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Oriol A, Dimopoulos M, Schjesvold F, Beksac M, Facon T, Dhanasiri S, Guo S, Mu Y, Hong K, Gentili C, Galli M, Yagci M, Larocca A, Richardson P, Weisel K. Pomalidomide, Bortezomib, and Dexamethasone in Lenalidomide-Pretreated Multiple Myeloma: A Subanalysis of OPTIMISMM by Frailty and Bortezomib Dose Adjustment. Clin Lymphoma Myeloma Leuk 2024; 24:165-176.e4. [PMID: 38072743 DOI: 10.1016/j.clml.2023.10.009] [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] [Received: 08/16/2023] [Revised: 10/06/2023] [Accepted: 10/26/2023] [Indexed: 03/01/2024]
Abstract
INTRODUCTION A proportion of patients with multiple myeloma (MM) are older and/or have comorbidities, requiring dose adjustments. Data from OPTIMISMM (NCT01734928) supported the use of pomalidomide, bortezomib, and dexamethasone (PVd) for treating relapsed/refractory MM. This subanalysis of OPTIMISMM assessed outcome by frailty and/or bortezomib dose adjustment. METHODS Patient frailty (nonfrail vs. frail) was classified using age, Charlson Comorbidity Index, and Eastern Cooperative Oncology Group performance status. Data from patients requiring a bortezomib dose reduction, interruption, and/or withdrawal during PVd treatment were assessed. RESULTS Among 559 patients, 93 of 281 (33.1%) and 93 of 278 (33.5%) patients who received PVd and bortezomib and dexamethasone (Vd), respectively, were frail. Overall response rate (ORR) and median progression-free survival (PFS) were higher in nonfrail vs. frail with PVd treatment (ORR, 82.8% vs. 79.6%; PFS, 14.7 vs. 9.7 months); significantly higher than with Vd regardless of frailty. Grade ≥ 3 treatment-emergent adverse events (TEAEs) were higher with PVd vs. Vd, regardless of frailty. Discontinuations of PVd were lower in nonfrail vs. frail patients (19.2% vs. 30.1%); the median duration of treatment was similar (DoT; 8.8 vs. 8.9 months, respectively). Patients who received PVd with a bortezomib dose adjustment (n = 240) had a longer median DoT (9.3 vs. 4.5 months) and PFS (12.1 vs. 8.4 months) vs. those without. CONCLUSION Frail patients treated with PVd demonstrated a higher ORR and a longer PFS and DoT vs. Vd, despite a higher frequency of grade ≥ 3 TEAEs leading to pomalidomide, bortezomib, and/or dexamethasone discontinuation. Therefore, PVd treatment may improve patient outcomes, regardless of frailty.
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Affiliation(s)
- Albert Oriol
- Institut Català d'Oncologia and Institut Josep Carreras, Hospital Germans Trias i Pujol, Barcelona, Spain.
| | | | - Fredrik Schjesvold
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital and KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway
| | - Meral Beksac
- Ankara Üniversitesi Tip Fakültes, Ankara, Turkey
| | | | - Sujith Dhanasiri
- Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
| | | | | | | | | | | | - Munci Yagci
- Gazi University Medical Faculty, Ankara, Turkey
| | | | | | - Katja Weisel
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Niemann CU, Munir T, Moreno C, Owen C, Follows GA, Benjamini O, Janssens A, Levin MD, Robak T, Simkovic M, Voloshin S, Vorobyev V, Yagci M, Ysebaert L, Qi K, Qi Q, Sinet P, Parisi L, Srinivasan S, Schuier N, Baeten K, Howes A, Caces DB, Kater AP. Fixed-duration ibrutinib-venetoclax versus chlorambucil-obinutuzumab in previously untreated chronic lymphocytic leukaemia (GLOW): 4-year follow-up from a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol 2023; 24:1423-1433. [PMID: 37944541 DOI: 10.1016/s1470-2045(23)00452-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/24/2023] [Accepted: 09/06/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND In the GLOW study, fixed-duration ibrutinib-venetoclax showed superior progression-free survival versus chlorambucil-obinutuzumab in patients with previously untreated chronic lymphocytic leukaemia who were older or had comorbidities, or both, at a median follow up of 27·7 months. In this Article, we report updated outcomes from GLOW after a 46-month median follow-up. METHODS GLOW was a randomised, multicentre, phase 3 study done at 67 hospital centres across 14 countries. Patients aged 65 years and older or 18-64 years with previously untreated chronic lymphocytic leukaemia and a cumulative illness rating scale score of more than 6 or creatinine clearance less than 70 mL/min, or both, and an Eastern Cooperative Oncology Group performance status of 2 or less were randomly assigned (1:1) via an interactive web system with permuted blocks (block size of four) and stratified by IGHV mutational status and the presence of del11q aberration to the ibrutinib-venetoclax group (three cycles of ibrutinib lead-in [420 mg/day, orally], followed by 12 cycles of ibrutinib plus venetoclax [400 mg/day, orally, including a 5-week dose ramp-up]) or the chlorambucil-obinutuzumab group (six cycles of chlorambucil [0·5 mg/kg, orally, on days 1 and 15 of each cycle], and obinutuzumab [1000 mg, intravenously, on days 1 (or 100 mg on day 1 and 900 mg on day 2), 8, and 15 of cycle 1 and day 1 of cycles 2-6]). The primary endpoint was progression-free survival in the intention-to-treat population, assessed by an independent review committee. The safety population included all randomised patients who received at least one dose of the study treatment. This study is registered with ClinicalTrials.gov (NCT03462719) and the EU Clinical Trials Register (EudraCT 2017-004699-77). FINDINGS Between May 4, 2018, and April 5, 2019, 211 patients (122 [58%] were male and 89 [42%] were female) were randomly assigned to receive ibrutinib-venetoclax (n=106) or chlorambucil-obinutuzumab (n=105). At a median of 46 months (IQR 43-47) of follow-up, progression-free survival remained superior for the ibrutinib-venetoclax group (hazard ratio 0·214 [95% CI 0·138-0·334]; p<0·0001); 42-month progression-free survival rates were 74·6% (95% CI 65·0-82·0) for ibrutinib-venetoclax and 24·8% (16·5-34·1) for chlorambucil-obinutuzumab. Following the primary analysis, one patient in the chlorambucil-obinutuzumab group had a serious adverse event of myelodysplastic syndrome. Treatment-related deaths were reported in one patient receiving ibrutinib-venetoclax (cardiac failure, pneumonia, and sinus node dysfunction) and in one patient receiving chlorambucil-obinutuzumab (pneumonia). There were 15 deaths in the ibrutinib-venetoclax group (of which three were due to post-treatment infections) and 30 deaths in the chlorambucil-obinutuzumab group (of which 10 were due to post-treatment infections). INTERPRETATION After 4 years of follow-up, ibrutinib-venetoclax continues to significantly prolong progression-free survival (vs chemoimmunotherapy) in patients with previously untreated chronic lymphocytic leukaemia, supporting its use as a first-line option. FUNDING Janssen Research & Development and Pharmacyclics.
