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Avenarius MR, Huang Y, Kittai AS, Bhat SA, Rogers KA, Grever MR, Woyach JA, Miller CR. Comparison of karyotype scoring guidelines for evaluating karyotype complexity in chronic lymphocytic leukemia. Leukemia 2024; 38:676-678. [PMID: 38374409 DOI: 10.1038/s41375-024-02177-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Affiliation(s)
| | - Ying Huang
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Adam S Kittai
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Seema A Bhat
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Kerry A Rogers
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Michael R Grever
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Jennifer A Woyach
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Cecelia R Miller
- Department of Pathology, The Ohio State University, Columbus, OH, USA.
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2
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Annunzio K, Ozga M, Huang Y, Anghelina M, Bhat SA, Blachly JS, Grever MR, Lozanski G, Neal J, Shindiapina P, Rogers KA. Single-center study of outcomes of patients with hairy cell leukemia who contracted SARS-CoV-2. EJHaem 2023; 4:1200-1202. [PMID: 38024604 PMCID: PMC10660372 DOI: 10.1002/jha2.764] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Kaitlin Annunzio
- Hematology and Medical Oncology Fellowship ProgramThe Ohio State UniversityColumbusOhioUSA
| | - Michael Ozga
- Hematology and Medical Oncology Fellowship ProgramThe Ohio State UniversityColumbusOhioUSA
| | - Ying Huang
- Division of HematologyThe Ohio State UniversityColumbusOhioUSA
| | - Mirela Anghelina
- Department of Biomedical InformaticsThe Ohio State UniversityColumbusOhioUSA
| | - Seema A. Bhat
- Division of HematologyThe Ohio State UniversityColumbusOhioUSA
| | | | | | - Gerard Lozanski
- Department of PathologyThe Ohio State UniversityColumbusOhioUSA
| | - Jasmine Neal
- Center for Clinical and Translational ScienceThe Ohio State UniversityColumbusOhioUSA
| | | | - Kerry A. Rogers
- Division of HematologyThe Ohio State UniversityColumbusOhioUSA
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3
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Kumar PS, Wiczer T, Rosen L, Pollauf AJ, Zheng A, Palettas M, Azali L, Bhat SA, Byrd JC, Grever MR, Rogers KA, Woyach JA, Kittai AS. Correction: Evaluation of bleeding events in patients receiving acalabrutinib therapy. Leukemia 2023:10.1038/s41375-023-01927-8. [PMID: 37231141 DOI: 10.1038/s41375-023-01927-8] [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: 05/27/2023]
Affiliation(s)
- Pooja S Kumar
- The Ohio State University, Department of Pharmacy, Columbus, OH, USA
| | - Tracy Wiczer
- The Ohio State University, Department of Pharmacy, Columbus, OH, USA
| | - Lindsay Rosen
- The Ohio State University, Department of Pharmacy, Columbus, OH, USA
| | | | - Amy Zheng
- The Ohio State College of Pharmacy, Columbus, OH, USA
| | - Marilly Palettas
- The Ohio State University, Department of Biomedical Informatics, Center for Biostatistics, Columbus, OH, USA
| | - Leylah Azali
- Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Seema A Bhat
- The Ohio State University, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA
| | - John C Byrd
- University of Cincinnati, Department of Internal Medicine, Cincinnati, OH, USA
| | - Michael R Grever
- The Ohio State University, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA
| | - Kerry A Rogers
- The Ohio State University, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA
| | - Jennifer A Woyach
- The Ohio State University, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA
| | - Adam S Kittai
- The Ohio State University, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA.
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4
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Grever MR. Two-inhibitor salvage therapy for hairy cell leukemia. Blood 2023; 141:965-966. [PMID: 36862436 DOI: 10.1182/blood.2022018319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
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5
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Kittai AS, Huang Y, Beckwith KA, Bhat SA, Bond DA, Byrd JC, Goldstein D, Grever MR, Miller C, Rogers KA, Yano M, Woyach JA. Patient characteristics that predict Richter's transformation in patients with chronic lymphocytic leukemia treated with ibrutinib. Am J Hematol 2023; 98:56-65. [PMID: 36216791 DOI: 10.1002/ajh.26755] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/23/2022] [Accepted: 10/03/2022] [Indexed: 02/04/2023]
Abstract
Chronic lymphocytic leukemia (CLL) transformation to aggressive lymphoma, known as Richter's Transformation (RT), has a dismal prognosis. There are limited data evaluating risk of RT in patients treated with ibrutinib. We performed a retrospective analysis to determine prognostic variables associated with development of RT and overall survival (OS) at progression after treatment with ibrutinib. We identified 559 patients with CLL treated with ibrutinib from 2010-2019. After a median follow-up of 44.5 months from ibrutinib start, 179 patients progressed and were included in our analysis. After a median follow-up of 20.8 months from progression, 54 out of 179 patients developed RT. Progression on treatment (hazard ratio [HR] 4.01 [1.60-10.00], p = .003), higher LDH (HR 1.80 for 2-fold increase [1.33-2.43], p = .0001), and lymphadenopathy without lymphocytosis (HR 2.88 [1.15-7.20], p = .02) were independent prognostic variables for the development of RT at progression. Progression with lymphadenopathy without lymphocytosis continued to be an independent prognostic variable of worse OS post-progression. In a subset analysis of 50 patients who obtained a PET-CT at progression, the median SUVmax for patients who would develop RT was 15.2 (n = 30, range: 4.0-46.3) versus those patients who did not develop RT with a SUVmax of 7.7 (n = 20, range: 2.3-27.2) (p = .0030). Median OS from date of RT was 4.0 months, suggesting that prognosis for RT remains poor. A lymph node biopsy to rule out RT should be considered in patients who received ibrutinib who progress on treatment, have an elevated LDH, or progress with lymphadenopathy without lymphocytosis.
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Affiliation(s)
- Adam S Kittai
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Ying Huang
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Kyle A Beckwith
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Seema A Bhat
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - David A Bond
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - John C Byrd
- Department of Internal Medicine, The University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel Goldstein
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Michael R Grever
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Cecelia Miller
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Kerry A Rogers
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Max Yano
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer A Woyach
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
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6
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Handa S, Lee JO, Derkach A, Stone RM, Saven A, Altman JK, Grever MR, Rai KR, Shukla M, Vemuri S, Montoya S, Taylor J, Abdel-Wahab O, Tallman MS, Park JH. Long-term outcomes in patients with relapsed or refractory hairy cell leukemia treated with vemurafenib monotherapy. Blood 2022; 140:2663-2671. [PMID: 35930750 PMCID: PMC9935554 DOI: 10.1182/blood.2022016183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/15/2022] [Accepted: 07/22/2022] [Indexed: 12/30/2022] Open
Abstract
Vemurafenib, an oral BRAF inhibitor, has demonstrated high response rates in relapsed/refractory (R/R) hairy cell leukemia (HCL). However, little is known about long-term outcomes and response to retreatment. Herein, we report the results of 36 patients with R/R HCL treated with vemurafenib from the United States arm of the phase 2 clinical trial (NCT01711632). The best overall response rate was 86%, including 33% complete response (CR) and 53% partial response (PR). After a median follow-up of 40 months, 21 of 31 responders (68%) experienced relapse with a median relapse-free survival (RFS) of 19 months (range, 12.5-53.9 months). There was no significant difference in the RFS for patients with CR vs PR. Fourteen of 21 (67%) relapsed patients were retreated with vemurafenib, with 86% achieving complete hematologic response. Two patients acquired resistance to vemurafenib with the emergence of new KRAS and CDKN2A mutations, respectively. Six of 12 (50%) responders to vemurafenib retreatment experienced another relapse with a median RFS of 12.7 months. Overall survival (OS) was 82% at 4 years, with a significantly shorter OS in patients who relapsed within 1 year of initial treatment with vemurafenib. Higher cumulative doses or a longer duration of treatment did not lengthen the durability of response. All adverse events in the retreatment cohort were grade 1/2 except for 1 case of a grade 3 rash and 1 grade 3 fever/pneumonia. Our data suggest that vemurafenib retreatment is a safe and effective option for patients with R/R HCL.
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Affiliation(s)
- Shivani Handa
- Division of Hematology-Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeong-Ok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Andriy Derkach
- Department of Biostatistics and Epidemiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Richard M. Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Alan Saven
- Division of Hematology and Oncology, Scripps Clinic, La Jolla, CA
| | - Jessica K. Altman
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Kanti R. Rai
- Cancer Institute at Zucker School of Medicine Hofstra-Northwell, New Hyde Park, NY
| | | | - Shreya Vemuri
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Skye Montoya
- Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Justin Taylor
- Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Omar Abdel-Wahab
- Department of Medicine, Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Leukemia Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Martin S. Tallman
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Leukemia Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jae H. Park
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Leukemia Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
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Hyak JM, Huang Y, Rogers KA, Bhat SA, Grever MR, Byrd JC, Kittai AS, Jones D, Miller CR, Woyach JA. Combined BCL2 and BTK inhibition in CLL demonstrates efficacy after monotherapy with both classes. Blood Adv 2022; 6:5124-5127. [PMID: 35834733 PMCID: PMC9631640 DOI: 10.1182/bloodadvances.2022007708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/29/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jonathan M. Hyak
- Department of Medicine and Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ying Huang
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH; and
| | - Kerry A. Rogers
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH; and
| | - Seema A. Bhat
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH; and
| | - Michael R. Grever
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH; and
| | - John C. Byrd
- Department of Internal Medicine, The University of Cincinnati, Cincinnati, OH
| | - Adam S. Kittai
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH; and
| | - Dan Jones
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH; and
| | - Cecelia R. Miller
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH; and
| | - Jennifer A. Woyach
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH; and
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8
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Sigmund AM, Huang Y, Ruppert AS, Maddocks K, Rogers KA, Jaglowski S, Bhat SA, Kittai AS, Grever MR, Byrd JC, Woyach JA. Depth of response and progression-free survival in chronic lymphocytic leukemia patients treated with ibrutinib. Leukemia 2022; 36:2129-2131. [PMID: 35842461 DOI: 10.1038/s41375-022-01640-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/29/2022] [Accepted: 06/28/2022] [Indexed: 01/16/2023]
Affiliation(s)
- Audrey M Sigmund
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Ying Huang
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Amy S Ruppert
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Kami Maddocks
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Kerry A Rogers
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | | | - Seema A Bhat
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Adam S Kittai
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Michael R Grever
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - John C Byrd
- Division of Hematology, The Ohio State University, Columbus, OH, USA.,Department of Internal Medicine, The University of Cincinnati, Cincinnati, OH, USA
| | - Jennifer A Woyach
- Division of Hematology, The Ohio State University, Columbus, OH, USA.
