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Crombie JL, Graff T, Falchi L, Karimi YH, Bannerji R, Nastoupil L, Thieblemont C, Ursu R, Bartlett N, Nachar V, Weiss J, Osterson J, Patel K, Brody J, Abramson JS, Lunning M, Shah NN, Ayed A, Kamdar M, Parsons B, Caimi P, Flinn I, Herrera A, Sharman J, McKenna M, Armand P, Kahl B, Smith S, Zelenetz A, Budde LE, Hutchings M, Phillips T, Dickinson M. Consensus recommendations on the management of toxicity associated with CD3×CD20 bispecific antibody therapy. Blood 2024; 143:1565-1575. [PMID: 38252906 DOI: 10.1182/blood.2023022432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/19/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
ABSTRACT Bispecific antibodies (BsAb) that target CD3 and CD20 represent a new milestone in the treatment of patients with B-cell non-Hodgkin lymphoma. These drugs have demonstrated remarkable single-agent activity in patients with heavily pretreated disease, and 3 drugs have so far received regulatory approvals in various countries. However, BsAbs can potentially lead to severe toxicity associated with T-cell activation, particularly cytokine release syndrome (CRS). The anticipated widespread use of these off-the-shelf products poses challenges for implementation and highlights the need for guidance in anticipating, mitigating, and managing adverse events. In clinical trials, guidance for the evaluation and treatment of CRS and neurotoxicity associated with BsAb therapy has been modeled after algorithms originally created for chimeric antigen receptor (CAR) T-cell therapies and other immune effector therapies, yet notable differences in timing, quality, and severity exist between the toxicities of BsAbs and CAR T-cell therapies. We therefore convened an international panel of academic and community practice physicians, advanced practitioners, registered nurses, and pharmacists with experience using CD3×CD20 BsAbs in clinical trial and off-trial settings to provide comprehensive, consensus-based recommendations specific to the assessment and management of CD3×CD20 BsAb-related toxicities.
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Affiliation(s)
| | - Tara Graff
- Mission Cancer and Blood, Des Moines, IA
| | - Lorenzo Falchi
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yasmin H Karimi
- Hematology Clinic, Rogel Cancer Center, University of Michigan Health System, Ann Arbor, MI
| | - Rajat Bannerji
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Catherine Thieblemont
- Department of Hemato-oncology, Assistance Publique Hôpitaux de Paris, INSERM U1153, Hôpital Saint Louis, Paris, France
| | - Renata Ursu
- Department of Neurology, Assistance Publique Hôpitaux de Paris, Hôpital Saint Louis, Paris, France
| | | | - Victoria Nachar
- Hematology Clinic, Rogel Cancer Center, University of Michigan Health System, Ann Arbor, MI
| | - Jonathan Weiss
- Hematology Clinic, Rogel Cancer Center, University of Michigan Health System, Ann Arbor, MI
| | | | - Krish Patel
- Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute, Seattle, WA
| | - Joshua Brody
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeremy S Abramson
- Center for Lymphoma, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Matthew Lunning
- Division of Oncology and Hematology, University of Nebraska, Omaha, NE
| | | | - Ayed Ayed
- Cancer Specialists of North Florida, Jacksonville, FL
| | - Manali Kamdar
- Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado Cancer Center, Aurora, CO
| | - Benjamin Parsons
- Department of Hematology and Oncology, Gundersen Lutheran Health System, La Crosse, WI
| | - Paolo Caimi
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Ian Flinn
- Tennessee Oncology and OneOncology, Nashville, TN
| | | | - Jeffrey Sharman
- Department of Medical Oncology, Willamette Valley Cancer Institute and Research Center/US Oncology Research, Eugene, OR
| | | | | | - Brad Kahl
- Washington University in St. Louis, St. Louis, MO
| | - Sonali Smith
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Andrew Zelenetz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Martin Hutchings
- Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Tycel Phillips
- Hematology Clinic, Rogel Cancer Center, University of Michigan Health System, Ann Arbor, MI
| | - Michael Dickinson
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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2
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Wang M, Siddiqi T, Gordon LI, Kamdar M, Lunning M, Hirayama AV, Abramson JS, Arnason J, Ghosh N, Mehta A, Andreadis C, Solomon SR, Kostic A, Dehner C, Espinola R, Peng L, Ogasawara K, Chattin A, Eliason L, Palomba ML. Lisocabtagene Maraleucel in Relapsed/Refractory Mantle Cell Lymphoma: Primary Analysis of the Mantle Cell Lymphoma Cohort From TRANSCEND NHL 001, a Phase I Multicenter Seamless Design Study. J Clin Oncol 2024; 42:1146-1157. [PMID: 38072625 DOI: 10.1200/jco.23.02214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/02/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To report the primary analysis results from the mantle cell lymphoma (MCL) cohort of the phase I seamless design TRANSCEND NHL 001 (ClinicalTrials.gov identifier: NCT02631044) study. METHODS Patients with relapsed/refractory (R/R) MCL after ≥two lines of previous therapy, including a Bruton tyrosine kinase inhibitor (BTKi), an alkylating agent, and a CD20-targeted agent, received lisocabtagene maraleucel (liso-cel) at a target dose level (DL) of 50 × 106 (DL1) or 100 × 106 (DL2) chimeric antigen receptor-positive T cells. Primary end points were adverse events (AEs), dose-limiting toxicities, and objective response rate (ORR) by independent review committee per Lugano criteria. RESULTS Of 104 leukapheresed patients, liso-cel was infused into 88. Median (range) number of previous lines of therapy was three (1-11) with 30% receiving ≥five previous lines of therapy, 73% of patients were age 65 years and older, 69% had refractory disease, 53% had BTKi refractory disease, 23% had TP53 mutation, and 8% had secondary CNS lymphoma. Median (range) on-study follow-up was 16.1 months (0.4-60.5). In the efficacy set (n = 83; DL1 + DL2), ORR was 83.1% (95% CI, 73.3 to 90.5) and complete response (CR) rate was 72.3% (95% CI, 61.4 to 81.6). Median duration of response was 15.7 months (95% CI, 6.2 to 24.0) and progression-free survival was 15.3 months (95% CI, 6.6 to 24.9). Most common grade ≥3 treatment-emergent AEs were neutropenia (56%), anemia (37.5%), and thrombocytopenia (25%). Cytokine release syndrome (CRS) was reported in 61% of patients (grade 3/4, 1%; grade 5, 0), neurologic events (NEs) in 31% (grade 3/4, 9%; grade 5, 0), grade ≥3 infections in 15%, and prolonged cytopenia in 40%. CONCLUSION Liso-cel demonstrated high CR rate and deep, durable responses with low incidence of grade ≥3 CRS, NE, and infections in patients with heavily pretreated R/R MCL, including those with high-risk, aggressive disease.
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Affiliation(s)
- Michael Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Leo I Gordon
- Northwestern University, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | | | | | | | - Jeremy S Abramson
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Jon Arnason
- Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | | | - M Lia Palomba
- Memorial Sloan Kettering Cancer Center, New York, NY
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3
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Abramson JS, Solomon SR, Arnason J, Johnston PB, Glass B, Bachanova V, Ibrahimi S, Mielke S, Mutsaers P, Hernandez-Ilizaliturri F, Izutsu K, Morschhauser F, Lunning M, Crotta A, Montheard S, Previtali A, Ogasawara K, Kamdar M. Plain language summary of the TRANSFORM study primary analysis results: lisocabtagene maraleucel as a second treatment regimen for large B-cell lymphoma following failure of the first treatment regimen. Future Oncol 2024. [PMID: 38547003 DOI: 10.2217/fon-2023-0898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? People diagnosed with a disease called large B-cell lymphoma (LBCL) may experience return, or early relapse, of their disease within the first year after receiving and responding to their first (first-line) treatment regimen. Others may have primary refractory disease, meaning that the disease either did not respond to first-line treatment at all or only responded for a very brief period. Second (second-line) treatment includes immunotherapy followed by high-dose chemotherapy and ASCT, which has the potential to cure LBCL. However, if the disease does not respond to immunotherapy, people cannot receive ASCT, and less than 30% of people are cured. Therefore, new second-line treatment options are required, such as CAR T cell therapy, which uses a person's own genetically engineered lymphocytes, also called T cells, to fight their lymphoma. In this article, we summarize the key results of the phase 3 TRANSFORM clinical study that tested if liso-cel, a CAR T cell treatment, can safely and effectively be used as a second-line treatment for people with early relapsed or primary refractory (relapsed/refractory) LBCL. A total of 184 adults with relapsed/refractory LBCL who were able to receive ASCT were randomly treated with either liso-cel or standard of care (SOC) as second-line treatment. SOC included immunochemotherapy followed by high-dose chemotherapy and ASCT. WHAT WERE THE KEY TAKEAWAYS? Almost all (97%) people in the liso-cel group completed treatment, whereas 53% of people in the SOC group did not complete treatment, mostly due to their disease not responding or relapsing, and therefore they were not able to receive ASCT. People who received liso-cel as a second-line treatment lived longer without the occurrence of an unfavorable medical event or worsening of the disease and had a better response to treatment than those who received SOC as second-line treatment. People who received liso-cel reported side effects that researchers considered to be manageable, and that were known to occur with CAR T cell treatment. WHAT WERE THE MAIN CONCLUSIONS REPORTED BY THE RESEARCHERS? Results from the TRANSFORM study support the use of liso-cel as a more effective second-line treatment compared with SOC that is safe for people with relapsed/refractory LBCL. Clinical Trial Registration: NCT03575351 (TRANSFORM study) (ClinicalTrials.gov).
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Affiliation(s)
- Jeremy S Abramson
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Scott R Solomon
- Transplant & Cellular Immunotherapy Program, Northside Hospital Cancer Institute, Atlanta, GA, USA
| | - Jon Arnason
- Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Bertram Glass
- Department of Hematology & Cell Therapy, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Veronika Bachanova
- Division of Hematology, Oncology & Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Sami Ibrahimi
- Transplant & Cellular Therapy Clinic, University of Oklahoma Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Stephan Mielke
- Departments of Laboratory Medicine & Medicine at Huddinge, Center of Allogeneic Stem Cell Transplantation & Cellular Therapy, Karolinska Institutet & University Hospital, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Pim Mutsaers
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Franck Morschhauser
- Centre Hospitalier Universitaire de Lille, Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Matthew Lunning
- Hematology/Oncology Division, University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | | | | | - Manali Kamdar
- Division of Hematology, Hematologic Malignancies & Stem Cell Transplantation, University of Colorado Cancer Center, Aurora, CO, USA
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4
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Jain MD, Jacobs MT, Gao F, Nastoupil LJ, Spiegel JY, Lin Y, Dahiya S, Lunning M, Lekakis L, Reagan P, Oluwole O, McGuirk J, Deol A, Sehgal AR, Goy A, Hill BT, Andreadis C, Munoz J, Chavez JC, Bennani NN, Rapoport AP, Vose JM, Miklos D, Neelapu SS, Locke FL, Ghobadi A. Bridging therapy with axicabtagene ciloleucel for large B-cell lymphoma: results from the US Lymphoma CAR-T Consortium. Blood Adv 2024; 8:1042-1050. [PMID: 38051550 PMCID: PMC10920102 DOI: 10.1182/bloodadvances.2023011489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/13/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
ABSTRACT During the manufacturing period of autologous chimeric antigen receptor (CAR) T-cell therapy, patients may experience a decline in their condition due to cancer progression. In this study, we investigated the impact of bridging therapy (BT) on the outcome of patients with relapsed/refractory large B-cell lymphoma who received antilymphoma treatment between leukapheresis and axicabtagene ciloleucel (axi-cel) infusion. We conducted our analysis using data from the multicenter US Lymphoma CAR-T Consortium, with a median follow-up of 33 months (range, 4.3-42.1). Out of the 298 patients who underwent leukapheresis, 275 patients received axi-cel. A total 52% of patients (n = 143) who received BT had a higher baseline risk profile than patients who did not receive BT, and these patients, as a group, had inferior outcomes compared with those who did not receive BT. However, after propensity score matching between the 2 groups, there were no statistically significant differences in overall response rate (77% vs 87%; P = .13), complete response rate (58% vs 70%; P = .1), progression-free survival (hazard ratio [HR], 1.25; P = .23), and overall survival (HR, 1.39; P=.09) between the BT group and the no-BT group, respectively. Analyzing the effects of BT in the whole cohort that underwent leukapheresis regardless of receiving axi-cel (intention-to-treat analysis) showed similar results. Radiation BT resulted in outcomes similar to those observed with nonradiation BT. Our findings suggest that BT may be safe without a significant impact on long-term survival for patients who require disease stabilization during the manufacturing period. Moreover, our results suggest that there is no clear advantage to using radiation-based BT over nonradiation-based BT.
