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Epstein-Peterson ZD, Drill E, Aypar U, Batlevi CL, Caron P, Dogan A, Drullinsky P, Gerecitano J, Hamlin PA, Ho C, Jacob A, Joseph A, Laraque L, Matasar MJ, Moskowitz AJ, Moskowitz CH, Mullins C, Owens C, Salles G, Schöder H, Straus DJ, Younes A, Zelenetz AD, Kumar A. Immunochemotherapy plus lenalidomide for high-risk mantle cell lymphoma with measurable residual disease evaluation. Haematologica 2024; 109:1149-1162. [PMID: 37646671 PMCID: PMC10985438 DOI: 10.3324/haematol.2023.282898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023] Open
Abstract
Chemoimmunotherapy followed by consolidative high-dose therapy with autologous stem cell rescue was a standard upfront treatment for fit patients with mantle cell lymphoma (MCL) in first remission; however, treatment paradigms are evolving in the era of novel therapies. Lenalidomide is an immunomodulatory agent with known efficacy in treating MCL. We conducted a single-center, investigator-initiated, phase II study of immunochemotherapy incorporating lenalidomide, without autologous stem cell transplant consolidation, enriching for patients with high-risk MCL (clinicaltrials gov. Identifier: NCT02633137). Patients received four cycles of lenalidomide-R-CHOP, two cycles of R-HiDAC, and six cycles of R-lenalidomide. The primary endpoint was rate of 3-year progression-free survival. We measured measurable residual disease (MRD) using a next-generation sequencing-based assay after each phase of treatment and at 6 months following end-oftreatment. We enrolled 49 patients of which 47 were response evaluable. By intent-to-treat, rates of overall and complete response were equivalent at 88% (43/49), one patient with stable disease, and two patients had disease progression during study; 3-year progression-free survival was 63% (primary endpoint not met) and differed by TP53 status (78% wild-type vs. 38% ALT; P=0.043). MRD status was prognostic and predicted long-term outcomes following R-HiDAC and at 6 months following end-of-treatment. In a high-dose therapy-sparing, intensive approach, we achieved favorable outcomes in TP53- wild-type MCL, including high-risk cases. We confirmed that sequential MRD assessment is a powerful prognostic tool in patients with MCL.
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Affiliation(s)
- Zachary D Epstein-Peterson
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Esther Drill
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center
| | - Umut Aypar
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | - Connie Lee Batlevi
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Philip Caron
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Ahmet Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | - Pamela Drullinsky
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - John Gerecitano
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Paul A Hamlin
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Caleb Ho
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | | | - Ashlee Joseph
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Leana Laraque
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Matthew J Matasar
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Alison J Moskowitz
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Craig H Moskowitz
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | | | - Colette Owens
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Gilles Salles
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David J Straus
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Anas Younes
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Andrew D Zelenetz
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Anita Kumar
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center.
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Bantilan KS, Smith AN, Maurer MJ, Teruya-Feldstein J, Matasar MJ, Moskowitz AJ, Straus DJ, Noy A, Palomba ML, Horwitz SM, Hamlin PA, Portlock CS, Cerhan JR, Habermann TM, Salles GA, Nowakowski GS, Moskowitz CH, Zelenetz AD. Matched control analysis suggests R-CHOP followed by (R)-ICE may improve outcome in non-GCB DLBCL compared to R-CHOP. Blood Adv 2024; 8:bloodadvances.2023011408. [PMID: 38271621 PMCID: PMC11068505 DOI: 10.1182/bloodadvances.2023011408] [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] [Received: 08/16/2023] [Revised: 11/17/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024] Open
Abstract
Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is considered the standard-of-care for patients with advanced-stage diffuse large B-cell lymphoma (DLBCL), despite findings that non-germinal center B-cell-like (non-GCB) patients have significantly worse outcome with this regimen. We evaluated the prognostic significance of baseline risk factors, including cell of origin (COO) classified by the Hans algorithm, within an alternative chemoimmunotherapy program. At Memorial Sloan Kettering Cancer Center (MSK), 151 patients with DLBCL received sequential R-CHOP induction and (R)-ICE (rituximab, ifosfamide, carboplatin, and etoposide) consolidation. Outcome analysis based on COO was validated with a propensity score matched cohort treated with R-CHOP from the Mayo Clinic component of the Molecular Epidemiology Resource (MER). Among the GCB (n=69) and non-GCB (n=69) patients at MSK, event-free survival (EFS) of non-GCB was superior to that of GCB (HR 0.53, 95% CI 0.29-0.98). Overall survival (OS) demonstrated an association in the same direction but was not statistically significant (HR 0.68, 95% CI 0.33-1.42). Propensity score matched patients from MSK (n=108) demonstrated a small attenuation in the HRs for EFS (HR 0.57, 95% CI 0.27-1.18) and OS (HR 0.76, 95% CI 0.33-1.79) and were no longer statistically significant. In contrast, the matched MER cohort (n=108) demonstrated an EFS association (HR 1.17, 95% CI 0.70-1.95) and OS association (HR 1.13, 95% CI 0.64-2.00) in the opposite direction, but were also not statistically significant. R-CHOP induction and (R)-ICE consolidation may overcome the negative prognostic impact of the non-GCB phenotype, per the Hans algorithm, and can be preferentially selected for this population.
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Affiliation(s)
- Kurt S. Bantilan
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Matthew J. Matasar
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Alison J. Moskowitz
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - David J. Straus
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ariela Noy
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - M. Lia Palomba
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Steven M. Horwitz
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Paul A. Hamlin
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carol S. Portlock
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James R. Cerhan
- Department of Quantitative Sciences, Mayo Clinic, Rochester, MN
| | | | - Gilles A. Salles
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | | | - Craig H. Moskowitz
- Department of Medicine, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
| | - Andrew D. Zelenetz
- Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
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Stuver R, Drill E, Qualls D, Okwali M, Lee Batlevi C, Caron PC, Dogan A, Epstein-Peterson ZD, Falchi L, Hamlin PA, Horwitz SM, Imber BS, Intlekofer AM, Johnson WT, Khan N, Kumar A, Lahoud OB, Lue JK, Matasar MJ, Moskowitz AJ, Noy A, Owens CN, Palomba ML, Schöder H, Vardhana SA, Yahalom J, Zelenetz AD, Salles G, Straus DJ. Retrospective characterization of nodal marginal zone lymphoma. Blood Adv 2023; 7:4838-4847. [PMID: 37307213 PMCID: PMC10469082 DOI: 10.1182/bloodadvances.2022009587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/08/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023] Open
Abstract
Nodal marginal zone lymphoma (NMZL) is a rare non-Hodgkin B-cell lymphoma that has historically been difficult to define, though is now formally recognized by the World Health Organization Classification. To better characterize the clinical outcomes of patients with NMZL, we reviewed a sequential cohort of 187 patients with NMZL to describe baseline characteristics, survival outcomes, and time-to-event data. Initial management strategies were classified into five categories: observation, radiation, anti-CD20 monoclonal antibody therapy, chemoimmunotherapy, or other. Baseline Follicular Lymphoma International Prognostic Index scores were calculated to evaluate prognosis. A total of 187 patients were analyzed. The five-year overall survival was 91% (95% confidence interval [CI], 87-95), with a median follow-up time of 71 months (range, 8-253) among survivors. A total of 139 patients received active treatment at any point, with a median follow-up time of 56 months (range, 13-253) among survivors who were never treated. The probability of remaining untreated at five years was 25% (95% CI, 19-33). For those initially observed, the median time to active treatment was 72 months (95% CI, 49-not reached). For those who received at least one active treatment, the cumulative incidence of receiving a second active treatment at 60 months was 37%. Transformation to large B-cell lymphoma was rare, with a cumulative incidence of 15% at 10 years. In summary, our series is a large cohort of uniformly diagnosed NMZL with detailed analyses of survival and time to event analyses. We showed that NMZL commonly presents as an indolent lymphoma for which initial observation is often a reasonable strategy.
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Affiliation(s)
- Robert Stuver
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Esther Drill
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Qualls
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michelle Okwali
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Connie Lee Batlevi
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Philip C. Caron
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ahmet Dogan
- Department of Pathology and Laboratory Medicine, Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Zachary D. Epstein-Peterson
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Lorenzo Falchi
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Paul A. Hamlin
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Steven M. Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brandon S. Imber
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew M. Intlekofer
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Human Oncology & Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William T. Johnson
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Niloufer Khan
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Anita Kumar
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Oscar B. Lahoud
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jennifer Kimberly Lue
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Matthew J. Matasar
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Alison J. Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ariela Noy
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Colette N. Owens
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M. Lia Palomba
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heiko Schöder
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Santosha A. Vardhana
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Human Oncology & Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joachim Yahalom
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew D. Zelenetz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Gilles Salles
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - David J. Straus
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
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4
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Lin RJ, Kim SJ, Brown S, Elko TA, Ruiz JD, Hanley DM, Lia Palomba M, Perales MA, Shah GL, Dahi PB, Scordo M, Sauter CS, Batlevi CL, Tomas AA, Shouval R, Lee N, Pavkovic EA, Engstler DE, Park JH, Salles GA, Devlin SM, Korc-Grodzicki B, Hamlin PA, Giralt SA. Prospective geriatric assessment and geriatric consultation in CAR T-cell therapy for older patients with lymphoma. Blood Adv 2023; 7:3501-3505. [PMID: 37078703 PMCID: PMC10362256 DOI: 10.1182/bloodadvances.2023010003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 02/15/2023] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023] Open
Affiliation(s)
- Richard J. Lin
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Soo Jung Kim
- Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samantha Brown
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Theresa A. Elko
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Josel D. Ruiz
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Danielle M. Hanley
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M. Lia Palomba
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Miguel-Angel Perales
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Gunjan L. Shah
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Parastoo B. Dahi
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Michael Scordo
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Craig S. Sauter
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Connie L. Batlevi
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ana Alarcon Tomas
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Roni Shouval
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Nicole Lee
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emma A. Pavkovic
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Danielle E. Engstler
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jae H. Park
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Gilles A. Salles
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean M. Devlin
- Weill Cornell Medical College, New York, NY
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Beatriz Korc-Grodzicki
- Weill Cornell Medical College, New York, NY
- Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul A. Hamlin
- Weill Cornell Medical College, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio A. Giralt
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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5
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Alexander K, Hamlin PA, Tew WP, Trevino K, Tin AL, Shahrokni A, Meditz E, Boparai M, Amirnia F, Sun SW, Korc-Grodzicki B. Development and implementation of an interdisciplinary telemedicine clinic for older patients with cancer-Preliminary data. J Am Geriatr Soc 2023; 71:1638-1649. [PMID: 36744590 PMCID: PMC10175129 DOI: 10.1111/jgs.18267] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/03/2023] [Accepted: 01/17/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Frailty assessment is an important marker of the older adult's fitness for cancer treatment independent of age. Pretreatment geriatric assessment (GA) is associated with improved mortality and morbidity outcomes but must occur in a time sensitive manner to be useful for cancer treatment decision making. Unfortunately, time, resources and other constraints make GA difficult to perform in busy oncology clinics. We developed the Cancer and Aging Interdisciplinary Team (CAIT) clinic model to provide timely GA and treatment recommendations independent of patient's physical location. METHODS The interdisciplinary CAIT clinic model was developed utilizing the surge in telemedicine during the COVID-19 pandemic. The core team consists of the patient's oncologist, geriatrician, registered nurse, pharmacist, and registered dietitian. The clinic's format is flexible, and the various assessments can be asynchronous. Patients choose the service method-in person, remotely, or hybrid. Based on GA outcomes, the geriatrician provides recommendations and arrange interventions. An assessment summary including life expectancy estimates and chemotoxicity risk calculator scores is conveyed to and discussed with the treating oncologist. Physician and patient satisfaction were assessed. RESULTS Between May 2021 and June 2022, 50 patients from multiple physical locations were evaluated in the CAIT clinic. Sixty-eight percent was 80 years of age or older (range 67-99). All the evaluations were hybrid. The median days between receiving a referral and having the appointment was 8. GA detected multiple unidentified impairments. About half of the patients (52%) went on to receive chemotherapy (24% standard dose, 28% with dose modifications). The rest received radiation (20%), immune (12%) or hormonal (4%) therapies, 2% underwent surgery, 2% chose alternative medicine, 8% were placed under observation, and 6% enrolled in hospice care. Feedback was extremely positive. CONCLUSIONS The successful development of the CAIT clinic model provides strong support for the potential dissemination across services and institutions.
