1
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Godfrey JK, Gao L, Shouse G, Song JY, Pak S, Lee B, Chen BT, Kallam A, Baird JH, Marcucci G, Ghoda LY, Vauleon S, Danilov AV, Herrera AF, Kwak LW, Budde LE. Glofitamab stimulates immune cell infiltration of CNS tumors and induces clinical responses in secondary CNS lymphoma. Blood 2024:blood.2024024168. [PMID: 38484137 DOI: 10.1182/blood.2024024168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
Although CD20xCD3 bispecific antibodies are effective against systemic B-cell lymphomas, their efficacy in CNS lymphoma is unknown. Here, we report the CD20xCD3 bispecific, glofitamab, penetrates the blood-brain barrier, stimulates immune-cell infiltration of CNS tumors, and induces responses in CNS lymphoma.
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Affiliation(s)
| | - Lei Gao
- City of Hope, Duarte, California, United States
| | - Geoffrey Shouse
- City of Hope National Medical Center, Duarte, California, United States
| | - Joo Y Song
- City of Hope Medical Center, Duarte, California, United States
| | - Stacy Pak
- City of Hope National Medical Center, Duarte, California, United States
| | - Brian Lee
- City of Hope, Duarte, California, United States
| | | | | | | | - Guido Marcucci
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, California, United States
| | - Lucy Y Ghoda
- Beckman Research Institute, City of Hope, Duarte, California, United States
| | | | | | | | | | - Lihua E Budde
- City of Hope National Medical Center, Duarte, California, United States
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2
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Godfrey J, Mei M, Chen L, Song JY, Bedell V, Budde E, Armenian S, Puverel S, Nikolaenko L, Chen R, Daniels S, Kennedy N, Peters L, Rosen ST, Forman SJ, Popplewell LL, Kwak LW, Herrera AF. Results from a phase I trial of pembrolizumab plus vorinostat in relapsed/refractory B-cell non-Hodgkin lymphoma. Haematologica 2024; 109:533-542. [PMID: 37470137 PMCID: PMC10828763 DOI: 10.3324/haematol.2023.283002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023] Open
Abstract
Outcomes after programmed death-1 (PD-1) blockade in B-cell lymphomas are disappointing with few durable responses. Histone deacetylase inhibitors exhibit favorable immunomodulatory effects and demonstrate synergistic anti-tumor immune responses with anti-PD-1 therapy in preclinical models. We, therefore, developed a phase I study to evaluate the safety and preliminary efficacy of pembrolizumab with vorinostat in relapsed/refractory B-cell lymphomas. Patients were treated in a dose-escalation cohort using a Rolling 6 design followed by an expansion cohort at the recommended phase II dose (R2PD). Fifty-two patients were enrolled (32 Hodgkin and 20 non-Hodgkin lymphoma [NHL]). Here, we report safety data from the dose escalation cohort, and the toxicity and efficacy within NHL patients. Vorinostat was administered twice daily on days 1-5 and 8-12 (dose-level [DL]1: 100 mg; DL2: 200 mg) and pembrolizumab (200 mg) was administered on day 1 of each 3-week cycle. Of six patients treated at DL1, one had a dose-limiting toxicity (DLT) (Stevens-Johnson syndrome [SJS]), and one of six had a DLT at DL2 (thromboembolism); therefore, DL2 was the RP2D. The patient developing SJS was treated with corticosteroids, infliximab, and cyclosporine but ultimately died of invasive fungal infection from the extensive immunosuppression used to treat the SJS. The most common adverse events were hypertension, diarrhea, and cytopenias. Of 20 NHL patients, nine had follicular lymphoma (FL) and 11 had diffuse large B-cell lymphoma (DLBCL). Five DLBCL patients had primary mediastinal B-cell lymphoma (PMBL). The complete and overall response rates (CR and ORR) were 11% and 22% for FL and 45% and 55% for all DLBCL. Amongst DLBCL, the CR and ORR was 80% and 80% for PMBL and 17% and 33% for non-PMBL. In conclusion, pembrolizumab with vorinostat was tolerable and produced responses in relapsed/refractory B-cell NHL, with particularly notable efficacy in PMBL (clinicaltrials gov. Identifier: NCT03150329).
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Affiliation(s)
- James Godfrey
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Lu Chen
- Department of Information Sciences, City of Hope, Duarte, CA
| | - Joo Y Song
- Department of Pathology, City of Hope, Duarte, CA
| | | | - Elizabeth Budde
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | | | - Sandrine Puverel
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Liana Nikolaenko
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Robert Chen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Shari Daniels
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Neena Kennedy
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Lacolle Peters
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Steven T Rosen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Leslie L Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Larry W Kwak
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA.
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Qazilbash MH, Kwak LW. Personalized Medicine's Coming of Age: One Drug, One Patient. Clin Cancer Res 2023; 29:4703-4705. [PMID: 37733765 DOI: 10.1158/1078-0432.ccr-23-2194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/30/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
A dendritic cell/myeloma fusion vaccine, given with lenalidomide and GM-CSF, did not result in a statistically significant increase in CR rates at 1 year posttransplant but was associated with a significant increase in circulating multiple myeloma-reactive lymphocytes indicative of tumor-specific immunity. See related article by Chung et al., p. 4784.
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Affiliation(s)
- Muzaffar H Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Larry W Kwak
- Beckman Research Institute, City of Hope, Duarte, California
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4
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Dong Z, Song JY, Thieme E, Anderson A, Oh E, Cheng WA, Kuang BZ, Lee V, Zhang T, Wang Z, Szymura S, Smith DL, Zhang J, Nian W, Zheng X, He F, Zhou Q, Cha SC, Danilov AV, Qin H, Kwak LW. Generation of a humanized afucosylated BAFF-R antibody with broad activity against human B-cell malignancies. Blood Adv 2023; 7:918-932. [PMID: 36469551 PMCID: PMC10027513 DOI: 10.1182/bloodadvances.2022008560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
B-cell activating factor receptor (BAFF-R) is a mature B-cell survival receptor, which is highly expressed in a wide variety of B-cell malignancies but with minimal expression in immature B cells. These properties make BAFF-R an attractive target for therapy of B-cell lymphomas. We generated a novel humanized anti BAFF-R monoclonal antibody (mAb) with high specificity and potent in vitro and in vivo activity against B-cell lymphomas and leukemias. The humanized variants of an original chimeric BAFF-R mAb retained BAFF-R binding affinity and antibody-dependent cellular cytotoxicity (ADCC) against a panel of human cell lines and primary lymphoma samples. Furthermore, 1 humanized BAFF-R mAb clone and its afucosylated version, glycoengineered to optimize the primary mechanism of action, prolonged survival of immunodeficient mice bearing human tumor cell lines or patient-derived lymphoma xenografts in 3 separate models, compared with controls. Finally, the tissue specificity of this humanized mAb was confirmed against a broad panel of normal human tissues. Taken together, we have identified a robust lead-candidate BAFF-R mAb for clinical development.
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Affiliation(s)
- Zhenyuan Dong
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA
| | - Joo Y. Song
- Department of Pathology, City of Hope Medical Center, Duarte, CA
| | - Elana Thieme
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA
| | - Aaron Anderson
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA
| | - Elizabeth Oh
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA
| | - Wesley A. Cheng
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA
| | - Benjamin Z. Kuang
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA
| | - Vincent Lee
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA
| | - Tiantian Zhang
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA
| | - Zhe Wang
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA
| | - Szymon Szymura
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA
| | - D. Lynne Smith
- Clinical and Translational Project Development, City of Hope Medical Center, Duarte, CA
| | | | - Weihong Nian
- Shanghai Escugen Biotechnology Co, Ltd, Shanghai, China
| | - Xintong Zheng
- Shanghai Escugen Biotechnology Co, Ltd, Shanghai, China
| | - Feng He
- Shanghai Escugen Biotechnology Co, Ltd, Shanghai, China
| | - Qing Zhou
- Shanghai Escugen Biotechnology Co, Ltd, Shanghai, China
| | - Soung-chul Cha
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA
| | - Alexey V. Danilov
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA
| | - Hong Qin
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA
| | - Larry W. Kwak
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA
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5
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Herrera AF, Chen L, Nieto Y, Holmberg L, Johnston P, Mei M, Popplewell L, Armenian S, Cao T, Farol L, Sahebi F, Spielberger R, Chen R, Nademanee A, Puverel S, Nwangwu M, Lee P, Song J, Skarbnik A, Kennedy N, Peters L, Rosen ST, Kwak LW, Forman SJ, Feldman T. Brentuximab vedotin plus nivolumab after autologous haematopoietic stem-cell transplantation for adult patients with high-risk classic Hodgkin lymphoma: a multicentre, phase 2 trial. Lancet Haematol 2023; 10:e14-e23. [PMID: 36403579 DOI: 10.1016/s2352-3026(22)00318-0] [Citation(s) in RCA: 1] [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: 06/15/2022] [Revised: 08/27/2022] [Accepted: 09/13/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND After autologous haematopoietic stem-cell transplantation (HSCT), consolidation with brentuximab vedotin in patients with high-risk relapsed or refractory classic Hodgkin lymphoma has been shown to improve progression-free survival compared with placebo. Brentuximab vedotin plus nivolumab is a safe and effective treatment for relapsed or refractory classic Hodgkin lymphoma; therefore, we aimed to evaluate the safety and activity of this drug combination post-autologous HSCT consolidation in patients with high-risk relapsed or refractory classic Hodgkin lymphoma. METHODS We did a multicentre phase 2 trial at five centres in the USA. Eligible patients were aged 18 years or older with high-risk relapsed or refractory classic Hodgkin lymphoma, had an ECOG performance status of 0-2, and had adequate organ and bone marrow function. Enrolled patients received brentuximab vedotin (1·8 mg/kg) and nivolumab (3 mg/kg) intravenously starting 30-60 days after autologous HSCT on day 1 of each 21-day cycle for up to 8 cycles. Nivolumab dose reduction was not allowed. Brentuximab vedotin dose reduction to 1·2 mg/kg was permitted. If one drug was discontinued because of a toxic effect, the other could be continued. The primary endpoint was 18-month progression-free survival in all treated patients. This study is registered with ClinicalTrials.gov, number NCT03057795. FINDINGS Between May 3, 2017, and July 13, 2019, 59 patients were enrolled and received the study therapy. Patients initiated brentuximab vedotin plus nivolumab for a median of 54 days (IQR 46-58) after autologous HSCT and received a median of 8 cycles (8-8). 34 (58%) of 59 patients were male, 29 (49%) completed 8 cycles of brentuximab vedotin plus nivolumab, and 45 (76%) completed 8 cycles of at least one drug. The median follow-up time was 29·9 months (IQR 24·6-34·8). The 18-month progression-free survival in all 59 patients was 94% (95% CI 84-98). The most common adverse events were sensory peripheral neuropathy (31 [53%] of 59) and neutropenia (25 [42%]), and immune-related adverse events requiring corticosteroids occurred in 17 (29%) of 59 patients. No treatment-related deaths were observed. INTERPRETATION Brentuximab vedotin plus nivolumab was highly active post-autologous HSCT consolidation for patients with high-risk relapsed or refractory classic Hodgkin lymphoma, most of whom had previous exposure to either brentuximab vedotin or PD-1 blockade. Combination immunotherapy in this setting should be further studied in patients with classic Hodgkin lymphoma with further refinement of the regimen to mitigate toxic effects, particularly in high-risk patients in whom more intensive therapy to prevent relapse is warranted. FUNDING Bristol Myers Squibb, Leukemia and Lymphoma Society, Lymphoma Research Foundation, and National Cancer Institute of the National Institutes of Health.
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Affiliation(s)
- Alex F Herrera
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA.
| | - Lu Chen
- Division of Biostatistics, City of Hope National Medical Center, Duarte, CA, USA
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Leona Holmberg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Matthew Mei
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Leslie Popplewell
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Saro Armenian
- Department of Pediatrics, City of Hope National Medical Center, Duarte, CA, USA
| | - Thai Cao
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA; Department of Bone Marrow Transplant, Southern California Permanente Medical Group, Duarte, CA, USA
| | - Leonardo Farol
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA; Department of Bone Marrow Transplant, Southern California Permanente Medical Group, Duarte, CA, USA
| | - Firoozeh Sahebi
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA; Department of Bone Marrow Transplant, Southern California Permanente Medical Group, Duarte, CA, USA
| | - Ricardo Spielberger
- Department of Bone Marrow Transplant, Southern California Permanente Medical Group, Duarte, CA, USA
| | - Robert Chen
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Auayporn Nademanee
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Sandrine Puverel
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Mary Nwangwu
- Department of Immuno-Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Peter Lee
- Department of Immuno-Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Joo Song
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Alan Skarbnik
- Lymphoma Division, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Neena Kennedy
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Lacolle Peters
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Steven T Rosen
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Larry W Kwak
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Stephen J Forman
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Tatyana Feldman
- Lymphoma Division, Hackensack University Medical Center, Hackensack, NJ, USA
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6
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Kambhampati S, Saumoy M, Schneider Y, Pak S, Budde LE, Mei MG, Siddiqi T, Popplewell LL, Wen YP, Zain J, Forman SJ, Kwak LW, Rosen ST, Danilov AV, Herrera AF, Thiruvengadam NR. Cost-effectiveness of polatuzumab vedotin combined with chemoimmunotherapy in untreated diffuse large B-cell lymphoma. Blood 2022; 140:2697-2708. [PMID: 35700381 PMCID: PMC10653095 DOI: 10.1182/blood.2022016624] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 04/12/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 12/30/2022] Open
Abstract
In patients with treatment-naive diffuse large B-cell lymphoma (DLBCL), the POLARIX study (A Study Comparing the Efficacy and Safety of Polatuzumab Vedotin With Rituximab-Cyclophosphamide, Doxorubicin, and Prednisone [R-CHP] Versus Rituximab-Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone [R-CHOP] in Participants With Diffuse Large B-Cell Lymphoma) reported a 6.5% improvement in the 2-year progression-free survival (PFS), with no difference in overall survival (OS) or safety using polatuzumab vedotin, rituximab, cyclophosphamide, doxorubicin, and prednisone (pola-R-CHP) compared with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). We evaluated the cost-effectiveness of pola-R-CHP for DLBCL. We modeled a hypothetical cohort of US adults (mean age, 65 years) with treatment-naive DLBCL by developing a Markov model (lifetime horizon) to model the cost-effectiveness of pola-R-CHP and R-CHOP using a range of plausible long-term outcomes. Progression rates and OS were estimated from POLARIX. Outcome measures were reported in incremental cost-effectiveness ratios, with a willingness-to-pay (WTP) threshold of $150 000 per quality-adjusted life-year (QALY). Assuming a 5-year PFS of 69.6% with pola-R-CHP and 62.7% with R-CHOP, pola-R-CHP was cost-effective at a WTP of $150 000 (incremental cost-effectiveness ratio, $84 308/QALY). pola-R-CHP was no longer cost-effective if its 5-year PFS was 66.1% or lower. One-way sensitivity analysis revealed that pola-R-CHP is cost-effective up to a cost of $276 312 at a WTP of $150 000. pola-R-CHP was the cost-effective strategy in 56.6% of the 10 000 Monte Carlo iterations at a WTP of $150 000. If the absolute benefit in PFS is maintained over time, pola-R-CHP is cost-effective compared with R-CHOP at a WTP of $150 000/QALY. However, its cost-effectiveness is highly dependent on its long-term outcomes and costs of chimeric antigen receptor T-cell therapy. Routine usage of pola-R-CHP would add significantly to health care expenditures. Price reductions or identification of subgroups that have maximal benefit would improve cost-effectiveness.
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Affiliation(s)
- Swetha Kambhampati
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Monica Saumoy
- Center for Digestive Health, Penn Medicine Princeton Medical Center, Plainsboro, NJ
| | | | - Stacy Pak
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Lihua Elizabeth Budde
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Matthew G. Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Tanya Siddiqi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Leslie L. Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Yi-Ping Wen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Jasmine Zain
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Stephen J. Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Larry W. Kwak
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Steven T. Rosen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Alexey V. Danilov
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Alex F. Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
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7
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Kambhampati S, Saumoy M, Schneider Y, Serrao S, Solaimani P, Budde LE, Mei MG, Popplewell LL, Siddiqi T, Zain J, Forman SJ, Kwak LW, Rosen ST, Danilov AV, Herrera AF, Thiruvengadam NR. Cost-effectiveness of second-line axicabtagene ciloleucel in relapsed refractory diffuse large B-cell lymphoma. Blood 2022; 140:2024-2036. [PMID: 35914220 PMCID: PMC9837443 DOI: 10.1182/blood.2022016747] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 04/22/2022] [Accepted: 07/06/2022] [Indexed: 01/21/2023] Open
Abstract
The ZUMA-7 (Efficacy of Axicabtagene Ciloleucel Compared to Standard of Care Therapy in Subjects With Relapsed/Refractory Diffuse Large B Cell Lymphoma) study showed that axicabtagene ciloleucel (axi-cel) improved event-free survival (EFS) compared with standard of care (SOC) salvage chemoimmunotherapy followed by autologous stem cell transplant in primary refractory/early relapsed diffuse large B-cell lymphoma (DLBCL); this led to its recent US Food and Drug Administration approval in this setting. We modeled a hypothetical cohort of US adults (mean age, 65 years) with primary refractory/early relapsed DLBCL by developing a Markov model (lifetime horizon) to model the cost-effectiveness of second-line axi-cel compared with SOC using a range of plausible long-term outcomes. EFS and OS were estimated from ZUMA-7. Outcome measures were reported in incremental cost-effectiveness ratios, with a willingness-to-pay (WTP) threshold of $150 000 per quality-adjusted life-year (QALY). Assuming a 5-year EFS of 35% with second-line axi-cel and 10% with SOC, axi-cel was cost-effective at a WTP of $150 000 per QALY ($93 547 per QALY). axi-cel was no longer cost-effective if its 5-year EFS was ≤26.4% or if it cost more than $972 061 at a WTP of $150 000. Second-line axi-cel was the cost-effective strategy in 73% of the 10 000 Monte Carlo iterations at a WTP of $150 000. If the absolute benefit in EFS is maintained over time, second-line axi-cel for aggressive relapsed/refractory DLBCL is cost-effective compared with SOC at a WTP of $150 000 per QALY. However, its cost-effectiveness is highly dependent on long-term outcomes. Routine use of second-line chimeric antigen receptor T-cell therapy would add significantly to health care expenditures in the United States (more than $1 billion each year), even when used in a high-risk subpopulation. Further reductions in the cost of chimeric antigen receptor T-cell therapy are needed to be affordable in many regions of the world.