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Affiliation(s)
- Michael D. Jain
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Miriam T. Jacobs
- Division of Medical Oncology, Washington University School of Medicine and Siteman Cancer Center, St Louis, MO
| | - Feng Gao
- Division of Medical Oncology, Washington University School of Medicine and Siteman Cancer Center, St Louis, MO
| | - Loretta J. Nastoupil
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jay Y. Spiegel
- Division of Blood and Marrow Transplantation & Cellular Therapy, Stanford University Medical Center, Stanford, CA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Saurabh Dahiya
- Department of Medicine, University of Maryland School of Medicine and Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Matthew Lunning
- Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Lazaros Lekakis
- Division of Transplant and Cellular Therapy, University of Miami Miller School of Medicine, Miami, FL
| | - Patrick Reagan
- Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
| | - Olalekan Oluwole
- Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Joseph McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Abhinav Deol
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Alison R. Sehgal
- Division of Hematology/Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Andre Goy
- Lymphoma Division, John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, NJ
| | - Brian T. Hill
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | | | - Javier Munoz
- Division of Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ
| | - Julio C Chavez
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | | | - Aaron P. Rapoport
- Department of Medicine, University of Maryland School of Medicine and Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Julie M. Vose
- Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE
| | - David Miklos
- Division of Blood and Marrow Transplantation & Cellular Therapy, Stanford University Medical Center, Stanford, CA
| | - Sattva S. Neelapu
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Frederick L. Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Armin Ghobadi
- Division of Medical Oncology, Washington University School of Medicine and Siteman Cancer Center, St Louis, MO
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5
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Abramson JS, Palomba ML, Gordon LI, Lunning M, Wang M, Arnason J, Purev E, Maloney DG, Andreadis C, Sehgal A, Solomon SR, Ghosh N, Dehner C, Kim Y, Ogasawara K, Kostic A, Siddiqi T. Two-year follow-up of lisocabtagene maraleucel in relapsed or refractory large B-cell lymphoma in TRANSCEND NHL 001. Blood 2024; 143:404-416. [PMID: 37890149 DOI: 10.1182/blood.2023020854] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
ABSTRACT Lisocabtagene maraleucel (liso-cel) demonstrated significant efficacy with a manageable safety profile as third-line or later treatment for patients with relapsed or refractory (R/R) large B-cell lymphoma (LBCL) in the TRANSCEND NHL 001 study. Primary end points were adverse events (AEs), dose-limiting toxicities, and objective response rate (ORR) per independent review committee. Key secondary end points were complete response (CR) rate, duration of response (DOR), progression-free survival (PFS), and overall survival (OS). After 2-year follow-up, patients could enroll in a separate study assessing long-term (≤15 years) safety and OS. Liso-cel-treated patients (N = 270) had a median age of 63 years (range, 18-86 years) and a median of 3 prior lines (range, 1-8) of systemic therapy, and 181 of them (67%) had chemotherapy-refractory LBCL. Median follow-up was 19.9 months. In efficacy-evaluable patients (N = 257), the ORR was 73% and CR rate was 53%. The median (95% confidence interval) DOR, PFS, and OS were 23.1 (8.6 to not reached), 6.8 (3.3-12.7), and 27.3 months (16.2-45.6), respectively. Estimated 2-year DOR, PFS, and OS rates were 49.5%, 40.6%, and 50.5%, respectively. In the 90-day treatment-emergent period (N = 270), grade 3 to 4 cytokine release syndrome and neurological events occurred in 2% and 10% of patients, respectively. The most common grade ≥3 AEs in treatment-emergent and posttreatment-emergent periods, respectively, were neutropenia (60% and 7%) and anemia (37% and 6%). Liso-cel demonstrated durable remissions and a manageable safety profile with no new safety signals during the 2-year follow-up in patients with R/R LBCL. These trials were registered at www.ClinicalTrials.gov as #NCT02631044 and #NCT03435796.
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Affiliation(s)
- Jeremy S Abramson
- Lymphoma Program, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - M Lia Palomba
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leo I Gordon
- Department of Hematology/Oncology, Northwestern University, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Matthew Lunning
- Hematology/Oncology Division, University of Nebraska Medical Center, Omaha, NE
| | - Michael Wang
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jon Arnason
- Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - David G Maloney
- Clinical Research Division Medicine and Oncology, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Alison Sehgal
- University of Pittsburgh Medical Center: Hillman Cancer Center, Pittsburgh, PA
| | - Scott R Solomon
- Transplant and Cellular Immunotherapy Program, Northside Hospital Cancer Institute, Atlanta, GA
| | - Nilanjan Ghosh
- Department of Hematologic Oncology and Blood Disorders, Atrium Health, Levine Cancer Institute, Charlotte, NC
| | | | | | | | | | - Tanya Siddiqi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
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6
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Vose JM, Fu K, Wang L, Mansoor A, Stewart D, Cheng H, Smith L, Yuan J, Qureishi HN, Link BK, Cessna MH, Barr PM, Kahl BS, Mckinney MS, Khan N, Advani RH, Martin P, Goy AH, Phillips TJ, Mehta A, Kamdar M, Crump M, Pro B, Flowers CR, Jacobson CA, Smith SM, Stephens DM, Bachanova V, Jin Z, Wu S, Hernandez-Ilizaliturri F, Torka P, Anampa-Guzmán A, Kashef F, Li X, Sharma S, Greiner TC, Armitage JO, Lunning M, Weisenburger DD, Bociek RG, Iqbal J, Yu G, Bi C. Integrative analysis of clinicopathological features defines novel prognostic models for mantle cell lymphoma in the immunochemotherapy era: a report from The North American Mantle Cell Lymphoma Consortium. J Hematol Oncol 2023; 16:122. [PMID: 38104096 PMCID: PMC10725579 DOI: 10.1186/s13045-023-01520-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Patients with mantle cell lymphoma (MCL) exhibit a wide variation in clinical presentation and outcome. However, the commonly used prognostic models are outdated and inadequate to address the needs of the current multidisciplinary management of this disease. This study aims to investigate the clinical and pathological features of MCL in the immunochemotherapy era and improve the prognostic models for a more accurate prediction of patient outcomes. METHODS The North American Mantle Cell Lymphoma Project is a multi-institutional collaboration of 23 institutions across North America to evaluate and refine prognosticators for front-line therapy. A total of 586 MCL cases diagnosed between 2000 and 2012 are included in this study. A comprehensive retrospective analysis was performed on the clinicopathological features, treatment approaches, and outcomes of these cases. The establishment of novel prognostic models was based on in-depth examination of baseline parameters, and subsequent validation in an independent cohort of MCL cases. RESULTS In front-line strategies, the use of hematopoietic stem cell transplantation was the most significant parameter affecting outcomes, for both overall survival (OS, p < 0.0001) and progression-free survival (PFS, p < 0.0001). P53 positive expression was the most significant pathological parameter correlating with inferior outcomes (p < 0.0001 for OS and p = 0.0021 for PFS). Based on the baseline risk factor profile, we developed a set of prognostic models incorporating clinical, laboratory, and pathological parameters that are specifically tailored for various applications. These models, when tested in the validation cohort, exhibited strong predictive power for survival and showed a stratification resembling the training cohort. CONCLUSIONS The outcome of patients with MCL has markedly improved over the past two decades, and further enhancement is anticipated with the evolution of clinical management. The innovative prognostic models developed in this study would serve as a valuable tool to guide the selection of more suitable treatment strategies for patients with MCL.
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Affiliation(s)
- Julie M Vose
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine Fred and Pamela Buffett Cancer Center, 505 S 45Th St, Omaha, NE, 68105, USA
| | - Kai Fu
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lu Wang
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Yantai University, Yantai, China
| | - Adnan Mansoor
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
| | - Douglas Stewart
- Departments of Oncology and Medicine, University of Calgary, Calgary, Canada
| | - Hongxia Cheng
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Lynette Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ji Yuan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Hina Naushad Qureishi
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Brian K Link
- Department of Internal Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Melissa H Cessna
- Department of Pathology, Intermountain Medical Center, Murray, UT, USA
| | - Paul M Barr
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Brad S Kahl
- Department of Medicine, Oncology Division, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Matthew S Mckinney
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Nadia Khan
- Department of Hematology/Oncology, Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Ranjana H Advani
- Division of Oncology, Stanford Cancer Institute, Stanford, CA, USA
| | - Peter Martin
- Division of Hematology and Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Andre H Goy
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | - Tycel J Phillips
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Amitkumar Mehta
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Manali Kamdar
- Division of Hematology, University of Colorado, Denver, CO, USA
| | - Michael Crump
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
| | - Barbara Pro
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Christopher R Flowers
- Division of Cancer Medicine, Department of Lymphoma-Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Caron A Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Sonali M Smith
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Deborah M Stephens
- Huntsman Cancer Institute at University of Utah, Salt Lake City, UT, USA
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Zhaohui Jin
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Shishou Wu
- Department of Pathology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, No.20 Yuhuangding East Road, Yantai, 264000, China
| | | | - Pallawi Torka
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Anampa-Guzmán
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Farshid Kashef
- Department of Pathology, University at Buffalo, Buffalo, NY, USA
| | - Xing Li
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Sunandini Sharma
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Timothy C Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - James O Armitage
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine Fred and Pamela Buffett Cancer Center, 505 S 45Th St, Omaha, NE, 68105, USA
| | - Matthew Lunning
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine Fred and Pamela Buffett Cancer Center, 505 S 45Th St, Omaha, NE, 68105, USA
| | - Dennis D Weisenburger
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Robert G Bociek
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine Fred and Pamela Buffett Cancer Center, 505 S 45Th St, Omaha, NE, 68105, USA
| | - Javeed Iqbal
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Guohua Yu
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA.
- Department of Pathology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, No.20 Yuhuangding East Road, Yantai, 264000, China.
| | - Chengfeng Bi
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine Fred and Pamela Buffett Cancer Center, 505 S 45Th St, Omaha, NE, 68105, USA.
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7
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Walker B, Zimmer AJ, Stohs EJ, Lunning M, Lyden E, Abbas A. Infectious complications among CD19 CAR-T cell therapy recipients: A single-center experience. Transpl Infect Dis 2023; 25 Suppl 1:e14191. [PMID: 37987114 DOI: 10.1111/tid.14191] [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: 06/30/2023] [Revised: 10/04/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND CD19 chimeric antigen receptor (CAR)-T cell therapy has emerged as an effective treatment in those with refractory or relapsed lymphoma. CD19 CAR-T cell therapy can cause direct and indirect toxic adverse effects and increased risk for infection. Infectious complications and optimal antimicrobial prophylaxis strategies are an ongoing area of investigation. METHODS A single-center retrospective cohort study was conducted to review recipients of CD19 CAR-T cell therapy between April 2018 and December 2020. Patient characteristics and clinical outcomes were extracted from the electronic health records. RESULTS Infectious complications were identified in 18/50 (36%) recipients with 31 episodes of infection. The median time to infection was 225 days (range 0-614). Bacterial infections were most common with bloodstream infection followed by sinusitis and skin and soft tissue infection. Eight viral infections were identified, most being respiratory viral illnesses. Two fungal infections were identified: Pneumocystis jirovecii pneumonia (PJP) and disseminated fusariosis. Seventeen infections (54.8%) were classified as severe: leading to death, requiring hospitalization, need for empiric intravenous antibiotics, or significant alteration in hospital course. No characteristics were found to be statistically significant risks for infection, although a trend toward significance was seen in prior autologous stem cell transplant recipients (p = .12) and those with recurrent neutropenia (p = .14). Three patients (6%) died from infection. CONCLUSION Infections were common after CD19 CAR-T cell therapy and occurred beyond the first year. Further multicenter studies are needed to define infectious risks and optimize antimicrobial prophylaxis recommendations in recipients of CD19 CAR-T cell therapy.
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Affiliation(s)
- Bryan Walker
- Division of Infectious Disease, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andrea J Zimmer
- Division of Infectious Disease, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Erica J Stohs
- Division of Infectious Disease, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Matthew Lunning
- Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Elizabeth Lyden
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Anum Abbas
- Division of Infectious Disease, University of Nebraska Medical Center, Omaha, Nebraska, USA
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8
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Vose JM, Ganguly S, Bierman PJ, Bociek RG, Lunning M, Lyden L, Meza JL, Caimi PF, Armitage JO. Lenalidomide maintenance following high-dose therapy and autologous haematopoietic stem cell transplantation in chemo-resistant or high-risk non-Hodgkin lymphoma: A phase I/II study. Br J Haematol 2023. [PMID: 37096954 DOI: 10.1111/bjh.18821] [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: 01/11/2023] [Revised: 03/06/2023] [Accepted: 04/09/2023] [Indexed: 04/26/2023]
Abstract
Improved maintenance treatments are needed for patients with relapsed/refractory aggressive lymphomas after autologous haematopoietic stem cell transplantation (ASCT). Several studies with lenalidomide have been found to have activity in the treatment of relapsed/refractory aggressive lymphomas. In the present phase I/II, single-arm, open-label study, 59 patients with high-risk relapsed non-Hodgkin lymphoma received pretransplant BEAM chemotherapy and ASCT followed by 12 months of maintenance lenalidomide once daily on Days 1-21 (28-day cycles) beginning at post-transplantation Day 100. The most common histologies were mantle cell lymphoma (56%) and diffuse large B-cell lymphoma (24%). The maximum tolerated dose in the dose-finding part of the study was 15 mg, but cytopenias led to the subsequent adoption of a 10 mg dose in the final study. Sixteen patients (27%) completed 12 cycles of lenalidomide maintenance. The most common reason for discontinuation was adverse events (31%). These were primarily haematologic, and 56% of patients experienced Grade 3-4 events. Two-year PFS rates (95% CIs) were 70% (56%-80%), 45% (19%-68%) and 81% (66%-90%); 2-year OS rates (95% CIs) were 91% (80%-96%), 93% (61%-99%) and 90% (76%-96%) in all patients, patients completing and patients not completing 12-month maintenance respectively. These results do not support the use of lenalidomide maintenance in this setting.
