1
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Zelenetz AD, Gordon LI, Abramson JS, Advani RH, Andreadis B, Bartlett NL, Budde LE, Caimi PF, Chang JE, Christian B, DeVos S, Dholaria B, Fayad LE, Habermann TM, Hamid MS, Hernandez-Ilizaliturri F, Hu B, Kaminski MS, Karimi Y, Kelsey CR, King R, Krivacic S, LaCasce AS, Lim M, Messmer M, Narkhede M, Rabinovitch R, Ramakrishnan P, Reid E, Roberts KB, Saeed H, Smith SD, Svoboda J, Swinnen LJ, Tuscano J, Vose JM, Dwyer MA, Sundar H. NCCN Guidelines® Insights: B-Cell Lymphomas, Version 6.2023. J Natl Compr Canc Netw 2023; 21:1118-1131. [PMID: 37935098 DOI: 10.6004/jnccn.2023.0057] [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] [Indexed: 11/09/2023]
Abstract
Novel targeted therapies (small molecule inhibitors, antibody-drug conjugates, and CD19-directed therapies) have changed the treatment landscape of relapsed/refractory B-cell lymphomas. Bruton's tyrosine kinase (BTK) inhibitors continue to evolve in the management of mantle cell lymphoma (MCL), in both the relapsed/refractory and the frontline setting. Anti-CD19 CAR T-cell therapies are now effective and approved treatment options for relapsed/refractory follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), and MCL. Bispecific T-cell engagers represent a novel immunotherapeutic approach for relapsed FL and DLBCL after multiple lines of therapies, including prior CAR T-cell therapy. These NCCN Guideline Insights highlight the significant updates to the NCCN Guidelines for B-Cell Lymphomas for the treatment of FL, DLBCL, and MCL.
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Affiliation(s)
| | - Leo I Gordon
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Nancy L Bartlett
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | - Paolo F Caimi
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Beth Christian
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Sven DeVos
- UCLA Jonsson Comprehensive Cancer Center
| | | | - Luis E Fayad
- The University of Texas MD Anderson Cancer Center
| | | | - Muhammad Saad Hamid
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Boyu Hu
- Huntsman Cancer Institute at the University of Utah
| | | | | | | | | | | | | | - Megan Lim
- Memorial Sloan Kettering Cancer Center
| | | | | | | | | | | | | | | | | | - Jakub Svoboda
- Abramson Cancer Center at the University of Pennsylvania
| | - Lode J Swinnen
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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2
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Burack WR, Li H, Adlowitz D, Spence JM, Rimsza LM, Shadman M, Spier CM, Kaminski MS, Leonard JP, Leblanc ML, Smith SM, Friedberg JW. Subclonal TP53 mutations are frequent and predict resistance to radioimmunotherapy in follicular lymphoma. Blood Adv 2023; 7:5082-5090. [PMID: 37379264 PMCID: PMC10471938 DOI: 10.1182/bloodadvances.2022009467] [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: 12/02/2022] [Revised: 05/12/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Abstract
Although TP53 is commonly mutated in transformed follicular lymphoma, mutations are reported in <5% of pretreatment follicular lymphoma (FL) specimens. We assayed archival follicular B-cell non-Hodgkin lymphoma specimens from a completed clinical trial, Southwest Oncology Group S0016, a phase 3 randomized intergroup trial of CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone) chemotherapy plus R-CHOP (rituximab-CHOP) compared with CHOP chemotherapy plus 131-iodine tositumomab (radioimmunotherapy [RIT]-CHOP). Subclonal TP53 mutations (median allele frequency 0.02) were found in 25% of diagnostic FL specimens and in 27% of a separate validation cohort. In the R-CHOP arm, pathogenic TP53 mutations were not associated with progression-free survival (PFS) (10-year PFS 43% vs 44%). In contrast, among patients with no detectable pathogenic TP53 mutation, RIT-CHOP was associated with a longer PFS than with R-CHOP (10-year PFS 67% vs 44%; hazard ratio = 0.49; P = .008). No relationship was detected between PFS and the extent of activation-induced cytidine deaminase (AICDA)-mediated heterogeneity. In summary, subclonal TP53 mutations are common in FL and are a distinct phenomenon from AICDA-mediated genetic heterogeneity. The absence of a detectable subclonal mutation in TP53 defined a population that particularly benefited from RIT.
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Affiliation(s)
- W. Richard Burack
- Department of Pathology, University of Rochester Medical Center, Rochester, NY
| | - Hongli Li
- Clinical Research Division, Fred Hutchison Cancer Research Center, Seattle, WA
| | - Diana Adlowitz
- Department of Pathology, University of Rochester Medical Center, Rochester, NY
| | - Janice M. Spence
- Department of Pathology, University of Rochester Medical Center, Rochester, NY
| | - Lisa M. Rimsza
- Department of Laboratory Medicine and Pathology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Mazyar Shadman
- Clinical Research Division, Fred Hutchison Cancer Research Center, Seattle, WA
| | | | - Mark S. Kaminski
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - John P. Leonard
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Michael L. Leblanc
- Clinical Research Division, Fred Hutchison Cancer Research Center, Seattle, WA
| | - Sonali M. Smith
- Department of Medicine, University of Chicago School of Medicine, Chicago, IL
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3
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Phillips TJ, Bond D, Takiar R, Kump K, Kandarpa M, Boonstra P, Mayer TL, Nachar V, Wilcox RA, Carty SA, Karimi YH, Nikolovska-Coleska Z, Kaminski MS, Herrera AF, Maddocks K, Popplewell L, Danilov AV. Adding venetoclax to lenalidomide and rituximab is safe and effective in patients with untreated mantle cell lymphoma. Blood Adv 2023; 7:4518-4527. [PMID: 37013954 PMCID: PMC10425679 DOI: 10.1182/bloodadvances.2023009992] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
Mantle cell lymphoma (MCL) is a rare, incurable hematological malignancy with a heterogeneous presentation and clinical course. A wide variety of chemotherapy-based regimens are currently used in patients who are untreated. Over the last several years, several targeted or small-molecule therapies have shown efficacy in the relapsed/refractory setting and have since been explored in the frontline setting. Lenalidomide plus rituximab was explored in a phase 2 study of 38 patients with MCL who were untreated and ineligible to receive transplantation, in which the combination produced durable remissions. We looked to build upon this regimen by adding venetoclax to the combination. We conducted a multicenter, open-label, nonrandomized, single-arm study to evaluate this combination. We enrolled 28 unselected patients with untreated disease irrespective of age, fitness, or risk factors. Lenalidomide was dosed at 20 mg daily from days 1 to 21 of each 28-day cycle. The dose of venetoclax was determined using the time-to-event continual reassessment method. Rituximab was dosed at 375 mg/m2 weekly, starting on cycle 1, day 1 until cycle 2, day 1. No dose-limiting toxicities were noted. All patients were treated with venetoclax at the maximum tolerated dose of 400 mg daily. The most common adverse events were neutropenia and thrombocytopenia. The overall and complete response rates were 96% and 86%, respectively. In total, 86% of patients achieved minimal residual disease undetectability via next-generation sequencing. The median overall and progression-free survivals were not reached. The combination of lenalidomide, rituximab, and venetoclax is a safe and effective regimen in patients with untreated MCL. This trial was registered at www.clinicaltrials.gov as #NCT03523975.
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Affiliation(s)
- Tycel J Phillips
- Department of Hematology and Bone Marrow Transplantation, City of Hope National Medical Center, Duarte, CA
| | - David Bond
- Division of Hematology, Department of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Radihka Takiar
- Division of Hematology-Oncology, The University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Karson Kump
- Division of Hematology-Oncology, The University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Malalthi Kandarpa
- Division of Hematology-Oncology, The University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Philip Boonstra
- Division of Hematology-Oncology, The University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Tera Lynn Mayer
- Division of Hematology-Oncology, The University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Victoria Nachar
- Division of Hematology-Oncology, The University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Ryan A Wilcox
- Division of Hematology-Oncology, The University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Shannon A Carty
- Division of Hematology-Oncology, The University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Yasmin H Karimi
- Division of Hematology-Oncology, The University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | - Mark S Kaminski
- Division of Hematology-Oncology, The University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Alex F Herrera
- Department of Hematology and Bone Marrow Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Kami Maddocks
- Division of Hematology, Department of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Leslie Popplewell
- Department of Hematology and Bone Marrow Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Alexey V Danilov
- Department of Hematology and Bone Marrow Transplantation, City of Hope National Medical Center, Duarte, CA
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4
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Burton CS, Frey K, Fahey F, Kaminski MS, Brown RKJ, Pohlen JM, Shulkin BL. Fetal Dose from PET and CT in Pregnant Patients. J Nucl Med 2023; 64:312-319. [PMID: 36215573 DOI: 10.2967/jnumed.122.263959] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 02/04/2023] Open
Abstract
When pregnancy is discovered during or after a diagnostic examination, the physician or the patient may request an estimate of the radiation dose received by the fetus as per guidelines and standard operating procedures. This study provided the imaging community with dose estimates to the fetus from PET/CT with protocols that are adapted to University of Michigan low-dose protocols for patients known to be pregnant. Methods: There were 9 patients analyzed with data for the first, second, and third trimesters, the availability of which is quite rare. These images were used to calculate the size-specific dose estimate (SSDE) from the CT scan portion and the SUV and 18F-FDG uptake dose from the PET scan portion using the MIRD formulation. The fetal dose estimates were tested for correlation with each of the following independent measures: gestational age, fetal volume, average water-equivalent diameter of the patient along the length of the fetus, SSDE, SUV, and percentage of dose from 18F-FDG. Stepwise multiple linear regression analysis was performed to assess the partial correlation of each variable. To our knowledge, this was the first study to determine fetal doses from CT and PET images. Results: Fetal self-doses from 18F for the first, second, and third trimesters were 2.18 mGy (single data point), 0.74-1.82 mGy, and 0.017-0.0017 mGy, respectively. The combined SSDE and fetal self-dose ranged from 1.2 to 8.2 mGy. These types of images from pregnant patients are rare. Conclusion: Our data indicate that the fetal radiation exposure from 18F-FDG PET and CT performed, when medically necessary, on pregnant women with cancer is low. All efforts should be made to minimize fetal radiation exposure by modifying the protocol.
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Affiliation(s)
| | - Kirk Frey
- Michigan Medicine, Ann Arbor, Michigan
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5
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Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Armand P, Bello CM, Benitez CM, Chen W, Dabaja B, Daly ME, Gordon LI, Hansen N, Herrera AF, Hochberg EP, Johnston PB, Kaminski MS, Kelsey CR, Kenkre VP, Khan N, Lynch RC, Maddocks K, McConathy J, Metzger M, Morgan D, Mulroney C, Pullarkat ST, Rabinovitch R, Rosenspire KC, Seropian S, Tao R, Torka P, Winter JN, Yahalom J, Yang JC, Burns JL, Campbell M, Sundar H. NCCN Guidelines® Insights: Hodgkin Lymphoma, Version 2.2022. J Natl Compr Canc Netw 2022; 20:322-334. [PMID: 35390768 DOI: 10.6004/jnccn.2022.0021] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hodgkin lymphoma (HL) is an uncommon malignancy of B-cell origin. Classical HL (cHL) and nodular lymphocyte-predominant HL are the 2 main types of HL. The cure rates for HL have increased so markedly with the advent of modern treatment options that overriding treatment considerations often relate to long-term toxicity. These NCCN Guidelines Insights discuss the recent updates to the NCCN Guidelines for HL focusing on (1) radiation therapy dose constraints in the management of patients with HL, and (2) the management of advanced-stage and relapsed or refractory cHL.
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Affiliation(s)
| | | | - Weiyun Z Ai
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | - Weina Chen
- UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | - Leo I Gordon
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | | | | | | | - Ryan C Lynch
- Fred Hutchinson Cancer Research Center/University of Washington
| | - Kami Maddocks
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Monika Metzger
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | | | - Randa Tao
- Huntsman Cancer Institute at the University of Utah
| | | | - Jane N Winter
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Joanna C Yang
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; and
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6
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Runge JS, Brown AB, Phillips TJ, Kaminski MS, Carty SA, Wilcox RA. The physical exam's role in determining dose-limiting toxicity prior to immunochemotherapy administration in lymphoma. J Oncol Pharm Pract 2022; 29:601-602. [PMID: 35105218 DOI: 10.1177/10781552221075224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has introduced new challenges to healthcare access and delivery. It is critical to identify areas for innovation within oncologic clinical practice to maintain high quality care. We evaluated the potential utility of telemedicine initiatives for patients with lymphoma undergoing immunochemotherapy. We conducted a retrospective review of adult lymphoma patients receiving R-CHOP + /- R, R-ICE, R-GEMOX, and R-DHAP at our institution in the last three years (2017-2019) and identified cycles for which dose modifications were required. METHODS We reviewed 1290 total treatment cycles in 301 unique patients, 1102 cycles (85.4%) were R-CHOP + /- R, 105 (8.1%) were R-ICE, 71 (5.5%) were R-GEMOX, and 12 (0.9%) were R-DHAP. We identified that 144 cycles (11.2%) were subject to dosing adjustments. We retrospectively reviewed laboratory results, patient history, and/or physical exam findings that informed dose modifications. RESULTS Of the 144 dose adjustments, 11% of cycles contained dose increases due to a well-tolerated previous dose noted in the clinical assessment. The remaining 128 modified cycles were dose reductions. Notably, only 7/128 dose reductions were based on physical exam findings alone, due solely to a change in patient body weight. As patients are routinely weighed immediately prior to chemotherapy administration, effectively no dose modifications (0/144) were exclusively based on abnormal physical exam finding during a pre-infusion assessment. CONCLUSION These findings suggest that pre-infusion assessments may be amenable to virtual visits for lymphoma patients undergoing immunochemotherapy.
