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Saifi O, Lester SC, Rule WG, Breen W, Stish BJ, Rosenthal A, Munoz J, Lin Y, Johnston P, Ansell SM, Paludo J, Khurana A, Bisneto JV, Wang Y, Iqbal M, Moustafa MA, Murthy HS, Kharfan-Dabaja M, Peterson JL, Hoppe BS. Consolidative Radiotherapy for Residual PET-Avid Disease on Day +30 Post CAR T-Cell Therapy in Non-Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2023; 117:S52. [PMID: 37784518 DOI: 10.1016/j.ijrobp.2023.06.335] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Up to30% of non-Hodgkin lymphoma (NHL) patients achieve a partial response (PR) to anti-CD19 Chimeric Antigen Receptor T-cell Therapy (CART) on day +30. Most PR patients relapse and only 30% achieve spontaneous complete response (CR) without additional therapies. This study is the first to report on the role of consolidative radiotherapy (cRT) for PR PET-avid disease on day +30 post-CART in NHL. MATERIALS/METHODS Aretrospective review across 3 institutions from 2018 to 2022 identified 60 patients with B-cell NHL who received CART and achieved PR (Deauville 4-5) with <5 PET-avid disease sites on day +30. Progression-free survival (PFS) was defined from CART infusion to any disease progression. Overall survival (OS) was defined from CART infusion to death. Local relapse-free survival (LRFS), calculated based on the total number of PR sites, was defined from CART infusion to local relapse (LR) in the PR site identified on day +30. cRT was defined as comprehensive (compRT) - treated all PR PET-avid sites - or focal (focRT). RESULTS Followingday +30 PET scan, 45 PR patients were observed and 15 received cRT. Only one patient received consolidative systemic therapy and belonged to the cRT group. Prior to CART, bridging RT was given to 13 patients (9 in observation group and 4 in cRT group). There were no significant differences in the pre-CART and day +30 baseline characteristics, including the median size and SUVmax of the PR sites, between the two groups. However, the median number of PR sites on day +30 was higher in the cRT group (2 [range 1-3] vs 1 [range 1-3], p = 0.003). The median equivalent 2 Gy dose was 39.1 (Interquartile range 36.8-41) Gy, and the most common cRT regimen was 37.5 Gy in 15 fractions. The median follow-up was 21 months. Among the observed patients, 15 (33%) achieved spontaneous CR, and 27 (60%) experienced disease progression with all relapses involving the initial PR sites. Among patients who received cRT, 10 (67%) achieved CR, and 3 (20%) had disease progression with no relapses in the radiated PR sites. None of the 10 cRT patients achieving CR relapsed or required subsequent therapies. The 2-year PFS was 80% and 37% (p = 0.012) and the 2-year OS was 78% and 43% (p = 0.12) in the cRT and observation groups, respectively. Patients consolidated with compRT (n = 12) had superior 2-year PFS (92% vs 37%, p = 0.003) and 2-year OS (86% vs 43%, p = 0.048) compared to observed or focRT patients (n = 48). There were no grade 3+ RT-related toxicities. A total of 90 PR sites were identified; 64 were observed and 26 received cRT. Fourteen (22%) observed PR sites achieved spontaneous sustained CR and 42 (66%) experienced LR. Twenty-four (92%) PR sites consolidated with cRT achieved sustained CR and none experienced LR. The 2-year LRFS was 100% in the cRT sites and 31% in the observed sites (p<0.001). CONCLUSION NHL patients who achieve PR by PET to CART are at high risk of local progression. cRT for residual PET-avid disease on day +30 post-CART appears to alter the pattern of relapse and improve LRFS and PFS.
