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Reynolds G, Maclean M, Cliff ERS, Teh BW, Thursky KA, Slavin MA, Anderson MA, Hawkes EA. Infections in lymphoma patients treated with bispecific antibodies: A systematic review and meta-analysis. Blood Adv 2024:bloodadvances.2024012916. [PMID: 38625983 DOI: 10.1182/bloodadvances.2024012916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/20/2024] [Accepted: 04/01/2024] [Indexed: 04/18/2024] Open
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Sales C, Anderson MA, Kuznetsova V, Rosenfeld H, Malpas CB, Roos I, Dickinson M, Harrison S, Kalincik T. Patterns of neurotoxicity among patients receiving chimeric antigen receptor T-cell therapy: A single-centre cohort study. Eur J Neurol 2024; 31:e16174. [PMID: 38085272 DOI: 10.1111/ene.16174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/28/2023] [Accepted: 11/23/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND PURPOSE Immune effector cell-associated neurotoxicity syndrome (ICANS) is an important complication of chimeric antigen receptor T-cell (CAR-T) therapy. This study aims to identify the patterns of neurotoxicity among patients with ICANS at a tertiary referral centre in Australia. METHODOLOGY This single-centre, prospective cohort study included all consecutively recruited patients who underwent CAR-T therapy for eligible haematological malignancies. All patients underwent a comprehensive neurological assessment and cognitive screening before CAR-T infusion, during the development of ICANS, and 1 month after treatment. Baseline demographic characteristics, incidence, and neurological patterns of neurotoxicity management were evaluated. RESULTS Over a 19-month period, 23% (12) of the 53 eligible patients developed neurotoxicity (10/12 [83%] being grade 1). All patients showed changes in handwriting and tremor as their initial presentation. Changes in cognition were manifested in most of the patients, with a more substantial drop noted in their Montreal Cognitive Assessment compared to immune effector cell-associated encephalopathy scores. All manifestations of neurotoxicity were short-lived and resolved within a 1-month period, with a mean duration of 8.2 days (range = 1-33). CONCLUSIONS The patterns of CAR-T-related neurotoxicity often include change in handwriting, tremor, and mild confusional state, especially early in their evolution. These may remain undetected by routine neurological surveillance. These features represent accessible clinical markers of incipient ICANS.
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Affiliation(s)
- Carmela Sales
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Mary Ann Anderson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Division of Blood Cells and Blood Cancer, Walter and Eliza Hall Institute, Parkville, Victoria, Australia
| | - Valeriya Kuznetsova
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Clinical Outcomes Research (CORe), Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Hannah Rosenfeld
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Charles B Malpas
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Clinical Outcomes Research (CORe), Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Izanne Roos
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Clinical Outcomes Research (CORe), Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Michael Dickinson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Simon Harrison
- Department of Clinical Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Tomas Kalincik
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Clinical Outcomes Research (CORe), Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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Anderson MA, Walewska R, Hackett F, Kater AP, Montegaard J, O'Brien S, Seymour JF, Smith M, Stilgenbauer S, Whitechurch A, Brown JR. Venetoclax Initiation in Chronic Lymphocytic Leukemia: International Insights and Innovative Approaches for Optimal Patient Care. Cancers (Basel) 2024; 16:980. [PMID: 38473342 DOI: 10.3390/cancers16050980] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 03/14/2024] Open
Abstract
Venetoclax, a highly selective, oral B-cell lymphoma 2 inhibitor, provides a robust targeted-therapy option for the treatment of chronic lymphocytic leukemia (CLL), including patients with high-risk del(17p)/mutated-TP53 and immunoglobulin heavy variable region unmutated CLL and those refractory to chemoimmunotherapy across all age groups. Due to the potent pro-apoptotic effect of venetoclax, treatment initiation carries a risk of tumor lysis syndrome (TLS). Prompt and appropriate management is needed to limit clinical TLS, which may entail serious adverse events and death. Venetoclax ramp-up involves gradual, stepwise increases in daily venetoclax dosing from 20 mg to 400 mg (target dose) over 5 weeks; adherence to on-label scheduling provides a tumor debulking phase, reducing the risk of TLS. The key components of safe venetoclax therapy involve assessment (radiographic evaluation and baseline blood chemistry), preparation (adequate hydration), and initiation (blood chemistry monitoring). In addition to summarizing the evidence for venetoclax's efficacy and safety, this review uses hypothetical patient scenarios based on risk level for TLS (high, medium, low) to share the authors' clinical experience with venetoclax initiation and present global approaches utilized in various treatment settings. These hypothetical scenarios highlight the importance of a multidisciplinary approach and shared decision-making, outlining best practices for venetoclax initiation and overall optimal treatment strategies in patients with CLL.
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Affiliation(s)
- Mary Ann Anderson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC 3000, Australia
- Division of Blood Cells and Blood Cancers, The Walter and Eliza Hall Institute, Melbourne, VIC 3000, Australia
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Renata Walewska
- University Hospitals Dorset, NHS Foundation Trust, Bournemouth BH7 7DW, UK
| | - Fidelma Hackett
- Cancer Services Directorate, University Hospital Limerick UL Hospitals Group, St. Nessan's Road, V94 F858 Limerick, Ireland
| | - Arnon P Kater
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
| | - Josie Montegaard
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Susan O'Brien
- Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA 92868, USA
| | - John F Seymour
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Matthew Smith
- Department of Haematology, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield S44 5BL, UK
| | - Stephan Stilgenbauer
- Division of CLL, Department of Internal Medicine III, Ulm University, 89081 Ulm, Germany
| | - Ashley Whitechurch
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC 3000, Australia
| | - Jennifer R Brown
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
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Minson A, Hamad N, Cheah CY, Tam C, Blombery P, Westerman D, Ritchie D, Morgan H, Holzwart N, Lade S, Anderson MA, Khot A, Seymour JF, Robertson M, Caldwell I, Ryland G, Saghebi J, Sabahi Z, Xie J, Koldej R, Dickinson M. CAR T cells and time-limited ibrutinib as treatment for relapsed/refractory mantle cell lymphoma: the phase 2 TARMAC study. Blood 2024; 143:673-684. [PMID: 37883795 DOI: 10.1182/blood.2023021306] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
ABSTRACT CD19-directed chimeric antigen receptor T cells (CAR-T) achieve high response rates in patients with relapsed/refractory mantle cell lymphoma (MCL). However, their use is associated with significant toxicity, relapse concern, and unclear broad tractability. Preclinical and clinical data support a beneficial synergistic effect of ibrutinib on apheresis product fitness, CAR-T expansion, and toxicity. We evaluated the combination of time-limited ibrutinib and CTL019 CAR-T in 20 patients with MCL in the phase 2 TARMAC study. Ibrutinib commenced before leukapheresis and continued through CAR-T manufacture for a minimum of 6 months after CAR-T administration. The median prior lines of therapy was 2; 50% of patients were previously exposed to a Bruton tyrosine kinase inhibitor (BTKi). The primary end point was 4-month postinfusion complete response (CR) rate, and secondary end points included safety and subgroup analysis based on TP53 aberrancy. The primary end point was met; 80% of patients demonstrated CR, with 70% and 40% demonstrating measurable residual disease negativity by flow cytometry and molecular methods, respectively. At 13-month median follow-up, the estimated 12-month progression-free survival was 75% and overall survival 100%. Fifteen patients (75%) developed cytokine release syndrome; 12 (55%) with grade 1 to 2 and 3 (20%) with grade 3. Reversible grade 1 to 2 neurotoxicity was observed in 2 patients (10%). Efficacy was preserved irrespective of prior BTKi exposure or TP53 mutation. Deep responses correlated with robust CAR-T expansion and a less exhausted baseline T-cell phenotype. Overall, the safety and efficacy of the combination of BTKi and T-cell redirecting immunotherapy appears promising and merits further exploration. This trial was registered at www.ClinicalTrials.gov as #NCT04234061.
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Affiliation(s)
- Adrian Minson
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital, Sydney, Australia
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia
- School of Medicine, University of Western Australia, Crawley, Australia
| | | | - Piers Blombery
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - David Westerman
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - David Ritchie
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - Huw Morgan
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - Nicholas Holzwart
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - Stephen Lade
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mary Ann Anderson
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Amit Khot
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - John F Seymour
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - Molly Robertson
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Imogen Caldwell
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Georgina Ryland
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Javad Saghebi
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Zahra Sabahi
- Department of Haematology, St Vincent's Hospital, Sydney, Australia
| | - Jing Xie
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Rachel Koldej
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
| | - Michael Dickinson
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
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Reynolds GK, Sim B, Spelman T, Thomas A, Longhitano A, Anderson MA, Thursky K, Slavin M, Teh BW. Infections in haematology patients treated with CAR-T therapies: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2023; 192:104134. [PMID: 37739146 DOI: 10.1016/j.critrevonc.2023.104134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/21/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023] Open
Abstract
A registered (PROSPERO - CRD42022346462) systematic review and meta-analysis was conducted of all-grade infections amongst adult patients receiving CAR-T therapy for haematological malignancy. Meta-analysis of pooled incidence, using random effects model, was conducted. Cochran's Q test examined heterogeneity. 2678 patients across 33 studies were included in the primary outcome. Forty-percent of patients (95% CI: 0.33 - 0.48) experienced an infection of any grade. Twenty-five percent of infection events (95% CI: 0.16 - 0.34) were severe. Late infections were as common as early infections (IRR = 0.86, 95% CI: 0.38 - 1.98). All-grade infections, bacterial and viral infections were highest in myeloma patients at 57%, 37% and 28% respectively. Patients with NHL more commonly experienced late infections. Pooled rate of invasive candidiasis/yeast infections was 2% in studies utilizing anti-yeast prophylaxis. This review identified a high rate of all-grade infections, moderate rate of severe infections, and myeloma as a high-risk haematological group.
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Affiliation(s)
- Gemma K Reynolds
- Dpartment of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.
| | - Beatrice Sim
- Dpartment of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Tim Spelman
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ashmitha Thomas
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - Anthony Longhitano
- Department of Infectious Diseases, Barwon Health, Melbourne, Victoria, Australia
| | - Mary Ann Anderson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Karin Thursky
- Dpartment of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Monica Slavin
- Dpartment of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Benjamin W Teh
- Dpartment of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Reynolds G, Anderson MA, Thursky K, Teh BW, Slavin MA. Recommendations on prevention of infections in patients with T-cell lymphomas: a narrative review and synthesis. Leuk Lymphoma 2023; 64:2057-2070. [PMID: 37688482 DOI: 10.1080/10428194.2023.2252945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/02/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023]
Abstract
T/Natural killer (NK) cell lymphomas (TCL) represent a heterogenous subgroup of non-Hodgkin lymphoma, associated with poorer prognosis and higher treatment toxicity. A cohesive synthesis of infection outcomes among TCL patients is lacking. International guidelines offer no specific recommendations regarding prophylaxis or supportive infection care for TCL patients. This systematic narrative review highlights infection outcomes in TCL patients treated with conventional, and novel therapies. Recommendations for infection screening, antimicrobial prophylaxis and vaccination strategies are outined.
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Affiliation(s)
- Gemma Reynolds
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - Mary Ann Anderson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Karin Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Benjamin W Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Harrop S, Nguyen PC, Byrne D, Wilson C, Ryland GL, Nguyen T, Anderson MA, Khaw SL, Martin M, Tiong IS, Sanij E, Blombery P. Persistence of UBTF tandem duplications in remission in acute myeloid leukaemia. EJHaem 2023; 4:1105-1109. [PMID: 38024622 PMCID: PMC10660390 DOI: 10.1002/jha2.808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 12/01/2023]
Abstract
UBTF tandem duplications are recurrent in adult and paediatric acute myeloid leukaemia and have been reported to be associated with a poor prognosis. Co-mutations in WT1 and FLT3 are common while morphological dysplasia is frequent. The role of UBTF-TDs in leukemogenesis is yet to be elucidated; however they have been proposed as early initiating events, making them attractive for assessment of MRD and a potential therapeutic target. We present two cases where the UBTF-TD was observed in remission and discuss the implications of these findings in the clinicobiological understanding of this emerging entity.
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Affiliation(s)
- Sean Harrop
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | | | - David Byrne
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | | | - Georgina L. Ryland
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneParkvilleVictoriaAustralia
| | - Tamia Nguyen
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | | | - Seong Lin Khaw
- Royal Children's HospitalMelbourneVictoriaAustralia
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
| | | | - Ing Soo Tiong
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Elaine Sanij
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- St Vincent's Institute of Medical ResearchFitzroyVictoriaAustralia
- Department of Medicine St Vincent's HospitalUniversity of MelbourneMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneParkvilleVictoriaAustralia
- Department of Biochemistry and Molecular BiologyMonash UniversityClaytonVictoriaAustralia
| | - Piers Blombery
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneParkvilleVictoriaAustralia
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Reynolds G, Sim B, Anderson MA, Spelman T, Teh BW, Slavin MA, Thursky KA. Predicting infections in patients with haematological malignancies treated with chimeric antigen receptor T-cell therapies: A systematic scoping review and narrative synthesis. Clin Microbiol Infect 2023; 29:1280-1288. [PMID: 37201866 DOI: 10.1016/j.cmi.2023.05.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/14/2023] [Accepted: 05/06/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Chimeric antigen receptor T cells (CAR-T cells) are increasingly used to treat haematological malignancies. Strategies for preventing infections in CAR-T-treated patients rely on expert opinions and consensus guidelines. OBJECTIVES This scoping review aimed to identify risk factors for infections in CAR-T-treated patients with haematological malignancies. DATA SOURCES A literature search utilized MEDLINE, EMBASE and Cochrane to identify relevant studies from conception until 30 September 2022. STUDY ELIGIBILITY CRITERIA Trials and observational studies were eligible. PARTICIPANTS Studies required ≥10 patients treated for haematological malignancy to report infection events (as defined by the study), and either (a) a descriptive, univariate or multivariate analysis of the relationship between infections event and a risk factors for infections, or (b) diagnostic performance of a biochemical/immunological marker in CAR-T-treated patients with infection. METHODS A scoping review was conducted in accordance with PRISMA guidelines. DATA SOURCES A literature search utilised MEDLINE, EMBASE and Cochrane to identify relevant studies from conception until September 30, 2022. Eligibility/Participants/Intervention: Trials and observational studies were eligible. Studies required ≥ 10 patients treated for haematological malignancy, to report infection events (as defined by the study), and either A) a descriptive, univariate or multivariate analysis of the relationship between infections event and a risk-factors for infections, or B) diagnostic performance of a biochemical/immunological marker in CAR-T treated patients with infection. ASSESSMENT OF RISK OF BIAS Bias assessment was undertaken according to Joanna Brigg's Institute criteria for observational studies. METHODS OF DATA SYNTHESIS Data were synthesized descriptively because of the heterogeneity of reporting. RESULTS A total of 1522 patients across 15 studies were identified. All-cause infections across haematological malignancies were associated with lines of prior therapy, steroid administration, immune-effector cell-associated neurotoxicity and treatment-emergent neutropenia. Procalcitonin, C-reactive protein and cytokine profiles did not reliably predict infections. Predictors of viral, bacterial and fungal infections were poorly canvassed. DISCUSSION Meta-analysis of the current literature is not possible because of significant heterogeneity in definitions of infections and risk factors, and small, underpowered cohort studies. Radical revision of how we approach reporting infections for novel therapies is required to promptly identify infection signals and associated risks in patients receiving novel therapies. Prior therapies, neutropenia, steroid administration and immune-effector cell-associated neurotoxicity remain the most associated with infections in CAR-T-treated patients.
