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Pennings ERA, Durmaz M, Visser O, Posthuma EFM, Issa DE, Chamuleau MED, Lugtenburg PJ, Kersten MJ, Dinmohamed AG. Treatment and outcomes for patients with relapsed or refractory diffuse large B-cell lymphoma: a contemporary, nationwide, population-based study in the Netherlands. Blood Cancer J 2024; 14:3. [PMID: 38177115 PMCID: PMC10766619 DOI: 10.1038/s41408-023-00970-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024] Open
Affiliation(s)
- Elise R A Pennings
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands.
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Müjde Durmaz
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Eduardus F M Posthuma
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Djamila E Issa
- Department of Internal Medicine, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Martine E D Chamuleau
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pieternella J Lugtenburg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands
| | - Avinash G Dinmohamed
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
- Department of Hematology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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de Boer JW, Keijzer K, Pennings ERA, van Doesum JA, Spanjaart AM, Jak M, Mutsaers PGNJ, van Dorp S, Vermaat JSP, van der Poel MWM, van Dijk LV, Kersten MJ, Niezink AGH, van Meerten T. Population-Based External Validation of the EASIX Scores to Predict CAR T-Cell-Related Toxicities. Cancers (Basel) 2023; 15:5443. [PMID: 38001703 PMCID: PMC10670876 DOI: 10.3390/cancers15225443] [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: 09/29/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) can hamper the clinical benefit of CAR T-cell therapy in patients with relapsed/refractory large B-cell lymphoma (r/r LBCL). To assess the risk of CRS and ICANS, the endothelial activation and stress index (EASIX), the modified EASIX (m-EASIX), simplified EASIX (s-EASIX), and EASIX with CRP/ferritin (EASIX-F(C)) were proposed. This study validates these scores in a consecutive population-based cohort. Patients with r/r LBCL treated with axicabtagene ciloleucel were included (n = 154). EASIX scores were calculated at baseline, before lymphodepletion (pre-LD) and at CAR T-cell infusion. The EASIX and the s-EASIX at pre-LD were significantly associated with ICANS grade ≥ 2 (both p = 0.04), and the EASIX approached statistical significance at infusion (p = 0.05). However, the predictive performance was moderate, with area under the curves of 0.61-0.62. Validation of the EASIX-FC revealed that patients in the intermediate risk group had an increased risk of ICANS grade ≥ 2 compared to low-risk patients. No significant associations between EASIX scores and CRS/ICANS grade ≥ 3 were found. The (m-/s-) EASIX can be used to assess the risk of ICANS grade ≥ 2 in patients treated with CAR T-cell therapy. However, due to the moderate performance of the scores, further optimization needs to be performed before broad implementation as a clinical tool, directing early intervention and guiding outpatient CAR T-cell treatment.
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Affiliation(s)
- Janneke W. de Boer
- Department of Hematology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (J.W.d.B.); (K.K.); (J.A.v.D.)
| | - Kylie Keijzer
- Department of Hematology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (J.W.d.B.); (K.K.); (J.A.v.D.)
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (L.V.v.D.); (A.G.H.N.)
| | - Elise R. A. Pennings
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, 1007 MB Amsterdam, The Netherlands (M.J.K.)
- Cancer Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), 1105 AZ Amsterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
| | - Jaap A. van Doesum
- Department of Hematology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (J.W.d.B.); (K.K.); (J.A.v.D.)
| | - Anne M. Spanjaart
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, 1007 MB Amsterdam, The Netherlands (M.J.K.)
- Cancer Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), 1105 AZ Amsterdam, The Netherlands
| | - Margot Jak
- Department of Hematology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Pim G. N. J. Mutsaers
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - Suzanne van Dorp
- Department of Hematology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Joost S. P. Vermaat
- Department of Hematology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Marjolein W. M. van der Poel
- Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands;
| | - Lisanne V. van Dijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (L.V.v.D.); (A.G.H.N.)
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, 1007 MB Amsterdam, The Netherlands (M.J.K.)
- Cancer Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), 1105 AZ Amsterdam, The Netherlands
| | - Anne G. H. Niezink
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (L.V.v.D.); (A.G.H.N.)
| | - Tom van Meerten
- Department of Hematology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (J.W.d.B.); (K.K.); (J.A.v.D.)
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