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Lewis KL, Jakobsen LH, Villa D, Smedby KE, Savage KJ, Eyre TA, Cwynarski K, Bishton MJ, Fox CP, Hawkes EA, Maurer MJ, El-Galaly TC, Cheah CY. High-Dose Methotrexate as CNS Prophylaxis in High-Risk Aggressive B-Cell Lymphoma. J Clin Oncol 2023; 41:5376-5387. [PMID: 37797284 DOI: 10.1200/jco.23.00365] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/01/2023] [Accepted: 07/28/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE CNS progression or relapse is an uncommon but devastating complication of aggressive B-cell lymphoma. There is no consensus regarding the optimal approach to CNS prophylaxis. This study was designed to determine whether high-dose methotrexate (HD-MTX) is effective at preventing CNS progression in patients at high risk of this complication. PATIENTS AND METHODS Patients age 18-80 years with aggressive B-cell lymphoma and high risk of CNS progression, treated with curative-intent anti-CD20-based chemoimmunotherapy, were included in this international, retrospective, observational study. Cause-specific hazard ratios (HRs) and cumulative risks of CNS progression were calculated according to use of HD-MTX, with time to CNS progression calculated from diagnosis for all patients (all-pts) and from completion of frontline systemic lymphoma induction therapy, for patients in complete response at completion of chemoimmunotherapy (CR-pts). RESULTS Two thousand four hundred eighteen all-pts (HD-MTX; n = 425) and 1,616 CR-pts (HD-MTX; n = 356) were included. CNS International Prognostic Index was 4-6 in 83.4% all-pts. Patients treated with HD-MTX had a lower risk of CNS progression (adjusted HR, 0.59 [95% CI, 0.38 to 0.90]; P = .014), but significance was not retained when confined to CR-pts (adjusted HR, 0.74 [95% CI, 0.42 to 1.30]; P = .29), with 5-year adjusted risk difference of 1.6% (95% CI, -1.5 to 4.4; all-pts) and 1.4% (95% CI, -1.5 to 4.1; CR-pts). Subgroups were underpowered to draw definitive conclusions regarding the efficacy of HD-MTX in individual high-risk clinical scenarios; however, there was no clear reduction in CNS progression risk with HD-MTX in any high-risk subgroup. CONCLUSION In this large study, high-risk patients receiving HD-MTX had a 7.2% 2-year risk of CNS progression, consistent with the progression risk in previously reported high-risk cohorts. Use of HD-MTX was not associated with a clinically meaningful reduction in risk of CNS progression.
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Affiliation(s)
- Katharine L Lewis
- Linear Clinical Research, Nedlands, WA, Australia
- Division of Haematology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - Lasse H Jakobsen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Diego Villa
- BC Cancer Centre for Lymphoid Cancer, The University of British Columbia, Vancouver, BC, Canada
| | - Karin E Smedby
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Kerry J Savage
- BC Cancer Centre for Lymphoid Cancer, The University of British Columbia, Vancouver, BC, Canada
| | - Toby A Eyre
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Kate Cwynarski
- University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark J Bishton
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- University of Nottingham, Nottingham, United Kingdom
| | - Christopher P Fox
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- University of Nottingham, Nottingham, United Kingdom
| | - Eliza A Hawkes
- Olivia Newton-John Cancer Research & Wellness Centre at Austin Health, Heidelberg, VIC, Australia
- Monash University School of Public Health and Preventive Medicine, Melbourne, VIC, Australia
| | - Matthew J Maurer
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Tarec C El-Galaly
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Chan Y Cheah
- Linear Clinical Research, Nedlands, WA, Australia
- Division of Haematology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia
- Department of Haematology, PathWest, Nedlands, WA, Australia
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Lewis KL, Cheah CY. Chimeric antigen receptor T-cell therapy for mantle cell lymphoma with central nervous system involvement: Progress, but not perfect. Br J Haematol 2023; 203:701-703. [PMID: 37743427 DOI: 10.1111/bjh.19095] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Katharine L Lewis
- Linear Clinical Research, Nedlands, Australia
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Australia
- University of Western Australia, Nedlands, Australia
| | - Chan Y Cheah
- Linear Clinical Research, Nedlands, Australia
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Australia
- University of Western Australia, Nedlands, Australia
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Lewis KL, Trotman J. Integration of PET in DLBCL. Semin Hematol 2023; 60:291-304. [PMID: 38326144 DOI: 10.1053/j.seminhematol.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/24/2023] [Accepted: 12/04/2023] [Indexed: 02/09/2024]
Abstract
F-fluorodeoxyglucose positron emission tomography-computerized tomography (18FDG-PET/CT) is the gold-standard imaging modality for staging and response assessment for most lymphomas. This review focuses on the utility of 18FDG-PET/CT, and its role in staging, prognostication and response assessment in diffuse large B-cell lymphoma (DLBCL), including emerging possibilities for future use.
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Affiliation(s)
| | - Judith Trotman
- Concord Repatriation General Hospital, Concord, NSW, Australia
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Villa D, Jiang A, Visco C, Crosbie N, McCulloch R, Buege MJ, Kumar A, Bond DA, Paludo J, Maurer MJ, Thanarajasingam G, Lewis KL, Cheah CY, Baech J, El-Galaly TC, Kugathasan L, Scott DW, Gerrie AS, Lewis D. Time to progression of disease and outcomes with second-line BTK inhibitors in relapsed/refractory mantle cell lymphoma. Blood Adv 2023; 7:4576-4585. [PMID: 37307169 PMCID: PMC10425680 DOI: 10.1182/bloodadvances.2023009804] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023] Open
Abstract
Time to progression of disease (POD) after first-line (1L) therapy is prognostic in mantle cell lymphoma (MCL), although studies have included a broad range of 1L, second-line (2L), and subsequent lines of therapy. The purpose of this study was to evaluate the factors predicting outcomes in patients with relapsed/refractory (R/R) MCL exclusively initiating 2L Bruton's tyrosine kinase inhibitors (BTKis) after 1L rituximab-containing therapy. Patients were accrued from 8 international centers (7 main, 1 validation cohort). Multivariable models evaluating the association between time to POD and clinical/pathologic factors were constructed and converted into nomograms and prognostic indexes predicting outcomes in this population. A total of 360 patients were included, including 160 in the main cohort and 200 in the validation cohort. Time to POD, Ki67 ≥ 30%, and MCL International Prognostic Index (MIPI) were associated with progression-free survival (PFS2) and overall survival (OS2) from the start of 2L BTKis. C-indexes were consistently ≥0.68 in both cohorts. Web/application-based calculators based on nomograms and prognostic indexes to estimate PFS2 and OS2 were constructed. The 2L BTKi MIPI identifies 3 groups with distinct 2-year PFS2, including high risk (14%), intermediate risk (50%), and low risk (64%). Time to POD, Ki67, and MIPI are associated with survival outcomes in patients with R/R MCL receiving 2L BTKis. Simple clinical models incorporating these variables may assist in planning for alternative therapies such as chimeric antigen receptor T-cell therapy, allogeneic stem cell transplantation, or novel agents with alternative mechanisms of action.
