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Isidori A, Loscocco F, Visani G, Paolasini S, Scalzulli P, Musto P, Perrone T, Guarini A, Pastore D, Mazza P, Tonialini L, Pavone V, De Santis G, Tarantini G. Real-life efficacy and safety of idelalisib in 55 double-refractory follicular lymphoma patients. Br J Haematol 2022; 199:339-343. [PMID: 36002151 DOI: 10.1111/bjh.18426] [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: 06/02/2022] [Revised: 08/07/2022] [Accepted: 08/12/2022] [Indexed: 11/28/2022]
Abstract
Idelalisib, a reversible inhibitor of PI3Kδ (phosphoinositide-3 kinase delta), showed remarkable activity in the phase II DELTA trial, leading to its approval by the European Medicines Agency (EMA) in patients with relapsed/refractory (R/R) follicular lymphoma (FL). However, real-life data on idelalisib are scarce. We treated 55 double-refractory FL patients with idelalisib in a real-life setting. With a median exposure to idelalisib of 10 months (range 1-43), overall response rate was 73%, the highest ever reported. Non-haematological toxicities were mild and manageable. At 12 months, 80% of patients were alive, and 72% disease-free. The efficacy and safety of idelalisib was confirmed in a real-life setting.
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Affiliation(s)
- Alessandro Isidori
- Hematology and Stem Cell Transplant Center, AORMN Hospital, Pesaro, Italy
| | - Federica Loscocco
- Hematology and Stem Cell Transplant Center, AORMN Hospital, Pesaro, Italy
| | - Giuseppe Visani
- Hematology and Stem Cell Transplant Center, AORMN Hospital, Pesaro, Italy
| | - Sara Paolasini
- Hematology and Stem Cell Transplant Center, AORMN Hospital, Pesaro, Italy
| | - Potito Scalzulli
- UOC di Ematologia San Giovanni Rotondo, San Giovanni Rotondo, Italy
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Treatment with Idelalisib in Patients with Relapsed or Refractory Follicular Lymphoma: The Observational Italian Multicenter FolIdela Study. Cancers (Basel) 2022; 14:cancers14030654. [PMID: 35158922 PMCID: PMC8833724 DOI: 10.3390/cancers14030654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Idelalisib, the first-in-class phosphatidylinositol 3-kinase inhibitor, approved by the Italian Medicines Agency for the treatment of relapsed/refractory follicular lymphoma patients, showed high antitumor activity with an acceptable safety profile in a phase II registration trial. A 6-year follow-up of the same trial did not reveal any new safety concerns, confirming the role of idelalisib as an effective option for indolent non-Hodgkin lymphoma, refractory to previous therapies. The aim of this multicenter study is to point out the role of idelalisib in a real-life context, since data from everyday clinical practices are scarce. We report the effective and manageable safety profile of idelalisib in the treatment of 72 relapsed/refractory follicular lymphoma patients, bringing further demonstrations of its role in this setting. Abstract Follicular lymphoma (FL) is an indolent hematological disease, often responsive to the first line of treatment, but characterized by repeated relapses. The therapeutic algorithm for relapsed/refractory FL patients comprises phosphatidylinositol 3-kinase inhibitors. Idelalisib showed anticancer activity, while inducing a significant rate of toxicities. Since the evidence in the literature on its use in normal clinical practice is scarce, a retrospective multicenter study was conducted to evaluate effectiveness and tolerability in a real-life context. Seventy-two patients with a median age at diagnosis of 57.2 years—mostly with an advanced stage (88.9%) and relapsed to the most recent therapy (79.1%)—were enrolled. The median number of prior therapies was three (20.8% refractory to the last therapy before idelalisib). With a median number of 4 months of treatment, the overall response rate was 41.7% (20.8% complete responses). Median disease-free survival and overall survival were achieved at 8.4 months and at 4 years, respectively. Forty-four percent of patients experienced at least one drug-related toxicity: 6.9% hematological ones and 43% non-hematological. The study confirmed that idelalisib has anticancer effectiveness and an acceptable safety profile in relapsed/refractory FL with unfavorable prognostic characteristics, even in the context of normal clinical practice.
