1
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Milrod CJ, Pelcovits A, Ollila TA. Immune checkpoint inhibitors in advanced and relapsed/refractory Hodgkin lymphoma: current applications and future prospects. Front Oncol 2024; 14:1397053. [PMID: 38699638 PMCID: PMC11063339 DOI: 10.3389/fonc.2024.1397053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
Classic Hodgkin lymphoma (cHL) treatment paradigms are undergoing a shift with the integration of immune checkpoint inhibitors (ICIs) into both first-line and relapsed/refractory (R/R) regimens. In first-line therapy, the synergy between ICIs and chemotherapy may surpass the previous standards of ABVD and BV-AVD established by landmark trials including RATHL and ECHELON-1. In R/R disease, the combination of ICIs with chemotherapy has begun to challenge the paradigm of chemotherapy as a bridge to consolidative autologous stem cell transplantation. The clinical advances heralded by ICI offer unique challenges to management. ICI treatment and the associated inflammatory response can make the traditional timing and modalities of treatment response assessment difficult to interpret. In contrast to ABVD and BV-AVD, pembrolizumab-AVD results in PET2 positivity rates that are higher and less predictive of treatment response even when ultimate outcomes may be superior. This suggests that the predictive value of PET2 may be less reliable in the ICI era, prompting a reevaluation of response assessment strategies. Looking forward, circulating tumor DNA (ctDNA) may be a promising tool in response-adapted therapy. Its potential to complement or even supersede PET scans in predicting response to ICIs represents a critical advancement. The integration of ctDNA analysis holds the promise of refining response-adapted approaches and enhancing precision in therapeutic decision-making for patients with cHL. This review navigates the evolving landscape of cHL therapy, emphasizing the paradigmatic shift brought about by ICIs. This article explores the impact of combining ICIs with chemotherapy in both relapsed/refractory and first-line settings, scrutinizes the challenges posed to response-adapted therapy by ICIs, and highlights the potential role of ctDNA as an adjunct in refining response-adapted strategies for cHL.
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2
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Milrod CJ, Kim KW, Raker C, Ollila TA, Olszewski AJ, Pelcovits A. Progression-free survival is a weakly predictive surrogate end-point for overall survival in follicular lymphoma: A systematic review and meta-analysis. Br J Haematol 2024. [PMID: 38571449 DOI: 10.1111/bjh.19449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
Although progression-free survival (PFS) is a commonly used surrogate end-point for clinical trials of follicular lymphoma (FL), no analyses have evaluated the strength of surrogacy for PFS with overall survival (OS). A systematic review was performed and 20 studies (total participants, 10 724) met final inclusion criteria. PFS was weakly associated with OS (correlation coefficient; 0.383, p < 0.001). The coefficient of determination was 0.15 (95% CI: 0.002-0.35) suggesting 15% of OS variance could be explained by changes in PFS. This challenges the role for PFS as a surrogate end-point for clinical trials and drug approvals.
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Affiliation(s)
- Charles J Milrod
- Department of Hematology/Oncology, Brown University, Providence, Rhode Island, USA
| | - Kang Woo Kim
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Christina Raker
- Lifespan Biostatistics, Epidemiology, Research Design, and Informatics, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Thomas A Ollila
- Department of Hematology/Oncology, Brown University, Providence, Rhode Island, USA
| | - Adam J Olszewski
- Department of Hematology/Oncology, Brown University, Providence, Rhode Island, USA
| | - Ari Pelcovits
- Department of Hematology/Oncology, Brown University, Providence, Rhode Island, USA
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3
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Karmali R, Machhi R, Epperla N, Shouse G, Romancik JT, Moyo TK, Kenkre VP, Ollila TA, Fitzgerald LA, Hess BT, David KA, Roy I, Zurko JC, Chowdhury SM, Annunzio K, Ferdman R, Bhansali RS, Harris EI, Liu J, Nizamuddin IA, Ma S, Moreira J, Winter JN, Pro B, Stephens DM, Danilov AV, Shah NN, Cohen JB, Barta SK, Torka P, Gordon LI. Impact of Race and Social Determinants of Health on Outcomes in Patients with Aggressive B-cell nHL Treated with CAR-T. Blood Adv 2024:bloodadvances.2023011996. [PMID: 38531057 DOI: 10.1182/bloodadvances.2023011996] [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: 11/13/2023] [Revised: 02/05/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024] Open
Abstract