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Affiliation(s)
- Diego Villa
- British Columbia Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - Aixiang Jiang
- British Columbia Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - Carlo Visco
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Nicola Crosbie
- Haematology, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Rory McCulloch
- Department of Haematology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom
| | - Michael J. Buege
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
- University of Illinois Chicago College of Pharmacy, Chicago, IL
| | - Anita Kumar
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David A. Bond
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Matthew J. Maurer
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | | | - Katharine L. Lewis
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - Chan Y. Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - Joachim Baech
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Haematology, Aalborg, Denmark
| | - Tarec C. El-Galaly
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Haematology, Aalborg, Denmark
| | | | - David W. Scott
- British Columbia Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - Alina S. Gerrie
- British Columbia Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - David Lewis
- Haematology, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
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Ghione P, Lewis KL, Bobillo S, Nayak L, Schorb E, Nichelli L, Ng A, Savage KJ, McKay P, Nastoupil L, Soussain C, Cwynarski K. Central nervous system lymphomas-Assessment and treatment and prevention of central nervous system relapse. Hematol Oncol 2023. [PMID: 37381737 DOI: 10.1002/hon.3197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/30/2023]
Abstract
In this review focused on lymphoma and the central nervous system (CNS), we summarize recent developments in the management of primary (PCNSL) and secondary CNS lymphoma (SCNSL), treatment of CNS lymphoma in the older population, the neuroradiological assessment of CNS lymphoma and finally highlight the ongoing debate on optimal CNS prophylaxis. The section on PCNSL focuses on the different approaches available for frontline treatment in Europe and the United States and discusses consolidation strategies. We then highlight available strategies to treat PCNSL in the elderly population, an area of unmet need. New therapies aiming at minimizing toxicity and prioritizing quality of life are emerging for these patients. Secondary CNS lymphoma, especially in the relapsed/refractory setting is another area of unmet need, and the efficacy of CAR-T cell therapy is being explored. We provide an overview of the imaging challenges in the neuroradiological assessment of CNS lymphoma. Finally, the section on CNS prophylaxis summarizes recent findings from large retrospective studies challenging the efficacy of present approaches to prophylaxis in higher-risk patients with lymphoma.
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Affiliation(s)
- Paola Ghione
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Katharine L Lewis
- Sir Charles Gairdner Hospital and Linear Clinical Research, Nedlands, Western Australia, Australia
| | | | - Laksmi Nayak
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Elisabeth Schorb
- Department of Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lucia Nichelli
- Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | - Andrea Ng
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kerry J Savage
- Centre for Lymphoid Cancer, Division of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | | | - Loretta Nastoupil
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Goh Z, Latimer M, Lewis KL, Cheah CY, Ciaccio PD, Cushion T, Hawkes EA, Harrop S, Ku M, Campbell A, Hamad N, Wood EM, Chung E, Chen PY, Cochrane T. Characteristics and Outcomes of Older Patients With Classical Hodgkin Lymphoma: An Australasian Lymphoma Alliance, and Lymphoma and Related Diseases Registry Study. Clin Lymphoma Myeloma Leuk 2023; 23:370-378. [PMID: 36804727 DOI: 10.1016/j.clml.2023.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/21/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is no standard front-line therapy for older patients with classical Hodgkin lymphoma (cHL). We analyzed the clinical presentation and front-line management of older Australian patients with cHL and explored factors associated with unplanned hospital admission and survival. METHODS Patients aged ≥ 61 years and diagnosed between 2011 and 2020, were retrospectively identified through the Lymphoma and Related Diseases Registry (LaRDR) and Australasian Lymphoma Alliance (ALA) institutional databases. Descriptive statistics and Kaplan-Meier survival analyses were performed using STATA-v17. RESULTS 195 patients were identified, 72 from LaRDR,123 from ALA. Median age of the combined cohort was 72 years (range 61-93); 56.4% male, 35.3% had stage I-II, bulk present in 9.2%, 33.9% had extra-nodal disease and 48.2% had B-symptoms. Chemotherapy was commenced in 91.3% of patients, with an anthracycline-based regimen used in 81%. Median number of cycles given for stage I-II was 2 and for stage III-IV was 6. Radiotherapy was administered in 26.2% of patients. A complete remission to front-line chemotherapy was achieved in 60.7% of patients. During front-line therapy in the ALA cohort, 89 unplanned hospitalizations occurred in 58 patients, with infection accounting for 59.6% of admissions. Treatment-related mortality was 5.2%. Only performance status and anthracycline use correlated with unplanned hospitalizations. Estimated 2-year progression free survival was 63.7% and 2-year overall survival was 71.2%. Anthracycline use and younger age were independently associated with improved survival. CONCLUSION The management of older patients with cHL in Australia is diverse but aligns with international data. Anthracycline-based therapy improved survival but resulted in frequent unplanned hospitalizations.
