and the incidence of adverse events was balanced between arms, with the exception of infusion-related reactions and cough, which were higher in the obinutuzumab arm. CONCLUSION Obinutuzumab demonstrated a higher ORR without appreciable differences in safety compared with rituximab. However, the clinical benefit of obinutuzumab in this setting remains unclear and should be evaluated within phase III trials.
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Affiliation(s)
- Laurie H Sehn
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA.
| | - Andre Goy
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Fritz C Offner
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Giovanni Martinelli
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - M Dolores Caballero
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ole Gadeberg
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Tara Baetz
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Andrew D Zelenetz
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Gianluca Gaidano
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Luis E Fayad
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Rena Buckstein
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jonathan W Friedberg
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Michael Crump
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Branimir Jaksic
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Pier Luigi Zinzani
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Swaminathan Padmanabhan Iyer
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Deniz Sahin
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Akiko Chai
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Günter Fingerle-Rowson
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Oliver W Press
- Laurie H. Sehn, Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia; Tara Baetz, Queen's University, Kingston General Hospital, Kingston; Rena Buckstein, Sunnybrook Health Sciences Center; Michael Crump, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Andre Goy and Luis E. Fayad, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Fritz C. Offner, Institute of Hematology and Medical Oncology, University of Bologna; Pier Luigi Zinzani, Institute of Hematology "Seràgnoli" University of Bologna, Bologna; Giovanni Martinelli, European Institute of Oncology, Milano; Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; M. Dolores Caballero, University Hospital of Salamanca, Salamanca, Spain; Ole Gadeberg, Vejle Hospital, Vejle, Denmark; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center, New York; Jonathan Friedberg, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Branimir Jadkisic, Clinical Hospital Merkur, University of Zagreb, Zagreb, Croatia; Swaminathan Padmanabhan Iyer, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX; Deniz Sahin and Günter Fingerle-Rowson, Roche, Basel, Switzerland; Akiko Chai, Genentech BioOncology, South San Francisco, CA; Oliver Press, Fred Hutchinson Cancer Research Center, Seattle, WA
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Bachy E, Salles G. Are we nearing an era of chemotherapy-free management of indolent lymphoma? Clin Cancer Res 2015; 20:5226-39. [PMID: 25320372 DOI: 10.1158/1078-0432.ccr-14-0437] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Indolent B-cell lymphomas are heterogeneous, comprising three grades of follicular lymphoma, small lymphocytic lymphoma, Waldenstöm macroglobulinemia, marginal zone lymphoma, and most recently, possibly low proliferative mantle cell lymphoma. These lymphomas are characterized by a high responsiveness to chemotherapy or immunochemotherapy; however, in most cases, conventional therapy might not offer a cure. Furthermore, the patient's age at diagnosis, at time to first or subsequent relapses, as well as potential comorbidities often preclude the use of chemotherapy. Recent progress has been made in our understanding of dysregulated pathways and immunologic antitumor responses in indolent lymphoma. Major therapeutic advances have been achieved in the development of nonchemotherapeutic agents, making "chemo-free" treatment a near-future reality. In this article, we highlight these promising approaches, such as the combination of anti-CD20 antibodies with immunomodulatory drugs, with mAbs directed against other surface antigens such as CD22, with immunomodulatory antibodies such as PD-1, or with inhibitors of key steps in the B-cell receptor pathway signaling. However, the cost of such therapies and potential, albeit manageable, toxicity should be considered. Phase III trials will confirm the benefit of these new treatment strategies that do not require a chemotherapeutic drug and help us identify their exact place in the therapeutic armamentarium for indolent lymphoma. Here we focus on follicular lymphoma, which is the most frequent subtype of indolent lymphoma and for which an increasing body of evidence has emerged that supports the dawn of a new era of chemotherapy-free treatment. See all articles in this CCR Focus section, "Paradigm Shifts in Lymphoma."