Healthcare disparities driven by multiple social, economic, and/or environmental factors lead to inequalities in health outcomes. CAR-T cell immunotherapy is an effective therapy for relapsed/refractory B-cell non-Hodgkin lymphoma (r/r B-NHL). However, data are limited on the impact of the convergence of race and social determinants of health on outcomes for patients treated with CAR-T therapy. We examined the impact of interactions between race and insurance type on health care utilization and outcomes in patients treated with CAR-T for aggressive B-NHL. Adult patients with r/r B-NHL treated with CD19 CAR-T were identified between 2015 and 2021 across 13 US academic centers. Insurance type, demographic and clinical data were collected and analyzed via Chi-squared and Kaplan-Meier analysis. Cox multivariable regression (MVA) was used to determine the impact of race/ethnicity and other variables on survival. 466 adult patients were included in our analysis. Median follow-up after CAR-T was 12.7 months. Median progression free survival (mPFS) was longer for Caucasians (11.5 months) than for African Americans (3.5 months, HR 1.56 [1.03-2.4], p=0.04) or Asians (2.7 months, HR 1.7 [1.02-2.67], p=0.04). Differences in median overall survival (mOS) were not significant. For Medicare (n=206) vs Medicaid (n=33) vs private insurance (n=219) vs self-pay (n=7): mPFS was 15.9 vs 4.2 vs 6.0 vs 0.9 months (p<0.001) and mOS was 31.2 vs 12.8 vs 21.5 vs 3.2 months (p<0.001), respectively. Collectively, our multi-center retrospective analysis showed that race and insurance status can impact outcomes for patients treated with CAR-T cell therapy.
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Affiliation(s)
- Reem Karmali
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Rushad Machhi
- Northwestern University, Chicago, Illinois, United States
| | | | - Geoffrey Shouse
- City of Hope National Medical Center, Duarte, California, United States
| | | | - Tamara K Moyo
- Levine Cancer Institute, Atrium Helath, Charlotte, North Carolina, United States
| | | | - Thomas A Ollila
- Brown University/Lifespan Cancer Institute, Providence, Rhode Island, United States
| | | | - Brian T Hess
- The Medical University of South Carolina, Charleston, South Carolina, United States
| | - Kevin A David
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, United States
| | - Ishan Roy
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
| | - Joanna C Zurko
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, United States
| | | | | | - Robert Ferdman
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
| | - Rahul S Bhansali
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Elyse I Harris
- University of Wisconsin, Madison, Wisconsin, United States
| | - Jieqi Liu
- Astera Cancer Care, Jersey City, New Jersey, United States
| | - Imran A Nizamuddin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Shuo Ma
- Northwestern University, Chicago, Illinois, United States
| | - Jonathan Moreira
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Jane N Winter
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Barbara Pro
- Columbia University Medical Center, New York, New York, United States
| | - Deborah M Stephens
- University of North Carolina, Chapel Hill, North Carolina, United States
| | | | - Nirav N Shah
- Medical College of Wisconsin, Wauwatosa, Wisconsin, United States
| | | | - Stefan K Barta
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Pallawi Torka
- Memorial Sloan Kettering Cancer Center, Montvale, New Jersey, United States
| | - Leo I Gordon
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
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4
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Melody M, Epperla N, Shouse G, Romancik JT, Allen PB, Moyo TK, Kenkre VP, Ollila TA, Fitzgerald LA, Hess BT, David KA, Herr MM, Odetola O, Lin AY, Moreira J, Ma S, Winter JN, Roy I, Stephens DM, Danilov AV, Shah NN, Barta SK, Cortese MJ, Cohen J, Gordon LI, Karmali R. Subsequent Malignant Neoplasms in Patients Previously Treated with Anti-CD19 CAR T-Cell Therapy. Blood Adv 2024:bloodadvances.2024012573. [PMID: 38498727 DOI: 10.1182/bloodadvances.2024012573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/20/2024] Open
Affiliation(s)
- Megan Melody
- Northwestern University Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, United States
| | | | - Geoffrey Shouse
- City of Hope National Medical Center, Duarte, California, United States
| | | | | | - Tamara K Moyo
- Levine Cancer Institute, Atrium Helath, Charlotte, North Carolina, United States
| | | | - Thomas A Ollila
- Brown University/Lifespan Cancer Institute, Providence, Rhode Island, United States
| | | | - Brian T Hess
- The Medical University of South Carolina, Charleston, South Carolina, United States
| | - Kevin A David
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, United States
| | - Megan M Herr
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
| | - Oluwatobi Odetola
- Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, United States
| | - Adam Yuh Lin
- Northwestern University Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, United States
| | - Jonathan Moreira
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Shuo Ma
- Northwestern University, Chicago, Illinois, United States
| | - Jane N Winter
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Ishan Roy
- Northwestern University, United States
| | - Deborah M Stephens
- University of North Carolina, Chapel Hill, North Carolina, United States
| | | | - Nirav N Shah