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Affiliation(s)
- John S Runge
- 12266University of Michigan Medical School, Michigan Medicine, Ann Arbor, Michigan
| | - Anna B Brown
- Department of Pharmacy, 21614Michigan Medicine, Ann Arbor, Michigan.,Rogel Cancer Center, 21614Michigan Medicine, Ann Arbor, Michigan
| | - Tycel J Phillips
- Rogel Cancer Center, 21614Michigan Medicine, Ann Arbor, Michigan.,Department of Internal Medicine - Hematology/Oncology, Michigan Medicine, Ann Arbor, Michigan
| | - Mark S Kaminski
- Rogel Cancer Center, 21614Michigan Medicine, Ann Arbor, Michigan.,Department of Internal Medicine - Hematology/Oncology, Michigan Medicine, Ann Arbor, Michigan
| | - Shannon A Carty
- Rogel Cancer Center, 21614Michigan Medicine, Ann Arbor, Michigan.,Department of Internal Medicine - Hematology/Oncology, Michigan Medicine, Ann Arbor, Michigan
| | - Ryan A Wilcox
- Rogel Cancer Center, 21614Michigan Medicine, Ann Arbor, Michigan.,Department of Internal Medicine - Hematology/Oncology, Michigan Medicine, Ann Arbor, Michigan
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7
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Zelenetz AD, Gordon LI, Chang JE, Christian B, Abramson JS, Advani RH, Bartlett NL, Budde LE, Caimi PF, De Vos S, Dholaria B, Fakhri B, Fayad LE, Glenn MJ, Habermann TM, Hernandez-Ilizaliturri F, Hsi E, Hu B, Kaminski MS, Kelsey CR, Khan N, Krivacic S, LaCasce AS, Lim M, Narkhede M, Rabinovitch R, Ramakrishnan P, Reid E, Roberts KB, Saeed H, Smith SD, Svoboda J, Swinnen LJ, Tuscano J, Vose JM, Dwyer MA, Sundar H. NCCN Guidelines® Insights: B-Cell Lymphomas, Version 5.2021. J Natl Compr Canc Netw 2021; 19:1218-1230. [PMID: 34781267 DOI: 10.6004/jnccn.2021.0054] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [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
In the last decade, a better understanding of the molecular pathogenesis of B-cell non-Hodgkin lymphomas has resulted in the development of novel targeted therapies, such as small molecule inhibitors of select kinases in the B-cell receptor pathway, antibody-drug conjugates, and small molecules that target a variety of proteins (eg, CD-19, EZH2, and XPO-1-mediated nuclear export). Anti-CD19 CAR T-cell therapy, first approved for relapsed/refractory (R/R) diffuse large B-cell lymphoma, has also emerged as a novel treatment option for R/R follicular lymphoma and mantle cell lymphoma. These NCCN Guideline Insights highlight the new targeted therapy options included in the NCCN Guidelines for B-Cell Lymphomas for the treatment of R/R disease.
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Affiliation(s)
| | - Leo I Gordon
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Beth Christian
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Nancy L Bartlett
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | - Paolo F Caimi
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | - Bita Fakhri
- UCSF Helen Diller Family Comprehensive Cancer Center
| | - Luis E Fayad
- The University of Texas MD Anderson Cancer Center
| | | | | | | | - Eric Hsi
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Boyu Hu
- Huntsman Cancer Institute at the University of Utah
| | | | | | | | | | | | - Megan Lim
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | | | | | | | | | - Stephen D Smith
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Jakub Svoboda
- Abramson Cancer Center at the University of Pennsylvania
| | - Lode J Swinnen
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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8
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Scott AJ, Tokaz MC, Shango M, Devata S, Carty SA, Kaminski MS, Chinnaiyan AM, Phillips TJ, Wilcox RA. Clinical application of next generation sequencing in lymphoma. Leuk Lymphoma 2020; 62:868-873. [PMID: 33191827 DOI: 10.1080/10428194.2020.1846734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Successful treatment of relapsed/refractory and rare subtypes of lymphomas remains a therapeutic challenge. Though the use of tumor profiling is increasing, little is described about how providers ultimately utilize this information in clinical decision-making. We reviewed 92 adult lymphoma patients who underwent an IRB-approved tumor sequencing protocol at the University of Michigan, MI-ONCOSEQ. Of this cohort, 60 had a targeted treatment suggested by their test results, and 11 patients ultimately underwent the MI-ONCOSEQ recommended therapy. One obtained complete response based on precision treatment recommendations. The two main barriers for targeted treatment utilization included inopportune timing (the patient either was sequenced too early or too late in their disease course) and clinical trial availability. While this study demonstrates the success of sequencing lymphomas for the identification of novel therapies, it also underlines the clinical challenges, namely the optimal timing and availability of trials, inherent in the successful application of this technology.
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Affiliation(s)
- Anthony J Scott
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Molly C Tokaz
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Sumana Devata
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Shannon A Carty
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mark S Kaminski
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Arul M Chinnaiyan
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Tycel J Phillips
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ryan A Wilcox
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
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9
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Zelenetz AD, Gordon LI, Abramson JS, Advani RH, Bartlett NL, Caimi PF, Chang JE, Chavez JC, Christian B, Fayad LE, Glenn MJ, Habermann TM, Lee Harris N, Hernandez-Ilizaliturri F, Kaminski MS, Kelsey CR, Khan N, Krivacic S, LaCasce AS, Mehta A, Nademanee A, Rabinovitch R, Reddy N, Reid E, Roberts KB, Smith SD, Snyder ED, Swinnen LJ, Vose JM, Dwyer MA, Sundar H. NCCN Guidelines Insights: B-Cell Lymphomas, Version 3.2019. J Natl Compr Canc Netw 2020; 17:650-661. [PMID: 31200358 DOI: 10.6004/jnccn.2019.0029] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diffuse large B-cell lymphomas (DLBCLs) and follicular lymphoma (FL) are the most common subtypes of B-cell non-Hodgkin's lymphomas in adults. Histologic transformation of FL to DLBCL (TFL) occurs in approximately 15% of patients and is generally associated with a poor clinical outcome. Phosphatidylinositol 3-kinase (PI3K) inhibitors have shown promising results in the treatment of relapsed/refractory FL. CAR T-cell therapy (axicabtagene ciloleucel and tisagenlecleucel) has emerged as a novel treatment option for relapsed/refractory DLBCL and TFL. These NCCN Guidelines Insights highlight important updates to the NCCN Guidelines for B-Cell Lymphomas regarding the treatment of TFL and relapsed/refractory FL and DLBCL.
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Affiliation(s)
| | - Leo I Gordon
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - Nancy L Bartlett
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Paolo F Caimi
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | - Beth Christian
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Luis E Fayad
- The University of Texas MD Anderson Cancer Center
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lode J Swinnen
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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10
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Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Armand P, Bello CM, Benitez CM, Bierman PJ, Boughan KM, Dabaja B, Gordon LI, Hernandez-Ilizaliturri FJ, Herrera AF, Hochberg EP, Huang J, Johnston PB, Kaminski MS, Kenkre VP, Khan N, Lynch RC, Maddocks K, McConathy J, McKinney M, Metzger M, Morgan D, Mulroney C, Rabinovitch R, Rosenspire KC, Seropian S, Tao R, Winter JN, Yahalom J, Burns JL, Ogba N. Hodgkin Lymphoma, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:755-781. [DOI: 10.6004/jnccn.2020.0026] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The NCCN Clinical Practice Guidelines in Oncology for Hodgkin Lymphoma (HL) provide recommendations for the management of adult patients with HL. The NCCN panel meets at least annually to review comments from reviewers within their institutions, examine relevant data, and reevaluate and update their recommendations. Current management of classic HL involves initial treatment with chemotherapy alone or combined modality therapy followed by restaging with PET/CT to assess treatment response. Overall, the introduction of less toxic and more effective regimens has significantly advanced HL cure rates. This portion of the NCCN Guidelines focuses on the management of classic HL.
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Affiliation(s)
| | | | - Weiyun Z. Ai
- 2UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | | | - Kirsten M. Boughan
- 7Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Leo I. Gordon
- 9Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Jiayi Huang
- 13Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Ryan C. Lynch
- 18Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Kami Maddocks
- 19The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Monika Metzger
- 22St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | - Randa Tao
- 28Huntsman Cancer Institute at the University of Utah
| | - Jane N. Winter
- 9Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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11
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Weis TM, Marini BL, Nachar VR, Brown AM, Phillips TJ, Brown J, Wilcox RA, Kaminski MS, Devata S, Perissinotti AJ. Impact of a vincristine dose cap on the incidence of neuropathies with DA-EPOCH-R for the treatment of aggressive lymphomas. Leuk Lymphoma 2019; 61:1126-1132. [DOI: 10.1080/10428194.2019.1703969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Taylor M. Weis
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Bernard L. Marini
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Victoria R. Nachar
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Anna M. Brown
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Tycel J. Phillips
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Julia Brown
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Ryan A. Wilcox
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mark S. Kaminski
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sumana Devata
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anthony J. Perissinotti
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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12
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Girard J, Reneau J, Devata S, Wilcox RA, Kaminski MS, Mercer J, Carty S, Phillips TJ. Evaluating Acalabrutinib In The Treatment Of Mantle Cell Lymphoma: Design, Development, And Place In Therapy. Onco Targets Ther 2019; 12:8003-8014. [PMID: 31686856 PMCID: PMC6777435 DOI: 10.2147/ott.s155778] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/16/2019] [Indexed: 01/09/2023] Open
Abstract
Mantle cell lymphoma (MCL) is an incurable intermediate-grade lymphoma representing 5-6% of non-Hodgkin's lymphomas diagnosed in the United States. The introduction of inhibitors of Bruton's tyrosine kinase (BTK) into targeted therapy for MCL has significantly improved outcomes in patients with relapsed/refractory (R/R) disease. Since the initial approval of the first-generation inhibitor, ibrutinib, several second-generation inhibitors have been explored. Acalabrutinib, a second-generation BTK inhibitor, has demonstrated impressive efficacy in clinical trials along with a safety profile that thus far appears improved compared to ibrutinib. The results of a Phase II trial in patients with R/R MCL led to the approval of acalabrutinib in this patient population while fueling further exploration of acalabrutinib in several ongoing clinical trials.
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Affiliation(s)
- Jennifer Girard
- Department of Internal Medicine, Division of Hematology-Oncology, Rogel Cancer Center University of Michigan, Ann Arbor, MI, USA
| | - John Reneau
- Department of Internal Medicine, Division of Hematology-Oncology, Rogel Cancer Center University of Michigan, Ann Arbor, MI, USA
| | - Sumana Devata
- Department of Internal Medicine, Division of Hematology-Oncology, Rogel Cancer Center University of Michigan, Ann Arbor, MI, USA
| | - Ryan A Wilcox
- Department of Internal Medicine, Division of Hematology-Oncology, Rogel Cancer Center University of Michigan, Ann Arbor, MI, USA
| | - Mark S Kaminski
- Department of Internal Medicine, Division of Hematology-Oncology, Rogel Cancer Center University of Michigan, Ann Arbor, MI, USA
| | - Jessica Mercer
- Department of Internal Medicine, Division of Hematology-Oncology, Rogel Cancer Center University of Michigan, Ann Arbor, MI, USA
| | - Shannon Carty
- Department of Internal Medicine, Division of Hematology-Oncology, Rogel Cancer Center University of Michigan, Ann Arbor, MI, USA
| | - Tycel J Phillips
- Department of Internal Medicine, Division of Hematology-Oncology, Rogel Cancer Center University of Michigan, Ann Arbor, MI, USA
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13
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Geer M, Roberts E, Shango M, Till BG, Smith SD, Abbas H, Hill BT, Kaplan J, Barr PM, Caimi P, Stephens DM, Lin E, Herrera AF, Rosenbaum E, Amengual JE, Boonstra PS, Devata S, Wilcox RA, Kaminski MS, Phillips TJ. Multicentre retrospective study of intravascular large B-cell lymphoma treated at academic institutions within the United States. Br J Haematol 2019; 186:255-262. [PMID: 31044423 DOI: 10.1111/bjh.15923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/28/2018] [Accepted: 02/12/2019] [Indexed: 11/26/2022]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare entity, with a generally aggressive course that may vary based on geographic presentation. While a United States (US) registry study showed relatively good outcomes with IVLBCL, clinicopathological and treatment data were unavailable. We performed a detailed retrospective review of cases identified at 8 US medical centres, to improve understanding of IVLBCL and inform management. We compiled data retrieved via an Institutional Review Board-approved review of IVLBCL cases identified from 1999 to 2015 at nine academic institutions across the US. We characterized the cohort's clinical status at time of diagnosis, presenting diagnostic and clinical features of the disease, treatment modalities used and overall prognostic data. Our cohort consisted of 54 patients with varying degrees of clinical features. Adjusting for age, better performance status at presentation was associated with increased survival time for the patients diagnosed in vivo (hazard ratio: 2·12, 95% confidence interval 1·28, 3·53). Based on the data we have collected, it would appear that the time interval to diagnosis is a significant contributor to outcomes of patients with IVLBCL.
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Affiliation(s)
| | | | | | - Brian G Till
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Stephen D Smith
- Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | | | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester Cancer Center, Rochester, NY, USA
| | - Paolo Caimi
- University Hospitals of Cleveland, Cleveland, OH, USA
| | - Deborah M Stephens
- Division of Hematology and Hematologic Malignancies, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Emily Lin
- City of Hope Medical Center, Duarte, CA, USA
| | | | | | - Jennifer E Amengual
- Center for Lymphoid Malignancies, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | | | - Sumana Devata
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Ryan A Wilcox
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Mark S Kaminski
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
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14
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Wang F, Gatica D, Ying ZX, Peterson LF, Kim P, Bernard D, Saiya-Cork K, Wang S, Kaminski MS, Chang AE, Phillips T, Klionsky DJ, Malek SN. Follicular lymphoma-associated mutations in vacuolar ATPase ATP6V1B2 activate autophagic flux and mTOR. J Clin Invest 2019; 129:1626-1640. [PMID: 30720463 DOI: 10.1172/jci98288] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 11/01/2017] [Accepted: 01/29/2019] [Indexed: 12/15/2022] Open
Abstract
The discovery of recurrent mutations in subunits of the vacuolar-type H+-translocating ATPase (v-ATPase) in follicular lymphoma (FL) highlights a role for the amino acid- and energy-sensing pathway to mTOR in the pathogenesis of this disease. Here, through the use of complementary experimental approaches involving mammalian cells and Saccharomyces cerevisiae, we have demonstrated that mutations in the human v-ATPase subunit ATP6V1B2 (also known as Vma2 in yeast) activate autophagic flux and maintain mTOR/TOR in an active state. Engineered lymphoma cell lines and primary FL B cells carrying mutated ATP6V1B2 demonstrated a remarkable ability to survive low leucine concentrations. The treatment of primary FL B cells with inhibitors of autophagy uncovered an addiction for survival for FL B cells harboring ATP6V1B2 mutations. These data support the idea of mutational activation of autophagic flux by recurrent hotspot mutations in ATP6V1B2 as an adaptive mechanism in FL pathogenesis and as a possible new therapeutically targetable pathway.
