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Garcia-Manero G, Podoltsev NA, Othus M, Pagel JM, Radich JP, Fang M, Rizzieri DA, Marcucci G, Strickland SA, Litzow MR, Savoie ML, Medeiros BC, Sekeres MA, Lin TL, Uy GL, Powell BL, Kolitz JE, Larson RA, Stone RM, Claxton D, Essell J, Luger SM, Mohan SR, Moseley A, Appelbaum FR, Erba HP. A randomized phase III study of standard versus high-dose cytarabine with or without vorinostat for AML. Leukemia 2024; 38:58-66. [PMID: 37935977 DOI: 10.1038/s41375-023-02073-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023]
Abstract
Prior experience indicated that use of higher doses of cytarabine during induction for acute myeloid leukemia (AML) with a histone deacetylase inhibitor resulted in high response rates. S1203 was a randomized multicenter trial for previously untreated patients aged 18-60 with AML which compared daunorubicin and cytarabine (DA), idarubicin with higher dose cytarabine (IA) and IA with vorinostat (IA + V). The primary endpoint was event free survival (EFS). 738 patients were randomized: 261 to each DA and IA arms and 216 to the IA + V arm. 96, 456, and 150 patients had favorable-, intermediate-, and unfavorable-risk cytogenetics, respectively. 152 were NPM1 and 158 FLT3 mutated. The overall remission rate was 77.5% including 62.5% CR and 15.0% CRi. No differences in remission, EFS, or overall survival were observed among the 3 arms except for the favorable cytogenetics subset who had improved outcomes with DA and postremission high dose cytarabine. A trend towards increased toxicity was observed with the IA and IA + V arms. The use of higher dose cytarabine during induction therapy in younger patients with AML, with or without vorinostat, does not result in improved outcomes. (Funded by the US National Institutes of Health and others, ClinicalTrials.gov number, NCT01802333.).
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Affiliation(s)
| | | | - Megan Othus
- SWOG Statistics and Data Management Center, Seattle, WA, USA
| | | | | | - Min Fang
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Guido Marcucci
- Ohio State University (Alliance), Columbus, OH, USA
- City of Hope, Duarte, CA, USA
| | - Stephen A Strickland
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
- Sarah Cannon, Nashville, TN, USA
| | | | | | | | - Mikkael A Sekeres
- Cleveland Clinic, Cleveland, OH, USA
- University of Miami, Maiami, FL, USA
| | - Tara L Lin
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Geoffrey L Uy
- Washington University School of Medicine, St. Louis, USA
| | - Bayard L Powell
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | | | | | - David Claxton
- Pennsylvania State Milton S Hershey Medical Center, Hummelstown, USA
| | | | - Selina M Luger
- University of Pennsylvania Abramson Cancer Center, Philadelphia, PA, USA
| | - Sanjay R Mohan
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
- Sarah Cannon, Nashville, TN, USA
| | - Anna Moseley
- SWOG Statistics and Data Management Center, Seattle, WA, USA
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Sehgal A, Hoda D, Riedell PA, Ghosh N, Hamadani M, Hildebrandt GC, Godwin JE, Reagan PM, Wagner-Johnston N, Essell J, Nath R, Solomon SR, Champion R, Licitra E, Fanning S, Gupta N, Dubowy R, D'Andrea A, Wang L, Ogasawara K, Thorpe J, Gordon LI. Lisocabtagene maraleucel as second-line therapy in adults with relapsed or refractory large B-cell lymphoma who were not intended for haematopoietic stem cell transplantation (PILOT): an open-label, phase 2 study. Lancet Oncol 2022; 23:1066-1077. [DOI: 10.1016/s1470-2045(22)00339-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 12/17/2022]
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3
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Sehgal A, Hoda D, Riedell PA, Ghosh N, Hamadani M, Hildebrandt G, Godwin JE, Reagan PM, Wagner-Johnston ND, Essell J, Nath R, Solomon SR, Champion R, Licitra E, Fanning S, Gupta NK, Dubowy RL, D’Andrea A, Wang L, Gordon LI. Lisocabtagene maraleucel (liso-cel) as second-line (2L) therapy for R/R large B-cell lymphoma (LBCL) in patients (pt) not intended for hematopoietic stem cell transplantation (HSCT): Primary analysis from the phase 2 PILOT study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7062 Background: Pts with R/R LBCL after first-line (1L) treatment (tx) who are unable to undergo high-dose chemotherapy (HDCT) and HSCT have poor outcomes and limited tx options. PILOT (NCT03483103) evaluated liso-cel, an autologous, CD19-directed chimeric antigen receptor (CAR) T cell product, as 2L tx in pts with R/R LBCL not intended for HSCT. Methods: Eligible pts were adults with R/R LBCL after 1L tx who were not deemed candidates for HDCT and HSCT by their physician and met ≥ 1 frailty criteria: age ≥ 70 yr, ECOG PS = 2, DLCO ≤ 60%, LVEF < 50%, CrCl < 60 mL/min, or ALT/AST > 2 × ULN. Bridging tx was allowed. Pts received lymphodepletion with cyclophosphamide and fludarabine, followed 2–7 days later by liso-cel at a target dose of 100 × 106 CAR+ T cells. Cytokine release syndrome (CRS) was graded per Lee 2014 criteria and neurological events (NE) per NCI CTCAE, version 4.03. Primary endpoint was ORR per independent review committee (IRC); all pts had ≥ 6 mo follow-up (f/u) from first response. Results: Of 74 pts leukapheresed, 61 received liso-cel and 1 received nonconforming product. Common reasons for pre-infusion dropout included death and loss of eligibility (5 each). For liso-cel–treated pts, median age was 74 yr (range, 53–84; 79% ≥ 70 yr) and 69%, 26%, and 5% met 1, 2, and 3 frailty criteria, respectively; 26% had ECOG PS = 2 and 44% had HCT-CI score ≥ 3. After 1L tx, 54% were chemotherapy refractory, 21% relapsed ≤ 12 mo, and 25% relapsed > 12 mo; 51% of pts received bridging chemotherapy. Median (range) on-study f/u was 12.3 mo (1.2–26.5). ORR and CR rate was 80% and 54%, respectively. Median DOR and PFS was 12.1 mo and 9.0 mo, respectively. Median OS has not been reached (Table). Most frequent tx-emergent AEs (TEAE) were neutropenia (51%), fatigue (39%), and CRS (38%), with grade (gr) 3 CRS in 1 pt (2%) and no gr 4/5 CRS. Any-grade NEs were seen in 31%, gr 3 in 5% (n = 3), and no gr 4/5 NEs; 7% received tocilizumab, 3% corticosteroids, and 20% both for tx of CRS/NEs. Overall, gr ≥ 3 TEAEs occurred in 79%, with gr 5 in 2 pts (both due to COVID-19). Two pts (3%) had gr 3/4 infections and 15 (25%) had gr ≥3 neutropenia at Day 29. Conclusions: In the PILOT study, liso-cel as 2L tx in pts with LBCL who met ≥ 1 frailty criteria and for whom HSCT was not intended demonstrated substantial and durable overall and complete responses, with no new safety concerns. Clinical trial information: NCT03483103. [Table: see text]
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Affiliation(s)
- Alison Sehgal
- University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA
| | - Daanish Hoda
- Intermountain Healthcare, Loveland Clinic for Blood Cancer Therapy, Salt Lake City, UT
| | | | | | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI
| | | | - John E. Godwin
- Providence Cancer Center, Earle A. Chiles Research Institute, Portland, OR
| | | | | | | | | | | | | | | | | | | | | | - Aleco D’Andrea
- Celgene, a Bristol-Myers Squibb Company, Boudry, Switzerland
| | - Lei Wang
- Bristol Myers Squibb, Seattle, WA
| | - Leo I. Gordon
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
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Phillips T, Brunvand M, Chen AI, Essell J, Chiappella A, Diefenbach C, Cheng J, Ramies D, Hirata J, Morschhauser F, Flinn IW. Safety and efficacy of polatuzumab vedotin + obinutuzumab for relapsed/refractory non-Hodgkin lymphomas: A phase IB/II study. Am J Hematol 2022; 97:E24-E27. [PMID: 34731510 DOI: 10.1002/ajh.26400] [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: 06/09/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Tycel Phillips
- Division of Hematology and Oncology University of Michigan Medical School Ann Arbor Michigan USA
| | | | - Andy I. Chen
- Division of Hematology/Medical Oncology Oregon Health & Science University Portland Oregon USA
| | - James Essell
- Blood Cancer Center Oncology Hematology Care Inc. Cincinnati Ohio USA
| | - Annalisa Chiappella
- Department of Hematology Città della Salute e della Scienza Hospital and University Torino Italy
| | - Catherine Diefenbach
- Department of Medicine, Division of Hematology and Medical Oncology Perlmutter Cancer Center at New York University Langone Health New York New York USA
| | - Ji Cheng
- Product Development ‐ Biostatistics F. Hoffmann‐La Roche Ltd Mississauga Ontario Canada
| | - David Ramies
- Genentech, Inc. South San Francisco California USA
| | - Jamie Hirata
- Genentech, Inc. South San Francisco California USA
| | - Franck Morschhauser
- Department of Hematology University Lille, Centre Hospitalier Régional Universitaire Lille, Groupe de Recherche sur les formes Injectables et les Technologies Associées Lille France
| | - Ian W. Flinn
- Department of Medical Oncology Sarah Cannon Research Institute/Tennessee Oncology Nashville Tennessee USA
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Jagasia M, Lazaryan A, Bachier CR, Salhotra A, Weisdorf DJ, Zoghi B, Essell J, Green L, Schueller O, Patel J, Zanin-Zhorov A, Weiss JM, Yang Z, Eiznhamer D, Aggarwal SK, Blazar BR, Lee SJ. ROCK2 Inhibition With Belumosudil (KD025) for the Treatment of Chronic Graft-Versus-Host Disease. J Clin Oncol 2021; 39:1888-1898. [PMID: 33877856 PMCID: PMC8189612 DOI: 10.1200/jco.20.02754] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [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: 09/08/2020] [Revised: 01/08/2021] [Accepted: 02/23/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The rho-associated coiled-coil-containing protein kinase-2 (ROCK2) signaling pathway regulates the Th17/regulatory T cells balance and controls profibrotic pathways. Selective ROCK2 inhibition with belumosudil (KD025) may offer a novel approach to the management of chronic graft-versus-host disease (cGVHD). PATIENTS AND METHODS A phase IIa, open-label, dose-finding study of belumosudil enrolled 54 patients with cGVHD who had received one to three prior lines of therapy (LOTs). The primary end point was overall response rate (ORR). RESULTS The median time from cGVHD diagnosis to enrollment was 20 months. Seventy-eight percent of patients had severe cGVHD, 50% had ≥ 4 organs involved, 73% had cGVHD refractory to their last LOT, and 50% had received ≥ 3 prior LOTs. With an overall median follow-up of 29 months, the ORR (95% CI) with belumosudil 200 mg once daily, 200 mg twice daily, and 400 mg once daily was 65% (38% to 86%), 69% (41% to 89%), and 62% (38% to 82%), respectively. Responses were clinically meaningful, with a median duration of response of 35 weeks, and were associated with quality-of-life improvements and corticosteroid (CS) dose reductions. CS treatment was discontinued in 19% of patients. The failure-free survival rate was 76% (62% to 85%) and 47% (33% to 60%) at 6 and 12 months, respectively. The 2-year overall survival rate was 82% (69% to 90%). Belumosudil was well-tolerated, with low rates of cytopenia. There were no unexpected adverse events and no apparent increased risk of infection, including cytomegalovirus infection and reactivation. CONCLUSION Belumosudil treatment resulted in a high ORR and overall survival rate and demonstrated quality-of-life improvements, CS dose reductions, and limited toxicity. Data from the study indicated that belumosudil may prove to be an effective therapy for patients with treatment-refractory cGVHD.