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Epperla N, Zhao Q, Anghelina M, Neal J, Blachly JS, Rogers KA, Lozanski G, Oakes C, Bhat S, Banerji V, Zent C, Grever MR, Andritsos LA. Impact of sex on outcomes in patients with hairy cell leukemia (HCL): An HCL Patient Data Registry (PDR) analysis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7577 Background: HCL is a rare indolent leukemia that is more common in men, with a 4:1 male predominance. To date, no studies have characterized the potential difference in outcomes of HCL between male and female patients. Hence, we sought to evaluate the outcomes of female HCL patients using the HCL-PDR. Methods: The HCL Foundation sponsored the development of HCL-PDR to characterize the clinical features and outcomes of this rare leukemia. HCL-PDR is an international multicenter PDR that includes patient, disease and treatment information abstracted from medical records. Adult patients enrolled in the HCL-PDR were included in the study. Female patients with HCL were the study population, with males as the comparator. The primary endpoint was the time to next treatment (TTNT) in females compared to males. Secondary endpoints included response rates (RR) and predictors of TTNT. Responses were categorized as: complete response (CR) including CR/CRu (CR unconfirmed)/HR (hematologic response), and partial response (PR), which included PR/PRu (PR unconfirmed)/pHR (partial HR). CRu was defined as no disease in bone marrow (BM) without available blood counts and HR as blood counts meeting criteria for HR, but no available BM. Cox proportional hazard models were used to estimate the hazard ratios for TTNT risk. Results: 357 patients were included: 265 males and 92 females. Table shows baseline characteristics stratified by sex. Among the patients who had disease status assessed after first treatment (n=224, males 169 and females 55), there was no significant difference in RR. However, females had significantly longer median TTNT (17.6 years) relative to males (8 years, HR 0.54, 95% CI 0.32-0.91, p=0.02) that remained significant after adjusting for other variables (RR and BRAF mutation) in multivariable analysis (HR 0.32, 95% CI 0.11-0.97, p=0.04). Factors predictive of longer TTNT include female sex and CR (HR.0.26, 95% CI 0.11-0.57, p=0.001). Conclusions: This is the first study to date reporting the clinical characteristics and outcomes in female HCL patients. The significantly longer TTNT in females compared to males may be related to factors such as underlying molecular features or hormonal influences. This finding needs to be explored further. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | - Gerard Lozanski
- Department of Pathology, The Ohio State University, Columbus, OH
| | | | - Seema Bhat
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Clive Zent
- University of Rochester Medical Center, Rochester, NY
| | - Michael R. Grever
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Kittai A, Huang Y, Fisher JL, Bhat S, Grever MR, Paskett ED, Rogers KA, Woyach JA. Racial and socioeconomic disparities among patients with chronic lymphocytic leukemia: Analysis of Surveillance, Epidemiology, and End Results program data. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7542 Background: Therapy for chronic lymphocytic leukemia (CLL) has changed dramatically over the past 20 years. With the cost of new therapies and rapid practice changes, it is unclear if patients (pts) are benefiting equally from this progress. We assessed Surveillance, Epidemiology, and End Results (SEER) program data to determine how race and socioeconomic status (SES) affect survival for pts with CLL. Methods: CLL cases reported to 18 SEER Program registries from 2006 – 2018 were included. Pt characteristics such as age at diagnosis (dx), sex, year (yr) of dx, race, and SES as determined by rural/urban census tract residence (RUCA), and neighborhood (as represented by the Yost Index, a composite measure of 7 variables assessing different aspects of the SES of a census tract) were collected and analyzed. Multivariable cox regression (MVA) was used to determine adjusted odds of survival. Two separate databases were utilized, one which included data to 2018, and another which contained SES data but only had data available to 2016. Results: 46,605 cases from 2009 – 2018 were identified without SES data. The median age was 70 yrs, 60% were male, and there was an even distribution of patients diagnosed with CLL annually from 2009 – 2018. Of the cases with race reported, 89.9% were white, 7.3% Black, 2.4% Asian/Pacific islander, and 0.3% American Indian/Alaska Native. After a median follow up of 47 months, the median 3, 5, and 10 yr overall survival (OS) was 79.5%, 69.5%, and 48.8%, respectively. MVA showed Black race (HR 1.5, 95% CI 1.4 – 1.6) as the strongest independent prognostic variable for worse OS controlling for yr of dx, suggesting race was a significant factor in OS in the era of modern therapies. Using the linked RUCA and Yost tertiles for SES, 47,867 cases of CLL from 2006 – 2016 were analyzed. Median age, sex, and race distribution were similar to the prior analysis. MVA showed American Indian/Alaska Native, and Black race as independent prognostic variables for worse OS, and Yost group 2 and 3, representing higher SES, were found to be significant independent prognostic variables for improved OS (Table 1). In this analysis, race remained an independent variable for worse OS after controlling for SES. Conclusions: Black race and low SES are prognostic of OS in CLL. Further research is needed to determine whether this is due to access to therapy, quality of care, social determinants of heath, or disease biology.[Table: see text]
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Affiliation(s)
- Adam Kittai
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ying Huang
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - James L. Fisher
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Seema Bhat
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Michael R. Grever
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Jennifer Ann Woyach
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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11
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Heerema NA, Muthusamy N, Zhao Q, Ruppert AS, Breidenbach H, Andritsos LA, Grever MR, Maddocks KJ, Woyach J, Awan F, Long M, Gordon A, Coombes C, Byrd JC. Prognostic significance of translocations in the presence of mutated IGHV and of cytogenetic complexity at diagnosis of chronic lymphocytic leukemia. Haematologica 2021; 106:1608-1615. [PMID: 32414849 PMCID: PMC8168513 DOI: 10.3324/haematol.2018.212571] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/08/2020] [Indexed: 11/09/2022] Open
Abstract
Mutations of the IGH variable region in patients with chronic lymphocytic leukemia (CLL) are associated with a favorable prognosis. Cytogenetic complexity (>3 unrelated aberrations) and translocations have been associated with an unfavorable prognosis. While mutational status of IGHV is stable, cytogenetic aberrations frequently evolve. However, the relationships of these features as prognosticators at diagnosis are unknown. We examined the CpG-stimulated metaphase cytogenetic features detected within one year of diagnosis of CLL and correlated these features with outcome and other clinical features including IGHV. Of 329 untreated patients, 53 (16.1%) had a complex karyotype (16.1%), and 85 (25.8%) had a translocation. Median time to first treatment (TFT) was 47 months. In univariable analyses, significant risk factors for shorter TFT (p3.5, log-transformed WBC, unmutated IGHV, complex karyotype, translocation, and FISH for trisomy 8, del(11q) and del(17p). In multivariable analysis, there was significant effect modification of IGHV status on the relationship between translocation and TFT (p=0.002). In IGHV mutated patients, those with a translocation had over 3.5 times higher risk of starting treatment than those without a translocation (p.
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Affiliation(s)
- Nyla A. Heerema
- Department of Pathology, The Ohio State University Wexner Medical Center
| | - Natarajan Muthusamy
- Department of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Qiuhong Zhao
- Department of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amy S. Ruppert
- Department of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Leslie A. Andritsos
- Department of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael R. Grever
- Department of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kami J. Maddocks
- Department of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jennifer Woyach
- Department of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Farrukh Awan
- Department of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Meixiao Long
- Department of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amber Gordon
- Department of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Caitlin Coombes
- Department of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John C. Byrd
- Department of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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12
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Troussard X, Grever MR. The revised guidelines for the diagnosis and management of hairy cell leukaemia and the hairy cell leukaemia variant. Br J Haematol 2020; 193:11-14. [PMID: 33368172 DOI: 10.1111/bjh.17201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 09/26/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Xavier Troussard
- Department of Haematology, CHU Caen Normandie, Caen cedex 9, France
| | - Michael R Grever
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
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13
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Saygin C, Larkin K, Blachly JS, Orwick S, Ngankeu A, Gregory CT, Phelps MA, Mani S, Walker A, Garzon R, Vasu S, Walsh KJ, Bhatnagar B, Klisovic RB, Grever MR, Marcucci G, Byrd JC, Blum W, Mims AS. A phase I study of lenalidomide plus chemotherapy with idarubicin and cytarabine in patients with relapsed or refractory acute myeloid leukemia and high-risk myelodysplastic syndrome. Am J Hematol 2020; 95:1457-1465. [PMID: 32777116 PMCID: PMC7821016 DOI: 10.1002/ajh.25958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/26/2020] [Accepted: 08/06/2020] [Indexed: 12/30/2022]
Abstract
Patients with relapsed/refractory (R/R) acute myeloid leukemia (AML) have poor outcomes and hematopoietic cell transplantation (HCT) is the only curative treatment. New targeted therapies improved survival in select patients with specific mutations, however management of patients without these molecular alterations is an unmet need. We conducted a phase one study of lenalidomide in combination with cytarabine/idarubicin salvage chemotherapy in patients with R/R AML and high‐risk myelodysplastic syndromes. A total of 33 patients were enrolled in the study (30 AML, 3 MDS), and treated at three dose levels with 3 + 3 design. Dose‐limiting toxicity (DLT) was seen in eight patients, including four hematologic DLTs. The most commonly observed non‐hematologic serious adverse events were febrile neutropenia, rash, sepsis and renal injury. Dose level −1, consisting of 25 mg/d lenalidomide D1‐21, 1 g/m2 cytarabine D5‐8, and 8 mg/m2 idarubicin D5‐7 was determined to be the maximum tolerated dose. Note, 15/33 (45%) of patients were able to receive pre‐planned 21 days of lenalidomide. Overall, 18 patients achieved complete remission (CR) (n = 14) or CR with incomplete count recovery (CRi) (n = 4) with total CR/CRi rate of 56%. The 1‐year and 2‐year overall survival (OS) were 24% and 10%, respectively. Among responders, 10/18 underwent allogeneic HCT and had a 1‐year OS of 40%. There was no molecular pattern associated with response. These data demonstrate that the combination had clinical activity in R/R AML. This regimen should be further investigated for patients who relapsed after HCT, and as a bridge therapy to HCT. (ClinicalTrials.gov identifier: NCT01132586).
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Affiliation(s)
- Caner Saygin
- Department of Internal Medicine The Ohio State University Columbus Ohio
| | - Karilyn Larkin
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - James S. Blachly
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Shelley Orwick
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Apollinaire Ngankeu
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Charles T. Gregory
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Mitch A. Phelps
- Division of Pharmaceutics College of Pharmacy, The Ohio State University Columbus Ohio
| | - Shylaja Mani
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Alison Walker
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Ramiro Garzon
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Sumithira Vasu
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Katherine J. Walsh
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Bhavana Bhatnagar
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Rebecca B. Klisovic
- Department of Hematology and Medical Oncology Emory University School of Medicine, Winship Cancer Institute Atlanta Georgia
| | - Michael R. Grever
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation City of Hope Medical Center Duarte California
| | - John C. Byrd
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - William Blum
- Department of Hematology and Medical Oncology Emory University School of Medicine, Winship Cancer Institute Atlanta Georgia
| | - Alice S. Mims
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
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Bond DA, Huang Y, Fisher JL, Ruppert AS, Owen DH, Bertino EM, Rogers KA, Bhat SA, Grever MR, Jaglowski SM, Maddocks KJ, Byrd JC, Woyach JA. Second cancer incidence in CLL patients receiving BTK inhibitors. Leukemia 2020; 34:3197-3205. [PMID: 32704159 PMCID: PMC7688551 DOI: 10.1038/s41375-020-0987-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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] [Received: 12/31/2019] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 01/20/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is associated with perturbed immune function and increased risk for second primary malignancies (SPM). Ibrutinib and acalabrutinib (BTKi) are effective therapies for CLL resulting in partial restoration of immune function. The incidence of and risk factors for SPM in CLL patients receiving BTKi are not yet characterized. We retrospectively determined the incidence of SPM in CLL patients treated with ibrutinib or acalabrutinib at our institution between 2009 and 2017, assessed for association between baseline characteristics and SPM incidence, and compared the observed to expected cancer incidence among age, sex, and year matched controls without CLL. After a median of 44 months follow-up, 64/691 patients (9%) were diagnosed with SPM (excluding non-melanoma skin cancer [NMSC]). The three-year cumulative incidence rate was 16% for NMSC and 7% for other SPM. On multivariable analysis, smoking was associated with increased SPM risk (HR 2.8 [95% CI: 1.6–4.8]) and higher baseline CD8 count was associated with lower SPM risk (HR 0.9 for 2-fold increase [95% CI: 0.8–0.9]). The observed over expected rate of SPM was 2.2 [95% CI: 1.7–2.9]. CLL patients treated with BTKi remain at increased risk for SPM, and secondary cancer detection is an important consideration in this population.
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Affiliation(s)
- David A Bond
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Ying Huang
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - James L Fisher
- Arthur G James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Amy S Ruppert
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dwight H Owen
- Department of Internal Medicine, Division of Medical Oncology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Erin M Bertino
- Department of Internal Medicine, Division of Medical Oncology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kerry A Rogers
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Seema A Bhat
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael R Grever
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Samantha M Jaglowski
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kami J Maddocks
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John C Byrd
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jennifer A Woyach
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Grever MR. Clara D. Bloomfield, M.D. (1942-2020): Legacy in Leukemia Research. Oncologist 2020; 25:543-544. [PMID: 32463139 DOI: 10.1634/theoncologist.2020-0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Michael R Grever
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
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16
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Wesolowski R, Stover DG, Lustberg MB, Shoben A, Zhao M, Mrozek E, Layman RM, Macrae E, Duan W, Zhang J, Hall N, Wright CL, Gillespie S, Berger M, Chalmers JJ, Carey A, Balasubramanian P, Miller BL, Amaya P, Andreopoulou E, Sparano J, Shapiro CL, Villalona‐Calero MA, Geyer S, Chen A, Grever MR, Knopp MV, Ramaswamy B. Phase I Study of Veliparib on an Intermittent and Continuous Schedule in Combination with Carboplatin in Metastatic Breast Cancer: A Safety and [18F]-Fluorothymidine Positron Emission Tomography Biomarker Study. Oncologist 2020; 25:e1158-e1169. [PMID: 32452601 PMCID: PMC7418347 DOI: 10.1634/theoncologist.2020-0039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Poly(ADP-ribose) polymerase inhibitors (PARPis) are U.S. Food and Drug Administration (FDA) approved for treatment of BRCA-mutated metastatic breast cancer. Furthermore, the BROCADE studies demonstrated benefit of adding an oral PARPi, veliparib, to carboplatin and paclitaxel in patients with metastatic breast cancer harboring BRCA mutation. Given multiple possible dosing schedules and the potential benefit of this regimen for patients with defective DNA repair beyond BRCA, we sought to find the recommended phase II dose (RP2D) and schedule of veliparib in combination with carboplatin in patients with advanced breast cancer, either triple-negative (TNBC) or hormone receptor (HR)-positive, human epidermal growth receptor 2 (HER2) negative with defective Fanconi anemia (FA) DNA-repair pathway based on FA triple staining immunofluorescence assay. MATERIALS AND METHODS Patients received escalating doses of veliparib on a 7-, 14-, or 21-day schedule with carboplatin every 3 weeks. Patients underwent [18]fluoro-3'-deoxythymidine (18 FLT) positron emission tomography (PET) imaging. RESULTS Forty-four patients (39 TNBC, 5 HR positive/HER2 negative with a defective FA pathway) received a median of 5 cycles (range 1-36). Observed dose-limiting toxicities were grade (G) 4 thrombocytopenia (n = 4), G4 neutropenia (n = 1), and G3 akathisia (n = 1). Common grade 3-4 toxicities included thrombocytopenia, lymphopenia, neutropenia, anemia, and fatigue. Of the 43 patients evaluable for response, 18.6% achieved partial response and 48.8% had stable disease. Median progression-free survival was 18.3 weeks. RP2D of veliparib was established at 250 mg twice daily on days 1-21 along with carboplatin at area under the curve 5. Patients with partial response had a significant drop in maximum standard uptake value (SUVmax ) of target lesions between baseline and early in cycle 1 based on 18 FLT-PET (day 7-21; ptrend = .006). CONCLUSION The combination of continuous dosing of veliparib and every-3-week carboplatin demonstrated activity and an acceptable toxicity profile. Decrease in SUVmax on 18 FLT-PET scan during the first cycle of this therapy can identify patients who are likely to have a response. IMPLICATIONS FOR PRACTICE The BROCADE studies suggest that breast cancer patients with BRCA mutation benefit from addition of veliparib to carboplatin plus paclitaxel. This study demonstrates that a higher dose of veliparib is tolerable and active in combination with carboplatin alone. With growing interest in imaging-based early response assessment, the authors demonstrate that decrease in [18]fluoro-3'-deoxythymidine positron emission tomography (FLT-PET) SUVmax during cycle 1 of therapy is associated with response. Collectively, this study established a safety profile of veliparib and carboplatin in advanced breast cancer while also providing additional data on the potential for FLT-PET imaging modality in monitoring therapy response.
