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Coombs CC. Frontline Therapy of CLL-Changing Treatment Paradigms. Curr Hematol Malig Rep 2024; 19:65-74. [PMID: 38337108 DOI: 10.1007/s11899-024-00726-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE OF REVIEW The therapeutic landscape for chronic lymphocytic leukemia (CLL) has undergone a complete makeover following the introduction of highly effective targeted therapies, beginning with ibrutinib which first attained regulatory approval for CLL in 2014. RECENT FINDINGS In recent years, we have seen further refinement of therapeutic options with the development of newer-generation Bruton's tyrosine kinase inhibitors (BTKi) including acalabrutinib and zanubrutinib that improve upon the safety of ibrutinib. Additionally, venetoclax-based approaches, combined with anti-CD20 antibodies, have allowed for time-limited targeted therapeutic strategies which are particularly attractive for certain subsets of patients though have demonstrated efficacy across all subgroups. Lastly, there is an ongoing movement toward the development of time-limited strategies inclusive of both a BTKi and venetoclax that may further widen potential options. CLL patients requiring frontline therapy have a unique burden of choice between highly effective therapies that differ substantially with respect to side effect profiles and schedules. This review will focus on the frontline management of CLL in the setting of these rapidly changing options.
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Affiliation(s)
- Catherine C Coombs
- University of California Irvine, 200 S. Manchester Avenue, Suite 400, Room 428, ZOT 4061, Orange, Irvine, CA, 92868, USA.
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Johnson SM, Haberberger J, Galeotti J, Ramkissoon L, Coombs CC, Richardson DR, Foster MC, Duncan D, Montgomery ND, Ferguson NL, Zeidner JF. Comprehensive genomic profiling reveals molecular subsets of ASXL1-mutated myeloid neoplasms. Leuk Lymphoma 2024; 65:209-218. [PMID: 37921062 DOI: 10.1080/10428194.2023.2277672] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
A large-scale genomic analysis of patients with ASXL1-mutated myeloid disease has not been performed to date. We reviewed comprehensive genomic profiling results from 6043 adults to characterize clinicopathologic features and co-mutation patterns by ASXL1 mutation status. ASXL1 mutations occurred in 1414 patients (23%). Mutation co-occurrence testing revealed strong co-occurrence (p < 0.01) between mutations in ASXL1 and nine genes (SRSF2, U2AF1, RUNX1, SETBP1, EZH2, STAG2, CUX1, CSF3R, CBL). Further analysis of patients with these co-mutations yielded several novel findings. Co-mutation patterns supported that ASXL1/SF3B1 co-mutation may be biologically distinct from ASXL1/non-SF3B1 spliceosome co-mutation. In AML, ASXL1/SRSF2 co-mutated patients frequently harbored STAG2 mutations (42%), which were dependent on the presence of both ASXL1 and SRSF2 mutation (p < 0.05). STAG2 and SETBP1 mutations were also exclusive in ASXL1/SRSF2 co-mutated patients and associated with divergent chronic myeloid phenotypes. Our findings support that certain multi-mutant genotypes may be biologically relevant in ASXL1-mutated myeloid disease.
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Affiliation(s)
- Steven M Johnson
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | | | - Jonathan Galeotti
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Lori Ramkissoon
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Catherine C Coombs
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- UC Irvine, Irvine, CA, USA
| | - Daniel R Richardson
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Matthew C Foster
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Novartis Pharmaceuticals, Cambridge, MA, USA
| | - Daniel Duncan
- Foundation Medicine, Inc, Cambridge, MA, USA
- GRAIL, Inc, Durham, NC, USA
| | - Nathan D Montgomery
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- NeoGenomics Laboratories, Aliso Viejo, CA, USA
| | | | - Joshua F Zeidner
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Easaw S, Ezzati S, Coombs CC. SOHO State of the Art Updates and Next Questions: Updates on BTK Inhibitors for the Treatment of Chronic Lymphocytic Leukemia. Clin Lymphoma Myeloma Leuk 2023; 23:697-704. [PMID: 37544810 DOI: 10.1016/j.clml.2023.07.011] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
Over the last decade, targeted inhibition of Bruton's tyrosine kinase (BTK) has led to a paradigm shift in the way chronic lymphocytic leukemia (CLL) is managed. BTK inhibitors (BTKi) are broadly classified as covalent BTKI and noncovalent BTKi (cBTKi and ncBTK) Ibrutinib, as the first approved cBTKi, vastly improved outcomes for patients with CLL over prior chemoimmunotherapy regimens. However, long-term use is limited by both intolerance and resistance. The second generation of more selective BTKi were developed to improve tolerability. While these agents have led to an improved safety profile in comparison to Ibrutinib (both acalabrutinib and zanubrutinib), and improved efficacy (zanubrutinib), intolerance occasionally occurs, and resistance remains a challenge. The third generation of BTKi, which noncovalently or reversibly inhibits BTK, has shown promising results in early phase trials and are being evaluated in the phase 3 setting. These drugs could be an effective treatment option in patients with either resistance and intolerance to cBTKi. The most recent development in therapeutic agents targeting BTK is the development of BTK degraders. By removing BTK, as opposed to inhibiting it, these drugs could remain efficacious irrespective of BTK resistance mutations, however clinical data are limited at this time. This review summarizes the evolution and ongoing development of newer BTKi and BTK degraders in the management of CLL, with a focus of future directions in this field, including how emerging clinical data could inform therapeutic sequencing in CLL management.
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Affiliation(s)
| | - Shawyon Ezzati
- California Northstate University College of Medicine, Elk Grove, CA
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Mato AR, Woyach JA, Brown JR, Ghia P, Patel K, Eyre TA, Munir T, Lech-Maranda E, Lamanna N, Tam CS, Shah NN, Coombs CC, Ujjani CS, Fakhri B, Cheah CY, Patel MR, Alencar AJ, Cohen JB, Gerson JN, Flinn IW, Ma S, Jagadeesh D, Rhodes JM, Hernandez-Ilizaliturri F, Zinzani PL, Seymour JF, Balbas M, Nair B, Abada P, Wang C, Ruppert AS, Wang D, Tsai DE, Wierda WG, Jurczak W. Pirtobrutinib after a Covalent BTK Inhibitor in Chronic Lymphocytic Leukemia. N Engl J Med 2023; 389:33-44. [PMID: 37407001 DOI: 10.1056/nejmoa2300696] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) have poor outcomes after the failure of covalent Bruton's tyrosine kinase (BTK) inhibitor treatment, and new therapeutic options are needed. Pirtobrutinib, a highly selective, noncovalent (reversible) BTK inhibitor, was designed to reestablish BTK inhibition. METHODS We conducted a phase 1-2 trial in which patients with relapsed or refractory B-cell cancers received pirtobrutinib. Here, we report efficacy results among patients with CLL or SLL who had previously received a BTK inhibitor as well as safety results among all the patients with CLL or SLL. The primary end point was an overall response (partial response or better) as assessed by independent review. Secondary end points included progression-free survival and safety. RESULTS A total of 317 patients with CLL or SLL received pirtobrutinib, including 247 who had previously received a BTK inhibitor. Among these 247 patients, the median number of previous lines of therapy was 3 (range, 1 to 11), and 100 patients (40.5%) had also received a B-cell lymphoma 2 (BCL2) inhibitor such as venetoclax. The percentage of patients with an overall response to pirtobrutinib was 73.3% (95% confidence interval [CI], 67.3 to 78.7), and the percentage was 82.2% (95% CI, 76.8 to 86.7) when partial response with lymphocytosis was included. The median progression-free survival was 19.6 months (95% CI, 16.9 to 22.1). Among all 317 patients with CLL or SLL who received pirtobrutinib, the most common adverse events were infections (in 71.0%), bleeding (in 42.6%), and neutropenia (in 32.5%). At a median duration of treatment of 16.5 months (range, 0.2 to 39.9), some adverse events that are typically associated with BTK inhibitors occurred relatively infrequently, including hypertension (in 14.2% of patients), atrial fibrillation or flutter (in 3.8%), and major hemorrhage (in 2.2%). Only 9 of 317 patients (2.8%) discontinued pirtobrutinib owing to a treatment-related adverse event. CONCLUSIONS In this trial, pirtobrutinib showed efficacy in patients with heavily pretreated CLL or SLL who had received a covalent BTK inhibitor. The most common adverse events were infections, bleeding, and neutropenia. (Funded by Loxo Oncology; BRUIN ClinicalTrials.gov number, NCT03740529.).
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Affiliation(s)
- Anthony R Mato
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Jennifer A Woyach
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Jennifer R Brown
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Paolo Ghia
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Krish Patel
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Toby A Eyre
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Talha Munir
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Ewa Lech-Maranda
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Nicole Lamanna
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Constantine S Tam
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Nirav N Shah
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Catherine C Coombs
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Chaitra S Ujjani
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Bita Fakhri
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Chan Y Cheah
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Manish R Patel
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Alvaro J Alencar
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Jonathon B Cohen
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - James N Gerson
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Ian W Flinn
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Shuo Ma
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Deepa Jagadeesh
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Joanna M Rhodes
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Francisco Hernandez-Ilizaliturri
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Pier L Zinzani
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - John F Seymour
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Minna Balbas
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Binoj Nair
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Paolo Abada
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Chunxiao Wang
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Amy S Ruppert
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Denise Wang
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Donald E Tsai
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - William G Wierda
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Wojciech Jurczak
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
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Johnson SM, Haberberger J, Galeotti J, Ramkissoon L, Coombs CC, Richardson DR, Foster MC, Duncan D, Zeidner JF, Ferguson NL, Montgomery ND. A reappraisal of ASXL1 mutation sites and the cohesin-binding motif in myeloid disease. Blood Cancer J 2023; 13:96. [PMID: 37365170 DOI: 10.1038/s41408-023-00876-w] [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] [Received: 03/29/2023] [Revised: 05/31/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Affiliation(s)
- Steven M Johnson
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | | | - Jonathan Galeotti
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Lori Ramkissoon
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Catherine C Coombs
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- UC Irvine, 1001 Health Sciences Road, Irvine, CA, 92697, USA
| | - Daniel R Richardson
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Matthew C Foster
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Novartis Pharmaceuticals, Cambridge, MA, 02139, USA
| | - Daniel Duncan
- Foundation Medicine, Inc, Cambridge, MA, USA
- GRAIL, Inc., 4001 E NC 54 Hwy Assembly Suite 1100, Durham, NC, 27709, USA
| | - Joshua F Zeidner
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | | | - Nathan D Montgomery
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Tempus Labs, Inc., 25 Alexandria Way, Durham, NC, 27703, USA
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Shadman M, Manzoor BS, Sail K, Tuncer HH, Allan JN, Ujjani C, Emechebe N, Kamalakar R, Coombs CC, Leslie L, Barr PM, Brown JR, Eyre TA, Rampotas A, Schuh A, Lamanna N, Skarbnik A, Roeker LE, Bannerji R, Eichhorst B, Fleury I, Davids MS, Alhasani H, Jiang D, Hill BT, Schuster SJ, Brander DM, Pivneva I, Burne R, Guerin A, Mato AR. Treatment Discontinuation Patterns for Patients With Chronic Lymphocytic Leukemia in Real-World Settings: Results From a Multi-Center International Study. Clin Lymphoma Myeloma Leuk 2023:S2152-2650(23)00107-6. [PMID: 37076367 DOI: 10.1016/j.clml.2023.03.010] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION This study assessed treatment discontinuation patterns and reasons among chronic lymphocytic leukemia (CLL) patients initiating first-line (1L) and second-line (2L) treatments in real-world settings. MATERIALS AND METHODS Using deidentified electronic medical records from the CLL Collaborative Study of Real-World Evidence, premature treatment discontinuation was assessed among FCR, BR, BTKi-based, and BCL-2-based regimen cohorts. RESULTS Of 1364 1L patients (initiated in 1997-2021), 190/13.9% received FCR (23.7% discontinued prematurely); 255/18.7% received BR (34.5% discontinued prematurely); 473/34.7% received BTKi-based regimens, of whom 28.1% discontinued prematurely; and 43/3.2% received venetoclax-based regimens, of whom 16.3% discontinued prematurely (venetoclax monotherapy: 7/0.5%, of whom 42.9% discontinued; VG/VR: 36/2.6%, of whom 11.1% discontinued). The most common reasons for treatment discontinuation were adverse events (FCR: 25/13.2%; BR: 36/14.1%; BTKi-based regimens: 75/15.9%) and disease progression (venetoclax-based: 3/7.0%). Of 626 2L patients, 20/3.2% received FCR (50.0% discontinued); 62/9.9% received BR (35.5% discontinued); 303/48.4% received BTKi-based regimens, of whom 38.0% discontinued; and 73/11.7% received venetoclax-based regimens, of whom 30.1% discontinued (venetoclax monotherapy: 27/4.3%, of whom 29.6% discontinued; VG/VR: 43/6.9%, of whom 27.9% discontinued). The most common reasons for treatment discontinuation were adverse events (FCR: 6/30.0%; BR: 11/17.7%; BTKi-based regimens: 60/19.8%; venetoclax-based: 6/8.2%). CONCLUSION The findings of this study highlight the continued need for tolerable therapies in CLL, with finite therapy offering a better tolerated option for patients who are newly diagnosed or relapsed/refractory to prior treatments.