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Affiliation(s)
- Carsten U Niemann
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | | | | | | | | | | | - Tadeusz Robak
- Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Martin Simkovic
- 4th Department of Internal Medicine-Haematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Hradec Králové, Czech Republic
| | - Sergey Voloshin
- Russian Scientific and Research Institute of Hematology and Transfusiology, St Petersburg, Russia
| | | | - Munci Yagci
- Gazi Universitesi Tip Fakultesi, Ankara, Türkiye
| | - Loic Ysebaert
- Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Keqin Qi
- Janssen Research & Development, Titusville, NJ, USA
| | - Qianya Qi
- Janssen Research & Development, Raritan, NJ, USA
| | - Pierre Sinet
- Janssen Research & Development, Bridgewater, NJ, USA
| | - Lori Parisi
- Janssen Research & Development, Raritan, NJ, USA
| | - Srimathi Srinivasan
- Oncology Translational Research, Janssen Research & Development, Lower Gwynedd Township, PA, USA
| | | | - Kurt Baeten
- Janssen Research & Development, Beerse, Belgium
| | - Angela Howes
- Janssen Research & Development, High Wycombe, UK
| | | | - Arnon P Kater
- Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, Netherlands
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Chatzikonstantinou T, Scarfò L, Karakatsoulis G, Minga E, Chamou D, Iacoboni G, Kotaskova J, Demosthenous C, Smolej L, Mulligan S, Alcoceba M, Al-Shemari S, Aurran-Schleinitz T, Bacchiarri F, Bellido M, Bijou F, Calleja A, Medina A, Khan MA, Cassin R, Chatzileontiadou S, Collado R, Christian A, Davis Z, Dimou M, Donaldson D, Santos GD, Dreta B, Efstathopoulou M, El-Ashwah S, Enrico A, Fresa A, Galimberti S, Galitzia A, García-Serra R, Gimeno E, González-Gascón-y-Marín I, Gozzetti A, Guarente V, Guieze R, Gogia A, Gupta R, Harrop S, Hatzimichael E, Herishanu Y, Hernández-Rivas JÁ, Inchiappa L, Jaksic O, Janssen S, Kalicińska E, Kamel L, Karakus V, Kater AP, Kho B, Kislova M, Konstantinou E, Koren-Michowitz M, Kotsianidis I, Kreitman RJ, Labrador J, Lad D, Levin MD, Levy I, Longval T, Lopez-Garcia A, Marquet J, Martin-Rodríguez L, Maynadié M, Maslejova S, Mayor-Bastida C, Mihaljevic B, Milosevic I, Miras F, Moia R, Morawska M, Murru R, Nath UK, Navarro-Bailón A, Oliveira AC, Olivieri J, Oscier D, Panovska-Stavridis I, Papaioannou M, Papajík T, Kubova Z, Phumphukhieo P, Pierie C, Puiggros A, Rani L, Reda G, Rigolin GM, Ruchlemer R, Daniel de Deus Santos M, Schipani M, Schiwitza A, Shen Y, Simkovic M, Smirnova S, Abdelrahman Soliman DS, Spacek M, Tadmor T, Tomic K, Tse E, Vassilakopoulos T, Visentin A, Vitale C, von Tresckow J, Vrachiolias G, Vukovic V, Walewska R, Wasik-Szczepanek E, Xu Z, Yagci M, Yañez L, Yassin M, Zuchnicka J, Angelopoulou M, Antic D, Biderman B, Catherwood M, Claus R, Coscia M, Cuneo A, Demirkan F, Espinet B, Gaidano G, Kalashnikova OB, Laurenti L, Nikitin E, Pangalis GA, Panagiotidis P, Popov VM, Pospisilova S, Sportoletti P, Stavroyianni N, Tam C, Trentin L, Chatzidimitriou A, Bosch F, Doubek M, Ghia P, Stamatopoulos K. Other malignancies in the history of CLL: an international multicenter study conducted by ERIC, the European Research Initiative on CLL, in HARMONY. EClinicalMedicine 2023; 65:102307. [PMID: 38033506 PMCID: PMC10685149 DOI: 10.1016/j.eclinm.2023.102307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Background Patients with chronic lymphocytic leukemia (CLL) have a higher risk of developing other malignancies (OMs) compared to the general population. However, the impact of CLL-related risk factors and CLL-directed treatment is still unclear and represents the focus of this work. Methods We conducted a retrospective international multicenter study to assess the incidence of OMs and detect potential risk factors in 19,705 patients with CLL, small lymphocytic lymphoma, or high-count CLL-like monoclonal B-cell lymphocytosis, diagnosed between 2000 and 2016. Data collection took place between October 2020 and March 2022. Findings In 129,254 years of follow-up after CLL diagnosis, 3513 OMs were diagnosed (27.2 OMs/1000 person-years). The most common hematological OMs were Richter transformation, myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). Non-melanoma skin (NMSC) and prostate cancers were the most common solid tumors (STs).The only predictor for MDS and AML development was treatment with fludarabine and cyclophosphamide with/without rituximab (FC ± R) (OR = 3.7; 95% CI = 2.79-4.91; p < 0.001). STs were more frequent in males and patients with unmutated immunoglobulin heavy variable genes (OR = 1.77; 95% CI = 1.49-2.11; p < 0.001/OR = 1.89; 95% CI = 1.6-2.24; p < 0.001).CLL-directed treatment was associated with non-melanoma skin and prostate cancers (OR = 1.8; 95% CI = 1.36-2.41; p < 0.001/OR = 2.11; 95% CI = 1.12-3.97; p = 0.021). In contrast, breast cancers were more frequent in untreated patients (OR = 0.17; 95% CI = 0.08-0.33; p < 0.001).Patients with CLL and an OM had inferior overall survival (OS) than those without. AML and MDS conferred the worst OS (p < 0.001). Interpretation OMs in CLL impact on OS. Treatment for CLL increased the risk for AML/MDS, prostate cancer, and NMSC. FCR was associated with increased risk for AML/MDS. Funding AbbVie, and EU/EFPIAInnovative Medicines Initiative Joint Undertaking HARMONY grant n° 116026.
