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Higgins K, Gay S, Parry R, Winters R, Miall F. Specialised foundation programme allocation: making research everyone's business. BMJ 2024; 385:q804. [PMID: 38589035 DOI: 10.1136/bmj.q804] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Affiliation(s)
- Kath Higgins
- Diabetes Outpatients Department, Leicester General Hospital, Leicester, UK
| | - Simon Gay
- George Davies Centre, University of Leicester, Leicester, UK
| | | | - Rachel Winters
- George Davies Centre, University of Leicester, Leicester, UK
| | - Fiona Miall
- George Davies Centre, University of Leicester, Leicester, UK
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Tivey A, Shotton R, Eyre TA, Lewis D, Stanton L, Allchin R, Walter H, Miall F, Zhao R, Santarsieri A, McCulloch R, Bishton M, Beech A, Willimott V, Fowler N, Bedford C, Goddard J, Protheroe S, Everden A, Tucker D, Wright J, Dukka V, Reeve M, Paneesha S, Prahladan M, Hodson A, Qureshi I, Koppana M, Owen M, Ediriwickrema K, Marr H, Wilson J, Lambert J, Wrench D, Burney C, Knott C, Talbot G, Gibb A, Lord A, Jackson B, Stern S, Sutton T, Webb A, Wilson M, Thomas N, Norman J, Davies E, Lowry L, Maddox J, Phillips N, Crosbie N, Flont M, Nga E, Virchis A, Camacho RG, Swe W, Pillai A, Rees C, Bailey J, Jones S, Smith S, Sharpley F, Hildyard C, Mohamedbhai S, Nicholson T, Moule S, Chaturvedi A, Linton K. Ibrutinib as first-line therapy for mantle cell lymphoma: a multicenter, real-world UK study. Blood Adv 2024; 8:1209-1219. [PMID: 38127279 PMCID: PMC10912842 DOI: 10.1182/bloodadvances.2023011152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
ABSTRACT During the COVID-19 pandemic, ibrutinib with or without rituximab was approved in England for initial treatment of mantle cell lymphoma (MCL) instead of immunochemotherapy. Because limited data are available in this setting, we conducted an observational cohort study evaluating safety and efficacy. Adults receiving ibrutinib with or without rituximab for untreated MCL were evaluated for treatment toxicity, response, and survival, including outcomes in high-risk MCL (TP53 mutation/deletion/p53 overexpression, blastoid/pleomorphic, or Ki67 ≥ 30%). A total of 149 patients from 43 participating centers were enrolled: 74.1% male, median age 75 years, 75.2% Eastern Cooperative Oncology Group status of 0 to 1, 36.2% high-risk, and 8.9% autologous transplant candidates. All patients received ≥1 cycle ibrutinib (median, 8 cycles), 39.0% with rituximab. Grade ≥3 toxicity occurred in 20.3%, and 33.8% required dose reductions/delays. At 15.6-month median follow-up, 41.6% discontinued ibrutinib, 8.1% due to toxicity. Of 104 response-assessed patients, overall (ORR) and complete response (CR) rates were 71.2% and 20.2%, respectively. ORR was 77.3% (low risk) vs 59.0% (high risk) (P = .05) and 78.7% (ibrutinib-rituximab) vs 64.9% (ibrutinib; P = .13). Median progression-free survival (PFS) was 26.0 months (all patients); 13.7 months (high risk) vs not reached (NR) (low risk; hazard ratio [HR], 2.19; P = .004). Median overall survival was NR (all); 14.8 months (high risk) vs NR (low risk; HR, 2.36; P = .005). Median post-ibrutinib survival was 1.4 months, longer in 41.9% patients receiving subsequent treatment (median, 8.6 vs 0.6 months; HR, 0.36; P = .002). Ibrutinib with or without rituximab was effective and well tolerated as first-line treatment of MCL, including older and transplant-ineligible patients. PFS and OS were significantly inferior in one-third of patients with high-risk disease and those unsuitable for post-ibrutinib treatment, highlighting the need for novel approaches in these groups.
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Affiliation(s)
- Ann Tivey
- The University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Rohan Shotton
- The University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Toby A. Eyre
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - David Lewis
- Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | | | - Rebecca Allchin
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Harriet Walter
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Fiona Miall
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Rui Zhao
- Torbay Hospital, Torquay, United Kingdom
| | | | - Rory McCulloch
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom
| | - Mark Bishton
- University of Nottingham, Nottingham, United Kingdom
| | - Amy Beech
- Nottingham University Hospitals, Nottingham, United Kingdom
| | | | - Nicole Fowler
- Royal Cornwall Hospital NHS Trust, Truro, United Kingdom
| | | | - Jack Goddard
- Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Sam Protheroe
- Stockport NHS Foundation Trust, Stockport, United Kingdom
| | | | - David Tucker
- Royal Cornwall Hospital NHS Trust, Truro, United Kingdom
| | - Josh Wright
- Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Vasavi Dukka
- Stockport NHS Foundation Trust, Stockport, United Kingdom
| | - Miriam Reeve
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Shankara Paneesha
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Mahesh Prahladan
- East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom
| | - Andrew Hodson
- East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom
| | - Iman Qureshi
- University Hospital Coventry and Warwickshire NHS Foundation Trust, Coventry, United Kingdom
| | - Manasvi Koppana
- East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom
| | - Mary Owen
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Helen Marr
- Newcastle Teaching Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Jamie Wilson
- St Richard's Hospital, Chichester, United Kingdom
| | - Jonathan Lambert
- University College Hospital NHS Foundation Trust, London, United Kingdom
| | - David Wrench
- Guy's and St.Thomas' NHS Foundation Trust, London, United Kingdom
| | - Claire Burney
- University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Chloe Knott
- University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Georgina Talbot
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Adam Gibb
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Simon Stern
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, United Kingdom
| | - Taylor Sutton
- Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
| | - Amy Webb
- Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom
| | - Marketa Wilson
- Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom
| | - Nicky Thomas
- Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom
| | - Jane Norman
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Elizabeth Davies
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Lisa Lowry
- Somerset NHS Foundation Trust, Taunton and Bridgwater, United Kingdom
| | - Jamie Maddox
- South Tees Hospitals NHS Foundation Trust, Middlesborough, United Kingdom
| | - Neil Phillips
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | | | - Marcin Flont
- York and Scarborough Teaching Hospitals NHS Foundation, York, United Kingdom
| | - Emma Nga