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Affiliation(s)
- Koshy Alexander
- Memorial Sloan Kettering Cancer Center
- Weil Cornell Medical College
| | - Paul A Hamlin
- Memorial Sloan Kettering Cancer Center
- Weil Cornell Medical College
| | - William P Tew
- Memorial Sloan Kettering Cancer Center
- Weil Cornell Medical College
| | | | - Amy L Tin
- Memorial Sloan Kettering Cancer Center
| | - Armin Shahrokni
- Memorial Sloan Kettering Cancer Center
- Weil Cornell Medical College
| | | | | | - Farnia Amirnia
- Memorial Sloan Kettering Cancer Center
- Weil Cornell Medical College
| | - Sung Wu Sun
- Memorial Sloan Kettering Cancer Center
- Weil Cornell Medical College
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6
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Qualls D, Imber BS, Okwali M, Hamlin PA, Kumar A, Lahoud OB, Matasar MJ, Noy A, Owens C, Zelenetz AD, North VS, Schöder H, Dogan A, Salles G, Yahalom J, Falchi L. Long-term outcomes of patients with limited-stage ocular adnexal DLBCL treated with combined modality therapy in the rituximab era. Br J Haematol 2023; 200:524-527. [PMID: 36484627 PMCID: PMC10407681 DOI: 10.1111/bjh.18590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022]
Affiliation(s)
- David Qualls
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brandon S Imber
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michelle Okwali
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul A Hamlin
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anita Kumar
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Oscar B Lahoud
- Department of Medicine, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew J Matasar
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ariela Noy
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Colette Owens
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew D Zelenetz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Victoria S. North
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center - New York-Presbyterian Hospital, USA
| | - Heiko Schöder
- Department of Radiology, Nuclear Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ahmet Dogan
- Department of Radiology, Nuclear Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gilles Salles
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lorenzo Falchi
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
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Wang ML, Jurczak W, Jerkeman M, Trotman J, Zinzani PL, Belada D, Boccomini C, Flinn IW, Giri P, Goy A, Hamlin PA, Hermine O, Hernández-Rivas JÁ, Hong X, Kim SJ, Lewis D, Mishima Y, Özcan M, Perini GF, Pocock C, Song Y, Spurgeon SE, Storring JM, Walewski J, Zhu J, Qin R, Henninger T, Deshpande S, Howes A, Le Gouill S, Dreyling M. Ibrutinib plus Bendamustine and Rituximab in Untreated Mantle-Cell Lymphoma. N Engl J Med 2022; 386:2482-2494. [PMID: 35657079 DOI: 10.1056/nejmoa2201817] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Ibrutinib, a Bruton's tyrosine kinase inhibitor, may have clinical benefit when administered in combination with bendamustine and rituximab and followed by rituximab maintenance therapy in older patients with untreated mantle-cell lymphoma. METHODS We randomly assigned patients 65 years of age or older to receive ibrutinib (560 mg, administered orally once daily until disease progression or unacceptable toxic effects) or placebo, plus six cycles of bendamustine (90 mg per square meter of body-surface area) and rituximab (375 mg per square meter). Patients with an objective response (complete or partial response) received rituximab maintenance therapy, administered every 8 weeks for up to 12 additional doses. The primary end point was progression-free survival as assessed by the investigators. Overall survival and safety were also assessed. RESULTS Among 523 patients, 261 were randomly assigned to receive ibrutinib and 262 to receive placebo. At a median follow-up of 84.7 months, the median progression-free survival was 80.6 months in the ibrutinib group and 52.9 months in the placebo group (hazard ratio for disease progression or death, 0.75; 95% confidence interval, 0.59 to 0.96; P = 0.01). The percentage of patients with a complete response was 65.5% in the ibrutinib group and 57.6% in the placebo group (P = 0.06). Overall survival was similar in the two groups. The incidence of grade 3 or 4 adverse events during treatment was 81.5% in the ibrutinib group and 77.3% in the placebo group. CONCLUSIONS Ibrutinib treatment in combination with standard chemoimmunotherapy significantly prolonged progression-free survival. The safety profile of the combined therapy was consistent with the known profiles of the individual drugs. (Funded by Janssen Research and Development and Pharmacyclics; SHINE ClinicalTrials.gov number, NCT01776840.).
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Affiliation(s)
- Michael L Wang
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Wojciech Jurczak
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Mats Jerkeman
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Judith Trotman
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Pier L Zinzani
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - David Belada
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Carola Boccomini
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Ian W Flinn
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Pratyush Giri
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Andre Goy
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Paul A Hamlin
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Olivier Hermine
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - José-Ángel Hernández-Rivas
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Xiaonan Hong
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Seok Jin Kim
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - David Lewis
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Yuko Mishima
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Muhit Özcan
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Guilherme F Perini
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Christopher Pocock
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Yuqin Song
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Stephen E Spurgeon
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - John M Storring
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Jan Walewski
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Jun Zhu
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Rui Qin
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Todd Henninger
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Sanjay Deshpande
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Angela Howes
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Steven Le Gouill
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Martin Dreyling
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
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Wang M, Jurczak W, Jerkeman M, Trotman J, Zinzani PL, Walewski JA, Zhu J, Spurgeon S, Goy A, Hamlin PA, Belada D, Ozcan M, Storring J, Lewis DJ, Hernandez Rivas JA, Henninger T, Deshpande S, Qin R, Le Gouill S, Dreyling MH. Primary results from the double-blind, placebo-controlled, phase III SHINE study of ibrutinib in combination with bendamustine-rituximab (BR) and R maintenance as a first-line treatment for older patients with mantle cell lymphoma (MCL). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.17_suppl.lba7502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA7502 Background: Elderly patients (pts) with MCL are unsuitable for intensive chemotherapy or transplantation due to excessive toxicities. Single-agent ibrutinib (Ibr), a first-in-class, oral Bruton’s tyrosine kinase inhibitor (BTKi), has transformed the care of pts with relapsed or refractory MCL with durable activity. We conducted a phase III trial (SHINE; NCT01776840) to evaluate combining Ibr with a standard chemoimmunotherapy (BR) and R maintenance in older pts with untreated MCL. Methods: Pts aged ≥ 65 years, enrolled between May 2013 and November 2014 from 183 sites across all geographical regions, were stratified by simplified MIPI score (low vs intermediate vs high risk) and were randomized 1:1 to Ibr (560 mg orally daily) or placebo (Pbo), plus 6 cycles of B (90 mg/m2) and R (375 mg/m2). Pts who achieved an objective response received R maintenance, administered every 8 weeks for up to 12 additional doses in both arms. Ibr and Pbo were administered until disease progression or unacceptable toxicity. The primary endpoint was progression-free survival (PFS) assessed by the investigators. Results: A total of 523 pts were randomized to Ibr + BR (n = 261) or Pbo + BR (n = 262). Median age was 71 years (range, 65–87), 65.6% of pts had low/intermediate simplified MIPI, and 8.6% had blastoid/pleiomorphic histology. At the primary analysis, median follow up was 84.7 months. The primary endpoint was met as PFS was significantly improved in the Ibr arm vs the Pbo arm (hazard ratio, 0.75; one-sided P = 0.011). Median PFS was 80.6 months with Ibr in combination with BR and R maintenance, a 50% improvement over Pbo in combination with BR and R maintenance (median PFS of 52.9 months). The complete response rate was 65.5% in the Ibr arm and 57.6% in the Pbo arm ( P = 0.0567). There was no difference in overall survival between treatment arms ( P = 0.648). Time to next treatment was longer in the Ibr arm compared with the Pbo arm ( P < 0.001). Fifty-two (19.9%) and 106 (40.5%) pts received subsequent anti-lymphoma therapy in the Ibr and Pbo arms, respectively; 41/106 (38.7%) received a second-line BTKi in the Pbo arm. Rates of grade 3 or 4 treatment-emergent adverse events were 81.5% and 77.3% in the Ibr and Pbo arms, respectively. Of adverse events of clinical interest for BTKis, atrial fibrillation was reported in 13.9% and 6.5% of pts in the Ibr and Pbo arms, respectively. Rates of major hemorrhage, hypertension, arthralgia, and secondary primary malignancies were similar in both arms. Quality of life was also similar in both arms. Conclusions: This phase III study in untreated MCL demonstrated that Ibr combined with BR and R maintenance significantly improved PFS compared with standard chemoimmunotherapy, with a median PFS of 6.7 years. The safety profile was consistent with the known profiles of the individual drugs. Clinical trial information: NCT01776840.
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Affiliation(s)
- Michael Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland
| | - Mats Jerkeman
- Skane University Hospital and Lund University, Lund, Sweden
| | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, Sydney, NSW, Australia
| | - Pier Luigi Zinzani
- Institute of Hematology “Seragnoli” University of Bologna, Bologna, Italy
| | | | - Jun Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute (Beijing Cancer Hospital), Beijing, China
| | - Stephen Spurgeon
- Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, OR
| | - Andre Goy
- John Theurer Cancer Center, Hackensack, NJ
| | | | - David Belada
- 4th Department of Internal Medicine - Haematology, Charles University, Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Muhit Ozcan
- Ankara University School of Medicine, Ankara, Turkey
| | - John Storring
- The Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - David John Lewis
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | | | | | | | - Rui Qin
- Janssen Research & Development, Raritan, NJ
| | - Steven Le Gouill
- Institut Curie comprehensive cancer center, Paris, France; Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes, France
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Canestraro J, Hultcrantz M, Modi S, Hamlin PA, Shoushtari AN, Konner JA, Tew WP, Iyengar NM, Heinemann M, Abramson DH, Francis JH. Refractive Shifts and Changes in Corneal Curvature Associated With Antibody-Drug Conjugates. Cornea 2022; 41:792-801. [PMID: 34839332 PMCID: PMC9106803 DOI: 10.1097/ico.0000000000002934] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Antibody-drug conjugates (ADCs) are a class of cancer drug wherein some are associated with corneal abnormalities, but there is a dearth of published information on refractive shifts in patients receiving ADCs. Here, we evaluated the dynamics of refractive error and keratometry readings in patients with ADC-related keratopathy and microcyst-like epithelial changes (MECs). METHODS This study is a retrospective case series including 58 eyes of 29 patients with ADC-related keratopathy from a single tertiary care cancer referral center (MSKCC). One eye (29 total) was randomly assigned for statistical analysis. In addition, a subset analysis of MEC location-refractive error correlation was performed on 20 eyes. Clinical records including slitlamp examination, indirect ophthalmoscopy, calculated spherical equivalence (SE), keratometry, and visual acuity were recorded at baseline, during, and off treatment. RESULTS A subset analysis of MEC location-refractive error correlation of 20 eyes revealed the following: Peripheral MECs were significantly associated with hyperopic shifts (P value < 0.001) and paracentral/central associated with myopic shifts (P value < 0.001). In the full cohort and on drug, the greatest change in SE from baseline was myopic (68%, as high as -4.75 D) and hyperopic (32%, as much as +3.75 D). Eighty-nine percent had a change in vision from baseline while on drug, but at the 3-month follow-up off drug, SE and vision returned to baseline in 33% and 82% of eyes. CONCLUSIONS Peripheral MECs were significantly associated with hyperopic shifts, and paracentral/central MECs were associated with myopic shifts. While on drug, most eyes had a myopic refractive shift, which corresponded with corneal steepening.
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Affiliation(s)
- Julia Canestraro
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Malin Hultcrantz
- Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shanu Modi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul A Hamlin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jason A Konner
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William P Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neil M Iyengar
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Murk Heinemann
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical Center, New York, NY, USA
| | - David H Abramson
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical Center, New York, NY, USA
| | - Jasmine H Francis
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical Center, New York, NY, USA
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Hamlin PA, Musteata V, Park SI, Burnett C, Dabovic K, Strack T, Williams ET, Anand BS, Higgins JP, Persky DO. Safety and Efficacy of Engineered Toxin Body MT-3724 in Relapsed or Refractory B-cell Non-Hodgkin's Lymphomas and Diffuse Large B-cell Lymphoma. Cancer Res Commun 2022; 2:307-315. [PMID: 36875713 PMCID: PMC9981212 DOI: 10.1158/2767-9764.crc-22-0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
Abstract
MT-3724, a novel engineered toxin body comprised of an anti-CD20 single-chain variable fragment genetically fused to Shiga-like Toxin A subunit, is capable of binding to and internalizing against CD20, inducing cell killing via permanent ribosomal inactivation. This study evaluated MT-3724 in patients with relapsed/refractory B-cell non-Hodgkin lymphoma (r/rNHL). This open-label, multiple-dose phase Ia/b trial included a dose escalation in patients with r/rNHL according to a standard 3+3 design. Primary objectives were to determine the MTD and pharmacokinetics/pharmacodynamics. In a dose expansion study at MTD in serum rituximab-negative patients with diffuse large B-cell lymphoma (DLBCL), primary objectives were safety, tolerability, and pharmacokinetics/pharmacodynamics. Twenty-seven patients enrolled. MTD was 50 μg/kg/dose with 6,000 μg/dose cap. Thirteen patients experienced at least one grade ≥3 treatment-related adverse events; the most common grade ≥3 event was myalgia (11.1%). Two patients (75 μg/kg/dose) experienced grade 2 treatment-related capillary leak syndrome. Overall objective response rate was 21.7%. In serum rituximab-negative patients with DLBCL or composite DLBCL (n = 12), overall response rate was 41.7% (complete response, n = 2; partial response, n = 3). In patients with detectable baseline peripheral B cells, treatment resulted in dose-dependent B-cell depletion. The proportion of patients with anti-drug antibodies (ADA) increased during treatment and the majority appeared to be neutralizing based on an in vitro assay; nevertheless, tumor regression and responses were observed. MT-3724 demonstrated efficacy at the MTD in this population of previously treated patients with r/rDLBCL, with mild-to-moderate immunogenic safety events. Significance This work describes the safety and efficacy of a new pharmaceutical pathway that could provide a treatment option for a subset of patients with a critical unmet therapeutic need. The study drug, MT-3724, is capable of targeting B-cell lymphomas via a unique, potent cell-killing mechanism that appears to be promising.