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Affiliation(s)
- O Saifi
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - S C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - W G Rule
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - W Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - B J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - A Rosenthal
- Division of Hematology, Mayo Clinic, Phoenix, AZ
| | - J Munoz
- Division of Hematology, Mayo Clinic, Phoenix, AZ
| | - Y Lin
- Division of Experimental Pathology, Mayo Clinic, Rochester, MN; Division of Hematology, Mayo Clinic, Rochester, MN
| | - P Johnston
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - S M Ansell
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - J Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - A Khurana
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Y Wang
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - M Iqbal
- Division of Hematology, Mayo Clinic, Jacksonville, FL
| | | | - H S Murthy
- Division of Hematology, Mayo Clinic, Jacksonville, FL
| | | | - J L Peterson
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - B S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
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D'Sa S, Matous JV, Advani R, Buske C, Castillo JJ, Gatt M, Kapoor P, Kersten MJ, Leblond V, Leiba M, Palomba ML, Paludo J, Qiu L, Sarosiek S, Shadman M, Talaulikar D, Tam CS, Tedeschi A, Thomas SK, Tohidi-Esfahani I, Trotman J, Varettoni M, Vos J, Garcia-Sanz R, San-Miguel J, Dimopoulos MA, Treon SP, Kastritis E. Report of consensus panel 2 from the 11th international workshop on Waldenström's macroglobulinemia on the management of relapsed or refractory WM patients. Semin Hematol 2023; 60:80-89. [PMID: 37147252 DOI: 10.1053/j.seminhematol.2023.03.003] [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: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
The consensus panel 2 (CP2) of the 11th International Workshop on Waldenström's macroglobulinemia (IWWM-11) has reviewed and incorporated current data to update the recommendations for treatment approaches in patients with relapsed or refractory WM (RRWM). The key recommendations from IWWM-11 CP2 include: (1) Chemoimmunotherapy (CIT) and/or a covalent Bruton tyrosine kinase (cBTKi) strategies are important options; their use should reflect the prior upfront strategy and are subject to their availability. (2) In selecting treatment, biological age, co-morbidities and fitness are important; nature of relapse, disease phenotype and WM-related complications, patient preferences and hematopoietic reserve are also critical factors while the composition of the BM disease and mutational status (MYD88, CXCR4, TP53) should also be noted. (3) The trigger for initiating treatment in RRWM should utilize knowledge of patients' prior disease characteristics to avoid unnecessary delays. (4) Risk factors for cBTKi related toxicities (cardiovascular dysfunction, bleeding risk and concurrent medication) should be addressed when choosing cBTKi. Mutational status (MYD88, CXCR4) may influence the cBTKi efficacy, and the role of TP53 disruptions requires further study) in the event of cBTKi failure dose intensity could be up titrated subject to toxicities. Options after BTKi failure include CIT with a non-cross-reactive regimen to one previously used CIT, addition of anti-CD20 antibody to BTKi, switching to a newer cBTKi or non-covalent BTKi, proteasome inhibitors, BCL-2 inhibitors, and new anti-CD20 combinations are additional options. Clinical trial participation should be encouraged for all patients with RRWM.
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Affiliation(s)
- S D'Sa
- UCLH Centre for Waldenström Macroglobulinaemia and Related Conditions, University College London Hospitals NHS Foundation Trust, London, UK.