- Airedale NHS Foundation Trust, Keighley, United Kingdom
| | - Andres Virchis
- The Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | - Wunna Swe
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, United Kingdom
| | - Arvind Pillai
- Countess of Chester Hospital NHS Foundation Trust, Chester, United Kingdom
| | - Clare Rees
- Frimley Health NHS Foundation Trust, Frimley, United Kingdom
| | - James Bailey
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Steve Jones
- Sherwood Forest Hospitals, Nottinghamshire, United Kingdom
| | - Susan Smith
- Sherwood Forest Hospitals, Nottinghamshire, United Kingdom
| | - Faye Sharpley
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Catherine Hildyard
- Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, United Kingdom
| | - Sajir Mohamedbhai
- University College Hospital NHS Foundation Trust, London, United Kingdom
| | - Toby Nicholson
- St Helens and Knowsley NHS Foundation Trust, Merseyside, United Kingdom
| | - Simon Moule
- Frimley Health NHS Foundation Trust, Frimley, United Kingdom
| | - Anshuman Chaturvedi
- The University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Kim Linton
- The University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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Shotton R, Broadbent R, Alchawaf A, Mohamed MB, Gibb A, Martinez-Calle N, Fox CP, Bishton M, Pender A, Gleeson M, Cunningham D, Davies A, Yadollahi S, Eyre TA, Collins G, Djebbari F, Kassam S, Garland P, Watts E, Osborne W, Townsend W, Pocock R, Ahearne MJ, Miall F, Wang X, Linton KM. Safety of bendamustine for the treatment of indolent non-Hodgkin lymphoma: a UK real-world experience. Blood Adv 2024; 8:878-888. [PMID: 37967358 PMCID: PMC10875258 DOI: 10.1182/bloodadvances.2023011305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023] Open
Abstract
ABSTRACT Bendamustine is among the most effective chemotherapeutics for indolent B-cell non-Hodgkin lymphomas (iNHL), but trial reports of significant toxicity, including opportunistic infections and excess deaths, led to prescriber warnings. We conducted a multicenter observational study evaluating bendamustine toxicity in real-world practice. Patients receiving at least 1 dose of bendamustine with/without rituximab (R) for iNHL were included. Demographics, lymphoma and treatment details, and grade 3 to 5 adverse events (AEs) were analyzed and correlated. In total, 323 patients were enrolled from 9 National Health Service hospitals. Most patients (96%) received bendamustine-R, and 46%, R maintenance. Overall, 21.7% experienced serious AEs (SAE) related to treatment, including infections in 12%, with absolute risk highest during induction (63%), maintenance (20%), and follow-up (17%) and the relative risk highest during maintenance (54%), induction (34%), and follow-up (28%). Toxicity led to permanent treatment discontinuation for 13% of patients, and 2.8% died of bendamustine-related infections (n = 5), myelodysplastic syndrome (n = 3), and cardiac disease (n = 1). More SAEs per patient were reported in patients with mantle cell lymphoma, poor preinduction performance status (PS), poor premaintenance PS, and abnormal preinduction total globulins and in those receiving growth factors. Use of antimicrobial prophylaxis was variable, and 3 of 10 opportunistic infections occurred despite prophylaxis. In this real-world analysis, bendamustine-related deaths and treatment discontinuation were similar to those of trial populations of younger, fitter patients. Poor PS, mantle cell histology, and maintenance R were potential risk factors. Infections, including late onset events, were the most common treatment-related SAE and cause of death, warranting extended antimicrobial prophylaxis and infectious surveillance, especially for maintenance-treated patients.
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Affiliation(s)
- Rohan Shotton
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Alia Alchawaf
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Adam Gibb
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Nicolás Martinez-Calle
- Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Christopher P. Fox
- Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Mark Bishton
- Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Alexandra Pender
- Department of Medicine, The Royal Marsden Hospital, London, United Kingdom
| | - Mary Gleeson
- Haematology, The Royal Marsden Hospital, London, United Kingdom
| | | | - Andrew Davies
- Cancer Research UK/NIHE Experimental Cancer Medicines Centre, University of Southampton, Southampton, United Kingdom
| | - Sina Yadollahi
- Haematology, Haematology and Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Toby A. Eyre
- Haematology, Haematology and Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Graham Collins
- Haematology, Haematology and Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Faouzi Djebbari
- Haematology, Haematology and Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Shireen Kassam
- Haematology, King’s College Hospital, London, United Kingdom
| | - Paula Garland
- Haematology, King's College Hospital, Princess Royal Site, Kent, United Kingdom
| | - Emily Watts
- Haematology, Freeman Hospital, Newcastle, United Kingdom
| | - Wendy Osborne
- Haematology, Freeman Hospital, Newcastle, United Kingdom
| | - William Townsend
- Haematology, University College Hospital London, London, United Kingdom
| | - Rachael Pocock
- Haematology, University College Hospital London, London, United Kingdom
| | - Matthew J. Ahearne
- Haematology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Fiona Miall
- Haematology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Xin Wang
- Statistics Group, Clinical Outcome Unit, Digital Services, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Kim M. Linton
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
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Howick J, Slavin D, Carr S, Miall F, Ohri C, Ennion S, Gay S. Towards an empathic hidden curriculum in medical school: A roadmap. J Eval Clin Pract 2024. [PMID: 38332641 DOI: 10.1111/jep.13966] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Abstract
The "hidden curriculum" in medical school includes a stressful work environment, un-empathic role models, and prioritisation of biomedical knowledge. It can provoke anxiety and cause medical students to adapt by becoming cynical, distanced and less empathic. Lower empathy, in turn, has been shown to harm patients as well as practitioners. Fortunately, evidence-based interventions can counteract the empathy dampening effects of the hidden curriculum. These include early exposure to real patients, providing students with real-world experiences, training role models, assessing empathy training, increasing the focus on the biopsychosocial model of disease, and enhanced wellbeing education. Here, we provide an overview of these interventions. Taken together, they can bring about an "empathic hidden curriculum" which can reverse the decline in medical student empathy.