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Affiliation(s)
- Paul A Hamlin
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vasile Musteata
- Institute of Oncology, ARENSIA EM, Chisinau, Republic of Moldova
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Stewart CM, Michaud L, Whiting K, Nakajima R, Nichols C, De Frank S, Hamlin PA, Matasar MJ, Gerecitano JF, Drullinsky P, Hamilton A, Straus D, Horwitz SM, Kumar A, Moskowitz CH, Moskowitz A, Zelenetz AD, Rademaker J, Salles G, Seshan V, Schöder H, Younes A, Tsui DWY, Batlevi CL. Phase I/Ib Study of the Efficacy and Safety of Buparlisib and Ibrutinib Therapy in MCL, FL, and DLBCL with Serial Cell-Free DNA Monitoring. Clin Cancer Res 2021; 28:45-56. [PMID: 34615723 DOI: 10.1158/1078-0432.ccr-21-2183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/14/2021] [Revised: 07/10/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Activation of Bruton tyrosine kinase (BTK) and phosphatidylinositol-3-kinase (PI3K) represent parallel, synergistic pathways in lymphoma pathogenesis. As predominant PI3Kδ inhibition is a possible mechanism of tumor escape, we proposed a clinical trial of dual BTK and pan-PI3K inhibition. PATIENTS AND METHODS We conducted a single-center phase I/Ib trial combining a BTK inhibitor (ibrutinib) and a pan-PI3K inhibitor (buparlisib) in 37 patients with relapsed/refractory (R/R) B-cell lymphoma. Buparlisib and ibrutinib were administered orally, once daily in 28-day cycles until progression or unacceptable toxicity. The clinical trial is registered with clinicaltrials.gov, NCT02756247. RESULTS Patients with mantle cell lymphoma (MCL) receiving the combination had a 94% overall response rate (ORR) and 33-month median progression-free survival; ORR of 31% and 20% were observed in patients with diffuse large B-cell lymphoma and follicular lymphoma, respectively. The maximum tolerated dose was ibrutinib 560 mg plus buparlisib 100 mg and the recommended phase II dose was ibrutinib 560 mg plus buparlisib 80 mg. The most common grade 3 adverse events were rash/pruritis/dermatitis (19%), diarrhea (11%), hyperglycemia (11%), and hypertension (11%). All grade mood disturbances ranging from anxiety, depression, to agitation were observed in 22% of patients. Results from serial monitoring of cell-free DNA samples corresponded to radiographic resolution of disease and tracked the emergence of mutations known to promote BTK inhibitor resistance. CONCLUSIONS BTK and pan-PI3K inhibition in mantle cell lymphoma demonstrates a promising efficacy signal. Addition of BCL2 inhibitors to a BTK and pan-PI3K combination remain suitable for further development in mantle cell lymphoma.
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Affiliation(s)
- Caitlin M Stewart
- Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Laure Michaud
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karissa Whiting
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Reiko Nakajima
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chelsea Nichols
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephanie De Frank
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul A Hamlin
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew J Matasar
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John F Gerecitano
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pamela Drullinsky
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Audrey Hamilton
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David Straus
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Steven M Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anita Kumar
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Craig H Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew D Zelenetz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jurgen Rademaker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gilles Salles
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Venkatraman Seshan
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anas Younes
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dana W Y Tsui
- Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Connie Lee Batlevi
- Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
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12
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Mehta‐Shah N, Lunning MA, Moskowitz AJ, Boruchov AM, Ruan J, Lynch P, Hamlin PA, Leonard J, Matasar MJ, Myskowski PL, Marzouk E, Nair S, Sholklapper T, Minnal V, Palomba ML, Vredenburgh J, Kumar A, Noy A, Straus DJ, Zelenetz AD, Schoder H, Rademaker J, Schaffer W, Galasso N, Ganesan N, Horwitz SM. Romidepsin and lenalidomide-based regimens have efficacy in relapsed/refractory lymphoma: Combined analysis of two phase I studies with expansion cohorts. Am J Hematol 2021; 96:1211-1222. [PMID: 34251048 DOI: 10.1002/ajh.26288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/06/2021] [Accepted: 07/02/2021] [Indexed: 12/17/2022]
Abstract
Romidepsin (histone deacetylase inhibitor), lenalidomide (immunomodulatory agent), and carfilzomib (proteasome inhibitor), have efficacy and lack cumulative toxicity in relapsed/refractory lymphoma. We performed two investigator initiated sequential phase I studies to evaluate the maximum tolerated dose (MTD) of romidepsin and lenalidomide (regimen A) and romidepsin, lenalidomide, and carfilzomib (regimen B) in relapsed/refractory lymphoma. Cohorts in T-cell lymphoma (TCL), B-cell lymphoma (BCL) were enrolled at the MTD. Forty-nine patients were treated in study A (27 TCL, 17 BCL, 5 Hodgkin lymphoma (HL)) and 27 (16 TCL, 11 BCL) in study B. The MTD of regimen A was romidepsin 14 mg/m2 IV on days 1, 8, and 15 and lenalidomide 25 mg oral on days 1-21 of a 28-day cycle. The MTD of regimen B was romidepsin 8 mg/m2 on days 1 and 8, lenalidomide 10 mg oral on days 1-14 and carfilzomib 36 mg/m2 IV on days 1 and 8 of a 21-day cycle. In study A, 94% had AEs ≥Grade 3, most commonly neutropenia (49%), thrombocytopenia (53%), and electrolyte abnormalities (49%). In study B 59% had AEs ≥Grade 3, including thrombocytopenia (30%) and neutropenia (26%). In study A the ORR was 49% (50% TCL, 47% BCL, 50% HL). In study B the ORR was 48% (50% TCL, 50% BCL). For study A and B the median progression free survival (PFS) was 5.7 months and 3.4 months respectively with 11 patients proceeding to allogeneic transplant. The combinations of romidepsin and lenalidomide and of romidepsin, lenalidomide and carfilzomib showed activity in relapsed/refractory lymphoma with an acceptable safety profile.
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Affiliation(s)
- Neha Mehta‐Shah
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
- Washington University School of Medicine in St. Louis St. Louis Missouri USA
| | - Matthew A. Lunning
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
- Department of Medicine University of Nebraska Medical Center Omaha Nebraska USA
| | - Alison J. Moskowitz
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Adam M. Boruchov
- Department of Medicine St. Francis Medical Center Hartford Connecticut USA
| | - Jia Ruan
- Department of Medicine Weill Cornell Medical Center New York New York USA
| | - Peggy Lynch
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Paul A. Hamlin
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - John Leonard
- Department of Medicine Weill Cornell Medical Center New York New York USA
| | - Matthew J. Matasar
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Patricia L. Myskowski
- Dermatology Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Evan Marzouk
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Sumithra Nair
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Tamir Sholklapper
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Veena Minnal
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Maria L. Palomba
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - James Vredenburgh
- Department of Medicine St. Francis Medical Center Hartford Connecticut USA
| | - Anita Kumar
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Ariela Noy
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - David J. Straus
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Andrew D. Zelenetz
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Heiko Schoder
- Department of Radiology Memorial Sloan Kettering Cancer Center New York New York USA
| | - Jurgen Rademaker
- Department of Radiology Memorial Sloan Kettering Cancer Center New York New York USA
| | - Wendy Schaffer
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Natasha Galasso
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Nivetha Ganesan
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Steven M. Horwitz
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
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13
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Lin RJ, Owens CN, Drill E, Iannotta A, Oliveros M, Schick DL, Noy A, Gerecitano JF, Drullinsky PR, Caron PC, Kumar A, Matasar MJ, Moskowitz C, Korc-Grodzicki B, Zelenetz AD, Salles GA, Hamlin PA. Prephase rituximab/prednisone therapy and aging-related, pro-inflammatory cytokine milieu in older, vulnerable patients with newly diagnosed diffuse large B-cell lymphoma. Haematologica 2021; 107:1144-1152. [PMID: 34289656 PMCID: PMC9052931 DOI: 10.3324/haematol.2021.278719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/06/2021] [Indexed: 11/12/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) predominantly affects older adults with suboptimal therapeutic outcomes due to increased treatment-related mortality and toxicities in vulnerable patients, clinically defined by geriatric impairments such as functional limitation, multimorbidity, or cognitive deficits. In this prospective pilot study, we evaluated a rituximab/prednisone prephase treatment strategy in 33 older, vulnerable patients with newly diagnosed DLBCL, defined by either age ≥70 years or age 60-70 years with Karnofsky performance scale (KPS) <80. A single dose of rituximab 375 mg/m2 between 3-10 days and oral prednisone for at least 5 days prior to the first dose of chemoimmunotherapy was administered. All patients completed prephase treatment and all but one commenced anthracycline-based chemoimmunotherapy. Only one early cycle death occurred. Toxicity events, defined by either unplanned hospitalization, unplanned dose reduction/delay, or chemotherapy discontinuation, occurred in 22 patients (67%). Sixteen patients (48%) experienced grade 3 or higher non-hematologic toxicities and/or grade 4 or higher hematologic toxicities. With a median follow-up of 4.4 years, both 5-year progression-free survival and overall survival were at 81% (95% confidence interval: 69-96). Importantly, we found that phenotypic impairments in basic and instrumental activities of daily living, physical function, mobility, KPS, and Cancer and Aging Research Group chemotherapy toxicity risk score were significantly associated with senescence-associated, proinflammatory cytokine milieu which was readily reversed with prephase treatment, potentially explaining its clinical effectiveness. Prephase therapy with rituximab/prednisone should be considered for all older, vulnerable DLBCL patients prior to curative intent, anthracycline-based chemoimmunotherapy. This trial was registered as clinicaltrials gov. Identifier: NCT 89028394.
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Affiliation(s)
- Richard J Lin
- Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York
| | - Colette N Owens
- Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York
| | - Esther Drill
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York
| | - Augustine Iannotta
- Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York
| | - Mayan Oliveros
- Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York
| | - Dylan L Schick
- Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York
| | - Ariela Noy
- Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York
| | - John F Gerecitano
- Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York
| | - Pamela R Drullinsky
- Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York
| | - Philip C Caron
- Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York
| | - Anita Kumar
- Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York
| | - Matthew J Matasar
- Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York
| | - Craig Moskowitz
- Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York
| | - Beatriz Korc-Grodzicki
- Department of Medicine, Weill Cornell Medical College, New York, NY; Department of Medicine, Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York
| | - Andrew D Zelenetz
- Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York
| | - Gilles A Salles
- Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York
| | - Paul A Hamlin
- Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York.
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14
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Bobillo S, Joffe E, Sermer D, Mondello P, Ghione P, Caron PC, Hamilton A, Hamlin PA, Horwitz SM, Kumar A, Matasar MJ, Batlevi CL, Moskowitz A, Noy A, Owens CN, Palomba ML, Straus D, von Keudell G, Dogan A, Zelenetz AD, Seshan VE, Younes A. Prophylaxis with intrathecal or high-dose methotrexate in diffuse large B-cell lymphoma and high risk of CNS relapse. Blood Cancer J 2021; 11:113. [PMID: 34135307 PMCID: PMC8209097 DOI: 10.1038/s41408-021-00506-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/29/2021] [Accepted: 05/10/2021] [Indexed: 02/07/2023] Open
Abstract
Although methotrexate (MTX) is the most widely used therapy for central nervous system (CNS) prophylaxis in patients with diffuse large B-cell lymphoma (DLBCL), the optimal regimen remains unclear. We examined the efficacy of different prophylactic regimens in 585 patients with newly diagnosed DLBCL and high-risk for CNS relapse, treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or R-CHOP-like regimens from 2001 to 2017, of whom 295 (50%) received prophylaxis. Intrathecal (IT) MTX was given to 253 (86%) and high-dose MTX (HD-MTX) to 42 (14%). After a median follow-up of 6.8 years, 36 of 585 patients relapsed in the CNS, of whom 14 had received prophylaxis. The CNS relapse risk at 1 year was lower for patients who received prophylaxis than patients who did not: 2% vs. 7.1%. However, the difference became less significant over time (5-year risk 5.6% vs. 7.5%), indicating prophylaxis tended to delay CNS relapse rather than prevent it. Furthermore, the CNS relapse risk was similar in patients who received IT and HD-MTX (5-year risk 5.6% vs. 5.2%). Collectively, our data indicate the benefit of MTX for CNS prophylaxis is transient, highlighting the need for more effective prophylactic regimens. In addition, our results failed to demonstrate a clinical advantage for the HD-MTX regimen.
