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Pluta A, Robak T, Brzozowski K, Stepka K, Wawrzyniak E, Krawczynska A, Czemerska M, Szmigielska-Kaplon A, Grzybowska-Izydorczyk O, Nowicki M, Stelmach P, Kuydowicz M, Gromek T, Hus M, Helbig G, Grosicki S, Bodzenta E, Razny M, Wojcik K, Bolkun L, Kloczko J, Knopinska-Posluszny W, Piekarska A, Hellman A, Sobas M, Wrobel T, Patkowska E, Lech-Maranda E, Warzocha K, Holowiecki J, Giebel S, Wierzbowska A. Early induction intensification with cladribine, cytarabine, and mitoxantrone (CLAM) in AML patients treated with the DAC induction regimen: a prospective, non-randomized, phase II study of the Polish Adult Leukemia Group (PALG). Leuk Lymphoma 2019; 61:588-603. [PMID: 31661339 DOI: 10.1080/10428194.2019.1678151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We present the results of a prospective, non-randomized phase 2 trial in which 253 AML patients (pts) under 60 years old received DAC (Daunorubicin + AraC + Cladribine) as first induction followed by CLAM (Cladribine + AraC + Mitoxantrone) as early second induction on day 16 based on bone marrow (BM) blasts on day 14 (D14). The CR/CRi rate after a single course of DAC was 83% for pts with D14 BM blasts less than 10%. Forty-six pts had >10% BM blasts on D14, of whom 35 received CLAM with rates of CR/CRi 60% and early death (ED) 23%. The remaining 11 pts were not fit to receive CLAM, with rates of CR/CRi 28%, PR 18%, and ED 18%. Median OS was 7.2 versus 7.5 months, respectively. The overall CR/CRi rate was 77% after the first induction, with final CR/CRi rate 80% after DAC reinduction for pts who achieved PR with initial DAC course. CLAM used as early second induction might improve CR/CRi rates for younger AML pts with poor early response to DAC induction, but may be associated with higher mortality.
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Affiliation(s)
- Agnieszka Pluta
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Kamil Brzozowski
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Konrad Stepka
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Ewa Wawrzyniak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Anna Krawczynska
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | | | | | | | - Mateusz Nowicki
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Piotr Stelmach
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Marta Kuydowicz
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Tomasz Gromek
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Marek Hus
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Helbig
- Department of Hematology and BMT, Medical School of Silesia, Katowice, Poland
| | - Sebastian Grosicki
- Department of Cancer Prevention, School of Public Health, Medical University of Silesia, Katowice, Poland
| | - Ewa Bodzenta
- Department of Hematology, Municipal Hospital, Chorzow, Poland
| | - Małgorzata Razny
- Hematology Department, Rydygier Memorial Hospital, Krakow, Poland
| | - Karol Wojcik
- Hematology Department, Rydygier Memorial Hospital, Krakow, Poland
| | - Lukasz Bolkun
- Department of Hematology, Medical University Hospital, Bialystok, Poland
| | - Janusz Kloczko
- Department of Hematology, Medical University Hospital, Bialystok, Poland
| | | | - Agnieszka Piekarska
- Department of Hematology, Transplantation Medical University of Gdansk, Gdansk, Poland
| | - Andrzej Hellman
- Department of Hematology, Transplantation Medical University of Gdansk, Gdansk, Poland
| | - Marta Sobas
- Department of Hematology, Blood Neoplasm and Bone Marrow Transplantation, Wroclaw, Poland
| | - Tomasz Wrobel
- Department of Hematology, Blood Neoplasm and Bone Marrow Transplantation, Wroclaw, Poland
| | - Elzbieta Patkowska
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.,Department of Hematology and Transfusion Medicine, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Ewa Lech-Maranda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.,Department of Hematology and Transfusion Medicine, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Krzysztof Warzocha
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Jerzy Holowiecki
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Institute - Cancer Center, Gliwice Branch, Gliwice, Poland
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Institute - Cancer Center, Gliwice Branch, Gliwice, Poland
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Czerw T, Sadus-Wojciechowska M, Michalak K, Najda J, Mendrek W, Sobczyk-Kruszelnicka M, Glowala-Kosinska M, Chwieduk A, Mitrus I, Smagur A, Holowiecki J, Giebel S. Increased Efficacy of Stem Cell Chemomobilization with Intermediate-Dose Cytarabine Plus Granulocyte Colony-Stimulating Factor (G-CSF) Compared with G-CSF Alone in Patients with Multiple Myeloma: Results of a Randomized Trial. Biol Blood Marrow Transplant 2019; 25:248-255. [DOI: 10.1016/j.bbmt.2018.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/16/2018] [Indexed: 12/27/2022]
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Nademanee A, Sureda A, Stiff P, Holowiecki J, Abidi M, Hunder N, Pecsok M, Uttarwar M, Purevjal I, Sweetenham J. Safety Analysis of Brentuximab Vedotin from the Phase III AETHERA Trial in Hodgkin Lymphoma in the Post-Transplant Consolidation Setting. Biol Blood Marrow Transplant 2018; 24:2354-2359. [DOI: 10.1016/j.bbmt.2018.05.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/24/2018] [Indexed: 10/16/2022]
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Nowak J, Nestorowicz K, Graczyk-Pol E, Mika-Witkowska R, Rogatko-Koros M, Jaskula E, Koscinska K, Madej S, Tomaszewska A, Nasilowska-Adamska B, Szczepinski A, Halaburda K, Dybko J, Kuliczkowski K, Czerw T, Giebel S, Holowiecki J, Baranska M, Pieczonka A, Wachowiak J, Czyz A, Gil L, Lojko-Dankowska A, Komarnicki M, Bieniaszewska M, Kucharska A, Hellmann A, Gronkowska A, Jedrzejczak WW, Markiewicz M, Koclega A, Kyrcz-Krzemien S, Mielcarek M, Kalwak K, Styczynski J, Wysocki M, Drabko K, Wojcik B, Kowalczyk J, Gozdzik J, Pawliczak D, Gwozdowicz S, Dziopa J, Szlendak U, Witkowska A, Zubala M, Gawron A, Warzocha K, Lange A. HLA-inferred extended haplotype disparity level is more relevant than the level of HLA mismatch alone for the patients survival and GvHD in T cell-replate hematopoietic stem cell transplantation from unrelated donor. Hum Immunol 2018; 79:403-412. [PMID: 29605688 DOI: 10.1016/j.humimm.2018.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/18/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
Serious risks in unrelated hematopoietic stem cell transplantation (HSCT) including graft versus host disease (GvHD) and mortality are associated with HLA disparity between donor and recipient. The increased risks might be dependent on disparity in not-routinely-tested multiple polymorphisms in genetically dense MHC region, being organized in combinations of two extended MHC haplotypes (Ehp). We assessed the clinical role of donor-recipient Ehp disparity levels in N = 889 patients by the population-based detection of HLA allele phase mismatch. We found increased GvHD incidences and mortality rates with increasing Ehp mismatch level even with the same HLA mismatch level. In multivariate analysis HLA mismatch levels were excluded from models and Ehp disparity level remained independent prognostic factor for high grade acute GvHD (p = 0.000037, HR = 10.68, 95%CI 5.50-32.5) and extended chronic GvHD (p < 0.000001, HR = 15.51, CI95% 5.36-44.8). In group with single HLA mismatch, patients with double Ehp disparity had worse 5-year overall survival (45% vs. 56%, p = 0.00065, HR = 4.05, CI95% 1.69-9.71) and non-relapse mortality (40% vs. 31%, p = 0.00037, HR = 5.63, CI95% 2.04-15.5) than patients with single Ehp disparity. We conclude that Ehp-linked factors contribute to the high morbidity and mortality in recipients given HLA-mismatched unrelated transplant and Ehp matching should be considered in clinical HSCT.
