1
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Lim YJ, Ward V, Brown A, Phillips E, Kronsteiner B, Malone T, Jennings D, Healy S, Longet S, James T, Thomson P, Farrell L, Oates M, Jackson R, Morrison A, Burns M, Carroll M, Klenerman P, Turtle L, Naisbitt D, Rhodes M, Robinson K, Gatto S, Young M, Linton K, Eyre TA, Eyre DW, Dunachie S, Barnes E, Pettitt A. Immunogenicity of COVID-19 vaccines in patients with follicular lymphoma receiving frontline chemoimmunotherapy. Br J Haematol 2024. [PMID: 38867615 DOI: 10.1111/bjh.19562] [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: 04/08/2024] [Accepted: 05/14/2024] [Indexed: 06/14/2024]
Abstract
Immune responses to primary COVID-19 vaccination were investigated in 58 patients with follicular lymphoma (FL) as part of the PETReA trial of frontline therapy (EudraCT 2016-004010-10). COVID-19 vaccines (BNT162b2 or ChAdOx1) were administered before, during or after cytoreductive treatment comprising rituximab (depletes B cells) and either bendamustine (depletes CD4+ T cells) or cyclophosphamide-based chemotherapy. Blood samples obtained after vaccine doses 1 and 2 (V1, V2) were analysed for antibodies and T cells reactive to the SARS-CoV-2 spike protein using the Abbott Architect and interferon-gamma ELISpot assays respectively. Compared to 149 healthy controls, patients with FL exhibited lower antibody but preserved T-cell responses. Within the FL cohort, multivariable analysis identified low pre-treatment serum IgA levels and V2 administration during induction or maintenance treatment as independent determinants of lower antibody and higher T-cell responses, and bendamustine and high/intermediate FLIPI-2 score as additional determinants of a lower antibody response. Several clinical scenarios were identified where dichotomous immune responses were estimated with >95% confidence based on combinations of predictive variables. In conclusion, the immunogenicity of COVID-19 vaccines in FL patients is influenced by multiple disease- and treatment-related factors, among which B-cell depletion showed differential effects on antibody and T-cell responses.
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Affiliation(s)
- Yeong Jer Lim
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Victoria Ward
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Medical Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Anthony Brown
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Eloise Phillips
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Tom Malone
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Daisy Jennings
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Saoirse Healy
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Stephanie Longet
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Timothy James
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford, UK
| | - Paul Thomson
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, UK
| | - Liam Farrell
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, UK
| | - Melanie Oates
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Richard Jackson
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Andrew Morrison
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Matthew Burns
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Miles Carroll
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Paul Klenerman
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lance Turtle
- Department of Clinical Infection, Microbiology & Immunology, University of Liverpool, Liverpool, UK
| | - Dean Naisbitt
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, UK
| | - Malcolm Rhodes
- National Cancer Research Institute Consumer Forum, London, UK
| | - Kate Robinson
- National Cancer Research Institute Consumer Forum, London, UK
| | - Simona Gatto
- Cardiff and Vale University Hospitals Board, Cardiff, UK
| | - Moya Young
- East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - Kim Linton
- University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Toby A Eyre
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David W Eyre
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Susanna Dunachie
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew Pettitt
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
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Ichikawa T, Tamura T, Takahata M, Ishio T, Ibata M, Kasahara I, Minauchi K, Yamamoto S, Teshima T, Fukuhara T. Prolonged shedding of viable SARS-CoV-2 in immunocompromised patients with haematological malignancies: A prospective study. Br J Haematol 2024; 204:815-820. [PMID: 37795527 DOI: 10.1111/bjh.19143] [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: 08/09/2023] [Revised: 09/08/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
Prolonged SARS-CoV-2 infection in immunocompromised individuals has been scattered, but the details remain unclear. We conducted a prospective study with 26 COVID-19 patients with haematological malignancies to determine viral shedding kinetics and characteristics. We obtained nasopharyngeal swabs from the patients 21-28 days post-onset for a PCR test and performed virus isolation from the PCR-positive samples. A viable virus was detected in five patients (19.2%), all of whom had malignant lymphoma. Those patients had significantly lower CD4+ T-cell counts than the PCR-negative patients. A comparison of previous chemotherapy showed that anti-CD20 antibodies and bendamustine may be risk factors for prolonged viral shedding.
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Affiliation(s)
- Takaya Ichikawa
- Department of Microbiology and Immunology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Department of Hematology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Department of Hematology, Sapporo City General Hospital, Sapporo, Japan
| | - Tomokazu Tamura
- Department of Microbiology and Immunology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Institute for Vaccine Research and Development, HU-IVReD, Hokkaido University, Sapporo, Japan
| | - Mutsumi Takahata
- Department of Hematology, Sapporo-Kosei General Hospital, Sapporo, Japan
| | - Takashi Ishio
- Department of Hematology, Sapporo-Kosei General Hospital, Sapporo, Japan
| | - Makoto Ibata
- Department of Hematology, Sapporo-Kosei General Hospital, Sapporo, Japan
| | - Ikumi Kasahara
- Department of Hematology, Sapporo City General Hospital, Sapporo, Japan
| | - Koichiro Minauchi
- Department of Hematology, Sapporo City General Hospital, Sapporo, Japan
| | - Satoshi Yamamoto
- Department of Hematology, Sapporo City General Hospital, Sapporo, Japan
| | - Takanori Teshima
- Department of Hematology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takasuke Fukuhara
- Department of Microbiology and Immunology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Institute for Vaccine Research and Development, HU-IVReD, Hokkaido University, Sapporo, Japan
- Laboratory of Virus Control, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
- AMED-CREST, Japan Agency for Medical Research and Development (AMED), Tokyo, Japan
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Shotton R, Broadbent R, Alchawaf A, Mohamed MB, Gibb A, Martinez-Calle N, Fox CP, Bishton M, Pender A, Gleeson M, Cunningham D, Davies A, Yadollahi S, Eyre TA, Collins G, Djebbari F, Kassam S, Garland P, Watts E, Osborne W, Townsend W, Pocock R, Ahearne MJ, Miall F, Wang X, Linton KM. Safety of bendamustine for the treatment of indolent non-Hodgkin lymphoma: a UK real-world experience. Blood Adv 2024; 8:878-888. [PMID: 37967358 PMCID: PMC10875258 DOI: 10.1182/bloodadvances.2023011305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023] Open
Abstract
ABSTRACT Bendamustine is among the most effective chemotherapeutics for indolent B-cell non-Hodgkin lymphomas (iNHL), but trial reports of significant toxicity, including opportunistic infections and excess deaths, led to prescriber warnings. We conducted a multicenter observational study evaluating bendamustine toxicity in real-world practice. Patients receiving at least 1 dose of bendamustine with/without rituximab (R) for iNHL were included. Demographics, lymphoma and treatment details, and grade 3 to 5 adverse events (AEs) were analyzed and correlated. In total, 323 patients were enrolled from 9 National Health Service hospitals. Most patients (96%) received bendamustine-R, and 46%, R maintenance. Overall, 21.7% experienced serious AEs (SAE) related to treatment, including infections in 12%, with absolute risk highest during induction (63%), maintenance (20%), and follow-up (17%) and the relative risk highest during maintenance (54%), induction (34%), and follow-up (28%). Toxicity led to permanent treatment discontinuation for 13% of patients, and 2.8% died of bendamustine-related infections (n = 5), myelodysplastic syndrome (n = 3), and cardiac disease (n = 1). More SAEs per patient were reported in patients with mantle cell lymphoma, poor preinduction performance status (PS), poor premaintenance PS, and abnormal preinduction total globulins and in those receiving growth factors. Use of antimicrobial prophylaxis was variable, and 3 of 10 opportunistic infections occurred despite prophylaxis. In this real-world analysis, bendamustine-related deaths and treatment discontinuation were similar to those of trial populations of younger, fitter patients. Poor PS, mantle cell histology, and maintenance R were potential risk factors. Infections, including late onset events, were the most common treatment-related SAE and cause of death, warranting extended antimicrobial prophylaxis and infectious surveillance, especially for maintenance-treated patients.