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Affiliation(s)
- Swetha Kambhampati
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Monica Saumoy
- Center for Digestive Health, Penn Medicine Princeton Medical Center, Plainsboro, NJ
| | | | - Steve Serrao
- Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, CA
| | - Pejman Solaimani
- Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, CA
| | - Lihua Elizabeth Budde
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Matthew G. Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Leslie L. Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Tanya Siddiqi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Jasmine Zain
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Stephen J. Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Larry W. Kwak
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Steven T. Rosen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Alexey V. Danilov
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Alex F. Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
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Kambhampati S, Saumoy M, Pak S, Budde LE, Mei MG, Popplewell L, Wen YP, Forman SJ, Kwak LW, Rosen ST, Herrera AF, Thiruvengadam N. Cost effectiveness of polatuzumab vedotin in combination with chemoimmunotherapy (Pola-R-CHP) in previously untreated diffuse large B-cell lymphoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7568] [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
7568 Background: In patients with treatment naive diffuse large B-cell lymphoma (DLBCL), the POLARIX study demonstrated a 6.5% improvement in the 2-year (yr) progression-free survival (PFS) with no difference in overall survival or safety using polatuzumab vedotin + R-CHP compared to standard RCHOP. We evaluated the cost effectiveness of pola-R-CHP for DLBCL. Methods: We modeled a hypothetical cohort of US adults (mean age, 58 yrs) with treatment naïve DLBCL by developing a Markov model with a 1-month cycle and 20-yr horizon. The cost-effectiveness of two strategies were directly compared (pola-R-CHP, RCHOP) using a range of plausible long-term outcomes. A patient with DLBCL in remission after treatment could develop subsequent progression or relapse, death, or alternative toxicity. Progression rates and overall survival were estimated from POLARIX study. Outcome measures were reported in incremental cost-effectiveness ratios (ICERs), with a willingness-to-pay (WTP) threshold of $150,000/quality-adjusted life-yr (QALY). Results: Assuming a 5-yr PFS of 69.6% with pola-R-CHP and 62.6% with RCHOP, pola-R-CHP was more effective (0.81 incremental QALYs) but more costly ($66,218) and was cost-effective at a WTP of 150,000 (ICER $82,220/QALY). Its cost effectiveness was highly dependent on the 5-yr PFS of pola-R-CHP with it no longer being cost effective if the 5-yr PFS was < 65%. One way sensitivity analysis demonstrated that pola-R-CHP is cost effective up to a cost of $270,506 at a WTP of $150,000. Probabilistic sensitivity analysis was derived from performing 10,000 Monte-Carlo model iterations and demonstrated that pola-R-CHP was the cost-effective strategy in 61.3% of iterations with RCHOP being cost-effective in 38.6% of iterations at a WTP of $150,000. Conclusions: If the absolute benefit in PFS is maintained over time, frontline pola-R-CHP for treatment of DLBCL would be cost effective at its current cost when compared to RCHOP at a WTP of $150,000/QALY. However, its cost effectiveness is highly sensitive to changes in long-term PFS and the cost of pola-R-CHP. If pola-R-CHP is adopted as frontline therapy for the 29,108 incident cases of DLBCL annually in the US, this will lead to an additional 1.8 billion dollars in healthcare expenditures. This highlights the importance of decreasing the cost of pola-R-CHP and identifying sub-populations that derive the highest benefit from it.[Table: see text]
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Affiliation(s)
| | - Monica Saumoy
- Penn Medicine Princeton Medical Center, Plainsboro, NJ
| | | | | | | | | | | | | | - Larry W. Kwak
- The University of Texas MD Anderson Cancer Center Chairman, Houston, TX
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9
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Wang X, Dong Z, Awuah D, Chang WC, Cheng WA, Vyas V, Cha S, Anderson A, Zhang T, Wang Z, Szymura S, Kuang B, Clark MC, Aldoss I, Forman SJ, Kwak LW, Qin H. CD19/BAFF-R dual-targeted CAR T cells for the treatment of mixed antigen-negative variants of acute lymphoblastic leukemia. Leukemia 2022; 36:1015-1024. [PMID: 35039637 PMCID: PMC8983465 DOI: 10.1038/s41375-021-01477-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/04/2021] [Accepted: 11/15/2021] [Indexed: 12/22/2022]
Abstract
Chimeric antigen receptor (CAR) T cells targeting CD19 mediate potent antitumor effects in B-cell malignancies including acute lymphoblastic leukemia (ALL), but antigen loss remains the major cause of treatment failure. To mitigate antigen escape and potentially improve the durability of remission, we developed a dual-targeting approach using an optimized, bispecific CAR construct that targets both CD19 and BAFF-R. CD19/BAFF-R dual CAR T cells exhibited antigen-specific cytokine release, degranulation, and cytotoxicity against both CD19-/- and BAFF-R-/- variant human ALL cells in vitro. Immunodeficient mice engrafted with mixed CD19-/- and BAFF-R-/- variant ALL cells and treated with a single dose of CD19/BAFF-R dual CAR T cells experienced complete eradication of both CD19-/- and BAFF-R-/- ALL variants, whereas mice treated with monospecific CD19 or BAFF-R CAR T cells succumbed to outgrowths of CD19-/BAFF-R+ or CD19+/BAFF-R- tumors, respectively. Further, CD19/BAFF-R dual CAR T cells showed prolonged in vivo persistence, raising the possibility that these cells may have the potential to promote durable remissions. Together, our data support clinical translation of BAFF-R/CD19 dual CAR T cells to treat ALL.
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Affiliation(s)
- Xiuli Wang
- Cellular Immunotherapy Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Zhenyuan Dong
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Dennis Awuah
- Cellular Immunotherapy Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Wen-Chung Chang
- Cellular Immunotherapy Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Wesley A Cheng
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Vibhuti Vyas
- Cellular Immunotherapy Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Soungchul Cha
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Aaron Anderson
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Tiantian Zhang
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Zhe Wang
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Szymon Szymura
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Benjamin Kuang
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Mary C. Clark
- Department of Clinical and Translational Project Development, City of Hope, Duarte, CA 91010, USA
| | - Ibrahim Aldoss
- Cellular Immunotherapy Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Stephen J. Forman
- Cellular Immunotherapy Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA,Corresponding Authors: Larry W. Kwak, MD., Ph.D., Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, ; Phone: 626-256-4673 ext. 80025; Fax: 626-218-3607, Stephen J. Forman., MD., Cellular Immunotherapy Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope1500 E. Duarte Rd., Duarte, CA 91010, ; Tel: 626-218-2405; Fax: 626-301-8256
| | - Larry W Kwak
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA.
| | - Hong Qin
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
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10
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Bennett CL, Gundabolu K, Kwak LW, Djulbegovic B, Champigneulle O, Josephson B, Martin L, Rosen ST. Using Twitter for the identification of COVID-19 vaccine-associated haematological adverse events. Lancet Haematol 2022; 9:e12-e13. [PMID: 34971576 PMCID: PMC8714180 DOI: 10.1016/s2352-3026(21)00378-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | - Krishna Gundabolu
- The University of Nebraska - Omaha School of Medicine, Omaha, NE, USA
| | - Larry W Kwak
- The City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | | | - Brian Josephson
- The University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Linda Martin
- The University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Steven T Rosen
- The City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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11
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Kwak LW, Sancho JM, Cho SG, Nakazawa H, Suzumiya J, Tumyan G, Kim JS, Menne T, Mariz J, Ilyin N, Jurczak W, Lopez Martinez A, Samoilova O, Zhavrid E, Yañez Ruiz E, Trneny M, Popplewell L, Ogura M, Kim WS, Lee SJ, Kim SH, Ahn KY, Buske C. Efficacy and Safety of CT-P10 Versus Rituximab in Untreated Low-Tumor-Burden Follicular Lymphoma: Final Results of a Randomized Phase III Study. Clin Lymphoma Myeloma Leuk 2021; 22:89-97. [PMID: 34686445 DOI: 10.1016/j.clml.2021.08.005] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/05/2021] [Accepted: 08/22/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION This double-blind, parallel-group, active-controlled phase III trial (NCT02260804) assessed CT-P10 and rituximab safety and efficacy in patients with previously untreated low-tumor-burden follicular lymphoma (LTBFL), including after a single switch from rituximab to CT-P10. PATIENTS AND METHODS LTBFL patients were randomized (1:1) to receive CT-P10 or rituximab (375 mg/m2 intravenously; day 1 of 4 7-day cycles). Patients achieving disease control entered a 2-year maintenance period. CT-P10 or rituximab were administered every 8 weeks (6 cycles) in year 1; all patients could receive CT-P10 (every 8 weeks; 6 cycles) in year 2. Secondary endpoints (reported here) were overall response rate (ORR) during the study period, progression-free survival (PFS), time to progression (TTP), and overall survival (OS). Safety and immunogenicity were evaluated. RESULTS Between November 9, 2015 and January 4, 2018, 258 patients were randomized (130 for CT-P10; 128 for rituximab). ORR was similar between groups over the study period (CT-P10: 88%; rituximab: 87%). After 29.2 months' median follow-up, median PFS, TTP, and OS were not estimable; 24-month Kaplan-Meier estimates suggested similarity between groups. Overall, 114 (CT-P10: 88%), and 104 (rituximab: 81%) patients experienced treatment-emergent adverse events. The single switch was well tolerated. CONCLUSION These updated data support therapeutic similarity of CT-P10 and rituximab and support the use of CT-P10 monotherapy for previously untreated LTBFL.
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Affiliation(s)
| | - Juan-Manuel Sancho
- Hematology Department, The Catalan Institute of Oncology-The Josep Carreras Leukemia Research Institute, Hospital Germans Trias i Pujol, Carretera Canyet, Badalona, 08916, Spain
| | - Seok-Goo Cho
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 06591, South Korea
| | - Hideyuki Nakazawa
- Department of Hematology, Shinshu University School of Medicine, Nagano 390-8621, Japan
| | - Junji Suzumiya
- Shimane University Hospital, Innovative Cancer Center/Oncology-Hematology, Izumo, Shimane 693-8501, Japan
| | - Gayane Tumyan
- Division of Hematology and Bone Marrow Transplantation, N. N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Science, Moscow, 115478, Russia
| | - Jin Seok Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, 03722, South Korea
| | - Tobias Menne
- Northern Institute for Cancer Care, Newcastle University, NE7 7DN, UK
| | - José Mariz
- Department of Onco-Hematology, Portuguese Institute of Oncology, Rua Dr Antonio Bernardino de Almeida, Porto, 4200-072, Portugal
| | - Nikolai Ilyin
- Russian Research Center for Radiology and Surgical Technologies, Ministry of Health of the Russian Federation, p. Pesochny, 197758, Russia
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Research Institute of Oncology, 331-115 Kraków, Poland
| | - Aurelio Lopez Martinez
- Department of Hematology, Hospital Arnau de Vilanova, Valencia, Comunidad Valenciana, 46015, Spain
| | - Olga Samoilova
- Department of Hematology, Nizhniy Novgorod Region Clinical Hospital, Nizhniy Novgorod, 603126, Russia
| | - Edvard Zhavrid
- N. N. Alexandrov Republican Scientific and Practical Centre of Oncology and Medical Radiology, Lesnoy, Minsk, 223040, Belarus
| | - Eduardo Yañez Ruiz
- Department of Internal Medicine, Oncology-Hematology Unit, School of Medicine, Universidad de la Frontera, Temuco, 4780000, Chile
| | - Marek Trneny
- Department of Medicine, Charles University, 128 08, Czech Republic
| | - Leslie Popplewell
- Toni Stephenson Lymphoma Cancer Center and Department of Hematology and Hematopoietic Cell Transplantation, Duarte, CA 91010
| | - Michinori Ogura
- Department of Hematology and Oncology, Kasugai Municipal Hospital, Aichi 486-8510, Japan
| | - Won-Seog Kim
- Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06355, South Korea
| | | | | | | | - Christian Buske
- Institute of Experimental Cancer Research, Comprehensive Cancer Center Ulm, University Hospital of Ulm, 89081 Ulm, Germany.
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12
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Nikolaenko L, Chen L, Herrera AF, Budde LE, Mei M, Siddiqi T, Chen R, Zain J, Kwak LW, Rosen S, Popplewell L. Avelumab (A) Plus Utomilumab (U) in Combination with RICE (rituximab, ifosfamide, carboplatin, etoposide) As a Second-Line Therapy for Patients with Relapsed/Refractory (R/R) Diffuse Large B-Cell Lymphoma (DLBCL) Eligible for Autologous Stem Cell Transplantation (ASCT). Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00076-2] [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: 12/01/2022]
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13
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Song JY, Perry AM, Herrera AF, Chen L, Skrabek P, Nasr MR, Ottesen RA, Nikowitz J, Bedell V, Murata-Collins J, Li Y, McCarthy C, Pillai R, Wang J, Wu X, Zain J, Popplewell L, Kwak LW, Nademanee AP, Niland JC, Scott DW, Gong Q, Chan WC, Weisenburger DD. Double-hit Signature with TP53 Abnormalities Predicts Poor Survival in Patients with Germinal Center Type Diffuse Large B-cell Lymphoma Treated with R-CHOP. Clin Cancer Res 2021; 27:1671-1680. [PMID: 33414134 DOI: 10.1158/1078-0432.ccr-20-2378] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/28/2020] [Accepted: 12/23/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE We performed detailed genomic analysis on 87 cases of de novo diffuse large B-cell lymphoma of germinal center type (GCB DLBCL) to identify characteristics that are associated with survival in those treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). EXPERIMENTAL DESIGN The cases were extensively characterized by combining the results of IHC, cell-of-origin gene expression profiling (GEP; NanoString), double-hit GEP (DLBCL90), FISH cytogenetic analysis for double/triple-hit lymphoma, copy-number analysis, and targeted deep sequencing using a custom mutation panel of 334 genes. RESULTS We identified four distinct biologic subgroups with different survivals, and with similarities to the genomic classifications from two large retrospective studies of DLBCL. Patients with the double-hit signature, but no abnormalities of TP53, and those lacking EZH2 mutation and/or BCL2 translocation, had an excellent prognosis. However, patients with an EZB-like profile had an intermediate prognosis, whereas those with TP53 inactivation combined with the double-hit signature had an extremely poor prognosis. This latter finding was validated using two independent cohorts. CONCLUSIONS We propose a practical schema to use genomic variables to risk-stratify patients with GCB DLBCL. This schema provides a promising new approach to identify high-risk patients for new and innovative therapies.
