1
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Gini G, Tani M, Tucci A, Marcheselli L, Cesaretti M, Bellei M, Pascarella A, Ballerini F, Petrini M, Merli F, Olivieri A, Lanza F, Annibali O, Zilioli VR, Liberati AM, Tisi MC, Arcari A, Marino D, Musuraca G, Pavone V, Fabbri A, Pozzi S, Mannina D, Plenteda C, Celli M, Luminari S. Lenalidomide plus rituximab for the initial treatment of frail older patients with DLBCL: the FIL_ReRi phase 2 study. Blood 2023; 142:1438-1447. [PMID: 37418685 DOI: 10.1182/blood.2022019173] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 07/09/2023] Open
Abstract
Treatment of diffuse large B-cell lymphoma (DLBCL) in older patients is challenging, especially for those who are not eligible for anthracycline-containing regimens. Fondazione Italiana Linfomi (FIL) started the FIL_ReRi study, a 2-stage single-arm trial to investigate the activity and safety of the chemo-free combination of rituximab and lenalidomide (R2) in ≥70-year-old untreated frail patients with DLBCL. Frailty was prospectively defined using a simplified geriatric assessment tool. Patients were administered a maximum of 6 28-day cycles of 20 mg oral lenalidomide from days 2 to 22 and IV rituximab 375 mg/m2 on day 1, with response assessment after cycles 4 and 6. Patients with partial response or complete response (CR) at cycle 6 were administered lenalidomide 10 mg/d from days 1 to 21 for every 28 cycles for a total of 12 cycles or until progression or unacceptable toxicity. The primary end point was the overall response rate (ORR) after cycle 6; the coprimary end point was the rate of grade 3 or 4 extrahematological toxicity. The ORR was 50.8%, with 27.7% CR. After a median follow-up of 24 months, the median progression-free survival was 14 months, and the 2-year duration of response was 64%. Thirty-four patients experienced extrahematological toxicity according to the National Cancer Institute Common Terminology Criteria for Adverse Events grade ≥3. The activity of the R2 combination was observed in a significant proportion of subjects, warranting further exploration of a chemo-free approach in frail older patients with DLBCL. This trial was registered at EudraCT as #2015-003371-29 and clinicaltrials.gov as #NCT02955823.
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Affiliation(s)
- Guido Gini
- Struttura Organizzativa Dipartimentale di Clinica Ematologica, Azienda Ospedaliero Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Monica Tani
- Unità di Ematologia, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Alessandra Tucci
- Unità di Ematologia, Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy
| | - Luigi Marcheselli
- Uffici Studi Fondazione Italiana Linfomi, sede di Modena, Modena, Italy
| | - Marina Cesaretti
- Uffici Studi Fondazione Italiana Linfomi, sede di Modena, Modena, Italy
| | - Monica Bellei
- Uffici Studi Fondazione Italiana Linfomi, sede di Modena, Modena, Italy
| | - Anna Pascarella
- Unità Operativa Complessa di Ematologia, Ospedale dell'Angelo, Venice-Mestre, Italy
| | - Filippo Ballerini
- Clinica Ematologica, IRCCS Ospedale Policlinico San Martino, Università di Genova, Genoa, Italy
| | - Mauro Petrini
- Struttura Organizzativa Dipartimentale di Clinica Ematologica, Azienda Ospedaliero Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Francesco Merli
- Ematologia, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Attilio Olivieri
- Struttura Organizzativa Dipartimentale di Clinica Ematologica, Azienda Ospedaliero Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Francesco Lanza
- Unità di Ematologia, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Ombretta Annibali
- Unità di Ematologia e Trapianto di Cellule Staminali, Università Campus Bio-Medico, Rome, Italy
| | - Vittorio Ruggero Zilioli
- Divisione di Ematologia, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Anna Marina Liberati
- Struttura Complessa di Oncoematologia e Autotrapianto, Azienda Ospedaliera Santa Maria, Università degli Studi di Perugia, Terni, Italy
| | - Maria Chiara Tisi
- Ematologia, Ospedale San Bortolo, Azienda Unità Sanitaria Locale Socio Sanitaria 8 "Berica," Vicenza, Italy
| | - Annalisa Arcari
- Unità di Ematologia, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Dario Marino
- Oncologia 1, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Gerardo Musuraca
- Ematologia, IRCCS Istituto Romagnolo per lo Studio dei Tumori, Meldola, Italy
| | - Vincenzo Pavone
- Unità Operativa Complessa di Ematologia e Trapianto, Ospedale Pia Fondazione Cardinale Panico, Tricase, Italy
| | - Alberto Fabbri
- Unità di Ematologia, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Samantha Pozzi
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, Università di Modena e Reggio Emilia, Centro Oncologico, Modena, Italy
| | - Donato Mannina
- Dipartimento di Oncoematologia, Ospedale Papardo, Messina, Italy
| | - Caterina Plenteda
- Unità Operativa di Ematologia e Centro Trapianti di Midollo Osseo, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Melania Celli
- Unità Operativa di Ematologia, Ospedale degli Infermi, Rimini, Italy
| | - Stefano Luminari
- Ematologia, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
- Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa, Università di Modena e Reggio Emilia, Reggio Emilia, Italy
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2
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Martín García-Sancho A, Baile M, Rodríguez G, Dlouhy I, Sancho JM, Jarque I, González-Barca E, Salar A, Espeso M, Grande C, Bergua J, Montes-Moreno S, Redondo A, Enjuanes A, Campo E, López-Guillermo A, Caballero D. Lenalidomide in combination with R-ESHAP in patients with relapsed or refractory diffuse large B-cell lymphoma: A phase 2 study from GELTAMO. Br J Haematol 2023; 203:202-211. [PMID: 37485564 DOI: 10.1111/bjh.18989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/18/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL) patients with relapsed or refractory (RR) disease have poor outcomes with current salvage regimens. We conducted a phase 2 trial to analyse the safety and efficacy of adding lenalidomide to R-ESHAP (LR-ESHAP) in patients with RR DLBCL. Subjects received 3 cycles of lenalidomide 10 mg/day on days 1-14 of every 21-day cycle, in combination with R-ESHAP at standard doses. Responding patients underwent autologous stem-cell transplantation (ASCT). The primary endpoint was the overall response rate (ORR) after 3 cycles. Centralized cell-of-origin (COO) classification was performed. Forty-six patients were included. The ORR after LR-ESHAP was 67% (35% of patients achieved complete remission). Patients with primary refractory disease (n = 26) had significantly worse ORR than patients with non-refractory disease (54% vs. 85%, p = 0.031). No differences in response rates according to the COO were observed. Twenty-eight patients (61%) underwent ASCT. At a median follow-up of 41 months, the estimated 3-year PFS and OS were 42% and 48%, respectively. The most common grade ≥3 adverse events were thrombocytopenia (70% of patients), neutropenia (67%) and anaemia (35%). There were no treatment-related deaths during LR-ESHAP cycles. In conclusion, LR-ESHAP is a feasible salvage regimen with promising efficacy results for patients with RR DLBCL.