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Affiliation(s)
- Rohan Shotton
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Alia Alchawaf
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Adam Gibb
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Nicolás Martinez-Calle
- Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Christopher P. Fox
- Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Mark Bishton
- Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Alexandra Pender
- Department of Medicine, The Royal Marsden Hospital, London, United Kingdom
| | - Mary Gleeson
- Haematology, The Royal Marsden Hospital, London, United Kingdom
| | | | - Andrew Davies
- Cancer Research UK/NIHE Experimental Cancer Medicines Centre, University of Southampton, Southampton, United Kingdom
| | - Sina Yadollahi
- Haematology, Haematology and Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Toby A. Eyre
- Haematology, Haematology and Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Graham Collins
- Haematology, Haematology and Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Faouzi Djebbari
- Haematology, Haematology and Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Shireen Kassam
- Haematology, King’s College Hospital, London, United Kingdom
| | - Paula Garland
- Haematology, King's College Hospital, Princess Royal Site, Kent, United Kingdom
| | - Emily Watts
- Haematology, Freeman Hospital, Newcastle, United Kingdom
| | - Wendy Osborne
- Haematology, Freeman Hospital, Newcastle, United Kingdom
| | - William Townsend
- Haematology, University College Hospital London, London, United Kingdom
| | - Rachael Pocock
- Haematology, University College Hospital London, London, United Kingdom
| | - Matthew J. Ahearne
- Haematology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Fiona Miall
- Haematology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Xin Wang
- Statistics Group, Clinical Outcome Unit, Digital Services, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Kim M. Linton
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
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Iacoboni G, Navarro V, Martín-López AÁ, Rejeski K, Kwon M, Jalowiec KA, Amat P, Reguera-Ortega JL, Gallur L, Blumenberg V, Gutiérrez-Herrero S, Roddie C, Benzaquén A, Delgado-Serrano J, Sánchez-Salinas MA, Bailén R, Carpio C, López-Corral L, Hernani R, Bastos M, O'Reilly M, Martín-Martín L, Subklewe M, Barba P. Recent Bendamustine Treatment Before Apheresis Has a Negative Impact on Outcomes in Patients With Large B-Cell Lymphoma Receiving Chimeric Antigen Receptor T-Cell Therapy. J Clin Oncol 2024; 42:205-217. [PMID: 37874957 DOI: 10.1200/jco.23.01097] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 10/26/2023] Open
Abstract
PURPOSE Approximately 30%-40% of patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL) infused with CD19-targeted chimeric antigen receptor (CAR) T cells achieve durable responses. Consensus guidelines suggest avoiding bendamustine before apheresis, but specific data in this setting are lacking. We report distinct outcomes after CAR T-cell therapy according to previous bendamustine exposure. METHODS The study included CAR T-cell recipients from seven European sites. Safety, efficacy, and CAR T-cell expansion kinetics were analyzed according to preapheresis bendamustine exposure. Additional studies on the impact of the washout period and bendamustine dose were performed. Inverse probability treatment weighting (IPTW) and propensity score matching (PSM) analyses were carried out for all efficacy comparisons between bendamustine-exposed and bendamustine-naïve patients. RESULTS The study included 439 patients with R/R LBCL infused with CD19-targeted commercial CAR T cells, of whom 80 had received bendamustine before apheresis. Exposed patients had significantly lower CD3+ cells and platelets at apheresis. These patients had a lower overall response rate (ORR, 53% v 72%; P < .01), a shorter progression-free survival (PFS, 3.1 v 6.2 months; P = .04), and overall survival (OS, 10.3 v 23.5 months; P = .01) in comparison with the bendamustine-naïve group. Following adjustment methods for baseline variables, these differences were mitigated. Focusing on the impact of bendamustine washout before apheresis, those with recent (<9 months) exposure (N = 42) displayed a lower ORR (40% v 72%; P < .01), shorter PFS (1.3 v 6.2 months; P < .01), and OS (4.6 v 23.5 months; P < .01) in comparison with bendamustine-naïve patients. These differences remained significant after IPTW and PSM analysis. Conversely, the cumulative dose of bendamustine before apheresis did not affect CAR-T efficacy outcomes. CONCLUSION Recent bendamustine exposure before apheresis was associated with negative treatment outcomes after CD19-targeted CAR T-cell therapy and should be therefore avoided in CAR T-cell candidates.
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Affiliation(s)
- Gloria Iacoboni
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Víctor Navarro
- Oncology Data Science (ODySey) Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Ana África Martín-López
- Hematology Department, Hospital Clínico Universitario de Salamanca, IBSAL, CIBERONC, Salamanca, Spain
- Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - Kai Rejeski
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center of the LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK) and Bavarian Center for Cancer Research (BZKF), partner site Munich, Munich, Germany
| | - Mi Kwon
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Katarzyna Aleksandra Jalowiec
- Hematology Department, University College London Cancer Institute, London, United Kingdom
- Department of Hematology and Central Hematology Laboratory, University Hospital of Bern, Bern, Switzerland
| | - Paula Amat
- Haematology Department, Hospital Clínico Universitario, Valencia, Spain
- INCLIVA Research Institute, Valencia, Spain
| | - Juan Luis Reguera-Ortega
- Hematology Department, Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Laura Gallur
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Viktoria Blumenberg
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center of the LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK) and Bavarian Center for Cancer Research (BZKF), partner site Munich, Munich, Germany
| | - Sara Gutiérrez-Herrero
- Cancer Research Centre (IBMCC, USAL-CSIC), Institute for Biomedical Research of Salamanca (IBSAL) and Department of Medicine and Cytometry Service (NUCLEUS Research Support Platform), University of Salamanca (USAL), Salamanca, Spain
| | - Claire Roddie
- Hematology Department, University College London Cancer Institute, London, United Kingdom
| | - Ana Benzaquén
- Haematology Department, Hospital Clínico Universitario, Valencia, Spain
- INCLIVA Research Institute, Valencia, Spain
| | - Javier Delgado-Serrano
- Hematology Department, Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Mario Andrés Sánchez-Salinas
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Rebeca Bailén
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Cecilia Carpio
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Lucia López-Corral
- Hematology Department, Hospital Clínico Universitario de Salamanca, IBSAL, CIBERONC, Salamanca, Spain
- Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - Rafael Hernani
- Haematology Department, Hospital Clínico Universitario, Valencia, Spain
- INCLIVA Research Institute, Valencia, Spain
| | - Mariana Bastos
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Maeve O'Reilly
- Hematology Department, University College London Cancer Institute, London, United Kingdom
| | - Lourdes Martín-Martín
- Cancer Research Centre (IBMCC, USAL-CSIC), Institute for Biomedical Research of Salamanca (IBSAL) and Department of Medicine and Cytometry Service (NUCLEUS Research Support Platform), University of Salamanca (USAL), Salamanca, Spain
| | - Marion Subklewe
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center of the LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK) and Bavarian Center for Cancer Research (BZKF), partner site Munich, Munich, Germany
| | - Pere Barba
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Alderuccio JP, Lossos IS. Enhancing prognostication and personalizing treatment of extranodal marginal zone lymphoma. Expert Rev Hematol 2023; 16:333-348. [PMID: 37086394 PMCID: PMC10183153 DOI: 10.1080/17474086.2023.2206557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/20/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION Extranodal marginal zone lymphoma (EMZL) of mucosa-associated lymphoid tissue is an indolent lymphoma originating from marginal zone B-cells and associated with chronic inflammation. EMZL demonstrates distinct genomic alterations according to the primary extranodal site of disease but commonly affects signaling pathways including NF-ĸB, B-cell receptor, and NOTCH. Treatment with radiation therapy is commonly implemented in localized diseases, and multiple agents are available for patients with advanced-stage diseases in need of therapy. Bendamustine with rituximab is a frontline platform associated with high efficacy. AREAS COVERED Clinical features, diagnosis, genomics, models enabling risk stratification, treatment options, and future directions. EXPERT OPINION The lack of consistent genotyping profile in EMZL precludes the development of tissue and circulatory biomarkers for the diagnosis, risk stratification, and monitoring of minimal residual disease. Furthermore, the biological heterogeneity observed in extranodal sites associated with overall limited genomic data prevents the testing of druggable pathways aiming for a personalized treatment approach. Future clinical trials should focus on EMZL considering the unique clinical characteristics in the eligibility criteria and response assessment to better inform efficacy of novel agents and delineate sequences of therapies.