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Affiliation(s)
- Fangyang Wang
- Department of Internal Medicine, Division of Hematology and Oncology
| | - Damián Gatica
- Life Sciences Institute, and.,Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, Michigan, USA
| | - Zhang Xiao Ying
- Department of Internal Medicine, Division of Hematology and Oncology
| | - Luke F Peterson
- Department of Internal Medicine, Division of Hematology and Oncology
| | - Peter Kim
- Department of Internal Medicine, Division of Hematology and Oncology
| | | | - Kamlai Saiya-Cork
- Department of Internal Medicine, Division of Hematology and Oncology
| | - Shaomeng Wang
- Department of Internal Medicine, Division of Hematology and Oncology
| | - Mark S Kaminski
- Department of Internal Medicine, Division of Hematology and Oncology
| | - Alfred E Chang
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Tycel Phillips
- Department of Internal Medicine, Division of Hematology and Oncology
| | - Daniel J Klionsky
- Life Sciences Institute, and.,Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sami N Malek
- Department of Internal Medicine, Division of Hematology and Oncology
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15
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Sharman JP, Forero-Torres A, Costa LJ, Flinn IW, Inhorn L, Kelly K, Bessudo A, Fayad LE, Kaminski MS, Evens AM, Flowers CR, Sahin D, Mundt KE, Sandmann T, Fingerle-Rowson G, Vignal C, Mobasher M, Zelenetz AD. Obinutuzumab plus CHOP is effective and has a tolerable safety profile in previously untreated, advanced diffuse large B-cell lymphoma: the phase II GATHER study. Leuk Lymphoma 2018; 60:894-903. [PMID: 30277102 DOI: 10.1080/10428194.2018.1515940] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study investigated the safety and efficacy of obinutuzumab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (G-CHOP) in patients with advanced diffuse large B-cell lymphoma (DLBCL) and explored the impact of cell-of-origin (COO) on patient outcomes. Patients (N = 100) received obinutuzumab (1000 mg on the days 1, 8, and 15 of cycle 1, and day 1 of cycles 2-8) plus CHOP (cycles 1-6). For patients without grade ≥3 infusion-related reactions (IRRs) to standard-rate obinutuzumab infusion, a shorter duration of infusion (SDI) was evaluated. Overall and complete response rates, as determined according to the Cheson et al. criteria by investigators/independent radiological facility, were 82.0/75.0% and 55.0/58.0%, respectively. SDI of 120 minutes and 90 minutes were well tolerated with no grade ≥3 IRRs. Among all patients, IRRs typically occurred during cycle 1, day 1. G-CHOP is active and has an acceptable safety profile in the first-line treatment of patients with advanced DLBCL. Clinical Trials: NCT01414855DLBCL.
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Affiliation(s)
- Jeff P Sharman
- a Willamette Valley Cancer Institute and Research Center , US Oncology Research , Eugene , OR , USA
| | | | - Luciano J Costa
- c Division of Hematology/Oncology , Medical University of South Carolina , Charleston , SC , USA
| | - Ian W Flinn
- d Sarah Cannon Research Institute , Nashville , TN , USA
| | | | - Kevin Kelly
- f USC Norris Comprehensive Cancer Center , Los Angeles , CA , USA
| | - Alberto Bessudo
- g California Cancer Associates for Research and Excellence , San Diego , CA , USA
| | - Luis E Fayad
- h Department of Lymphoma and Myeloma , M.D. Anderson Cancer Center, University of Texas , Houston , TX , USA
| | - Mark S Kaminski
- i Division of Hematology/Oncology , University of Michigan Comprehensive Cancer Center, Ann Arbor , MI , USA
| | - Andrew M Evens
- j Rutgers Cancer Institute of New Jersey , New Brunswick , NJ , USA
| | | | - Deniz Sahin
- l F. Hoffmann-La Roche Ltd , Basel , Switzerland
| | | | | | | | | | | | - Andrew D Zelenetz
- n Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center , New York , NY , USA
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16
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Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Aoun P, Armand P, Bello CM, Benitez CM, Bierman PJ, Chen R, Dabaja B, Dean R, Forero A, Gordon LI, Hernandez-Ilizaliturri FJ, Hochberg EP, Huang J, Johnston PB, Kaminski MS, Kenkre VP, Khan N, Maddocks K, Maloney DG, Metzger M, Moore JO, Morgan D, Moskowitz CH, Mulroney C, Rabinovitch R, Seropian S, Tao R, Winter JN, Yahalom J, Burns JL, Ogba N. NCCN Guidelines Insights: Hodgkin Lymphoma, Version 1.2018. J Natl Compr Canc Netw 2018. [DOI: 10.6004/jnccn.2018.0013] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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17
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Shadman M, Li H, Rimsza L, Leonard JP, Kaminski MS, Braziel RM, Spier CM, Gopal AK, Maloney DG, Cheson BD, Dakhil S, LeBlanc M, Smith SM, Fisher RI, Friedberg JW, Press OW. Continued Excellent Outcomes in Previously Untreated Patients With Follicular Lymphoma After Treatment With CHOP Plus Rituximab or CHOP Plus 131I-Tositumomab: Long-Term Follow-Up of Phase III Randomized Study SWOG-S0016. J Clin Oncol 2018; 36:697-703. [PMID: 29356608 PMCID: PMC6553811 DOI: 10.1200/jco.2017.74.5083] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [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] [Indexed: 11/20/2022] Open
Abstract
Purpose SWOG S0016 was a phase III randomized study that compared the safety and efficacy of R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) with CHOP-RIT (CHOP followed by consolidation with iodine-133-tositumomab radioimmunotherapy) for previously untreated patients with follicular lymphoma. Understanding the long-term outcome of patients provides a benchmark for novel treatment regimens for FL. Patients and Methods Between 2001 and 2008, 531 previously untreated patients with FL were randomly assigned to receive either six cycles of R-CHOP or six cycles of CHOP-RIT. Patients with advanced-stage disease (bulky stage II, III, or IV) of any pathologic grade (1, 2, or 3) were eligible. Results After a median follow-up of 10.3 years, 10-year estimates of progression-free and overall survival were 49% and 78% among all patients, respectively. Patients in the CHOP-RIT arm had significantly better 10-year progression-free survival compared with patients in the R-CHOP arm (56% v 42%; P = .01), but 10-year overall survival was not different between the two arms (75% v 81%; P = .13). There was no significant difference between the CHOP-RIT and R-CHOP arms in regard to incidence of second malignancies (15.1% v 16.1%; P = .81) or myelodysplastic syndrome or acute myeloid leukemia (4.9% v 1.8%; P = .058). The estimated 10-year cumulative incidences of death resulting from second malignancies were not different (7.1% v 3.2%; P = .16), but cumulative incidence of death resulting from myelodysplastic syndrome or acute myeloid leukemia was higher in the CHOP-RIT arm compared with the R-CHOP arm (4% v 0.9%; P = .02). Conclusion Given these outstanding outcomes, immunochemotherapy should remain the standard induction approach for patients with high-risk FL until long-term follow-up of alternative approaches demonstrates superiority.
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Affiliation(s)
- Mazyar Shadman
- Mazyar Shadman, Ajay K. Gopal, David G. Maloney, and Oliver W. Press, University of Washington and Fred Hutchinson Cancer Research Center; Hongli Li and Michael LeBlanc, SWOG Statistical Center, Seattle, WA; Lisa Rimsza, Mayo Clinic Arizona, Scottsdale; Catherine M. Spier, University of Arizona, Tucson, AZ; John P. Leonard, Weill Cornell Medical College, New York; Jonathan W. Friedberg, Wilmot Cancer Institute, University of Rochester, Rochester, NY; Mark S. Kaminski, University of Michigan Health System, Ann Arbor, MI; Rita M. Braziel, Oregon Health & Science University, Portland, OR; Bruce D. Cheson, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC; Shaker Dakhil, University of Kansas School of Medicine–Wichita, Wichita, KS; Sonali M. Smith, University of Chicago Medicine, Chicago, IL; and Richard I. Fisher, Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
| | - Hongli Li
- Mazyar Shadman, Ajay K. Gopal, David G. Maloney, and Oliver W. Press, University of Washington and Fred Hutchinson Cancer Research Center; Hongli Li and Michael LeBlanc, SWOG Statistical Center, Seattle, WA; Lisa Rimsza, Mayo Clinic Arizona, Scottsdale; Catherine M. Spier, University of Arizona, Tucson, AZ; John P. Leonard, Weill Cornell Medical College, New York; Jonathan W. Friedberg, Wilmot Cancer Institute, University of Rochester, Rochester, NY; Mark S. Kaminski, University of Michigan Health System, Ann Arbor, MI; Rita M. Braziel, Oregon Health & Science University, Portland, OR; Bruce D. Cheson, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC; Shaker Dakhil, University of Kansas School of Medicine–Wichita, Wichita, KS; Sonali M. Smith, University of Chicago Medicine, Chicago, IL; and Richard I. Fisher, Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
| | - Lisa Rimsza
- Mazyar Shadman, Ajay K. Gopal, David G. Maloney, and Oliver W. Press, University of Washington and Fred Hutchinson Cancer Research Center; Hongli Li and Michael LeBlanc, SWOG Statistical Center, Seattle, WA; Lisa Rimsza, Mayo Clinic Arizona, Scottsdale; Catherine M. Spier, University of Arizona, Tucson, AZ; John P. Leonard, Weill Cornell Medical College, New York; Jonathan W. Friedberg, Wilmot Cancer Institute, University of Rochester, Rochester, NY; Mark S. Kaminski, University of Michigan Health System, Ann Arbor, MI; Rita M. Braziel, Oregon Health & Science University, Portland, OR; Bruce D. Cheson, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC; Shaker Dakhil, University of Kansas School of Medicine–Wichita, Wichita, KS; Sonali M. Smith, University of Chicago Medicine, Chicago, IL; and Richard I. Fisher, Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
| | - John P. Leonard
- Mazyar Shadman, Ajay K. Gopal, David G. Maloney, and Oliver W. Press, University of Washington and Fred Hutchinson Cancer Research Center; Hongli Li and Michael LeBlanc, SWOG Statistical Center, Seattle, WA; Lisa Rimsza, Mayo Clinic Arizona, Scottsdale; Catherine M. Spier, University of Arizona, Tucson, AZ; John P. Leonard, Weill Cornell Medical College, New York; Jonathan W. Friedberg, Wilmot Cancer Institute, University of Rochester, Rochester, NY; Mark S. Kaminski, University of Michigan Health System, Ann Arbor, MI; Rita M. Braziel, Oregon Health & Science University, Portland, OR; Bruce D. Cheson, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC; Shaker Dakhil, University of Kansas School of Medicine–Wichita, Wichita, KS; Sonali M. Smith, University of Chicago Medicine, Chicago, IL; and Richard I. Fisher, Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
| | - Mark S. Kaminski
- Mazyar Shadman, Ajay K. Gopal, David G. Maloney, and Oliver W. Press, University of Washington and Fred Hutchinson Cancer Research Center; Hongli Li and Michael LeBlanc, SWOG Statistical Center, Seattle, WA; Lisa Rimsza, Mayo Clinic Arizona, Scottsdale; Catherine M. Spier, University of Arizona, Tucson, AZ; John P. Leonard, Weill Cornell Medical College, New York; Jonathan W. Friedberg, Wilmot Cancer Institute, University of Rochester, Rochester, NY; Mark S. Kaminski, University of Michigan Health System, Ann Arbor, MI; Rita M. Braziel, Oregon Health & Science University, Portland, OR; Bruce D. Cheson, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC; Shaker Dakhil, University of Kansas School of Medicine–Wichita, Wichita, KS; Sonali M. Smith, University of Chicago Medicine, Chicago, IL; and Richard I. Fisher, Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
| | - Rita M. Braziel
- Mazyar Shadman, Ajay K. Gopal, David G. Maloney, and Oliver W. Press, University of Washington and Fred Hutchinson Cancer Research Center; Hongli Li and Michael LeBlanc, SWOG Statistical Center, Seattle, WA; Lisa Rimsza, Mayo Clinic Arizona, Scottsdale; Catherine M. Spier, University of Arizona, Tucson, AZ; John P. Leonard, Weill Cornell Medical College, New York; Jonathan W. Friedberg, Wilmot Cancer Institute, University of Rochester, Rochester, NY; Mark S. Kaminski, University of Michigan Health System, Ann Arbor, MI; Rita M. Braziel, Oregon Health & Science University, Portland, OR; Bruce D. Cheson, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC; Shaker Dakhil, University of Kansas School of Medicine–Wichita, Wichita, KS; Sonali M. Smith, University of Chicago Medicine, Chicago, IL; and Richard I. Fisher, Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
| | - Catherine M. Spier
- Mazyar Shadman, Ajay K. Gopal, David G. Maloney, and Oliver W. Press, University of Washington and Fred Hutchinson Cancer Research Center; Hongli Li and Michael LeBlanc, SWOG Statistical Center, Seattle, WA; Lisa Rimsza, Mayo Clinic Arizona, Scottsdale; Catherine M. Spier, University of Arizona, Tucson, AZ; John P. Leonard, Weill Cornell Medical College, New York; Jonathan W. Friedberg, Wilmot Cancer Institute, University of Rochester, Rochester, NY; Mark S. Kaminski, University of Michigan Health System, Ann Arbor, MI; Rita M. Braziel, Oregon Health & Science University, Portland, OR; Bruce D. Cheson, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC; Shaker Dakhil, University of Kansas School of Medicine–Wichita, Wichita, KS; Sonali M. Smith, University of Chicago Medicine, Chicago, IL; and Richard I. Fisher, Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
| | - Ajay K. Gopal