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Affiliation(s)
- Jacek Nowak
- Department of Immunogenetics, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
| | - Klaudia Nestorowicz
- Department of Immunogenetics, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Elzbieta Graczyk-Pol
- Department of Immunogenetics, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Renata Mika-Witkowska
- Department of Immunogenetics, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Marta Rogatko-Koros
- Department of Immunogenetics, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Emilia Jaskula
- Department of Clinical Immunology, L. Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland; Lower Silesian Center for Cellular Transplantation with National Bone Marrow Donor Registry, Wrocław, Poland
| | - Katarzyna Koscinska
- Lower Silesian Center for Cellular Transplantation with National Bone Marrow Donor Registry, Wrocław, Poland
| | - Sylwia Madej
- Lower Silesian Center for Cellular Transplantation with National Bone Marrow Donor Registry, Wrocław, Poland
| | - Agnieszka Tomaszewska
- Department of Hematopoietic Stem Cell Transplantation, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Barbara Nasilowska-Adamska
- Department of Hematopoietic Stem Cell Transplantation, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Andrzej Szczepinski
- Department of Hematopoietic Stem Cell Transplantation, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Kazimierz Halaburda
- Department of Hematopoietic Stem Cell Transplantation, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Jaroslaw Dybko
- Department of Hematology, Blood Malignancies and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Kazimierz Kuliczkowski
- Department of Hematology, Blood Malignancies and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Tomasz Czerw
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Jerzy Holowiecki
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Malgorzata Baranska
- Department of Oncology Hematology and Paediatric Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Pieczonka
- Department of Oncology Hematology and Paediatric Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek Wachowiak
- Department of Oncology Hematology and Paediatric Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Czyz
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Lojko-Dankowska
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Mieczyslaw Komarnicki
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Maria Bieniaszewska
- Department of Hematology and Transplantology, Gdansk Medical University Clinical Center, Gdansk, Poland
| | - Agnieszka Kucharska
- Department of Hematology and Transplantology, Gdansk Medical University Clinical Center, Gdansk, Poland
| | - Andrzej Hellmann
- Department of Hematology and Transplantology, Gdansk Medical University Clinical Center, Gdansk, Poland
| | - Anna Gronkowska
- Department of Hematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Wieslaw W Jedrzejczak
- Department of Hematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Miroslaw Markiewicz
- Department of Hematology and Bone Marrow Transplantation, Silesian Medical University, Katowice, Poland
| | - Anna Koclega
- Department of Hematology and Bone Marrow Transplantation, Silesian Medical University, Katowice, Poland
| | - Slawomira Kyrcz-Krzemien
- Department of Hematology and Bone Marrow Transplantation, Silesian Medical University, Katowice, Poland
| | - Monika Mielcarek
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Kalwak
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum Nicolaus Copernicus University Hospital, Bydgoszcz, Poland
| | - Mariusz Wysocki
- Department of Pediatric Hematology and Oncology, Collegium Medicum Nicolaus Copernicus University Hospital, Bydgoszcz, Poland
| | - Katarzyna Drabko
- Department of Paediatric Hematology, Oncology and Transplantology, Medical University, Lublin, Poland
| | - Beata Wojcik
- Department of Paediatric Hematology, Oncology and Transplantology, Medical University, Lublin, Poland
| | - Jerzy Kowalczyk
- Department of Paediatric Hematology, Oncology and Transplantology, Medical University, Lublin, Poland
| | - Jolanta Gozdzik
- Department of Transplantation Children's University Hospital, Polish-American Institute of Pediatrics, Jagiellonian University Medical College, Cracow, Poland
| | - Daria Pawliczak
- Department of Immunogenetics, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Slawomir Gwozdowicz
- Department of Immunogenetics, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Joanna Dziopa
- Department of Immunogenetics, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Urszula Szlendak
- Department of Immunogenetics, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Agnieszka Witkowska
- Department of Immunogenetics, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Marta Zubala
- Department of Immunogenetics, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Agnieszka Gawron
- Department of Immunogenetics, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Krzysztof Warzocha
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Andrzej Lange
- Department of Clinical Immunology, L. Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland; Lower Silesian Center for Cellular Transplantation with National Bone Marrow Donor Registry, Wrocław, Poland
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Pluta A, Robak T, Wrzesien-Kus A, Katarzyna Budziszewska B, Sulek K, Wawrzyniak E, Czemerska M, Zwolinska M, Golos A, Holowiecka-Goral A, Kyrcz-Krzemien S, Piszcz J, Kloczko J, Mordak-Domagala M, Lange A, Razny M, Madry K, Wiktor-Jedrzejczak W, Grosicki S, Butrym A, Kuliczkowski K, Warzocha K, Holowiecki J, Giebel S, Szydlo R, Wierzbowska A. Addition of cladribine to the standard induction treatment improves outcomes in a subset of elderly acute myeloid leukemia patients. Results of a randomized Polish Adult Leukemia Group (PALG) phase II trial. Am J Hematol 2017; 92:359-366. [PMID: 28103640 DOI: 10.1002/ajh.24654] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/13/2017] [Accepted: 01/14/2017] [Indexed: 11/09/2022]
Abstract
Intensive induction chemotherapy using anthracycline and cytarabine backbone is considered the most effective upfront therapy in physically fit older patients with acute myeloid leukemia (AML). However, outcomes of the standard induction in elderly AML are inferior to those observed in younger patients, and they are still unsatisfactory. As addition of cladribine to the standard induction therapy is known to improve outcome in younger AML patients. The present randomized phase II study compares efficacy and toxicity of the DAC (daunorubicin plus cytarabine plus cladribine) regimen with the standard DA (daunorubicin plus cytarabine) regimen in the newly diagnosed AML patients over 60 years of age. A total of 171 patients were enrolled in the study (DA, 86; DAC, 85). A trend toward higher complete remission (CR) was observed in the DAC arm compared to the DA arm (44% vs. 34%; P = .19), which did not lead to improved median overall survival, which in the case of the DAC group was 8.6 months compared to in 9.1 months in the DA group (P = .64). However, DAC appeared to be superior in the group of patients aged 60-65 (CR rate: DAC 51% vs. DA 29%; P = .02). What is more, a subgroup of patients, with good and intermediate karyotypes, benefited from addition of cladribine also in terms of overall survival (P = .02). No differences in hematological and nonhematological toxicity between the DA and DAC regimens were observed.
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Affiliation(s)
- Agnieszka Pluta
- Department of Hematology; Medical University of Lodz; Lodz Poland
| | - Tadeusz Robak
- Department of Hematology; Medical University of Lodz; Lodz Poland
| | | | | | - Kazimierz Sulek
- Department of Clinical Hematology; Military Medical Academy; Warsaw Poland
| | - Ewa Wawrzyniak
- Department of Hematology; Medical University of Lodz; Lodz Poland
| | | | | | - Aleksandra Golos
- Department of Hematology; Medical University of Lodz; Lodz Poland
| | | | | | - Jaroslaw Piszcz
- Department of Hematology; Bialystok Medical Academy; Bialystok Poland
| | - Janusz Kloczko
- Department of Hematology; Bialystok Medical Academy; Bialystok Poland
| | - Monika Mordak-Domagala
- L. Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland and Lower Silesian Center for Cellular Transplantation & National Bone Marrow Donor Registry; Wrocław Poland
| | - Andrzej Lange
- L. Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland and Lower Silesian Center for Cellular Transplantation & National Bone Marrow Donor Registry; Wrocław Poland
| | - Małgorzata Razny
- Hematology Department; Rydygier Memorial Hospital; Krakow Poland
| | - Krzysztof Madry
- Department of Hematology, Oncology and Internal Diseases; Medical University of Warsaw; Warsaw Poland
| | | | - Sebastian Grosicki
- Department of Cancer Prevention, Faculty of Public Health; Silesian Medical University; Katowice Poland
| | - Aleksandra Butrym
- Department of Physiology; Wroclaw Medical University; Wroclaw Poland
| | - Kazimierz Kuliczkowski
- Department of Hematology and Proliferative Diseases; Wroclaw Medical Academy; Wroclaw Poland
| | - Krzysztof Warzocha
- Department of Hematology; Institute of Hematology and Transfusion Medicine; Warsaw Poland
| | - Jerzy Holowiecki
- Department of Bone Marrow Transplantation; Comprehensive Cancer Center, M. Sklodowska-Curie Memorial Institute; Gliwice Poland
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation; Comprehensive Cancer Center, M. Sklodowska-Curie Memorial Institute; Gliwice Poland
| | - Richard Szydlo
- Hammersmith Hospital; Centre for Haematology, Imperial College London; London United Kingdom
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Ramsey SD, Nademanee A, Masszi T, Holowiecki J, Abidi M, Chen A, Stiff P, Viviani S, Sweetenham JW, Radford J, Zhu Y, Bonthapally V, Thomas E, Richhariya A, Hunder NN, Walewski J, Moskowitz CH. Quality of life results from a phase 3 study of brentuximab vedotin consolidation following autologous haematopoietic stem cell transplant for persons with Hodgkin lymphoma. Br J Haematol 2016; 175:860-867. [PMID: 27649689 DOI: 10.1111/bjh.14316] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 05/20/2016] [Accepted: 07/13/2016] [Indexed: 11/27/2022]
Abstract
Brentuximab vedotin (BV) significantly improved progression-free survival in a phase 3 study in patients with relapsed or refractory Hodgkin lymphoma (RR-HL) post-autologous-haematopoietic stem cell transplant (auto-HSCT); we report the impact of BV on quality of life (QOL) from this trial. The European Quality of Life five dimensions questionnaire was administered at the beginning of each cycle, end of treatment, and every 3 months during follow-up; index value scores were calculated using the time trade-off (TTO) method for UK-weighted value sets. Questionnaire adherence during the trial was 87·5% (N = 329). In an intent-to-treat analysis, compared with placebo, TTO scores in the BV arm did not exceed the minimally important difference (MID) of 0·08 except at month 15 (-0·084; 95% confidence interval, -0·143 to -0·025). On-treatment index scores were similar between arms and did not reach the MID at any time point; mixed-effect modelling showed that BV treatment effect was not significant (P = 0·2127). BV-associated peripheral neuropathy did not meaningfully impact QOL. Utility scores for patients who progressed declined compared with those who did not; TTO scores between these patients exceeded the MID beginning at month 15. In conclusion, QOL decreased modestly with BV consolidation treatment in patients with RR-HL at high risk of relapse after auto-HSCT.
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Affiliation(s)
- Scott D Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Tamas Masszi
- Haematology & Stem Cell Department, Szent Istvan & Szent Laszlo Corporate Hospital, Budapest, Hungary
| | - Jerzy Holowiecki
- Department of Bone Marrow Transplantation & Oncohaematology, Maria Sklodowska-Curie Institute of Oncology, Gliwice, Poland
| | - Muneer Abidi
- Spectrum Health Cancer Center, Michigan State University, Grand Rapids, MI, USA
| | - Andy Chen
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - John W Sweetenham
- Huntsman Cancer Institute, University of Utah Health Care, Salt Lake City, UT, USA
| | - John Radford
- University of Manchester and Christie NHS Foundation Trust, Manchester, UK
| | - Yanyan Zhu
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Vijayveer Bonthapally
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | | | | | | | - Jan Walewski
- Maria Sklodowska-Curie Institute and Institute of Oncology, Warsaw, Poland
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Wierzbowska A, Wawrzyniak E, Siemieniuk-Rys M, Kotkowska A, Pluta A, Golos A, Robak T, Szarawarska M, Jaskowiec A, Duszenko E, Rybka J, Holojda J, Grosicki S, Pienkowska-Grela B, Woroniecka R, Ejduk A, Watek M, Wach M, Mucha B, Skonieczka K, Czyzewska M, Jachalska A, Klonowska A, Iliszko M, Knopinska-Posluszny W, Jarmuz-Szymczak M, Przybylowicz-Chalecka A, Gil L, Kopacz A, Holowiecki J, Haus O. Concomitance of monosomal karyotype with at least 5 chromosomal abnormalities is associated with dismal treatment outcome of AML patients with complex karyotype – retrospective analysis of Polish Adult Leukemia Group (PALG). Leuk Lymphoma 2016; 58:889-897. [DOI: 10.1080/10428194.2016.1219901] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sweetenham JW, Walewski J, Nadamanee A, Masszi T, Agura E, Holowiecki J, Abidi MH, Chen AI, Stiff P, Viviani S, Carella A, Osmanov D, Bachanova V, Sureda A, Huebner D, Larsen EK, Hunder NN, Moskowitz CH. Updated Efficacy and Safety Data from the AETHERA Trial of Consolidation with Brentuximab Vedotin after Autologous Stem Cell Transplant (ASCT) in Hodgkin Lymphoma Patients at High Risk of Relapse. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.315] [Citation(s) in RCA: 4] [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] [Indexed: 10/22/2022]
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Giebel S, Sadus-Wojciechowska M, Halaburda K, Drozd-Sokolowska J, Wierzbowska A, Najda J, Mendrek W, Sobczyk-Kruszelnicka M, Nowicki M, Holowiecki J, Czerw T. Increased efficacy of intermediate-dose cytarabine + G-CSF compared to DHAP + G-CSF for stem cell mobilization in patients with lymphoma: an analysis by the polish lymphoma research group. Ann Hematol 2015; 95:263-9. [PMID: 26611854 DOI: 10.1007/s00277-015-2557-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 08/20/2015] [Accepted: 11/11/2015] [Indexed: 02/01/2023]
Abstract
Salvage regimens, like DHAP (dexamethasone, cytarabine, and cisplatin) are frequently used for stem cell mobilization in lymphoma. The aim of this study was to compare the efficacy of DHAP + G-CSF with intermediate-dose cytarabine (ID-AraC) + G-CSF, recently proposed as an alternative schedule. Consecutive patients with Hodgkin's or non-Hodgkin lymphoma who had received at least 2 lines of chemotherapy, mobilized with either DHAP (n = 51) or ID-AraC (n = 50) + G-CSF were included in the analysis. AraC was administered at the dose of 400 mg/m [1] bid intravenously for 2 days followed by filgrastim starting from day 5. In the AraC group, 96 % of patients collected at least 2 × 10 [2] CD34(+) cells/kg compared to 71 % in the DHAP group (p = 0.0006). The CD34(+) cell yield was 9.3 (0-30.3) × 10 [2]/kg vs. 5.6 (0-24.8) × 10 [2]/kg, respectively (p = 0.006). A single apheresis was sufficient to achieve the threshold number of CD34(+) cells in 82 % of the cases after AraC compared to 45 % after DHAP (p = 0.001). We conclude that stem cell mobilization using ID-AraC is associated with a significantly higher efficacy than DHAP, allowing for collection of the transplant material in almost all patients with lymphoma. Our observation suggests that ID-AraC + G-CSF may be a preferable mobilization regimen in this setting.