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Affiliation(s)
- Zhong Goh
- Department of Haematology, Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia
| | - Maya Latimer
- ACT Pathology and Canberra Hospital, Canberra, Australia; Australian National University, Canberra, Australia
| | - Katharine L Lewis
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia; Division Medical School, University of Western Australia, Perth, WA, Australia; WA Linear Clinical Research, Nedlands, WA, Australia
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia; Division Medical School, University of Western Australia, Perth, WA, Australia
| | - Pietro Di Ciaccio
- Australian National University, Canberra, Australia; Department of Haematology Sydney Adventist Hospital, Wahroonga NSW, Australia; University of New South Wales, Randwick, NSW, Australia
| | - Tania Cushion
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Eliza A Hawkes
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sean Harrop
- Department of Haematology, St Vincent's hospital, Fitzroy, Victoria, Australia
| | - Matthew Ku
- Department of Haematology, St Vincent's hospital, Fitzroy, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Ashlea Campbell
- Department of Haematology and Bone Marrow Transplant, St Vincent's Hospital, Sydney, NSW, Australia
| | - Nada Hamad
- Department of Haematology and Bone Marrow Transplant, St Vincent's Hospital, Sydney, NSW, Australia; School of Clinical Medicine, UNSW Medicine and Health, Sydney, Australia; School of Medicine, Sydney, University of Notre Dame Australia, Sydney, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Monash Health, Clayton, Victoria, Australia
| | - Eliza Chung
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Pin-Yen Chen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tara Cochrane
- Department of Haematology, Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia.
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Tariq B, Ou YC, Stern JC, Mundra V, Wong Doo N, Walker P, Lewis KL, Lin C, Novotny W, Sahasranaman S, Opat S. A phase 1, open-label, randomized drug-drug interaction study of zanubrutinib with moderate or strong CYP3A inhibitors in patients with B-cell malignancies. Leuk Lymphoma 2023; 64:329-338. [PMID: 36480811 DOI: 10.1080/10428194.2022.2150820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BTK inhibitor exposure increases significantly when coadministered with CYP3A inhibitors, which may lead to dose-related toxicities. This study explored the pharmacokinetics, efficacy, and safety of zanubrutinib when coadministered with moderate or strong CYP3A inhibitors in 26 patients with relapsed or refractory B-cell malignancies. Coadministration of zanubrutinib (80 mg BID) with moderate CYP3A inhibitors fluconazole and diltiazem or zanubrutinib (80 mg QD) with strong CYP3A inhibitor voriconazole resulted in comparable exposures to zanubrutinib (320 mg QD) with AUC0-24h geometric least squares mean ratios approaching 1 (0.94, 0.81, and 0.83, for fluconazole, diltiazem, and voriconazole, respectively). The most common treatment-emergent adverse events were contusion (26.9%), back pain (19.2%), constipation and neutropenia (15.4% each), and rash, diarrhea, and fall (11.5% each). This study supports current United States Prescribing Information dose recommendations for the coadministration of reduced-dose zanubrutinib with moderate or strong CYP3A inhibitors and confirms the favorable efficacy and safety profile of zanubrutinib.
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Affiliation(s)
- Bilal Tariq
- Clinical Pharmacology, BeiGene USA, Inc, Fulton, MD, USA
| | - Ying C Ou
- Clinical Pharmacology, BeiGene USA, Inc, San Mateo, CA, USA
| | | | - Vaibhav Mundra
- Clinical Pharmacology, BeiGene USA, Inc, San Mateo, CA, USA
| | - Nicole Wong Doo
- Department of Hematology, Concord Repatriation General Hospital, Concord, Australia.,Concord Clinical School, University of Sydney, Sydney, Australia
| | - Patricia Walker
- Department of Hematology, Peninsula Health and Peninsula Private Hospitals, Frankston, Australia
| | - Katharine L Lewis
- Department of Haematology, Sir Charles Gairdner Hospital and Linear Clinical Research, Nedlands, Australia
| | - Chester Lin
- Biostatistics, BeiGene, Ltd, Emeryville, CA, USA
| | - William Novotny
- Clinical Development, Hematology, BeiGene USA, Inc, San Mateo, CA, USA
| | | | - Stephen Opat
- Clinical Hematology, Monash Health and Monash University, Clayton, Australia
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Eyre TA, Savage KJ, Cheah CY, El-Galaly TC, Lewis KL, McKay P, Wilson MR, Evens AM, Bobillo S, Villa D, Maurer MJ, Cwynarski K, Ferreri AJM. CNS prophylaxis for diffuse large B-cell lymphoma. Lancet Oncol 2022; 23:e416-e426. [DOI: 10.1016/s1470-2045(22)00371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022]
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Roeker LE, Mato AR, Brown JR, Coombs CC, Shah NN, Wierda WG, Patel MR, Lewis KL, Balbas M, Zhao J, Ku NC, Kherani JF, Tsai DE, Nair B, Cheah CY. Abstract CT138: Pirtobrutinib, a highly selective, non-covalent (reversible) BTK inhibitor in combination with venetoclax ± rituximab in relapsed/refractory chronic lymphocytic leukemia: Results from the BRUIN phase 1b study. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Covalent Bruton tyrosine kinase inhibitors (BTKi) have transformed the management of chronic lymphocytic leukemia (CLL), but patients (pts) discontinue these agents due to resistance or intolerance. Pirtobrutinib is an oral, highly selective, non-covalent (reversible) BTKi with promising efficacy and safety in heavily pretreated relapsed/refractory (R/R) CLL pts, regardless of BTK C481 mutation status. Recent clinical studies reported on the safety and efficacy of time-limited venetoclax and covalent BTKi combination regimens. We evaluated the safety and efficacy of pirtobrutinib combined with venetoclax ± rituximab in pts with R/R CLL.
Methods: BRUIN is a phase 1/2 global, multicenter study (NCT03740529) of pirtobrutinib in pts with advanced B-cell malignancies. The phase 1b portion evaluated the safety of pirtobrutinib at a continuous dose of 200 mg QD from Cycle 1, Day 1 plus venetoclax starting on Cycle 2, Day 1 with a standard 5-week dose ramp to 400 mg QD (PV) and PV plus rituximab at 375 mg/m2 on Cycle 1, Day 1, then 500 mg/m2 on Day 1 of Cycles 2-6 (PVR). Prior BTKi was allowed; prior venetoclax was not permitted. Objectives included safety and overall response rate (ORR) of each combination.