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Affiliation(s)
- Jeremy Howick
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Daniel Slavin
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Sue Carr
- Department of Nephrology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Fiona Miall
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Chandra Ohri
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Steve Ennion
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Simon Gay
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
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Abrisqueta P, González-Barca E, Panizo C, Pérez JMA, Miall F, Bastos-Oreiro M, Triguero A, Banerjee L, McMillan A, Seymour E, Hirata J, de Guzman J, Sharma S, Jin HY, Musick L, Diefenbach C. Polatuzumab vedotin plus rituximab and lenalidomide in patients with relapsed or refractory diffuse large B-cell lymphoma: a cohort of a multicentre, single-arm, phase 1b/2 study. Lancet Haematol 2024; 11:e136-e146. [PMID: 38190832 DOI: 10.1016/s2352-3026(23)00345-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Diffuse large B-cell lymphoma comprises nearly 30% of non-Hodgkin lymphoma cases and patients with relapsed or refractory diffuse large B-cell lymphoma who are ineligible for stem-cell transplantation have few treatment options and poor prognoses. We aimed to determine whether the novel combination of polatuzumab vedotin in combination with rituximab and lenalidomide (Pola+R+Len) would provide a tolerable treatment option with enhanced antitumour response in patients with relapsed or refractory diffuse large B-cell lymphoma. METHODS This completed phase 1b/2, open-label, multicentre, single-arm study (GO29834) evaluated the safety and efficacy of Pola+R+Len in patients with relapsed or refractory diffuse large B-cell lymphoma at 19 sites in three countries (USA, Spain, and UK). Patients (≥18 years old) were eligible for inclusion if they had histologically documented CD20-positive relapsed or refractory diffuse large B-cell lymphoma and Eastern Cooperative Oncology Group performance status of 2 or lower, had received at least one previous line of chemoimmunotherapy, including an anti-CD20 agent, and were ineligible for stem-cell transplantation. The dose-escalation phase (1b) used escalating doses of lenalidomide to find the recommended phase 2 dose. Patients received six 28-day cycles of induction treatment with intravenous rituximab 375 mg/m2 and intravenous polatuzumab vedotin 1·8 mg/kg (all cohorts) plus oral lenalidomide at the following doses: 10 mg (cohort A); 15 mg (cohort B); and 20 mg (cohort C). Rituximab and polatuzumab vedotin were administered on day 1 and lenalidomide on days 1-21 of each 28-day cycle. During the dose-expansion phase (2), patients received six 28-day cycles of Pola+R+Len at the recommended phase 2 dose established during dose escalation. In both phases, patients with a complete response or partial response at the end of induction were eligible for post-induction therapy with rituximab 375 mg/m2 on day 1 and lenalidomide 10 mg/day on days 1-21 of each 28-day cycle for a maximum of 6 cycles. The primary safety objective of the dose-escalation phase was identification of the maximum tolerated dose through incidence of dose-limiting toxic effects. The primary efficacy outcome of the dose-expansion phase was Independent Review Committee-assessed complete response rate at end of induction, based on PET-CT. Analyses were conducted in the safety population, which included all patients who received at least one dose of any study drug, and the efficacy population, which included all patients who received at least one dose of any study drug at the recommended phase 2 dose. This study is registered with ClinicalTrials.gov, number NCT02600897. FINDINGS Between July 11, 2017 and Feb 3, 2020, 57 patients were enrolled (median age 71 years [IQR 60-75]; 38 [67%] were male and 19 (33%) were female; 47 [82%] were not Hispanic or Latino; and the median previous lines of therapy was 2 [IQR 1-3]). 18 participants were included in phase 1b and 39 were included in phase 2. Phase 1b confirmed a 20 mg recommended phase 2 dose for lenalidomide. After a median follow-up of 11·8 months (IQR 4·7-25·8), the complete response rate, as assessed by the Independent Review Committee, was 31% (90% CI 20-43). The most common grade 3-4 adverse events were neutropenia (35 [61%] of 57) and thrombocytopenia (eight [14%] of 57). Serious adverse events were reported in 23 (40%) of 57 patients and one patient died due to a treatment-related adverse event (neutropenic sepsis). INTERPRETATION Although the combination of Pola+R+Len did not meet the prespecified activity threshold, some patients derived clinical benefit and the regimen had a tolerable safety profile in patients with relapsed or refractory diffuse large B-cell lymphoma. FUNDING Genentech/F Hoffmann-La Roche.
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Affiliation(s)
| | - Eva González-Barca
- Insitut Català d'Oncologia, Hospital Duran I Reynals and IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Carlos Panizo
- Hospital Universitario Donostia, San Sebastián, Spain
| | | | - Fiona Miall
- Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Mariana Bastos-Oreiro
- Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana Triguero
- Department of Haematology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Lalita Banerjee
- Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Kent, UK
| | - Andrew McMillan
- Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Erlene Seymour
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
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Diefenbach C, Abrisqueta P, Gonzalez-Barca E, Panizo C, Arguinano Perez JM, Miall F, Bastos-Oreiro M, Lopez-Guillermo A, Banerjee L, McMillan A, Hirata J, Musick L, Saha S, Croft B, Seymour E. POLATUZUMAB VEDOTIN + RITUXIMAB + LENALIDOMIDE IN PATIENTS (PTS) WITH RELAPSED/REFRACTORY (R/R) DIFFUSE LARGE B‐CELL LYMPHOMA (DLBCL): PRIMARY ANALYSIS OF A PHASE 1B/2 TRIAL. Hematol Oncol 2021. [DOI: 10.1002/hon.155_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- C Diefenbach
- Perlmutter Cancer Center at NYU Langone Health, New York New York USA
| | - P Abrisqueta
- Hospital Vall Hebron Department of Haematology Barcelona Spain
| | - E Gonzalez-Barca
- Instititut Catala D'Oncologia IDIBELL, Universitat de Barcelona Barcelona Spain
| | - C Panizo
- Clínica Universidad de Navarra IdiSNA, Servicio de Hematología Pamplona Spain
| | | | - F Miall
- University Hospitals of Leicester NHS Trust Department of Haematology Leicester UK
| | - M Bastos-Oreiro
- Hospital General Universitario Gregorio Marañón Department of Haematology Madrid Spain
| | - A Lopez-Guillermo
- Hospital Clínic de Barcelona Department of Haematology Barcelona Spain
| | - L Banerjee
- Maidstone and Tunbridge Wells NHS Trust Oncology Centre Kent UK
| | - A McMillan
- Nottingham University Hospitals NHS Trust Centre for Clinical Haematology Nottingham UK
| | - J Hirata
- Genentech, Inc. Product Development Oncology South San Francisco USA
| | - L Musick
- Genentech, Inc. Product Development Oncology South San Francisco USA
| | - S Saha
- F. Hoffmann‐La Roche Ltd Product Development Biometrics Welwyn Garden City UK
| | - B Croft
- Genentech, Inc. Product Development Oncology South San Francisco USA
| | - E Seymour
- Karmanos Cancer Institute/Wayne State University Department of Oncology Detroit USA
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Davies A, McKay P, Osborne W, Stanton L, Tansley‐Hancock O, Lawrence M, Mercer K, Allen A, Pottinger B, Zhelyazkova A, Miall F, Rafferty J, Sale B, Cucco F, Nunn L, Coleman A, Griffiths G, Du MQ, Burton C, Barrons S, Johnson P. 9P GAIN PREDICTS OUTCOMES IN PATIENTS WITH RELAPSED/REFRACTORY (R/R) DIFFUSE LARGE B‐CELL LYMPHOMA (DLBCL) TREATED WITH R‐GEMOX +/‐ ATEZOLIZUMAB. ARGO: A RANDOMISED PHASE II STUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.11_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A Davies
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - P McKay
- Beatson West of Scotland Cancer Centre Department of Haematology Glasgow UK