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Affiliation(s)
| | - Izidore S. Lossos
- Department of Medicine, Division of Hematology
- Department of Molecular and Cellular Pharmacology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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6
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Jo T, Yoshihara S, Okuyama Y, Fujii K, Henzan T, Kahata K, Yamazaki R, Takeda W, Umezawa Y, Fukushima K, Ashida T, Yamada-Fujiwara M, Hanajiri R, Yonetani N, Tada Y, Shimura Y, Nishikii H, Shiba N, Mimura N, Ando J, Sato T, Nakashima Y, Ikemoto J, Iwaki K, Fujiwara SI, Ri M, Nagamura-Inoue T, Tanosaki R, Arai Y. Risk factors for CAR-T cell manufacturing failure among DLBCL patients: A nationwide survey in Japan. Br J Haematol 2023. [PMID: 37096915 DOI: 10.1111/bjh.18831] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 04/26/2023]
Abstract
For successful chimeric antigen receptor T (CAR-T) cell therapy, CAR-T cells must be manufactured without failure caused by suboptimal expansion. In order to determine risk factors for CAR-T cell manufacturing failure, we performed a nationwide cohort study in Japan and analysed patients with diffuse large B-cell lymphoma (DLBCL) who underwent tisagenlecleucel production. We compared clinical factors between 30 cases that failed (7.4%) with those that succeeded (n = 378). Among the failures, the proportion of patients previously treated with bendamustine (43.3% vs. 14.8%; p < 0.001) was significantly higher, and their platelet counts (12.0 vs. 17.0 × 104 /μL; p = 0.01) and CD4/CD8 T-cell ratio (0.30 vs. 0.56; p < 0.01) in peripheral blood at apheresis were significantly lower than in the successful group. Multivariate analysis revealed that repeated bendamustine use with short washout periods prior to apheresis (odds ratio [OR], 5.52; p = 0.013 for ≥6 cycles with washout period of 3-24 months; OR, 57.09; p = 0.005 for ≥3 cycles with washout period of <3 months), low platelet counts (OR, 0.495 per 105 /μL; p = 0.022) or low CD4/CD8 ratios (<one third) (OR, 3.249; p = 0.011) in peripheral blood at apheresis increased the risk of manufacturing failure. Manufacturing failure remains an obstacle to CAR-T cell therapy for DLBCL patients. Avoiding risk factors, such as repeated bendamustine administration without sufficient washout, and risk-adapted strategies may help to optimize CAR-T cell therapy for DLBCL patients.
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Affiliation(s)
- Tomoyasu Jo
- Department of Clinical Laboratory Medicine and Center for Research and Application of Cellular Therapy, Kyoto University Hospital, Kyoto, Japan
- Department of Hematology and Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Satoshi Yoshihara
- Department of Transfusion Medicine and Cell Therapy, Hyogo Medical University Hospital, Nishinomiya, Japan
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Japan
| | - Yoshiki Okuyama
- Division of Transfusion and Cell Therapy, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Keiko Fujii
- Division of Transfusion, Okayama University Hospital, Okayama, Japan
| | - Tomoko Henzan
- Center for Cellular and Molecular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Kaoru Kahata
- Department of Hematology, Hokkaido University, Faculty of Medicine, Sapporo, Japan
| | - Rie Yamazaki
- Center for Transfusion Medicine and Cell Therapy, Keio University School of Medicine, Tokyo, Japan
| | - Wataru Takeda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshihiro Umezawa
- Department of Hematology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kentaro Fukushima
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Ashida
- Division of Hematology and Rheumatology, Department of Internal Medicine, Kindai University Hospital, Osakasayama, Japan
| | - Minami Yamada-Fujiwara
- Division of Blood Transfusion and Cell Therapy, Tohoku University Hospital, Sendai, Japan
| | - Ryo Hanajiri
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Noboru Yonetani
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yuma Tada
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Yuji Shimura
- Department of Blood Transfusion, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Norio Shiba
- Department of Division of Blood Transfusion and Cell Therapy, Yokohama City University, Yokohama, Japan
| | - Naoya Mimura
- Department of Transfusion Medicine and Cell Therapy, Chiba University Hospital, Chiba, Japan
| | - Jun Ando
- Department of Cell Therapy and Transfusion Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Takayuki Sato
- Department of Haematology and Oncology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yasuhiro Nakashima
- Department of Hematology, Osaka Metropolitan University Hospital, Osaka, Japan
| | - Junko Ikemoto
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Japan
| | - Keita Iwaki
- Division of Blood Transfusion and Cell Therapy, Tohoku University Hospital, Sendai, Japan
| | - Shin-Ichiro Fujiwara
- Division of Cell Transplantation and Transfusion, Jichi Medical University Hospital, Tochigi, Japan
| | - Masaki Ri
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tokiko Nagamura-Inoue
- Department of Cell Processing and Transfusion, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Ryuji Tanosaki
- Department of Hematology, Hokkaido University, Faculty of Medicine, Sapporo, Japan
| | - Yasuyuki Arai
- Department of Clinical Laboratory Medicine and Center for Research and Application of Cellular Therapy, Kyoto University Hospital, Kyoto, Japan
- Department of Hematology and Oncology, Kyoto University Hospital, Kyoto, Japan
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7
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Vodárek P, Écsiová D, Řezáčová V, Souček O, Šimkovič M, Vokurková D, Belada D, Žák P, Smolej L. A comprehensive assessment of lymphocyte subsets, their prognostic significance, and changes after first‐line therapy administration in patients with chronic lymphocytic leukemia. Cancer Med 2022; 12:6956-6970. [PMID: 36440594 PMCID: PMC10067047 DOI: 10.1002/cam4.5492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/03/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In chronic lymphocytic leukemia (CLL), changes in the peripheral blood lymphocyte subsets play an important role in disease progression and infectious complications. The impact of chemoimmunotherapy (CIT) on these changes has not been extensively studied METHODS: We used multi-color flow cytometry, to prospectively measure absolute and relative numbers of CD4+ and CD8+ T-cells and their subsets in 45 patients with indolent untreated CLL, 86 patients indicated for first-line treatment, and 34 healthy controls. In 55 patients, we analyzed the impact of CIT RESULTS: CLL patients had a significant increase in most cell populations in comparison to controls. Progression of CLL was characterized by significantly elevated counts with the exception of a lower percentage of naïve T-cells. After treatment, the percentage of naïve T-cells further decreased at the expense of effector memory T-cells (TEM). In patients with indolent CLL, higher percentages of naïve CD4+ (p = 0.0026) and naïve CD8+ (p = 0.023) T-cells were associated with a longer time to first treatment (TTFT). The elevation of CD4+ central memory T-cells (TCM) (p = 0.27) and TEM (p = 0.003) counts and a higher percentage of CD4+ TEM (p = 0.0047), were linked with shorter TTFT. In treated patients, increased regulatory T-cells count was associated with shorter time to next treatment (TTNT) (p = 0.042), while higher CD4+ TCM count with shorter TTNT (p = 0.035) and shorter overall survival (p = 0.041). CONCLUSION Our results indicate that naïve cell depletion and CD4+ TCM and TEM increases are detrimental to CLL patients' prognosis.