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Affiliation(s)
- Mazyar Shadman
- Fred Hutch Cancer Center and University of Washington, Seattle, WA
| | | | | | - Hande H Tuncer
- The Cancer Center at Lowell General Hospital, Lowell, MA
| | | | - Chaitra Ujjani
- Fred Hutch Cancer Center and University of Washington, Seattle, WA
| | | | | | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lori Leslie
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ
| | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | - Toby A Eyre
- Churchill Hospital, Oxford University, Oxford, UK
| | | | - Anna Schuh
- Churchill Hospital, Oxford University, Oxford, UK
| | - Nicole Lamanna
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | | | - Lindsey E Roeker
- CLL Program, Leukemia Service, Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rajat Bannerji
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Barbara Eichhorst
- Department of Internal Medicine, Center of Integrated Oncology Köln Bonn, University of Cologne, Cologne, Germany
| | | | | | | | | | | | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | - Anthony R Mato
- CLL Program, Leukemia Service, Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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Jensen JL, Easaw S, Anderson T, Varma Y, Zhang J, Jensen BC, Coombs CC. Clonal Hematopoiesis and the Heart: a Toxic Relationship. Curr Oncol Rep 2023; 25:455-463. [PMID: 36920637 PMCID: PMC10015145 DOI: 10.1007/s11912-023-01398-1] [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] [Accepted: 01/31/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE OF REVIEW Clonal hematopoiesis (CH) refers to the expansion of hematopoietic stem cell clones and their cellular progeny due to somatic mutations, mosaic chromosomal alterations (mCAs), or copy number variants which naturally accumulate with age. CH has been linked to increased risk of blood cancers, but CH has also been linked to adverse cardiovascular outcomes. RECENT FINDINGS A combination of clinical outcome studies and mouse models have offered strong evidence that CH mutations either correlate with or cause atherosclerosis, diabetes mellitus, chronic kidney disease, heart failure, pulmonary hypertension, aortic aneurysm, myocardial infarction, stroke, aortic stenosis, poor outcomes following transcatheter aortic valve replacement (TAVR) or orthotopic heart transplant, death or need of renal replacement therapy secondary to cardiogenic shock, death from cardiovascular causes at large, and enhance anthracycline cardiac toxicity. Mechanistically, some adverse outcomes are caused by macrophage secretion of IL-1β and IL-6, neutrophil invasion of injured myocardium, and T-cell skewing towards inflammatory phenotypes. CH mutations lead to harmful inflammation and arterial wall invasion by bone marrow-derived cells resulting in poor cardiovascular health and outcomes. Blockade of IL-1β or JAK2 signaling are potential avenues for preventing CH-caused cardiovascular morbidity and mortality.
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Affiliation(s)
- Jeffrey L Jensen
- Department of Medicine, Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Saumya Easaw
- Carolinas Hospitalist Group, Atrium Health, Charlotte, NC, USA
| | - Travis Anderson
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yash Varma
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jiandong Zhang
- Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian C Jensen
- Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Catherine C Coombs
- Department of Medicine, Division of Hematology and Oncology, University of California, 101 The City Dr S, Irvine, Orange, CA, 92868-3201, USA.
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8
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Coombs CC. Noncovalent BTK inhibitors in B-cell lymphoma. Clin Adv Hematol Oncol 2023; 21:100-103. [PMID: 36780476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- Catherine C Coombs
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, Orange, California
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9
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Coombs CC. EXABS-124-CLL Extended Abstract: New BTKi. Clin Lymphoma Myeloma Leuk 2022; 22 Suppl 2:S27-S29. [PMID: 36163875 DOI: 10.1016/s2152-2650(22)00650-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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10
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Collins J, Stump SE, Heiling H, Muir M, Deal A, Proco D, Nguyen C, Cozad M, Mato A, Coombs CC, Muluneh B. Impact of adherence to ibrutinib on clinical outcomes in real-world patients with chronic lymphocytic leukemia. Leuk Lymphoma 2022; 63:1823-1830. [DOI: 10.1080/10428194.2022.2045597] [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: 10/18/2022]
Affiliation(s)
- James Collins
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah E. Stump
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Michele Muir
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Allison Deal
- UNC Lineberger Cancer Center, Chapel Hill, NC, USA
| | - Darrian Proco
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Catharine Nguyen
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Monica Cozad
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Anthony Mato
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Benyam Muluneh
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
- UNC Lineberger Cancer Center, Chapel Hill, NC, USA
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11
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Cozad M, Stump SE, Buhlinger K, Collins J, Muir M, Coombs CC, Muluneh B. Evaluation of an interdisciplinary venetoclax initiation process in minimizing risk of tumor lysis syndrome. Leuk Lymphoma 2022; 63:1831-1838. [DOI: 10.1080/10428194.2022.2047963] [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: 10/18/2022]
Affiliation(s)
- Monica Cozad
- University of North Carolina Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah E. Stump
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kaitlyn Buhlinger
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - James Collins
- University of North Carolina Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Michele Muir
- University of North Carolina Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Catherine C. Coombs
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benyam Muluneh
- University of North Carolina Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
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12
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Jensen JL, Mato AR, Pena C, Roeker LE, Coombs CC. The potential of pirtobrutinib in multiple B-cell malignancies. Ther Adv Hematol 2022; 13:20406207221101697. [PMID: 35747462 PMCID: PMC9210100 DOI: 10.1177/20406207221101697] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 01/06/2022] [Accepted: 04/29/2022] [Indexed: 12/30/2022] Open
Abstract
Bruton’s tyrosine kinase (BTK) is a critical downstream signaling element from the B-cell receptor (BCR) that has been effectively inhibited in B-cell cancers by irreversible, covalent inhibitors including ibrutinib and acalabrutinib. All FDA-approved covalent BTK inhibitors rely on binding to the cysteine 481 (C481) amino acid within the active site of BTK, thus rendering it inert. While covalent BTK inhibitors have been very successful in multiple B-cell malignancies, improving both overall survival and progression-free survival relative to chemoimmunotherapy in phase 3 trials, they can be limited by intolerance and disease progression. Pirtobrutinib is a novel, highly selective, and non-covalent BTK inhibitor that binds independently of C481, and in a recent, first-in-human phase 1/2 clinical trial was shown to be extremely well tolerated and lead to remissions in relapsed/refractory patients with multiple B-cell malignancies. Here, we review the pharmacologic rationale for pursuing non-covalent BTK inhibitors, the clinical need for such inhibitors, existing safety, and resistance mechanism data for pirtobrutinib, and the forthcoming clinical trials that seek to define the clinical utility of pirtobrutinib, which has the potential to fulfill multiple areas of unmet clinical need for patients with B-cell malignancies.
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Affiliation(s)
- Jeffrey L Jensen
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony R Mato
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Camila Pena
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Catherine C Coombs
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill, 170 Manning Drive, Chapel Hill, NC 27599, USA
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Roeker LE, Mato AR, Brown JR, Coombs CC, Shah NN, Wierda WG, Patel MR, Lewis KL, Balbas M, Zhao J, Ku NC, Kherani JF, Tsai DE, Nair B, Cheah CY. Abstract CT138: Pirtobrutinib, a highly selective, non-covalent (reversible) BTK inhibitor in combination with venetoclax ± rituximab in relapsed/refractory chronic lymphocytic leukemia: Results from the BRUIN phase 1b study. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct138] [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: 11/16/2022]
Abstract
Abstract
Background: Covalent Bruton tyrosine kinase inhibitors (BTKi) have transformed the management of chronic lymphocytic leukemia (CLL), but patients (pts) discontinue these agents due to resistance or intolerance. Pirtobrutinib is an oral, highly selective, non-covalent (reversible) BTKi with promising efficacy and safety in heavily pretreated relapsed/refractory (R/R) CLL pts, regardless of BTK C481 mutation status. Recent clinical studies reported on the safety and efficacy of time-limited venetoclax and covalent BTKi combination regimens. We evaluated the safety and efficacy of pirtobrutinib combined with venetoclax ± rituximab in pts with R/R CLL.
Methods: BRUIN is a phase 1/2 global, multicenter study (NCT03740529) of pirtobrutinib in pts with advanced B-cell malignancies. The phase 1b portion evaluated the safety of pirtobrutinib at a continuous dose of 200 mg QD from Cycle 1, Day 1 plus venetoclax starting on Cycle 2, Day 1 with a standard 5-week dose ramp to 400 mg QD (PV) and PV plus rituximab at 375 mg/m2 on Cycle 1, Day 1, then 500 mg/m2 on Day 1 of Cycles 2-6 (PVR). Prior BTKi was allowed; prior venetoclax was not permitted. Objectives included safety and overall response rate (ORR) of each combination.
Results: As of 27 SEP 2021, 15 pts received PV and 10 pts received PVR. Median age was 66 years (range, 39-78). Median prior lines of therapy was 2 (range, 1-4). The majority of pts in both cohorts had received prior chemotherapy (56%, n=14), CD20 monoclonal antibody (72%, n=18), and/or covalent BTKi (68%, n=17). No dose-limiting toxicities were reported. Safety profiles were generally similar across both cohorts. The most common treatment-emergent adverse events (TEAE) of any grade, regardless of attribution, were neutrophil count decrease (36%), nausea (32%), fatigue (32%), diarrhea (28%), and constipation (24%). The only Grade ≥3 TEAE to occur in more than 2 pts was neutrophil count decrease (36%, n=9). One pt experienced Grade 4 clinical tumor lysis syndrome with resultant acute kidney injury during venetoclax dose escalation, which resolved with supportive measures. No pts discontinued treatment due to AEs. For the 22 pts with efficacy data available as of 03 NOV 2021, median duration of follow-up was 9 months (range, 3.9-15) and the ORR was 95.5% (95% CI, 77-100). All responding pts except 1 remain on therapy (PVR responder discontinued due to death unrelated to study treatment). As all responses were ongoing and early, and MRD analysis was not yet performed.
Conclusions: Pirtobrutinib combined with venetoclax ± rituximab was well tolerated and had a safety profile consistent with known drug class findings and no clear additive toxicities in pts with R/R CLL. Early results demonstrate promising efficacy with combination therapy.
Citation Format: Lindsey E. Roeker, Anthony R. Mato, Jennifer R. Brown, Catherine C. Coombs, Nirav N. Shah, William G. Wierda, Manish R. Patel, Katharine L. Lewis, Minna Balbas, Junjie Zhao, Nora C. Ku, Jennifer F. Kherani, Donald E. Tsai, Binoj Nair, Chan Y. Cheah. Pirtobrutinib, a highly selective, non-covalent (reversible) BTK inhibitor in combination with venetoclax ± rituximab in relapsed/refractory chronic lymphocytic leukemia: Results from the BRUIN phase 1b study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT138.
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Affiliation(s)
| | | | - Jennifer R. Brown
- 2Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | | | | | | | - Manish R. Patel
- 6Florida Cancer Specialists/Sarah Cannon Research Institute, Sarasota, FL
| | - Katharine L. Lewis
- 7Linear Clinical Research and Sir Charles Gairdner Hospital, Perth, Australia
| | | | | | | | | | | | | | - Chan Y. Cheah
- 7Linear Clinical Research and Sir Charles Gairdner Hospital, Perth, Australia
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14
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Wang E, Mi X, Thompson MC, Montoya S, Notti RQ, Afaghani J, Durham BH, Penson A, Witkowski MT, Lu SX, Bourcier J, Hogg SJ, Erickson C, Cui D, Cho H, Singer M, Totiger TM, Chaudhry S, Geyer M, Alencar A, Linley AJ, Palomba ML, Coombs CC, Park JH, Zelenetz A, Roeker L, Rosendahl M, Tsai DE, Ebata K, Brandhuber B, Hyman DM, Aifantis I, Mato A, Taylor J, Abdel-Wahab O. Mechanisms of Resistance to Noncovalent Bruton's Tyrosine Kinase Inhibitors. N Engl J Med 2022; 386:735-743. [PMID: 35196427 PMCID: PMC9074143 DOI: 10.1056/nejmoa2114110] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Covalent (irreversible) Bruton's tyrosine kinase (BTK) inhibitors have transformed the treatment of multiple B-cell cancers, especially chronic lymphocytic leukemia (CLL). However, resistance can arise through multiple mechanisms, including acquired mutations in BTK at residue C481, the binding site of covalent BTK inhibitors. Noncovalent (reversible) BTK inhibitors overcome this mechanism and other sources of resistance, but the mechanisms of resistance to these therapies are currently not well understood. METHODS We performed genomic analyses of pretreatment specimens as well as specimens obtained at the time of disease progression from patients with CLL who had been treated with the noncovalent BTK inhibitor pirtobrutinib. Structural modeling, BTK-binding assays, and cell-based assays were conducted to study mutations that confer resistance to noncovalent BTK inhibitors. RESULTS Among 55 treated patients, we identified 9 patients with relapsed or refractory CLL and acquired mechanisms of genetic resistance to pirtobrutinib. We found mutations (V416L, A428D, M437R, T474I, and L528W) that were clustered in the kinase domain of BTK and that conferred resistance to both noncovalent BTK inhibitors and certain covalent BTK inhibitors. Mutations in BTK or phospholipase C gamma 2 (PLCγ2), a signaling molecule and downstream substrate of BTK, were found in all 9 patients. Transcriptional activation reflecting B-cell-receptor signaling persisted despite continued therapy with noncovalent BTK inhibitors. CONCLUSIONS Resistance to noncovalent BTK inhibitors arose through on-target BTK mutations and downstream PLCγ2 mutations that allowed escape from BTK inhibition. A proportion of these mutations also conferred resistance across clinically approved covalent BTK inhibitors. These data suggested new mechanisms of genomic escape from established covalent and novel noncovalent BTK inhibitors. (Funded by the American Society of Hematology and others.).