| | - W Osborne
- Freeman Hospital The Newcastle upon Tyne Hospitals NHS Foundation Trust Department of Haematology Newcastle UK
| | - L Stanton
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - O Tansley‐Hancock
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - M Lawrence
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - K Mercer
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - A Allen
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - B Pottinger
- Royal Cornwall Hospitals NHS Trust Department of Haematology Truro UK
| | - A Zhelyazkova
- The Pennine Acute Hospitals NHS Trust Department of Haematology Manchester UK
| | - F Miall
- University Hospitals of Leicester NHS Trust Department of Haematology Leicester UK
| | - J Rafferty
- Patient Representative, c/o CRUK Southampton Clinical Trials Unit Southampton UK
| | - B Sale
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - F Cucco
- University of Cambridge Department of Pathology Cambridge UK
| | - L Nunn
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - A Coleman
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - G Griffiths
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - M. Q Du
- University of Cambridge Department of Pathology Cambridge UK
| | - C Burton
- Leeds Cancer Centre Haematological Malignancies Diagnostic Service Leeds UK
| | - S Barrons
- Leeds Cancer Centre Haematological Malignancies Diagnostic Service Leeds UK
| | - P Johnson
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
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Shotton R, Kirkwood AA, Northend M, Fathoala D, Burton K, Ferguson G, Aiken L, Shrubsole C, Henry L, Owen M, Oliver R, Martinez‐Calle N, Etherington A, Gallop‐Evans E, Burton C, Miall F, Osborne W, Dieu R, McKay P, Ardeshna K, Collins GP, Phillips E. REAL WORLD OUTCOMES AND RESPONSES TO SECOND‐LINE THERAPY IN RELAPSED/REFRACTORY HODGKIN LYMPHOMA: A MULTICENTRE UK STUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.106_2880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- R. Shotton
- The Christie NHS Foundation Trust Medical oncology Manchester UK
| | - A. A. Kirkwood
- UCL Cancer institute University College London Cancer Research UK and UCL Cancer Trials Centre London UK
| | - M. Northend
- University College Hospital University College London Haematology Dept London UK
| | - D. Fathoala
- University College Hospital University College London Haematology Dept London UK
| | - K. Burton
- Oxford University Hospitals NHS Foundation Trust Haematology Dept Oxford UK
| | - G. Ferguson
- Beatson West of Scotland Cancer Centre Haematology Dept Glasgow UK
| | - L. Aiken
- Bart’s Health NHS Trust Haemato‐Oncology Dept London UK
| | - C. Shrubsole
- Newcastle upon Tyne Hospitals NHS Foundation Trust Haematology Dept Newcastle UK
| | - L. Henry
- University Hospitals of Leicester Haematology Dept Leicester UK
| | - M. Owen
- Leeds Cancer Centre Leeds UK
| | - R. Oliver
- University Hospitals Bristol Haematology Dept Bristol UK
| | | | | | | | | | - F. Miall
- University Hospitals of Leicester Haematology Dept Leicester UK
| | - W. Osborne
- Newcastle upon Tyne Hospitals NHS Foundation Trust Haematology Dept Newcastle UK
| | - R. Dieu
- Bart’s Health NHS Trust Haemato‐Oncology Dept London UK
| | - P. McKay
- Beatson West of Scotland Cancer Centre Haematology Dept Glasgow UK
| | - K. Ardeshna
- University College Hospital University College London Haematology Dept London UK
| | - G. P. Collins
- Oxford University Hospitals NHS Foundation Trust Haematology Dept Oxford UK
| | - E. Phillips
- The Christie NHS Foundation Trust NIHR Manchester Biomedical Research Centre and University of Manchester Manchester UK
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9
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Magid Diefenbach CS, Abrisqueta P, Gonzalez-Barca E, Panizo C, Arguinano Perez JM, Miall F, Bastos-Oreiro M, Lopez-Guillermo A, Banerjee L, McMillan A, Hirata J, Musick L, Saha S, Croft B, Seymour EK. Polatuzumab vedotin (Pola) + rituximab (R) + lenalidomide (Len) in patients (pts) with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL): Primary analysis of a phase 1b/2 trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7512 Background: The combination of Pola-R-Len may enhance anti-tumor response in R/R DLBCL. We report the primary analysis of the R/R DLBCL cohort in a Phase 1b/2 study (GO29834; NCT02600897). Methods: Pts received induction with 6 x 28-Day (D) cycles (C) of: Pola 1.8mg/kg intravenous (IV; C1−6: D1); R 375mg/m2 IV (C1−6: D1) and oral Len 10–20mg (dose escalation) or recommended Phase 2 dose (RP2D) daily on D1–21. Pts with a response at end of induction (EOI) received 6 months (mo) consolidation with R 375mg/m2 (D1 every 2 mo) and Len 10mg (D1–21 monthly). Primary endpoints were safety/tolerability and positron emission tomography (PET)-complete response (CR) rate at EOI by independent review committee (IRC) by modified Lugano criteria. Results: At primary analysis (Sep 08, 2020), 57 pts were enrolled. Median age was 71 years (range 28–92); male (67%); Ann Arbor Stage III–IV (86%); International Prognostic Index 3–5 (60%); median 2 prior therapies; prior bone marrow transplant (11%); prior CAR-T therapy (5%); primary refractory (49%) and refractory to last therapy (65%). Grade 3–4 adverse events (AEs) were experienced by 75% of pts, most commonly, neutropenia (58%), thrombocytopenia (14%), infections (14%) and anemia (11%). AEs led to Len dose reduction in 25% and interruption in 63% of pts. One Grade 5 treatment-related AE (neutropenic sepsis) was reported. In total, 49 pts were treated at RP2D (Pola 1.8mg/kg + Len 20mg). IRC PET-CR rate at EOI was 29% (Table). A best overall response (BOR) assessed by investigator (INV) was seen in 36/49 (74%) pts with 17/49 (35%) pts achieving a CR; of these, 14/17 (82%) remain in remission at the cutoff date. Median duration of response (DOR) was 8.1 mo (95% confidence interval [CI]: 4.7–not evaluable [NE]). After a median follow-up of 9.7 mo, median progression-free survival (PFS) and overall survival (OS) were 6.3 mo (95% CI: 4.5–9.7) and 10.9 mo (95% CI: 7.4–NE), respectively. Conclusions: Our study of the novel triplet combination, Pola-R-Len, demonstrates a tolerable safety profile. This first efficacy report of Pola-R-Len shows promising activity in a difficult-to-treat R/R DLBCL population, particularly in pts achieving CR, a large proportion of whom remain in remission at the cutoff date. Further evaluation of Pola-R-Len and the impact of consolidation therapy is warranted to address the significant unmet need in this patient population. Clinical trial information: NCT02600897. [Table: see text]
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Affiliation(s)
| | | | - Eva Gonzalez-Barca
- Instititut Catala D'Oncologia, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Carlos Panizo
- University Clinic of Navarra and Healthcare Research Institute of Navarra (IdiSNA), Pamplona, Spain
| | | | - Fiona Miall
- Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | | | | | - Lalita Banerjee
- Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Kent, United Kingdom
| | - Andrew McMillan
- Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | | | | | - Sourish Saha
- F. Hoffmann-La Roche Ltd., Welwyn Garden City, United Kingdom
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10
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Diefenbach C, Kahl B, Banerjee L, McMillan A, Ramchandren R, Miall F, Briones J, Cordoba R, Gonzalez-Barca E, Panizo C, Hirata J, Chang N, Musick L, Abrisqueta P. POLATUZUMAB VEDOTIN (POLA) + OBINUTUZUMAB (G) + LENALIDOMIDE (LEN) IN PATIENTS (PTS) WITH RELAPSED/REFRACTORY (R/R) FOLLICULAR LYMPHOMA (FL): PHASE IB/II INTERIM ANALYSIS. Hematol Oncol 2019. [DOI: 10.1002/hon.132_2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- C. Diefenbach
- Department of Hematology/Oncology; Perlmutter Cancer Center at NYU Langone Health; New York NY United States
| | - B. Kahl
- Division of Oncology; Washington University; St. Louis MO United States
| | - L. Banerjee
- Oncology Centre; Maidstone and Tonbridge Wells NHS Trust; Kent United Kingdom