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Affiliation(s)
- Pavel Vodárek
- 4th Department of Internal Medicine – Hematology Faculty of Medicine University Hospital and Charles University Hradec Kralove Czech Republic
| | - Dominika Écsiová
- 4th Department of Internal Medicine – Hematology Faculty of Medicine University Hospital and Charles University Hradec Kralove Czech Republic
| | - Vladimíra Řezáčová
- Institute of Clinical Immunology and Allergology Faculty of Medicine University Hospital and Charles University Hradec Kralove Czech Republic
| | - Ondřej Souček
- Institute of Clinical Immunology and Allergology Faculty of Medicine University Hospital and Charles University Hradec Kralove Czech Republic
| | - Martin Šimkovič
- 4th Department of Internal Medicine – Hematology Faculty of Medicine University Hospital and Charles University Hradec Kralove Czech Republic
| | - Doris Vokurková
- Institute of Clinical Immunology and Allergology Faculty of Medicine University Hospital and Charles University Hradec Kralove Czech Republic
| | - David Belada
- 4th Department of Internal Medicine – Hematology Faculty of Medicine University Hospital and Charles University Hradec Kralove Czech Republic
| | - Pavel Žák
- 4th Department of Internal Medicine – Hematology Faculty of Medicine University Hospital and Charles University Hradec Kralove Czech Republic
| | - Lukáš Smolej
- 4th Department of Internal Medicine – Hematology Faculty of Medicine University Hospital and Charles University Hradec Kralove Czech Republic
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8
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Yano M, Byrd JC, Muthusamy N. Natural Killer Cells in Chronic Lymphocytic Leukemia: Functional Impairment and Therapeutic Potential. Cancers (Basel) 2022; 14:cancers14235787. [PMID: 36497266 PMCID: PMC9739887 DOI: 10.3390/cancers14235787] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
Immunotherapy approaches have advanced rapidly in recent years. While the greatest therapeutic advances so far have been achieved with T cell therapies such as immune checkpoint blockade and CAR-T, recent advances in NK cell therapy have highlighted the therapeutic potential of these cells. Chronic lymphocytic leukemia (CLL), the most prevalent form of leukemia in Western countries, is a very immunosuppressive disease but still shows significant potential as a target of immunotherapy, including NK-based therapies. In addition to their antileukemia potential, NK cells are important immune effectors in the response to infections, which represent a major clinical concern for CLL patients. Here, we review the interactions between NK cells and CLL, describing functional changes and mechanisms of CLL-induced NK suppression, interactions with current therapeutic options, and the potential for therapeutic benefit using NK cell therapies.
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Affiliation(s)
- Max Yano
- Medical Science Training Program, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - John C. Byrd
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
- Correspondence: (J.C.B.); (N.M.)
| | - Natarajan Muthusamy
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
- Correspondence: (J.C.B.); (N.M.)
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9
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Lim SH, Stuart B, Joseph-Pietras D, Johnson M, Campbell N, Kelly A, Jeffrey D, Turaj AH, Rolfvondenbaumen K, Galloway C, Wynn T, Coleman AR, Ward B, Long K, Coleman H, Mundy C, Bates AT, Ayres D, Lown R, Falconer J, Brake O, Batchelor J, Willimott V, Bowzyk Al-Naeeb A, Robinson L, O'Callaghan A, Collins GP, Menne T, Faust SN, Fox CP, Ahearne M, Johnson PWM, Davies AJ, Goldblatt D. Immune responses against SARS-CoV-2 variants after two and three doses of vaccine in B-cell malignancies: UK PROSECO study. NATURE CANCER 2022; 3:552-564. [PMID: 35332334 PMCID: PMC9135622 DOI: 10.1038/s43018-022-00364-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/10/2022] [Indexed: 12/11/2022]
Abstract
Patients with hematological malignancies are at increased risk of severe COVID-19 outcomes due to compromised immune responses, but the insights of these studies have been compromised due to intrinsic limitations in study design. Here we present the PROSECO prospective observational study ( NCT04858568 ) on 457 patients with lymphoma that received two or three COVID-19 vaccine doses. We show undetectable humoral responses following two vaccine doses in 52% of patients undergoing active anticancer treatment. Moreover, 60% of patients on anti-CD20 therapy had undetectable antibodies following full vaccination within 12 months of receiving their anticancer therapy. However, 70% of individuals with indolent B-cell lymphoma displayed improved antibody responses following booster vaccination. Notably, 63% of all patients displayed antigen-specific T-cell responses, which increased after a third dose irrespective of their cancer treatment status. Our results emphasize the urgency of careful monitoring of COVID-19-specific immune responses to guide vaccination schemes in these vulnerable populations.
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Affiliation(s)
- Sean H Lim
- Centre for Cancer Immunology, University of Southampton, Southampton, UK.
- Cancer Research UK Research Centre, University of Southampton, Southampton, UK.
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Beth Stuart
- Cancer Research UK Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Debora Joseph-Pietras
- Cancer Research UK Research Centre, University of Southampton, Southampton, UK
- NIHR/Cancer Research UK Southampton Experimental Cancer Medicine Centre, WISH Laboratory, Southampton General Hospital, Southampton, UK
| | - Marina Johnson
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | - Nicola Campbell
- Centre for Cancer Immunology, University of Southampton, Southampton, UK
- Cancer Research UK Research Centre, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Adam Kelly
- NIHR/Cancer Research UK Southampton Experimental Cancer Medicine Centre, WISH Laboratory, Southampton General Hospital, Southampton, UK
| | - Danielle Jeffrey
- NIHR/Cancer Research UK Southampton Experimental Cancer Medicine Centre, WISH Laboratory, Southampton General Hospital, Southampton, UK
| | - Anna H Turaj
- Centre for Cancer Immunology, University of Southampton, Southampton, UK
- Cancer Research UK Research Centre, University of Southampton, Southampton, UK
| | - Kate Rolfvondenbaumen
- NIHR/Cancer Research UK Southampton Experimental Cancer Medicine Centre, WISH Laboratory, Southampton General Hospital, Southampton, UK
| | - Celine Galloway
- NIHR/Cancer Research UK Southampton Experimental Cancer Medicine Centre, WISH Laboratory, Southampton General Hospital, Southampton, UK
| | - Thomas Wynn
- NIHR/Cancer Research UK Southampton Experimental Cancer Medicine Centre, WISH Laboratory, Southampton General Hospital, Southampton, UK
| | - Adam R Coleman
- NIHR/Cancer Research UK Southampton Experimental Cancer Medicine Centre, WISH Laboratory, Southampton General Hospital, Southampton, UK
| | - Benjamin Ward
- NIHR/Cancer Research UK Southampton Experimental Cancer Medicine Centre, WISH Laboratory, Southampton General Hospital, Southampton, UK
| | - Karen Long
- University of Southampton Clinical Informatics Research Unit, Southampton General Hospital, Southampton, UK
| | - Helen Coleman
- Cancer Research UK Research Centre, University of Southampton, Southampton, UK
| | - Carina Mundy
- Cancer Research UK Research Centre, University of Southampton, Southampton, UK
| | - Andrew T Bates
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Diana Ayres
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Robert Lown
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janlyn Falconer
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Oliver Brake
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - James Batchelor
- University of Southampton Clinical Informatics Research Unit, Southampton General Hospital, Southampton, UK
| | - Victoria Willimott
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | - Lisa Robinson
- Department of Haematology, County Hospital Hereford, Hereford, UK
| | | | - Graham P Collins
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tobias Menne
- Department of Haematology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Saul N Faust
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Peter W M Johnson
- Centre for Cancer Immunology, University of Southampton, Southampton, UK
- Cancer Research UK Research Centre, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrew J Davies
- Centre for Cancer Immunology, University of Southampton, Southampton, UK
- Cancer Research UK Research Centre, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR/Cancer Research UK Southampton Experimental Cancer Medicine Centre, WISH Laboratory, Southampton General Hospital, Southampton, UK
| | - David Goldblatt
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
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10
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Effects of B-Cell Lymphoma on the Immune System and Immune Recovery after Treatment: The Paradigm of Targeted Therapy. Int J Mol Sci 2022; 23:ijms23063368. [PMID: 35328789 PMCID: PMC8952275 DOI: 10.3390/ijms23063368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 12/10/2022] Open
Abstract
B-cell lymphoma and lymphoproliferative diseases represent a heterogeneous and complex group of neoplasms that are accompanied by a broad range of immune regulatory disorder phenotypes. Clinical features of autoimmunity, hyperinflammation, immunodeficiency and infection can variously dominate, depending on the immune pathway most involved. Immunological imbalance can play a role in lymphomagenesis, also supporting the progression of the disease, while on the other hand, lymphoma acts on the immune system to weaken immunosurveillance and facilitate immunoevasion. Therefore, the modulation of immunity can have a profound effect on disease progression or resolution, which makes the immune system a critical target for new therapies. In the current therapeutic scenario enriched by chemo-free regimens, it is important to establish the effect of various drugs on the disease, as well as on the restoration of immune functions. In fact, treatment of B-cell lymphoma with passive immunotherapy that targets tumor cells or targets the tumor microenvironment, together with adoptive immunotherapy, is becoming more frequent. The aim of this review is to report relevant data on the evolution of the immune system during and after treatment with targeted therapy of B-cell lymphomas.