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Affiliation(s)
- Sebastian Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Str. Wybrzeze Armii Krajowej 15, 44-101, Gliwice, Poland.
| | - Maria Sadus-Wojciechowska
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Str. Wybrzeze Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Kazimierz Halaburda
- Department of Hematopoietic Cell Transplantation, Institute of Hematology and Blood Transfusion, Str. Indiry Gandhi 14, 02-776, Warsaw, Poland
| | - Joanna Drozd-Sokolowska
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, Str. Banacha 1a, 02-097, Warsaw, Poland
| | - Agnieszka Wierzbowska
- Department of Hematology, Lodz Medical University, Str. Pabianicka 62, 93-513, Lodz, Poland
| | - Jacek Najda
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Str. Wybrzeze Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Wlodzimierz Mendrek
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Str. Wybrzeze Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Malgorzata Sobczyk-Kruszelnicka
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Str. Wybrzeze Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Mateusz Nowicki
- Department of Hematology, Lodz Medical University, Str. Pabianicka 62, 93-513, Lodz, Poland
| | - Jerzy Holowiecki
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Str. Wybrzeze Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Tomasz Czerw
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Str. Wybrzeze Armii Krajowej 15, 44-101, Gliwice, Poland
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10
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Grosicki S, Holowiecki J, Kuliczkowski K, Skotnicki A, Hellmann A, Kyrcz-Krzemien S, Dmoszynska A, Sułek K, Kloczko J, Jedrzejczak WW, Warzocha K, Zdziarska B, Wierzbowska A, Pluta A, Komarnicki M, Giebel S. Assessing the efficacy of allogeneic hematopoietic stem cells transplantation (allo-HSCT) by analyzing survival end points in defined groups of acute myeloid leukemia patients: a retrospective, multicenter Polish Adult Leukemia Group study. Am J Hematol 2015; 90:904-9. [PMID: 26149802 DOI: 10.1002/ajh.24113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/05/2015] [Accepted: 07/02/2015] [Indexed: 11/07/2022]
Abstract
The importance of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for survival outcomes in patients with acute myeloid leukemia (AML) currently remains unclear. The study aimed to compare measures of clinical treatment for patients with AML in CR1 (the first complete remission) with or without being subjected to allo-HSCT. These consisted of leukemia-free survival (LFS), overall survival (OS), cumulative incidence of relapse (CIR), and non-relapse mortality disease (NRM). Subjects were 622 patients, median age of 44, forming part of the prospective, randomized, and multicenter clinical Polish Adult Leukemia Group trials during 1999-2008. The Mantel-Byar approach was used to assess allo-HSCT on survival endpoints, accounting for a changing transplant status. Undergoing allo-HSCT significantly improved the LFS and OS for the entire group of patients with AML in CR1, along with the DAC induction subgroup and for the group with unfavorable cytogenetics aged 41-60. The CIR demonstrated that allo-HSCT reduced the risk of relapse for patients with AML in CR1 and those with an unfavorable cytogenetic risk. In addition, the NRM analysis showed that allo-HSCT significantly reduced the risk of death unrelated to relapse for the entire group of AML patients in CR1 and aged 41-60. The allo-HSCT treatment particularly benefitted survival for the AML in CR1 group having an unfavorable cytogenetic prognosis.
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Affiliation(s)
- Sebastian Grosicki
- Department of Cancer Prevention, School of Public Health; Medical University of Silesia; Katowice Poland
| | - Jerzy Holowiecki
- Department of Bone Marrow Transplantation, Branch Gliwice; Comprehensive Cancer Center M. Sklodowska-Curie Memorial Institute; Gliwice Poland
| | - Kazimierz Kuliczkowski
- Department of Haematology, Hematopoietic Malignancies and BMT; Medical University; Wroclaw Poland
| | - Aleksander Skotnicki
- Department of Haematology, Collegium Medicum; Jagiellonian University; Cracow Poland
| | - Andrzej Hellmann
- Department of Haematology and Transplantology; Medical University; Gdansk Poland
| | - Slawomira Kyrcz-Krzemien
- Department of Haematology and Bone Marrow Transplantation; Medical University of Silesia; Katowice Poland
| | - Anna Dmoszynska
- Samodzielna Pracownia Transplantologii Klinicznej; Uniwersytet Medyczny; Lublin Poland
| | | | - Janusz Kloczko
- Department of Hematology; Medical University; Bialystok Poland
| | - Wieslaw W. Jedrzejczak
- Department of Hematology, Oncology and Internal Medicine; Medical University; Warsaw Poland
| | - Krzysztof Warzocha
- Department of Haematology; Institute of Haematology and Transfusion Medicine; Warsaw Poland
| | - Barbara Zdziarska
- Department of Internal Medicine and Haematology; SPSK Nr 1; Szczecin Poland
| | - Agnieszka Wierzbowska
- Department of Haematology, Copernicus Memorial Hospital; Medical University; Lodz Poland
| | - Agnieszka Pluta
- Department of Haematology, Copernicus Memorial Hospital; Medical University; Lodz Poland
| | - Mieczyslaw Komarnicki
- Department of Hematology and Proliferative Diseases of The Hematopoietic Systems; Poznan University of Medical Sciences; Poznan Poland
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation, Branch Gliwice; Comprehensive Cancer Center M. Sklodowska-Curie Memorial Institute; Gliwice Poland
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11
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Walewski JA, Nademanee A, Masszi T, Holowiecki J, Abidi M, Chen AI, Stiff PJ, Viviani S, Bachanova V, Sweetenham JW, Lee SY, Huebner D, Larsen EK, Hunder NNH, Moskowitz CH. Multivariate analysis of PFS from the AETHERA trial: A phase III study of brentuximab vedotin consolidation after autologous stem cell transplant for HL. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8519] [Citation(s) in RCA: 2] [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: 11/20/2022] Open
Affiliation(s)
- Jan Andrzej Walewski
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | | | - Tamás Masszi
- Szent Istvan & Szent Laszlo Corporate Hospital Hematology & Stem Cell Dept., Budapest, Hungary
| | - Jerzy Holowiecki
- Department of Bone Marrow Transplantation & Oncohematology, Maria Sklodowska-Curie Institute of Oncology, Gliwice, Poland
| | | | - Andy I. Chen
- Oregon Health and Science University, Portland, OR
| | | | | | | | | | - Shih-Yuan Lee
- Takeda Pharmaceuticals International Company, Cambridge, MA
| | - Dirk Huebner
- Takeda Pharmaceuticals International Company, Cambridge, MA
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12
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Ramsey SD, Nademanee A, Masszi T, Holowiecki J, Abidi M, Chen AI, Stiff PJ, Viviani S, Zhu Y, Bonthapally V, Thomas E, Hunder NNH, Walewski JA. Quality of life EQ-5D results from the AETHERA trial: A phase III study of brentuximab vedotin consolidation following autologous stem cell transplant for HL. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.6568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Scott David Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Tamás Masszi
- Szent Istvan & Szent Laszlo Corporate Hospital Hematology & Stem Cell Dept., Budapest, Hungary
| | - Jerzy Holowiecki
- Department of Bone Marrow Transplantation & Oncohematology, Maria Sklodowska-Curie Institute of Oncology, Gliwice, Poland
| | | | - Andy I. Chen
- Oregon Health and Science University, Portland, OR
| | | | | | - Yanyan Zhu
- Takeda Pharmaceuticals International Company, Cambrid, MA
| | | | | | | | - Jan Andrzej Walewski
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
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13
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Moskowitz CH, Nademanee A, Masszi T, Agura E, Holowiecki J, Abidi MH, Chen AI, Stiff P, Gianni AM, Carella A, Osmanov D, Bachanova V, Sweetenham J, Sureda A, Huebner D, Sievers EL, Chi A, Larsen EK, Hunder NN, Walewski J. Brentuximab vedotin as consolidation therapy after autologous stem-cell transplantation in patients with Hodgkin's lymphoma at risk of relapse or progression (AETHERA): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2015; 385:1853-62. [PMID: 25796459 DOI: 10.1016/s0140-6736(15)60165-9] [Citation(s) in RCA: 489] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND High-dose therapy followed by autologous stem-cell transplantation is standard of care for patients with relapsed or primary refractory Hodgkin's lymphoma. Roughly 50% of patients might be cured after autologous stem-cell transplantation; however, most patients with unfavourable risk factors progress after transplantation. We aimed to assess whether brentuximab vedotin improves progression-free survival when given as early consolidation after autologous stem-cell transplantation. METHODS We did this randomised, double-blind, placebo-controlled, phase 3 trial at 78 sites in North America and Europe. Patients with unfavourable-risk relapsed or primary refractory classic Hodgkin's lymphoma who had undergone autologous stem-cell transplantation were randomly assigned, by fixed-block randomisation with a computer-generated random number sequence, to receive 16 cycles of 1·8 mg/kg brentuximab vedotin or placebo intravenously every 3 weeks, starting 30-45 days after transplantation. Randomisation was stratified by best clinical response after completion of salvage chemotherapy (complete response vs partial response vs stable disease) and primary refractory Hodgkin's lymphoma versus relapsed disease less than 12 months after completion of frontline therapy versus relapse 12 months or more after treatment completion. Patients and study investigators were masked to treatment assignment. The primary endpoint was progression-free survival by independent review, defined as the time from randomisation to the first documentation of tumour progression or death. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01100502. FINDINGS Between April 6, 2010, and Sept 21, 2012, we randomly assigned 329 patients to the brentuximab vedotin group (n=165) or the placebo group (n=164). Progression-free survival by independent review was significantly improved in patients in the brentuximab vedotin group compared with those in the placebo group (hazard ratio [HR] 0·57, 95% CI 0·40-0·81; p=0·0013). Median progression-free survival by independent review was 42·9 months (95% CI 30·4-42·9) for patients in the brentuximab vedotin group compared with 24·1 months (11·5-not estimable) for those in the placebo group. We recorded consistent benefit (HR <1) of brentuximab vedotin consolidation across subgroups. The most frequent adverse events in the brentuximab vedotin group were peripheral sensory neuropathy (94 [56%] of 167 patients vs 25 [16%] of 160 patients in the placebo group) and neutropenia (58 [35%] vs 19 [12%] patients). At time of analysis, 28 (17%) of 167 patients had died in the brentuximab vedotin group compared with 25 (16%) of 160 patients in the placebo group. INTERPRETATION Early consolidation with brentuximab vedotin after autologous stem-cell transplantation improved progression-free survival in patients with Hodgkin's lymphoma with risk factors for relapse or progression after transplantation. This treatment provides an important therapeutic option for patients undergoing autologous stem-cell transplantation. FUNDING Seattle Genetics and Takeda Pharmaceuticals International.