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Affiliation(s)
| | - Lydia Scarfò
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Georgios Karakatsoulis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
- Department of Mathematics, University of Ioannina, Ioannina, Greece
| | - Eva Minga
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Dimitra Chamou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Gloria Iacoboni
- Department of Haematology, University Hospital Vall d'Hebron, Autonomous University, Barcelona, Spain
| | - Jana Kotaskova
- Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Lukas Smolej
- 4th Department of Internal Medicine-Haematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | | | - Miguel Alcoceba
- Department of Haematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC (CB16/12/00233) and Cancer Research Centre (CIC-IBMCC, USAL-CSIC), Salamanca, Spain
| | - Salem Al-Shemari
- Faculty of Medicine, Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | | | - Mar Bellido
- Hematology Department, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Anne Calleja
- Department of Hemato-Oncology, Institut Paoli Calmettes, Marseille, France
| | | | - Mehreen Ali Khan
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi, Pakistan
| | - Ramona Cassin
- Hematology Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | - Sofia Chatzileontiadou
- Hematology Unit, 1st Dept of Internal Medicine, AUTH, AHEPA Hospital, Thessaloniki, Greece
| | - Rosa Collado
- Servicio de Hematología, Consorcio Hospital General Universitario de Valencia, Fundación de Investigación Hospital General Universitario de Valencia, Valencia, Spain
| | - Amy Christian
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Zadie Davis
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Maria Dimou
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - David Donaldson
- Clinical Haematology, Belfast City Hospital, Belfast, United Kingdom
| | | | - Barbara Dreta
- Division of Hematology, Department of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Maria Efstathopoulou
- Department of Haematology, Athens Medical Center-Psychikon Branch, Athens, Greece
| | | | | | - Alberto Fresa
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Galitzia
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS "G. Brotzu", Cagliari, Italy
| | - Rocío García-Serra
- Servicio de Hematología, Consorcio Hospital General Universitario de Valencia, Fundación de Investigación Hospital General Universitario de Valencia, Valencia, Spain
| | - Eva Gimeno
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | | | | | - Valerio Guarente
- Institute of Hematology and Center for Hemato-Oncology Research, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Romain Guieze
- Department of Hematology and Cell Therapy, Estaing University Hospital, Clermont-Ferrand, France
| | - Ajay Gogia
- Laboratory Oncology Unit, Dr. B.R.A. IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ritu Gupta
- Laboratory Oncology Unit, Dr. B.R.A. IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sean Harrop
- Peter MacCallum Cancer Centre, St Vincent's Hospital, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Eleftheria Hatzimichael
- Faculty of Medicine, Department of Haematology, School of Health Sciences, University of Ioannina, Stavros Niarchos Avenue, Ioannina 45110, Greece
| | - Yair Herishanu
- Department of Hematology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Luca Inchiappa
- Department of Hemato-Oncology, Institut Paoli Calmettes, Marseille, France
| | - Ozren Jaksic
- Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
| | - Susanne Janssen
- Dept of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Elżbieta Kalicińska
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation Wroclaw Medical University, Wroclaw, Poland
| | - Laribi Kamel
- Department of Hematology, Centre Hospitalier Le Mans, Le Mans, France
| | | | - Arnon P. Kater
- Dept of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Bonnie Kho
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China
| | - Maria Kislova
- Department of Hematology, Oncology, and Chemotherapy, S. P. Botkin's City Hospital, Moscow, Russia
| | | | - Maya Koren-Michowitz
- Department of Hematology, Shamir Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ioannis Kotsianidis
- Department of Hematology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Robert J. Kreitman
- Laboratory of Molecular Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jorge Labrador
- Department of Hematology, Hospital Universitario de Burgos, Burgos, Spain
| | - Deepesh Lad
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Ilana Levy
- Hematology, Bnai-Zion Medical Center, Haifa, Israel
| | - Thomas Longval
- Service d'Hématologie Oncologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Alberto Lopez-Garcia
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Juan Marquet
- Hematology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Lucia Martin-Rodríguez
- Department of Haematology, University Hospital Vall d'Hebron, Autonomous University, Barcelona, Spain
| | - Marc Maynadié
- Biological Haematology Department, Dijon Bourgogne University Hospital, Haematological Malignancies Registry, LNC UMR 1231, Dijon 21000, France
| | - Stanislava Maslejova
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Biljana Mihaljevic
- Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Milosevic
- Faculty of Medicine, Clinical Centre of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Fatima Miras
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Marta Morawska
- Experimental Hematooncology Department, Medical University of Lublin, Lublin, Poland
- Hematology Department, St. John's Cancer Center, Lublin, Poland
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS "G. Brotzu", Cagliari, Italy
| | - Uttam Kumar Nath
- Department of Medical Oncology & Hematology, All India Institute of Medical Sciences, Rishikesh, India
| | - Almudena Navarro-Bailón
- Department of Haematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC (CB16/12/00233) and Cancer Research Centre (CIC-IBMCC, USAL-CSIC), Salamanca, Spain
| | - Ana C. Oliveira
- Department of Clinical Hematology, ICO, Hospital Duran i Reynals, IDIBELL, Barcelona, Spain
| | | | - David Oscier
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Irina Panovska-Stavridis
- Medical Faculty, University Clinic of Hematology, University Ss. Cyril and Methodius, Skopje, North Macedonia
| | - Maria Papaioannou
- Hematology Unit, 1st Dept of Internal Medicine, AUTH, AHEPA Hospital, Thessaloniki, Greece
| | - Tomas Papajík
- Faculty of Medicine and Dentistry, Department of Hemato-Oncology, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Zuzana Kubova
- Faculty of Medicine and Dentistry, Department of Hemato-Oncology, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | | | - Cheyenne Pierie
- Dept of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Anna Puiggros
- Molecular Cytogenetics Laboratory, Pathology Department, Hospital del Mar and Translational Research on Hematological Neoplasms Group, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Lata Rani