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Affiliation(s)
- Madan Jagasia
- Prior affiliation: Vanderbilt-Ingram Cancer Center, Nashville, TN
| | | | | | | | | | - Behyar Zoghi
- Texas Transplant Institute, Methodist Hospital, San Antonio, TX
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Godwin JE, Mattar B, Maris M, Bachier C, Stevens DA, Hoda D, Varela JC, Cherry M, Fanning S, Essell J, Yimer H, Courtright J, Sharman J, Trede NS, Youssef M, Lymp J, Shaughnessy P. OUTREACH: PRELIMINARY SAFETY & EFFICACY RESULTS FROM A PHASE 2 STUDY OF LISOCABTAGENE MARALEUCEL (LISO‐CEL) IN THE NONUNIVERSITY SETTING. Hematol Oncol 2021. [DOI: 10.1002/hon.185_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: 11/07/2022]
Affiliation(s)
- J. E. Godwin
- Providence Cancer Center Earle A. Chiles Research Institute Oncology Hematology Clinic Portland Oregon USA
| | - B. Mattar
- Cancer Center of Kansas Internal Medicine Wichita Kansas USA
| | - M. Maris
- Colorado Blood and Cancer Institute and Sarah Cannon Research Institute Hematology/Oncology Denver Colorado USA
| | - C. Bachier
- Sarah Cannon Center for Blood Cancer Hematology Nashville Tennessee USA
| | - D. A. Stevens
- Norton Healthcare Medical Oncology Louisville Kentucky USA
| | - D. Hoda
- Intermountain Healthcare Loveland Clinic for Blood Cancer Therapy Salt Lake City Utah USA
| | - J. C. Varela
- Advent Health Blood and Marrow Transplant Program Orlando Florida USA
| | - M. Cherry
- Atlantic Health System Carol Simon Cancer Center Morristown New Jersey USA
| | - S. Fanning
- Prisma Health Hematology Greenville South Carolina USA
| | - J. Essell
- Oncology Hematology Care Medical Oncology, Hematology, Blood and Marrow Transplantation Cincinnati Ohio USA
| | - H. Yimer
- Texas Oncology‐Tyler Hematology Medical Oncology Tyler Texas USA
| | | | - J. Sharman
- Willamette Valley Cancer Institute Blood Cancers General Oncology Eugene Oregon USA
| | - N. S. Trede
- Bristol Myers Squibb Clinical Development Seattle Washington USA
| | - M. Youssef
- Bristol Myers Squibb Global Drug Development Princeton New Jersey USA
| | - J. Lymp
- Bristol Myers Squibb Cell Therapy Biostatistics Seattle Washington USA
| | - P. Shaughnessy
- Sarah Cannon Transplant and Cellular Therapy Program Methodist Hospital San Antonio Texas USA
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Godwin J, Freytes CO, Maris M, Stevens DA, Hoda D, Mattar B, Varela JC, Cherry M, Essell J, Courtright J, Fanning S, Yimer H, Trede NS, Youssef M, Lymp J, Bachier CR. Outcomes of Treatment with the Chimeric Antigen Receptor (CAR) T Cell Therapy Lisocabtagene Maraleucel (liso-cel) at Nonuniversity Medical Centers (NMCs): Initial Results from the Outreach Study in Patients with Relapsed/Refractory (R/R) Large B-Cell Lymphoma (LBCL). Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00251-7] [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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Pagel JM, Othus M, Garcia-Manero G, Fang M, Radich JP, Rizzieri DA, Marcucci G, Strickland SA, Litzow MR, Savoie ML, Spellman SR, Confer DL, Chell JW, Brown M, Medeiros BC, Sekeres MA, Lin TL, Uy GL, Powell BL, Bayer RL, Larson RA, Stone RM, Claxton D, Essell J, Luger SM, Mohan SR, Moseley A, Erba HP, Appelbaum FR. Rapid Donor Identification Improves Survival in High-Risk First-Remission Patients With Acute Myeloid Leukemia. JCO Oncol Pract 2020; 16:e464-e475. [PMID: 32048933 DOI: 10.1200/jop.19.00133] [Citation(s) in RCA: 4] [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
PURPOSE Patients with acute myeloid leukemia with high-risk cytogenetics in first complete remission (CR1) achieve better outcomes if they undergo allogeneic hematopoietic cell transplantation (HCT) compared with consolidation chemotherapy alone. However, only approximately 40% of such patients typically proceed to HCT. METHODS We used a prospective organized approach to rapidly identify donors to improve the allogeneic HCT rate in adults with high-risk acute myeloid leukemia in CR1. Newly diagnosed patients had cytogenetics obtained at enrollment, and those with high-risk cytogenetics underwent expedited HLA typing and were encouraged to be referred for consultation with a transplantation team with the goal of conducting an allogeneic HCT in CR1. RESULTS Of 738 eligible patients (median age, 49 years; range, 18-60 years of age), 159 (22%) had high-risk cytogenetics and 107 of these patients (67%) achieved CR1. Seventy (65%) of the high-risk patients underwent transplantation in CR1 (P < .001 compared with the historical rate of 40%). Median time to HCT from CR1 was 77 days (range, 20-356 days). In landmark analysis, overall survival (OS) among patients who underwent transplantation was significantly better compared with that of patients who did not undergo transplantation (2-year OS, 48% v 35%, respectively [P = .031]). Median relapse-free survival after transplantation in the high-risk cohort who underwent transplantation in CR1 (n = 70) was 11.5 months (range, 4-47 months), and median OS after transplantation was 14 months (range, 4-44 months). CONCLUSION Early cytogenetic testing with an organized effort to identify a suitable allogeneic HCT donor led to a CR1 transplantation rate of 65% in the high-risk group, which, in turn, led to an improvement in OS when compared with the OS of patients who did not undergo transplantation.
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Affiliation(s)
| | - Megan Othus
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Min Fang
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | | | | | | | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN.,National Marrow Donor Program, Minneapolis, MN
| | - Jeffrey W Chell
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN.,National Marrow Donor Program, Minneapolis, MN
| | - Maria Brown
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | | | | | | | - Geoffrey L Uy
- Washington University School of Medicine, St Louis, MO
| | - Bayard L Powell
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Ruthee-Lu Bayer
- Monter Cancer Center, Northwell Health System, Lake Success, NY
| | | | | | - David Claxton
- Pennsylvania State Milton S. Hershey Medical Center, Hershey, PA
| | | | - Selina M Luger
- University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA
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Davids MS, Kuss BJ, Hillmen P, Montillo M, Moreno C, Essell J, Lamanna N, Nagy Z, Tam CS, Stilgenbauer S, Ghia P, Delgado J, Lustgarten S, Weaver DT, Youssoufian H, Jäger U. Efficacy and Safety of Duvelisib Following Disease Progression on Ofatumumab in Patients with Relapsed/Refractory CLL or SLL in the DUO Crossover Extension Study. Clin Cancer Res 2020; 26:2096-2103. [PMID: 31964785 DOI: 10.1158/1078-0432.ccr-19-3061] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/09/2019] [Accepted: 01/15/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE In the phase III DUO trial, duvelisib, an oral dual PI3K-δ,γ inhibitor, demonstrated significantly improved efficacy versus ofatumumab [median (m) progression-free survival (PFS), 13.3 vs. 9.9 months (HR, 0.52; P < 0.0001); overall response rate [ORR], 74% vs. 45% (P < 0.0001)], with a manageable safety profile in patients with relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). We report results from patients with progressive disease (PD) after ofatumumab who crossed over to duvelisib in the DUO trial. PATIENTS AND METHODS Patients with radiographically confirmed PD after ofatumumab received duvelisib 25 mg twice daily in 28-day cycles until PD, intolerance, death, or study withdrawal. The primary endpoint was ORR per investigator. Secondary endpoints included duration of response (DOR), PFS, and safety. RESULTS As of December 14, 2018, 90 ofatumumab-treated patients in the DUO trial prior to crossover had an ORR of 29%, mDOR of 10.4 months, and mPFS of 9.4 months. After crossover, 77% of patients (69/90) achieved a response, with an mDOR of 14.9 months and mPFS of 15.7 months. Patients with del(17p) and/or TP53 mutations had similar outcomes [ORR, 77% (20/26); mPFS, 14.7 months]. Notably, 73% of patients (47/64) with disease previously refractory to ofatumumab achieved a response. The most frequent any-grade/grade 3/4 treatment-emergent adverse events were diarrhea (47%/23%), neutropenia (26%/23%), pyrexia (24%/4%), cutaneous reactions (23%/4%), and thrombocytopenia (10%/6%). CONCLUSIONS Duvelisib demonstrated high response rates with good durability and a manageable safety profile in patients with R/R CLL/SLL who progressed on ofatumumab, including patients with high-risk disease and disease previously refractory to ofatumumab.