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Affiliation(s)
| | | | - Tamas Masszi
- Szent Istvan & Szent Laszlo Corporate Hospital Hematology & Stem Cell Dept, Budapest, Hungary
| | - Edward Agura
- Baylor University Medical Center, Dallas, TX, USA
| | - Jerzy Holowiecki
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Institute of Oncology, Gliwice, Poland
| | | | - Andy I Chen
- Oregon Health and Science University, Portland, OR, USA
| | | | | | - Angelo Carella
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - Dzhelil Osmanov
- Blokhin Cancer Research Center under the Russian Academy of Medical Sciences, Moscow, Russia
| | | | - John Sweetenham
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Anna Sureda
- Institut Catala d'Oncologia-Hospital Duran i Reynals, Barcelona, Spain
| | - Dirk Huebner
- Takeda Pharmaceuticals International, Cambridge, MA, USA
| | | | - Andy Chi
- Takeda Pharmaceuticals International, Cambridge, MA, USA
| | | | | | - Jan Walewski
- Maria Sklodowska-Curie Institute and Oncology Center, Warszawa, Poland
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14
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Moskowitz CH, Nademanee A, Masszi T, Agura E, Holowiecki J, Abidi MH, Chen AI, Stiff P, Gianni AM, Carella A, Osmanov D, Bachanova V, Sweetenham J, Sureda A, Huebner D, Sievers EL, Chi A, Larsen EK, Hunder NN, Walewski J. Brentuximab vedotin as consolidation therapy after autologous stem-cell transplantation in patients with Hodgkin's lymphoma at risk of relapse or progression (AETHERA): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2015. [PMID: 25796459 DOI: 10.1016/s0140-6736(1560165-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND High-dose therapy followed by autologous stem-cell transplantation is standard of care for patients with relapsed or primary refractory Hodgkin's lymphoma. Roughly 50% of patients might be cured after autologous stem-cell transplantation; however, most patients with unfavourable risk factors progress after transplantation. We aimed to assess whether brentuximab vedotin improves progression-free survival when given as early consolidation after autologous stem-cell transplantation. METHODS We did this randomised, double-blind, placebo-controlled, phase 3 trial at 78 sites in North America and Europe. Patients with unfavourable-risk relapsed or primary refractory classic Hodgkin's lymphoma who had undergone autologous stem-cell transplantation were randomly assigned, by fixed-block randomisation with a computer-generated random number sequence, to receive 16 cycles of 1·8 mg/kg brentuximab vedotin or placebo intravenously every 3 weeks, starting 30-45 days after transplantation. Randomisation was stratified by best clinical response after completion of salvage chemotherapy (complete response vs partial response vs stable disease) and primary refractory Hodgkin's lymphoma versus relapsed disease less than 12 months after completion of frontline therapy versus relapse 12 months or more after treatment completion. Patients and study investigators were masked to treatment assignment. The primary endpoint was progression-free survival by independent review, defined as the time from randomisation to the first documentation of tumour progression or death. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01100502. FINDINGS Between April 6, 2010, and Sept 21, 2012, we randomly assigned 329 patients to the brentuximab vedotin group (n=165) or the placebo group (n=164). Progression-free survival by independent review was significantly improved in patients in the brentuximab vedotin group compared with those in the placebo group (hazard ratio [HR] 0·57, 95% CI 0·40-0·81; p=0·0013). Median progression-free survival by independent review was 42·9 months (95% CI 30·4-42·9) for patients in the brentuximab vedotin group compared with 24·1 months (11·5-not estimable) for those in the placebo group. We recorded consistent benefit (HR <1) of brentuximab vedotin consolidation across subgroups. The most frequent adverse events in the brentuximab vedotin group were peripheral sensory neuropathy (94 [56%] of 167 patients vs 25 [16%] of 160 patients in the placebo group) and neutropenia (58 [35%] vs 19 [12%] patients). At time of analysis, 28 (17%) of 167 patients had died in the brentuximab vedotin group compared with 25 (16%) of 160 patients in the placebo group. INTERPRETATION Early consolidation with brentuximab vedotin after autologous stem-cell transplantation improved progression-free survival in patients with Hodgkin's lymphoma with risk factors for relapse or progression after transplantation. This treatment provides an important therapeutic option for patients undergoing autologous stem-cell transplantation. FUNDING Seattle Genetics and Takeda Pharmaceuticals International.
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Affiliation(s)
| | | | - Tamas Masszi
- Szent Istvan & Szent Laszlo Corporate Hospital Hematology & Stem Cell Dept, Budapest, Hungary
| | - Edward Agura
- Baylor University Medical Center, Dallas, TX, USA
| | - Jerzy Holowiecki
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Institute of Oncology, Gliwice, Poland
| | | | - Andy I Chen
- Oregon Health and Science University, Portland, OR, USA
| | | | | | - Angelo Carella
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - Dzhelil Osmanov
- Blokhin Cancer Research Center under the Russian Academy of Medical Sciences, Moscow, Russia
| | | | - John Sweetenham
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Anna Sureda
- Institut Catala d'Oncologia-Hospital Duran i Reynals, Barcelona, Spain
| | - Dirk Huebner
- Takeda Pharmaceuticals International, Cambridge, MA, USA
| | | | - Andy Chi
- Takeda Pharmaceuticals International, Cambridge, MA, USA
| | | | | | - Jan Walewski
- Maria Sklodowska-Curie Institute and Oncology Center, Warszawa, Poland
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15
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Smagur A, Mitrus I, Ciomber A, Panczyniak K, Fidyk W, Sadus-Wojciechowska M, Holowiecki J, Giebel S. Comparison of the cryoprotective solutions based on human albumin vs. autologous plasma: its effect on cell recovery, clonogenic potential of peripheral blood hematopoietic progenitor cells and engraftment after autologous transplantation. Vox Sang 2015; 108:417-24. [DOI: 10.1111/vox.12238] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 10/15/2014] [Accepted: 11/29/2014] [Indexed: 12/30/2022]
Affiliation(s)
- A. Smagur
- Department of Bone Marrow Transplantation and Oncohematology; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch; Gliwice Poland
| | - I. Mitrus
- Department of Bone Marrow Transplantation and Oncohematology; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch; Gliwice Poland
| | - A. Ciomber
- Department of Bone Marrow Transplantation and Oncohematology; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch; Gliwice Poland
| | - K. Panczyniak
- Analytics and Clinical Biochemistry Department; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch; Gliwice Poland
| | - W. Fidyk
- Department of Bone Marrow Transplantation and Oncohematology; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch; Gliwice Poland
| | - M. Sadus-Wojciechowska
- Department of Bone Marrow Transplantation and Oncohematology; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch; Gliwice Poland
| | - J. Holowiecki
- Department of Bone Marrow Transplantation and Oncohematology; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch; Gliwice Poland
| | - S. Giebel
- Department of Bone Marrow Transplantation and Oncohematology; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch; Gliwice Poland
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16
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Budziszewska BK, Pluta A, Sulek K, Wierzbowska A, Robak T, Giebel S, Holowiecka-Goral A, Sawicki W, Ejduk A, Patkowska E, Manko J, Gajkowska-Kulik J, Piszcz J, Mordak-Domagala M, Madry K, Holowiecki J, Kyrcz-Krzemien S, Nowakowska-Domagala M, Dmoszynska A, Calbecka M, Kloczko J, Wiktor Jędrzejczak W, Lange A, Razny M, Bilinski P, Warzocha K, Lech-Maranda E. Treatment of elderly patients with acute myeloid leukemia adjusted for performance status and presence of comorbidities: a Polish Adult Leukemia Group study. Leuk Lymphoma 2015; 56:2331-8. [PMID: 25393675 DOI: 10.3109/10428194.2014.985672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This prospective study estimated outcomes in 509 elderly patients with acute myeloid leukemia (AML) with different treatment approaches depending on Eastern Cooperative Oncology Group (ECOG) performance status and Charlson Comorbidity Index (CCI). Patients were stratified into fit (ECOG 0-2 and CCI 0-2) or frail (ECOG>2 and/or CCI>2) groups. Fit patients with CCI 0 received intensive chemotherapy whilst reduced-intensive chemotherapy (R-IC) was given to those with CCI 1-2. Frail patients received best supportive therapy. Fit patients presented a longer overall survival (OS) than frail subjects, but 8-week mortality rates were similar. The complete response (CR) rate between fit CCI 0 and CCI 1-2 subgroups was significantly different. Both of the fit subgroups showed similar 8-week mortality rates and OS probabilities. Allocating fit patients with CCI 1-2 to R-IC enabled an increase in the group of elderly patients who could be treated with the intention of inducing remission.