| | - A. McMillan
- Centre for Clinical Haematology; Nottingham University Hospitals NHS Trust; Nottingham United Kingdom
| | - R. Ramchandren
- Division of Oncology; University of Tennessee, Knoxville, TN, United States, Barbara Ann Karmanos Cancer Institute; Detroit MI United States
| | - F. Miall
- Department of Haematology; University Hospitals of Leicester NHS Trust; Leicester United Kingdom
| | - J. Briones
- Department of Hematology; Hospital Santa Creu i Sant Pau; Barcelona Spain
| | - R. Cordoba
- Department of Hematology; Fundacion Jimenez Diaz; Madrid Spain
| | | | - C. Panizo
- Haemotology and Haemotherapy Department; Clínica Universidad de Navarra; Madrid Spain
| | - J. Hirata
- Production Development Oncology; Genentech, Inc.; South San Francisco CA United States
| | - N. Chang
- Oncology; F. Hoffmann-La Roche Ltd; Mississauga Canada
| | - L. Musick
- Clinical Sciences-Hematology; Genentech, Inc.; South San Francisco CA United States
| | - P. Abrisqueta
- Department of Hematology; Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron; Barcelona Spain
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11
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Diefenbach C, Kahl B, Banerjee L, McMillan A, Ramchandren R, Miall F, Briones J, Cordoba R, González Barca E, Panizo C, Hirata J, Chang N, Musick L, Abrisqueta Costa P. Polatuzumab vedotin (Pola) + obinutuzumab (G) and lenalidomide (Len) in patients (pts) with relapsed/refractory (R/R) follicular lymphoma (FL): Interim analysis of a phase Ib/II trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.7505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7505 Background: Pola-G-Len may enhance anti-tumor immune response in R/R FL. We report a pre-planned interim analysis of the safety/efficacy of induction and maintenance with Pola-G-Len in pts with R/R FL in a phase Ib/II study. Methods: Pts received induction treatment with 6x 28-D cycles of: G 1000mg IV (C1: D1, D8, D15; C2–6: D1); Pola 1.4mg/kg or 1.8mg/kg (dose escalation [DE]) or RP2D (expansion) IV (D1); and Len 10–20mg (DE) or RP2D (expansion) PO (D1–21). Pts with CR/PR/SD at the end of induction (EOI) received G 1000mg (D1 every 2mo, for 24mo), and Len (10mg, D1–21 monthly, 12mo). Primary endpoints: C1 DLTs, safety/tolerability, CR rate at EOI (modified Lugano criteria). Results: At the interim data cut-off (7/6/2018), 52 pts were enrolled: 9 discontinued the study (adverse events [AE], n=3; death due to PD, n=4; pt withdrawal, n=1; other, n=1). Median pt age was 62 (range 32–87) years; 58% FLIPI 3–5; 79% ≥2 prior therapy lines; 50% refractory to last treatment. Grade ≥3 AEs were experienced by 75% of pts: neutropenia (46%), thrombocytopenia (17%), anemia (12%) and infections (12%) were most common. AEs leading to Len dose reduction/interruption occurred in 31%/52% of pts. One Grade 5 AE was reported (septic shock after PD in pt receiving subsequent therapy). RP2D: Pola 1.4mg/kg + Len 20mg. Preliminary efficacy data suggest high activity (Table). Median PFS not reached (median follow-up duration 8.95mo; efficacy-evaluable population [EEP]). Conclusions: The safety profile of Pola-G-Len is consistent with known profiles of the individual drugs. Response rates at EOI with Pola-G-Len are promising, with high CR compared with available R/R FL treatments. Responses at EOI (EEP; RP2D; N=18). Clinical trial information: NCT02600897. [Table: see text]
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Affiliation(s)
| | - Brad Kahl
- Division of Oncology, Washington University, St Louis, MO
| | - Lalita Banerjee
- Oncology Centre, Maidstone and Tonbridge Wells Hospital, Kent, United Kingdom
| | - Andrew McMillan
- Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Radhakrishnan Ramchandren
- Division of Oncology, University of Tennessee, Knoxville, TN; Barbara Ann Karmanos Cancer Institute, Detroit, MI
| | - Fiona Miall
- Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Javier Briones
- Department of Hematology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | - Naomi Chang
- F. Hoffmann-La Roche Ltd, Mississauga, ON, Canada
| | | | - Pau Abrisqueta Costa
- Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Barcelona, Spain
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12
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Martínez‐Calle N, Hartley S, Ahearne M, Kasenda B, Beech A, Knight H, Balotis C, Kennedy B, Wagner S, Dyer MJS, Smith D, McMillan AK, Miall F, Bishton M, Fox CP. Kinetics of T‐cell subset reconstitution following treatment with bendamustine and rituximab for low‐grade lymphoproliferative disease: a population‐based analysis. Br J Haematol 2018; 184:957-968. [DOI: 10.1111/bjh.15722] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/05/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Nicolás Martínez‐Calle
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
| | - Sarah Hartley
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
| | - Matthew Ahearne
- Haematology Department University Hospitals of Leicester NHS Trust Leicester UK
| | - Benjamin Kasenda
- Department of Medical Oncology & Department of Haematology University Hospital Basel Basel Switzerland
| | - Amy Beech
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
| | - Helen Knight
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
| | - Constantine Balotis
- Haematology Department University Hospitals of Leicester NHS Trust Leicester UK
| | - Ben Kennedy
- Haematology Department University Hospitals of Leicester NHS Trust Leicester UK
| | - Simon Wagner
- Haematology Department University Hospitals of Leicester NHS Trust Leicester UK
| | - Martin J. S. Dyer
- Ernest and Helen Scott Haematological Research Institute University of Leicester Leicester UK
| | - Dean Smith
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
| | - Andrew K. McMillan
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
| | - Fiona Miall
- Haematology Department University Hospitals of Leicester NHS Trust Leicester UK
| | - Mark Bishton
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
| | - Christopher P. Fox
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
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13
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Eyre TA, Phillips EH, Linton KM, Arumainathan A, Kassam S, Gibb A, Allibone S, Radford J, Peggs K, Burton C, Stewart G, LeDieu R, Booth C, Osborne WL, Miall F, Eyre DW, Ardeshna KM, Collins GP. Results of a multicentre UK-wide retrospective study evaluating the efficacy of brentuximab vedotin in relapsed, refractory classical Hodgkin lymphoma in the transplant naive setting. Br J Haematol 2017; 179:471-479. [PMID: 28857136 DOI: 10.1111/bjh.14898] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 07/18/2017] [Indexed: 11/29/2022]
Abstract
Relapsed or refractory classical Hodgkin lymphoma (cHL) is associated with a poor outcome when standard chemotherapy fails. Brentuximab vedotin (BV) is an anti-CD30 monoclonal antibody-drug conjugate licensed for use at relapse after autologous stem cell transplant (ASCT) or following two prior therapies in those unsuitable for ASCT. There are limited data assessing the ability of BV to enable curative SCT. We performed a UK-wide retrospective study of 99 SCT-naïve relapsed/refractory cHL. All had received 2 prior lines and were deemed fit for transplant but had an insufficient remission to proceed. The median age was 32 years. Most had nodular sclerosis subtype, Eastern Cooperative Oncology Group performance status 0-1 and advanced stage disease. The median progression-free survival (PFS) was 5·6 months and median overall survival (OS) was 37·2 months. The overall response rate was 56% (29% complete response; 27% partial response). 61% reached SCT: 34% immediately post-BV and 27% following an inadequate BV response but were salvaged and underwent deferred SCT. Patients consolidated with SCT had a superior PFS and OS to those not receiving SCT (P < 0·001). BV is an effective, non-toxic bridge to immediate SCT in 34% and deferred SCT in 27%. 39% never reached SCT with a PFS of 3·0 months, demonstrating the unmet need to improve outcomes in those unsuitable for SCT post-BV.