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Affiliation(s)
- Gemma Reynolds
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.
| | - Beatrice Sim
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Mary Ann Anderson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Tim Spelman
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Benjamin W Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Karin A Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Cochrane T, Enrico A, Gomez-Almaguer D, Hadjiev E, Lech-Maranda E, Masszi T, Nikitin E, Robak T, Weinkove R, Wu SJ, Manzoor BS, Busman T, Pai M, Komlosi V, Anderson MA. Updated quality of life data from the phase 3b VENICE II trial: patients with relapsed or refractory chronic lymphocytic leukemia receiving venetoclax monotherapy. Leuk Lymphoma 2023:1-4. [PMID: 37626019 DOI: 10.1080/10428194.2023.2247511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Tara Cochrane
- Department of Haematology, Gold Coast University Hospital, Southport, Australia
- School of Medicine, Griffiths University, Parkwood, Queensland, Australia
| | - Alicia Enrico
- Area Hematology, Hospital Italiano La Plata, Buenos Aires, Argentina
| | - David Gomez-Almaguer
- Hematology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Mexico
| | - Evgueniy Hadjiev
- Department of Internal Medicine, Medical University Sofia, University Hospital Alexandrovska, Sofia, Bulgaria
| | - Ewa Lech-Maranda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Tamas Masszi
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Eugene Nikitin
- Department of Hematology, Oncology and Chemotherapy, S. P. Botkin's City Hospital, Moscow, Russia
| | - Tadeusz Robak
- Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland
| | - Robert Weinkove
- Te Rerenga Ora Wellington Blood & Cancer Centre, Te Whatu Ora Health New Zealand Capital, Coast & Hutt Valley, Wellington, New Zealand
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Shang-Ju Wu
- Department of Internal Medicine, Division of Haematology, National Taiwan University Hospital, Taipei City, Taiwan
| | | | | | | | | | - Mary Ann Anderson
- The Clinical Haematology Department of the Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Division of Blood Cells and Blood Cancer, The Walter and Eliza Hall Institute, Parkville, Victoria, Australia
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10
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Bennett R, Anderson MA, Seymour JF. Unresolved questions in selection of therapies for treatment-naïve chronic lymphocytic leukemia. J Hematol Oncol 2023; 16:72. [PMID: 37422670 PMCID: PMC10329329 DOI: 10.1186/s13045-023-01469-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/19/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND The treatment landscape for chronic lymphocytic leukemia (CLL) continues to undergo considerable evolution. Optimal selection of initial therapy from multiple effective options provides a major challenge for clinicians, who need to consider both disease and patient factors in conjunction with a view to sequencing available therapies in event of disease relapse. REVIEW We explore the most topical clinically relevant unresolved questions through discussion of important available pertinent literature and propose expert opinion based on these data. (1) Shrinking role of chemoimmunotherapy (CIT); while novel therapies are generally superior, we highlight the utility of FCR for IGHV-mutated CLL. (2) Choosing between inhibitors of Bruton's tyrosine kinase (BTKi); while efficacy between agents is likely similar there are important differences in toxicity profiles, including the incidence of cardiac arrhythmia and hypertension. (3) BTKi with or without anti-CD20 monoclonal antibodies (mAb); while obinutuzumab-acalabrutinib (AO) may confer superior progression-free survival to acalabrutinib (Acala), this is not true of rituximab (Ritux) to ibrutinib (Ib)-we highlight that potential for increased side effects should be carefully considered. (4) Continuous BTKi versus time-limited venetoclax-obinutuzumab (VenO); we propose that venetoclax (Ven)-based therapy is generally preferable to BTKi with exception of TP53 aberrant disease. (5) BTKi-Ven versus VenO as preferred time-limited therapy; we discuss comparable efficacies and the concerns about simultaneous 1L exposure to both BTKi and Ven drug classes. (6) Utility of triplet therapy (BTKi-Ven-antiCD20 mAb) versus VenO; similar rates of complete response are observed yet with greater potential for adverse events. (7) Optimal therapy for TP53 aberrant CLL; while limited data are available, there are likely effective novel therapy combinations for TP53 aberrant disease including BTKi, BTKi-Ven ± antiCD20 mAb. CONCLUSION Frontline therapy for CLL should be selected based on efficacy considering the patient specific biologic profile of their disease and potential toxicities, considering patient comorbidities and preferences. With the present paradigm of sequencing effective agents, 1L combinations of novel therapies should be used with caution in view of potential adverse events and theoretical resistance mechanism concerns in the absence of compelling randomized data to support augmented efficacy.
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Affiliation(s)
- Rory Bennett
- Department of Clinical Haematology, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, 305 Grattan St, Parkville, Melbourne, VIC, 3000, Australia
| | - Mary Ann Anderson
- Department of Clinical Haematology, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, 305 Grattan St, Parkville, Melbourne, VIC, 3000, Australia
- Division of Blood Cells and Blood Cancer, The Walter and Eliza Hall Institute, 1G, Royal Parade, Parkville, Melbourne, VIC, 3052, Australia
- University of Melbourne, Grattan St, Parkville, Melbourne, VIC, 3010, Australia
| | - John F Seymour
- Department of Clinical Haematology, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, 305 Grattan St, Parkville, Melbourne, VIC, 3000, Australia.
- University of Melbourne, Grattan St, Parkville, Melbourne, VIC, 3010, Australia.
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11
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Mills GS, Chadwick V, Tang C, Perram J, Anderson MA, Anazodo A, Kidson-Gerber G, Shand A, Lavee O, Withers B, Milliken S, Di Ciaccio PR, Hamad N. Immunochemotherapy for life-threatening haematological malignancies in pregnancy: a systematic review of the literature and cross-sectional analysis of clinical trial eligibility. Lancet Haematol 2023; 10:e458-e467. [PMID: 37263722 DOI: 10.1016/s2352-3026(23)00059-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 06/03/2023]
Abstract
The management of potentially life-threatening malignancies in pregnancy is complicated by a lack of robust safety and efficacy evidence. This data shortage stems from a historical exclusion of women of childbearing potential from prospective clinical trials due to concerns around potential teratogenicity and toxicity of investigational agents. We conducted a systematic review of published data on immunochemotherapeutic treatment of life-threatening haematological malignancies in pregnancy between 2010 and 2022, and the maternal and neonatal outcomes. We then performed a cross-sectional observational study of clinical trial protocols on ClinicalTrials.gov, between 2016 and 2022, recruiting women of childbearing potential with potentially life-threatening haematological malignancies, collecting trial demographic data, and documenting whether pregnant or lactating women were explicitly excluded, along with the type and duration of contraception required for women of childbearing potential. We included 17 studies for analysis in our systematic review. A total of 595 women were treated with immunochemotherapy during pregnancy, with a median age of 29 years (range 14-48). Of these, 81 women (14%) were treated in the first trimester, and 514 (86%) were treated in the second and third trimesters collectively. In total, 68 trials for acute myeloid leukaemia, acute lymphocytic leukaemia, high-grade non-Hodgkin lymphoma, and Hodgkin lymphoma (40%, 26%, 21%, and 13%, respectively) were included in our ClinicalTrials.gov analysis. Most protocols (66 [97%]) explicitly excluded pregnant women, with 40 (69%) not providing a rationale for exclusion. The potential harm to the fetus from anti-cancer therapy has historically been given greater moral precedence than a pregnant woman's autonomy. This pattern is reflected in the lack of rigorous evidence for immunochemotherapy in pregnancy and a universal exclusion of pregnant and lactating women from clinical trial protocols in this study. Nonetheless, the administration of systemic chemotherapy in the second and third trimesters was not associated with an increased rate of congenital malformations or perinatal mortality in our systematic review cohort, with maternal outcomes broadly comparable to those of the non-pregnant population.
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Affiliation(s)
- Georgia S Mills
- Department of Haematology, Northern Beaches Hospital, Frenchs Forest, NSW, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine, Macquarie University, North Ryde, NSW, Australia.
| | - Verity Chadwick
- Department of Haematology and Bone Marrow Transplant, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Catherine Tang
- Department of Haematology, Gosford Hospital, Gosford, NSW, Australia
| | - Jacinta Perram
- Department of Haematology and Bone Marrow Transplant, St Vincent's Hospital, Darlinghurst, NSW, Australia; Department of Haematology and Bone Marrow Transplant, Westmead Hospital, Westmead, NSW, Australia
| | - Mary Ann Anderson
- Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Division of Blood Cells and Blood Cancer, The Walter and Eliza Hall Institute, Parkville, VIC, Australia
| | - Antoinette Anazodo
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Giselle Kidson-Gerber
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Maternal Fetal Medicine, Royal Hospital for Women, Randwick, NSW, Australia; Department of Haematology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Antonia Shand
- Department of Maternal Fetal Medicine, Royal Hospital for Women, Randwick, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Orly Lavee
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Haematology and Bone Marrow Transplant, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Barbara Withers
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Haematology and Bone Marrow Transplant, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Sam Milliken
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Haematology and Bone Marrow Transplant, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Pietro R Di Ciaccio
- Department of Haematology, Sydney Adventist Hospital, Sydney, NSW, Australia; College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Nada Hamad
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Haematology and Bone Marrow Transplant, St Vincent's Hospital, Darlinghurst, NSW, Australia; Faculty of Medicine, University of Notre Dame, Sydney, NSW, Australia
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12
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Lew TE, Minson A, Dickinson M, Handunnetti SM, Blombery P, Khot A, Anderson MA, Ritchie D, Tam CS, Seymour JF. Treatment approaches for patients with TP53-mutated mantle cell lymphoma. Lancet Haematol 2023; 10:e142-e154. [PMID: 36725119 DOI: 10.1016/s2352-3026(22)00355-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 02/01/2023]
Abstract
Mantle cell lymphoma is an uncommon subtype of lymphoma characterised by clinical and biological heterogeneity. Although most patients with mantle cell lymphoma have durable responses after chemoimmunotherapy, there is a need to prospectively identify high-risk subsets of patients for whom disease control with standard chemotherapy will be short lived. Among the available prognostic factors, TP53 mutations are uniquely informative owing to their strong association with early disease progression and death among patients receiving conventional chemoimmunotherapy, with the highest negative prognostic value compared with other established risk indicators, including the mantle cell lymphoma international prognostic index, histological features, elevated Ki-67, and other genetic lesions. The poor outcomes for patients with TP53-mutated mantle cell lymphoma receiving chemoimmunotherapy and second-line Bruton tyrosine kinase inhibitors represent an urgent need for alternative approaches. In this Review, we synthesise the available data to inform the management of this high-risk subset of patients and present a treatment strategy prioritising clinical trials and early use of cellular therapies.
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Affiliation(s)
- Thomas E Lew
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Adrian Minson
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Dickinson
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Sasanka M Handunnetti
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Piers Blombery
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Amit Khot
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Mary Ann Anderson
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - David Ritchie
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Constantine S Tam
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Department of Haematology, The Alfred Hospital, Melbourne, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - John F Seymour
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
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13
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Thijssen R, Tian L, Anderson MA, Flensburg C, Jarratt A, Garnham AL, Jabbari JS, Peng H, Lew TE, Teh CE, Gouil Q, Georgiou A, Tan T, Djajawi TM, Tam CS, Seymour JF, Blombery P, Gray DH, Majewski IJ, Ritchie ME, Roberts AW, Huang DC. Single-cell multiomics reveal the scale of multilayered adaptations enabling CLL relapse during venetoclax therapy. Blood 2022; 140:2127-2141. [PMID: 35709339 PMCID: PMC10653037 DOI: 10.1182/blood.2022016040] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/06/2022] [Indexed: 11/20/2022] Open
Abstract
Venetoclax (VEN) inhibits the prosurvival protein BCL2 to induce apoptosis and is a standard therapy for chronic lymphocytic leukemia (CLL), delivering high complete remission rates and prolonged progression-free survival in relapsed CLL but with eventual loss of efficacy. A spectrum of subclonal genetic changes associated with VEN resistance has now been described. To fully understand clinical resistance to VEN, we combined single-cell short- and long-read RNA-sequencing to reveal the previously unappreciated scale of genetic and epigenetic changes underpinning acquired VEN resistance. These appear to be multilayered. One layer comprises changes in the BCL2 family of apoptosis regulators, especially the prosurvival family members. This includes previously described mutations in BCL2 and amplification of the MCL1 gene but is heterogeneous across and within individual patient leukemias. Changes in the proapoptotic genes are notably uncommon, except for single cases with subclonal losses of BAX or NOXA. Much more prominent was universal MCL1 gene upregulation. This was driven by an overlying layer of emergent NF-κB (nuclear factor kappa B) activation, which persisted in circulating cells during VEN therapy. We discovered that MCL1 could be a direct transcriptional target of NF-κB. Both the switch to alternative prosurvival factors and NF-κB activation largely dissipate following VEN discontinuation. Our studies reveal the extent of plasticity of CLL cells in their ability to evade VEN-induced apoptosis. Importantly, these findings pinpoint new approaches to circumvent VEN resistance and provide a specific biological justification for the strategy of VEN discontinuation once a maximal response is achieved rather than maintaining long-term selective pressure with the drug.