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Affiliation(s)
- A Martín García-Sancho
- Hematology Department, Hospital Universitario de Salamanca-IBSAL, CIBERONC, Universidad de Salamanca, Salamanca, Spain
| | - M Baile
- Hematology Department, Hospital Universitario de Salamanca-IBSAL, CIBERONC, Universidad de Salamanca, Salamanca, Spain
| | - G Rodríguez
- Hematology Department, Hospital Universitario Virgen del Rocío/Virgen Macarena, Sevilla, Spain
| | - I Dlouhy
- Hematology Department, Hospital Clinic, Barcelona, Spain
| | - J M Sancho
- Hematology Department, Hospital Germans Trias i Pujol/ICO-IJC, Badalona, Spain
| | - I Jarque
- Hematology Department, Hospital Universitari i Plotècnic La Fe, CIBERONC, Valencia, Spain
| | - E González-Barca
- Institut Català d'Oncologia-Hospitalet, IDIBELL, Universitat de-Barcelona, Barcelona, Spain
| | - A Salar
- Hematology Department, Hospital del Mar, Barcelona, Spain
| | - M Espeso
- Hematology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - C Grande
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Bergua
- Hematology Department, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - S Montes-Moreno
- Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - A Redondo
- Hematology Department, Hospital Virgen del Puerto, Plasencia, Spain
| | - A Enjuanes
- Unidad de Genómica del IDIBAPS, Barcelona, Spain
| | - E Campo
- Pathology Department, Hospital Clinic, Barcelona, Spain
| | | | - D Caballero
- Hematology Department, Hospital Universitario de Salamanca-IBSAL, CIBERONC, Universidad de Salamanca, Salamanca, Spain
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3
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Vose JM, Ganguly S, Bierman PJ, Bociek RG, Lunning M, Lyden L, Meza JL, Caimi PF, Armitage JO. Lenalidomide maintenance following high-dose therapy and autologous haematopoietic stem cell transplantation in chemo-resistant or high-risk non-Hodgkin lymphoma: A phase I/II study. Br J Haematol 2023. [PMID: 37096954 DOI: 10.1111/bjh.18821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/06/2023] [Accepted: 04/09/2023] [Indexed: 04/26/2023]
Abstract
Improved maintenance treatments are needed for patients with relapsed/refractory aggressive lymphomas after autologous haematopoietic stem cell transplantation (ASCT). Several studies with lenalidomide have been found to have activity in the treatment of relapsed/refractory aggressive lymphomas. In the present phase I/II, single-arm, open-label study, 59 patients with high-risk relapsed non-Hodgkin lymphoma received pretransplant BEAM chemotherapy and ASCT followed by 12 months of maintenance lenalidomide once daily on Days 1-21 (28-day cycles) beginning at post-transplantation Day 100. The most common histologies were mantle cell lymphoma (56%) and diffuse large B-cell lymphoma (24%). The maximum tolerated dose in the dose-finding part of the study was 15 mg, but cytopenias led to the subsequent adoption of a 10 mg dose in the final study. Sixteen patients (27%) completed 12 cycles of lenalidomide maintenance. The most common reason for discontinuation was adverse events (31%). These were primarily haematologic, and 56% of patients experienced Grade 3-4 events. Two-year PFS rates (95% CIs) were 70% (56%-80%), 45% (19%-68%) and 81% (66%-90%); 2-year OS rates (95% CIs) were 91% (80%-96%), 93% (61%-99%) and 90% (76%-96%) in all patients, patients completing and patients not completing 12-month maintenance respectively. These results do not support the use of lenalidomide maintenance in this setting.
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Affiliation(s)
- Julie M Vose
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Siddhartha Ganguly
- University of Kansas Cancer Center, Westwood, Kansas, USA
- Houston Methodist Hospital and Neal Cancer Center, Houston, Texas, USA
| | - Philip J Bierman
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - R Gregory Bociek
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Matthew Lunning
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Liz Lyden
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jane L Meza
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Paolo F Caimi
- University Hospital Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - James O Armitage
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
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4
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Shimkus G, Nonaka T. Molecular classification and therapeutics in diffuse large B-cell lymphoma. Front Mol Biosci 2023; 10:1124360. [PMID: 36818048 PMCID: PMC9936827 DOI: 10.3389/fmolb.2023.1124360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) encompasses a wide variety of disease states that have to date been subgrouped and characterized based on immunohistochemical methods, which provide limited prognostic value to clinicians and no alteration in treatment regimen. The addition of rituximab to CHOP therapy was the last leap forward in terms of treatment, but regimens currently follow a standardized course when disease becomes refractory with no individualization based on genotype. Research groups are tentatively proposing new strategies for categorizing DLBCL based on genetic abnormalities that are frequently found together to better predict disease course following dysregulation of specific pathways and to deliver targeted treatment. Novel algorithms in combination with next-generation sequencing techniques have identified between 4 and 7 subgroups of DLBCL, depending on the research team, with potentially significant and actionable genetic alterations. Various drugs aimed at pathways including BCR signaling, NF-κB dysfunction, and epigenetic regulation have shown promise in their respective groups and may show initial utility as second or third line therapies to patients with recurrent DLBCL. Implementation of subgroups will allow collection of necessary data to determine which groups are significant, which treatments may be indicated, and will provide better insight to clinicians and patients on specific disease course.
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Affiliation(s)
- Gaelen Shimkus
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA, United States
| | - Taichiro Nonaka
- Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences Center, Shreveport, LA, United States,Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, LA, United States,*Correspondence: Taichiro Nonaka,
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5
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Jiang Y, Sun H, Xu H, Hu X, Wu W, Lv Y, Wang J, Liu S, Zhai Y, Tian L, Wang Y, Zhao Z. Immunophenotypic Landscape and Prognosis-Related mRNA Signature in Diffuse Large B Cell Lymphoma. Front Genet 2022; 13:872001. [PMID: 35754837 PMCID: PMC9214219 DOI: 10.3389/fgene.2022.872001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/20/2022] [Indexed: 11/25/2022] Open
Abstract
Diffuse large B cell lymphoma (DLBCL) exhibits a tightly complexity immune landscape. In this study, we intended to identify different immune phenotype and to examine the immune related mRNA signature for clinical characteristic, therapeutic responsiveness as well as risk stratification and survival prediction in DLBCL. We identified two immune infiltration subtypes of DLBCL patients based on 28 immune cell types. GSEA analysis uncovered the concordant classification of two robust significant subtypes of DLBCL. Considering the convenient application of the immune infiltration subtypes for prognostic prediction, we developed a risk score based on the differentially expressed genes between the Immunity-H and Immunity-L groups. By a least absolute shrinkage and selection operator (LASSO)-Cox regression model, a sixteen-gene risk signature, comprising ANTXR1, CD3D, TIMP1, FPR3, NID2, CTLA4, LPAR6, GPR183, LYZ, PTGDS, ITK, FBN1, FRMD6, PLAU, MICAL2, C1S, was established. The comprehensive results showed that the high-risk group was correlated with lower immune infiltration, more aggressive phenotypes, lower overall survival and more sensitive to lenalidomide. In contrast, a low-risk group score was associated with higher immune infiltration, less aggressive phenotypes, better overall survival and more likely to benefit from PD-1/PD-L1 inhibitors. Finally, a nomogram comprised of the risk score and IPI score was verified to more accurately predict the overall survival of DLBCL than traditional clinical prediction models. Altogether, our data demonstrate the heterogeneity of immune patterns within DLBCL and deepen our molecular understanding of this tumor entity.
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Affiliation(s)
- Yanan Jiang
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Huimeng Sun
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Hong Xu
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xin Hu
- Key Laboratory of Cancer Prevention and Therapy of Tianjin, Key Laboratory of Molecular Cancer Epidemiology, Department of Epidemiology and Biostatistics, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Wenqi Wu
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yangyang Lv
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jinhuan Wang
- Department of Oncology, Institute of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Su Liu
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yixin Zhai
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Linyan Tian
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yafei Wang
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Zhigang Zhao
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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6
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Ward JP, Berrien-Elliott MM, Gomez F, Luo J, Becker-Hapak M, Cashen AF, Wagner-Johnston ND, Maddocks K, Mosior M, Foster M, Krysiak K, Schmidt A, Skidmore ZL, Desai S, Watkins MP, Fischer A, Griffith M, Griffith OL, Fehniger TA, Bartlett NL. Phase 1/dose expansion trial of brentuximab vedotin and lenalidomide in relapsed or refractory diffuse large B-cell lymphoma. Blood 2022; 139:1999-2010. [PMID: 34780623 PMCID: PMC8972094 DOI: 10.1182/blood.2021011894] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 11/02/2021] [Indexed: 11/20/2022] Open
Abstract
New therapies are needed for patients with relapsed/refractory (rel/ref) diffuse large B-cell lymphoma (DLBCL) who do not benefit from or are ineligible for stem cell transplant and chimeric antigen receptor therapy. The CD30-targeted, antibody-drug conjugate brentuximab vedotin (BV) and the immunomodulator lenalidomide (Len) have demonstrated promising activity as single agents in this population. We report the results of a phase 1/dose expansion trial evaluating the combination of BV/Len in rel/ref DLBCL. Thirty-seven patients received BV every 21 days, with Len administered continuously for a maximum of 16 cycles. The maximum tolerated dose of the combination was 1.2 mg/kg BV with 20 mg/d Len. BV/Len was well tolerated with a toxicity profile consistent with their use as single agents. Most patients required granulocyte colony-stimulating factor support because of neutropenia. The overall response rate was 57% (95% CI, 39.6-72.5), complete response rate, 35% (95% CI, 20.7-52.6); median duration of response, 13.1 months; median progression-free survival, 10.2 months (95% CI, 5.5-13.7); and median overall survival, 14.3 months (95% CI, 10.2-35.6). Response rates were highest in patients with CD30+ DLBCL (73%), but they did not differ according to cell of origin (P = .96). NK cell expansion and phenotypic changes in CD8+ T-cell subsets in nonresponders were identified by mass cytometry. BV/Len represents a potential treatment option for patients with rel/ref DLBCL. This combination is being further explored in a phase 3 study (registered on https://clinicaltrials.org as NCT04404283). This trial was registered on https://clinicaltrials.gov as NCT02086604.
