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Baird CE, Wulff-Burchfield E, Egan PC, Hugar LA, Vyas A, Trikalinos NA, Liu MA, Bélanger E, Olszewski AJ, Bantis LE, Panagiotou OA. Predictors of high-intensity care at the end of life among older adults with solid tumors: A population-based study. J Geriatr Oncol 2024; 15:101774. [PMID: 38676975 DOI: 10.1016/j.jgo.2024.101774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/05/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION High-intensity end-of-life (EoL) care can be burdensome for patients, caregivers, and health systems and does not confer any meaningful clinical benefit. Yet, there are significant knowledge gaps regarding the predictors of high-intensity EoL care. In this study, we identify risk factors associated with high-intensity EoL care among older adults with the four most common malignancies, including breast, prostate, lung, and colorectal cancer. MATERIALS AND METHODS Using SEER-Medicare data, we conducted a retrospective analysis of Medicare beneficiaries aged 65 and older who died of breast, prostate, lung, or colorectal cancer between 2011 and 2015. We used multivariable logistic regression to identify clinical, demographic, socioeconomic, and geographic predictors of high-intensity EoL care, which we defined as death in an acute care hospital, receipt of any oral or parenteral chemotherapy within 14 days of death, one or more admissions to the intensive care unit within 30 days of death, two or more emergency department visits within 30 days of death, or two or more inpatient admissions within 30 days of death. RESULTS Among 59,355 decedents, factors associated with increased likelihood of receiving high-intensity EoL care were increased comorbidity burden (odds ratio [OR]:1.29; 95% confidence interval [CI]:1.28-1.30), female sex (OR:1.05; 95% CI:1.01-1.09), Black race (OR:1.14; 95% CI:1.07-1.23), Other race/ethnicity (OR:1.20; 95% CI:1.10-1.30), stage III disease (OR:1.11; 95% CI:1.05-1.18), living in a county with >1,000,000 people (OR:1.23; 95% CI:1.16-1.31), living in a census tract with 10%-<20% poverty (OR:1.09; 95% CI:1.03-1.16) or 20%-100% poverty (OR:1.12; 95% CI:1.04-1.19), and having state-subsidized Medicare premiums (OR:1.18; 95% CI:1.12-1.24). The risk of high-intensity EoL care was lower among patients who were older (OR:0.98; 95% CI:0.98-0.99), lived in the Midwest (OR:0.69; 95% CI:0.65-0.75), South (OR:0.70; 95% CI:0.65-0.74), or West (OR:0.81; 95% CI:0.77-0.86), lived in mostly rural areas (OR:0.92; 95% CI:0.86-1.00), and had poor performance status (OR:0.26; 95% CI:0.25-0.28). Results were largely consistent across cancer types. DISCUSSION The risk factors identified in our study can inform the development of new interventions for patients with cancer who are likely to receive high-intensity EoL care. Health systems should consider incorporating these risk factors into decision-support tools to assist clinicians in identifying which patients should be referred to hospice and palliative care.
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Affiliation(s)
- Courtney E Baird
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA.
| | - Elizabeth Wulff-Burchfield
- Medical Oncology Division and Palliative Medicine Division, Department of Internal Medicine, University of Kansas School of Medicine, University of Kansas Cancer Center, The University of Kansas Health System, Kansas City, KS, USA
| | - Pamela C Egan
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Lee A Hugar
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Ami Vyas
- University of Rhode Island, College of Pharmacy, Department of Pharmacy Practice, Kingston, RI, USA
| | - Nikolaos A Trikalinos
- Division of Oncology, Department of Medicine, Washington University Medical School Campus, St. Louis, MO, USA; Siteman Cancer Center, St. Louis, MO, USA
| | - Michael A Liu
- Columbia University Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Emmanuelle Bélanger
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Adam J Olszewski
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Leonidas E Bantis
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Orestis A Panagiotou
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
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2
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Milrod CJ, Kim KW, Raker C, Ollila TA, Olszewski AJ, Pelcovits A. Progression-free survival is a weakly predictive surrogate end-point for overall survival in follicular lymphoma: A systematic review and meta-analysis. Br J Haematol 2024. [PMID: 38571449 DOI: 10.1111/bjh.19449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
Although progression-free survival (PFS) is a commonly used surrogate end-point for clinical trials of follicular lymphoma (FL), no analyses have evaluated the strength of surrogacy for PFS with overall survival (OS). A systematic review was performed and 20 studies (total participants, 10 724) met final inclusion criteria. PFS was weakly associated with OS (correlation coefficient; 0.383, p < 0.001). The coefficient of determination was 0.15 (95% CI: 0.002-0.35) suggesting 15% of OS variance could be explained by changes in PFS. This challenges the role for PFS as a surrogate end-point for clinical trials and drug approvals.
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Affiliation(s)
- Charles J Milrod
- Department of Hematology/Oncology, Brown University, Providence, Rhode Island, USA
| | - Kang Woo Kim
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Christina Raker
- Lifespan Biostatistics, Epidemiology, Research Design, and Informatics, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Thomas A Ollila
- Department of Hematology/Oncology, Brown University, Providence, Rhode Island, USA
| | - Adam J Olszewski
- Department of Hematology/Oncology, Brown University, Providence, Rhode Island, USA
| | - Ari Pelcovits
- Department of Hematology/Oncology, Brown University, Providence, Rhode Island, USA
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3
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Olszewski AJ. When B cells rebuff bispecifics. Blood 2024; 143:744-746. [PMID: 38421818 DOI: 10.1182/blood.2023023312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
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4
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Epperla N, Zhao Q, Moyo T, Watkins MP, Tavakkoli M, Bello C, Torka P, Reddy N, Thomas C, Annunzio K, Christian B, Barta SK, Shouse G, Olszewski AJ, Bartlett NL. Outcomes of marginal zone lymphoma treated with ibrutinib in the first-line setting in the United States: a real-world analysis. Blood Adv 2024; 8:549-552. [PMID: 38091577 PMCID: PMC10835265 DOI: 10.1182/bloodadvances.2023011698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/08/2023] [Indexed: 01/25/2024] Open
Affiliation(s)
- Narendranath Epperla
- Division of Hematology, Department of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Qiuhong Zhao
- Division of Hematology, Department of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Tamara Moyo
- Department of Medicine, Levine Cancer Center, Atrium Health, Charlotte, NC
| | - Marcus P. Watkins
- Department of Medicine, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Montreh Tavakkoli
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Celeste Bello
- Department of Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Pallawi Torka
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nishitha Reddy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Colin Thomas
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Kaitlin Annunzio
- Division of Hematology, Department of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Beth Christian
- Division of Hematology, Department of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Stefan K. Barta
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Geoffrey Shouse
- Department of Medicine, City of Hope National Medical Center, Duarte, CA
| | | | - Nancy L. Bartlett
- Department of Medicine, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
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5
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Budde LE, Olszewski AJ, Assouline S, Lossos IS, Diefenbach C, Kamdar M, Ghosh N, Modi D, Sabry W, Naik S, Mehta A, Nakhoda SK, Smith SD, Dorritie K, Jia T, Pham S, Huw LY, Jing J, Wu H, Ead WS, To I, Batlevi CL, Wei MC, Chavez JC. Mosunetuzumab with polatuzumab vedotin in relapsed or refractory aggressive large B cell lymphoma: a phase 1b/2 trial. Nat Med 2024; 30:229-239. [PMID: 38072960 PMCID: PMC10803244 DOI: 10.1038/s41591-023-02726-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/16/2023] [Indexed: 01/24/2024]
Abstract
Relapsed/refractory aggressive large B cell lymphoma (LBCL) remains an area of unmet need. Here we report the primary analysis of a phase 1b/2 trial of outpatient mosunetuzumab (a CD20xCD3 T-cell-engaging bispecific antibody) plus polatuzumab vedotin (an anti-CD79B antibody-drug conjugate) in relapsed/refractory LBCL. The phase 2 component is a single arm of an ongoing multi-arm trial. The primary endpoint during dose expansion was independent review committee (IRC)-assessed best overall response rate. Secondary endpoints included investigator-assessed overall response rate, complete response, duration of response, progression-free survival and overall survival. At data cutoff, 120 patients were enrolled (22 dose escalation, 98 dose expansion). The primary endpoint was met during dose expansion, with IRC-assessed best overall response rate and complete response rates of 59.2% (58/98; 95% confidence interval (CI): 48.8-69.0) and 45.9% (45/98; 95% CI: 35.8-56.3), respectively (median follow-up, 23.9 months). Median duration of complete was not reached (95% CI: 20.5-not estimable (NE)). Median progression-free survival was 11.4 months (95% CI: 6.2-18.7). Median overall survival was 23.3 months (95% CI: 14.8-NE). Across dose escalation and expansion, the most common grade 3 or higher adverse events were neutropenia (25.0%, 30/120) and fatigue (6.7%, 8/120). Any-grade cytokine release syndrome occurred in 16.7% of patients. These data demonstrate that mosunetuzumab plus polatuzumab vedotin has a favorable safety profile with highly durable responses suitable as second-line therapy in transplant-ineligible relapsed/refractory LBCL. ClinicalTrials.gov identifier: NCT03671018 .
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Affiliation(s)
- Lihua E Budde
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
| | | | - Sarit Assouline
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Izidore S Lossos
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL, USA
| | | | | | - Nilanjan Ghosh
- Hematologic Oncology and Blood Disorders, Atrium Health Levine Cancer Institute, Charlotte, NC, USA
| | - Dipenkumar Modi
- Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA
| | - Waleed Sabry
- Saskatoon Cancer Center, Saskatoon, Saskatchewan, Canada
| | - Seema Naik
- Penn State Cancer Institute, Hershey, PA, USA
| | | | | | | | - Kathleen Dorritie
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ting Jia
- Roche (China) Holding Ltd, Shanghai, China
| | - Song Pham
- F. Hoffmann-La Roche Ltd, Mississauga, Ontario, Canada
| | | | - Jing Jing
- Genentech, Inc., South San Francisco, CA, USA
| | - Hao Wu
- Genentech, Inc., South San Francisco, CA, USA
| | - Wahib S Ead
- Genentech, Inc., South San Francisco, CA, USA
| | - Iris To
- Genentech, Inc., South San Francisco, CA, USA
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6
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Annunzio K, Grover NS, Welkie RL, Torka P, Watkins MP, Anampa-Guzmán A, Tavakkoli M, Oh TS, Reves H, Jones D, Hanel W, Christian B, Ramakrishnan Geethakumari P, Karmali R, Barta SK, Bartlett NL, Olszewski AJ, Epperla N. Impact of circulating lymphoma cells at diagnosis on outcomes in patients with marginal zone lymphoma: a multicenter cohort study. Blood Adv 2023; 7:6839-6843. [PMID: 37792806 PMCID: PMC10679805 DOI: 10.1182/bloodadvances.2023011288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/05/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Kaitlin Annunzio
- Division of Hematology, Department of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Natalie S. Grover
- Department of Medicine, Lineberger Comprehensive Cancer Center, The University of North Carolina, Chapel Hill, NC
| | - Rina Li Welkie
- Division of Hematology, Department of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Pallawi Torka
- Division of Hematology and Oncology, Roswell Park Cancer Institute, Buffalo, NY
| | - Marcus P. Watkins
- Department of Medicine, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | | | - Montreh Tavakkoli
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Timothy S. Oh
- Department of Medicine, Northwestern University, Chicago, IL
| | - Heather Reves
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Daniel Jones
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Walter Hanel
- Division of Hematology, Department of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Beth Christian
- Division of Hematology, Department of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Reem Karmali
- Department of Medicine, Northwestern University, Chicago, IL
| | - Stefan K. Barta
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nancy L. Bartlett
- Department of Medicine, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | | | - Narendranath Epperla
- Division of Hematology, Department of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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7
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Zayac AS, Landsburg DJ, Hughes ME, Bock AM, Nowakowski GS, Ayers EC, Girton M, Hu M, Beckman AK, Li S, Medeiros LJ, Chang JE, Stepanovic A, Kurt H, Sandoval-Sus J, Ansari-Lari MA, Kothari SK, Kress A, Xu ML, Torka P, Sundaram S, Smith SD, Naresh KN, Karimi YH, Epperla N, Bond DA, Farooq U, Saad M, Evens AM, Pandya K, Naik SG, Kamdar M, Haverkos B, Karmali R, Oh TS, Vose JM, Nutsch H, Rubinstein PG, Chaudhry A, Olszewski AJ. High-grade B-cell lymphoma, not otherwise specified: a multi-institutional retrospective study. Blood Adv 2023; 7:6381-6394. [PMID: 37171397 PMCID: PMC10598493 DOI: 10.1182/bloodadvances.2023009731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023] Open
Abstract
In this multi-institutional retrospective study, we examined the characteristics and outcomes of 160 patients with high-grade B-cell lymphoma, not otherwise specified (HGBL-NOS)-a rare category defined by high-grade morphologic features and lack of MYC rearrangements with BCL2 and/or BCL6 rearrangements ("double hit"). Our results show that HGBL-NOS tumors are heterogeneous: 83% of patients had a germinal center B-cell immunophenotype, 37% a dual-expressor immunophenotype (MYC and BCL2 expression), 28% MYC rearrangement, 13% BCL2 rearrangement, and 11% BCL6 rearrangement. Most patients presented with stage IV disease, a high serum lactate dehydrogenase, and other high-risk clinical factors. Most frequent first-line regimens included dose-adjusted cyclophosphamide, doxorubicin, vincristine, and etoposide, with rituximab and prednisone (DA-EPOCH-R; 43%); rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; 33%); or other intensive chemotherapy programs. We found no significant differences in the rates of complete response (CR), progression-free survival (PFS), or overall survival (OS) between these chemotherapy regimens. CR was attained by 69% of patients. PFS at 2 years was 55.2% and OS was 68.1%. In a multivariable model, the main prognostic factors for PFS and OS were poor performance status, lactate dehydrogenase >3 × upper limit of normal, and a dual-expressor immunophenotype. Age >60 years or presence of MYC rearrangement were not prognostic, but patients with TP53 alterations had a dismal PFS. Presence of MYC rearrangement was not predictive of better PFS in patients treated with DA-EPOCH-R vs R-CHOP. Improvements in the diagnostic criteria and therapeutic approaches beyond dose-intense chemotherapy are needed to overcome the unfavorable prognosis of patients with HGBL-NOS.
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Affiliation(s)
- Adam S. Zayac
- Division of Hematology/Oncology, The Warren Alpert Medical School Medical School of Brown University, Providence, RI
| | | | | | | | | | - Emily C. Ayers
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Mark Girton
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA
| | - Marie Hu
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Amy K. Beckman
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Shaoying Li
- Division of Pathology and Laboratory Medicine, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - L. Jeffrey Medeiros
- Division of Pathology and Laboratory Medicine, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Julie E. Chang
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Adam Stepanovic
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Habibe Kurt
- Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Jose Sandoval-Sus
- Department of Malignant Hematology and Cellular Therapy, Moffitt Cancer Center at Memorial Healthcare System, Pembroke Pines, FL
| | | | - Shalin K. Kothari
- Division of Hematology, Yale University School of Medicine, New Haven, CT
| | - Anna Kress
- Division of Hematology, Yale University School of Medicine, New Haven, CT
| | - Mina L. Xu
- Department of Pathology and Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
| | - Pallawi Torka
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Suchitra Sundaram
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Stephen D. Smith
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, University of Washington, Seattle, WA
| | | | - Yasmin H. Karimi
- Division of Hematology-Oncology, University of Michigan Health, Ann Arbor, MI
| | | | - David A. Bond
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Umar Farooq
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Mahak Saad
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Andrew M. Evens
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Karan Pandya
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Seema G. Naik
- Penn State Cancer Institute, Penn State Hershey Medical Center, Hershey, PA
| | - Manali Kamdar
- Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado, Denver, CO
| | - Bradley Haverkos
- Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado, Denver, CO
| | - Reem Karmali
- Division of Hematology and Oncology, Northwestern University, Chicago, IL
| | - Timothy S. Oh
- Division of Hematology and Oncology, Northwestern University, Chicago, IL
| | - Julie M. Vose
- Department of Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Heather Nutsch
- Department of Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Paul G. Rubinstein
- Department of Medicine, Section of Hematology-Oncology, University of Illinois, Chicago, IL
| | - Amina Chaudhry
- Department of Medicine, Section of Hematology-Oncology, University of Illinois, Chicago, IL
| | - Adam J. Olszewski
- Division of Hematology/Oncology, The Warren Alpert Medical School Medical School of Brown University, Providence, RI
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8
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Olszewski AJ, Phillips TJ, Hoffmann MS, Armand P, Kim TM, Yoon DH, Mehta A, Greil R, Westin J, Lossos IS, Munoz JL, Sit J, Wei MC, Yang A, Chen V, Purev E, Yee DL, Jaeger U. Mosunetuzumab in combination with CHOP in previously untreated DLBCL: safety and efficacy results from a phase 2 study. Blood Adv 2023; 7:6055-6065. [PMID: 37581593 PMCID: PMC10582312 DOI: 10.1182/bloodadvances.2023010840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/28/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023] Open
Abstract
Up to 40% of patients with diffuse large B-cell lymphoma (DLBCL) are refractory to or relapse after first-line therapy, highlighting the need for better treatments. Mosunetuzumab is a CD20 × CD3 bispecific antibody that engages and redirects T cells to eliminate malignant B cells. In this phase 2, open-label study (NCT03677141), 40 patients (52.5% with international prognostic index ≥3) with previously untreated DLBCL initiated 6 cycles of IV mosunetuzumab with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy. Mosunetuzumab was administered in cycle 1 as step-up doses to mitigate cytokine release syndrome [CRS], and a dose of 30 mg was given on day 1 of cycles 2-6. Efficacy end points included objective and complete response rates, as determined by the investigator, via positron emission tomography-computed tomography, using Lugano 2014 criteria (87.5% and 85.0%, respectively). At a median follow-up of 32.0 months, the estimated 2-year progression-free survival and event-free survival rates were 65.4% (95% confidence interval [CI], 49.5-81.4) and 60.4% (95% CI, 44.7-76.1), respectively. CRS occurred in 60.0% of patients; all events were grade 1 (45.0%) or grade 2 (15.0%) and occurred primarily in cycle 1. Mosunetuzumab-related grade ≥3 neurologic adverse events (AEs) potentially consistent with immune effector cell-associated neurotoxicity syndrome occurred in 1 patient (2.5%). Grade 5 AEs were reported in 2 patients. Neutropenia occurred in 70.0% of patients, mostly during cycle 1 and was of short duration. These findings demonstrate promising activity and a manageable safety profile for mosunetuzumab-CHOP and warrant further investigation of mosunetuzumab in first-line combination regimens for DLBCL.