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Affiliation(s)
- Matthew S Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Bryone J Kuss
- Department of Haematology, Flinders Medical Centre and Flinders University, Bedford Park, South Australia, Australia
| | - Peter Hillmen
- St James's University Hospital, Leeds, United Kingdom
| | - Marco Montillo
- Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Nicole Lamanna
- Hematology/Oncology Division, Columbia University Medical Center, New York, New York
| | - Zsolt Nagy
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Constantine S Tam
- St Vincent's Hospital and University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Stephan Stilgenbauer
- Department of Internal Medicine III, Ulm University, Ulm, and Department of Internal Medicine I, Saarland University, Homburg, Germany
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Julio Delgado
- Servicio de Hematología, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | | | | | | | - Ulrich Jäger
- Department of Medicine I, Division of Hematology and Hemostaseology, and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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11
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Burke JM, Shustov A, Essell J, Patel-Donnelly D, Yang J, Chen R, Ye W, Shi W, Assouline S, Sharman J. An Open-label, Phase II Trial of Entospletinib (GS-9973), a Selective Spleen Tyrosine Kinase Inhibitor, in Diffuse Large B-cell Lymphoma. Clin Lymphoma Myeloma Leuk 2018; 18:e327-e331. [PMID: 29934062 PMCID: PMC6857170 DOI: 10.1016/j.clml.2018.05.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/24/2018] [Accepted: 05/30/2018] [Indexed: 12/23/2022]
Abstract
In an open-label, phase II study, we evaluated entospletinib monotherapy for patients with relapsed or refractory diffuse large B-cell lymphoma. Entospletinib had limited activity in these patients. Seventy-four percent of the patients experienced a grade ≥ 3 adverse event. Treatment was interrupted in 42% of the patients, and the drug was discontinued in 19% of the patients.
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Affiliation(s)
- John M Burke
- Rocky Mountain Cancer Centers, The US Oncology Network, Aurora, CO.
| | - Andrei Shustov
- University of Washington School of Medicine, Seattle, WA
| | | | | | - Jay Yang
- Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | | | - Wei Ye
- Gilead Sciences, Inc, Foster City, CA
| | - Wen Shi
- Gilead Sciences, Inc, Foster City, CA
| | - Sarit Assouline
- Gerald Bronfman Centre, McGill University, Montreal, QC, Canada
| | - Jeff Sharman
- Willamette Valley Cancer Institute and Research Center, The US Oncology Network, Eugene, OR
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Berdeja JG, Bauer T, Arrowsmith E, Essell J, Murphy P, Reeves JA, Boccia RV, Donnellan W, Flinn I. Phase II study of bendamustine, bortezomib and dexamethasone (BBD) in the first-line treatment of patients with multiple myeloma who are not candidates for high dose chemotherapy. Br J Haematol 2017; 177:254-262. [PMID: 28169430 DOI: 10.1111/bjh.14536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 09/12/2016] [Accepted: 11/23/2016] [Indexed: 12/01/2022]
Abstract
The combination of bendamustine, bortezomib and dexamethasone (BBD) was evaluated as a first-line therapy for multiple myeloma. The original treatment regimen of bendamustine 80 mg/m2 , days 1, 4; bortezomib 1·3 mg/m2 , days 1, 4, 8, 11; dexamethasone 40 mg, days 1, 2, 3, 4 on a 28-day cycle (up to 8 cycles) was efficacious but determined relatively toxic in an interim analysis. The regimen was amended to bendamustine 80 mg/m2 , days 1, 2; bortezomib 1·3 mg/m2 , days 1, 8, 15; dexamethasone 20 mg, days 1, 2, 8, 9, 15, 16 every 28 days (up to 8 cycles), then maintenance 1·3 mg/m2 IV bortezomib every 2 weeks. Fifty-nine patients were enrolled. Primary endpoint was complete response (CR) rate. The original schema was given for a median of 7 cycles (range 1-8); modified schema was given for a median of 8 cycles (range 1-8) plus maintenance. Overall response was 91%, CR was 9%. Median follow-up was 19·1 months; median progression-free survival was 11·1 months and 18·9 months on the original and modified regimens, respectively. The most common Grade 3/4 adverse events were fatigue and neuropathy. The combination of BBD is tolerable and efficacious in this patient population. Modifications to decrease intensity but increase duration translated to better outcomes.
