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Jonas BA, DiNardo C, Fracchiolla N, Pristupa A, Ishizawa K, Jin J, Konopleva M, Ofran Y, Montesinos P, Kovacsovics T, Jang JH, Kantarjian H, Duan Y, Potluri J, Werner M, Pratz KW. Use of CYP3Ai and impact on outcomes in patients with acute myeloid leukemia treated with venetoclax plus azacitidine in the VIALE-A study. Am J Hematol 2022; 97:E422-E425. [PMID: 36053878 DOI: 10.1002/ajh.26707] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/05/2022] [Accepted: 08/23/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Brian A Jonas
- Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Courtney DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicola Fracchiolla
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Kenichi Ishizawa
- Department of Internal Medicine III, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yishai Ofran
- Department of Hematology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politecnic la Fe, Valencia, Spain
| | - Tibor Kovacsovics
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Jun-Ho Jang
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | | | - Keith W Pratz
- Department of Medicine, Hematology-Oncology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Mascarenhas J, Hoffman R, Talpaz M, Gerds AT, Stein B, Gupta V, Szoke A, Drummond M, Pristupa A, Granston T, Daly R, Al-Fayoumi S, Callahan JA, Singer JW, Gotlib J, Jamieson C, Harrison C, Mesa R, Verstovsek S. Pacritinib vs Best Available Therapy, Including Ruxolitinib, in Patients With Myelofibrosis: A Randomized Clinical Trial. JAMA Oncol 2019. [PMID: 29522138 DOI: 10.1001/jamaoncol.2017.5818] [Citation(s) in RCA: 229] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Importance Myelofibrosis is a hematologic malignancy characterized by splenomegaly and debilitating symptoms. Thrombocytopenia is a poor prognostic feature and limits use of Janus kinase 1 (JAK1)/Janus kinase 2 (JAK2) inhibitor ruxolitinib. Objective To compare the efficacy and safety of JAK2 inhibitor pacritinib with that of best available therapy (BAT), including ruxolitinib, in patients with myelofibrosis and thrombocytopenia. Design, Setting, and Participants For this phase 3 randomized international multicenter study-the PERSIST-2 study-of pacritinib vs BAT, 311 patients with myelofibrosis and platelet count 100 × 109/L or less were recruited for analysis. Crossover from BAT was allowed after week 24 or for progression of splenomegaly. Interventions Patients were randomized 1:1:1 to pacritinib 400 mg once daily, pacritinib 200 mg twice daily, or BAT. Main Outcomes and Measures Coprimary end points were rates of patients achieving 35% or more spleen volume reduction (SVR) and 50% or more reduction in total symptom score (TSS) at week 24. Efficacy analyses were performed on the intention-to-treat efficacy population, comprising all patients with a randomization date allowing for week 24 data. Results Overall, 311 patients (mean [SD] age, 63.70 [9.08] years; 171 men [55%] and 140 women [45%]) were included in the study; 149 patients (48%) had prior ruxolitinib. The most common BAT was ruxolitinib (44 patients [45%]); 19 patients (19%) received watchful-waiting only. The intention-to-treat efficacy population included 75 patients randomized to pacritinib once daily; 74, pacritinib twice daily, and 72, BAT. Pacritinib (arms combined) was more effective than BAT for 35% or more SVR (27 patients [18%] vs 2 patients [3%]; P = .001) and had a nonsignificantly greater rate of 50% or more reduction in TSS (37 patients [25%] vs 10 patients [14%]; P = .08). Pacritinib twice daily led to significant improvements in both end points over BAT (≥35% SVR: 16 patients [22%] vs 2 patients [3%]; P = .001; ≥50% reduction in TSS: 24 patients [32%] vs 10 patients [14%]; P = .01). Clinical improvement in hemoglobin and reduction in transfusion burden were greatest with pacritinib twice daily. For pacritinib once daily, pacritinib twice daily, and BAT, the most common (>10%) grade 3 or 4 adverse events were thrombocytopenia (32 patients [31%], 34 patients [32%], 18 patients [18%]), and anemia (28 patients [27%], 23 patients [22%], 14 patients [14%]). In the pacritinib once daily, twice daily, and BAT arms, discontinuation owing to adverse events occurred in 15 patients (14%), 10 patients (9%), and 4 patients (4%). Conclusions and Relevance In patients with myelofibrosis and thrombocytopenia, including those with prior anti-JAK therapy, pacritinib twice daily was more effective than BAT, including ruxolitinib, for reducing splenomegaly and symptoms. Trial Registration clinicaltrials.gov Identifier: NCT02055781.