- Mazyar Shadman, Ajay K. Gopal, David G. Maloney, and Oliver W. Press, University of Washington and Fred Hutchinson Cancer Research Center; Hongli Li and Michael LeBlanc, SWOG Statistical Center, Seattle, WA; Lisa Rimsza, Mayo Clinic Arizona, Scottsdale; Catherine M. Spier, University of Arizona, Tucson, AZ; John P. Leonard, Weill Cornell Medical College, New York; Jonathan W. Friedberg, Wilmot Cancer Institute, University of Rochester, Rochester, NY; Mark S. Kaminski, University of Michigan Health System, Ann Arbor, MI; Rita M. Braziel, Oregon Health & Science University, Portland, OR; Bruce D. Cheson, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC; Shaker Dakhil, University of Kansas School of Medicine–Wichita, Wichita, KS; Sonali M. Smith, University of Chicago Medicine, Chicago, IL; and Richard I. Fisher, Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
| | - David G. Maloney
- Mazyar Shadman, Ajay K. Gopal, David G. Maloney, and Oliver W. Press, University of Washington and Fred Hutchinson Cancer Research Center; Hongli Li and Michael LeBlanc, SWOG Statistical Center, Seattle, WA; Lisa Rimsza, Mayo Clinic Arizona, Scottsdale; Catherine M. Spier, University of Arizona, Tucson, AZ; John P. Leonard, Weill Cornell Medical College, New York; Jonathan W. Friedberg, Wilmot Cancer Institute, University of Rochester, Rochester, NY; Mark S. Kaminski, University of Michigan Health System, Ann Arbor, MI; Rita M. Braziel, Oregon Health & Science University, Portland, OR; Bruce D. Cheson, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC; Shaker Dakhil, University of Kansas School of Medicine–Wichita, Wichita, KS; Sonali M. Smith, University of Chicago Medicine, Chicago, IL; and Richard I. Fisher, Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
| | - Bruce D. Cheson
- Mazyar Shadman, Ajay K. Gopal, David G. Maloney, and Oliver W. Press, University of Washington and Fred Hutchinson Cancer Research Center; Hongli Li and Michael LeBlanc, SWOG Statistical Center, Seattle, WA; Lisa Rimsza, Mayo Clinic Arizona, Scottsdale; Catherine M. Spier, University of Arizona, Tucson, AZ; John P. Leonard, Weill Cornell Medical College, New York; Jonathan W. Friedberg, Wilmot Cancer Institute, University of Rochester, Rochester, NY; Mark S. Kaminski, University of Michigan Health System, Ann Arbor, MI; Rita M. Braziel, Oregon Health & Science University, Portland, OR; Bruce D. Cheson, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC; Shaker Dakhil, University of Kansas School of Medicine–Wichita, Wichita, KS; Sonali M. Smith, University of Chicago Medicine, Chicago, IL; and Richard I. Fisher, Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
| | - Shaker Dakhil
- Mazyar Shadman, Ajay K. Gopal, David G. Maloney, and Oliver W. Press, University of Washington and Fred Hutchinson Cancer Research Center; Hongli Li and Michael LeBlanc, SWOG Statistical Center, Seattle, WA; Lisa Rimsza, Mayo Clinic Arizona, Scottsdale; Catherine M. Spier, University of Arizona, Tucson, AZ; John P. Leonard, Weill Cornell Medical College, New York; Jonathan W. Friedberg, Wilmot Cancer Institute, University of Rochester, Rochester, NY; Mark S. Kaminski, University of Michigan Health System, Ann Arbor, MI; Rita M. Braziel, Oregon Health & Science University, Portland, OR; Bruce D. Cheson, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC; Shaker Dakhil, University of Kansas School of Medicine–Wichita, Wichita, KS; Sonali M. Smith, University of Chicago Medicine, Chicago, IL; and Richard I. Fisher, Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
| | - Michael LeBlanc
- Mazyar Shadman, Ajay K. Gopal, David G. Maloney, and Oliver W. Press, University of Washington and Fred Hutchinson Cancer Research Center; Hongli Li and Michael LeBlanc, SWOG Statistical Center, Seattle, WA; Lisa Rimsza, Mayo Clinic Arizona, Scottsdale; Catherine M. Spier, University of Arizona, Tucson, AZ; John P. Leonard, Weill Cornell Medical College, New York; Jonathan W. Friedberg, Wilmot Cancer Institute, University of Rochester, Rochester, NY; Mark S. Kaminski, University of Michigan Health System, Ann Arbor, MI; Rita M. Braziel, Oregon Health & Science University, Portland, OR; Bruce D. Cheson, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC; Shaker Dakhil, University of Kansas School of Medicine–Wichita, Wichita, KS; Sonali M. Smith, University of Chicago Medicine, Chicago, IL; and Richard I. Fisher, Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
| | - Sonali M. Smith
- Mazyar Shadman, Ajay K. Gopal, David G. Maloney, and Oliver W. Press, University of Washington and Fred Hutchinson Cancer Research Center; Hongli Li and Michael LeBlanc, SWOG Statistical Center, Seattle, WA; Lisa Rimsza, Mayo Clinic Arizona, Scottsdale; Catherine M. Spier, University of Arizona, Tucson, AZ; John P. Leonard, Weill Cornell Medical College, New York; Jonathan W. Friedberg, Wilmot Cancer Institute, University of Rochester, Rochester, NY; Mark S. Kaminski, University of Michigan Health System, Ann Arbor, MI; Rita M. Braziel, Oregon Health & Science University, Portland, OR; Bruce D. Cheson, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC; Shaker Dakhil, University of Kansas School of Medicine–Wichita, Wichita, KS; Sonali M. Smith, University of Chicago Medicine, Chicago, IL; and Richard I. Fisher, Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
| | - Richard I. Fisher
- Mazyar Shadman, Ajay K. Gopal, David G. Maloney, and Oliver W. Press, University of Washington and Fred Hutchinson Cancer Research Center; Hongli Li and Michael LeBlanc, SWOG Statistical Center, Seattle, WA; Lisa Rimsza, Mayo Clinic Arizona, Scottsdale; Catherine M. Spier, University of Arizona, Tucson, AZ; John P. Leonard, Weill Cornell Medical College, New York; Jonathan W. Friedberg, Wilmot Cancer Institute, University of Rochester, Rochester, NY; Mark S. Kaminski, University of Michigan Health System, Ann Arbor, MI; Rita M. Braziel, Oregon Health & Science University, Portland, OR; Bruce D. Cheson, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC; Shaker Dakhil, University of Kansas School of Medicine–Wichita, Wichita, KS; Sonali M. Smith, University of Chicago Medicine, Chicago, IL; and Richard I. Fisher, Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
| | - Jonathan W. Friedberg
- Mazyar Shadman, Ajay K. Gopal, David G. Maloney, and Oliver W. Press, University of Washington and Fred Hutchinson Cancer Research Center; Hongli Li and Michael LeBlanc, SWOG Statistical Center, Seattle, WA; Lisa Rimsza, Mayo Clinic Arizona, Scottsdale; Catherine M. Spier, University of Arizona, Tucson, AZ; John P. Leonard, Weill Cornell Medical College, New York; Jonathan W. Friedberg, Wilmot Cancer Institute, University of Rochester, Rochester, NY; Mark S. Kaminski, University of Michigan Health System, Ann Arbor, MI; Rita M. Braziel, Oregon Health & Science University, Portland, OR; Bruce D. Cheson, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC; Shaker Dakhil, University of Kansas School of Medicine–Wichita, Wichita, KS; Sonali M. Smith, University of Chicago Medicine, Chicago, IL; and Richard I. Fisher, Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
| | - Oliver W. Press
- Mazyar Shadman, Ajay K. Gopal, David G. Maloney, and Oliver W. Press, University of Washington and Fred Hutchinson Cancer Research Center; Hongli Li and Michael LeBlanc, SWOG Statistical Center, Seattle, WA; Lisa Rimsza, Mayo Clinic Arizona, Scottsdale; Catherine M. Spier, University of Arizona, Tucson, AZ; John P. Leonard, Weill Cornell Medical College, New York; Jonathan W. Friedberg, Wilmot Cancer Institute, University of Rochester, Rochester, NY; Mark S. Kaminski, University of Michigan Health System, Ann Arbor, MI; Rita M. Braziel, Oregon Health & Science University, Portland, OR; Bruce D. Cheson, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC; Shaker Dakhil, University of Kansas School of Medicine–Wichita, Wichita, KS; Sonali M. Smith, University of Chicago Medicine, Chicago, IL; and Richard I. Fisher, Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
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18
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Zhang JY, Briski R, Devata S, Kaminski MS, Phillips TJ, Mayer TL, Bailey NG, Wilcox RA. Survival following salvage therapy for primary refractory peripheral T-cell lymphomas (PTCL). Am J Hematol 2018; 93:394-400. [PMID: 29194714 DOI: 10.1002/ajh.24992] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/07/2017] [Accepted: 11/27/2017] [Indexed: 12/11/2022]
Abstract
Optimal salvage therapy for primary refractory peripheral T-cell lymphomas (PTCL) and the role of hematopoietic stem cell transplant (SCT) remain poorly defined. We conducted a retrospective review of clinical outcomes and prognostic factors in a single-center cohort of 93 patients with primary refractory PTCL, defined as progression during first-line therapy or relapse within 6 months of its completion. Clinical outcomes were poor in this population, with median event-free survival (EFS) of 3.5 months, median overall survival (OS) of 9.1 months, and 34% 3-year survival. Outcomes were comparable in patients who progressed through first-line therapy and patients who achieved CR/PR and subsequently relapsed within 6 months. A majority exhibited high-risk features and had intermediate to high risk IPI, which correlated with inferior outcomes. There was no difference in outcomes between patients who received single-agent salvage regimens and patients who underwent traditional, multi-agent salvage regimens. Thus, participation in well-designed clinical trials should be encouraged in this population. Additionally, there may be a trend toward improved EFS and OS in patients who underwent autologous or allogeneic SCT compared to patients who achieved CR or PR but were not transplanted.
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Affiliation(s)
- Janie Y. Zhang
- Department of Internal Medicine; University of Michigan; Ann Arbor Michigan
| | - Robert Briski
- Division of Hematology, Department of Internal Medicine; University of Michigan; Ann Arbor Michigan
| | - Sumana Devata
- Division of Hematology, Department of Internal Medicine; University of Michigan; Ann Arbor Michigan
| | - Mark S. Kaminski
- Division of Hematology, Department of Internal Medicine; University of Michigan; Ann Arbor Michigan
| | - Tycel J. Phillips
- Division of Hematology, Department of Internal Medicine; University of Michigan; Ann Arbor Michigan
| | - Tera L. Mayer
- Division of Hematology, Department of Internal Medicine; University of Michigan; Ann Arbor Michigan
| | | | - Ryan A. Wilcox
- Division of Hematology, Department of Internal Medicine; University of Michigan; Ann Arbor Michigan
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19
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Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Aoun P, Bello CM, Benitez CM, Bernat K, Bierman PJ, Blum KA, Chen R, Dabaja B, Forero A, Gordon LI, Hernandez-Ilizaliturri FJ, Hochberg EP, Huang J, Johnston PB, Kaminski MS, Kenkre VP, Khan N, Maloney DG, Mauch PM, Metzger M, Moore JO, Morgan D, Moskowitz CH, Mulroney C, Poppe M, Rabinovitch R, Seropian S, Smith M, Winter JN, Yahalom J, Burns J, Ogba N, Sundar H. Hodgkin Lymphoma Version 1.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2017; 15:608-638. [PMID: 28476741 DOI: 10.6004/jnccn.2017.0064] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This portion of the NCCN Guidelines for Hodgkin lymphoma (HL) focuses on the management of classical HL. Current management of classical HL involves initial treatment with chemotherapy or combined modality therapy followed by restaging with PET/CT to assess treatment response using the Deauville criteria (5-point scale). The introduction of less toxic and more effective regimens has significantly advanced HL cure rates. However, long-term follow-up after completion of treatment is essential to determine potential long-term effects.
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20
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Boonstra PS, Avery P, Brown N, Hristov AC, Bailey NG, Kaminski MS, Phillips T, Devata S, Mayer T, Wilcox RA. A single center phase II study of ixazomib in patients with relapsed or refractory cutaneous or peripheral T-cell lymphomas. Am J Hematol 2017; 92:1287-1294. [PMID: 28842936 PMCID: PMC6116510 DOI: 10.1002/ajh.24895] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 06/16/2017] [Revised: 08/09/2017] [Accepted: 08/22/2017] [Indexed: 12/13/2022]
Abstract
The transcription factor GATA-3, highly expressed in many cutaneous T-cell lymphoma (CTCL) and peripheral T-cell lymphomas (PTCL), confers resistance to chemotherapy in a cell-autonomous manner. As GATA-3 is transcriptionally regulated by NF-κB, we sought to determine the extent to which proteasomal inhibition impairs NF-κB activation and GATA-3 expression and cell viability in malignant T cells. Proteasome inhibition, NF-κB activity, GATA-3 expression, and cell viability were examined in patient-derived cell lines and primary T-cell lymphoma specimens ex vivo treated with the oral proteasome inhibitor ixazomib. Significant reductions in cell viability, NF-κB activation, and GATA-3 expression were observed preclinically in ixazomib-treated cells. Therefore, an investigator-initiated, single-center, phase II study with this agent in patients with relapsed/refractory CTCL/PTCL was conducted. Concordant with our preclinical observations, a significant reduction in NF-κB activation and GATA-3 expression was observed in an exceptional responder following one month of treatment with ixazomib. While ixazomib had limited activity in this small and heterogeneous cohort of patients, inhibition of the NF-κB/GATA-3 axis in a single exceptional responder suggests that ixazomib may have utility in appropriately selected patients or in combination with other agents.