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Affiliation(s)
- Joo Y Song
- Department of Pathology, City of Hope National Medical Center, Duarte, California. .,Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California
| | - Anamarija M Perry
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Alex F Herrera
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California.,Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Lu Chen
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California.,Department of Information Sciences, City of Hope National Medical Center, Duarte, California
| | - Pamela Skrabek
- Department of Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Michel R Nasr
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York
| | - Rebecca A Ottesen
- Department of Diabetes & Cancer Discovery Science, City of Hope National Medical Center, Duarte, California
| | - Janet Nikowitz
- Department of Diabetes & Cancer Discovery Science, City of Hope National Medical Center, Duarte, California
| | - Victoria Bedell
- Department of Pathology, City of Hope National Medical Center, Duarte, California.,Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California
| | - Joyce Murata-Collins
- Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Yuping Li
- Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Christine McCarthy
- Department of Diabetes & Cancer Discovery Science, City of Hope National Medical Center, Duarte, California
| | - Raju Pillai
- Department of Pathology, City of Hope National Medical Center, Duarte, California.,Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California
| | - Jinhui Wang
- Integrative Genomics Core, City of Hope National Medical Center, Duarte, California
| | - Xiwei Wu
- Integrative Genomics Core, City of Hope National Medical Center, Duarte, California
| | - Jasmine Zain
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California.,Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Leslie Popplewell
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California.,Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Larry W Kwak
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California.,Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Auayporn P Nademanee
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California.,Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Joyce C Niland
- Department of Diabetes & Cancer Discovery Science, City of Hope National Medical Center, Duarte, California
| | - David W Scott
- British Columbia Research Center, Vancouver, British Columbia, Canada
| | - Qiang Gong
- Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Wing C Chan
- Department of Pathology, City of Hope National Medical Center, Duarte, California.,Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California
| | - Dennis D Weisenburger
- Department of Pathology, City of Hope National Medical Center, Duarte, California.,Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California
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14
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Wang X, Huynh C, Urak R, Weng L, Walter M, Lim L, Vyas V, Chang WC, Aguilar B, Brito A, Sarkissian A, Bandara NA, Yang L, Wang J, Wu X, Zhang J, Priceman SJ, Qin H, Kwak LW, Budde LE, Thomas SH, Clark MC, Popplewell L, Siddiqi T, Brown CE, Forman SJ. The Cerebroventricular Environment Modifies CAR T Cells for Potent Activity against Both Central Nervous System and Systemic Lymphoma. Cancer Immunol Res 2020; 9:75-88. [PMID: 33093217 DOI: 10.1158/2326-6066.cir-20-0236] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/24/2020] [Accepted: 10/15/2020] [Indexed: 11/16/2022]
Abstract
Lymphomas with central nervous system (CNS) involvement confer a worse prognosis than those without CNS involvement, and patients currently have limited treatment options. T cells genetically engineered with CD19-targeted chimeric antigen receptors (CAR) are effective against B-cell malignancies and show tremendous potential in the treatment of systemic lymphoma. We aimed to leverage this strategy toward a more effective therapy for patients with lymphoma with CNS disease. NOD-scid IL2Rgammanull (NSG) mice with CNS and/or systemic lymphoma were treated with CD19-CAR T cells via intracerebroventricular (ICV) or intravenous (IV) injection. CAR T cells isolated after treatment were rigorously examined for phenotype, gene expression, and function. We observed that CAR T cells infused ICV, but not IV, completely and durably eradicated both CNS and systemic lymphoma. CAR T cells delivered ICV migrated efficiently to the periphery, homed to systemic tumors, and expanded in vivo, leading to complete elimination of disease and resistance to tumor rechallenge. Mechanistic studies indicated that ICV-delivered CAR T cells are conditioned by exposure to cerebrospinal fluid in the ICV environment for superior antilymphoma activity and memory function compared with IV-delivered CAR T cells. Further analysis suggested that manipulating cellular metabolism or preactivating therapeutic CAR T cells with antigen ex vivo may improve the efficacy of CAR T cells in vivo Our demonstration that ICV-delivered CD19-CAR T cells had activity against CNS and systemic lymphoma could offer a valuable new strategy for treatment of B-cell malignancies with CNS involvement.
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Affiliation(s)
- Xiuli Wang
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California.
| | - Christian Huynh
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Ryan Urak
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Lihong Weng
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Miriam Walter
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Laura Lim
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Vibhuti Vyas
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Wen-Chung Chang
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Brenda Aguilar
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Alfonso Brito
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Aniee Sarkissian
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - N Achini Bandara
- Clinical and Translational Project Development Core, City of Hope, Duarte, California
| | - Lu Yang
- Department of Molecular and Cellular Biology, Beckman Research Institute, City of Hope, Duarte, California
| | - Jinhui Wang
- Integrative Genomics Core, Beckman Research Institute, City of Hope, Duarte, California
| | - Xiwei Wu
- Integrative Genomics Core, Beckman Research Institute, City of Hope, Duarte, California
| | - Jianying Zhang
- The Department of Computational and Quantitative Medicine, City of Hope, Duarte, California
| | - Saul J Priceman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Hong Qin
- Toni Stephenson Lymphoma Center, Beckman Research Institute, City of Hope, Duarte, California
| | - Larry W Kwak
- Toni Stephenson Lymphoma Center, Beckman Research Institute, City of Hope, Duarte, California
| | - Lihua E Budde
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Sandra H Thomas
- Clinical and Translational Project Development Core, City of Hope, Duarte, California
| | - Mary C Clark
- Clinical and Translational Project Development Core, City of Hope, Duarte, California
| | - Leslie Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Tanya Siddiqi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Christine E Brown
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
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15
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Qin H, Dong Z, Wang X, Cheng WA, Wen F, Xue W, Sun H, Walter M, Wei G, Smith DL, Sun X, Fei F, Xie J, Panagopoulou TI, Chen CW, Song JY, Aldoss I, Kayembe C, Sarno L, Müschen M, Inghirami GG, Forman SJ, Kwak LW. CAR T cells targeting BAFF-R can overcome CD19 antigen loss in B cell malignancies. Sci Transl Med 2020; 11:11/511/eaaw9414. [PMID: 31554741 DOI: 10.1126/scitranslmed.aaw9414] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/03/2019] [Accepted: 07/31/2019] [Indexed: 02/05/2023]
Abstract
CAR T cells targeting CD19 provide promising options for treatment of B cell malignancies. However, tumor relapse from antigen loss can limit efficacy. We developed humanized, second-generation CAR T cells against another B cell-specific marker, B cell activating factor receptor (BAFF-R), which demonstrated cytotoxicity against human lymphoma and acute lymphoblastic leukemia (ALL) lines. Adoptively transferred BAFF-R-CAR T cells eradicated 10-day preestablished tumor xenografts after a single treatment and retained efficacy against xenografts deficient in CD19 expression, including CD19-negative variants within a background of CD19-positive lymphoma cells. Four relapsed, primary ALLs with CD19 antigen loss obtained after CD19-directed therapy retained BAFF-R expression and activated BAFF-R-CAR, but not CD19-CAR, T cells. BAFF-R-CAR, but not CD19-CAR, T cells also demonstrated antitumor effects against an additional CD19 antigen loss primary patient-derived xenograft (PDX) in vivo. BAFF-R is amenable to CAR T cell therapy, and its targeting may prevent emergence of CD19 antigen loss variants.
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Affiliation(s)
- Hong Qin
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Zhenyuan Dong
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Xiuli Wang
- Center for CAR T Cell Therapy, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Wesley A Cheng
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Feng Wen
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA.,Department of Medical Oncology Cancer Center, West China Hospital, Sichuan University, Sichuan 910041, China
| | - Weili Xue
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA.,The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
| | - Han Sun
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Miriam Walter
- Center for CAR T Cell Therapy, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Guowei Wei
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - D Lynne Smith
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Xiuhua Sun
- The Second Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| | - Fan Fei
- Department of Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, CA 90007, USA
| | - Jianming Xie
- Department of Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, CA 90007, USA
| | - Theano I Panagopoulou
- Department of Systems Biology, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Chun-Wei Chen
- Department of Systems Biology, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Joo Y Song
- Department of Pathology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Clarisse Kayembe
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Luisa Sarno
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Markus Müschen
- Department of Systems Biology, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Giorgio G Inghirami
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Stephen J Forman
- Center for CAR T Cell Therapy, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Larry W Kwak
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA.
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16
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Ghoda LY, Rosen ST, Kwak LW. The changing investment in translational science by academic medical centers: HOPE in the Valley of Death. J Clin Invest 2020; 130:3333-3335. [PMID: 32484455 DOI: 10.1172/jci138640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Lucy Y Ghoda
- Comprehensive Cancer Center and Beckman Research Institute.,Gehr Family Center for Leukemia Research
| | - Steven T Rosen
- Comprehensive Cancer Center and Beckman Research Institute.,Toni Stephenson Lymphoma Center, and.,Department of Hematology and Hematopoietic Stem Cell Transplantation, City of Hope, Duarte, California, USA
| | - Larry W Kwak
- Comprehensive Cancer Center and Beckman Research Institute.,Toni Stephenson Lymphoma Center, and.,Department of Hematology and Hematopoietic Stem Cell Transplantation, City of Hope, Duarte, California, USA
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17
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Dong Z, Cheng WA, Smith DL, Huang B, Zhang T, Chang WC, Wang X, Forman SJ, Kwak LW, Qin H. Antitumor efficacy of BAFF-R targeting CAR T cells manufactured under clinic-ready conditions. Cancer Immunol Immunother 2020; 69:2139-2145. [PMID: 32451682 PMCID: PMC7511472 DOI: 10.1007/s00262-020-02614-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/16/2020] [Indexed: 12/23/2022]
Abstract
B-cell malignancies can potentially be cured by CD19 chimeric antigen receptor (CAR) T-cell therapy. Although clinical response rates can be up to 93% in acute lymphoblastic leukemia, treatment-related antigen loss and lack of therapeutic persistence contribute to disease relapse. These shortcomings of current CAR T-cell therapy indicate the need for biologically relevant target selection and for improving the efficacy and persistence of the CAR T cells, which we have addressed by developing a novel B-cell activating factor receptor (BAFF-R) CAR T-cell therapy with improved therapeutic persistence. BAFF-R is a B-cell survival receptor and highly expressed in B-cell malignancies. We developed a prototype CAR T cell that efficiently and specifically eliminated BAFF-R expressing human B-cell tumors in several xenogeneic mouse models, including models of CD19 antigen loss. We proceeded with translational development and validation of BAFF-R CAR T cells produced under current good manufacturing practices (cGMP). cGMP-grade BAFF-R CAR T cells underwent in vitro and in vivo validation in established models to confirm that the potency and efficacy of our original research modeling was replicated. Food and Drug Administration required release testing was performed to ensure our BAFF-R CAR T cells meet specifications for new drug products. Completing and exceeding these requirements, the data fully support the initiation of a first-in-human Phase 1 trial for BAFF-R-positive relapsed/refractory (r/r) B-ALL.
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Affiliation(s)
- Zhenyuan Dong
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Wesley A Cheng
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - D Lynne Smith
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Brian Huang
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Tiantian Zhang
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Wen-Chung Chang
- Center for CAR T Cell Therapy, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Xiuli Wang
- Center for CAR T Cell Therapy, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Stephen J Forman
- Center for CAR T Cell Therapy, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Larry W Kwak
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Hong Qin
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA.
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18
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Chen R, Herrera AF, Hou J, Chen L, Wu J, Guo Y, Synold TW, Ngo VN, Puverel S, Mei M, Popplewell L, Yi S, Song JY, Tao S, Wu X, Chan WC, Forman SJ, Kwak LW, Rosen ST, Newman EM. Inhibition of MDR1 Overcomes Resistance to Brentuximab Vedotin in Hodgkin Lymphoma. Clin Cancer Res 2019; 26:1034-1044. [PMID: 31811017 DOI: 10.1158/1078-0432.ccr-19-1768] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/28/2019] [Accepted: 12/03/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE In classical Hodgkin lymphoma, the malignant Reed-Sternberg cells express the cell surface marker CD30. Brentuximab vedotin is an antibody-drug conjugate (ADC) that selectively delivers a potent cytotoxic agent, monomethyl auristatin E (MMAE), to CD30-positive cells. Although brentuximab vedotin elicits a high response rate (75%) in relapsed/refractory Hodgkin lymphoma, most patients who respond to brentuximab vedotin eventually develop resistance. PATIENTS AND METHODS We developed two brentuximab vedotin-resistant Hodgkin lymphoma cell line models using a pulsatile approach and observed that resistance to brentuximab vedotin is associated with an upregulation of multidrug resistance-1 (MDR1). We then conducted a phase I trial combining brentuximab vedotin and cyclosporine A (CsA) in patients with relapsed/refractory Hodgkin lymphoma. RESULTS Here, we show that competitive inhibition of MDR1 restored sensitivity to brentuximab vedotin in our brentuximab vedotin-resistant cell lines by increasing intracellular MMAE levels, and potentiated brentuximab vedotin activity in brentuximab vedotin-resistant Hodgkin lymphoma tumors in a human xenograft mouse model. In our phase I trial, the combination of brentuximab vedotin and CsA was tolerable and produced an overall and complete response rate of 75% and 42% in a population of patients who were nearly all refractory to brentuximab vedotin. CONCLUSIONS This study may provide a new therapeutic strategy to combat brentuximab vedotin resistance in Hodgkin lymphoma. This is the first study reporting an effect of multidrug resistance modulation on the therapeutic activity of an ADC in humans. The expansion phase of the trial is ongoing and enrolling patients who are refractory to brentuximab vedotin to confirm clinical activity in this population with unmet need.
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Affiliation(s)
- Robert Chen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California.
| | - Jessie Hou
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California
| | - Lu Chen
- Department of Computational and Quantitative Medicine, City of Hope, Duarte, California
| | - Jun Wu
- Center for Comparative Medicine, Beckman Research Institute, City of Hope, Duarte, California
| | - Yuming Guo
- Center for Comparative Medicine, Beckman Research Institute, City of Hope, Duarte, California
| | - Timothy W Synold
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California
| | - Vu N Ngo
- Department of Systems Biology, City of Hope, Duarte, California
| | - Sandrine Puverel
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Leslie Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Shuhua Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Joo Y Song
- Department of Pathology, City of Hope, Duarte, California
| | - Shu Tao
- Integrative Genomics Core, City of Hope, Duarte, California
| | - Xiwei Wu
- Integrative Genomics Core, City of Hope, Duarte, California
| | - Wing C Chan
- Department of Pathology, City of Hope, Duarte, California
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Larry W Kwak
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Steven T Rosen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Edward M Newman
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California
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Thomas SK, Cha S, Parshottam SR, Rao SS, Olsem JB, Crumpton BN, Feng L, Lee HC, Manasanch EE, Weber DM, Patel KK, Orlowski RZ, Neelapu SS, Kwak LW. Phase I trial of a novel DNA vaccine in patients (pts) with smoldering Waldenstrom macroglobulinemia (sWM). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.8050] [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
8050 Background: Idiotypic determinants of the surface immunoglobulin (Ig) associated with a given pt’s B-cell lymphoma are unique to that tumor, and thus are a tumor-specific marker. This study aims to use an idiotype DNA vaccine to lengthen the smoldering phase of WM without inducing cross-resistance to available therapies. Administered vaccine used recombinant plasmid DNA encoding a fusion protein, consisting of autologous lymphoma scFv (pt-specific idiotype) and human CCL20 (macrophage inflammatory protein-3 alpha - MIP-3α) chemokine. Targeted delivery of this fusion protein to APCs, and subsequent processing and presentation, is hypothesized to break tolerance and generate an immune response against the idiotype, promoting eradication of antigen-expressing B-cell lymphoma cells. Methods: Pts with sWM received 3 i.d. vaccinations of pt-specific DNA vaccine at 4-week (wk) intervals (wks 0, 4 and 8). Two dose levels (500µg; 2500µg) were evaluated in a 3+3 design. Primary objective: to evaluate the vaccine’s safety and identify it’s MTD. Secondary objectives: 1) to assess immunogenicity of the vaccine 2) to determine time to symptomatic WM. Results: Between 1/2016 - 1/2019, 9 pts (7 men) were treated (500 µg: n = 3; 2500µg: n = 6). Median age at enrollment was 67 yrs (range 56-78); median time from diagnosis to 1st vaccination was 26.5 mos (8.8-120.9). MYD88 L265P + (6 pts). CXCR4 WHIM + (1 pt). With median follow up of 26.5 months (range: 8-36.4), all pts remain alive. Seven have stable disease; 2 progressed to symptomatic WM (8 mos. (1pt) and 26 mos. (1pt) from 1st vaccination). All pts completed planned therapy. No DLTs or Grade 4 AEs occurred. Ten mos. after the 3rd vaccination, 1 pt had a grade 3 pleural effusion and leukopenia with an increase in rheumatoid factor (23.1 IU/mL [normal range 0.0-15.9]) and ANA titer of 1:80; all resolved within 2 mos. Grade 1-2 AEs ( > 3pts): leukopenia (6), nausea (5), anemia (4), increased creatinine (4), fatigue (4). Conclusions: Idiotype (scFv-CCL20) DNA vaccine therapy appears to be safe in pts with sWM. Results of immunogenicity assays are underway, and will inform whether tumor specific immune responses are induced. Additional follow up is required to determine time to symptomatic WM. Clinical trial information: NCT01209871.