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Affiliation(s)
- Jeffrey P Ward
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Melissa M Berrien-Elliott
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Felicia Gomez
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - Jingqin Luo
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Michelle Becker-Hapak
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Amanda F Cashen
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Nina D Wagner-Johnston
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Kami Maddocks
- Division of Hematology, The Ohio State University, Columbus, OH; and
| | - Matthew Mosior
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - Mark Foster
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Kilannin Krysiak
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Alina Schmidt
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - Zachary L Skidmore
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - Sweta Desai
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Marcus P Watkins
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Anne Fischer
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Malachi Griffith
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - Obi L Griffith
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - Todd A Fehniger
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Nancy L Bartlett
- Division of Oncology and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
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7
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Susanibar‐Adaniya S, Barta SK. 2021 Update on Diffuse large B cell lymphoma: A review of current data and potential applications on risk stratification and management. Am J Hematol 2021; 96:617-629. [PMID: 33661537 DOI: 10.1002/ajh.26151] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 12/30/2022]
Abstract
Diffuse large B cell lymphoma (DLBCL), the most common type of Non-Hodgkin lymphoma (NHL), comprises a heterogeneous group of diseases with different biology, clinical presentations, and response to treatment. R-CHOP remains the mainstay of therapy and can achieve long-term disease control in nearly 90% of patients presenting with limited-stage and in up to 60% of those presenting with advanced stages. Advances on the understanding of the genetic landscape and molecular features of DLBCL have identified high-risk subsets with poor outcomes to chemo-immunotherapy that are actively being studied in clinical trials. Novel therapies could potentially improve outcomes for patients with high-risk disease. Studies evaluating risk-adapted therapy based on classification by cell of origin (COO) and molecular features are ongoing. Developments in the fields of immunotherapy, mostly with adoptive T-cell therapy, have significantly improved the outcomes of patients with relapsed refractory disease. In this review, we will summarize the recent data and discuss ongoing efforts to improve DLBCL treatment in the frontline and relapsed refractory settings.
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Affiliation(s)
| | - Stefan K. Barta
- Department of Hematology/Oncology University of Pennsylvania Philadelphia Pennsylvania
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8
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Wang L, Li LR, Young KH. New agents and regimens for diffuse large B cell lymphoma. J Hematol Oncol 2020; 13:175. [PMID: 33317571 PMCID: PMC7734862 DOI: 10.1186/s13045-020-01011-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
As a widely recognized standard regimen, R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) is able to cure two-thirds patients with diffuse large B cell lymphoma (DLBCL), and the remaining patients suffer from refractory or relapsed disease due to resistance to R-CHOP and fare poorly. Unsatisfied outcomes for those relapsed/refractory patients prompted efforts to discover new treatment approaches for DLBCL, including chimeric antigen receptor T cells, bispecific T cell engagers, immunomodulatory drugs, immune checkpoint inhibitors, monoclonal antibodies, antibody-drug conjugates, molecular pathway inhibitors, and epigenetic-modifying drugs. Herein, up-to-date data about the most promising treatment approaches for DLBCL are recapitulated, and novel genetic classification systems are introduced to guide individualized treatment for DLBCL.
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MESH Headings
- Animals
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Drug Development
- Epigenesis, Genetic/drug effects
- Humans
- Immune Checkpoint Inhibitors/pharmacology
- Immune Checkpoint Inhibitors/therapeutic use
- Immunoconjugates/pharmacology
- Immunoconjugates/therapeutic use
- Immunologic Factors/pharmacology
- Immunologic Factors/therapeutic use
- Immunotherapy/methods
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/therapy
- Signal Transduction
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Affiliation(s)
- Liang Wang
- Department of Hematology, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China.
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University & Capital Medical University, Beijing TongRen Hospital, Beijing, 100730, China.
| | - Lin-Rong Li
- Peking Union Medical College Hospital, Beijing, 100560, China
| | - Ken H Young
- Division of Hematopathology, Department of Pathology, Duke University Medical Center and Cancer Institute, Durham, NC, 27710, USA.
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9
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Tanaka N, Imai Y, Yoshinaga K, Shiseki M, Tanaka J. Fractionated ifosfamide, carboplatin, and etoposide with rituximab as a safe and effective treatment for relapsed/refractory diffuse large B cell lymphoma with severe comorbidities. Ann Hematol 2020; 99:2577-2586. [PMID: 32945942 DOI: 10.1007/s00277-020-04267-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/07/2020] [Indexed: 11/24/2022]
Abstract
Although treatment outcomes for diffuse large B cell lymphoma (DLBCL) have improved with the introduction of rituximab, approximately half of patients experience relapsed/refractory (r/r) disease. Furthermore, no standard salvage therapy has yet been established to date, while limitations in treatment options exist due to toxicity and restricted tolerability among elderly patients and/or those with comorbidities. The ICE (ifosfamide, cyclophosphamide, and etoposide) regimen is often used as salvage therapy for r/r DLBCL. Several modified ICE regimens not requiring continuous ifosfamide infusion are available, which can be used in outpatient clinics. This study analyzed the efficacy and toxicity of fractionated ICE with rituximab (f-R-ICE) as a salvage regimen among 47 patients with relapsed/refractory DLBCL (median age upon f-R-ICE initiation, 71 years). The whole cohort had an overall (ORR) and complete response rate of 53.1% (n = 25) and 25.5% (n = 12), respectively, and an estimated 1-year overall survival after f-R-ICE initiation of 57%. Comorbidities were evaluated using the Charlson Comorbidity Index (CCI) upon f-R-ICE initiation. Patients with low CCI scores (68%) had a higher ORR than those with high CCI scores (36.4%) upon f-R-ICE initiation (P = 0.042). In contrast, no significant differences in overall survival (OS) were observed between the low and high CCI groups (1-year OS 56.6% vs. 52.2%; median OS 24 vs. 22.8 months) after initiating f-R-ICE. Our results suggest that f-R-ICE is a safe and effective salvage therapy for r/r DLBCL and can be used for older patients and/or those with high CCI scores in outpatient clinics.
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Affiliation(s)
- Norina Tanaka
- Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoichi Imai
- Department of Hematology/Oncology, Research Hospital, Institute of Medical Science, University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan.
| | - Kentaro Yoshinaga
- Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayuki Shiseki
- Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
| | - Junji Tanaka
- Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
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10
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[Expression of Cereblon/CRBN in diffuse large B-cell lymphoma and its significance for prognosis]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:254-256. [PMID: 32311898 PMCID: PMC7357926 DOI: 10.3760/cma.j.issn.0253-2727.2020.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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11
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Hou K, Yu Z, Jia Y, Fang H, Shao S, Huang L, Feng Y. Efficacy and safety of ibrutinib in diffuse large B-cell lymphoma: A single-arm meta-analysis. Crit Rev Oncol Hematol 2020; 152:103010. [DOI: 10.1016/j.critrevonc.2020.103010] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/26/2020] [Indexed: 01/15/2023] Open
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12
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Abstract
PURPOSE OF REVIEW IMiDs are a class of biologic agents with immunomodulatory, anti-angiogenic, and direct anti-cancer activities. This review summarizes current data on clinical development and application of IMiDs in non-Hodgkin lymphoma (NHL) subtypes, focusing primarily on lenalidomide, with additional discussion on managing common side effects. RECENT FINDINGS Improved upon the prototype thalidomide, the second-generation compound lenalidomide has enhanced immunological and anti-cancer properties with fewer side effects, while next-generation small molecule cereblon/E3 ubiquitin ligase modulator CC-122 is in early clinical studies. Lenalidomide is FDA-approved for treatment of relapsed/refractory mantle cell lymphoma as a single agent, as well as in combination with rituximab for R/R follicular lymphoma and marginal zone lymphoma. In addition, numerous clinical trials of lenalidomide, as single agent, in combination with anti-CD20 antibodies, or in combination with chemoimmunotherapy regimens, have shown promise in aggressive and indolent NHL in both the upfront and relapsed/refractory setting. As clinical trials with lenalidomide continue to find success in both indolent and aggressive lymphomas, IMiDs are poised to be important building blocks for combinatorial strategies with antibodies, chemotherapy, novel target agents, and emerging immunotherapy involving immune checkpoint inhibitors and chimeric antigen receptor T cell (CAR-T) therapy. Delineation of treatment-specific and disease-specific biomarkers is an important research objective to gain insight into potential mechanisms of action, and to guide future clinical development.