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Affiliation(s)
- Toby A Eyre
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Elizabeth H Phillips
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kim M Linton
- Department of Medical Oncology, The Christie Hospital NHS Trust, Manchester, UK
| | | | - Shireen Kassam
- Department of Haematology, Kings College London Hospitals NHS Foundation Trust Denmark Hill, London, UK
| | - Adam Gibb
- Department of Medical Oncology, The Christie Hospital NHS Trust, Manchester, UK
| | - Suzanne Allibone
- Department of Medical Oncology, The Christie Hospital NHS Trust, Manchester, UK
| | - John Radford
- Department of Medical Oncology, The Christie Hospital NHS Trust, Manchester, UK
| | - Karl Peggs
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Cathy Burton
- Department of Haematology, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Gillian Stewart
- Department of Haematology, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Rifca LeDieu
- Department of Haematology, St Bartholomew's Hospital, London, UK
| | - Catherine Booth
- Department of Haematology, St Bartholomew's Hospital, London, UK
| | - Wendy L Osborne
- Department of Haematology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Fiona Miall
- Department of Haematology University Hospitals of Leicester NHS Trust, Leicester, UK
| | - David W Eyre
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kirit M Ardeshna
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Graham P Collins
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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14
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Gibb A, Pirrie S, Linton K, Paterson K, Davies A, Collins G, Menne T, McKay P, Fields P, Miall F, Nagy E, Wheatley K, Warbey V, Barrington S, Radford J. RESULTS OF a PHASE II STUDY OF BRENTUXIMAB VEDOTIN IN THE FIRST LINE TREATMENT OF HODGKIN LYMPHOMA PATIENTS CONSIDERED UNSUITABLE FOR STANDARD CHEMOTHERAPY (BREVITY). Hematol Oncol 2017. [DOI: 10.1002/hon.2437_68] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A. Gibb
- Christie Hospital; The Christie NHS Foundation Trust; Manchester UK
| | - S. Pirrie
- CRCTU, Part of the Bloodwise Funded Trials Acceleration Programme; University of Birmingham; Birmingham UK
| | - K. Linton
- Manchester Academic Health Science Centre; University of Manchester and The Christie NHS Foundation Trust; Manchester UK
| | - K. Paterson
- CRCTU, Part of the Bloodwise Funded Trials Acceleration Programme; University of Birmingham; Birmingham UK
| | - A. Davies
- Cancer Research UK Centre, Cancer Sciences Unit, Faculty of Medicine; University of Southampton; Southampton UK
| | - G. Collins
- Churchill Hospital; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - T. Menne
- Freeman Hospital; Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle UK
| | - P. McKay
- Haematology; The Beatson West of Scotland Cancer Centre; Glasgow UK
| | - P. Fields
- Guy's Hospital; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - F. Miall
- Leicester Royal Infirmary; University Hospitals of Leicester NHS Foundation Trust; Leicester UK
| | - E. Nagy
- CRCTU, Part of the Bloodwise Funded Trials Acceleration Programme; University of Birmingham; Birmingham UK
| | - K. Wheatley
- CRCTU, Part of the Bloodwise Funded Trials Acceleration Programme; University of Birmingham; Birmingham UK
| | - V. Warbey
- KCL and Guys' & St Thomas PET Imaging Centre, Division of Imaging and Biomedical Engineering; Kings College London; London UK
| | - S. Barrington
- KCL and Guys' & St Thomas PET Imaging Centre, Division of Imaging and Biomedical Engineering; Kings College London; London UK
| | - J. Radford
- Manchester Academic Health Science Centre; University of Manchester and The Christie NHS Foundation Trust; Manchester UK
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15
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Eyre T, Phillips E, Linton K, Kassam S, Gibb A, Allibone S, Peggs K, Burton C, Stewart G, Ledieu R, Booth C, Osborne W, Miall F, Eyre D, Ardeshna K, Collins G. RESULTS OF a MULTICENTRE UK-WIDE STUDY EVALUATING THE EFFICACY OF BRENTUXIMAB VEDOTIN IN RELAPSED, REFRACTORY CLASSICAL HODGKIN LYMPHOMA IN THE PRE-TRANSPLANT NAÏVE SETTING. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- T.A. Eyre
- Haematology; Oxford University Hospitals NHS Trust; Oxford UK
| | - E.H. Phillips
- Department of Haematology; University College London Hospitals NHS Foundation Trust; London UK
| | - K.M. Linton
- Department of Medical Oncology; The Christie Hospital NHS Trust; UK
| | - S. Kassam
- Department of Haematology; Kings College London Hospitals NHS Foundation Trust; UK
| | - A. Gibb
- Department of Medical Oncology; The Christie Hospital NHS Trust; UK
| | - S. Allibone
- Department of Medical Oncology; The Christie Hospital NHS Trust; UK
| | - K. Peggs
- Department of Haematology; University College London Hospitals NHS Foundation Trust; London UK
| | - C. Burton
- Department of Haematology; Leeds Teaching Hospital NHS Trust; Leeds UK
| | - G. Stewart
- Department of Haematology; Leeds Teaching Hospital NHS Trust; Leeds UK
| | - R. Ledieu
- Department of Haematology; St Bartholomew's Hospital; London UK
| | - C. Booth
- Department of Haematology; St Bartholomew's Hospital; London UK
| | - W. Osborne
- Department of Haematology; Newcastle upon Tyne NHS Foundation Trust; Newcastle UK
| | - F. Miall
- Department of Haematology; University Hospitals of Leicester NHS Trust; Leicester UK
| | - D.W. Eyre
- Nuffield Department of Medicine; University of Oxford; Oxford UK
| | - K. Ardeshna
- Department of Haematology; University College London Hospitals NHS Foundation Trust; London UK
| | - G.P. Collins
- Haematology; Oxford University Hospitals NHS Trust; Oxford UK
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16
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Webster A, Crea P, Bamford MW, Hew R, Griffin Y, Miall F. Enteropathy-associated T-cell lymphoma presenting as cutaneous deposits. Br J Haematol 2016; 176:7. [DOI: 10.1111/bjh.14375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Amy Webster
- Department of Haematology; University Hospitals of Leicester NHS Trust; Leicester UK
| | - Philip Crea