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Affiliation(s)
- Adam J. Olszewski
- Lifespan Cancer Institute, Warren Alpert Medical School of Brown University, Providence, RI
| | - Tycel J. Phillips
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Marc S. Hoffmann
- Hematologic Malignancies and Cellular Therapeutics, The University of Kansas Cancer Center, Kansas City, KS
| | - Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dok Hyun Yoon
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Amitkumar Mehta
- Division of Hematology and Oncology, University of Alabama School of Medicine, Birmingham, AL
| | - Richard Greil
- IIIrd Medical Department, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University, Salzburg, Austria
| | - Jason Westin
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Izidore S. Lossos
- Division of Hematology, Department of Medicine, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | | | - Jason Sit
- Genentech, Inc., South San Francisco, CA
| | | | - Annie Yang
- Genentech, Inc., South San Francisco, CA
| | | | | | | | - Ulrich Jaeger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
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9
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Farooq F, Brandt JS, Cardonick E, Polushkina E, Vose J, Ahmed S, Ramakrishnan Geethakumari P, Olszewski AJ, Yasin H, Farooq U, Hamad N, Lin Y, Maggen C, Fruscio R, Gziri MM, Steffensen KD, Amant F, Evens AM. An international real-world analysis of relapsed/refractory lymphoma occurring during pregnancy. Blood Adv 2023; 7:5480-5484. [PMID: 37259563 PMCID: PMC10515306 DOI: 10.1182/bloodadvances.2023010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/07/2023] [Accepted: 04/30/2023] [Indexed: 06/02/2023] Open
Affiliation(s)
- Faheem Farooq
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Justin S. Brandt
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Elyce Cardonick
- Maternal-Fetal Medicine, Cooper University Hospital, Camden, NJ
| | - Evgeniya Polushkina
- National Medical Research Centre for Obstetrics, Gynaecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Julie Vose
- Division of Hematology & Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Fred and Pamela Buffett Cancer Center, Omaha, NE
| | | | - Praveen Ramakrishnan Geethakumari
- Division of Hematologic Malignancies and Cellular Therapy, Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Hesham Yasin
- Hematology/Oncology and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Umar Farooq
- Hematology/Oncology and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Nada Hamad
- Department of Haematology and Bone Marrow Transplantation, St Vincent’s Hospital, Sydney, Australia
| | - Yong Lin
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Robert Fruscio
- University of Milan – Bicocca, San Gerardo Hospital, Monza, Italy
| | - Mina Mhallem Gziri
- Department of Obstetrics, Cliniques Universitaires Saint-Luc, Woluwe-Saint-Lambert, Belgium
| | - Karina Dahl Steffensen
- Center for Shared Decsion Making, Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark
| | - Frédéric Amant
- Center for Gynecological Oncology, University of Amsterdam, Amsterdam, The Netherlands
| | - Andrew M. Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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10
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Ollila TA, Taher R, Moku P, Olszewski AJ. Immunochemotherapy or chemotherapy alone in primary central nervous system lymphoma: a National Cancer Database analysis. Blood Adv 2023; 7:5470-5479. [PMID: 37459209 PMCID: PMC10515309 DOI: 10.1182/bloodadvances.2023010352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/06/2023] [Indexed: 09/16/2023] Open
Abstract
Debate remains over the role of rituximab, a large molecule with reduced central nervous system (CNS) penetration, in therapy for primary CNS lymphoma (PCNSL). Since 2013, the National Cancer Database has distinguished between chemotherapy and immunotherapy for frontline treatment. In this setting, rituximab would be the only standard frontline immunotherapy. We examined factors associated with the receipt of immunotherapy using a multivariate regression model for relative risk, with a random intercept to account for the hospital-specific treatment selection process. Patients were matched using a 1:1 propensity score to limit possible confounders, and overall survival (OS) was compared in the matched cohort. We identified 4691 patients with PCNSL diagnosed between 2013 and 2018. The use of immunotherapy has increased from 45% in 2013 to 76% in 2018. Immunotherapy use was associated with sociodemographic variables and local (hospital level) preference rather than clinical factors. The main factors associated with reduced use of immunotherapy included male sex, Black race or Hispanic ethnicity (compared with White non-Hispanic), HIV+ status, treatment in a lower-volume hospital, and earlier year of diagnosis. We matched 2830 patients for the survival analysis. Receipt of immunotherapy was associated with a significantly better OS (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.67-0.83). There was heterogeneity according to age, because the advantage of immunotherapy was more pronounced for patients aged ≤75 years (HR, 0.71; 95% CI, 0.63-0.80) than for those older than 75 years (HR, 0.87; 95% CI, 0.70-1.08). Overall, our findings support the current trend toward rituximab use, although a nuanced approach should be adopted when treating older patients.
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Affiliation(s)
- Thomas A. Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
- Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI
| | - Rashida Taher
- Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI
| | - Prashanth Moku
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Adam J. Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
- Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI
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11
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Epperla N, Zhao Q, Karmali R, Torka P, Shea L, Oh TS, Anampa-Guzmán A, Reves H, Tavakkoli M, Greenwell IB, Hansinger E, Umyarova E, Annunzio K, Sawalha Y, Christian B, Thomas C, Barta SK, Geethakumari PR, Bartlett NL, Grover NS, Olszewski AJ. Impact of detectable monoclonal protein at diagnosis on outcomes in marginal zone lymphoma: a multicenter cohort study. Blood Adv 2023; 7:5038-5046. [PMID: 37315169 PMCID: PMC10471932 DOI: 10.1182/bloodadvances.2023010133] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/16/2023] Open
Abstract
Given the paucity of data surrounding the prognostic relevance of monoclonal paraprotein (M-protein) in marginal zone lymphoma (MZL), we sought to evaluate the impact of detecting M-protein at diagnosis on outcomes in patients with MZL in a large retrospective cohort. The study included 547 patients receiving first-line therapy for MZL. M-protein was detectable at diagnosis in 173 (32%) patients. There was no significant difference in the time from diagnosis to initiation of any therapy (systemic and local) between the M-protein and no M-protein groups. Patients with M-protein at diagnosis had significantly inferior progression-free survival (PFS) compared with those without M-protein at diagnosis. After adjusting for factors associated with inferior PFS in univariate models, presence of M-protein remained significantly associated with inferior PFS (hazard ratio, 1.74; 95% confidence interval, 1.20-2.54; P = .004). We observed no significant difference in the PFS based on the type or quantity of M-protein at diagnosis. There were differential outcomes in PFS based on the first-line therapy in patients with M-protein at diagnosis, in that, those receiving immunochemotherapy had better outcomes compared with those receiving rituximab monotherapy. The cumulative incidence of relapse in stage 1 disease among the recipients of local therapy was higher in the presence of M-protein; however, this did not reach statistical significance. We found that M-protein at diagnosis was associated with a higher risk of histologic transformation. Because the PFS difference related to presence of M-protein was not observed in patients receiving bendamustine and rituximab, immunochemotherapy may be a preferred approach over rituximab monotherapy in this group and needs to be explored further.
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Affiliation(s)
- Narendranath Epperla
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Qiuhong Zhao
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Reem Karmali
- Department of Medicine, Northwestern University, Chicago, IL
| | - Pallawi Torka
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lauren Shea
- Department of Medicine, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Timothy S. Oh
- Department of Medicine, Northwestern University, Chicago, IL
| | | | - Heather Reves
- Department of Medicine, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Montreh Tavakkoli
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Irl Brian Greenwell
- Department of Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Emily Hansinger
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Elvira Umyarova
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH
- Department of Medicine, University of Vermont, Burlington, VT
| | - Kaitlin Annunzio
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Yazeed Sawalha
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Beth Christian
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Colin Thomas
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Stefan K. Barta
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Nancy L. Bartlett
- Department of Medicine, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Natalie S. Grover
- Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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12
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Pelcovits A, Ollila TA, Olszewski AJ. Advances in Immunotherapy for the Treatment of Cutaneous T-Cell Lymphoma. Cancer Manag Res 2023; 15:989-998. [PMID: 37700809 PMCID: PMC10493109 DOI: 10.2147/cmar.s330908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
Cutaneous T-Cell Lymphoma (CTCL) is a heterogenous disease that consists of distinct clinicopathologic entities and presentations requiring a unique and expert approach to management. The most common subtype is mycosis fungoides, in which local disease has an excellent prognosis and is often managed with topical therapy alone. More extensive cutaneous involvement as well as involvement of lymph nodes and the peripheral blood (Sezary syndrome) require systemic therapies. Recent years have brought an expansion of therapeutic options, specifically with immune-based approaches that were developed using the knowledge gained regarding the biology and molecular pathology of CTCL. Previous systemic therapies such as retinoids, histone deacetylase inhibitors, and chemotherapeutic agents come with significant toxicity and only short-term response. Newer agents such as mogamulizumab and brentuximab vedotin use a targeted immune-based approach leading to longer periods of response with less systemic toxicity. While still in its infancy, the use of immune checkpoint inhibitors such as nivolumab and pembrolizumab appears promising, and while their current clinical application is limited, early data suggest possible future areas for research of immune manipulation to treat CTCL. Herein, we review these novel immune-based treatment strategies, their superiority over prior systemic options, and the ongoing need for further research and clinical trial enrollment.
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Affiliation(s)
- Ari Pelcovits
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
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13
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Di M, Keeney T, Belanger E, Huntington SF, Olszewski AJ, Panagiotou OA. Functional status and therapy for older adults with diffuse large B-cell lymphoma in nursing homes: A population-based study. J Am Geriatr Soc 2023; 71:2239-2249. [PMID: 36882865 PMCID: PMC10483014 DOI: 10.1111/jgs.18302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/20/2023] [Accepted: 01/28/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES To characterize the prevalence of functional and cognitive impairments, and associations between impairments and treatment among older patients with diffuse large B cell lymphoma (DLBCL) receiving nursing home (NH) care. METHODS We used the Surveillance, Epidemiology, and End Results-Medicare database to identify beneficiaries diagnosed with DLBCL 2011-2015 who received care in a NH within -120 ~ +30 days of diagnosis. Multivariable logistic regression was used to compare receipt of chemoimmunotherapy (including multi-agent, anthracycline-containing regimens), 30-day mortality, and hospitalization between NH and community-dwelling patients, estimating odds ratios (OR) and 95% confidence interval (CI). We also examined overall survival (OS). Among NH patients, we examined receipt of chemoimmunotherapy based on functional and cognitive impairment. RESULTS Of the eligible 649 NH patients (median age: 82 years), 45% received chemoimmunotherapy; among the recipients, 47% received multi-agent, anthracycline-containing regimens. Compared with community-dwelling patients, those in a NH were less likely to receive chemoimmunotherapy (OR: 0.34, 95%CI: 0.29-0.41), had higher 30-day mortality (OR: 2.00, 95%CI: 1.43-2.78) and hospitalization (OR: 1.51, 95%CI: 1.18-1.93), and poorer OS (hazard ratio: 1.36, 95%CI: 1.11-1.65). NH patients with severe functional (61%) or any cognitive impairment (48%) were less likely to receive chemoimmunotherapy. CONCLUSIONS High rates of functional and cognitive impairment and low rates of chemoimmunotherapy were observed among NH residents diagnosed with DLBCL. Further research is needed to better understand the potential role of novel and alternative treatment strategies and patient preferences for treatment to optimize clinical care and outcomes in this high-risk population.
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Affiliation(s)
- Mengyang Di
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Tamra Keeney
- Center for Aging and Serious Illness, Massachusetts General Hospital, Mongan Institute, Boston, Massachusetts, USA
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Services, Policy and Practice, Brown University Health School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Emmanuelle Belanger
- Department of Services, Policy and Practice, Brown University Health School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Scott F. Huntington
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Adam J. Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Orestis A. Panagiotou
- Department of Services, Policy and Practice, Brown University Health School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
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14
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Bakow BR, Phung Q, Rabinovich D, Olszewski AJ, Reagan JL. Choice of anticoagulation in patients with low risk antiphospholipid syndrome. J Thromb Thrombolysis 2023:10.1007/s11239-023-02826-6. [PMID: 37219825 DOI: 10.1007/s11239-023-02826-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/24/2023]
Abstract
Antiphospholipid syndrome (APS) is an acquired hypercoagulable state necessitating long-term anticoagulation for secondary thrombosis prevention. Anticoagulation guidelines are predominantly based on data in high risk, triple positive patients, and favor Vitamin K antagonists over other forms of anticoagulation. The efficacy of alternative anticoagulants for secondary thrombosis prevention in low risk, single and double positive APS remains uncertain. This study aimed to assess the incidence of recurrent thrombosis and major bleeding for patient with low risk APS on long-term anticoagulation. We performed a retrospective cohort study of patients who met revised criteria for thrombotic APS between January, 2001 and April, 2021 and received care through the Lifespan Health System. Primary outcomes included recurrent thrombosis and WHO Grades 3 and 4 major bleeding. A total of 190 patients were followed over a median duration of 3.1 years. At time of APS diagnosis, 89 patients were treated with warfarin and 59 patients with a direct oral anticoagulant (DOAC). There were similar rates of recurrent thrombosis in low risk patients on warfarin versus DOACs (adjusted IRR 6.91; 95% CI 0.90-53.40, p = 0.064). Major bleeding events only occurred in low risk patients on warfarin (n = 8, log-rank p = 0.13). In conclusion, despite the choice of anticoagulation, patients with low risk APS had similar rates of recurrent thrombosis suggesting DOACs may be a potential treatment option for this cohort. There was a non-significant increase in major bleeding rates in low risk patients on warfarin versus DOACs. Study limitations include a retrospective study design and small event numbers.
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Affiliation(s)
- Brianna R Bakow
- Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Division of Hematology/Oncology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI, 02903, USA.
| | - Quan Phung
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Medicine, Rhode Island Hospital, Providence, RI, USA
| | | | - Adam J Olszewski
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology/Oncology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI, 02903, USA
| | - John L Reagan
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology/Oncology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI, 02903, USA
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15
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Epperla N, Welkie RL, Torka P, Shouse G, Karmali R, Shea L, Anampa-Guzmán A, Oh TS, Reaves H, Tavakkoli M, Lindsey K, Greenwell IB, Hansinger E, Thomas C, Chowdhury SM, Annunzio K, Christian B, Barta SK, Geethakumari PR, Bartlett NL, Herrera AF, Grover NS, Olszewski AJ. Impact of early relapse within 24 months after first-line systemic therapy (POD24) on outcomes in patients with marginal zone lymphoma: A US multisite study. J Hematol Oncol 2023; 16:49. [PMID: 37158890 PMCID: PMC10165748 DOI: 10.1186/s13045-023-01448-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/03/2023] [Indexed: 05/10/2023] Open
Abstract
Progression of disease within 24 months (POD24) from diagnosis in marginal zone lymphoma (MZL) was shown to portend poor outcomes in prior studies. However, many patients with MZL do not require immediate therapy, and the time from diagnosis-to-treatment interval can be highly variable with no universal criteria to initiate systemic therapy. Hence, we sought to evaluate the prognostic relevance of early relapse or progression within 24 months from systemic therapy initiation in a large US cohort. The primary objective was to evaluate the overall survival (OS) in the two groups. The secondary objective included the evaluation of factors predictive of POD24 and the assessment of cumulative incidence of histologic transformation (HT) in POD24 versus non-POD24 groups. The study included 524 patients with 143 (27%) in POD24 and 381 (73%) in non-POD24 groups. Patients with POD24 had inferior OS compared to those without POD24, regardless of the type of systemic therapy received (rituximab monotherapy or immunochemotherapy) at diagnosis. After adjusting for factors associated with inferior OS in the univariate Cox model, POD24 remained associated with significantly inferior OS (HR = 2.50, 95% CI = 1.53-4.09, p = 0.0003) in multivariable analysis. The presence of monoclonal protein at diagnosis and those who received first-line rituximab monotherapy had higher odds of POD24 on logistic regression analysis. Patients with POD24 had a significantly higher risk for HT compared to those without POD24. POD24 in MZL might be associated with adverse biology and could be used as an additional information point in clinical trials and investigated as a marker for worse prognosis.
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Affiliation(s)
- Narendranath Epperla
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA.
| | - Rina Li Welkie
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | | | | | | | - Lauren Shea
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Heather Reaves
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Kathryn Lindsey
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Irl Brian Greenwell
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | | | - Colin Thomas
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Sayan Mullick Chowdhury
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Kaitlin Annunzio
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Beth Christian
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | | | | | - Nancy L Bartlett
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Natalie S Grover
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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16
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McKenna M, Epperla N, Ghobadi A, Liu J, Lazaryan A, Ibrahim U, Jacobson CA, Naik SG, Nastoupil L, Chowdhury SM, Voorhees TJ, Jacobs MT, Farooq U, Osman K, Olszewski AJ, Ahmed S, Evens AM. Real-world evidence of the safety and survival with CD19 CAR-T cell therapy for relapsed/refractory solid organ transplant-related PTLD. Br J Haematol 2023. [PMID: 37129856 DOI: 10.1111/bjh.18828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
The use of CD19 chimeric antigen receptor T-cell (CAR-T) therapy for relapsed/refractory solid organ transplantation (SOT)-related post-transplant lymphoproliferative disorder (PTLD) is not well studied. We conducted a multicentre, retrospective analysis of adults with relapsed/refractory SOT-associated PTLD. Among 22 relapsed/refractory SOT-PTLD patients, the pathology was monomorphic B cell. Prior SOTs included 14 kidney (64%), three liver (14%), two heart (9%), one intestinal (5%), one lung (5%), and one pancreas after kidney transplant (5%). The median time from SOT to PTLD diagnosis was 107 months. Pre-CAR-T bridging therapy was used in 55% of patients, and immunosuppression was stopped completely before CAR-T infusion in 64%. Eighteen (82%) patients experienced cytokine release syndrome: one (5%) each grade (G) 3 and G4. The immune effector cell-associated neurotoxicity syndrome was observed in 16 (73%) patients: six (27%) G3 and two (9%) G4. The overall response rate was 64% (55% complete response). Three patients (14%) experienced allograft rejection after CAR-T. The two-year progression-free survival and overall survival rates were 35% and 58%, respectively. Additionally, the achievement of CR post-CAR-T was strongly associated with survival. Collectively, the safety and efficacy of CD19 CAR-T therapy in relapsed/refractory SOT-related PTLD appeared similar to pivotal CAR-T data, including approximately one-third of patients achieving sustained remission.
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Affiliation(s)
- Marshall McKenna
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Narendranath Epperla
- Division of Hematology, Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Armin Ghobadi
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jieqi Liu
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Aleksandr Lazaryan
- Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida, USA
| | - Uroosa Ibrahim
- Department of Hematology and Oncology, Bone Marrow Transplantation and Cellular Therapy Program, Mount Sinai Hospital, New York, New York, USA
| | - Caron A Jacobson
- Division of Hematologic Malignancies, Harvard Medical School, Dana Faber Cancer Institute, Boston, Massachusetts, USA
| | - Seema G Naik
- Penn State Cancer Institute, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Loretta Nastoupil
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sayan Mullick Chowdhury
- Division of Hematology, Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy J Voorhees
- Division of Hematology, Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Miriam T Jacobs
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Umar Farooq
- Division of Hematology, Oncology and Blood & Marrow Transplantation, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Keren Osman
- Department of Hematology and Oncology, Bone Marrow Transplantation and Cellular Therapy Program, Mount Sinai Hospital, New York, New York, USA
| | - Adam J Olszewski
- Lifespan Cancer Institute, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sairah Ahmed
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
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17
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Pelcovits A, Barth P, Reagan JL, Olszewski AJ, Rosati V, Wood R, Sturtevant A, Winer ES. Ixazomib, Oral Metronomic Cyclophosphamide, and Dexamethasone for First-Line Treatment of Multiple Myeloma: A Phase II Brown University Oncology Group Study. Oncologist 2023; 28:462-e303. [PMID: 36942937 PMCID: PMC10166163 DOI: 10.1093/oncolo/oyad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/03/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Newly diagnosed multiple myeloma patients have many available treatment options. While lenalidomide, bortezomib, and dexamethasone (RVD) is the preferred initial treatment for many patients, several other agents may provide similar efficacy with less toxicity and improved ease of administration. METHODS We evaluated the safety and efficacy of the all-oral regimen of ixazomib, cyclophosphamide, and dexamethasone with the use of metronomic cyclophosphamide dosing in the treatment of patients with newly diagnosed multiple myeloma. RESULTS The study was stopped prior to planned enrollment due to slow recruitment, with 12 patients available for final analysis. The overall response rate was 58.3% with 2 patients achieving a very good partial response (16.7%) and 5 patients achieving a partial response (41.7%). Median progression-free survival was 16 months, and median overall survival was 43 months. There were no episodes of grade 3 or greater peripheral neuropathy. Grade 3 or greater dermatologic toxicity was experienced in 50% of patients. CONCLUSION Although limited enrollment prevented full efficacy evaluation, our data do not support further study of metronomic cyclophosphamide in combination with ixazomib and dexamethasone in the treatment of newly diagnosed multiple myeloma. The activity of this regimen in the relapsed/refractory setting requires further study (ClinicalTrials.gov Identifier: NCT02412228).