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Affiliation(s)
- Samuel Yamshon
- Division of Hematology and Medical Oncology, Department of Medicine, Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, 1305 York Avenue, New York, NY, 10021, USA
| | - Jia Ruan
- Division of Hematology and Medical Oncology, Department of Medicine, Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, 1305 York Avenue, New York, NY, 10021, USA.
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13
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B-cell non-Hodgkin lymphoma: importance of angiogenesis and antiangiogenic therapy. Angiogenesis 2020; 23:515-529. [PMID: 32451774 DOI: 10.1007/s10456-020-09729-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/11/2020] [Indexed: 02/06/2023]
Abstract
Angiogenesis is critical for the initiation and progression of solid tumors, as well as hematological malignancies. While angiogenesis in solid tumors has been well characterized, a large body of investigation is devoted to clarify the impact of angiogenesis on lymphoma development. B-cell non-Hodgkin lymphoma (B-NHL) is the most common lymphoid malignancy with a highly heterogeneity. The malignancy remains incurable despite that the addition of rituximab to conventional chemotherapies provides substantial improvements. Several angiogenesis-related parameters, such as proangiogenic factors, circulating endothelial cells, microvessel density, and tumor microenvironment, have been identified as prognostic indicators in different types of B-NHL. A better understanding of how these factors work together to facilitate lymphoma-specific angiogenesis will help to design better antiangiogenic strategies. So far, VEGF-A monoclonal antibodies, receptor tyrosine kinase inhibitors targeting VEGF receptors, and immunomodulatory drugs with antiangiogenic activities are being tested in preclinical and clinical studies. This review summarizes recent advances in the understanding of the role of angiogenesis in B-NHL, and discusses the applications of antiangiogenic therapies.
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14
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Kühnl A, Peckitt C, Patel B, Ardeshna KM, Macheta MP, Radford J, Johnson R, Paneesha S, Barton S, Chau I, Begum R, Valeri N, Wotherspoon A, Du Y, Zerizer I, Cunningham D. R-GEM-Lenalidomide versus R-GEM-P as second-line treatment of diffuse large B-cell lymphoma: results of the UK NRCI phase II randomised LEGEND trial. Ann Hematol 2020; 99:105-112. [PMID: 31776726 DOI: 10.1007/s00277-019-03842-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/05/2019] [Indexed: 01/25/2023]
Abstract
Outcome of patients with relapsed/refractory (r/r) diffuse large B-cell lymphoma (DLBCL) remains poor, highlighting the need for novel treatment approaches. The multicentre randomised phase II LEGEND trial evaluated lenalidomide in combination with rituximab, methylprednisolone and gemcitabine (R-GEM-L) vs. standard R-GEM-P as second-line treatment of DLBCL. The study closed early to recruitment after the planned interim analysis failed to demonstrate a complete response (CR) rate of ≥ 40% in either arm. Among 34 evaluable patients, 7/18 (38.9%) achieved CR with R-GEM-L and 3/16 (18.8%) with R-GEM-P. Median event-free and overall survival was 3.5/3.8 months and 10.8/8.3 months for R-GEM-L and R-GEM-P, respectively. The incidence of grade ≥ 3 toxicities was 52% in R-GEM-L and 83% in R-GEM-P. Efficacy and tolerability of R-GEM-L seem comparable with R-GEM-P and other standard salvage therapies, but a stringent design led to early trial closure. Combination of lenalidomide with gemcitabine-based regimens should be further evaluated in r/r DLBCL.
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Affiliation(s)
- Andrea Kühnl
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, UK
| | - Clare Peckitt
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
| | - Bijal Patel
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
| | | | | | - John Radford
- University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | - Sarah Barton
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
- Wellington Blood and Cancer Centre, Wellington, New Zealand
| | - Ian Chau
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
| | - Ruwaida Begum
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
| | - Nicola Valeri
- Division of Molecular Pathology, The Institute of Cancer Research, Surrey, UK
| | - Andrew Wotherspoon
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
| | - Yong Du
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
| | - Imene Zerizer
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
| | - David Cunningham
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK.
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15
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Lekakis LJ, Moskowitz CH. The Role of Autologous Stem Cell Transplantation in the Treatment of Diffuse Large B-cell Lymphoma in the Era of CAR-T Cell Therapy. Hemasphere 2019; 3:e295. [PMID: 31976472 PMCID: PMC6924546 DOI: 10.1097/hs9.0000000000000295] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 12/29/2022] Open
Abstract
For many years now and based on the results of the PARMA trial, relapsed Diffuse Large B-cell Lymphoma (DLBCL) is treated with salvage combination cytotoxic chemotherapy (most often platinum-based) followed by high dose myeloablative chemotherapy and autologous stem cell transplantation (auto-HCT). This approach has resulted in long-term disease free survival in about half of the patients. With the incorporation of rituximab in the upfront treatment (RCHOP), more patients with DLBCL are cured but there has been a signal of inferior outcomes with auto-HCT if DLBCL relapses. Nevertheless, a careful review of the literature still shows very good outcomes with auto-HCT for DLBCL with complete remission to salvage chemotherapy. For those who do not respond well to classic salvage other approaches are reviewed here including chimeric antigen receptor (CAR) T-cell therapy and treatment with antibody-drug conjugates (ADCs) as well as bispecific T-cell engagers (BiTEs). The outcome of auto-HCT after successful treatment with ADCs or BITEs is unknown. It is also unknown if CAR-T cell therapy should be reserved for those who have failed 2 lines of chemotherapy or it should be moved earlier. Finally, we review here the effects of Myc and bcl2 amplifications or translocations to the outcome of the auto-HCT. Some attempts to improve the salvage or conditioning regimens are mentioned. We also discuss the role of allogeneic stem cell transplantation (allo-HCT) in the paradigm of treatment for relapsed DLBCL.
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16
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Miao Y, Medeiros LJ, Li Y, Li J, Young KH. Genetic alterations and their clinical implications in DLBCL. Nat Rev Clin Oncol 2019; 16:634-652. [PMID: 31127191 DOI: 10.1038/s41571-019-0225-1] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Diffuse large B cell lymphoma (DLBCL) is a highly heterogeneous lymphoid neoplasm with variations in gene expression profiles and genetic alterations, which lead to substantial variations in clinical course and response to therapy. The advent of high-throughput genome sequencing platforms, and especially whole-exome sequencing, has helped to define the genetic landscape of DLBCL. In the past 10 years, these studies have identified many genetic alterations in DLBCL, some of which are specific to B cell lymphomas, whereas others can also be observed in other types of cancer. These aberrations result in altered activation of a wide range of signalling pathways and other cellular processes, including those involved in B cell differentiation, B cell receptor signalling, activation of the NF-κB pathway, apoptosis and epigenetic regulation. Further elaboration of the genetics of DLBCL will not only improve our understanding of disease pathogenesis but also provide further insight into disease classification, prognostication and therapeutic targets. In this Review, we describe the current understanding of the prevalence and causes of specific genetic alterations in DLBCL and their role in disease development and progression. We also summarize the available clinical data on therapies designed to target the aberrant pathways driven by these alterations.
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Affiliation(s)
- Yi Miao
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yong Li
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jianyong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Ken H Young
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Graduate School of Biomedical Sciences, University of Texas Health Science Center, Houston, TX, USA.
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17
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Nowakowski GS, Feldman T, Rimsza LM, Westin JR, Witzig TE, Zinzani PL. Integrating precision medicine through evaluation of cell of origin in treatment planning for diffuse large B-cell lymphoma. Blood Cancer J 2019; 9:48. [PMID: 31097684 PMCID: PMC6522601 DOI: 10.1038/s41408-019-0208-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/08/2019] [Indexed: 12/12/2022] Open
Abstract
Precision medicine is modernizing strategies for clinical study design to help improve diagnoses guiding individualized treatment based on genetic or phenotypic characteristics that discriminate between patients with similar clinical presentations. Methodology to personalize treatment choices is being increasingly employed in clinical trials, yielding favorable correlations with improved response rates and survival. In patients with diffuse large B-cell lymphoma (DLBCL), disease characteristics and outcomes may vary widely, underscoring the importance of patient classification through identification of sensitive prognostic features. The discovery of distinct DLBCL molecular subtypes based on cell of origin (COO) is redefining the prognosis and treatment of this heterogeneous cancer. Owing to significant molecular and clinical differences between activated B-cell-like (ABC)- and germinal center B-cell-like (GCB)-DLBCL subtypes, COO identification offers opportunities to optimize treatment selection. Widespread adoption of COO classification would greatly improve treatment and prognosis; however, limitations in interlaboratory concordance between immunohistochemistry techniques, cost, and availability of gene expression profiling tools undermine universal integration in the clinical setting. With advanced methodology to determine COO in a real-world clinical setting, therapies targeted to specific subtypes are under development. The focus here is to review applications of precision medicine exemplified by COO determination in DLBCL patients.