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Affiliation(s)
- Eric Wang
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Xiaoli Mi
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Meghan C Thompson
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Skye Montoya
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Ryan Q Notti
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Jumana Afaghani
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Benjamin H Durham
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Alex Penson
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Matthew T Witkowski
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Sydney X Lu
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Jessie Bourcier
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Simon J Hogg
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Caroline Erickson
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Dan Cui
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Hana Cho
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Michael Singer
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Tulasigeri M Totiger
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Sana Chaudhry
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Mark Geyer
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Alvaro Alencar
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Adam J Linley
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - M Lia Palomba
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Catherine C Coombs
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Jae H Park
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Andrew Zelenetz
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Lindsey Roeker
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Mary Rosendahl
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Donald E Tsai
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Kevin Ebata
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Barbara Brandhuber
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - David M Hyman
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Iannis Aifantis
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Anthony Mato
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Justin Taylor
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
| | - Omar Abdel-Wahab
- From the Human Oncology and Pathogenesis Program (E.W., X.M., B.H.D., A.P., S.X.L., J.B., S.J.H., C.E., D.C., H.C., M.S., O.A.-W.), the Leukemia Service (M.C.T., M.G., J.H.P., L.R., A.M., O.A.-W.), and the Lymphoma Service (M.L.P., A.Z.), Department of Medicine, and the Department of Pathology (B.H.D.), Memorial Sloan Kettering Cancer Center, the Laboratory of Molecular Electron Microscopy, Rockefeller University (R.Q.N.), and the Department of Pathology and Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine (M.T.W., I.A.) - all in New York; Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami (S.M., J.A., T.M.T., S.C., A.A., J.T.); the Department of Molecular Physiology and Cell Signaling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom (A.J.L.); University of North Carolina Medical Center, Chapel Hill (C.C.C.); and Loxo Oncology at Lilly, Boulder, CO (M.R., D.E.T., K.E., B.B., D.M.H.)
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15
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Mato AR, Davids MS, Sharman J, Roeker LE, Kay N, Kater A, Rogers K, Thompson MC, Rhodes J, Goy A, Skarbnik A, Schuster SJ, Tam CS, Eyre TA, O’Brien S, Nabhan C, Lamanna N, Sun C, Shadman M, Pagel JM, Ujjani C, Brander D, Coombs CC, Jain N, Cheah CY, Brown JR, Seymour JF, Woyach JA. Recognizing Unmet Need in the Era of Targeted Therapy for CLL/SLL: "What's Past Is Prologue" (Shakespeare). Clin Cancer Res 2022; 28:603-608. [PMID: 34789482 PMCID: PMC9253788 DOI: 10.1158/1078-0432.ccr-21-1237] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/18/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022]
Abstract
The management of chronic lymphocytic leukemia (CLL) has undergone unprecedented changes over the last decade. Modern targeted therapies are incorporated into clinical practice. Unfortunately, patients have begun to develop resistance or intolerance to multiple classes. Symptomatic patients previously treated with a BTK inhibitor (BTKi) and venetoclax represent a new and rapidly growing unmet need in CLL. Here, we define unmet needs in a modern treatment context. We also critically review the literature for PI3K inhibitors and chemoimmunotherapy and lack of data to support their utility following BTKis and venetoclax. Finally, we suggest opportunities to ensure the continued innovation for patients with CLL.
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Affiliation(s)
- Anthony R Mato
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew S Davids
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Jeff Sharman
- Willamette Valley Cancer Institute/US Oncology, Eugene, OR, USA
| | | | - Neil Kay
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Arnon Kater
- Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam, the Netherlands
| | - Kerry Rogers
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Joanna Rhodes
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Andre Goy
- MD Anderson Cancer Center, Houston, TX, USA
| | - Alan Skarbnik
- Lymphoproliferative Disorders Program, Novant Health, Charlotte, NC, USA
| | - Stephen J Schuster
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Constantine S Tam
- Peter MacCallum Cancer Center, Royal Melbourne Hospital, and University of Melbourne, Melbourne, Australia
| | - Toby A Eyre
- Churchill Cancer Center, Oxford University Hospitals NHS Foundation Trust, Old Road, UK
| | - Susan O’Brien
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | - Chadi Nabhan
- Department of Clinical Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Nicole Lamanna
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Clare Sun
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA
| | - Chaitra Ujjani
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Danielle Brander
- Division of Hematology and Oncology, Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Nitin Jain
- MD Anderson Cancer Center, Houston, TX, USA
| | - Chan Y Cheah
- Linear Clinical Research and Sir Charles Gairdner Hospital and University of Western Australia, Perth, Australia
| | - Jennifer R Brown
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - John F Seymour
- Peter MacCallum Cancer Center, Royal Melbourne Hospital, and University of Melbourne, Melbourne, Australia
| | - Jennifer A Woyach
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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16
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Miyahira AK, Zarif JC, Coombs CC, Flavell RR, Russo JW, Zaidi S, Zhao D, Zhao SG, Pienta KJ, Soule HR. Prostate cancer research in the 21st century; report from the 2021 Coffey-Holden prostate cancer academy meeting. Prostate 2022; 82:169-181. [PMID: 34734426 PMCID: PMC8688282 DOI: 10.1002/pros.24262] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The 2021 Coffey-Holden Prostate Cancer Academy (CHPCA) Meeting, "Prostate Cancer Research in the 21st Century," was held virtually, from June 24-25, 2021. METHODS The CHPCA Meeting is organized by the Prostate Cancer Foundation as a unique discussion-oriented meeting focusing on critical topics in prostate cancer research envisioned to bridge the next major advances in prostate cancer biology and treatment. The 2021 CHPCA Meeting was virtually attended by 89 investigators and included 31 talks over nine sessions. RESULTS Major topic areas discussed at the meeting included: cancer genomics and sequencing, functional genomic approaches to studying mediators of plasticity, emerging signaling pathways in metastatic castration resistant prostate cancer, Wnt signaling biology and the challenges of targeted therapy, clonal hematopoiesis, neuroendocrine cell plasticity and antitumor immunity, cancer immunotherapy and its synergizers, and imaging the tumor microenvironment and metabolism. DISCUSSION This meeting report summarizes the research presented at the 2021 CHPCA Meeting. We hope that publication of this knowledge will accelerate new understandings and the development of new biomarkers and treatments for prostate cancer.
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Affiliation(s)
| | - Jelani C. Zarif
- Department of Oncology, Johns Hopkins University School of Medicine and The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
- Bloomberg Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Catherine C. Coombs
- Department of Medicine, Division of Hematology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robert R. Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, CA
| | - Joshua W. Russo
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Samir Zaidi
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Di Zhao
- Department of Experimental Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Shuang G. Zhao
- Department of Human Oncology, Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Kenneth J. Pienta
- The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD
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17
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Tschernia NP, Kumar V, Moore DT, Vincent BG, Coombs CC, Van Deventer H, Foster MC, DeZern AE, Luznik L, Riches ML, Serody JS, Gojo I, Zeidner JF. Safety and Efficacy of Pembrolizumab Prior to Allogeneic Stem Cell Transplantation for Acute Myelogenous Leukemia. Transplant Cell Ther 2021; 27:1021.e1-1021.e5. [PMID: 34474164 DOI: 10.1016/j.jtct.2021.08.022] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/01/2021] [Accepted: 08/24/2021] [Indexed: 12/12/2022]
Abstract
Programmed death 1 (PD-1) is an integral component of acute myelogenous leukemia (AML) immune evasion, chemotherapy resistance, and disease progression. PD-1 inhibitors are being investigated as treatment for AML in combination with hypomethylating agents and cytotoxic chemotherapy with encouraging findings. Although allogeneic stem cell transplantation (alloSCT) remains the most established curative treatment for patients with relapsed and refractory AML in complete remission, there are limited data on the clinical outcomes and safety of immune checkpoint inhibitors (ICIs) prior to alloSCT in AML. In the present study, we compared clinical outcomes of 9 patients with AML receiving high-dose cytarabine followed by pembrolizumab in a phase II clinical trial (NCT02768792) prior to alloSCT versus a historical control group of 18 AML patients who underwent alloSCT without prior ICI exposure. The nonparametric Jonckheere-Terpstra test was used to test for a difference in the ordered severity categories of acute graft-versus-host disease (GVHD) within 100 days of transplantation. Time-to-event estimates for overall survival and relapse-free survival were calculated using the Kaplan-Meier method and compared using a log-rank test. One-year survival was not significantly different between the treatment groups (67% versus 78%; P = .34). 100-day mortality was 0% in the ICI group versus 17% in the control group, and there was no increase in grade III-IV acute GVHD in patients treated with pembrolizumab prior to alloSCT. No chronic GVHD was seen in patients treated with pembrolizumab prior to alloSCT and who received post-transplantation cyclophosphamide (PTCy) as part of their conditioning regimen. These findings reinforce the safety and feasibility of ICI therapy prior to alloSCT in patients with AML, and suggest that PTCy may abrogate GVHD risk and severity in patients who receive ICI prior to undergoing alloSCT for AML.
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Affiliation(s)
- Nicholas P Tschernia
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Vaibhav Kumar
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Dominic T Moore
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Benjamin G Vincent
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Hendrik Van Deventer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Matthew C Foster
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Amy E DeZern
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Leo Luznik
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Marcie L Riches
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Jonathan S Serody
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Ivana Gojo
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Joshua F Zeidner
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
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18
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Zeidner JF, Vincent BG, Ivanova A, Moore D, McKinnon KP, Wilkinson AD, Mukhopadhyay R, Mazziotta F, Knaus HA, Foster MC, Coombs CC, Jamieson K, Van Deventer H, Webster JA, Prince GT, DeZern AE, Smith BD, Levis MJ, Montgomery ND, Luznik L, Serody JS, Gojo I. Phase II Trial of Pembrolizumab after High-Dose Cytarabine in Relapsed/Refractory Acute Myeloid Leukemia. Blood Cancer Discov 2021; 2:616-629. [PMID: 34778801 DOI: 10.1158/2643-3230.bcd-21-0070] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/12/2021] [Accepted: 08/25/2021] [Indexed: 12/17/2022] Open
Abstract
Immune suppression, exhaustion, and senescence are frequently seen throughout disease progression in acute myeloid leukemia (AML). We conducted a phase II study of high-dose cytarabine followed by pembrolizumab 200 mg i.v. on day 14 to examine whether PD-1 inhibition improves clinical responses in relapsed/refractory (R/R) AML. Overall responders could receive pembrolizumab maintenance up to 2 years. Among 37 patients enrolled, the overall response rate, composite complete remission (CRc) rate (primary endpoint), and median overall survival (OS) were 46%, 38%, and 11.1 months, respectively. Patients with refractory/early relapse and those receiving treatment as first salvage had encouraging outcomes (median OS, 13.2 and 11.3 months, respectively). Grade ≥3 immune-related adverse events were rare (14%) and self-limiting. Patients who achieved CRc had a higher frequency of progenitor exhausted CD8+ T cells expressing TCF-1 in the bone marrow prior to treatment. A multifaceted correlative approach of genomic, transcriptomic, and immunophenotypic profiling offers insights on molecular correlates of response and resistance to pembrolizumab. Significance Immune-checkpoint blockade with pembrolizumab was tolerable and feasible after high-dose cytarabine in R/R AML, with encouraging clinical activity, particularly in refractory AML and those receiving treatment as first salvage regimen. Further study of pembrolizumab and other immune-checkpoint blockade strategies after cytotoxic chemotherapy is warranted in AML.See related commentary by Wei et al., p. 551. This article is highlighted in the In This Issue feature, p. 549.