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Affiliation(s)
- Robert Wesolowski
- Stefanie Spielman Comprehensive Breast Center, The Ohio State UniversityColumbusOhioUSA
- The Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
| | - Daniel G. Stover
- Stefanie Spielman Comprehensive Breast Center, The Ohio State UniversityColumbusOhioUSA
- The Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
| | - Maryam B. Lustberg
- Stefanie Spielman Comprehensive Breast Center, The Ohio State UniversityColumbusOhioUSA
| | - Abigail Shoben
- The Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
| | - Meng Zhao
- Stefanie Spielman Comprehensive Breast Center, The Ohio State UniversityColumbusOhioUSA
| | - Ewa Mrozek
- Mercy Health – St. Rita's Medical CenterLimaOhioUSA
| | | | | | - Wenrui Duan
- The Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
| | - Jun Zhang
- The Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
| | - Nathan Hall
- The Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
| | | | - Susan Gillespie
- Stefanie Spielman Comprehensive Breast Center, The Ohio State UniversityColumbusOhioUSA
| | - Michael Berger
- Stefanie Spielman Comprehensive Breast Center, The Ohio State UniversityColumbusOhioUSA
| | | | - Alahdra Carey
- The Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
| | | | - Brandon L. Miller
- The Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
| | - Peter Amaya
- The Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
| | | | - Joseph Sparano
- Montefiore Medical Center, Albert Einstein College of MedicineBronxNew YorkUSA
| | | | | | | | - Alice Chen
- National Cancer InstituteBethesdaMarylandUSA
| | - Michael R. Grever
- The Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
| | - Michael V. Knopp
- The Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
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17
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Bond DA, Huang Y, Fisher JL, Ruppert AS, Owen DH, Bertino EM, Rogers KA, Bhat SA, Jaglowski SM, Grever MR, Byrd JC, Maddocks KJ, Woyach JA. Second cancer incidence in CLL patients receiving BTK inhibitors. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.7511] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7511 Background: Patients (pts) with chronic lymphocytic leukemia (CLL) suffer morbidity and mortality from CLL and increased risk for second primary neoplasia (SPN). BTK inhibitors (BTKi) are highly effective for the treatment (tx) of CLL and are associated with partial restoration of immune function with ongoing tx. The impact of BTKi on the risk for and patterns of SPN is yet to be characterized. Methods: CLL pts treated with ibrutinib or acalabrutinib at our center were identified retrospectively. Baseline (bl) and outcome data were collected including incidence (inc) of Richter’s transformation (RT), non-melanoma skin cancer (NMSC), and SPN. Standard inc ratio (SIR) with 95% confidence intervals (CI) were calculated using expected inc rates from the Surveillance, Epidemiology, and End Results Program, assuming a Poisson distribution for the observed inc. Cumulative inc (CIR) of SPN (excluding RT and NMSC) was calculated from BTKi start date to the diagnosis of SPN; death was a competing risk and pts without event were censored at last follow-up (f/u). SPN was correlated with bl data using the Fine-Gray model. Results: 691 pts were included; median age was 64 years (y), median prior lines of treatment (tx) was 2 (20% tx-naïve, 66% with prior chemo-immunotherapy), and 56% were never smokers. At median f/u of 44 months, 68 pts (10%) were diagnosed (dx) with SPN (SIR 2.4, CI 1.9-3.0) including 13 lung (SIR 3.2, CI 1.7-5.5), 9 melanoma (SIR 6.9, CI 3.1-13), 9 prostate (SIR 1.4, CI 0.6-2.6), 7 bladder (SIR 5.2, CI 2.1-10.6) cancers. CIR of SPN at 3 y was 7.6% (Table). Smoking (hazard ratio (HR) 2.9, CI 1.7-5.0, p < .01) and low bl CD8 count (HR 0.9 for 2-fold increase, CI 0.8-0.9, p < .01) were associated with higher inc of SPN. RT was dx in 58 pts (8%) and NMSC in 138 pts (20%). 179 pts had died with 3 y overall survival of 79% (CI 76-82); the most common causes of death were CLL/RT (57%) and SPN (13%). Conclusions: The inc of SPN in pts treated with BTKi for CLL is increased relative to the general population. With a 5 y CIR of NMSC and SPN of 23% and 12%, these data support consideration of intensive cancer screening for CLL pts receiving BTKi. [Table: see text]
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Affiliation(s)
- David Alan Bond
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ying Huang
- The Ohio State University, Division of Hematology, Columbus, OH
| | - James L Fisher
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Amy S. Ruppert
- The Ohio State University, Department of Internal Medicine, Columbus, OH
| | - Dwight Hall Owen
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
| | | | | | | | | | | | - John C. Byrd
- The Ohio State University, Division of Hematology, Columbus, OH
| | - Kami J. Maddocks
- Department of Internal Medicine, Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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18
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Hughes JH, Phelps MA, Upton RN, Reuter SE, Gao Y, Byrd JC, Grever MR, Hofmeister CC, Marcucci G, Blum W, Blum KA, Foster DJR. Population pharmacokinetics of lenalidomide in patients with B-cell malignancies. Br J Clin Pharmacol 2019; 85:924-934. [PMID: 30672004 DOI: 10.1111/bcp.13873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS Lenalidomide is an immunomodulatory imide drug used broadly in the treatment of multiple myeloma and lymphoma. It continues to be evaluated in chronic lymphocytic leukaemia (CLL) at lower doses due to dose-related toxicities including tumour flare and tumour lysis syndrome. This study aimed to develop a population pharmacokinetic model for lenalidomide in multiple cancers, including CLL, to identify any disease-related differences in disposition. METHODS Lenalidomide concentrations from 4 clinical trials were collated (1999 samples, 125 subjects), covering 4 cancers (multiple myeloma, CLL, acute myeloid leukaemia and acute lymphoblastic leukaemia) and a large dose range (2.5-75 mg). A population pharmacokinetic model was developed with NONMEM and patient demographics were tested as covariates. RESULTS The data were best fitted by a 1-compartment kinetic model with absorption described by 7 transit compartments. Clearance and volume of distribution were allometrically scaled for fat-free mass. The population parameter estimates for apparent clearance, apparent volume of distribution and transit rate constant were 12 L/h (10.8-13.6), 68.8 L (61.8-76.3), and 13.5 h-1 (11.9-36.8) respectively. Patients with impaired renal function (creatinine clearance <30 mL/min) exhibited a 22% reduction in lenalidomide clearance compared to patients with creatinine clearance of 90 mL/min. Cancer type had no discernible effect on lenalidomide disposition. CONCLUSIONS This is the first report of a lenalidomide population pharmacokinetic model to evaluate lenalidomide pharmacokinetics in patients with CLL and compare its pharmacokinetics with other B-cell malignancies. As no differences in pharmacokinetics were found between the observed cancer-types, the unique toxicities observed in CLL may be due to disease-specific pharmacodynamics.
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Affiliation(s)
- Jim H Hughes
- Australian Centre for Pharmacometrics, School of Pharmacy and Medical Sciences, Division of Health Sciences, University of South Australia, Australia
| | - Mitch A Phelps
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Division of Pharmaceutics, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Richard N Upton
- Australian Centre for Pharmacometrics, School of Pharmacy and Medical Sciences, Division of Health Sciences, University of South Australia, Australia
| | - Stephanie E Reuter
- School of Pharmacy and Medical Sciences, Division of Health Sciences, University of South Australia, Australia
| | - Yue Gao
- Division of Pharmaceutics, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - John C Byrd
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Division of Pharmaceutics, College of Pharmacy, The Ohio State University, Columbus, OH, USA.,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Michael R Grever
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Craig C Hofmeister
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Guido Marcucci
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - William Blum
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Kristie A Blum
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - David J R Foster
- Australian Centre for Pharmacometrics, School of Pharmacy and Medical Sciences, Division of Health Sciences, University of South Australia, Australia
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19
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Wang RF, Kuehn GJ, Andritsos LA, Grever MR, Kaffenberger BH. Cutaneous adverse events associated with purine analogs in the treatment of hairy cell leukemia. Int J Dermatol 2018; 58:e109-e110. [PMID: 30478890 DOI: 10.1111/ijd.14320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/22/2018] [Accepted: 10/31/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Rebecca F Wang
- Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Gina J Kuehn
- Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Leslie A Andritsos
- Division of Hematology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael R Grever
- Division of Hematology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Benjamin H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
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20
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Sigmund A, Huang Y, Ruppert AS, Ny F, Lucas M, Chase W, Maddocks KJ, Rogers KA, Jaglowski SM, Andritsos LA, Awan FT, Grever MR, Byrd JC, Woyach JA. Depth of response and progression free survival in CLL patients on ibrutinib. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Audrey Sigmund
- The Ohio State University, Department of Internal Medicine, Columbus, OH
| | - Ying Huang
- The Ohio State University, Division of Hematology, Columbus, OH
| | - Amy S. Ruppert
- The Ohio State University, Division of Hematology, Columbus, OH
| | - Fan Ny
- The Ohio State University, Division of Hematology, Columbus, OH
| | - Margaret Lucas
- The Ohio State University, Division of Hematology, Columbus, OH
| | - Weihong Chase
- The Ohio State University, Division of Hematology, Columbus, OH
| | | | | | | | | | | | | | - John C. Byrd
- The Ohio State University, Division of Hematology, Columbus, OH
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21
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Gunn JS, Ledford CH, Mousetes SJ, Grever MR. Biomedical Science Undergraduate Major: A New Pathway to Advance Research and the Health Professions. Teach Learn Med 2018; 30:184-192. [PMID: 29190142 DOI: 10.1080/10401334.2017.1361827] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PROBLEM Many students entering professional degree programs, particularly M.D., Ph.D., and M.D./Ph.D., are not well prepared regarding the breadth of scientific knowledge required, communication skills, research experience, reading and understanding the scientific literature, and significant shadowing (for M.D.-related professions). In addition, physician scientists are a needed and necessary part of the academic research environment but are dwindling in numbers. INTERVENTION In response to predictions of critical shortages of clinician investigators and the lack of proper preparation as undergraduates for these professions, the Biomedical Science (BMS) undergraduate major was created at The Ohio State University to attract incoming college freshmen with interests in scientific research and the healthcare professions. The intent of this major was to graduate an elite cohort of highly talented individuals who would pursue careers in the healthcare professions, biomedical research, or both. CONTEXT Students were admitted to the BMS major through an application and interview process. Admitted cohorts were small, comprising 22 to 26 students, and received a high degree of individualized professional academic advising and mentoring. The curriculum included a minimum of 4 semesters (or 2 years) of supervised research experience designed to enable students to gain skills in clinical and basic science investigation. In addition to covering the prerequisites for medicine and advanced degrees in health professions, the integrated BMS coursework emphasized research literacy as well as skills related to work as a healthcare professional, with additional emphasis on independent learning, teamwork to solve complex problems, and both oral and written communication skills. Supported by Ohio State's Department of Internal Medicine, a unique clinical internship provided selected students with insights into potential careers as physician scientists. OUTCOME In this educational case report, we describe the BMS undergraduate major and its outcomes after 10 years of implementation. Major outcomes include the strength of the major's matriculates (average ACT score = 32.6; average high school class percentile rank = 95.5) and the high percentage of BMS students who pursued graduate/professional degrees (91%; n = 110). Other markers of success include the strong focus on research, which resulted in 120 articles published by graduates to date (range = 0-12/student; 43% with at least 1 peer-reviewed journal article). LESSONS LEARNED Based on its successes, adoption of a similar program at other academic medical centers would help feed the pipeline of well-trained health professionals and biomedical researchers.