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Affiliation(s)
| | - Polk Avery
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Noah Brown
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | | | | | - Mark S. Kaminski
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Tycel Phillips
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Sumana Devata
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Tera Mayer
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Ryan A. Wilcox
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
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21
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Roberson PL, Smith LB, Morgan MA, Schipper MJ, Wilderman SJ, Avram AM, Kaminski MS, Dewaraja YK. Beyond Dose: Using Pretherapy Biomarkers to Improve Dose Prediction of Outcomes for Radioimmunotherapy of Non-Hodgkin Lymphoma. Cancer Biother Radiopharm 2017; 32:309-319. [PMID: 29083933 DOI: 10.1089/cbr.2017.2182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Non-Hodgkin Lymphoma patients respond differently to therapy according to inherent biological variations. Pretherapy biomarkers may improve dose-response prediction. MATERIALS AND METHODS Hybrid single-photon emission computed tomography (SPECT)/computed tomography (CT) three-dimensional imaging at multiple time points plus follow-up positron emission tomography (PET)/CT or CT at 2 and 6 months post therapy were used to fit tumor response to combined biological effect and cell clearance models from which three biological effect response parameters (radiosensitivity, cold effect sensitivity, and proliferation potential) were determined per patient. A correlation of biological effect parameters and pretherapy biomarker data (ki67, p53, and phospho-histone H3) allowed a dose-based equivalent biological effect (EBE) to be calculated for each patient. RESULTS Significant correlations were found between biological effect parameters and pretherapy biomarkers. Optimum correlations were found by splitting the patient data according to p53 status. Response correlation of progression free survival (PFS) and EBE were significantly improved compared with PFS and absorbed dose alone. CONCLUSIONS It is possible and desirable to use pretherapy biomarkers to enhance the predictive potential of dose calculations for patient-specific treatment planning.
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Affiliation(s)
- Peter L Roberson
- 1 Department of Radiation Oncology, University of Michigan , Ann Arbor, Michigan
| | - Lauren B Smith
- 2 Department of Pathology, University of Michigan , Ann Arbor, Michigan
| | - Meredith A Morgan
- 1 Department of Radiation Oncology, University of Michigan , Ann Arbor, Michigan
| | - Matthew J Schipper
- 1 Department of Radiation Oncology, University of Michigan , Ann Arbor, Michigan
| | - Scott J Wilderman
- 3 Department of Radiology, University of Michigan , Ann Arbor, Michigan
| | - Anca M Avram
- 3 Department of Radiology, University of Michigan , Ann Arbor, Michigan
| | - Mark S Kaminski
- 4 Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan , Ann Arbor, Michigan
| | - Yuni K Dewaraja
- 3 Department of Radiology, University of Michigan , Ann Arbor, Michigan
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22
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Wierda WG, Zelenetz AD, Gordon LI, Abramson JS, Advani RH, Andreadis CB, Bartlett N, Byrd JC, Caimi P, Fayad LE, Fisher RI, Glenn MJ, Habermann TM, Harris NL, Hernandez-Ilizaliturri F, Hoppe RT, Horwitz SM, Kaminski MS, Kelsey CR, Kim YH, Krivacic S, LaCasce AS, Martin MG, Nademanee A, Porcu P, Press O, Rabinovitch R, Reddy N, Reid E, Roberts K, Saad AA, Snyder ED, Sokol L, Swinnen LJ, Vose JM, Yahalom J, Dwyer MA, Sundar H. NCCN Guidelines Insights: Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma, Version 1.2017. J Natl Compr Canc Netw 2017; 15:293-311. [PMID: 28275031 DOI: 10.6004/jnccn.2017.0030] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are different manifestations of the same disease and managed in much the same way. The advent of novel CD20 monoclonal antibodies led to the development of effective chemoimmunotherapy regimens. More recently, small molecule inhibitors targeting kinases involved in a number of critical signaling pathways and a small molecule inhibitor of the BCL-2 family of proteins have demonstrated activity for the treatment of patients with CLL/SLL. These NCCN Guidelines Insights highlight important updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for CLL/SLL for the treatment of patients with newly diagnosed or relapsed/refractory CLL/SLL.
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Affiliation(s)
| | | | - Leo I Gordon
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Nancy Bartlett
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - John C Byrd
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Paolo Caimi
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Luis E Fayad
- The University of Texas MD Anderson Cancer Center
| | | | | | | | | | | | | | | | | | | | | | | | | | - Michael G Martin
- St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
| | | | - Pierluigi Porcu
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Oliver Press
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | | | - Ayman A Saad
- University of Alabama at Birmingham Comprehensive Cancer Center
| | - Erin D Snyder
- University of Alabama at Birmingham Comprehensive Cancer Center
| | | | - Lode J Swinnen
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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23
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Hanel W, Briski R, Ross CW, Anderson TF, Kaminski MS, Hristov AC, Wilcox RA. A retrospective comparative outcome analysis following systemic therapy in Mycosis fungoides and Sezary syndrome. Am J Hematol 2016; 91:E491-E495. [PMID: 27649045 DOI: 10.1002/ajh.24564] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/27/2016] [Accepted: 09/17/2016] [Indexed: 12/24/2022]
Abstract
Cutaneous T-cell lymphomas (CTCL), with few exceptions, remain incurable and treatment is largely palliative. We performed a retrospective analysis of systemic treatment outcomes of patients diagnosed with MF/SS. We identified 223 patients with MF/SS evaluated at a single institution from 1997 to 2013. Disease stage at diagnosis, time of treatment, and treatments received were retrospectively analyzed using our CTCL database. The primary endpoint was time to next treatment (TTNT). Treatment outcomes were analyzed using Kaplan-Meier method and comparisons among groups were made using log-rank analysis. A superior TTNT was associated with retinoid or interferon therapies when compared with HDAC inhibitors or systemic chemotherapy. Retinoids and interferon were associated with superior TTNT in both limited-stage and advanced stage disease. Extracorporeal photophoresis (ECP) had a superior TTNT in Sezary Syndrome. HDAC inhibitors and chemotherapy were associated with inferior TTNT in both limited stage disease and advanced stage disease. With the exception of interferon, retinoids, or ECP, durable responses are rarely achieved with systemic therapies in MF/SS patients, particularly those with advanced-stage disease. Therefore, clinical trial participation with novel agents should be encouraged. Am. J. Hematol. 91:E491-E495, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Walter Hanel
- Department of Internal MedicineUniversity of Michigan Comprehensive Cancer CenterAnn Arbor Michigan
| | - Robert Briski
- Department of Internal Medicine, Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer CenterAnn Arbor Michigan
| | - Charles W. Ross
- Department of PathologyUniversity of Michigan Comprehensive Cancer CenterAnn Arbor Michigan
| | - Thomas F. Anderson
- Department of DermatologyUniversity of Michigan Comprehensive Cancer CenterAnn Arbor Michigan
| | - Mark S. Kaminski
- Department of Internal Medicine, Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer CenterAnn Arbor Michigan
| | - Alexandra C. Hristov
- Department of Dermatology and PathologyUniversity of Michigan Comprehensive Cancer CenterAnn Arbor Michigan
| | - Ryan A Wilcox
- Department of Internal Medicine, Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer CenterAnn Arbor Michigan
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24
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Zhou Z, Rademaker AW, Gordon LI, LaCasce AS, Crosby-Thompson A, Vanderplas A, Abel GA, Rodriguez MA, Nademanee A, Kaminski MS, Czuczman MS, Millenson MM, Zelenetz AD, Niland J, Friedberg JW, Winter JN. High Body Mass Index in Elderly Patients With DLBCL Treated With Rituximab-Containing Therapy Compensates for Negative Impact of Male Sex. J Natl Compr Canc Netw 2016; 14:1274-1281. [DOI: 10.6004/jnccn.2016.0136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 06/14/2016] [Indexed: 11/17/2022]
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25
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Horwitz SM, Zelenetz AD, Gordon LI, Wierda WG, Abramson JS, Advani RH, Andreadis CB, Bartlett N, Byrd JC, Fayad LE, Fisher RI, Glenn MJ, Habermann TM, Lee Harris N, Hernandez-Ilizaliturri F, Hoppe RT, Kaminski MS, Kelsey CR, Kim YH, Krivacic S, LaCasce AS, Lunning M, Nademanee A, Press O, Rabinovitch R, Reddy N, Reid E, Roberts K, Saad AA, Sokol L, Swinnen LJ, Vose JM, Yahalom J, Zafar N, Dwyer M, Sundar H, Porcu P. NCCN Guidelines Insights: Non-Hodgkin's Lymphomas, Version 3.2016. J Natl Compr Canc Netw 2016; 14:1067-79. [DOI: 10.6004/jnccn.2016.0117] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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26
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Ying ZX, Jin M, Peterson LF, Bernard D, Saiya-Cork K, Yildiz M, Wang S, Kaminski MS, Chang AE, Klionsky DJ, Malek SN. Recurrent Mutations in the MTOR Regulator RRAGC in Follicular Lymphoma. Clin Cancer Res 2016; 22:5383-5393. [PMID: 27267853 DOI: 10.1158/1078-0432.ccr-16-0609] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/30/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE This study was performed to further our understanding of the biological and genetic basis of follicular lymphoma and to identify potential novel therapy targets. EXPERIMENTAL DESIGN We analyzed previously generated whole exome sequencing data of 23 follicular lymphoma cases and one transformed follicular lymphoma case and expanded findings to a combined total of 125 follicular lymphoma/3 transformed follicular lymphoma. We modeled the three-dimensional location of RRAGC-associated hotspot mutations. We performed functional studies on novel RRAGC mutants in stable retrovirally transduced HEK293T cells, stable lentivirally transduced lymphoma cell lines, and in Saccharomyces cerevisiae RESULTS: We report recurrent mutations, including multiple amino acid hotspots, in the small G-protein RRAGC, which is part of a protein complex that signals intracellular amino acid concentrations to MTOR, in 9.4% of follicular lymphoma cases. Mutations in RRAGC distinctly clustered on one protein surface area surrounding the GTP/GDP-binding sites. Mutated RRAGC proteins demonstrated increased binding to RPTOR (raptor) and substantially decreased interactions with the product of the tumor suppressor gene FLCN (folliculin). In stable retrovirally transfected 293T cells, cultured in the presence or absence of leucine, multiple RRAGC mutations demonstrated elevated MTOR activation as evidenced by increased RPS6KB/S6-kinase phosphorylation. Similar activation phenotypes were uncovered in yeast engineered to express mutations in the RRAGC homolog Gtr2 and in multiple lymphoma cell lines expressing HA-tagged RRAGC-mutant proteins. CONCLUSIONS Our discovery of activating mutations in RRAGC in approximately 10% of follicular lymphoma provides the mechanistic rationale to study mutational MTOR activation and MTOR inhibition as a potential novel actionable therapeutic target in follicular lymphoma. Clin Cancer Res; 22(21); 5383-93. ©2016 AACR.
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Affiliation(s)
- Zhang Xiao Ying
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Meiyan Jin
- Life Sciences Institute, University of Michigan, Ann Arbor, Michigan
| | - Luke F Peterson
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Denzil Bernard
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kamlai Saiya-Cork
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Mehmet Yildiz
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Shaomeng Wang
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Mark S Kaminski
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Alfred E Chang
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Daniel J Klionsky
- Life Sciences Institute, University of Michigan, Ann Arbor, Michigan
| | - Sami N Malek
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
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27
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Hanel W, Briski R, Ross CW, Anderson TF, Kaminski MS, Hristov AC, Wilcox RA. A comparative outcome analysis comparing systemic therapies in Mycosis Fungoides and Sezary Syndrome. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7571] [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)
- Walter Hanel
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Robert Briski
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Charles W Ross
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | - Mark S Kaminski
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
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28
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Zelenetz AD, Gordon LI, Wierda WG, Abramson JS, Advani RH, Andreadis CB, Bartlett N, Byrd JC, Fayad LE, Fisher RI, Glenn MJ, Habermann TM, Lee Harris N, Hernandez-Ilizaliturri F, Hoppe RT, Horwitz SM, Kaminski MS, Kelsey CR, Kim YH, Krivacic S, LaCasce AS, Lunning M, Nademanee A, Porcu P, Press O, Rabinovitch R, Reddy N, Reid E, Roberts K, Saad AA, Sokol L, Swinnen LJ, Vose JM, Yahalom J, Zafar N, Dwyer M, Sundar H. Diffuse Large B-Cell Lymphoma Version 1.2016. J Natl Compr Canc Netw 2016; 14:196-231. [DOI: 10.6004/jnccn.2016.0023] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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29
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Wahl RL, Horner TJ, Lin TS, Kaminski MS. Observational Retrospective Study of Altered Biodistribution of Tositumomab and 131I-Tositumomab. J Nucl Med 2015; 56:1800-3. [PMID: 26338897 DOI: 10.2967/jnumed.115.156190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 08/17/2015] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The tositumomab/(131)I-tositumomab radioimmunotherapy regimen is administered as a dosimetric dose followed by a therapeutic dose. The biodistribution of the dosimetric dose is assessed by quantitative calculations of whole-body residence time (TBRT) and visual examination of whole-body γ-camera images, to determine the administered radioactivity dose and whether a therapeutic dose can be administered. We investigated whether altered biodistribution of (131)I-tositumomab could be identified using quantitative TBRT. METHODS BioClinica, Inc., provided γ-camera images to an independent reviewer to assess altered (131)I-tositumomab biodistribution in patients reported to a registry. RESULTS Of 2,649 therapeutic doses, 5 (0.2%) were cancelled because of altered biodistribution as determined by γ-camera images and TBRT. Of these, 3 γ-camera images were assessed by the independent reviewer; one showed altered biodistribution (0.04%) and was in agreement with the TBRT on-site calculation. CONCLUSION TBRT alone should be used to determine altered biodistribution and hence whether to administer the therapeutic dose.