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Affiliation(s)
- Jesus G Berdeja
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Nashville, TN, USA
| | - Todd Bauer
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Nashville, TN, USA
| | - Edward Arrowsmith
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Chattanooga, TN, USA
| | - James Essell
- Sarah Cannon Research Institute, Nashville, TN, USA.,Oncology Hematology Care, Inc, Cincinnati, OH, USA
| | - Patrick Murphy
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Nashville, TN, USA
| | - James A Reeves
- Sarah Cannon Research Institute, Nashville, TN, USA.,Florida Cancer Specialists, Ft. Myers, FL, USA
| | - Ralph V Boccia
- Center for Cancer and Blood Disorders, Bethesda, MD, USA
| | - William Donnellan
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Nashville, TN, USA
| | - Ian Flinn
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Nashville, TN, USA
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Garcia-Manero G, Montalban-Bravo G, Berdeja JG, Abaza Y, Jabbour E, Essell J, Lyons RM, Ravandi F, Maris M, Heller B, DeZern AE, Babu S, Wright D, Anz B, Boccia R, Komrokji RS, Kuriakose P, Reeves J, Sekeres MA, Kantarjian HM, Ghalie R, Roboz GJ. Phase 2, randomized, double-blind study of pracinostat in combination with azacitidine in patients with untreated, higher-risk myelodysplastic syndromes. Cancer 2017; 123:994-1002. [PMID: 28094841 DOI: 10.1002/cncr.30533] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND The prognosis of patients with higher-risk myelodysplastic syndromes (MDS) remains poor despite available therapies. Histone deacetylase inhibitors have demonstrated activity in patients with MDS and in vitro synergy with azacitidine. METHODS A phase 2 randomized, placebo-controlled clinical trial of azacitidine and pracinostat was conducted in patients who had International Prognostic Scoring System intermediate-2-risk or high-risk MDS. The primary endpoint was the complete response (CR) rate by cycle 6 of therapy. RESULTS Of 102 randomized patients, there were 51 in the pracinostat group and 51 in the placebo group. The median age was 69 years. The CR rate by cycle 6 of therapy was 18% and 33% (P = .07) in the pracinostat and placebo groups, respectively. No significant differences in overall survival (median, 16 vs 19 months, respectively; hazard ratio, 1.21; 95% confidence interval, 0.66-2.23) or progression-free survival (11 vs 9 months, respectively; hazard ratio, 0.82; 95% confidence interval, 0.546-1.46) were observed between groups. Grade ≥3 adverse events occurred more frequently in the pracinostat group (98% vs 74%), leading to more treatment discontinuations (20% vs 10%). CONCLUSIONS The combination of azacitidine with pracinostat did not improve outcomes in patients with higher-risk MDS. Higher rates of treatment discontinuation may partially explain these results, suggesting alternative dosing and schedules to improve tolerability may be required to determine the potential of the combination. Cancer 2017;123:994-1002. © 2016 American Cancer Society.
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Affiliation(s)
| | | | | | - Yasmin Abaza
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Roger M Lyons
- Cancer Care Center of South Texas, San Antonio, Texas
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Amy E DeZern
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Sunil Babu
- Fort Wayne Medical Oncology and Hematology, Fort Wain, Indiana
| | - David Wright
- Florida Cancer Specialists-North, Jacksonville, Florida
| | | | - Ralph Boccia
- Center for Cancer and Blood Disorders, Bethesda, Maryland
| | | | - Philip Kuriakose
- Department of Internal Medicine, Division of Hematology Oncology, Henry Ford Hospital, Detroit, Michigan
| | - James Reeves
- Florida Cancer Specialists-South, Cape Coral, Florida
| | | | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Gail J Roboz
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical
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14
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Niesvizky R, Flinn IW, Rifkin R, Gabrail N, Charu V, Clowney B, Essell J, Gaffar Y, Warr T, Neuwirth R, Zhu Y, Elliott J, Esseltine DL, Niculescu L, Reeves J. Community-Based Phase IIIB Trial of Three UPFRONT Bortezomib-Based Myeloma Regimens. J Clin Oncol 2015; 33:3921-9. [PMID: 26056177 DOI: 10.1200/jco.2014.58.7618] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The US community-based, phase IIIB UPFRONT trial was designed to compare three frontline bortezomib-based regimens in transplantation-ineligible patients with myeloma. PATIENTS AND METHODS Patients (N = 502) were randomly assigned 1:1:1 to 24 weeks (eight 21-day cycles) of induction with bortezomib-dexamethasone (VD; n = 168; intravenous bortezomib 1.3 mg/m(2), days 1, 4, 8, and 11 plus oral dexamethasone 20 mg, days 1, 2, 4, 5, 8, 9, 11, and 12 [cycles 1 to 4], or 1, 2, 4, and 5 [cycles 5 to 8]), bortezomib-thalidomide-dexamethasone (VTD; n = 167; bortezomib and dexamethasone as before plus oral thalidomide 100 mg, days 1 to 21), or bortezomib-melphalan-prednisone (VMP; n = 167; bortezomib as before plus oral melphalan 9 mg/m(2) and oral prednisone 60 mg/m(2), days 1 to 4, every other cycle), followed by 25 weeks (five 35-day cycles) of bortezomib maintenance (1.6 mg/m(2), days 1, 8, 15, and 22). The primary end point was progression-free survival. RESULTS After 42.7 months' median follow-up, median progression-free survival with VD, VTD, and VMP was 14.7, 15.4, and 17.3 months, respectively; median overall survival was 49.8, 51.5, and 53.1 months, with no significant differences among treatments for either end point (global P = .46 and P = .79, respectively, Wald test). Overall response rates were 73% (VD), 80% (VTD), and 70% (VMP). Adverse events were more common with VTD than VD or VMP. Bortezomib maintenance was feasible without producing cumulative toxicity. CONCLUSION Although all bortezomib-containing regimens produced good outcomes, VTD and VMP did not appear to offer an advantage over VD in transplantation-ineligible patients with myeloma treated in US community practice.
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Affiliation(s)
- Ruben Niesvizky
- Ruben Niesvizky, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Ian W. Flinn, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Robert Rifkin, US Oncology Research/McKesson Specialty Health, The Woodlands, TX; Nashat Gabrail, Gabrail Cancer Center, Canton, OH; Veena Charu, Pacific Cancer Medical Center, Anaheim, CA; Billy Clowney, Santee Hematology/Oncology, Sumter, SC; James Essell, Sarah Cannon Research Institute and Oncology Hematology Care, Cincinnati, OH; Yousuf Gaffar, University of Maryland-St Joseph Medical Center, Towson, MD; Thomas Warr, Clinic Cancer Care, Great Falls, MT; Rachel Neuwirth, Yanyan Zhu, Jennifer Elliott, Dixie-Lee Esseltine, and Liviu Niculescu, Millennium Pharmaceuticals, Cambridge, MA; and James Reeves, Sarah Cannon Research Institute and Florida Cancer Specialists, Fort Myers, FL.