- Laboratory Oncology Unit, Dr. B.R.A. IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Gianluigi Reda
- Hematology Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | | | - Rosa Ruchlemer
- Department of Hematology, Shaare-Zedek Medical Center, Affiliated with the Hebrew University Medical School, Jerusalem, Israel
| | | | - Mattia Schipani
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Annett Schiwitza
- Hematology and Oncology, Faculty of Medicine, University of Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany
| | - Yandong Shen
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Martin Simkovic
- 4th Department of Internal Medicine-Haematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - Svetlana Smirnova
- Consultative Hematology Department with a Day Hospital for Intensive High-Dose Chemotherapy, National Medical Research Center for Hematology, Moscow, Russia
| | | | - Martin Spacek
- First Faculty of Medicine, 1st Department of Medicine - Hematology, Charles University and General Hospital in Prague, Czech Republic
| | - Tamar Tadmor
- Hematology, Bnai-Zion Medical Center, Haifa, Israel
| | - Kristina Tomic
- Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Eric Tse
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Julia von Tresckow
- Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - George Vrachiolias
- Department of Hematology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vojin Vukovic
- Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Renata Walewska
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Ewa Wasik-Szczepanek
- Dept. Hematooncology and Bone Marrow Transplantation, Medical University in Lublin, Lublin, Poland
| | - Zhenshu Xu
- Fujian Provincial Key Laboratory of Hematology, Fujian Institute of Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Munci Yagci
- Gazi University Medical Faculty, Ankara, Turkey
| | - Lucrecia Yañez
- Department of Hematology, University Hospital Marqués de Valdecilla, Santander, Spain
- Department of Hematological Malignancies and Stem Cell Transplantation, Research Institute of Marques de Valdecilla (IDIVAL), Santander, Spain
| | - Mohamed Yassin
- Hematology Section, Department of Medical Oncology, National Center for Cancer Care and Research, Doha, Qatar
| | - Jana Zuchnicka
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Maria Angelopoulou
- Haematology, University of Athens, Laikon General Hospital, Athens, Greece
| | - Darko Antic
- Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bella Biderman
- Department of Molecular Hematology, National Medical Research Center for Hematology, Moscow, Russia
| | - Mark Catherwood
- Clinical Haematology, Belfast City Hospital, Belfast, United Kingdom
| | - Rainer Claus
- Pathology, Faculty of Medicine, University of Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany
- Faculty of Medicine, Comprehensive Cancer Center Augsburg, University of Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | | | - Fatih Demirkan
- Division of Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Blanca Espinet
- Molecular Cytogenetics Laboratory, Pathology Department, Hospital del Mar and Translational Research on Hematological Neoplasms Group, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Olga B. Kalashnikova
- Federal State Budgetary Educational Institution of Higher Education Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia
| | - Luca Laurenti
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Eugene Nikitin
- Department of Hematology, Oncology, and Chemotherapy, S. P. Botkin's City Hospital, Moscow, Russia
| | | | - Panagiotis Panagiotidis
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Viola Maria Popov
- Hematology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Sarka Pospisilova
- Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Paolo Sportoletti
- Institute of Hematology and Center for Hemato-Oncology Research, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Niki Stavroyianni
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Constantine Tam
- Peter MacCallum Cancer Centre, St Vincent's Hospital, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | | | - Francesc Bosch
- Department of Haematology, University Hospital Vall d'Hebron, Autonomous University, Barcelona, Spain
| | - Michael Doubek
- Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
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4
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Munir T, Moreno C, Owen C, Follows G, Benjamini O, Janssens A, Levin MD, Osterborg A, Robak T, Simkovic M, Stevens D, Voloshin S, Vorobyev V, Yagci M, Ysebaert L, Qi K, Qi Q, Parisi L, Srinivasan S, Schuier N, Baeten K, Howes A, Caces DB, Niemann CU, Kater AP. Impact of Minimal Residual Disease on Progression-Free Survival Outcomes After Fixed-Duration Ibrutinib-Venetoclax Versus Chlorambucil-Obinutuzumab in the GLOW Study. J Clin Oncol 2023:JCO2202283. [PMID: 37279408 DOI: 10.1200/jco.22.02283] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/31/2023] [Accepted: 04/25/2023] [Indexed: 06/08/2023] Open
Abstract
PURPOSE In GLOW, fixed-duration ibrutinib + venetoclax showed superior progression-free survival (PFS) versus chlorambucil + obinutuzumab in older/comorbid patients with previously untreated chronic lymphocytic leukemia (CLL). The current analysis describes minimal residual disease (MRD) kinetics and any potential predictive value for PFS, as it has not yet been evaluated for ibrutinib + venetoclax treatment. METHODS Undetectable MRD (uMRD) was assessed by next-generation sequencing at <1 CLL cell per 10,000 (<10-4) and <1 CLL cell per 100,000 (<10-5) leukocytes. PFS was analyzed by MRD status at 3 months after treatment (EOT+3). RESULTS Ibrutinib + venetoclax achieved deeper uMRD (<10-5) rates in bone marrow (BM) and peripheral blood (PB), respectively, in 40.6% and 43.4% of patients at EOT+3 versus 7.6% and 18.1% of patients receiving chlorambucil + obinutuzumab. Of these patients, uMRD (<10-5) in PB was sustained during the first year post-treatment (EOT+12) in 80.4% of patients receiving ibrutinib + venetoclax and 26.3% receiving chlorambucil + obinutuzumab. Patients with detectable MRD (dMRD; ≥10-4) in PB at EOT+3 were more likely to sustain MRD levels through EOT+12 with ibrutinib + venetoclax versus chlorambucil + obinutuzumab. PFS rates at EOT+12 were high among patients treated with ibrutinib + venetoclax regardless of MRD status at EOT+3: 96.3% and 93.3% in patients with uMRD (<10-4) and dMRD (≥10-4) in BM, respectively, versus 83.3% and 58.7% for patients receiving chlorambucil + obinutuzumab. PFS rates at EOT+12 also remained high in patients with unmutated immunoglobulin heavy-chain variable region (IGHV) receiving ibrutinib + venetoclax, independent of MRD status in BM. CONCLUSION Molecular and clinical relapses were less frequent during the first year post-treatment with ibrutinib + venetoclax versus chlorambucil + obinutuzumab regardless of MRD status at EOT+3 and IGHV status. Even for patients not achieving uMRD (<10-4), PFS rates remained high with ibrutinib + venetoclax; this is a novel finding and requires additional follow-up to confirm its persistence over time.