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MESH Headings
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Myeloid Cell Leukemia Sequence 1 Protein/metabolism
- Proto-Oncogene Proteins c-bcl-2/metabolism
- NF-kappa B
- Drug Resistance, Neoplasm/genetics
- Bridged Bicyclo Compounds, Heterocyclic/pharmacology
- Bridged Bicyclo Compounds, Heterocyclic/therapeutic use
- Recurrence
- Antineoplastic Agents/therapeutic use
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Affiliation(s)
- Rachel Thijssen
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Luyi Tian
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Mary Ann Anderson
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Christoffer Flensburg
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Andrew Jarratt
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Alexandra L. Garnham
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Jafar S. Jabbari
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Hongke Peng
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Thomas E. Lew
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Charis E. Teh
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Quentin Gouil
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Angela Georgiou
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Tania Tan
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Tirta M. Djajawi
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Constantine S. Tam
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - John F. Seymour
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Piers Blombery
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Daniel H.D. Gray
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Ian J. Majewski
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Matthew E. Ritchie
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Andrew W. Roberts
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia
| | - David C.S. Huang
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
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14
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Tam CS, Gregory GP, Ku M, Fleming S, Handunnetti SM, Lee D, Walker P, Perkins A, Lew TE, Sirdesai S, Chua CC, Gilbertson M, Lasica M, Anderson MA, Renwick W, Grigg A, Patil S, Opat S, Friebe A, Cooke R, De Boer J, Spencer A, Ritchie D, Agarwal R, Blombery P. Recommendation for TP53 mutation testing in newly diagnosed mantle cell lymphoma: a statement from working groups sponsored by the Victorian Comprehensive Cancer Centre. Intern Med J 2022; 52:1286-1287. [PMID: 35879233 DOI: 10.1111/imj.15851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Constantine S Tam
- Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,VCCC Alliance, Melbourne, Victoria, Australia
| | - Gareth P Gregory
- Monash University, Melbourne, Victoria, Australia.,Monash Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Matthew Ku
- Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Shaun Fleming
- Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Sasanka M Handunnetti
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Denise Lee
- Department of Haematology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Patricia Walker
- Alfred Hospital, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Peninsula Health, Melbourne, Victoria, Australia.,Peninsula Private Hospital, Melbourne, Victoria, Australia
| | - Andrew Perkins
- Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Thomas E Lew
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Shreerang Sirdesai
- Department of Haematology, University Hospital Geelong, Geelong, Victoria, Australia
| | - Chong Chyn Chua
- Alfred Hospital, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Northern Health, Melbourne, Victoria, Australia
| | - Michael Gilbertson
- Monash University, Melbourne, Victoria, Australia.,Monash Haematology, Monash Health, Melbourne, Victoria, Australia.,Department of Haematology and Oncology, Western Health, Melbourne, Victoria, Australia
| | - Masa Lasica
- Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Mary Ann Anderson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - William Renwick
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Haematology and Oncology, Western Health, Melbourne, Victoria, Australia
| | - Andrew Grigg
- Department of Clinical Haematology, Austin Hospital, Melbourne, Victoria, Australia
| | - Sush Patil
- Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Stephen Opat
- Monash University, Melbourne, Victoria, Australia.,Monash Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Adam Friebe
- Department of Haematology, University Hospital Geelong, Geelong, Victoria, Australia
| | - Rachel Cooke
- Department of Clinical Haematology, Northern Health, Melbourne, Victoria, Australia
| | | | - Andrew Spencer
- Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - David Ritchie
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rishu Agarwal
- Department of Clinical Haematology, Austin Hospital, Melbourne, Victoria, Australia
| | - Piers Blombery
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
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15
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Lapidus AH, Anderson MA, Harrison SJ, Dickinson M, Kalincik T, Lasocki A. Neuroimaging findings in immune effector cell associated neurotoxicity syndrome after chimeric antigen receptor T-cell therapy. Leuk Lymphoma 2022; 63:2364-2374. [DOI: 10.1080/10428194.2022.2074990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Adam H. Lapidus
- Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Mary Ann Anderson
- Department of Medical Biology, The University of Melbourne, Parkville, Australia
- Clinical Haematology and Centre of Excellence for Cellular Immunotherapy, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Division of Blood Cells and Blood Cancer, The Walter and Eliza Hall Institute, Parkville, Australia
| | - Simon J. Harrison
- Clinical Haematology and Centre of Excellence for Cellular Immunotherapy, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Michael Dickinson
- Clinical Haematology and Centre of Excellence for Cellular Immunotherapy, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Tomas Kalincik
- MS Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia
- CORe, Department of Medicine, The University of Melbourne, Parkville, Australia
| | - Arian Lasocki
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Radiology, The University of Melbourne, Parkville, Australia
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16
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Lew TE, Anderson MA. Health-related quality of life for patients with chronic lymphocytic leukaemia - A critical outcome measure in the era of highly effective therapies. Br J Haematol 2022; 197:394-396. [PMID: 35262916 DOI: 10.1111/bjh.18118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Thomas E Lew
- Department of Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Australia.,Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Mary Ann Anderson
- Department of Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Australia.,Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
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17
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Blombery P, Lew TE, Dengler MA, Thompson ER, Lin VS, Chen X, Nguyen T, Panigrahi A, Handunnetti SM, Carney DA, Westerman DA, Tam CS, Adams JM, Wei AH, Huang DC, Seymour JF, Roberts AW, Anderson MA. Clonal hematopoiesis, myeloid disorders and BAX-mutated myelopoiesis in patients receiving venetoclax for CLL. Blood 2022; 139:1198-1207. [PMID: 34469514 PMCID: PMC11017791 DOI: 10.1182/blood.2021012775] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/13/2021] [Indexed: 11/20/2022] Open
Abstract
The BCL2 inhibitor venetoclax has established therapeutic roles in chronic lymphocytic leukemia (CLL) and acute myeloid leukemia (AML). As BCL2 is an important determinant of survival of both myeloid progenitor and B cells, we investigated whether clinical and molecular abnormalities arise in the myeloid compartment during long-term continuous venetoclax treatment of CLL in 89 patients (87 with relapsed/refractory CLL). Over a median follow-up of 75 (range 21-98) months, persistent cytopenias (≥1 of neutropenia, thrombocytopenia, anemia) lasting ≥4 months and unrelated to CLL occurred in 25 patients (28%). Of these patients, 20 (80%) displayed clonal hematopoiesis, including 10 with therapy-related myeloid neoplasms (t-MNs). t-MNs occurred exclusively in patients previously exposed to fludarabine-alkylator combination therapy with a cumulative 5-year incidence of 10.4% after venetoclax initiation, consistent with rates reported for patients exposed to fludarabine-alkylator combination therapy without venetoclax. To determine whether the altered myelopoiesis reflected the acquisition of mutations, we analyzed samples from patients with no or minimal bone marrow CLL burden (n = 41). Mutations in the apoptosis effector BAX were identified in 32% (13/41). In cellular assays, C-terminal BAX mutants abrogated outer mitochondrial membrane localization of BAX and engendered resistance to venetoclax killing. BAX-mutated clonal hematopoiesis occurred independently of prior fludarabine-alkylator combination therapy exposure and was not associated with t-MNs. Single-cell sequencing revealed clonal co-occurrence of mutations in BAX with DNMT3A or ASXL1. We also observed simultaneous BCL2 mutations within CLL cells and BAX mutations in the myeloid compartment of the same patients, indicating lineage-specific adaptation to venetoclax therapy.
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MESH Headings
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Bridged Bicyclo Compounds, Heterocyclic/administration & dosage
- Bridged Bicyclo Compounds, Heterocyclic/adverse effects
- Female
- Hematologic Neoplasms/genetics
- Hematologic Neoplasms/metabolism
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Male
- Middle Aged
- Mutation
- Myelopoiesis/drug effects
- Myeloproliferative Disorders/genetics
- Myeloproliferative Disorders/metabolism
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/metabolism
- Sulfonamides/administration & dosage
- Sulfonamides/adverse effects
- Vidarabine/administration & dosage
- Vidarabine/adverse effects
- Vidarabine/analogs & derivatives
- bcl-2-Associated X Protein/antagonists & inhibitors
- bcl-2-Associated X Protein/genetics
- bcl-2-Associated X Protein/metabolism
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Affiliation(s)
- Piers Blombery
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Thomas E. Lew
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Michael A. Dengler
- University of Melbourne, Melbourne, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Division on Oncology, Medical University of Graz, Graz, Austria
| | - Ella R. Thompson
- University of Melbourne, Melbourne, VIC, Australia
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Victor S. Lin
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Xiangting Chen
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Tamia Nguyen
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Ashish Panigrahi
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Sasanka M. Handunnetti
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Dennis A. Carney
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | - David A. Westerman
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Constantine S. Tam
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | - Jerry M. Adams
- University of Melbourne, Melbourne, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Andrew H. Wei
- The Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - David C.S. Huang
- University of Melbourne, Melbourne, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - John F. Seymour
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | - Andrew W. Roberts
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Mary Ann Anderson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
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18
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Diepstraten ST, Anderson MA, Czabotar PE, Lessene G, Strasser A, Kelly GL. The manipulation of apoptosis for cancer therapy using BH3-mimetic drugs. Nat Rev Cancer 2022; 22:45-64. [PMID: 34663943 DOI: 10.1038/s41568-021-00407-4] [Citation(s) in RCA: 116] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 12/14/2022]
Abstract
Apoptosis is a form of programmed cell death that is regulated by the balance between prosurvival and proapoptotic BCL-2 protein family members. Evasion of apoptosis is a hallmark of cancer that arises when this balance is tipped in favour of survival. One form of anticancer therapeutic, termed 'BH3-mimetic drugs', has been developed to directly activate the apoptosis machinery in malignant cells. These drugs bind to and inhibit specific prosurvival BCL-2 family proteins, thereby mimicking their interaction with the BH3 domains of proapoptotic BCL-2 family proteins. The BCL-2-specific inhibitor venetoclax is approved by the US Food and Drug Administration and many regulatory authorities worldwide for the treatment of chronic lymphocytic leukaemia and acute myeloid leukaemia. BH3-mimetic drugs targeting other BCL-2 prosurvival proteins have been tested in preclinical models of cancer, and drugs targeting MCL-1 or BCL-XL have advanced into phase I clinical trials for certain cancers. As with all therapeutics, efficacy and tolerability need to be carefully balanced to achieve a therapeutic window whereby there is significant anticancer activity with an acceptable safety profile. In this Review, we outline the current state of BH3-mimetic drugs targeting various prosurvival BCL-2 family proteins and discuss emerging data regarding primary and acquired resistance to these agents and approaches that may overcome this. We highlight issues that need to be addressed to further advance the clinical application of BH3-mimetic drugs, both alone and in combination with additional anticancer agents (for example, standard chemotherapeutic drugs or inhibitors of oncogenic kinases), for improved responses in patients with cancer.
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Affiliation(s)
- Sarah T Diepstraten
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Mary Ann Anderson
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
- Department of Clinical Haematology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Peter E Czabotar
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Guillaume Lessene
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
- Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, VIC, Australia
| | - Andreas Strasser
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
- Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia.
| | - Gemma L Kelly
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
- Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia.
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19
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Mills G, Anderson MA, Tang C, Hamad N. The untold effect of the combined oral contraceptive pill on anticancer drugs. Lancet Haematol 2022; 9:e10-e11. [PMID: 34971575 DOI: 10.1016/s2352-3026(21)00377-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Georgia Mills
- Department of Haematology, St Vincent's Hospital Sydney, Sydney, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Mary Ann Anderson
- Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Division of Blood Cells and Blood Cancer, The Walter and Eliza Hall Institute, Parkville, VIC, Australia
| | - Catherine Tang
- Department of Haematology, Gosford Hospital, Gosford, NSW, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital Sydney, Sydney, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia; School of Medicine, University of Notre Dame Sydney, Sydney, NSW, Australia
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20
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Tian L, Jabbari JS, Thijssen R, Gouil Q, Amarasinghe SL, Voogd O, Kariyawasam H, Du MRM, Schuster J, Wang C, Su S, Dong X, Law CW, Lucattini A, Prawer YDJ, Collar-Fernández C, Chung JD, Naim T, Chan A, Ly CH, Lynch GS, Ryall JG, Anttila CJA, Peng H, Anderson MA, Flensburg C, Majewski I, Roberts AW, Huang DCS, Clark MB, Ritchie ME. Comprehensive characterization of single-cell full-length isoforms in human and mouse with long-read sequencing. Genome Biol 2021; 22:310. [PMID: 34763716 PMCID: PMC8582192 DOI: 10.1186/s13059-021-02525-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/21/2021] [Indexed: 12/11/2022] Open
Abstract
A modified Chromium 10x droplet-based protocol that subsamples cells for both short-read and long-read (nanopore) sequencing together with a new computational pipeline (FLAMES) is developed to enable isoform discovery, splicing analysis, and mutation detection in single cells. We identify thousands of unannotated isoforms and find conserved functional modules that are enriched for alternative transcript usage in different cell types and species, including ribosome biogenesis and mRNA splicing. Analysis at the transcript level allows data integration with scATAC-seq on individual promoters, improved correlation with protein expression data, and linked mutations known to confer drug resistance to transcriptome heterogeneity.