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Affiliation(s)
- Julie M Vose
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Siddhartha Ganguly
- University of Kansas Cancer Center, Westwood, Kansas, USA
- Houston Methodist Hospital and Neal Cancer Center, Houston, Texas, USA
| | - Philip J Bierman
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - R Gregory Bociek
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Matthew Lunning
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Liz Lyden
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jane L Meza
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Paolo F Caimi
- University Hospital Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - James O Armitage
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
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9
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Abramson JS, Solomon SR, Arnason J, Johnston PB, Glass B, Bachanova V, Ibrahimi S, Mielke S, Mutsaers P, Hernandez-Ilizaliturri F, Izutsu K, Morschhauser F, Lunning M, Crotta A, Montheard S, Previtali A, Ogasawara K, Kamdar M. Lisocabtagene maraleucel as second-line therapy for large B-cell lymphoma: primary analysis of the phase 3 TRANSFORM study. Blood 2023; 141:1675-1684. [PMID: 36542826 PMCID: PMC10646768 DOI: 10.1182/blood.2022018730] [Citation(s) in RCA: 61] [Impact Index Per Article: 61.0] [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: 10/24/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
This global phase 3 study compared lisocabtagene maraleucel (liso-cel) with a standard of care (SOC) as second-line therapy for primary refractory or early relapsed (≤12 months) large B-cell lymphoma (LBCL). Adults eligible for autologous stem cell transplantation (ASCT; N = 184) were randomly assigned in a 1:1 ratio to liso-cel (100 × 106 chimeric antigen receptor-positive T cells) or SOC (3 cycles of platinum-based immunochemotherapy followed by high-dose chemotherapy and ASCT in responders). The primary end point was event-free survival (EFS). In this primary analysis with a 17.5-month median follow-up, median EFS was not reached (NR) for liso-cel vs 2.4 months for SOC. Complete response (CR) rate was 74% for liso-cel vs 43% for SOC (P < .0001) and median progression-free survival (PFS) was NR for liso-cel vs 6.2 months for SOC (hazard ratio [HR] = 0.400; P < .0001). Median overall survival (OS) was NR for liso-cel vs 29.9 months for SOC (HR = 0.724; P = .0987). When adjusted for crossover from SOC to liso-cel, 18-month OS rates were 73% for liso-cel and 54% for SOC (HR = 0.415). Grade 3 cytokine release syndrome and neurological events occurred in 1% and 4% of patients in the liso-cel arm, respectively (no grade 4 or 5 events). These data show significant improvements in EFS, CR rate, and PFS for liso-cel compared with SOC and support liso-cel as a preferred second-line treatment compared with SOC in patients with primary refractory or early relapsed LBCL. This trial was registered at www.clinicaltrials.gov as #NCT03575351.
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Affiliation(s)
- Jeremy S. Abramson
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Harvard University, Boston, MA
| | - Scott R. Solomon
- Transplant and Cellular Immunotherapy Program, Northside Hospital Cancer Institute, Atlanta, GA
| | - Jon Arnason
- Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Bertram Glass
- Department of Hematology and Cell Therapy, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Sami Ibrahimi
- Transplant and Cellular Therapy Clinic, University of Oklahoma Stephenson Cancer Center, Oklahoma City, OK
| | - Stephan Mielke
- Departments of Laboratory Medicine and Medicine at Huddinge, Center of Allogeneic Stem Cell Transplantation and Cellular Therapy, Karolinska Institutet and University Hospital, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Pim Mutsaers
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Franck Morschhauser
- Centre Hospitalier Universitaire de Lille, Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Matthew Lunning
- Hematology/Oncology Division, University of Nebraska Medical Center, Omaha, NE
| | | | | | | | | | - Manali Kamdar
- Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado Cancer Center, Aurora, CO
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10
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Shah NN, Maziarz RT, Jacobson CA, Ghosh M, Isufi I, Ulrickson ML, Perales MA, Lunning M, Hardy DNM, Wijatyk A, Ancukiewicz M, Nallewar MM, Coleman KC, Prudner B, Eromosele E, Kaleta R, Miklos DB. Interim Analysis of a Phase II Study of Administered Fresh Bispecific Anti-CD20/Anti-CD19 CAR T-Cell Therapy: Zamtocabtagene Autoleucel (zamto-cel) for Relapsed/ Refractory (R/R) DLBCL (DALY II USA NCT04792489). Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00085-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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11
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Iqbal M, Tun H, Joffe E, Grommes C, Nowakowski G, Lunning M, Ramchandren R, Li CC, Zhao W, Martinez E, von Roemeling R, Earhart R, McMahon M, Isufi I, Leslie L, Rosenthal A. CTIM-34. PRELIMINARY SAFETY AND EFFICACY DATA ON TWO PATIENTS WITH RELAPSED/REFRACTORY CNS LYMPHOMA TREATED WITH EMAVUSERTIB (CA-4948) AND IBRUTINIB COMBINATION: A SUBSET ANALYSIS OF TAKEAIM LYMPHOMA TRIAL. Neuro Oncol 2022. [PMCID: PMC9660877 DOI: 10.1093/neuonc/noac209.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Emavusertib, an oral interleukin-1 receptor-associated kinase 4 (IRAK4) inhibitor, targets toll-like receptor (TLR) and interleukin-1 receptor (IL-1R) signaling pathway in B-cell proliferation. IRAK4 forms a Myddosome complex with MYD88 adaptor protein and drives overactivation of NF-κB, causing inflammation and tumor growth. Emavusertib has been reported to be well tolerated and active as monotherapy in heavily pretreated relapsed/refractory (R/R) non-Hodgkin lymphoma (NHL). In a murine PDX model of primary CNS lymphoma (PCNSL), emavusertib crossed the blood-brain barrier, resulting in tumor response and prolonged survival. In combination with Bruton tyrosine kinase (BTK) inhibitors, emavusertib showed in vivo anti-cancer synergy in B-cell NHL.
METHODS
This is an ongoing open-label trial (NCT03328078) in patients with R/R NHL. Currently, we are in the dose escalation portion of combination therapy to evaluate safety and efficacy following treatment of emavusertib at dose levels of 200 or 300mg BID with ibrutinib at full prescribed dose. As of May 6th, 2022, 13 patients have been treated with emavusertib+ibrutinib combination therapy.
RESULTS
Among the 13 patients, two were diagnosed with R/R PCNSL and had several prior lines of anti-cancer therapy. Emavusertib in combination with ibrutinib (560 mg daily) appeared to be well tolerated in these two subjects. One patient experienced Gr3 treatment-related adverse events (thrombocytopenia, muscle weakness, pain). The preliminary efficacy data demonstrated one CR and one SD. The patient who achieved CR after the combination therapy was originally intolerant to high-dose methotrexate based chemoimmunotherapy and did not achieve complete remission after switching to ibrutinib, providing early clinical evidence of CNS penetration and anti-tumor activity of emavusertib.
CONCLUSION
In R/R PCNSL, these preliminary data suggest that combination therapy has a tolerable safety profile with promising anti-cancer activity and may overcome ibrutinib resistance.
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Affiliation(s)
| | - Han Tun
- Mayo Clinic , Jacksonville, FL , USA
| | - Erel Joffe
- Memorial Sloan Kettering Cancer Center , New York , USA
| | | | | | | | | | | | | | | | | | | | | | | | - Lori Leslie
- John Theurer Cancer Center , Hackensack , USA
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12
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Jacobs MT, Jain MD, Gao F, Nastoupil LJ, Spiegel JY, Lin Y, Dahiya S, Lunning M, Lekakis L, Reagan PM, Oluwole OO, McGuirk J, Deol A, Sehgal A, Goy A, Hill BT, Andreadis C, Munoz J, Chavez JC, Bennani NN, Rapoport AP, Vose JM, Miklos DB, Neelapu SS, Ghobadi A, Locke FL. Severity of Cytokine Release Syndrome Influences Outcome After Axicabtagene Ciloleucel for Large B cell Lymphoma: Results from the US Lymphoma CAR-T Consortium. Clin Lymphoma Myeloma Leuk 2022; 22:753-759. [PMID: 35780055 DOI: 10.1016/j.clml.2022.05.004] [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] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/01/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The majority of patients with large B-cell lymphoma treated with axicabtagene ciloleucel (axi-cel), an anti-CD19 chimeric antigen receptor (CAR) T-cell therapy, develop cytokine release syndrome (CRS). Whether the lack of development of CRS with axi-cel is associated with inferior lymphoma outcomes is unknown. Additionally, relationship between CRS grade and lymphoma outcome is not well established. METHODS The US Lymphoma CAR T Consortium includes seventeen US academic centers that contribute data independently of manufacturers. We analyzed the modified intent-to-treat population of 275 patients receiving axi-cel in two different ways: 1) Two group analysis comparing no CRS with any grade CRS; 2) Three group analysis comparing grade 0 CRS with grade 1 to 2 CRS, and grade 3-5 CRS. RESULTS In this large multi-center observational cohort of 275 patients receiving axi-cel, 9% (n = 24) did not develop CRS, 84% (n = 232) developed grade 1-2 CRS, and 7% (n = 19) developed grade 3 to 5 CRS. Patients without CRS, compared with those having any grade CRS, had similar overall response rates (ORR), lower complete response (CR) rates and inferior progression free survival (PFS) with no statistically significant difference in overall survival (OS). Patients experiencing grade 1 to 2 CRS had superior CR rate and PFS, as compared to those without CRS or with grade 3 to 5 CRS. Grade 3 to 5 CRS was associated with a worse OS. CONCLUSION Overall, durable responses were seen in patients that did not develop CRS, however grade 1 to 2 CRS was associated with better outcomes while those with grade 3 to 5 experienced the worse outcomes.