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Affiliation(s)
- Joshua F Zeidner
- University of North Carolina School of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.,Division of Hematology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Benjamin G Vincent
- University of North Carolina School of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.,Division of Hematology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,University of North Carolina, Department of Microbiology and Immunology, Chapel Hill, North Carolina.,Program in Computational Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anastasia Ivanova
- University of North Carolina School of Medicine, Department of Biostatistics, Chapel Hill, North Carolina
| | - Dominic Moore
- University of North Carolina School of Medicine, Department of Biostatistics, Chapel Hill, North Carolina
| | - Karen P McKinnon
- University of North Carolina School of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.,University of North Carolina, Department of Microbiology and Immunology, Chapel Hill, North Carolina
| | - Alec D Wilkinson
- University of North Carolina School of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Rupkatha Mukhopadhyay
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Francesco Mazziotta
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,University of Siena, Department of Medical Biotechnologies, Siena, Italy
| | - Hanna A Knaus
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Matthew C Foster
- University of North Carolina School of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.,Division of Hematology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Catherine C Coombs
- University of North Carolina School of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.,Division of Hematology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Katarzyna Jamieson
- University of North Carolina School of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.,Division of Hematology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Hendrik Van Deventer
- University of North Carolina School of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.,Division of Hematology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jonathan A Webster
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,Department of Oncology, Division of Hematological Malignancies, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Gabrielle T Prince
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,Department of Oncology, Division of Hematological Malignancies, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Amy E DeZern
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,Department of Oncology, Division of Hematological Malignancies, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - B Douglas Smith
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,Department of Oncology, Division of Hematological Malignancies, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mark J Levis
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,Department of Oncology, Division of Hematological Malignancies, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nathan D Montgomery
- University of North Carolina School of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.,Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Leo Luznik
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,Department of Oncology, Division of Hematological Malignancies, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jonathan S Serody
- University of North Carolina School of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.,Division of Hematology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,University of North Carolina, Department of Microbiology and Immunology, Chapel Hill, North Carolina.,Program in Computational Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ivana Gojo
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,University of Siena, Department of Medical Biotechnologies, Siena, Italy
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19
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Ramkissoon LA, Buhlinger K, Nichols A, Coombs CC, Foster MC, Galeotti J, Kaiser-Rogers K, Richardson DR, Montgomery ND, Zeidner JF. Clonal evolution of Philadelphia chromosome in acute myeloid leukemia after enasidenib treatment. Leuk Lymphoma 2021; 62:3035-3038. [PMID: 34151687 DOI: 10.1080/10428194.2021.1941928] [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: 10/21/2022]
Affiliation(s)
- Lori A Ramkissoon
- Department of Pathology & Laboratory Medicine, The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kaitlyn Buhlinger
- Lineberger Comprehensive Cancer Center, The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Angela Nichols
- Lineberger Comprehensive Cancer Center, The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, The University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Division of Hematology, Department of Medicine, The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Matthew C Foster
- Lineberger Comprehensive Cancer Center, The University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Division of Hematology, Department of Medicine, The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jonathan Galeotti
- Department of Pathology & Laboratory Medicine, The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kathleen Kaiser-Rogers
- Department of Pathology & Laboratory Medicine, The University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Department of Pediatrics, The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Daniel R Richardson
- Lineberger Comprehensive Cancer Center, The University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Division of Hematology, Department of Medicine, The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Nathan D Montgomery
- Department of Pathology & Laboratory Medicine, The University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Joshua F Zeidner
- Lineberger Comprehensive Cancer Center, The University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Division of Hematology, Department of Medicine, The University of North Carolina School of Medicine, Chapel Hill, NC, USA
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20
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Richardson DR, Swoboda DM, Moore DT, Johnson SM, Chan O, Galeotti J, Esparza S, Hussaini MO, Van Deventer H, Foster MC, Coombs CC, Montgomery ND, Sallman DA, Zeidner JF. Genomic characteristics and prognostic significance of co-mutated ASXL1/SRSF2 acute myeloid leukemia. Am J Hematol 2021; 96:462-470. [PMID: 33502020 DOI: 10.1002/ajh.26110] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/12/2021] [Accepted: 01/17/2021] [Indexed: 12/24/2022]
Abstract
The ASXL1 and SRSF2 mutations in AML are frequently found in patients with preexisting myeloid malignancies and are individually associated with poor outcomes. In this multi-institutional retrospective analysis, we assessed the genetic features and clinical outcomes of 43 patients with ASXL1mut SRSF2mut AML and compared outcomes to patients with either ASXL1 (n = 57) or SRSF2 (n = 70) mutations. Twenty-six (60%) had secondary-AML (s-AML). Variant allele fractions suggested that SRSF2 mutations preceded ASXL1 mutational events. Median overall survival (OS) was 7.0 months (95% CI:3.8,15.3) and was significantly longer in patients with de novo vs s-AML (15.3 vs 6.4 months, respectively; P = .04 on adjusted analysis). Compared to ASXL1mut SRSF2wt and ASXL1wt SRSF2mut , co-mutated patients had a 1.4 and 1.6 times increase in the probability of death, respectively (P = .049), with a trend towards inferior OS (median OS = 7.0 vs 11.5 vs 10.9 months, respectively; P = .10). Multivariable analysis suggests this difference in OS is attributable to the high proportion of s-AML patients in the co-mutated cohort (60% vs 32% and 23%, respectively). Although this study is limited by the retrospective data collection and the relatively small sample size, these data suggest that ASXL1mut SRSF2mut AML is a distinct subgroup of AML frequently associated with s-AML and differs from ASXL1mut SRSF2wt /ASXL1wt SRSF2mut with respect to etiology and leukemogenesis.
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Affiliation(s)
- Daniel R. Richardson
- Lineberger Comprehensive Cancer Center The University of North Carolina School of Medicine Chapel Hill North Carolina USA
- Division of Hematology, Department of Medicine The University of North Carolina School of Medicine Chapel Hill North Carolina USA
- The Cecil G. Sheps Center for Health Services Research University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - David M. Swoboda
- Department of Malignant Hematology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Dominic T. Moore
- Lineberger Comprehensive Cancer Center The University of North Carolina School of Medicine Chapel Hill North Carolina USA
| | - Steven M. Johnson
- Department of Pathology and Laboratory Medicine The University of North Carolina School of Medicine Chapel Hill North Carolina USA
| | - Onyee Chan
- Department of Malignant Hematology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Jonathan Galeotti
- Department of Pathology and Laboratory Medicine The University of North Carolina School of Medicine Chapel Hill North Carolina USA
| | - Sonia Esparza
- Lineberger Comprehensive Cancer Center The University of North Carolina School of Medicine Chapel Hill North Carolina USA
- Division of Hematology, Department of Medicine The University of North Carolina School of Medicine Chapel Hill North Carolina USA
| | - Mohammad O. Hussaini
- Department of Malignant Hematology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Hendrick Van Deventer
- Lineberger Comprehensive Cancer Center The University of North Carolina School of Medicine Chapel Hill North Carolina USA
- Division of Hematology, Department of Medicine The University of North Carolina School of Medicine Chapel Hill North Carolina USA
| | - Matthew C. Foster
- Lineberger Comprehensive Cancer Center The University of North Carolina School of Medicine Chapel Hill North Carolina USA
- Division of Hematology, Department of Medicine The University of North Carolina School of Medicine Chapel Hill North Carolina USA
| | - Catherine C. Coombs
- Lineberger Comprehensive Cancer Center The University of North Carolina School of Medicine Chapel Hill North Carolina USA
- Division of Hematology, Department of Medicine The University of North Carolina School of Medicine Chapel Hill North Carolina USA
| | - Nathan D. Montgomery
- Lineberger Comprehensive Cancer Center The University of North Carolina School of Medicine Chapel Hill North Carolina USA
- Department of Pathology and Laboratory Medicine The University of North Carolina School of Medicine Chapel Hill North Carolina USA
| | - David A. Sallman
- Department of Malignant Hematology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Joshua F. Zeidner
- Lineberger Comprehensive Cancer Center The University of North Carolina School of Medicine Chapel Hill North Carolina USA
- Division of Hematology, Department of Medicine The University of North Carolina School of Medicine Chapel Hill North Carolina USA
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21
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Mato AR, Shah NN, Jurczak W, Cheah CY, Pagel JM, Woyach JA, Fakhri B, Eyre TA, Lamanna N, Patel MR, Alencar A, Lech-Maranda E, Wierda WG, Coombs CC, Gerson JN, Ghia P, Le Gouill S, Lewis DJ, Sundaram S, Cohen JB, Flinn IW, Tam CS, Barve MA, Kuss B, Taylor J, Abdel-Wahab O, Schuster SJ, Palomba ML, Lewis KL, Roeker LE, Davids MS, Tan XN, Fenske TS, Wallin J, Tsai DE, Ku NC, Zhu E, Chen J, Yin M, Nair B, Ebata K, Marella N, Brown JR, Wang M. Pirtobrutinib in relapsed or refractory B-cell malignancies (BRUIN): a phase 1/2 study. Lancet 2021; 397:892-901. [PMID: 33676628 DOI: 10.1016/s0140-6736(21)00224-5] [Citation(s) in RCA: 221] [Impact Index Per Article: 73.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Covalent Bruton's tyrosine kinase (BTK) inhibitors are efficacious in multiple B-cell malignancies, but patients discontinue these agents due to resistance and intolerance. We evaluated the safety and efficacy of pirtobrutinib (working name; formerly known as LOXO-305), a highly selective, reversible BTK inhibitor, in these patients. METHODS Patients with previously treated B-cell malignancies were enrolled in a first-in-human, multicentre, open-label, phase 1/2 trial of the BTK inhibitor pirtobrutinib. The primary endpoint was the maximum tolerated dose (phase 1) and overall response rate (ORR; phase 2). This trial is registered with ClinicalTrials.gov, NCT03740529. FINDINGS 323 patients were treated with pirtobrutinib across seven dose levels (25 mg, 50 mg, 100 mg, 150 mg, 200 mg, 250 mg, and 300 mg once per day) with linear dose-proportional exposures. No dose-limiting toxicities were observed and the maximum tolerated dose was not reached. The recommended phase 2 dose was 200 mg daily. Adverse events in at least 10% of 323 patients were fatigue (65 [20%]), diarrhoea (55 [17%]), and contusion (42 [13%]). The most common adverse event of grade 3 or higher was neutropenia (32 [10%]). There was no correlation between pirtobrutinib exposure and the frequency of grade 3 treatment-related adverse events. Grade 3 atrial fibrillation or flutter was not observed, and grade 3 haemorrhage was observed in one patient in the setting of mechanical trauma. Five (1%) patients discontinued treatment due to a treatment-related adverse event. In 121 efficacy evaluable patients with chronic lymphocytic leukaemia (CLL) or small lymphocytic lymphoma (SLL) treated with a previous covalent BTK inhibitor (median previous lines of treatment 4), the ORR with pirtobrutinib was 62% (95% CI 53-71). The ORR was similar in CLL patients with previous covalent BTK inhibitor resistance (53 [67%] of 79), covalent BTK inhibitor intolerance (22 [52%] of 42), BTK C481-mutant (17 [71%] of 24) and BTK wild-type (43 [66%] of 65) disease. In 52 efficacy evaluable patients with mantle cell lymphoma (MCL) previously treated with covalent BTK inhibitors, the ORR was 52% (95% CI 38-66). Of 117 patients with CLL, SLL, or MCL who responded, all but eight remain progression-free to date. INTERPRETATION Pirtobrutinib was safe and active in multiple B-cell malignancies, including patients previously treated with covalent BTK inhibitors. Pirtobrutinib might address a growing unmet need for alternative therapies for these patients. FUNDING Loxo Oncology.
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Affiliation(s)
- Anthony R Mato
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Nirav N Shah
- Medical College of Wisconsin, Brookfield, WI, USA
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland
| | - Chan Y Cheah
- Linear Clinical Research and Sir Charles Gairdner Hospital and University of Western Australia, Perth, WA, Australia
| | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA
| | - Jennifer A Woyach
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Bita Fakhri
- Division of Hematology and Oncology, University of California, San Francisco, CA, USA
| | - Toby A Eyre
- Churchill Cancer Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nicole Lamanna
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Manish R Patel
- Florida Cancer Specialists and Sarah Cannon Research Institute, Sarasota, FL, USA
| | - Alvaro Alencar
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ewa Lech-Maranda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - James N Gerson
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Steven Le Gouill
- Service d'hématologie clinique du CHU de Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | | | | | | | - Ian W Flinn
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN, USA
| | - Constantine S Tam
- Peter MacCallum Cancer Center, Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC, Australia
| | - Minal A Barve
- Mary Crowley Cancer Research Center, Dallas, TX, USA
| | - Bryone Kuss
- Flinders University Medical Centre, Bedford Park, SA, Australia
| | - Justin Taylor
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | | | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - M Lia Palomba
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katharine L Lewis
- Linear Clinical Research and Sir Charles Gairdner Hospital and University of Western Australia, Perth, WA, Australia
| | | | - Matthew S Davids
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Xuan Ni Tan
- Linear Clinical Research and Sir Charles Gairdner Hospital and University of Western Australia, Perth, WA, Australia
| | | | | | | | - Nora C Ku
- Loxo Oncology at Lilly, Stamford, CT, USA
| | - Edward Zhu
- Loxo Oncology at Lilly, Stamford, CT, USA
| | | | - Ming Yin
- Loxo Oncology at Lilly, Stamford, CT, USA
| | - Binoj Nair
- Loxo Oncology at Lilly, Stamford, CT, USA
| | | | | | - Jennifer R Brown
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
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22
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Garner LM, Kline T, Miller J, Deal A, Zhu A, Sketch MR, Coombs CC, Muluneh B. Impact of Adherence to Ibrutinib on Clinical Outcomes in Real-World Patients With Chronic Lymphocytic Leukemia. J Adv Pract Oncol 2021; 12:20-28. [PMID: 33552659 PMCID: PMC7844188 DOI: 10.6004/jadpro.2021.12.1.2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Chronic lymphocytic leukemia (CLL) is a B-cell neoplasm with clonal expansion of small lymphocytes. Ibrutinib, an irreversible inhibitor of Bruton tyrosine kinase (BTK), is a first-line treatment option, and recent data suggest that strict adherence is directly related to clinical outcomes. Objectives The primary objective of this study was to quantify ibrutinib adherence rates in real-world patients with CLL on ibrutinib; secondary outcomes included progression-free survival and overall survival. Methods This retrospective study included subjects who were treated at a large academic medical center over approximately 5 years. Subjects were at least 18 years, diagnosed with CLL or small lymphocytic lymphoma, and treated with ibrutinib monotherapy for at least 6 months. Adherence was quantified using the medication possession ratio (MPR), which is the ratio of the sum of days' supply of medication in a period over the number of days in that period, and was based on fill history from the medical center's specialty pharmacy. Results For the 32 subjects in this study, the mean ibrutinib adherence rate was 91.7% (range, 84.4%-100%). Only 3 subjects had disease progression, and 1 death was recorded while on therapy (all with MPR < 95%); therefore, analyses of clinical outcomes were unable to be assessed due to a low number of events. There were no statistically significant differences in rates of adherence based on baseline characteristics and adverse drug events. Conclusion In patients with CLL treated with ibrutinib, mean adherence was 91.7%, which is lower than rates seen in clinical trials.