Results: As of 27 SEP 2021, 15 pts received PV and 10 pts received PVR. Median age was 66 years (range, 39-78). Median prior lines of therapy was 2 (range, 1-4). The majority of pts in both cohorts had received prior chemotherapy (56%, n=14), CD20 monoclonal antibody (72%, n=18), and/or covalent BTKi (68%, n=17). No dose-limiting toxicities were reported. Safety profiles were generally similar across both cohorts. The most common treatment-emergent adverse events (TEAE) of any grade, regardless of attribution, were neutrophil count decrease (36%), nausea (32%), fatigue (32%), diarrhea (28%), and constipation (24%). The only Grade ≥3 TEAE to occur in more than 2 pts was neutrophil count decrease (36%, n=9). One pt experienced Grade 4 clinical tumor lysis syndrome with resultant acute kidney injury during venetoclax dose escalation, which resolved with supportive measures. No pts discontinued treatment due to AEs. For the 22 pts with efficacy data available as of 03 NOV 2021, median duration of follow-up was 9 months (range, 3.9-15) and the ORR was 95.5% (95% CI, 77-100). All responding pts except 1 remain on therapy (PVR responder discontinued due to death unrelated to study treatment). As all responses were ongoing and early, and MRD analysis was not yet performed.
Conclusions: Pirtobrutinib combined with venetoclax ± rituximab was well tolerated and had a safety profile consistent with known drug class findings and no clear additive toxicities in pts with R/R CLL. Early results demonstrate promising efficacy with combination therapy.
Citation Format: Lindsey E. Roeker, Anthony R. Mato, Jennifer R. Brown, Catherine C. Coombs, Nirav N. Shah, William G. Wierda, Manish R. Patel, Katharine L. Lewis, Minna Balbas, Junjie Zhao, Nora C. Ku, Jennifer F. Kherani, Donald E. Tsai, Binoj Nair, Chan Y. Cheah. Pirtobrutinib, a highly selective, non-covalent (reversible) BTK inhibitor in combination with venetoclax ± rituximab in relapsed/refractory chronic lymphocytic leukemia: Results from the BRUIN phase 1b study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT138.
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Affiliation(s)
| | | | - Jennifer R. Brown
- 2Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | | | | | | | - Manish R. Patel
- 6Florida Cancer Specialists/Sarah Cannon Research Institute, Sarasota, FL
| | - Katharine L. Lewis
- 7Linear Clinical Research and Sir Charles Gairdner Hospital, Perth, Australia
| | | | | | | | | | | | | | - Chan Y. Cheah
- 7Linear Clinical Research and Sir Charles Gairdner Hospital, Perth, Australia
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Abstract
Mantle cell lymphoma is a rare B-cell non-Hodgkin lymphoma that is clinically and biologically heterogeneous. Risk stratification at the time of diagnosis is critical. One of the most powerful prognostic indices is the Mantle Cell Lymphoma International Prognostic Index-Combined, which integrates an estimate of proliferation (Ki67 index) with the standard Mantle Cell Lymphoma International Prognostic Index clinical factors. In addition, the presence of TP53 mutation is associated with suboptimal response to intensive chemoimmunotherapy and particularly dismal survival outcomes. Given their excellent activity in the relapsed/refractory setting, increasingly, biologically targeted therapeutics-such as covalent Bruton tyrosine kinase inhibitors, lenalidomide, and venetoclax-are being incorporated into "chemotherapy-free" regimens and in combination with established chemoimmunotherapy backbones for treatment-naïve mantle cell lymphoma. In addition, risk-adapted treatment programs are increasingly being studied. These programs tailor treatment according to baseline prognostic factors (e.g., presence of TP53 mutation) and may incorporate biomarkers of response such as minimal residual disease assessment. Although still investigational, these studies present an opportunity to move beyond the biology-agnostic, historical fitness-based treatment selection paradigm and toward a more personalized, tailored treatment approach in mantle cell lymphoma. After Bruton tyrosine kinase inhibitor failure, many promising standard or investigational therapies exist, including CAR T-cell therapy (including brexucabtagene autoleucel and lisocabtagene maraleucel), bispecific antibody therapy targeting CD20-CD3, zilovertamab vedotin (an antibody-drug conjugate that targets ROR1), and the noncovalent Bruton tyrosine kinase inhibitor pirtobrutinib. These new therapies show promising efficacy, even among high-risk patients, and will likely translate to improvements in survival outcomes for patients with progressive mantle cell lymphoma following treatment with a Bruton tyrosine kinase inhibitor.