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Affiliation(s)
- Richard L Wahl
- Department of Medical Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Thierry J Horner
- Oncology Research and Development, GlaxoSmithKline, Collegeville, Pennsylvania; and
| | - Thomas S Lin
- Oncology Research and Development, GlaxoSmithKline, Collegeville, Pennsylvania; and
| | - Mark S Kaminski
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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30
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Briski R, Feldman AL, Bailey NG, Lim MS, Ristow K, Habermann TM, Macon WR, Inwards DJ, Colgan JP, Nowakowski GS, Kaminski MS, Witzig TE, Ansell SM, Wilcox RA. Survival in patients with limited-stage peripheral T-cell lymphomas. Leuk Lymphoma 2014; 56:1665-70. [PMID: 25248884 DOI: 10.3109/10428194.2014.963078] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The natural history of limited-stage peripheral T-cell lymphoma (PTCL) remains poorly defined. Therefore, we examined outcomes in patients with the most common PTCL subtypes (PTCL, not otherwise specified [PTCL, NOS], angioimmunoblastic T-cell lymphoma [AITL], anaplastic large cell lymphoma [ALCL]) and limited-stage disease. In this retrospective, multicenter study, 75 patients with limited-stage disease were identified. The median event-free survival (EFS) and overall survival (OS) observed were 2.1 and 6.5 years, respectively. In a landmark analysis excluding patients with primary refractory disease, no significant benefit was observed for patients undergoing consolidative radiation therapy. With the exception of patients undergoing salvage hematopoietic stem cell transplant, survival following disease relapse or progression was poor, thus highlighting the need for improved therapeutic strategies.
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Affiliation(s)
- Robert Briski
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan , Ann Arbor, MI , USA
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Dewaraja YK, Schipper MJ, Shen J, Smith LB, Murgic J, Savas H, Youssef E, Regan D, Wilderman SJ, Roberson PL, Kaminski MS, Avram AM. Tumor-Absorbed Dose Predicts Progression-Free Survival Following (131)I-Tositumomab Radioimmunotherapy. J Nucl Med 2014; 55:1047-53. [PMID: 24842891 PMCID: PMC4237694 DOI: 10.2967/jnumed.113.136044] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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: 12/11/2013] [Accepted: 03/21/2014] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The study aimed at identifying patient-specific dosimetric and nondosimetric factors predicting outcome of non-Hodgkin lymphoma patients after (131)I-tositumomab radioimmunotherapy for potential use in treatment planning. METHODS Tumor-absorbed dose measures were estimated for 130 tumors in 39 relapsed or refractory non-Hodgkin lymphoma patients by coupling SPECT/CT imaging with the Dose Planning Method (DPM) Monte Carlo code. Equivalent biologic effect was calculated to assess the biologic effects of nonuniform absorbed dose including the effects of the unlabeled antibody. Evaluated nondosimetric covariates included histology, presence of bulky disease, and prior treatment history. Tumor level outcome was based on volume shrinkage assessed on follow-up CT. Patient level outcome measures were overall response (OR), complete response (CR), and progression-free survival (PFS), determined from clinical assessments that included PET/CT. RESULTS The estimated mean tumor-absorbed dose had a median value of 275 cGy (range, 94-711 cGy). A high correlation was observed between tracer-predicted and therapy-delivered mean tumor-absorbed doses (P < 0.001; r = 0.85). In univariate tumor-level analysis, tumor shrinkage correlated significantly with almost all of the evaluated dosimetric factors, including equivalent biologic effect. Regression analysis showed that OR, CR, and PFS were associated with the dosimetric factors and equivalent biologic effect. Both mean tumor-absorbed dose (P = 0.025) and equivalent biologic effect (P = 0.035) were significant predictors of PFS whereas none of the nondosimetric covariates were found to be statistically significant factors affecting PFS. The most important finding of the study was that in Kaplan-Meier curves stratified by mean dose, longer PFS was observed in patients receiving mean tumor-absorbed doses greater than 200 cGy than in those receiving 200 cGy or less (median PFS, 13.6 vs. 1.9 mo for the 2 dose groups; log-rank P < 0.0001). CONCLUSION A higher mean tumor-absorbed dose was significantly predictive of improved PFS after (131)I-tositumomab radioimmunotherapy. Hence tumor-absorbed dose, which can be estimated before therapy, can potentially be used to design radioimmunotherapy protocols to improve efficacy.
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Affiliation(s)
- Yuni K Dewaraja
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Matthew J Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jincheng Shen
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Lauren B Smith
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Jure Murgic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Hatice Savas
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Ehab Youssef
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Denise Regan
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Scott J Wilderman
- Department of Nuclear Engineering, University of Michigan, Ann Arbor, Michigan; and
| | - Peter L Roberson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Mark S Kaminski
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Anca M Avram
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
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Elstrom RL, Ruan J, Christos PJ, Martin P, Lebovic D, Osborne J, Goldsmith S, Greenberg J, Furman RR, Avram A, Putman R, Chapman E, Mazumdar M, Griffith K, Coleman M, Leonard JP, Kaminski MS. Phase 1 study of radiosensitization using bortezomib in patients with relapsed non-Hodgkin lymphoma receiving radioimmunotherapy with 131I-tositumomab. Leuk Lymphoma 2014; 56:342-6. [PMID: 24730538 DOI: 10.3109/10428194.2014.914195] [Citation(s) in RCA: 8] [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] [Indexed: 01/17/2023]
Abstract
Radioimmunotherapy (RIT) is effective treatment for indolent non-Hodgkin lymphomas (NHLs), but response durations are usually limited, especially in aggressive NHL. We hypothesized that administration of bortezomib as a radiosensitizer with RIT would be tolerable and improve efficacy in NHL. This phase 1 dose-escalation study evaluated escalating doses of bortezomib combined with 131I-tositumomab in patients with relapsed/refractory NHL. Twenty-five patients were treated. Treatment was well tolerated, with primarily hematologic toxicity. The maximum tolerated dose (MTD) was determined to be 0.9 mg/m2 bortezomib, in combination with a standard dose of 75 cGy 131I-tositumomab. Sixteen patients responded (64%), including 44% complete responses (CRs), with 82% CR in patients with follicular lymphoma (FL). At a median follow-up of 7 months, median progression-free survival was 7 months, and seven of 11 patients with FL remained in remission at a median of 22 months. In conclusion, bortezomib can be safely administered in combination with 131I-tositumomab with promising response rates.
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Affiliation(s)
- Rebecca L Elstrom
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medical College , New York, NY , USA
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33
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Wang M, Popplewell LL, Collins RH, Winter JN, Goy A, Kaminski MS, Bartlett NL, Johnston PB, Lister J, Fanning SR, Tuscano JM, Beck JT, Kaya H, Robeva A, Fan J, Klimovsky J, Cheung W, Cherfi A, O'Connor OA. Everolimus for patients with mantle cell lymphoma refractory to or intolerant of bortezomib: multicentre, single-arm, phase 2 study. Br J Haematol 2014; 165:510-8. [PMID: 24579926 DOI: 10.1111/bjh.12780] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 06/27/2013] [Accepted: 12/06/2013] [Indexed: 02/03/2023]
Abstract
The multicentre, open-label, two-stage, single-arm, phase 2, PILLAR (PIvotaL Lymphoma triAls of RAD001)-1 study (NCT00702052) assessed the efficacy and safety of everolimus 10 mg/d in adults with confirmed mantle cell lymphoma (MCL) refractory to or intolerant of bortezomib who received ≥1 other antineoplastic agent, either separately or in combination with bortezomib. Primary endpoint was overall response rate (ORR) per investigator review according to the response criteria for malignant lymphoma. Secondary endpoints included progression-free survival (PFS), overall survival (OS) and safety. Fifty-eight patients were enrolled from August 2008-January 2011. Five partial responses were observed (ORR 8·6%; 90% confidence interval [CI] 3·5-17·3%); the study did not meet the prespecified objective of ≥8 objective responses among 57 patients. Median PFS and OS were 4·4 months (95% CI 3·5-6·1) and 16·9 months (95% CI 14·4-29·9), respectively. Grade 3/4 non-haematological toxicities occurred in 70·7% of patients. Based on laboratory values, grade 3/4 thrombocytopenia, neutropenia and anaemia occurred in 13·8%, 13·8% and 8·6% of patients, respectively. Everolimus demonstrated modest activity and acceptable tolerability in heavily pretreated patients with MCL refractory to or intolerant of bortezomib. Future studies evaluating everolimus in a less refractory population or in combination with other targeted therapies in refractory MCL are warranted.
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Affiliation(s)
- Michael Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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34
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Friedberg JW, Unger JM, Burack WR, Gopal AK, Raju RN, Nademanee AP, Kaminski MS, Li H, Press OW, Miller TP, Fisher RI. R-CHOP with iodine-131 tositumomab consolidation for advanced stage diffuse large B-cell lymphoma (DLBCL): SWOG S0433. Br J Haematol 2014; 166:382-9. [PMID: 24749780 DOI: 10.1111/bjh.12906] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 01/13/2014] [Accepted: 03/17/2014] [Indexed: 12/16/2022]
Abstract
Radiolabelled antiCD-20 antibodies have demonstrated single agent activity in relapsed diffuse large B-cell lymphoma (DLBCL). The S0433 clinical trial enrolled patients with newly diagnosed, advanced stage or bulky stage II, histologically confirmed DLBCL. Patients received six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), two cycles of CHOP, then iodine-131 tositumomab radioimmunotherapy consolidation 30-60 d after completion of chemotherapy. The primary endpoint was 2-year progression-free survival (PFS). Eighty-four eligible patients were enrolled, and 56 patients completed the entire course of protocol treatment. Of the 84 patients evaluable for treatment response, 72 [86%, 95% confidence interval (CI): 76-92%] achieved a partial response (n = 21) or a confirmed (n = 41) or unconfirmed (n = 10) complete response to therapy. With a median follow-up of 3·9 years, the 2-year PFS estimate is 69% and the 2-year overall survival estimate is 77%. Rituximab levels at time of radioimmunotherapy did not correlate with toxicity or outcome. Twenty percent of patients had double hit features (MYC+; BCL2+) by immunohistochemistry, and had inferior outcome. These current results suggest that the incorporation of novel agents earlier in therapy may ultimately have greater impact in DLBCL, as early progressions, deaths and declining performance status during CHOP chemotherapy limited the number of patients who ultimately could benefit from radioimmunotherapy consolidation.
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35
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Herrera AF, Crosby-Thompson A, Friedberg JW, Abel GA, Czuczman MS, Gordon LI, Kaminski MS, Millenson MM, Nademanee AP, Niland JC, Rodig SJ, Rodriguez MA, Zelenetz AD, LaCasce AS. Comparison of referring and final pathology for patients with T-cell lymphoma in the National Comprehensive Cancer Network. Cancer 2014; 120:1993-9. [PMID: 24706502 DOI: 10.1002/cncr.28676] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 12/23/2013] [Revised: 02/04/2014] [Accepted: 02/20/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND T-cell lymphomas (TCLs) are uncommon in the United States. The accurate diagnosis of TCL is challenging and requires morphologic interpretation, immunophenotyping, and molecular techniques. The authors compared pathologic diagnoses at referring centers with diagnoses from expert hematopathology review to determine concordance rates and to characterize the usefulness of second-opinion pathology review for TCL. METHODS Patients in the National Comprehensive Cancer Network non-Hodgkin lymphoma database with peripheral TCL, not otherwise specified (PTCL-NOS), angioimmunoblastic TCL (AITL), and anaplastic lymphoma kinase (ALK)-positive and ALK-negative anaplastic large cell lymphoma (ALCL) were eligible if they had prior tissue specimens examined at a referring institution. Pathologic concordance was evaluated using available pathology and diagnostic testing reports and provider progress notes. The etiology of discordance and the potential impact on treatment were examined. RESULTS Among 131 eligible patients, 57 (44%) had concordant results, totaling 64% of the 89 patients who were referred with a final diagnosis. Thirty-two patients (24%) had discordant results, representing 36% of those who were referred with a final diagnosis. The rates of discordance among patients with of PTCL-NOS, AITL, ALK-negative ALCL, and ALK-positive ALCL were 19%, 33%, 34%, and 6%, respectively. In 14 patients (44% of discordant results), pathologic reclassification could have resulted in a different therapeutic strategy. Forty-two patients (32%) were referred for classification with a provisional diagnosis. CONCLUSIONS In a large cohort of patients with TCL who were referred to National Comprehensive Cancer Network centers, the likelihood of a concordant final diagnosis at a referring institution was low. As current and future therapies target TCL subsets, these data suggest that patients with suspected TCLs would benefit from evaluation by an expert hematopathologist.
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Affiliation(s)
- Alex F Herrera
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Armand P, Nagler A, Weller EA, Devine SM, Avigan DE, Chen YB, Kaminski MS, Holland HK, Winter JN, Mason JR, Fay JW, Rizzieri DA, Hosing CM, Ball ED, Uberti JP, Lazarus HM, Mapara MY, Gregory SA, Timmerman JM, Andorsky D, Or R, Waller EK, Rotem-Yehudar R, Gordon LI. Disabling immune tolerance by programmed death-1 blockade with pidilizumab after autologous hematopoietic stem-cell transplantation for diffuse large B-cell lymphoma: results of an international phase II trial. J Clin Oncol 2013; 31:4199-206. [PMID: 24127452 DOI: 10.1200/jco.2012.48.3685] [Citation(s) in RCA: 365] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The Programmed Death-1 (PD-1) immune checkpoint pathway may be usurped by tumors, including diffuse large B-cell lymphoma (DLBCL), to evade immune surveillance. The reconstituting immune landscape after autologous hematopoietic stem-cell transplantation (AHSCT) may be particularly favorable for breaking immune tolerance through PD-1 blockade. PATIENTS AND METHODS We conducted an international phase II study of pidilizumab, an anti-PD-1 monoclonal antibody, in patients with DLBCL undergoing AHSCT, with correlative studies of lymphocyte subsets. Patients received three doses of pidilizumab beginning 1 to 3 months after AHSCT. RESULTS Sixty-six eligible patients were treated. Toxicity was mild. At 16 months after the first treatment, progression-free survival (PFS) was 0.72 (90% CI, 0.60 to 0.82), meeting the primary end point. Among the 24 high-risk patients who remained positive on positron emission tomography after salvage chemotherapy, the 16-month PFS was 0.70 (90% CI, 0.51 to 0.82). Among the 35 patients with measurable disease after AHSCT, the overall response rate after pidilizumab treatment was 51%. Treatment was associated with increases in circulating lymphocyte subsets including PD-L1E-bearing lymphocytes, suggesting an on-target in vivo effect of pidilizumab. CONCLUSION This is the first demonstration of clinical activity of PD-1 blockade in DLBCL. Given these results, PD-1 blockade after AHSCT using pidilizumab may represent a promising therapeutic strategy in this disease.