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Affiliation(s)
- Lauren M Garner
- University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Theresa Kline
- University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Jordan Miller
- University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Allison Deal
- University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Anqi Zhu
- University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Margaret R Sketch
- University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Catherine C Coombs
- University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Benyam Muluneh
- University of North Carolina Medical Center, Chapel Hill, North Carolina
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23
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Eyre TA, Lamanna N, Roeker LE, Ujjani CS, Hill BT, Barr PM, Lansigan E, Cheson BD, Yazdy M, Allan JN, Rhodes J, Schuster SJ, Nabhan C, Skarbnik A, Leslie L, Islam P, Whitaker K, Coombs CC, Tuncer HH, Pagel JM, Jacobs R, Winter AM, Bailey N, Sitlinger A, Schuh AH, Follows G, Fox CP, Brander DM, Shadman M, Mato AR. Comparative analysis of targeted novel therapies in relapsed, refractory chronic lymphocytic leukaemia. Haematologica 2021; 106:284-287. [PMID: 32079693 PMCID: PMC7776352 DOI: 10.3324/haematol.2019.241539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Toby A Eyre
- Hematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Nicole Lamanna
- New York-Presbyterian Columbia University Medical Center, New York, NY
| | | | - Chaitra S Ujjani
- Seattle Cancer Care Alliance/Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Brian T Hill
- Dept. of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation
| | - Paul M Barr
- Division of Hematology/Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | | | - Bruce D Cheson
- Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Maryam Yazdy
- Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC
| | - John N Allan
- Weill Cornell Medicine School of Medicine, Long Island City, NY
| | - Joanna Rhodes
- Div. of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Stephen J Schuster
- Div of Hematology and Oncology,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | | | - Lori Leslie
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ
| | - Prioty Islam
- Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC
| | | | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Hande H Tuncer
- Department of Medicine, Cancer Center, Tufts Medical Center, Boston, MA
| | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA
| | - Ryan Jacobs
- Department of Hematology, Lymphoma Division, Levine Cancer Institute, Charlotte, NC
| | - Allison M Winter
- Dept of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation
| | - Neil Bailey
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA
| | - Andrea Sitlinger
- Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC
| | - Anna H Schuh
- Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford
| | | | | | - Danielle M Brander
- Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC
| | - Mazyar Shadman
- Seattle Cancer Care Alliance/Fred Hutchinson Cancer Research Center, Seattle, WA
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24
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Bolton KL, Ptashkin RN, Gao T, Braunstein L, Devlin SM, Kelly D, Patel M, Berthon A, Syed A, Yabe M, Coombs CC, Caltabellotta NM, Walsh M, Offit K, Stadler Z, Mandelker D, Schulman J, Patel A, Philip J, Bernard E, Gundem G, Ossa JEA, Levine M, Martinez JSM, Farnoud N, Glodzik D, Li S, Robson ME, Lee C, Pharoah PDP, Stopsack KH, Spitzer B, Mantha S, Fagin J, Boucai L, Gibson CJ, Ebert BL, Young AL, Druley T, Takahashi K, Gillis N, Ball M, Padron E, Hyman DM, Baselga J, Norton L, Gardos S, Klimek VM, Scher H, Bajorin D, Paraiso E, Benayed R, Arcila ME, Ladanyi M, Solit DB, Berger MF, Tallman M, Garcia-Closas M, Chatterjee N, Diaz LA, Levine RL, Morton LM, Zehir A, Papaemmanuil E. Cancer therapy shapes the fitness landscape of clonal hematopoiesis. Nat Genet 2020; 52:1219-1226. [PMID: 33106634 PMCID: PMC7891089 DOI: 10.1038/s41588-020-00710-0] [Citation(s) in RCA: 312] [Impact Index Per Article: 78.0] [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: 04/05/2020] [Accepted: 09/02/2020] [Indexed: 01/30/2023]
Abstract
Acquired mutations are pervasive across normal tissues. However, understanding of the processes that drive transformation of certain clones to cancer is limited. Here we study this phenomenon in the context of clonal hematopoiesis (CH) and the development of therapy-related myeloid neoplasms (tMNs). We find that mutations are selected differentially based on exposures. Mutations in ASXL1 are enriched in current or former smokers, whereas cancer therapy with radiation, platinum and topoisomerase II inhibitors preferentially selects for mutations in DNA damage response genes (TP53, PPM1D, CHEK2). Sequential sampling provides definitive evidence that DNA damage response clones outcompete other clones when exposed to certain therapies. Among cases in which CH was previously detected, the CH mutation was present at tMN diagnosis. We identify the molecular characteristics of CH that increase risk of tMN. The increasing implementation of clinical sequencing at diagnosis provides an opportunity to identify patients at risk of tMN for prevention strategies.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/pharmacology
- Cell Transformation, Neoplastic/drug effects
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/radiation effects
- Child
- Child, Preschool
- Clonal Evolution
- Clonal Hematopoiesis/drug effects
- Clonal Hematopoiesis/genetics
- Cohort Studies
- Female
- Genetic Fitness
- Humans
- Infant
- Infant, Newborn
- Leukemia, Myeloid/genetics
- Male
- Middle Aged
- Models, Biological
- Mutation
- Neoplasms/drug therapy
- Neoplasms/radiotherapy
- Neoplasms, Second Primary/genetics
- Selection, Genetic
- Young Adult
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Affiliation(s)
- Kelly L Bolton
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ryan N Ptashkin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Teng Gao
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lior Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean M Devlin
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel Kelly
- Department of Information Systems, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Minal Patel
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Antonin Berthon
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aijazuddin Syed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mariko Yabe
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Catherine C Coombs
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nicole M Caltabellotta
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mike Walsh
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kenneth Offit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zsofia Stadler
- Department of Medicine, Clinical Genetics Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Diana Mandelker
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jessica Schulman
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Akshar Patel
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John Philip
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elsa Bernard
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gunes Gundem
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Juan E Arango Ossa
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Max Levine
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Noushin Farnoud
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dominik Glodzik
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sonya Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark E Robson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Paul D P Pharoah
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Konrad H Stopsack
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Barbara Spitzer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Simon Mantha
- Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James Fagin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura Boucai
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Benjamin L Ebert
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andrew L Young
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Todd Druley
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Koichi Takahashi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nancy Gillis
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Markus Ball
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
- Institute of Pathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eric Padron
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - David M Hyman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Jose Baselga
- Research & Development, AstraZeneca, Milton, Cambridge, UK
| | - Larry Norton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Stuart Gardos
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Virginia M Klimek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Howard Scher
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Dean Bajorin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Eder Paraiso
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Strategy & Innovation, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ryma Benayed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria E Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David B Solit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael F Berger
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin Tallman
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nilanjan Chatterjee
- Department of Biostatistics, Bloomberg School of Public Health Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Luis A Diaz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Program in Precision Interception and Prevention, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Solid Tumor Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ross L Levine
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ahmet Zehir
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Elli Papaemmanuil
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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25
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Mato AR, Roeker LE, Jacobs R, Hill BT, Lamanna N, Brander D, Shadman M, Ujjani CS, Yazdy MS, Perini GF, Pinilla-Ibarz JA, Barrientos J, Skarbnik AP, Torka P, Pu JJ, Pagel JM, Gohil S, Fakhri B, Choi M, Coombs CC, Rhodes J, Barr PM, Portell CA, Parry H, Garcia CA, Whitaker KJ, Winter AM, Sitlinger A, Khajavian S, Grajales-Cruz AF, Isaac KM, Shah P, Akhtar OS, Pocock R, Lam K, Voorhees TJ, Schuster SJ, Rodgers TD, Fox CP, Martinez-Calle N, Munir T, Bhavsar EB, Bailey N, Lee JC, Weissbrot HB, Nabhan C, Goodfriend JM, King AC, Zelenetz AD, Dorsey C, Bigelow K, Cheson BD, Allan JN, Eyre TA. Assessment of the Efficacy of Therapies Following Venetoclax Discontinuation in CLL Reveals BTK Inhibition as an Effective Strategy. Clin Cancer Res 2020; 26:3589-3596. [PMID: 32198151 PMCID: PMC8588795 DOI: 10.1158/1078-0432.ccr-19-3815] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [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: 11/23/2019] [Revised: 02/05/2020] [Accepted: 03/17/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Venetoclax-based therapy is a standard-of-care option in first-line and relapsed/refractory chronic lymphocytic leukemia (CLL). Patient management following venetoclax discontinuation remains nonstandard and poorly understood. EXPERIMENTAL DESIGN To address this, we conducted a large international study to identify a cohort of 326 patients who discontinued venetoclax and have been subsequently treated. Coprimary endpoints were overall response rate (ORR) and progression-free survival for the post-venetoclax treatments stratified by treatment type [Bruton's tyrosine kinase inhibitor (BTKi), PI3K inhibitor (PI3Ki), and cellular therapies]. RESULTS We identified patients with CLL who discontinued venetoclax in the first-line (4%) and relapsed/refractory settings (96%). Patients received a median of three therapies prior to venetoclax; 40% were BTKi naïve (n = 130), and 81% were idelalisib naïve (n = 263). ORR to BTKi was 84% (n = 44) in BTKi-naïve patients versus 54% (n = 30) in BTKi-exposed patients. We demonstrate therapy selection following venetoclax requires prior novel agent exposure consideration and discontinuation reasons. CONCLUSIONS For BTKi-naïve patients, selection of covalently binding BTKis results in high ORR and durable remissions. For BTKi-exposed patients, covalent BTK inhibition is not effective in the setting of BTKi resistance. PI3Kis following venetoclax do not appear to result in durable remissions. We conclude that BTKi in naïve or previously responsive patients and cellular therapies following venetoclax may be the most effective strategies.See related commentary by Rogers, p. 3501.
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Affiliation(s)
- Anthony R Mato
- Memorial Sloan Kettering Cancer Center, New York, New York.
| | | | - Ryan Jacobs
- Department of Hematology, Lymphoma Division, Levine Cancer Institute, Charlotte, North Carolina
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicole Lamanna
- Herbert Irving Comprehensive Cancer Center (New York-Presbyterian Columbia University Medical Center), New York, New York
| | | | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Chaitra S Ujjani
- Seattle Cancer Care Alliance/Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Maryam Sarraf Yazdy
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington D.C
| | | | | | | | | | - Pallawi Torka
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Jeffrey J Pu
- SUNY Upstate Medical University, Syracuse, New York
| | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, Washington
| | - Satyen Gohil
- University College London, London, United Kingdom
| | - Bita Fakhri
- Department of Medicine, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
| | - Michael Choi
- Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Joanna Rhodes
- Division of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul M Barr
- Division of Hematology/Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | - Craig A Portell
- Division of Hematology and Oncology, University of Virginia, Charlottesville, Virginia
| | - Helen Parry
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Christine A Garcia
- Hillman Cancer Pavilion, Division of Hematology and Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Allison M Winter
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andrea Sitlinger
- Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | | | | | - Krista M Isaac
- Division of Hematology and Oncology, University of Virginia, Charlottesville, Virginia
| | | | | | | | - Kentson Lam
- Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Timothy J Voorhees
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Stephen J Schuster
- Division of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Christopher P Fox
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Nicolas Martinez-Calle
- Clinical Haematology Department, Nottingham University Hospitals NHS Trust, Nottingham, England, United Kingdom
| | - Talha Munir
- Weill Cornell Medicine, Long Island City, New York
| | - Erica B Bhavsar
- Department of Haematology, St James's University Hospital, Leeds, United Kingdom
| | - Neil Bailey
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, Washington
| | - Jason C Lee
- Herbert Irving Comprehensive Cancer Center (New York-Presbyterian Columbia University Medical Center), New York, New York
| | - Hanna B Weissbrot
- Herbert Irving Comprehensive Cancer Center (New York-Presbyterian Columbia University Medical Center), New York, New York
| | | | | | - Amber C King
- Clinical Pharmacy Specialist-Leukemia, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew D Zelenetz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Colleen Dorsey
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kayla Bigelow
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bruce D Cheson
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington D.C
| | - John N Allan
- Department of Haematology, St James's University Hospital, Leeds, United Kingdom
| | - Toby A Eyre
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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26
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Abstract
Liquid biopsies are new technologies that allow cancer profiling of tumor fragments found in body fluids, such as peripheral blood, collected noninvasively from patients with malignancies. These assays are increasingly valuable in clinical oncology practice as prognostic biomarkers, as guides for therapy selection, for treatment monitoring, and for early detection of disease progression and relapse. However, application of these assays to rare cancers, such as pediatric and adult sarcomas, have lagged. In this article, we review the technical challenges of applying liquid biopsy technologies to sarcomas, provide an update on progress in the field, describe common pitfalls in interpreting liquid biopsy data, and discuss the intersection of sarcoma clinical care and commercial assays emerging on the horizon.