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Affiliation(s)
| | - Soungchul Cha
- Toni Stephenson Lymphoma Center and Department of Hematology and Hematopoietic Stem Cell Transplantation, City of Hope, Duarte, CA
| | | | - Sheetal S Rao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jasper B. Olsem
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Lei Feng
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Donna M. Weber
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Krina K. Patel
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Larry W. Kwak
- The University of Texas MD Anderson Cancer Center Chairman, Houston, TX
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20
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Khashab T, Hagemeister F, Romaguera JE, Fanale MA, Pro B, McLaughlin P, Rodriguez MA, Neelapu SS, Fayad L, Younes A, Feng L, Vega F, Kwak LW, Samaniego F. Long‐term overall‐ and progression‐free survival after pentostatin, cyclophosphamide and rituximab therapy for indolent non‐Hodgkin lymphoma. Br J Haematol 2019; 185:670-678. [DOI: 10.1111/bjh.15814] [Citation(s) in RCA: 5] [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: 10/08/2018] [Accepted: 12/18/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Tamer Khashab
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
- Department of Internal Medicine Lankenau Medical Center Wynnewood PAUSA
| | - Fredrick Hagemeister
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Jorge E. Romaguera
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Michelle A. Fanale
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
- Seattle Genetics, Inc. Bothell WAUSA
| | - Barbara Pro
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
- Robert H Lurie Medical Research Center Chicago ILUSA
| | - Peter McLaughlin
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - M. Alma Rodriguez
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Sattva S. Neelapu
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Luis Fayad
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Anas Younes
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
- Memorial Sloan Kettering Cancer Center New York NYUSA
| | - Lei Feng
- Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Francisco Vega
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
- University of Miami Sylvester Comprehensive Cancer Center Miami FL USA
| | - Larry W. Kwak
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
- City of Hope Hospital Duarte CA USA
| | - Felipe Samaniego
- Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston TXUSA
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21
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Ogura M, Sancho JM, Cho SG, Nakazawa H, Suzumiya J, Tumyan G, Kim JS, Lennard A, Mariz J, Ilyin N, Jurczak W, Lopez Martinez A, Samoilova O, Zhavrid E, Yañez Ruiz E, Trneny M, Popplewell L, Coiffier B, Buske C, Kim WS, Lee SJ, Lee SY, Bae YJ, Kwak LW. Efficacy, pharmacokinetics, and safety of the biosimilar CT-P10 in comparison with rituximab in patients with previously untreated low-tumour-burden follicular lymphoma: a randomised, double-blind, parallel-group, phase 3 trial. Lancet Haematol 2018; 5:e543-e553. [PMID: 30389036 DOI: 10.1016/s2352-3026(18)30157-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/31/2018] [Accepted: 09/10/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Studies in patients with rheumatoid arthritis and advanced follicular lymphoma have shown that CT-P10, a rituximab biosimilar, has equivalent or non-inferior efficacy and pharmacokinetics to rituximab. We aimed to assess the therapeutic equivalence of single-agent CT-P10 and rituximab in patients with newly diagnosed low-tumour burden follicular lymphoma. METHODS In this ongoing, randomised, double-blind, parallel-group, active-controlled, phase 3 trial, adult patients (≥18 years) with stage II-IV low-tumour-burden follicular lymphoma were randomly assigned (1:1) using an interactive web or voice response system stratified by region, stage, and age to CT-P10 or US-sourced rituximab. Patients received CT-P10 or rituximab (375 mg/m2 intravenous) on day 1 of four 7-day cycles (induction period). Patients who had disease control after the induction period continued to a maintenance period of CT-P10 or rituximab administered every 8 weeks for six cycles and, if completed, a second year of maintenance therapy of additional CT-P10 (every 8 weeks for six cycles) was offered. The study was partially unmasked after database lock (Feb 23, 2018) for all data up to 7 months (before cycle 3 of the maintenance period). The primary endpoint was the proportion of patients who achieved an overall response by 7 months in the intention-to-treat population. Efficacy equivalence was shown if the two-sided 90% CIs for the treatment difference in the proportion of responders between CT-P10 and rituximab was within the equivalence margin of 17%. This trial is registered with ClinicalTrials.gov, number NCT02260804. FINDINGS Between Nov 9, 2015, and Jan 4, 2018, 402 patients were assessed for eligibility, of whom 258 were randomly assigned: 130 to CT-P10 and 128 to rituximab. 108 (83%) of 130 patients assigned to CT-P10 and 104 (81%) of 128 assigned to rituximab achieved an overall response by month 7 (treatment difference estimate 1·8%; 90% CI -6·43 to 10·20). Therapeutic equivalence was shown (90% CIs were within the prespecified margin of 17%). The most common grade 3 or 4 treatment-emergent adverse events were decreased neutrophil count (two grade 3 in the CT-P10 group) and neutropenia (one in each group); all other grade 3 or 4 treatment-emergent adverse events occurred in one patient each. Six (5%) of 130 patients who received CT-P10 and three (2%) of 128 who received rituximab experienced at least one treatment-emergent serious adverse event. INTERPRETATION CT-P10 was equivalent to rituximab in terms of efficacy and was well tolerated. CT-P10 monotherapy is suggested as a new therapeutic option for patients with low-tumour-burden follicular lymphoma. FUNDING Celltrion, Inc.
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MESH Headings
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/pharmacokinetics
- Antibodies, Monoclonal, Murine-Derived/pharmacology
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Biosimilar Pharmaceuticals/adverse effects
- Biosimilar Pharmaceuticals/pharmacokinetics
- Biosimilar Pharmaceuticals/pharmacology
- Biosimilar Pharmaceuticals/therapeutic use
- Disease-Free Survival
- Double-Blind Method
- Female
- Humans
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/metabolism
- Lymphoma, Follicular/pathology
- Male
- Middle Aged
- Rituximab/adverse effects
- Rituximab/pharmacokinetics
- Rituximab/pharmacology
- Rituximab/therapeutic use
- Safety
- Treatment Outcome
- Tumor Burden/drug effects
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Affiliation(s)
- Michinori Ogura
- Department of Haematology and Oncology, Kasugai Municipal Hospital, Kasugai, Japan; School of Medicine, Fujita Medical University, Toyoake, Japan
| | - Juan Manuel Sancho
- Hematology Department, The Catalan Institute of Oncology-The Josep Carreras Leukaemia Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Seok-Goo Cho
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Hideyuki Nakazawa
- Department of Hematology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Junji Suzumiya
- Shimane University Hospital, Innovative Cancer Center/Oncology-Hematology, Izumo, Japan
| | - Gayane Tumyan
- Division of Hematology and Bone Marrow Transplantation, N N Blokhin Russian Cancer Research Center, Moscow, Russia
| | - Jin Seok Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Anne Lennard
- Northern Institute for Cancer Care, Newcastle University, Newcastle-upon-Tyne, UK
| | - José Mariz
- Department of Onco-Hematology, Portuguese Institute of Oncology, Porto, Portugal
| | - Nikolai Ilyin
- Russian Research Center for Radiology and Surgical Technologies, Ministry of Health of the Russian Federation, St Petersburg, Russia
| | - Wojciech Jurczak
- Department of Haematology, Jagiellonian University, Kraków, Poland
| | | | - Olga Samoilova
- Department of Hematology, Nizhniy Novgorod Region Clinical Hospital, Nizhniy Novgorod, Russia
| | - Edvard Zhavrid
- N N Alexandrov Republican Scientific and Practical Centre of Oncology and Medical Radiology, Minsk, Belarus
| | - Eduardo Yañez Ruiz
- Department of Internal Medicine, Universidad de la Frontera, Temuco, Chile
| | - Marek Trneny
- Department of Medicine, Charles University, General Hospital in Prague, Prague, Czech Republic
| | - Leslie Popplewell
- Toni Stephenson Lymphoma Center and Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | | | - Christian Buske
- Comprehensive Cancer Center Ulm, University Hospital of Ulm, Ulm, Germany
| | - Won-Seog Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | - Larry W Kwak
- Toni Stephenson Lymphoma Center and Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA.
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22
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Liu Y, Wei G, Cheng WA, Dong Z, Sun H, Lee VY, Cha SC, Smith DL, Kwak LW, Qin H. Targeting myeloid-derived suppressor cells for cancer immunotherapy. Cancer Immunol Immunother 2018; 67:1181-1195. [PMID: 29855694 PMCID: PMC11028324 DOI: 10.1007/s00262-018-2175-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [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: 08/28/2017] [Accepted: 05/19/2018] [Indexed: 01/05/2023]
Abstract
Myeloid-derived suppressor cells (MDSCs) are a heterogeneous population of immature myeloid cells with an immune suppressive phenotype. They represent a critical component of the immune suppressive niche described in cancer, where they support immune escape and tumor progression through direct effects on both the innate and adaptive immune responses, largely by contributing to maintenance of a high oxidative stress environment. The number of MDSCs positively correlates with protumoral activity, and often diminishes the effectiveness of immunotherapies, which is particularly problematic with the emergence of personalized medicine. Approaches targeting MDSCs showed promising results in preclinical studies and are under active investigation in clinical trials in combination with various immune checkpoint inhibitors. In this review, we discuss MDSC targets and therapeutic approaches targeting MDSC that have the aim of enhancing the existing tumor therapies.
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Affiliation(s)
- Yijun Liu
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Guowei Wei
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Wesley A Cheng
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Zhenyuan Dong
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Han Sun
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Vincent Y Lee
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Soung-Chul Cha
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - D Lynne Smith
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Larry W Kwak
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA.
| | - Hong Qin
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA
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23
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Chen RW, Palmer JM, Tomassetti S, Popplewell LL, Alluin J, Chomchan P, Nademanee AP, Siddiqi T, Tsai NC, Chen L, Zuo F, Abary R, Cai JL, Herrera AF, Rossi JJ, Rosen ST, Forman SJ, Kwak LW, Holmberg LA. Multi-center phase II trial of bortezomib and rituximab maintenance combination therapy in patients with mantle cell lymphoma after consolidative autologous stem cell transplantation. J Hematol Oncol 2018; 11:87. [PMID: 29954415 PMCID: PMC6022297 DOI: 10.1186/s13045-018-0631-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/19/2018] [Indexed: 11/18/2022] Open
Abstract
Background Mantle cell lymphoma (MCL) is an aggressive and incurable lymphoma. Standard of care for younger patients with MCL is induction chemotherapy followed by autologous stem cell transplantation (auto-HCT). Rituximab maintenance after auto-HCT has been shown to improve progression-free survival (PFS) and overall survival (OS) in MCL. Bortezomib maintenance therapy has also been shown to be tolerable and feasible in this setting. However, the combination of bortezomib and rituximab as maintenance therapy post-auto-HCT has not been studied. Methods We conducted a multicenter, phase II trial of bortezomib given in combination with rituximab as maintenance in MCL patients after consolidative auto-HCT. Enrolled patients (n = 23) received bortezomib 1.3 mg/m2 subcutaneously weekly for 4 weeks every 3 months (up to 24 months) and rituximab 375 mg/m2 intravenously weekly for 4 weeks every 6 months (up to 24 months) for a total duration of 2 years. The primary study endpoint was disease-free survival (DFS). Results With a median follow-up of 35.9 months, the 2-year DFS probability was 90.2% (95% CI 66–97), and 2-year OS was 94.7% (95% CI 68–99). The most frequent grade 3/4 toxic events were neutropenia (in 74% of patients) and lymphopenia (in 35%). The incidence of peripheral neuropathy was 48% for grade 1, 9% for grade 2, and 0% for grade 3/4. We also examined the role of quantitative cyclin D1 (CCND1) mRNA in monitoring minimal residual disease. Conclusion Combined bortezomib and rituximab as maintenance therapy in MCL patients following auto-HCT is an active and well-tolerated regimen. Trial registration ClinicalTrials.govNCT01267812, registered Dec 29, 2010.
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Affiliation(s)
- Robert W Chen
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, 1500 E Duarte Road, Duarte, CA, 91010, USA.
| | - Joycelynne M Palmer
- Department of Information Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Sarah Tomassetti
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, 1500 E Duarte Road, Duarte, CA, 91010, USA
| | - Leslie L Popplewell
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, 1500 E Duarte Road, Duarte, CA, 91010, USA
| | - Jessica Alluin
- Department of Molecular and Cellular Biology, Beckman Research Institute of the City of Hope National Medical Center, Duarte, CA, USA
| | - Pritsana Chomchan
- Department of Molecular and Cellular Biology, Beckman Research Institute of the City of Hope National Medical Center, Duarte, CA, USA
| | - Auayporn P Nademanee
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, 1500 E Duarte Road, Duarte, CA, 91010, USA
| | - Tanya Siddiqi
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, 1500 E Duarte Road, Duarte, CA, 91010, USA
| | - Ni-Chun Tsai
- Department of Information Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Lu Chen
- Department of Information Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Fay Zuo
- Clinical Trial Office, City of Hope National Medical Center, Duarte, CA, USA
| | - Rosemarie Abary
- Clinical Trial Office, City of Hope National Medical Center, Duarte, CA, USA
| | - Ji-Lian Cai
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, 1500 E Duarte Road, Duarte, CA, 91010, USA.,Kaiser Permanente Southern California Bone Marrow Transplantation Program, Los Angeles, CA, USA
| | - Alex F Herrera
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, 1500 E Duarte Road, Duarte, CA, 91010, USA
| | - John J Rossi
- Department of Molecular and Cellular Biology, Beckman Research Institute of the City of Hope National Medical Center, Duarte, CA, USA
| | - Steven T Rosen
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Stephen J Forman
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, 1500 E Duarte Road, Duarte, CA, 91010, USA
| | - Larry W Kwak
- Toni Stephenson Lymphoma Center, Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Leona A Holmberg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Department of Medicine, University of Washington, Seattle, WA, USA
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24
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Romaguera JE, Wang M, Feng L, Fayad LE, Hagemeister F, McLaughlin P, Rodriguez MA, Fanale M, Orlowski R, Kwak LW, Neelapu S, Oki Y, Pro B, Younes A, Samaniego F, Fowler N, Hartig K, Valentinetti M, Smith J, Ford P, Naig A, Medeiros LJ, Kantarjian HM, Goy A. Phase 2 trial of bortezomib in combination with rituximab plus hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with bortezomib, rituximab, methotrexate, and cytarabine for untreated mantle cell lymphoma. Cancer 2018; 124:2561-2569. [DOI: 10.1002/cncr.31361] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/25/2018] [Accepted: 02/28/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Jorge E. Romaguera
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Michael Wang
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Lei Feng
- Department of Biostatistics; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Luis E. Fayad
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Frederick Hagemeister
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Peter McLaughlin
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - M. Alma Rodriguez
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Michelle Fanale
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Robert Orlowski
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | | | - Sattva Neelapu
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Yasuhiro Oki
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Barbara Pro
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Anas Younes
- Lymphoma Service, Memorial Sloan Kettering Cancer Center; New York New York
| | - Felipe Samaniego
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Nathan Fowler
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Kimberly Hartig
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Marisa Valentinetti
- Lymphoma Division; John Theurer Cancer Hackensack University Medical Center; Hackensack New Jersey
| | - Judy Smith
- Lymphoma Division; John Theurer Cancer Hackensack University Medical Center; Hackensack New Jersey
| | - Peggy Ford
- Lymphoma Division; John Theurer Cancer Hackensack University Medical Center; Hackensack New Jersey
| | - Adam Naig
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - L. Jeffrey Medeiros
- Department of Hematopathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Hagop M. Kantarjian
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Andre Goy
- Lymphoma Division; John Theurer Cancer Hackensack University Medical Center; Hackensack New Jersey
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25
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Herrera AF, Palmer J, Martin P, Armenian S, Tsai NC, Kennedy N, Sahebi F, Cao T, Budde LE, Mei M, Siddiqi T, Popplewell L, Rosen ST, Kwak LW, Nademanee A, Forman SJ, Chen R. Autologous stem-cell transplantation after second-line brentuximab vedotin in relapsed or refractory Hodgkin lymphoma. Ann Oncol 2018; 29:724-730. [PMID: 29272364 PMCID: PMC5889038 DOI: 10.1093/annonc/mdx791] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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] [Indexed: 11/14/2022] Open
Abstract
Background We previously demonstrated that brentuximab vedotin (BV) used as second-line therapy in patients with Hodgkin lymphoma is a tolerable and effective bridge to autologous hematopoietic cell transplantation (AHCT). Here, we report the post-AHCT outcomes of patients treated with second-line standard/fixed-dose BV and an additional cohort of patients where positron-emission tomography adapted dose-escalation of second-line BV was utilized. Patients and methods Patients on the dose-escalation cohort received 1.8 mg/kg of BV intravenously every 3 weeks for two cycles. Patients in complete remission (CR) after two cycles received two additional cycles of BV at 1.8 mg/kg, while patients with stable disease or partial response were escalated to 2.4 mg/kg for two cycles. All patients, regardless of treatment cohort, proceeded directly to AHCT or received additional pre-AHCT therapy at the discretion of the treating physician based on remission status after second-line BV. Results Of the 20 patients enrolled to the BV dose-escalation cohort, 8 patients underwent BV dose-escalation. BV escalation was well-tolerated, but no patients who were escalated converted to CR. Of 56 evaluable patients treated across cohorts, the overall response rate (ORR) to second-line BV was 75% with 43% CR. Twenty-eight (50%) patients proceeded directly to AHCT without post-BV chemotherapy, and a total of 50 patients proceeded to AHCT. Thirteen patients received consolidative post-AHCT therapy with either radiation, BV, or a PD-1 inhibitor. After AHCT, the 2-year progression-free survival (PFS) and overall survival were 67% and 93%, respectively. The 2-year PFS among patients in CR at the time of AHCT (n = 37) was 71% compared with 54% in patients not in CR (p = 0.12). The 2-year PFS in patients who proceeded to AHCT directly after receiving BV alone was 77%. Conclusions Second-line BV is an effective bridge to AHCT that produces responses of sufficient depth to provide durable remission in conjunction with AHCT (clinicaltrials.gov: NCT01393717).
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Affiliation(s)
- A F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - J Palmer
- Department of Information Sciences, Division of Biostatistics, City of Hope, Duarte, USA
| | - P Martin
- Department of Hematology/Oncology, Weill Cornell Medical College, New York, USA
| | - S Armenian
- Department of Population Sciences, City of Hope, Duarte, USA
| | - N-C Tsai
- Department of Information Sciences, Division of Biostatistics, City of Hope, Duarte, USA
| | - N Kennedy
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - F Sahebi
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - T Cao
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - L E Budde
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - M Mei
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - T Siddiqi
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - L Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - S T Rosen
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - L W Kwak
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - A Nademanee
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - S J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - R Chen
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA.