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Affiliation(s)
- John Mascarenhas
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ronald Hoffman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Moshe Talpaz
- University of Michigan, Comprehensive Cancer Center, Ann Arbor
| | | | - Brady Stein
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Vikas Gupta
- Princess Margaret Cancer Center, University of Toronto, Ontario, Canada
| | - Anita Szoke
- Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Mark Drummond
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | | | | | | | | | | | | | - Jason Gotlib
- Stanford University School of Medicine/Stanford Cancer Institute, Stanford, California
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Fraser G, Cramer P, Demirkan F, Silva RS, Grosicki S, Pristupa A, Janssens A, Mayer J, Bartlett NL, Dilhuydy MS, Pylypenko H, Loscertales J, Avigdor A, Rule S, Villa D, Samoilova O, Panagiotidis P, Goy A, Pavlovsky MA, Karlsson C, Hallek M, Mahler M, Salman M, Sun S, Phelps C, Balasubramanian S, Howes A, Chanan-Khan A. Updated results from the phase 3 HELIOS study of ibrutinib, bendamustine, and rituximab in relapsed chronic lymphocytic leukemia/small lymphocytic lymphoma. Leukemia 2019; 33:969-980. [PMID: 30315239 PMCID: PMC6484712 DOI: 10.1038/s41375-018-0276-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/09/2018] [Accepted: 08/28/2018] [Indexed: 12/21/2022]
Abstract
We report follow-up results from the randomized, placebo-controlled, phase 3 HELIOS trial of ibrutinib+bendamustine and rituximab (BR) for previously treated chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) without deletion 17p. Overall, 578 patients were randomized 1:1 to either ibrutinib (420 mg daily) or placebo, in combination with 6 cycles of BR, followed by ibrutinib or placebo alone. Median follow-up was 34.8 months (range: 0.1-45.8). Investigator-assessed median progression-free survival (PFS) was not reached for ibrutinib+BR, versus 14.3 months for placebo+BR (hazard ratio [HR] [95% CI], 0.206 [0.159-0.265]; P < 0.0001); 36-month PFS rates were 68.0% versus 13.9%, respectively. The results are consistent with the primary analysis findings (HR = 0.203, as assessed by independent review committee, with 17-month median follow-up). Median overall survival was not reached in either arm; HR (95% CI) for ibrutinib+BR versus placebo: 0.652 (0.454-0.935; P = 0.019). Minimal residual disease (MRD)-negative response rates were 26.3% for ibrutinib+BR and 6.2% for placebo+BR (P < 0.0001). Incidence of treatment-emergent adverse events (including grades 3-4) were generally consistent with the initial HELIOS report. These long-term data support improved survival outcomes and deepening responses with ibrutinib+BR compared with BR in relapsed CLL/SLL.
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Affiliation(s)
- G Fraser
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada.
| | - P Cramer
- Department of Internal Medicine, Center of Integrated Oncology and German CLL Study Group, University of Cologne, Cologne, Germany
| | - F Demirkan
- Division of Hematology, Dokuz Eylul University, Izmir, Turkey
| | - R Santucci Silva
- IEP São Lucas/Hemomed Oncologia e Hematologia, São Paulo, Brazil
| | - S Grosicki
- Department of Cancer Prevention, Faculty of Public Health, Silesian Medical University, Katowice, Poland
| | - A Pristupa
- Regional Clinical Hospital, Ryazan, Russia
| | - A Janssens
- Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - J Mayer
- Department of Internal Medicine, Hematology and Oncology, Masaryk University Hospital Brno, Jihlavska, Brno, Czech Republic
| | - N L Bartlett
- Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA
| | | | - H Pylypenko
- Department of Hematology, Cherkassy Regional Oncological Center, Cherkassy, Ukraine
| | - J Loscertales
- Hematology Department, Hospital Universitario La Princesa, IIS-IP, Madrid, Spain
| | - A Avigdor
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, University of Tel-Aviv, Tel-Aviv, Israel
| | - S Rule
- Department of Haematology, Plymouth University Medical School, Plymouth, UK
| | - D Villa
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - O Samoilova
- Nizhny Novogorod Regional Clinical Hospital, Nizhny Novogorod, Russia
| | - P Panagiotidis
- 1st Department of Propedeutic Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Goy
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | - M A Pavlovsky
- Department of Hematology, Fundaleu, Buenos Aires, Argentina
| | - C Karlsson
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - M Hallek
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - M Mahler
- Janssen Research & Development, Raritan, NJ, USA
| | - M Salman
- Janssen Research & Development, Raritan, NJ, USA
| | - S Sun
- Janssen Research & Development, Raritan, NJ, USA
| | - C Phelps
- Janssen Research & Development, Raritan, NJ, USA
| | | | - A Howes
- Janssen Research & Development, High Wycombe, UK