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Affiliation(s)
- Sabela Bobillo
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Erel Joffe
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Sermer
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patrizia Mondello
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paola Ghione
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip C Caron
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Audrey Hamilton
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul A Hamlin
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Steven M Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Anita Kumar
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Matthew J Matasar
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Connie L Batlevi
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Alison Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Ariela Noy
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Collette N Owens
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Lia Palomba
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - David Straus
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Gottfried von Keudell
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Ahmet Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew D Zelenetz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Venkatraman E Seshan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anas Younes
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Weill Cornell Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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15
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Kumar A, Casulo C, Advani RH, Budde E, Barr PM, Batlevi CL, Caron P, Constine LS, Dandapani SV, Drill E, Drullinsky P, Friedberg JW, Grieve C, Hamilton A, Hamlin PA, Hoppe RT, Horwitz SM, Joseph A, Khan N, Laraque L, Matasar MJ, Moskowitz AJ, Noy A, Palomba ML, Schöder H, Straus DJ, Vemuri S, Yang J, Younes A, Zelenetz AD, Yahalom J, Moskowitz CH. Brentuximab Vedotin Combined With Chemotherapy in Patients With Newly Diagnosed Early-Stage, Unfavorable-Risk Hodgkin Lymphoma. J Clin Oncol 2021; 39:2257-2265. [PMID: 33909449 DOI: 10.1200/jco.21.00108] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To improve curability and limit long-term adverse effects for newly diagnosed early-stage (ES), unfavorable-risk Hodgkin lymphoma. METHODS In this multicenter study with four sequential cohorts, patients received four cycles of brentuximab vedotin (BV) and doxorubicin, vinblastine, and dacarbazine (AVD). If positron emission tomography (PET)-4-negative, patients received 30-Gy involved-site radiotherapy in cohort 1, 20-Gy involved-site radiotherapy in cohort 2, 30-Gy consolidation-volume radiotherapy in cohort 3, and no radiotherapy in cohort 4. Eligible patients had ES, unfavorable-risk disease. Bulk disease defined by Memorial Sloan Kettering criteria (> 7 cm in maximal transverse or coronal diameter on computed tomography) was not required for cohorts 1 and 2 but was for cohorts 3 and 4. The primary end point was to evaluate safety for cohort 1 and to evaluate complete response rate by PET for cohorts 2-4. RESULTS Of the 117 patients enrolled, 116 completed chemotherapy, with the median age of 32 years: 50% men, 98% stage II, 86% Memorial Sloan Kettering-defined disease bulk, 27% traditional bulk (> 10 cm), 52% elevated erythrocyte sedimentation rate, 21% extranodal involvement, and 56% > 2 involved lymph node sites. The complete response rate in cohorts 1-4 was 93%, 100%, 93%, and 97%, respectively. With median follow-up of 3.8 years (5.9, 4.5, 2.5, and 2.2 years for cohorts 1-4), the overall 2-year progression-free and overall survival were 94% and 99%, respectively. In cohorts 1-4, the 2-year progression-free survival was 93%, 97%, 90%, and 97%, respectively. Adverse events included neutropenia (44%), febrile neutropenia (8%), and peripheral neuropathy (54%), which was largely reversible. CONCLUSION BV + AVD × four cycles is a highly active and well-tolerated treatment program for ES, unfavorable-risk Hodgkin lymphoma, including bulky disease. The efficacy of BV + AVD supports the safe reduction or elimination of consolidative radiation among PET-4-negative patients.
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Affiliation(s)
- Anita Kumar
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carla Casulo
- Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | | | | | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | | | - Philip Caron
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Esther Drill
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Clare Grieve
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Paul A Hamlin
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard T Hoppe
- Stanford Cancer Institute, Stanford University, Stanford, CA
| | | | - Ashlee Joseph
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Niloufer Khan
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leana Laraque
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Ariela Noy
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Heiko Schöder
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Shreya Vemuri
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joanna Yang
- University of California San Francisco, San Francisco, CA
| | | | | | | | - Craig H Moskowitz
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
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16
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Lin RJ, Lobaugh SM, Pennisi M, Chan HT, Batlevi Y, Ruiz JD, Elko TA, Maloy MA, Batlevi CL, Dahi PB, Giralt SA, Hamlin PA, Mead E, Noy A, Palomba ML, Santomasso BD, Sauter CS, Scordo M, Shah GL, Korc-Grodzicki B, Kim SJ, Silverberg ML, Brooklyn CA, Devlin SM, Perales MA. Impact and safety of chimeric antigen receptor T-cell therapy in older, vulnerable patients with relapsed/refractory large B-cell lymphoma. Haematologica 2021; 106:255-258. [PMID: 32079691 PMCID: PMC7776258 DOI: 10.3324/haematol.2019.243246] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Richard J Lin
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephanie M Lobaugh
- Dept. of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Martina Pennisi
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hei Ton Chan
- Adult BMT Service, Memorial Sloan Kettering Cancer Center
| | - Yakup Batlevi
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Josel D Ruiz
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Theresa A Elko
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Molly A Maloy
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Connie L Batlevi
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Parastoo B Dahi
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio A Giralt
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul A Hamlin
- Critical Care Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Elena Mead
- Critical Care Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Arela Noy
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Lia Palomba
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York
| | | | - Craig S Sauter
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael Scordo
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gunjan L Shah
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Soo Jung Kim
- Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Sean M Devlin
- Dept. of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
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17
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Lin RJ, Michaud L, Lobaugh SM, Nakajima R, Mauguen A, Elko TA, Ruiz JD, Maloy MA, Sauter CS, Dahi PB, Perales MA, Shah GL, Flores NC, Sanchez-Escamilla M, Tomas AA, Segundo LYS, Cho C, Politikos I, Kim SJ, Korc-Grodzicki B, Devlin SM, Scordo M, Schöder H, Giralt SA, Hamlin PA. The geriatric syndrome of sarcopenia impacts allogeneic hematopoietic cell transplantation outcomes in older lymphoma patients. Leuk Lymphoma 2020; 61:1833-1841. [PMID: 32228298 PMCID: PMC7429343 DOI: 10.1080/10428194.2020.1742909] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/04/2020] [Accepted: 03/08/2020] [Indexed: 01/06/2023]
Abstract
Older patients with advanced hematologic malignancies are increasingly considered for allogeneic hematopoietic cell transplantation (allo-HCT) yet their survival outcomes remain suboptimal. We and others have previously shown that pre-HCT multi-morbidity and functional limitation and post-HCT geriatric syndromes significantly impact outcomes. Sarcopenia, an accelerated loss of muscle mass and function, has been increasingly recognized in older cancer patients. We identified 146 lymphoma patients 50 years or older who were allografted from 2008 to 2018 at our institution and found that before allo-HCT, 80 (55%) patients were sarcopenic. Pre-HCT sarcopenia was significantly associated with overall survival, progression-free survival, and nonrelapse mortality independent of multi-morbidity and functional limitation. In 6-month landmark analysis, post-HCT sarcopenia remained significantly associated with survival. Our findings illustrate the high prevalence and profound impact of sarcopenia on survival. While requiring prospective confirmation, preemptive, longitudinal, and multidisciplinary interventions for sarcopenia are warranted to improve HCT outcomes for older patients.
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Affiliation(s)
- Richard J. Lin
- Adult BMT Service, Memorial Sloan Kettering Cancer Center
- Weill Cornell Medical College
| | - Laure Michaud
- Nuclear Medicine Service, Memorial Sloan Kettering Cancer Center
| | - Stephanie M. Lobaugh
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Reiko Nakajima
- Nuclear Medicine Service, Memorial Sloan Kettering Cancer Center
| | - Audrey Mauguen
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center
| | | | - Josel D. Ruiz
- Adult BMT Service, Memorial Sloan Kettering Cancer Center
| | - Molly A. Maloy
- Adult BMT Service, Memorial Sloan Kettering Cancer Center
| | - Craig S. Sauter
- Adult BMT Service, Memorial Sloan Kettering Cancer Center
- Weill Cornell Medical College
| | - Parastoo B. Dahi
- Adult BMT Service, Memorial Sloan Kettering Cancer Center
- Weill Cornell Medical College
| | - Miguel-Angel Perales
- Adult BMT Service, Memorial Sloan Kettering Cancer Center
- Weill Cornell Medical College
| | - Gunjan L. Shah
- Adult BMT Service, Memorial Sloan Kettering Cancer Center
- Weill Cornell Medical College
| | | | | | | | | | - Christina Cho
- Adult BMT Service, Memorial Sloan Kettering Cancer Center
- Weill Cornell Medical College
| | - Ioannis Politikos
- Adult BMT Service, Memorial Sloan Kettering Cancer Center
- Weill Cornell Medical College
| | - Soo Jung Kim
- Lymphoma Service, Memorial Sloan Kettering Cancer Center
| | | | - Sean M. Devlin
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Michael Scordo
- Adult BMT Service, Memorial Sloan Kettering Cancer Center
- Weill Cornell Medical College
| | - Heiko Schöder
- Weill Cornell Medical College
- Nuclear Medicine Service, Memorial Sloan Kettering Cancer Center
| | - Sergio A. Giralt
- Adult BMT Service, Memorial Sloan Kettering Cancer Center
- Weill Cornell Medical College
| | - Paul A. Hamlin
- Weill Cornell Medical College
- Lymphoma Service, Memorial Sloan Kettering Cancer Center
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18
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Zheng S, Gupta K, Goyal P, Nakajima R, Michaud L, Batlevi CL, Hamlin PA, Horwitz SM, Kumar A, Matasar MJ, Moskowitz AJ, Moskowitz CH, Noy A, Palomba ML, Straus DJ, Schöder H, Yahalom J, Zelenetz AD, Younes A, Joffe E. Impact of interim PET on Hodgkin lymphoma treatment outcome and survival in clinical practice. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e20017] [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
e20017 Background: FDG avidity above liver on interim PET (PET2) during frontline ABVD is considered a marker of impending treatment failure and an indication to switch to an intensified regimen. However, in clinical practice the utility of PET2 for treatment decisions is less clear. We describe outcomes of patients with positive PET2 who continued treatment with ABVD in the clinical setting. Methods: A retrospective study of all patients with newly diagnosed advanced-stage Hodgkin lymphoma treated with frontline ABVD at Memorial Sloan Kettering Cancer Center between 2008-2017. Eligibility criteria were set to correspond with the RATHL inclusion criteria (stage IIB - IV, or IIA bulky or ≥ 3 involved sites). We identified all PET2 reports indicating suspected residual uptake. All positive PET2 images were then reviewed by a single study radiologist. To increase reproducibility and avoid selection of borderline cases, we defined as PET2 positive only those cases with a lesion-to-liver (mean) SUV ratio ≥ 1.3. We also used a recently published stringent criterion of lesion-to-liver (max) ratio ≥ 1.4 (mPET2+). Progression-free and overall survival (PFS, OS) were calculated from the date of initial treatment until progression or death of any cause. Consolidative radiation was not considered a PFS event, and all progressions were verified by biopsy. Results: We identified 227 patients fitting RATHL inclusion criteria treated with ABVD. Median age was 34, with 25% (58) ≥ 45 years, 12% (26) had an IPS ≥ 4; 28% (64) stage II (5% II-X) and 38% (87) with extranodal involvement. 57 (25%) patients had a PET2 report indicating suspected residual lymphoma (PET2+), however, only 32 (14%) met the more stringent mPET2+ criterion. Most patients with PET2+ continued ABVD (84%, 48), and 9 switched to escBEACOPP (this subset of patients had substantially worse disease and are not the focus of this analysis). 21 (9%) patients received consolidative radiation. With a median follow-up of 47 months (42-54m), PET2+ patients who continued ABVD had a 3yPFS of 70% (58-85%, n = 48); mPET+ had a 3yPFS of 71% (55-92%, n = 24). Overall survival was excellent regardless of PET2 status (5yOS 97%). Conclusions: The outcome of PET2+ patients in this analysis was better than previously reported and the continuation of ABVD was appropriate for most patients. Use of a confirmatory biopsy is important for identifying true progressions. Patients with PET2+ had an excellent OS. Evaluation of the superiority of alternative regimens in PET2+ patients requires an ABVD comparator arm.
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Affiliation(s)
- Serena Zheng
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kanika Gupta
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Piyush Goyal
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Laure Michaud
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Anita Kumar
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Ariela Noy
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Heiko Schöder
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Anas Younes
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Erel Joffe
- Memorial Sloan Kettering Cancer Center, New York, NY
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19
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Ghione P, Joffe E, De Paola N, Mainardi T, Noor SJ, Bobillo S, Myskowski PL, Palomba ML, Moskowitz AJ, Mato AR, Sha F, Von Keudell G, Straus DJ, Noy A, Younes A, Hamlin PA, Brentjens RJ, Tejedor-Alonso MA, Horwitz SM, Zelenetz AD. Alternative anti-CD20 antibody versus desensitization for lymphoma patients with drug hypersensitivity reactions requiring discontinuation of rituximab, obinutuzumab, or ofatumumab. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.8062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8062 Background: Immunotherapy with anti CD20 is often associated with mild easily manageable infusion reactions. In rare cases, patients experience severe drug hypersensitivity reactions (DHR) serum sickness or anaphylaxis. These in turn may lead to discontinuation of the drug. In our experience, switching to a different anti-CD20 agent is a feasible alternative to discontinuation or desensitization protocols. Methods: From our pharmacology database we identified all the patients that received rituximab and/or obinutuzumab, and/or ofatumumab, and/or all the patients who received a flat dose of less than 50 mL of the same drugs and were followed at our institution. From the medical record, we identified all the cases where the anti-CD20 antibody was changed due to allergy, serum sickness or other types of DHR, and all those who received minimal doses of anti-CD20 in the context of a desensitization protocol. DHRs were evaluated either by an allergist, or by retrospective review following the World Allergy Organization guidelines. Our primary comparison, was to assess the proportion of pts able to completed planned infusion of abs using either approach (Fisher’s exact Test). Results: Among 343 patients receiving at least two different anti-CD20 antibodies or a flat dose of < 50 mL, we identified 44 patients experiencing severe DHRs needing intervention. At the time of the reaction, 16 (36%) received the anti-CD20 as single agent, 24 (54%) in combination with chemotherapy, 4 (9%) in combination with ibrutinib or lenalidomide. In 9 (20%) patients the reaction was defined as anaphylactoid (8 rituximab; 1 obinutuzumab) and in 8 (18%) patients, all receiving rituximab, as serum sickness. Episodes of DHR were addressed with either desensitization (n = 29) or change of anti-CD20 agent (n = 25), 9 patients received both of these approaches, one patient switched anti-CD20 antibodies twice. Overall, 21 desensitizations were successful (72.4%), 8 failed; 23 changes of anti-CD20 were successful (92%) and 2 failed (p = 0.09). Conclusions: In patients with DHR use of an alternative anti-CD20 antibody is safe and is an alternative or complementary approach to anti-CD20 desensitization.