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Affiliation(s)
- Emmanuel Bachy
- Hospices Civils de Lyon, Service d'Hématologie, Pierre Bénite Cedex, France. Université Claude Bernard, Faculté de Médecine Lyon-Sud Charles Mérieux, Université de Lyon, Pierre Bénite Cedex, France
| | - Gilles Salles
- Hospices Civils de Lyon, Service d'Hématologie, Pierre Bénite Cedex, France. Université Claude Bernard, Faculté de Médecine Lyon-Sud Charles Mérieux, Université de Lyon, Pierre Bénite Cedex, France.
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Smolewski P, Robak T. The preclinical discovery of rituximab for the treatment of non-Hodgkin’s lymphoma. Expert Opin Drug Discov 2015; 10:791-808. [DOI: 10.1517/17460441.2015.1045295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Deehan M, Garcês S, Kramer D, Baker MP, Rat D, Roettger Y, Kromminga A. Managing unwanted immunogenicity of biologicals. Autoimmun Rev 2015; 14:569-74. [PMID: 25742758 DOI: 10.1016/j.autrev.2015.02.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 02/02/2015] [Indexed: 01/15/2023]
Abstract
All protein drugs (biologicals) have an immunogenic potential and we are armed with multiple guidelines, regulatory documents and white papers to assist us in assessing the level of risk for unwanted immunogenicity of new biologicals. However, for certain biologicals, significant immunogenicity becomes only apparent after their use in patients. Causes of immunogenicity are multifactorial but not yet fully understood. Within the pharmaceutical industry there are only a few opportunities to openly discuss the causes and consequences of immunogenicity with regard to the development of new biologicals. The annual Open Scientific Symposium of the European Immunogenicity Platform (EIP) is one such meeting that brings together scientists and clinicians from academia and industry to build know-how and expertise in the field of immunogenicity. The critical topics discussed at the last EIP meeting (February 2014) will be reviewed here. The current opinion of this expert group is that the assessment of unwanted immunogenicity can be improved by using prediction tools, optimizing the performance of immunogenicity assays and learning from the clinical impact of other biologicals that have already been administered to patients. A multidisciplinary approach is warranted to better understand and minimize drug immunogenicity and its clinical consequences.
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Affiliation(s)
- Maureen Deehan
- Novimmune SA, 14 Chemin des Aulx, 1228 Plan-Les-Ouates, Geneva, Switzerland.
| | - Sandra Garcês
- Gulbenkian Institute of Science, Portugal, Rua da Quinta Grande, 6, 2780-156 Oeiras, Portugal; Garcia de Orta Hospital, Portugal, Department of Rheumatology; HGO Research Center, Av. Torrado da Silva, 2801-951 Almada, Portugal.
| | - Daniel Kramer
- Sanofi, R&D, DSAR-PSI, Industriepark Höchst, D-65926 Frankfurt/M., Germany.
| | - Matthew P Baker
- Abzena, Babraham Research Campus, Babraham, Cambridge CB22 3AT, United Kingdom.
| | - Dorothea Rat
- Sanofi, R&D, DSAR-BBB, Industriepark Höchst, D-65926 Frankfurt/M., Germany.
| | - Yvonne Roettger
- Sanofi, R&D, DSAR-BBB, Industriepark Höchst, D-65926 Frankfurt/M., Germany.
| | - Arno Kromminga
- Institute for Immunology, University of Kiel, Germany, Arnold-Heller-Straße 3, Haus 17, 24105 Kiel, Germany; IPM Biotech, Lademannbogen 61, 22453 Hamburg, Germany.