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Affiliation(s)
- Luyi Tian
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia.
| | - Jafar S Jabbari
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Australian Genome Research Facility, Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Rachel Thijssen
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Quentin Gouil
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Shanika L Amarasinghe
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Oliver Voogd
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Hasaru Kariyawasam
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Mei R M Du
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Jakob Schuster
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Changqing Wang
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Shian Su
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Xueyi Dong
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Charity W Law
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Alexis Lucattini
- Australian Genome Research Facility, Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Yair David Joseph Prawer
- Centre for Stem Cell Systems, Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, VIC, Australia
| | | | - Jin D Chung
- Centre for Muscle Research, Department of Physiology, The University of Melbourne, Melbourne, VIC, Australia
| | - Timur Naim
- Centre for Muscle Research, Department of Physiology, The University of Melbourne, Melbourne, VIC, Australia
| | - Audrey Chan
- Centre for Muscle Research, Department of Physiology, The University of Melbourne, Melbourne, VIC, Australia
| | - Chi Hai Ly
- Centre for Muscle Research, Department of Physiology, The University of Melbourne, Melbourne, VIC, Australia
- Present address: Department of Neurology, Stanford University, Stanford, CA, USA
| | - Gordon S Lynch
- Centre for Muscle Research, Department of Physiology, The University of Melbourne, Melbourne, VIC, Australia
| | - James G Ryall
- Centre for Muscle Research, Department of Physiology, The University of Melbourne, Melbourne, VIC, Australia
- Present address: VOW, North Parramatta, NSW, Australia
| | - Casey J A Anttila
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Hongke Peng
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Mary Ann Anderson
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Christoffer Flensburg
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Ian Majewski
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew W Roberts
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Centre for Cancer Research, University of Melbourne, Melbourne, VIC, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - David C S Huang
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Michael B Clark
- Centre for Stem Cell Systems, Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, VIC, Australia
| | - Matthew E Ritchie
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia.
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21
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Cochrane T, Enrico A, Gomez-Almaguer D, Hadjiev E, Lech-Maranda E, Masszi T, Nikitin E, Robak T, Weinkove R, Wu SJ, Sail KR, Pesko J, Pai M, Komlosi V, Anderson MA. Impact of venetoclax monotherapy on the quality of life of patients with relapsed or refractory chronic lymphocytic leukemia: results from the phase 3b VENICE II trial. Leuk Lymphoma 2021; 63:304-314. [PMID: 34632935 DOI: 10.1080/10428194.2021.1986217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Venetoclax, a potent B-cell lymphoma-2 (BCL-2) inhibitor, has demonstrated clinical efficacy in chronic lymphocytic leukemia (CLL). VENICE II is an open-label, single-arm, phase 3b study (NCT02980731) evaluating the impact of venetoclax monotherapy (400 mg once daily) for ≤2 years on health-related quality of life (HRQoL) of patients with relapsed/refractory CLL. The primary endpoint was mean change in the global health status (GHS)/quality of life (QoL) subscale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) from baseline to Week 48. Overall, 210 patients received ≥1 dose of venetoclax; median treatment duration was 67.4 weeks. The primary endpoint was met with mean improvement of +9.3 points (n = 156, 95% confidence interval 6.1-12.5; p=.004) in GHS/QoL. At Week 48, clinically meaningful improvements were observed for role functioning, fatigue, and insomnia domains of EORTC QLQ-C30, suggesting venetoclax monotherapy has a positive impact on HRQoL. No new safety signals were reported.
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Affiliation(s)
- Tara Cochrane
- Department of Haematology, Gold Coast University Hospital, Southport, Australia.,Griffiths University, Parkwood, Australia
| | - Alicia Enrico
- Area Hematology, Hospital Italiano La Plata, Buenos Aires, Argentina
| | - David Gomez-Almaguer
- Hematology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Mexico
| | - Evgueniy Hadjiev
- Department of Internal Medicine, Medical University Sofia, University Hospital Alexandrovska, Sofia, Bulgaria
| | - Ewa Lech-Maranda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Tamas Masszi
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Eugene Nikitin
- Department of Hematology, Oncology and Chemotherapy, S. P. Botkin's City Hospital, Moscow, Russia
| | - Tadeusz Robak
- Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland
| | - Robert Weinkove
- Wellington Blood & Cancer Centre, Capital & Coast District Health Board, Wellington, New Zealand.,Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Shang-Ju Wu
- Department of Internal Medicine, Division of Haematology, National Taiwan University Hospital, Taipei City, Taiwan
| | | | | | | | | | - Mary Ann Anderson
- The Clinical Haematology Department of the Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, Australia.,Division of Blood Cells and Blood Cancer, The Walter and Eliza Hall Institute, Parkville, Australia
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22
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Selim AG, Minson A, Blombery P, Dickinson M, Harrison SJ, Anderson MA. CAR-T cell therapy: practical guide to routine laboratory monitoring. Pathology 2021; 53:408-415. [PMID: 33685719 DOI: 10.1016/j.pathol.2021.02.002] [Citation(s) in RCA: 4] [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] [Received: 01/11/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 01/24/2023]
Abstract
Chimeric antigen receptor (CAR)-T cell therapy is a genetically-modified cellular immunotherapy that has a current established role in the treatment of relapsed/refractory B-cell acute lymphoblastic leukaemia and diffuse large B-cell lymphoma, with emerging utility in a spectrum of other haematological and solid organ malignancies. It is associated with a number of characteristic toxicities, most notably cytokine release syndrome and neurotoxicity, for which laboratory testing can aid in the prediction of severity and in monitoring. Other toxicities, such as cytopenias/marrow hypoplasia, hypogammagloblinaemia and delayed immune reconstitution are recognised and require monitoring due to the implications for infection risk and prophylaxis. The detection or quantitation of circulating CAR-T can be clinically useful, and is achieved through both direct methods, if available, or indirect/surrogate methods. It is important that the laboratory is informed of the CAR-T therapy and target antigen whenever tissue is collected, both for response assessment and investigation of possible relapse, so that the expression of the relevant antigen can be assessed, in order to distinguish antigen-positive and -negative relapses. Finally, the measurement of circulating tumour DNA has an evolving role in the surveillance of malignancy, with evidence of its utility in the post-CAR-T setting, including predicting patients who will inevitably experience frank relapse, potentially allowing for pre-emptive therapy.
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Affiliation(s)
- Adrian G Selim
- Clinical Hematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; Centre of Excellence in Cellular Immunotherapy, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia
| | - Adrian Minson
- Clinical Hematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Vic, Australia
| | - Piers Blombery
- Clinical Hematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Vic, Australia
| | - Michael Dickinson
- Clinical Hematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Vic, Australia
| | - Simon J Harrison
- Clinical Hematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; Centre of Excellence in Cellular Immunotherapy, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Vic, Australia
| | - Mary Ann Anderson
- Clinical Hematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; Centre of Excellence in Cellular Immunotherapy, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; Division of Blood Cells and Blood Cancer, The Walter and Eliza Hall Institute, Parkville, Vic, Australia.
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23
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Handunnetti S, Anderson MA, Roberts AW, Davids MS, Ma S, Boyer M, Arzt J, Masud AA, Popovic R, Jacobson A, Kim SY, Seymour JF. Addition of rituximab in relapsed/refractory chronic lymphocytic leukemia after progression on venetoclax monotherapy. ACTA ACUST UNITED AC 2021; 2:266-271. [PMID: 35845292 PMCID: PMC9175959 DOI: 10.1002/jha2.177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Sasanka Handunnetti
- Clinical Haematology Department Peter MacCallum Cancer Centre and Royal Melbourne Hospital Melbourne Victoria Australia
- Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne Victoria Australia
| | - Mary Ann Anderson
- Clinical Haematology Department Peter MacCallum Cancer Centre and Royal Melbourne Hospital Melbourne Victoria Australia
- Division of Blood Cells and Blood Cancer Walter and Eliza Hall Institute of Medical Research Parkville Victoria Australia
| | - Andrew W. Roberts
- Clinical Haematology Department Peter MacCallum Cancer Centre and Royal Melbourne Hospital Melbourne Victoria Australia
- Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne Victoria Australia
- Division of Blood Cells and Blood Cancer Walter and Eliza Hall Institute of Medical Research Parkville Victoria Australia
| | - Matthew S. Davids
- Department of Medical Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Shuo Ma
- Robert H. Lurie Comprehensive Cancer Center Northwestern University Chicago Illinois USA
| | | | | | | | | | | | - Su Y. Kim
- AbbVie, Inc. North Chicago Illinois USA
| | - John F. Seymour
- Clinical Haematology Department Peter MacCallum Cancer Centre and Royal Melbourne Hospital Melbourne Victoria Australia
- Division of Blood Cells and Blood Cancer Walter and Eliza Hall Institute of Medical Research Parkville Victoria Australia
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24
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Affiliation(s)
- Mary Ann Anderson
- Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Australia
- Division of Blood Cells and Blood Cancer, The Walter and Eliza Hall Institute, Parkville, Australia
| | - John Francis Seymour
- Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Medicine Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
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25
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Lew TE, Anderson MA, Seymour JF. Promises and pitfalls of targeted agents in chronic lymphocytic leukemia. Cancer Drug Resist 2020; 3:415-444. [PMID: 35582452 PMCID: PMC8992498 DOI: 10.20517/cdr.2019.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/19/2020] [Accepted: 02/05/2020] [Indexed: 11/12/2022]
Abstract
Targeted agents have significantly improved outcomes for patients with chronic lymphocytic leukemia, particularly high-risk subgroups for whom chemoimmunotherapy previously offered limited efficacy. Two classes of agent in particular, the Bruton tyrosine kinase inhibitors (e.g., ibrutinib) and the B-cell lymphoma 2 inhibitor, venetoclax, induce high response rates and durable remissions in the relapsed/refractory and frontline settings. However, maturing clinical data have revealed promises and pitfalls for both agents. These drugs induce remissions and disease control in the majority of patients, often in situations where modest efficacy would be expected with traditional chemoimmunotherapy approaches. Unfortunately, in the relapsed and refractory setting, both agents appear to be associated with an inevitable risk of disease relapse and progression. Emerging patterns of resistance are being described for both agents but a common theme appears to be multiple sub-clonal drivers of disease progression. Understanding these mechanisms and developing effective and safe methods to circumvent the emergence of resistance will determine the longer-term utility of these agents to improve patients' quality and length of life. Rational drug combinations, optimised scheduling and sequencing of therapy will likely hold the key to achieving these important goals.
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Affiliation(s)
- Thomas E. Lew
- Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville 3050, Australia
- Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Parkville 3050, Australia
| | - Mary Ann Anderson
- Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville 3050, Australia
- Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Parkville 3050, Australia
| | - John F. Seymour
- Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville 3050, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville 3050, Australia
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26
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Anderson MA, Davids MS, Kater AP, Cochrane T, Demirkan F, Herishanu Y, Leber B, Nikitin E, Masud AA, Rosenberg TS, Sharmokh S, Fort S, Forconi F. Neutropenia analysis of venetoclax monotherapy in patients with relapsed or refractory chronic lymphocytic leukemia: Pooled data from VENICE-I and -II Phase IIIb trials. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e20011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20011 Background: Neutropenia is a common hematologic Grade (Gr) 3+ adverse event (AE) recorded in patients with chronic lymphocytic leukemia (CLL) receiving venetoclax (VEN). In this analysis, we evaluated fixed duration VEN monotherapy given to patients with relapsed or refractory (R/R) CLL with and without pre-existing Gr3+ neutropenia. Methods: This post-hoc analysis pooled data from patients in the ongoing Phase 3b trials VENICE-I and VENICE-II with R/R CLL who had received ≥1 dose of VEN monotherapy (ramp-up to 400 mg QD). Gr4 hematologic AEs and Gr3+ neutropenia ( < 1000 cells/mm3) with infection or fever were managed using dose interruption/reduction. Granulocyte colony stimulating factor (G-CSF) was used in Gr3+ neutropenia. Results: At data cutoff (June 30, 2019), 44/468 (9%) patients had Gr3+ neutropenia at baseline (BL; Gr3+ neutropenia group), 80% of whom received G-CSF during the study vs 38% of those with < Gr3 neutropenia at BL ( < Gr3 neutropenia group). Median on-study duration for VEN was 20.2 months (range: 0.1–36.1). Median number of prior CLL therapies was 2 for both groups (range: 1–10). Serious infections were experienced by 10/44 (23%) and 69/424 (16%) of patients in the Gr3+ and < Gr3 neutropenia groups, respectively. The most common AEs leading to discontinuation overall were second primary malignancies (13/468; 3%). 5/468 (1%) patients in the total population discontinued due to neutropenia/febrile neutropenia. One case of Gr5 infection with concomitant Gr3 neutropenia was reported in the < Gr3 neutropenia group post-VEN discontinuation. See Table. Conclusions: In this large post-hoc analysis, discontinuation due to neutropenia was rare (1%) in the overall population and accounted for 3/11 AE discontinuations in the Gr3+ neutropenia group; 10 patients had a serious infection. Patients with pre-existing neutropenia can be managed on VEN, though concurrent use of G-CSF is likely to be required. Additional data to follow. Clinical trial information: NCT02756611; NCT02980731 . [Table: see text]
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Affiliation(s)
- Mary Ann Anderson
- The Clinical Haematology Department of the Royal Melbourne Hospital and Peter MacCallum Cancer Centre, The Blood Cells and Blood Cancer Division of the Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | | | - Arnon P. Kater
- Department of Hematology, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Tara Cochrane
- Department of Haematology, Gold Coast University Hospital, Southport, Australia
| | - Fatih Demirkan
- Division of Hematology, Dokuz Eylül University Faculty of Medicine, Ìzmir, Turkey
| | - Yair Herishanu
- Department of Hematology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Brian Leber
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Eugene Nikitin
- Hematology Research Center of Russia, Moscow, Russian Federation
| | | | | | | | | | - Francesco Forconi
- Cancer Sciences Unit, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, University of Southampton, Haematology Department, Cancer Care Directorate, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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Thijssen R, Anderson MA, Teh C, Trussart M, Blombery P, Birkinshaw R, Gong J, Gray D, Huang D, Roberts A. RESISTANCE TO VENETOCLAX IN CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL). Exp Hematol 2019. [DOI: 10.1016/j.exphem.2019.06.445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stamm J, Joshi G, Anderson MA, Bussing K, Houchin C, Elinsky A, Flyte J, Husseini N, Jarosz D, Johnson C, Johnson A, Jones C, Kooner T, Myhre D, Rafaill T, Sayed S, Swan K, Toma J, Kagey J. Genetic mapping of EgfrL.3.1 in Drosophila melanogaster. MicroPubl Biol 2019; 2019. [PMID: 32550448 PMCID: PMC7252331 DOI: 10.17912/micropub.biology.000098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Joyce Stamm
- Department of Biology, University of Evansville
| | | | | | | | | | | | - Jacob Flyte
- Biology Department, University of Detroit Mercy
| | | | | | | | | | | | - Taj Kooner
- Biology Department, University of Detroit Mercy
| | | | | | - Sarah Sayed
- Biology Department, University of Detroit Mercy
| | - Kirby Swan
- Biology Department, University of Detroit Mercy
| | | | - Jacob Kagey
- Biology Department, University of Detroit Mercy
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Blombery P, Anderson MA, Gong JN, Thijssen R, Birkinshaw RW, Thompson ER, Teh CE, Nguyen T, Xu Z, Flensburg C, Lew TE, Majewski IJ, Gray DHD, Westerman DA, Tam CS, Seymour JF, Czabotar PE, Huang DCS, Roberts AW. Acquisition of the Recurrent Gly101Val Mutation in BCL2 Confers Resistance to Venetoclax in Patients with Progressive Chronic Lymphocytic Leukemia. Cancer Discov 2018; 9:342-353. [PMID: 30514704 DOI: 10.1158/2159-8290.cd-18-1119] [Citation(s) in RCA: 261] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/16/2022]
Abstract
The BCL2 inhibitor venetoclax induces high rates of durable remission in patients with previously treated chronic lymphocytic leukemia (CLL). However, despite continuous daily treatment, leukemia recurs in most patients. To investigate the mechanisms of secondary resistance, we analyzed paired pre-venetoclax and progression samples from 15 patients with CLL progression enrolled on venetoclax clinical trials. The novel Gly101Val mutation in BCL2 was identified at progression in 7 patients, but not at study entry. It was first detectable after 19 to 42 months of therapy, and its emergence anticipated clinical disease progression by many months. Gly101Val reduces the affinity of BCL2 for venetoclax by ∼180-fold in surface plasmon resonance assays, thereby preventing the drug from displacing proapoptotic mediators from BCL2 in cells and conferring acquired resistance in cell lines and primary patient cells. This mutation provides new insights into the pathobiology of venetoclax resistance and provides a potential biomarker of impending clinical relapse. SIGNIFICANCE: Why CLL recurs in patients who achieve remission with the BCL2 inhibitor venetoclax has been unknown. We provide the first description of an acquired point mutation in BCL2 arising recurrently and exclusively in venetoclax-treated patients. The mutation reduces venetoclax binding and is sufficient to confer resistance.See related commentary by Thangavadivel and Byrd, p. 320.This article is highlighted in the In This Issue feature, p. 305.