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26
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Thomas SK, Cha SC, Smith DL, Kim KH, Parshottam SR, Rao S, Popescu M, Lee VY, Neelapu SS, Kwak LW. Phase I study of an active immunotherapy for asymptomatic phase Lymphoplasmacytic lymphoma with DNA vaccines encoding antigen-chemokine fusion: study protocol. BMC Cancer 2018; 18:187. [PMID: 29439670 PMCID: PMC5812202 DOI: 10.1186/s12885-018-4094-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 02/05/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is now a renewed interest in cancer vaccines. Patients responding to immune checkpoint blockade usually bear tumors that are heavily infiltrated by T cells and express a high load of neoantigens, indicating that the immune system is involved in the therapeutic effect of these agents; this finding strongly supports the use of cancer vaccine strategies. Lymphoplasmacytic lymphoma (LPL) is a low grade, incurable disease featuring an abnormal proliferation of Immunoglobulin (Ig)-producing malignant cells. Asymptomatic patients are currently managed by a "watchful waiting" approach, as available therapies provide no survival advantage if started before symptoms develop. Idiotypic determinants of a lymphoma surface Ig, formed by the interaction of the variable regions of heavy and light chains, can be used as a tumor-specific marker and effective vaccination using idiotypes was demonstrated in a positive controlled phase III trial. METHODS These variable region genes can be cloned and used as a DNA vaccine, a delivery system holding tremendous potential for streamlining vaccine production. To increase vaccination potency, we are targeting antigen-presenting cells (APCs) by fusing the antigen with a sequence encoding a chemokine (MIP-3α), which binds an endocytic surface receptor on APCs. Asymptomatic phase LPL is an excellent model to test our vaccine since patients have not received chemotherapeutics that interfere with innate immune function and have low tumor burden. We are evaluating the safety of this next-generation DNA vaccine in a first-in-human clinical trial currently enrolling asymptomatic LPL patients. To elucidate the mode of action of this vaccine, we will assess its ability to generate tumor-specific immune responses and examine changes in the immune profile of both the peripheral blood and bone marrow. DISCUSSION This vaccine could shift the current paradigm of clinical management for patients with asymptomatic LPL and inform development of other personalized approaches. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT01209871; registered on September 24, 2010.
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Affiliation(s)
- Sheeba K Thomas
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Soung-Chul Cha
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - D Lynne Smith
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Kun Hwa Kim
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Sapna R Parshottam
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Sheetal Rao
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Michael Popescu
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Vincent Y Lee
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA
| | - Sattva S Neelapu
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Larry W Kwak
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Stem Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA, 91010, USA.
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27
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Herrera AF, Rodig SJ, Song JY, Kim Y, Griffin GK, Yang D, Nikolaenko L, Mei M, Bedell V, Dal Cin P, Pak C, Alyea EP, Budde LE, Chen R, Chen YB, Chan WC, Cutler CS, Ho VT, Koreth J, Krishnan A, Murata-Collins JL, Nikiforow S, Palmer J, Pihan GA, Pillai R, Popplewell L, Rosen ST, Siddiqi T, Sohani AR, Zain J, Kwak LW, Weisenburger DD, Weinstock DM, Soiffer RJ, Antin JH, Forman SJ, Nademanee AP, Armand P. Outcomes after Allogeneic Stem Cell Transplantation in Patients with Double-Hit and Double-Expressor Lymphoma. Biol Blood Marrow Transplant 2017; 24:514-520. [PMID: 29196080 DOI: 10.1016/j.bbmt.2017.11.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/18/2017] [Indexed: 01/22/2023]
Abstract
Double-hit lymphomas (DHLs) and double-expressor lymphomas (DELs) are associated with resistance to frontline and salvage immunochemotherapy, as well as autologous stem cell transplantation (SCT). We hypothesized that allogeneic SCT (alloSCT) could overcome the chemoresistance associated with DEL/DHL. We retrospectively studied the impact of DEL/DHL status in a multicenter cohort of patients who underwent alloSCT for relapsed/refractory (rel/ref) aggressive B cell non-Hodgkin lymphoma (B-NHL). Seventy-eight patients transplanted at 3 centers in whom tumor tissue was available for immunohistochemistry and fluorescence in situ hybridization were enrolled; 47% had DEL and 13% had DHL. There were no significant differences in 4-year progression-free (PFS) or overall survival (OS) between patients with DEL compared with patients without DEL (PFS 30% versus 39%, P = .24; OS 31% versus 49%, P = .17) or between patients with DHL compared with patients without DHL (PFS 40% versus 34%, P = .62; OS 50% versus 38%, P = .46). The lack of association between DEL or DHL and outcome was confirmed in multivariable models, although inadequate sample size may have limited our ability to detect significant differences. In our cohort alloSCT produced durable remissions in patients with rel/ref aggressive B-NHL irrespective of DEL and DHL status, justifying its consideration in the treatment of patients with rel/ref DEL/DHL.
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Affiliation(s)
- Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California.
| | - Scott J Rodig
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joo Y Song
- Department of Pathology, City of Hope, Duarte, California
| | - Young Kim
- Department of Pathology, City of Hope, Duarte, California
| | - Gabriel K Griffin
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dongyun Yang
- Department of Information Sciences, City of Hope, Duarte, California
| | - Liana Nikolaenko
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | | | - Paola Dal Cin
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christine Pak
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Edwin P Alyea
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lihua E Budde
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Robert Chen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Yi-Bin Chen
- Division of Bone Marrow Transplantation, Massachusetts General Hospital, Boston, Massachusetts
| | - Wing C Chan
- Department of Pathology, City of Hope, Duarte, California
| | - Corey S Cutler
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Vincent T Ho
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - John Koreth
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Amrita Krishnan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | | | - Sarah Nikiforow
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joycelynne Palmer
- Department of Information Sciences, City of Hope, Duarte, California
| | - German A Pihan
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Raju Pillai
- Department of Pathology, City of Hope, Duarte, California
| | - Leslie Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Steven T Rosen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Tanya Siddiqi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jasmine Zain
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Larry W Kwak
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | | | - David M Weinstock
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Robert J Soiffer
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joseph H Antin
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Auayporn P Nademanee
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Philippe Armand
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
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28
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Qin H, Wei G, Sakamaki I, Dong Z, Cheng WA, Smith DL, Wen F, Sun H, Kim K, Cha S, Bover L, Neelapu SS, Kwak LW. Novel BAFF-Receptor Antibody to Natively Folded Recombinant Protein Eliminates Drug-Resistant Human B-cell Malignancies In Vivo. Clin Cancer Res 2017; 24:1114-1123. [PMID: 29180606 DOI: 10.1158/1078-0432.ccr-17-1193] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/20/2017] [Accepted: 11/21/2017] [Indexed: 02/05/2023]
Abstract
Purpose: mAbs such as anti-CD20 rituximab are proven therapies in B-cell malignancies, yet many patients develop resistance. Novel therapies against alternative targets are needed to circumvent resistance mechanisms. We sought to generate mAbs against human B-cell-activating factor receptor (BAFF-R/TNFRSF13C), which has not yet been targeted successfully for cancer therapy.Experimental Design: Novel mAbs were generated against BAFF-R, expressed as a natively folded cell surface immunogen on mouse fibroblast cells. Chimeric BAFF-R mAbs were developed and assessed for in vitro and in vivo monotherapy cytotoxicity. The chimeric mAbs were tested against human B-cell tumor lines, primary patient samples, and drug-resistant tumors.Results: Chimeric antibodies bound with high affinity to multiple human malignant B-cell lines and induced potent antibody-dependent cellular cytotoxicity (ADCC) against multiple subtypes of human lymphoma and leukemia, including primary tumors from patients who had relapsed after anti-CD20 therapy. Chimeric antibodies also induced ADCC against ibrutinib-resistant and rituximab-insensitive CD20-deficient variant lymphomas, respectively. Importantly, they demonstrated remarkable in vivo growth inhibition of drug-resistant tumor models in immunodeficient mice.Conclusions: Our method generated novel anti-BAFF-R antibody therapeutics with remarkable single-agent antitumor effects. We propose that these antibodies represent an effective new strategy for targeting and treating drug-resistant B-cell malignancies and warrant further development. Clin Cancer Res; 24(5); 1114-23. ©2017 AACR.
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Affiliation(s)
- Hong Qin
- Beckman Research Institute City of Hope National Medical Center, Toni Stephenson Lymphoma Center, and Department of Hematology and Hematopoietic Stem Cell Transplantation, Duarte, California.
| | - Guowei Wei
- Beckman Research Institute City of Hope National Medical Center, Toni Stephenson Lymphoma Center, and Department of Hematology and Hematopoietic Stem Cell Transplantation, Duarte, California
| | - Ippei Sakamaki
- Department of Clinical Infectious diseases, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Zhenyuan Dong
- Beckman Research Institute City of Hope National Medical Center, Toni Stephenson Lymphoma Center, and Department of Hematology and Hematopoietic Stem Cell Transplantation, Duarte, California
| | - Wesley A Cheng
- Beckman Research Institute City of Hope National Medical Center, Toni Stephenson Lymphoma Center, and Department of Hematology and Hematopoietic Stem Cell Transplantation, Duarte, California
| | - D Lynne Smith
- Beckman Research Institute City of Hope National Medical Center, Toni Stephenson Lymphoma Center, and Department of Hematology and Hematopoietic Stem Cell Transplantation, Duarte, California
| | - Feng Wen
- Beckman Research Institute City of Hope National Medical Center, Toni Stephenson Lymphoma Center, and Department of Hematology and Hematopoietic Stem Cell Transplantation, Duarte, California.,Department of Medical Oncology Cancer Center, West China Hospital, Sichuan University, Sichuan, China
| | - Han Sun
- Beckman Research Institute City of Hope National Medical Center, Toni Stephenson Lymphoma Center, and Department of Hematology and Hematopoietic Stem Cell Transplantation, Duarte, California
| | - Kunhwa Kim
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Soungchul Cha
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Laura Bover
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sattva S Neelapu
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Larry W Kwak
- Beckman Research Institute City of Hope National Medical Center, Toni Stephenson Lymphoma Center, and Department of Hematology and Hematopoietic Stem Cell Transplantation, Duarte, California.
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Kim WS, Buske C, Ogura M, Jurczak W, Sancho JM, Zhavrid E, Kim JS, Hernández-Rivas JÁ, Prokharau A, Vasilica M, Nagarkar R, Osmanov D, Kwak LW, Lee SJ, Lee SY, Bae YJ, Coiffier B. Efficacy, pharmacokinetics, and safety of the biosimilar CT-P10 compared with rituximab in patients with previously untreated advanced-stage follicular lymphoma: a randomised, double-blind, parallel-group, non-inferiority phase 3 trial. Lancet Haematol 2017; 4:e362-e373. [PMID: 28712940 DOI: 10.1016/s2352-3026(17)30120-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Studies in patients with rheumatoid arthritis have shown that the rituximab biosimilar CT-P10 (Celltrion, Incheon, South Korea) has equivalent efficacy and pharmacokinetics to rituximab. In this phase 3 study, we aimed to assess the non-inferior efficacy and pharmacokinetic equivalence of CT-P10 compared with rituximab, when used in combination with cyclophosphamide, vincristine, and prednisone (CVP) in patients with newly diagnosed advanced-stage follicular lymphoma. METHODS In this ongoing, randomised, double-blind, parallel-group, active-controlled study, patients aged 18 years or older with Ann Arbor stage III-IV follicular lymphoma were assigned 1:1 to CVP plus intravenous infusions of 375 mg/m2 CT-P10 or rituximab on day 1 of eight 21-day cycles. Randomisation was done by the investigators using an interactive web or voice response system and a computer-generated randomisation schedule, prepared by a clinical research organisation. Randomisation was balanced using permuted blocks and was stratified by country, gender, and Follicular Lymphoma International Prognostic Index score (0-2 vs 3-5). Study teams from the sponsor and clinical research organisation, investigators, and patients were masked to treatment assignment. The study was divided into two parts: part 1 assessing equivalence of pharmacokinetics (in the pharmacokinetics subset), and part 2 assessing efficacy in all randomised patients (patients from the pharmacokinetics subset plus additional patients enrolled in part 2). Equivalence of pharmacokinetics was shown if the 90% CIs for the geometric mean ratio of CT-P10 to rituximab in AUCτ and CmaxSS were within the bounds of the equivalence margin of 80% and 125%. Non-inferiority of response was shown if the one-sided 97·5% CI lay on the positive side of the -7% margin, using a one-sided test done at the 2·5% significance level. The primary efficacy endpoint was the proportion of patients who had an overall response over eight cycles and was assessed in the efficacy population (all randomised patients). The primary pharmacokinetic endpoints were area under the serum concentration-time curve at steady state (AUCτ) and maximum serum concentration at steady state (CmaxSS) at cycle 4, assessed in the pharmokinetic population. This trial is registered with ClinicalTrials.gov, number NCT02162771. FINDINGS Between July 28, 2014, and Dec 29, 2015, 140 patients were enrolled. Here we report data for the eight-cycle induction period, up to week 24. The proportion of patients with an overall response in the efficacy population was 64 (97·0%) of 66 patients in the CT-P10 treatment group and 63 (92·6%) of 68 patients in the rituximab treatment group (4·3%; one-sided 97·5% CI -4·25), which lay on the positive side of the predefined non-inferiority margin. The ratio of geometric least squares means (CT-P10/rituximab) was 102·25% (90% CI 94·05-111·17) for AUCτ and 100·67% (93·84-108·00) for CmaxSS, with all CIs within the bioequivalence margin of 80-125%. Treatment-emergent adverse events were reported for 58 (83%) of 70 patients in the CT-P10 treatment group and 56 (80%) of 70 in the rituximab treatment group. The most common grade 3 or 4 treatment-emergent adverse event in each treatment group was neutropenia (grade 3, 15 [21%] of 70 patients in the CT-P10 group and seven [10%] of 70 patients in the rituximab group). The proportion of patients who experienced at least one treatment-emergent serious adverse event was 16 (23%) of 70 patients in the CT-P10 group and nine (13%) of 70 patients in the rituximab group. INTERPRETATION In this study, we show that CT-P10 exhibits non-inferior efficacy and pharmacokinetic equivalence to rituximab. The safety profile of CT-P10 was comparable to that of rituximab. CT-P10 might represent a new therapeutic option for advanced-stage follicular lymphoma. FUNDING Celltrion, Inc.
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Affiliation(s)
- Won Seog Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Christian Buske
- Comprehensive Cancer Center Ulm, University Hospital of Ulm, Ulm, Germany
| | - Michinori Ogura
- Department of Haematology, Tokai Central Hospital, Kakamigahara, Gifu, Japan
| | - Wojciech Jurczak
- Department of Haematology, Jagiellonian University, Kraków, Poland
| | - Juan-Manuel Sancho
- Hematology Department, ICO-IJC-Hospital Germans Trias i Pujol, Badalona, Spain
| | - Edvard Zhavrid
- N N Alexandrov Republican Scientific and Practical Centre of Oncology and Medical Radiology, Minsk, Belarus
| | - Jin Seok Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | | | | | - Mariana Vasilica
- Hematology Department, Fundeni Clinical Institute, Bucharest, Romania
| | | | | | - Larry W Kwak
- Toni Stephenson Lymphoma Center and Department of Haematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
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Qin H, Wei G, Sakamaki I, Dong Z, Cheng WA, Smith DL, Wen F, Sun H, Cha SC, Neelapu SS, Kwak LW. Abstract 2655: Drug resistant B-cell tumors eliminated by novel therapeutic antibodies in vivo. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2655] [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
B-cell malignancies have been successfully targeted in the clinic by therapies such as anti-CD20 antibody rituximab or Bruton’s tyrosine kinase inhibitor ibrutinib. However, leukemias and lymphomas remain incurable due to primary or acquired resistance, ultimately leaving patients without an effective treatment option. We sought to circumvent this drug resistance by pursuing an alternative target known as B cell activating factor receptor (BAFF-R). Despite past limited success, BAFF-R remains a prime target for B-cell lymphoma and leukemia therapeutic antibody development due to its key role in B-cell proliferation and development.
We report the development of two novel monoclonal antibodies (mAbs) against human (h) BAFF-R. The mAbs were generated by immunizing mice with (h)BAFF-R-expressing mouse fibroblast cells presenting a natively folded, cell-surface immunogen. The two mAbs presented unique complementarity determining regions that specifically bound (h)BAFF-R-expressing mouse fibroblast cells but not the parental counterpart. Furthermore, the antibodies were specific to B-cell containing organs such as tonsil and spleen, by immunohistochemical staining and without detectable reactivity in heart, lung, brain, liver, and kidney tissues. To tailor the antibodies for clinical application, a human IgG1 Fc capable of eliciting an immune response was substituted, creating chimeric versions. We showed that both chimeric mAbs bound with high affinity to human B-cell lymphoma cell lines including JeKo-1 (mantle cell lymphoma; MCL), SU-DHL-6 (diffuse large B cell lymphoma; DLBCL), Raji (Burkitt lymphoma), and RL (follicular lymphoma). The chimeric antibodies also elicited antibody-dependent cell-mediated cytotoxicity (ADCC) with primary human natural killer (NK) cells in vitro against these tumor lines as well as primary lymphoma samples (n=5) from patients who progressed after rituximab exposure. Most notably, the antibodies demonstrated efficacy in two in vivo drug resistant lymphoma models we developed, a rituximab-resistant CD20 genomic knockout variant of JeKo-1 and the naturally ibrutinib-resistant Z-138. Using these lymphomas lines for xenogeneic tumor models in NOD scid gamma (NSG) mice, we found our antibodies significantly inhibited tumor growth, conferring long-term and tumor free survival on the mice.