| | - Ian W Flinn
- Ruben Niesvizky, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Ian W. Flinn, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Robert Rifkin, US Oncology Research/McKesson Specialty Health, The Woodlands, TX; Nashat Gabrail, Gabrail Cancer Center, Canton, OH; Veena Charu, Pacific Cancer Medical Center, Anaheim, CA; Billy Clowney, Santee Hematology/Oncology, Sumter, SC; James Essell, Sarah Cannon Research Institute and Oncology Hematology Care, Cincinnati, OH; Yousuf Gaffar, University of Maryland-St Joseph Medical Center, Towson, MD; Thomas Warr, Clinic Cancer Care, Great Falls, MT; Rachel Neuwirth, Yanyan Zhu, Jennifer Elliott, Dixie-Lee Esseltine, and Liviu Niculescu, Millennium Pharmaceuticals, Cambridge, MA; and James Reeves, Sarah Cannon Research Institute and Florida Cancer Specialists, Fort Myers, FL
| | - Robert Rifkin
- Ruben Niesvizky, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Ian W. Flinn, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Robert Rifkin, US Oncology Research/McKesson Specialty Health, The Woodlands, TX; Nashat Gabrail, Gabrail Cancer Center, Canton, OH; Veena Charu, Pacific Cancer Medical Center, Anaheim, CA; Billy Clowney, Santee Hematology/Oncology, Sumter, SC; James Essell, Sarah Cannon Research Institute and Oncology Hematology Care, Cincinnati, OH; Yousuf Gaffar, University of Maryland-St Joseph Medical Center, Towson, MD; Thomas Warr, Clinic Cancer Care, Great Falls, MT; Rachel Neuwirth, Yanyan Zhu, Jennifer Elliott, Dixie-Lee Esseltine, and Liviu Niculescu, Millennium Pharmaceuticals, Cambridge, MA; and James Reeves, Sarah Cannon Research Institute and Florida Cancer Specialists, Fort Myers, FL
| | - Nashat Gabrail
- Ruben Niesvizky, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Ian W. Flinn, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Robert Rifkin, US Oncology Research/McKesson Specialty Health, The Woodlands, TX; Nashat Gabrail, Gabrail Cancer Center, Canton, OH; Veena Charu, Pacific Cancer Medical Center, Anaheim, CA; Billy Clowney, Santee Hematology/Oncology, Sumter, SC; James Essell, Sarah Cannon Research Institute and Oncology Hematology Care, Cincinnati, OH; Yousuf Gaffar, University of Maryland-St Joseph Medical Center, Towson, MD; Thomas Warr, Clinic Cancer Care, Great Falls, MT; Rachel Neuwirth, Yanyan Zhu, Jennifer Elliott, Dixie-Lee Esseltine, and Liviu Niculescu, Millennium Pharmaceuticals, Cambridge, MA; and James Reeves, Sarah Cannon Research Institute and Florida Cancer Specialists, Fort Myers, FL
| | - Veena Charu
- Ruben Niesvizky, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Ian W. Flinn, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Robert Rifkin, US Oncology Research/McKesson Specialty Health, The Woodlands, TX; Nashat Gabrail, Gabrail Cancer Center, Canton, OH; Veena Charu, Pacific Cancer Medical Center, Anaheim, CA; Billy Clowney, Santee Hematology/Oncology, Sumter, SC; James Essell, Sarah Cannon Research Institute and Oncology Hematology Care, Cincinnati, OH; Yousuf Gaffar, University of Maryland-St Joseph Medical Center, Towson, MD; Thomas Warr, Clinic Cancer Care, Great Falls, MT; Rachel Neuwirth, Yanyan Zhu, Jennifer Elliott, Dixie-Lee Esseltine, and Liviu Niculescu, Millennium Pharmaceuticals, Cambridge, MA; and James Reeves, Sarah Cannon Research Institute and Florida Cancer Specialists, Fort Myers, FL
| | - Billy Clowney
- Ruben Niesvizky, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Ian W. Flinn, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Robert Rifkin, US Oncology Research/McKesson Specialty Health, The Woodlands, TX; Nashat Gabrail, Gabrail Cancer Center, Canton, OH; Veena Charu, Pacific Cancer Medical Center, Anaheim, CA; Billy Clowney, Santee Hematology/Oncology, Sumter, SC; James Essell, Sarah Cannon Research Institute and Oncology Hematology Care, Cincinnati, OH; Yousuf Gaffar, University of Maryland-St Joseph Medical Center, Towson, MD; Thomas Warr, Clinic Cancer Care, Great Falls, MT; Rachel Neuwirth, Yanyan Zhu, Jennifer Elliott, Dixie-Lee Esseltine, and Liviu Niculescu, Millennium Pharmaceuticals, Cambridge, MA; and James Reeves, Sarah Cannon Research Institute and Florida Cancer Specialists, Fort Myers, FL
| | - James Essell
- Ruben Niesvizky, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Ian W. Flinn, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Robert Rifkin, US Oncology Research/McKesson Specialty Health, The Woodlands, TX; Nashat Gabrail, Gabrail Cancer Center, Canton, OH; Veena Charu, Pacific Cancer Medical Center, Anaheim, CA; Billy Clowney, Santee Hematology/Oncology, Sumter, SC; James Essell, Sarah Cannon Research Institute and Oncology Hematology Care, Cincinnati, OH; Yousuf Gaffar, University of Maryland-St Joseph Medical Center, Towson, MD; Thomas Warr, Clinic Cancer Care, Great Falls, MT; Rachel Neuwirth, Yanyan Zhu, Jennifer Elliott, Dixie-Lee Esseltine, and Liviu Niculescu, Millennium Pharmaceuticals, Cambridge, MA; and James Reeves, Sarah Cannon Research Institute and Florida Cancer Specialists, Fort Myers, FL
| | - Yousuf Gaffar
- Ruben Niesvizky, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Ian W. Flinn, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Robert Rifkin, US Oncology Research/McKesson Specialty Health, The Woodlands, TX; Nashat Gabrail, Gabrail Cancer Center, Canton, OH; Veena Charu, Pacific Cancer Medical Center, Anaheim, CA; Billy Clowney, Santee Hematology/Oncology, Sumter, SC; James Essell, Sarah Cannon Research Institute and Oncology Hematology Care, Cincinnati, OH; Yousuf Gaffar, University of Maryland-St Joseph Medical Center, Towson, MD; Thomas Warr, Clinic Cancer Care, Great Falls, MT; Rachel Neuwirth, Yanyan Zhu, Jennifer Elliott, Dixie-Lee Esseltine, and Liviu Niculescu, Millennium Pharmaceuticals, Cambridge, MA; and James Reeves, Sarah Cannon Research Institute and Florida Cancer Specialists, Fort Myers, FL
| | - Thomas Warr
- Ruben Niesvizky, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Ian W. Flinn, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Robert Rifkin, US Oncology Research/McKesson Specialty Health, The Woodlands, TX; Nashat Gabrail, Gabrail Cancer Center, Canton, OH; Veena Charu, Pacific Cancer Medical Center, Anaheim, CA; Billy Clowney, Santee Hematology/Oncology, Sumter, SC; James Essell, Sarah Cannon Research Institute and Oncology Hematology Care, Cincinnati, OH; Yousuf Gaffar, University of Maryland-St Joseph Medical Center, Towson, MD; Thomas Warr, Clinic Cancer Care, Great Falls, MT; Rachel Neuwirth, Yanyan Zhu, Jennifer Elliott, Dixie-Lee Esseltine, and Liviu Niculescu, Millennium Pharmaceuticals, Cambridge, MA; and James Reeves, Sarah Cannon Research Institute and Florida Cancer Specialists, Fort Myers, FL
| | - Rachel Neuwirth