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Affiliation(s)
- Anita Kumar
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Toby A Eyre
- Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Katharine L Lewis
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia.,Medical School, University of Western Australia, Perth, Australia
| | | | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia.,Medical School, University of Western Australia, Perth, Australia
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Cheah C, Jurczak W, Lasica M, Wickham NW, Wrobel T, Walewski JA, Yannakou CK, Cheung S, Lewis KL, Długosz-Danecka M, Giannopoulos K, Miskin HP, Tang JP, Normant E, O'Connor OA, Ricart AD, Tam CSL. Updated results of the selective Bruton tyrosine kinase (BTK) inhibitor TG-1701, as monotherapy and in combination with ublituximab and umbralisib (U2) in patients (pts) with B-cell malignancies. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7525 Background: TG-1701 is a selective, covalent BTK inhibitor administered once daily (QD). Both the “U2” combination (anti-CD20 mAb ublituximab + the PI3Kδ-CK1ε inhibitor umbralisib) and BTK inhibition are highly active in treatment-naïve (TN) and relapsed/refractory (R/R) CLL, each having previously demonstrated superiority over standard chemoimmunotherapy. Here we report the results of the dose escalation of TG-1701 monotherapy and TG-1701+U2. Methods: Pts with R/R CLL and lymphoma were enrolled in a Ph 1 study initially evaluating dose escalation (DE) of oral TG-1701 QD continuously administered in 28-day cycles (100, 200, 300, and 400 mg). After characterizing the safety profile of TG-1701 monotherapy, we implemented a parallel DE arm of TG-1701+U2. Select dose levels of TG-1701 monotherapy were expanded in CLL, MCL and Waldenström's (WM). All pts were treated until disease progression. The primary objectives are to characterize the safety profile and define the recommended Ph 2 doses for the drugs alone and in combination. Results: As of 03 February 2021, 123 pts were treated with TG-1701: 25 in the monotherapy DE arm, 61 in the 200 mg disease-specific cohorts (20 CLL [5 TN], 21 MCL [4 TN], 20 WM [8 TN]), 20 in the 300 mg CLL cohort (4 TN), and 17 in the 1701+U2 DE arm. The median # of prior therapies was 1 (range, 1 - 10). All pts were BTKi-naïve. All 123 pts were evaluable for safety. TG-1701 was well tolerated and the maximum tolerated dose (MTD) for monotherapy was not reached at 400 mg (demonstrating near 100% saturation of the BTK at all dose levels studied). Treatment emergent adverse events (TEAE) of clinical interest included atrial fibrillation (AF 4.0% of pts, G ≥3 in 1 case), G ≥3 hypertension (2.4%), and bleeding events (18.7%, all G1-2). No cases of ventricular tachyarrhythmia were reported. TEAEs leading to TG-1701 dose reduction occurred in 6.5% of pts. TEAEs leading to treatment discontinuation occurred in 1.6% of pts (AF, COVID-19). At the data cut-off, 119 pts were evaluable for response, including 40 in DE (Table). The median duration of response has not been reached among responders overall. The median follow-up (mFU range) was 15.9 mos (1.3 - 28.6+) in DE and 8.5 mos (1.4 -15.6+) in disease-specific cohorts. Conclusions: TG-1701 exhibits an encouraging safety and efficacy profile. The combination of 1701+U2 has been well tolerated and dose escalation continues. The combination shows enhanced depth of response over TG-1701 monotherapy. Recruitment to this study continues. Response per investigator review by treatment group. Clinical trial information: NCT03671590. [Table: see text]
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Affiliation(s)
- Chan Cheah
- Sir Charles Gairdner Hospital, Comprehensive Cancer Centre, Nedlands, Australia
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Institute of Oncology, Krakow, Poland
| | - Masa Lasica
- St. Vincent’s Hospital Sydney, Darlinghurst, Australia
| | | | - Tomasz Wrobel
- Department of Hematology, Wroclaw Medical University, Wroclaw, Poland
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Mato AR, Shah NN, Jurczak W, Cheah CY, Pagel JM, Woyach JA, Fakhri B, Eyre TA, Lamanna N, Patel MR, Alencar A, Lech-Maranda E, Wierda WG, Coombs CC, Gerson JN, Ghia P, Le Gouill S, Lewis DJ, Sundaram S, Cohen JB, Flinn IW, Tam CS, Barve MA, Kuss B, Taylor J, Abdel-Wahab O, Schuster SJ, Palomba ML, Lewis KL, Roeker LE, Davids MS, Tan XN, Fenske TS, Wallin J, Tsai DE, Ku NC, Zhu E, Chen J, Yin M, Nair B, Ebata K, Marella N, Brown JR, Wang M. Pirtobrutinib in relapsed or refractory B-cell malignancies (BRUIN): a phase 1/2 study. Lancet 2021; 397:892-901. [PMID: 33676628 DOI: 10.1016/s0140-6736(21)00224-5] [Citation(s) in RCA: 221] [Impact Index Per Article: 73.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Covalent Bruton's tyrosine kinase (BTK) inhibitors are efficacious in multiple B-cell malignancies, but patients discontinue these agents due to resistance and intolerance. We evaluated the safety and efficacy of pirtobrutinib (working name; formerly known as LOXO-305), a highly selective, reversible BTK inhibitor, in these patients. METHODS Patients with previously treated B-cell malignancies were enrolled in a first-in-human, multicentre, open-label, phase 1/2 trial of the BTK inhibitor pirtobrutinib. The primary endpoint was the maximum tolerated dose (phase 1) and overall response rate (ORR; phase 2). This trial is registered with ClinicalTrials.gov, NCT03740529. FINDINGS 323 patients were treated with pirtobrutinib across seven dose levels (25 mg, 50 mg, 100 mg, 150 mg, 200 mg, 250 mg, and 300 mg once per day) with linear dose-proportional exposures. No dose-limiting toxicities were observed and the maximum tolerated dose was not reached. The recommended phase 2 dose was 200 mg daily. Adverse events in at least 10% of 323 patients were fatigue (65 [20%]), diarrhoea (55 [17%]), and contusion (42 [13%]). The most common adverse event of grade 3 or higher was neutropenia (32 [10%]). There was no correlation between pirtobrutinib exposure and the frequency of grade 3 treatment-related adverse events. Grade 3 atrial fibrillation or flutter was not observed, and grade 3 haemorrhage was observed in one patient in the setting of mechanical trauma. Five (1%) patients discontinued treatment due to a treatment-related adverse event. In 121 efficacy evaluable patients with chronic lymphocytic leukaemia (CLL) or small lymphocytic lymphoma (SLL) treated with a previous covalent BTK inhibitor (median previous lines of treatment 4), the ORR with pirtobrutinib was 62% (95% CI 53-71). The ORR was similar in CLL patients with previous covalent BTK inhibitor resistance (53 [67%] of 79), covalent BTK inhibitor intolerance (22 [52%] of 42), BTK C481-mutant (17 [71%] of 24) and BTK wild-type (43 [66%] of 65) disease. In 52 efficacy evaluable patients with mantle cell lymphoma (MCL) previously treated with covalent BTK inhibitors, the ORR was 52% (95% CI 38-66). Of 117 patients with CLL, SLL, or MCL who responded, all but eight remain progression-free to date. INTERPRETATION Pirtobrutinib was safe and active in multiple B-cell malignancies, including patients previously treated with covalent BTK inhibitors. Pirtobrutinib might address a growing unmet need for alternative therapies for these patients. FUNDING Loxo Oncology.