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Affiliation(s)
- Miriam T Jacobs
- Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO
| | | | - Feng Gao
- Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO
| | | | | | - Yi Lin
- Mayo Clinic, Rochester, MN
| | - Saurabh Dahiya
- University of Maryland School of Medicine and Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | | | | | | | | | | | - Abhinav Deol
- Karmanos Center Institute/Wayne State University, Detroit, MI
| | | | - Andre Goy
- John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, NJ
| | | | | | | | - Julio C Chavez
- Dept. of Malignant Hematology, Moffitt Cancer Center, Washington, DC
| | | | - Aaron P Rapoport
- University of Maryland School of Medicine and Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Julie M Vose
- University of Nebraska Medical Center, Omaha, NE
| | | | | | - Armin Ghobadi
- Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO
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13
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Al-Kadhimi Z, Pirruccello S, Gul Z, Maness-Harris L, Bhatt VR, Gundabolu K, Yuan J, Lunning M, Bociek G, D'Angelo C, Kallam A, Armitage J, Abdullah K, Hunter A, Mccaslin S, Lyden E, Smith L, Callahan M, Cole K, Hinrichs S, Talmadge J, Vose J. Split dose ATG strategy prevents grade III-IV acute GVHD and is associated with immune surrogates of GVL. Bone Marrow Transplant 2022; 57:1629-1631. [PMID: 35953707 DOI: 10.1038/s41409-022-01772-w] [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: 05/11/2022] [Revised: 07/23/2022] [Accepted: 07/27/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Zaid Al-Kadhimi
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Samuel Pirruccello
- Department of Pathology & Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Zartash Gul
- Division of Hematology/Oncology, Aurora Health Care, Milwaukee, WI, USA
| | - Lori Maness-Harris
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Vijaya Raj Bhatt
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Krishna Gundabolu
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jane Yuan
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, NY, USA
| | - Matthew Lunning
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Gregory Bociek
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Christopher D'Angelo
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Avyakta Kallam
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - James Armitage
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Khansa Abdullah
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Angela Hunter
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sarah Mccaslin
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Elizabeth Lyden
- Division of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lynnette Smith
- Division of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael Callahan
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kathryn Cole
- Department of Pathology & Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Steven Hinrichs
- Department of Pathology & Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - James Talmadge
- Department of Pathology & Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Julie Vose
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
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14
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Kamdar M, Solomon SR, Arnason J, Johnston PB, Glass B, Bachanova V, Ibrahimi S, Mielke S, Mutsaers P, Hernandez-Ilizaliturri F, Izutsu K, Morschhauser F, Lunning M, Maloney DG, Crotta A, Montheard S, Previtali A, Stepan L, Ogasawara K, Mack T, Abramson JS. Lisocabtagene maraleucel versus standard of care with salvage chemotherapy followed by autologous stem cell transplantation as second-line treatment in patients with relapsed or refractory large B-cell lymphoma (TRANSFORM): results from an interim analysis of an open-label, randomised, phase 3 trial. Lancet 2022; 399:2294-2308. [PMID: 35717989 DOI: 10.1016/s0140-6736(22)00662-6] [Citation(s) in RCA: 235] [Impact Index Per Article: 117.5] [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] [Received: 02/24/2022] [Revised: 03/29/2022] [Accepted: 04/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with large B-cell lymphoma (LBCL) primary refractory to or relapsed within 12 months of first-line therapy are at high risk for poor outcomes with current standard of care, platinum-based salvage immunochemotherapy and autologous haematopoietic stem cell transplantation (HSCT). Lisocabtagene maraleucel (liso-cel), an autologous, CD19-directed chimeric antigen receptor (CAR) T-cell therapy, has previously demonstrated efficacy and manageable safety in third-line or later LBCL. In this Article, we report a prespecified interim analysis of liso-cel versus standard of care as second-line treatment for primary refractory or early relapsed (within 12 months after response to initial therapy) LBCL. METHODS TRANSFORM is a global, phase 3 study, conducted in 47 sites in the USA, Europe, and Japan, comparing liso-cel with standard of care as second-line therapy in patients with primary refractory or early (≤12 months) relapsed LBCL. Adults aged 18-75 years, Eastern Cooperative Oncology Group performance status score of 1 or less, adequate organ function, PET-positive disease per Lugano 2014 criteria, and candidates for autologous HSCT were randomly assigned (1:1), by use of interactive response technology, to liso-cel (100 × 106 CAR+ T cells intravenously) or standard of care. Standard of care consisted of three cycles of salvage immunochemotherapy delivered intravenously-R-DHAP (rituximab 375 mg/m2 on day 1, dexamethasone 40 mg on days 1-4, two infusions of cytarabine 2000 mg/m2 on day 2, and cisplatin 100 mg/m2 on day 1), R-ICE (rituximab 375 mg/m2 on day 1, ifosfamide 5000 mg/m2 on day 2, etoposide 100 mg/m2 on days 1-3, and carboplatin area under the curve 5 [maximum dose of 800 mg] on day 2), or R-GDP (rituximab 375 mg/m2 on day 1, dexamethasone 40 mg on days 1-4, gemcitabine 1000 mg/m2 on days 1 and 8, and cisplatin 75 mg/m2 on day 1)-followed by high-dose chemotherapy and autologous HSCT in responders. Primary endpoint was event-free survival, with response assessments by an independent review committee per Lugano 2014 criteria. Efficacy was assessed per intention-to-treat (ie, all randomly assigned patients) and safety in patients who received any treatment. This trial is registered with ClinicalTrials.gov, NCT03575351, and is ongoing. FINDINGS Between Oct 23, 2018, and Dec 8, 2020, 232 patients were screened and 184 were assigned to the liso-cel (n=92) or standard of care (n=92) groups. At the data cutoff for this interim analysis, March 8, 2021, the median follow-up was 6·2 months (IQR 4·4-11·5). Median event-free survival was significantly improved in the liso-cel group (10·1 months [95% CI 6·1-not reached]) compared with the standard-of-care group (2·3 months [2·2-4·3]; stratified hazard ratio 0·35; 95% CI 0·23-0·53; stratified Cox proportional hazards model one-sided p<0·0001). The most common grade 3 or worse adverse events were neutropenia (74 [80%] of 92 patients in the liso-cel group vs 46 [51%] of 91 patients in the standard-of-care group), anaemia (45 [49%] vs 45 [49%]), thrombocytopenia (45 [49%] vs 58 [64%]), and prolonged cytopenia (40 [43%] vs three [3%]). Grade 3 cytokine release syndrome and neurological events, which are associated with CAR T-cell therapy, occurred in one (1%) and four (4%) of 92 patients in the liso-cel group, respectively (no grade 4 or 5 events). Serious treatment-emergent adverse events were reported in 44 (48%) patients in the liso-cel group and 44 (48%) in the standard-of-care group. No new liso-cel safety concerns were identified in the second-line setting. There were no treatment-related deaths in the liso-cel group and one treatment-related death due to sepsis in the standard-of-care group. INTERPRETATION These results support liso-cel as a new second-line treatment recommendation in patients with early relapsed or refractory LBCL. FUNDING Celgene, a Bristol-Myers Squibb Company.
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Affiliation(s)
- Manali Kamdar
- Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado Cancer Center, Aurora, CO, USA.
| | - Scott R Solomon
- Transplant and Cellular Immunotherapy Program, Northside Hospital Cancer Institute, Atlanta, GA, USA
| | - Jon Arnason
- Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Bertram Glass
- Department of Hematology and Cell Therapy, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Sami Ibrahimi
- Transplant and Cellular Therapy Clinic, University of Oklahoma Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Stephan Mielke
- Departments of Laboratory Medicine and Medicine at Huddinge, Center of Allogeneic Stem Cell Transplantation and Cellular Therapy (CAST), Karolinska Institutet and University Hospital, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Pim Mutsaers
- Department of Hematology, Erasmus University Medical Center, Rotterdam, Netherlands, on behalf of HOVON/LLPC
| | | | - Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Franck Morschhauser
- Département d'Hématologie, Université de Lille, Centre Hospitalier Universitaire de Lille, Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Matthew Lunning
- Hematology/Oncology Division, University of Nebraska Medical Center, Omaha, NE, USA
| | - David G Maloney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | | | - Lara Stepan
- Bristol Myers Squibb, Lawrence Township, NJ, USA
| | | | - Timothy Mack
- Bristol Myers Squibb, Lawrence Township, NJ, USA
| | - Jeremy S Abramson
- Lymphoma Program, Massachusetts General Hospital Cancer Center, Boston, MA, USA
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15
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Joffe E, Nowakowski G, Tun H, Rosenthal A, Lunning M, Ramchandren R, Li CC, Zhou L, Martinez E, von Roemeling R, Earhart R, McMahon M, Isufi I, Leslie L. P1121: TAKEAIM LYMPHOMA- AN OPEN-LABEL, DOSE ESCALATION AND EXPANSION TRIAL OF EMAVUSERTIB (CA-4948) IN COMBINATION WITH IBRUTINIB IN PATIENTS WITH RELAPSED OR REFRACTORY HEMATOLOGIC MALIGNANCIES. Hemasphere 2022. [PMCID: PMC9430533 DOI: 10.1097/01.hs9.0000847352.16311.ea] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Caimi PF, Ardeshna KM, Reid E, Ai W, Lunning M, Zain J, Solh M, Kahl BS, Hamadani M. The AntiCD19 Antibody Drug Immunoconjugate Loncastuximab Achieves Responses in DLBCL Relapsing After AntiCD19 CAR-T Cell Therapy. Clin Lymphoma Myeloma Leuk 2022; 22:e335-e339. [PMID: 35034868 DOI: 10.1016/j.clml.2021.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Chimeric antigen receptor T (CAR-T) cells targeting CD19 result in durable responses in approximately 40% of DLBCL patients. Loncastuximab tesirine, an antibody drug conjugate targeting CD19 with a pyrrolobenzodiazepine payload, has activity against DLBCL. PATIENTS AND METHODS We evaluated the outcomes of 13 DLBCL patients relapsed after CAR-T cells treated with loncastuximab in the LOTIS-2 trial. RESULTS Six patients (46%) had responses to loncastuximab (CR, n = 2). Median OS, PFS and duration of response after loncastuximab were 8.2, 1.4 and 8 months, respectively. CONCLUSION Loncastuximab can achieve responses in patients progressing after CAR-T cells. Sequencing CD19-targeting therapies is possible in cases without CD19 loss.
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Affiliation(s)
- Paolo F Caimi
- Cleveland Clinic/Case Comprehensive Cancer Center, Cleveland, OH.
| | - Kirit M Ardeshna
- Department of Hematology, University College London Hospitals (UCLH) NHS Foundation Trust, London, UK
| | - Erin Reid
- Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, CA
| | - Weiyun Ai
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, CA
| | - Matthew Lunning
- Division of Oncology and Hematology, Department of Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Jasmine Zain
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Melhem Solh
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA
| | - Brad S Kahl
- Department of Medicine, Oncology Division, Washington University, St. Louis, MO
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI
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17
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Kamdar M, Solomon SR, Arnason JE, Johnston PB, Glass B, Bachanova V, Ibrahimi S, Mielke S, Mutsaers P, Hernandez-Ilizaliturri FJ, Izutsu K, Morschhauser F, Lunning M, Maloney DG, Crotta A, Montheard S, Previtali A, Stepan L, Ogasawara K, Mack T, Abramson JS. Lisocabtagene Maraleucel (liso-cel), a CD19-Directed Chimeric Antigen Receptor (CAR) T Cell Therapy, Versus Standard of Care (SOC) with Salvage Chemotherapy (CT) Followed By Autologous Stem Cell Transplantation (ASCT) As Second-Line (2L) Therapy in Patients (Pts) with Relapsed or Refractory (R/R) Large B-Cell Lymphoma (LBCL): Results from the Randomized Phase 3 Transform Study. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00227-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Lunning M. Autologous and allogeneic CAR T-cell therapies: spotlighting the "brain-to-vein" time. Clin Adv Hematol Oncol 2022; 20:134-137. [PMID: 36607341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Matthew Lunning
- Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, Nebraska
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19
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Abramson JS, Palomba ML, Gordon LI, Lunning M, Wang M, Arnason JE, Purev E, Maloney DG, Andreadis C, Sehgal AR, Solomon SR, Ghosh N, Kostic A, Kim Y, Ogasawara K, Dehner C, Siddiqi T. Two-Year (yr) Follow-up (FU) of Transcend NHL 001, a Multicenter Phase 1 Study of Lisocabtagene Maraleucel (liso-cel) in Relapsed or Refractory (R/R) Large B-Cell Lymphomas (LBCL). Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00226-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Coutu B, Lawrence E, Bociek G, Armitage J, Vose J, Lunning M, Enke C. Consolidative Radiotherapy Remains a Key Player in the Salvage Management of Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Krishnan M, Bociek RG, Fanale M, Iyer SP, Lechowicz MJ, Bierman PJ, Armitage JO, Lunning M, Kallam A, Vose JM. Phase 1 trial of carfilzomib in relapsed/refractory peripheral T-cell lymphoma. Ann Hematol 2021; 101:335-340. [PMID: 34668982 DOI: 10.1007/s00277-021-04692-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022]
Abstract
Peripheral T-cell lymphomas (PTCL) are a unique subset of lymphomas with a poor prognosis due to limited treatment options. We performed a phase 1 study of carfilzomib in patients with relapsed/refractory PTCL to determine the safety profile and the maximum tolerated dose (MTD) of this agent. The study was a classical 3 + 3 phase 1 design with intra-patient dose escalation allowed beginning on day 8 of cycle 1 and subsequently. Dose-limiting toxicity (DLT) was defined as the occurrence of any grade 3/4 adverse event. Carfilzomib was given on days 1, 2, 8, 9, 15, and 16 of a 28-day cycle. Fifteen patients were enrolled from 3 centers. The median age of patients was 62. The median number of prior therapies for subjects on this trial was five. The MTD of carfilzomib was 36 mg/m2. Dose-limiting toxicities included anemia and sepsis. Serious adverse events were seen in 45% of patients. Single-agent carfilzomib leads to a complete response in one patient and a partial response in one patient. Overall, the drug was reasonably tolerated for a heavily pretreated population, but the limited response rate and short duration of response demonstrate a lack of promise for carfilzomib as a single agent in this patient population.
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Affiliation(s)
- Mridula Krishnan
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
| | - R Gregory Bociek
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michelle Fanale
- Department of Lymphoma/Multiple Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Swaminathan P Iyer
- Department of Lymphoma/Multiple Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Philip J Bierman
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - James O Armitage
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Matthew Lunning
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Avyakta Kallam
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Julie M Vose
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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22
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Munshi PN, Hamadani M, Kumar A, Dreger P, Friedberg JW, Dreyling M, Kahl B, Jerkeman M, Kharfan-Dabaja MA, Locke FL, Shadman M, Hill BT, Ahmed S, Herrera AF, Sauter CS, Bachanova V, Ghosh N, Lunning M, Kenkre VP, Aljurf M, Wang M, Maddocks KJ, Leonard JP, Kamdar M, Phillips T, Cashen AF, Inwards DJ, Sureda A, Cohen JB, Smith SM, Carlo-Stella C, Savani B, Robinson SP, Fenske TS. American Society of Transplantation and Cellular Therapy, Center of International Blood and Marrow Transplant Research, and European Society for Blood and Marrow Transplantation Clinical Practice Recommendations for Transplantation and Cellular Therapies in Mantle Cell Lymphoma. Transplant Cell Ther 2021; 27:720-728. [PMID: 34452722 PMCID: PMC8447221 DOI: 10.1016/j.jtct.2021.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 11/18/2022]
Abstract
Autologous (auto-) and allogeneic (allo-) hematopoietic cell transplantation (HCT) are accepted treatment modalities in contemporary treatment algorithms for mantle cell lymphoma (MCL). Chimeric antigen receptor (CAR) T cell therapy recently received approval for MCL; however, its exact place and sequence in relation to HCT remain unclear. The American Society of Transplantation and Cellular Therapy, Center of International Blood and Marrow Transplant Research, and the European Society for Blood and Marrow Transplantation jointly convened an expert panel to formulate consensus recommendations for role, timing, and sequencing of auto-HCT, allo-HCT, and CAR T cell therapy for patients with newly diagnosed and relapsed/refractory (R/R) MCL. The RAND-modified Delphi method was used to generate consensus statements. Seventeen consensus statements were generated, with a few key statements as follows: in the first line setting, auto-HCT consolidation represents standard of care in eligible patients, whereas there is no clear role of allo-HCT or CAR T cell therapy outside of clinical trials. In the R/R setting, the preferential option is CAR T cell therapy, especially in patients with MCL failing or intolerant to at least one Bruton's tyrosine kinase inhibitor, while allo-HCT is recommended if CAR T cell therapy fails or is infeasible. Several recommendations were based on expert opinion, where the panel developed consensus statements for important real-world clinical scenarios to guide clinical practice. In the absence of contemporary evidence-based data, the panel found RAND-modified Delphi methodology effective in providing a formal framework for developing consensus recommendations for the timing and sequence of cellular therapies for MCL.