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Affiliation(s)
- Piers Blombery
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. .,Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Mary Ann Anderson
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.,The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jia-Nan Gong
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Thijssen
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard W Birkinshaw
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Ella R Thompson
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Charis E Teh
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Tamia Nguyen
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Zhen Xu
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Christoffer Flensburg
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Thomas E Lew
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Ian J Majewski
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Daniel H D Gray
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - David A Westerman
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Constantine S Tam
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - John F Seymour
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter E Czabotar
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - David C S Huang
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew W Roberts
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia. .,The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
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Agarwal R, Chan YC, Tam CS, Hunter T, Vassiliadis D, Teh CE, Thijssen R, Yeh P, Wong SQ, Ftouni S, Lam EYN, Anderson MA, Pott C, Gilan O, Bell CC, Knezevic K, Blombery P, Rayeroux K, Zordan A, Li J, Huang DCS, Wall M, Seymour JF, Gray DHD, Roberts AW, Dawson MA, Dawson SJ. Dynamic molecular monitoring reveals that SWI–SNF mutations mediate resistance to ibrutinib plus venetoclax in mantle cell lymphoma. Nat Med 2018; 25:119-129. [DOI: 10.1038/s41591-018-0243-z] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 09/21/2018] [Indexed: 11/09/2022]
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Tam CS, Anderson MA, Pott C, Agarwal R, Handunnetti S, Hicks RJ, Burbury K, Turner G, Di Iulio J, Bressel M, Westerman D, Lade S, Dreyling M, Dawson SJ, Dawson MA, Seymour JF, Roberts AW. Ibrutinib plus Venetoclax for the Treatment of Mantle-Cell Lymphoma. N Engl J Med 2018; 378:1211-1223. [PMID: 29590547 DOI: 10.1056/nejmoa1715519] [Citation(s) in RCA: 291] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Both the BTK inhibitor ibrutinib and the BCL2 inhibitor venetoclax are active as monotherapy in the treatment of mantle-cell lymphoma. Complete response rates of 21% have been observed for each agent when administered as long-term continuous therapy. Preclinical models predict synergy in combination. METHODS We conducted a single-group, phase 2 study of daily oral ibrutinib and venetoclax in patients, as compared with historical controls. Patients commenced ibrutinib monotherapy at a dose of 560 mg per day. After 4 weeks, venetoclax was added in stepwise, weekly increasing doses to 400 mg per day. Both drugs were continued until progression or an unacceptable level of adverse events. The primary end point was the rate of complete response at week 16. Minimal residual disease (MRD) was assessed by flow cytometry in bone marrow and by allele-specific oligonucleotide-polymerase chain reaction (ASO-PCR) in blood. RESULTS The study included 24 patients with relapsed or refractory mantle-cell lymphoma (23 patients) or previously untreated mantle-cell lymphoma (1 patient). Patients were 47 to 81 years of age, and the number of previous treatments ranged from none to six. Half the patients had aberrations of TP53, and 75% had a high-risk prognostic score. The complete response rate according to computed tomography at week 16 was 42%, which was higher than the historical result of 9% at this time point with ibrutinib monotherapy (P<0.001). The rate of complete response as assessed by positron-emission tomography was 62% at week 16 and 71% overall. MRD clearance was confirmed by flow cytometry in 67% of the patients and by ASO-PCR in 38%. In a time-to-event analysis, 78% of the patients with a response were estimated to have an ongoing response at 15 months. The tumor lysis syndrome occurred in 2 patients. Common side effects were generally low grade and included diarrhea (in 83% of the patients), fatigue (in 75%), and nausea or vomiting (in 71%). CONCLUSIONS In this study involving historical controls, dual targeting of BTK and BCL2 with ibrutinib and venetoclax was consistent with improved outcomes in patients with mantle-cell lymphoma who had been predicted to have poor outcomes with current therapy. (Funded by Janssen and others; AIM ClinicalTrials.gov number, NCT02471391 .).
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Affiliation(s)
- Constantine S Tam
- From the Peter MacCallum Cancer Centre, Melbourne, VIC (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., G.T., J.D.I., M.B., D.W., S.L., S.-J.D., M.A.D., J.F.S., A.W.R.), and the Victorian Comprehensive Cancer Centre (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., D.W., S.-J.D., M.A.D., J.F.S., A.W.R.), the Faculty of Medicine (C.S.T., R.J.H., S.-J.D., M.A.D., J.F.S., A.W.R.) and Centre for Cancer Research (S.-J.D., M.A.D.), University of Melbourne, the Department of Clinical Haematology and Bone Marrow Transplantation, the Royal Melbourne Hospital (C.S.T., M.A.A., K.B., J.F.S., A.W.R.), and the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (M.A.A., A.W.R.), Parkville, VIC - all in Australia; and the University Hospital of Schleswig-Holstein, Kiel (C.P.), and Klinikum der Universität, Ludwig-Maximilian University of Munich, Munich (M.D.) - both in Germany
| | - Mary Ann Anderson
- From the Peter MacCallum Cancer Centre, Melbourne, VIC (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., G.T., J.D.I., M.B., D.W., S.L., S.-J.D., M.A.D., J.F.S., A.W.R.), and the Victorian Comprehensive Cancer Centre (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., D.W., S.-J.D., M.A.D., J.F.S., A.W.R.), the Faculty of Medicine (C.S.T., R.J.H., S.-J.D., M.A.D., J.F.S., A.W.R.) and Centre for Cancer Research (S.-J.D., M.A.D.), University of Melbourne, the Department of Clinical Haematology and Bone Marrow Transplantation, the Royal Melbourne Hospital (C.S.T., M.A.A., K.B., J.F.S., A.W.R.), and the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (M.A.A., A.W.R.), Parkville, VIC - all in Australia; and the University Hospital of Schleswig-Holstein, Kiel (C.P.), and Klinikum der Universität, Ludwig-Maximilian University of Munich, Munich (M.D.) - both in Germany
| | - Christiane Pott
- From the Peter MacCallum Cancer Centre, Melbourne, VIC (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., G.T., J.D.I., M.B., D.W., S.L., S.-J.D., M.A.D., J.F.S., A.W.R.), and the Victorian Comprehensive Cancer Centre (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., D.W., S.-J.D., M.A.D., J.F.S., A.W.R.), the Faculty of Medicine (C.S.T., R.J.H., S.-J.D., M.A.D., J.F.S., A.W.R.) and Centre for Cancer Research (S.-J.D., M.A.D.), University of Melbourne, the Department of Clinical Haematology and Bone Marrow Transplantation, the Royal Melbourne Hospital (C.S.T., M.A.A., K.B., J.F.S., A.W.R.), and the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (M.A.A., A.W.R.), Parkville, VIC - all in Australia; and the University Hospital of Schleswig-Holstein, Kiel (C.P.), and Klinikum der Universität, Ludwig-Maximilian University of Munich, Munich (M.D.) - both in Germany
| | - Rishu Agarwal
- From the Peter MacCallum Cancer Centre, Melbourne, VIC (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., G.T., J.D.I., M.B., D.W., S.L., S.-J.D., M.A.D., J.F.S., A.W.R.), and the Victorian Comprehensive Cancer Centre (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., D.W., S.-J.D., M.A.D., J.F.S., A.W.R.), the Faculty of Medicine (C.S.T., R.J.H., S.-J.D., M.A.D., J.F.S., A.W.R.) and Centre for Cancer Research (S.-J.D., M.A.D.), University of Melbourne, the Department of Clinical Haematology and Bone Marrow Transplantation, the Royal Melbourne Hospital (C.S.T., M.A.A., K.B., J.F.S., A.W.R.), and the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (M.A.A., A.W.R.), Parkville, VIC - all in Australia; and the University Hospital of Schleswig-Holstein, Kiel (C.P.), and Klinikum der Universität, Ludwig-Maximilian University of Munich, Munich (M.D.) - both in Germany
| | - Sasanka Handunnetti
- From the Peter MacCallum Cancer Centre, Melbourne, VIC (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., G.T., J.D.I., M.B., D.W., S.L., S.-J.D., M.A.D., J.F.S., A.W.R.), and the Victorian Comprehensive Cancer Centre (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., D.W., S.-J.D., M.A.D., J.F.S., A.W.R.), the Faculty of Medicine (C.S.T., R.J.H., S.-J.D., M.A.D., J.F.S., A.W.R.) and Centre for Cancer Research (S.-J.D., M.A.D.), University of Melbourne, the Department of Clinical Haematology and Bone Marrow Transplantation, the Royal Melbourne Hospital (C.S.T., M.A.A., K.B., J.F.S., A.W.R.), and the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (M.A.A., A.W.R.), Parkville, VIC - all in Australia; and the University Hospital of Schleswig-Holstein, Kiel (C.P.), and Klinikum der Universität, Ludwig-Maximilian University of Munich, Munich (M.D.) - both in Germany
| | - Rodney J Hicks
- From the Peter MacCallum Cancer Centre, Melbourne, VIC (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., G.T., J.D.I., M.B., D.W., S.L., S.-J.D., M.A.D., J.F.S., A.W.R.), and the Victorian Comprehensive Cancer Centre (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., D.W., S.-J.D., M.A.D., J.F.S., A.W.R.), the Faculty of Medicine (C.S.T., R.J.H., S.-J.D., M.A.D., J.F.S., A.W.R.) and Centre for Cancer Research (S.-J.D., M.A.D.), University of Melbourne, the Department of Clinical Haematology and Bone Marrow Transplantation, the Royal Melbourne Hospital (C.S.T., M.A.A., K.B., J.F.S., A.W.R.), and the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (M.A.A., A.W.R.), Parkville, VIC - all in Australia; and the University Hospital of Schleswig-Holstein, Kiel (C.P.), and Klinikum der Universität, Ludwig-Maximilian University of Munich, Munich (M.D.) - both in Germany
| | - Kate Burbury
- From the Peter MacCallum Cancer Centre, Melbourne, VIC (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., G.T., J.D.I., M.B., D.W., S.L., S.-J.D., M.A.D., J.F.S., A.W.R.), and the Victorian Comprehensive Cancer Centre (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., D.W., S.-J.D., M.A.D., J.F.S., A.W.R.), the Faculty of Medicine (C.S.T., R.J.H., S.-J.D., M.A.D., J.F.S., A.W.R.) and Centre for Cancer Research (S.-J.D., M.A.D.), University of Melbourne, the Department of Clinical Haematology and Bone Marrow Transplantation, the Royal Melbourne Hospital (C.S.T., M.A.A., K.B., J.F.S., A.W.R.), and the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (M.A.A., A.W.R.), Parkville, VIC - all in Australia; and the University Hospital of Schleswig-Holstein, Kiel (C.P.), and Klinikum der Universität, Ludwig-Maximilian University of Munich, Munich (M.D.) - both in Germany
| | - Gillian Turner
- From the Peter MacCallum Cancer Centre, Melbourne, VIC (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., G.T., J.D.I., M.B., D.W., S.L., S.-J.D., M.A.D., J.F.S., A.W.R.), and the Victorian Comprehensive Cancer Centre (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., D.W., S.-J.D., M.A.D., J.F.S., A.W.R.), the Faculty of Medicine (C.S.T., R.J.H., S.-J.D., M.A.D., J.F.S., A.W.R.) and Centre for Cancer Research (S.-J.D., M.A.D.), University of Melbourne, the Department of Clinical Haematology and Bone Marrow Transplantation, the Royal Melbourne Hospital (C.S.T., M.A.A., K.B., J.F.S., A.W.R.), and the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (M.A.A., A.W.R.), Parkville, VIC - all in Australia; and the University Hospital of Schleswig-Holstein, Kiel (C.P.), and Klinikum der Universität, Ludwig-Maximilian University of Munich, Munich (M.D.) - both in Germany
| | - Juliana Di Iulio
- From the Peter MacCallum Cancer Centre, Melbourne, VIC (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., G.T., J.D.I., M.B., D.W., S.L., S.-J.D., M.A.D., J.F.S., A.W.R.), and the Victorian Comprehensive Cancer Centre (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., D.W., S.-J.D., M.A.D., J.F.S., A.W.R.), the Faculty of Medicine (C.S.T., R.J.H., S.-J.D., M.A.D., J.F.S., A.W.R.) and Centre for Cancer Research (S.-J.D., M.A.D.), University of Melbourne, the Department of Clinical Haematology and Bone Marrow Transplantation, the Royal Melbourne Hospital (C.S.T., M.A.A., K.B., J.F.S., A.W.R.), and the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (M.A.A., A.W.R.), Parkville, VIC - all in Australia; and the University Hospital of Schleswig-Holstein, Kiel (C.P.), and Klinikum der Universität, Ludwig-Maximilian University of Munich, Munich (M.D.) - both in Germany