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Affiliation(s)
- Ari Pelcovits
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Peter Barth
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - John L Reagan
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Vallerie Rosati
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Roxanne Wood
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Ashlee Sturtevant
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Eric S Winer
- Division of Adult Leukemia, Dana-Farber Cancer Center, Boston, MA, USA
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Ollila TA, Kishkovich TP, Olszewski AJ, Patel NR, Jackson C, Roussel B, Niroula R, Treaba DO. Testicular Relapse of Primary Diffuse Large B-cell Lymphoma of the Central Nervous System - a Rare Occurrence. R I Med J (2013) 2023; 106:8-12. [PMID: 36848533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Among diffuse large b-cell lymphoma (DLBCL) subtypes, primary testicular lymphoma (PTL) has one of the highest risks of central nervous system (CNS) relapse. The converse, primary CNS lymphoma (PCNSL) relapse outside the CNS is rare. Molecular analysis has illustrated a genetic similarity between PTL and PCNSL. Here we present a case of a 64-year-old man with testicular relapse of PCNSL 20 months after a complete response to high dose methotrexate-based chemotherapy. His tumor demonstrated a molecular profile similar to both PCNSL and PTL on next generation sequencing, and molecular analysis confirmed common clonal origin of his CNS and testicular lesions. We review prior cases of testicular relapse of PCNSL, which lacked molecular investigations, and discuss the implications of the genomic findings in our patient, including future treatment options.
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Affiliation(s)
- Thomas A Ollila
- Alpert Medical School of Brown University, Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI
| | - Thomas P Kishkovich
- Division of Obstetrics and Gynecology, Brigham and Women's Hospital/Massachusetts General Hospital, Boston, MA
| | - Adam J Olszewski
- Alpert Medical School of Brown University; Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI
| | - Nimesh R Patel
- Alpert Medical School of Brown University; Department of Pathology, Rhode Island Hospital, Providence, RI
| | - Cynthia Jackson
- Alpert Medical School of Brown University; Department of Pathology, Rhode Island Hospital, Providence, RI
| | - Breton Roussel
- Alpert Medical School of Brown University; Division of Gastroenterology, Rhode Island Hospital, Providence, RI
| | - Rabin Niroula
- Alpert Medical School of Brown University; Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI
| | - Diana O Treaba
- Alpert Medical School of Brown University; Department of Pathology, Rhode Island Hospital, Providence, RI
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19
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Treaba DO, Bonal DM, Chorzalska A, Castillo-Martin M, Oakes A, Pardo M, Petersen M, Schorl C, Hopkins K, Melcher D, Zhao TC, Liang O, So EY, Reagan J, Olszewski AJ, Butera J, Anthony DC, Rintels P, Quesenberry P, Dubielecka PM. Transcriptomics of acute myeloid leukaemia core bone marrow biopsies reveals distinct therapy response-specific osteo-mesenchymal profiles. Br J Haematol 2023; 200:740-754. [PMID: 36354085 DOI: 10.1111/bjh.18513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/12/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022]
Abstract
While the bone marrow (BM) microenvironment is significantly remodelled in acute myeloid leukaemia (AML), molecular insight into AML-specific alterations in the microenvironment has been historically limited by the analysis of liquid marrow aspirates rather than core biopsies that contain solid-phase BM stroma. We assessed the effect of anthracycline- and cytarabine-based induction chemotherapy on both haematopoietic and non-haematopoietic cells directly in core BM biopsies using RNA-seq and histological analysis. We compared matched human core BM biopsies at diagnosis and 2 weeks after cytarabine- and anthracycline-based induction therapy in responders (<5% blasts present after treatment) and non-responders (≥5% blasts present after treatment). Our data indicated enrichment in vimentin (VIM), platelet-derived growth factor receptor beta (PDGFRB) and Snail family transcriptional repressor 2 (SNAI2) transcripts in responders, consistent with the reactivation of the mesenchymal population in the BM stroma. Enrichment of osteoblast maturation-related transcripts of biglycan (BGN), osteopontin (SPP1) and osteonectin (SPARC) was observed in non-responders. To the best of our knowledge, this is the first report demonstrating distinct osteogenic and mesenchymal transcriptome profiles specific to AML response to induction chemotherapy assessed directly in core BM biopsies. Detailing treatment response-specific alterations in the BM stroma may inform optimised therapeutic strategies for AML.
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Affiliation(s)
- Diana O Treaba
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Dennis M Bonal
- Signal Transduction Lab, Division of Hematology/Oncology, Department of Medicine, Rhode Island Hospital and Warren Alpert Medical School at Brown University, Rhode Island, Providence, USA
| | - Anna Chorzalska
- Signal Transduction Lab, Division of Hematology/Oncology, Department of Medicine, Rhode Island Hospital and Warren Alpert Medical School at Brown University, Rhode Island, Providence, USA
| | | | - Alissa Oakes
- Signal Transduction Lab, Division of Hematology/Oncology, Department of Medicine, Rhode Island Hospital and Warren Alpert Medical School at Brown University, Rhode Island, Providence, USA
| | - Makayla Pardo
- Signal Transduction Lab, Division of Hematology/Oncology, Department of Medicine, Rhode Island Hospital and Warren Alpert Medical School at Brown University, Rhode Island, Providence, USA
| | - Max Petersen
- Signal Transduction Lab, Division of Hematology/Oncology, Department of Medicine, Rhode Island Hospital and Warren Alpert Medical School at Brown University, Rhode Island, Providence, USA
| | | | - Kelsey Hopkins
- Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Dean Melcher
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Ting C Zhao
- Department of Surgery at Rhode Island Hospital and Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Olin Liang
- Division of Hematology/Oncology at Rhode Island Hospital and Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Eui-Young So
- Division of Hematology/Oncology at Rhode Island Hospital and Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - John Reagan
- Division of Hematology/Oncology at Rhode Island Hospital and Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Adam J Olszewski
- Division of Hematology/Oncology at Rhode Island Hospital and Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - James Butera
- Division of Hematology/Oncology at Rhode Island Hospital and Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Douglas C Anthony
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Peter Rintels
- Hematology and Oncology Associates of Rhode Island, Cranston, Rhode Island, USA
| | - Peter Quesenberry
- Division of Hematology/Oncology at Rhode Island Hospital and Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Patrycja M Dubielecka
- Signal Transduction Lab, Division of Hematology/Oncology, Department of Medicine, Rhode Island Hospital and Warren Alpert Medical School at Brown University, Rhode Island, Providence, USA
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20
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Olszewski AJ. Meet the Burkitts: a dark zone family. Blood 2023; 141:816-818. [PMID: 36821186 DOI: 10.1182/blood.2022018509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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21
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De Souza AL, Mega AE, Douglass J, Olszewski AJ, Gamsiz Uzun ED, Uzun A, Chou C, Duan F, Wang J, Ali A, Golijanin DJ, Holder SL, Lagos GG, Safran H, El-Deiry WS, Carneiro BA. Clinical features of patients with MTAP-deleted bladder cancer. Am J Cancer Res 2023; 13:326-339. [PMID: 36777505 PMCID: PMC9906077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/03/2023] [Indexed: 02/14/2023] Open
Abstract
Advanced urothelial carcinoma continues to have a dismal prognosis despite several new therapies in the last 5 years. FGFR2 and FGFR3 mutations and fusions, PD-L1 expression, tumor mutational burden, and microsatellite instability are established predictive biomarkers in advanced urothelial carcinoma. Novel biomarkers can optimize the sequencing of available treatments and improve outcomes. We describe herein the clinical and pathologic features of patients with an emerging subtype of bladder cancer characterized by deletion of the gene MTAP encoding the enzyme S-Methyl-5'-thioadenosine phosphatase, a potential biomarker of response to pemetrexed. We performed a retrospective analysis of 61 patients with advanced urothelial carcinoma for whom demographics, pathologic specimens, next generation sequencing, and clinical outcomes were available. We compared the frequency of histology variants, upper tract location, pathogenic gene variants, tumor response, progression free survival (PFS) and overall survival (OS) between patients with tumors harboring MTAP deletion (MTAP-del) and wild type tumors (MTAP-WT). A propensity score matching of 5 covariates (age, gender, presence of variant histology, prior surgery, and prior non-muscle invasive bladder cancer) was calculated to compensate for disparity when comparing survival in these subgroups. Non-supervised clustering analysis of differentially expressed genes between MTAP-del and MTAP-WT urothelial carcinomas was performed. MTAP-del occurred in 19 patients (31%). Tumors with MTAP-del were characterized by higher prevalence of squamous differentiation (47.4 vs 11.9%), bone metastases (52.6 vs 23.5%) and lower frequency of upper urinary tract location (5.2% vs 26.1%). Pathway gene set enrichment analysis showed that among the genes upregulated in the MTAP-del cohort, at least 5 were linked to keratinization (FOXN1, KRT33A/B, KRT84, RPTN) possibly contributing to the higher prevalence of squamous differentiation. Alterations in the PIK3 and MAPK pathways were more frequent when MTAP was deleted. There was a trend to inferior response to chemotherapy among MTAP-del tumors, but no difference in the response to immune checkpoint inhibitors or enfortumab. Median progression free survival after first line therapy (PFS1) was 5.5 months for patients with MTAP-WT and 4.5 months for patients with MTAP-del (HR = 1.30; 95% CI, 0.64-2.63; P = 0.471). There was no difference in the time from metastatic diagnosis to death (P = 0.6346). Median OS from diagnosis of localized or de novo metastatic disease was 16 months (range 1.5-60, IQR 8-26) for patients with MTAP-del and 24.5 months (range 3-156, IQR 16-48) for patients with MTAP-WT (P = 0.0218), suggesting that time to progression to metastatic disease is shorter in MTAP-del patients. Covariates did not impact significantly overall survival on propensity score matching. In conclusion, MTAP -del occurs in approximately 30% of patients with advanced urothelial carcinoma and defines a subgroup of patients with aggressive features, such as squamous differentiation, frequent bone metastases, poor response to chemotherapy, and shorter time to progression to metastatic disease.
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Affiliation(s)
- Andre L De Souza
- Division of Hematology Oncology, Legorreta Cancer Center at Brown University, Lifespan Cancer InstituteProvidence RI, United States
| | - Anthony E Mega
- Division of Hematology Oncology, Legorreta Cancer Center at Brown University, Lifespan Cancer InstituteProvidence RI, United States
| | - John Douglass
- Division of Hematology Oncology, Legorreta Cancer Center at Brown University, Lifespan Cancer InstituteProvidence RI, United States
| | - Adam J Olszewski
- Division of Hematology Oncology, Legorreta Cancer Center at Brown University, Lifespan Cancer InstituteProvidence RI, United States
| | - Ece D Gamsiz Uzun
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical CenterProvidence, RI, United States
| | - Alper Uzun
- Center for Computational Molecular Biology, Brown UniversityProvidence RI, United States,Department of Pediatrics, The Warren Alpert Medical School, Brown UniversityProvidence, RI, United States
| | - Charissa Chou
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical CenterProvidence, RI, United States
| | - Fenghai Duan
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public HealthProvidence, RI, United States
| | - Jinyu Wang
- Data Science Initiative, Brown UniversityProvidence, RI, United States
| | - Amin Ali
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical CenterProvidence, RI, United States
| | - Dragan J Golijanin
- Urology Department, Minimally Invasive Urology Institute, The Miriam Hospital, The Warren Alpert Medical School of Brown UniversityProvidence, RI, United States
| | - Sheldon L Holder
- Division of Hematology Oncology, Legorreta Cancer Center at Brown University, Lifespan Cancer InstituteProvidence RI, United States,Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical CenterProvidence, RI, United States
| | - Galina G Lagos
- Division of Hematology Oncology, Legorreta Cancer Center at Brown University, Lifespan Cancer InstituteProvidence RI, United States
| | - Howard Safran
- Division of Hematology Oncology, Legorreta Cancer Center at Brown University, Lifespan Cancer InstituteProvidence RI, United States
| | - Wafik S El-Deiry
- Division of Hematology Oncology, Legorreta Cancer Center at Brown University, Lifespan Cancer InstituteProvidence RI, United States,Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical CenterProvidence, RI, United States
| | - Benedito A Carneiro
- Division of Hematology Oncology, Legorreta Cancer Center at Brown University, Lifespan Cancer InstituteProvidence RI, United States
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22
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Epperla N, Zhao Q, Chowdhury SM, Shea L, Moyo TK, Reddy N, Sheets J, Weiner DM, Geethakumari PR, Kandarpa M, Bruno XJ, Thomas C, Churnetski MC, Hsu A, Zurbriggen L, Tan XWC, Lindsey K, Maakaron J, Caimi PF, Torka P, Bello C, Ayyappan S, Oh TS, Karmali R, Kim SH, Kress A, Kothari S, Sawalha Y, Christian B, David KA, Greenwell IB, Janakiram M, Kenkre VP, Olszewski AJ, Cohen JB, Palmisiano N, Umyarova E, Wilcox RA, Awan FT, Alderuccio JP, Barta SK, Grover NS, Ghosh N, Bartlett NL, Herrera AF, Shouse G. Postibrutinib relapse outcomes for patients with marginal zone lymphoma. Blood Adv 2023; 7:88-91. [PMID: 36269847 PMCID: PMC9827027 DOI: 10.1182/bloodadvances.2022008634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/07/2022] [Accepted: 09/24/2022] [Indexed: 01/18/2023] Open
Affiliation(s)
- Narendranath Epperla
- Division of Hematology, The Ohio State University, Columbus, OH
- Correspondence: Narendranath Epperla, Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH 43210;
| | - Qiuhong Zhao
- Division of Hematology, The Ohio State University, Columbus, OH
| | | | - Lauren Shea
- Division of Hematology, Washington University, St. Louis, MO
| | | | | | - Julia Sheets
- Division of Hematology and Oncology, University of North Carolina, Chapel Hill, NC
| | - David M. Weiner
- Division of Hematology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Malathi Kandarpa
- Division of Hematology, Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | | | - Colin Thomas
- Division of Hematology, Thomas Jefferson University, Philadelphia, PA
| | | | - Andrew Hsu
- Division of Hematology, Brown University, Providence, RI
| | - Luke Zurbriggen
- Division of Hematology, University of Wisconsin, Madison, WI
| | | | - Kathryn Lindsey
- Division of Hematology and Oncology, Medical University of South Carolina, Charleston, SC
| | - Joseph Maakaron
- Division of Hematology, University of Minnesota, Minneapolis, MN
| | - Paolo F. Caimi
- University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Pallawi Torka
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | - Celeste Bello
- Division of Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Sabarish Ayyappan
- Division of Hematology and Oncology, University of Iowa, Iowa City, IA
| | - Timothy S. Oh
- Division of Hematology, Northwestern University, Chicago, IL
| | - Reem Karmali
- Division of Hematology, Northwestern University, Chicago, IL
| | - Seo-Hyun Kim
- Division of Hematology and Oncology, Rush University, Chicago, IL
| | - Anna Kress
- Division of Hematology, Yale University, New Haven, CT
| | | | - Yazeed Sawalha
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Beth Christian
- Division of Hematology, The Ohio State University, Columbus, OH
| | | | - Irl Brian Greenwell
- Division of Hematology and Oncology, Medical University of South Carolina, Charleston, SC
| | - Murali Janakiram
- Division of Hematology, University of Minnesota, Minneapolis, MN
| | | | | | - Jonathon B. Cohen
- Winship Cancer Institute, Emory University Medical Center, Atlanta, GA
| | - Neil Palmisiano
- Division of Hematology, Thomas Jefferson University, Philadelphia, PA
| | - Elvira Umyarova
- Division of Hematology and Oncology, University of Vermont, Burlington, VT
| | - Ryan A. Wilcox
- Division of Hematology, Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Farrukh T. Awan
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Stefan K. Barta
- Division of Hematology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Natalie S. Grover
- Division of Hematology and Oncology, University of North Carolina, Chapel Hill, NC
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23