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Cramer P, Demirkan F, Fraser G, Pristupa A, Bartlett N, Dilhuydy M, Loscertales J, Avigdor A, Rule S, Samoilova O, Goy A, Ganguly S, Poggesi I, Lavezzi S, De Nicolao G, de Jong J, Neyens M, Salman M, Howes A, Mahler M. IBRUTINIB INCREASES THE SYSTEMIC EXPOSURE OF RITUXIMAB: PHARMACOKINETIC RESULTS FROM THE HELIOS TRIAL. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- P. Cramer
- Department I of Internal Medicine and German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - F. Demirkan
- Hematology; Dokuz Eylul University; Izmir Turkey
| | - G. Fraser
- Oncology; McMaster University, Juravinski Cancer Centre; Hamilton Canada
| | - A. Pristupa
- Hematology; Ryazan Regional Clinical Hospital; Ryazan Russian Federation
| | - N. Bartlett
- Medicine; Washington University School of Medicine, Siteman Cancer Center; St. Louis USA
| | - M. Dilhuydy
- Hematology and Cell Therapy, Hôpital Haut-Lévèque; Bordeaux France
| | - J. Loscertales
- Hematology; Hospital Universitario de La Princesa, IIS-IP; Madrid Spain
| | - A. Avigdor
- Hematology and Bone-Marrow Transplantation, Chaim Sheba Medical Center; Tel Hashomer Israel
| | - S. Rule
- Haematology; Derriford Hospital; Plymouth UK
| | - O. Samoilova
- Hematology; Nizhny Novgorod Regional Clinical Hospital; Nizhny Novgorod Russian Federation
| | - A. Goy
- Lymphoma; John Theurer Cancer Center at Hackensack University Medical Center; Hackensack USA
| | - S. Ganguly
- Hematologic Malignancies and Cellular Therapeutics; University of Kansas Medical Center; Kansas City USA
| | - I. Poggesi
- Clinical Pharmacology, Janssen R&D; Cologno Monzese Italy
| | - S.M. Lavezzi
- Electrical, Computer, and Biomedical Engineering, University of Pavia; Pavia Italy
| | - G. De Nicolao
- Electrical, Computer, and Biomedical Engineering, University of Pavia; Pavia Italy
| | - J. de Jong
- Clinical Pharmacology, Janssen R&D; San Diego USA
| | - M. Neyens
- Clinical Pharmacology-Pharmacometrics, Janssen R&D; Beerse Belgium
| | - M. Salman
- Clinical Oncology, Janssen R&D; Raritan USA
| | - A. Howes
- Clinical Oncology, Janssen R&D; High Wycombe UK
| | - M. Mahler
- Clinical Oncology, Janssen R&D; Raritan USA
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Chanan-Khan AAA, Cramer P, Demirkan F, Fraser G, Silva RS, Pylypenko H, Grosicki S, Janssens A, Pristupa A, Mayer J, Dilhuydy MS, Loscertales J, Bartlett NL, Avigdor A, Rule S, Sun S, Mahler M, Salman M, Howes AJ, Hallek MJ. Ibrutinib combined with bendamustine and rituximab (BR) in previously treated chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL): First results from a randomized, double-blind, placebo-controlled, phase III study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.18_suppl.lba7005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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
LBA7005 Background: The phase III HELIOS study evaluated the first-in-class, oral covalent BTK inhibitor ibrutinib in combination with BR (BR+ibr) vs BR plus placebo (BR+plb) in patients (pts) with previously treated CLL/SLL. The preplanned interim analysis reported here showed that the primary end point was met, upon which the IDMC recommended unblinding the study. Methods: Pts received BR ( ≤ 6 cycles) and were randomized 1:1 to ibr (420 mg daily) or plb. Purine analog refractoriness was a stratification factor. Pts with del17p ( > 20% of cells) were excluded. Primary end point was independent review committee (IRC)-assessed progression-free survival (PFS). Secondary end points included overall survival (OS) and overall response rate (ORR) per IRC. Results: 578 pts were randomized (289 per arm); median age 64 yrs; 38% Rai Stage III/IV; median 2 prior therapies. 6 cycles of BR were completed in 83% and 78% of pts in the ibr and plb arms, respectively. At a median follow-up of 17.2 months, IRC-assessed PFS was significantly longer with BR+ibr vs BR+plb (median not reached vs 13.3 months; HR: 0.203, 95% CI: 0.150-0.276, P< 0.0001); PFS results were consistent across high-risk subgroups. ORR and CR/CRi rates were 82.7% vs 67.8% (P< 0.0001) and 10.4% vs 2.8%. Median OS was not reached. 90 pts (31%) in the BR+plb arm with confirmed PD crossed over to receive ibr, as permitted per the protocol. Incidence of most AEs was similar between arms. The most common all-grade AEs with BR+ibr and BR+plb were neutropenia (58.2% vs 54.7%) and nausea (36.9% vs 35.2%); most common grade 3/4 AEs were neutropenia (53.7% vs 50.5%) and thrombocytopenia (15.0% each arm). Rates of grade 3/4 atrial fibrillation were 2.8% and 0.7%, and major hemorrhage were 2.1% and 1.7%. Fatigue (FACIT-Fatigue) was improved with BR+ibr vs BR+plb. Conclusions: The addition of ibr to BR reduced the risk of progression or death by 80% compared with BR+plb. ORR was also significantly improved. Safety of BR+ibr was consistent with the known profiles for BR and ibr. The data further support ibr as an important treatment option for pts with previously treated CLL/SLL. Clinical trial information: EudraCT No. 2012-000600-15; UTN No. U1111-1135-3745.