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Affiliation(s)
| | - Tatyana Feldman
- Division of Lymphoma, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | - Lisa M Rimsza
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | - Jason R Westin
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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18
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Venous thromboembolism in patients with B-cell non-Hodgkin lymphoma treated with lenalidomide: a systematic review and meta-analysis. Blood Adv 2019; 2:1429-1438. [PMID: 29934343 DOI: 10.1182/bloodadvances.2018016683] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 05/25/2018] [Indexed: 12/17/2022] Open
Abstract
Lenalidomide is associated with increased risk of thromboembolism (VTE) in patients with multiple myeloma. This risk has not previously been defined in B-cell non-Hodgkin lymphoma (NHL), for which lenalidomide is also an active agent. We conducted a systematic literature search in Ovid MEDLINE (1946 to February 2017), Ovid EMBASE (1974 to February 2017), The Cochrane Library (Wiley), and Web of Science Core Collection for prospective studies evaluating lenalidomide-containing regimens in B-cell NHL with adequate reporting of patient characteristics, total cycles received, and safety data including VTE rates. The primary outcome was VTE events per 100 patient-cycles by meta-analysis using random-effects models. Our literature search identified 1719 citations; 28 articles were included. For all patients with B-cell NHL receiving lenalidomide, the rate of VTE per 100 patient-cycles was 0.77 (95% confidence interval [CI], 0.48-1.12; I2, 67%). The rate for single-agent lenalidomide was 1.09 events per 100 patient-cycles (95% CI, 0.49-1.94; I2, 76%), the rate for lenalidomide plus biologics was 0.49 (95% CI, 0.17-0.97; I2, 59%), and the rate for lenalidomide plus chemotherapy was 0.89 (95% CI, 0.39-1.60; I2, 57%). Rate of VTE events in B-cell NHL patients treated with lenalidomide in clinical trials is similar to the rate in multiple myeloma. The VTE rate appears to be lowest for lenalidomide combined with a biologic compared with single-agent lenalidomide or its combination with chemotherapy. This protocol was registered at www.crd.york.ac.uk/prospero/ as #CRD42017056042.
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19
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Strategies to improve outcomes of autologous hematopoietic cell transplant in lymphoma. Bone Marrow Transplant 2018; 54:943-960. [PMID: 30390059 DOI: 10.1038/s41409-018-0378-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/05/2018] [Accepted: 09/30/2018] [Indexed: 11/08/2022]
Abstract
High-dose chemotherapy and autologous hematopoietic cell transplantation (HDT-AHCT) remains an effective therapy in lymphoma. Over the past several decades, HDT with BEAM (carmustine, etoposide, cytarabine, and melphalan) and CBV (cyclophosphamide, carmustine, and etoposide) have been the most frequently used preparatory regimens for AHCT in Hodgkin (HL) and non-Hodgkin lymphoma (NHL). This article reviews alternative combination conditioning regimens, as well as novel transplant strategies that have been developed, to reduce transplant-related toxicity while maintaining or improving efficacy. These data demonstrate that incorporation of maintenance therapy posttransplant might be the best way to improve outcomes.
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20
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Luo B, Gu YY, Wang XD, Chen G, Peng ZG. Identification of potential drugs for diffuse large b-cell lymphoma based on bioinformatics and Connectivity Map database. Pathol Res Pract 2018; 214:1854-1867. [PMID: 30244948 DOI: 10.1016/j.prp.2018.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/28/2018] [Accepted: 09/14/2018] [Indexed: 12/17/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most main subtype in non-Hodgkin lymphoma. After chemotherapy, about 30% of patients with DLBCL develop resistance and relapse. This study was to identify potential therapeutic drugs for DLBCL using the bioinformatics method. The differentially expressed genes (DEGs) between DLBCL and non-cancer samples were downloaded from the Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO). Gene ontology enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis of DEGs were analyzed using the Database for Annotation, Visualization, and Integrated Discovery. The R software package (SubpathwayMiner) was used to perform pathway analysis on DEGs affected by drugs found in the Connectivity Map (CMap) database. Protein-protein interaction (PPI) networks of DEGs were constructed using the Search Tool for the Retrieval of Interacting Genes online database and Cytoscape software. In order to identify potential novel drugs for DLBCL, the DLBCL-related pathways and drug-affected pathways were integrated. The results showed that 1927 DEGs were identified from TCGA and GEO. We found 54 significant pathways of DLBCL using KEGG pathway analysis. By integrating pathways, we identified five overlapping pathways and 47 drugs that affected these pathways. The PPI network analysis results showed that the CDK2 is closely associated with three overlapping pathways (cell cycle, p53 signaling pathway, and small cell lung cancer). The further literature verification results showed that etoposide, rinotecan, methotrexate, resveratrol, and irinotecan have been used as classic clinical drugs for DLBCL. Anisomycin, naproxen, gossypol, vorinostat, emetine, mycophenolic acid and daunorubicin also act on DLBCL. It was found through bioinformatics analysis that paclitaxel in the drug-pathway network can be used as a potential novel drug for DLBCL.
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Affiliation(s)
- Bin Luo
- Department of Medical Oncology, First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, PR China
| | - Yong-Yao Gu
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, PR China
| | - Xiao-Dong Wang
- The Ultrasonics Division of Radiology Department, First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, PR China
| | - Gang Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, PR China
| | - Zhi-Gang Peng
- Department of Medical Oncology, First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, PR China.
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21
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Sorigue M, Orna E, Sancho JM. Venous thromboembolism in patients with non-Hodgkin lymphoma or chronic lymphocytic leukemia treated with lenalidomide: a systematic review. Leuk Lymphoma 2018; 59:2602-2611. [PMID: 29561206 DOI: 10.1080/10428194.2018.1448085] [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: 10/17/2022]
Abstract
Lenalidomide has been associated with an increased risk of venous thromboembolism (VTE) in multiple myeloma. It is unclear whether patients with non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL) are also at such risk. We conducted a systematic review of the incidence of VTE in prospective trials of lenalidomide-treated patients with NHL or CLL. Sixty-eight unique reports were assessed for inclusion. For grade ≥3 VTE, 98 events were reported in 3043 patients (60 studies) (crude incidence: 3.22% [95% confidence interval: 2.6-3.9%]). For any grade VTE, 97 events were reported in 2244 patients (46 studies) (crude incidence: 4.32% [3.5-5.2%]). Subgroup analysis showed no difference based on histological subtype or use of prophylaxis. The study is at risk of bias, largely due to insufficient data from the individual studies. Within the limitations of this systematic review, we found a low risk of VTE in patients with NHL treated with lenalidomide.
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Affiliation(s)
- Marc Sorigue
- a Department of Hematology , ICO-Hospital Germans Trias i Pujol. Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona , Badalona , Spain
| | - Elisa Orna
- a Department of Hematology , ICO-Hospital Germans Trias i Pujol. Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona , Badalona , Spain
| | - Juan-Manuel Sancho
- a Department of Hematology , ICO-Hospital Germans Trias i Pujol. Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona , Badalona , Spain
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22
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A phase 1 study of ibrutinib in combination with R-ICE in patients with relapsed or primary refractory DLBCL. Blood 2018; 131:1805-1808. [PMID: 29386196 DOI: 10.1182/blood-2017-08-802561] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/15/2018] [Indexed: 01/03/2023] Open
Abstract
In the postrituximab era, approximately half of the patients with relapsed or refractory (rel/ref) diffuse large B-cell lymphoma (DLBCL) fail to achieve a chemosensitive response to standard salvage therapy, and are thus ineligible to proceed to autologous stem cell transplantation with curative intent. The Bruton tyrosine kinase inhibitor ibrutinib demonstrates single-agent activity in rel/ref DLBCL, particularly of non-germinal center (non-GC) cell of origin. We conducted a single-center phase 1 study evaluating dose-escalated ibrutinib, in a 3-by-3 design, in combination with rituximab, ifosfamide, carboplatin, and etoposide (R-ICE) in physiologically transplant-eligible rel/ref DLBCL patients. Twenty-one patients have been treated and are evaluable for toxicity with no dose-limiting toxicities observed through expansion with ibrutinib at 840 mg daily at dose level 3. Of the 20 patients evaluable for response, per modern International Conference on Malignant Lymphoma criteria, 11 patients achieved complete remission (CR) and 7 patients achieved partial remission for an overall response rate of 90%. All evaluable patients with non-GC DLBCL achieved a metabolic CR. Ibrutinib in combination with R-ICE demonstrates tolerability and efficacy in rel/ref DLBCL, particularly of non-GC phenotype. This treatment program warrants further investigation in later-phase studies. This trial was registered at www.clinicaltrials.gov as #NCT02219737.