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Bakouny Z, Labaki C, Grover P, Awosika J, Gulati S, Hsu CY, Alimohamed SI, Bashir B, Berg S, Bilen MA, Bowles D, Castellano C, Desai A, Elkrief A, Eton OE, Fecher LA, Flora D, Galsky MD, Gatti-Mays ME, Gesenhues A, Glover MJ, Gopalakrishnan D, Gupta S, Halfdanarson TR, Hayes-Lattin B, Hendawi M, Hsu E, Hwang C, Jandarov R, Jani C, Johnson DB, Joshi M, Khan H, Khan SA, Knox N, Koshkin VS, Kulkarni AA, Kwon DH, Matar S, McKay RR, Mishra S, Moria FA, Nizam A, Nock NL, Nonato TK, Panasci J, Pomerantz L, Portuguese AJ, Provenzano D, Puc M, Rao YJ, Rhodes TD, Riely GJ, Ripp JJ, Rivera AV, Ruiz-Garcia E, Schmidt AL, Schoenfeld AJ, Schwartz GK, Shah SA, Shaya J, Subbiah S, Tachiki LM, Tucker MD, Valdez-Reyes M, Weissmann LB, Wotman MT, Wulff-Burchfield EM, Xie Z, Yang YJ, Thompson MA, Shah DP, Warner JL, Shyr Y, Choueiri TK, Wise-Draper TM, Gandhi R, Gartrell BA, Goel S, Halmos B, Makower DF, O' Sullivan D, Ohri N, Portes M, Shapiro LC, Shastri A, Sica RA, Verma AK, Butt O, Campian JL, Fiala MA, Henderson JP, Monahan RS, Stockerl-Goldstein KE, Zhou AY, Bitran JD, Hallmeyer S, Mundt D, Pandravada S, Papaioannou PV, Patel M, Streckfuss M, Tadesse E, Gatson NTN, Kundranda MN, Lammers PE, Loree JM, Yu IS, Bindal P, Lam B, Peters MLB, Piper-Vallillo AJ, Egan PC, Farmakiotis D, Arvanitis P, Klein EJ, Olszewski AJ, Vieira K, Angevine AH, Bar MH, Del Prete SA, Fiebach MZ, Gulati AP, Hatton E, Houston K, Rose SJ, Steve Lo KM, Stratton J, Weinstein PL, Garcia JA, Routy B, Hoyo-Ulloa I, Dawsey SJ, Lemmon CA, Pennell NA, Sharifi N, Painter CA, Granada C, Hoppenot C, Li A, Bitterman DS, Connors JM, Demetri GD, Florez (Duma) N, Freeman DA, Giordano A, Morgans AK, Nohria A, Saliby RM, Tolaney SM, Van Allen EM, Xu WV, Zon RL, Halabi S, Zhang T, Dzimitrowicz H, Leighton JC, Graber JJ, Grivas P, Hawley JE, Loggers ET, Lyman GH, Lynch RC, Nakasone ES, Schweizer MT, Vinayak S, Wagner MJ, Yeh A, Dansoa Y, Makary M, Manikowski JJ, Vadakara J, Yossef K, Beckerman J, Goyal S, Messing I, Rosenstein LJ, Steffes DR, Alsamarai S, Clement JM, Cosin JA, Daher A, Dailey ME, Elias R, Fein JA, Hosmer W, Jayaraj A, Mather J, Menendez AG, Nadkarni R, Serrano OK, Yu PP, Balanchivadze N, Gadgeel SM, Accordino MK, Bhutani D, Bodin BE, Hershman DL, Masson C, Alexander M, Mushtaq S, Reuben DY, Bernicker EH, Deeken JF, Jeffords KJ, Shafer D, Cárdenas AI, Cuervo Campos R, De-la-Rosa-Martinez D, Ramirez A, Vilar-Compte D, Gill DM, Lewis MA, Low CA, Jones MM, Mansoor AH, Mashru SH, Werner MA, Cohen AM, McWeeney S, Nemecek ER, Williamson SP, Peters S, Smith SJ, Lewis GC, Zaren HA, Akhtari M, Castillo DR, Cortez K, Lau E, Nagaraj G, Park K, Reeves ME, O'Connor TE, Altman J, Gurley M, Mulcahy MF, Wehbe FH, Durbin EB, Nelson HH, Ramesh V, Sachs Z, Wilson G, Bardia A, Boland G, Gainor JF, Peppercorn J, Reynolds KL, Rosovsky RP, Zubiri L, Bekaii-Saab TS, Joyner MJ, Riaz IB, Senefeld JW, Shah S, Ayre SK, Bonnen M, Mahadevan D, McKeown C, Mesa RA, Ramirez AG, Salazar M, Shah PK, Wang CP, Bouganim N, Papenburg J, Sabbah A, Tagalakis V, Vinh DC, Nanchal R, Singh H, Bahadur N, Bao T, Belenkaya R, Nambiar PH, O’Cearbhaill RE, Papadopoulos EB, Philip J, Robson M, Rosenberg JE, Wilkins CR, Tamimi R, Cerrone K, Dill J, Faller BA, Alomar ME, Chandrasekhar SA, Hume EC, Islam JY, Ajmera A, Brouha SS, Cabal A, Choi S, Hsiao A, Jiang JY, Kligerman S, Park J, Razavi P, Reid EG, Bhatt PS, Mariano MG, Thomson CC, Glace M(G, Knoble JL, Rink C, Zacks R, Blau SH, Brown C, Cantrell AS, Namburi S, Polimera HV, Rovito MA, Edwin N, Herz K, Kennecke HF, Monfared A, Sautter RR, Cronin T, Elshoury A, Fleissner B, Griffiths EA, Hernandez-Ilizaliturri F, Jain P, Kariapper A, Levine E, Moffitt M, O'Connor TL, Smith LJ, Wicher CP, Zsiros E, Jabbour SK, Misdary CF, Shah MR, Batist G, Cook E, Ferrario C, Lau S, Miller WH, Rudski L, Santos Dutra M, Wilchesky M, Mahmood SZ, McNair C, Mico V, Dixon B, Kloecker G, Logan BB, Mandapakala C, Cabebe EC, Jha A, Khaki AR, Nagpal S, Schapira L, Wu JTY, Whaley D, Lopes GDL, de Cardenas K, Russell K, Stith B, Taylor S, Klamerus JF, Revankar SG, Addison D, Chen JL, Haynam M, Jhawar SR, Karivedu V, Palmer JD, Pillainayagam C, Stover DG, Wall S, Williams NO, Abbasi SH, Annis S, Balmaceda NB, Greenland S, Kasi A, Rock CD, Luders M, Smits M, Weiss M, Chism DD, Owenby S, Ang C, Doroshow DB, Metzger M, Berenberg J, Uyehara C, Fazio A, Huber KE, Lashley LN, Sueyoshi MH, Patel KG, Riess J, Borno HT, Small EJ, Zhang S, Andermann TM, Jensen CE, Rubinstein SM, Wood WA, Ahmad SA, Brownfield L, Heilman H, Kharofa J, Latif T, Marcum M, Shaikh HG, Sohal DPS, Abidi M, Geiger CL, Markham MJ, Russ AD, Saker H, Acoba JD, Choi H, Rho YS, Feldman LE, Gantt G, Hoskins KF, Khan M, Liu LC, Nguyen RH, Pasquinelli MM, Schwartz C, Venepalli NK, Vikas P, Zakharia Y, Friese CR, Boldt A, Gonzalez CJ, Su C, Su CT, Yoon JJ, Bijjula R, Mavromatis BH, Seletyn ME, Wood BR, Zaman QU, Kaklamani V, Beeghly A, Brown AJ, Charles LJ, Cheng A, Crispens MA, Croessmann S, Davis EJ, Ding T, Duda SN, Enriquez KT, French B, Gillaspie EA, Hausrath DJ, Hennessy C, Lewis JT, Li X(L, Prescott LS, Reid SA, Saif S, Slosky DA, Solorzano CC, Sun T, Vega-Luna K, Wang LL, Aboulafia DM, Carducci TM, Goldsmith KJ, Van Loon S, Topaloglu U, Moore J, Rice RL, Cabalona WD, Cyr S, Barrow McCollough B, Peddi P, Rosen LR, Ravindranathan D, Hafez N, Herbst RS, LoRusso P, Lustberg MB, Masters T, Stratton C. Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19. JAMA Oncol 2023; 9:128-134. [PMID: 36326731 PMCID: PMC9634600 DOI: 10.1001/jamaoncol.2022.5357] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/11/2022] [Indexed: 11/06/2022]
Abstract
Importance Cytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation. Objective To determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with cancer. Design, Setting, and Participants This registry-based retrospective cohort study included 12 046 patients reported to the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. The CCC19 registry is a centralized international multi-institutional registry of patients with COVID-19 with a current or past diagnosis of cancer. Records analyzed included patients with active or previous cancer who had a laboratory-confirmed infection with SARS-CoV-2 by polymerase chain reaction and/or serologic findings. Exposures Immunosuppression due to therapy; systemic anticancer therapy (IO or non-IO). Main Outcomes and Measures The primary outcome was a 5-level ordinal scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; death. The secondary outcome was the occurrence of cytokine storm. Results The median age of the entire cohort was 65 years (interquartile range [IQR], 54-74) years and 6359 patients were female (52.8%) and 6598 (54.8%) were non-Hispanic White. A total of 599 (5.0%) patients received IO, whereas 4327 (35.9%) received non-IO systemic anticancer therapies, and 7120 (59.1%) did not receive any antineoplastic regimen within 3 months prior to COVID-19 diagnosis. Although no difference in COVID-19 severity and cytokine storm was found in the IO group compared with the untreated group in the total cohort (adjusted odds ratio [aOR], 0.80; 95% CI, 0.56-1.13, and aOR, 0.89; 95% CI, 0.41-1.93, respectively), patients with baseline immunosuppression treated with IO (vs untreated) had worse COVID-19 severity and cytokine storm (aOR, 3.33; 95% CI, 1.38-8.01, and aOR, 4.41; 95% CI, 1.71-11.38, respectively). Patients with immunosuppression receiving non-IO therapies (vs untreated) also had worse COVID-19 severity (aOR, 1.79; 95% CI, 1.36-2.35) and cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79). Conclusions and Relevance This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially IO, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm. Trial Registration ClinicalTrials.gov Identifier: NCT04354701.
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Affiliation(s)
- Ziad Bakouny
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chris Labaki
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Punita Grover
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Joy Awosika
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Shuchi Gulati
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Chih-Yuan Hsu
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Saif I Alimohamed
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Babar Bashir
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Mehmet A Bilen
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | | | - Aakash Desai
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Arielle Elkrief
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Omar E Eton
- Hartford Healthcare Cancer Institute, Hartford, Connecticut
| | | | | | | | | | | | | | | | | | | | | | - Mohamed Hendawi
- Aurora Cancer Center, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Emily Hsu
- Hartford Healthcare Cancer Institute, Hartford, Connecticut
| | - Clara Hwang
- Henry Ford Cancer Institute, Detroit, Michigan
| | - Roman Jandarov
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | | | | | - Monika Joshi
- Penn State Cancer Institute, Hershey, Pennsylvania
| | - Hina Khan
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island
| | - Shaheer A Khan
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | - Natalie Knox
- Loyola University Medical Center, Maywood, Illinois
| | - Vadim S Koshkin
- UCSF, Helen Diller Comprehensive Cancer Center, San Francisco
| | | | - Daniel H Kwon
- UCSF, Helen Diller Comprehensive Cancer Center, San Francisco
| | - Sara Matar
- Hollings Cancer Center, MUSC, Charleston
| | - Rana R McKay
- Moores Cancer Center, UCSD, San Diego, California
| | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Feras A Moria
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Nora L Nock
- Case Comprehensive Cancer Center, Department of Population and Quantitative Health Sciences, Cleveland, Ohio
| | | | - Justin Panasci
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | | | | | | | - Yuan J Rao
- George Washington University, Washington, DC
| | | | | | - Jacob J Ripp
- University of Kansas Medical Center, Kansas City
| | - Andrea V Rivera
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Andrew L Schmidt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Gary K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | | | - Justin Shaya
- Moores Cancer Center, UCSD, San Diego, California
| | - Suki Subbiah
- Stanley S. Scott Cancer Center, LSU, New Orleans, Louisiana
| | - Lisa M Tachiki
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | | | | | - Zhuoer Xie
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Michael A Thompson
- Aurora Cancer Center, Advocate Aurora Health, Milwaukee, Wisconsin.,Tempus Labs, Chicago, Illinois
| | - Dimpy P Shah
- Mays Cancer Center, UT Health, San Antonio, Texas
| | | | - Yu Shyr
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Trisha M Wise-Draper
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Omar Butt
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ang Li
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Lau
- for the COVID-19 and Cancer Consortium
| | | | - Kyu Park
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ting Bao
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ji Park
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Erin Cook
- for the COVID-19 and Cancer Consortium
| | | | - Susie Lau
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anup Kasi
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Li C Liu
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | - Chris Su
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tan Ding
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | - Sara Saif
- for the COVID-19 and Cancer Consortium
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24
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Epperla N, Zhao Q, Chowdhury SM, Shea L, Moyo TK, Reddy N, Sheets J, Weiner DM, Geethakumari PR, Kandarpa M, Bruno XJ, Thomas C, Churnetski MC, Hsu A, Zurbriggen L, Tan C, Lindsey K, Maakaron J, Caimi PF, Torka P, Bello C, Ayyappan S, Karmali R, Kim SH, Kress A, Kothari S, Sawalha Y, Christian B, David KA, Greenwell IB, Janakiram M, Kenkre VP, Olszewski AJ, Cohen JB, Palmisiano N, Umyarova E, Wilcox RA, Awan FT, Alderuccio JP, Barta SK, Grover NS, Ghosh N, Bartlett NL, Herrera AF, Shouse G. Predictive factors and outcomes for ibrutinib in relapsed/refractory marginal zone lymphoma: a multicenter cohort study. J Hematol Oncol 2022; 15:96. [PMID: 35842643 PMCID: PMC9287914 DOI: 10.1186/s13045-022-01316-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
Ibrutinib is effective in the treatment of relapsed/refractory (R/R) marginal zone lymphoma (MZL) with an overall response rate (ORR) of 48%. However, factors associated with response (or lack thereof) to ibrutinib in R/R MZL in clinical practice are largely unknown. To answer this question, we performed a multicenter (25 US centers) cohort study and divided the study population into three groups: "ibrutinib responders"-patients who achieved complete or partial response (CR/PR) to ibrutinib; "stable disease (SD)"; and "primary progressors (PP)"-patients with progression of disease as their best response to ibrutinib. One hundred and nineteen patients met the eligibility criteria with 58%/17% ORR/CR, 29% with SD, and 13% with PP. The median PFS and OS were 29 and 71.4 months, respectively, with no difference in PFS or OS based on the ibrutinib line of therapy or type of therapy before ibrutinib. Patients with complex cytogenetics had an inferior PFS (HR = 3.08, 95% CI 1.23-7.67, p = 0.02), while those with both complex cytogenetics (HR = 3.00, 95% CI 1.03-8.68, p = 0.04) and PP (HR = 13.94, 95% CI 5.17-37.62, p < 0.001) had inferior OS. Only primary refractory disease to first-line therapy predicted a higher probability of PP to ibrutinib (RR = 3.77, 95% CI 1.15-12.33, p = 0.03). In this largest study to date evaluating outcomes of R/R MZL treated with ibrutinib, we show that patients with primary refractory disease and those with PP on ibrutinib are very high-risk subsets and need to be prioritized for experimental therapies.
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Affiliation(s)
- Narendranath Epperla
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH, 43210, USA.
| | - Qiuhong Zhao
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Sayan Mullick Chowdhury
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | | | - Tamara K Moyo
- Levine Cancer Center, Atrium Health, Charlotte, NC, USA
| | - Nishitha Reddy
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julia Sheets
- University of North Carolina, Chapel Hill, NC, USA
| | - David M Weiner
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Colin Thomas
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | - Cherie Tan
- Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | | | - Paolo F Caimi
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | | | - Celeste Bello
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | | | | | | | - Yazeed Sawalha
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Beth Christian
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Kevin A David
- Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | | | | | | | - Jonathon B Cohen
- Winship Cancer Institute, Emory University Medical Center, Atlanta, GA, USA
| | | | | | - Ryan A Wilcox
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Farrukh T Awan
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Stefan K Barta
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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25
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Ollila TA, Masel RH, Reagan JL, Lu S, Rogers RD, Paiva KJ, Taher R, Burguera-Couce E, Zayac AS, Yakirevich I, Niroula R, Barth P, Olszewski AJ. Seroconversion and outcomes after initial and booster COVID-19 vaccination in adults with hematologic malignancies. Cancer 2022; 128:3319-3329. [PMID: 35811461 PMCID: PMC9349722 DOI: 10.1002/cncr.34354] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/04/2022] [Accepted: 05/25/2022] [Indexed: 12/15/2022]
Abstract
Background Patients with hematologic malignancies have impaired humoral immunity secondary to their malignancy and its treatment, placing them at risk of severe coronavirus disease‐19 (COVID‐19) infection and reduced response to vaccination. Methods The authors retrospectively analyzed serologic responses to initial and booster COVID‐19 vaccination in 378 patients with hematologic malignancy and subsequently tracked COVID‐19–related outcomes. Results Seroconversion occurred in 181 patients (48%) after initial vaccination; patients who had active malignancy or those who were recently treated with a B‐cell–depleting monoclonal antibody had the lowest rates of seroconversion. For initial nonresponders to vaccination, seroconversion after a booster dose occurred in 48 of 85 patients (56%). The seroconversion rate after the booster was similar for patients on (53%) and off (58%) active therapy (p = .82). Thirty‐three patients (8.8%) developed a COVID‐19 infection, and there were three COVID‐19–related deaths (0.8%). Although no significant association was observed between postvaccination seroconversion and the incidence of COVID‐19 infection, no patient with seroconversion died from COVID‐19, and no patient who received tixagevimab/cilgavimab (N = 25) was diagnosed with a COVID‐19 infection. Conclusions Booster vaccinations can promote seroconversion in a significant proportion of patients who are seronegative after the initial vaccination course regardless of the specific vaccine or on/off treatment status at the time of revaccination. Although postvaccination seroconversion may not be associated with a decrease in any (including asymptomatic) COVID‐19 infection, the authors' experience suggested that effective vaccination (including a booster), supplemented by passive immunization using tixagevimab/cilgavimab in case of lack of seroconversion, effectively eliminated the risk of COVID‐19 death in the otherwise high‐risk population. Lay summary Patients with hematologic malignancy, especially lymphoma, have an impaired response to coronavirus disease 2019 (COVID‐19) vaccination. In this single‐institution review, less than one half of the patients studied made detectable antibodies. For those who did not make detectable antibodies after initial vaccination, over one half (65%) were able to produce antibodies after booster vaccination. By the end of February 2022, 33 of the original 378 patients had a documented COVID‐19 infection. The only deaths from COVID‐19 were in those who had undetectable antibodies, and no patient who received prophylactic antibody therapy developed a COVID‐19 infection.
Hematologic malignancies and their treatments impaired humoral immunity from coronavirus disease 2019 vaccination, and booster vaccine overcame a lack of initial response in 58% of patients, including 63% those on active therapy. The findings indicated that booster vaccinations should be strongly encouraged; however, even with boosters, many remain unprotected, which should inform infection prevention and treatment strategies.
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Affiliation(s)
- Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Rebecca H Masel
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - John L Reagan
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Shaolei Lu
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ralph D Rogers
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Infectious Disease, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Kimberly J Paiva
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Rashida Taher
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ella Burguera-Couce
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adam S Zayac
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Inna Yakirevich
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Rabin Niroula
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Peter Barth
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
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26
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Hsu A, Huntington KE, De Souza A, Zhou L, Olszewski AJ, Makwana NP, Treaba DO, Cavalcante L, Giles FJ, Safran H, El-Deiry WS, Carneiro BA. Clinical activity of 9-ING-41, a small molecule selective glycogen synthase kinase-3 beta (GSK-3β) inhibitor, in refractory adult T-Cell leukemia/lymphoma. Cancer Biol Ther 2022; 23:417-423. [PMID: 35815408 PMCID: PMC9272832 DOI: 10.1080/15384047.2022.2088984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
GSK-3β is a serine/threonine kinase implicated in tumorigenesis and chemotherapy resistance. GSK-3β blockade downregulates the NF-κB pathway, modulates immune cell PD-1 and tumor cell PD-L1 expression, and increases CD8 + T cell and NK cell function. We report a case of adult T-cell leukemia/lymphoma (ATLL) treated with 9-ING-41, a selective GSK-3β inhibitor in clinical development, who achieved a durable response. A 43-year-old male developed diffuse lymphadenopathy, and biopsy of axillary lymph node showed acute-type ATLL. Peripheral blood flow cytometry revealed a circulating clonal T cell population, and CSF was positive for ATLL involvement. After disease progression on the 3rd line of treatment, he started treatment with 9-ING-41 monotherapy in a clinical trial (NCT03678883). CT imaging after seven months showed a partial response. Sustained reduction of peripheral blood ATLL cells lasted 15 months. Treatment of patient-derived CD8 + T cells with 9-ING-41 increased the secretion of IFN-γ, granzyme B, and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL). In conclusion, treatment of a patient with refractory ATLL with the GSK-3β inhibitor 9-ING-41 resulted in a prolonged response. Ongoing experiments are investigating the hypothesis that 9-ING-41-induced T cell activation and immunomodulation contributes to its clinical activity. Further clinical investigation of 9-ING-41 for treatment of ATLL is warranted.