Our in vitro and in vivo results robustly demonstrate the high specificity and significant anti-tumor effects of our anti-BAFF-R antibodies against a broad variety of B-cell malignancies, especially against cases of rituximab and ibrutinib resistance. This successful development of novel anti-BAFF-R therapeutic antibodies warrants support for further translational development for clinical use in light of current resistance cases.
Citation Format: Hong Qin, Guowei Wei, Ippei Sakamaki, Zhenyuan Dong, Wesley A. Cheng, Diane L. Smith, Feng Wen, Han Sun, Soung-chul Cha, Sattva S. Neelapu, Larry W. Kwak. Drug resistant B-cell tumors eliminated by novel therapeutic antibodies in vivo [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2655. doi:10.1158/1538-7445.AM2017-2655
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Affiliation(s)
| | | | | | | | | | | | | | | | - Soung-chul Cha
- 4University of Texas MD Anderson Cancer Center, Houston, TX
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Chao J, Synold TW, Frankel PH, Mortimer JE, Chung VM, Smith DL, Nallu R, Pillai RK, Simpson J, Horne D, Kwak LW, Malkas L. A phase I study to assess the safety, pharmacokinetics (PK), pharmacodynamics (PD), and anti-tumor activity of oral COH29, a novel ribonucleotide reductase (RNR) inhibitor in adult patients (pts) with advanced solid tumors. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps2600] [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
TPS2600 Background: Human RNR catalyzes the rate-limiting step in the formation of deoxyribonucleotide triphosphates (dNTPs) necessary for DNA repair and replication. Rapidly dividing tumor cells are especially sensitive to RNR inhibition due to elevated dNTP requirements. Overexpression of the RNR RRM2 subunit is also associated with neoplasia, metastasis, and poor prognosis. COH29 is an aromatically substituted thiazole compound that is a novel small molecule inhibitor of RNR activity, and exhibits unique mechanisms and target specificity that overcomes the weaknesses of other small molecule RNR inhibitors. Preclinically, it is more potent than hydroxyurea and gemcitabine, and is not associated with iron chelating-related toxicities such as hypoxia. Cell lines deficient in BRCA1 also exhibit greater sensitivity to COH29 than BRCA1 wildtype cell lines, implicating inhibition of DNA repair mechanisms in line with PARP inhibitors. Methods: In this Phase I, single site, dose escalation, safety study pts will receive oral COH29 twice a day for 21 days of a 28-day cycle. Eligible pts are age ≥ 18 years, ECOG ≤ 2, able to take oral medication, have adequate organ and marrow function, and diagnosed with any solid tumor refractory to standard therapies. Dose escalation will be pursued utilizing a Simon’s accelerated titration design, which allows skipping of dose levels (dose doubling) during the accelerated dose-finding phase. Primary objectives are to determine the maximum tolerated dose of COH29, toxicities per CTCAEv4, and PKs. Secondary objectives include assessment of objective response per RECIST 1.1 every 2 cycles. PD assessment includes measurement of plasma CK18 levels to determine degree of cellular apoptosis, evaluation of dNTP pool levels in peripheral blood mononuclear cells (PBMCs) to evaluate RNR inhibition, as well as measurement of PAR expression in PBMCs to assess PARP inhibition. Quantitation of tumor RRM2 expression using dual-color immunohistochemistry will be explored as a predictive biomarker of anti-tumor response to COH29. Clinical trial information: NCT02112565.
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Affiliation(s)
- Joseph Chao
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | | | | | | | | | | | | | | | | | - David Horne
- City of Hope Comprehensive Cancer Center, Duarte, CA
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Khashab T, Niaz MO, Hagemeister FB, Romaguera JE, Fanale MA, Pro B, McLaughlin P, Rodriguez MA, Neelapu SS, Fayad L, Younes A, Feng L, Berkova Z, Jain N, Sehgal L, Vega F, Kwak LW, Samaniego F. Ten-year follow-up of pentostatin combined with cyclophosphamide, and rituximab in previously untreated indolent B-cell lymphoma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e19040] [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
e19040 Background: Frontline regimens for indolent lymphoma are effective, but patients still suffer from relapse. From 2005 to 2007 we enrolled previously untreated patients on a phase II trial to investigate response rate and efficacy of pentostatin combined with cyclophosphamide and rituximab (PCR). PCR is an effective frontline therapy in chronic lymphocytic leukemia. We report the final analysis with a median follow up of nearly ten years. Methods: Patients were treated with 6 cycles of therapy with additional 3 cycles in case of not attaining a CR/CRu. All patients received Pentostatin (4 mg/m2), Cyclophosphamide (600 mg/m2), and Rituximab (375 mg/m2) on day one and every 21 days. Results: Of the 83 patients, five were considered unevaluable for response, but are included as non-responders in our intent-to-treat analysis. Diagnoses included FL (43.4%), SLL (38.5%), and MZL (18.1%). 78.3% had Ann Arbor stage IV lymphoma and 63.9% had bone marrow (BM) involvement. For all 83 patients, the overall response was 92%, and most toxicity events were hematologic, with grade ≥3 neutropenia in 68 of 509 cycles of chemotherapy administered. Long term toxicity includes secondary malignancies in 14 patients. Two patients developed treatment related MDS/AML and both occurred after additional lines of therapy. PFS at 10 years for FL, MZL, and SLL was 71%, 67% and 15%, respectively. PFS was affected by clinicopathologic characteristics. 10-year PFS rates for those with pretreatment β2M < 2.2 and > 2.2 mg/l were 71 % and 21 % respectively. Patients without BM involvement had 10-year PFS of 72% versus 29% for those with BM involvement. The median OS has not been reached. The overall survival rate was 87% at 5 years and 64% at 10 years. The difference in OS rate was statistically significant based on histology, 94% for FL, 66% for MZL, and 39 % for SLL. Conclusions: Long term follow up confirms that PCR is an effective, robust and tolerable treatment regimen for indolent B-cell lymphomas with 34 of 36 patients with FL alive at 10 years with 27 remaining in remission. Clinical Trial Information NCT00496873 Clinical trial information: NCT00496873.
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Affiliation(s)
- Tamer Khashab
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Barbara Pro
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | - Luis Fayad
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anas Younes
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Lei Feng
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zuzana Berkova
- The Univeristy of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Lalit Sehgal
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Francisco Vega
- University of Miami Miller School of Medicine, Miami, FL
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Boyiadzis M, Bishop MR, Abonour R, Anderson KC, Ansell SM, Avigan D, Barbarotta L, Barrett AJ, Van Besien K, Bergsagel PL, Borrello I, Brody J, Brufsky J, Cairo M, Chari A, Cohen A, Cortes J, Forman SJ, Friedberg JW, Fuchs EJ, Gore SD, Jagannath S, Kahl BS, Kline J, Kochenderfer JN, Kwak LW, Levy R, de Lima M, Litzow MR, Mahindra A, Miller J, Munshi NC, Orlowski RZ, Pagel JM, Porter DL, Russell SJ, Schwartz K, Shipp MA, Siegel D, Stone RM, Tallman MS, Timmerman JM, Van Rhee F, Waller EK, Welsh A, Werner M, Wiernik PH, Dhodapkar MV. The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of hematologic malignancies: multiple myeloma, lymphoma, and acute leukemia. J Immunother Cancer 2016; 4:90. [PMID: 28018601 PMCID: PMC5168808 DOI: 10.1186/s40425-016-0188-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/07/2016] [Indexed: 12/24/2022] Open
Abstract
Increasing knowledge concerning the biology of hematologic malignancies as well as the role of the immune system in the control of these diseases has led to the development and approval of immunotherapies that are resulting in impressive clinical responses. Therefore, the Society for Immunotherapy of Cancer (SITC) convened a hematologic malignancy Cancer Immunotherapy Guidelines panel consisting of physicians, nurses, patient advocates, and patients to develop consensus recommendations for the clinical application of immunotherapy for patients with multiple myeloma, lymphoma, and acute leukemia. These recommendations were developed following the previously established process based on the Institute of Medicine's clinical practice guidelines. In doing so, a systematic literature search was performed for high-impact studies from 2004 to 2014 and was supplemented with further literature as identified by the panel. The consensus panel met in December of 2014 with the goal to generate consensus recommendations for the clinical use of immunotherapy in patients with hematologic malignancies. During this meeting, consensus panel voting along with discussion were used to rate and review the strength of the supporting evidence from the literature search. These consensus recommendations focus on issues related to patient selection, toxicity management, clinical endpoints, and the sequencing or combination of therapies. Overall, immunotherapy is rapidly emerging as an effective therapeutic strategy for the management of hematologic malignances. Evidence-based consensus recommendations for its clinical application are provided and will be updated as the field evolves.
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Affiliation(s)
- Michael Boyiadzis
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh Cancer Institute, University of Pittsburgh Medical Center, 5150 Centre Avenue, Suite 564, Pittsburg, PA 15232 USA
| | - Michael R. Bishop
- Hematopoietic Cellular Therapy Program, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637 USA
| | - Rafat Abonour
- Indiana University School of Medicine, 980 W. Walnut St., Walther Hall-R3, C400, Indianapolis, IN 46202 USA
| | | | | | - David Avigan
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Lisa Barbarotta
- Smilow Cancer Hospital at Yale New Haven, 35 Park Street, New Haven, CT 06519 USA
| | - Austin John Barrett
- National Institutes of Health, Building 10-CRC Room 3-5330, Bethesda, MD 20814 USA
| | - Koen Van Besien
- Weill Cornell Medical College, 407 E 71st St, New York, NY 10065 USA
| | | | - Ivan Borrello
- Johns Hopkins School of Medicine, 1650 Orleans St, Baltimore, MD 21231 USA
| | - Joshua Brody
- Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, New York, NY 10029 USA
| | - Jill Brufsky
- University of Pittsburgh Cancer Institute, 5150 Centre Avenue, Pittsburgh, PA 15232 USA
| | - Mitchell Cairo
- New York Medical College at Maria Fareri Children’s Hospital, 100 Woods Road, Valhalla, New York 10595 USA
| | - Ajai Chari
- Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, New York, NY 10029 USA
| | - Adam Cohen
- Abramson Cancer Center at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Jorge Cortes
- MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Stephen J. Forman
- City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010 USA
| | - Jonathan W. Friedberg
- Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14642 USA
| | - Ephraim J. Fuchs
- Johns Hopkins University School of Medicine, 401 N. Broadway, Baltimore, MD 21231 USA
| | - Steven D. Gore
- Yale Cancer Center, 333 Cedar Street, New Haven, CT 06511 USA
| | - Sundar Jagannath
- Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, New York, NY 10029 USA
| | - Brad S. Kahl
- Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110 USA
| | - Justin Kline
- The University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - James N. Kochenderfer
- National Institutes of Health, National Cancer Institute, 8500 Roseweood Drive, Bethesda, MD 20814 USA
| | - Larry W. Kwak
- City of Hope National Medical Center, 1500 E. Duarte Road, Beckman Bldg., Room 4117, Duarte, CA 91010 USA
| | - Ronald Levy
- Division of Medical Oncology, Stanford University School of Medicine, 269 Campus Drive, Stanford, CA 94305 USA
| | - Marcos de Lima
- Department of Medicine-Hematology and Oncology, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106 USA
| | - Mark R. Litzow
- Department of Hematology, Mayo Clinic Cancer Center, 200 First Street SW, Rochester, MN 55905 USA
| | - Anuj Mahindra
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, Box 0324, San Francisco, CA 94143 USA
| | - Jeffrey Miller
- Division of Hematology/Oncology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455 USA
| | - Nikhil C. Munshi
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Dana B106, Boston, MA 02215 USA
| | - Robert Z. Orlowski
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 429, Houston, TX 77030 USA
| | - John M. Pagel
- Swedish Cancer Institute, 1221 Madison Street, Suite 1020, Seattle, WA 98104 USA
| | - David L. Porter
- University of Pennsylvania, 3400 Civic Center Blvd, PCAM 12 South Pavilion, Philadelphia, PA 19104 USA
| | | | - Karl Schwartz
- Patients Against Lymphoma, 3774 Buckwampum Road, Riegelsville, PA 18077 USA
| | - Margaret A. Shipp
- Dana-Farber Cancer Institute, 450 Brookline Ave, Mayer 513, Boston, MA 02215 USA
| | - David Siegel
- Hackensack University Medical Center, 92 2nd St., Hackensack, NJ 07601 USA
| | - Richard M. Stone
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215 USA
| | - Martin S. Tallman
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - John M. Timmerman
- University of California, Los Angeles, 10833 LeConte Ave., Los Angeles, CA 90095 USA
| | - Frits Van Rhee
- University of Arkansas for Medical Sciences, Myeloma Institute, 4301 W Markham #816, Little Rock, AR 72205 USA
| | - Edmund K. Waller
- Winship Cancer Institute, Emory University, 1365B Clifton Road NE, Atlanta, GA 30322 USA
| | - Ann Welsh
- University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213 USA
| | - Michael Werner
- Patient Advocate, 33 East Bellevue Place, Chicago, IL 60611 USA
| | - Peter H. Wiernik
- Cancer Research Foundation of New York, 43 Longview Lane, Chappaqua, NY 10514 USA
| | - Madhav V. Dhodapkar
- Department of Hematology & Immunobiology, Yale University, 333 Cedar Street, Box 208021, New Haven, CT 06510 USA
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Herrera AF, Mei M, Low L, Kim HT, Griffin GK, Song JY, Merryman RW, Bedell V, Pak C, Sun H, Paris T, Stiller T, Brown JR, Budde LE, Chan WC, Chen R, Davids MS, Freedman AS, Fisher DC, Jacobsen ED, Jacobson CA, LaCasce AS, Murata-Collins J, Nademanee AP, Palmer JM, Pihan GA, Pillai R, Popplewell L, Siddiqi T, Sohani AR, Zain J, Rosen ST, Kwak LW, Weinstock DM, Forman SJ, Weisenburger DD, Kim Y, Rodig SJ, Krishnan A, Armand P. Relapsed or Refractory Double-Expressor and Double-Hit Lymphomas Have Inferior Progression-Free Survival After Autologous Stem-Cell Transplantation. J Clin Oncol 2016; 35:24-31. [PMID: 28034071 DOI: 10.1200/jco.2016.68.2740] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose Double-hit lymphomas (DHLs) and double-expressor lymphomas (DELs) are subtypes of diffuse large B-cell lymphoma (DLBCL) associated with poor outcomes after standard chemoimmunotherapy. Data are limited regarding outcomes of patients with relapsed or refractory (rel/ref) DEL or DHL who undergo autologous stem-cell transplantation (ASCT). We retrospectively studied the prognostic impact of DEL and DHL status on ASCT outcomes in patients with rel/ref DLBCL. Methods Patients with chemotherapy-sensitive rel/ref DLBCL who underwent ASCT at two institutions and in whom archival tumor material was available were enrolled. Immunohistochemistry for MYC, BCL2, and BCL6 and fluorescence in situ hybridization (FISH) for MYC were performed. In cases with MYC rearrangement or copy gain, FISH for BCL2 and BCL6 was also performed. Results A total of 117 patients were included; 44% had DEL and 10% had DHL. DEL and DHL were associated with inferior progression-free survival (PFS), and DHL was associated with poorer overall survival (OS). The 4-year PFS in patients with DEL compared with those with non-DEL was 48% versus 59% ( P = .049), and the 4-year OS was 56% versus 67% ( P = .10); 4-year PFS in patients with DHL compared with those with non-DHL was 28% versus 57% ( P = .013), and 4-year OS was 25% versus 61% ( P = .002). The few patients with concurrent DEL and DHL had a poor outcome (4-year PFS, 0%). In multivariable models, DEL and DHL were independently associated with inferior PFS, whereas DHL and partial response ( v complete response) at transplant were associated with inferior OS. Conclusion DEL and DHL are both associated with inferior outcomes after ASCT in patients with rel/ref DLBCL. Although ASCT remains a potentially curative approach, these patients, particularly those with DHL, are a high-risk subset who should be targeted for investigational strategies other than standard ASCT.
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Affiliation(s)
- Alex F Herrera
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Matthew Mei
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Lawrence Low
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Haesook T Kim
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Gabriel K Griffin
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Joo Y Song
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Reid W Merryman
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Victoria Bedell
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Christine Pak
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Heather Sun
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Tanya Paris
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Tracey Stiller
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Jennifer R Brown
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Lihua E Budde
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Wing C Chan
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Robert Chen
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Matthew S Davids
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Arnold S Freedman
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - David C Fisher
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Eric D Jacobsen
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Caron A Jacobson
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Ann S LaCasce
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Joyce Murata-Collins
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Auayporn P Nademanee
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Joycelynne M Palmer
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - German A Pihan
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Raju Pillai
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Leslie Popplewell
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Tanya Siddiqi
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Aliyah R Sohani
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Jasmine Zain
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Steven T Rosen
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Larry W Kwak
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - David M Weinstock
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Stephen J Forman
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Dennis D Weisenburger
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Young Kim
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Scott J Rodig
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Amrita Krishnan
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Philippe Armand
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
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Weng J, Moriarty KE, Baio FE, Chu F, Kim SD, He J, Jie Z, Xie X, Ma W, Qian J, Zhang L, Yang J, Yi Q, Neelapu SS, Kwak LW. IL-15 enhances the antitumor effect of human antigen-specific CD8 + T cells by cellular senescence delay. Oncoimmunology 2016; 5:e1237327. [PMID: 28123872 DOI: 10.1080/2162402x.2016.1237327] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/31/2016] [Accepted: 09/10/2016] [Indexed: 01/08/2023] Open
Abstract
Optimal expansion protocols for adoptive human T-cell therapy often include interleukin (IL)-15; however, the mechanism by which IL-15 improves the in vivo antitumor effect of T cells remains to be elucidated. Using human T cells generated from HLA-A2+ donors against novel T-cell epitopes derived from the human U266 myeloma cell line Ig light chain V-region (idiotype) as a model, we found that T cells cultured with IL-15 provided superior resistance to tumor growth in vivo, compared with IL-2, after adoptive transfer into immunodeficient hosts. This effect of IL-15 was associated with delayed/reversed senescence in tumor antigen-specific memory CD8+ T cells mediated through downregulation of P21WAF1, P16INK4a, and P53 expression. Compared to IL-2, IL-15 stimulation dramatically activated JAK3-STAT5 signaling and inhibited the expression of DNA damage genes. Thus, our study elucidates a new mechanism for IL-15 in the regulation of STAT signaling pathways and CD8+ T-cell senescence.