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11
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The Past, Present, and Future of Clinically Applied Chimeric Antigen Receptor-T-Cell Therapy. Pharmaceuticals (Basel) 2022; 15:ph15020207. [PMID: 35215319 PMCID: PMC8876595 DOI: 10.3390/ph15020207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 12/13/2022] Open
Abstract
Immunotherapy represents the fourth pillar of cancer therapy after surgery, chemotherapy, and radiation. Chimeric antigen receptor (CAR)-T-cell therapy is an artificial immune cell therapy applied in clinical practice and is currently indicated for hematological malignancies, with cluster of differentiation 19 (CD19) as its target molecule. In this review, we discuss the past, present, and future of CAR-T-cell therapy. First, we summarize the various clinical trials that were conducted before the clinical application of CD19-targeted CAR-T-cell therapies began. Second, we discuss the accumulated real-world evidence and the barriers associated with applying clinical trials to clinical practices from the perspective of the quality and technical aspects. After providing an overview of all the moving parts involved in the production of CAR-T-cell products, we discuss the characteristics of immune cells (given that T cells are the raw materials for CAR-T-cell therapy) and elucidate the relationship between lifestyle, including diet and exercise, and immune cells. Finally, we briefly highlight future trends in the development of immune cell therapy. These advancements may help position CAR-T-cell therapy as a standard of care.
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12
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Avivi I, Perry C, Segman Y, Amit O, Bar-On Y, Katz OB, Gold R, Ribakovsky E, Avigdor A, Vainstein V, Goldschmidt N, Ringelstein-Harlev S, Horowitz NA, Gutwein O, Gurion R, Itchaki G, Abadi U, Nemets A, Sofer O, Vezker M, Tadmor T, Dally N, Filanovsky K, Leiba M, Sarid N, Benyamini N, Luttwak E, Herishanu Y, Ram R. Polatuzumab-based regimen or CAR T cell for patients with refractory/relapsed DLBCL-a matched cohort analysis. Ann Hematol 2022; 101:755-762. [PMID: 35083525 DOI: 10.1007/s00277-021-04749-9] [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: 10/25/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022]
Abstract
Polatuzumab (Pola)-based regimens and chimeric antigen receptor T (CAR T) cells provide superior outcome compared to conventional chemoimmunotherapy in patients with relapsed/refractory diffuse large B cell lymphoma (R/R DLBCL). Choosing between these strategies remains controversial. The efficacy of CAR T versus Pola-rituximab(R) /Pola-bendamustine(B)-R in R/R DLBCL patients after failing ≥2 lines of treatment was compared in a retrospective, 'real-world' study. Propensity score matching, for age, lymphoma category (de-novo/transformed), number of prior lines, Eastern Cooperative Oncology Group performance status and lactate dehydrogenase level, was applied to control for differences in patients' characteristics. Response rate, progression-free survival (PFS) and overall survival (OS) were analyzed. A total of 82 patients, treated with CAR T (n=41) or Pola-based regimens (n=41), were included. No treatment-related deaths occurred with CAR T vs. 3 (7.3%) with Pola. The overall and complete response rates were 83% and 58% with CAR T vs. 66% and 44% with Pola-based-regimens (p=0.077 and p=0.18, respectively). At a median follow-up of 9 months (range 1-19.2) and 16 months (range 0.7-25.3) for the CAR T and Pola arm respectively, the median PFS has not been reached for CAR T vs. 5.6 months for Pola (95% CI 3.6-7.6, p=0.014). Median OS has not been reached for CAR T vs. 10.8 months (95% CI 2.2-19.4) for Pola (p=0.026). To conclude, in a real-world setting, treatment with CAR T achieved superior PFS and OS compared to Pola-based regimens in patients with R/R DLBCL.
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Affiliation(s)
- Irit Avivi
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chava Perry
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yafit Segman
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Odelia Amit
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaeli Bar-On
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofrat Beyer Katz
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Gold
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elena Ribakovsky
- Hematology Division, Chaim Sheba Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Abraham Avigdor
- Hematology Division, Chaim Sheba Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Vladimir Vainstein
- Hematology Division, Hadassah Medical Center and the Hebrew Faculty of Medicine, Jerusalem University, Jerusalem, Israel
| | - Neta Goldschmidt
- Hematology Division, Hadassah Medical Center and the Hebrew Faculty of Medicine, Jerusalem University, Jerusalem, Israel
| | | | | | - Odit Gutwein
- Department of Hematology, Assaf Harofeh Medical Center, Tzrifin, Israel
| | - Ronit Gurion
- Institute of Hematology, Rabin Medical Center, Petch Tikva, Israel
| | - Gilad Itchaki
- Institute of Hematology, Rabin Medical Center, Petch Tikva, Israel
| | - Uri Abadi
- Department of Hematology, Meir Medical Center, Kfar Saba, Israel
| | - Anatoly Nemets
- Department of Hematology, Barzilai Medical Center, Ashkelon, Israel
| | - Orit Sofer
- Institute of Hematology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Miri Vezker
- Department of Hematology, Soroka University Medical Center, Negev, Beer Sheva, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Najib Dally
- Hematology Unit, Ziv Medical Center, Zefat, Israel
| | | | - Merav Leiba
- Hematology Institute, Assuta Medical Center, Ashdod, Israel
| | - Nadav Sarid
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Benyamini
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Luttwak
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Herishanu
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Ram
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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13
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Sawalha Y. Relapsed/Refractory Diffuse Large B-Cell Lymphoma: A Look at the Approved and Emerging Therapies. J Pers Med 2021; 11:jpm11121345. [PMID: 34945817 PMCID: PMC8708171 DOI: 10.3390/jpm11121345] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/12/2021] [Accepted: 11/28/2021] [Indexed: 12/11/2022] Open
Abstract
Approximately 40% of patients with diffuse large B cell lymphoma (DLBCL) do not respond or develop relapsed disease after first-line chemoimmunotherapy. A minority of these patients can be cured with autologous hematopoietic stem cell transplantation (AHCT). Although chimeric antigen receptor (CAR) T cells have transformed the treatment paradigm of relapsed/refractory DLBCL, only 30–40% of patients achieve durable remissions. In addition, many patients with relapsed/refractory DLBCL are ineligible to receive treatment with CAR T cells due to comorbidities or logistical limitations. Since 2019, the following four non-CAR T-cell treatments have been approved in relapsed/refractory DLBCL: polatuzumab in combination with bendamustine and rituximab, selinexor, tafasitamab plus lenalidomide, and loncastuximab. In this article, I review the data behind these four approvals and discuss important considerations on their use in clinical practice. I also review emerging therapies that have shown promising early results in relapsed/refractory DLBCL including the bispecific antibodies, antibody–drug conjugates, Bruton tyrosine kinase inhibitors, BCL2 inhibitors, immune checkpoint inhibitors, and epigenetic modifiers.