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Affiliation(s)
- John S Gunn
- a Department of Microbial Infection and Immunity , The Ohio State University , Columbus , Ohio , USA
- b Department of Biomedical Education and Anatomy , The Ohio State University , Columbus , Ohio , USA
| | - Cynthia H Ledford
- c Department of Internal Medicine , The Ohio State University Wexner Medical Center , Columbus , Ohio , USA
| | - Steven J Mousetes
- b Department of Biomedical Education and Anatomy , The Ohio State University , Columbus , Ohio , USA
| | - Michael R Grever
- c Department of Internal Medicine , The Ohio State University Wexner Medical Center , Columbus , Ohio , USA
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22
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Mims AS, Mishra A, Orwick S, Blachly J, Klisovic RB, Garzon R, Walker AR, Devine SM, Walsh KJ, Vasu S, Whitman S, Marcucci G, Jones D, Heerema NA, Lozanski G, Caligiuri MA, Bloomfield CD, Byrd JC, Piekarz R, Grever MR, Blum W. A novel regimen for relapsed/refractory adult acute myeloid leukemia using a KMT2A partial tandem duplication targeted therapy: results of phase 1 study NCI 8485. Haematologica 2018; 103:982-987. [PMID: 29567781 PMCID: PMC6058798 DOI: 10.3324/haematol.2017.186890] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/21/2017] [Indexed: 12/29/2022] Open
Abstract
KMT2A partial tandem duplication occurs in approximately 5–10% of patients with acute myeloid leukemia and is associated with adverse prognosis. KMT2A wild type is epigenetically silenced in KMT2A partial tandem duplication; re-expression can be induced with DNA methyltransferase and/or histone deacetylase inhibitors in vitro, sensitizing myeloid blasts to chemotherapy. We hypothesized that epigenetic silencing of KMT2A wildtype contributes to KMT2A partial tandem duplication-associated leukemogenesis and pharmacologic re-expression activates apoptotic mechanisms important for chemoresponse. We developed a regimen for this unique molecular subset, but due to relatively low frequency of KMT2A partial tandem duplication, this dose finding study was conducted in relapsed/refractory disease regardless of molecular subtype. Seventeen adults (< age 60) with relapsed/refractory acute myeloid leukemia were treated on study. Patients received decitabine 20 milligrams/meter2 daily on days 1–10 and vorinostat 400 milligrams daily on days 5–10. Cytarabine was dose-escalated from 1.5 grams/meter2 every 12 hours to 3 grams/meter2 every 12 hours on days 12, 14 and 16. Two patients experienced dose limiting toxicities at dose level 1 due to prolonged myelosuppression. However, as both patients achieved complete remission after Day 42, the protocol was amended to adjust the definition of hematologic dose limiting toxicity. No further dose limiting toxicities were found. Six of 17 patients achieved complete remission including 2 of 4 patients with KMT2A partial tandem duplication. Combination therapy with decitabine, vorinostat and cytarabine was tolerated in younger relapsed/refractory acute myeloid leukemia and should be explored further focusing on the KMT2A partial tandem duplication subset. (clinicaltrials.gov identifier 01130506).
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Affiliation(s)
- Alice S Mims
- Division of Hematology, Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Anjali Mishra
- Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Shelley Orwick
- Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - James Blachly
- Division of Hematology, Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Rebecca B Klisovic
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
| | - Ramiro Garzon
- Division of Hematology, Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Alison R Walker
- Division of Hematology, Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Steven M Devine
- Division of Hematology, Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Katherine J Walsh
- Division of Hematology, Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Sumithira Vasu
- Division of Hematology, Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Susan Whitman
- Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Daniel Jones
- Department of Pathology, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Nyla A Heerema
- Department of Pathology, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Michael A Caligiuri
- Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Clara D Bloomfield
- Division of Hematology, Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - John C Byrd
- Division of Hematology, Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Richard Piekarz
- Investigational Drug Branch of CTEP, National Cancer Institute, Bethesda, MD, USA
| | - Michael R Grever
- Division of Hematology, Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - William Blum
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
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23
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Andritsos LA, Grieselhuber NR, Anghelina M, Rogers KA, Roychowdhury S, Reeser JW, Timmers CD, Freud AG, Blachly JS, Lucas DM, Lozanski G, Jones JA, Williams K, Oakes C, Jones D, Grever MR. Trametinib for the treatment of IGHV4-34, MAP2K1-mutant variant hairy cell leukemia. Leuk Lymphoma 2017; 59:1008-1011. [PMID: 28918710 DOI: 10.1080/10428194.2017.1365853] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Leslie A Andritsos
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Nicole R Grieselhuber
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Mirela Anghelina
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Kerry A Rogers
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Sameek Roychowdhury
- b Division of Medical Oncology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Julie W Reeser
- b Division of Medical Oncology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Cynthia D Timmers
- b Division of Medical Oncology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Aharon G Freud
- c Department of Pathology , The Ohio State University , Columbus , OH , USA
| | - James S Blachly
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - David M Lucas
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Gerard Lozanski
- c Department of Pathology , The Ohio State University , Columbus , OH , USA
| | - Jeffrey A Jones
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Katie Williams
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Christopher Oakes
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Dan Jones
- c Department of Pathology , The Ohio State University , Columbus , OH , USA
| | - Michael R Grever
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
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24
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Lakshmanan A, Tsai YT, Lehman A, Sass EJ, Tran M, Lucas F, Long M, Harrington BK, Perle KL, Coppola V, Lozanski G, Muthusamy N, Byrd JC, Grever MR, Lucas DM. Abstract 1029: MAPK-mediated immunomodulation in disseminated murine Emu-TCL1 chronic lymphocytic leukemia. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Work in melanoma and other solid tumors shows mutations activating MAPK pathway not only promote malignancy by promoting survival and proliferation but also are immunosuppressive than wild-type (WT) counterparts. However, relevance of MAPK-activating mutations to immune modulation in disseminated cancers such as leukemia is uncertain, and the mechanisms by which this occurs are likely to differ. BRAF activating mutation is found in nearly all hairy cell leukemia cases, 4% of chronic lymphocytic leukemia (CLL) and 9% CLL cases when including other MAPK-activating mutations such as KRAS and NRAS. To assess immunomodulatory effects of BRAF-mutant CLL cells, we co-cultured dox-inducible OSU-CLL cells transfected with WT or BRAFV600E constructs with healthy donor T cells incubated with anti-CD3/anti-CD28 antibodies, and T cell proliferation, cytokine production and expression of surface proteins were assessed by flow cytometry. We also employed a transgenic mouse model of BRAF B cell leukemia. CD19-Cre x BRAFV600E or CD19-Cre only mice were crossed with the well-characterized Emu-TCL1 model of CLL to obtain mice with spontaneous B cell leukemia expressing either WT BRAF (CD19-Cre xTCL1) or mutant BRAF (BRAFV600E xCD19-Cre xTCL1) under the native BRAF promoter. For adoptive transfer (AT) experiments, leukemia cells (2e7) from transgenic mice were engrafted intravenously into syngeneic healthy adult animals. Blood and spleen cells were examined by flow cytometry. OSU-CLL cells expressing BRAFV600E more strongly inhibited anti-CD3/CD28-induced proliferation of normal donor T cells. Transwell assays showed this effect was due both to soluble and contact-dependent factors. TNF levels were higher in BRAFV600E-expressing cells and reduced by vemurafenib, but a TNF neutralizing antibody did not alter the inhibitory effect of BRAFV600E-expressing cells on T cell proliferation. Proliferation was rescued by the BRAFV600E inhibitor dabrafenib, further supporting the contribution of mutant BRAF to this effect. Impact of BRAFV600E mutation on myeloid compartment was also evaluated using AT model. Mice were engrafted with BRAFWT or BRAFV600E leukemia cells, and upon achieving similar disease loads, BRAFV600E leukemic B cells caused 2.2-fold increase in PD-L1 expressing-peripheral myeloid cells (p<0.001; n=25 WT; 11 mutant). Additionally, there was an increase in F4/80+ macrophages (11%; p=0.002), CD11b+Ly6CintLy6Ghi MDSCs (8.5%, p=0.014) and decrease in CD11b+Ly6CloLy6Glo patrolling monocytes (11%; p=0.031; n=33 WT; 40 mutant) in spleens of mice with BRAFV600E leukemia, indicating that this mutation influences the myeloid cell compartment as well. Ongoing studies are investigating the mechanism of these effects and the potential for pharmacologic reversal. Together, these results demonstrate immunosuppressive impact of BRAF in B-cell leukemia.
Citation Format: Aparna Lakshmanan, Yo-Ting Tsai, Amy Lehman, Ellen J. Sass, Minh Tran, Fabienne Lucas, Meixiao Long, Bonnie K. Harrington, Krista La Perle, Vincenzo Coppola, Gerard Lozanski, Natarajan Muthusamy, John C. Byrd, Michael R. Grever, David M. Lucas. MAPK-mediated immunomodulation in disseminated murine Emu-TCL1 chronic lymphocytic leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1029. doi:10.1158/1538-7445.AM2017-1029
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Affiliation(s)
| | | | | | | | - Minh Tran
- The Ohio State University, Columbus, OH
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25
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Wesolowski R, Lustberg MB, Reinbolt RE, VanDeusen JB, Sardesai SD, Williams NO, Noonan AM, Dewani SJ, Poi M, Wilson D, Grever MR, Stephens J, Puhalla S, Mathew A, Carson WE, Ramaswamy B. Phase Ib study of heat shock protein 90 inhibitor, onalespib in combination with paclitaxel in patients with advanced, triple-negative breast cancer (NCT02474173). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps1127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS1127 Background: Heat shock protein 90 (HSP90) is a molecular chaperone which is necessary for proper folding and stabilization of proteins. Client proteins of HSP90 include many oncogenic proteins known to be over-activated in triple negative breast cancer such as AKT, EGFR, members of RAS/MAPK signaling pathway and androgen receptor. High expression of HSP90 in breast cancer has been associated with poor outcome. In addition, over-expression of HSP90 client proteins such as AKT and c-RAF has been implicated in paclitaxel resistance. Onalespib (AT13387) is a synthetic non-ansamycin small molecule that acts as an inhibitor of HSP90 by binding to the amino terminal of the protein and has dissociation constant (Kd) of 0.71 nM. Methods: Patients with inoperable or metastatic, triple negative or < 10% hormone receptor positive breast cancer are treated with onalespib and paclitaxel on days 1, 8, 15 every 28 days. Paclitaxel is given at a standard dose of 80 mg/m2 while the dose of onalespib is gradually increased using standard 3+3 design (see table). In order to assess the effect of each drug on pharmacokinetics of the other drug, onalespib is given on day -7 prior to cycle 1 and skipped on day 1 of cycle 1 during which paclitaxel is administered alone. The primary objective of the study is to determine recommended phase II dose and assess the toxicity profile of the combination. The secondary objectives include pharmacokinetic of each agent. Overall response rate, response duration and progression-free survival will also be assessed. The study is currently enrolling patients to dose level 2. Clinical trial information: NCT02474173. [Table: see text]
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Affiliation(s)
- Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | - Maryam B. Lustberg
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | - Raquel E. Reinbolt
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | | | | | | | - Anne M. Noonan
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | | | - Ming Poi
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | - Julie Stephens
- Center for Biostatistics in the Department of Biomedical Informatics, The Ohio State University, Columbus, OH
| | | | - Aju Mathew
- University of Kentucky Markey Cancer Center, Lexington, KY
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26
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Woyach JA, Ruppert AS, Guinn D, Lehman A, Blachly JS, Lozanski A, Heerema NA, Zhao W, Coleman J, Jones D, Abruzzo L, Gordon A, Mantel R, Smith LL, McWhorter S, Davis M, Doong TJ, Ny F, Lucas M, Chase W, Jones JA, Flynn JM, Maddocks K, Rogers K, Jaglowski S, Andritsos LA, Awan FT, Blum KA, Grever MR, Lozanski G, Johnson AJ, Byrd JC. BTK C481S-Mediated Resistance to Ibrutinib in Chronic Lymphocytic Leukemia. J Clin Oncol 2017; 35:1437-1443. [PMID: 28418267 DOI: 10.1200/jco.2016.70.2282] [Citation(s) in RCA: 328] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Therapeutic targeting of Bruton tyrosine kinase (BTK) with ibrutinib in chronic lymphocytic leukemia has led to a paradigm shift in therapy, and relapse has been uncommon with current follow-up. Acquired mutations in BTK and PLCG2 can cause relapse, but data regarding the prevalence and natural history of these mutations are limited. Patients and Methods Patients accrued to four sequential studies of ibrutinib were included in these analyses. Deep sequencing for BTK and PLCG2 was performed retrospectively on patients who experienced relapse and prospectively on a screening population. Results With a median follow-up time of 3.4 years, the estimated cumulative incidence of progression at 4 years is 19% (95% CI, 14% to 24%). Baseline karyotypic complexity, presence of del(17)(p13.1), and age less than 65 years were risk factors for progression. Among patients who experienced relapse, acquired mutations of BTK or PLCG2 were found in 85% (95% CI, 71% to 94%), and these mutations were detected an estimated median of 9.3 months (95% CI, 7.6 to 11.7 months) before relapse. Of a group of 112 patients examined prospectively, eight patients have experienced relapse, and all of these patients had acquired resistance mutations before relapse. A resistance mutation was detected in an additional eight patients who have not yet met criteria for clinical relapse. Conclusion Relapse of chronic lymphocytic leukemia after ibrutinib is an issue of increasing clinical significance. We show that mutations in BTK and PLCG2 appear early and have the potential to be used as a biomarker for future relapse, suggesting an opportunity for intervention.