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Affiliation(s)
- Bozena Katarzyna Budziszewska
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland.,b Center of Postgraduate Medical Education , Warsaw , Poland
| | - Agnieszka Pluta
- c Hematology Department, Medical University of Lodz , Lodz , Poland
| | - Kazimierz Sulek
- d Hematology Department, Military Medical Institute , Warsaw , Poland
| | | | - Tadeusz Robak
- c Hematology Department, Medical University of Lodz , Lodz , Poland
| | - Sebastian Giebel
- e Department of Bone Marrow Transplantation , Comprehensive Cancer Center, M. Sklodowska-Curie Memorial Institute , Gliwice , Poland
| | | | - Waldemar Sawicki
- d Hematology Department, Military Medical Institute , Warsaw , Poland
| | - Anna Ejduk
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland
| | - Elzbieta Patkowska
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland.,b Center of Postgraduate Medical Education , Warsaw , Poland
| | - Joanna Manko
- f Hematology Department, Medical University of Lublin , Lublin , Poland
| | | | - Jaroslaw Piszcz
- h Hematology Department, Medical University of Bialystok , Bialystok , Poland
| | | | - Krzysztof Madry
- j Hematology and Oncology Department, Warsaw Medical University , Warsaw , Poland
| | - Jerzy Holowiecki
- e Department of Bone Marrow Transplantation , Comprehensive Cancer Center, M. Sklodowska-Curie Memorial Institute , Gliwice , Poland
| | | | | | - Anna Dmoszynska
- f Hematology Department, Medical University of Lublin , Lublin , Poland
| | | | - Janusz Kloczko
- h Hematology Department, Medical University of Bialystok , Bialystok , Poland
| | | | - Andrzej Lange
- i Lower Silesian Centrum for Cellular Transplantation , Wroclaw , Poland
| | - Malgorzata Razny
- m Hematology Department, Rydygier Memorial Hospital , Krakow , Poland
| | - Przemyslaw Bilinski
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland
| | - Krzysztof Warzocha
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland
| | - Ewa Lech-Maranda
- a Hematology Department, Institute of Hematology and Transfusion Medicine , Warsaw , Poland.,b Center of Postgraduate Medical Education , Warsaw , Poland
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Mitrus I, Smagur A, Giebel S, Gliwinska J, Prokop M, Glowala-Kosinska M, Chwieduk A, Sadus-Wojciechowska M, Tukiendorf A, Holowiecki J. A faster reconstitution of hematopoiesis after autologous transplantation of hematopoietic cells cryopreserved in 7.5% dimethyl sulfoxide if compared to 10% dimethyl sulfoxide containing medium. Cryobiology 2013; 67:327-31. [DOI: 10.1016/j.cryobiol.2013.09.167] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/12/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
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Wawrzyniak E, Wierzbowska A, Kotkowska A, Siemieniuk-Rys M, Robak T, Knopinska-Posluszny W, Klonowska A, Iliszko M, Woroniecka R, Pienkowska-Grela B, Ejduk A, Wach M, Duszenko E, Jaskowiec A, Jakobczyk M, Mucha B, Kosny J, Pluta A, Grosicki S, Holowiecki J, Haus O. Different prognosis of acute myeloid leukemia harboring monosomal karyotype with total or partial monosomies determined by FISH: Retrospective PALG study. Leuk Res 2013; 37:293-9. [DOI: 10.1016/j.leukres.2012.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 09/25/2012] [Accepted: 10/27/2012] [Indexed: 10/27/2022]
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Giebel S, Kruzel T, Czerw T, Sadus-Wojciechowska M, Najda J, Chmielowska E, Grosicki S, Jurczyszyn A, Pasiarski M, Nowara E, Glowala-Kosinka M, Chwieduk A, Mitrus I, Smagur A, Holowiecki J. Intermediate-dose Ara-C plus G-CSF for stem cell mobilization in patients with lymphoid malignancies, including predicted poor mobilizers. Bone Marrow Transplant 2013; 48:915-21. [DOI: 10.1038/bmt.2012.269] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/06/2012] [Accepted: 11/28/2012] [Indexed: 11/09/2022]
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Smagur A, Mitrus I, Giebel S, Sadus-Wojciechowska M, Najda J, Kruzel T, Czerw T, Gliwinska J, Prokop M, Glowala-Kosinska M, Chwieduk A, Holowiecki J. Impact of different dimethyl sulphoxide concentrations on cell recovery, viability and clonogenic potential of cryopreserved peripheral blood hematopoietic stem and progenitor cells. Vox Sang 2012; 104:240-7. [DOI: 10.1111/j.1423-0410.2012.01657.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Kruzel T, Czerw T, Sadus-Wojciechowska M, Najda J, Glowala-Kosinska M, Chwieduk A, Holowiecki J, Giebel S. Very High Efficacy of Cytarabine + G-CSF Compared to Cyclophosphamide + G-CSF as Hematopoietic Stem Cell Mobilization in Patients with Lymphoid Malignancies Referred for Autologous Transplantation. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33638-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Holowiecki J, Grosicki S, Giebel S, Robak T, Kyrcz-Krzemien S, Kuliczkowski K, Skotnicki AB, Hellmann A, Sulek K, Dmoszynska A, Kloczko J, Jedrzejczak WW, Zdziarska B, Warzocha K, Zawilska K, Komarnicki M, Kielbinski M, Piatkowska-Jakubas B, Wierzbowska A, Wach M, Haus O. Cladribine, But Not Fludarabine, Added to Daunorubicin and Cytarabine During Induction Prolongs Survival of Patients With Acute Myeloid Leukemia: A Multicenter, Randomized Phase III Study. J Clin Oncol 2012; 30:2441-8. [DOI: 10.1200/jco.2011.37.1286] [Citation(s) in RCA: 178] [Impact Index Per Article: 14.8] [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 The goal of this study was to evaluate whether the addition of a purine analog, cladribine or fludarabine, to the standard induction regimen affects the outcome of adult patients with acute myeloid leukemia (AML). Patients and Methods A cohort of 652 untreated AML patients with median age 47 years (range, 17 to 60 years) were randomly assigned to receive one of three induction regimens: DA (daunorubicin plus cytarabine), DAC (DA plus cladribine), or DAF (DA plus fludarabine). Postremission treatment was the same for all arms. Results Complete remission rate in the DAC arm was higher compared with the DA arm (67.5% v 56%; P = .01) as a consequence of reduced incidence of resistant disease (21% v 34%; P = .004). There was no significant difference in early outcome between the DAF and DA arms. The probability of overall survival was improved for the DAC arm (45% ± 4% at 3 years) compared with the DA arm (33% ± 4%; P = .02), and leukemia-free survival was comparable. Long-term outcome did not differ significantly for the comparison of the DAF and DA arms. A survival advantage of the DAC arm over the DA arm was observed among patients age 50 years or older (P = .005), those with initial leukocyte count above 50 × 109/L (P = .03), and those with unfavorable karyotype (P = .03). DAF revealed a significant advantage over DA in patients with adverse karyotype (P = .02). Conclusion The addition of cladribine to the standard induction regimen is associated with increased rate of complete remission and improved survival of adult patients with AML.
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Affiliation(s)
- Jerzy Holowiecki
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Sebastian Grosicki
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Sebastian Giebel
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Tadeusz Robak
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Slawomira Kyrcz-Krzemien
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Kazimierz Kuliczkowski
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Aleksander B. Skotnicki
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Andrzej Hellmann
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Kazimierz Sulek
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Anna Dmoszynska
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Janusz Kloczko
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Wieslaw W. Jedrzejczak
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Barbara Zdziarska
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Krzysztof Warzocha
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Krystyna Zawilska
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Mieczysław Komarnicki
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Marek Kielbinski
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Beata Piatkowska-Jakubas
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Agnieszka Wierzbowska
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Malgorzata Wach
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
| | - Olga Haus
- Jerzy Holowiecki and Sebastian Giebel, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Branch Gliwice, Gliwice; Sebastian Grosicki, Samodzielny Publiczny Zakład Opieki Zdrowotnej Zespol Szpitali Miejskich, Chorzow; Tadeusz Robak and Agnieszka Wierzbowska, Medical University of Lodz, Lodz; Slawomira Kyrcz-Krzemien, Silesian Medical University, Katowice; Kazimierz Kuliczkowski, Marek Kielbinski, and Olga Haus, Wroclaw Medical University, Wroclaw; Aleksander B. Skotnicki and Beata
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Giebel S, Thomas X, Hallbook H, Geissler K, Boiron JM, Huguet F, Koller E, Jaeger U, Smedmyr B, Hellmann A, Holowiecki J. The prophylactic use of granulocyte-colony stimulating factor during remission induction is associated with increased leukaemia-free survival of adults with acute lymphoblastic leukaemia: a joint analysis of five randomised trials on behalf of the EWALL. Eur J Cancer 2011; 48:360-7. [PMID: 22196969 DOI: 10.1016/j.ejca.2011.11.023] [Citation(s) in RCA: 13] [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] [Received: 10/03/2011] [Revised: 11/23/2011] [Accepted: 11/24/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Granulocyte-colony stimulating factor (G-CSF) is used to prevent febrile neutropenia and support intense chemotherapy. However, its impact on long-term outcome in oncological patients including adults with acute lymphoblastic leukaemia (ALL) has not been determined so far. METHODS In the current study follow-up data from individual patients recruited in five multicentre, prospective, randomised trials were pooled to perform a joint analysis. Among 347 adults and adolescents with ALL, 185 were assigned to receive prophylactically G-CSF along with induction chemotherapy while 162 patients were treated without G-CSF support. RESULTS With the median follow-up of 5.3years, there was a tendency towards increased 5year probability of the overall survival for the G-CSF arm compared to the controls (32%±4% versus 23%±4%, p=.07), which reached statistical significance in a subgroup of T-ALL (51%±8% versus 29%±9%, p=.01) and among patients aged 21-40years (44%±6% versus 27%±6%, p=.03). The probability of leukaemia-free survival was 38%±4% and 24%±4% (p=.01) while the median remission duration equalled 33 and 17months (p=.007), respectively. In a multivariate analysis the prophylactic use of G-CSF was independently associated with reduced risk of relapse (hazard ratio (HR)=.64, p=.007) and treatment failure (HR=.67, p=.02). CONCLUSIONS The prophylactic use of G-CSF during induction of ALL is associated with improved long-term outcome and should be recommended especially in a setting of T-ALL and in 'young adults'. Our analysis provides the first direct evidence coming from prospective trials for the impact of primary G-CSF prophylaxis on disease-free survival of oncological patients.
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Affiliation(s)
- Sebastian Giebel
- Department of Bone Marrow Transplantation, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland
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Casper J, Holowiecki J, Trenschel R, Wandt H, Schaefer-Eckart K, Ruutu T, Volin L, Einsele H, Stuhler G, Uharek L, Blau I, Bornhaeuser M, Zander AR, Larsson K, Markiewicz M, Giebel S, Kruzel T, Mylius HA, Baumgart J, Pichlmeier U, Freund M, Beelen DW. Allogeneic hematopoietic SCT in patients with AML following treosulfan/fludarabine conditioning. Bone Marrow Transplant 2011; 47:1171-7. [PMID: 22158386 DOI: 10.1038/bmt.2011.242] [Citation(s) in RCA: 41] [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: 12/31/2022]
Abstract
An alternative reduced-toxicity conditioning regimen for allogeneic transplantation, based on treosulfan and fludarabine, has recently been identified. The safety and efficacy of this new conditioning regimen has been investigated prospectively in patients with AML. A total number of 75 patients with AML in CR were treated with 3 × 14 g/m(2) treosulfan and 5 × 30 mg/m(2) fludarabine, followed by matched sibling or unrelated SCT. Patients were evaluated for engraftment, adverse events, GVHD, and for non-relapse mortality, relapse incidence, overall and disease-free survival (DFS). All patients showed primary engraftment of neutrophils after a median of 20 days. Non-hematological adverse events grade III-IV in severity included mainly infections (59%) and gastrointestinal symptoms (7%). Acute GVHD grade II-IV occurred in 21% and extensive chronic GVHD occurred in 16% of the patients. After a median follow-up of 715 days, the 2-year overall and DFS estimates were 61% and 55%, respectively. The 2-year incidences of relapse and non-relapse mortality reached 34% and 11%, respectively. In summary, our data confirm promising safety and efficacy of the treosulfan-based conditioning therapy in AML patients, ClinicalTrials.gov Identifier: NCT01063660.