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Affiliation(s)
- Jinsheng Weng
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Center Laboratory, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kelsey E Moriarty
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Flavio Egidio Baio
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Fuliang Chu
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Sung-Doo Kim
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Jin He
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Zuliang Jie
- Department of Immunology, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Xiaoping Xie
- Department of Immunology, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Wencai Ma
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Jianfei Qian
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Liang Zhang
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Jing Yang
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Qing Yi
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Sattva S Neelapu
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Larry W Kwak
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
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Weng J, Baio FE, Moriarty KE, Torikai H, Wang H, Liu Z, Maiti SN, Gwak D, Popescu MS, Cha SC, Cooper LJN, Neelapu SS, Kwak LW. Targeting B-cell malignancies through human B-cell receptor specific CD4 + T cells. Oncoimmunology 2016; 5:e1232220. [PMID: 27999743 DOI: 10.1080/2162402x.2016.1232220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 05/13/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022] Open
Abstract
The B-cell receptor (BCR) expressed by a clonal B cell tumor is a tumor specific antigen (idiotype). However, the T-cell epitopes within human BCRs which stimulate protective immunity still lack detailed characterization. In this study, we identified 17 BCR peptide-specific CD4+ T-cell epitopes derived from BCR heavy and light chain variable region sequences. Detailed analysis revealed these CD4+ T-cell epitopes stimulated normal donors' and patients' Th1 CD4+ T cells to directly recognize the autologous tumors by secretion of IFNγ, indicating the epitopes are processed and presented by tumor cells. One BCR peptide-specific CD4+ T cell line was also cytotoxic and lysed autologous tumor cells through the perforin pathway. Sequence analysis of the epitopes revealed that 10 were shared by multiple primary patients' tumors, and 16 had the capacity to bind to more than one HLA DRB1 allele. T cells stimulated by shared epitopes recognized primary tumors expressing the same sequences on multiple HLA DRB1 alleles. In conclusion, we identified 17 BCR-derived CD4+ T-cell epitopes with promiscuous HLA DRB1 binding affinity that are shared by up to 36% of patients, suggesting a strategy to overcome the requirement for individual preparation of therapeutic agents targeting idiotype.
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Affiliation(s)
- Jinsheng Weng
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Center Laboratory, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Flavio Egidio Baio
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Kelsey E Moriarty
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Hiroki Torikai
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Hua Wang
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Zhiqiang Liu
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Sourindra N Maiti
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Dongho Gwak
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Michael S Popescu
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Soung-Chul Cha
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Laurence J N Cooper
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Sattva S Neelapu
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Larry W Kwak
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
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Liu Z, Xu J, He J, Liu H, Lin P, Wan X, Navone NM, Tong Q, Kwak LW, Orlowski RZ, Yang J. Mature adipocytes in bone marrow protect myeloma cells against chemotherapy through autophagy activation. Oncotarget 2016; 6:34329-41. [PMID: 26455377 PMCID: PMC4741456 DOI: 10.18632/oncotarget.6020] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/05/2015] [Indexed: 12/17/2022] Open
Abstract
A major problem in patients with multiple myeloma is chemotherapy resistance, which develops in myeloma cells upon interaction with bone marrow stromal cells. However, few studies have determined the role of bone marrow adipocytes, a major component of stromal cells in the bone marrow, in myeloma chemotherapy resistance. We reveal that mature human adipocytes activate autophagy and upregulate the expression of autophagic proteins, thereby suppressing chemotherapy-induced caspase cleavage and apoptosis in myeloma cells. We found that adipocytes secreted known and novel adipokines, such as leptin and adipsin. The addition of these adipokines enhanced the expression of autophagic proteins and reduced apoptosis in myeloma cells. In vivo studies further demonstrated the importance of bone marrow-derived adipocytes in the reduced response of myeloma cells to chemotherapy. Our findings suggest that adipocytes, adipocyte-secreted adipokines, and adipocyte-activated autophagy are novel targets for combatting chemotherapy resistance and enhancing treatment efficacy in myeloma patients.
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Affiliation(s)
- Zhiqiang Liu
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, Center for Cancer Immunology Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jingda Xu
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, Center for Cancer Immunology Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jin He
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, Center for Cancer Immunology Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Huan Liu
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, Center for Cancer Immunology Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pei Lin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xinhai Wan
- Department of Genitourinary Medical Oncology-Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nora M Navone
- Department of Genitourinary Medical Oncology-Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Qiang Tong
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
| | - Larry W Kwak
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, Center for Cancer Immunology Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert Z Orlowski
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, Center for Cancer Immunology Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Yang
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, Center for Cancer Immunology Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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38
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Chihara D, Cheah CY, Westin JR, Fayad LE, Rodriguez MA, Hagemeister FB, Pro B, McLaughlin P, Younes A, Samaniego F, Goy A, Cabanillas F, Kantarjian H, Kwak LW, Wang ML, Romaguera JE. Rituximab plus hyper-CVAD alternating with MTX/Ara-C in patients with newly diagnosed mantle cell lymphoma: 15-year follow-up of a phase II study from the MD Anderson Cancer Center. Br J Haematol 2015; 172:80-8. [PMID: 26648336 DOI: 10.1111/bjh.13796] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [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: 06/27/2015] [Accepted: 08/21/2015] [Indexed: 01/10/2023]
Abstract
Intensive chemotherapy regimens containing cytarabine have substantially improved remission durability and overall survival in younger adults with mantle cell lymphoma (MCL). However, there have been no long-term follow-up results for patients treated with these regimens. We present long-term survival outcomes from a pivotal phase II trial of rituximab, hyper-fractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone alternating with methotrexate and cytarabine (R-HCVAD/MA). At 15 years of follow-up (median: 13·4 years), the median failure-free survival (FFS) and overall survival (OS) for all patients was 4·8 years and 10·7 years, respectively. The FFS seems to have plateaued after 10 years, with an estimated 15-year FFS of 30% in younger patients (≤65 years). Patients who achieved complete response (CR) after 2 cycles had a favourable median FFS of 8·8 years. Six patients developed myelodysplastic syndrome/acute myeloid leukaemia (MDS/AML) whilst in first CR. The 10-year cumulative incidence of MDS/AML of patients in first remission was 6·2% (95% confidence interval: 2·5-12·2%). In patients with newly diagnosed MCL, R-HCVAD/MA showed sustained efficacy, with a median OS exceeding 10 years in all patients and freedom from disease recurrence of nearly 15 years in almost one-third of the younger patients (≤65 years).
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Affiliation(s)
- Dai Chihara
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chan Y Cheah
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason R Westin
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luis E Fayad
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria A Rodriguez
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fredrick B Hagemeister
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Barbara Pro
- Division of Hematology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Peter McLaughlin
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anas Younes
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Felipe Samaniego
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andre Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Larry W Kwak
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael L Wang
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jorge E Romaguera
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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39
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Takahashi K, Sivina M, Hoellenriegel J, Oki Y, Hagemeister FB, Fayad L, Romaguera JE, Fowler N, Fanale MA, Kwak LW, Samaniego F, Neelapu S, Xiao L, Huang X, Kantarjian H, Keating MJ, Wierda W, Fu K, Chan WC, Vose JM, O'Brien S, Davis RE, Burger JA. CCL3 and CCL4 are biomarkers for B cell receptor pathway activation and prognostic serum markers in diffuse large B cell lymphoma. Br J Haematol 2015; 171:726-35. [PMID: 26358140 DOI: 10.1111/bjh.13659] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [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: 03/25/2015] [Accepted: 07/22/2015] [Indexed: 01/21/2023]
Abstract
B cell receptor (BCR) signalling is an important pathway in diffuse large B cell lymphoma (DLBCL). In response to BCR triggering, normal and malignant B cells secrete the chemokines CCL3 and CCL4 to attract accessory cells to the tissue microenvironment. We measured CCL3 and CCL4 serum concentrations in 102 patients with newly diagnosed DLBCL by enzyme-linked immunosorbent assay, investigated their prognostic impact and validated our findings in an independent cohort of 51 patient samples. We also tested CCL3 and CCL4 secretion by DLBCL cells, and the influence of BTK inhibitors on the secretion of these chemokines. High CCL3 (≥40 pg/ml) serum concentrations correlated with higher international prognostic index, lactate dehydrogenase and β2 microglobulin, as did CCL4 (≥180 pg/ml) with advanced Ann Arbor stages. High CCL3 levels correlated with significantly shorter progression-free and overall survival. The in vitro studies demonstrated that activated B cell-like, but not germinal centre B cell-like DLBCL cells, secrete high levels of CCL3 and CCL4 after BCR triggering, which was exquisitely sensitive to BCR pathway inhibition. These findings support CCL3 and CCL4 protein concentrations as biomarkers for BCR pathway activation and prognosis in DLBCL.
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Affiliation(s)
- Koichi Takahashi
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.,Department of Haematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mariela Sivina
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Julia Hoellenriegel
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Yasuhiro Oki
- Department of Lymphoma and Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Fredrick B Hagemeister
- Department of Lymphoma and Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Luis Fayad
- Department of Lymphoma and Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Jorge E Romaguera
- Department of Lymphoma and Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Nathan Fowler
- Department of Lymphoma and Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle A Fanale
- Department of Lymphoma and Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Larry W Kwak
- Department of Lymphoma and Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Felipe Samaniego
- Department of Lymphoma and Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Sattva Neelapu
- Department of Lymphoma and Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Xuelin Huang
- Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Michael J Keating
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - William Wierda
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Kai Fu
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Wing C Chan
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Julie M Vose
- Division of Oncology and Hematology, University of NebraskaMedical Center, Omaha, NE, USA
| | - Susan O'Brien
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Richard E Davis
- Department of Lymphoma and Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Jan A Burger
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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40
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Chihara D, Pro B, Loghavi S, Miranda RN, Medeiros LJ, Fanale MA, Hagemeister FB, Fayad LE, Romaguera JE, Samaniego F, Neelapu SS, Younes A, Fowler NH, Rodriguez MA, Wang M, Kwak LW, McLaughlin P, Dang NH, Oki Y. Phase II study of HCVIDD/MA in patients with newly diagnosed peripheral T-cell lymphoma. Br J Haematol 2015; 171:509-16. [PMID: 26260306 DOI: 10.1111/bjh.13628] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/03/2015] [Indexed: 11/29/2022]
Abstract
A phase II study was performed to evaluate the efficacy of hyper-fractionated cyclophosphamide, vincristine, pegylated liposomal doxorubicin and dexamethasone alternating with methotrexate/cytarabine (HCVIDD/MA) in patients with newly diagnosed peripheral T-cell lymphoma (PTCL), excluding ALK-positive anaplastic large cell lymphoma. Fifty-three patients were enrolled. Treatment was planned for up to 8 cycles but only 9% of patients received more than 6 cycles due primarily to disease progression (n = 13) or prolonged thrombocytopenia (n = 12). The overall response rate was 66% with a complete response rate of 57%. Median progression-free survival (PFS) was 7·5 months. With a median follow-up of 7·6 years, 5-year PFS and overall survival (OS) were 21% and 48%, respectively. The patients with extranodal Natural Killer-cell lymphoma had a shorter PFS (median, 2·4 months) than other subtypes. Grade 3/4 anaemia, neutropenia and thrombocytopenia were observed in 66%, 74% and 79% of patients, respectively. Of note, 23% of patients discontinued therapy due to prolonged thrombocytopenia. In conclusion, HCVIDD/MA for the first-line treatment of PTCL patients is associated with significant myelosuppression leading to poor treatment adherence, and the response and survival outcomes with this regimen are similar to standard CHOP. This study was registered at www.clinicaltrials.gov as #NCT00290433.
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Affiliation(s)
- Dai Chihara
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Barbara Pro
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanam Loghavi
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle A Fanale
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fredrick B Hagemeister
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luis E Fayad
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jorge E Romaguera
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Felipe Samaniego
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sattva S Neelapu
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anas Younes
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nathan H Fowler
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Alma Rodriguez
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Wang
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Larry W Kwak
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter McLaughlin
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nam H Dang
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yasuhiro Oki
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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41
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Oki Y, Fanale M, Romaguera J, Fayad L, Fowler N, Copeland A, Samaniego F, Kwak LW, Neelapu S, Wang M, Feng L, Younes A. Phase II study of an AKT inhibitor MK2206 in patients with relapsed or refractory lymphoma. Br J Haematol 2015. [PMID: 26213141 DOI: 10.1111/bjh.13603] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We conducted a phase II study of the AKT inhibitor, MK2206 in patients with relapsed or refractory lymphoma of any histology excluding Burkitt lymphoma or lymphoblastic lymphoma. MK-2206 was administered orally at 200 mg once weekly in 28-d cycles up to 12 cycles in the absence of progression or significant toxicity. The dose was adjusted based on tolerance. A total of 59 patients were enrolled. The final doses patients received were 300 mg (n = 33), 250 mg (n = 2), 200 mg (n = 16) and 135 mg (n = 8). Based on intent-to-treat analysis, objective response was observed in 8 (14%) patients (2 complete response and 6 partial response), with median response duration of 5·8 months. The overall response rate was 20% in 25 patients with classical Hodgkin lymphoma. Rash was the most common toxicity (any grade 53%, Grade 3 in 15%) and was observed in a dose-dependent manner. The correlative cytokine analysis showed paradoxical increase in several cytokines, which may be explained by negative feedback mechanism induced by the on-target effect of AKT inhibitor. Our data demonstrate that MK2206 has a favourable safety profile with a modest activity in patients with relapsed Hodgkin lymphoma. The future studies should explore mechanism-based combinations (clinicaltrials.gov NCT01258998).
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Affiliation(s)
- Yasuhiro Oki
- Department of Lymphoma/Myeloma, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Michelle Fanale
- Department of Lymphoma/Myeloma, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jorge Romaguera
- Department of Lymphoma/Myeloma, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Luis Fayad
- Department of Lymphoma/Myeloma, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Nathan Fowler
- Department of Lymphoma/Myeloma, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Amanda Copeland
- Department of Lymphoma/Myeloma, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Felipe Samaniego
- Department of Lymphoma/Myeloma, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Larry W Kwak
- Department of Lymphoma/Myeloma, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Sattva Neelapu
- Department of Lymphoma/Myeloma, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Michael Wang
- Department of Lymphoma/Myeloma, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Lei Feng
- Department of Biostatistics, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Anas Younes
- Department of Lymphoma/Myeloma, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
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42
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Chihara D, Pro B, Loghavi S, Miranda RN, Medeiros LJ, Fanale MA, Hagemeister FB, Fayad L, Romaguera JE, Samaniego F, Neelapu SS, Younes A, Fowler NH, Rodriguez MA, Wang M, Kwak LW, McLaughlin P, Dang NH, Oki Y. Phase II study of Hyper-CVAD with pegylated liposomal doxorubicin alternating with methotrexate and cytarabine (HCVIDD/MA) in patients with newly diagnosed T- and NK-cell lymphoma (T/NKCL). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8538] [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)
- Dai Chihara
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Barbara Pro
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - Sanam Loghavi
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Luis Fayad
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Sattva Swarup Neelapu
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anas Younes
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Michael Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Larry W. Kwak
- The University of Texas MD Anderson Cancer Center Chairman, Houston, TX
| | | | | | - Yasuhiro Oki
- The University of Texas MD Anderson Cancer Center, Houston, TX
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43
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Zhang M, He J, Liu Z, Lu Y, Zheng Y, Li H, Xu J, Liu H, Qian J, Orlowski RZ, Kwak LW, Yi Q, Yang J. Anti-β₂-microglobulin monoclonal antibodies overcome bortezomib resistance in multiple myeloma by inhibiting autophagy. Oncotarget 2015; 6:8567-78. [PMID: 25895124 PMCID: PMC4496167 DOI: 10.18632/oncotarget.3251] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/29/2015] [Indexed: 01/19/2023] Open
Abstract
Our previous studies showed that anti-β2M monoclonal antibodies (mAbs) have strong and direct apoptotic effects on multiple myeloma (MM) cells, suggesting that anti-β2M mAbs might be developed as a novel therapeutic agent. In this study, we investigated the anti-MM effects of combination treatment with anti-β2M mAbs and bortezomib (BTZ). Our results showed that anti-β2M mAbs enhanced BTZ-induced apoptosis of MM cell lines and primary MM cells. Combination treatment could also induce apoptosis of BTZ-resistant MM cells, and the enhanced effect depended on the surface expression of β2M on MM cells. BTZ up-regulated the expression of autophagy proteins, whereas combination with anti-β2M mAbs inhibited autophagy. Sequence analysis of the promoter region of beclin 1 identified 3 putative NF-κB-binding sites from -615 to -789 bp. BTZ treatment increased, whereas combination with anti-β2M mAbs reduced, NF-κB transcription activities in MM cells, and combination treatment inhibited NF-κB p65 binding to the beclin 1 promoter. Furthermore, anti-β2M mAbs and BTZ combination treatment had anti-MM activities in an established MM mouse model. Thus, our studies provide new insight and support for the clinical development of an anti-β2M mAb and BTZ combination treatment to overcome BTZ drug resistance and improve MM patient survival.