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Affiliation(s)
| | | | - Fatih Demirkan
- Dokuz Eylul University, Department of Hematology, Izmir, Turkey, Izmir, Turkey
| | | | | | - Halyna Pylypenko
- Department of Hematology, Cherkassy Regional Oncological Center, Cherkassy, Ukraine
| | - Sebastian Grosicki
- Department of Cancer Prevention, Faculty of Public Health, Silesian Medical University, Katowice, Poland
| | - Ann Janssens
- Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | | | - Jiri Mayer
- Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | | | | | - Abraham Avigdor
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine,University of Tel-Aviv, Tel-Aviv, Israel
| | - Simon Rule
- Department of Hematology, Derriford Hospital, Plymouth, United Kingdom
| | - Steven Sun
- Janssen Research & Development, Raritan, NJ
| | | | | | - Angela J. Howes
- Janssen Research and Development, High Wycombe, United Kingdom
| | - Michael J. Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
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Baldini S, Rossi C, Spina M, Federico M, Jordan K, Aurer I, Nagy Z, Ribera JM, Pristupa A, Glushko NL, Ristic D, Scartoni S, Scordari A, Matera M, Maggi CA, Capriati A, Simonelli C. European Union (EU) vs. non-EU (NOEU) countries study compliance: the experience of the phase III FLORENCE study testing febuxostat in the Tumor Lysis Syndrome (TLS) prevention. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e20677] [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: 11/20/2022] Open
Affiliation(s)
| | | | | | - Massimo Federico
- Dept of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Igor Aurer
- University Hospital Centre Zagreb and Medical School, University of Zagreb, Zagreb, Croatia
| | - Zsolt Nagy
- 1st Department of Medicine Semmelweis University Medical School, Koranyi 2/A, Budapest, Hungary
| | - Josep M. Ribera
- ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute, UAB, Badalona, Spain
| | | | - Nataliia L. Glushko
- Hematology Department, Ivano-Frankivsk Regional Clinical Hospital, Ivano-Frankivsk, Ukraine
| | - Dusan Ristic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
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7
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Chanan-Khan AAA, Cramer P, Demirkan F, Fraser G, Silva RS, Pylypenko H, Grosicki S, Janssens A, Pristupa A, Mayer J, Dilhuydy MS, Loscertales J, Bartlett NL, Avigdor A, Rule S, Sun S, Mahler M, Salman M, Howes AJ, Hallek MJ. Ibrutinib combined with bendamustine and rituximab (BR) in previously treated chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL): First results from a randomized, double-blind, placebo-controlled, phase III study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.lba7005] [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: 11/20/2022] Open
Affiliation(s)
| | | | - Fatih Demirkan
- Dokuz Eylul University, Department of Hematology, Izmir, Turkey, Izmir, Turkey
| | | | | | - Halyna Pylypenko
- Department of Hematology, Cherkassy Regional Oncological Center, Cherkassy, Ukraine
| | - Sebastian Grosicki
- Department of Cancer Prevention, Faculty of Public Health, Silesian Medical University, Katowice, Poland
| | - Ann Janssens
- Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | | | - Jiri Mayer
- Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | | | | | - Abraham Avigdor
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine,University of Tel-Aviv, Tel-Aviv, Israel
| | - Simon Rule
- Department of Hematology, Derriford Hospital, Plymouth, United Kingdom
| | - Steven Sun
- Janssen Research & Development, Raritan, NJ
| | | | | | - Angela J. Howes
- Janssen Research and Development, High Wycombe, United Kingdom
| | - Michael J. Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
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