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Schetelig J, Chevallier P, van Gelder M, Hoek J, Hermine O, Chakraverty R, Browne P, Milpied N, Malagola M, Socié G, Delgado J, Deconinck E, Damaj G, Maury S, Beelen D, Quoc SN, Shankara P, Brecht A, Mayer J, Hunault-Berger M, Bittenbring J, Thieblemont C, Lepretre S, Baldauf H, de Wreede LC, Tournilhac O, Yakoub-Agha I, Kröger N, Dreger P. Idelalisib treatment prior to allogeneic stem cell transplantation for patients with chronic lymphocytic leukemia: a report from the EBMT chronic malignancies working party. Bone Marrow Transplant 2020; 56:605-613. [PMID: 33004942 PMCID: PMC8589680 DOI: 10.1038/s41409-020-01069-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 01/28/2023]
Abstract
No studies have been reported so far on bridging treatment with idelalisib for patients with chronic lymphocytic leukemia (CLL) prior to allogeneic hematopoietic cell transplantation (alloHCT). To study potential carry-over effects of idelalisib and to assess the impact of pathway-inhibitor (PI) failure we performed a retrospective EBMT registry-based study. Patients with CLL who had a history of idelalisib treatment and received a first alloHCT between 2015 and 2017 were eligible. Data on 72 patients (median age 58 years) were analyzed. Forty percent of patients had TP53mut/del CLL and 64% had failed on at least one PI. No primary graft failure occurred. Cumulative incidences of acute GVHD °II–IV and chronic GVHD were 51% and 39%, respectively. Estimates for 2-year overall survival (OS), progression-free survival (PFS), and cumulative incidences of relapse/progression (CIR) and non-relapse mortality NRM were 59%, 44%, 25%, and 31%. In univariate analysis, drug sensitivity was a strong risk factor. For patients who had failed neither PI treatment nor chemoimmunotherapy (CIT) the corresponding 2-year estimates were 73%, 65%, 15%, and 20%, respectively. In conclusion, idelalisib may be considered as an option for bridging therapy prior to alloHCT. Owing to the high risk for acute GVHD intensified clinical monitoring is warranted.
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Affiliation(s)
- Johannes Schetelig
- Medical Clinic I, University Hospital, Dresden, Germany. .,DKMS, Dresden, Germany.
| | | | | | | | - Olivier Hermine
- Department of Hematology, Necker Hospital and INSERM U1163 Imagine Institute, University of Paris, Paris, France
| | - Ronjon Chakraverty
- Cancer Institute and Institute of Immunity and Transplantation, University College London Hospital, London, UK
| | | | | | - Michele Malagola
- Bone Marrow Transplant Unit, ASST-Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | | | | | | | - Ghandi Damaj
- Centre Hospitalier-Universitaire, Institut d'Hématologie, Normandie University, Caen, France
| | - Sebastian Maury
- Service d'Hématologie Clinique et de Thérapie Cellulaire Creteil, CHU Henri Mondor, Créteil, France
| | | | | | | | - Arne Brecht
- Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Jiri Mayer
- University Hospital Brno, Brno, Czech Republic
| | | | | | | | - Stéphane Lepretre
- Inserm U1245 and Department of Hematology, Centre Henri Becquerel, Normandie University, Rouen, France
| | | | - Liesbeth C de Wreede
- Department of Medical Statistics & Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Olivier Tournilhac
- Service Therapie Cellulaire & Hematologie Cliniquer, Centre Hospitalier Universitaire, Clermont Ferrand, France
| | - Ibrahim Yakoub-Agha
- Centre Hospitalier Universitaire de Lille, LIRIC, INSERM U995, Université de Lille, Lille, France
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