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Affiliation(s)
- Paola Ghione
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Erel Joffe
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Timothy Mainardi
- Allergy and Immunology, New York Presbyterian Hospital, New York, NY
| | - Sarah J. Noor
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Anthony R. Mato
- Center for CLL, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fushen Sha
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Ariela Noy
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anas Younes
- Memorial Sloan Kettering Cancer Center, New York, NY
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20
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Batlevi CL, Sha F, Alperovich A, Ni A, Smith K, Ying Z, Gerecitano JF, Hamlin PA, Horwitz SM, Joffe E, Kumar A, Matasar MJ, Moskowitz AJ, Moskowitz CH, Noy A, Owens C, Palomba LM, Straus D, von Keudell G, Zelenetz AD, Seshan VE, Luminari S, Marcheselli L, Federico M, Younes A. Positron-emission tomography-based staging reduces the prognostic impact of early disease progression in patients with follicular lymphoma. Eur J Cancer 2020; 126:78-90. [PMID: 31927165 PMCID: PMC7331469 DOI: 10.1016/j.ejca.2019.12.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/14/2019] [Accepted: 12/02/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Previous studies reported that early progression of disease (POD) after initial therapy predicted poor overall survival (OS) in patients with follicular lymphoma (FL). Here, we investigated whether pre-treatment imaging modality had an impact on prognostic significance of POD. METHODS In this retrospective study, we identified 1088 patients with grade I-IIIA FL; of whom, 238 patients with stage II-IV disease were initially treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP), and 346 patients were treated with rituximab-based chemotherapy. Patients (N = 484) from the FOLL05 study served as an independent validation cohort. We risk-stratified patients based on pre-treatment radiographic imaging (positron-emission tomography [PET] versus computed tomography [CT]) and early POD status using event-defining and landmark analyses. A competing risk analysis evaluated the association between early POD and histologic transformation. RESULTS In the discovery cohort, patients with POD within 24 months (PFS24) of initiating R-CHOP therapy had a 5-year OS of 57.6% for CT-staged patients compared with 70.6% for PET-staged patients. In the validation cohort, the 5-year OS for patients with early POD was 53.9% and 100% in CT- and PET-staged patients, respectively. The risk of histologic transformation in patients whose disease progressed within one year of initiating therapy was higher in CT-staged patients than in PET-staged patients (16.7% versus 6.3%, respectively), which was associated with a 9.7-fold higher risk of death. CONCLUSION In FL, pre-treatment PET staging reduced the prognostic impact of early POD compared with CT staging. Patients with early POD and no histologic transformation have an extended OS with standard therapy.
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Affiliation(s)
- Connie L Batlevi
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Fushen Sha
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anna Alperovich
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ai Ni
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katy Smith
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zhitao Ying
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John F Gerecitano
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul A Hamlin
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steve M Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erel Joffe
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anita Kumar
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew J Matasar
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alison J Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Craig H Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ariela Noy
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Colette Owens
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lia M Palomba
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Straus
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gottfried von Keudell
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew D Zelenetz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Venkatraman E Seshan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stefano Luminari
- Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy; Hematology Unit, AUSL IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Marcheselli
- Department of Medical and Surgical Sciences, FIL Trial Office, University of Modena and Reggio Emilia, Italy
| | - Massimo Federico
- Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy
| | - Anas Younes
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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21
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Hamlin PA, Flinn IW, Wagner‐Johnston N, Burger JA, Coffey GP, Conley PB, Michelson G, Leeds JM, Der K, Kim Y, Sabalvaro‐Torres A, Birrell M, Pandey A, Curnutte JT, Patel MR. Efficacy and safety of the dual SYK/JAK inhibitor cerdulatinib in patients with relapsed or refractory B-cell malignancies: Results of a phase I study. Am J Hematol 2019; 94:E90-E93. [PMID: 30592080 DOI: 10.1002/ajh.25387] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Paul A. Hamlin
- Division of Hematologic Malignancies Memorial Sloan Kettering Cancer Center New York New York
- Department of Medicine Weill Cornell Medical College New York New York
| | - Ian W. Flinn
- Center for Blood Cancer Sarah Cannon Research Institute/Tennessee Oncology Nashville Tennessee
| | | | - Jan A. Burger
- Division of Cancer Medicine MD Anderson Cancer Center Houston Texas
| | - Greg P. Coffey
- Biology and Pharmacology Portola Pharmaceuticals, Inc. South San Francisco California
| | - Pamela B. Conley
- Biology and Pharmacology Portola Pharmaceuticals, Inc. South San Francisco California
| | - Glenn Michelson
- Clinical Development Portola Pharmaceuticals, Inc. South San Francisco California
| | - Janet M. Leeds
- Drug Metabolism and Pharmacokinetics Portola Pharmaceuticals, Inc. South San Francisco California
| | - Kenneth Der
- Pharmacokinetics Portola Pharmaceuticals, Inc. South San Francisco California
| | - Yvonne Kim
- Regulatory Affairs Portola Pharmaceuticals, Inc. South San Francisco California
| | | | - Matt Birrell
- Corporate Development Portola Pharmaceuticals, Inc. South San Francisco California
| | - Anjali Pandey
- Medicinal Chemistry and Chemical Development Portola Pharmaceuticals, Inc. South San Francisco California
| | - John T. Curnutte
- Research and Development Portola Pharmaceuticals, Inc. South San Francisco California
| | - Manish R. Patel
- Drug Development Unit Florida Cancer Specialists/Sarah Cannon Research Institute Sarasota Florida
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22
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Lin RJ, Ho C, Hilden PD, Barker JN, Giralt SA, Hamlin PA, Jakubowski AA, Castro-Malaspina HR, Robinson KS, Papadopoulos EB, Perales MA, Sauter CS. Allogeneic haematopoietic cell transplantation impacts on outcomes of mantle cell lymphoma with TP53 alterations. Br J Haematol 2018; 184:1006-1010. [PMID: 30537212 DOI: 10.1111/bjh.15721] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 08/25/2018] [Accepted: 11/05/2018] [Indexed: 01/26/2023]
Abstract
TP53 alterations portend extremely poor prognosis in patients with mantle cell lymphoma treated with standard treatment modalities. We reviewed outcomes of 42 patients with available TP53 status who had received a reduced-intensity or non-myeloablative allogeneic haematopoietic cell transplant at our institution. We demonstrated a 2-year overall survival and progression-free survival of 78% [95% confidence interval (CI) 60-88] and 61% (95% CI 43-75), respectively. The 2-year cumulative incidences of relapse and non-relapse mortality were 19% and 20%, respectively. Importantly, there is no significant difference among patients with and without TP53 alterations, suggesting for the first time a beneficial treatment modality for these high-risk patients.
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Affiliation(s)
- Richard J Lin
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Caleb Ho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patrick D Hilden
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Juliet N Barker
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Sergio A Giralt
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Paul A Hamlin
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Ann A Jakubowski
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Hugo R Castro-Malaspina
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Kevin S Robinson
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Esperanza B Papadopoulos
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Miguel-Angel Perales
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Craig S Sauter
- Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
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Abstract
Background: Rosai-Dorfman disease (RDD) is a rare histiocytic proliferative disorder of unknown etiology. The skin is the most frequent extranodal site of RDD involvement and may be the only organ involved. While RDD is an indolent self-limited disease, treatment is needed in patients with extensive, persistent or progressive disease, or if cosmetic disfigurement or physical impairment significantly affects the patient. There is no specific treatment for RDD, and multiple therapeutic approaches have been described with variable success rates. Ojective: To demonstrate the clinical efficacy of oral bexarotene for RDD. Materials and methods: Descriptive retrospective case series of three patients with RDD receiving oral bexarotene. Results: Two patients had excellent response and regression of their skin lesions was achieved with long-term therapy. In the other patient, pruritus was promptly controlled while the lesions did not seem to regress and treatment was discontinued after five months. Conclusions: Our case series is the first report in the literature of the use of oral bexarotene as an effective and safe treatment for RDD.
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Affiliation(s)
- Shamir Geller
- a Dermatology Service, Department of Medicine , Memorial Sloan Kettering Cancer Center, and Weill Cornell Medicine , New York , NY , USA
| | - Klaus Busam
- b Department of Pathology , Memorial Sloan Kettering Cancer Center, and Weill Cornell Medicine , New York , NY , USA
| | - Paul A Hamlin
- c Lymphoma Service, Department of Medicine , Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine , New York , NY , USA
| | - Alison J Moskowitz
- c Lymphoma Service, Department of Medicine , Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine , New York , NY , USA
| | - Steven M Horwitz
- c Lymphoma Service, Department of Medicine , Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine , New York , NY , USA
| | - Patricia L Myskowski
- a Dermatology Service, Department of Medicine , Memorial Sloan Kettering Cancer Center, and Weill Cornell Medicine , New York , NY , USA
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24
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Evens AM, Advani RH, Helenowski IB, Fanale M, Smith SM, Jovanovic BD, Bociek GR, Klein AK, Winter JN, Gordon LI, Hamlin PA. Multicenter Phase II Study of Sequential Brentuximab Vedotin and Doxorubicin, Vinblastine, and Dacarbazine Chemotherapy for Older Patients With Untreated Classical Hodgkin Lymphoma. J Clin Oncol 2018; 36:3015-3022. [PMID: 30179569 DOI: 10.1200/jco.2018.79.0139] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To improve the curability of older patients with newly diagnosed Hodgkin lymphoma. PATIENTS AND METHODS We conducted a multicenter phase II study that administered brentuximab vedotin (Bv) sequentially before and after standard doxorubicin, vinblastine, and dacarbazine (AVD) for untreated patients with Hodgkin lymphoma age 60 years or older. After two lead-in doses of single-agent Bv (1.8 mg/kg once every 3 weeks), patients received six cycles of AVD chemotherapy followed by four consolidative doses of Bv in responding patients. RESULTS Patient characteristics included median age of 69 years (range, 60 to 88 years), 63% male, median Eastern Cooperative Oncology Group performance status 1, 81% stage III to IV disease, 60% International Prognostic Score 3 to 7, median Cumulative Illness Rating Scale-Geriatric comorbidity score of 7 (52% grade 3 to 4); and 12% had loss of instrumental activities of daily living at diagnosis. Thirty-seven (77%) of 48 patients completed six cycles of AVD, and 35 patients (73%) received at least one Bv consolidation. Overall response and complete remission rates after initial Bv lead-in dose were 18 (82%) of 22 and 8 (36%) of 22, respectively, and 40 (95%) of 42 and 34 (90%) of 42, respectively, after six cycles of AVD among 42 response-evaluable patients. Twenty (42%) of 48 patients experienced a grade 3 to 4 adverse event, most commonly neutropenia (44%), febrile neutropenia and pneumonia (8%), or diarrhea (6%); 33% had grade 2 peripheral neuropathy, which was reversible in a majority of patients. By intent-to-treat, the 2-year event-free survival, progression-free survival, and overall survival rates were 80%, 84%, and 93%, respectively. Furthermore, 2-year progression-free survival rates for patients with a Cumulative Illness Rating Scale-Geriatric comorbidity score of ≥ 10 versus < 10 were 45% versus 100%, respectively (P < .001), and with baseline loss versus no loss of instrumental activities of daily living were 25% versus 94% (P < .001), respectively, the latter persisting on multivariable analyses. CONCLUSION Altogether, sequential Bv-AVD was well tolerated and was associated with robust outcomes. Furthermore, geriatric-based measures were strongly associated with patient survival.
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Affiliation(s)
- Andrew M Evens
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ranjana H Advani
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Irene B Helenowski
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michelle Fanale
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sonali M Smith
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Borko D Jovanovic
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gregory R Bociek
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andreas K Klein
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jane N Winter
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leo I Gordon
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul A Hamlin
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
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Vardhana S, Hamlin PA, Yang J, Zelenetz A, Sauter CS, Matasar MJ, Ni A, Yahalom J, Moskowitz CH. Outcomes of Relapsed and Refractory Primary Mediastinal (Thymic) Large B Cell Lymphoma Treated with Second-Line Therapy and Intent to Transplant. Biol Blood Marrow Transplant 2018; 24:2133-2138. [PMID: 29909154 DOI: 10.1016/j.bbmt.2018.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/07/2018] [Indexed: 12/16/2022]
Abstract
Primary mediastinal (thymic) large B cell lymphoma is a subtype of diffuse large B cell lymphoma with distinct clinical, molecular, and genetic features, many of which overlap with Hodgkin lymphoma. Increasingly, initial therapy for these patients has used dose-dense chemotherapy with or without radiation with excellent results. In patients with relapsed and primary refractory disease, outcomes of second-line therapy followed by consolidation with high-dose therapy and autologous stem cell transplantation remains largely undefined. We reviewed the outcomes of 60 transplant-eligible patients with relapsed or refractory primary mediastinal (thymic) large B cell lymphoma enrolled on sequential protocols with uniform second-line therapy with intent to consolidate with autologous stem cell transplant. The estimated 3-year overall and event-free survivals for all patients were 61% and 57%, respectively, and 68% and 65%, respectively, for patients proceeding to stem cell transplant. Multivariable analysis of risk factors before transplant revealed that an incomplete response to initial therapy, advanced Ann Arbor stage at disease progression, and failure to achieve a partial remission or better to second-line therapy to be independently associated with inferior event-free and overall survival. A risk score based on these variables was able to identify patients who are unlikely to respond to conventional second-line strategies. These results suggest that salvage chemoradiotherapy with intent of subsequent high-dose therapy and autologous stem cell transplant is successful in most patients with relapsed and refractory primary mediastinal (thymic) large B cell lymphoma. Alternative strategies are warranted for a significant subset of patients with high-risk disease who are unlikely to be cured with this strategy.