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Affiliation(s)
| | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Josep Carreras Research Leukaemia Research Institute, Barcelona, Spain
| | | | | | | | | | | | | | - Tadeusz Robak
- Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Martin Simkovic
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | | | - Sergey Voloshin
- Russian Scientific and Research Institute of Hematology and Transfusiology, St Petersburg, Russia
| | | | - Munci Yagci
- Gazi Universitesi Tip Fakultesi, Ankara, Turkey
| | - Loic Ysebaert
- Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Keqin Qi
- Janssen Research & Development, Titusville, NJ
| | - Qianya Qi
- Janssen Research & Development, Raritan, NJ
| | | | - Srimathi Srinivasan
- Oncology Translational Research, Janssen Research & Development, Lower Gwynedd Township, PA
| | | | - Kurt Baeten
- Janssen Research & Development, Beerse, Belgium
| | - Angela Howes
- Janssen Research & Development, High Wycombe, United Kingdom
| | | | | | - Arnon P Kater
- Amsterdam Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
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5
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Richardson PG, Schjesvold F, Weisel K, Moreau P, Anderson LD, White D, Rodriguez-Otero P, Sonneveld P, Engelhardt M, Jenner M, Corso A, Dürig J, Pavic M, Salomo M, Beksac M, Oriol A, Lindsay J, Liberati AM, Galli M, Robak P, Larocca A, Yagci M, Vural F, Kanate AS, Jiang R, Grote L, Peluso T, Dimopoulos M. Pomalidomide, bortezomib, and dexamethasone at first relapse in lenalidomide-pretreated myeloma: A subanalysis of OPTIMISMM by clinical characteristics. Eur J Haematol 2021; 108:73-83. [PMID: 34496096 PMCID: PMC9293199 DOI: 10.1111/ejh.13706] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 01/17/2023]
Abstract
Objective We evaluated the efficacy and safety of pomalidomide, bortezomib, and dexamethasone (PVd) vs bortezomib and dexamethasone (Vd) by age, renal function, and high‐risk cytogenetic abnormalities in lenalidomide‐pretreated patients with multiple myeloma at first relapse. Methods OPTIMISMM was a phase 3, multicenter, open‐label, randomized study (NCT01734928; N = 559). The primary endpoint was progression‐free survival (PFS). Results Overall, 226 patients had received one prior line of therapy. PVd significantly prolonged PFS vs Vd in patients aged ≤65 years (median, 22.0 vs 13.1 months; P = .0258) and >65 years (median, 17.6 vs 9.9 months; P = .0369). Median PFS in patients with renal impairment (RI; creatinine clearance <60 mL/min) was 15.1 months with PVd vs 9.5 months with Vd (hazard ratio [HR], 0.67 [95% CI, 0.34‐1.34]). In patients without RI, median PFS was 22.0 vs 13.1 months (HR, 0.45 [95% CI, 0.27‐0.76]). In patients with high‐risk cytogenetics, median PFS was 14.7 vs 9.9 months (HR, 0.39 [95% CI, 0.13‐1.17]). PVd significantly improved overall response rate vs Vd in all subgroups. The safety profile of PVd was consistent with previous reports. Conclusions These findings confirmed the benefits of PVd at first relapse, including in patients with poor prognostic factors.
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Affiliation(s)
- Paul G Richardson
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Fredrik Schjesvold
- Oslo Myeloma Center at Oslo University Hospital, KG Jebsen Center for B-Cell Malignancies, University of Oslo, Oslo, Norway
| | - Katja Weisel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Larry D Anderson
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Darrell White
- Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | | | | | | | | | | | - Jan Dürig
- University Hospital Essen, Essen, Germany
| | - Michel Pavic
- Centre Hospitalier Universitaire De Sherbrooke (CHUS), Centre de Recherche Clinique Etienne-Le Bel (CRCELB) Hopital Fleurimont, Sherbrooke, QC, Canada
| | - Morten Salomo
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Albert Oriol
- Institut Català d'Oncologia I Institut Josep Carreras, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Jindriska Lindsay
- East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, UK
| | | | - Monica Galli
- Ospedale Papa Giovanni XXIII, U.O. di Ematologia, Ispedali Riuniti di Bergamo, Bergamo, Italy
| | | | | | - Munci Yagci
- Gazi University Medical Faculty, Ankara, Turkey
| | | | | | - Ruiyun Jiang
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Lara Grote
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Teresa Peluso
- Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
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6
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Karadag FK, Yenerel MN, Yılmaz M, Uskudar H, Ozkocaman V, Tuglular TF, Erdem F, Unal A, Ayyildiz O, Ozet G, Comert M, Kaya E, Ayer M, Salim O, Guvenc B, Ozdogu H, Mehtap Ö, Sonmez M, Guler N, Hacioglu S, Aydogdu İ, Bektas O, Toprak SK, Kaynar L, Yagci M, Aksu S, Tombak A, Karakus V, Yavasoglu İ, Onec B, Ozcan MA, Undar L, Ali R, Ilhan O, Saydam G, Sahin F. Evaluation of clinical characteristics of patients with paroxysmal nocturnal hemoglobinuria treated with eculizumab in Turkey: a multicenter retrospective analysis. Am J Blood Res 2021; 11:279-285. [PMID: 34322292 PMCID: PMC8303018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare X-linked genetic disorder. On the contrary to its name, it is a multisystemic disease and various symptoms other than hemoglobinuria could be occurred. It could be life threatening especially because of thromboembolic events. In the last decade, a terminal complement inhibition with eculizumab approved with promising results for PNH patients. We conducted this study to evaluate the long term experience of eculizumab therapy from Turkey for the first time. Our cohort included 138 patients with PNH treated with eculizumab between January 2008 and December 2018 at 28 centers in Turkey. Laboratory and clinical findings at the time of diagnosis and after eculizumab therapy were recorded retrospectively. The median age was 39 (range 18-84) years and median granulocyte PNH clone size was 74% (range 3.06-99.84%) at the time of diagnosis. PNH with bone marrow failure syndrome was detected in 49 patients and the rest of 89 patients had classical PNH. Overall 45 patients (32.6%) had a history of any prior thrombotic event before eculizumab therapy and only 2 thrombotic events were reported during the study period. Most common symptoms are fatigue (75.3%), hemoglobinuria (18.1%), abdominal pain (15.2%) and dysphagia (7.9%). Although PNH is commonly related with coombs negativity, we detected coombs positivity in 2.17% of patients. Seven months after the therapy, increased hemoglobin level was seen and remarkably improvement of lactate dehydrogenase level during the treatment was occurred. In addition to previous studies, our real life data support that eculizumab is well tolerated with no serious adverse events and improves the PNH related findings.