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Affiliation(s)
- Andrew Hsu
- Division of Hematology/Oncology, Brown University and the Lifespan Cancer Institute, Providence, RI, USA
| | - Kelsey E. Huntington
- Legorreta Cancer Center at Brown University, The Warren Alpert Medical School, Brown University, Providence, RI, USA
- Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Andre De Souza
- Division of Hematology/Oncology, Brown University and the Lifespan Cancer Institute, Providence, RI, USA
- Legorreta Cancer Center at Brown University, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Lanlan Zhou
- Legorreta Cancer Center at Brown University, The Warren Alpert Medical School, Brown University, Providence, RI, USA
- Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Adam J. Olszewski
- Division of Hematology/Oncology, Brown University and the Lifespan Cancer Institute, Providence, RI, USA
- Legorreta Cancer Center at Brown University, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Nirav P. Makwana
- Department of Radiology, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Diana O. Treaba
- Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | | | - Howard Safran
- Division of Hematology/Oncology, Brown University and the Lifespan Cancer Institute, Providence, RI, USA
- Legorreta Cancer Center at Brown University, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Wafik S. El-Deiry
- Division of Hematology/Oncology, Brown University and the Lifespan Cancer Institute, Providence, RI, USA
- Legorreta Cancer Center at Brown University, The Warren Alpert Medical School, Brown University, Providence, RI, USA
- Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Benedito A. Carneiro
- Division of Hematology/Oncology, Brown University and the Lifespan Cancer Institute, Providence, RI, USA
- Legorreta Cancer Center at Brown University, The Warren Alpert Medical School, Brown University, Providence, RI, USA
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27
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Muthiah A, Chudasama R, Mingrino J, Olszewski AJ, Kurt H, Garcia-Moliner M, Khan H. Clinical characteristic and outcomes of KRAS G13 mutant non-small cell lung cancers. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e21017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21017 Background: KRAS is the most commonly mutated oncogene in lung adenocarcinoma. Different KRAS mutations (mts) have unique prognostic and therapeutic implications. New drugs to target KRAS G12C have raised interest in studying the unique clinical and molecular characteristics of the different KRAS subtypes. We sought to evaluate the clinical outcomes of KRAS G13C/D (*) mutant (mut) non-small cell lung cancers (NSCLC) patients (pts), compared to those with G12C and other non-G12C mutations. Methods: We identified 255 KRAS mt NSCLC pts at Brown University-Lifespan Cancer Institute that were diagnosed between 06/2016 to 12/2021. Demographics, therapies and outcomes were retrospectively recorded. Progression-free (PFS) and overall survival (OS) was compared using log-rank test. For clinical relevance, we divided pts into G12C, G13*, and other non-G12C groups. Treatments (tt) received were divided into chemotherapy alone and immune-checkpoint inhibitor (IO) containing regimens. Results: Across the KRAS cohort (n = 255), median age was 71 years and 62% were females. Most pts had advanced disease (85%) at diagnosis (dx) and > 90% were smokers. Most common KRAS mt was G12C (42%), and 7% of pts had G13*. Compared to other KRAS mut groups, G13 * had worse PFS counted from dx (median 4 vs 12 m, p = .037). When comparing outcomes of any tt among pts with G13*, G12C and other non-G12C KRAS mut, G13 group had the worst PFS (2.1 vs 10.3 vs 6.4 m, p = .004) and OS (4.1 vs 27.8 vs 18.1 m, p = .027). When treated with IO-based regimens, pts with G13 had also worse outcomes than those with other KRAS mts: PFS 1.8 vs 7.3 m, respectively, (p < 0.001) and OS 1.8 vs 16.5 m, respectively (p = .006). Within the G13 group, pts who received IO-based regimens had worse PFS (1.8 vs 7.9 m, p = .037) and OS (1.8 vs 16.1 m, p = .093), compared to chemotherapy alone. While response to all systemic therapies was poor in G13* group (disease control rate [DCR] 10%, p = .004), DCR was particularly low with IO-based tt in G13* (0%) compared to other groups (p = .023). Conclusions: Pts with KRAS G13C/D had poor survival and response to therapies in comparison with G12C and other non-G12C KRAS mts, particularly with IO-containing regimens. Recently (Judd et al, MCT-21-0201), STK11 and KEAP1 were reported to be frequently co-mutated with KRAS G13* (37.3 and 12.6%) compared to other KRAS mts, and this genotype may confer primary resistance to IO. We hypothesize that the poor outcomes and immune resistance in G13* mut may be secondary to higher prevalence of STK11 and KEAP1 co-mutations. Larger data sets should confirm our observations and correlate them with PD-L1 scores and co-mutations.[Table: see text]
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Affiliation(s)
- Arun Muthiah
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Rani Chudasama
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Jennifer Mingrino
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Adam J Olszewski
- Lifespan Cancer Institute, Cancer Center at Brown University, Providence, RI
| | - Habibe Kurt
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Maria Garcia-Moliner
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Hina Khan
- Lifespan Cancer Institute, Cancer Center at Brown University, Providence, RI
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28
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DeCarli K, Masel R, Olszewski AJ, Belani N, Koffer P, Azzoli CG. Inflammatory signals hidden in the CBC are detectable prior to durvalumab-induced pneumonitis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e21116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21116 Background: For patients with unresectable stage III non-small cell lung cancer (NSCLC), chemoradiation followed by 1 year of durvalumab is standard of care. Treatment-induced pneumonitis can be life-threatening. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune inflammation index (SII, defined as platelet x neutrophil / lymphocyte counts) are calculated from the CBC and have been studied as inflammatory biomarkers in a variety of settings. This study assessed trends in these indices among patients treated for stage III NSCLC. Methods: We reviewed medical records of adults with stage III NSCLC who completed chemoradiation and durvalumab from 1/2017 to 9/2021 as part of routine care. Patients who developed non-pneumonitis immune toxicity were excluded. NLR, PLR and SII were calculated at dates of first and last radiation dose and first durvalumab dose. For patients who developed pneumonitis, indices were also calculated at each of 8 weeks leading up to pneumonitis onset, defined as the first diagnostic CT scan and graded as 1-5 based on CTCAE criteria. Indices were compared between the pneumonitis and no pneumonitis group using rank-sum test. P values < 0.05 were considered statistically significant without adjustment for multiple testing. The slope of linear trend for each index was examined via log-gamma generalized linear regression model using a random intercept for each patient and robust standard error. Results: Of 65 patients who received chemoradiation followed by durvalumab, 2 were excluded because they were on clinical trial and 28 were excluded for non-pneumonitis immune toxicity. Among the 35 patients eligible for analysis, median age was 67 years; 20 (57%) were female; 6 (17%) were current smokers; 15 (43%) had COPD; and 17 (49%) developed pneumonitis (2 G1; 11 G2; 3 G3; 0 G4; 1 G5). In the pneumonitis group, NLR (p = 0.022), PLR (p = 0.007) and SII (p = 0.001) showed a statistically significant linear increase in the 5 weeks preceding pneumonitis onset. There were no differences in clinical characteristics, SII, NLR or PLR between the pneumonitis and no pneumonitis groups at the 3 time points examined. Conclusions: In this exploratory analysis, patients who developed pneumonitis showed a linear increase in inflammatory indices for 5 weeks before pneumonitis onset, suggesting information hidden in routine blood tests can anticipate development of a life-threatening complication. Our hypothesis-generating study will need validation in a larger prospective analysis with a control group. Future directions may also include examination of selected acute phase reactants or cytokines.
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Affiliation(s)
- Kathryn DeCarli
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Rebecca Masel
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Adam J Olszewski
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Neel Belani
- Temple University-Fox Chase Cancer Center, Philadelphia, PA
| | - Paul Koffer
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Christopher G. Azzoli
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
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Bakow BR, Muthiah A, Olszewski AJ, Butera JN. Lymphopenia and outcomes of bendamustine-based therapy in follicular lymphoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e19540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19540 Background: Bendamustine plus rituximab (BR) is the preferred first-line immunochemotherapy for follicular lymphoma (FL) due to its efficacy and generally favorable adverse effect profile. However, it often causes prolonged lymphopenia, and impaired lymphocyte recovery after BR therapy has been recognized as a risk factor for opportunistic infections. On the other hand, little is known about the impact of profound lymphopenia on the overall treatment outcomes of BR. We examined the relationship between lymphopenia and treatment response in patients with FL who received BR at our institution. Methods: We retrospectively identified patients who received BR as first-line therapy for FL at the Lifespan Cancer Institute between October 2008 and November 2020. We used log-transformed absolute lymphocyte count (ALC) as the potential prognostic variable, integrated as the area under curve based on all available laboratory tests over the typical duration of BR (6 months). Outcomes included complete response to BR determined by post-treatment positron emission tomography or computed tomography, survival, and occurrence of hospitalization or herpes zoster on therapy. The association between ALC and survival or binary endpoints was examined using Cox or logistic models, respectively, adjusting for age, sex, cumulative bendamustine dose, and baseline ECOG performance status (PS). Results: We included 53 patients followed for a median of 69 months from start of BR. At treatment initiation, most patients had a PS of 0-1, stage III or IV disease, and high-risk lymphoma as defined by the Follicular Lymphoma International Prognostic Index (FLIPI) (Table). We observed an association between higher ALC during treatment and increased rates of CR (adjusted odds ratio, 2.50, 95% CI 1.04 – 6.00; p = 0.040), longer progression free survival (PFS) (adjusted hazard ratio [HR], 0.53, 95% CI 0.31 – 0.92, p = 0.023), and overall survival (OS) (HR, 0.45, 95% CI 0.23 – 0.87, p = 0.018). Higher ALC values during treatment and 1 month after treatment initiation were also associated with lower probability of hospitalization (p = 0.048 and p = 0.028, respectively). We did not find a statistically significant association between ALC and rates of zoster infection, but the number of observed events was low (n = 6). Conclusions: Our results suggest an association between higher ALC values during bendamustine therapy and improved treatment outcomes. Improvement in PFS, OS, and hospitalization rates with higher ALC values may be due relative preservation of nutritional balance and immune reserve. The association with survival should be confirmed in larger datasets and its potential mechanism elucidated.[Table: see text]
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Affiliation(s)
| | - Arun Muthiah
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Adam J Olszewski
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
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Alderuccio JP, Arcaini L, Watkins MP, Beaven AW, Shouse G, Epperla N, Spina M, Stefanovic A, Sandoval-Sus J, Torka P, Alpert AB, Olszewski AJ, Kim SH, Hess B, Gaballa S, Ayyappan S, Castillo JJ, Argnani L, Voorhees TJ, Saba R, Chowdhury SM, Vargas F, Reis IM, Kwon D, Alexander JS, Zhao W, Edwards D, Martin P, Cencini E, Kamdar M, Link BK, Logothetis CN, Herrera AF, Friedberg JW, Kahl BS, Luminari S, Zinzani PL, Lossos IS. An international analysis evaluating frontline bendamustine with rituximab in extranodal marginal zone lymphoma. Blood Adv 2022; 6:2035-2044. [PMID: 35196377 PMCID: PMC9006265 DOI: 10.1182/bloodadvances.2021006844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/13/2022] [Indexed: 11/20/2022] Open
Abstract
Extranodal marginal zone lymphoma (EMZL) is a heterogeneous non-Hodgkin lymphoma. No consensus exists regarding the standard-of-care in patients with advanced-stage disease. Current recommendations are largely adapted from follicular lymphoma, for which bendamustine with rituximab (BR) is an established approach. We analyzed the safety and efficacy of frontline BR in EMZL using a large international consortium. We included 237 patients with a median age of 63 years (range, 21-85). Most patients presented with Eastern Cooperative Oncology Group (ECOG) performance status 0 to 1 (n = 228; 96.2%), stage III/IV (n = 179; 75.5%), and intermediate (49.8%) or high (33.3%) Mucosa Associated Lymphoid Tissue International Prognosis Index (MALT-IPI). Patients received a median of 6 (range, 1-8) cycles of BR, and 20.3% (n = 48) received rituximab maintenance. Thirteen percent experienced infectious complications during BR therapy; herpes zoster (4%) was the most common. Overall response rate was 93.2% with 81% complete responses. Estimated 5-year progression-free survival (PFS) and overall survival (OS) were 80.5% (95% CI, 73.1% to 86%) and 89.6% (95% CI, 83.1% to 93.6%), respectively. MALT-IPI failed to predict outcomes. In the multivariable model, the presence of B symptoms was associated with shorter PFS. Rituximab maintenance was associated with longer PFS (hazard ratio = 0.16; 95% CI, 0.04-0.71; P = .016) but did not impact OS. BR is a highly effective upfront regimen in EMZL, providing durable remissions and overcoming known adverse prognosis factors. This regimen is associated with occurrence of herpes zoster; thus, prophylactic treatment may be considered.
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Affiliation(s)
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS San Mateo and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Anne W. Beaven
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | | | - Michele Spina
- Medical Oncology Division, Centro Riferimento Oncologico, Aviano, Italy
| | | | - Jose Sandoval-Sus
- Moffitt Cancer Center at Memorial Healthcare System, Pembroke Pines, FL
| | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Ash B. Alpert
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI
| | | | - Seo-Hyun Kim
- Division of Hematology/Oncology, Rush University Medical Center, Chicago, IL
| | - Brian Hess
- Hollings Cancer Center at Medical University of South Carolina, Charleston, SC
| | | | - Sabarish Ayyappan
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | | | - Lisa Argnani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia “Seràgnoli”
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
| | - Timothy J. Voorhees
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Raya Saba
- Washington University in St. Louis, St. Louis, MO
| | | | - Fernando Vargas
- Moffitt Cancer Center at Memorial Healthcare System, Pembroke Pines, FL
| | | | - Deukwoo Kwon
- Sylvester Comprehensive Cancer Center, Miami, FL
| | | | - Wei Zhao
- Sylvester Comprehensive Cancer Center, Miami, FL
| | - Dali Edwards
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Peter Martin
- Division of Hematology/Oncology, Weill Cornell Medicine, New York, NY
| | - Emanuele Cencini
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena SI, Italy
| | | | - Brian K. Link
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | | | | | | | - Brad S. Kahl
- Washington University in St. Louis, St. Louis, MO
| | - Stefano Luminari
- CHIMOMO Department University of Modena and Reggio Emilia, Reggio Emilia, Italy; and
- Department of Hematology, Azienda USL IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia “Seràgnoli”
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
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Rubinstein SM, Bhutani D, Lynch RC, Hsu CY, Shyr Y, Advani S, Mesa RA, Mishra S, Mundt DP, Shah DP, Sica RA, Stockerl-Goldstein KE, Stratton C, Weiss M, Beeghly-Fadiel A, Accordino M, Assouline SE, Awosika J, Bakouny Z, Bashir B, Berg S, Bilen MA, Castellano CA, Cogan JC, Kc D, Friese CR, Gupta S, Hausrath D, Hwang C, Johnson NA, Joshi M, Kasi A, Klein EJ, Koshkin VS, Kuderer NM, Kwon DH, Labaki C, Latif T, Lau E, Li X, Lyman GH, McKay RR, Nagaraj G, Nizam A, Nonato TK, Olszewski AJ, Polimera HV, Portuguese AJ, Puc MM, Razavi P, Rosovski R, Schmidt A, Shah SA, Shastri A, Su C, Torka P, Wise-Draper TM, Zubiri L, Warner JL, Thompson MA. Patients recently treated for B-lymphoid malignancies show increased risk of severe COVID-19: a CCC19 registry analysis. Blood Cancer Discov 2022; 3:181-193. [PMID: 35262738 DOI: 10.1158/2643-3230.bcd-22-0013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/07/2022] [Accepted: 03/05/2022] [Indexed: 12/15/2022] Open
Abstract
Patients with B-lymphoid malignancies have been consistently identified as a population at high risk of severe COVID-19. Whether this is exclusively due to cancer-related deficits in humoral and cellular immunity, or whether risk of severe COVID-19 is increased by anti-cancer therapy, is uncertain. Using data derived from the COVID-19 and Cancer Consortium (CCC19), we show that patients treated for B-lymphoid malignancies have an increased risk of severe COVID-19 compared to control populations of patients with non-B-lymphoid hematologic malignancies. Among patients with B-lymphoid malignancies, those who received anti-cancer therapy within 12 months of COVID-19 diagnosis experienced increased COVID-19 severity compared to patients with B-lymphoid malignancies off therapy, after adjustment for cancer status and several other prognostic factors. Our findings suggest that patients recently treated for a B-lymphoid malignancy are at uniquely high risk for severe COVID-19.
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Affiliation(s)
| | - Divaya Bhutani
- Herbert Irving Comprehensive Cancer Center, United States
| | - Ryan C Lynch
- University of Washington, Seattle, WA, United States
| | - Chih-Yuan Hsu
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Yu Shyr
- Vanderbilt University Medical Center, Nashville,, TN, United States
| | - Shailesh Advani
- Georgetown University Medical Center, Washington DC, MD, United States
| | - Ruben A Mesa
- Mays Cancer Center at UT Health San Antonio, San Antonio, TX, United States
| | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | | | - Dimpy P Shah
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | | | | | | | | | | | | | - Sarit E Assouline
- Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada
| | - Joy Awosika
- University of Cincinnati Cancer Center, Cincinnati, OH, United States
| | - Ziad Bakouny
- Brigham and Women's Hospital, Boston, MA, United States
| | - Babar Bashir
- Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Stephanie Berg
- Loyola University Medical Center, Maywood, IL, United States
| | - Mehmet Asim Bilen
- Winship Cancer Institute of Emory Univesity, Atlanta, GA, United States
| | | | | | - Devendra Kc
- Hartford HealthCare Cancer Institute, Hartford, CT, United States
| | | | - Shilpa Gupta
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Daniel Hausrath
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Clara Hwang
- Henry Ford Cancer Institute, Detroit, MI, United States
| | - Nathalie A Johnson
- Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada
| | - Monika Joshi
- Penn State Hershey Cancer Institute, Hershey, PA, United States
| | - Anup Kasi
- University of Kansas Medical Center, Kansas City, KS, United States
| | | | - Vadim S Koshkin
- University of California, San Francisco, San Francisco, CA, United States
| | | | - Daniel H Kwon
- University of California, San Francisco, San Francisco, United States
| | - Chris Labaki
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Tahir Latif
- University of Cincinnati Cancer Center, United States
| | - Eric Lau
- Loma Linda University, Loma Linda, California, United States
| | - Xuanyi Li
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Rana R McKay
- University of California, San Diego, La Jolla, CA, United States
| | | | - Amanda Nizam
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Taylor K Nonato
- Franciscan Health Mooresvilles Comprehensive Cancer Center, United States
| | - Adam J Olszewski
- Brown University/Rhode Island Hospital, Providence, RI, United States
| | | | | | | | - Pedram Razavi
- Moores Comprehensive Cancer Center, La Jolla, United States
| | - Rachel Rosovski
- Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Andrew Schmidt
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Sumit A Shah
- Stanford University, Stanford, CA, United States
| | - Aditi Shastri
- Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, United States
| | - Christopher Su
- University of Michigan Medical Center, Ann Arbor, MI, United States
| | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | | | - Leyre Zubiri
- Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Jeremy L Warner
- Vanderbilt University Medical Center, Nashville, TN, United States
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Ollila T, Butera J, Egan P, Reagan J, Thomas A, Yakirevich I, MacKinnon K, Margolis J, McMahon J, Rosati V, Olszewski AJ. Vincristine Sulfate Liposome Injection with Bendamustine and Rituximab as First-Line Therapy for B-Cell Lymphomas: A Phase I Study. Oncologist 2022; 27:532-e542. [PMID: 35641232 PMCID: PMC9255974 DOI: 10.1093/oncolo/oyab079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/06/2021] [Indexed: 12/13/2022] Open
Abstract
Background We conducted an investigator-initiated, phase I trial of vincristine sulfate liposomal injection (VSLI) in combination with bendamustine and rituximab (BR) for indolent B-cell (BCL) or mantle cell lymphoma. Methods Participants received 6 cycles of standard BR with VSLI at patient-specific dose determined by the Escalation with Overdose Control (EWOC) model targeting 33% probability of dose-limiting toxicity (DLT). Maximum tolerated dose (MTD) was the primary endpoint; secondary endpoints included rates of adverse events (AEs), overall response rate (ORR), and complete response (CR). Vincristine sulfate liposomal injection is FDA approved for the treatment of patients with recurrent Philadelphia chromosome-negative (Ph−) acute lymphoblastic leukemia (ALL). Results Among 10 enrolled patients, VSLI was escalated from 1.80 to 2.24 mg/m2, with one DLT (ileus) at 2.04 mg/m2. Two patients discontinued VSLI early. The most common AE included lymphopenia (100%), constipation, nausea, infusion reaction (each 60%), neutropenia, and peripheral neuropathy (50%). Grade 3/4 AE included lymphopenia (90%), neutropenia (20%), and ileus (10%), with prolonged grade ≥2 lymphopenia observed in most patients. Calculated MTD for VSLI was 2.25 mg/m2 (95% Bayesian credible interval: 2.00-2.40). Overall response was 100% with 50% CR. With median follow-up 26 months, 4/10 patients experienced recurrence and 1 died. Conclusion Vincristine sulfate liposomal injection at 2.25 mg/m2 can be safely combined with BR for indolent B-cell lymphoma, but given observed toxicities and recurrences, we did not pursue an expanded cohort. Clinical Trials Registration Number: ClinicalTrials.gov identifier NCT02257242.