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Affiliation(s)
| | | | - Brian D Crompton
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
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27
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Eyre TA, Roeker LE, Fox CP, Gohill SH, Walewska R, Walter HS, Forconi F, Broom A, Arumainathan A, Brander DM, Allan JN, Schuster SJ, Hill BT, Lansigan F, Cheson BD, Lamanna N, Coombs CC, Barr PM, Skarbnik AP, Shadman M, Ujjani CS, Pearson L, Pagel JM, Jacobs R, Mato AR. The efficacy and safety of venetoclax therapy in elderly patients with relapsed, refractory chronic lymphocytic leukaemia. Br J Haematol 2020; 188:918-923. [PMID: 31682002 PMCID: PMC7528953 DOI: 10.1111/bjh.16271] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 07/10/2019] [Accepted: 09/09/2019] [Indexed: 11/30/2022]
Abstract
Elderly chronic lymphocytic leukaemia (CLL) patients treated outside of trials have notably greater toxicity with the Bruton's tyrosine kinase inhibitor ibrutinib compared to younger patients. It is not known whether the same holds true for the B-cell lymphoma 2 inhibitor venetoclax. We provide a comprehensive analysis of key safety measures and efficacy in 342 patients comparing age categories ≥75 and <75 years treated in the relapsed, refractory non-trial setting. We demonstrate that venetoclax has equivalent efficacy and safety in relapsed/refractory CLL patients who are elderly, the majority of whom are previous ibrutinib-exposed and therefore may otherwise have few clear therapeutic options.
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Affiliation(s)
- Toby A. Eyre
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lindsey E. Roeker
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Christopher P. Fox
- Department of Clinical Haematology, Nottingham University Hospitals NHS Foundation Trust, Nottingham
| | - Satyen H. Gohill
- Department of Haematology, University College London Hospitals, London
| | - Renata Walewska
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth
| | | | - Francesco Forconi
- Department of Haematology, University Hospital Trust and Cancer Sciences Unit, Cancer Research
- National Institute for Health Research Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton
| | - Angus Broom
- Department of Haematology, Western General Hospital, Edinburgh
| | | | | | - John N. Allan
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, NY
| | - Stephen J. Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Brian T. Hill
- Department of Hematology & Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Bruce D. Cheson
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, DC
| | - Nicole Lamanna
- Hematology/Oncology Division, Columbia University Medical Center, New York, NY
| | - Catherine C. Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Paul M. Barr
- Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | | | | | | | | | | | - Ryan Jacobs
- Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA
| | - Anthony R. Mato
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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28
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Abstract
OBJECTIVE To review the current state of molecular and genetic profiling of acute myeloid leukemia (AML) and its implications. DATA SOURCE Peer-reviewed journal articles. CONCLUSION Significant advances in the understanding of the pathology of acute myeloid leukemia have led to refined risk stratification of patients and application of novel targeted therapies based on genetic profiles. Minimal residual disease testing allows for highly sensitive disease surveillance that can be used to predict relapse and assess treatment response. IMPLICATIONS FOR NURSING PRACTICE Accurate prognostication and therapeutic decision-making for patients with acute myeloid leukemia is dependent on molecular profiling. Being knowledgeable of the implications of minimal residual disease testing is critical for patient-centered care.
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Affiliation(s)
- Daniel R Richardson
- UNC Lineberger Comprehensive Cancer Center, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Matthew C Foster
- UNC Lineberger Comprehensive Cancer Center, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Catherine C Coombs
- UNC Lineberger Comprehensive Cancer Center, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Joshua F Zeidner
- UNC Lineberger Comprehensive Cancer Center, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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29
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Trennepohl C, Sorah J, Eulitt P, Galeotti J, Zeidner JF, Montgomery ND, Coombs CC. Myeloid sarcoma manifesting as generalized lymphadenopathy in a patient with myelofibrosis. Clin Case Rep 2019; 7:2274-2276. [PMID: 31788302 PMCID: PMC6878033 DOI: 10.1002/ccr3.2473] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/17/2019] [Accepted: 08/12/2019] [Indexed: 11/15/2022] Open
Abstract
Immunophenotyping is critical to the diagnosis of MS, as it can be difficult to differentiate from other diagnoses including lymphoma using conventional light microscopy.
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Affiliation(s)
| | - Jonathan Sorah
- Department of MedicineUniversity of North CarolinaChapel HillNCUSA
| | - Patrick Eulitt
- Division of Hematology/OncologyDepartment of MedicineUniversity of North CarolinaChapel HillNCUSA
| | | | - Joshua F. Zeidner
- Division of Hematology/OncologyDepartment of MedicineUniversity of North CarolinaChapel HillNCUSA
| | | | - Catherine C. Coombs
- Division of Hematology/OncologyDepartment of MedicineUniversity of North CarolinaChapel HillNCUSA
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30
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Esparza S, Muluneh B, Galeotti J, Matson M, Richardson DR, Montgomery ND, Coombs CC, Jamieson K, Foster MC, Zeidner JF. Venetoclax-induced tumour lysis syndrome in acute myeloid leukaemia. Br J Haematol 2019; 188:173-177. [PMID: 31621058 DOI: 10.1111/bjh.16235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/08/2019] [Accepted: 08/16/2019] [Indexed: 01/25/2023]
Affiliation(s)
- Sonia Esparza
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Benyam Muluneh
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Jonathan Galeotti
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Melissa Matson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel R Richardson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.,The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Nathan D Montgomery
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Katarzyna Jamieson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Matthew C Foster
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Joshua F Zeidner
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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31
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Ptashkin RN, Mandelker DL, Coombs CC, Bolton K, Yelskaya Z, Hyman DM, Solit DB, Baselga J, Arcila ME, Ladanyi M, Zhang L, Levine RL, Berger MF, Zehir A. Prevalence of Clonal Hematopoiesis Mutations in Tumor-Only Clinical Genomic Profiling of Solid Tumors. JAMA Oncol 2019; 4:1589-1593. [PMID: 29872864 DOI: 10.1001/jamaoncol.2018.2297] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Importance Although clonal hematopoiesis (CH) is well described in aging healthy populations, few studies have addressed the practical clinical implications of these alterations in solid-tumor sequencing. Objective To identify and quantify CH-related mutations in patients with solid tumors using matched tumor-blood sequencing, and to establish the proportion that would be misattributed to the tumor based on tumor-only sequencing (unmatched analysis). Design, Setting, and Participants Retrospective analysis of samples from 17 469 patients with solid cancers who underwent prospective clinical sequencing of DNA isolated from tumor tissue and matched peripheral blood using the MSK-IMPACT assay between January 2014 and August 2017. Main Outcomes and Measures We identified the presence of CH-related mutations in each patient's blood leukocytes and quantified the fraction of DNA molecules harboring the mutation in the corresponding matched tumor sample. Results The mean age of the 17 469 patients with cancer at sample collection was 59.2 years (range, 0.3-98.9 years); 53.6% were female. We identified 7608 CH-associated mutations in the blood of 4628 (26.5%) patients. A total of 1075 (14.1%) CH-associated mutations were also detectable in the matched tumor above established thresholds for calling somatic mutations. Overall, 912 (5.2%) patients would have had at least 1 CH-associated mutation erroneously called as tumor derived in the absence of matched blood sequencing. A total of 1061 (98.7%) of these mutations were absent from population scale databases of germline polymorphisms and therefore would have been challenging to filter informatically. Annotating variants with OncoKB classified 534 (49.7%) as oncogenic or likely oncogenic. Conclusions and Relevance This study demonstrates how CH-derived mutations could lead to erroneous reporting and treatment recommendations when tumor-only sequencing is used.
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Affiliation(s)
- Ryan N Ptashkin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Diana L Mandelker
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Catherine C Coombs
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,now with Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Kelly Bolton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zarina Yelskaya
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David M Hyman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York
| | - David B Solit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York.,Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - José Baselga
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York
| | - Maria E Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Liying Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ross L Levine
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York.,Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael F Berger
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.,Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ahmet Zehir
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
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32
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Falchook G, Rosen S, LoRusso P, Watts J, Gupta S, Coombs CC, Talpaz M, Kurzrock R, Mita M, Cassaday R, Harb W, Peguero J, Smith DC, Piha-Paul SA, Szmulewitz R, Noel MS, Yeleswaram S, Liu P, Switzky J, Zhou G, Zheng F, Mehta A. Development of 2 Bromodomain and Extraterminal Inhibitors With Distinct Pharmacokinetic and Pharmacodynamic Profiles for the Treatment of Advanced Malignancies. Clin Cancer Res 2019; 26:1247-1257. [PMID: 31527168 DOI: 10.1158/1078-0432.ccr-18-4071] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 06/13/2019] [Accepted: 09/11/2019] [Indexed: 01/17/2023]
Abstract
PURPOSE Bromodomain and extraterminal (BET) proteins are key epigenetic transcriptional regulators, inhibition of which may suppress oncogene expression. We report results from 2 independent first-in-human phase 1/2 dose-escalation and expansion, safety and tolerability studies of BET inhibitors INCB054329 (study INCB 54329-101; NCT02431260) and INCB057643 (study INCB 57643-101; NCT02711137). PATIENTS AND METHODS Patients (≥18 years) with advanced malignancies, ≥1 prior therapy, and adequate organ functions received oral INCB054329 (monotherapy) or INCB057643 (monotherapy or in combination with standard-of-care) in 21-day cycles (or 28-day cycles depending on standard-of-care combination). Primary endpoints were safety and tolerability. RESULTS Sixty-nine and 134 patients received INCB054329 and INCB057643, respectively. Study INCB 54329-101 has been completed; INCB 57643-101 is currently active, but not recruiting (no patients were receiving treatment as of January 8, 2019). Terminal elimination half-life was shorter for INCB054329 versus INCB057643 (mean [SD], 2.24 [2.03] vs. 11.1 [8.27] hours). INCB054329 demonstrated higher interpatient variability in oral clearance versus INCB057643 (CV%, 142% vs. 45.5%). Most common (>20%) any-grade treatment-related adverse events were similar for both drugs (INCB054329; INCB057643): nausea (35%; 30%), thrombocytopenia (33%; 32%), fatigue (29%; 30%), decreased appetite (26%; 22%). Two confirmed complete responses and 4 confirmed partial responses with INCB057643 were reported as best responses. CONCLUSIONS INCB057643 exhibited a more favorable PK profile versus INCB054329; exposure-dependent thrombocytopenia was observed with both drugs which limited the target inhibition that could be safely maintained. Further efforts are required to identify patient populations that can benefit most, and an optimal dosing scheme to maximize therapeutic index.
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Affiliation(s)
- Gerald Falchook
- Sarah Cannon Research Institute at HealthONE, Denver, Colorado.
| | - Seth Rosen
- Hematology-Oncology Associates of Treasure Coast, Port St Lucie, Florida
| | | | - Justin Watts
- Sylvester Comprehensive Cancer Center, Miami, Florida
| | | | - Catherine C Coombs
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | - Monica Mita
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Ryan Cassaday
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Wael Harb
- Horizon Oncology Center, Lafeyette, Indiana
| | | | | | | | | | - Marcus S Noel
- University of Rochester, Wilmot Cancer Center, Rochester, New York
| | - Swamy Yeleswaram
- Incyte Research Institute, Incyte Corporation, Wilmington, Delaware
| | - Phillip Liu
- Incyte Research Institute, Incyte Corporation, Wilmington, Delaware
| | | | | | - Fred Zheng
- Incyte Corporation, Wilmington, Delaware
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33
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Roeker LE, Fox CP, Eyre TA, Brander DM, Allan JN, Schuster SJ, Nabhan C, Hill BT, Shah NN, Lansigan F, Yazdy M, Cheson BD, Lamanna N, Singavi AK, Coombs CC, Barr PM, Skarbnik AP, Shadman M, Ujjani CS, Tuncer HH, Winter AM, Rhodes J, Dorsey C, Morse H, Kabel C, Pagel JM, Williams AM, Jacobs R, Goy A, Muralikrishnan S, Pearson L, Sitlinger A, Bailey N, Schuh A, Kirkwood AA, Mato AR. Tumor Lysis, Adverse Events, and Dose Adjustments in 297 Venetoclax-Treated CLL Patients in Routine Clinical Practice. Clin Cancer Res 2019; 25:4264-4270. [PMID: 31004001 DOI: 10.1158/1078-0432.ccr-19-0361] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/08/2019] [Accepted: 04/15/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Clinical trials of venetoclax reported negligible rates of clinical tumor lysis syndrome (TLS) in patients with chronic lymphocytic leukemia (CLL) when using an extended dose escalation schedule. We aimed to understand TLS prophylaxis, rates of select adverse events (AE), and impact of dosing modifications in routine clinical practice. EXPERIMENTAL DESIGN This retrospective cohort study included 297 CLL venetoclax-treated patients outside of clinical trials in academic and community centers. Demographics, baseline disease characteristics, venetoclax dosing, TLS risk and prophylaxis, and AEs were collected. RESULTS The group was 69% male, 96% had relapsed/refractory CLL, 45% had deletion chromosome 17p, 84% had unmutated IGHV, 80% received venetoclax monotherapy, and median age was 67. TLS risk was categorized as low (40%), intermediate (32%), or high (28%), and 62% had imaging prior to venetoclax initiation. Clinical TLS occurred in 2.7% of patients and laboratory TLS occurred in 5.7%. Pre-venetoclax TLS risk group and creatinine clearance independently predict TLS development in multivariable analysis. Grade 3/4 AEs included neutropenia (39.6%), thrombocytopenia (29.2%), infection (25%), neutropenic fever (7.9%), and diarrhea (6.9%). Twenty-two patients (7.4%) discontinued venetoclax due to an AE. Progression-free survival was similar regardless of number of dose interruptions, length of dose interruption, and stable venetoclax dose. CONCLUSIONS These data provide insights into current use of venetoclax in clinical practice, including TLS rates observed in clinical practice. We identified opportunities for improved adherence to TLS risk stratification and prophylaxis, which may improve safety.