| | - J V Matous
- Colorado Blood Cancer Institute, Sarah Cannon Research Institute, Denver, CO
| | - R Advani
- Stanford University Medical Center, Stanford, CA
| | - C Buske
- University Hospital Ulm, Ulm, Germany
| | - J J Castillo
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - M Gatt
- Hadassah University Medical Center, Jerusalem, Israel
| | | | - M J Kersten
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Cancer Center Amsterdam/LYMMCARE, Amsterdam, Netherlands
| | - V Leblond
- Groupe Hospitalier Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - M Leiba
- Assuta Ashdod University Hospital; Faculty of Health Science, Ben-Gurion University of the Negev, Negev, Israel Memorial Sloan Kettering Cancer Center, New York, NY
| | - M L Palomba
- Memorial Sloan Kettering Cancer Center, New York NY US
| | | | - L Qiu
- National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - S Sarosiek
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - D Talaulikar
- ANU College of Health and Medicine, Canberra, Australia
| | - C S Tam
- Alfred Health, Monash University, Melbourne, Australia
| | - A Tedeschi
- A. O. Ospedale Niguarda Ca' Granda, Milan, Italy
| | - S K Thomas
- University of Texas, MD Anderson Cancer Center, Houston TX USA
| | - I Tohidi-Esfahani
- Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
| | - J Trotman
- Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
| | - M Varettoni
- Division of Hematology, Fondazione iRCCS Policlinico, San Matteo, Italy
| | - Jmi Vos
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Cancer Center Amsterdam/LYMMCARE, Amsterdam, Netherlands
| | - R Garcia-Sanz
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca, CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
| | - J San-Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Centro de Investigación Biomédica en Red Cáncer, Pamplona, Spain
| | - M A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - S P Treon
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - E Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
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Tawfiq R, Abeykoon J, Zanwar S, Paludo J, Kapoor P. P1145: OUTCOMES AND TREATMENT PATTERNS AFTER FIRST RELAPSE IN PATIENTS WITH WALDENSTRÖM MACROGLOBULINEMIA. Hemasphere 2022. [PMCID: PMC9431189 DOI: 10.1097/01.hs9.0000847448.06276.e7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Tun AM, Wang Y, Maliske S, Farooq U, Micallef IN, Inwards DJ, Porrata LF, Ansell SM, Rosenthal AC, Kharfan‐Dabaja M, Link BK, Villasboas JC, Paludo J, Cerhan JR, Habermann TM, Witzig TE, Nowakowski GS, Johnston PB. IMPACT OF TIME TO RELAPSE AND RESPONSE TO SALVAGE THERAPY ON POST AUTOLOGOUS STEM CELL TRANSPLANT OUTCOMES IN RELAPSED OR REFRACTORY DIFFUSE LARGE B‐CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.98_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)
- A. M Tun
- The university of Kansas Division of hematologic malignancies and cellular therapeutics Westwood Kansas USA
| | - Y Wang
- Mayo Clinic Division of Hematology Rochester Minnesota USA
| | - S Maliske
- University of Iowa Division of Hematology, Oncology, and Blood & Marrow Transplantation Iowa City USA
| | - U Farooq
- University of Iowa Division of Hematology, Oncology, and Blood & Marrow Transplantation Iowa City USA
| | - I. N Micallef
- Mayo Clinic Division of Hematology Rochester Minnesota USA
| | | | - L. F Porrata
- Mayo Clinic Division of Hematology Rochester Minnesota USA
| | - S. M Ansell
- Mayo Clinic Division of Hematology Rochester Minnesota USA
| | - A. C Rosenthal
- Mayo Clinic Division of Hematology Mayo Clinic Phoenix USA
| | | | - B. K Link
- University of Iowa Division of Hematology, Oncology, and Blood & Marrow Transplantation Iowa City USA
| | | | - J Paludo
- Mayo Clinic Division of Hematology Rochester Minnesota USA
| | - J. R Cerhan
- Mayo Clinic Department of Health Sciences Research Rochester USA
| | - T. M Habermann
- Mayo Clinic Division of Hematology Rochester Minnesota USA
| | - T. E Witzig
- Mayo Clinic Division of Hematology Rochester Minnesota USA
| | | | - P. B Johnston
- Mayo Clinic Division of Hematology Rochester Minnesota USA