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Affiliation(s)
- Anthony R Mato
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Nirav N Shah
- Medical College of Wisconsin, Brookfield, WI, USA
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland
| | - Chan Y Cheah
- Linear Clinical Research and Sir Charles Gairdner Hospital and University of Western Australia, Perth, WA, Australia
| | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA
| | - Jennifer A Woyach
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Bita Fakhri
- Division of Hematology and Oncology, University of California, San Francisco, CA, USA
| | - Toby A Eyre
- Churchill Cancer Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nicole Lamanna
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Manish R Patel
- Florida Cancer Specialists and Sarah Cannon Research Institute, Sarasota, FL, USA
| | - Alvaro Alencar
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ewa Lech-Maranda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - James N Gerson
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Steven Le Gouill
- Service d'hématologie clinique du CHU de Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | | | | | | | - Ian W Flinn
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN, USA
| | - Constantine S Tam
- Peter MacCallum Cancer Center, Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC, Australia
| | - Minal A Barve
- Mary Crowley Cancer Research Center, Dallas, TX, USA
| | - Bryone Kuss
- Flinders University Medical Centre, Bedford Park, SA, Australia
| | - Justin Taylor
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | | | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - M Lia Palomba
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katharine L Lewis
- Linear Clinical Research and Sir Charles Gairdner Hospital and University of Western Australia, Perth, WA, Australia
| | | | - Matthew S Davids
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Xuan Ni Tan
- Linear Clinical Research and Sir Charles Gairdner Hospital and University of Western Australia, Perth, WA, Australia
| | | | | | | | - Nora C Ku
- Loxo Oncology at Lilly, Stamford, CT, USA
| | - Edward Zhu
- Loxo Oncology at Lilly, Stamford, CT, USA
| | | | - Ming Yin
- Loxo Oncology at Lilly, Stamford, CT, USA
| | - Binoj Nair
- Loxo Oncology at Lilly, Stamford, CT, USA
| | | | | | - Jennifer R Brown
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
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Lewis KL, Cheah CY. Event free survival at 12 months (EFS12) in stage 1 DLBCL - a reassuring milestone? Leuk Lymphoma 2020; 61:2542-2543. [PMID: 32812823 DOI: 10.1080/10428194.2020.1808214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Katharine L Lewis
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Australia.,Linear Clinical Research, Nedlands, Australia.,Medical School, University of Western Australia, Crawley, Australia
| | - Chan Yoon Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Australia.,Linear Clinical Research, Nedlands, Australia.,Medical School, University of Western Australia, Crawley, Australia.,Department of Haematology, Pathwest Laboratory Medicine, Nedlands, Australia
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14
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Lewis KL, Chin CK, Manos K, Casey J, Hamad N, Crawford J, Ho SJ, Issa S, Grigg A, Wood P, Gandhi MK, Do B, Nastoupil L, Hawkes EA, Cheah CY. Ibrutinib for central nervous system lymphoma: the Australasian Lymphoma Alliance/MD Anderson Cancer Center experience. Br J Haematol 2020; 192:1049-1053. [PMID: 32677095 DOI: 10.1111/bjh.16946] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/14/2020] [Indexed: 12/24/2022]
Abstract
Primary and secondary central nervous system lymphomas (PCNSL/SCNSL) are aggressive rare malignancies with dismal outcomes. Encouraging data have emerged from Phase I/II clinical trials treating relapsed/refractory PCNSL/SCNSL with ibrutinib. We analysed 33 patients who received ibrutinib, alone or with other therapies, for PCNSL (n = 9) or SCNSL (n = 24). The objective response rate was 58% (complete response 55%). The median progression-free survival and overall survival for patients with PCNSL were both 3·1 months; for SCNSL, 10·2 and 11·5 months respectively. Only one invasive fungal infection was observed, despite concurrent or recent use of dexamethasone 8-16 mg daily in 14 patients (42%). Ibrutinib has encouraging activity in these aggressive malignancies.
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Affiliation(s)
- Katharine L Lewis
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Medical School, University of Western Australia, Nedlands, WA, Australia.,Linear Clinical Research, Nedlands, WA, Australia
| | - Collin K Chin
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Kate Manos
- Department of Clinical Haematology, Austin Health, Heidelberg, VIC, Australia
| | - John Casey
- Department of Haematology, The Townsville Hospital, Townsville, QLD, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital, UNSW, Sydney, NSW, Australia
| | - Julie Crawford
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Department of Haematology, Pathwest Laboratory Medicine, Perth, WA, Australia
| | - Shir-Jing Ho
- Department of Haematology, St George Hospital, Sydney, NSW, Australia
| | - Samar Issa
- Department of Haematology, Middlemore Hospital, Auckland, New Zealand
| | - Andrew Grigg
- Department of Clinical Haematology, Austin Health, Heidelberg, VIC, Australia
| | - Peter Wood
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Maher K Gandhi
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Bryan Do
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Loretta Nastoupil
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Eliza A Hawkes
- Department of Clinical Haematology, Austin Health, Heidelberg, VIC, Australia.,Department of Haematology, Eastern Health, Box Hill, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Medical School, University of Western Australia, Nedlands, WA, Australia.,Linear Clinical Research, Nedlands, WA, Australia.,Department of Haematology, Pathwest Laboratory Medicine, Perth, WA, Australia
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15