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Affiliation(s)
- Thomas Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - James Butera
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Pamela Egan
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - John Reagan
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Anthony Thomas
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Inna Yakirevich
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Kelsey MacKinnon
- Brown University Oncology Research Group (BrUOG), Providence, RI, USA
| | - Jeannine Margolis
- Brown University Oncology Research Group (BrUOG), Providence, RI, USA
| | | | - Valerie Rosati
- Lifespan Oncology Clinical Research, Providence, RI, USA
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
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Di M, Keeney T, Belanger E, Panagiotou OA, Olszewski AJ. Global Risk Indicator and Therapy for Older Patients With Diffuse Large B-Cell Lymphoma: A Population-Based Study. JCO Oncol Pract 2022; 18:e383-e402. [PMID: 34846916 PMCID: PMC8932488 DOI: 10.1200/op.21.00513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/04/2021] [Accepted: 10/27/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To examine the impact of global risk, a measure comprising age, comorbidities, function, and cognitive statuses, on treatment selection and outcomes among older home care recipients with diffuse large B-cell lymphoma. METHODS From SEER-Medicare, we selected home care recipients diagnosed with diffuse large B-cell lymphoma in 2011-2015, who had pretreatment Outcome and Assessment Information Set (OASIS) evaluations. We created a global risk indicator categorizing patients as low-, moderate-, or high-risk on the basis of OASIS assessments. We examined the association of global risk with receipt of therapy and among chemotherapy recipients, with mortality, emergency department visits, hospitalization, and intensive care unit admission within 30 days from first treatment in logistic models, reporting adjusted odds ratios (OR) with 95% CI. We compared overall survival across risk groups estimating adjusted hazard ratios. RESULTS Of the 1,232 patients (median age, 80 years), 65% received chemotherapy. High-risk patients (v moderate-risk) were less likely to receive any chemotherapy (OR, 0.50; 95% CI, 0.39 to 0.64) and curative regimens (OR, 0.59; 95% CI, 0.40 to 0.86) if treated, although even in the moderate-risk group, only 61% received curative regimens. High-risk patients were more likely to experience acute mortality (OR, 2.24; 95% CI, 1.43 to 3.52), emergency department visits (OR, 1.35; 95% CI, 1.00 to 1.83), hospitalization (OR, 1.60; 95% CI, 1.19 to 2.17), or intensive care unit admission (OR, 1.52; 95% CI, 1.04 to 2.22) and had inferior overall survival (hazard ratio, 1.41; 95% CI, 1.11 to 1.78). CONCLUSION Global risk on the basis of OASIS is easily available, suggesting a potential way to improve patient selection for curative treatment and institution of preventive measures.
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Affiliation(s)
- Mengyang Di
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
- Division of Hematology/Oncology, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT
| | - Tamra Keeney
- Mongan Institute, Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI
| | - Emmanuelle Belanger
- Mongan Institute, Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI
| | - Orestis A. Panagiotou
- Mongan Institute, Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI
| | - Adam J. Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI
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Carneiro BA, DeSouza A, Golijanin D, Wood R, Olszewski AJ, Holder SL, El-Deiry WS, Aggarwal RR, Mega AE. BrUOG360: A phase Ib/II study of copanlisib combined with rucaparib in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
128 Background: mCRPC with alterations in genes associated with homologous recombination (HR) DNA repair (e.g., BRCA1/2) is sensitive to poly ADP-ribose polymerase inhibitors (PARPi). Preclinical studies showed that PI3K inhibitors (PI3Ki) impairs HR and sensitize cancer cells to PARPi even in the absence of HR gene mutations. These results support our hypothesis that dual PI3K and PARP inhibition may improve clinical outcomes in progressive mCRPC. We describe preliminary results of a phase Ib/II study investigating safety of the combination of copanlisib (pan-class I PI3Ki) and rucaparib (PARP-1, -2 and -3 inhibitor). Methods: Enrollment criteria included progressive mCRPC, prior androgen inhibitors (abiraterone, enzalutamide, and/or apalutamide); prior taxane chemotherapy was allowed. HR-deficiency was not required for the phase Ib. The phase I followed a standard 3+3 escalation design. Dose schema: rucaparib (continuous oral administration twice daily) 400mg (dose level [DL] -1, 1), 500mg (DL 2) or 600mg (DL 3,4) and intravenous copanlisib (45mg D1, D15 (DL -1, -2); 45mg, D1, D8, D15 (DL 1, 2, 3); 60mg, D1, D8, D15 (DL 4); 28-day cycle). Adverse events (AE) were graded by CTCAE v5.0. The primary aim of the phase I was to establish the MTD and the recommended phase II dose (RP2D) of copanlisib in combination with rucaparib. Results: Eleven pts were enrolled with a median age of 63 (55-78) and median PSA of 12 ng/mL (0.018–2,101). Seven pts (63%) received prior chemotherapy (docetaxel [7], cabazitaxel [3]). Pathogenic HR mutations included BRCA1 (1), BRCA2 (3), CDK12 (1), and FANCA (1). Treatment-related AE included grade 2 (G2) leukopenia (30%), G2 anemia (20%), G2 rash (20%). Two dose-limiting toxicities (DLTs) were observed in DL 1: G3 rash and G3 AST/ALT elevation attributed to both drugs. Six pts were treated at DL -1 without DLTs. The RP2D was rucaparib 400mg BID with copanlisib 45mg (D1, D15; 28-day cycle). There were 2 confirmed PSA50 responses among 7 evaluable pts (28%). One pt had BRCA2 loss and 1 had PALB2 VUS (ongoing PSA response for 14 mo). Three stable disease and 1 partial response were observed among 6 pts evaluable by RECIST 1.1. Conclusions: The combination of rucaparib and copanlisib is well tolerated. The RP2D was rucaparib 400mg BID with copanlisib 45mg (D1, D15; 28-day cycle) with signal of efficacy. Enrollment in a phase 2 expansion cohort in HR-mutated mCRPC is ongoing. Clinical trial information: NCT04253262.
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Affiliation(s)
| | - Andre DeSouza
- Lifespan Cancer Institute, Division of Hematology/Oncology, Cancer Center at Brown University, Providence, RI
| | | | - Roxanne Wood
- Brown University Oncology Research Group, Providence, RI
| | - Adam J Olszewski
- Lifespan Cancer Institute, Division of Hematology/Oncology, Cancer Center at Brown University, Providence, RI
| | - Sheldon L. Holder
- Lifespan Cancer Institute, Division of Hematology/Oncology, Cancer Center at Brown University, Providence, RI
| | - Wafik S. El-Deiry
- Lifespan Cancer Institute, Division of Hematology/Oncology, Cancer Center at Brown University, Providence, RI
| | | | - Anthony E. Mega
- Lifespan Cancer Institute, Division of Hematology/Oncology, Cancer Center at Brown University, Providence, RI
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Satyanarayana G, Enriquez KT, Sun T, Klein EJ, Abidi M, Advani SM, Awosika J, Bakouny Z, Bashir B, Berg S, Bernardes M, Egan PC, Elkrief A, Feldman LE, Friese CR, Goel S, Gomez CG, Grant KL, Griffiths EA, Gulati S, Gupta S, Hwang C, Jain J, Jani C, Kaltsas A, Kasi A, Khan H, Knox N, Koshkin VS, Kwon DH, Labaki C, Lyman GH, McKay RR, McNair C, Nagaraj G, Nakasone ES, Nguyen R, Nonato TK, Olszewski AJ, Panagiotou OA, Puc M, Razavi P, Robilotti EV, Santos-Dutra M, Schmidt AL, Shah DP, Shah SA, Vieira K, Weissmann LB, Wise-Draper TM, Wu U, Wu JTY, Choueiri TK, Mishra S, Warner JL, French B, Farmakiotis D. Coinfections in Patients with Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Study. Open Forum Infect Dis 2022; 9:ofac037. [PMID: 35198648 PMCID: PMC8860152 DOI: 10.1093/ofid/ofac037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background The frequency of coinfections and their association with outcomes have not been adequately studied among patients with cancer and coronavirus disease 2019 (COVID-19), a high-risk group for coinfection. Methods We included adult (≥18 years) patients with active or prior hematologic or invasive solid malignancies and laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection, using data from the COVID-19 and Cancer Consortium (CCC19, NCT04354701). We captured coinfections within ±2 weeks from diagnosis of COVID-19, identified factors cross-sectionally associated with risk of coinfection, and quantified the association of coinfections with 30-day mortality. Results Among 8765 patients (hospitalized or not; median age, 65 years; 47.4% male), 16.6% developed coinfections: 12.1% bacterial, 2.1% viral, 0.9% fungal. An additional 6.4% only had clinical diagnosis of a coinfection. The adjusted risk of any coinfection was positively associated with age >50 years, male sex, cardiovascular, pulmonary, and renal comorbidities, diabetes, hematologic malignancy, multiple malignancies, Eastern Cooperative Oncology Group Performance Status, progressing cancer, recent cytotoxic chemotherapy, and baseline corticosteroids; the adjusted risk of superinfection was positively associated with tocilizumab administration. Among hospitalized patients, high neutrophil count and C-reactive protein were positively associated with bacterial coinfection risk, and high or low neutrophil count with fungal coinfection risk. Adjusted mortality rates were significantly higher among patients with bacterial (odds ratio [OR], 1.61; 95% CI, 1.33–1.95) and fungal (OR, 2.20; 95% CI, 1.28–3.76) coinfections. Conclusions Viral and fungal coinfections are infrequent among patients with cancer and COVID-19, with the latter associated with very high mortality rates. Clinical and laboratory parameters can be used to guide early empiric antimicrobial therapy, which may improve clinical outcomes.
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Affiliation(s)
| | | | - Tianyi Sun
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth J Klein
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | - Maheen Abidi
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Shailesh M Advani
- Cancer Prevention and Control, Department of Oncology, Georgetown University School of Medicine, Georgetown University, Washington DC, USA
| | - Joy Awosika
- University of Cincinnati Cancer Center, Cincinnati, OH, USA
| | | | - Babar Bashir
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Stephanie Berg
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | - Marilia Bernardes
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Pamela C Egan
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | | | - Lawrence E Feldman
- University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | | | - Shipra Goel
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | - Keith L Grant
- Hartford HealthCare Cancer Institute, Hartford, CT, USA
| | | | - Shuchi Gulati
- University of Cincinnati Cancer Center, Cincinnati, OH, USA
| | | | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Jayanshu Jain
- The University of Kansas Cancer Center, Overland Park, KS, USA
| | | | - Anna Kaltsas
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Anup Kasi
- The University of Kansas Cancer Center, Overland Park, KS, USA
| | - Hina Khan
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | - Natalie Knox
- Stritch School of Medicine at Loyola University, Maywood, IL, USA
| | - Vadim S Koshkin
- Helen Diller Family Comprehensive Cancer Center at the University of California at San Francisco, San Francisco, CA, USA
| | - Daniel H Kwon
- Helen Diller Family Comprehensive Cancer Center at the University of California at San Francisco, San Francisco, CA, USA
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington Seattle, WA, USA
| | - Rana R McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Christopher McNair
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Elisabeth S Nakasone
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington Seattle, WA, USA
| | - Ryan Nguyen
- University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | - Taylor K Nonato
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Adam J Olszewski
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | - Orestis A Panagiotou
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | | | - Pedram Razavi
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | | | | | | | - Dimpy P Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Sumit A Shah
- Stanford Cancer Institute at Stanford University, Stanford, CA, USA
| | - Kendra Vieira
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | | | | | - Ulysses Wu
- Hartford HealthCare Cancer Institute, Hartford, CT, USA
| | - Julie Tsu-Yu Wu
- Stanford Cancer Institute at Stanford University, Stanford, CA, USA
| | | | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Dimitrios Farmakiotis
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
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Olszewski AJ. Ferritin, sex, and the wildfire of inflammation in Hodgkin lymphoma. Leuk Lymphoma 2022; 63:765-767. [PMID: 35105249 PMCID: PMC9704415 DOI: 10.1080/10428194.2022.2034161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Adam J Olszewski
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
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37
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Giri S, Dahal S, Bal S, Godby KN, Richman J, Olszewski AJ, Williams GR, Brown C, Buford TW, Costa LJ, Bhatia S. Pre-treatment neutrophil to lymphocyte ratio as a biomarker of frailty and predictor of survival among older adults with multiple myeloma. J Geriatr Oncol 2021; 13:486-492. [PMID: 34924305 DOI: 10.1016/j.jgo.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 11/16/2021] [Accepted: 12/06/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Neutrophil to Lymphocyte Ratio (NLR) combines a marker of inflammation and reduced cell turnover to reflect age related alterations in the immune system. Whether NLR can serve as a biomarker of frailty and predict survival among older adults with Multiple Myeloma (MM) is unknown. MATERIALS AND METHODS We used an electronic health record-derived database to identify older adults (age ≥ 60y) with incident MM diagnosed between 1/2011 and 2/2020, with known pre-treatment absolute neutrophil and lymphocyte count up to 90 days before the start of therapy. The calculated NLR values were stratified into quartiles (Q1-Q4). We constructed a previously validated, simplified frailty index combining age, comorbidity and ECOG performance status. We measured the association between NLR quartiles and this frailty index using a logistic regression, adjusted for age, sex and race/ethnicity. We used Kaplan Meier methods and multivariable Cox regression to assess the impact of NLR on overall survival adjusting for potential confounders. RESULTS We identified 1729 older adults with newly diagnosed MM, at a median age of 73y (IQR: 67-78y). The median NLR was 2.13 (IQR: 1.44 to 3.31). Of the 1135 evaluable patients, 55% met criteria for frailty. Multivariable analysis revealed a 2.1-fold higher odds of frailty (95%CI = 1.42-3.10, p < 0.001) for patients in the NLR Q4 group vs. NLR Q1 group. In a multivariable analysis, adjusting for age, sex, race/ethnicity, M-protein type, stage, high risk cytogenetics, baseline creatinine, LDH and type of first line therapy, patients in NLR Q4 group had a 1.51 times increased hazards of death (95%CI = 1.15-1.98, p 0.002) when compared to those in NLR Q1 group. CONCLUSION NLR, a readily available laboratory biomarker, is associated with frailty measured using a simplified frailty index as well as inferior overall survival among older adults with MM. Future studies should explore its value as a screening tool to identify frail older adults with MM.
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Affiliation(s)
- Smith Giri
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, United States; Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Sumit Dahal
- Department of Hospital Medicine, St. Joseph Hospital, Bangor, ME, United States
| | - Susan Bal
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kelly N Godby
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Joshua Richman
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Adam J Olszewski
- Division of Hematology-Oncology, Lifespan Cancer Institute, Providence, RI, United States
| | - Grant R Williams
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, United States; Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Cynthia Brown
- Division of Gerontology, Geriatrics & Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Thomas W Buford
- Division of Gerontology, Geriatrics & Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Luciano J Costa
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Smita Bhatia
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, United States
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38
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Pelcovits A, Olszewski AJ, Decker D, Guyer D, Leblanc TW, Egan P. Impact of Early Palliative Care on End-of-Life Outcomes in Hematologic Malignancies. J Palliat Med 2021; 25:556-561. [PMID: 34842462 DOI: 10.1089/jpm.2021.0193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Patients with hematologic malignancies (HMs) receive more disease directed care at the end of life (EOL) and often die in the hospital. The impact of early palliative care (PC) consultation on EOL quality outcomes in HMs has not been well described. Objectives: In 2017 we embedded a PC specialist within our inpatient malignant hematology team at our hospital in Providence, Rhode Island to facilitate the use of early PC. We sought to determine if this practice was accompanied by a shift in EOL outcomes. Design/Setting: We conducted a retrospective review of patients diagnosed with acute myeloid leukemia (AML) at our institution in the two years before (Cohort A) and after (Cohort B) insertion of a PC specialist. We identified patients who received a PC consultation and whether it was early or late. We then examined EOL quality outcomes: hospitalizations and intensive care unit (ICU) admissions in the last 30 days of life, chemotherapy use in the last 14 days of life, use of hospice, and death out of hospital. Results: Among 139 AML patients, 46 in Cohort A and 93 in Cohort B, we identified 34 and 47 decedents in each cohort, respectively. There was no significant improvement in EOL outcomes between Cohort A and B or among patients receiving early PC (p > 0.05); however, PC in general across all cohorts was associated with significant increase in hospice use and fewer ICU admissions (p = 0.016 and 0.0043, respectively). Conclusion: Earlier PC consultation in AML was not significantly associated with improvement in EOL quality outcomes; however, PC use in general was with improvement in use of hospice and ICU utilization. Further studies are needed to more definitively examine the relationship between early PC and EOL outcomes in patients with HMs and to examine non EOL outcomes such as patient experience and quality-of-life measures.