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Affiliation(s)
| | - Amy S Ruppert
- All authors: The Ohio State University, Columbus, OH
| | - Daphne Guinn
- All authors: The Ohio State University, Columbus, OH
| | - Amy Lehman
- All authors: The Ohio State University, Columbus, OH
| | | | | | | | - Weiqiang Zhao
- All authors: The Ohio State University, Columbus, OH
| | | | - Daniel Jones
- All authors: The Ohio State University, Columbus, OH
| | - Lynne Abruzzo
- All authors: The Ohio State University, Columbus, OH
| | - Amber Gordon
- All authors: The Ohio State University, Columbus, OH
| | - Rose Mantel
- All authors: The Ohio State University, Columbus, OH
| | - Lisa L Smith
- All authors: The Ohio State University, Columbus, OH
| | | | - Melanie Davis
- All authors: The Ohio State University, Columbus, OH
| | | | - Fan Ny
- All authors: The Ohio State University, Columbus, OH
| | | | - Weihong Chase
- All authors: The Ohio State University, Columbus, OH
| | | | | | - Kami Maddocks
- All authors: The Ohio State University, Columbus, OH
| | - Kerry Rogers
- All authors: The Ohio State University, Columbus, OH
| | | | | | | | | | | | | | - Amy J Johnson
- All authors: The Ohio State University, Columbus, OH
| | - John C Byrd
- All authors: The Ohio State University, Columbus, OH
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27
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Grever MR, Abdel-Wahab O, Andritsos LA, Banerji V, Barrientos J, Blachly JS, Call TG, Catovsky D, Dearden C, Demeter J, Else M, Forconi F, Gozzetti A, Ho AD, Johnston JB, Jones J, Juliusson G, Kraut E, Kreitman RJ, Larratt L, Lauria F, Lozanski G, Montserrat E, Parikh SA, Park JH, Polliack A, Quest GR, Rai KR, Ravandi F, Robak T, Saven A, Seymour JF, Tadmor T, Tallman MS, Tam C, Tiacci E, Troussard X, Zent CS, Zenz T, Zinzani PL, Falini B. Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia. Blood 2017; 129:553-560. [PMID: 27903528 PMCID: PMC5290982 DOI: 10.1182/blood-2016-01-689422] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 11/06/2016] [Indexed: 12/20/2022] Open
Abstract
Hairy cell leukemia is an uncommon hematologic malignancy characterized by pancytopenia and marked susceptibility to infection. Tremendous progress in the management of patients with this disease has resulted in high response rates and improved survival, yet relapse and an appropriate approach to re-treatment present continuing areas for research. The disease and its effective treatment are associated with immunosuppression. Because more patients are being treated with alternative programs, comparison of results will require general agreement on definitions of response, relapse, and methods of determining minimal residual disease. The development of internationally accepted, reproducible criteria is of paramount importance in evaluating and comparing clinical trials to provide optimal care. Despite the success achieved in managing these patients, continued participation in available clinical trials in the first-line and particularly in the relapse setting is highly recommended. The Hairy Cell Leukemia Foundation convened an international conference to provide common definitions and structure to guide current management. There is substantial opportunity for continued research in this disease. In addition to the importance of optimizing the prevention and management of the serious risk of infection, organized evaluations of minimal residual disease and treatment at relapse offer ample opportunities for clinical research. Finally, a scholarly evaluation of quality of life in the increasing number of survivors of this now manageable chronic illness merits further study. The development of consensus guidelines for this disease offers a framework for continued enhancement of the outcome for patients.
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Affiliation(s)
- Michael R Grever
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Omar Abdel-Wahab
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leslie A Andritsos
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Versha Banerji
- Section of Hematology/Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - Jacqueline Barrientos
- Department of Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Hofstra University, Hempstead, NY
| | - James S Blachly
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | | | - Daniel Catovsky
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Claire Dearden
- Department of Haemato-Oncology, Royal Marsden Biomedical Research Centre, London, United Kingdom
| | - Judit Demeter
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Monica Else
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Francesco Forconi
- Haematology Department, University Hospital Trust and Cancer Sciences Unit, Cancer Research UK and National Institute for Health Research Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | | | - Anthony D Ho
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - James B Johnston
- Section of Hematology/Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - Jeffrey Jones
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Gunnar Juliusson
- Department of Hematology, Skåne University Hospital and Stem Cell Center, Lund University, Lund, Sweden
| | - Eric Kraut
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Robert J Kreitman
- Laboratory of Molecular Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Loree Larratt
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Francesco Lauria
- Hematology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Emili Montserrat
- Department of Hematology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Jae H Park
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Aaron Polliack
- Department of Hematology, Hadassah University Hospital and Hebrew University Medical School, Jerusalem, Israel
| | - Graeme R Quest
- Department of Laboratory Medicine and Pathology, University Health Network, Toronto, ON, Canada
| | - Kanti R Rai
- Department of Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Hofstra University, Hempstead, NY
| | - Farhad Ravandi
- Section of Developmental Therapeutics, Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Alan Saven
- Division of Hematology and Oncology, Scripps Clinic, La Jolla, CA
| | - John F Seymour
- Haematology Department, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center, and the Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Martin S Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Constantine Tam
- Haematology Department, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Enrico Tiacci
- Institute of Hematology, Department of Medicine, University and Hospital of Perugia, Perugia, Italy
| | - Xavier Troussard
- Department of Hematology, Centre Hospitalier Universitaire Côte de Nacre, Caen, France
| | - Clive S Zent
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Thorsten Zenz
- Department of Molecular Therapy in Hematology and Oncology, National Center for Tumor Diseases and German Cancer Research Center (DKFZ), Heidelberg, Germany; and
| | - Pier Luigi Zinzani
- Institute of Hematology "Seràgnoli," University of Bologna, Bologna, Italy
| | - Brunangelo Falini
- Institute of Hematology, Department of Medicine, University and Hospital of Perugia, Perugia, Italy
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Valencia H, Newton HB, Hade E, Sborov DW, Cavaliere R, Poi M, Phelps M, Wang J, Coss CC, Khountham S, Monk P, Olencki T, Shapiro CL, Piekarz R, Hofmeister CC, Grever MR, Welling DB, Mortazavi A. A phase 1 study of AR-42 in patients with advanced solid tumors, including nervous system tumors. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.2558] [Citation(s) in RCA: 3] [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: 11/20/2022] Open
Affiliation(s)
| | | | - Erinn Hade
- The Ohio State University Center for Biostatistics, Columbus, OH
| | | | | | - Ming Poi
- The Ohio State Univ Med Ctr, Columbus, OH
| | | | - Jiang Wang
- The Ohio State University and The Comprehensive Cancer Center, Columbus, OH
| | | | - Soun Khountham
- The Ohio State University and The Comprehensive Cancer Center, Columbus, OH
| | - Paul Monk
- The Ohio State University, Columbus, OH
| | | | - Charles L Shapiro
- The Ohio State University and The Comprehensive Cancer Center, Columbus, OH
| | - Richard Piekarz
- Cancer Therapy Evaluation Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | | | | | - Amir Mortazavi
- Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH
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29
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Awan FT, Jones JA, Maddocks K, Poi M, Grever MR, Johnson A, Byrd JC, Andritsos LA. A phase 1 clinical trial of flavopiridol consolidation in chronic lymphocytic leukemia patients following chemoimmunotherapy. Ann Hematol 2016; 95:1137-43. [PMID: 27118540 DOI: 10.1007/s00277-016-2683-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/18/2016] [Indexed: 12/17/2022]
Abstract
Patients with chronic lymphocytic leukemia (CLL) who receive chemoimmunotherapy and do not achieve complete remission experience significantly shortened progression-free interval (PFS). Additionally, the majority of patients treated for relapsed disease demonstrate evidence of measurable disease. Eradication of minimal residual disease (MRD) results in improved PFS and overall survival. Maintenance therapy might result in eradication of MRD and improve response duration but might be associated with an increase in incidence of infectious complications. Flavopiridol is a broad cyclin-dependent kinase (CDK) inhibitor with established safety and efficacy in patients with relapsed CLL, particularly patients with high-risk cytogenetic features. A pharmacologically derived schedule was utilized as consolidation therapy in this phase I study to assess the safety and feasibility of outpatient therapy with flavopiridol in patients with low tumor burden. Flavopiridol was administered as a 30-min loading dose of 30 mg/m(2) followed by a 4-h infusion of 30 mg/m(2) once weekly for 3 weeks every 5 weeks (1 cycle) for planned 2 cycles in ten patients. Therapy was extremely well tolerated and no patient developed acute tumor lysis syndrome. The most common toxicities were gastrointestinal. Of the patients, 22 % improved their response from a PR to CR. Eighty-eight percent experienced a reduction in tumor burden as measured by extent of bone marrow involvement including patients with del17p and complex karyotype. The study establishes the safety and efficacy of flavopiridol as consolidation therapy after chemoimmunotherapy for patients with CLL. Further evaluation is required in larger trials for the utility of CDK inhibitors as consolidation or maintenance strategies.Registration number at ClinicalTrials.gov: NCT00377104.
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Affiliation(s)
- Farrukh T Awan
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 320 W. 10th Avenue, Columbus, Ohio, 43210, USA.
| | - Jeffrey A Jones
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 320 W. 10th Avenue, Columbus, Ohio, 43210, USA
| | - Kami Maddocks
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 320 W. 10th Avenue, Columbus, Ohio, 43210, USA
| | - Ming Poi
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 320 W. 10th Avenue, Columbus, Ohio, 43210, USA
| | - Michael R Grever
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 320 W. 10th Avenue, Columbus, Ohio, 43210, USA
| | - Amy Johnson
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 320 W. 10th Avenue, Columbus, Ohio, 43210, USA
| | - John C Byrd
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 320 W. 10th Avenue, Columbus, Ohio, 43210, USA
| | - Leslie A Andritsos
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 320 W. 10th Avenue, Columbus, Ohio, 43210, USA.
- Starling Loving Hall, 320 W. 10th Avenue, Columbus, Ohio, 43210, USA.