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Affiliation(s)
| | - Paul A Hamlin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joanna Yang
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Craig S Sauter
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Andy Ni
- Memorial Sloan Kettering Cancer Center, New York, New York
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26
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Batlevi CL, De Frank S, Stewart C, Hamlin PA, Matasar MJ, Gerecitano JF, Moskowitz AJ, Hamilton AM, Zelenetz AD, Drullinsky P, Straus DJ, Kumar A, Moskowitz CH, Dicostanzo J, Callan D, Tsui D, Rademaker J, Schöder H, Ni A, Younes A. Phase I/II clinical trial of ibrutinib and buparlisib in relapsed/refractory diffuse large B-cell lymphoma, mantle cell lymphoma, and follicular lymphoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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)
| | | | | | | | | | | | | | | | | | | | | | - Anita Kumar
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Devin Callan
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dana Tsui
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Heiko Schöder
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ai Ni
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anas Younes
- Memorial Sloan Kettering Cancer Center, New York, NY
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27
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Fanale MA, Hamlin PA, Park SI, Persky DO, Higgins JP, Burnett C, Dabovic K, Poma E, Sarapa N, Younes A. Safety and efficacy of anti-CD20 immunotoxin MT-3724 in relapsed/refractory (R/R) B-cell non-Hodgkin lymphoma (NHL) in a phase I study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7580] [Citation(s) in RCA: 7] [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)
| | | | | | | | | | | | | | - Eric Poma
- Molecular Templates, Inc., Jersey City, NJ
| | | | - Anas Younes
- Memorial Sloan Kettering Cancer Center, New York, NY
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28
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Evens AM, Advani RH, Fanale MA, Smith SM, Helenowski IB, Bociek G, Klein AK, Winter JN, Gordon LI, Hamlin PA. Prognostication of older Hodgkin lymphoma (HL) patients (pts): Findings from a multicenter phase II study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7540] [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)
| | | | | | - Sonali M. Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | | | - Gregory Bociek
- Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE
| | | | - Jane N. Winter
- Robert H. Lurie Cancer Center of Northwestern University, Chicago, IL
| | - Leo I. Gordon
- Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
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29
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Horwitz SM, Hamlin PA, Feldman T, Hess BT, Mato AR, Munoz J, Patel MR, Ye JC, Steele A, Pandey A, Birrell M, Leeds J, Coffey G, Curnutte JT. Tolerability and response of the novel SYK/JAK inhibitor cerdulatinib in a phase 2a study in relapsed/refractory peripheral t cell lymphoma (PTCL). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e19532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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)
| | | | | | - Brian T. Hess
- Hollings Medical Cancer Center, Medical University of South Carolina, Charleston, SC
| | | | - Javier Munoz
- Cancer Immunology Program, Banner MD Anderson Cancer Center, Gilbert, AZ
| | | | | | - Andrew Steele
- Portola Pharmaceuticals, Inc., South San Francisco, CA
| | - Anjali Pandey
- Portola Pharmaceuticals, Inc., South San Francisco, CA
| | - Matt Birrell
- Portola Pharmaceuticals, Inc., South San Francisco, CA
| | - Janet Leeds
- Portola Pharmaceuticals, Inc., South San Francisco, CA
| | - Greg Coffey
- Portola Pharmaceuticals, Inc., South San Francisco, CA
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30
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Hamlin PA, Cheson BD, Farber CM, Feldman T, Fenske TS, Hess BT, Khatcheressian JL, Miller CB, Munoz J, Patel MR, Smith SM, Smith SD, Stevens DA, Ye JC, Steele A, Pandey A, Birrell M, Leeds J, Coffey G, Curnutte JT. The dual SYK/JAK inhibitor cerdulatinib demonstrates rapid tumor responses in a phase 2 study in patients with relapsed/refractory B- and T-cell non-Hodgkin lymphoma (NHL). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Bruce D. Cheson
- Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC
| | | | | | - Timothy S Fenske
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Brian T. Hess
- Hollings Medical Cancer Center, Medical University of South Carolina, Charleston, SC
| | | | | | - Javier Munoz
- Cancer Immunology Program, Banner MD Anderson Cancer Center, Gilbert, AZ
| | | | - Sonali M. Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | | | | | | | - Andrew Steele
- Portola Pharmaceuticals, Inc., South San Francisco, CA
| | - Anjali Pandey
- Portola Pharmaceuticals, Inc., South San Francisco, CA
| | - Matt Birrell
- Portola Pharmaceuticals, Inc., South San Francisco, CA
| | - Janet Leeds
- Portola Pharmaceuticals, Inc., South San Francisco, CA
| | - Greg Coffey
- Portola Pharmaceuticals, Inc., South San Francisco, CA
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31
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Dang NH, Ogura M, Castaigne S, Fayad LE, Jerkeman M, Radford J, Pezzutto A, Bondarenko I, Stewart DA, Shnaidman M, Sullivan S, Vandendries E, Tobinai K, Ramchandren R, Hamlin PA, Giné E, Ando K. Randomized, phase 3 trial of inotuzumab ozogamicin plus rituximab versus chemotherapy plus rituximab for relapsed/refractory aggressive B-cell non-Hodgkin lymphoma. Br J Haematol 2017; 182:583-586. [PMID: 28677896 DOI: 10.1111/bjh.14820] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nam H Dang
- University of Florida, Gainesville, FL, USA
| | - Michinori Ogura
- Nagoya Daini Red Cross Hospital, Nagoya, Japan.,Tokai Central Hospital, Kakamigahara, Japan
| | | | - Luis E Fayad
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - John Radford
- University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | | | | | | | | | | | | | - Paul A Hamlin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eva Giné
- Hospital Clínic, Barcelona, Spain
| | - Kiyoshi Ando
- School Medicine, Tokai University, Isehara, Kanagawa, Japan
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32
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Batlevi CL, Hamlin PA, Matasar MJ, Horwitz SM, Gerecitano JF, Moskowitz CH, Straus DJ, Zelenetz AD, Drullinsky P, Copeland A, Ahsanuddin S, Callan D, Freidin B, Porzio R, Dang TO, Ni A, Rademaker J, Schöder H, Dogan A, Younes A. Phase I dose escalation of ibrutinib and buparlisib in relapsed/refractory diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma (MCL), and follicular lymphoma (FL). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.7544] [Citation(s) in RCA: 3] [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
7544 Background: In vitro studies of BTK and PI3K inhibitors demonstrate synergy in non-Hodgkin lymphoma (NHL). We embarked on a phase I/Ib investigator-initiated clinical trial evaluating the combination of ibrutinib (BTK inhibitor) and buparlisib (pan-PI3K inhibitor) in relapsed/refractory (R/R) NHL. The completed dose escalation is reported. Methods: Patients (pts) were eligible if they had R/R DLBCL, MCL, or FL with ECOG≤2 and adequate organ function. Ibrutinib and buparlisib were given daily by mouth on a 28-day cycle. Dose reductions were permitted after cycle 1. Tumor response was based on Lugano Classification however CR required both PET resolution and ≥ PR by CT. Results: As of Dec 16, 2016, 13 pts were enrolled and evaluated for toxicity (DLBCL 5, FL 2, MCL 6). Dose levels and DLT per table. Six pts discontinued treatment for disease progression (DLBCL 4, FL 2). Hematologic AE ≥ grade 3 are anemia (2), leukocytosis (2), and leukopenia (4). Relevant non-hematologic AEs of any grade ≥ 20% across all pts were fatigue (77%), diarrhea (62%), anorexia (54%), rash (46%), hyperbilirubinemia (46%), gastric reflux (46%), CMV reactivation (31%), mood change (31%), and hypertension (23%). Most common related grade 3/4 toxicity is rash (N = 3). No grade 5 toxicities noted. Serious adverse events (SAE) include: grade 2 pleural effusion and grade 2 nausea (N = 1), grade 1 fever with hospitalization (N = 1), grade 2 confusion and grade 4 hyponatremia (N = 1) were unrelated to therapy. Responses noted in 13 pts: MCL (N = 6: CR 4, PR 2), FL (N = 2: SD 2), DLBCL (N = 5: SD 1). One CR was a MCL pt with CR after 2 cycles on combination therapy and continues in remission on ibrutinib alone because of buparlisib toxicity. Conclusions: Combination of ibrutinib and buparlisib while generally well tolerated has predicted toxicities of both BTK and PI3K inhibitors. The recommended phase 2 dose is ibrutinib 560 mg and buparlisib 100 mg though dose reductions for tolerability may be needed for long term oral therapies. Promising efficacy is observed in MCL. Clinical trial information: NCT02756247. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Devin Callan
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Robert Porzio
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Thu Oanh Dang
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Ai Ni
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Heiko Schöder
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Ahmet Dogan
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Anas Younes
- Memorial Sloan-Kettering Cancer Center, New York, NY
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33
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Hamlin PA, Wisniewski M. Nuances in the Management of Aggressive Lymphomas. J Adv Pract Oncol 2017; 8:279-284. [PMID: 29928552 PMCID: PMC6003762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Treatment for both Hodgkin and Non-Hodgkin lymphoma now includes chemotherapy, targeted therapy, and new immunotherapies. As research continues to shine the light on tumor genetics, clinical variability, and new treatment approaches, advanced practitioners need to translate this information in the management of aggressive lymphomas.
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Affiliation(s)
- Paul A Hamlin
- Memorial Sloan Kettering Cancer Center, New York New York
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34
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Soumerai JD, Zelenetz AD, Moskowitz CH, Palomba ML, Hamlin PA, Noy A, Straus DJ, Moskowitz AJ, Younes A, Matasar MJ, Horwitz SM, Portlock CS, Konner JA, Gounder MM, Hyman DM, Voss MH, Fury MG, Gajria D, Carvajal RD, Ho AL, Beumer JH, Kiesel B, Zhang Z, Chen A, Little RF, Jarjies C, Dang TO, France F, Mishra N, Gerecitano JF. The PARP Inhibitor Veliparib Can Be Safely Added to Bendamustine and Rituximab and Has Preliminary Evidence of Activity in B-Cell Lymphoma. Clin Cancer Res 2017; 23:4119-4126. [PMID: 28314788 DOI: 10.1158/1078-0432.ccr-16-3068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/06/2017] [Accepted: 03/08/2017] [Indexed: 11/16/2022]
Abstract
Purpose: The PARP inhibitor veliparib enhances the cytotoxicity of alkylating agents. This phase I study evaluated veliparib with the bifunctional alkylator bendamustine (VB) in patients with relapsed/refractory lymphoma, multiple myeloma, and solid malignancies, with a cohort expansion of VB with rituximab (VBR) in patients with B-cell lymphomas.Experimental Design: This dose-escalation study evaluated safety, pharmacokinetics, and preliminary efficacy of veliparib (20-400 mg twice a day, days 1-7 of 28-day cycle) and bendamustine (70 and 90 mg/m2 intravenously, days 1 and 2). A cohort expansion was conducted, which combined veliparib and bendamustine at the maximum tolerated dose (MTD) with rituximab (375 mg/m2, day 1) in patients with B-cell lymphomas. Thirty-four patients were treated in seven dose-escalation cohorts and seven patients in the dose-expansion cohort.Results: The MTD was veliparib 300 mg twice daily plus bendamustine 90 mg/m2 Dose-limiting toxicities (DLT) were anemia, nausea, hypertension, and hyperhidrosis. Grade ≥3 toxicities included lymphopenia (87.8%), anemia (19.5%), neutropenia (12.2%), thrombocytopenia (9.8%), leukopenia (9.8%), nausea (7.3%), and hypophosphatemia (7.3%). Apparent veliparib clearance was slightly lower than previously reported. Of 14 patients with lymphoma evaluable for response, five of seven (71%) on VB and six of seven (86%) on VBR achieved objective response. One patient with multiple myeloma achieved partial response.Conclusions: VB and VBR were generally well-tolerated. VBR had preliminary clinical activity in patients with B-cell lymphoma, which warrants further investigation in a phase II trial. This trial was registered at www.clinicaltrials.gov as NCT01326702 Clin Cancer Res; 23(15); 4119-26. ©2017 AACR.