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Affiliation(s)
- Philippe Armand
- Philippe Armand and Edie Weller, Dana-Farber Cancer Institute; David E. Avigan, Beth Israel Deaconess Medical Center; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Arnon Nagler, Chaim Sheba Medical Center, Tel-Hashomer; Reuven Or, Hadassah Medical Center, Jerusalem; Rinat Rotem-Yehudar, CureTech, Yavne, Israel; Steven M. Devine, The Ohio State University Comprehensive Cancer Center, Ohio State University, Columbus; Hillard M. Lazarus, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, OH; Mark S. Kaminski, University of Michigan, Ann Arbor, MI; H. Kent Holland, Northside Hospital; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine; Stephanie A. Gregory, Rush Medical Center, Chicago, IL; James R. Mason, Scripps Clinic; Edward D. Ball, Moores University of California at San Diego Cancer Center, University of California, San Diego; John M. Timmerman and David Andorsky, University of California, Los Angeles, Los Angeles, CA; Joseph W. Fay, Baylor Research Institute, Baylor University Medical Center, Dallas; Chitra M. Hosing, The University of Texas MD Anderson Cancer Center, Houston, TX; David A. Rizzieri, Duke Cancer Center, Durham, NC; Joseph P. Uberti, Karmanos Cancer Institute, Detroit, MI; Markus Y. Mapara, University of Pittsburgh School of Medicine and Cancer Institute, Pittsburgh, PA
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Roberson PL, Wilderman SJ, Avram AM, Kaminski MS, Schipper MJ, Dewaraja YK. Biological-effect modeling of radioimmunotherapy for non-hodgkins lymphoma: determination of model parameters. Cancer Biother Radiopharm 2013; 29:26-33. [PMID: 24102174 DOI: 10.1089/cbr.2012.1467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Treatment with Tositumomab and 131I tositumomab anti-CD20 radioimmunotherapy (Bexxar) yields a nonradioactive antibody antitumor response (the so-called cold effect) and a radiation response. Numerical parameter determination by least-squares (LS) fitting was implemented for more accurate parameter estimates in equivalent biological-effect calculations. METHODS One hundred thirty-two tumors in 37 patients were followed using five or six SPECT/CT studies per patient, three each (typical) post-tracer (0.2 GBq) and post-therapy (∼3 GBq) injections. The SPECT/CT data were used to calculate position- and time-dependent dose rates and antibody concentrations for each tumor. CT-defined tumor volumes were used to track tumor volume changes. Combined biological-effect and cell-clearance models were fit to tumor volume changes. Optimized parameter values determined using LS fitting were compared to previous fitted values that were determined by matching calculated to measured tumor volume changes using visual assessment. Absorbed dose sensitivity (α) and cold-effect sensitivity (λp) parameters were the primary fitted parameters, yielding equivalent biological-effect (E) values. RESULTS Individual parameter uncertainties were approximately 10% and 30% for α and λp, respectively. LS versus previously fit parameter values were highly correlated, although the averaged α value decreased and the averaged λp value increased for the LS fits compared to the previous fits. Correlation of E with 2-month tumor shrinkage data was similar for the two fitting techniques. The LS fitting yielded improved fit quality and likely improved parameter estimation.
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Affiliation(s)
- Peter L Roberson
- 1 Department of Radiation Oncology, University of Michigan , Ann Arbor, Michigan
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38
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Ban-Hoefen M, Vanderplas A, Crosby-Thompson AL, Abel GA, Czuczman MS, Gordon LI, Kaminski MS, Kelly J, Millenson M, Nademanee AP, Rodriguez MA, Zelenetz AD, Niland J, LaCasce AS, Friedberg JW. Transformed non-Hodgkin lymphoma in the rituximab era: analysis of the NCCN outcomes database. Br J Haematol 2013; 163:487-95. [DOI: 10.1111/bjh.12570] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/14/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Makiko Ban-Hoefen
- Department of Hematology and Oncology; James P. Wilmot Cancer Center; University of Rochester; Rochester NY USA
| | - Ann Vanderplas
- Department of Biostatistics; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | | | - Gregory A. Abel
- Department of Hematology and Oncology; Dana-Farber Cancer Center; Boston MA USA
| | - Myron S. Czuczman
- Department of Hematology and Oncology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Leo I. Gordon
- Department of Hematology and Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago IL USA
| | - Mark S. Kaminski
- Department of Hematology and Oncology; University of Michigan Comprehensive Cancer Center; Ann Arbor MI USA
| | - Jennifer Kelly
- Department of Hematology and Oncology; James P. Wilmot Cancer Center; University of Rochester; Rochester NY USA
| | - Michael Millenson
- Department of Hematology and Oncology; Fox Chase Cancer Center; Philadelphia PA USA
| | - Auayporn P. Nademanee
- Department of Biostatistics; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | - Maria A. Rodriguez
- Department of Hematology and Oncology; MD Anderson Cancer Center; Houston TX USA
| | - Andrew D. Zelenetz
- Department of Hematology and Oncology; Memorial Sloan-Kettering Cancer Center; New York NY USA
| | - Joyce Niland
- Department of Biostatistics; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | - Ann S. LaCasce
- Department of Hematology and Oncology; Dana-Farber Cancer Center; Boston MA USA
| | - Jonathan W. Friedberg
- Department of Hematology and Oncology; James P. Wilmot Cancer Center; University of Rochester; Rochester NY USA
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Evens AM, Vanderplas A, LaCasce AS, Crosby AL, Nademanee AP, Kaminski MS, Abel GA, Millenson M, Czuczman MS, Rodriguez MA, Niland J, Zelenetz AD, Gordon LI, Friedberg JW. Stem cell transplantation for follicular lymphoma relapsed/refractory after prior rituximab. Cancer 2013; 119:3662-71. [DOI: 10.1002/cncr.28243] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/25/2013] [Accepted: 03/19/2013] [Indexed: 01/09/2023]
Affiliation(s)
- Andrew M. Evens
- Division of Hematology/Oncology; Tufts University School of Medicine; Boston Massachusetts
| | - Ann Vanderplas
- Department of Biostatistics; City of Hope National Medical Center; Duarte California
| | - Ann S. LaCasce
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Allison L. Crosby
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Auayporn P. Nademanee
- Department of Stem Cell Transplant; City of Hope National Medical Center; Duarte California
| | | | - Gregory A. Abel
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
| | | | | | | | - Joyce Niland
- Department of Biostatistics; City of Hope National Medical Center; Duarte California
| | | | - Leo I. Gordon
- Division of Hematology/Oncology; Northwestern University; Chicago Illinois
| | - Jonathan W. Friedberg
- Division of Hematology/Oncology; University of Rochester, James P. Wilmot Cancer Center; Rochester New York
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Schipper MJ, Koral KF, Avram AM, Kaminski MS, Dewaraja YK. Prediction of therapy tumor-absorbed dose estimates in I-131 radioimmunotherapy using tracer data via a mixed-model fit to time activity. Cancer Biother Radiopharm 2013; 27:403-11. [PMID: 22947086 DOI: 10.1089/cbr.2011.1053] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND For individualized treatment planning in radioimmunotherapy (RIT), correlations must be established between tracer-predicted and therapy-delivered absorbed doses. The focus of this work was to investigate this correlation for tumors. METHODS The study analyzed 57 tumors in 19 follicular lymphoma patients treated with I-131 tositumomab and imaged with SPECT/CT multiple times after tracer and therapy administrations. Instead of the typical least-squares fit to a single tumor's measured time-activity data, estimation was accomplished via a biexponential mixed model in which the curves from multiple subjects were jointly estimated. The tumor-absorbed dose estimates were determined by patient-specific Monte Carlo calculation. RESULTS The mixed model gave realistic tumor time-activity fits that showed the expected uptake and clearance phases even with noisy data or missing time points. Correlation between tracer and therapy tumor-residence times (r=0.98; p<0.0001) and correlation between tracer-predicted and therapy-delivered mean tumor-absorbed doses (r=0.86; p<0.0001) were very high. The predicted and delivered absorbed doses were within ± 25% (or within ± 75 cGy) for 80% of tumors. CONCLUSIONS The mixed-model approach is feasible for fitting tumor time-activity data in RIT treatment planning when individual least-squares fitting is not possible due to inadequate sampling points. The good correlation between predicted and delivered tumor doses demonstrates the potential of using a pretherapy tracer study for tumor dosimetry-based treatment planning in RIT.
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Affiliation(s)
- Matthew J Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Dytfeld D, Griffith KA, Friedman J, Lebovic D, Harvey C, Kaminski MS, Jakubowiak AJ. Superior overall survival of patients with myeloma achieving very good partial response or better to initial treatment with bortezomib, pegylated liposomal doxorubicin, and dexamethasone, predicted after two cycles by a free light chain- and M-protein-based model: extended follow-up of a phase II trial. Leuk Lymphoma 2011; 52:1271-80. [PMID: 21699382 DOI: 10.3109/10428194.2011.567316] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In myeloma, achievement of very good partial response (VGPR) post-transplant is associated with prolonged overall (OS) and progression-free survival (PFS). In this study of bortezomib, pegylated liposomal doxorubicin, and dexamethasone (VDD) in 40 patients with newly diagnosed myeloma (median follow-up 45.1 months), 2-/4-year OS estimates were 95.7%/86.5% versus 82.4%/58.2% for patients achieving ≥VGPR versus <VGPR to VDD (p=0.0241). In 30 patients undergoing transplant, PFS (p = 0.0357) and OS (p = 0.0272) were longer in patients achieving ≥VGPR to VDD. Achievement of ≥VGPR was predicted by a novel model based on occurrence after two cycles of ≥90% involved free light chain reduction, free light kappa/lambda ratio normalization, and/or ≥90% M-protein reduction. Prediction of ≥VGPR was associated with superior PFS and OS in patients with transplant. These findings emphasize the importance of achieving ≥VGPR to initial therapy, associated with prolonged OS. The predictive model provides a potential basis for developing individualized therapy, which requires further study.
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Affiliation(s)
- Dominik Dytfeld
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI 48109-5936, USA
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Jakubowiak AJ, Griffith KA, Reece DE, Hofmeister CC, Lonial S, Zimmerman TM, Campagnaro EL, Schlossman RL, Laubach JP, Raje NS, Anderson T, Mietzel MA, Harvey CK, Wear SM, Barrickman JC, Tendler CL, Esseltine DL, Kelley SL, Kaminski MS, Anderson KC, Richardson PG. Lenalidomide, bortezomib, pegylated liposomal doxorubicin, and dexamethasone in newly diagnosed multiple myeloma: a phase 1/2 Multiple Myeloma Research Consortium trial. Blood 2011; 118:535-43. [PMID: 21596852 PMCID: PMC3142898 DOI: 10.1182/blood-2011-02-334755] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [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: 02/07/2011] [Accepted: 05/02/2011] [Indexed: 12/17/2022] Open
Abstract
This phase 1/2 trial evaluated combination lenalidomide, bortezomib, pegylated liposomal doxorubicin, and dexamethasone (RVDD) in newly diagnosed multiple myeloma (MM) patients. Patients received RVDD at 4 dose levels, including the maximum tolerated dose (MTD). Patients with a very good partial response or better (≥ VGPR) after cycle 4 proceeded to autologous stem cell transplantation or continued treatment. The primary objectives were MTD evaluation and response to RVDD after 4 and 8 cycles. Seventy-two patients received a median of 4.5 cycles. The MTDs were lenalidomide 25 mg, bortezomib 1.3 mg/m(2), pegylated liposomal doxorubicin 30 mg/m(2), and dexamethasone 20/10 mg, as established with 3-week cycles. The most common adverse events were fatigue, constipation, sensory neuropathy, and infection; there was no treatment-related mortality. Response rates after 4 and 8 cycles were 96% and 95% partial response or better, 57% and 65% ≥ VGPR, and 29% and 35% complete or near-complete response, respectively. After a median follow-up of 15.5 months, median progression-free survival (PFS) and overall survival (OS) were not reached. The estimated 18-month PFS and OS were 80.8% and 98.6%, respectively. RVDD was generally well tolerated and highly active, warranting further study in newly diagnosed MM patients. This trial was registered at www.clinicaltrials.gov as NCT00724568.
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Roberson PL, Amro H, Wilderman SJ, Avram AM, Kaminski MS, Schipper MJ, Dewaraja YK. Bio-effect model applied to 131I radioimmunotherapy of refractory non-Hodgkin's lymphoma. Eur J Nucl Med Mol Imaging 2010; 38:874-83. [PMID: 21174088 DOI: 10.1007/s00259-010-1699-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Improved data collection methods have improved absorbed dose estimation by tracking activity distributions and tumor extent at multiple time points, allowing individualized absorbed dose estimation. Treatment with tositumomab and (131)I-tositumomab anti-CD20 radioimmunotherapy (BEXXAR) yields a cold antibody antitumor response (cold protein effect) and a radiation response. Biologically effective contributions, including the cold protein effect, are included in an equivalent biological effect model that was fit to patient data. METHODS Fifty-seven tumors in 19 patients were followed using 6 single proton emission computed tomography (SPECT)/CT studies, 3 each post tracer (5 mCi) and therapy (∼100 mCi) injections with tositumomab and (131)I-tositumomab. Both injections used identical antibody mass, a flood dose of 450 mg plus 35 mg of (131)I tagged antibody. The SPECT/CT data were used to calculate absorbed dose rate distributions and tumor and whole-body time-activity curves, yielding a space-time dependent absorbed dose rate description for each tumor. Tumor volume outlines on CT were used to derive the time dependence of tumor size for tracer and therapy time points. A combination of an equivalent biological effect model and an inactivated cell clearance model was used to fit absorbed dose sensitivity and cold effect sensitivity parameters to tumor shrinkage data, from which equivalent therapy values were calculated. RESULTS Patient responses were categorized into three groups: standard radiation sensitivity with no cold effect (7 patients), standard radiation sensitivity with cold effect (11 patients), and high radiation sensitivity with cold effect (1 patient). CONCLUSION Fit parameters can be used to categorize patient response, implying a potential predictive capability.