- Ruben Niesvizky, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Ian W. Flinn, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Robert Rifkin, US Oncology Research/McKesson Specialty Health, The Woodlands, TX; Nashat Gabrail, Gabrail Cancer Center, Canton, OH; Veena Charu, Pacific Cancer Medical Center, Anaheim, CA; Billy Clowney, Santee Hematology/Oncology, Sumter, SC; James Essell, Sarah Cannon Research Institute and Oncology Hematology Care, Cincinnati, OH; Yousuf Gaffar, University of Maryland-St Joseph Medical Center, Towson, MD; Thomas Warr, Clinic Cancer Care, Great Falls, MT; Rachel Neuwirth, Yanyan Zhu, Jennifer Elliott, Dixie-Lee Esseltine, and Liviu Niculescu, Millennium Pharmaceuticals, Cambridge, MA; and James Reeves, Sarah Cannon Research Institute and Florida Cancer Specialists, Fort Myers, FL
| | - Yanyan Zhu
- Ruben Niesvizky, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Ian W. Flinn, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Robert Rifkin, US Oncology Research/McKesson Specialty Health, The Woodlands, TX; Nashat Gabrail, Gabrail Cancer Center, Canton, OH; Veena Charu, Pacific Cancer Medical Center, Anaheim, CA; Billy Clowney, Santee Hematology/Oncology, Sumter, SC; James Essell, Sarah Cannon Research Institute and Oncology Hematology Care, Cincinnati, OH; Yousuf Gaffar, University of Maryland-St Joseph Medical Center, Towson, MD; Thomas Warr, Clinic Cancer Care, Great Falls, MT; Rachel Neuwirth, Yanyan Zhu, Jennifer Elliott, Dixie-Lee Esseltine, and Liviu Niculescu, Millennium Pharmaceuticals, Cambridge, MA; and James Reeves, Sarah Cannon Research Institute and Florida Cancer Specialists, Fort Myers, FL
| | - Jennifer Elliott
- Ruben Niesvizky, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Ian W. Flinn, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Robert Rifkin, US Oncology Research/McKesson Specialty Health, The Woodlands, TX; Nashat Gabrail, Gabrail Cancer Center, Canton, OH; Veena Charu, Pacific Cancer Medical Center, Anaheim, CA; Billy Clowney, Santee Hematology/Oncology, Sumter, SC; James Essell, Sarah Cannon Research Institute and Oncology Hematology Care, Cincinnati, OH; Yousuf Gaffar, University of Maryland-St Joseph Medical Center, Towson, MD; Thomas Warr, Clinic Cancer Care, Great Falls, MT; Rachel Neuwirth, Yanyan Zhu, Jennifer Elliott, Dixie-Lee Esseltine, and Liviu Niculescu, Millennium Pharmaceuticals, Cambridge, MA; and James Reeves, Sarah Cannon Research Institute and Florida Cancer Specialists, Fort Myers, FL
| | - Dixie-Lee Esseltine
- Ruben Niesvizky, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Ian W. Flinn, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Robert Rifkin, US Oncology Research/McKesson Specialty Health, The Woodlands, TX; Nashat Gabrail, Gabrail Cancer Center, Canton, OH; Veena Charu, Pacific Cancer Medical Center, Anaheim, CA; Billy Clowney, Santee Hematology/Oncology, Sumter, SC; James Essell, Sarah Cannon Research Institute and Oncology Hematology Care, Cincinnati, OH; Yousuf Gaffar, University of Maryland-St Joseph Medical Center, Towson, MD; Thomas Warr, Clinic Cancer Care, Great Falls, MT; Rachel Neuwirth, Yanyan Zhu, Jennifer Elliott, Dixie-Lee Esseltine, and Liviu Niculescu, Millennium Pharmaceuticals, Cambridge, MA; and James Reeves, Sarah Cannon Research Institute and Florida Cancer Specialists, Fort Myers, FL
| | - Liviu Niculescu
- Ruben Niesvizky, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Ian W. Flinn, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Robert Rifkin, US Oncology Research/McKesson Specialty Health, The Woodlands, TX; Nashat Gabrail, Gabrail Cancer Center, Canton, OH; Veena Charu, Pacific Cancer Medical Center, Anaheim, CA; Billy Clowney, Santee Hematology/Oncology, Sumter, SC; James Essell, Sarah Cannon Research Institute and Oncology Hematology Care, Cincinnati, OH; Yousuf Gaffar, University of Maryland-St Joseph Medical Center, Towson, MD; Thomas Warr, Clinic Cancer Care, Great Falls, MT; Rachel Neuwirth, Yanyan Zhu, Jennifer Elliott, Dixie-Lee Esseltine, and Liviu Niculescu, Millennium Pharmaceuticals, Cambridge, MA; and James Reeves, Sarah Cannon Research Institute and Florida Cancer Specialists, Fort Myers, FL
| | - James Reeves
- Ruben Niesvizky, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Ian W. Flinn, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Robert Rifkin, US Oncology Research/McKesson Specialty Health, The Woodlands, TX; Nashat Gabrail, Gabrail Cancer Center, Canton, OH; Veena Charu, Pacific Cancer Medical Center, Anaheim, CA; Billy Clowney, Santee Hematology/Oncology, Sumter, SC; James Essell, Sarah Cannon Research Institute and Oncology Hematology Care, Cincinnati, OH; Yousuf Gaffar, University of Maryland-St Joseph Medical Center, Towson, MD; Thomas Warr, Clinic Cancer Care, Great Falls, MT; Rachel Neuwirth, Yanyan Zhu, Jennifer Elliott, Dixie-Lee Esseltine, and Liviu Niculescu, Millennium Pharmaceuticals, Cambridge, MA; and James Reeves, Sarah Cannon Research Institute and Florida Cancer Specialists, Fort Myers, FL
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Ghose A, Morris JC, Breneman JC, Essell J, Wang J, Benzaquen S. Medulloblastoma in an Adult With Late Extraneural Metastases to the Mediastinum. J Investig Med High Impact Case Rep 2014; 2:2324709614532798. [PMID: 26425604 PMCID: PMC4528885 DOI: 10.1177/2324709614532798] [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] [Indexed: 11/29/2022] Open
Abstract
Background. Medulloblastoma, although the most common brain tumor of childhood, is exceedingly rare in adults. These tumors have a propensity for local recurrence and to metastasize along the leptomeninges; however, extraneural metastases are very rare and typically occur in the bone or bone marrow. We have not come across any case in literature of medulloblastoma with mediastinal metastases in an adult. Case Presentation. We report a case of medulloblastoma in a 38-year-old lady who was treated with surgery followed by craniospinal radiation. Ten years later she presented with hoarseness from true vocal cord paralysis. She was diagnosed to have infiltrating metastases of her medulloblastoma to the mediastinum, which was confirmed by biopsy. There was no local recurrence. This was treated with chemotherapy followed by stem cell rescue, and she remained progression free for 2 years. Conclusion. Medulloblastomas are rare in adults and can present with late extraneural metastases following treatment. Although most common reported sites are bone and bone marrow, late metastases to other unexpected areas like the mediastinum are possible too and warrant awareness. This can be treated with chemotherapy followed by high-dose chemotherapy and stem cell rescue in a young patient with good performance status.