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Chin CK, Lim KJC, Lewis KL, Jain P, Qing Y, Feng L, Cheah C, Seymour JF, Ritchie D, Burbury K, Tam CSL, Fowler NH, Fayad L, Westin J, Neelapu SS, Hagemeister FB, Samaniego F, Flowers C, Nastoupil LJ, Dickinson M. Autologous stem cell transplantation for untreated transformed indolent B-cell lymphoma in first remission: An international, multicenter propensity matched study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.8021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8021 Background: Transformation of untreated indolent B-cell lymphoma (Tr-iNHL) is associated with poor outcomes. Current practices are extrapolated from prospective studies of de novo large B-cell lymphoma (DLBCL) or small retrospective studies. High dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) is used as consolidation in first remission (CR1) in some centers but the evidence-base is weak. Methods: CLL/SLL, MCL as primary diseases and non-DLBCL transformations were excluded. Propensity score analysis (PSM) using the “greedy match” algorithm was used to match the baseline covariates to adjust for potential selection bias. Landmark analysis was performed with time zero at 3 months after completion of front line chemotherapy (FLC). Kaplan-Meier method and the Cox proportional hazards model were was used for time-to-event analysis including progression-free survival (PFS) and overall survival (OS). Results: 319 transplant eligible patients (age <75, LVEF >45%, no severe lung disease, CR by PET or CT >3 months after FLC) who received >/= standard RCHOP intensity FLC were identified across three centers in Australia & US. 283 (89%) patients had follicular lymphoma, 30 (9%) marginal zone lymphoma, 6 (2%) other subtypes. 49 patients underwent HDC and ASCT in CR1, a matched cohort of 98 pts based on age, stage, HGBL-DH and ECOG PS at diagnosis was generated with a 1:2 ratio using PSM. After a median follow-up of 3.6 (min: 0.1, max: 18.3) years, ASCT was associated with significantly superior PFS on multivariable analysis (MVA) (HR 0.51, 0.27-0.98; P=0.043). Univariate analysis demonstrated a trend towards inferior OS in the ASCT cohort (HR 2.36; 0.87-6.42; P=0.092) with more deaths in the ASCT arm due to PD (8% v 4%). Of the 40 patients (41%) with relapsed disease in the non-ASCT cohort–15 patients underwent salvage HDC & ASCT with 7/15 (47%) ongoing CR; 10 patients underwent CAR-T therapy (5 relapse post ASCT, 4 refractory disease, 1 relapse post FLC) with 6/10 (60%) ongoing CR; 3 patients underwent allogeneic SCT (2 relapse post ASCT, 1 relapse post FLC) with 2/3 (67%) ongoing CR. Conclusions: Although ASCT in CR1 may improve initial duration of disease control in de novo Tr-iNHL, the impact on OS is less clear with effective salvage therapies in the CAR-T era.
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Affiliation(s)
- Collin K Chin
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma/Myeloma, Houston, TX
| | - Kenneth JC Lim
- Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, Australia
| | | | - Preetesh Jain
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma/Myeloma, Houston, TX
| | - Yun Qing
- The University of Texas MD Anderson Cancer Center, Department of Biostatistics, Houston, TX
| | - Lei Feng
- The University of Texas MD Anderson Cancer Center, Department of Biostatistics, Houston, TX
| | - Chan Cheah
- Sir Charles Gairdner Hospital, Nedlands, Australia
| | - John Francis Seymour
- Peter MacCallum Cancer Centre, Melbourne, University of Melbourne, Parkville, Victoria, Australia
| | - David Ritchie
- Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, Australia
| | - Kate Burbury
- Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, Australia
| | | | - Nathan Hale Fowler
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma/Myeloma, Houston, TX
| | - Luis Fayad
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma/Myeloma, Houston, TX
| | - Jason Westin
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma/Myeloma, Houston, TX
| | - Sattva Swarup Neelapu
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma/Myeloma, Houston, TX
| | - Fredrick B. Hagemeister
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma/Myeloma, Houston, TX
| | - Felipe Samaniego
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma/Myeloma, Houston, TX
| | - Christopher Flowers
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma/Myeloma, Houston, TX
| | - Loretta J. Nastoupil
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma/Myeloma, Houston, TX
| | - Michael Dickinson
- Peter MacCallum Cancer Centre & University of Melbourne, Melbourne, Australia
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16
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Lewis KL, Spagnolo D, Radeski D, Cheah CY. Refractory α/β-Hepatosplenic T-cell Lymphoma With Secondary CNS Dissemination and Severe Morbidity Related to Intrathecal Chemotherapy: A Case Report and Literature Review. Clinical Lymphoma Myeloma and Leukemia 2019; 19:e564-e567. [DOI: 10.1016/j.clml.2019.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/09/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
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17
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Lawal TA, Lewis KL, Johnston JJ, Heidlebaugh AR, Ng D, Gaston-Johansson FG, Klein WMP, Biesecker BB, Biesecker LG. Disclosure of cardiac variants of uncertain significance results in an exome cohort. Clin Genet 2018; 93:1022-1029. [PMID: 29383714 DOI: 10.1111/cge.13220] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 01/19/2018] [Accepted: 01/25/2018] [Indexed: 01/26/2023]
Abstract
This study examined the impact of disclosing subclassifications of genetic variants of uncertain significance (VUS) on behavioral intentions. We studied return of VUS results to 79 individuals with a cardiomyopathy-associated VUS, subclassified into VUS-high or VUS-low. Primary outcomes were perceived risk (absolute and comparative), perceived severity, perceived value of information, self-efficacy, decision regret, and behavioral intentions to share results and change behaviors. There was no significant difference between the 2 subclasses in overall behavioral intentions (t = 0.023, P = .982) and each of the individual items on the behavioral intentions scale; absolute (t = -1.138, P = .259) or comparative (t = -0.463, P = .645) risk perceptions; perceived value of information (t = 0.582, P = .563) and self-efficacy (t = -0.733, P = .466). Decision regret was significantly different (t = 2.148, P = .035), with VUS-low (mean = 17.24, SD = 16.08) reporting greater regret. Combining the subclasses, perceived value of information was the strongest predictor of behavioral intentions (β = 0.524, P < .001). Participants generally understood the meaning of a genetic VUS result classification and reported satisfaction with result disclosure. No differences in behavioral intentions were found, but differences in decision regret suggest participants distinguish subclasses of VUS results. The perceived value of VUS may motivate recipients to pursue health-related behaviors.