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48
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Pei SN, Chen CH. Risk and prophylaxis strategy of hepatitis B virus reactivation in patients with lymphoma undergoing chemotherapy with or without rituximab. Leuk Lymphoma 2015; 56:1611-8. [PMID: 25248874 DOI: 10.3109/10428194.2014.964699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatitis B virus (HBV) reactivation is a serious but preventable complication for patients with lymphoma receiving systemic therapy. Without antiviral prophylaxis, the HBV reactivation rate is estimated to be > 50% in patients who are positive for hepatitis B surface antigen (HBsAg), and fatal hepatic failure is not uncommon. Current guidelines suggest that routine antiviral prophylaxis should be administered to all HBsAg-positive patients until 6-12 months after completion of chemotherapy. For those who are negative for HBsAg and positive for hepatitis B core antibody, HBV reactivation is uncommon when a conventional dose of chemotherapy is administered. However, with rituximab-containing immunochemotherapy, the HBV reactivation rate is 18% and the clinical course can vary from asymptomatic viremia to fulminant hepatic failure that can be potentially fatal. In this review, we discuss the risk, clinical course and prophylactic strategy of HBV reactivation in patients with lymphoma treated with chemotherapy with or without rituximab.
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Worch J, Makarova O, Burkhardt B. Immunreconstitution and infectious complications after rituximab treatment in children and adolescents: what do we know and what can we learn from adults? Cancers (Basel) 2015; 7:305-28. [PMID: 25643241 PMCID: PMC4381260 DOI: 10.3390/cancers7010305] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/21/2015] [Accepted: 01/23/2015] [Indexed: 01/19/2023] Open
Abstract
Rituximab, an anti CD20 monoclonal antibody, is widely used in the treatment of B-cell malignancies in adults and increasingly in pediatric patients. By depleting B-cells, rituximab interferes with humoral immunity. This review provides a comprehensive overview of immune reconstitution and infectious complications after rituximab treatment in children and adolescents. Immune reconstitution starts usually after six months with recovery to normal between nine to twelve months. Extended rituximab treatment results in a prolonged recovery of B-cells without an increase of clinically relevant infections. The kinetic of B-cell recovery is influenced by the concomitant chemotherapy and the underlying disease. Intensive B-NHL treatment such as high-dose chemotherapy followed by rituximab bears a risk for prolonged hypogammaglobulinemia. Overall transient alteration of immune reconstitution and infections after rituximab treatment are acceptable for children and adolescent without significant differences compared to adults. However, age related disparities in the kinetic of immune reconstitution and the definitive role of rituximab in the treatment for children and adolescents with B-cell malignancies need to be evaluated in prospective controlled clinical trials.
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Affiliation(s)
- Jennifer Worch
- Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, 48149, Germany.
| | - Olga Makarova
- Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, 48149, Germany.
| | - Birgit Burkhardt
- Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, 48149, Germany.
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50
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Sarkozy C, Salles G, Bachy E. Chemotherapy-free treatment in patients with follicular lymphoma. Expert Rev Hematol 2015; 8:187-203. [PMID: 25585961 DOI: 10.1586/17474086.2015.998995] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The outcome of patients with follicular lymphoma (FL) has improved over the last two decades through the introduction of anti-CD20 monoclonal antibodies, usually used in combination with chemotherapy. However, patients with FL still experience multiple relapses, requiring several lines of treatment. Early toxicity of chemotherapy is a significant concern and as the life expectancy of patients with FL is increasing, late toxicities become an increasingly important concern. Progress made in understanding the biology of FL, especially dysregulation of intracellular pathways and immunological antitumor responses, recently allowed for the development of innovative chemo-free therapeutic approaches. In this report, different options such as new anti-CD20 antibodies, antibodies targeting other cell surface antigens, bi-specific antibodies, immunomodulation, idiotype vaccine and other targeted therapies are presented. The article also highlights how, although promising in early phase studies, the cost-effectiveness of new agents will have to be justified in Phase III trials. Furthermore, chemo-free regimen might not mean toxicity-free treatment and monitoring of early and late toxicities is required.
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Affiliation(s)
- Clémentine Sarkozy
- Hospices Civils de Lyon, Service d'Hématologie, 69495 Pierre Bénite cedex, France
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