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Maddocks KJ, Ruppert AS, Lozanski G, Heerema NA, Zhao W, Abruzzo L, Lozanski A, Davis M, Gordon A, Smith LL, Mantel R, Jones JA, Flynn JM, Jaglowski SM, Andritsos LA, Awan F, Blum KA, Grever MR, Johnson AJ, Byrd JC, Woyach JA. Etiology of Ibrutinib Therapy Discontinuation and Outcomes in Patients With Chronic Lymphocytic Leukemia. JAMA Oncol 2016; 1:80-7. [PMID: 26182309 DOI: 10.1001/jamaoncol.2014.218] [Citation(s) in RCA: 443] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
IMPORTANCE The Bruton tyrosine kinase (BTK) inhibitor ibrutinib is effective in patients with chronic lymphocytic leukemia (CLL). Reasons for discontinuing therapy with this drug and outcomes following discontinuation have not been evaluated outside of clinical trials with relatively short follow-up. OBJECTIVE To determine features associated with discontinuation of ibrutinib therapy and outcomes. DESIGN, SETTING, AND PARTICIPANTS A total of 308 patients participating in 4 sequential trials of ibrutinib at The Ohio State University Comprehensive Cancer Center were included. These clinical trials accrued patients included in this analysis from May 2010 until April 2014, and data were locked in June 2014. MAIN OUTCOMES AND MEASURES Patients were evaluated for time to therapy discontinuation, reasons for discontinuation, and survival following discontinuation. For patients who discontinued therapy because of disease progression, targeted deep sequencing was performed in samples at baseline and time of relapse. RESULTS With a median follow-up of 20 months, 232 patients remained on therapy, 31 had discontinued because of disease progression, and 45 had discontinued for other reasons. Disease progression includes Richter's transformation (RT) or progressive CLL. Richter's transformation appeared to occur early and CLL progressions later (cumulative incidence at 12 months, 4.5% [95% CI, 2.0%-7.0%] and 0.3% [95% CI, 0%-1.0%], respectively). Median survival following RT was 3.5 months (95% CI, 0.3-6.0 months) and 17.6 months (95% CI, 4.7 months-"not reached") following CLL progression. Sequencing on peripheral blood from 8 patients with RT revealed 2 with mutations in BTK, and a lymph node sample showed no mutations in BTK or PLCG2. Deep sequencing on 11 patients with CLL progression revealed BTK or PLCG2 mutations in all. These mutations were not identified before treatment in any patient. CONCLUSIONS AND RELEVANCE This single-institution experience with ibrutinib confirms it to be an effective therapy and identifies, for the first time, baseline factors associated with ibrutinib therapy discontinuation. Outcomes data show poor prognosis after discontinuation, especially for those patients with RT. Finally, sequencing data confirm initial reports associating mutations in BTK and PLCG2 with progression and clearly show that CLL progressions are associated with these mutations, while RT is likely not. TRIAL REGISTRATIONS clinicaltrials.gov Identifiers:NCT01105247, NCT01217749, NCT01589302, and NCT01578707.
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Affiliation(s)
- Kami J Maddocks
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Amy S Ruppert
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University, Columbus
| | - Nyla A Heerema
- Department of Pathology, The Ohio State University, Columbus
| | - Weiqiang Zhao
- Department of Pathology, The Ohio State University, Columbus
| | - Lynne Abruzzo
- Department of Pathology, The Ohio State University, Columbus
| | - Arletta Lozanski
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Melanie Davis
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Amber Gordon
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Lisa L Smith
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Rose Mantel
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Jeffrey A Jones
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Joseph M Flynn
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Samantha M Jaglowski
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Leslie A Andritsos
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Farrukh Awan
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Kristie A Blum
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Michael R Grever
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Amy J Johnson
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus
| | - John C Byrd
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Jennifer A Woyach
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus
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Yeh YY, Chen R, Hessler J, Mahoney E, Lehman AM, Heerema NA, Grever MR, Plunkett W, Byrd JC, Johnson AJ. Up-regulation of CDK9 kinase activity and Mcl-1 stability contributes to the acquired resistance to cyclin-dependent kinase inhibitors in leukemia. Oncotarget 2015; 6:2667-79. [PMID: 25596730 PMCID: PMC4413609 DOI: 10.18632/oncotarget.2096] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 06/11/2014] [Indexed: 11/25/2022] Open
Abstract
Flavopiridol is a small molecule inhibitor of cyclin-dependent kinases (CDK) known to impair global transcription via inactivation of positive transcription elongation factor b. It has been demonstrated to have significant activity predominantly in chronic lymphocytic leukemia and acute myeloid leukemia in phase I/II clinical trials while other similar CDK inhibitors are vigorously being pursued in pre-clinical and clinical studies. Although flavopiridol is a potent therapeutic agent against blood diseases, some patients still have primary or acquired resistance throughout their clinical course. Considering the limited knowledge of resistance mechanisms of flavopiridol, we investigated the potential mechanisms of resistance to flavopiridol in a cell line system, which gradually acquired resistance to flavopiridol in vitro, and then confirmed the mechanism in patient samples. Herein, we present that this resistant cell line developed resistance through up-regulation of phosphorylation of RNA polymerase II C-terminal domain, activation of CDK9 kinase activity, and prolonged Mcl-1 stability to counter flavopiridol's drug actions. Further analyses suggest MAPK/ERK activation-mediated Mcl-1 stabilization contributes to the resistance and knockdown of Mcl-1 in part restores sensitivity to flavopiridol-induced cytotoxicity. Altogether, these findings demonstrate that CDK9 is the most relevant target of flavopiridol and provide avenues to improve the therapeutic strategies in blood malignancies.
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Affiliation(s)
- Yuh-Ying Yeh
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Rong Chen
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joshua Hessler
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Emilia Mahoney
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Amy M Lehman
- Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Nyla A Heerema
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Michael R Grever
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - William Plunkett
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John C Byrd
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA.,Division of Medicinal Chemistry, College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
| | - Amy J Johnson
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA.,Division of Medicinal Chemistry, College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
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Andritsos LA, Grever MR. Historical overview of hairy cell leukemia. Best Pract Res Clin Haematol 2015; 28:166-74. [DOI: 10.1016/j.beha.2015.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/15/2015] [Accepted: 10/19/2015] [Indexed: 12/29/2022]
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Stephens DM, Ruppert AS, Weirda WG, Jones JA, Woyach JA, Maddocks K, Jaglowski SM, Andritsos LA, Flynn JM, Grever MR, Lozanski G, Tam C, O'Brien S, Keating MJ, Muthusamy N, Abruzzo LV, Heerema NA, Byrd JC. Externally validated predictive clinical model for untreated del(17p13.1) chronic lymphocytic leukemia patients. Am J Hematol 2015. [PMID: 26202978 DOI: 10.1002/ajh.24125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Little is known about outcomes of patients with chronic lymphocytic leukemia (CLL) with del(17p13.1) karyotype at diagnosis. We reviewed 114 de novo del(17p13.1) CLL patients seen at our institution. Using proportional hazards models to identify pretreatment clinical variables significantly associated with treatment-free survival (TFS) and overall survival (OS), we developed a simplified risk score for de novo del(17p13.1) CLL patients to predict TFS and OS based on these variables. These scores, particularly the very highest, can be utilized to identify high-risk patients for expedient enrollment on clinical trials. Our data support careful observation for low-risk patients, potentially preventing unnecessary use of aggressive therapies.
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Affiliation(s)
- Deborah M. Stephens
- Division of Hematology; Department of Internal Medicine; University of Utah; Salt Lake City Utah
| | - Amy S. Ruppert
- Comprehensive Cancer Center, Ohio State University; Columbus Ohio
| | - William G. Weirda
- Division of Cancer Medicine; Department of Leukemia; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jeffrey A. Jones
- Comprehensive Cancer Center, Ohio State University; Columbus Ohio
- Division of Hematology; Department of Internal Medicine; Ohio State University; Columbus Ohio
| | - Jennifer A. Woyach
- Comprehensive Cancer Center, Ohio State University; Columbus Ohio
- Division of Hematology; Department of Internal Medicine; Ohio State University; Columbus Ohio
| | - Kami Maddocks
- Comprehensive Cancer Center, Ohio State University; Columbus Ohio
- Division of Hematology; Department of Internal Medicine; Ohio State University; Columbus Ohio
| | - Samantha M. Jaglowski
- Comprehensive Cancer Center, Ohio State University; Columbus Ohio
- Division of Hematology; Department of Internal Medicine; Ohio State University; Columbus Ohio
| | - Leslie A. Andritsos
- Comprehensive Cancer Center, Ohio State University; Columbus Ohio
- Division of Hematology; Department of Internal Medicine; Ohio State University; Columbus Ohio
| | - Joseph M. Flynn
- Comprehensive Cancer Center, Ohio State University; Columbus Ohio
- Division of Hematology; Department of Internal Medicine; Ohio State University; Columbus Ohio
| | - Michael R. Grever
- Comprehensive Cancer Center, Ohio State University; Columbus Ohio
- Division of Hematology; Department of Internal Medicine; Ohio State University; Columbus Ohio
| | - Gerard Lozanski
- Division of Hematopathology; Department of Pathology; Ohio State University; Columbus Ohio
| | - Constantine Tam
- Division of Medicine; Department of Haematology; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
| | - Susan O'Brien
- Division of Cancer Medicine; Department of Leukemia; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Michael J. Keating
- Division of Cancer Medicine; Department of Leukemia; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Natarajan Muthusamy
- Comprehensive Cancer Center, Ohio State University; Columbus Ohio
- Division of Hematology; Department of Internal Medicine; Ohio State University; Columbus Ohio
| | - Lynne V. Abruzzo
- Comprehensive Cancer Center, Ohio State University; Columbus Ohio
- Division of Hematology; Department of Internal Medicine; Ohio State University; Columbus Ohio
| | - Nyla A. Heerema
- Comprehensive Cancer Center, Ohio State University; Columbus Ohio
- Division of Cytogenetics; Department of Pathology; Ohio State University; Columbus Ohio
| | - John C. Byrd
- Comprehensive Cancer Center, Ohio State University; Columbus Ohio
- Division of Hematology; Department of Internal Medicine; Ohio State University; Columbus Ohio
- Division of Medicinal Chemistry; College of Pharmacy; Ohio State University; Columbus Ohio
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Tiacci E, Park JH, De Carolis L, Chung SS, Broccoli A, Scott S, Zaja F, Devlin S, Pulsoni A, Chung YR, Cimminiello M, Kim E, Rossi D, Stone RM, Motta G, Saven A, Varettoni M, Altman JK, Anastasia A, Grever MR, Ambrosetti A, Rai KR, Fraticelli V, Lacouture ME, Carella AM, Levine RL, Leoni P, Rambaldi A, Falzetti F, Ascani S, Capponi M, Martelli MP, Park CY, Pileri SA, Rosen N, Foà R, Berger MF, Zinzani PL, Abdel-Wahab O, Falini B, Tallman MS. Targeting Mutant BRAF in Relapsed or Refractory Hairy-Cell Leukemia. N Engl J Med 2015; 373:1733-47. [PMID: 26352686 PMCID: PMC4811324 DOI: 10.1056/nejmoa1506583] [Citation(s) in RCA: 231] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND BRAF V600E is the genetic lesion underlying hairy-cell leukemia. We assessed the safety and activity of the oral BRAF inhibitor vemurafenib in patients with hairy-cell leukemia that had relapsed after treatment with a purine analogue or who had disease that was refractory to purine analogues. METHODS We conducted two phase 2, single-group, multicenter studies of vemurafenib (at a dose of 960 mg twice daily)--one in Italy and one in the United States. The therapy was administered for a median of 16 weeks in the Italian study and 18 weeks in the U.S. study. Primary end points were the complete response rate (in the Italian trial) and the overall response rate (in the U.S. trial). Enrollment was completed (28 patients) in the Italian trial in April 2013 and is still open (26 of 36 planned patients) in the U.S. trial. RESULTS The overall response rates were 96% (25 of 26 patients who could be evaluated) after a median of 8 weeks in the Italian study and 100% (24 of 24) after a median of 12 weeks in the U.S. study. The rates of complete response were 35% (9 of 26 patients) and 42% (10 of 24) in the two trials, respectively. In the Italian trial, after a median follow-up of 23 months, the median relapse-free survival was 19 months among patients with a complete response and 6 months among those with a partial response; the median treatment-free survival was 25 months and 18 months, respectively. In the U.S. trial, at 1 year, the progression-free survival rate was 73% and the overall survival rate was 91%. Drug-related adverse events were usually of grade 1 or 2, and the events most frequently leading to dose reductions were rash and arthralgia or arthritis. Secondary cutaneous tumors (treated with simple excision) developed in 7 of 50 patients. The frequent persistence of phosphorylated ERK-positive leukemic cells in bone marrow at the end of treatment suggests bypass reactivation of MEK and ERK as a resistance mechanism. CONCLUSIONS A short oral course of vemurafenib was highly effective in patients with relapsed or refractory hairy-cell leukemia. (Funded by the Associazione Italiana per la Ricerca sul Cancro and others; EudraCT number, 2011-005487-13; ClinicalTrials.gov number NCT01711632.).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Brunangelo Falini
- Corresponding author: Dr. Brunangelo Falini, Institute of Hematology-CREO (Centro di Ricerche Emato-Oncologiche), Ospedale S. Maria della Misericordia, University of Perugia, 06132 Perugia, Italy,
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Blachly JS, Lozanski G, Lucas DM, Grever MR, Kendra K, Andritsos LA. Cotreatment of hairy cell leukemia and melanoma with the BRAF inhibitor dabrafenib. J Natl Compr Canc Netw 2015; 13:9-13; quiz 13. [PMID: 25583765 DOI: 10.6004/jnccn.2015.0004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The activating BRAF mutation p.V600E has been identified in many cancers, including colon and lung adenocarcinomas, papillary thyroid cancer, malignant melanoma, and hairy cell leukemia (HCL). Malignant melanoma and HCL are of particular interest because of both the high proportion of cases harboring the mutation and the dramatic responses to BRAF inhibitor therapy reported in the literature. This report presents a patient with HCL and malignant melanoma with the BRAF p.V600E mutation, and discusses the successful treatment of both cancers with the BRAF inhibitor dabrafenib.