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Affiliation(s)
- Pashna N Munshi
- Department of Blood and Marrow Transplantation, MedStar Georgetown University Hospital, Washington, DC
| | - Mehdi Hamadani
- Center for International Blood & Marrow Transplant Research and the BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Ambuj Kumar
- Department of Internal Medicine, Office of Research, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Peter Dreger
- Department of Medicine, University of Heidelberg, Germany
| | | | - Martin Dreyling
- Department of Medicine III, LMU Hospital Munich, Munich, Germany
| | - Brad Kahl
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Mats Jerkeman
- Department of Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapies Program, Mayo Clinic, Jacksonville, Florida
| | - Frederick L Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Mazyar Shadman
- Blood and Marrow Transplantation Program, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sairah Ahmed
- Department of Lymphoma, Myeloma and Stem Cell Transplantation & Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California
| | - Craig S Sauter
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Nilanjan Ghosh
- Levine Cancer Institute, Atrium Health, Charlotte, Nnorth Carolina
| | - Matthew Lunning
- Divsion of Hematology and Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Vaishalee P Kenkre
- Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mahmoud Aljurf
- Blood and Marrow Transplantation Program, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Michael Wang
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kami J Maddocks
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - John P Leonard
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Manali Kamdar
- Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado Cancer Center, Denver, Colorado
| | - Tycel Phillips
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Amanda F Cashen
- Division of Oncology, Section of Stem Cell Transplantation, Washington University School of Medicine, St Louis, Missouri
| | | | - Anna Sureda
- Clinical Hematology Department, Catalan Institute of Oncology, Institut d'Investigació Biomèdica de Bellvitge IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | | | - Sonali M Smith
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Carmello Carlo-Stella
- Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital, Milan, Italy
| | - Bipin Savani
- Blood and Marrow Transplantation Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephen P Robinson
- University Hospital Bristol NHS Foundation Trust, London, United Kingdom
| | - Timothy S Fenske
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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23
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Munshi PN, Hamadani M, Kumar A, Dreger P, Friedberg JW, Dreyling M, Kahl B, Jerkeman M, Kharfan-Dabaja MA, Locke FL, Shadman M, Hill BT, Ahmed S, Herrera AF, Sauter CS, Bachanova V, Ghosh N, Lunning M, Kenkre VP, Aljurf M, Wang M, Maddocks KJ, Leonard JP, Kamdar M, Phillips T, Cashen AF, Inwards DJ, Sureda A, Cohen JB, Smith SM, Carlo-Stella C, Savani B, Robinson SP, Fenske TS. ASTCT, CIBMTR, and EBMT clinical practice recommendations for transplant and cellular therapies in mantle cell lymphoma. Bone Marrow Transplant 2021; 56:2911-2921. [PMID: 34413469 PMCID: PMC8639670 DOI: 10.1038/s41409-021-01288-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/08/2021] [Accepted: 03/25/2021] [Indexed: 11/09/2022]
Abstract
Autologous (auto-) or allogeneic (allo-) hematopoietic cell transplantation (HCT) are accepted treatment modalities for mantle cell lymphoma (MCL). Recently, chimeric antigen receptor (CAR) T-cell therapy received approval for MCL; however, its exact place and sequence in relation to HCT is unclear. The ASTCT, CIBMTR, and the EBMT, jointly convened an expert panel to formulate consensus recommendations for role, timing, and sequencing of auto-, allo-HCT, and CAR T-cell therapy for patients with newly diagnosed and relapsed/refractory (R/R) MCL. The RAND-modified Delphi method was used to generate consensus statements. Seventeen consensus statements were generated; in the first-line setting auto-HCT consolidation represents standard-of-care in eligible patients, whereas there is no clear role of allo-HCT or CAR T-cell therapy, outside of a clinical trial. In the R/R setting, the preferential option is CAR T-cell therapy especially in MCL failing or intolerant to at least one Bruton's tyrosine kinase inhibitor, while allo-HCT is recommended if CAR T-cell therapy has failed or is not feasible. In the absence of contemporary evidence-based data, the panel found RAND-modified Delphi methodology effective in providing a formal framework for developing consensus recommendations for the timing and sequence of cellular therapies for MCL.
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Affiliation(s)
| | - Mehdi Hamadani
- CIBMTR & BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Ambuj Kumar
- Department of Internal Medicine, Office of Research, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | | | - Martin Dreyling
- Department of Medicine III, LMU Hospital Munich, Munich, Germany
| | - Brad Kahl
- Washington University School of Medicine, St. Louis, MO, USA
| | - Mats Jerkeman
- Department of Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapies Program, Mayo Clinic, Jacksonville, FL, USA
| | - Frederick L Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sairah Ahmed
- Department of Lymphoma, Myeloma and Stem Cell Transplantation & Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Craig S Sauter
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Nilanjan Ghosh
- Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | | | - Vaishalee P Kenkre
- University of Wisconsin, Division of Hematology and Oncology, Madison, WI, USA
| | | | - Michael Wang
- Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Kami J Maddocks
- Division of Hematology, Ohio State University, Columbus, OH, USA
| | | | - Manali Kamdar
- Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado Cancer Center, Denver, CO, USA
| | - Tycel Phillips
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Amanda F Cashen
- Division of Oncology, Section of Stem Cell Transplantation, Washington University School of Medicine, St Louis, MO, USA
| | - David J Inwards
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Anna Sureda
- Clinical Hematology Department, Catalan Institute of Oncology, Institut d'Investigació Biomèdica de Bellvitge IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | | | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Carmello Carlo-Stella
- Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital, Milan, Italy
| | - Bipin Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Timothy S Fenske
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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24
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Thompson JA, Schneider BJ, Brahmer J, Andrews S, Armand P, Bhatia S, Budde LE, Costa L, Davies M, Dunnington D, Ernstoff MS, Frigault M, Kaffenberger BH, Lunning M, McGettigan S, McPherson J, Mohindra NA, Naidoo J, Olszanski AJ, Oluwole O, Patel SP, Pennell N, Reddy S, Ryder M, Santomasso B, Shofer S, Sosman JA, Wang Y, Weight RM, Johnson-Chilla A, Zuccarino-Catania G, Engh A. NCCN Guidelines Insights: Management of Immunotherapy-Related Toxicities, Version 1.2020. J Natl Compr Canc Netw 2021; 18:230-241. [PMID: 32135517 DOI: 10.6004/jnccn.2020.0012] [Citation(s) in RCA: 231] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The NCCN Guidelines for Management of Immunotherapy-Related Toxicities provide interdisciplinary guidance on the management of immune-related adverse events (irAEs) resulting from cancer immunotherapy. These NCCN Guidelines Insights describe symptoms that may be caused by an irAE and should trigger further investigation, and summarize the NCCN Management of Immunotherapy-Related Toxicities Panel discussions for the 2020 update to the guidelines regarding immune checkpoint inhibitor-related diarrhea/colitis and cardiovascular irAEs.
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Affiliation(s)
- John A Thompson
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Julie Brahmer
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | | | | | | | | | - Benjamin H Kaffenberger
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | - Nisha A Mohindra
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Jarushka Naidoo
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | - Nathan Pennell
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Jeffrey A Sosman
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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Joffe E, Ramchandren R, Nowakowski G, Rosenthal A, Tun HW, Lunning M, Mead MD, Martinez E, von Roemeling R, Leslie L. AN OPEN‐LABEL TRIAL OF ORAL CA‐4948 AN IRAK4 INHIBITOR COMBINED WITH IBRUTINIB IN ADULT PATIENTS WITH RELAPSED OR REFRACTORY HEMATOLOGIC MALIGNANCIES. Hematol Oncol 2021. [DOI: 10.1002/hon.169_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- E. Joffe
- Memorial Sloan Kettering Cancer Center Hematology Oncology‐ Lymphoma Services NY New York USA
| | - R. Ramchandren
- University of Tennessee Medical Center‐ University Cancer Specialists Hematology Medical Oncology Knoxville Tennessee USA
| | - G. Nowakowski
- Mayo Clinic‐Minnesota Rochester MN, Hematology ‐ Cancer Center Rochester Minnesota USA
| | - A. Rosenthal
- Mayo Clinic‐Arizona, Hematology Phoenix Arizona USA
| | - H. W. Tun
- Mayo Clinic Florida Hematology Oncology‐ Caner Center Jacksonville Florida USA
| | - M. Lunning
- University of Nebraska Division of Oncology & Hematology Omaha Nebraska USA
| | - M. D. Mead
- University of California Los Angeles‐ Santa Monica Medical Center Medicine, Hematology and Oncology Santa Monica California USA
| | - E. Martinez
- Curis, Clinical Development Lexington Massachusetts USA
| | | | - L. Leslie
- John Theurer Cancer Center Hackensack, NJ, Hematology Oncology Hackensack New Jersey USA
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Al-Kadhimi Z, Maness-Harris L, Gundabolu K, Bhatt VR, Bociek RG, Lunning M, Pirrucello S, Lyden E, Pravoverov K, Talmadge J, Vose JM. Two Step Anti-Thymocyte Globulin (ATG) Is Associated with No Severe Acute Graft Versus Host Disease and Favorable Immune Reconstitution Post Allogeneic Hematopoietic Stem Cell Transplantation (AHSCT). Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00421-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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27
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Solomon SR, Mehta A, Abramson JS, Siddiqi T, Lunning M, Maloney DG, Kamdar M, Kostic A, Kim Y, Ogasawara K, Palomba ML. Experience of Prior Anti-CD19 Therapy in Patients (Pts) with Relapsed or Refractory (R/R) Large B-Cell Non-Hodgkin Lymphoma (B-NHL) Receiving Lisocabtagene Maraleucel (liso-cel), an Investigational Anti-CD19 Chimeric Antigen Receptor (CAR) T Cell Product. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00254-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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28
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Elnair R, Thiel G, Schmit-Pokorny K, Swanson D, Jourdan D, Franco T, Shostrom VK, Armitage JO, Bierman PJ, Bociek RG, Kallam A, Vose JM, Lunning M. Assessment of Time to CAR-T Cell Therapy and Patients’ Outcomes in Relapsed or Refractory Diffuse Large B-Cell Lymphoma Based on Insurance Status (Public Versus Private) and Distance Traveled to Treatment Center. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00384-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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29
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Byar KL, Lunning M. Addressing the Challenges of Aggressive Lymphomas. J Adv Pract Oncol 2021; 11:316-320. [PMID: 33598333 PMCID: PMC7857314 DOI: 10.6004/jadpro.2020.11.3.20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Katherine L. Byar, MSN, ANP-BC, BMTCN®, and Matthew Lunning, DO, FACP, covered how to tackle challenges in the treatment of aggressive lymphomas by understanding how to apply emerging data, reviewing optimal therapies and treatment recommendations, and discovering how to manage associated adverse events in this disease state at JADPRO Live 2019.