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Affiliation(s)
- Peter L Roberson
- Department of Radiation Oncology, University of Michigan, 519 W. William St, Argus I, Ann Arbor, MI 48103-4943, USA.
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Link BK, Martin P, Kaminski MS, Goldsmith SJ, Coleman M, Leonard JP. Cyclophosphamide, Vincristine, and Prednisone Followed by Tositumomab and Iodine-131–Tositumomab in Patients With Untreated Low-Grade Follicular Lymphoma: Eight-Year Follow-Up of a Multicenter Phase II Study. J Clin Oncol 2010; 28:3035-41. [DOI: 10.1200/jco.2009.27.8325] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The efficacy and safety of cyclophosphamide, vincristine, and prednisone (CVP) followed by tositumomab and iodine-131 (131I) –tositumomab therapy were evaluated in a multicenter phase II study in patients with untreated low-grade follicular lymphoma. Patients and Methods Patients received six cycles of CVP followed by one cycle of tositumomab and 131I-tositumomab (one dosimetric dose and one therapeutic dose). The treatment was evaluated for efficacy and safety. Results All 30 patients enrolled completed CVP as well as tositumomab and 131I-tositumomab therapy. The overall response rate after completion of therapy was 100%, with 28 patients (93%) achieving a complete response (CR) and two patients achieving a partial response. Of the 17 patients with bone marrow involvement at enrollment, 15 achieved a confirmed CR. Fourteen of 15 patients with bulky disease (≥ 5 cm) had a CR after treatment completion. After a median follow-up of 8.4 years, the median response duration had not been reached (range, 3 to 111+ months). Five-year progression-free and overall survival rates were 56% and 83%, respectively. The most common grade ≥ 3 hematologic adverse events were neutropenia (87%) and thrombocytopenia (37%). Nineteen patients received growth factor support, and three required blood product transfusions. No patients developed human antimurine antibodies. Two patients developed myelodysplastic syndrome/acute myeloid leukemia. Conclusion These mature data demonstrate that sequential therapy with a non-anthracycline–containing regimen comprising CVP followed by one cycle of tositumomab and 131I-tositumomab produced high response rates with adequate safety and durable remissions and that this regimen represents a highly active treatment for first-line therapy of follicular non-Hodgkin's lymphoma.
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Affiliation(s)
- Brian K. Link
- From the University of Iowa Hospitals and Clinics, Iowa City, IA; Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, NY; and University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Peter Martin
- From the University of Iowa Hospitals and Clinics, Iowa City, IA; Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, NY; and University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Mark S. Kaminski
- From the University of Iowa Hospitals and Clinics, Iowa City, IA; Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, NY; and University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Stanley J. Goldsmith
- From the University of Iowa Hospitals and Clinics, Iowa City, IA; Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, NY; and University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Morton Coleman
- From the University of Iowa Hospitals and Clinics, Iowa City, IA; Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, NY; and University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - John P. Leonard
- From the University of Iowa Hospitals and Clinics, Iowa City, IA; Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, NY; and University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
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Dewaraja YK, Schipper MJ, Roberson PL, Wilderman SJ, Amro H, Regan DD, Koral KF, Kaminski MS, Avram AM. 131I-tositumomab radioimmunotherapy: initial tumor dose-response results using 3-dimensional dosimetry including radiobiologic modeling. J Nucl Med 2010; 51:1155-62. [PMID: 20554734 DOI: 10.2967/jnumed.110.075176] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [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] Open
Abstract
UNLABELLED For optimal treatment planning in radionuclide therapy, robust tumor dose-response correlations must be established. Here, fully 3-dimensional (3D) dosimetry was performed coupling SPECT/CT at multiple time points with Monte Carlo-based voxel-by-voxel dosimetry to examine such correlations. METHODS Twenty patients undergoing (131)I-tositumomab for the treatment of refractory B-cell lymphoma volunteered for the study. Sixty tumors were imaged. Activity quantification and dosimetry were performed using previously developed 3D algorithms for SPECT reconstruction and absorbed dose estimation. Tumors were outlined on CT at multiple time points to obtain absorbed dose distributions in the presence of tumor deformation and regression. Equivalent uniform dose (EUD) was calculated to assess the biologic effects of the nonuniform absorbed dose, including the cold antibody effect. Response for correlation analysis was determined on the basis of the percentage reduction in the product of the largest perpendicular tumor diameters on CT at 2 mo. Overall response classification (as complete response, partial response, stable disease, or progressive disease) used for prediction analysis was based on criteria that included findings on PET. RESULTS Of the evaluated tumor-absorbed dose summary measures (mean absorbed dose, EUD, and other measures from dose-volume histogram analysis), a statistically significant correlation with response was seen only with EUD (r = 0.36 and P = 0.006 at the individual tumor level; r = 0.46 and P = 0.048 at the patient level). The median value of mean absorbed dose for stable disease, partial response, and complete response patients was 196, 346, and 342 cGy, respectively, whereas the median value of EUD for each of these categories was 170, 363, and 406 cGy, respectively. At a threshold of 200 cGy, both mean absorbed dose and EUD had a positive predictive value for responders (partial response + complete response) of 0.875 (14/16) and a negative predictive value of 1.0 (3/3). CONCLUSION Improved dose-response correlations were demonstrated when EUD incorporating the cold antibody effect was used instead of the conventionally used mean tumor-absorbed dose. This work demonstrates the importance of 3D calculation and radiobiologic modeling when estimating absorbed dose for correlation with outcome.
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Affiliation(s)
- Yuni K Dewaraja
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Zelenetz AD, Abramson JS, Advani RH, Andreadis CB, Byrd JC, Czuczman MS, Fayad L, Forero A, Glenn MJ, Gockerman JP, Gordon LI, Harris NL, Hoppe RT, Horwitz SM, Kaminski MS, Kim YH, Lacasce AS, Mughal TI, Nademanee A, Porcu P, Press O, Prosnitz L, Reddy N, Smith MR, Sokol L, Swinnen L, Vose JM, Wierda WG, Yahalom J, Yunus F. NCCN Clinical Practice Guidelines in Oncology: non-Hodgkin's lymphomas. J Natl Compr Canc Netw 2010; 8:288-334. [PMID: 20202462 DOI: 10.6004/jnccn.2010.0021] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Dewaraja YK, Wilderman SJ, Koral KF, Kaminski MS, Avram AM. Use of integrated SPECT/CT imaging for tumor dosimetry in I-131 radioimmunotherapy: a pilot patient study. Cancer Biother Radiopharm 2009; 24:417-26. [PMID: 19694576 DOI: 10.1089/cbr.2008.0568] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Integrated systems combining functional (single-photon emission computed tomography; SPECT) imaging with anatomic (computed tomography; CT) imaging have the potential to greatly improve the accuracy of dose estimation in radionuclide therapy. In this article, we present the methodology for highly patient-specific tumor dosimetry by utilizing such a system and apply it to a pilot study of 4 follicular lymphoma patients treated with I-131 tositumomab. SPECT quantification included three-dimensional ordered-subset expectation-maximization reconstruction and CT-defined tumor outlines at each time point. SPECT/CT images from multiple time points were coupled to a Monte Carlo algorithm to calculate a mean tumor dose that incorporated measured changes in tumor volume. The tumor shrinkage, defined as the difference between volumes drawn on the first and last CT scan (a typical time period of 15 days) was in the range 5%-49%. The therapy-delivered mean tumor-absorbed dose was in the range 146-334 cGy. For comparison, the therapy dose was also calculated by assuming a static volume from the initial CT and was found to underestimate this dose by up to 47%. The agreement between tracer-predicted and therapy-delivered tumor-absorbed dose was in the range 7%-21%. In summary, malignant lymphomas can have dramatic tumor regression within days of treatment, and advanced imaging methods allow for a highly patient-specific tumor-dosimetry calculation that accounts for this regression.
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Affiliation(s)
- Yuni K Dewaraja
- Division of Nuclear Medicine, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA.
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Jakubowiak AJ, Kendall T, Al-Zoubi A, Khaled Y, Mineishi S, Ahmed A, Campagnaro E, Brozo C, Braun T, Talpaz M, Kaminski MS. Phase II trial of combination therapy with bortezomib, pegylated liposomal doxorubicin, and dexamethasone in patients with newly diagnosed myeloma. J Clin Oncol 2009; 27:5015-22. [PMID: 19738129 DOI: 10.1200/jco.2008.19.5370] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE This single-center, open-label, phase II trial evaluated the bortezomib, pegylated liposomal doxorubicin (PLD), and dexamethasone combination regimen (VDD) as initial treatment for patients with newly diagnosed multiple myeloma (MM). PATIENTS AND METHODS Enrolled patients (N = 40) received up to six 3-week cycles of treatment with bortezomib 1.3 mg/m(2) intravenously (IV) on days 1, 4, 8, and 11; PLD 30 mg/m(2) IV on day 4; and dexamethasone 20 to 40 mg daily as specified in the study design. The primary end point was the complete/near-complete response (CR/nCR) rate after six cycles. Secondary end points included overall response rate (ORR), progression-free survival (PFS), and overall survival (OS). The impact of VDD on stem-cell mobilization and collection also was evaluated. RESULTS After six cycles, the ORR was 85.0% (CR/nCR, 37.5%; very good partial response [VGPR] or better, 57.5%). Patients who underwent stem-cell transplantation (SCT) after VDD (n = 30) experienced increased rates of VGPR or better (53.3% to 76.6% after SCT). Overall, 1-year PFS and OS rates were 92.5% and 97.5%, respectively. Those who achieved VGPR or better after treatment with VDD showed a significantly greater 1-year PFS versus those who achieved less than VGPR (100% v 82%, respectively; P = .03). Similar results were observed in patients who underwent SCT. Grades 3 or 4 hematologic toxicities occurred in < or = 10% of patients; grade 2 painful neuropathy occurred in 7.5%; and grade 3 palmar-plantar erythrodysesthesia occurred in 2.5%. CONCLUSION VDD is highly effective for initial treatment of MM followed by SCT in appropriate patients, and it has a reasonable safety profile. Achievement of VGPR or better with this initial therapy predicted longer PFS, regardless of the consolidation therapy given.
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Affiliation(s)
- Andrzej J Jakubowiak
- Comprehensive Cancer Center, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI 48109-5936, USA.
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Knight JS, Tsodikov A, Cibrik DM, Ross CW, Kaminski MS, Blayney DW. Lymphoma after solid organ transplantation: risk, response to therapy, and survival at a transplantation center. J Clin Oncol 2009; 27:3354-62. [PMID: 19451438 DOI: 10.1200/jco.2008.20.0857] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE We studied the incidence, risk factors, treatment, and outcomes of post-transplantation lymphoproliferative disorder (PTLD) that occurred at the University of Michigan since 1964. PATIENTS AND METHODS We identified 7,040 patients who received solid organ transplantation (SOT) and post-transplantation immunosuppressive therapy. Seventy-eight patients developed PTLD. RESULTS Diffuse large B-cell lymphoma (n = 43), polymorphic PTLD (n = 10), Hodgkin's lymphoma (n = 7), Burkitts lymphoma (n = 6), plasmacytoma (n = 5), and mucosa-associated lymphoid tissue lymphoma (n = 3) were all over-represented in the SOT population compared with a population sample from the Surveillance, Epidemiology, and End Results (SEER) database; follicular lymphoma (n = 0) was underrepresented. Negative pretransplantation Epstein-Barr virus (EBV) serology was a risk factor for PTLD. Available histologic analysis of tumor tissue showed that 75% were CD20 positive and that 62% were EBV positive; EBV-positive tumors occurred sooner after SOT than EBV-negative tumors (mean, 29 v 66 months). Extralymphatic disease (79%), poor performance status (68%), elevated lactate dehydrogenase (LDH; 71%), and advanced stage (68%) disease were all common at the time of lymphoma diagnosis. Two thirds of patients had a complete response when treated with cyclophosphamide, doxorubicin, vincristine, and prednisone-like chemotherapy (either with or without rituximab). Median overall survival in all patients with PTLD was 8.23 years (95% CI, 2.28 to 30.0 years). CONCLUSION EBV-naïve patients who receive a donor organ from an EBV-infected donor are in the highest-risk situation for PTLD development. Most of these lymphomas are CD20 positive. Follicular lymphoma is unusual. With treatment, survival of patients with PTLD was indistinguishable from that of the SEER population sample.
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Affiliation(s)
- Jason S Knight
- Department of Internal Medicine, Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, USA
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Zelenetz AD, Advani RH, Buadi F, Cabanillas F, Caligiuri MA, Czuczman MS, Damon LE, Fayad L, Flinn IW, Forero A, Glenn MJ, Gockerman JP, Gordon LI, Harris NL, Hoppe RT, Kaminski MS, Lacasce AS, Nademanee A, Porcu P, Press O, Prosnitz L, Smith MR, Sotomayor EM, Vose JM, Yahalom J. Non-Hodgkin's lymphoma. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 2006; 4:258-310. [PMID: 16507273 DOI: 10.6004/jnccn.2006.0025] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Non-Hodgkin's lymphomas (NHLs) may be classified on the basis of morphology, natural history, and immunophenotypic and molecular characteristics. These guidelines were developed for more common NHL histologic types, including chronic lymphocytic leukemia/small lymphocytic lymphoma, follicular lymphoma, and diffuse large B-cell lymphoma, and for less common entities with unique natural histories and therapies, such as marginal zone lymphoma, mantle cell lymphoma, and highly aggressive lymphoma subtypes, including Burkitt's, and lymphoblastic lymphomas and AIDS-related B-cell lymphomas. Certain components of the diagnosis and therapy of the various NHLs are similar. In all cases, an accurate pathologic diagnosis must first be made.
For the most recent version of the guidelines, please visit NCCN.org
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