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Affiliation(s)
- James S Blachly
- From the Division of Hematology, Department of Internal Medicine, Department of Pathology, and Division of Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Gerard Lozanski
- From the Division of Hematology, Department of Internal Medicine, Department of Pathology, and Division of Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - David M Lucas
- From the Division of Hematology, Department of Internal Medicine, Department of Pathology, and Division of Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Michael R Grever
- From the Division of Hematology, Department of Internal Medicine, Department of Pathology, and Division of Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Kari Kendra
- From the Division of Hematology, Department of Internal Medicine, Department of Pathology, and Division of Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Leslie A Andritsos
- From the Division of Hematology, Department of Internal Medicine, Department of Pathology, and Division of Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
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Tsai YT, Lozanski G, Lehman A, Sass EJ, Hertlein E, Salunke SB, Chen CS, Grever MR, Byrd JC, Lucas DM. BRAF V600E induces ABCB1/P-glycoprotein expression and drug resistance in B-cells via AP-1 activation. Leuk Res 2015; 39:S0145-2126(15)30371-4. [PMID: 26350141 PMCID: PMC4779435 DOI: 10.1016/j.leukres.2015.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 08/25/2015] [Indexed: 12/15/2022]
Abstract
A subset of patients with chronic lymphocytic leukemia (CLL) and nearly all patients with classic hairy cell leukemia (HCL) harbor somatic BRAF activating mutations. However, the pathological role of activated BRAF in B-cell leukemia development and progression remains unclear. In addition, although HCL patients respond well to the BRAFV600E inhibitor vemurafenib, relapses are being observed, suggesting the development of drug resistance in patients with this mutation. To investigate the biological role of BRAFV600E in B-cell leukemia, we generated a CLL-like B-cell line, OSUCLL, with doxycycline-inducible BRAFV600E expression. Microarray and real-time PCR analysis showed that ABCB1 mRNA is upregulated in these cells, and P-glycoprotein (P-gp) expression as well as function were confirmed by immunoblot and rhodamine exclusion assays. Additionally, pharmacological inhibition of BRAFV600E and MEK alleviated the BRAFV600E-induced ABCB1/P-gp expression. ABCB1 reporter assays and gel shift assays demonstrated that AP-1 activity is crucial in this mechanism. This study, uncovers a pathological role for BRAFV600E in B-cell leukemia, and provides further evidence that combination strategies with inhibitors of BRAFV600E and MEK can be used to delay disease progression and occurrence of resistance.
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Affiliation(s)
- Yo-Ting Tsai
- Division of Medicinal Chemistry & Pharmacognosy, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Gerard Lozanski
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Amy Lehman
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Ellen J Sass
- Department of Internal Medicine, College of Medicine; The Ohio State University, Columbus, OH, USA
| | - Erin Hertlein
- Department of Internal Medicine, College of Medicine; The Ohio State University, Columbus, OH, USA
| | - Santosh B Salunke
- Division of Medicinal Chemistry & Pharmacognosy, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Ching-Shih Chen
- Division of Medicinal Chemistry & Pharmacognosy, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Michael R Grever
- Department of Internal Medicine, College of Medicine; The Ohio State University, Columbus, OH, USA
| | - John C Byrd
- Division of Medicinal Chemistry & Pharmacognosy, College of Pharmacy, The Ohio State University, Columbus, OH, USA; Department of Internal Medicine, College of Medicine; The Ohio State University, Columbus, OH, USA
| | - David M Lucas
- Division of Medicinal Chemistry & Pharmacognosy, College of Pharmacy, The Ohio State University, Columbus, OH, USA; Department of Internal Medicine, College of Medicine; The Ohio State University, Columbus, OH, USA.
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Kutsch N, Bahlo J, Byrd JC, Dohner H, Eichhorst B, Else M, Geisler C, Grever MR, Leprêtre S, Bergman M, Neuberg DS, Oscier D, Rosenquist R, Robak T, Shanafelt TD, Stilgenbauer S, Hallek MJ. The international Prognostic Index for patients with CLL (CLL-IPI): An international meta-analysis. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.7002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nadine Kutsch
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - John C. Byrd
- Ohio State University Medical Center, Columbus, OH
| | - Hartmut Dohner
- Department for Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Monica Else
- Division of Molecular Pathology, The Institute of Cancer Research London, London, United Kingdom
| | | | | | | | - Manuela Bergman
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | | | - David Oscier
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Richard Rosenquist
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | | | | | - Michael J. Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
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Maddocks K, Wei L, Rozewski D, Jiang Y, Zhao Y, Adusumilli M, Pierceall WE, Doykin C, Cardone MH, Jones JA, Flynn J, Andritsos LA, Grever MR, Byrd JC, Johnson AJ, Phelps MA, Blum KA. Reduced occurrence of tumor flare with flavopiridol followed by combined flavopiridol and lenalidomide in patients with relapsed chronic lymphocytic leukemia (CLL). Am J Hematol 2015; 90:327-33. [PMID: 25639448 DOI: 10.1002/ajh.23946] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/08/2015] [Indexed: 12/13/2022]
Abstract
Flavopiridol and lenalidomide have activity in refractory CLL without immunosuppression or opportunistic infections seen with other therapies. We hypothesized that flavopiridol treatment could adequately de-bulk disease prior to lenalidomide therapy, decreasing the incidence of tumor flare with higher doses of lenalidomide. In this Phase I study, the maximum tolerated dose was not reached with treatment consisting of flavopiridol 30 mg m(-2) intravenous bolus (IVB) + 30 mg m(-2) continuous intravenous infusion (CIVI) cycle (C) 1 day (D) 1 and 30 mg m(-2) IVB + 50 mg m(-2) CIVI C1 D8,15 and C2-8 D3,10,17 with lenalidomide 15 mg orally daily C2-8 D1-21. There was no unexpected toxicity seen, including no increased tumor lysis, tumor flare (even at higher doses of lenalidomide) or opportunistic infection. Significant clinical activity was demonstrated, with a 51% response rate in this group of heavily pretreated patients. Biomarker testing confirmed association of mitochondrial priming of the BH3 only peptide Puma with response.
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Affiliation(s)
- Kami Maddocks
- Division of Hematology; Department of Internal Medicine; The Ohio State University, Comprehensive Cancer Center, The Ohio State University, College of Pharmacy, The Ohio State University; Ohio
| | - Lai Wei
- Division of Hematology; Department of Internal Medicine; The Ohio State University, Comprehensive Cancer Center, The Ohio State University, College of Pharmacy, The Ohio State University; Ohio
| | - Darlene Rozewski
- Division of Hematology; Department of Internal Medicine; The Ohio State University, Comprehensive Cancer Center, The Ohio State University, College of Pharmacy, The Ohio State University; Ohio
| | - Yao Jiang
- Division of Hematology; Department of Internal Medicine; The Ohio State University, Comprehensive Cancer Center, The Ohio State University, College of Pharmacy, The Ohio State University; Ohio
| | - Yuan Zhao
- Division of Hematology; Department of Internal Medicine; The Ohio State University, Comprehensive Cancer Center, The Ohio State University, College of Pharmacy, The Ohio State University; Ohio
| | - Mikhil Adusumilli
- Division of Hematology; Department of Internal Medicine; The Ohio State University, Comprehensive Cancer Center, The Ohio State University, College of Pharmacy, The Ohio State University; Ohio
| | - William E. Pierceall
- Division of Hematology; Department of Internal Medicine; The Ohio State University, Comprehensive Cancer Center, The Ohio State University, College of Pharmacy, The Ohio State University; Ohio
| | - Camille Doykin
- Division of Hematology; Department of Internal Medicine; The Ohio State University, Comprehensive Cancer Center, The Ohio State University, College of Pharmacy, The Ohio State University; Ohio
| | - Michael H. Cardone
- Division of Hematology; Department of Internal Medicine; The Ohio State University, Comprehensive Cancer Center, The Ohio State University, College of Pharmacy, The Ohio State University; Ohio
| | - Jeffrey A. Jones
- Division of Hematology; Department of Internal Medicine; The Ohio State University, Comprehensive Cancer Center, The Ohio State University, College of Pharmacy, The Ohio State University; Ohio
| | - Joseph Flynn
- Division of Hematology; Department of Internal Medicine; The Ohio State University, Comprehensive Cancer Center, The Ohio State University, College of Pharmacy, The Ohio State University; Ohio
| | - Leslie A. Andritsos
- Division of Hematology; Department of Internal Medicine; The Ohio State University, Comprehensive Cancer Center, The Ohio State University, College of Pharmacy, The Ohio State University; Ohio
| | - Michael R. Grever
- Division of Hematology; Department of Internal Medicine; The Ohio State University, Comprehensive Cancer Center, The Ohio State University, College of Pharmacy, The Ohio State University; Ohio
| | - John C. Byrd
- Division of Hematology; Department of Internal Medicine; The Ohio State University, Comprehensive Cancer Center, The Ohio State University, College of Pharmacy, The Ohio State University; Ohio
| | - Amy J. Johnson
- Division of Hematology; Department of Internal Medicine; The Ohio State University, Comprehensive Cancer Center, The Ohio State University, College of Pharmacy, The Ohio State University; Ohio
| | - Mitch A. Phelps
- Division of Hematology; Department of Internal Medicine; The Ohio State University, Comprehensive Cancer Center, The Ohio State University, College of Pharmacy, The Ohio State University; Ohio
| | - Kristie A Blum
- Division of Hematology; Department of Internal Medicine; The Ohio State University, Comprehensive Cancer Center, The Ohio State University, College of Pharmacy, The Ohio State University; Ohio
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Lucas DM, Ruppert AS, Lozanski G, Dewald GW, Lozanski A, Claus R, Plass C, Flinn IW, Neuberg DS, Paietta EM, Bennett JM, Jelinek DF, Gribben JG, Hussein MA, Appelbaum FR, Larson RA, Moore DF, Tallman MS, Byrd JC, Grever MR. Cytogenetic prioritization with inclusion of molecular markers predicts outcome in previously untreated patients with chronic lymphocytic leukemia treated with fludarabine or fludarabine plus cyclophosphamide: a long-term follow-up study of the US intergroup phase III trial E2997. Leuk Lymphoma 2015; 56:3031-7. [PMID: 25721902 DOI: 10.3109/10428194.2015.1023800] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Fludarabine (F) and cyclophosphamide (C) remain backbones of up-front chemotherapy regimens for chronic lymphocytic leukemia (CLL). We report long-term follow-up of a randomized F vs. FC trial in untreated CLL (#) . With median follow-up of 88 months, estimated median progression-free survival (PFS) was 19.3 vs. 48.1 months for F (n = 109) and FC (n = 118), respectively (p < 0.0001), and median overall survival (OS) was 88.0 vs. 79.1 months (p = 0.96). In multivariable analyses, variables associated with inferior PFS and OS respectively were age (p = 0.002, p < 0.001), Rai stage (p = 0.006, p = 0.02) and sex (p = 0.03, PFS only). Del(17)(p13.1) predicted shorter PFS and OS (p < 0.0001 for each), as did del(11q)(22.3) (p < 0.0001, p = 0.005, respectively), trisomy 12 with mutated Notch1 (p = 0.003, p = 0.03, respectively) and unmutated IGHV (p = 0.009, p = 0.002, respectively), all relative to patients without these features. These data confirm results from shorter follow-up and further justify targeted therapies for CLL.