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Nastoupil LJ, Jain MD, Feng L, Spiegel JY, Ghobadi A, Lin Y, Dahiya S, Lunning M, Lekakis L, Reagan P, Oluwole O, McGuirk J, Deol A, Sehgal AR, Goy A, Hill BT, Vu K, Andreadis C, Munoz J, Westin J, Chavez JC, Cashen A, Bennani NN, Rapoport AP, Vose JM, Miklos DB, Neelapu SS, Locke FL. Standard-of-Care Axicabtagene Ciloleucel for Relapsed or Refractory Large B-Cell Lymphoma: Results From the US Lymphoma CAR T Consortium. J Clin Oncol 2020; 38:3119-3128. [PMID: 32401634 PMCID: PMC7499611 DOI: 10.1200/jco.19.02104] [Citation(s) in RCA: 450] [Impact Index Per Article: 112.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Axicabtagene ciloleucel (axi-cel) is an autologous CD19-directed chimeric antigen receptor (CAR) T-cell therapy approved for relapsed/refractory large B-cell lymphoma (LBCL) on the basis of the single-arm phase II ZUMA-1 trial, which showed best overall and complete response rates in infused patients of 83% and 58%, respectively. We report clinical outcomes with axi-cel in the standard-of-care (SOC) setting for the approved indication. PATIENTS AND METHODS Data were collected retrospectively from all patients with relapsed/refractory LBCL who underwent leukapheresis as of September 30, 2018, at 17 US institutions with the intent to receive SOC axi-cel. Toxicities were graded and managed according to each institution's guidelines. Responses were assessed as per Lugano 2014 classification. RESULTS Of 298 patients who underwent leukapheresis, 275 (92%) received axi-cel therapy. Compared with the registrational ZUMA-1 trial, 129 patients (43%) in this SOC study would not have met ZUMA-1 eligibility criteria because of comorbidities at the time of leukapheresis. Among the axi-cel-treated patients, grade ≥ 3 cytokine release syndrome and neurotoxicity occurred in 7% and 31%, respectively. Nonrelapse mortality was 4.4%. Best overall and complete response rates in infused patients were 82% (95% CI, 77% to 86%) and 64% (95% CI, 58% to 69%), respectively. At a median follow-up of 12.9 months from the time of CAR T-cell infusion, median progression-free survival was 8.3 months (95% CI, 6.0 to15.1 months), and median overall survival was not reached. Patients with poor Eastern Cooperative Oncology Group performance status of 2-4 and elevated lactate dehydrogenase had shorter progression-free and overall survival on univariable and multivariable analysis. CONCLUSION The safety and efficacy of axi-cel in the SOC setting in patients with relapsed/refractory LBCL was comparable to the registrational ZUMA-1 trial.
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Affiliation(s)
| | | | - Lei Feng
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Armin Ghobadi
- Washington University School of Medicine and Siteman Cancer Center, St Louis, MO
| | - Yi Lin
- Mayo Clinic, Rochester, MN
| | - Saurabh Dahiya
- University of Maryland School of Medicine and Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | | | | | | | | | | | - Abhinav Deol
- Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | | | - Andre Goy
- John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, NJ
| | | | - Khoan Vu
- University of California, San Francisco, San Francisco, CA
| | | | | | - Jason Westin
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Amanda Cashen
- Washington University School of Medicine and Siteman Cancer Center, St Louis, MO
| | | | - Aaron P. Rapoport
- University of Maryland School of Medicine and Greenebaum Comprehensive Cancer Center, Baltimore, MD
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Abstract
Hepatosplenic γ-δ T-cell lymphoma, an exceptionally uncommon subtype of peripheral T-cell lymphomas, commonly presents with advanced-stage disease manifesting with hepatosplenomegaly, cytopenias, and constitutional symptoms. Management of this subset is challenging as a result of the unique presentation and refractory nature to conventional treatment approaches. There is a lack of consensus guidelines for up-front induction strategies, and the role of consolidative autologous or allogeneic stem-cell transplantation is controversial. Prospective studies are lacking, and treatment is often guided by literature on the basis of case series or single-institution studies, lending to expert opinions influencing treatment paradigms.
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Affiliation(s)
- Mridula Krishnan
- 1 Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
| | - Matthew Lunning
- 1 Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
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Ghione P, Qi S, Imber BS, Seshan V, Moskowitz A, Galasso N, Lunning M, Straus D, Sauter C, Dahi P, Dogan A, Yahalom J, Horwitz S. Modified SMILE (mSMILE) and intensity-modulated radiotherapy (IMRT) for extranodal NK-T lymphoma nasal type in a single-center population. Leuk Lymphoma 2020; 61:3331-3341. [PMID: 32844695 DOI: 10.1080/10428194.2020.1811864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A modification of the SMILE regimen with dexamethasone, methotrexate, ifosfamide, L-asparaginase, etoposide (mSMILE) followed by Intensity-Modulated Radiotherapy (IMRT) at lower than usual dose, has been adopted as standard of care for extranodal NK-/T-cell lymphoma (ENKL) at our institution. mSMILE is a short course, intensive regimen incorporating pegylated asparaginase. Here, we describe clinical details, outcome and safety of patients receiving mSMILE. Among 28 patients with ENKL treated, response post-mSMILE was 93% (CR 68%), response post IMRT was 95% (CR 87.5%). Among early-stage patients/low PINK-E (n = 13), overall survival (OS) was 100% at the median follow-up of 31 months; progression-free survival (PFS) was 92%. Advanced-stage and intermediate/high PINK-E patients fared similarly (OS 43%, PFS 33.3% at the median follow-up). Thirty-two percent of the patients experienced G3-4 non-hematologic toxicity, all experienced hematologic toxicity. Most localized-stage patients achieved long-term disease control. Despite high response rates, most of the advanced stage patients relapsed quickly.
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Affiliation(s)
- Paola Ghione
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shunan Qi
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Brandon S Imber
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Venkatraman Seshan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alison Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Natasha Galasso
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew Lunning
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Straus
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Craig Sauter
- Department of Medicine, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Parastoo Dahi
- Department of Medicine, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmet Dogan
- Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steven Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Cinar P, Kubal T, Freifeld A, Mishra A, Shulman L, Bachman J, Fonseca R, Uronis H, Klemanski D, Slusser K, Lunning M, Liu C. Safety at the Time of the COVID-19 Pandemic: How to Keep our Oncology Patients and Healthcare Workers Safe. J Natl Compr Canc Netw 2020; 18:1-6. [PMID: 32294617 DOI: 10.6004/jnccn.2020.7572] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The novel coronavirus, SARS-CoV-2, was first detected as a respiratory illness in December 2019 in Wuhan City, China. Since then, coronavirus disease 2019 (COVID-19) has impacted every aspect of our lives worldwide. In a time when terms such as social distancing and flattening the curve have become a part of our vernacular, it is essential that we understand what measures can be implemented to protect our patients and healthcare workers. Undoubtedly, healthcare providers have had to rapidly alter care delivery models while simultaneously acknowledging the crucial unknowns of how these changes may affect clinical outcomes. This special feature reviews strategies on how to mitigate transmission of COVID-19 in an effort to reduce morbidity and mortality associated with the disease for patients with cancer without infection, for patients with cancer with COVID-19 infection, and for the healthcare workers caring for them, while continuing to provide the best possible cancer care. [Editor's Note: This article includes the most current information available at time of publication; however, recommendations regarding public safety and practice may change rapidly in this situation. Individuals should get the most up to date information from the CDC website.].
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Affiliation(s)
- Pelin Cinar
- Division of Medical Oncology, Department of Medicine, University of California San Francisco, California
| | | | | | | | - Lawrence Shulman
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James Bachman
- University of Colorado Cancer Center, Aurora, Colorado
| | | | - Hope Uronis
- Duke Cancer Institute, Durham, North Carolina
| | - Dori Klemanski
- Ohio State Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Kim Slusser
- Yale Cancer Center/Smilow Cancer Hospital, New Haven, Connecticut
| | | | - Catherine Liu
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center; and
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
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Chari A, Cornell RF, Gasparetto C, Karanes C, Matous JV, Niesvizky R, Lunning M, Usmani SZ, Anderson LD, Chhabra S, Girnius S, Shustik C, Stuart R, Lee Y, Salman Z, Liu E, Valent J. Final analysis of a phase 1/2b study of ibrutinib combined with carfilzomib/dexamethasone in patients with relapsed/refractory multiple myeloma. Hematol Oncol 2020; 38:353-362. [PMID: 32053229 PMCID: PMC7496325 DOI: 10.1002/hon.2723] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/31/2020] [Accepted: 02/08/2020] [Indexed: 01/10/2023]
Abstract
Patients with multiple myeloma (MM) inevitably relapse on initial treatment regimens, and novel combination therapies are needed. Ibrutinib is a first‐in‐class, once‐daily inhibitor of Bruton's tyrosine kinase, an enzyme implicated in growth and survival of MM cells. Preclinical data suggest supra‐additivity or synergy between ibrutinib and proteasome inhibitors (PIs) against MM. This phase 1/2b study evaluated the efficacy and safety of ibrutinib plus the PI carfilzomib and dexamethasone in patients with relapsed/refractory MM (RRMM). In this final analysis, we report results in patients who received the recommended phase 2 dose (RP2D; ibrutinib 840 mg and carfilzomib 36 mg/m2 with dexamethasone), which was determined in phase 1. The primary efficacy endpoint was overall response rate (ORR). Fifty‐nine patients with RRMM received the RP2D (18 in phase 1 and 41 in phase 2b). These patients had received a median of three prior lines of therapy; 69% were refractory to bortezomib, and 90% were refractory to their last treatment. ORR in the RP2D population was 71% (stringent complete response and complete response: 3% each). Median duration of clinical benefit and median duration of response were both 6.5 months. Median progression‐free survival (PFS) was 7.4 months, and median overall survival (OS) was 35.9 months. High‐risk patients had comparable ORR and median PFS (67% and 7.7 months, respectively) to non–high‐risk patients, whose ORR was 73% and median PFS was 6.9 months, whereas median OS in high‐risk patients was 13.9 months and not reached in non–high‐risk patients. The most common grade ≥3 hematologic treatment‐emergent adverse events (TEAEs) were anemia and thrombocytopenia (17% each); the most common grade ≥3 non‐hematologic TEAE was hypertension (19%). In patients with RRMM treated with multiple previous lines of therapy, ibrutinib plus carfilzomib demonstrated anticancer activity within the expected efficacy range. No new safety signals were identified and the combination was well‐tolerated.