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Affiliation(s)
- Yazeed Sawalha
- Department of Internal Medicine, Division of Hematology, Arthur G. James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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14
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Moreno C, Muñoz C, Terol MJ, Hernández-Rivas JÁ, Villanueva M. Restoration of the immune function as a complementary strategy to treat Chronic Lymphocytic Leukemia effectively. J Exp Clin Cancer Res 2021; 40:321. [PMID: 34654437 PMCID: PMC8517318 DOI: 10.1186/s13046-021-02115-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/24/2021] [Indexed: 12/02/2022] Open
Abstract
Chronic Lymphocytic Leukemia (CLL) is a hematological malignancy characterized by uncontrolled proliferation of B-cells and severe immune dysfunction. Chemo(immuno)therapies (CIT) have traditionally aimed to reduce tumor burden without fully understanding their effects on the immune system. As a consequence, CIT are usually associated with higher risk of infections, secondary neoplasms and autoimmune disorders. A better understanding of the biology of the disease has led to the development of therapeutic strategies which not only act against malignant B-cells but also reactivate and enhance the patient's own anti-tumor immune response. Here, we review the current understanding of the underlying interplay between the malignant cells and non-malignant immune cells that may promote tumor survival and proliferation. In addition, we review the available evidence on how different treatment options for CLL including CIT regimens, small molecular inhibitors (i.e, BTK inhibitors, PI3K inhibitors, BCL-2 inhibitors) and T-cell therapies, affect the immune system and their clinical consequences. Finally, we propose that a dual therapeutic approach, acting directly against malignant B-cells and restoring the immune function is clinically relevant and should be considered when developing future strategies to treat patients with CLL.
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Affiliation(s)
| | - Cecilia Muñoz
- Hospital Universitario de la Princesa, Madrid, Spain
| | | | - José-Ángel Hernández-Rivas
- Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, Spain.
- Servicio de Hematología y Hemoterapia, Hospital Universitario Infanta Leonor, Departamento de Medicina, Universidad Complutense de Madrid, Madrid, España.
- , C/ Gran Vía del Este 80, 28031, Madrid, Spain.
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15
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Severe CMV Infection after Chemo-Immunotherapy with Dose-Reduced Bendamustine and Rituximab in a Mantle Cell Lymphoma Old Patient. Mediterr J Hematol Infect Dis 2021; 13:e2021054. [PMID: 34527206 PMCID: PMC8425343 DOI: 10.4084/mjhid.2021.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/07/2021] [Indexed: 02/07/2023] Open
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16
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Drouin AC, Theberge MW, Liu SY, Smither AR, Flaherty SM, Zeller M, Geba GP, Reynaud P, Rothwell WB, Luk AP, Tian D, Boisen ML, Branco LM, Andersen KG, Robinson JE, Garry RF, Fusco DN. Successful Clearance of 300 Day SARS-CoV-2 Infection in a Subject with B-Cell Depletion Associated Prolonged (B-DEAP) COVID by REGEN-COV Anti-Spike Monoclonal Antibody Cocktail. Viruses 2021; 13:1202. [PMID: 34201591 PMCID: PMC8310246 DOI: 10.3390/v13071202] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/02/2021] [Accepted: 06/16/2021] [Indexed: 12/20/2022] Open
Abstract
A 59-year-old male with follicular lymphoma treated by anti-CD20-mediated B-cell depletion and ablative chemotherapy was hospitalized with a COVID-19 infection. Although the patient did not develop specific humoral immunity, he had a mild clinical course overall. The failure of all therapeutic options allowed infection to persist nearly 300 days with active accumulation of SARS-CoV-2 virus mutations. As a rescue therapy, an infusion of REGEN-COV (10933 and 10987) anti-spike monoclonal antibodies was performed 270 days from initial diagnosis. Due to partial clearance after the first dose (2.4 g), a consolidation dose (8 g) was infused six weeks later. Complete virus clearance could then be observed over the following month, after he was vaccinated with the Pfizer-BioNTech anti-COVID-19 vaccination. The successful management of this patient required prolonged enhanced quarantine, monitoring of virus mutations, pioneering clinical decisions based upon close consultation, and the coordination of multidisciplinary experts in virology, immunology, pharmacology, input from REGN, the FDA, the IRB, the health care team, the patient, and the patient's family. Current decisions to take revolve around patient's follicular lymphoma management, and monitoring for virus clearance persistence beyond disappearance of REGEN-COV monoclonal antibodies after anti-SARS-CoV-2 vaccination. Overall, specific guidelines for similar cases should be established.
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Affiliation(s)
- Arnaud C. Drouin
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (S.Y.L.); (S.M.F.); (P.R.); (W.B.R.); (A.P.L.); (D.N.F.)
| | - Marc W. Theberge
- Department of Immunology and Microbiology, Tulane University, New Orleans, LA 70118, USA;
| | - Sharon Y. Liu
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (S.Y.L.); (S.M.F.); (P.R.); (W.B.R.); (A.P.L.); (D.N.F.)
| | - Allison R. Smither
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA 70112, USA; (A.R.S.); (R.F.G.)
| | - Shelby M. Flaherty
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (S.Y.L.); (S.M.F.); (P.R.); (W.B.R.); (A.P.L.); (D.N.F.)
| | - Mark Zeller
- The Scripps Research Institute, San Diego, CA 92037, USA; (M.Z.); (K.G.A.)
| | | | - Peter Reynaud
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (S.Y.L.); (S.M.F.); (P.R.); (W.B.R.); (A.P.L.); (D.N.F.)
| | - W. Benjamin Rothwell
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (S.Y.L.); (S.M.F.); (P.R.); (W.B.R.); (A.P.L.); (D.N.F.)
| | - Alfred P. Luk
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (S.Y.L.); (S.M.F.); (P.R.); (W.B.R.); (A.P.L.); (D.N.F.)
| | - Di Tian
- Department of Pathology, Tulane University School of Medicine, New Orleans, LA 70112, USA;
| | | | - Luis M. Branco
- Zalgen Labs, Germantown, MD 20876, USA; (M.L.B.); (L.M.B.)
| | | | - James E. Robinson
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 70112, USA;
| | - Robert F. Garry
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA 70112, USA; (A.R.S.); (R.F.G.)
| | - Dahlene N. Fusco
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (S.Y.L.); (S.M.F.); (P.R.); (W.B.R.); (A.P.L.); (D.N.F.)
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17
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Marcacci G, Fiorentino G, Volzone F, Falcone U, Parrella R, Donnarumma D, D'Ovidio S, Annunziata A, Micallo G, Portella G, De Chiara A, De Filippi R, Crisci S, Pinto A. Atypical COVID-19 dynamics in a patient with mantle cell lymphoma exposed to rituximab. Infect Agent Cancer 2021; 16:38. [PMID: 34078415 PMCID: PMC8170447 DOI: 10.1186/s13027-021-00376-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/07/2021] [Indexed: 12/15/2022] Open
Abstract
Patients with non-hodgkin lymphomas (NHL) represent a population of special interest during the current Coronavirus disease-19 (COVID-19) pandemics. NHLs are associated with disease- and treatment-related immunodeficiencies which may generate unusual COVID-19 dynamics and pose unique management challenges. We report the unusual clinical course of COVID-19 in a patient with mantle cell lymphoma (MCL) exposed to nine doses of Rituximab shortly before infection with severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). He had a prolonged asymptomatic phase, with negative molecular and antibody testing for SARS-CoV-2, followed by a rapidly progressive evolution to severe COVID-19. Despite detection of viral RNA overlapped with first symptoms occurrence, anti-SARS-CoV-2 antibodies displayed an asynchronous pattern, with IgG first appearing 2 days after RNA positivity and IgM never being detected throughout the entire clinical course. While disease-associated immune derangements and/or previous treatments involving anti-CD20 antibodies might have contributed to COVID-19 dynamics in our patient, data suggests that antibody testings, without concurrent molecular assessment for SARS-CoV-2, may turn inadequate for monitoring of MCL patients, and in general NHL patients heavily exposed to anti-CD20 antibodies, during the current pandemics. We suggest that repeated molecular testing of nasopharyngeal swab should be implemented in these subjects despite a negative serology and absence of symptoms of SARS-CoV-2 infection. For the same reasons, a customized strategy needs to be developed for patients exposed to anti-CD20 antibodies, based on different features and mechanism of action of available SARS-CoV-2 vaccines and novel vaccinomics developments.