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Affiliation(s)
| | | | | | - James Essell
- Oncology Hematology Care Inc, Cincinnati, OH, USA
| | - Jiang Wang
- University of Cincinnati, Cincinnati, OH, USA
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DeVoe M, Heying K, Brown E, Essell J, Sigmund D, Tierney C, Keller S. 246Ambisome® I mg/kg/day as empiric antifungal therapy in patients with prolonged neutropenia and fever. Biol Blood Marrow Transplant 2003. [DOI: 10.1016/s1083-8791(03)80231-8] [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: 10/24/2022]
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Broun E, Sigmund D, Essell J, Tierney C. 177Outcome of patients treated with high dose melphalan with or without TBI followed by CD34 selected stem cell rescue using the Baxter Isolex 3001. Biol Blood Marrow Transplant 2003. [DOI: 10.1016/s1083-8791(03)80175-1] [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: 11/16/2022]
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18
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Eisen D, Essell J, Broun ER, Sigmund D, DeVoe M. Clinical utility of oral valacyclovir compared with oral acyclovir for the prevention of herpes simplex virus mucositis following autologous bone marrow transplantation or stem cell rescue therapy. Bone Marrow Transplant 2003; 31:51-5. [PMID: 12621507 DOI: 10.1038/sj.bmt.1703817] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Oral acyclovir has been demonstrated to prevent reactivation of herpes simplex virus (HSV) infections when administered prophylactically to autologous bone marrow transplant (BMT) recipients or patients undergoing stem cell rescue therapy. Oral valacyclovir, which is converted in the body to acyclovir, has greater oral bioavailability than oral acyclovir and compared with oral acyclovir yields similar acyclovir plasma concentrations with less frequent (twice-daily) dosing. This study compared the efficacy of oral valacyclovir with that of oral acyclovir at preventing HSV mucositis in BMT recipients. A total of 60 HSV-1-positive patients scheduled for BMT or stem cell rescue therapy were treated prophylactically with valacyclovir 500 mg twice daily until resolution of neutropenia. Data from these patients were compared with those of a historical control group of 60 patients who had received acyclovir 600 mg every 6 h until resolution of neutropenia or acyclovir 125 mg/m(2) intravenously every 6 h. The results show that none of the patients developed oral or oropharyngeal HSV infection while receiving either treatment. Of the 60 patients receiving valacyclovir, 38 (63%) completed treatment without the need for intravenous acyclovir compared with 12 of 60 (20%) patients in the acyclovir group. Additionally, the total number of doses of drug administered to the valacyclovir group was significantly less than the number received by patients in the acyclovir group. No serious adverse events occurred in either group of patients. This study demonstrates that oral valacyclovir and acyclovir are comparably effective and safe in preventing reactivation of HSV infections in autologous BMT and stem cell recipients. The less frequent dosing schedule with valacyclovir compared with acyclovir offers a potential advantage for patients undergoing BMT who frequently suffer with severe mucositis and have difficulty taking oral medications.
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Affiliation(s)
- D Eisen
- Dermatology Research Associates, Cincinnati, OH, USA
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Eisen D, Essell J. Drug-induced thrombocytopenia presenting with isolated oral lesions: report of two cases. Cutis 1998; 62:193-5. [PMID: 9798108] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Patients with platelet-mediated bleeding disorders often present with clinical manifestations of bruising and bleeding. Although these changes are detected most frequently on the skin and in the oral cavity, the nasal and genital mucosa, as well as the renal and gastrointestinal systems, also may exhibit signs of bleeding. In this report, we describe two patients who presented with isolated oral features: one with oral hemorrhagic bullae and a second with oral petechiae and gingival bleeding indicative of a bleeding disorder. Results of laboratory tests revealed severe thrombocytopenia and a careful history disclosed drug hypersensitivity as the cause. It is important to recognize the oral manifestations of thrombocytopenia since the oral cavity is a frequent site of hemorrhage and may be the only manifestation of the disease. Proper identification permits the prompt institution of treatment and prevention of serious complications.
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Affiliation(s)
- D Eisen
- Dermatology Research Associates, Cincinnati, Ohio 45230, USA
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Abstract
Bone marrow transplantation, once regarded as experimental, has evolved into a standard treatment for a variety of malignancies. Considerable advances have been made in histocompatibility typing, pretransplantation chemotherapy, and posttransplantation immunosuppressive therapy as well as prophylaxis and treatment of infections. Oral complications develop in almost all patients, and their early recognition may result in the institution of prompt treatment and prolonged survival. Mucositis, often severe and extremely painful, develops in more than three quarters of bone marrow transplant recipients, and its prevention, unfortunately, remains unsatisfactory. Herpes simplex virus and Candida albicans account for most oral infections, although their incidence has been dramatically reduced by the institution of prophylactic agents. Graft versus host disease continues to be a significant complication of marrow transplantation, and the detection of commonly occurring oral changes may support its diagnosis.
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Affiliation(s)
- D Eisen
- Dermatology Research Associates of Cincinnati and The Jewish Hospital of Cincinnati Bone Marrow Transplant Program, OH 45230, USA
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