| | - Mathias Bressel
- From the Peter MacCallum Cancer Centre, Melbourne, VIC (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., G.T., J.D.I., M.B., D.W., S.L., S.-J.D., M.A.D., J.F.S., A.W.R.), and the Victorian Comprehensive Cancer Centre (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., D.W., S.-J.D., M.A.D., J.F.S., A.W.R.), the Faculty of Medicine (C.S.T., R.J.H., S.-J.D., M.A.D., J.F.S., A.W.R.) and Centre for Cancer Research (S.-J.D., M.A.D.), University of Melbourne, the Department of Clinical Haematology and Bone Marrow Transplantation, the Royal Melbourne Hospital (C.S.T., M.A.A., K.B., J.F.S., A.W.R.), and the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (M.A.A., A.W.R.), Parkville, VIC - all in Australia; and the University Hospital of Schleswig-Holstein, Kiel (C.P.), and Klinikum der Universität, Ludwig-Maximilian University of Munich, Munich (M.D.) - both in Germany
| | - David Westerman
- From the Peter MacCallum Cancer Centre, Melbourne, VIC (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., G.T., J.D.I., M.B., D.W., S.L., S.-J.D., M.A.D., J.F.S., A.W.R.), and the Victorian Comprehensive Cancer Centre (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., D.W., S.-J.D., M.A.D., J.F.S., A.W.R.), the Faculty of Medicine (C.S.T., R.J.H., S.-J.D., M.A.D., J.F.S., A.W.R.) and Centre for Cancer Research (S.-J.D., M.A.D.), University of Melbourne, the Department of Clinical Haematology and Bone Marrow Transplantation, the Royal Melbourne Hospital (C.S.T., M.A.A., K.B., J.F.S., A.W.R.), and the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (M.A.A., A.W.R.), Parkville, VIC - all in Australia; and the University Hospital of Schleswig-Holstein, Kiel (C.P.), and Klinikum der Universität, Ludwig-Maximilian University of Munich, Munich (M.D.) - both in Germany
| | - Stephen Lade
- From the Peter MacCallum Cancer Centre, Melbourne, VIC (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., G.T., J.D.I., M.B., D.W., S.L., S.-J.D., M.A.D., J.F.S., A.W.R.), and the Victorian Comprehensive Cancer Centre (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., D.W., S.-J.D., M.A.D., J.F.S., A.W.R.), the Faculty of Medicine (C.S.T., R.J.H., S.-J.D., M.A.D., J.F.S., A.W.R.) and Centre for Cancer Research (S.-J.D., M.A.D.), University of Melbourne, the Department of Clinical Haematology and Bone Marrow Transplantation, the Royal Melbourne Hospital (C.S.T., M.A.A., K.B., J.F.S., A.W.R.), and the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (M.A.A., A.W.R.), Parkville, VIC - all in Australia; and the University Hospital of Schleswig-Holstein, Kiel (C.P.), and Klinikum der Universität, Ludwig-Maximilian University of Munich, Munich (M.D.) - both in Germany
| | - Martin Dreyling
- From the Peter MacCallum Cancer Centre, Melbourne, VIC (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., G.T., J.D.I., M.B., D.W., S.L., S.-J.D., M.A.D., J.F.S., A.W.R.), and the Victorian Comprehensive Cancer Centre (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., D.W., S.-J.D., M.A.D., J.F.S., A.W.R.), the Faculty of Medicine (C.S.T., R.J.H., S.-J.D., M.A.D., J.F.S., A.W.R.) and Centre for Cancer Research (S.-J.D., M.A.D.), University of Melbourne, the Department of Clinical Haematology and Bone Marrow Transplantation, the Royal Melbourne Hospital (C.S.T., M.A.A., K.B., J.F.S., A.W.R.), and the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (M.A.A., A.W.R.), Parkville, VIC - all in Australia; and the University Hospital of Schleswig-Holstein, Kiel (C.P.), and Klinikum der Universität, Ludwig-Maximilian University of Munich, Munich (M.D.) - both in Germany
| | - Sarah-Jane Dawson
- From the Peter MacCallum Cancer Centre, Melbourne, VIC (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., G.T., J.D.I., M.B., D.W., S.L., S.-J.D., M.A.D., J.F.S., A.W.R.), and the Victorian Comprehensive Cancer Centre (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., D.W., S.-J.D., M.A.D., J.F.S., A.W.R.), the Faculty of Medicine (C.S.T., R.J.H., S.-J.D., M.A.D., J.F.S., A.W.R.) and Centre for Cancer Research (S.-J.D., M.A.D.), University of Melbourne, the Department of Clinical Haematology and Bone Marrow Transplantation, the Royal Melbourne Hospital (C.S.T., M.A.A., K.B., J.F.S., A.W.R.), and the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (M.A.A., A.W.R.), Parkville, VIC - all in Australia; and the University Hospital of Schleswig-Holstein, Kiel (C.P.), and Klinikum der Universität, Ludwig-Maximilian University of Munich, Munich (M.D.) - both in Germany
| | - Mark A Dawson
- From the Peter MacCallum Cancer Centre, Melbourne, VIC (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., G.T., J.D.I., M.B., D.W., S.L., S.-J.D., M.A.D., J.F.S., A.W.R.), and the Victorian Comprehensive Cancer Centre (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., D.W., S.-J.D., M.A.D., J.F.S., A.W.R.), the Faculty of Medicine (C.S.T., R.J.H., S.-J.D., M.A.D., J.F.S., A.W.R.) and Centre for Cancer Research (S.-J.D., M.A.D.), University of Melbourne, the Department of Clinical Haematology and Bone Marrow Transplantation, the Royal Melbourne Hospital (C.S.T., M.A.A., K.B., J.F.S., A.W.R.), and the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (M.A.A., A.W.R.), Parkville, VIC - all in Australia; and the University Hospital of Schleswig-Holstein, Kiel (C.P.), and Klinikum der Universität, Ludwig-Maximilian University of Munich, Munich (M.D.) - both in Germany
| | - John F Seymour
- From the Peter MacCallum Cancer Centre, Melbourne, VIC (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., G.T., J.D.I., M.B., D.W., S.L., S.-J.D., M.A.D., J.F.S., A.W.R.), and the Victorian Comprehensive Cancer Centre (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., D.W., S.-J.D., M.A.D., J.F.S., A.W.R.), the Faculty of Medicine (C.S.T., R.J.H., S.-J.D., M.A.D., J.F.S., A.W.R.) and Centre for Cancer Research (S.-J.D., M.A.D.), University of Melbourne, the Department of Clinical Haematology and Bone Marrow Transplantation, the Royal Melbourne Hospital (C.S.T., M.A.A., K.B., J.F.S., A.W.R.), and the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (M.A.A., A.W.R.), Parkville, VIC - all in Australia; and the University Hospital of Schleswig-Holstein, Kiel (C.P.), and Klinikum der Universität, Ludwig-Maximilian University of Munich, Munich (M.D.) - both in Germany
| | - Andrew W Roberts
- From the Peter MacCallum Cancer Centre, Melbourne, VIC (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., G.T., J.D.I., M.B., D.W., S.L., S.-J.D., M.A.D., J.F.S., A.W.R.), and the Victorian Comprehensive Cancer Centre (C.S.T., M.A.A., R.A., S.H., R.J.H., K.B., D.W., S.-J.D., M.A.D., J.F.S., A.W.R.), the Faculty of Medicine (C.S.T., R.J.H., S.-J.D., M.A.D., J.F.S., A.W.R.) and Centre for Cancer Research (S.-J.D., M.A.D.), University of Melbourne, the Department of Clinical Haematology and Bone Marrow Transplantation, the Royal Melbourne Hospital (C.S.T., M.A.A., K.B., J.F.S., A.W.R.), and the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (M.A.A., A.W.R.), Parkville, VIC - all in Australia; and the University Hospital of Schleswig-Holstein, Kiel (C.P.), and Klinikum der Universität, Ludwig-Maximilian University of Munich, Munich (M.D.) - both in Germany
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Tam CSL, Roberts AW, Anderson MA, Dawson SJ, Hicks RJ, Burbury K, Turner G, Di Iulio J, Bressel M, Westerman DA, Agarwal R, Pott C, Dreyling MH, Dawson MA, Seymour JF. Combination ibrutinib (Ibr) and venetoclax (Ven) for the treatment of mantle cell lymphoma (MCL): Primary endpoint assessment of the phase 2 AIM study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.7520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7520 Background: Both ibr and ven have activity in relapsed/refractory (R/R) MCL, but complete remissions (CR) are attained in <25% with either. We sought to determine the activity of the combination in an investigator-initiated, phase 2 study. Methods: Enrolment of 24 patients (pts) with R/R (n=23) or frontline (n=1) MCL completed in 09/16. Pts received 4 weeks of ibr (560mg/d), followed by introduction of ven (weekly ramp-up to target 400mg/d). The primary endpoint was CR rate at week 16, as assessed by PET/CT, BMAT, flow & molecular MRD, and endoscopy (if baseline gut involvement). Response was calculated separately with and without knowledge of the PET result by IWG criteria (Cheson JCO 2007), in order to compare with published studies (ibr, 9% CR at wk16; ven, best CR rate 21%). Results: Median age of pts was 68 (range, 47-81) years. For the R/R pts (n=23), median lines of prior therapy was 2 (1-6), 48% were refractory to last treatment, and 30% had failed previous autologous SCT. As of data cutoff on Jan 11 2017, 18 pts remain on therapy, and 6 stopped treatment due to progressive disease (4), adverse event (1) or unrelated death (1). At week 16, ORR was 71% (63% CR) and 80% of complete responders were flow-cytometry negative in the marrow (sensitivity 10-3 to 10-4). Using CT without PET, the comparison responses were CR 42%, CRu 17%, PR 17% (ORR 78%). After a median follow-up of 8.3 (range 1.4-17.7) months, the 8-month estimates of PFS and OS months are 74% and 81%. Adverse events ≥20%, irrespective of attribution, were fatigue (71%), diarrhea (67%), nausea (50%), URTI (38%), gastro-esophageal reflux (33%), neutropenia (33%), cough (25%) and bruising (21%); with the exception of neutropenia (25% grade 3-4), these were predominantly grade 1-2 in severity. Tumour lysis syndrome occurred in 2 pts with high tumour burden, leading to revision of the protocol ven starting dose from 50mg, to 20mg/d. Conclusions: The combination of ibr and ven was tolerable and achieved CR rate of 63% at week 16 in pts with MCL. The efficacy results compare favorably with historical results, and warrant further phase III investigation. Clinical trial information: NCT02471391.
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Affiliation(s)
- Constantine Si Lun Tam
- Peter MacCallum Cancer Centre; St Vincent's Hospital; University of Melbourne, Melbourne, Australia
| | | | - Mary Ann Anderson
- Royal Melbourne Hospital; Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | | | - Rodney J Hicks
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kate Burbury
- Peter MacCallum Cancer Centre, Melbourne, Australia
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Davids MS, Roberts AW, Seymour JF, Pagel JM, Kahl BS, Wierda WG, Puvvada S, Kipps TJ, Anderson MA, Salem AH, Dunbar M, Zhu M, Peale F, Ross JA, Gressick L, Desai M, Kim SY, Verdugo M, Humerickhouse RA, Gordon GB, Gerecitano JF. Phase I First-in-Human Study of Venetoclax in Patients With Relapsed or Refractory Non-Hodgkin Lymphoma. J Clin Oncol 2017; 35:826-833. [PMID: 28095146 DOI: 10.1200/jco.2016.70.4320] [Citation(s) in RCA: 516] [Impact Index Per Article: 73.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose B-cell leukemia/lymphoma-2 (BCL-2) overexpression is common in many non-Hodgkin lymphoma (NHL) subtypes. A phase I trial in patients with NHL was conducted to determine safety, pharmacokinetics, and efficacy of venetoclax, a selective, potent, orally bioavailable BCL-2 inhibitor. Patients and Methods A total of 106 patients with relapsed or refractory NHL received venetoclax once daily until progressive disease or unacceptable toxicity at target doses from 200 to 1,200 mg in dose-escalation and safety expansion cohorts. Treatment commenced with a 3-week dose ramp-up period for most patients in dose-escalation cohorts and for all patients in safety expansion. Results NHL subtypes included mantle cell lymphoma (MCL; n = 28), follicular lymphoma (FL; n = 29), diffuse large B-cell lymphoma (DLBCL; n = 34), DLBCL arising from chronic lymphocytic leukemia (Richter transformation; n = 7), Waldenström macroglobulinemia (n = 4), and marginal zone lymphoma (n = 3). Venetoclax was generally well tolerated. Clinical tumor lysis syndrome was not observed, whereas laboratory tumor lysis syndrome was documented in three patients. Treatment-emergent adverse events were reported in 103 patients (97%), a majority of which were grade 1 to 2 in severity. Grade 3 to 4 events were reported in 59 patients (56%), and the most common were hematologic, including anemia (15%), neutropenia (11%), and thrombocytopenia (9%). Overall response rate was 44% (MCL, 75%; FL, 38%; DLBCL, 18%). Estimated median progression-free survival was 6 months (MCL, 14 months; FL, 11 months; DLBCL, 1 month). Conclusion Selective targeting of BCL-2 with venetoclax was well tolerated, and single-agent activity varied among NHL subtypes. We determined 1,200 mg to be the recommended single-agent dose for future studies in FL and DLBCL, with 800 mg being sufficient to consistently achieve durable response in MCL. Additional investigations including combination therapy to augment response rates and durability are ongoing.