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Affiliation(s)
- T A Lawal
- National Institute of Nursing Research, National Institutes of Health (NIH), Bethesda, Maryland
| | - K L Lewis
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - J J Johnston
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - A R Heidlebaugh
- Social and Behavioral Research Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - D Ng
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - F G Gaston-Johansson
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - W M P Klein
- Behavioral Research Program, National Cancer Institute, NIH, Bethesda, Maryland
| | - B B Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - L G Biesecker
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland
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18
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Kohler JN, Turbitt E, Lewis KL, Wilfond BS, Jamal L, Peay HL, Biesecker LG, Biesecker BB. Defining personal utility in genomics: A Delphi study. Clin Genet 2017; 92:290-297. [PMID: 28218387 DOI: 10.1111/cge.12998] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Individual genome sequencing results are valued by patients in ways distinct from clinical utility. Such outcomes have been described as components of "personal utility," a concept that broadly encompasses patient-endorsed benefits, that is operationally defined as non-clinical outcomes. No empirical delineation of these outcomes has been reported. AIM To address this gap, we administered a Delphi survey to adult participants in a National Institute of Health (NIH) clinical exome study to extract the most highly endorsed outcomes constituting personal utility. MATERIALS AND METHODS Forty research participants responded to a Delphi survey to rate 35 items identified by a systematic literature review of personal utility. RESULTS Two rounds of ranking resulted in 24 items that represented 14 distinct elements of personal utility. Elements most highly endorsed by participants were: increased self-knowledge, knowledge of "the condition," altruism, and anticipated coping. DISCUSSION Our findings represent the first systematic effort to delineate elements of personal utility that may be used to anticipate participant expectation and inform genetic counseling prior to sequencing. The 24 items reported need to be studied further in additional clinical genome sequencing studies to assess generalizability in other populations. Further research will help to understand motivations and to predict the meaning and use of results.
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Affiliation(s)
- J N Kohler
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes Health, Bethesda, Maryland
| | - E Turbitt
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes Health, Bethesda, Maryland
| | - K L Lewis
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes Health, Bethesda, Maryland
| | - B S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | - L Jamal
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland
| | - H L Peay
- RTI International, Research Triangle Park, Durham, North Carolina
| | - L G Biesecker
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes Health, Bethesda, Maryland
| | - B B Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes Health, Bethesda, Maryland
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Biesecker BB, Woolford SW, Klein WMP, Brothers KB, Umstead KL, Lewis KL, Biesecker LG, Han PKJ. PUGS: A novel scale to assess perceptions of uncertainties in genome sequencing. Clin Genet 2017; 92:172-179. [PMID: 27925165 DOI: 10.1111/cge.12949] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 06/15/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 01/25/2023]
Abstract
Expectations of results from genome sequencing by end users are influenced by perceptions of uncertainty. This study aimed to assess uncertainties about sequencing by developing, evaluating, and implementing a novel scale. The Perceptions of Uncertainties in Genome Sequencing (PUGS) scale comprised ten items to assess uncertainties within three domains: clinical, affective, and evaluative. Participants (n=535) from the ClinSeq® NIH sequencing study completed a baseline survey that included the PUGS; responses (mean = 3.4/5, SD=0.58) suggested modest perceptions of certainty. A confirmatory factor analysis identified factor loadings that led to elimination of two items. A revised eight-item PUGS scale was used to test correlations with perceived ambiguity (r = -0.303, p < 0.001), attitudinal ambivalence (r = -0.111, p = 0.011), and ambiguity aversion (r = -0.093, p = 0.033). Results support nomological validity. A correlation with the MICRA uncertainty subscale was found among 175 cohort participants who had received results (r = -0.335, p < 0.001). Convergent and discriminant validity were also satisfied in a second sample of 208 parents from the HudsonAlpha CSER Project who completed the PUGS (mean = 3.4/5, SD = 0.72), and configural invariance was supported across the two datasets. As such, the PUGS is a promising scale for evaluating perceived uncertainties in genome sequencing, which can inform interventions to help patients form realistic expectations of these uncertainties.
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Affiliation(s)
- B B Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - S W Woolford
- Mathematical Sciences, Bentley University, Waltham, MA, USA
| | - W M P Klein
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - K B Brothers
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | - K L Umstead
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - K L Lewis
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - L G Biesecker
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - P K J Han
- Maine Medical Center Research Institute, Center for Outcomes Research and Evaluation, New Haven, CT, USA
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Lewis KL. Development of Indicators to Assess Quality of Life in a Community Setting. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s64-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Affiliation(s)
- P B Vrtunski
- Research Service, Cleveland VA Medical Center, Brecksville, OH 44141
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Lewis KL, Muirhead IT, Pitt AM, Cullis AG, Chew NG, Miller A, Wyatt-Davies TJ. Molecular beam deposition of optical coatings and their characterization. Appl Opt 1989; 28:2785-2790. [PMID: 20555599 DOI: 10.1364/ao.28.002785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Significant improvements can be made in the fabrication of optical thin film structures by using molecular beam and ultrahigh vacuum techniques. These lead to the achievement of more stable films and multilayer coatings with improved morphology, density, and resistance to laser-induced damage. The microstructure of the film can be controlled to a high degree by using quasisuperlattice techniques, which also provide a means of refractive index synthesis. This can be applied to simple graded structures or complex periodic gradings as required for Bragglike structures. Etalon filters fabricated using the technique have been used for optical bistability experiments and have exhibited stable operation for periods of many hours under continuous cycling.
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Muirhead IT, Miller A, Lewis KL, Staromlynska J, Welford K. Molecular beam deposited bistable interference filters. Appl Opt 1989; 28:2796-2799. [PMID: 20555601 DOI: 10.1364/ao.28.002796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Ultrahigh vacuum and molecular beam deposition techniques have been used to fabricate ZnSe interference filters. These demonstrate optical bistability with critical switching power being measured at five wavelengths between 521 and 676 nm. These filters demonstrate considerably improved long term operation stability over that offered by samples deposited using conventional thermal evaporation. Both dispersive and absorptive bistability could be demonstrated in the same sample.
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Abstract
Three patients with toxemia developed acute neurologic deterioration postpartum. In all, cerebral angiography revealed widespread arterial vasoconstriction. Cerebral vasoconstriction may be an important cause of neurologic complications in toxemia.
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Banes D, Ensminger LG, Hoffman I, Horwitz W, Lewis KL, Mathers AP, Poundstone B, Schechter MS, Randle SB. Report of the Committee on AOAC Missions. J AOAC Int 1970. [DOI: 10.1093/jaoac/53.2.411a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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