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Affiliation(s)
- J Casper
- Division of Hematology and Oncology, University of Rostock, Rostock, Germany.
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Ruutu T, Volin L, Beelen DW, Trenschel R, Finke J, Schnitzler M, Holowiecki J, Giebel S, Markiewicz M, Uharek L, Blau IW, Kienast J, Stelljes M, Larsson K, Zander AR, Gramatzki M, Repp R, Einsele H, Stuhler G, Baumgart J, Mylius HA, Pichlmeier U, Freund M, Casper J. Reduced-toxicity conditioning with treosulfan and fludarabine in allogeneic hematopoietic stem cell transplantation for myelodysplastic syndromes: final results of an international prospective phase II trial. Haematologica 2011; 96:1344-50. [PMID: 21659356 DOI: 10.3324/haematol.2011.043810] [Citation(s) in RCA: 50] [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] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND An alternative reduced-toxicity conditioning regimen for allogeneic transplantation, based on treosulfan and fludarabine, has recently been identified. The rationale for this study was to investigate the efficacy and safety of this regimen prospectively in patients with a primary myelodysplastic syndrome. DESIGN AND METHODS A total of 45 patients with primary myelodysplastic syndromes were conditioned with 3×14 g/m(2) treosulfan and 5×30 mg/m(2) fludarabine followed by allogeneic hematopoietic stem cell transplantation. Subtypes of myelodysplastic syndromes were refractory anemia with excess blasts-2 (44%), refractory cytopenia with multilineage dysplasia (27%), refractory anemia (9%), refractory anemia with ringed sideroblasts (4%), refractory cytopenia with multilineage dysplasia and ringed sideroblasts (4%), refractory anemia with excess blasts-1 (2%), and myelodysplastic syndrome with isolated del (5q) (2%). The myelodysplastic syndrome was unclassified in 7% of the patients. Forty-seven percent of the patients had a favorable karyotype, 29% an unfavorable one, and 18% an intermediate karyotype. Patients were evaluated for engraftment, adverse events, graft-versus-host disease, non-relapse mortality, relapse incidence, overall survival and disease-free survival. RESULTS All but one patient showed primary engraftment of neutrophils after a median of 17 days. Non-hematologic adverse events of grade III-IV in severity included mainly infections and gastrointestinal symptoms (80% and 22% of the patients, respectively). Acute graft-versus-host disease grade II-IV developed in 24%, and extensive chronic graft-versus-host disease in 28% of the patients. After a median follow-up of 780 days, the 2-year overall and disease-free survival estimates were 71% and 67%, respectively. The 2-year cumulative incidences of non-relapse mortality and relapse were 17% and 16%, respectively. CONCLUSIONS Our safety and efficacy data suggest that treosulfan-based conditioning therapy is a promising treatment option for patients with myelodysplastic syndromes. clinicaltrials.gov identifier: NCT01062490.
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Affiliation(s)
- Tapani Ruutu
- Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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Grosicki S, Holowiecki J, Giebel S, Kyrcz-Krzemien S, Kuliczkowski K, Kielbinski M, Skotnicki AB, Piatkowska-Jakubas B, Hellmann A, Wierzbowska A, Stella-Holowiecka B, Zdziarska B, Calbecka M. The early reduction of leukemic blasts in bone marrow on day 6 of induction treatment is predictive for complete remission rate and survival in adult acute myeloid leukemia; the results of multicenter, prospective Polish Adult Leukemia Group study. Am J Hematol 2011; 86:437-9. [PMID: 21465518 DOI: 10.1002/ajh.21996] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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: 11/12/2022]
Abstract
The aim of this study was to prospectively evaluate the impact of early bone marrow response on complete remission (CR) rate and long-term outcome in adults with acute myeloid leukemia. Bone marrow cytology was assessed on day 6 of induction treatment in 164 patients, revealing the presence of ≥5% blasts in 61 cases. In this subgroup the CR rate was significantly lower compared to the remaining patients (P < 0.00001) resulting in decrease of the overall survival (P = 0.002). Persistence of ≥5% blasts in bone marrow on day 6 of induction is an easily available surrogate marker to be used for treatment decisions.
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Affiliation(s)
- Sebastian Grosicki
- Oddzial Hematologiczny, SPZOZ ZSM, Karola Miarki Str 40, Chorzow, Poland.
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Nasilowska-Adamska B, Szydlo R, Rzepecki P, Czyz A, Tomaszewska A, Markiewicz M, Torosian T, Bieniaszewska M, Hellman A, Jedrzejczak WW, Holowiecki J, Komarnicki M, Warzocha K, Marianska B. Palifermin does not influence the incidence and severity of GvHD nor long-term survival of patients with hematological diseases undergoing HSCT. Ann Transplant 2011; 16:47-54. [DOI: 10.12659/aot.882218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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] Open
Affiliation(s)
| | | | | | - Anna Czyz
- K. Marcinkowski University of Medical Science, Poznan, Poland
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Casper J, Wolff D, Knauf W, Blau IW, Ruutu T, Volin L, Wandt H, Schäfer-Eckart K, Holowiecki J, Giebel S, Aschan J, Zander AR, Kröger N, Hilgendorf I, Baumgart J, Mylius HA, Pichlmeier U, Freund M. Allogeneic hematopoietic stem-cell transplantation in patients with hematologic malignancies after dose-escalated treosulfan/fludarabine conditioning. J Clin Oncol 2010; 28:3344-51. [PMID: 20498405 DOI: 10.1200/jco.2009.23.3429] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [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 Treosulfan was introduced recently as a conditioning agent for allogeneic blood stem-cell transplantation. The favorable nonhematologic toxicity profile at 3 x 10 g/m(2) was the basis for dose escalation in this prospective, multicenter trial. PATIENTS AND METHODS Fifty-six patients with various hematologic malignancies who were not eligible for standard conditioning were treated with one of three doses: 10 g/m(2), 12 g/m(2), or 14 g/m(2) of intravenous treosulfan, which was administered on days -6 to -4 combined with fludarabine 30 mg/m(2) on days -6 to -2. Patients in complete remission (CR; 42%) or non-CR (58%) received grafts from matched related (47%) or matched unrelated (51%) donors; one patient had a mismatched related donor (2%). RESULTS No engraftment failure occurred. Overall, extramedullary toxicity and the nonrelapse mortality rate at 2 years (20%) were low and did not increase with dose. Cumulative incidence of relapse/progression reached 31%. The overall survival and progression-free survival rates were 64% and 49%, respectively, in the total study population. An inverse dose dependency of relapse incidence was indicated in the subgroup receiving transplantations from matched related donors (P = .0568). CONCLUSION Treosulfan-based conditioning was feasible at all three doses. The 3 x 14 g/m(2) dose was selected for additional studies, because it combines desired characteristics of low toxicity and a low relapse rate.
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Coiffier B, Losic N, Rønn BB, Lepretre S, Pedersen LM, Gadeberg O, Frederiksen H, van Oers MHJ, Wooldridge J, Kloczko J, Holowiecki J, Hellmann A, Walewski J, Robak T, Petersen J. Pharmacokinetics and pharmacokinetic/pharmacodynamic associations of ofatumumab, a human monoclonal CD20 antibody, in patients with relapsed or refractory chronic lymphocytic leukaemia: a phase 1-2 study. Br J Haematol 2010; 150:58-71. [PMID: 20408846 DOI: 10.1111/j.1365-2141.2010.08193.x] [Citation(s) in RCA: 18] [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: 12/01/2022]
Abstract
The purpose of this phase 1-2 study was to investigate the association between the pharmacokinetic properties of ofatumumab, a human monoclonal CD20 antibody, and outcomes in 33 patients with relapsed/refractory chronic lymphocytic leukaemia receiving 4 weekly infusions of ofatumumab. The ofatumumab concentration profiles were fitted well by a two-compartment model with different elimination rate constant at first infusion compared to the remaining infusions in line with the observed rapid and sustained B-cell depletion. Exposure to ofatumumab was linked to clinical outcomes: high exposure was associated with higher probability of overall clinical response and longer progression-free survival. This association still remained statistically significant even when adjusting for relevant baseline covariates including tumour burden.
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Affiliation(s)
- Bertrand Coiffier
- Département d'Hématologie, Centre Hospitalier Lyon Sud, Pierre-Benite Cedex, France. bertrand
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Giebel S, Stella-Holowiecka B, Krawczyk-Kulis M, Gökbuget N, Hoelzer D, Doubek M, Mayer J, Piatkowska-Jakubas B, Skotnicki AB, Dombret H, Ribera JM, Piccaluga PP, Czerw T, Kyrcz-Krzemien S, Holowiecki J. Status of minimal residual disease determines outcome of autologous hematopoietic SCT in adult ALL. Bone Marrow Transplant 2009; 45:1095-101. [PMID: 19855438 DOI: 10.1038/bmt.2009.308] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The role of autologous hematopoietic SCT (autoHSCT) in the treatment of high-risk (HR) adult ALL is controversial. In this study, we retrospectively analyzed the results of autoHSCT according to the status of minimal residual disease (MRD) at transplantation, as a joint analysis of the European Study Group for Adult ALL (EWALL). Data on 123 recipients of autoHSCT, aged 31 (16-59) years, with B-lineage (n=77) or T-lineage (n=46) ALL were included. In a cohort of Ph-negative ALL, the probability of leukemia-free survival at 5 years was higher for patients with MRD <0.1% compared with those with MRD > or = 0.1% (57 vs 17%, P=0.0002). The difference was significant for T-lineage ALL (62 vs 8%, P=0.001), and a tendency was observed for B-lineage ALL (54 vs 26%, P=0.17). In a multivariate analysis, adjusted for other potential prognostic factors, high MRD level remained the only independent factor associated with increased risk of failure (risk ratio, 2.8; P=0.0005). We conclude that MRD determines the outcome of autoHSCT in HR adult ALL. Our results suggest the need to reevaluate the role of this treatment option in prospective trials.