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Affiliation(s)
- Gianpaolo Marcacci
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
| | - Giuseppe Fiorentino
- Respiratory Physiopathology and Rehabilitation Unit, AORN dei Colli, Naples, Italy
| | - Francesco Volzone
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
| | - Umberto Falcone
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
| | - Roberto Parrella
- Respiratory Infectious Disease Unit, AORN dei Colli, Naples, Italy
| | - Daniela Donnarumma
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
| | - Silvia D'Ovidio
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
| | - Anna Annunziata
- Respiratory Physiopathology and Rehabilitation Unit, AORN dei Colli, Naples, Italy
| | - Giovanni Micallo
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
| | - Giuseppe Portella
- Department of Translational Medical Sciences, Università degli Studi Federico II, Naples, Italy
| | - Annarosaria De Chiara
- Pathology Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
| | - Rosaria De Filippi
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
- Department of Clinical Medicine and Surgery, Università degli Studi Federico II, Naples, Italy
| | - Stefania Crisci
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
| | - Antonio Pinto
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy.
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18
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Clinical impact of bendamustine exposure on lymphopenia risk after bendamustine and rituximab combination therapy for follicular lymphoma: a single-institute retrospective study. Ann Hematol 2021; 101:209-211. [PMID: 33392703 PMCID: PMC7779080 DOI: 10.1007/s00277-020-04388-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 11/24/2022]
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19
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Dufour I, Duprez T, Wertz M, Saussoy P, Ackermans N, El Sankari S, van Pesch V, Van Den Neste E. Improvement in progressive multifocal leukoencephalopathy after pembrolizumab-induced immune reconstruction inflammatory syndrome in a patient with follicular lymphoma. EJHAEM 2020; 1:585-588. [PMID: 35845001 PMCID: PMC9175693 DOI: 10.1002/jha2.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/12/2022]
Abstract
Progressive multifocal leukoencephalopathy (PML) may develop in follicular lymphoma patients treated with bendamustine-rituximab. In this report, treatment with pembrolizumab successfully inhibited the clinical progression of PML by promoting radiologically demonstrated immune restoration inflammatory syndrome (IRIS), allowing complete clearance of the virus. These findings may further support the use of pembrolizumab in PML with special consideration for the potential occurrence of IRIS.
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Affiliation(s)
- Inès Dufour
- Department of HematologyUniversité catholique de Louvain, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Thierry Duprez
- Department of Radiology and Medical ImagingUniversité catholique de Louvain, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Marie Wertz
- Department of NeurologyClinique Notre‐Dame de GrâceGosseliesBelgium
| | - Pascale Saussoy
- Hematology LaboratoryUniversité catholique de Louvain, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Nathalie Ackermans
- Department of NeurologyUniversité catholique de Louvain, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Souraya El Sankari
- Department of NeurologyUniversité catholique de Louvain, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Vincent van Pesch
- Department of NeurologyUniversité catholique de Louvain, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Eric Van Den Neste
- Department of HematologyUniversité catholique de Louvain, Cliniques universitaires Saint‐LucBrusselsBelgium
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20
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Gaiolla R, Hartley S, Beech A, Knight H, Smith D, Bishton M, Fox CP, Martinez-Calle N. Extended follow-up of CD4 + T cell recovery kinetics in a large cohort of patients with B-cell lymphoproliferative disease treated with rituximab-bendamustine. Hematol Oncol 2020; 39:137-140. [PMID: 32860715 DOI: 10.1002/hon.2797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Rafael Gaiolla
- Clinical Haematology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Haematology Division, Clinical Hospital of Botucatu Medical School-HCFMB, Botucatu, Brazil
| | - Sarah Hartley
- Clinical Haematology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Amy Beech
- Clinical Haematology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Helen Knight
- Clinical Haematology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Dean Smith
- Clinical Haematology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Mark Bishton
- Clinical Haematology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Christopher P Fox
- Clinical Haematology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Nicolas Martinez-Calle
- Clinical Haematology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
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21
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Kos I, Balensiefer B, Roth S, Ahlgrimm M, Sester M, Schmidt T, Thurner L, Bewarder M, Bals R, Lammert F, Stilgenbauer S, Kaddu-Mulindwa D. Prolonged Course of COVID-19-Associated Pneumonia in a B-Cell Depleted Patient After Rituximab. Front Oncol 2020; 10:1578. [PMID: 32984017 PMCID: PMC7493633 DOI: 10.3389/fonc.2020.01578] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 01/08/2023] Open
Abstract
Patients with pre-existing comorbidities and immunosuppression are at greater risk for SARS-CoV-2 infection and severe manifestations of COVID-19. This also includes cancer patients, who are shown to have a poor prognosis after infection. Here, we describe the case of a 72-year old male patient with B-cell depletion after maintenance treatment with rituximab for non-Hodgkin-lymphoma who had a prolonged COVID-19 course and initial false negative test results. Our case highlights the diagnostic pitfalls in diagnosing COVID-19 in B-cell depleted patients and discuss the role of B-cell depletion in the course and treatment of COVID-19. Furthermore, we investigated peripheral blood monocytes and SARS-CoV-2 specific T cells in our patient. In conclusion, our case report can help physicians to avoid diagnostic pitfalls for COVID-19 in hemato-oncological patients under chemoimmunotherapy and tries to explain the role of B-cell depletion and SARS-CoV-2 specific T cells in this context.
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Affiliation(s)
- Igor Kos
- Department of Hematology, Oncology, Clinical Immunology, Rheumatology, Saarland University, Homburg, Germany
| | - Benedikt Balensiefer
- Department of Hematology, Oncology, Clinical Immunology, Rheumatology, Saarland University, Homburg, Germany
| | - Sophie Roth
- Department of Medical Microbiology and Hygiene, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Manfred Ahlgrimm
- Department of Hematology, Oncology, Clinical Immunology, Rheumatology, Saarland University, Homburg, Germany
| | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Tina Schmidt
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Lorenz Thurner
- Department of Hematology, Oncology, Clinical Immunology, Rheumatology, Saarland University, Homburg, Germany
| | - Moritz Bewarder
- Department of Hematology, Oncology, Clinical Immunology, Rheumatology, Saarland University, Homburg, Germany
| | - Robert Bals
- Department of Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, Germany
| | - Frank Lammert
- Department of Gastroenterology, Hepatology, Endocrinology, Diabetology and Nutrition Medicine, Saarland University, Homburg, Germany
| | - Stephan Stilgenbauer
- Department of Hematology, Oncology, Clinical Immunology, Rheumatology, Saarland University, Homburg, Germany
| | - Dominic Kaddu-Mulindwa
- Department of Hematology, Oncology, Clinical Immunology, Rheumatology, Saarland University, Homburg, Germany
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22
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Di Ciaccio P, McCaughan G, Trotman J, Ho PJ, Cheah CY, Gangatharan S, Wight J, Ku M, Quach H, Gasiorowski R, Polizzotto MN, Prince HM, Mulligan S, Tam CS, Gregory G, Hapgood G, Spencer A, Dickinson M, Latimer M, Johnston A, Armytage T, Lee C, Cochrane T, Berkhahn L, Weinkove R, Doocey R, Harrison SJ, Webber N, Lee HP, Chapman S, Campbell BA, Gibbs SDJ, Hamad N. Australian and New Zealand consensus statement on the management of lymphoma, chronic lymphocytic leukaemia and myeloma during the COVID-19 pandemic. Intern Med J 2020; 50:667-679. [PMID: 32415723 DOI: 10.1111/imj.14859] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 02/06/2023]
Abstract
The COVID-19 pandemic poses a unique challenge to the care of patients with haematological malignancies. Viral pneumonia is known to cause disproportionately severe disease in patients with cancer, and patients with lymphoma, myeloma and chronic lymphocytic leukaemia are likely to be at particular risk of severe disease related to COVID-19. This statement has been developed by consensus among authors from Australia and New Zealand. We aim to provide supportive guidance to clinicians making individual patient decisions during the COVID-19 pandemic, in particular during periods that access to healthcare resources may be limited. General recommendations include those to minimise patient exposure to COVID-19, including the use of telehealth, avoidance of non-essential visits and minimisation of time spent by patients in infusion suites and other clinical areas. This statement also provides recommendations where appropriate in assessing indications for therapy, reducing therapy-associated immunosuppression and reducing healthcare utilisation in patients with specific haematological malignancies during the COVID-19 pandemic. Specific decisions regarding therapy of haematological malignancies will need to be individualised, based on disease risk, risks of immunosuppression, rates of community transmission of COVID-19 and available local healthcare resources.