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Affiliation(s)
| | | | - Mehmet Yılmaz
- Department of Hematology Gaziantep, Gaziantep UniversityGaziantep, Turkey
| | - Hava Uskudar
- Department of Hematology, Eskisehir Osmangazi UniversityEskisehir, Turkey
| | | | | | - Fuat Erdem
- Department of Hematology, Ataturk UniversityErzurum, Turkey
| | - Ali Unal
- Department of Hematology, Erciyes UniversityKayseri, Turkey
| | - Orhan Ayyildiz
- Department of Hematology, Dicle UniversityDiyarbakir, Turkey
| | - Gülsüm Ozet
- Department of Hematology, Ankara Numune HospitalAnkara, Turkey
| | - Melda Comert
- Department of Hematology, Gulhane Research and Training HospitalAnkara, Turkey
| | - Emin Kaya
- Department of Hematology, Malatya Inonu UniversityMalatya, Turkey
| | - Mesut Ayer
- Department of Hematology, Haseki Research and Training HospitalIstanbul, Turkey
| | - Ozan Salim
- Department of Hematology, Akdeniz UniversityAntalya, Turkey
| | - Birol Guvenc
- Department of Hematology, Cukurova UniversityAdana, Turkey
| | - Hakan Ozdogu
- Department of Hematology, Baskent UniversityAdana, Turkey
| | - Özgur Mehtap
- Department of Hematology, Kocaeli UniversityKocaeli, Turkey
| | - Mehmet Sonmez
- Department of Hematology, Karadeniz Technical UniversityTrabzon, Turkey
| | - Nil Guler
- Department of Hematology, Pamukkale UniversityDenizli, Turkey
| | - Sibel Hacioglu
- Department of Hematology, Pamukkale UniversityDenizli, Turkey
| | - İsmet Aydogdu
- Department of Hematology, Celal Bayar UniversityManisa, Turkey
| | - Ozlen Bektas
- Department of Hematology, Karadeniz Technical UniversityTrabzon, Turkey
| | | | - Lale Kaynar
- Department of Hematology, Gazi UniversityAnkara, Turkey
| | - Munci Yagci
- Department of Hematology, Gazi UniversityAnkara, Turkey
| | - Salih Aksu
- Department of Hematology, Hacettepe UniversityAnkara, Turkey
| | - Anil Tombak
- Department of Hematology, Mersin UniversityMersin, Turkey
| | - Volkan Karakus
- Department of Hematology, Muğla Sıtkı Kocman UniversityMugla, Turkey
| | - İrfan Yavasoglu
- Department of Hematology, Adnan Menderes UniversityAydın, Turkey
| | - Birgul Onec
- Department of Hematology, Düzce UniversityTrabzon, Turkey
| | | | - Levent Undar
- Department of Hematology, Akdeniz UniversityAntalya, Turkey
| | - Rıdvan Ali
- Department of Hematology, Uludag UniversityBursa, Turkey
| | - Osman Ilhan
- Department of Hematology, Ankara UniversityAnkara, Turkey
| | - Guray Saydam
- Department of Hematology, Ege UniversityIzmir, Turkey
| | - Fahri Sahin
- Department of Hematology, Ege UniversityIzmir, Turkey
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7
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Paydas S, Laçin S, Doğan M, Barista I, Yildiz B, Seydaoglu G, Karadurmus N, Civriz S, Kaplan MA, Yagci M, Gurkan E, Ercolak V. IPS-3 Validation in 1012 cases with classical hodgkin lymphoma. Leuk Res 2021; 102:106519. [PMID: 33556744 DOI: 10.1016/j.leukres.2021.106519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/30/2020] [Accepted: 01/26/2021] [Indexed: 11/27/2022]
Abstract
The aim of this study is to validate the IPS-3 scoring system as a prognostic indicator in 1012 patients with advanced stage classical Hodgkin Lymphoma (cHL) treated by doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD). According to the IPS-3 scoring system only 3.5 % had high risk and 50.8 % had low risk disease disease and 45.8 % of the cases had intermediate risk disease. Each factors of IPS-7 and IPS-3 scoring systems (age, sex, stage hemoglobin, albumin, lymphocyte count and white cell count) were found to be significant for overall survival (OS) and progression free survival (PFS) according to univariate analyses. Two different multivariate Cox analyses were performed for OS and PFS including the IPS-3/ IPS-7 scoring system parameters. Among 7 risk factors of IPS scoring system, gender and albumin were not found as independent risk factors for both OS and PFS according to cox regression model. But all parameters such as age, stage and hemoglobin those included in IPS-3, were found to be independent significant risk factors for both models obtained for OS and PFS. The results of the study shows that the IPS-3 scoring system can be used as a prognostic indicator in ABVD treated patients in every day practice which is more easily calculate according to the IPS-7.
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Affiliation(s)
- Semra Paydas
- Cukurova University Fac of Med Dept of Medical Oncology, Turkey.
| | - Sahin Laçin
- Hacettepe University, Fac of Med Dept of Medical Oncology, Turkey
| | | | - Ibrahim Barista
- Hacettepe University, Fac of Med Dept of Medical Oncology, Turkey
| | | | | | | | - Sinem Civriz
- Ankara University Fac of Med Dept of Hematology, Turkey
| | | | - Munci Yagci
- Gazi University Fac of Med Dept of Hematology, Turkey
| | - Emel Gurkan
- Cukurova University Fac of Med Dept of Hematology, Turkey
| | - Vehbi Ercolak
- Cukurova University Fac of Med Dept of Medical Oncology, Turkey
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8
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Paydas S, Lacin S, Dogan M, Barista I, Yildiz B, Seydaoglu G, Karadurmuş N, Civriz S, Kaplan MA, Yagci M, Gurkan E, Ercolak V. Abstract PO-30: Is it more explanatory to integrate the leukocyte/lymphocyte ratio (LLR) and prognostic nutritional index (PNI) to international prognostic systems (IPS) in cases with Hodgkin lymphoma (HL)? Blood Cancer Discov 2020. [DOI: 10.1158/2643-3249.lymphoma20-po-30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Aim: To determine the power of the International Prognostic Scoring systems (IPS-7 and IPS-3) and to obtain more explanatory indexes by integrating LLR and PNI as prognostic indicators to IPS in cases with HL.
Patients and Methods: 1,060 patients with HL were included in this study from 8 centers in Turkey. IPS-7 using seven parameters (age, sex, stage hemoglobin, albumin, lymphocyte count, and white cell count) and the modified IPS-3 score with three parameters (stage, age, and hemoglobin level) were calculated. An alternative IPS-4 score with four parameters (stage, age, hemoglobin level, and LLR or PNI) was also calculated. LLR and PNI were integrated to IPSs.