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Kantarjian H, Pasquini R, Lévy V, Jootar S, Holowiecki J, Hamerschlak N, Hughes T, Bleickardt E, Dejardin D, Cortes J, Shah NP. Dasatinib or high-dose imatinib for chronic-phase chronic myeloid leukemia resistant to imatinib at a dose of 400 to 600 milligrams daily: two-year follow-up of a randomized phase 2 study (START-R). Cancer 2009; 115:4136-47. [PMID: 19536906 DOI: 10.1002/cncr.24504] [Citation(s) in RCA: 168] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In patients with chronic-phase chronic myeloid leukemia (CP-CML), imatinib resistance is of increasing importance. Imatinib dose escalation was the main treatment option before dasatinib, which has 325-fold more potent inhibition than imatinib against unmutated Bcr-Abl in vitro. Data with a minimum of 2 years of follow-up were available for the current study of dasatinib and high-dose imatinib in CP-CML resistant to imatinib at daily doses from 400 mg to 600 mg. METHODS A phase 2, open-label study was initiated of 150 patients with imatinib-resistant CP-CML who were randomized (2:1) to receive either dasatinib 70 mg twice daily (n=101) or high-dose imatinib 800 mg (400 mg twice daily; n=49). RESULTS At a minimum follow-up of 2 years, dasatinib demonstrated higher rates of complete hematologic response (93% vs 82%; P=.034), major cytogenetic response (MCyR) (53% vs 33%; P=.017), and complete cytogenetic response (44% vs 18%; P=.0025). At 18 months, the MCyR was maintained in 90% of patients on the dasatinib arm and in 74% of patients on the high-dose imatinib arm. Major molecular response rates also were more frequent with dasatinib than with high-dose imatinib (29% vs 12%; P=.028). The estimated progression-free survival also favored dasatinib (unstratified log-rank test; P=.0012). CONCLUSIONS After 2 years of follow-up, dasatinib demonstrated durable responses and improved response and progression-free survival rates relative to high-dose imatinib.
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Affiliation(s)
- Hagop Kantarjian
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77230-1402, USA.
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Giebel S, Nowak I, Dziaczkowska J, Czerw T, Wojnar J, Krawczyk-Kulis M, Holowiecki J, Holowiecka-Goral A, Markiewicz M, Kopera M, Karolczyk A, Kyrcz-Krzemien S, Kusnierczyk P. Activating killer immunoglobulin-like receptor incompatibilities enhance graft-versus-host disease and affect survival after allogeneic hematopoietic stem cell transplantation. Eur J Haematol 2009; 83:343-56. [DOI: 10.1111/j.1600-0609.2009.01280.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Giebel S, Holowiecki J, Krawczyk-Kulis M, Jagoda K, Stella-Holowiecka B, Sadus-Wojciechowska M, Hellmann A, Dmoszynska A, Paluszewska M, Robak T, Konopka L, Seferynska I, Skotnicki AB, Kyrcz-Krzemien S, on Behalf of the Polish Adult Leuke. Impact of granulocyte colony stimulating factor administered during induction and consolidation of adults with acute lymphoblastic leukemia on survival: long-term follow-up of the Polish adult leukemia group 4-96 study. Leuk Lymphoma 2009; 50:1050-3. [DOI: 10.1080/10428190902919176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lech-Maranda E, Seweryn M, Giebel S, Holowiecki J, Piatkowska-Jakubas B, Wegrzyn J, Skotnicki A, Kielbinski M, Kuliczkowski K, Paluszewska M, Jedrzejczak WW, Dutka M, Hellmann A, Flont M, Zdziarska B, Palynyczko G, Konopka L, Szpila T, Gawronski K, Sulek K, Sokolowski J, Kloczko J, Warzocha K, Robak T. Infectious complications in patients with acute myeloid leukemia treated according to the protocol with daunorubicin and cytarabine with or without addition of cladribine. A multicenter study by the Polish Adult Leukemia Group (PALG). Int J Infect Dis 2009; 14:e132-40. [PMID: 19581118 DOI: 10.1016/j.ijid.2009.02.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 09/22/2008] [Accepted: 02/04/2009] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES The addition of cladribine to the standard regimen consisting of daunorubicin and cytarabine has been reported to increase the efficacy of induction therapy in acute myeloid leukemia (AML). The goal of this study was to determine the effect of this modification on the incidence and spectrum of infectious complications. METHODS Case report forms of 309 patients with newly diagnosed AML who had been enrolled in the prospective, randomized 'DAC-7 vs. DA-7' trial were reviewed. The frequency, etiology, localization, severity, and outcome of infections were compared for patients receiving only daunorubicin and cytarabine (DA-7) and those additionally treated with cladribine (DAC-7). RESULTS A total of 443 febrile episodes were reported with no significant difference between the treatment groups. A trend towards a higher frequency of bacteremias was observed among DA-7 patients compared to those in the DAC-7 group (31% vs. 21%; p=0.08). The treatment arms did not differ in terms of the distribution of the isolated Gram-positive, Gram-negative, fungal, and viral organisms. However, when bacteremias were considered, Gram-positive blood cultures tended to be more frequent in the DA-7 compared to the DAC-7 group (16% vs. 8.5%; p=0.07). This difference reached statistical significance when major blood bacteremias were analyzed separately (13% vs. 5%; p=0.02). Complete recovery from infections was observed in the majority of patients across both treatment arms and no significant difference was noted regarding infection-related mortality. CONCLUSIONS The addition of cladribine to standard induction chemotherapy has no impact on the incidence and spectrum of infectious complications in newly diagnosed AML patients.
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Affiliation(s)
- Ewa Lech-Maranda
- Department of Hematology, Medical University of Lodz, Copernicus Hospital, Ciolkowskiego 2 str, 93-510 Lodz, Poland
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Giebel S, Krawczyk-Kulis M, Kyrcz-Krzemien S, Haus O, Jagoda K, Piatkowska-Jakubas B, Paluszewska M, Seferynska I, Chrobok A, Stella-Holowiecka B, Kielbinski M, Holowiecki J. Could cytogenetics and minimal residual disease replace conventional risk criteria in adults with Ph-negative acute lymphoblastic leukaemia? Br J Haematol 2009; 144:970-2. [PMID: 19120362 DOI: 10.1111/j.1365-2141.2008.07540.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kalinka‐Warzocha E, Wajs J, Lech‐Maranda E, Ceglarek B, Holowiecki J, Federowicz I, Walewski J, Czyz J, Robak T, Warzocha K. Randomized comparison of cladribine alone or in combination with cyclophosphamide, and cyclophosphamide, vincristine and prednisone in previously untreated low‐grade B‐cell non‐Hodgkin lymphoma patients. Cancer 2008; 113:367-75. [DOI: 10.1002/cncr.23558] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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37
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Holowiecki J, Krawczyk-Kulis M, Giebel S, Jagoda K, Stella-Holowiecka B, Piatkowska-Jakubas B, Paluszewska M, Seferynska I, Lewandowski K, Kielbinski M, Czyz A, Balana-Nowak A, Krl M, Skotnicki AB, Jedrzejczak WW, Warzocha K, Lange A, Hellmann A. Status of minimal residual disease after induction predicts outcome in both standard and high-risk Ph-negative adult acute lymphoblastic leukaemia. The Polish Adult Leukemia Group ALL 4-2002 MRD Study. Br J Haematol 2008; 142:227-37. [DOI: 10.1111/j.1365-2141.2008.07185.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [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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Holowiecki J, Giebel S, Wojnar J, Krawczyk-Kulis M, Markiewicz M, Holowiecka-Goral A, Freund M, Casper J. Treosulfan and fludarabine low-toxicity conditioning for allogeneic haematopoietic stem cell transplantation in chronic myeloid leukaemia. Br J Haematol 2008; 142:284-92. [DOI: 10.1111/j.1365-2141.2008.07179.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wachowiak J, Labopin M, Miano M, Chybicka A, Stary J, Sterba J, Masszi T, Labar B, Maschan A, Kowalczyk JR, Lange A, Holowiecki J, Kalman N, Afanassiev BV, Dini G. Haematopoietic stem cell transplantation in children in eastern European countries 1985–2004: development, recent activity and role of the EBMT/ESH Outreach Programme. Bone Marrow Transplant 2008; 41 Suppl 2:S112-7. [DOI: 10.1038/bmt.2008.68] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Giebel S, Nowak I, Wojnar J, Krawczyk-Kulis M, Holowiecki J, Kyrcz-Krzemien S, Kusnierczyk P. Association of KIR2DS4 and its variant KIR1D with leukemia. Leukemia 2008; 22:2129-30; discussion 2130-1. [PMID: 18463675 DOI: 10.1038/leu.2008.108] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Helbig G, Stella-Holowiecka B, Majewski M, Lewandowska M, Holowiecki J. Interferon induces a good molecular response in a patient with chronic eosinophilic leukemia (CEL) carrying the JAK2V617F point mutation. Haematologica 2007; 92:e118-e119. [DOI: 10.3324/haematol.11841] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Stella-Holowiecka B, Czerw T, Holowiecka-Goral A, Giebel S, Wojnar J, Holowiecki J. Beta-2-Microglobulin Level Predicts Outcome Following Autologous Hematopoietic Stem Cell Transplantation in Patients With Multiple Myeloma. Transplant Proc 2007; 39:2893-7. [DOI: 10.1016/j.transproceed.2007.08.052] [Citation(s) in RCA: 9] [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] [Indexed: 10/22/2022]
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43
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Nasilowska-Adamska B, Rzepecki P, Manko J, Czyz A, Markiewicz M, Federowicz I, Tomaszewska A, Piatkowska-Jakubas B, Wrzesien-Kus A, Bieniaszewska M, Duda D, Szydlo R, Halaburda K, Szczepinski A, Lange A, Hellman A, Robak T, Skotnicki A, Jedrzejczak WW, Walewski J, Holowiecki J, Komarnicki M, Dmoszynska A, Warzocha K, Marianska B. The influence of palifermin (Kepivance) on oral mucositis and acute graft versus host disease in patients with hematological diseases undergoing hematopoietic stem cell transplant. Bone Marrow Transplant 2007; 40:983-8. [PMID: 17846600 DOI: 10.1038/sj.bmt.1705846] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [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
In this multicenter study, we assessed the use of palifermin (recombinant human-keratinocyte growth factor 1) in the prevention of oral mucositis (OM) and acute GvHD (aGvHD) induced by a hematopoietic stem cell transplant (HSCT). Fifty-three patients with hematological diseases received three doses of palifermin (60 mug/kg once daily i.v.) pre- and post-conditioning regimens (total six doses). A retrospective control group of 53 transplant patients received no palifermin. There was a significant reduction in the incidence of OM of WHO (World Health Organization) grades 1-4 (58 vs 94%, P<0.001), 3-4 (13 vs 43%, P<0.001) and the median duration of OM (4 vs 9 days, P<0.001) in the palifermin group compared to the control group. The incidence of analgesics (32 vs 75.5%, P<0.001), opioid analgesics (24 vs 64%, P<0.001) and total parenteral nutrition (11 vs 45%, P<0.001) was also significantly reduced. The analysis of distribution of affected organs revealed that aGvHD was less prevalent in the palifermin group (P=0.036). There was no significant difference in the onset of any OM after HSCT, time to engraftment and length of hospitalization between groups. The drug was generally well tolerated and safe. Our results suggest that the use of palifermin reduces OM and probably aGvHD after HSCT, but a randomized trial is needed.