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23
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Dada R. Lenalidomide Maintenance after R-CHOP Therapy in Diffuse Large B-Cell Lymphoma: Can It Be a Standard of Care. Acta Haematol 2017; 138:216-220. [PMID: 29212067 DOI: 10.1159/000484515] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/24/2017] [Indexed: 01/02/2023]
Abstract
Diffuse large B-cell lymphoma is an aggressive non-Hodgkin lymphoma subtype which requires immediate treatment. Standard treatment is usually a combined immune chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Since R-CHOP was approved, several attempts to combine it with novel agents and/or use them as maintenance therapy failed to improve the outcome. Recently, maintenance with lenalidomide after standard immune chemotherapy showed promising results. This review discusses the most pertinent published and running studies, analyzing study design, results, and practicality.
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Affiliation(s)
- Reyad Dada
- King Faisal Specialist Hospital and Research Center, Jeddah, and College of Medicine, Al-Faisal University, Riyadh, Kingdom of Saudi Arabia
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Ferreri AJM, Sassone M, Zaja F, Re A, Spina M, Rocco AD, Fabbri A, Stelitano C, Frezzato M, Rusconi C, Zambello R, Couto S, Ren Y, Arcari A, Bertoldero G, Nonis A, Scarfò L, Calimeri T, Cecchetti C, Chiozzotto M, Govi S, Ponzoni M. Lenalidomide maintenance in patients with relapsed diffuse large B-cell lymphoma who are not eligible for autologous stem cell transplantation: an open label, single-arm, multicentre phase 2 trial. LANCET HAEMATOLOGY 2017; 4:e137-e146. [DOI: 10.1016/s2352-3026(17)30016-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 12/24/2022]
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Coiffier B, Sarkozy C. Diffuse large B-cell lymphoma: R-CHOP failure-what to do? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:366-378. [PMID: 27913503 PMCID: PMC6142522 DOI: 10.1182/asheducation-2016.1.366] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Although rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is the standard treatment for patients with diffuse large B-cell lymphoma (DLBCL), ∼30% to 50% of patients are not cured by this treatment, depending on disease stage or prognostic index. Among patients for whom R-CHOP therapy fails, 20% suffer from primary refractory disease (progress during or right after treatment) whereas 30% relapse after achieving complete remission (CR). Currently, there is no good definition enabling us to identify these 2 groups upon diagnosis. Most of the refractory patients exhibit double-hit lymphoma (MYC-BCL2 rearrangement) or double-protein-expression lymphoma (MYC-BCL2 hyperexpression) which have a more aggressive clinical picture. New strategies are currently being explored to obtain better CR rates and fewer relapses. Although young relapsing patients are treated with high-dose therapy followed by autologous transplant, there is an unmet need for better salvage regimens in this setting. To prevent relapse, maintenance therapy with immunomodulatory agents such as lenalidomide is currently undergoing investigation. New drugs will most likely be introduced over the next few years and will probably be different for relapsing and refractory patients.
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Affiliation(s)
- Bertrand Coiffier
- Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Clémentine Sarkozy
- Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
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Tavernier-Tardy E, Cornillon J, Molucon-Chabrot C, Cahn JY, Tinquaut F, Bourmaud A, Guyotat D, Thomas X. A phase 1/2 trial of lenalidomide and dexamethasone in adult patients with refractory/relapsed acute lymphoblastic leukemia. ACTA ACUST UNITED AC 2016; 22:217-223. [PMID: 27848278 DOI: 10.1080/10245332.2016.1255372] [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: 10/20/2022]
Abstract
OBJECTIVES Adult patients with refractory/relapsed ALL have poor survival outcomes with current chemotherapies. We aimed to determine safety and efficacy of lenalidomide, an oral immunomodulator, in these patients. METHODS This phase 1/2 trial (EUDRACT # 2009-009372-13) included 10 patients who received 28-day cycles of oral lenalidomide 25 mg/day, days 1 through 21, in combination with oral dexamethasone 40 mg/day on days 1, 8, 15, 22. Primary endpoints were tolerance and the overall response rate (ORR). Secondary endpoints included overall survival (OS) and quality of life. RESULTS The most common grade 3 or 4 adverse events were myelosuppression. The ORR among the participants who could be evaluated was 28.6% (95% confidence interval [CI], 0-62.2%). The median OS was 92 days (range, 43-133 days). All patients have died because of progressive disease. Quality of life remains stable during treatment cycles. DISCUSSION AND CONCLUSION The safety of combination therapy consisting of lenalidomide plus dexamethasone is consistent with ambulatory administration. Efficacy should be reevaluated in a larger series including patients less intensively previously treated.
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Affiliation(s)
- E Tavernier-Tardy
- a Hematology Unit , Institut de Cancérologie de la Loire , Saint Priest en Jarez , France
| | - J Cornillon
- a Hematology Unit , Institut de Cancérologie de la Loire , Saint Priest en Jarez , France
| | | | - J Y Cahn
- c Hematology Unit , CHU , Grenoble , France
| | - F Tinquaut
- d Public Health department , Institut de Cancérologie de la Loire , Saint Priest en Jarez , France
| | - A Bourmaud
- d Public Health department , Institut de Cancérologie de la Loire , Saint Priest en Jarez , France
| | - D Guyotat
- a Hematology Unit , Institut de Cancérologie de la Loire , Saint Priest en Jarez , France
| | - X Thomas
- e Hematology Unit , CHU Hospices Civils de Lyon , Lyon , France
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Klinger M, Benjamin J, Kischel R, Stienen S, Zugmaier G. Harnessing T cells to fight cancer with BiTE® antibody constructs--past developments and future directions. Immunol Rev 2016; 270:193-208. [PMID: 26864113 DOI: 10.1111/imr.12393] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Bispecific T-cell engager (BiTE(®)) antibody constructs represent a novel immunotherapy that bridges cytotoxic T cells to tumor cells, thereby inducing target cell-dependent polyclonal T-cell activation and proliferation, and leading to apoptosis of bound tumor cells. Anti-CD19 BiTE(®) blinatumomab has demonstrated clinical activity in Philadelphia chromosome (Ph)-negative relapsed or refractory (r/r) acute lymphoblastic leukemia (ALL) eventually resulting in conditional approval by the U.S. Food and Drug Administration in 2014. This drug is currently further developed in pediatric and Ph(+) r/r, as well as in minimal residual disease-positive ALL, and might also offer clinical benefit for patients with non-Hodgkin's lymphoma, especially for those with aggressive forms like diffuse large B-cell lymphoma. Another BiTE(®) antibody construct in hemato-oncology designated AMG 330 targets CD33 on acute myeloid leukemia blast cells. After showing promising ex vivo activity, this drug candidate has recently entered phase 1 clinical development, and has further indicated potential for combination with checkpoint inhibitors. In solid tumor indications, three BiTE(®) antibody constructs have been tested in phase 1 studies so far: anti-EpCAM BiTE(®) AMG 110, anti-CEA BiTE(®) MEDI-565/AMG 211, and anti-PSMA BiTE(®) BAY2010112/AMG 212. Pertinent questions comprise how to maximize BiTE(®) penetration and T-cell infiltration of the tumor while simultaneously minimizing any adverse events, which is currently explored by a continuous intravenous infusion approach. Thus, BiTE(®) antibody constructs will hopefully provide new treatment options for patients in several indications with high unmet medical need.