Statistical Analyses: Chi square test or Student t test was used to compare the groups. The cut-off points of this population for the LLR and PNI were evaluated using AUC (area under ROC curve) statistics and median values of the distributions of the variables. Possible alternative cut-off points for the LLR and PNI were evaluated using AUC statistics and median values of the distributions of the variables. For LLR, 5.7 was detected as cut-off point based on ROC analysis and 5.1 based on median. Cut-off for PNI was 45.2 based on ROC analysis and 47.5 based on median. The Kaplan-Meier method and Cox proportional regression model were used to estimate the mean-median overall survival (OS), failure-free survival (FFS) rates, and hazard ratios (HRs). Log-rank test was used to compare the survival distributions between groups. The prognostic ability of parameters was evaluated for OS and FFS in both univariate and multivariate Cox regression models. p value < 0.05 was considered as significant. The analyses were performed using the statistical package SPSS v 22.0.
Results: Female/male ratio was 396/664; mean age was 37.6±15.8 (15-88). About 75% of the patients had stage II-III disease and two thirds of the patient had nodular sclerosis subtype. All factors of IPS-7 and IPS-3 scoring systems were found to be significant factors that related with OS and FFS according to univariate analyses. PNI and LLR were also found to be prognostic factors for OS and FFS. PNI ≤45.2 and LLR ≥5.8 were found to be poor prognostic indicators. Among 7 factors of IPS-7, gender and albumin were not found to be significant according to multivariate Cox regression model. Hence albumin and gender were excluded from the models and PNI and LLR as prognostic factors were added to obtain easier and more explanatory indexes to the model, respectively. Two different Cox regression models were obtained for OS and FFS. Model 1 showed LLR ≥5.8 as the highest risk for OS (OR: 2.7) and Hb <10.5g/dL as the highest risk for FFS (OR: 2.3). Model 2 showed PNI ≤45.2 as the highest risk for OS (OR: 3.2) and Hb <10.5g/dL as the highest risk for FFS (OR: 2.9). Goodness of fit and agreement between IPS-7, IPS-3 groups and IPS-4 groups were found to be acceptable.
Conclusion: IPS-4 score obtained by integrating LLR or PNI to IPS systems can be used as an explanatory index for prognostic indicator in HL.
Citation Format: Semra Paydas, Sahin Lacin, Mutlu Dogan, Ibrahim Barista, Birol Yildiz, Gulsah Seydaoglu, Nuri Karadurmuş, Sinem Civriz, Muhammed Ali Kaplan, Munci Yagci, Emel Gurkan, Vehbi Ercolak. Is it more explanatory to integrate the leukocyte/lymphocyte ratio (LLR) and prognostic nutritional index (PNI) to international prognostic systems (IPS) in cases with Hodgkin lymphoma (HL)? [abstract]. In: Proceedings of the AACR Virtual Meeting: Advances in Malignant Lymphoma; 2020 Aug 17-19. Philadelphia (PA): AACR; Blood Cancer Discov 2020;1(3_Suppl):Abstract nr PO-30.
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9
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Beksac M, Aydin Y, Goker H, Turgut M, Besisik SK, Cagirgan S, Tuglular T, Vural F, Yagci M, Alacacioglu I, Aytan P, Goksoy HS, Gulbas Z, Gunes AK, Gurkan E, Hacioglu SK, Karti SS, Kaynar L, Ozdogu H, Paydas S, Solmaz S, Sonmez M, Tekgunduz E, Yildirim R, Ilhan O. Early Access Program Results From Turkey and a Literature Review on Daratumumab Monotherapy Among Heavily Pretreated Patients With Relapsed/Refractory Myeloma. Clinical Lymphoma Myeloma and Leukemia 2020; 20:e474-e484. [DOI: 10.1016/j.clml.2020.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/14/2022]
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10
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Weisel K, Dimopoulos M, Moreau P, Yagci M, Larocca A, Kanate AS, Vural F, Cascavilla N, Basu S, Johnson P, Byeff P, Hus M, Rodríguez-Otero P, Muelduer E, Anttila P, Hayden PJ, Krauth MT, Lucio P, Ben-Yehuda D, Mendeleeva L, Guo S, Yu X, Grote L, Biyukov T, Dhanasiri S, Richardson P. Health-related quality-of-life results from the phase 3 OPTIMISMM study: pomalidomide, bortezomib, and low-dose dexamethasone versus bortezomib and low-dose dexamethasone in relapsed or refractory multiple myeloma. Leuk Lymphoma 2020; 61:1850-1859. [DOI: 10.1080/10428194.2020.1747066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Katja Weisel
- University Medical Center of Hamburg-Eppendorf, Hamburg, Germany and University Hospital of Tuebingen, Tuebingen, Germany
| | | | | | - Munci Yagci
- Gazi Universitesi Tip Fakultesi Hastanesi, Besevler, Turkey
| | - Alessandra Larocca
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Abraham S. Kanate
- Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, WV, USA
| | | | - Nicola Cascavilla
- Fondazione IRCSS Casa Sollievo Della Sofferenza, San Giovanni Rotundo, Italy
| | - Supratik Basu
- New Cross Hospital, Wolverhampton, University Of Wolverhampton, United Kingdom
| | - Peter Johnson
- Department of Haematology, Western General Hospital, Edinburgh, United Kingdom
| | - Peter Byeff
- Cancer Center of Central Connecticut, Southington, CT, USA
| | - Marek Hus
- Samodzielny Publiczny Szpital Nr 1 W Lublinie, Lublin, Poland
| | | | | | - Pekka Anttila
- Division of Hematology, Helsinki University and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | | | - Maria-Theresa Krauth
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Paulo Lucio
- Champalimaud Center for the Unknown, Lisbon, Portugal
| | | | - Larisa Mendeleeva
- National Research Center for Hematology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | | | - Xin Yu
- Bristol Myers Squibb, Summit, NJ, USA
| | | | - Tsvetan Biyukov
- Celgene International Sàrl, a Bristol Myers Squibb Company, Boudry, Switzerland
| | - Sujith Dhanasiri
- Celgene International Sàrl, a Bristol Myers Squibb Company, Boudry, Switzerland
| | - Paul Richardson
- Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Buyukasik Y, Acar K, Kelkitli E, Uz B, Serefhanoglu S, Ozdemir E, Pamukcuoglu M, Atay H, Bektas O, Sucak GT, Turgut M, Aksu S, Yagci M, Sayınalp N, Ozcebe OI, Goker H, Haznedaroglu IC. Hyper-CVAD regimen in routine management of adult acute lymphoblastic leukemia: a retrospective multicenter study. Acta Haematol 2013; 130:199-205. [PMID: 23797290 DOI: 10.1159/000351172] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 04/06/2013] [Indexed: 12/19/2022]
Abstract
Treatment of acute lymphoblastic leukemia is unsatisfactory in adults due to disease and patient-related factors and probably because adult chemotherapy regimens are weaker than pediatric protocols. Worries about inadequacy of adult regimens urged many hematologists, including us, to reconsider their routine treatment practices. In this retrospective multicenter study, we aimed to evaluate results of hyper-CVAD treatment in comparison to other intensive protocols. All patients aged ≤65 years who were commenced on intensive induction chemotherapy between 1999 and 2011 were included in the study. Sixty-eight of 166 patients received hyper-CVAD, 65 were treated with CALGB-8811 regimen and 33 with multiple other protocols. Limited number of patients who were treated with other intensive protocols and mature B-acute lymphoblastic leukemia cases who were mostly given hyper-CVAD were eliminated from the statistical analyses. In spite of a favorable complete remission rate (84.2%), overall (26.3 vs. 44.2% at 5 years, p = 0.05) and disease-free (24.9 vs. 48.2%, p = 0.001) survival rates were inferior with hyper-CVAD compared to CALGB-8811 due to higher cumulative nonrelapse mortality risk (29.7 vs. 5.9%, p = 0.003) and no superiority in cumulative relapse incidence comparison (45% for both arms, p = 0.44). Hyper-CVAD, in its original form, was a less favorable regimen in our practice.