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Affiliation(s)
- Matthew S Davids
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Andrew W Roberts
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - John F Seymour
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - John M Pagel
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Brad S Kahl
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - William G Wierda
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Soham Puvvada
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Thomas J Kipps
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Mary Ann Anderson
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Ahmed Hamed Salem
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Martin Dunbar
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Ming Zhu
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Franklin Peale
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Jeremy A Ross
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Lori Gressick
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Monali Desai
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Su Young Kim
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Maria Verdugo
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Rod A Humerickhouse
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Gary B Gordon
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - John F Gerecitano
- Matthew S. Davids, Dana-Farber Cancer Institute, Boston, MA; Andrew W. Roberts, John F. Seymour, and Mary Ann Anderson, University of Melbourne; Andrew W. Roberts and Mary Ann Anderson, Royal Melbourne Hospital and Eliza Hall Institute of Medical Research; and John F. Seymour, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; John M. Pagel, Swedish Cancer Institute, Seattle, WA; Brad S. Kahl, Washington University Medical School, St Louis, MO; William G. Wierda, University of Texas MD Anderson Cancer Center, Houston, TX; Soham Puvvada, University of Arizona, Tucson, AZ; Thomas J. Kipps, University of California San Diego, San Diego, CA; Ahmed Hamed Salem, Martin Dunbar, Ming Zhu, Jeremy A. Ross, Lori Gressick, Monali Desai, Su Young Kim, Maria Verdugo, Rod A. Humerickhouse, and Gary B. Gordon, AbbVie, Chicago, IL; Ahmed Hamed Salem, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; Franklin Peale, Genentech, South San Francisco, CA; John F. Gerecitano, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
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Seymour JF, Ma S, Brander DM, Choi MY, Barrientos J, Davids MS, Anderson MA, Beaven AW, Rosen ST, Tam CS, Prine B, Agarwal SK, Munasinghe W, Zhu M, Lash LL, Desai M, Cerri E, Verdugo M, Kim SY, Humerickhouse RA, Gordon GB, Kipps TJ, Roberts AW. Venetoclax plus rituximab in relapsed or refractory chronic lymphocytic leukaemia: a phase 1b study. Lancet Oncol 2017; 18:230-240. [PMID: 28089635 DOI: 10.1016/s1470-2045(17)30012-8] [Citation(s) in RCA: 245] [Impact Index Per Article: 35.0] [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: 09/03/2016] [Revised: 10/26/2016] [Accepted: 10/28/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Selective BCL2 inhibition with venetoclax has substantial activity in patients with relapsed or refractory chronic lymphocytic leukaemia. Combination therapy with rituximab enhanced activity in preclinical models. The aim of this study was to assess the safety, pharmacokinetics, and activity of venetoclax in combination with rituximab. METHODS Adult patients with relapsed or refractory chronic lymphocytic leukaemia (according to the 2008 Modified International Workshop on CLL guidelines) or small lymphocytic lymphoma were eligible for this phase 1b, dose-escalation trial. The primary outcomes were to assess the safety profile, to determine the maximum tolerated dose, and to establish the recommended phase 2 dose of venetoclax when given in combination with rituximab. Secondary outcomes were to assess the pharmacokinetic profile and analyse efficacy, including overall response, duration of response, and time to tumour progression. Minimal residual disease was a protocol-specified exploratory objective. Central review of the endpoints was not done. Venetoclax was dosed daily using a stepwise escalation to target doses (200-600 mg) and then monthly rituximab commenced (375 mg/m2 in month 1 and 500 mg/m2 in months 2-6). Adverse events were graded according to the National Cancer Institute Common Terminology Criteria for adverse events version 4.0. Protocol-guided drug cessation was allowed for patients who achieved complete response (including complete response with incomplete marrow recovery) or negative bone marrow minimal residual disease. Analyses were done per protocol for all patients who commenced drug and included all patients who received at least one dose of venetoclax. Data were pooled across dose cohorts. Patients are still receiving therapy and follow-up is ongoing. The trial is registered at ClinicalTrials.gov, number NCT01682616. FINDINGS Between Aug 6, 2012, and May 28, 2014, we enrolled 49 patients. Common grade 1-2 toxicities included upper respiratory tract infections (in 28 [57%] of 49 patients), diarrhoea (27 [55%]), and nausea (25 [51%]). Grade 3-4 adverse events occurred in 37 (76%) of 49 patients; most common were neutropenia (26 [53%]), thrombocytopenia (eight [16%]), anaemia (seven [14%]), febrile neutropenia (six [12%]), and leucopenia (six [12%]). The most common serious adverse events were pyrexia (six [12%]), febrile neutropenia (five [10%]), lower respiratory tract infection, and pneumonia (each three [6%]). Clinical tumour lysis syndrome occurred in two patients (resulting in one death) who initiated venetoclax at 50 mg. After enhancing tumour lysis syndrome prophylaxis measures and commencing venetoclax at 20 mg, clinical tumour lysis syndrome did not occur. The maximum tolerated dose was not identified; the recommended phase 2 dose of venetoclax in combination with rituximab was 400 mg. Overall, 42 (86%) of 49 patients achieved a response, including a complete response in 25 (51%) of 49 patients. 2 year estimates for progression-free survival and ongoing response were 82% (95% CI 66-91) and 89% (95% CI 72-96), respectively. Negative marrow minimal residual disease was attained in 20 (80%) of 25 complete responders and 28 (57%) of 49 patients overall. 13 responders ceased all therapy; among these all 11 minimal residual disease-negative responders remain progression-free off therapy. Two with minimal residual disease-positive complete response progressed after 24 months off therapy and re-attained response after re-initiation of venetoclax. INTERPRETATION A substantial proportion of patients achieved an overall response with the combination of venetoclax and rituximab including 25 (51%) of 49 patients who achieved a complete response and 28 (57%) of 49 patients who achieved negative marrow minimal residual disease with acceptable safety. The depth and durability of responses observed with the combination offers an attractive potential treatment option for patients with relapsed or refractory chronic lymphocytic leukaemia and could allow some patients to maintain response after discontinuing therapy, a strategy that warrants further investigation in randomised studies. FUNDING AbbVie Inc and Genentech Inc.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bridged Bicyclo Compounds, Heterocyclic/administration & dosage
- Cohort Studies
- Drug Resistance, Neoplasm/drug effects
- Female
- Follow-Up Studies
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Maximum Tolerated Dose
- Middle Aged
- Neoplasm Grading
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/pathology
- Prognosis
- Remission Induction
- Rituximab/administration & dosage
- Salvage Therapy
- Sulfonamides/administration & dosage
- Survival Rate
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Affiliation(s)
- John F Seymour
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Parkville, Melbourne, VIC, Australia; Faculty of Medicine, University of Melbourne, Parkville, Melbourne, VIC, Australia.
| | - Shuo Ma
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Mary Ann Anderson
- Department of Clinical Haematology and BMT, The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia; Division of Cancer and Haematology, The Walter and Eliza Hall Institute of Medical Research, Parkville, Melbourne, VIC, Australia
| | | | | | - Constantine S Tam
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Parkville, Melbourne, VIC, Australia; Faculty of Medicine, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | | | | | | | - Ming Zhu
- AbbVie, Inc, North Chicago, IL, USA
| | | | | | | | | | | | | | | | | | - Andrew W Roberts
- Victorian Comprehensive Cancer Centre, Parkville, Melbourne, VIC, Australia; Faculty of Medicine, University of Melbourne, Parkville, Melbourne, VIC, Australia; Department of Clinical Haematology and BMT, The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia; Division of Cancer and Haematology, The Walter and Eliza Hall Institute of Medical Research, Parkville, Melbourne, VIC, Australia
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Anderson MA, Mann MD, Evans MA, Sparks-Thissen RL. The inner membrane protein YhiM is necessary for Escherichia coli growth at high temperatures and low osmolarity. Arch Microbiol 2016; 199:171-175. [PMID: 27629277 DOI: 10.1007/s00203-016-1288-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/16/2016] [Accepted: 09/01/2016] [Indexed: 11/30/2022]
Abstract
To survive, Escherichia coli must be able to survive in rapidly changing environmental conditions including changes in temperature and osmolarity. We have studied the role of the inner membrane protein YhiM in changing environmental conditions. Our data indicate that YhiM is required for normal growth at 37 and 41 °C but not 21 °C. YhiM-deficient cells grown at high temperatures spend more time in lag phase and stop growing at lower cell densities in comparison with their wild-type counterparts. They also have growth defects in low NaCl medium at 37 °C and do not grow at all at 41 °C. The effects of low NaCl can be rescued by addition of KCl or sucrose to the low salt medium. Finally, YhiM-deficient cells fail to grow in dilute medium at 41 °C. These data suggest that YhiM may be important in protecting the cells from changes in temperature and osmolarity.
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Affiliation(s)
- M A Anderson
- Department of Biology, University of Southern Indiana, 8600 University Blvd, Evansville, IN, 47712, USA
| | - M D Mann
- Department of Biology, University of Southern Indiana, 8600 University Blvd, Evansville, IN, 47712, USA
| | - M A Evans
- Department of Biology, University of Southern Indiana, 8600 University Blvd, Evansville, IN, 47712, USA
| | - R L Sparks-Thissen
- Department of Biology, University of Southern Indiana, 8600 University Blvd, Evansville, IN, 47712, USA.
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Tam CSL, Roberts AW, Anderson MA, Dawson SJ, Hicks RJ, Pott C, Westerman DA, Burke G, Kamel S, Dreyling MH, Dawson MA, Seymour JF. The combination of ibrutinib and venetoclax (ABT-199) to achieve complete remissions in patients with relapsed/refractory mantle cell lymphoma: Preliminary results of the phase II AIM study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7548] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Mary Ann Anderson
- Royal Melbourne Hospital; Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | | | | | | | | | - Glenda Burke
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Martin H. Dreyling
- Medizinische Klinik und Poliklinik III Klinikum der Universität München, München, Germany
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Abstract
High-grade B-cell lymphomas with recurrent chromosomal break points have been termed 'double hit lymphoma' (DHL). The most commonly seen DHL is diffuse large B-cell lymphoma (DLBCL) with t(14;18) and t(8;14) or t(8;22) resulting in overexpression of BCL2 and MYC, respectively. The increased proliferation due to MYC overexpression, without the ability for an apoptotic brake as a result of BCL2 overexpression, results in 'the perfect storm of oncogenesis'. Thus this disease presents a number of diagnostic and therapeutic challenges for the hematologist. The first and foremost challenge is to recognize the DHL. As different morphological entities can be affected it is incumbent on pathologists and clinicians to maintain a high index of suspicion especially in disease that appears unusually aggressive or refractory to therapy. Diagnosis by fluorescence in situ hybridization (FISH) is a sensitive and specific method for detection of the disease but is time-consuming and expensive. While detection by immunohistochemistry (IHC) is sensitive and correlates with survival, standardized methods for this are not widely agreed upon. The second and equally important challenge in DHL is optimizing clinical outcome in a group of patients for whom the prognosis is widely regarded as poor. While improvements have been achieved by dose escalating standard chemotherapeutic regimens, many patients continue to do badly. Furthermore as a disease of aging many patients are unsuitable for dose-intensive chemotherapy regimens. There are now multiple novel targeted agents in various stages of clinical development that offer hope for better outcomes without undue toxicity. Among the most exciting of these developments include specific inhibitors of both BCL2 and MYC.