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Ping LY, Song YQ, Zheng W, Wang XP, Xie Y, Lin NJ, Tu MF, Ying ZT, Liu WP, Zhang C, Deng LJ, Zhu J. [Efficacy and survival analysis of DICE regimen for 97 patients with relapsed or refractory Non-Hodgkin's lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:790-794. [PMID: 27719723 PMCID: PMC7342104 DOI: 10.3760/cma.j.issn.0253-2727.2016.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
目的 观察DICE方案(顺铂+异环磷酰胺+依托泊苷+地塞米松)治疗复发/难治非霍奇金淋巴瘤(NHL)患者的疗效和安全性。 方法 回顾性分析2008年9月1日至2013年12月31日在北京大学肿瘤医院接受DICE方案治疗的97例复发/难治NHL患者的临床资料。 结果 ①97例患者中男64例(65.08%),女33例(34.02%),中位年龄49(13~84)岁。T细胞淋巴瘤9例,B细胞淋巴瘤88例[其中弥漫大B细胞淋巴瘤(DLBCL)71例(73.20%)]。难治(原发耐药)60例(61.86%),一线治疗后复发37例。35例B细胞淋巴瘤患者联合应用利妥昔单抗。26例患者在挽救化疗结束后行自体造血干细胞移植(auto-HSCT)。②治疗后达到完全缓解(CR)、部分缓解(PR)患者分别为22、24例,总有效率(ORR)为47.42%(46/97)。复发组ORR高于难治组[67.57%(25/37)对35.00%(21/60),χ2=9.736,P= 0.002]。③全部97例患者中位随访时间为15.0 (1.5~80.0)个月,预期中位无进展生存(PFS)、总生存(OS)时间分别为12.0(95%CI 5.0~19.0)、26.0 (95%CI 6.0~45.9)个月。④auto-HSCT组(26例)与非auto-HSCT组(71例)中位OS时间差异无统计学意义[41.0 (95%CI 8.9~73.1)对22.0(95%CI 8.5~35.5)个月,P=0.361]。DICE方案获得CR/PR患者(46例)中位OS时间长于疾病稳定/进展患者(51例)(56.0个月对18.5个月,P<0.001)。利妥昔单抗组的中位OS时间长于非利妥昔单抗组(51.5个月对28.5个月,P=0.041)。多因素分析结果显示DICE方案近期疗效是OS的独立预后因素[HR=4.24 (95%CI 2.12~8.50),P<0.001]。⑤82例(84.54%)患者出现粒细胞减少,43例(41.24%)患者出现血小板减少,66例(68.04%)出现贫血,14例(14.43%)出现肝功能损伤,1例出现急性肾功能损伤,64例(65.98%)出现不同程度的消化道反应。无治疗相关死亡。 结论 DICE方案治疗复发/难治NHL患者有效,安全性良好;DICE方案治疗有效(CR/PR)的患者预期生存较好;DICE联合利妥昔单抗可延长B细胞淋巴瘤患者OS时间。
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Affiliation(s)
- L Y Ping
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education) , Peking University School of Clinical Oncology, Beijing Cancer Hospital, Beijing Institute for Cancer Research, Beijing 100142, China
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Garciaz S, Coso D, Schiano de Colella JM, Bouabdallah R. Lenalidomide for the treatment of B-cell lymphoma. Expert Opin Investig Drugs 2016; 25:1103-16. [PMID: 27414850 DOI: 10.1080/13543784.2016.1208170] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Although the combination of an anti-CD20 monoclonal antibody and chemotherapy has widely improved survival of patients with B-cell lymphoma, the disease still relapses. A better understanding of the biology of lymphomas has highlighted the role of the cell of origin in response to treatment and outcome. Lenalidomide represents an attractive therapeutic option due to its original mechanism of action. AREAS COVERED In this review, the authors describe the pharmacological properties of lenalidomide, and the rational for its use in B-cell lymphomas; focusing on diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), and mantle cell lymphoma (MCL). They discuss the mechanism of action of the drug and its current and future clinical development. They also review the current data in relapsed/refractory situations as well as in first-line treatment. EXPERT OPINION Lenalidomide is an oral non-chemotherapy immunomodulatory agent with an acceptable toxicity profile and manageable side-effects. Efficacy has widely been demonstrated, especially in MCL, FL and non-Germinal Center DLBCL patients. Further studies are now warranted to better define the strategy for the use of lenalidomide in B-NHL patients, and clarify which subgroup of patients will really benefit of lenalidomide as part of first-line treatment or in a relapsed/refractory setting.
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Affiliation(s)
- Sylvain Garciaz
- a Department of Hematology, Institut Paoli-Calmettes , Université de la Méditerranée , Marseille , France
| | - Diane Coso
- a Department of Hematology, Institut Paoli-Calmettes , Université de la Méditerranée , Marseille , France
| | | | - Réda Bouabdallah
- a Department of Hematology, Institut Paoli-Calmettes , Université de la Méditerranée , Marseille , France
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Martín A, Redondo AM, Dlouhy I, Salar A, González-Barca E, Canales M, Montes-Moreno S, Ocio EM, López-Guillermo A, Caballero D. Lenalidomide in combination with R-ESHAP in patients with relapsed or refractory diffuse large B-cell lymphoma: a phase 1b study from GELTAMO group. Br J Haematol 2016; 173:245-52. [DOI: 10.1111/bjh.13945] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/07/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Alejandro Martín
- Department of Haematology; Hospital Universitario de Salamanca-IBSAL; Salamanca Spain
| | - Alba M. Redondo
- Department of Haematology; Hospital Universitario de Salamanca-IBSAL; Salamanca Spain
| | - Iván Dlouhy
- Department of Haematology; Hospital Clinic; Barcelona Spain
| | - Antonio Salar
- Department of Haematology; Hospital del Mar; Barcelona Spain
| | - Eva González-Barca
- Department of Haematology; Institut Català D'Oncologia Duran I Reynals; L'Hospitalet de Llobregat Spain
| | - Miguel Canales
- Department of Haematology; Hospital Universitario La Paz; Madrid Spain
| | - Santiago Montes-Moreno
- Department of Pathology; Hospital Universitario Marqués de Valdecilla; IFIMAV; Santander Spain
| | - Enrique M. Ocio
- Department of Haematology; Hospital Universitario de Salamanca-IBSAL; Salamanca Spain
- Centro de Investigación del Cáncer; IBMCC/CSIC-Universidad de Salamanca; Salamanca Spain
| | | | - Dolores Caballero
- Department of Haematology; Hospital Universitario de Salamanca-IBSAL; Salamanca Spain
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Camicia R, Winkler HC, Hassa PO. Novel drug targets for personalized precision medicine in relapsed/refractory diffuse large B-cell lymphoma: a comprehensive review. Mol Cancer 2015; 14:207. [PMID: 26654227 PMCID: PMC4676894 DOI: 10.1186/s12943-015-0474-2] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 08/26/2015] [Indexed: 02/07/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a clinically heterogeneous lymphoid malignancy and the most common subtype of non-Hodgkin's lymphoma in adults, with one of the highest mortality rates in most developed areas of the world. More than half of DLBLC patients can be cured with standard R-CHOP regimens, however approximately 30 to 40 % of patients will develop relapsed/refractory disease that remains a major cause of morbidity and mortality due to the limited therapeutic options.Recent advances in gene expression profiling have led to the identification of at least three distinct molecular subtypes of DLBCL: a germinal center B cell-like subtype, an activated B cell-like subtype, and a primary mediastinal B-cell lymphoma subtype. Moreover, recent findings have not only increased our understanding of the molecular basis of chemotherapy resistance but have also helped identify molecular subsets of DLBCL and rational targets for drug interventions that may allow for subtype/subset-specific molecularly targeted precision medicine and personalized combinations to both prevent and treat relapsed/refractory DLBCL. Novel agents such as lenalidomide, ibrutinib, bortezomib, CC-122, epratuzumab or pidilizumab used as single-agent or in combination with (rituximab-based) chemotherapy have already demonstrated promising activity in patients with relapsed/refractory DLBCL. Several novel potential drug targets have been recently identified such as the BET bromodomain protein (BRD)-4, phosphoribosyl-pyrophosphate synthetase (PRPS)-2, macrodomain-containing mono-ADP-ribosyltransferase (ARTD)-9 (also known as PARP9), deltex-3-like E3 ubiquitin ligase (DTX3L) (also known as BBAP), NF-kappaB inducing kinase (NIK) and transforming growth factor beta receptor (TGFβR).This review highlights the new insights into the molecular basis of relapsed/refractory DLBCL and summarizes the most promising drug targets and experimental treatments for relapsed/refractory DLBCL, including the use of novel agents such as lenalidomide, ibrutinib, bortezomib, pidilizumab, epratuzumab, brentuximab-vedotin or CAR T cells, dual inhibitors, as well as mechanism-based combinatorial experimental therapies. We also provide a comprehensive and updated list of current drugs, drug targets and preclinical and clinical experimental studies in DLBCL. A special focus is given on STAT1, ARTD9, DTX3L and ARTD8 (also known as PARP14) as novel potential drug targets in distinct molecular subsets of DLBCL.