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Affiliation(s)
- Yahya Buyukasik
- Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Nazliel B, Batur Caglayan H, Yildirim Capraz I, Irkec C, Yagci M, Gesoglu T. Heparin-induced thrombocytopenia leading to stroke, lower extremity arterial occlusive disease, and skin necrosis: A case report. Platelets 2013; 25:129-31. [DOI: 10.3109/09537104.2013.779655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yegin ZA, Turkoz Sucak G, Erbas G, Yagci M. ARA-C associated pulmonary toxicity. Turk J Haematol 2011; 28:81-3. [DOI: 10.5152/tjh.2011.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sucak G, Suyanı E, Özkurt ZN, Yeğin ZA, Aki Z, Yagci M. Abnormal protein bands in patients with multiple myeloma after haematopoietic stem cell transplantation: does it have a prognostic significance? Hematol Oncol 2011; 28:180-4. [PMID: 20155734 DOI: 10.1002/hon.936] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Abnormal protein bands (APB) unrelated to the original monoclonal protein occasionally appear in serum immunofixation samples from patients with multiple myeloma (MM) following haematopoietic stem cell transplantation (HCT). To investigate the significance of APB, medical records and serum immunofixation patterns of 53 MM patients, who had undergone HCT (49 autologous and 4 allogeneic) at the stem cell transplantation unit of Gazi University Faculty of Medicine, were reviewed. Patients were staged according to Durie-Salmon and International staging systems (ISS) and disease response was determined according to European Bone Marrow Transplantation (EBMT) criteria. Fourteen (26.4%) of the 53 patients developed APBs after HCT. The median time for the appearance and duration of APB was 3 (range 1-24) and 5.5 (range 1.5-14) months, respectively. Probability of overall survival (OS) at the end of the follow-up was 77 and 61.4% in patients with and without APB, respectively (p = 0.334). The median duration of follow-up (767 days (range, 220-2905) vs. 726 days (range, 120-1780) p = 0.545) was not different in patients with and without APB. Probability of progression free survival (PFS) at the end of follow-up was 28.8% in patients with and 27.7% in patients without APB (p = 0.835). PFS (910 days (range 180-2905) vs. 730 days (range 90-1765) p = 0.835) was longer in patients with APB, though without statistical significance. Thus, the occurrence of APB post-transplantation is not associated with any adverse long-term consequences and does not require treatment modification.
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Affiliation(s)
- G Sucak
- Department of Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey.
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Ozkurt ZN, Yegin ZA, Yenicesu I, Aki SZ, Yagci M, Sucak GT. Impact of ABO-incompatible donor on early and late outcome of hematopoietic stem cell transplantation. Transplant Proc 2010; 41:3851-8. [PMID: 19917400 DOI: 10.1016/j.transproceed.2009.06.189] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 06/19/2009] [Indexed: 10/20/2022]
Abstract
ABO incompatibility is not a barrier to allogeneic hematopoietic stem cell transplantation (HSCT). However, the impact of an ABO mismatch on the outcome of the HSCT remains controversial. We analyzed whether ABO incompatibility leads to an increased risk of early/late complications, mortality, or increased transfusion requirements. The 147 consecutive allogeneic HSCTs includes 80 ABO-identical and 25 major, 30 minor, and 12 bidirectional ABO-mismatched grafts. The four groups were balanced with respect to disease status at transplantation. Transplantation-related mortality was significantly greater (P < .01) and overall survival significantly shorter (P = 0.2) among HSCT recipients with minor ABO-mismatched grafts. The relapse rate, progression-free survival, and transfusion requirements until discharge were not different between ABO-identical and ABO-mismatched groups. Pure red cell aplasia (PRCA); (P < .0001) and delayed red blood cell (RBC) engraftment (P < .001) were more frequent in HSCT recipients with major mismatched donors. Delayed RBC engraftment was associated with posttransplantation hyperferritininemia and increased mortality risk (P = .05). The greater frequency of sinusoidal obstruction syndrome and graft-versus-host disease (GVHD) in patients with minor mismatched transplants, did not show statistical significance. In contrast severe GVHD was significantly more frequent among minor mismatched patients (P = .04). ABO-mismatched HSCT might have an unfavorable impact on transplant outcomes. Selection of ABO-compatible donors when possible, strategies to prevent and treat PRCA, modifications in transfusion practice, and effective iron chelation are among the measures that can improve transplant outcomes.
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Affiliation(s)
- Z N Ozkurt
- Gazi University Faculty of Medicine, Besevler, Ankara, Turkey
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Belgerden S, Yagci M. [Blunt abdominal injuries]. Zentralbl Chir 1972; 97:1814-9. [PMID: 4653777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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