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Affiliation(s)
- Jacob D Soumerai
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Andrew D Zelenetz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Craig H Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - M Lia Palomba
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul A Hamlin
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ariela Noy
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David J Straus
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison J Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anas Younes
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew J Matasar
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Steven M Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carol S Portlock
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jason A Konner
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mrinal M Gounder
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David M Hyman
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martin H Voss
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew G Fury
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Devika Gajria
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard D Carvajal
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alan L Ho
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jan H Beumer
- Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.,Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Brian Kiesel
- Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Zhigang Zhang
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alice Chen
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, Maryland
| | - Richard F Little
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, Maryland
| | | | - Thu O Dang
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Fallon France
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nishant Mishra
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - John F Gerecitano
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
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35
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Fanale MA, Hamlin PA, Diefenbach CS, Park SI, Valacer DJ, Higgins JP, Younes A. Abstract CT049: Phase I/Ib study of the novel CD20-targeted immunotoxin MT-3724 in relapsed/refractory non-Hodgkin's B-cell lymphoma. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-ct049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Anti-CD20 monoclonal antibody (MAb) therapy is widely employed in the treatment of non-Hodgkin's B-cell lymphoma (NHL), but most patients eventually become refractory to CD20 MAb(s). MT-3724 is a recombinant fusion protein consisting of a CD20 binding variable fragment (scFv) fused to the ribosomal inhibitory protein Shiga-like toxin-I A1 subunit (SLT-I A1). Upon its scFv binding to surface CD20, SLT-I A1 forces MT-3724 internalization and irreversibly inactivates cell ribosomes triggering cell death. MT-3724 specifically binds and kills CD20+ malignant human B-cells in vitro and non-human primate (NHP) B-cells in vivo. In healthy NHPs 6 intravenous (IV) doses of MT-3724 were given over 12 days (d) at doses of 50, 150, and 450 mcg/kg with no deaths or effects on serum chemistry. Given the preclinical activity and novel mechanism of action, a Phase I/Ib study of MT-3724 was initiated.
Methods
MT-3724 is being tested in a first-in-human (FIH), open label, dose escalation study (3 + 3 design) in sequential cohorts of 5, 10, 20 and 50 mcg/kg/dose. Eligible subjects who previously responded to a CD20 MAb containing therapy followed by relapse/recurrence of NHL receive 6 doses by 2 hour IV infusions over the first 12 d of a 28 d cycle (first cycle). With continued safety, tolerability and lack of tumor progression, subjects may receive additional 6-dose cycles (21 d cycles) with tumor assessments after cycles 2, 4 and 5. Dose escalation is based on < 33% dose limiting toxicities (DLTs) observed during the first 28 d cycle.
Results
Twelve evaluable relapsed/refractory (R/R) NHL subjects have completed at least the first cycle in the 5, 10, 20 or 50 mcg/kg/dose cohort: 6 women/6 men; mean age 66.2 years (range 34-78). In these subjects who have received multiple approved and experimental treatments prior to enrollment, there have been no DLTs or infusion related reactions. With the exception of one Grade 4 isolated neutropenia lasting < 7 days which was possibly attributed to MT-3724 there have been no Grade 3 or 4 adverse events or serious adverse events attributed to MT-3724. In the 5 mcg/kg/dose cohort, one subject with transformed diffuse large B-cell lymphoma (tDLBCL) completed 5 cycles achieving a partial response (PR) post cycle 2 which was sustained through cycle 5; a second subject with tDLBCL had a mixed response. All three subjects treated in the 10 mcg/kg/dose cohort achieved stable disease (SD) with tumor regression. One subject with mixed DLBCL/follicular lymphoma in the 20 mcg/kg/dose cohort achieved a PR that further deepened to minimal residual disease and will undergo allo-SCT. All patients with high levels (>1,000 ng/mL) of circulating CD20 MAb developed progressive disease. Pharmacokinetic data suggest receptor saturation has not yet been reached at the 20 mcg/kg dose.
Conclusions
MT-3724 up to 50 mcg/kg/dose has been well tolerated for up to 5 cycles in this FIH study in heavily pre-treated patients with R/R NHL. Treatment in the 100 mcg/kg cohort has commenced with continuing dose ascension planned. Because of the shared epitope and the significantly higher doses and longer half-lives of CD20 MAbs relative to MT-3724, recent exposure to these Mabs is likely to inhibit MT-3724 activity. There is early evidence of clinical activity (2 PRs, 1 mixed response, 3 SDs with tumor regression), all observed in patients without recent CD20 MAb exposure.
Citation Format: Michelle A. Fanale, Paul A. Hamlin, Catherine S. Diefenbach, Steven I. Park, David J. Valacer, Jack P. Higgins, Anas Younes. Phase I/Ib study of the novel CD20-targeted immunotoxin MT-3724 in relapsed/refractory non-Hodgkin's B-cell lymphoma. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr CT049.
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Affiliation(s)
- Michelle A. Fanale
- 1Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul A. Hamlin
- 2Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Steven I. Park
- 4Division of Hematology/Oncology, Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | - Anas Younes
- 2Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
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Affiliation(s)
- Paul A Hamlin
- Basking Ridge Medical Oncology Service; and Lymphoma Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York Presbyterian Hospital, Department of Medicine, New York, NY, USA.
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Hamlin PA, Flinn I, Wagner-Johnston N, Burger J, Michelson G, Pandey A, Birrell M, Coffey G, Leeds J, sabalvaro-Torres A, Kim Y, Curnutte JT, Patel MR. Cerdulatinib (PRT062070): A dual SYK/JAK inhibitor in patients with relapsed/refractory b-cell malignancies—Pharmacokinetic and pharmacodynamic outcomes with twice-daily (BID) vs once-daily (QD) dosing. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7557] [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)
| | - Ian Flinn
- Hematologic Malignancies Research Program, Sarah Cannon Research Institute, Nashville, TN
| | | | - Jan Burger
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Anjali Pandey
- Portola Pharmaceuticals, Inc., South San Francisco, CA
| | - Matt Birrell
- Portola Pharmaceuticals, Inc., South San Francisco, CA
| | - Greg Coffey
- Portola Pharmaceuticals, Inc., South San Francisco, CA
| | - Janet Leeds
- Portola Pharmaceuticals, Inc., South San Francisco, CA
| | | | - Yvonne Kim
- Portola Pharmaceuticals, South San Francisco, CA
| | | | - Manish R. Patel
- Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL
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Fenske TS, Hamadani M, Cohen JB, Costa LJ, Kahl BS, Evens AM, Hamlin PA, Lazarus HM, Petersdorf E, Bredeson C. Allogeneic Hematopoietic Cell Transplantation as Curative Therapy for Patients with Non-Hodgkin Lymphoma: Increasingly Successful Application to Older Patients. Biol Blood Marrow Transplant 2016; 22:1543-1551. [PMID: 27131863 DOI: 10.1016/j.bbmt.2016.04.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 04/21/2016] [Indexed: 12/31/2022]
Abstract
Non-Hodgkin lymphoma (NHL) constitutes a collection of lymphoproliferative disorders with widely varying biological, histological, and clinical features. For the B cell NHLs, great progress has been made due to the addition of monoclonal antibodies and, more recently, other novel agents including B cell receptor signaling inhibitors, immunomodulatory agents, and proteasome inhibitors. Autologous hematopoietic cell transplantation (auto-HCT) offers the promise of cure or prolonged remission in some NHL patients. For some patients, however, auto-HCT may never be a viable option, whereas in others, the disease may progress despite auto-HCT. In those settings, allogeneic HCT (allo-HCT) offers the potential for cure. Over the past 10 to 15 years, considerable progress has been made in the implementation of allo-HCT, such that this approach now is a highly effective therapy for patients up to (and even beyond) age 75 years. Recent advances in conventional lymphoma therapy, peritransplantation supportive care, patient selection, and donor selection (including the use of alternative hematopoietic cell donors), has allowed broader application of allo-HCT to patients with NHL. As a result, an ever-increasing number of NHL patients over age 60 to 65 years stand to benefit from allo-HCT. In this review, we present data in support of the use of allo-HCT for patients with diffuse large B cell lymphoma, follicular lymphoma, and mantle cell lymphoma. These histologies account for a large majority of allo-HCTs performed for patients over age 60 in the United States. Where possible, we highlight available data in older patients. This body of literature strongly supports the concept that allo-HCT should be offered to fit patients well beyond age 65 and, accordingly, that this treatment should be covered by their insurance carriers.
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Affiliation(s)
- Timothy S Fenske
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Mehdi Hamadani
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Emory University, Winship Cancer Institute, Atlanta, Georgia
| | - Luciano J Costa
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brad S Kahl
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew M Evens
- Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts
| | - Paul A Hamlin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, and Department of Medicine, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Hillard M Lazarus
- Division of Hematology-Oncology, Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Effie Petersdorf
- Division of Medical Oncology, University of Washington School of Medicine, and Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Christopher Bredeson
- Blood and Marrow Transplant Program, Ottawa Hospital Research Institute at University of Ottawa, Ottawa, Ontario, Canada
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Portlock CS, Hamlin PA, Gerecitano JF, Noy A, Palomba ML, Walkley J, Corcoran S, Migliacci J, Schoder H, Papanicolaou G, Markowitz AJ. A Positive Prospective Trial of Antibiotic Therapy in Advanced Stage, Non-Bulky Indolent Lymphoma. Tumor Microenviron Ther 2016; 2:14-18. [PMID: 26798624 DOI: 10.1515/tumor-2015-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We have prospectively studied a three month course of clarithromycin (substituted by Prevpac®, lansoprazole/ amoxicillin/ clarithromycin, in the first two wks when stool H pylori+) for non-bulky, advanced stage indolent lymphoma. These patients are often candidates for expectant monitoring and it is during this period that a window of opportunity may exist to identify and treat associated infections. METHODS All previously untreated patients with a new diagnosis of indolent lymphoma (FL and non-FL) meeting GELF criteria were treated with 12 weeks of clarithromycin. There were 32 evaluable patients, 4 of whom had stool H pylori. RESULTS At one month post-antibiotic therapy, we have observed lymphoma responses in 7 of 32 patients (21.9%). Two additional patients had objective response during followup (28.1% overall response). The median treatment free survival for antibiotic responders is 69.9 months and for non-responders, 30.6 months (p = 0.019). CONCLUSION Three response patterns have been noted, perhaps suggestive of an immune-mediated response -- prompt PET negative; flair with delayed PET negative response; and gradual continuous improvement. This prospective study appears promising, may be a step toward developing a lymphoma prevention strategy by reducing "antigen drive," and deserves further clinical/biological study. http://clinicaltrials.gov/show/NCT00461084.
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Affiliation(s)
- Carol S Portlock
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Paul A Hamlin
- Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue New York, NY, 10065 USA
| | - John F Gerecitano
- Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue New York, NY, 10065 USA
| | - Ariela Noy
- Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue New York, NY, 10065 USA
| | - Maria Lia Palomba
- Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue New York, NY, 10065 USA
| | - Janelle Walkley
- Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue New York, NY, 10065 USA
| | - Stacie Corcoran
- Memorial Sloan Kettering Cancer Center, Office of Physician-in-Chief, 1275 York Avenue New York, NY, 10065 USA
| | - Jocelyn Migliacci
- Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue New York, NY, 10065 USA
| | - Heiko Schoder
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue New York, NY, 10065 USA
| | - Genovefa Papanicolaou
- Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue New York, NY, 10065 USA
| | - Arnold J Markowitz
- Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue New York, NY, 10065 USA
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Abstract
High-dose chemotherapy followed by autologous hematopoietic stem cell transplant (HDT/ASCT) can improve survival in patients with lymphoma. Limited experience is available on the safety and efficacy of HDT/ASCT in elderly patients. In this article, we review the published data on the role of HDT/ASCT in management of lymphoma in older patients. Based on available data, evaluation of comorbidities, functional status, and comprehensive geriatric assessment (CGA) will help identify those who can benefit most from this intervention. Prospective clinical trials focusing on HDT/ASCT in older patients with lymphoma are needed to establish optimal management protocols in this select population.