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Affiliation(s)
- Ajai Chari
- Department of Hematology and Medical Oncology, Mount Sinai School of Medicine, New York, New York
| | - Robert F Cornell
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Health System, Durham, North Carolina
| | - Chatchada Karanes
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Jeffrey V Matous
- Department of Hematology/Oncology, Colorado Blood Cancer Institute, Denver, Colorado
| | - Ruben Niesvizky
- Department of Medical Oncology, Weill Cornell Medicine, New York, New York
| | - Matthew Lunning
- Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Saad Z Usmani
- Department of Hematologic Oncology & Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Larry D Anderson
- Division of Hematology Oncology, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Saulius Girnius
- Department of Medicine, University of Cincinnati Cancer Institute, Cincinnati, Ohio
| | - Chaim Shustik
- Division of Hematology, Cedars Cancer Centre, McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert Stuart
- Division of Hematology/Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Yihua Lee
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, California
| | - Zeena Salman
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, California
| | - Emily Liu
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, California
| | - Jason Valent
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Cleveland, Ohio
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35
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Coutu B, Kallam A, Lunning M, Bociek G, Bierman P, Vose J, Armitage J, Enke C. Accelerated Fractionated Compared to Conventional Fractionated Salvage Radiation Therapy Improves Outcomes in Salvage Chemotherapy Refractory Diffuse Large B-Cell Lymphoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Siddiqi T, Abramson J, Lee H, Schuster S, Hasskarl J, Montheard S, Dell Aringa J, Thompson E, Ananthakrishnan R, Lunning M. SAFETY OF LISOCABTAGENE MARALEUCEL GIVEN WITH DURVALUMAB IN PATIENTS WITH RELAPSED/REFRACTORY AGGRESSIVE B-CELL NON HODGKIN LYMPHOMA: FIRST RESULTS FROM THE PLATFORM STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.128_2629] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- T. Siddiqi
- Hematology/Hematopoietic Cell Transplantation; City of Hope National Medical Center; Duarte United States
| | - J.S. Abramson
- Center for Lymphoma; Massachusetts General Hospital; Boston United States
| | - H.J. Lee
- Department of Lymphoma & Myeloma; The University of Texas MD Anderson Cancer Center; Houston United States
| | - S. Schuster
- Department of Medicine; Abramson Cancer Center; Philadelphia United States
| | - J. Hasskarl
- Global Clinical Research & Development; Celgene International; Boudry Switzerland
| | - S. Montheard
- Global Clinical Research & Development; Celgene International; Boudry Switzerland
| | - J. Dell Aringa
- Translational Medicine; Immuno Oncology and Cellular Therapy, Juno Therapeutics, a Celgene Company; Seattle United States
| | - E. Thompson
- Informatics and Predictive Sciences; Juno Therapeutics, a Celgene Company; Seattle United States
| | | | - M. Lunning
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
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Lunning M, Horwitz S, Advani R, Vose J, Lee H, Mehta-Shah N, Zain J, Haverkos B, Lechowicz M, Moskowitz A, Heires P, Lyden L, Ansell S. PHASE I/II STUDY OF CHOEP PLUS LENALIDOMIDE AS INITIAL THERAPY FOR PATIENTS WITH STAGE II-IV PERIPHERAL T-CELL LYMPHOMA: PHASE II RESULTS. Hematol Oncol 2019. [DOI: 10.1002/hon.91_2630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- M. Lunning
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
| | - S. Horwitz
- Lymphoma Service; Memorial Sloan Kettering Cancer Center; New York United States
| | - R. Advani
- Lymphoma Program; Stanford University; Palo Alto United States
| | - J. Vose
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
| | - H. Lee
- Lymphoma & Myeloma; MD Anderson Cancer Center; Houston United States
| | - N. Mehta-Shah
- Oncology; Washington University; St. Louis United States
| | - J. Zain
- Hematology & Hematopoetic Cell Transplantation; City of Hope; Duarte United States
| | - B. Haverkos
- Oncology; University of Colorado; Aurora United States
| | - M. Lechowicz
- Hematology/Oncology; Emory; Atlanta United States
| | - A. Moskowitz
- Lymphoma Service; Memorial Sloan Kettering Cancer Center; New York United States
| | - P. Heires
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
| | - L. Lyden
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
| | - S. Ansell
- Lymphoma; Mayo Clinic; Rochester United States
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Sano D, Lekakis L, Feng L, Nastoupil L, Jain M, Spiegel J, Dahiya S, Lin Y, Ghobadi A, Lunning M, Hill B, Reagan P, Oluwole O, McGuirk J, Sehgal A, Deol A, Charalambos A, Goy A, Munoz J, Cashen A, Bennani N, Rapoport A, Vose J, Miklos D, Locke F, Neelapu S. SAFETY AND EFFICACY OF AXICABTAGENE CILOLEUCEL (AXI-CEL) IN OLDER PATIENTS: RESULTS FROM THE US LYMPHOMA CAR-T CONSORTIUM. Hematol Oncol 2019. [DOI: 10.1002/hon.113_2630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- D. Sano
- Lymphoma/Myeloma; MD Anderson Cancer Center; Houston United States
| | - L. Lekakis
- Bone Marrow Transplant/Hematology; University Of Miami; Miami United States
| | - L. Feng
- Lymphoma/Myeloma; MD Anderson Cancer Center; Houston United States
| | - L.J. Nastoupil
- Lymphoma/Myeloma; MD Anderson Cancer Center; Houston United States
| | - M.D. Jain
- Blood; Bone Marrow Transplant and Cellular Therapy, Moffitt Cancer Center; Tampa United States
| | - J.Y. Spiegel
- Hematology; Stanford University; Stanford United States
| | - S. Dahiya
- Hematology/Bone Marrow Transplant; University of Maryland Medical Center; Baltimore United States
| | - Y. Lin
- Hematology; Mayo Clinic; Rochester United States
| | - A. Ghobadi
- Bone Marrow Transplant; Washington University Medical Campus; Saint Louis United States
| | - M. Lunning
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
| | - B.T. Hill
- Hematology and Medical Oncology; Cleveland Clinic; Cleveland United States
| | - P. Reagan
- Lymphoma; University of Rochester Medical Center/Wilmot Cancer institute; Rochester United States
| | - O. Oluwole
- Hematology and Oncology; Vanderbilt University Medical Center; Nashville United States
| | - J. McGuirk
- Hematological Malignancies and Cellular Therapeutic; The University of Kansas Health System; Kansas City United States
| | - A. Sehgal
- Hematology and Oncology; UPMC Hillman Cancer Center; Pittsburgh United States
| | - A. Deol
- Department of Oncology; Wayne State University/Karmanos Cancer Center; Detroit United States
| | - A. Charalambos
- Hematology and Bone Marrow Transplant; University of California San francisco; San Francisco United States
| | - A.H. Goy
- Hematology and Oncology; Hackensack University Medical Center; Hackensack United States
| | - J. Munoz
- Lymphoma/Myeloma; Banner MD Anderson Cancer Center; Gilbert United States
| | - A. Cashen
- Bone Marrow Transplantation & Leukemia; Washington University Medical School; St. Louis United States
| | - N.N. Bennani
- Hematology; Mayo Clinic; Rochester United States
| | - A.P. Rapoport
- Hematology/Bone Marrow Transplant; University of Maryland Medical Center; Baltimore United States
| | - J.M. Vose
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
| | - D.B. Miklos
- Hematology; Stanford University; Stanford United States
| | - F.L. Locke
- Blood; Bone Marrow Transplant and Cellular Therapy, Moffitt Cancer Center; Tampa United States
| | - S.S. Neelapu
- Lymphoma/Myeloma; MD Anderson Cancer Center; Houston United States
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Ghione P, Qi S, Imber B, Venkatraman S, Moskowitz A, Galasso N, Lunning M, Straus D, Sauter C, Dahi P, Dogan A, Yahalom J, Horwitz S. TREATMENT AND OUTCOMES OF PATIENTS WITH NK/T-CELL LYMPHOMA TREATED WITH MODIFIED (m)SMILE AND INTENSITY-MODULATED RADIOTHERAPY (IMRT), A SINGLE CENTER EXPERIENCE. Hematol Oncol 2019. [DOI: 10.1002/hon.156_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- P. Ghione
- Lymphoma Service; Memorial Sloan Ketterin Cancer Center; New York United States
| | - S. Qi
- Radiation Oncology; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing Shi China
| | - B.S. Imber
- Department of Radiation Oncology; Memorial Sloan Ketterin Cancer Center; New York United States
| | - S. Venkatraman
- Department of Epidemiology and Biostatistics; Memorial Sloan Ketterin Cancer Center; New York United States
| | - A. Moskowitz
- Lymphoma Service; Memorial Sloan Ketterin Cancer Center; New York United States
| | - N. Galasso
- Lymphoma Service; Memorial Sloan Ketterin Cancer Center; New York United States
| | - M. Lunning
- Oncology and Hematology; University of Nebraska Medical Center; Omaha United States
| | - D. Straus
- Lymphoma Service; Memorial Sloan Ketterin Cancer Center; New York United States
| | - C. Sauter
- Bone Marrow Transplant Service; Memorial Sloan Ketterin Cancer Center; New York United States
| | - P. Dahi
- Bone Marrow Transplant Service; Memorial Sloan Ketterin Cancer Center; New York United States
| | - A. Dogan
- Hematopathology Service; Memorial Sloan Ketterin Cancer Center; New York United States
| | - J. Yahalom
- Department of Radiation Oncology; Memorial Sloan Ketterin Cancer Center; New York United States
| | - S.M. Horwitz
- Lymphoma Service; Memorial Sloan Ketterin Cancer Center; New York United States
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40
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Lunning M, Bierman P, Bociek R, Armitage J, Heires P, Blumel S, Hohenstein M, Lyden L, Vose J. A PHASE IIA STUDY EVALUATING THE SAFETY AND TOLERABILITY OF UMBRALISIB AND IBRUTINIB IN PATIENTS WITH RELAPSED OR REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.204_2631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M. Lunning
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
| | - P. Bierman
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
| | - R. Bociek
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
| | - J. Armitage
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
| | - P. Heires
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
| | - S. Blumel
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
| | - M. Hohenstein
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
| | - L. Lyden
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
| | - J. Vose
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
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Wang M, Gordon L, Palomba M, Abramson J, Andreadis C, Ghosh N, Lunning M, Maloney D, Farazi T, Garcia J, Xie B, Newhall K, Dehner C, Siddiqi T. SAFETY AND PRELIMINARY EFFICACY IN PATIENTS WITH RELAPSED/REFRACTORY MANTLE CELL LYMPHOMA RECEIVING LISOCABTAGENE MARALEUCEL IN TRANSCEND NHL 001. Hematol Oncol 2019. [DOI: 10.1002/hon.111_2630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- M. Wang
- Lymphoma/Myeloma; University of Texas MD Anderson Cancer Center; Houston United States
| | - L.I. Gordon
- Division of Hematology/Oncology; Northwestern University, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center; Chicago United States
| | - M.L. Palomba
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York United States
| | - J.S. Abramson
- Center for Lymphoma; Massachusetts General Hospital Cancer Center; Boston United States
| | - C. Andreadis
- Department of Medicine; University of California; San Francisco United States
| | - N. Ghosh
- Hematologic Oncology and Blood Disorders; Levine Cancer Institute, Atrium Health; Charlotte United States
| | - M. Lunning
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
| | - D. Maloney
- Clinical Research Division; Fred Hutchison Cancer Research Center; Seattle United States
| | - T. Farazi
- Clinical Research and Development; Juno Therapeutics, a Celgene Company; Seattle United States
| | - J. Garcia
- Clinical Research & Development; Juno Therapeutics, a Celgene Company; Seattle United States
| | - B. Xie
- Biostatistics; Juno Therapeutics, a Celgene Company; Seattle United States
| | - K. Newhall
- Clinical Operations; Juno Therapeutics, a Celgene Company; Seattle United States
| | - C. Dehner
- Clinical Operations; Juno Therapeutics, a Celgene Company; Seattle United States
| | - T. Siddiqi
- Hematology/ Hematopoietic Cell Transplantation; City of Hope National Medical Center; Duarte United States
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Anderson DE, Bhatt VR, Schmid K, Holstein SA, Lunning M, Berger AM, Rizzo M. Neurophysiological evidence of impaired attention and working memory in untreated hematologic cancer patients. Clin Neurophysiol 2019; 130:1243-1252. [PMID: 31163369 DOI: 10.1016/j.clinph.2019.04.714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/27/2019] [Accepted: 04/15/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Neuroimaging studies of hematologic cancer patients report altered activity in dorsal attention and central executive networks. To determine the consequences of these altered brain networks, we evaluated neurophysiological correlates of attention and working memory in hematologic cancer patients prior to initiating treatment. METHODS Hematologic cancer patients (19-80 years) were excluded for premorbid cognitive impairment, prior non-hematologic cancer diagnosis, and prior chemotherapy. Attention was manipulated by presenting an irrelevant spatial cue prior to visual search displays. Working memory was manipulated by presenting irrelevant distractors within memory displays. Electroencephalogram was recorded during task performance. RESULTS Patients (n = 28) and controls (n = 15) were balanced on age, gender, and education. Spatial cues evoked larger N2pc amplitudes, a correlate of spatial attention, in patients than controls (p < .05; Cohen's d > 0.7). Memory distractors evoked larger contralateral delay activity amplitudes, a correlate of working memory load, in patients (p = .028; Cohen's d = 1.1) but not controls (p = .64). CONCLUSIONS Prior to initiating treatment, hematologic cancer patients demonstrated poor control over spatial attention and working memory, consistent with altered dorsal attention and central executive network activity. SIGNIFICANCE Hematologic cancer patients may be at a higher risk for selecting, processing, and storing distracting information that would compete with more immediate goal-related behaviors.
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Affiliation(s)
- D E Anderson
- Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center (UNMC), United States; Fred & Pamela Buffett Cancer Center, UNMC, United States; Department of Ophthalmology & Visual Science, College of Medicine, UNMC, United States.
| | - V R Bhatt
- Fred & Pamela Buffett Cancer Center, UNMC, United States; Division of Oncology & Hematology, Department of Internal Medicine, UNMC, United States
| | - K Schmid
- Department of Biostatistics, College of Public Health, UNMC, United States
| | - S A Holstein
- Fred & Pamela Buffett Cancer Center, UNMC, United States; Division of Oncology & Hematology, Department of Internal Medicine, UNMC, United States
| | - M Lunning
- Fred & Pamela Buffett Cancer Center, UNMC, United States; Division of Oncology & Hematology, Department of Internal Medicine, UNMC, United States
| | - A M Berger
- Fred & Pamela Buffett Cancer Center, UNMC, United States; College of Nursing, UNMC, United States
| | - M Rizzo
- Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center (UNMC), United States; Fred & Pamela Buffett Cancer Center, UNMC, United States
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Abramson JS, Lunning M, Palomba ML. Chimeric Antigen Receptor T-Cell Therapies for Aggressive B-Cell Lymphomas: Current and Future State of the Art. Am Soc Clin Oncol Educ Book 2019; 39:446-453. [PMID: 31099671 DOI: 10.1200/edbk_238693] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aggressive B-cell lymphomas that are primary refractory to, or relapse after, frontline chemoimmunotherapy have a low cure rate with conventional therapies. Although high-dose chemotherapy remains the standard of care at first relapse for sufficiently young and fit patients, fewer than one-quarter of patients with relapsed/refractory disease are cured with this approach. Anti-CD19 chimeric antigen receptor (CAR) T cells have emerged as an effective therapy in patients with multiple relapsed/refractory disease, capable of inducing durable remissions in patients with chemotherapy-refractory disease. Three anti-CD19 CAR T cells for aggressive B-cell lymphoma (axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene ciloleucel) are either U.S. Food and Drug Administration approved or in late-stage development. All three CAR T cells produce durable remissions in 33%-40% of treated patients. Differences among these products include the specific CAR constructs, costimulatory domains, manufacturing process, dose, and eligibility criteria for their pivotal trials. Notable toxicities include cytokine release syndrome and neurologic toxicities, which are usually treatable and reversible, as well as cytopenias and hypogammaglobulinemia. Incidences of cytokine release syndrome and neurotoxicity differ across CAR T-cell products, related in part to the type of costimulatory domain. Potential mechanisms of resistance include CAR T-cell exhaustion and immune evasion, CD19 antigen loss, and a lack of persistence. Rational combination strategies with CAR T cells are under evaluation, including immune checkpoint inhibitors, immunomodulators, and tyrosine kinase inhibitors. Novel cell products are also being developed and include CAR T cells that target multiple tumor antigens, cytokine-secreting CAR T cells, and gene-edited CAR T cells, among others.