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Affiliation(s)
- Rosalba Camicia
- Institute of Veterinary Biochemistry and Molecular Biology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.,Stem Cell Research Laboratory, NHS Blood and Transplant, Nuffield Division of Clinical, Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK.,MRC-UCL Laboratory for Molecular Cell Biology Unit, University College London, Gower Street, London, WC1E6BT, UK
| | - Hans C Winkler
- Institute of Veterinary Biochemistry and Molecular Biology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.,Institute of Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland
| | - Paul O Hassa
- Institute of Veterinary Biochemistry and Molecular Biology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
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Wong KK, Ch'ng ES, Loo SK, Husin A, Muruzabal MA, Møller MB, Pedersen LM, Pomposo MP, Gaafar A, Banham AH, Green TM, Lawrie CH. Low HIP1R mRNA and protein expression are associated with worse survival in diffuse large B-cell lymphoma patients treated with R-CHOP. Exp Mol Pathol 2015; 99:537-45. [DOI: 10.1016/j.yexmp.2015.08.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/31/2015] [Indexed: 10/23/2022]
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Salihoglu A, Ar MC, Soysal T. Novelties in the management of B-cell malignancies: B-cell receptor signaling inhibitors and lenalidomide. Expert Rev Hematol 2015; 8:765-83. [PMID: 26413907 DOI: 10.1586/17474086.2015.1091301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
B-cell lymphoproliferative disorders comprise 85% of Non-Hodgkin's lymphomas. Despite successful chemoimmunotherapy regimens, responses are not durable and the outcome is fatal in a considerable portion of patients. There is an inevitable need for less toxic and more potent therapeutic agents. Over the recent years, a plethora of agents including monoclonal antibodies, Bcl-2 antagonists, tyrosine kinase inhibitors, cyclin-dependent kinase inhibitors, mTOR inhibitors and immunomodulatory drugs have been developed in B-cell malignancies. The aim of this paper is to focus on B-cell receptor signaling inhibitors and lenalidomide as an immunomodulatory drug and to provide insight on how and when to incorporate these agents into the treatment algorithms.
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Affiliation(s)
- Ayse Salihoglu
- a Department of Internal Medicine, Division of Haematology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Muhlis Cem Ar
- a Department of Internal Medicine, Division of Haematology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Fang C, Zhu D, Dong H, Ji M, Wu J, Xu X, Cheng G, Wu C, Jiang J. Lenalidomide alone or in combination with chemotherapy treatment for subtypes of diffuse large B cell lymphoma: a systematic review and meta-analysis. Int J Clin Exp Med 2015; 8:10705-10713. [PMID: 26379862 PMCID: PMC4565245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/06/2015] [Indexed: 06/05/2023]
Abstract
Lenalidomide has been shown to produce durable responses in patients with relapsed or refractory diffuse large B cell lymphoma (DLBCL). In order to gain better understanding of the efficacy of lenalidomide and compared the difference in clinical outcome between two subtypes of DLBCL. Seven eligible trials involving 375 adult patients were included in this meta-analysis. The patients in non-germinal center B-cell (non-GCB) subtype had higher overall response (OR) rate compared with GCB patients (P=0.21). In subgroup analysis, as first-line and second-line treatment for DLBCL patient, GCB DLBCL did not show significantly better outcome compared with non-GCB subtype patients (P=0.96; P=0.27). More importantly, after lenalidomide treatment, the patients with non-GCB DLBCL did not show significantly worse progression-free survival (PFS) and overall survival (OS) compared with GCB subtype. Lenalidomide as treatments for DLBCL patients, non-GCB DLBCL patients did not show significantly worse prognosis compared with GCB DLBCL.
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Affiliation(s)
- Cheng Fang
- Department of Oncology, The Third Affiliated Hospital of Soochow UniversityChangzhou 213003, China
| | - Danxia Zhu
- Department of Oncology, The Third Affiliated Hospital of Soochow UniversityChangzhou 213003, China
| | - Huajie Dong
- Department of Oncology, Changzhou Tumor Hospital Soochow UniversityChangzhou 213001, China
| | - Mei Ji
- Department of Oncology, The Third Affiliated Hospital of Soochow UniversityChangzhou 213003, China
| | - Jun Wu
- Department of Oncology, The Third Affiliated Hospital of Soochow UniversityChangzhou 213003, China
| | - Xiaoli Xu
- Department of Oncology, The Third Affiliated Hospital of Soochow UniversityChangzhou 213003, China
| | - Gui Cheng
- Department of Oncology, The Third Affiliated Hospital of Soochow UniversityChangzhou 213003, China
| | - Changping Wu
- Department of Oncology, The Third Affiliated Hospital of Soochow UniversityChangzhou 213003, China
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow UniversityChangzhou 213003, China
| | - Jingting Jiang
- Department of Oncology, The Third Affiliated Hospital of Soochow UniversityChangzhou 213003, China
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow UniversityChangzhou 213003, China
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Abstract
INTRODUCTION Ofatumumab is a second-generation humanized monoclonal antibody targeting CD20 registered for the treatment of patients with relapsing/refractory chronic lymphocytic leukemia. This review will describe the activity of ofatumumab in patients with CD20 B-cell lymphomas. AREAS COVERED A review of all manuscript published on ofatumumab activity in B-cell lymphomas is presented with conclusions on the future use of this antibody in these patients. EXPERT OPINION Ofatumumab activity is low in indolent or aggressive B-cell lymphomas. The future of this drug is challenged by new monoclonal antibodies and new targeted drugs.
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Affiliation(s)
- Lionel Karlin
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Hematology Department , 165, Chemin du Grand Revoyet 69495 Pierre-Benite , France +33 478864301 ; +33 478864355 ;
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Ghosh N, Grunwald MR, Fasan O, Bhutani M. Expanding role of lenalidomide in hematologic malignancies. Cancer Manag Res 2015; 7:105-19. [PMID: 25999761 PMCID: PMC4427066 DOI: 10.2147/cmar.s81310] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Lenalidomide is an immunomodulatory agent that has been approved by the US Food and Drug Administration for treatment of multiple myeloma, deletion 5q myelodysplastic syndrome, and mantle cell lymphoma. In addition, it has clinical activity in lymphoproliferative disorders and acute myeloid leukemia. The mode of action includes immunomodulatory, anti-inflammatory, antiangiogenic, and antiproliferative mechanisms. The antitumor effect is a result of direct interference of key pathways in tumor cells and indirect modulation of the tumor microenvironment. There has been no recent collective review on lenalidomide in multiple myeloma, myelodysplastic syndrome/acute myeloid leukemia, and lymphoma. This review summarizes the results of current clinical studies of lenalidomide, alone and in combination with other agents, as a therapeutic option for various hematologic malignancies.
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Affiliation(s)
- Nilanjan Ghosh
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - Michael R Grunwald
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - Omotayo Fasan
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - Manisha Bhutani
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
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Lenalidomide in non-Hodgkin lymphoma: biological perspectives and therapeutic opportunities. Blood 2015; 125:2471-6. [PMID: 25736312 DOI: 10.1182/blood-2014-11-567792] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/22/2015] [Indexed: 12/16/2022] Open
Abstract
Lenalidomide is an immunomodulatory drug (IMiD) with activity in lymphoid malignancies occurring primarily through immune modulation (eg, T-cell immune synapse enhancement and NK-cell/T-cell effector augmentation) and antiproliferative effects. Food and Drug Administration-approved for bortezomib-resistant, relapsed/refractory mantle-cell lymphoma, lenalidomide has demonstrated efficacy in several additional lymphoma subtypes. There are many ongoing clinical trials examining the use of lenalidomide alone or in combinatorial therapy. It will be important in these studies to delineate reliable, predictive biomarkers to optimally integrate lenalidomide into lymphoma treatment paradigms.
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Abstract
Novel pharmacotherapeutic agents were recently approved for treatment of low-grade B-cell neoplasms, and many other agents are under investigation. Several agents have demonstrated impressive activity in targeting malignant B-cell processes and specific pathways, all with the potential to expand our ability to effectively treat B-cell malignancies. The inhibitors of several cell regulatory proteins, including Bruton tyrosine kinase (Btk), phosphoinositide 3-kinase (PI3-K), B-cell lymphoma/leukemia-2 (Bcl-2), and histone deacetylases, as well as immunomodulatory agents are a few of the many pharmacotherapeutic agents under study. A comprehensive review and assessment is presented of the current pharmacotherapies under investigation targeting B-cell lymphomas and leukemias.
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