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Affiliation(s)
- Mary Ann Anderson
- The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade Parkville, Victoria 3052, Australia
| | - Alpha Tsui
- Department of Pathology, Royal Melbourne Hospital, Parkville, Australia
| | - Meaghan Wall
- Victorian Cancer Cytogenetics Service, St Vincent's Hospital, Fitzroy, Australia
| | - David C S Huang
- Departments of Medical Biology and Medicine, Faculty of Medicine, University of Melbourne, Parkville, Australia
| | - Andrew W Roberts
- Department of Clinical Hematology and Bone Marrow Transplant, Royal Melbourne Hospital, Parkville, Australia
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Roberts AW, Davids MS, Pagel JM, Kahl BS, Puvvada SD, Gerecitano JF, Kipps TJ, Anderson MA, Brown JR, Gressick L, Wong S, Dunbar M, Zhu M, Desai MB, Cerri E, Heitner Enschede S, Humerickhouse RA, Wierda WG, Seymour JF. Targeting BCL2 with Venetoclax in Relapsed Chronic Lymphocytic Leukemia. N Engl J Med 2016; 374:311-22. [PMID: 26639348 PMCID: PMC7107002 DOI: 10.1056/nejmoa1513257] [Citation(s) in RCA: 1328] [Impact Index Per Article: 166.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND New treatments have improved outcomes for patients with relapsed chronic lymphocytic leukemia (CLL), but complete remissions remain uncommon. Venetoclax has a distinct mechanism of action; it targets BCL2, a protein central to the survival of CLL cells. METHODS We conducted a phase 1 dose-escalation study of daily oral venetoclax in patients with relapsed or refractory CLL or small lymphocytic lymphoma (SLL) to assess safety, pharmacokinetic profile, and efficacy. In the dose-escalation phase, 56 patients received active treatment in one of eight dose groups that ranged from 150 to 1200 mg per day. In an expansion cohort, 60 additional patients were treated with a weekly stepwise ramp-up in doses as high as 400 mg per day. RESULTS The majority of the study patients had received multiple previous treatments, and 89% had poor prognostic clinical or genetic features. Venetoclax was active at all dose levels. Clinical tumor lysis syndrome occurred in 3 of 56 patients in the dose-escalation cohort, with one death. After adjustments to the dose-escalation schedule, clinical tumor lysis syndrome did not occur in any of the 60 patients in the expansion cohort. Other toxic effects included mild diarrhea (in 52% of the patients), upper respiratory tract infection (in 48%), nausea (in 47%), and grade 3 or 4 neutropenia (in 41%). A maximum tolerated dose was not identified. Among the 116 patients who received venetoclax, 92 (79%) had a response. Response rates ranged from 71 to 79% among patients in subgroups with an adverse prognosis, including those with resistance to fludarabine, those with chromosome 17p deletions (deletion 17p CLL), and those with unmutated IGHV. Complete remissions occurred in 20% of the patients, including 5% who had no minimal residual disease on flow cytometry. The 15-month progression-free survival estimate for the 400-mg dose groups was 69%. CONCLUSIONS Selective targeting of BCL2 with venetoclax had a manageable safety profile and induced substantial responses in patients with relapsed CLL or SLL, including those with poor prognostic features. (Funded by AbbVie and Genentech; ClinicalTrials.gov number, NCT01328626.).
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Affiliation(s)
- Andrew W Roberts
- From the Department of Clinical Haematology and the Bone Marrow Transplantation Unit, Royal Melbourne Hospital (A.W.R., M.A.A.), the Division of Cancer and Haematology, Walter and Eliza Hall Institute of Medical Research (A.W.R., M.A.A.), and the Victorian Comprehensive Cancer Centre (A.W.R., J.F.S.), Parkville, VIC, and the University of Melbourne (A.W.R., J.F.S.) and Peter MacCallum Cancer Centre (J.F.S.), Melbourne, VIC - all in Australia; Dana-Farber Cancer Institute, Boston (M.S.D., J.R.B.); the Swedish Medical Center, Seattle (J.M.P.); Washington University, St. Louis (B.S.K.); University of Arizona, Tucson (S.D.P.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (J.F.G.); University of California, San Diego, San Diego (T.J.K.); AbbVie, North Chicago, IL (L.G., S.W., M.D., M.Z., M.B.D., E.C., S.H.E., R.A.H.); and University of Texas M.D. Anderson Cancer Center, Houston (W.G.W.)
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Affiliation(s)
- Mary Ann Anderson
- Division of Cancer and Haematology, The Walter and Eliza Hall Institute of Medical Research , Parkville , Australia
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Abstract
Objective: The aim of this study was to describe the emotional intelligence (EI) and examine the corresponding demographic characteristics of front-line Nurse Managers in acute care settings. Methods: This quantitative descriptive study was conducted in eight acute care hospitals in the Midwestern United States. The Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT) was used to measure the EI of 87 front-line Nurse Managers. Demographic characteristics of the participants were captured on a second tool, the Nurse Manager Demographic Characteristics questionnaire. Descriptive and inferential statistics were used for analysis. Results: Significant correlations were found between the perceiving and using branches of the model and total EI score and nurses certified in a specialty. No significant correlations were found between EI and graduate education, age, years in management, percentage of time in management or number of direct reports. Considerations for future research are discussed. Conclusions: Opportunity exists to develop EI in front-line Nurse Managers.
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Affiliation(s)
- Susan M Ohlson
- Hawaii Pacific Health, Pali Momi Medical Center, Aiea Hawaii, HI, USA
| | - Mary Ann Anderson
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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Seymour JF, Davids MS, Pagel JM, Kahl BS, Wierda WG, Puvvada S, Gerecitano JF, Kipps TJ, Anderson MA, Huang DC, Rudersdorf N, Gressick LA, Montalvo NP, Yang J, Zhu M, Dunbar M, Cerri E, Enschede SH, Humerickhouse R, Roberts AW. ABT-199 (GDC-0199) in relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL): High complete- response rate and durable disease control. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7015] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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)
| | | | | | - Brad S. Kahl
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | | | | | - Thomas J. Kipps
- University of California, San Diego, School of Medicine, San Diego, CA
| | - Mary Ann Anderson
- Royal Melbourne Hospital; Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - David C.S. Huang
- Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
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Davids MS, Seymour JF, Gerecitano JF, Kahl BS, Pagel JM, Wierda WG, Anderson MA, Rudersdorf N, Gressick LA, Montalvo NP, Yang J, Zhu M, Dunbar M, Cerri E, Enschede SH, Humerickhouse R, Roberts AW. Phase I study of ABT-199 (GDC-0199) in patients with relapsed/refractory (R/R) non-Hodgkin lymphoma (NHL): Responses observed in diffuse large B-cell (DLBCL) and follicular lymphoma (FL) at higher cohort doses. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8522] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [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)
| | | | | | - Brad S. Kahl
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | | | - Mary Ann Anderson
- Royal Melbourne Hospital; Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
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Anderson MA, Glazebrook B, Cutts B, Stevenson L, Bielby L, Borosak M. When do we transfuse cryoprecipitate? Intern Med J 2014; 43:896-902. [PMID: 23425520 DOI: 10.1111/imj.12104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 02/08/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The 2001 National Health and Medical Research Council/Australasian Society of Blood Transfusion Clinical Practice Guidelines for cryoprecipitate are being updated, and cryoprecipitate has been incorporated into new Patient Blood Management modules. AIMS This clinical audit sought to clarify current cryoprecipitate use in Victoria, Tasmania and the Australian Capital Territory; assess adherence to guidelines; and gain insights into deviations from recommended practice. This information can be utilised in updating guidelines to make them more relevant, to identify areas for clinician education and to form a baseline of practice prior to release of the 2011 guidelines. METHODS Participating institutions were invited to audit up to 30 consecutive episodes of cryoprecipitate transfusion over an 11-month period in 2008. The audits were conducted using a standardised pro forma and involved review of patient records. These were collated electronically using algorithms to determine alignment versus non-alignment with guidelines. RESULTS Cryoprecipitate is used in a variety of situations with surgery accounting for the highest volume. Twenty-six per cent (26%) of transfusions were aligned with 2001 guidelines rising to 61% with a modified fibrinogen trigger. Fibrinogen levels did not appear to dictate all clinical decisions regarding cryoprecipitate use perhaps owing to the acuity of many cases. Additional bleeding risk together with low fibrinogen levels (e.g. thrombocytopenic patients) may contribute to empiric cryoprecipitate use. CONCLUSIONS These results highlight discrepancies between guidelines and practice, providing rationale for the update of the guidelines that is currently underway. Cryoprecipitate has attendant risks, and it is appropriate that transfusion be restricted to situations with good evidence or sound principles to underpin use.
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Affiliation(s)
- M A Anderson
- Transfusion Medicine, Australian Red Cross Blood Service, Melbourne, Victoria, Australia
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Seymour JF, Davids MS, Pagel JM, Kahl BS, Wierda WG, Miller TP, Gerecitano JF, Kipps TJ, Anderson MA, Huang DC, Darden DE, Gressick LA, Nolan CE, Yang J, Busman TA, Graham AM, Cerri E, Enschede SH, Humerickhouse RA, Roberts AW. Updated results of a phase I first-in-human study of the BCL-2 inhibitor ABT-199 (GDC-0199) in patients with relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.7018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7018 Background: Targeting BCL-2 is a promising strategy for treating CLL, including disease refractory to fludarabine (F), or with (del(17p). ABT-199 is a selective BCL-2 inhibitor with >500-fold higher affinity for BCL-2 (Ki<0.10 nM) than for BCL-XL (Ki=48 nM). Methods: Objectives of this Ph I dose-escalation study include evaluations of safety, pharmacokinetics and preliminary efficacy of ABT-199 in patients (pts) with R/R CLL. A single oral dose was given followed by 6 days off drug, before continuous once daily dosing. After cohort 1, the initial dose was reduced and daily dosing modified to include a 2 or 3 step dose-escalation to the target dose for each cohort. Results: As of January 11, 2013, 56 pts have been enrolled; median age 67 y (range 36-86); 41 males; median 3.5 prior therapies (range 1-10). 16 (29%) had del(17p) and 18 (32%) F-refractory CLL. Median follow up is 6.3 months (range 0.03-16.5); 7 pts have been on study for more than 1 yr. 13 pts discontinued; 7 due to PD, 6 for other reasons: tumor lysis syndrome (TLS; 2), other illness (2), thromboembolic event (1), consent withdrawal (1). The most common non-hematological AEs (>15% pts) were nausea (36%), diarrhea (30%), fatigue (25%), upper respiratory tract infection (23%), and cough (16%). Grade 3/4 AEs occurring in > 5 pts were neutropenia 21(38%), thrombocytopenia 6 (11%) and TLS 5 (9%). TLS occurred in 3/3 pts in cohort 1 and 2/53 pts with the modified stepped dosing schedule (DLTs). Additionally, 1 fatal AE occurred within 48 hrs of dose-escalation to 1200 mg in a pt with laboratory evidence of TLS (DLT). 46 of 54 pts (85%) evaluable for efficacy achieved a response to ABT-199; 7 (13%) a CR or CR with incomplete count recovery and 39 (72%) a PR (30 confirmed by consecutive scans). 14/16 (88%) and 12/16 (75%) of pts with del(17p) and F-refractory CLL, respectively, achieved at least a PR. Conclusions: ABT-199 is highly active achieving a 85% overall response rate in R/R CLL, independent of high risk markers such as del(17p) and F-refractory disease. Additional dosing and scheduling modifications are currently being explored to minimize the risk of TLS. Clinical trial information: NCT01328626.
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Affiliation(s)
| | | | | | - Brad S. Kahl
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | | | | | | | - Mary Ann Anderson
- Royal Melbourne Hospital; Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - David C.S. Huang
- Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
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Davids MS, Seymour JF, Gerecitano JF, Kahl BS, Pagel JM, Wierda WG, Anderson MA, Darden DE, Nolan CE, Gressick LA, Yang J, Chyla BJ, Busman TA, Graham AM, Cerri E, Enschede SH, Humerickhouse RA, Roberts AW. Updated results of a phase I first-in-human study of the BCL-2 inhibitor ABT-199 (GDC-0199) in patients with relapsed/refractory non-Hodgkin lymphoma (NHL). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.8520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8520 Background: BCL-2 is highly expressed in NHL, including mantle cell lymphoma (MCL), and is a promising therapeutic target as it is involved in NHL pathogenesis and mediates resistance to many cytotoxics. ABT-199 is a second generation inhibitor with 500-fold higher affinity for BCL-2 (Ki<0.10 nM) than BCL-XL (Ki=48 nM). Methods: Objectives of this Ph 1 dose-escalation study include evaluations of safety, pharmacokinetics and preliminary efficacy in patients (pts) with relapsed or refractory (R/R) NHL. A single oral dose (50-400 mg) was administered followed by 6 days off drug prior to the initiation of continuous once daily dosing. Due to concerns of potential tumor lysis syndrome (TLS), a 2 to 3 wk lead-in period with step-wise escalation to the target cohort dose was implemented. Dose cohorts up to 900 mg have been evaluated to date. Results: As of January 2013, 31 pts have been enrolled (median age 68 y (range 35-85); 20 males; median prior therapies 3 (range 1-7). 13 (42%) and 4 (13%) had bulky adenopathy (>5 and >10 cm, respectively). The most common AEs (≥15% of patients) were nausea (36%), diarrhea (26%), dyspepsia, vomiting, fatigue, pyrexia and cough (16% each). Gr 3/4 AEs occurring in >1 patient were anemia, neutropenia (4 pts each), and febrile neutropenia (2 pts). Two of 14 pts in cohort 5 experienced DLTs at the target dose of 600 mg: Gr 3 febrile neutropenia and Gr 4 neutropenia. Although Gr 3/4 thrombocytopenia was observed in 3 pts, it was not dose dependent. Gr 3 TLS was seen after the initial dose in 1 pt with very bulky MCL (>10 cm). With a median follow-up of 5 months (range 0.5-15), 17 have discontinued: 13 due to PD, 2 due to AEs and 2 who received a BMT. Of the 29 pts evaluable for efficacy, the overall best response rate was 55% with 1 DLBCL pt achieving a CR and 15 (52%) a PR (8/8 MCL, 3/3 Waldenstrom macroglobulinemia, 2/7 follicular lymphoma and 2/7 DLBCL pts). Conclusions: ABT-199 is highly active in R/R NHL, particularly in MCL. Additional dosing and scheduling modifications are currently being explored to optimize the efficacy/safety profile of this active new agent. ABT-199 warrants further single-agent and combination trials in NHL. Clinical trial information: NCT01328626.
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Affiliation(s)
| | | | | | - Brad S. Kahl
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | | | - Mary Ann Anderson
- Royal Melbourne Hospital; Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
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Abstract
AIM To compare and contrast postal and internet surveys in studies of nurse workforces. BACKGROUND There is little research that examines the advantages and disadvantages of different surveys in studies of nurse workforces. DATA SOURCES Previous studies that used different approaches to disseminate surveys. DISCUSSION There are advantages and disadvantages to using postal or internet surveys for nurse workforce studies. CONCLUSION Factors researchers may wish to consider in selecting survey methods include research topic, costs, coverage, timing and the characteristics of potential respondents. IMPLICATIONS FOR RESEARCH/PRACTICE Response rate, data quality and adequate coverage of the population being studied can be optimised if the researcher selects an appropriate survey method.
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Affiliation(s)
- O Ed Reitz
- Mennonite College of Nursing, Illinois State University, United States.
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Affiliation(s)
- Mary Ann Anderson
- Division of Cancer and Hematology, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
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