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Giebel S, Dziaczkowska J, Wysoczanska B, Wojnar J, Krawczyk-Kulis M, Lange A, Holowiecki J. Lymphocyte reconstitution after allogeneic bone marrow transplantation in a previously thymectomized patient—no evidence of extrathymic T-cell maturation. Bone Marrow Transplant 2007; 40:705-6. [PMID: 17680024 DOI: 10.1038/sj.bmt.1705794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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45
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Helbig G, Stella-Holowiecka B, Wojnar J, Krawczyk M, Krzemien S, Wojciechowska-Sadus M, Markiewicz M, Wylezol I, Kopera M, Holowiecki J. Pure red-cell aplasia following major and bi-directional ABO-incompatible allogeneic stem-cell transplantation: recovery of donor-derived erythropoiesis after long-term treatment using different therapeutic strategies. Ann Hematol 2007; 86:677-83. [PMID: 17486341 DOI: 10.1007/s00277-007-0304-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [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: 12/24/2006] [Accepted: 04/17/2007] [Indexed: 10/23/2022]
Abstract
Blood group incompatibility between donor and recipient of allogeneic stem cell transplants may be associated with post-transplant erythroid aplasia. A total of 548 patients (pts) received allogeneic transplant for malignant and non-malignant hematologic disorders. In a retrospective analysis, the prevalence and outcome of pure red-cell aplasia (PRCA) in 44 pts with major and bi-directional ABO-mismatch were investigated. Bone marrow grafts were major ABO incompatible in 30 pts; there was bi-directional mismatch in the remaining 14 pts. The median number of transplanted mononuclear cells (NC) was 4.74 x 10(8)/kg (range 0.1-26.4) including CD34+ cells, 3.02 x 10(6)/kg (range 0.9-21.7). Granulocyte engraftment >0.5 x 10e9/l occurred after a median of 21 days (7-32), and platelet exceeded >50 x 10e9/l after a median of 23.5 days (12-109). Acute and chronic graft vs host disease (GVHD) developed in 23 (52%) and 26 (59%) of the patients, respectively. Six (13%) patients transplanted with major and bi-directional ABO-incompatibility developed PRCA. The treatment of PRCA consisted of plasmapheresis (PEX), rapid cyclosporine (CsA) discontinuation, donor lymphocyte infusions (DLI), erythropoietin (EPO), azathioprine, and rituximab. The therapy resulted in erythroid recovery in five out of six patients after a median of 13 months (range 3-16). The median number of transfused red blood cells (RBCs) was 36 U (range 8-57). With a median follow-up of 37 months, the 5-year probability of overall survival (OS) for the PRCA group was 66%. Major ABO mismatch may lead to delayed donor erythroid engraftment. It results in long-term transfusion dependence and, therefore, the risk of iron overload. The therapy is long lasting, but usually effective in majority of patients.
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Affiliation(s)
- Grzegorz Helbig
- Department of Haematology and Bone Marrow Transplantation, Silesian Medical University, Reymont Street 8, 40-027 Katowice, Poland.
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Kantarjian H, Pasquini R, Hamerschlak N, Rousselot P, Holowiecki J, Jootar S, Robak T, Khoroshko N, Masszi T, Skotnicki A, Hellmann A, Zaritsky A, Golenkov A, Radich J, Hughes T, Countouriotis A, Shah N. Dasatinib or high-dose imatinib for chronic-phase chronic myeloid leukemia after failure of first-line imatinib: a randomized phase 2 trial. Blood 2007; 109:5143-50. [PMID: 17317857 DOI: 10.1182/blood-2006-11-056028] [Citation(s) in RCA: 298] [Impact Index Per Article: 17.5] [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: 12/19/2022] Open
Abstract
Therapeutic options for chronic myelogenous leukemia (CML) resistant to 400 to 600 mg imatinib are limited. Escalating imatinib doses may overcome resistance. Dasatinib, a significantly more potent inhibitor of BCR-ABL, is safe and effective in this population. Patients with imatinib-resistant chronic-phase (CP) CML were randomized 2:1 to 140 mg dasatinib (n=101) or 800 mg imatinib (n=49). With a median follow up of 15 months, complete hematologic responses were observed in 93% and 82% of patients receiving dasatinib and high-dose imatinib (P=.034), respectively. Dasatinib resulted in higher major cytogenetic response rates (52%) than high-dose imatinib (33%) (P=.023); this included complete cytogenetic response in 40% and 16% (P=.004). Major molecular responses were also more frequent with dasatinib (16% versus 4%; P=0.038). Treatment failure (hazard ratio [HR], 0.16; P<.001) and progression-free survival (HR, 0.14; P<.001) both favored dasatinib. Superficial edema (42% versus 15%) and fluid retention (45% versus 30%) were more prevalent with imatinib; pleural effusion was more common with dasatinib (17% versus 0%). Grade 3 to 4 nonhematologic toxicity was minimal. Cytopenias were more frequent and severe with dasatinib. Dasatinib represents a safe and effective therapy for CP-CML resistant to conventional imatinib doses with improved cytogenetic and molecular response rates and progression-free survival relative to high-dose imatinib.
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Affiliation(s)
- Hagop Kantarjian
- Department of Leukemia, University of Texas M. D. Anderson Cancer Center, Houston, TX 77230-1402, USA.
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47
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Nasilowska-Adamska B, Rzepecki P, Manko J, Czyz A, Markiewicz M, Fedorowicz I, Tomaszewska A, Piatkowska-Jakubas B, Wrzesien-Kus A, Bieniaszewska M, Duda D, Halaburda K, Szczepinski A, Lange A, Hellman A, Robak T, Skotnicki A, Jedrzejczak W, Walewski J, Holowiecki J, Komarnicki M, Dmoszynska A, Warzocha K, Marianska B. 211: The significance of palifermin (Kepivance®) in reduction of oral mucositis (OM) incidence and acute graft versus host disease in patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT). Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2006.12.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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48
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Cornely OA, Maertens J, Winston DJ, Perfect J, Ullmann AJ, Walsh TJ, Helfgott D, Holowiecki J, Stockelberg D, Goh YT, Petrini M, Hardalo C, Suresh R, Angulo-Gonzalez D. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med 2007; 356:348-59. [PMID: 17251531 DOI: 10.1056/nejmoa061094] [Citation(s) in RCA: 1246] [Impact Index Per Article: 73.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Patients with neutropenia resulting from chemotherapy for acute myelogenous leukemia or the myelodysplastic syndrome are at high risk for difficult-to-treat and often fatal invasive fungal infections. METHODS In this randomized, multicenter study involving evaluators who were unaware of treatment assignments, we compared the efficacy and safety of posaconazole with those of fluconazole or itraconazole as prophylaxis for patients with prolonged neutropenia. Patients received prophylaxis with each cycle of chemotherapy until recovery from neutropenia and complete remission, until occurrence of an invasive fungal infection, or for up to 12 weeks, whichever came first. We compared the incidence of proven or probable invasive fungal infections during treatment (the primary end point) between the posaconazole and fluconazole or itraconazole groups; death from any cause and time to death were secondary end points. RESULTS A total of 304 patients were randomly assigned to receive posaconazole, and 298 patients were randomly assigned to receive fluconazole (240) or itraconazole (58). Proven or probable invasive fungal infections were reported in 7 patients (2%) in the posaconazole group and 25 patients (8%) in the fluconazole or itraconazole group (absolute reduction in the posaconazole group, -6%; 95% confidence interval, -9.7 to -2.5%; P<0.001), fulfilling statistical criteria for superiority. Significantly fewer patients in the posaconazole group had invasive aspergillosis (2 [1%] vs. 20 [7%], P<0.001). Survival was significantly longer among recipients of posaconazole than among recipients of fluconazole or itraconazole (P=0.04). Serious adverse events possibly or probably related to treatment were reported by 19 patients (6%) in the posaconazole group and 6 patients (2%) in the fluconazole or itraconazole group (P=0.01). The most common treatment-related adverse events in both groups were gastrointestinal tract disturbances. CONCLUSIONS In patients undergoing chemotherapy for acute myelogenous leukemia or the myelodysplastic syndrome, posaconazole prevented invasive fungal infections more effectively than did either fluconazole or itraconazole and improved overall survival. There were more serious adverse events possibly or probably related to treatment in the posaconazole group. (ClinicalTrials.gov number, NCT00044486 [ClinicalTrials.gov].).
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49
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Helbig G, Stella-Holowiecka B, Bober G, Majewski M, Grzegorczyk J, Wozniczka K, Kruzel T, Dziaczkowska J, Najda J, Wojnar J, Holowiecki J. The achievement of complete molecular remission after autologous stem cell transplantation for T-cell lymphoma with associated hypereosinophilia, rare aberration t(6;11) and elevated IL-4 and IgE. Haematologica 2006; 91:ECR42. [PMID: 16923526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Affiliation(s)
- Grzegorz Helbig
- Department of Haematology and Bone Marrow Transplantation, Silesian Medical University, Katowice, Poland
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50
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Giebel S, Krawczyk-Kulis M, Adamczyk-Cioch M, Jakubas B, Palynyczko G, Lewandowski K, Dmoszynska A, Skotnicki A, Nowak K, Holowiecki J. Fludarabine, cytarabine, and mitoxantrone (FLAM) for the treatment of relapsed and refractory adult acute lymphoblastic leukemia. A phase study by the Polish Adult Leukemia Group (PALG). Ann Hematol 2006; 85:717-22. [PMID: 16832677 DOI: 10.1007/s00277-006-0121-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2006] [Accepted: 04/04/2006] [Indexed: 12/14/2022]
Abstract
Outcome of adults with acute lymphoblastic leukemia (ALL) who fail to achieve complete remission (CR) or who relapse soon after initial response is poor. The goal of this phase II study by the Polish Adult Leukemia Group (PALG) was to evaluate safety and efficacy of a new salvage regimen (FLAM) consisting of sequential fludarabine, cytarabine, and mitoxantrone. Fifty patients were included with primary (n = 13) or secondary (n = 5) refractoriness, early (<12 months) first relapse (n = 15), first relapse after hematopoietic cell transplantation (HCT) regardless CR duration (n = 13), and second or subsequent relapse (n = 4). Median age was 31(18-60) years, 28% of patients were bcr/abl-positive. CR rate equaled 50% and was significantly higher for patients in whom FLAM was administered as a second-line therapy compared to those more heavily pre-treated (66 vs 13%, p = 0.02). Seventeen patients had leukemia regrowth after initial cytoreduction, whereas, eight patients died in aplasia. The incidence of early death was higher in patients aged > or =40 years compared to the younger subgroup (33 vs 8%, p=0.03). Septic infections were the most frequent severe complication. At 3 years, the probability of disease-free survival for patients who achieved CR equaled 16%. Seven patients underwent allogeneic HCT. FLAM regimen is feasible for relapsed and refractory adults with ALL and could be recommended in particular for younger patients as a second-line treatment. However, as the remission duration is short, allogeneic HCT (alloHCT) should be considered as soon as possible.
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Affiliation(s)
- Sebastian Giebel
- Department of Haematology and BMT, Silesian Medical University, Reymonta 8 St., 40-038, Katowice, Poland.
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