- Department of Haematology; University Hospitals of Leicester NHS Trust; Leicester UK
| | - Mark W. Bamford
- Department of Histopathology; University Hospitals of Leicester NHS Trust; Leicester UK
| | - Roger Hew
- Department of Histopathology; University Hospitals of Leicester NHS Trust; Leicester UK
| | - Yvette Griffin
- Department of Radiology; University Hospitals of Leicester NHS Trust; Leicester UK
| | - Fiona Miall
- Department of Haematology; University Hospitals of Leicester NHS Trust; Leicester UK
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17
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Ladani S, Valassiadou K, Griffin Y, Miall F. Use of 18F-fludeoxyglucose positron emission tomography-CT in the management of breast implant-associated anaplastic large cell lymphoma. BJR Case Rep 2016; 2:20150424. [PMID: 30459981 PMCID: PMC6243353 DOI: 10.1259/bjrcr.20150424] [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] [Received: 10/28/2015] [Revised: 02/28/2016] [Accepted: 03/08/2016] [Indexed: 11/05/2022] Open
Abstract
The prognosis and preferred management of breast implant-associated anaplastic large cell lymphoma is dependent on whether lymphoproliferative cells are confined to within the fibrous capsule, in an effusion or lining the fibrous capsule, or if there is spread beyond the capsule in the form of a mass lesion. We describe a case where 18F-fludeoxyglucose positron emission tomography-CT was used to confirm localized disease and guide management decisions.
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Affiliation(s)
- Sapna Ladani
- Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kalliope Valassiadou
- Department of Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Yvette Griffin
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Fiona Miall
- Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester, UK
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18
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Ardeshna KM, Qian W, Smith P, Braganca N, Lowry L, Patrick P, Warden J, Stevens L, Pocock CFE, Miall F, Cunningham D, Davies J, Jack A, Stephens R, Walewski J, Ferhanoglu B, Bradstock K, Linch DC. Rituximab versus a watch-and-wait approach in patients with advanced-stage, asymptomatic, non-bulky follicular lymphoma: an open-label randomised phase 3 trial. Lancet Oncol 2014; 15:424-35. [PMID: 24602760 DOI: 10.1016/s1470-2045(14)70027-0] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [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] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients with advanced-stage, low-tumour-burden follicular lymphoma have conventionally undergone watchful waiting until disease progression. We assessed whether rituximab use could delay the need for chemotherapy or radiotherapy compared with watchful waiting and the effect of this strategy on quality of life (QoL). METHODS Asymptomatic patients (aged ≥18 years) with low-tumour-burden follicular lymphoma (grades 1, 2, and 3a) were randomly assigned centrally (1:1:1), by the minimisation approach stratified by institution, grade, stage, and age, to watchful waiting, rituximab 375 mg/m(2) weekly for 4 weeks (rituximab induction), or rituximab induction followed by a maintenance schedule of 12 further infusions given at 2-monthly intervals for 2 years (maintenance rituximab). On Sept 30, 2007, recruitment into the rituximab induction group was closed and the study was amended to a two-arm study. The primary endpoints were time to start of new treatment and QoL at month 7 (ie, 6 months after completion of rituximab induction). All randomly assigned patients were included in the analysis of time to start of new treatment on an intention-to-treat basis. The main study is now completed and is in long-term follow-up. The study is registered with ClinicalTrials.gov, NCT00112931. FINDINGS Between Oct 15, 2004, and March 25, 2009, 379 patients from 118 centres in the UK, Australia, New Zealand, Turkey, and Poland were randomly assigned to watchful waiting or maintenance rituximab. 84 patients were recruited to the rituximab induction group before it was closed early. There was a significant difference in the time to start of new treatment, with 46% (95% CI 39-53) of patients in the watchful waiting group not needing treatment at 3 years compared with 88% (83-92) in the maintenance rituximab group (hazard ratio [HR] 0·21, 95% CI 0·14-0·31; p<0·0001). 78% (95% CI 69-87) of patients in the rituximab induction group did not need treatment at 3 years, which was significantly more than in the watchful waiting group (HR 0·35, 95% CI 0·22-0·56; p<0·0001), but no different compared with the maintenance rituximab group (0·75, 0·41-1·34; p=0·33). Compared with the watchful waiting group, patients in the maintenance rituximab group had significant improvements in the Mental Adjustment to Cancer scale score (p=0·0004), and Illness Coping Style score (p=0·0012) between baseline and month 7. Patients in the rituximab induction group did not show improvements in their QoL compared with the watchful waiting group. There were 18 serious adverse events reported in the rituximab groups (four in the rituximab induction group and 14 in the maintenance rituximab group), 12 of which were grade 3 or 4 (five infections, three allergic reactions, and four cases of neutropenia), all of which fully resolved. INTERPRETATION Rituximab monotherapy should be considered as a treatment option for patients with asymptomatic, advanced-stage, low-tumour-burden follicular lymphoma. FUNDING Cancer Research UK, Lymphoma Research Trust, Lymphoma Association, and Roche.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Asymptomatic Diseases
- Australia
- Disease Progression
- Disease-Free Survival
- Drug Administration Schedule
- Europe
- Female
- Humans
- Intention to Treat Analysis
- Kaplan-Meier Estimate
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Male
- Middle Aged
- Neoplasm Grading
- Neoplasm Staging
- New Zealand
- Patient Selection
- Proportional Hazards Models
- Quality of Life
- Risk Factors
- Rituximab
- Time Factors
- Treatment Outcome
- Watchful Waiting
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Affiliation(s)
- Kirit M Ardeshna
- Department of Haematology, University College Hospital, London, UK.