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Affiliation(s)
| | | | - M Lia Palomba
- 3 Memorial Sloan Kettering Cancer Center, New York, NY
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Thompson JA, Schneider BJ, Brahmer J, Andrews S, Armand P, Bhatia S, Budde LE, Costa L, Davies M, Dunnington D, Ernstoff MS, Frigault M, Hoffner B, Hoimes CJ, Lacouture M, Locke F, Lunning M, Mohindra NA, Naidoo J, Olszanski AJ, Oluwole O, Patel SP, Reddy S, Ryder M, Santomasso B, Shofer S, Sosman JA, Wahidi M, Wang Y, Johnson-Chilla A, Scavone JL. Management of Immunotherapy-Related Toxicities, Version 1.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 17:255-289. [DOI: 10.6004/jnccn.2019.0013] [Citation(s) in RCA: 288] [Impact Index Per Article: 57.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aim of the NCCN Guidelines for Management of Immunotherapy-Related Toxicities is to provide guidance on the management of immune-related adverse events resulting from cancer immunotherapy. The NCCN Management of Immunotherapy-Related Toxicities Panel is an interdisciplinary group of representatives from NCCN Member Institutions and ASCO, consisting of medical and hematologic oncologists with expertise in a wide array of disease sites, and experts from the fields of dermatology, gastroenterology, neuro-oncology, nephrology, emergency medicine, cardiology, oncology nursing, and patient advocacy. Several panel representatives are members of the Society for Immunotherapy of Cancer (SITC). The initial version of the NCCN Guidelines was designed in general alignment with recommendations published by ASCO and SITC. The content featured in this issue is an excerpt of the recommendations for managing toxicity related to immune checkpoint blockade and a review of existing evidence. For the full version of the NCCN Guidelines, including recommendations for managing toxicities related to chimeric antigen receptor T-cell therapy, visitNCCN.org.
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Affiliation(s)
- John A. Thompson
- 1Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Julie Brahmer
- 3The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | - Shailender Bhatia
- 1Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Luciano Costa
- 7University of Alabama at Birmingham Comprehensive Cancer Center
| | | | | | | | | | | | - Christopher J. Hoimes
- 13Case Comprehensive Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | - Nisha A. Mohindra
- 16Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Jarushka Naidoo
- 3The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | | | | | - Jeffrey A. Sosman
- 16Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Yinghong Wang
- 23The University of Texas MD Anderson Cancer Center; and
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Cook LB, Fuji S, Hermine O, Bazarbachi A, Ramos JC, Ratner L, Horwitz S, Fields P, Tanase A, Bumbea H, Cwynarski K, Taylor G, Waldmann TA, Bittencourt A, Marcais A, Suarez F, Sibon D, Phillips A, Lunning M, Farid R, Imaizumi Y, Choi I, Ishida T, Ishitsuka K, Fukushima T, Uchimaru K, Takaori-Kondo A, Tokura Y, Utsunomiya A, Matsuoka M, Tsukasaki K, Watanabe T. Revised Adult T-Cell Leukemia-Lymphoma International Consensus Meeting Report. J Clin Oncol 2019; 37:677-687. [PMID: 30657736 PMCID: PMC6494249 DOI: 10.1200/jco.18.00501] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Adult T-cell leukemia-lymphoma (ATL) is a distinct mature T-cell malignancy caused by chronic infection with human T-lymphotropic virus type 1 with diverse clinical features and prognosis. ATL remains a challenging disease as a result of its diverse clinical features, multidrug resistance of malignant cells, frequent large tumor burden, hypercalcemia, and/or frequent opportunistic infection. In 2009, we published a consensus report to define prognostic factors, clinical subclassifications, treatment strategies, and response criteria. The 2009 consensus report has become the standard reference for clinical trials in ATL and a guide for clinical management. Since the last consensus there has been progress in the understanding of the molecular pathophysiology of ATL and risk-adapted treatment approaches. METHODS Reflecting these advances, ATL researchers and clinicians joined together at the 18th International Conference on Human Retrovirology-Human T-Lymphotropic Virus and Related Retroviruses-in Tokyo, Japan, March, 2017, to review evidence for current clinical practice and to update the consensus with a new focus on the subtype classification of cutaneous ATL, CNS lesions in aggressive ATL, management of elderly or transplantation-ineligible patients, and treatment strategies that incorporate up-front allogeneic hematopoietic stem-cell transplantation and novel agents. RESULTS As a result of lower-quality clinical evidence, a best practice approach was adopted and consensus statements agreed on by coauthors (> 90% agreement). CONCLUSION This expert consensus highlights the need for additional clinical trials to develop novel standard therapies for the treatment of ATL.
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Affiliation(s)
- Lucy B Cook
- 1 Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom.,2 Imperial College London, London, United Kingdom
| | - Shigeo Fuji
- 3 Osaka International Cancer Institute, Osaka, Japan
| | | | | | | | - Lee Ratner
- 7 Washington University School of Medicine, St Louis, MO
| | - Steve Horwitz
- 8 Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Fields
- 9 Guys and St Thomas Hospital, Kings Health Partners, London, United Kingdom
| | - Alina Tanase
- 10 Fundeni Clinical Institute, Bucharest, Romania
| | - Horia Bumbea
- 11 Emergency University Hospital, Bucharest, Romania
| | - Kate Cwynarski
- 12 University College London Hospitals NHS Trust, London, United Kingdom
| | | | | | | | | | | | | | | | | | - Reza Farid
- 17 Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Ilseung Choi
- 19 National Kyushu Cancer Center, Fukuoka, Japan
| | | | | | | | | | | | - Yoshiki Tokura
- 25 Hamamatsu University School of Medicine, Hamamatsu, Japan
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Lin H, Li Q, Du Q, Wang O, Wang Z, Akert L, Carlson MA, Zhang C, Subramanian A, Zhang C, Lunning M, Li M, Lei Y. Integrated generation of induced pluripotent stem cells in a low-cost device. Biomaterials 2019; 189:23-36. [DOI: 10.1016/j.biomaterials.2018.10.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 12/15/2022]
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Umakanthan JM, Iqbal J, Batlevi CL, Bouska A, Smith LM, Shostrom V, Nutsch H, William BM, Gregory Bociek R, Lunning M, Bierman P, Younes A, Armitage JO, Vose JM. Phase I/II study of dasatinib and exploratory genomic analysis in relapsed or refractory non-Hodgkin lymphoma. Br J Haematol 2018; 184:744-752. [PMID: 30520026 DOI: 10.1111/bjh.15702] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/05/2018] [Indexed: 12/22/2022]
Abstract
Relapsed or refractory non-Hodgkin lymphomas (NHLs) often carry poor prognosis and pose management challenges. We evaluated the safety and efficacy of dasatinib, a broad-spectrum multi-kinase inhibitor in relapsed/refractory NHL with correlative genomic analysis in a Phase I/II trial. The study included 33 patients with various sub-types of NHL who had received at least one prior therapy. The most common sub-types were diffuse large B-cell lymphoma (24%), follicular lymphoma, grade 1/2 (21%) and peripheral T-cell lymphoma not otherwise specified (PTCL-NOS; 21%). Most patients were heavily pre-treated, including 42% with more than four prior therapies, 67% with rituximab exposure and 24% with prior autologous transplant. In this cohort, dasatinib showed modest activity in evaluable patients with an objective response rate of 29% (7/24) and clinical benefit rate of 71% (17/24). In 32 patients with outcome data, median progression-free survival was 3 months and median overall survival was 22·4 months. There were two patients with sustained complete responses, both with PTCL-NOS histology. The side effect profile was consistent with prior studies, with pleural effusion being the most common non-haematological toxicity. Exploratory genomic analysis showed two cases of PTCL-NOS with sustained response had a common mutation in LRRK2 and high prevalence of FOXO1 mutation in relapsed/refractory follicular lymphoma.
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Affiliation(s)
- Jayadev M Umakanthan
- Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Javeed Iqbal
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Connie L Batlevi
- Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Alyssa Bouska
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lynette M Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Valerie Shostrom
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Heather Nutsch
- Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Basem M William
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center (OSUCCC-James), The Ohio State University, Columbus, OH, USA
| | - R Gregory Bociek
- Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Matthew Lunning
- Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Philip Bierman
- Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Anas Younes
- Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - James O Armitage
- Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Julie M Vose
- Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, NE, USA
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Anderson DE, Bhatt VR, Schmid K, Lunning M, Holstein SA, Rizzo M. Electrophysiological Measure of Impaired Information Processing in Drivers with Hematological Malignancy. Transp Res Rec 2018; 2672:64-73. [PMID: 31031516 PMCID: PMC6482833 DOI: 10.1177/0361198118791666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The broad goal of this study is to measure remote effects of cancer on brain physiology and behaviors that underpin instrumental activities of daily living such as automobile driving. Studies of hematological malignancies (HM) have demonstrated impairments in multiple brain functions shown to be critical for safe automobile driving. In the current pilot study, brain physiology during driving simulation was examined in 14 HM patients and 13 healthy comparison drivers. Electroencephalography was used to measure the eye fixation-related potential (EFRP)-a positive amplitude deflection evoked approximately 100 milliseconds after eye movement termination. Previous studies have demonstrated sensitivity of EFRP activity to information-processing capacity. All drivers completed visual search tasks to evaluate the relationship between driving-related changes in performance and EFRP activity. Results showed smaller EFRP amplitudes in drivers who had: (1) greater driving-related changes in visual search performance (p = 0.03, Cohen's d = 0.91); and (2) HM diagnosis (p = 0.18, Cohen's d = 0.54). Extending previous studies, these results provide neural evidence of reduced information-processing capacity associated with cancer diagnosis. Future large-scale studies are needed to confirm these results, given the high level of uncertainty and small sample size. This study provides a novel platform for linking changes in brain physiology and safety-critical driving behaviors.
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Affiliation(s)
- David E. Anderson
- Department of Neurological Sciences, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE
| | - Vijaya R. Bhatt
- Department of Internal Medicine, Division of Oncology & Hematology, Nebraska Medical Center, Omaha, NE
| | - Kendra Schmid
- Department of Biostatistics, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE
| | - Matthew Lunning
- Department of Internal Medicine, Division of Oncology & Hematology, Nebraska Medical Center, Omaha, NE
| | - Sarah A. Holstein
- Department of Internal Medicine, Division of Oncology & Hematology, Nebraska Medical Center, Omaha, NE
| | - Matthew Rizzo
- Department of Neurological Sciences, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE
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Chari A, Larson S, Holkova B, Cornell RF, Gasparetto C, Karanes C, Matous JV, Niesvizky R, Valent J, Lunning M, Usmani SZ, Anderson LD, Chang L, Lee Y, Pak Y, Salman Z, Graef T, Bilotti E, Chhabra S. Phase 1 trial of ibrutinib and carfilzomib combination therapy for relapsed or relapsed and refractory multiple myeloma. Leuk Lymphoma 2018; 59:2588-2594. [PMID: 29616843 DOI: 10.1080/10428194.2018.1443337] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This phase 1, dose-finding study investigated ibrutinib and carfilzomib ± dexamethasone in patients with relapsed or relapsed/refractory multiple myeloma (≥2 lines of therapy including bortezomib and an immunomodulatory agent). Of 43 patients enrolled, 74% were refractory to bortezomib and 23% had high-risk cytogenetics. No dose-limiting toxicities were observed. The recommended phase 2 dose was ibrutinib 840 mg and carfilzomib 36 mg/m2 with dexamethasone. The most common ≥ grade 3 (>10%) treatment-emergent adverse events were hypertension, anemia, pneumonia, fatigue, diarrhea, and thrombocytopenia. Overall response rate was 67% (very good partial response, 21%; stringent complete response, 2%), with an additional 9% minimal response. Median progression-free survival was 7.2 months and was not inferior in refractory nor high-risk patients. Median overall survival was not reached. Ibrutinib plus carfilzomib demonstrated encouraging responses with a manageable safety profile in this advanced population.
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Affiliation(s)
- Ajai Chari
- a Icahn School of Medicine at Mount Sinai , Tisch Cancer Institute , New York , NY , USA
| | - Sarah Larson
- b University of California , Los Angeles , CA , USA
| | - Beata Holkova
- c Virginia Commonwealth University Medical Center , Richmond , VA , USA
| | | | | | | | | | | | - Jason Valent
- i Cleveland Clinic , Taussig Cancer Institute , Cleveland , OH , USA
| | | | - Saad Z Usmani
- k Levine Cancer Institute/Carolinas Healthcare System , Charlotte , NC , USA
| | - Larry D Anderson
- l Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Lipo Chang
- m Pharmacyclics LLC, an AbbVie Company , Sunnyvale , CA , USA
| | - Yihua Lee
- m Pharmacyclics LLC, an AbbVie Company , Sunnyvale , CA , USA
| | - Yvonne Pak
- m Pharmacyclics LLC, an AbbVie Company , Sunnyvale , CA , USA
| | - Zeena Salman
- m Pharmacyclics LLC, an AbbVie Company , Sunnyvale , CA , USA
| | - Thorsten Graef
- m Pharmacyclics LLC, an AbbVie Company , Sunnyvale , CA , USA
| | | | - Saurabh Chhabra
- n Medical University of South Carolina , Charleston , SC , USA
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