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Affiliation(s)
- Ari Pelcovits
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | | | - Dana Guyer
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Geriatrics and Palliative Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Thomas W Leblanc
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina, USA
| | - Pamela Egan
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
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39
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Hsu A, Kurt H, Zayac AS, Olszewski AJ. CD5 expression in marginal zone lymphoma predicts differential response to rituximab or bendamustine/rituximab. Leuk Lymphoma 2021; 63:31-42. [PMID: 34467833 DOI: 10.1080/10428194.2021.1973670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We examined outcomes of 244 patients with marginal zone lymphoma (MZL) diagnosed in 2010-2020, of which 25 (10%) expressed CD5. CD5 expression was present in 22% of splenic, 8% of nodal, and 5% of extranodal MZL, and showed frequent blood/bone marrow involvement, elevated lactate dehydrogenase, and TP53 deletions. CD5 expression was not associated with progression-free or overall survival, but it conferred a significantly higher risk of histologic transformation (22% versus 4% at 5 years, p = 0.002). Among patients receiving first-line rituximab monotherapy, CD5 expression was associated with lower response rate (30% versus 77%, p = 0.006), PFS (25% versus 45% at 3 years, p = 0.003) and OS (44% versus 77%, p = 0.010), whereas CD5 status did not significantly affect outcomes of patients receiving bendamustine with rituximab (P for interaction = 0.012 for progression-free survival). CD5-positive MZL may have a propensity to leukemic dissemination, histologic transformation, and may derive benefit from first-line bendamustine/rituximab rather than rituximab alone.
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Affiliation(s)
- Andrew Hsu
- Division of Hematology/Oncology, Lifespan Cancer Institute, Providence, RI, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Habibe Kurt
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Adam S Zayac
- Division of Hematology/Oncology, Lifespan Cancer Institute, Providence, RI, USA
| | - Adam J Olszewski
- Division of Hematology/Oncology, Lifespan Cancer Institute, Providence, RI, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
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40
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Ollila TA, Lu S, Masel R, Zayac A, Paiva K, Rogers RD, Olszewski AJ. Antibody Response to COVID-19 Vaccination in Adults With Hematologic Malignant Disease. JAMA Oncol 2021; 7:1714-1716. [PMID: 34379085 DOI: 10.1001/jamaoncol.2021.4381] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island
| | - Shaolei Lu
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, Rhode Island
| | - Rebecca Masel
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adam Zayac
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island
| | - Kimberly Paiva
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, Rhode Island
| | - Ralph D Rogers
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.,Division of Infectious Disease, Rhode Island Hospital, Providence, Rhode Island
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island
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41
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Zayac AS, Evens AM, Danilov A, Smith SD, Jagadeesh D, Leslie LA, Wei C, Kim SH, Naik S, Sundaram S, Reddy N, Farooq U, Kenkre VP, Epperla N, Blum KA, Khan N, Singh D, Alderuccio JP, Godara A, Yazdy MS, Diefenbach C, Rabinovich E, Varma G, Karmali R, Shao Y, Trabolsi A, Burkart M, Martin P, Stettner S, Chauhan A, Choi YK, Straker-Edwards A, Klein A, Churnetski MC, Boughan KM, Berg S, Haverkos BM, Orellana-Noia VM, D'Angelo C, Bond DA, Maliske SM, Vaca R, Magarelli G, Sperling A, Gordon MJ, David KA, Savani M, Caimi P, Kamdar M, Lunning MA, Palmisiano N, Venugopal P, Portell CA, Bachanova V, Phillips T, Lossos IS, Olszewski AJ. Outcomes of Burkitt lymphoma with central nervous system involvement: evidence from a large multicenter cohort study. Haematologica 2021; 106:1932-1942. [PMID: 33538152 PMCID: PMC8252937 DOI: 10.3324/haematol.2020.270876] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Indexed: 11/09/2022] Open
Abstract
Central nervous system (CNS) involvement in Burkitt lymphoma poses a major therapeutic challenge, and the relative ability of contemporary regimens to treat CNS involvement remains uncertain. We describe the prognostic significance of CNS involvement and the incidence of CNS recurrence/progression after contemporary immunochemotherapy using real-world clinicopathological data from adults with Burkitt lymphoma diagnosed between 2009 and 2018 in 30 institutions in the USA. We examined associations between baseline CNS involvement, patients’ characteristics, complete response rates, and survival. We also examined risk factors for CNS recurrence. Of 641 patients (aged 18 to 88 years), 120 (19%) had CNS involvement. CNS involvement was independently associated with human immunodeficiency virus infection, poor performance status, involvement of ≥2 extranodal sites, and bone marrow involvement. Selection of the first-line treatment regimen was unaffected by CNS involvement (P=0.93). Patients with CNS disease had significantly lower rates of complete response (59% vs. 77% for patients with and without CNS involvement, respectively; P<0.001), worse 3-year progression-free survival (adjusted hazard ratio [aHR]=1.53, 95% confidence interval [95% CI]: 1.14-2.06; P=0.004) and overall survival (aHR=1.62, 95% CI: 1.18-2.22; P=0.003). The 3-year cumulative incidence of CNS recurrence was 6% (95% CI: 4-8%) and was significantly lower among patients receiving other regimens (CODOX-M/IVAC, 4%, or hyperCVAD/MA, 3%) compared with DA-EPOCH-R (13%; adjusted sub-distribution HR=4.38, 95% CI:, 2.16-8.87; P<0.001). Baseline CNS involvement in Burkitt lymphoma is relatively common and portends inferior prognosis independently of the first-line treatment regimen selected. In real-world practice, regimens including intravenous systemic agents with pronounced CNS penetrance were associated with a lower risk of CNS recurrence. This finding may be influenced by observed suboptimal adherence to the strict CNS staging and intrathecal therapy procedures incorporated in the DA-EPOCH-R regimen.
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Affiliation(s)
- Adam S Zayac
- Lifespan Cancer Institute, Alpert Medical School of Brown University, Providence, RI
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Alexey Danilov
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Stephen D Smith
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Lori A Leslie
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Catherine Wei
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | | | - Seema Naik
- Penn State Cancer Institute, Penn State University College of Medicine, Hershey, PA
| | | | | | - Umar Farooq
- University of Iowa Carver College of Medicine, Iowa City, IA
| | | | | | | | - Nadia Khan
- Fox Chase Cancer Center, Philadelphia, PA
| | - Daulath Singh
- Loyola University Medical Center, Loyola University Chicago, Maywood, IL
| | - Juan P Alderuccio
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | | | - Maryam Sarraf Yazdy
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | | | | | | | | | - Yusra Shao
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Asaad Trabolsi
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | | | | | | | - Ayushi Chauhan
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - Yun Kyong Choi
- New York University School of Medicine, Perlmutter Cancer Center, New York, NY
| | | | | | | | | | - Stephanie Berg
- Loyola University Medical Center, Loyola University Chicago, Maywood, IL
| | | | | | | | - David A Bond
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Seth M Maliske
- University of Iowa Carver College of Medicine, Iowa City, IA
| | - Ryan Vaca
- Penn State Cancer Institute, Penn State University College of Medicine, Hershey, PA
| | - Gabriella Magarelli
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Amy Sperling
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Max J Gordon
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Kevin A David
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | | | - Paolo Caimi
- University Hospitals Seidman Cancer Center, Cleveland, OH
| | | | | | - Neil Palmisiano
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | - Craig A Portell
- University of Virginia School of Medicine, Charlottesville, VA
| | | | | | - Izidore S Lossos
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Adam J Olszewski
- Lifespan Cancer Institute, Alpert Medical School of Brown University, Providence, RI.
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Lopresti ML, Bian JJ, Sakr BJ, Strenger RS, Legare RD, Fenton M, Witherby SM, Dizon DS, Pandya SV, Stuckey AR, Edmondson DA, Gass JS, Emmick CM, Graves TA, Cutitar M, Olszewski AJ, Sikov WM. Neoadjuvant weekly paclitaxel and carboplatin with trastuzumab and pertuzumab in HER2-positive breast cancer: a Brown University Oncology Research Group (BrUOG) study. Breast Cancer Res Treat 2021; 189:93-101. [PMID: 34086171 DOI: 10.1007/s10549-021-06266-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE In HER2-positive breast cancer (HER2+ BC), neoadjuvant chemotherapy (NACT) with dual HER2-targeted therapy achieves high pathologic complete response (pCR) rates. Anthracycline-free NACT regimens avoid toxicities associated with anthracyclines, but every 3-week TCHP also has substantial side effects. We hypothesized that a weekly regimen might have equivalent efficacy with less toxicity; we also investigated whether poorly responding patients would benefit from switching to AC. METHODS Patients with clinical stage II-III HER2+ BC received weekly paclitaxel 80 mg/m2 and carboplatin AUC2 with every 3-week trastuzumab and pertuzumab (wPCbTP), with the option of splitting the pertuzumab loading dose. After 12 weeks, responding patients continued wPCbTP for another 6 weeks, while non-responders switched to AC. Dose modifications and post-op therapy were at investigator discretion. RESULTS In 30 evaluable patients, the pCR rate was 77% (95% CI 58-90%); 12/14 (86%) in ER-negative and 11/16 (69%) in ER-positive. Only two patients transitioned to AC for non-response, of which one achieved pCR. There were no episodes of febrile neutropenia or grade ≥ 3 peripheral neuropathy, though several patients who continued wPCbTP stopped before week 18. Split-dose pertuzumab was associated with less grade ≥ 2 diarrhea (40%) than the standard loading dose (60%). CONCLUSION pCR rates with our regimen were as high as reported with TCHP with fewer grade ≥ 3 toxicities, though diarrhea remains a concern. Too few patients had a suboptimal response to adequately test switching to AC. The wPCbTP regimen should be considered an alternative to TCHP as neoadjuvant therapy for HER2+ BC. TRAIL REGISTRATION ClinicalTrials.gov identifier: NCT02789657.
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Affiliation(s)
- M L Lopresti
- Departments of Medicine and Surgery, Warren Alpert Medical School of Brown University, Lifespan Comprehensive Cancer Centers, Providence, RI, USA
| | - J J Bian
- Departments of Medicine and Surgery, Warren Alpert Medical School of Brown University, Lifespan Comprehensive Cancer Centers, Providence, RI, USA.,Division of Hematology-Oncology, Maine Medical Center, Portland, ME, USA
| | - B J Sakr
- Department of Obstetrics & Gynecology, Program in Women's Oncology, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - R S Strenger
- Departments of Medicine and Surgery, Warren Alpert Medical School of Brown University, Lifespan Comprehensive Cancer Centers, Providence, RI, USA
| | - R D Legare
- Department of Obstetrics & Gynecology, Program in Women's Oncology, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - M Fenton
- Departments of Medicine and Surgery, Warren Alpert Medical School of Brown University, Lifespan Comprehensive Cancer Centers, Providence, RI, USA
| | - S M Witherby
- Departments of Medicine and Surgery, Warren Alpert Medical School of Brown University, Lifespan Comprehensive Cancer Centers, Providence, RI, USA
| | - D S Dizon
- Departments of Medicine and Surgery, Warren Alpert Medical School of Brown University, Lifespan Comprehensive Cancer Centers, Providence, RI, USA
| | - S V Pandya
- Department of Obstetrics & Gynecology, Program in Women's Oncology, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - A R Stuckey
- Department of Obstetrics & Gynecology, Program in Women's Oncology, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - D A Edmondson
- Department of Obstetrics & Gynecology, Program in Women's Oncology, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - J S Gass
- Department of Obstetrics & Gynecology, Program in Women's Oncology, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - C M Emmick
- Departments of Medicine and Surgery, Warren Alpert Medical School of Brown University, Lifespan Comprehensive Cancer Centers, Providence, RI, USA
| | - T A Graves
- Departments of Medicine and Surgery, Warren Alpert Medical School of Brown University, Lifespan Comprehensive Cancer Centers, Providence, RI, USA
| | - M Cutitar
- Departments of Medicine and Surgery, Warren Alpert Medical School of Brown University, Lifespan Comprehensive Cancer Centers, Providence, RI, USA
| | - A J Olszewski
- Departments of Medicine and Surgery, Warren Alpert Medical School of Brown University, Lifespan Comprehensive Cancer Centers, Providence, RI, USA
| | - W M Sikov
- Department of Obstetrics & Gynecology, Program in Women's Oncology, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI, USA. .,Breast Health Center, 101 Dudley Street, Providence, RI, 02905, USA.
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Hsu A, Ohnigian S, Chang A, Liu Y, Zayac AS, Olszewski AJ, Reagan JL. Thrombosis in COVID-19: A Narrative Review of Current Literature and Inpatient Management. R I Med J (2013) 2021; 104:14-19. [PMID: 34044431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
COVID-19 infection has been associated with an increased incidence of thrombotic events leading to poor patient outcomes. Given the rapid rise of the COVID-19 pandemic, the ability to conduct prospective trials has been limited and data regarding the use of standard-dose versus intermediate-dose thromboprophylaxis, use of empiric therapeutic anticoagulation, and use of extended-duration thromboprophylaxis after discharge has been largely based upon observational data without any high-quality prospective data guiding their use. In this article, we will review the incidence and frequency of arterial and venous thrombotic events along with the current literature surrounding the use of intermediate-dose thromboprophylaxis, empiric therapeutic anticoagulation, and use of extended-duration thromboprophylaxis for patients hospitalized with COVID-19.
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Affiliation(s)
- Andrew Hsu
- Division of Hematology/Oncology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Sarah Ohnigian
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Augustus Chang
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
| | - Yuchen Liu
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
| | - Adam S Zayac
- Division of Hematology/Oncology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Adam J Olszewski
- Division of Hematology/Oncology, Warren Alpert Medical School of Brown University, Providence, RI
| | - John L Reagan
- Division of Hematology/Oncology, Warren Alpert Medical School of Brown University, Providence, RI
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Tohidi‐Esfahani I, Warden A, Malunis E, DeNardis PL, Haurat J, Black M, Opat S, Kee D, D'Sa S, Kersten MJ, Spearing RL, Palomba ML, Olszewski AJ, Harrington C, Scott CL, Trotman J. WhiMSICAL: A global Waldenström's Macroglobulinemia patient-derived data registry capturing treatment and quality of life outcomes. Am J Hematol 2021; 96:E218-E222. [PMID: 33755232 DOI: 10.1002/ajh.26173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Ibrahim Tohidi‐Esfahani
- Haematology Department Concord Repatriation General Hospital Sydney Australia
- Faculty of Medicine and Health University of Sydney Sydney Australia
| | - Andrew Warden
- Australian Patient Support Group for WM WMozzies Sydney Australia
| | - Elena Malunis
- Board of Trustees International Waldenström's Macroglobulinemia Foundation Sarasota Florida
| | - Peter L. DeNardis
- Board of Trustees International Waldenström's Macroglobulinemia Foundation Sarasota Florida
| | - Javier Haurat
- Administrative Team BioGrid Australia Melbourne Australia
- Administrative Team CART‐WHEEL.org Melbourne Australia
| | - Marita Black
- Administrative Team BioGrid Australia Melbourne Australia
- Administrative Team CART‐WHEEL.org Melbourne Australia
| | - Stephen Opat
- School of Clinical Sciences Monash University Melbourne Australia
- Haematology Department Monash Health Melbourne Australia
| | - Damien Kee
- Cancer Research Division Walter and Eliza Hall Institute of Medical Research Melbourne Australia
- Oncology Department Peter MacCallum Cancer Centre Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
| | - Shirley D'Sa
- UCLH Centre for Waldenström's Macroglobulinemia and Related Conditions University College London Hospitals NHS Foundation Trust London UK
| | - Marie José Kersten
- Department of Hematology Amsterdam UMC, University of Amsterdam and LYMMCARE Netherlands
| | - Ruth L. Spearing
- Otago School of Medicine University of Otago New Zealand
- Department of Haematology Christchurch Hospital New Zealand
| | - Maria Lia Palomba
- Lymphoma Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York
- Department of Medicine Weill Cornell Medical College New York New York
| | - Adam J. Olszewski
- Department of Medicine Warren Alpert Medical School, Brown University Providence Rhode Island
- Division of Hematology‐Oncology Rhode Island Hospital Providence Rhode Island
| | - Carl Harrington
- Board of Trustees International Waldenström's Macroglobulinemia Foundation Sarasota Florida
| | - Clare L. Scott
- Administrative Team CART‐WHEEL.org Melbourne Australia
- Cancer Research Division Walter and Eliza Hall Institute of Medical Research Melbourne Australia
- Department of Medical Oncology Royal Melbourne Hospital Melbourne Australia
| | - Judith Trotman
- Haematology Department Concord Repatriation General Hospital Sydney Australia
- Faculty of Medicine and Health University of Sydney Sydney Australia
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Panagiotou OA, Keeney T, Ogarek JA, Wulff-Burchfield E, Olszewski AJ, Bélanger E. Prevalence of functional limitations and their associations with systemic cancer therapy among older adults in nursing homes with advanced non-small cell lung cancer. J Geriatr Oncol 2021; 12:765-770. [PMID: 33610505 PMCID: PMC8184570 DOI: 10.1016/j.jgo.2021.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To determine the relationship of self-care task disabilities with the use of systemic cancer therapies for advanced non-small cell lung cancer (NSCLC) in nursing home patients. MATERIALS AND METHODS Using the Surveillance, Epidemiology, and End Results-Medicare database linked with Minimum Data Set assessments, we identified nursing home residents with advanced NSCLC from 2011 to 2015. We considered disability in activities of daily living (ADL) including dressing, personal hygiene, toilet use, locomotion on unit, transfer, bed mobility, and eating. We estimated the association between ADL disabilities and receipt of systemic cancer therapies within 3 months of diagnosis. RESULTS Of the 3174 patients, 2702 (85.2%) experienced disability in one or more ADLs and 64.7% had disability in 5-7 ADLs. A total of 415 (13.1%) patients received systemic therapy. There was a strong association between disability in each ADL and receipt of therapy including dressing (OR, 0.52 [95% CI, 0.42-0.65]), toileting (odds ratio, OR, 0.52 [95% confidence interval, CI, 0.42-0.65]), personal hygiene (OR, 0.48 [95% CI, 0.39-0.59]), transfers (OR, 0.51 [95% CI, 0.41-0.64]), bed mobility (OR, 0.55 [95% CI, 0.44-0.69]), locomotion (OR, 0.57 [95% CI, 0.46-0.71]), or eating (OR, 0.45 [95% CI, 0.31-0.67]). Compared to patients having no ADL disability, patients were less likely to receive chemotherapy if they had disability in 1-2 ADLs (OR, 0.95 [95% CI, 0.66-1.37]), 3-4 ADLs (OR, 0.81 [95% CI, 0.56-1.15]), or 5-7 ADLs (OR, 0.43 [95% CI, 0.33-0.56]). CONCLUSIONS Systemic cancer therapy is not commonly used in this population and is strongly predicted by disability in self-care tasks.