| | - Wendi Qian
- Cambridge Clinical Trials Unit-Cancer Theme, Medical Research Council Biostatistics Unit Hub for Trials Methodology, Cambridge, UK
| | - Paul Smith
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | | | - Lisa Lowry
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | - Pip Patrick
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | - June Warden
- School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester, UK
| | | | | | - Fiona Miall
- Department of Haematology, Leicester Royal Infirmary, Leicester, UK
| | | | - John Davies
- Department of Haematology, Western General Hospital, Edinburgh, UK
| | - Andrew Jack
- Haematological Malignancy Diagnostic Service, St James' Institute, Leeds, UK
| | | | - Jan Walewski
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie Memorial Institute and Cancer Centre, Warsaw, Poland
| | - Burhan Ferhanoglu
- Cerrahpasa Medical Faculty, Department of Internal Medicine Division of Hematology, Istanbul University, Istanbul, Turkey
| | - Ken Bradstock
- Department of Haematology, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
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Ahearne MJ, Willimott S, Piñon L, Kennedy DB, Miall F, Dyer MJS, Wagner SD. Enhancement of CD154/IL4 proliferation by the T follicular helper (Tfh) cytokine, IL21 and increased numbers of circulating cells resembling Tfh cells in chronic lymphocytic leukaemia. Br J Haematol 2013; 162:360-70. [DOI: 10.1111/bjh.12401] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/16/2013] [Indexed: 01/27/2023]
Affiliation(s)
- Matthew J. Ahearne
- Department of Cancer Studies and Molecular Medicine; MRC Toxicology Unit; University of Leicester; Leicester; UK
| | - Shaun Willimott
- Department of Cancer Studies and Molecular Medicine; MRC Toxicology Unit; University of Leicester; Leicester; UK
| | - Lucia Piñon
- Department of Cancer Studies and Molecular Medicine; MRC Toxicology Unit; University of Leicester; Leicester; UK
| | | | - Fiona Miall
- Department of Haematology; Leicester Royal Infirmary; Leicester; UK
| | | | - Simon D. Wagner
- Department of Cancer Studies and Molecular Medicine; MRC Toxicology Unit; University of Leicester; Leicester; UK
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Pepper C, Majid A, Lin TT, Hewamana S, Pratt G, Walewska R, Gesk S, Siebert R, Wagner S, Kennedy B, Miall F, Davis ZA, Tracy I, Gardiner AC, Brennan P, Hills RK, Dyer MJS, Oscier D, Fegan C. Defining the prognosis of early stage chronic lymphocytic leukaemia patients. Br J Haematol 2011; 156:499-507. [PMID: 22171799 DOI: 10.1111/j.1365-2141.2011.08974.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Approximately 70% of chronic lymphocytic leukaemia (CLL) patients present with early stage disease, therefore defining which patients will progress and require treatment is a major clinical challenge. Here, we present the largest study of prognostic markers ever carried out in Binet stage A patients (n = 1154) with a median follow-up of 8 years. We assessed the prognostic impact of lymphocyte doubling time (LDT), immunoglobulin gene (IGHV) mutation status, CD38 expression, ZAP-70 expression and fluorescence in situ hybridization (FISH) cytogenetics with regards to time to first treatment (TTFT) and overall survival (OS). Univariate analysis revealed LDT as the most prognostic parameter for TTFT, with IGHV mutation status most prognostic for OS. CD38 expression, ZAP-70 expression and FISH were also prognostic variables; combinations of these markers increased prognostic power in concordant cases. Multivariate analysis revealed that only LDT, IGHV mutation status, CD38 and age at diagnosis were independent prognostic variables for TTFT and OS. Therefore, IGHV mutation status and CD38 expression have independent prognostic value in early stage CLL and should be performed as part of the routine diagnostic workup. ZAP-70 expression and FISH were not independent prognostic markers in early stage disease and can be omitted at diagnosis but FISH analysis should be undertaken at disease progression to direct treatment strategy.
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Affiliation(s)
- Chris Pepper
- School of Medicine, Cardiff University, Cardiff, UK
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Majid A, Richards T, Dusanjh P, Kennedy DBJ, Miall F, Gesk S, Siebert R, Wagner SD, Dyer MJS. TP53 codon 72 polymorphism in patients with chronic lymphocytic leukaemia: identification of a subgroup with mutated IGHV genes and poor clinical outcome. Br J Haematol 2011; 153:533-5. [PMID: 21323870 DOI: 10.1111/j.1365-2141.2010.08484.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Majid A, Lin TT, Best G, Fishlock K, Hewamana S, Pratt G, Yallop D, Buggins AGS, Wagner S, Kennedy BJ, Miall F, Hills R, Devereux S, Oscier DG, Dyer MJS, Fegan C, Pepper C. CD49d is an independent prognostic marker that is associated with CXCR4 expression in CLL. Leuk Res 2010; 35:750-6. [PMID: 21093051 DOI: 10.1016/j.leukres.2010.10.022] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 10/23/2010] [Accepted: 10/24/2010] [Indexed: 11/16/2022]
Abstract
The world of chronic lymphocytic leukemia (CLL) research is awash with prognostic markers. However, very few of the current group play a clearly defined role in the pathology of this disease and even fewer represent a tractable therapeutic target. One such marker that fulfils both of these criteria is the integrin CD49d. This molecule been implicated in the capacity of CLL cells to migrate into lymphoid tissues and there is a CD49d blocking antibody, Natalizumab, currently in clinical trials. Here we carried out the largest multi-centre evaluation of CD49d as a prognostic marker in 652 primary CLL samples. We confirm that CD49d is predictive for time to first treatment (P<0.0001) and overall survival (P<0.0001) and increases the prognostic power of CD38, ZAP-70 and IGHV gene mutation status in concordant cases. Furthermore, CD49d retained independent prognostic significance in multivariate analysis. In contrast to previous studies, we showed no correlation between CD49d expression and in vitro resistance to fludarabine in liquid cultures (P=0.28) but CD49d(hi) cells were significantly more resistant than CD49d(lo) cells when assays were carried out on fibronectin-coated plates (P=0.03). Furthermore, we showed for the first time that the expression of CD49d is strongly associated with expression of the chemokine receptor CXCR4 suggesting a co-ordinated role for these molecules in the trafficking of CLL cells to the lymphoid tissues. Taken together, our data support the introduction of CD49d into routine immunophenotyping panels for CLL and indicate that the therapeutic targeting of this molecule may prove useful in this disease.
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Affiliation(s)
- Aneela Majid
- Medical Research Council (MRC) Toxicology Unit, University of Leicester, Leicester, UK
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Miall F, Rye A, Fraser M, Hunter A, Snowden JA. Human parainfluenza type 4 infection: a case report highlighting pathogenicity and difficulties in rapid diagnosis in the post-transplant setting. Bone Marrow Transplant 2002; 29:541-2. [PMID: 11960279 DOI: 10.1038/sj.bmt.1703402] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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