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MESH Headings
- Active Transport, Cell Nucleus/drug effects
- Animals
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/pharmacology
- Apoptosis/drug effects
- Apoptosis Regulatory Proteins/biosynthesis
- Apoptosis Regulatory Proteins/genetics
- Autophagy/drug effects
- Beclin-1
- Bortezomib/pharmacology
- Drug Resistance, Neoplasm/drug effects
- Drug Resistance, Neoplasm/physiology
- Drug Screening Assays, Antitumor
- Drug Synergism
- Humans
- Lysosomal Membrane Proteins/biosynthesis
- Lysosomal Membrane Proteins/genetics
- Male
- Membrane Proteins/biosynthesis
- Membrane Proteins/genetics
- Mice
- Mice, SCID
- Microtubule-Associated Proteins/biosynthesis
- Microtubule-Associated Proteins/genetics
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasm Proteins/biosynthesis
- Neoplasm Proteins/genetics
- Neoplasm Proteins/immunology
- RNA, Bacterial
- RNA, Small Interfering/genetics
- Signal Transduction/drug effects
- Transcription Factor RelA/antagonists & inhibitors
- Tumor Cells, Cultured
- Xenograft Model Antitumor Assays
- beta 2-Microglobulin/antagonists & inhibitors
- beta 2-Microglobulin/biosynthesis
- beta 2-Microglobulin/genetics
- beta 2-Microglobulin/immunology
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Affiliation(s)
- Mingjun Zhang
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jin He
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhiqiang Liu
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yong Lu
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yuhuan Zheng
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Haiyan Li
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jingda Xu
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Huan Liu
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jianfei Qian
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert Z. Orlowski
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Larry W. Kwak
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Qing Yi
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jing Yang
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Cancer Research Institute and Cancer Hospital, Guangzhou Medical University, Guangzhou, China
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44
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Qin H, Wei G, Gwak D, Dong Z, Xiong A, Kwak LW. Targeting tumor-associated myeloid cells for cancer immunotherapy. Oncoimmunology 2015; 4:e983961. [PMID: 25949898 DOI: 10.4161/2162402x.2014.983761] [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: 10/07/2014] [Accepted: 10/31/2014] [Indexed: 01/04/2023] Open
Abstract
Tumor-associated myeloid cells undermine the therapeutic efficacy of cancer immunotherapy by their inhibitory properties on immune effector cells. Development of therapeutic agents to deplete suppressive myeloid cells in tumor microenvironment requires identification of cell-specific targets. A competitive phage display technique on live cells paves the way to discovery of such a target.
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Affiliation(s)
- Hong Qin
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center ; Houston, TX, USA ; Center for Cancer Immunology Research; The University of Texas MD Anderson Cancer Center ; Houston, TX, USA
| | - Guowei Wei
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center ; Houston, TX, USA ; Center for Cancer Immunology Research; The University of Texas MD Anderson Cancer Center ; Houston, TX, USA
| | - Dongho Gwak
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center ; Houston, TX, USA ; Center for Cancer Immunology Research; The University of Texas MD Anderson Cancer Center ; Houston, TX, USA
| | - Zhenyuan Dong
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center ; Houston, TX, USA ; Center for Cancer Immunology Research; The University of Texas MD Anderson Cancer Center ; Houston, TX, USA
| | - Ailian Xiong
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center ; Houston, TX, USA ; Center for Cancer Immunology Research; The University of Texas MD Anderson Cancer Center ; Houston, TX, USA
| | - Larry W Kwak
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center ; Houston, TX, USA ; Center for Cancer Immunology Research; The University of Texas MD Anderson Cancer Center ; Houston, TX, USA
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45
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Samaniego F, Hagemeister F, Romaguera JE, Fanale MA, Pro B, McLaughlin P, Rodriguez MA, Neelapu SS, Fayad L, Younes A, Feng L, Berkova Z, Khashab T, Sehgal L, Vega-Vasquez F, Kwak LW. Pentostatin, cyclophosphamide and rituximab for previously untreated advanced stage, low-grade B-cell lymphomas. Br J Haematol 2015; 169:814-23. [PMID: 25828695 DOI: 10.1111/bjh.13367] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/20/2015] [Indexed: 11/26/2022]
Abstract
We conducted a prospective phase II trial of pentostatin, cyclophosphamide and rituximab as initial therapy for patients with previously untreated advanced stage low-grade or indolent B-cell lymphomas (iNHLs). Of 83 evaluable patients, 91·6% attained an overall response and 86·8% a complete or unconfirmed complete response. The 3-year progression-free survival (PFS) and overall survival rates were 73% and 93%, respectively. The 3-year PFS rate was significantly different for different diagnoses (P = 0·01): 83% [95% confidence interval (CI): 0·72, 0·96] for follicular lymphomas, 73% (95% CI: 0·54, 1·0) for marginal zone lymphomas and 61% (95% CI: 0·46, 0·81) for small lymphocytic lymphomas. The most common adverse events were haematological. Of 509 cycles of chemotherapy administered, grade 3 or 4 neutropenia was reported in 68 cycles (13% of cycles administered) and most frequently occurred during cycles 4-6. This is the first report demonstrating the effectiveness of pentostatin, cyclophosphamide and rituximab in patients with previously untreated iNHLs, including those over 60 years of age.
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Affiliation(s)
- Felipe Samaniego
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fredrick Hagemeister
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jorge E Romaguera
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle A Fanale
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Barbara Pro
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter McLaughlin
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Alma Rodriguez
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sattva S Neelapu
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luis Fayad
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anas Younes
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lei Feng
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zuzana Berkova
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tamer Khashab
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lalit Sehgal
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Francisco Vega-Vasquez
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Larry W Kwak
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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46
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Oki Y, Neelapu SS, Fanale M, Kwak LW, Fayad L, Rodriguez MA, Wallace M, Klinger M, Carlton V, Kong K, Faham M, Younes A. Detection of classical Hodgkin lymphoma specific sequence in peripheral blood using a next-generation sequencing approach. Br J Haematol 2015; 169:689-93. [PMID: 25818067 DOI: 10.1111/bjh.13349] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/20/2015] [Indexed: 11/29/2022]
Abstract
We applied a highly sensitive next-generation sequencing method to identify lymphoma-specific immunoglobulin gene segments in classical Hodgkin lymphoma (CHL) at initial diagnosis or recurrence, and assessed the ability of detecting such lymphoma-specific sequences in peripheral blood (PB). Seventeen CHL cases were tested and lymphoma-specific sequences were identified in 12 of the primary tumour biopsies. In 11 of these patients whose paired PB samples were available, tumour-specific clonotypes were detected in PB in eight patients. This data demonstrates the feasibility of detecting circulating tumour-specific sequences, creating an unprecedented opportunity to optimize the future treatment and monitoring strategies for patients with CHL.
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Affiliation(s)
- Yasuhiro Oki
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Sattva S Neelapu
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Michelle Fanale
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Larry W Kwak
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Luis Fayad
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Maria A Rodriguez
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Michael Wallace
- Department of Interventional Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Malek Faham
- Sequenta, Inc., South San Francisco, CA, USA
| | - Anas Younes
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Baio FE, Kwak LW, Weng J. Towards an off-the-shelf vaccine therapy targeting shared B-cell tumor idiotypes. Am J Blood Res 2014; 4:46-52. [PMID: 25755905 PMCID: PMC4348793] [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] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 11/06/2014] [Indexed: 06/04/2023]
Abstract
The ideal tumor antigen is one expressed selectively by the tumor, present in all cancer patients, essential for tumor survival and nonetheless able to induce both humoral and cellular immune response. The personalized idiotype (Id) of the surface immunoglobulin is a tumor specific antigen in that it is expressed on clonal B-cell tumors, mediates B-cell survival, and induces tumor specific immunity in both human and animal models. With the availability of monoclonal antibodies against B cells, such as rituximab, the cellular immune response mediated by specific T cells has gained more importance as a combination therapy for the complete elimination of residual tumor cells in lymphoma and myeloma.
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Affiliation(s)
- Flavio E Baio
- Department of Lymphoma and Myeloma, M.D. Anderson Cancer CenterHouston, TX, USA
- Center for Cancer Immunology Research, M.D. Anderson Cancer CenterHouston, TX, USA
| | - Larry W Kwak
- Department of Lymphoma and Myeloma, M.D. Anderson Cancer CenterHouston, TX, USA
- Center for Cancer Immunology Research, M.D. Anderson Cancer CenterHouston, TX, USA
| | - Jinsheng Weng
- Department of Lymphoma and Myeloma, M.D. Anderson Cancer CenterHouston, TX, USA
- Center for Cancer Immunology Research, M.D. Anderson Cancer CenterHouston, TX, USA
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Fowler NH, Davis RE, Rawal S, Nastoupil L, Hagemeister FB, McLaughlin P, Kwak LW, Romaguera JE, Fanale MA, Fayad LE, Westin JR, Shah J, Orlowski RZ, Wang M, Turturro F, Oki Y, Claret LC, Feng L, Baladandayuthapani V, Muzzafar T, Tsai KY, Samaniego F, Neelapu SS. Safety and activity of lenalidomide and rituximab in untreated indolent lymphoma: an open-label, phase 2 trial. Lancet Oncol 2014; 15:1311-8. [PMID: 25439689 DOI: 10.1016/s1470-2045(14)70455-3] [Citation(s) in RCA: 200] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Standard treatments for indolent non-Hodgkin lymphomas are often toxic, and most patients ultimately relapse. Lenalidomide, an immunomodulatory agent, is effective as monotherapy for relapsed indolent non-Hodgkin lymphoma. We assessed the efficacy and safety of lenalidomide plus rituximab in patients with untreated, advanced stage indolent non-Hodgkin lymphoma. METHODS In this phase 2 trial, undertaken at one instution, patients with follicular lymphoma and marginal zone lymphoma were given lenalidomide, orally, at 20 mg/day on days 1-21 of each 28-day cycle. For patients with small lymphocytic lymphoma, dosing began at 10 mg/day to avoid tumour flare, with an escalation of 5 mg/month to 20 mg/day. Rituximab was given at 375 mg/m(2) as an intravenous infusion on day 1 of each cycle. Patients responding after six cycles could continue therapy for up to 12 cycles. The primary endpoint was overall response, defined as the proportion of patients who achieved a partial or complete response; patients were assessed for response if they had any post-baseline tumour assessment. This trial is registered with ClinicalTrials.gov, number NCT00695786. FINDINGS 110 patients with follicular lymphoma (n=50), marginal zone lymphoma (n=30), and small lymphocytic lymphoma (n=30) were enrolled from June 30, 2008, until Aug 12, 2011. 93 of 103 evaluable patients had an overall response (90%, 95% CI 83-95). Complete responses occurred in 65 (63%, 95% CI 53-72) and partial responses in 28 patients (27%, 19-37). Of 46 evaluable patients with follicular lymphoma, 40 (87%) patients had a complete response and five (11%) had a partial response. Of 27 evaluable patients with marginal zone lymphoma, 18 (67%) had a complete response and six (22%) had a partial response. Of 30 evaluable patients with small lymphocytic lymphoma, seven (23%) had a complete response and 17 (57%) had a partial response. The most common grade 3 or 4 adverse events were neutropenia (38 [35%] of 110 patients), muscle pain (ten [9%]), rash (eight [7%]), cough, dyspnoea, or other pulmonary symptoms (five [5%]), fatigue (five [5%]), thrombosis (five [5%]), and thrombocytopenia (four [4%]). INTERPRETATION Lenalidomide plus rituximab is well tolerated and highly active as initial treatment for indolent non-Hodgkin lymphoma. An international phase 3 study (NCT01476787) to compare this regimen with chemotherapy in patients with untreated follicular lymphoma is in progress. FUNDING Celgene Corporation and Richard Spencer Lewis Memorial Foundation and Cancer Center Support Grant.
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Affiliation(s)
- Nathan H Fowler
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - R Eric Davis
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Seema Rawal
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Loretta Nastoupil
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fredrick B Hagemeister
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter McLaughlin
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Larry W Kwak
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Center for Cancer Immunology Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jorge E Romaguera
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle A Fanale
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luis E Fayad
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason R Westin
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jatin Shah
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert Z Orlowski
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Wang
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Francesco Turturro
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yasuhiro Oki
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Linda C Claret
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lei Feng
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Tariq Muzzafar
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kenneth Y Tsai
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Felipe Samaniego
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sattva S Neelapu
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Center for Cancer Immunology Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Qin H, Cha S, Rao SS, Kim K, Gwak D, Kim SD, Parshottam SR, Thomas SK, Kwak LW. Abstract 2891: Bench-to-bedside development of a novel idiotype vaccine against lymphoma. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-2891] [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
Available therapies for lymphoplasmacytic lymphoma (LPL) provide no survival advantage if started before symptoms of end organ damage develop. Current recommendations are to follow a program of observation while patients are in the asymptomatic phase of disease. In this clinical study we will use idiotypic determinants of B-cell lymphoma surface immunoglobulins as tumor-specific antigens (idiotype) to develop a patient-specific vaccine against LPL. By activating the host immune system through vaccination to eradicate tumor cells, we postulate that disease control of asymptomatic phase lymphoplasmacytic lymphoma can be maintained. This novel 2nd generation idiotype vaccine was initially developed by genetic fusion of idiotype antigen in single-chain format with a pro-inflammatory chemokine. The central hypothesis is that antitumor immunity can be triggered by targeting antigen delivery to antigen-presenting cells in vivo by chemokine receptor-mediated binding, uptake and processing of idiotype antigens for more efficient presentation to T cells. A large body of preclinical data demonstrated that the immunogenecity of the idiotype antigen was considerably enhanced by such a genetic modification by a mechanism of facilitating antigen presentation. As a consequence, vaccine-induced prophylactic and therapeutic antitumor effects were significantly potentiated. To translate our vaccine therapy from bench to bedside, we established a CLP laboratory for vaccine preparation. Furthermore, we developed reliable technology to differentiate lymphoma idiotype antigens from idiotypic cell-surface immunoglobulins on normal B cells. Using this technology, we successfully cloned the cDNA encoding variable regions of heavy and light chains of LPL idiotype, and generated patient-specific plasmid constructs containing LPL idiotype single chain in fusion with macrophage inflammatory protein 3 alpha (MIP3a). All three engineering rounds of down-stream GMP amplification of clinical-grade plasmid DNA have been accomplished, which eventually paves the way for us to take a lab-grown agent to a first-in-human clinical trial.
Citation Format: Hong Qin, Soungchul Cha, Sheetal S. Rao, Kunhwa Kim, Dongho Gwak, Sung-doo Kim, Sapna R. Parshottam, Sheeba K. Thomas, Larry W. Kwak. Bench-to-bedside development of a novel idiotype vaccine against lymphoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2891. doi:10.1158/1538-7445.AM2014-2891
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Affiliation(s)
- Hong Qin
- UT MD Anderson Cancer Center, Houston, TX
| | | | | | - Kunhwa Kim
- UT MD Anderson Cancer Center, Houston, TX
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Samaniego F, Berkova Z, Romaguera JE, Fowler N, Fanale MA, Pro B, Shah JJ, McLaughlin P, Sehgal L, Selvaraj V, Braun FK, Mathur R, Feng L, Neelapu SS, Kwak LW. 90Y-ibritumomab tiuxetan radiotherapy as first-line therapy for early stage low-grade B-cell lymphomas, including bulky disease. Br J Haematol 2014; 167:207-13. [PMID: 25040450 DOI: 10.1111/bjh.13021] [Citation(s) in RCA: 23] [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: 05/14/2014] [Accepted: 06/05/2014] [Indexed: 02/03/2023]
Abstract
(90) Y-ibritumomab-tiuxetan ((90) YIT) was used as a first-line therapy for patients with early-stage follicular lymphoma (FL) or marginal zone B-cell lymphoma (MZL). Thirty-one patients were treated, with an overall 3-month response rate of 100% (68% complete response, 29% unconfirmed complete response and 3% partial response). At a median follow-up of 56 months, ten patients (32%) had disease relapse or progression. The progression-free rates at 3 and 5 years were lower in males, patients with FL, stage II disease and non-bulky disease, although they did not reach statistical significance. Grade 3-4 neutropenia, thrombocytopenia and anaemia were 61%, 35%, and 3%, respectively. (90) YIT was well tolerated, including in those patients over 60 years old, and achieved high response rates in patients with early-stage low-grade B-cell lymphomas. Bulky disease did not adversely affect tumour response.
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Affiliation(s)
- Felipe Samaniego
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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