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Affiliation(s)
- Oscar B Lahoud
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Owens CN, Iannotta A, Gerecitano JF, Matasar MJ, Noy A, Moskowitz CH, Drullinsky P, Palomba ML, Straus DJ, Horwitz SM, Zelenetz AD, Portlock CS, Kumar A, Hamlin PA. Effect of prednisone and rituximab prephase on early toxicity in older DLBCL patients (pts) receiving RCHOP within a NHL specific comprehensive geriatric assessment (CGA) trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8571] [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
Affiliation(s)
| | | | | | | | - Ariela Noy
- Memorial Sloan Kettering Cancer Center, Englewood, NJ
| | | | | | | | | | | | | | | | - Anita Kumar
- Memorial Sloan Kettering Cancer Center, New York, NY
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Mehta-Shah N, Lunning MA, Boruchov AM, Ruan J, Nair S, Lynch P, Byrne R, Moskowitz AJ, Matasar MJ, Gerecitano JF, Hamlin PA, Leonard J, Moskowitz CH, Myskowski PL, Querfeld C, Nolan P, Palomba ML, Straus DJ, Zelenetz AD, Horwitz SM. A phase I/II trial of the combination of romidepsin and lenalidomide in patients with relapsed/refractory lymphoma and myeloma: Activity in T-cell lymphoma. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8521] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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)
| | | | | | - Jia Ruan
- New York Presbyterian Hosp Cornell Campus, New York, NY
| | - Sumithra Nair
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peggy Lynch
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Regina Byrne
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - John Leonard
- Weill Cornell Medical College - New York Presbyterian Hospital, New York, NY
| | | | | | | | - Patrick Nolan
- Memorial Sloan Kettering Cancer Center, New York, NY
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Flinn I, Hamlin PA, Strickland DK, Pandey A, Birrell M, Coffey G, Leeds J, Curnutte JT, Burger JA, Wagner-Johnston ND, Patel MR. Phase 1 open-label dose escalation study of the dual SYK/JAK inhibitor cerdulatinib (PRT062070) in patients with relapsed/refractory B-cell malignancies: Safety profile and clinical activity. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8531] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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)
- Ian Flinn
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | | | | | - Anjali Pandey
- Portola Pharmaceuticals, Inc., South San Francisco, CA
| | - Matt Birrell
- Portola Pharmaceuticals, Inc., South San Francisco, CA
| | - Greg Coffey
- Portola Pharmaceuticals, Inc., South San Francisco, CA
| | - Janet Leeds
- Portola Pharmaceuticals, Inc., South San Francisco, CA
| | | | | | | | - Manish R. Patel
- Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL
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Wagner-Johnston ND, Goy A, Rodriguez MA, Ehmann WC, Hamlin PA, Radford J, Thieblemont C, Suh C, Sweetenham J, Huang Y, Sullivan ST, Vandendries ER, Gisselbrecht C. A phase 2 study of inotuzumab ozogamicin and rituximab, followed by autologous stem cell transplant in patients with relapsed/refractory diffuse large B-cell lymphoma. Leuk Lymphoma 2015; 56:2863-9. [PMID: 25707288 DOI: 10.3109/10428194.2015.1017821] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study evaluated the safety and efficacy of inotuzumab ozogamicin (INO), a targeted humanized anti-CD22 antibody conjugated to calicheamicin, plus rituximab (R-INO) every 3 weeks, up to six cycles, followed by high dose therapy and autologous stem cell transplant (HDT-aSCT) in patients with high-risk relapsed/refractory diffuse large B-cell lymphoma (DLBCL). The primary endpoint was overall response (OR) rate after three cycles of R-INO. Sixty-three patients were enrolled. Common grade 3/4 adverse events during R-INO treatment were thrombocytopenia, lymphopenia and neutropenia. OR rate after three cycles of R-INO was 28.6% (95% confidence interval: 17.9-41.4). Eighteen patients underwent HDT-aSCT; 2-year progression-free survival (PFS) for these patients was 61.1%. Serious infections and hepatic toxicity following aSCT occurred in 33% and 22%, respectively. One- and 2-year PFS rates for all enrolled patients were 28.9% and 25.3%, respectively (median, 3.0 months). R-INO had lower than expected activity as a salvage regimen for transplant eligible patients with DLBCL.
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Affiliation(s)
| | - Andrè Goy
- b The Cancer Center at Hackensack University Medical Center , Hackensack , NJ , USA
| | - Maria A Rodriguez
- c University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | | | - Paul A Hamlin
- e Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - John Radford
- f The University of Manchester and The Christie NHS Foundation Trust , Manchester , UK
| | | | - Cheolwon Suh
- h Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea
| | | | - Yifan Huang
- j Pfizer Oncology , (LaJolla, CA and Cambridge, MA) , USA
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Moskowitz AJ, Schöder H, Yahalom J, McCall SJ, Fox SY, Gerecitano J, Grewal R, Hamlin PA, Horwitz S, Kobos R, Kumar A, Matasar M, Noy A, Palomba ML, Perales MA, Portlock CS, Sauter C, Shukla N, Steinherz P, Straus D, Trippett T, Younes A, Zelenetz A, Moskowitz CH. PET-adapted sequential salvage therapy with brentuximab vedotin followed by augmented ifosamide, carboplatin, and etoposide for patients with relapsed and refractory Hodgkin's lymphoma: a non-randomised, open-label, single-centre, phase 2 study. Lancet Oncol 2015; 16:284-92. [DOI: 10.1016/s1470-2045(15)70013-6] [Citation(s) in RCA: 189] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hamlin PA, Satram-Hoang S, Reyes C, Hoang KQ, Guduru SR, Skettino S. Treatment patterns and comparative effectiveness in elderly diffuse large B-cell lymphoma patients: a surveillance, epidemiology, and end results-medicare analysis. Oncologist 2014; 19:1249-57. [PMID: 25342313 DOI: 10.1634/theoncologist.2014-0113] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The incidence of diffuse large B-cell lymphoma (DLBCL) occurs disproportionately in elderly patients. We evaluated real-world treatment patterns and outcomes in elderly DLBCL patients in the U.S. MATERIALS AND METHODS A retrospective cohort analysis of 9,333 DLBCL patients from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database was conducted. Patients were diagnosed between January 1, 2000, and December 31, 2007; were aged >66 years, and were continuously enrolled in Medicare Part A and B in the year prior to diagnosis. Within 3 months of diagnosis, 4,565 (49%) received rituximab plus chemotherapy (R+chemo), 2,181 (23%) received chemotherapy only, and 467 (5%) received rituximab monotherapy (R-mono). Cox proportional hazards regression assessed overall survival between R+chemo versus chemotherapy only and R-mono versus no treatment. RESULTS Overall, 23% of patients received no treatment, and the proportion was higher among those aged >80 years (33%). Patients receiving R+chemo were younger and more likely white compared with those receiving chemotherapy only. Patients receiving R-mono were older and more likely female compared with those not treated. In multivariate analysis, patients receiving chemotherapy only had a twofold increased mortality risk versus R+chemo, and this was confirmed in a subanalysis of patients aged >80 years. A 91% higher mortality risk was noted with receipt of fewer than six cycles versus six cycles of chemotherapy or chemoimmunotherapy. Patients receiving R-mono had a 69% decreased mortality risk compared with patients who were not treated. CONCLUSION This real-world analysis of elderly DLBCL patients confirmed that 23% do not receive treatment. Overall survival is higher for patients receiving R+chemo and R-mono relative to chemotherapy only and no treatment, respectively. Suboptimal durations of therapy with curative intent (fewer than six cycles) were associated with poorer outcomes.
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Affiliation(s)
- Paul A Hamlin
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Q.D. Research, Inc., Granite Bay, California, USA; Genentech, Inc., South San Francisco, California, USA; University of California San Francisco, San Francisco, California, USA
| | - Sacha Satram-Hoang
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Q.D. Research, Inc., Granite Bay, California, USA; Genentech, Inc., South San Francisco, California, USA; University of California San Francisco, San Francisco, California, USA
| | - Carolina Reyes
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Q.D. Research, Inc., Granite Bay, California, USA; Genentech, Inc., South San Francisco, California, USA; University of California San Francisco, San Francisco, California, USA
| | - Khang Q Hoang
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Q.D. Research, Inc., Granite Bay, California, USA; Genentech, Inc., South San Francisco, California, USA; University of California San Francisco, San Francisco, California, USA
| | - Sridhar R Guduru
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Q.D. Research, Inc., Granite Bay, California, USA; Genentech, Inc., South San Francisco, California, USA; University of California San Francisco, San Francisco, California, USA
| | - Sandra Skettino
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Q.D. Research, Inc., Granite Bay, California, USA; Genentech, Inc., South San Francisco, California, USA; University of California San Francisco, San Francisco, California, USA
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Straus DJ, Hamlin PA, Matasar MJ, Lia Palomba M, Drullinsky PR, Zelenetz AD, Gerecitano JF, Noy A, Hamilton AM, Elstrom R, Wegner B, Wortman K, Cella D. Phase I/II trial of vorinostat with rituximab, cyclophosphamide, etoposide and prednisone as palliative treatment for elderly patients with relapsed or refractory diffuse large B-cell lymphoma not eligible for autologous stem cell transplantation. Br J Haematol 2014; 168:663-70. [PMID: 25316653 DOI: 10.1111/bjh.13195] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/27/2014] [Indexed: 12/20/2022]
Abstract
The standard treatment of relapsed/refractory diffuse large B-cell lymphoma (DLBCL) in frail elderly patients has not been established. A variation was made on rituximab (R), cyclophosphamide (C), etoposide (E), procarbazine and prednisone (P), substituting vorinostat (V) for procarbazine. Patients ≥aged 60 years with relapsed/refractory DLBCL, not candidates for autologous stem cell transplantation, were treated R-CVEP [R 375 mg/m(2) intravenously (IV), day 1; C 600 mg/m(2) IV days 1, 8: E 70 mg/m(2) IV day 1, 140 mg/m(2) days 2, 3 orally (PO); V (300 vs. 400 mg) PO and P 60 mg/m(2) PO days 1-10] every 28 d for six cycles. Quality of life (QoL) was assessed in addition to response. Thirty patients (median age 76 years, 69-88) were enrolled (one died before treatment). Maximum tolerated dose (MTD) for V was 300 mg. For 23 patients at MTD (six phase I + 17 phase II), two were discontinued for toxicity, one withdrew consent, eight achieved complete response (35%), five achieved partial response (22%) and seven progressed (25%). Median overall survival was 17·5 months. Median progression-free survival was 9·2 months. Nine patients are alive. QoL declined during treatment but improved above baseline for patients who completed treatment. In conclusion, R-CVEP was tolerated at MTD and produced durable responses with improved QoL.
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Affiliation(s)
- David J Straus
- Memorial Sloan-Kettering Cancer Center, Division of Hematologic Oncology, Lymphoma Service, New York, NY, USA
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Tannir NM, Forero-Torres A, Ramchandren R, Pal SK, Ansell SM, Infante JR, de Vos S, Hamlin PA, Kim SK, Whiting NC, Gartner EM, Zhao B, Thompson JA. Phase I dose-escalation study of SGN-75 in patients with CD70-positive relapsed/refractory non-Hodgkin lymphoma or metastatic renal cell carcinoma. Invest New Drugs 2014; 32:1246-57. [PMID: 25142258 DOI: 10.1007/s10637-014-0151-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE This first-in-human study evaluated the CD70-targeted antibody-drug conjugate SGN-75 in patients with relapsed or refractory CD70-positive non-Hodgkin lymphoma (NHL) or metastatic renal cell carcinoma (RCC). Methods SGN-75 was administered intravenously to 58 patients (39 RCC, 19 NHL) every 3 weeks (Q3Wk; doses escalated from 0.3 to 4.5 mg/kg) or on Days 1, 8, and 15 of 28-day cycles (weekly; doses of 0.3 or 0.6 mg/kg). Dose-limiting toxicities were evaluated during Cycle 1; treatment response was monitored every 2 cycles. RESULTS The maximum tolerated dose of SGN-75 in RCC patients was 3 mg/kg Q3Wk. Due to toxicity concerns (idiopathic thrombocytopenic purpura in 2 NHL patients treated weekly), dose escalation in the weekly schedule was terminated; no regimen was recommended for NHL patients. The most common adverse events reported in patients treated Q3Wk (N = 47) were fatigue (40%), dry eye (32%), nausea (30%), and thrombocytopenia (26%). The nadir for thrombocytopenia typically occurred during Cycle 1. Ocular adverse events (e.g., corneal epitheliopathy, dry eye) were reported for 57% of patients treated Q3Wk and were generally reversible. Antitumor activity in patients treated Q3Wk included 1 complete response, 2 partial responses, and 20 stable disease. SGN-75 exposures were approximately dose proportional, with a mean terminal half-life of 10 days. Substantial depletions of CD70-positive peripheral blood lymphocytes were observed after SGN-75 treatment. CONCLUSIONS Modest single-agent activity and generally manageable adverse events were observed in heavily pretreated RCC and NHL patients. Administration Q3Wk was better tolerated than weekly dosing. Targeted ablation of CD70-positive lymphocytes was demonstrated.
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Affiliation(s)
- Nizar M Tannir
- MD, FACP; MD Anderson Cancer Center, Department of Genitourinary Medical Oncology, 1155 Pressler St, Unit 1374, Houston, TX, 77030, USA,
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Lunning MA, Ruan J, Nair S, Boruchov AM, Byrne R, Gerecitano JF, Hamlin PA, Inserra B, Leonard J, Lynch P, Matasar MJ, Moskowitz AJ, Moskowitz C, Myskowski PL, Nolan P, Palomba ML, Quefeld C, Straus DJ, Zelenetz AD, Horwitz SM. A phase I/II trial of the combination of romidepsin and lenalidomide in patients with relapsed/refractory lymphoma and myeloma: Phase I results. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8582] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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)
| | - Jia Ruan
- Weill Cornell Medical College, New York, NY
| | - Sumithra Nair
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Regina Byrne
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | - Beth Inserra
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Peggy Lynch
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | | | - Patrick Nolan
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Maria Lia Palomba
- Lymphoma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
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50
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Dang NH, Ogura M, Castaigne S, Fayad L, Jerkeman M, Radford JA, Pezzutto A, Bondarenko I, Stewart DA, Shnaidman M, Sullivan S, Vandendries E, Tobinai K, Ramchandren R, Hamlin PA, Giné E, Ando K. Randomized, phase 3 trial of inotuzumab ozogamicin plus rituximab (R-InO) versus chemotherapy for relapsed/refractory aggressive B-cell non-Hodgkin lymphoma (B-NHL). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8529] [Citation(s) in RCA: 4] [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)
| | | | | | - Luis Fayad
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - John A. Radford
- University of Manchester/Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Antonio Pezzutto
- Department of Hematology, Oncology, and Tumor Immunology, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Igor Bondarenko
- State Medical Academy, Municipal Clinical Hospital #4, Dnepropetrovsk, Ukraine
| | | | | | | | | | | | - Rod Ramchandren
- Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | | | - Eva Giné
- Unidad de Hematología, Instituto Oncológico Baselga, Hospital Quirón Barcelona, Barcelona, Spain
| | - Kiyoshi Ando
- Tokai University School of Medicine, University Hospital, Kanagawa, Japan
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