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Affiliation(s)
- Lindsey E Roeker
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Christopher P Fox
- Department of Clinical Haematology, Nottingham University Hospitals NHS Foundation Trust, Nottingham, United Kingdom
| | - Toby A Eyre
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Danielle M Brander
- Duke Cancer Institute, Duke University Health System, Durham, North Carolina
| | - John N Allan
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, New York
| | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Brian T Hill
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nirav N Shah
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Maryam Yazdy
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, D
| | - Bruce D Cheson
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, D
| | - Nicole Lamanna
- Hematology/Oncology Division, Columbia University Medical Center, New York, New York
| | - Arun K Singavi
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | - Alan P Skarbnik
- John Theurer Cancer Center, Hackensack University Medical Center, Closter, New Jersey
| | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | - Joanna Rhodes
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Colleen Dorsey
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Hannah Morse
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Charlene Kabel
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | | | - Ryan Jacobs
- Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Andre Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Closter, New Jersey
| | | | | | - Andrea Sitlinger
- Duke Cancer Institute, Duke University Health System, Durham, North Carolina
| | - Neil Bailey
- Swedish Cancer Institute, Seattle, Washington
| | - Anna Schuh
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Amy A Kirkwood
- Cancer Research UK and University College London Cancer Trials Centre, London, United Kingdom
| | - Anthony R Mato
- Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
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Bolton KL, Gillis NK, Coombs CC, Takahashi K, Zehir A, Bejar R, Garcia-Manero G, Futreal A, Jensen BC, Diaz LA, Gupta D, Mantha S, Klimek V, Papaemmanuil E, Levine R, Padron E. Managing Clonal Hematopoiesis in Patients With Solid Tumors. J Clin Oncol 2019; 37:7-11. [PMID: 30403571 PMCID: PMC6354773 DOI: 10.1200/jco.18.00331] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Nancy K. Gillis
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | - Ahmet Zehir
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rafael Bejar
- University of California, San Diego, San Diego, CA
| | | | - Andrew Futreal
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brian C. Jensen
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Luis A. Diaz
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dipti Gupta
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Simon Mantha
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Ross Levine
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric Padron
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Boucai L, Falcone J, Ukena J, Coombs CC, Zehir A, Ptashkin R, Berger MF, Levine RL, Fagin JA. Radioactive Iodine-Related Clonal Hematopoiesis in Thyroid Cancer Is Common and Associated With Decreased Survival. J Clin Endocrinol Metab 2018; 103:4216-4223. [PMID: 30137527 PMCID: PMC6194804 DOI: 10.1210/jc.2018-00803] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/13/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Radioactive iodine (RAI) has been epidemiologically associated with the development of hematologic malignancies. Clonal hematopoiesis (CH) is a precursor clonal state that confers increased risk of leukemia and occurs at an elevated rate in patients with thyroid cancer relative to other solid tumors. OBJECTIVE We explore if the high prevalence of CH may be a result of RAI exposure and whether CH may be a surrogate in the association between RAI and leukemia. DESIGN CH, CH-potential driver (CH-PD), and overall survival were evaluated in 279 patients with advanced thyroid carcinoma. RESULTS The prevalence of CH in patients with thyroid cancer was 37%, and that of CH-PD was 5.2%. Age was the strongest predictor of CH and CH-PD. For every year increase in age, there was a 5% and 13% increase in the odds of CH and CH-PD, respectively. RAI dose was significantly associated with CH and CH-PD, even after adjustment for age, external beam radiation therapy, and chemotherapy. For every 10 mCi increase in the dose of RAI administered, there was a 2% and 4% increase in the odds of CH and CH-PD, respectively. Patients with CH-PD previously exposed to RAI had a significantly poorer survival, even when stratified by age (heart rate = 3.75, 95% CI = 1.23 to 11.5, P = 0.02). CONCLUSIONS RAI was associated with a high prevalence of CH, and CH is a precursor state of hematologic malignancies. The implications of this study may favor identification of CH in patients where the risks might outweigh the benefits of receiving RAI therapy for thyroid cancer.
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Affiliation(s)
- Laura Boucai
- Division of Endocrinology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
- Correspondence and Reprint Requests: Laura Boucai, MD, MS, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 313, New York, New York 10065. E-mail:
| | - John Falcone
- Weill Cornell Medical College, New York, New York
| | - Jenny Ukena
- Division of Endocrinology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Catherine C Coombs
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ahmet Zehir
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ryan Ptashkin
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Michael F Berger
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ross L Levine
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
- Department of Medicine, Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - James A Fagin
- Division of Endocrinology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
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36
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Galeotti J, Coombs CC. Enasidenib‐induced eosinophilic differentiation in a patient with acute myeloid leukaemia with
IDH
2
and
U2
AF
1
mutations. Br J Haematol 2018; 184:496. [DOI: 10.1111/bjh.15609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jonathan Galeotti
- Department of Pathology University of North Carolina at Chapel Hill Chapel HillNC USA
| | - Catherine C. Coombs
- Department of Medicine Division of Hematology and Oncology University of North Carolina at Chapel Hill Chapel Hill NC USA
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37
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Coombs CC, Mathews SP. Acute promyelocytic leukemia and chronic lymphocytic leukemia diagnosed concurrently. Am J Hematol 2018; 93:595-596. [PMID: 29052253 DOI: 10.1002/ajh.24950] [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] [Received: 08/29/2017] [Revised: 10/09/2017] [Accepted: 10/16/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Catherine C. Coombs
- Division of Hematology/Oncology, Department of Medicine; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Stephanie P. Mathews
- Division of Hematopathology, Department of Pathology and Laboratory Medicine; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
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38
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Coombs CC, Gillis NK, Tan X, Berg JS, Ball M, Balasis ME, Montgomery ND, Bolton KL, Parker JS, Mesa TE, Yoder SJ, Hayward MC, Patel NM, Richards KL, Walko CM, Knepper TC, Soper JT, Weiss J, Grilley-Olson JE, Kim WY, Earp HS, Levine RL, Papaemmanuil E, Zehir A, Hayes DN, Padron E. Identification of Clonal Hematopoiesis Mutations in Solid Tumor Patients Undergoing Unpaired Next-Generation Sequencing Assays. Clin Cancer Res 2018; 24:5918-5924. [PMID: 29866652 DOI: 10.1158/1078-0432.ccr-18-1201] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/16/2018] [Accepted: 06/01/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE In this era of precision-based medicine, for optimal patient care, results reported from commercial next-generation sequencing (NGS) assays should adequately reflect the burden of somatic mutations in the tumor being sequenced. Here, we sought to determine the prevalence of clonal hematopoiesis leading to possible misattribution of tumor mutation calls on unpaired Foundation Medicine NGS assays. EXPERIMENTAL DESIGN This was a retrospective cohort study of individuals undergoing NGS of solid tumors from two large cancer centers. We identified and quantified mutations in genes known to be frequently altered in clonal hematopoiesis (DNMT3A, TET2, ASXL1, TP53, ATM, CHEK2, SF3B1, CBL, JAK2) that were returned to physicians on clinical Foundation Medicine reports. For a subset of patients, we explored the frequency of true clonal hematopoiesis by comparing mutations on Foundation Medicine reports with matched blood sequencing. RESULTS Mutations in genes that are frequently altered in clonal hematopoiesis were identified in 65% (1,139/1,757) of patients undergoing NGS. When excluding TP53, which is often mutated in solid tumors, these events were still seen in 35% (619/1,757) of patients. Utilizing paired blood specimens, we were able to confirm that 8% (18/226) of mutations reported in these genes were true clonal hematopoiesis events. The majority of DNMT3A mutations (64%, 7/11) and minority of TP53 mutations (4%, 2/50) were clonal hematopoiesis. CONCLUSIONS Clonal hematopoiesis mutations are commonly reported on unpaired NGS testing. It is important to recognize clonal hematopoiesis as a possible cause of misattribution of mutation origin when applying NGS findings to a patient's care.See related commentary by Pollyea, p. 5790.
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Affiliation(s)
- Catherine C Coombs
- Department of Medicine, Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. .,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nancy K Gillis
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Xianming Tan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jonathan S Berg
- Department of Medicine, Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Markus Ball
- Department of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Maria E Balasis
- Department of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Nathan D Montgomery
- Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kelly L Bolton
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joel S Parker
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tania E Mesa
- Molecular Genomics Core, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Sean J Yoder
- Molecular Genomics Core, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Michele C Hayward
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nirali M Patel
- Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Q Solutions - EA Genomics, Morrisville, North Carolina
| | - Kristy L Richards
- Department of Medicine, Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Christine M Walko
- DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Todd C Knepper
- DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - John T Soper
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jared Weiss
- Department of Medicine, Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Juneko E Grilley-Olson
- Department of Medicine, Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - William Y Kim
- Department of Medicine, Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - H Shelton Earp
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ross L Levine
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Ahmet Zehir
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - D Neil Hayes
- Department of Medicine, Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Medical Oncology at the University of Tennessee Health Science Center (UTHSC), Memphis, Tennessee
| | - Eric Padron
- Department of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, Florida
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39
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Duchmann M, Yalniz FF, Sanna A, Sallman D, Coombs CC, Renneville A, Kosmider O, Braun T, Platzbecker U, Willems L, Adès L, Fontenay M, Rampal R, Padron E, Droin N, Preudhomme C, Santini V, Patnaik MM, Fenaux P, Solary E, Itzykson R. Prognostic Role of Gene Mutations in Chronic Myelomonocytic Leukemia Patients Treated With Hypomethylating Agents. EBioMedicine 2018; 31:174-181. [PMID: 29728305 PMCID: PMC6013781 DOI: 10.1016/j.ebiom.2018.04.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [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: 04/02/2018] [Accepted: 04/20/2018] [Indexed: 12/02/2022] Open
Abstract
Somatic mutations contribute to the heterogeneous prognosis of chronic myelomonocytic leukemia (CMML). Hypomethylating agents (HMAs) are active in CMML, but analyses of small series failed to identify mutations predicting response or survival. We analyzed a retrospective multi-center cohort of 174 CMML patients treated with a median of 7 cycles of azacitidine (n = 68) or decitabine (n = 106). Sequencing data before treatment initiation were available for all patients, from Sanger (n = 68) or next generation (n = 106) sequencing. Overall response rate (ORR) was 52%, including complete response (CR) in 28 patients (17%). In multivariate analysis, ASXL1 mutations predicted a lower ORR (Odds Ratio [OR] = 0.85, p = 0.037), whereas TET2mut/ASXL1wt genotype predicted a higher CR rate (OR = 1.18, p = 0.011) independently of clinical parameters. With a median follow-up of 36.7 months, overall survival (OS) was 23.0 months. In multivariate analysis, RUNX1mut (Hazard Ratio [HR] = 2.00, p = .011), CBLmut (HR = 1.90, p = 0.03) genotypes and higher WBC (log10(WBC) HR = 2.30, p = .005) independently predicted worse OS while the TET2mut/ASXL1wt predicted better OS (HR = 0.60, p = 0.05). CMML-specific scores CPSS and GFM had limited predictive power. Our results stress the need for robust biomarkers of HMA activity in CMML and for novel treatment strategies in patients with myeloproliferative features and RUNX1 mutations. TET2mut/ASXL1wt genotype predicts higher complete response rate and prolonged survival in CMML with hypomethylating agents. Conversely, RUNX1mut and CBLmut genotypes are associated with poorer outcome, independently of higher leukocyte count. CPSS and GFM prognostic scores showed modest performance when calculated at initiation of hypomethylating agents.