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Villa D, Jiang A, Crosbie N, Rule S, McCulloch R, Visco C, Buege MJ, Kumar A, Bond D, Paludo J, Maurer MJ, Thanarajasingam G, Baech J, El‐Galaly T, Kugathasan L, Gerrie AS, Lewis D. TIME TO SECOND LINE BRUTON TYROSINE KINASE THERAPY AND AGE AT ITS INITIATION ARE STRONGLY ASSOCIATED WITH SUBSEQUENT OVERALL SURVIVAL IN PATIENTS WITH FIRST RELAPSE OF MANTLE CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.59_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: 11/10/2022]
Affiliation(s)
- D. Villa
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - A. Jiang
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - N. Crosbie
- University Hospitals Plymouth NHS Trust Haematology Plymouth UK
| | - S. Rule
- University Hospitals Plymouth NHS Trust Haematology Plymouth UK
| | - R. McCulloch
- University Hospitals Plymouth NHS Trust Haematology Plymouth UK
| | - C. Visco
- University of Verona Hematology Verona Italy
| | - M. J. Buege
- Memorial Sloan Kettering Cancer Center Clinical Pharmacy, Lymphoma New York USA
| | - A. Kumar
- Memorial Sloan Kettering Cancer Center Division of Hematologic Malignancies New York USA
| | - D. Bond
- The Ohio State University Hematology Columbus USA
| | - J. Paludo
- Mayo Clinic Hematology Rochester USA
| | - M. J. Maurer
- Mayo Clinic Division of Clinical Trials and Biostatistics Rochester USA
| | | | - J. Baech
- Aalborg University Hospital Haematology Aalborg Denmark
| | - T. El‐Galaly
- Aalborg University Hospital Haematology Aalborg Denmark
| | - L. Kugathasan
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - A. S. Gerrie
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - D. Lewis
- University Hospitals Plymouth NHS Trust Haematology Plymouth UK
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Castillo J, Itchaki G, Paludo J, Varettoni M, Buske C, Eyre T, Chavez J, Shain K, Issa S, Palomba L, Pasvolsky O, Simpson D, Talaulikar D, Tam C, Tedeschi A, Ansell S, Nayak L, Treon S. IBRUTINIB FOR THE TREATMENT OF BING-NEEL SYNDROME: A RETROSPECTIVE, MULTICENTER STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.140_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: 11/12/2022]
Affiliation(s)
- J. Castillo
- Bing Center for Waldenstrom Macroglobulinemia; Dana-Farber Cancer Institute; Boston United States
| | - G. Itchaki
- Hematology; Rabin Medical Center; Petah Tikva Israel
| | - J. Paludo
- Hematology and Oncology; Mayo Clinic; Rochester United States
| | - M. Varettoni
- Hematology; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - C. Buske
- Comprehensive Cancer Center; University Hospital Ulm; Ulm Germany
| | - T. Eyre
- Hematology; Churchill Hospital; Oxford United Kingdom
| | - J. Chavez
- Malignant Hematology; Moffitt Cancer Institute; Tampa United States
| | - K. Shain
- Malignant Hematology; Moffitt Cancer Institute; Tampa United States
| | - S. Issa
- Hematology; Middlemore Hospital; Auckland New Zealand
| | - L. Palomba
- Hematology and Oncology; Memorial Sloan Kettering Cancer Center; New York United States
| | - O. Pasvolsky
- Hematology; Rabin Medical Center; Petah Tikva Israel
| | - D. Simpson
- Hematology; North Shore Hospital; Auckland New Zealand
| | | | - C. Tam
- Hematology; Peter MacCallum Cancer Centre; Melbourne Australia
| | | | - S. Ansell
- Hematology and Oncology; Mayo Clinic; Rochester United States
| | - L. Nayak
- Center for CNS Lymphoma; Dana-Farber Cancer Institute; Boston United States
| | - S. Treon
- Bing Center for Waldenstrom Macroglobulinemia; Dana-Farber Cancer Institute; Boston United States
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Duma N, Azzouqa A, Yadav S, Hoversten K, Reed C, Sitek A, Enninga E, Paludo J, Vera Aguilera J, Lou Y, Molina J, Leventakos K, Kottschade L, Dong H, Mansfield A, Manochakian R, Dronca R, Adjei A. P1.01-17 Immune-Related Adverse Events in Patients with Metastatic Non-Small Cell Lung Cancer: Sex Differences and Response to Therapy. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vera-Aguilera J, Paludo J, Duma N, Tschautscher M, Markovic S. A clinical insight into therapeutic sequence in advanced melanoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx711.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Duma N, Yu C, Paludo J, Aguilera JV, Velez M, Haddox C, Mansfield A, Go R, Adjei A. MA 18.09 Enrollment of Minorities, the Elderly, and Women in Lung Cancer Clinical Trials. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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