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Affiliation(s)
- Orestis A Panagiotou
- Department of Health Services, Policy and Practice, Brown University School of Public Health, RI, United States of America; Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, United States of America; Center for Evidence Synthesis in Health, Brown University School of Public Health, RI, United States of America; Providence VA Medical Center, Providence, RI, United States of America.
| | - Tamra Keeney
- Department of Health Services, Policy and Practice, Brown University School of Public Health, RI, United States of America; Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, United States of America; Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jessica A Ogarek
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, United States of America
| | - Elizabeth Wulff-Burchfield
- Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Adam J Olszewski
- Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Emmanuelle Bélanger
- Department of Health Services, Policy and Practice, Brown University School of Public Health, RI, United States of America; Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, United States of America
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Muthiah A, Chudasama R, Olszewski AJ, Saiganesh H, Kurt H, Mingrino J, Garcia-Moliner M, Azzoli CG, Khurshid H, Birnbaum AE, Khan H. Clinical characteristics, co-mutations and outcomes of advanced non-small cell lung cancer (NSCLC) patients with KRAS mutations. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e21174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21174 Background: Mutations (mt) in the KRAS gene are common oncogenic drivers in advanced NSCLC. The KRAS mt subtypes and certain co-mutations (co-mt) have prognostic and predictive implications. New drugs promise to uniquely target KRAS G12C, raising interest in studying the unique clinical and molecular characteristics of this subtype. Methods: We retrospectively identified 56 KRAS mt advanced NSCLC patients (pts) that underwent Next-Generation Sequencing (NGS) from 06/2015 to 12/2020. We used a commercial NGS panel that tested for > 300 genomic alterations, including substitutions, insertions, deletions and copy number alterations. For statistical analysis, we divided the patients into G12C and non-G12C groups. Results: In our cohort of 56 KRAS mt pts, median age was 67 (range: 58-74) with a predominance of females (63%) and heavy smokers (89%). KRAS G12C was the most common subtype 38%; G12V 14%, G12D 11%, G12S 11%, G13D 7% and others < 5% each. G12C, G12D and G13D groups had a higher proportion of PD-L1+ tumors (84%, 100%, and 100% respectively, p = 0.02) compared to other KRAS subtypes. Pts in G12C group were on average older (median age 71 vs 61, p = 0.02) than non-G12C. Most frequent co-mt in G12C were TP53 (33%), STK11 (29%), TET2 (19%), RB1 (14%), CDKN2A/B (14%) , MCL1 (14%) and ASXL1 (14%) ; for non-G12C, they were TP53 (54%), CDKN2A/B (37%), STK11 (34%) and RBM10 (17%). CDKN2A/B co-mt (37% vs 14%, p = 0.08) was significantly more frequent in non-G12C group and TET2 in G12C (19% vs 0%, p = 0.016). Non-G12C group more frequently had high TMB (17% vs 0%, p = 0.07) compared to G12C. No difference in survival was seen between G12C and non-G12C groups. We observed no difference in PFS (p = 0.31) or OS (p = 0.64) between smokers and no/light-smokers with KRAS mt. Co-mt with KEAP1 and SMARCA4 were significantly associated with survival in KRAS mt. Compared to KRAS+/KEAP1wt, KRAS +/ KEAP1+ pts had poor PFS (median 1.1 vs 7.5 m, p < 0.0001) and OS (1.1 vs. 27.8 m, p < 0.0001) measured from start of initial therapy. KRAS+/SMARCA4+ had worse PFS (1.0 vs 6.9 m, p < 0.0001) and OS (1.4 vs. 27.8, p = 0.0001) compared to KRAS+/SMARCA4wt. KRAS mt pts with STK11/KEAP1 that were treated with immunotherapy-based regimens had shorter PFS (1.1 vs 7.6 m, p = 0.001) and OS (1.4 vs 90.9 m, p = 0.0007) compared to those treated with chemotherapy alone. Conclusions: Our data shows that pts with KRAS co-mt with STK11/KEAP1 had worse PFS and OS with the addition of immunotherapy compared to chemotherapy alone, highlighting the potential implications of these co-mt patterns on treatment outcomes. The types of co-mts are similar between KRAS G12C and non-G12C, with the exception of CDKN2A/B (less likely) and TET2 (more likely). Larger data sets are warranted to confirm our observations and determine if these co-mts may create a predictive model for individualized therapy for KRAS mt pts, potentially independent of current predictive markers.
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Affiliation(s)
- Arun Muthiah
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Rani Chudasama
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Adam J. Olszewski
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Habibe Kurt
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Jennifer Mingrino
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Maria Garcia-Moliner
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Christopher G. Azzoli
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Humera Khurshid
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Ariel E. Birnbaum
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
| | - Hina Khan
- Rhode Island Hospital-The Warren Alpert Medical School of Brown University, Providence, RI
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Ollila TA, Olszewski AJ. Chemotherapy-Free Management of Follicular and Marginal Zone Lymphoma. Cancer Manag Res 2021; 13:3935-3952. [PMID: 34017197 PMCID: PMC8131013 DOI: 10.2147/cmar.s267258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
Many patients with follicular (FL) or marginal zone lymphoma (MZL) are not eligible to receive immunochemotherapy due to advanced age or comorbidities. Recent innovations in the treatment of these indolent lymphomas provide options for multiple lines of chemotherapy-free management. More research is needed to determine which older patients are best served by a chemotherapy-free approach in the context of geriatric vulnerabilities. In the first line, regardless of disease burden, rituximab monotherapy can provide high rates of disease control with minimal toxicity, while judicious use of brief maintenance extends the duration of response. Radioimmunotherapy using ibritumomab tiuxetan is an effective and safe post-rituximab consolidation for older patients who have <25% bone marrow involvement. The combination of rituximab and lenalidomide, although “chemotherapy-free”, does not improve tolerability over immunochemotherapy. However, studies support lower doses and shorter duration of lenalidomide exposure as a means to improve safety without materially compromising efficacy for older individuals. Extranodal MZL can often be effectively controlled with low-dose radiation therapy, and splenic MZL has excellent outcomes with rituximab monotherapy. For many patients with relapsed FL/MZL, simple retreatment with anti-CD20 antibodies will prove sufficient. Other currently available options for relapsed/refractory disease include ibritumomab tiuxetan, lenalidomide with rituximab, umbralisib as a potentially less toxic PI3K inhibitor, ibrutinib (for MZL), and tazemetostat (for FL, especially with EZH2 mutation). Emerging data with novel forms of immunotherapy (antibody-drug conjugates like polatuzumab vedotin or loncastuximab tesirine; T-cell-engaging bispecific antibodies like mosunetuzumab or epcoritamab; and chimeric antigen receptor CAR T-cells like axicabtagene ciloleucel) suggest that immune-directed approaches can produce very high and potentially durable responses in FL/MZL with limited toxicities, further obviating the need for chemotherapy.
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Affiliation(s)
- Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
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Olszewski AJ, Jakobsen LH, Collins GP, Cwynarski K, Bachanova V, Blum KA, Boughan KM, Bower M, Dalla Pria A, Danilov A, David KA, Diefenbach C, Ellin F, Epperla N, Farooq U, Feldman TA, Gerrie AS, Jagadeesh D, Kamdar M, Karmali R, Kassam S, Kenkre VP, Khan N, Kim SH, Klein AK, Lossos IS, Lunning MA, Martin P, Martinez-Calle N, Montoto S, Naik S, Palmisiano N, Peace D, Phillips EH, Phillips TJ, Portell CA, Reddy N, Santarsieri A, Sarraf Yazdy M, Smeland KB, Smith SE, Smith SD, Sundaram S, Zayac AS, Zhang XY, Zhu C, Cheah CY, El-Galaly TC, Evens AM. Burkitt Lymphoma International Prognostic Index. J Clin Oncol 2021; 39:1129-1138. [PMID: 33502927 PMCID: PMC9851706 DOI: 10.1200/jco.20.03288] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Burkitt lymphoma (BL) has unique biology and clinical course but lacks a standardized prognostic model. We developed and validated a novel prognostic index specific for BL to aid risk stratification, interpretation of clinical trials, and targeted development of novel treatment approaches. METHODS We derived the BL International Prognostic Index (BL-IPI) from a real-world data set of adult patients with BL treated with immunochemotherapy in the United States between 2009 and 2018, identifying candidate variables that showed the strongest prognostic association with progression-free survival (PFS). The index was validated in an external data set of patients treated in Europe, Canada, and Australia between 2004 and 2019. RESULTS In the derivation cohort of 633 patients with BL, age ≥ 40 years, performance status ≥ 2, serum lactate dehydrogenase > 3× upper limit of normal, and CNS involvement were selected as equally weighted factors with an independent prognostic value. The resulting BL-IPI identified groups with low (zero risk factors, 18% of patients), intermediate (one factor, 36% of patients), and high risk (≥ 2 factors, 46% of patients) with 3-year PFS estimates of 92%, 72%, and 53%, respectively, and 3-year overall survival estimates of 96%, 76%, and 59%, respectively. The index discriminated outcomes regardless of HIV status, stage, or first-line chemotherapy regimen. Patient characteristics, relative size of the BL-IPI groupings, and outcome discrimination were consistent in the validation cohort of 457 patients, with 3-year PFS estimates of 96%, 82%, and 63% for low-, intermediate-, and high-risk BL-IPI, respectively. CONCLUSION The BL-IPI provides robust discrimination of survival in adult BL, suitable for use as prognostication and stratification in trials. The high-risk group has suboptimal outcomes with standard therapy and should be considered for innovative treatment approaches.
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Affiliation(s)
- Adam J. Olszewski
- Lifespan Cancer Institute, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Lasse H. Jakobsen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Graham P. Collins
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Kate Cwynarski
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | | | - Kirsten M. Boughan
- Adult Hematologic Malignancies and Stem Cell Transplant Section, University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Mark Bower
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Alessia Dalla Pria
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Alexey Danilov
- Toni Stephenson Lymphoma Center, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Kevin A. David
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Fredrik Ellin
- Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund, Sweden
| | | | - Umar Farooq
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Tatyana A. Feldman
- John Theurer Cancer Center, Hackensack Meridian Health School of Medicine, Hackensack, NJ
| | - Alina S. Gerrie
- BC Cancer Centre for Lymphoid Cancer and The University of British Columbia, Vancouver, British Columbia, Canada
| | - Deepa Jagadeesh
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | | | - Reem Karmali
- Division of Hematology Oncology, Northwestern University, Chicago, IL
| | | | | | - Nadia Khan
- Fox Chase Cancer Center, Philadelphia, PA
| | - Seo-Hyun Kim
- Division of Hematology Oncology, Rush University Medical Center, Chicago, IL
| | - Andreas K. Klein
- Division of Hematology and Oncology, Tufts Medical Center, Boston, MA
| | - Izidore S. Lossos
- Division of Hematology, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | | | - Peter Martin
- Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY
| | | | - Silvia Montoto
- Department of Haemato-oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Seema Naik
- Penn State Cancer Institute, Penn State Hershey Medical Center, Hershey, PA
| | - Neil Palmisiano
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - David Peace
- Division of Hematology/Oncology, Department of Medicine, University of Illinois College of Medicine, Chicago, IL
| | | | | | - Craig A. Portell
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | | | - Anna Santarsieri
- Department of Haematology, Cambridge University Hospitals NHSFT, Cambridge, United Kingdom
| | | | - Knut B. Smeland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Stephen D. Smith
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Suchitra Sundaram
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Adam S. Zayac
- Lifespan Cancer Institute, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Xiao-Yin Zhang
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Catherine Zhu
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Chan Y. Cheah
- Linear Clinical Research and Sir Charles Gairdner Hospital, Perth, Australia
| | - Tarec C. El-Galaly
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Andrew M. Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,Andrew M. Evens, DO, MSc, Rutgers Cancer Institute of New Jersey, 195 Little Albany St, New Brunswick, NJ 08901; e-mail:
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Evens AM, Danilov A, Jagadeesh D, Sperling A, Kim SH, Vaca R, Wei C, Rector D, Sundaram S, Reddy N, Lin Y, Farooq U, D'Angelo C, Bond DA, Berg S, Churnetski MC, Godara A, Khan N, Choi YK, Yazdy M, Rabinovich E, Varma G, Karmali R, Mian A, Savani M, Burkart M, Martin P, Ren A, Chauhan A, Diefenbach C, Straker-Edwards A, Klein AK, Blum KA, Boughan KM, Smith SE, Haverkos BM, Orellana-Noia VM, Kenkre VP, Zayac A, Ramdial J, Maliske SM, Epperla N, Venugopal P, Feldman TA, Smith SD, Stadnik A, David KA, Naik S, Lossos IS, Lunning MA, Caimi P, Kamdar M, Palmisiano N, Bachanova V, Portell CA, Phillips T, Olszewski AJ, Alderuccio JP. Burkitt lymphoma in the modern era: real-world outcomes and prognostication across 30 US cancer centers. Blood 2021; 137:374-386. [PMID: 32663292 PMCID: PMC8765121 DOI: 10.1182/blood.2020006926] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/01/2020] [Indexed: 11/20/2022] Open
Abstract
We examined adults with untreated Burkitt lymphoma (BL) from 2009 to 2018 across 30 US cancer centers. Factors associated with progression-free survival (PFS) and overall survival (OS) were evaluated in univariate and multivariate Cox models. Among 641 BL patients, baseline features included the following: median age, 47 years; HIV+, 22%; Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2 to 4, 23%; >1 extranodal site, 43%; advanced stage, 78%; and central nervous system (CNS) involvement, 19%. Treatment-related mortality was 10%, with most common causes being sepsis, gastrointestinal bleed/perforation, and respiratory failure. With 45-month median follow-up, 3-year PFS and OS rates were 64% and 70%, respectively, without differences by HIV status. Survival was better for patients who received rituximab vs not (3-year PFS, 67% vs 38%; OS, 72% vs 44%; P < .001) and without difference based on setting of administration (ie, inpatient vs outpatient). Outcomes were also improved at an academic vs community cancer center (3-year PFS, 67% vs 46%, P = .006; OS, 72% vs 53%, P = .01). In multivariate models, age ≥ 40 years (PFS, hazard ratio [HR] = 1.70, P = .001; OS, HR = 2.09, P < .001), ECOG PS 2 to 4 (PFS, HR = 1.60, P < .001; OS, HR = 1.74, P = .003), lactate dehydrogenase > 3× normal (PFS, HR = 1.83, P < .001; OS, HR = 1.63, P = .009), and CNS involvement (PFS, HR = 1.52, P = .017; OS, HR = 1.67, P = .014) predicted inferior survival. Furthermore, survival varied based on number of factors present (0, 1, 2 to 4 factors) yielding 3-year PFS rates of 91%, 73%, and 50%, respectively; and 3-year OS rates of 95%, 77%, and 56%, respectively. Collectively, outcomes for adult BL in this real-world analysis appeared more modest compared with results of clinical trials and smaller series. In addition, clinical prognostic factors at diagnosis identified patients with divergent survival rates.
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Affiliation(s)
- Andrew M Evens
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alexey Danilov
- Division of Hematology & Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Deepa Jagadeesh
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Amy Sperling
- Division of Medical Oncology, University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Seo-Hyun Kim
- Division of Hematology/Oncology, Rush University Medical Center, Chicago, IL
| | - Ryan Vaca
- Division of Hematology/Oncology, Penn State Cancer Institute, Penn State University College of Medicine, Hershey, PA
| | - Catherine Wei
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Daniel Rector
- Division of Hematology/Oncology, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Suchitra Sundaram
- Division of Hematology/Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Nishitha Reddy
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Yong Lin
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Umar Farooq
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Christopher D'Angelo
- Division of Hematology/Oncology, Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - David A Bond
- Division of Hematology, James Cancer Center, The Ohio State University Hospital, Columbus, OH
| | - Stephanie Berg
- Division of Hematology/Oncology, Loyola University Medical Center, Maywood, IL
| | - Michael C Churnetski
- Division of Hematology/Oncology, Winship Cancer Institute, Emory University Medical Center, Atlanta, GA
| | - Amandeep Godara
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA
| | - Nadia Khan
- Division of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Yun Kyong Choi
- Division of Hematology/Oncology, NYU Cancer Institute, New York University School of Medicine, New York, NY
| | - Maryam Yazdy
- Division of Hematology/Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - Emma Rabinovich
- Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL
| | - Gaurav Varma
- Division of Hematology/Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY
| | - Reem Karmali
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Agrima Mian
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Malvi Savani
- Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN
| | - Madelyn Burkart
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Peter Martin
- Division of Hematology/Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY
| | - Albert Ren
- Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL
| | - Ayushi Chauhan
- Division of Hematology/Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - Catherine Diefenbach
- Division of Hematology/Oncology, NYU Cancer Institute, New York University School of Medicine, New York, NY
| | | | - Andreas K Klein
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA
| | - Kristie A Blum
- Division of Hematology/Oncology, Winship Cancer Institute, Emory University Medical Center, Atlanta, GA
| | - Kirsten Marie Boughan
- Division of Hematology/Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Scott E Smith
- Division of Hematology/Oncology, Loyola University Medical Center, Maywood, IL
| | | | | | - Vaishalee P Kenkre
- Division of Hematology/Oncology, Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Adam Zayac
- Division of Hematology/Oncology, Brown University, Providence, RI
| | - Jeremy Ramdial
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Seth M Maliske
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Narendranath Epperla
- Division of Hematology, James Cancer Center, The Ohio State University Hospital, Columbus, OH
| | | | - Tatyana A Feldman
- Division of Hematology/Oncology, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Stephen D Smith
- Division of Medical Oncology, University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Andrzej Stadnik
- Division of Hematology & Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Kevin A David
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Seema Naik
- Division of Hematology/Oncology, Penn State Cancer Institute, Penn State University College of Medicine, Hershey, PA
| | - Izidore S Lossos
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Matthew A Lunning
- Division of Hematology/Oncology, University of Nebraska, Omaha, Nebraska
| | - Paolo Caimi
- Division of Hematology/Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Manali Kamdar
- Division of Hematology, University of Colorado, Denver, CO
| | - Neil Palmisiano
- Division of Hematology/Oncology, Thomas Jefferson University Hospital, Philadelphia, PA; and
| | - Veronika Bachanova
- Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN
| | - Craig A Portell
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Tycel Phillips
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
| | - Adam J Olszewski
- Division of Hematology/Oncology, Brown University, Providence, RI
| | - Juan Pablo Alderuccio
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
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Rao VB, Belanger E, Egan PC, LeBlanc TW, Olszewski AJ. Early Palliative Care Services and End-of-Life Care in Medicare Beneficiaries with Hematologic Malignancies: A Population-Based Retrospective Cohort Study. J Palliat Med 2021; 24:63-70. [PMID: 32609039 PMCID: PMC8020510 DOI: 10.1089/jpm.2020.0006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2020] [Indexed: 01/07/2023] Open
Abstract
Background: Patients with hematologic malignancies (HM) often receive aggressive care at the end of life (EOL). Early palliative care (PC) has been shown to improve EOL care outcomes, but its benefits are less established in HM than in solid tumors. Objectives: We sought to describe the use of billed PC services among Medicare beneficiaries with HM. We hypothesized that receipt of early PC services (rendered >30 days before death) may be associated with less aggressive EOL care. Design: Retrospective cohort analysis Setting/Subjects: Using the Surveillance, Epidemiology, and End Results-Medicare registry, we studied patients with leukemia, lymphoma, myeloma, myelodysplastic syndrome, or myeloproliferative neoplasm who died between 2001 and 2015. Measurements: We described trends in the use of PC services and evaluated the association between early PC services and metrics of EOL care aggressiveness. Results: Among 139,191 decedents, the proportion receiving PC services increased from 0.4% in 2001 to 13.3% in 2015. Median time from first encounter to death was 10 days and 84.3% of encounters occurred during hospitalizations. In patients who survived >30 days from diagnosis (N = 120,741), the use of early PC services was more frequent in acute leukemia, women, and black patients, among other characteristics. Early PC services were associated with increased hospice use and decreased health care utilization at the EOL. Conclusion: Among patients with HM, there was an upward trend in PC services, and early PC services were associated with less aggressive EOL care. Our results support the need for prospective trials of early PC in HM.
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Affiliation(s)
- Vinay B. Rao
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Emmanuelle Belanger
- Department of Health Services, Policy and Practice, Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Pamela C. Egan
- Division of Hematology/Oncology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Thomas W. LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina, USA
| | - Adam J. Olszewski
- Division of Hematology/Oncology, Brown University, Providence, Rhode Island, USA
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