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Affiliation(s)
- David M Lucas
- a Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Amy S Ruppert
- a Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Gerard Lozanski
- a Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | | | - Arletta Lozanski
- a Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Rainer Claus
- c University of Freiburg Medical Center , Freiburg , Germany.,d German Cancer Research Center , Heidelberg , Germany
| | | | - Ian W Flinn
- e Sarah Cannon Research Institute and Tennessee Oncology , Nashville , TN , USA
| | | | | | | | | | - John G Gribben
- i Barts Cancer Institute, Queen Mary University of London , London , UK
| | | | | | | | | | | | - John C Byrd
- a Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Michael R Grever
- a Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
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Andritsos LA, Dunavin N, Lozanski G, Jones JA, Blachly JS, Lucas DM, Byrd JC, Kraut E, Grever MR. Reduced dose pentostatin for initial management of hairy cell leukemia patients who have active infection or risk of hemorrhage is safe and effective. Haematologica 2014; 100:e18-20. [PMID: 25361945 DOI: 10.3324/haematol.2014.113290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Leslie A Andritsos
- The Ohio State University, Department of Internal Medicine, Division of Hematology, Columbus, OH
| | - Neil Dunavin
- National Institutes of Health, National Heart, Lung, and Blood Institute, Hematology Branch, Bethesda, MD
| | - Gerard Lozanski
- The Ohio State University, Department of Pathology, Columbus, OH, USA
| | - Jeffrey A Jones
- The Ohio State University, Department of Internal Medicine, Division of Hematology, Columbus, OH
| | - James S Blachly
- The Ohio State University, Department of Internal Medicine, Division of Hematology, Columbus, OH
| | - David M Lucas
- The Ohio State University, Department of Internal Medicine, Division of Hematology, Columbus, OH
| | - John C Byrd
- The Ohio State University, Department of Internal Medicine, Division of Hematology, Columbus, OH
| | - Eric Kraut
- The Ohio State University, Department of Internal Medicine, Division of Hematology, Columbus, OH
| | - Michael R Grever
- The Ohio State University, Department of Internal Medicine, Division of Hematology, Columbus, OH
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Sborov DW, Nuovo GJ, Stiff A, Mace T, Lesinski GB, Benson DM, Efebera YA, Rosko AE, Pichiorri F, Grever MR, Hofmeister CC. A phase I trial of single-agent reolysin in patients with relapsed multiple myeloma. Clin Cancer Res 2014; 20:5946-55. [PMID: 25294913 DOI: 10.1158/1078-0432.ccr-14-1404] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Reolysin, a proprietary isolate of reovirus type III dearing, enters and preferentially induces apoptosis of malignant cells. RAS pathway activation has been associated with more efficient reoviral infectivity and enhanced oncolysis. Reovirus is currently in advanced solid tumor phase I-II trials; no clinical trials have been conducted in patients with hematologic malignancies. EXPERIMENTAL DESIGN A phase I trial treated 12 relapsed myeloma patients at two dose levels. Reolysin was infused daily for 5 days every 28 days. Bone marrow specimens were examined by in situ-based hybridization (ISH) for CD138, p38, caspase-3, reoviral RNA, and capsid protein at screening and cycle 1 day 8. Junctional adhesion molecule 1 (JAM-1) and cancer upregulated gene 2 (CUG2) were evaluated in patient samples and multiple myeloma cell lines. Neutralizing anti-reovirus antibody assay was performed weekly during cycle 1. RESULTS There were no dose-limiting toxicities, patients reached the 3 × 10(10) TCID50 daily on days 1 to 5 dose level, and grade 3 laboratory toxicities included neutropenia, thrombocytopenia, and hypophosphatemia. ISH demonstrated reoviral genome confined in multiple myeloma cells. Reoviral capsid protein and caspase-3 were rarely identified within reoviral RNA-positive cells. The longest durations of stable disease were 4, 5, and 8 months. CONCLUSIONS Treatment with single-agent Reolysin was well tolerated and associated with avid reoviral RNA myeloma cell entry but only minimal intracellular reoviral protein production within multiple myeloma cells. Our data support that in multiple myeloma cells, Reolysin-induced oncolysis requires combination therapy, similar to other cancers.
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Affiliation(s)
- Douglas W Sborov
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | | | - Andrew Stiff
- College of Medicine, The Ohio State University, Columbus, Ohio
| | - Thomas Mace
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Gregory B Lesinski
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Don M Benson
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Yvonne A Efebera
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Ashley E Rosko
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Flavia Pichiorri
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Michael R Grever
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Craig C Hofmeister
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio.
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Grever MR, Blachly JS, Andritsos LA. Hairy cell leukemia: Update on molecular profiling and therapeutic advances. Blood Rev 2014; 28:197-203. [PMID: 25110197 DOI: 10.1016/j.blre.2014.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 06/12/2014] [Accepted: 06/12/2014] [Indexed: 02/07/2023]
Abstract
Hairy cell leukemia was initially described as a clinicopathologic entity more than 50 years ago. We have subsequently discovered that HCL is really at least two diseases: classical HCL and the hairy cell leukemia variant. The former is among a small group of cancers exceptional for being (nearly) unified by a single genetic lesion, the BRAF V600E mutation. Over the past three decades, tremendous progress in both diagnostic and prognostic clarification has been accompanied by therapeutic advances in classical HCL. Consequently, this once uniformly fatal disease has been converted in most cases into a chronic illness enabling patients to live long and productive lives. In response to standard therapy, patients have high complete remission rates. Unfortunately, the long-term survival curves have not plateaued, revealing that this disease is controlled but not cured. Though rare and representing only about 10% of an already rare disease, those patients with the variant fare exceptionally poorly with standard therapy: complete response rates to purine nucleoside analogs are reported to be less than 50%, whereas the complete response rates in classical HCL are up to 90%. Novel small molecules targeting BRAF and the B-cell receptor signaling complex, and biologic agents like antibodies and immunotoxin conjugates are being explored for those patients who have relapsed. Substantial opportunities for continued research remain. This complex and multi-faceted disease incorporates challenges from altered immunity associated with the underlying disease and its treatments. Considering the rarity of this malignancy, optimization of patient management requires multi-institutional collaboration. The Hairy Cell Leukemia Foundation (www.hairycellleukemia.org) was formed to coordinate these efforts.
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Affiliation(s)
- Michael R Grever
- 395 W. 12th Ave, Room 392, Columbus, OH 43210, USA; Department of Internal Medicine, Division of Hematology at The Ohio State University, Columbus, OH, USA.
| | - James S Blachly
- 320 W. 10th Ave, 406C Starling Loving Hall, Columbus, OH 43210, USA; Department of Internal Medicine, Division of Hematology at The Ohio State University, Columbus, OH, USA.
| | - Leslie A Andritsos
- 320 W. 10th Ave, A352 Starling Loving Hall, Columbus, OH 43210, USA; Department of Internal Medicine, Division of Hematology at The Ohio State University, Columbus, OH, USA.
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43
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Pierceall WE, Warner SL, Lena RJ, Doykan C, Blake N, Elashoff M, Hoff DV, Bearss DJ, Cardone MH, Andritsos L, Byrd JC, Lanasa MC, Grever MR, Johnson AJ. Mitochondrial priming of chronic lymphocytic leukemia patients associates Bcl-xL dependence with alvocidib response. Leukemia 2014; 28:2251-4. [PMID: 24990615 PMCID: PMC4221486 DOI: 10.1038/leu.2014.206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - S L Warner
- Tolero Pharmaceuticals, Inc., Lehi, UT, USA
| | - R J Lena
- Eutropics Inc., Cambridge, MA, USA
| | - C Doykan
- Eutropics Inc., Cambridge, MA, USA
| | - N Blake
- Eutropics Inc., Cambridge, MA, USA
| | | | - D V Hoff
- 1] Tolero Pharmaceuticals, Inc., Lehi, UT, USA [2] Translational Genomics Research Institute, Scottsdale, AZ, USA
| | - D J Bearss
- Tolero Pharmaceuticals, Inc., Lehi, UT, USA
| | | | - L Andritsos
- Department of Internal Medicine, Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - J C Byrd
- Department of Internal Medicine, Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - M C Lanasa
- Department of Medicine, Duke Cancer Institute, Durham, NC, USA
| | - M R Grever
- Department of Internal Medicine, Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - A J Johnson
- Department of Internal Medicine, Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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Jaglowski SM, Jones JA, Flynn JM, Andritsos LA, Maddocks KJ, Woyach JA, Blum KA, Grever MR, Geyer SM, Heerema NA, Lozanski G, Stefanos M, Hall N, Nagar V, Munneke B, West JS, Neuenburg J, James DF, Johnson AJ, Byrd JC. A phase 1b/2 study evaluating activity and tolerability of the BTK inhibitor ibrutinib in combination with ofatumumab in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and related diseases. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jones JA, Andritsos LA, Lucas DM, Lozanski G, Hutchinson T, Sexton JL, Harris PJ, Grever MR. Preliminary safety and efficacy of the Bruton’s tyrosine kinase (BTK) inhibitor ibrutinib (IBR) in patients (pts) with hairy cell leukemia (HCL). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Terri Hutchinson
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
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46
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Pierceall WE, Maddocks KJ, Wei EN, Chen C, Warner S, Doykan C, Lena R, Blake N, Cardone MH, Andritsos LA, Grever MR, Byrd JC, Trudel S, Johnson AJ. Distinct biomarkers as prognostic in chronic lymphocytic leukemia patients treated with alvocidib and lenalidomide as single agents or combination regimens thereof. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Ellen N Wei
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | - Ryan Lena
- Eutropics Pharmaceuticals, Cambridge, MA
| | - Noel Blake
- Eutropics Pharmaceuticals, Cambridge, MA
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47
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Woyach JA, Ruppert AS, Lozanski G, Lozanski A, Heerema NA, Zhao W, Abruzzo L, Gordon A, Jones JA, Flynn JM, Jaglowski SM, Andritsos LA, Awan F, Blum KA, Grever MR, Johnson AJ, Byrd JC, Maddocks KJ. Association of disease progression on ibrutinib therapy with the acquisition of resistance mutations: A single-center experience of 267 patients. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wesolowski R, Zhao M, Geyer SM, Lustberg MB, Mrozek E, Layman RM, Macrae EM, Zhang J, Hall N, Schregel K, Ottman S, Camp A, Chalmers JJ, Andreopoulou E, Villalona-Calero MA, Shapiro CL, Knopp MV, Grever MR, Ramaswamy B. Phase I trial of the PARP inhibitor veliparib (V) in combination with carboplatin (C) in metastatic breast cancer (MBC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.1074] [Citation(s) in RCA: 12] [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: 11/20/2022] Open
Affiliation(s)
| | | | | | - Maryam B. Lustberg
- The Breast Program, The Ohio State University Comprehensive Cancer Center and the Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - Ewa Mrozek
- The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
| | | | - Erin Macrae Macrae
- The Stefanie Spielman Comprehensive Breast Center, Ohio State University Wexner Medical Center, Columbus, OH
| | - Jun Zhang
- The Ohio State University, Columbus, OH
| | | | | | - Susan Ottman
- The Breast Program, The Ohio State University Comprehensive Cancer Center and the Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - Andrea Camp
- The Breast Program, The Ohio State University Comprehensive Cancer Center and the Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | | | - Eleni Andreopoulou
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
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Bertino EM, McMichael EL, Villalona-Calero MA, Grever MR, Carson WE, Otterson GA. Enhancement of cetuximab-induced antibody-dependent cellular cytotoxicity (ADCC) with lenalidomide in advanced solid tumors: A phase 1 trial. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.3044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Gregory Alan Otterson
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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50
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Poi MJ, Hofmeister CC, Johnston JS, Edwards RB, Jansak BS, Lucas DM, Farag SS, Dalton JT, Devine SM, Grever MR, Phelps MA. Standard pentostatin dose reductions in renal insufficiency are not adequate: selected patients with steroid-refractory acute graft-versus-host disease. Clin Pharmacokinet 2014; 52:705-12. [PMID: 23588536 DOI: 10.1007/s40262-013-0064-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Pentostatin is an irreversible inhibitor of adenosine deaminase and has been used to prevent graft-versus-host disease (GVHD) and to treat both acute and chronic GVHD. Dose reduction equations for patients with renal insufficiency are based on few patients with limited pharmacokinetic and clinical results. This phase II study (NCT00201786) was conducted to assess pentostatin efficacy and infectious complications seen from our previous phase I study in steroid-refractory acute GVHD (aGVHD). PATIENTS AND METHODS Hospitalized patients with steroid-refractory aGVHD were given pentostatin 1.5 mg/m(2)/day intravenously on days 1-3 of each 14-day cycle. Prior to each dose, dose modifications were based on Cockcroft-Gault estimated creatinine clearance (eCrCL) with 30-50 mL/min/1.73 m(2) leading to a 50 % dose reduction and eCrCL less than 30 mL/min/1.73 m(2) leading to study removal. Plasma pentostatin area under the concentration-time curve (AUC) and incidence of infectious complications were evaluated. RESULTS Two of the eight patients treated demonstrated excessive pentostatin exposure as determined by measurement of AUC. One of these patients had renal impairment, whereas the other patient demonstrated borderline renal function. Despite dose reduction to 0.75 mg/m(2), AUCs were significantly increased compared to the other patients in this study. Seven of eight patients treated with pentostatin had cytomegalovirus (CMV) viremia after pentostatin treatment; however none developed proven CMV disease. CONCLUSION A 50 % dose reduction in patients with eCrCL 30-50 mL/min/1.73 m(2) seems reasonable. However, the eCrCL should be interpreted with extreme caution in patients who are critically ill and/or with poor performance status. Renal function assessment based on the Cockcroft-Gault method could be significantly overestimated thus risking pentostatin overdosing. These results imply a need to closely monitor pentostatin exposure in patients with renal insufficiency.
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Affiliation(s)
- Ming J Poi
- Department of Pharmacy, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA
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