Somatic mutations contribute to the heterogeneous prognosis of chronic myelomonocytic leukemia (CMML). Hypomethylating agents (HMAs) are active in CMML. Response and survival in MDS and AML patients treated with HMAs is difficult to predict. We explore the predictive role of recurrent somatic mutations in a large retrospective cohort of 174 HMA-treated CMMLs. Consistent with MDS studies, we report a higher response rate in TET2mut/ASXL1wt patients. We also identify a CMML-specific molecular pattern (RUNX1mut or CBLmut) associated with shorter survival. Our results can inform treatment decision in CMML, for instance by using HMAs prior to transplant in TET2mut/ASXL1wt patients.
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Affiliation(s)
| | | | - Alessandro Sanna
- MDS Unit-Hematology, Università di Firenze AOU careggi, Firenze, Italy
| | - David Sallman
- Malignant Hematology Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Catherine C Coombs
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aline Renneville
- Laboratory of Hematology, Biology and Pathology Center, CHRU of Lille, Lille, France
| | - Olivier Kosmider
- Laboratory of Hematology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thorsten Braun
- Department of Hematology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Uwe Platzbecker
- Department of Hematology and Oncology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Lise Willems
- Department of Hematology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lionel Adès
- Department of Hematology, St Louis Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, Paris, France
| | - Michaela Fontenay
- Laboratory of Hematology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raajit Rampal
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Padron
- Malignant Hematology Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Nathalie Droin
- INSERM U1170, Gustave Roussy Cancer Center, Villejuif, France
| | - Claude Preudhomme
- Laboratory of Hematology, Biology and Pathology Center, CHRU of Lille, Lille, France
| | - Valeria Santini
- MDS Unit-Hematology, Università di Firenze AOU careggi, Firenze, Italy
| | | | - Pierre Fenaux
- Department of Hematology, St Louis Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, Paris, France
| | - Eric Solary
- INSERM U1170, Gustave Roussy Cancer Center, Villejuif, France; Department of Hematology, Gustave Roussy Cancer Center, University Paris Sud, Villejuif, France
| | - Raphael Itzykson
- Department of Hematology, St Louis Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, Paris, France; INSERM/CNRS UMR 944/7212, Saint-Louis Institute, Paris, France.
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40
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Coombs CC, Zehir A, Devlin SM, Kishtagari A, Syed A, Jonsson P, Hyman DM, Solit DB, Robson ME, Baselga J, Arcila ME, Ladanyi M, Tallman MS, Levine RL, Berger MF. Therapy-Related Clonal Hematopoiesis in Patients with Non-hematologic Cancers Is Common and Associated with Adverse Clinical Outcomes. Cell Stem Cell 2017; 21:374-382.e4. [PMID: 28803919 DOI: 10.1016/j.stem.2017.07.010] [Citation(s) in RCA: 482] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/27/2017] [Accepted: 07/14/2017] [Indexed: 11/26/2022]
Abstract
Clonal hematopoiesis (CH), as evidenced by recurrent somatic mutations in leukemia-associated genes, commonly occurs among aging human hematopoietic stem cells. We analyzed deep-coverage, targeted, next-generation sequencing (NGS) data of paired tumor and blood samples from 8,810 individuals to assess the frequency and clinical relevance of CH in patients with non-hematologic malignancies. We identified CH in 25% of cancer patients, with 4.5% harboring presumptive leukemia driver mutations (CH-PD). CH was associated with increased age, prior radiation therapy, and tobacco use. PPM1D and TP53 mutations were associated with prior exposure to chemotherapy. CH and CH-PD led to an increased incidence of subsequent hematologic cancers, and CH-PD was associated with shorter patient survival. These data suggest that CH occurs in an age-dependent manner and that specific perturbations can enhance fitness of clonal hematopoietic stem cells, which can impact outcome through progression to hematologic malignancies and through cell-non-autonomous effects on solid tumor biology.
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Affiliation(s)
- Catherine C Coombs
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ahmet Zehir
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ashwin Kishtagari
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Aijazuddin Syed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Philip Jonsson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - David M Hyman
- Department of Medicine, Developmental Therapeutics Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - David B Solit
- Department of Medicine, Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Mark E Robson
- Department of Medicine, Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Medicine, Hereditary Cancer and Genetics Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - José Baselga
- Department of Medicine, Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Maria E Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Martin S Tallman
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Ross L Levine
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Memorial Sloan Kettering Cancer Center, Center for Hematologic Malignancies, New York, NY 10065, USA.
| | - Michael F Berger
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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41
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Coombs CC, Sallman DA, Devlin SM, Dixit S, Mohanty A, Knapp K, Al Ali NH, Lancet JE, List AF, Komrokji RS, Padron E, Arcila ME, Klimek VM, van den Brink MRM, Tallman MS, Levine RL, Rampal RK, Rapaport F. Mutational correlates of response to hypomethylating agent therapy in acute myeloid leukemia. Haematologica 2016; 101:e457-e460. [PMID: 27418649 DOI: 10.3324/haematol.2016.148999] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Catherine C Coombs
- Memorial Sloan Kettering Cancer Center, Department of Medicine, Leukemia Service, New York, NY, USA
| | - David A Sallman
- H. Lee Moffitt Cancer Center and Research Institute, Department of Malignant Hematology, Tampa, FL, USA
| | - Sean M Devlin
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology & Biostatistics, New York, NY, USA
| | - Shweta Dixit
- Memorial Sloan Kettering Cancer Center, Human Oncology and Pathogenesis Program, New York, NY, USA
| | - Abhinita Mohanty
- Memorial Sloan Kettering Cancer Center, Department of Pathology, New York, NY, USA
| | - Kristina Knapp
- Memorial Sloan Kettering Cancer Center, Human Oncology and Pathogenesis Program, New York, NY, USA
| | - Najla H Al Ali
- H. Lee Moffitt Cancer Center and Research Institute, Department of Malignant Hematology, Tampa, FL, USA
| | - Jeffrey E Lancet
- H. Lee Moffitt Cancer Center and Research Institute, Department of Malignant Hematology, Tampa, FL, USA
| | - Alan F List
- H. Lee Moffitt Cancer Center and Research Institute, Department of Malignant Hematology, Tampa, FL, USA
| | - Rami S Komrokji
- H. Lee Moffitt Cancer Center and Research Institute, Department of Malignant Hematology, Tampa, FL, USA
| | - Eric Padron
- H. Lee Moffitt Cancer Center and Research Institute, Department of Malignant Hematology, Tampa, FL, USA
| | - Maria E Arcila
- Memorial Sloan Kettering Cancer Center, Department of Pathology, New York, NY, USA
| | - Virginia M Klimek
- Memorial Sloan Kettering Cancer Center, Department of Medicine, Leukemia Service, New York, NY, USA
| | | | - Martin S Tallman
- Memorial Sloan Kettering Cancer Center, Department of Medicine, Leukemia Service, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Ross L Levine
- Memorial Sloan Kettering Cancer Center, Department of Medicine, Leukemia Service, New York, NY, USA.,Memorial Sloan Kettering Cancer Center, Human Oncology and Pathogenesis Program, New York, NY, USA
| | - Raajit K Rampal
- Memorial Sloan Kettering Cancer Center, Department of Medicine, Leukemia Service, New York, NY, USA
| | - Franck Rapaport
- Memorial Sloan Kettering Cancer Center, Department of Medicine, Leukemia Service, New York, NY, USA
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Abstract
Acute myeloid leukaemia (AML) is a heterogeneous disease that is, in general, associated with a very poor prognosis. Multiple cytogenetic and molecular abnormalities that characterize different forms of AML have been used to better prognosticate patients and inform treatment decisions. Indeed, risk status in patients with this disease has classically been based on cytogenetic findings; however, additional molecular characteristics have been shown to inform risk assessment, including FLT3, NPM1, KIT, and CEBPA mutation status. Advances in sequencing technology have led to the discovery of novel somatic mutations in tissue samples from patients with AML, providing deeper insight into the mutational landscape of the disease. The majority of patients with AML (>97%) are found to have a clonal somatic abnormality on mutational profiling. Nevertheless, our understanding of the utility of mutation profiling in clinical practice remains incomplete and is continually evolving, and evidence-based approaches to application of these data are needed. In this Review, we discuss the evidence-base for integrating mutational data into treatment decisions for patients with AML, and propose novel therapeutic algorithms in the era of molecular medicine.
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Affiliation(s)
- Catherine C Coombs
- Leukemia Service, Department of Medicine, Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA
| | - Martin S Tallman
- Leukemia Service, Department of Medicine, Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA.,Weill Cornell Medical Center, 1300 York Avenue, New York, New York 10065, USA
| | - Ross L Levine
- Leukemia Service, Department of Medicine, Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA
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Coombs CC, DeAngelis LM, Feusner JH, Rowe JM, Tallman MS. Pseudotumor Cerebri in Acute Promyelocytic Leukemia Patients on Intergroup Protocol 0129: Clinical Description and Recommendations for New Diagnostic Criteria. Clin Lymphoma Myeloma Leuk 2015; 16:146-51. [PMID: 26724834 DOI: 10.1016/j.clml.2015.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/11/2015] [Accepted: 11/17/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Multiple randomized trials have demonstrated a benefit for all-trans retinoic acid (ATRA) in patients with acute promyelocytic leukemia (APL). Pseudotumor cerebri (PTC) is an infrequently reported adverse effect of ATRA. METHODS We examined the incidence, clinical course, and outcomes of patients with APL treated on Intergroup Protocol 0129 (I0129) who developed PTC. This trial evaluated the role of ATRA alone during induction and/or as maintenance therapy. RESULTS Of the patients on trial, 240 received ATRA during induction, maintenance, or both; 8 had a clinical suspicion for PTC. Upon review of individual cases, this was felt to be "probable" in 4 patients, "possible" in 1 and "unlikely" in 3 due to lack of diagnostic criteria or presence of a more likely alternate diagnosis. CONCLUSIONS "Probable" PTC occurred in 1.7% of patients who received ATRA during induction and/or maintenance therapy. In agreement with previous reports, the incidence of PTC in APL patients receiving ATRA was higher in the pediatric population. Here, we discuss the method for diagnosing PTC in the setting of ATRA therapy and management strategies.
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Affiliation(s)
- Catherine C Coombs
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lisa M DeAngelis
- Department of Neurology, Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James H Feusner
- Department of Pediatric Hematology/Oncology, Children's Hospital and Research Center Oakland, Oakland, CA
| | - Jacob M Rowe
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Martin S Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY.
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Falchi L, Keating MJ, Wang X, Coombs CC, Lanasa MC, Strom S, Wierda WG, Ferrajoli A. Clinical characteristics, response to therapy, and survival of African American patients diagnosed with chronic lymphocytic leukemia: joint experience of the MD Anderson Cancer Center and Duke University Medical Center. Cancer 2013; 119:3177-85. [PMID: 24022787 DOI: 10.1002/cncr.28030] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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: 09/21/2012] [Revised: 12/21/2012] [Accepted: 02/05/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND Little is known regarding racial disparities in characteristics and outcomes among patients with chronic lymphocytic leukemia (CLL). METHODS The characteristics and outcomes of untreated African American (AA) patients with CLL (n = 84) were analyzed and compared with a reference nonblack (NB) patient population (n = 1571). RESULTS At the time of presentation, AA patients had lower median hemoglobin levels (12.9 g/dL vs 13.7 g/dL), higher β2 microglobulin levels (2.7 mg/dL vs 2.4 mg/dL), greater frequency of constitutional symptoms (27% vs 10%), unmutated immunoglobulin heavy-chain variable region (IGHV) mutation status (65% vs 47%), ζ-chain-associated protein kinase 70 (ZAP70) expression (58% vs 32%), and deletion of chromosome 17p or chromosome 11q (28% vs 17%; P ≤ 02 for each comparison). Fifty-one percent of AA patients and 39% of NB patients required first-line therapy and 91% and 88%, respectively, received chemoimmunotherapy. Overall response rates to treatment were 85% for AA patients and 94% for NB patients (P = .06); and the complete response rates were 56% and 58%, respectively (P = .87). The median survival of AA patients was shorter compared with that of NB patients (event-free survival: 36 months vs 61 months; P = .007; overall survival: 152 months vs not reached; P = .0001). AA race was an independent predictor of shorter event-free and overall survival in multivariable regression models. CONCLUSIONS The current results indicated that AA patients with CLL have more unfavorable prognostic characteristics and shorter survival compared with their NB counterparts.
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Affiliation(s)
- Lorenzo Falchi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Abstract
Chronic lymphocytic leukemia (CLL) is the most prevalent leukemia in the United States with almost 4390 attributable deaths per year. Epidemiologic data compiled by the Surveillance, Epidemiology and End Results (SEER) program identifies important differences in incidence and survival for African Americans with CLL. Although the incidence of CLL is lower among African Americans than among Caucasians (4.6 and 6.2 per 100 000 men, respectively), age-adjusted survival is inferior. African American patients with CLL are almost twice as likely to die from a CLL-related complication in the first 5 years after diagnosis as are Caucasian patients with CLL. The biologic basis for these observations is almost entirely unexplored, and a comprehensive clinical analysis of African American patients with CLL is lacking. This is the subject of the present review.
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