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Affiliation(s)
- Pietro Di Ciaccio
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Georgia McCaughan
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Judith Trotman
- University of Sydney, Sydney, New South Wales, Australia.,Department of Haematology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Phoebe Joy Ho
- University of Sydney, Sydney, New South Wales, Australia.,Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Department of Haematology, Pathwest Laboratory Medicine, Perth, Western Australia, Australia.,University of Western Australia, Perth, Western Australia, Australia
| | - Shane Gangatharan
- University of Western Australia, Perth, Western Australia, Australia.,Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Joel Wight
- Townsville University Hospital, Townsville, Queensland, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew Ku
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Hang Quach
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Robin Gasiorowski
- University of Sydney, Sydney, New South Wales, Australia.,Department of Haematology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Mark N Polizzotto
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia.,The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Henry Miles Prince
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Haematology, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Stephen Mulligan
- University of Sydney, Sydney, New South Wales, Australia.,Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Constantine S Tam
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Gareth Gregory
- Department of Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Greg Hapgood
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Andrew Spencer
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Haematology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Michael Dickinson
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Maya Latimer
- Department of Haematology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Anna Johnston
- Department of Haematology, The Royal Hobart Hospital, Hobart, Tasmania, Australia.,University of Tasmania, Hobart, Tasmania, Australia
| | - Tasman Armytage
- Department of Haematology, Gosford Hospital, Gosford, New South Wales, Australia
| | - Cindy Lee
- Department of Haematology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Tara Cochrane
- Department of Haematology, Gold Coast University Hospital, Southport, Queensland, Australia.,Griffith University, Brisbane, Queensland, Australia
| | - Leanne Berkhahn
- Department of Haematology, The Auckland City Hospital, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
| | - Robert Weinkove
- Department of Haematology, Wellington Blood and Cancer Centre, Capital and Coast District Health Board, Wellington, New Zealand.,Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Richard Doocey
- Department of Haematology, The Auckland City Hospital, Auckland, New Zealand
| | - Simon J Harrison
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Nicholas Webber
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Hui-Peng Lee
- Department of Haematology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Scott Chapman
- Department of Infectious Diseases, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Belinda A Campbell
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Simon D J Gibbs
- Department of Haematology, Eastern Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
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23
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D’Alò F, Malafronte R, Piludu F, Bellesi S, Cuccaro A, Maiolo E, Modoni A, Leccisotti L, Macis G, Mores N, De Stefano V, Hohaus S. Progressive multifocal leukoencephalopathy in patients with follicular lymphoma treated with bendamustine plus rituximab followed by rituximab maintenance. Br J Haematol 2020; 189:e140-e144. [DOI: 10.1111/bjh.16563] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Francesco D’Alò
- Area of Hematology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
- Università Cattolica del Sacro Cuore Rome Italy
| | - Rosalia Malafronte
- Area of Hematology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Francesca Piludu
- Unit of Radiology and Neuroradiology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Silvia Bellesi
- Area of Hematology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Annarosa Cuccaro
- Area of Hematology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Elena Maiolo
- Area of Hematology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Anna Modoni
- Unit of Neurology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Lucia Leccisotti
- Unit of Nuclear Medicine Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Giuseppe Macis
- Università Cattolica del Sacro Cuore Rome Italy
- Unit of Radiology and Neuroradiology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Nadia Mores
- Università Cattolica del Sacro Cuore Rome Italy
- Unit of Pharmacovigilance Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Valerio De Stefano
- Area of Hematology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
- Università Cattolica del Sacro Cuore Rome Italy
| | - Stefan Hohaus
- Area of Hematology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
- Università Cattolica del Sacro Cuore Rome Italy
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24
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Kiefer T, Krahl D, Kohlmann T, Nogai A, Baurmann H, Schüler F, Krüger W, de Wit M, Pink D, Dietz M, Völler H, Buhlert H, Daeschlein G. Does rehabilitation pose a risk to patients suffering from haemato-oncological diseases? Results of a monocentric, retrospective analysis in Germany. Eur J Cancer Care (Engl) 2019; 29:e13201. [PMID: 31808982 DOI: 10.1111/ecc.13201] [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: 11/09/2017] [Revised: 10/16/2019] [Accepted: 11/22/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patients suffering from haemato-oncological diseases tend to have a weakened immune system after the end of their therapy. To avoid infections, patients are advised to limit contact with other people. This poses the question whether a stay at a rehabilitation facility can be recommended. METHODS We report about 134 rehabilitation stays of patients. Premature discontinuation of the rehabilitation stay was selected as the criterion for a serious complication during the rehabilitation, and the underlying reasons were analysed. RESULTS Compared to the discontinuation rates of patients suffering from solid tumours (2.4%), the percentage of haemato-oncological patients ending prematurely their rehabilitation stay (8.2%) is significantly increased. This rises to 17.1% for patients who have undergone an allogeneic stem cell transplantation. The analysis of the discontinuation reasons revealed that they were not directly connected to the rehabilitation. Apart from the already known risk factors for premature termination of the rehabilitation stay, we have identified the period (days) between the last therapy and the beginning of the rehabilitation stay as a risk factor. CONCLUSIONS We show for the first time that a rehabilitation stay does not pose additional risks for patients suffering from haemato-oncological diseases.
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Affiliation(s)
- Thomas Kiefer
- Klinik am See, Rehabilitationszentrum, Rüdersdorf, Germany
| | - Dorothea Krahl
- Klinik am See, Rehabilitationszentrum, Rüdersdorf, Germany
| | - Thomas Kohlmann
- Institut für Community Medicine, Methods of Community Medicine, Universität Greifswald, Greifswald, Germany
| | - Axel Nogai
- Department of Hematology, Oncology and Tumor Immunology, Charite Medical School, Berlin, Germany
| | - Herrad Baurmann
- Klinik für Hämatologie, Onkologie, Tumorimmunologie und Palliativmedizin, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Frank Schüler
- Abteilung Hämatologie/Onkologie, DRK Krankenhaus Luckenwalde, Luckenwalde, Germany
| | - William Krüger
- Klinik und Poliklinik für Innere Medizin C, Hämatologie und Onkologie, Transplantationszentrum, Palliativmedizin, Universität Greifswald, Greifswald, Germany
| | - Maike de Wit
- Klinik für Innere Medizin, Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Daniel Pink
- Klinik und Poliklinik für Innere Medizin C, Hämatologie und Onkologie, Transplantationszentrum, Palliativmedizin, Universität Greifswald, Greifswald, Germany.,Klinik für Hämatologie, Onkologie und Palliativmedizin, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Bad-Saarow, Bad Saarow, Germany
| | - Marion Dietz
- Klinik am See, Rehabilitationszentrum, Rüdersdorf, Germany
| | - Heinz Völler
- Klinik am See, Rehabilitationszentrum, Rüdersdorf, Germany.,humanwissenschaftliche Fakultät, Universität Potsdam, Potsdam, Germany
| | | | - Georg Daeschlein
- Klinik und Poliklinik für Hautkrankheiten, Universität Greifswald, Greifswald, Germany
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25
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Trotman J, Cheah CY, Marlton P, Opat S. Author reply. Intern Med J 2019; 49:1338-1339. [DOI: 10.1111/imj.14460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Judith Trotman
- Department of HaematologyConcord Hospital Sydney New South Wales Australia
- Department of MedicineUniversity of Sydney Sydney New South Wales Australia
| | - Chan Y. Cheah
- Department of HaematologySir Charles Gairdner Hospital Perth Western Australia Australia
- Department of HaematologyPathwest Laboratory Medicine Perth Western Australia Australia
- School of MedicineUniversity of Western Australia Perth Western Australia Australia
| | - Paula Marlton
- Division of Cancer Services, Clinical HaematologyPrincess Alexandra Hospital Brisbane Queensland Australia
- University of Queensland, School of Clinical Medicine Brisbane Queensland Australia
| | - Stephen Opat
- Clinical Haematology and School of Clinical SciencesMonash Health Melbourne Victoria Australia
- Division of MedicineMonash University Melbourne Victoria Australia
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