- Medical College of Wisconsin, Wauwatosa, Wisconsin, United States
| | - Stefan K Barta
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Matthew J Cortese
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
| | | | - Leo I Gordon
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Reem Karmali
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
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5
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Ollila TA, Taher R, Moku P, Olszewski AJ. Immunochemotherapy or chemotherapy alone in primary central nervous system lymphoma: a National Cancer Database analysis. Blood Adv 2023; 7:5470-5479. [PMID: 37459209 PMCID: PMC10515309 DOI: 10.1182/bloodadvances.2023010352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/06/2023] [Indexed: 09/16/2023] Open
Abstract
Debate remains over the role of rituximab, a large molecule with reduced central nervous system (CNS) penetration, in therapy for primary CNS lymphoma (PCNSL). Since 2013, the National Cancer Database has distinguished between chemotherapy and immunotherapy for frontline treatment. In this setting, rituximab would be the only standard frontline immunotherapy. We examined factors associated with the receipt of immunotherapy using a multivariate regression model for relative risk, with a random intercept to account for the hospital-specific treatment selection process. Patients were matched using a 1:1 propensity score to limit possible confounders, and overall survival (OS) was compared in the matched cohort. We identified 4691 patients with PCNSL diagnosed between 2013 and 2018. The use of immunotherapy has increased from 45% in 2013 to 76% in 2018. Immunotherapy use was associated with sociodemographic variables and local (hospital level) preference rather than clinical factors. The main factors associated with reduced use of immunotherapy included male sex, Black race or Hispanic ethnicity (compared with White non-Hispanic), HIV+ status, treatment in a lower-volume hospital, and earlier year of diagnosis. We matched 2830 patients for the survival analysis. Receipt of immunotherapy was associated with a significantly better OS (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.67-0.83). There was heterogeneity according to age, because the advantage of immunotherapy was more pronounced for patients aged ≤75 years (HR, 0.71; 95% CI, 0.63-0.80) than for those older than 75 years (HR, 0.87; 95% CI, 0.70-1.08). Overall, our findings support the current trend toward rituximab use, although a nuanced approach should be adopted when treating older patients.
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Affiliation(s)
- Thomas A. Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
- Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI
| | - Rashida Taher
- Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI
| | - Prashanth Moku
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Adam J. Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
- Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI
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Ollila TA, Taher R, Moku P. Reassessing the risks and benefits of COVID-19 precautions in 2023. Oncotarget 2023; 14:819-820. [PMID: 37737658 PMCID: PMC10515730 DOI: 10.18632/oncotarget.28468] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Indexed: 09/23/2023] Open
Affiliation(s)
- Thomas A. Ollila
- Correspondence to:Thomas A. Ollila, Department of Medicine, Alpert Medical School of Brown University, Providence, RI 02903, USA; Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI 02903, USA email
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7
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Pelcovits A, Ollila TA, Olszewski AJ. Advances in Immunotherapy for the Treatment of Cutaneous T-Cell Lymphoma. Cancer Manag Res 2023; 15:989-998. [PMID: 37700809 PMCID: PMC10493109 DOI: 10.2147/cmar.s330908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
Cutaneous T-Cell Lymphoma (CTCL) is a heterogenous disease that consists of distinct clinicopathologic entities and presentations requiring a unique and expert approach to management. The most common subtype is mycosis fungoides, in which local disease has an excellent prognosis and is often managed with topical therapy alone. More extensive cutaneous involvement as well as involvement of lymph nodes and the peripheral blood (Sezary syndrome) require systemic therapies. Recent years have brought an expansion of therapeutic options, specifically with immune-based approaches that were developed using the knowledge gained regarding the biology and molecular pathology of CTCL. Previous systemic therapies such as retinoids, histone deacetylase inhibitors, and chemotherapeutic agents come with significant toxicity and only short-term response. Newer agents such as mogamulizumab and brentuximab vedotin use a targeted immune-based approach leading to longer periods of response with less systemic toxicity. While still in its infancy, the use of immune checkpoint inhibitors such as nivolumab and pembrolizumab appears promising, and while their current clinical application is limited, early data suggest possible future areas for research of immune manipulation to treat CTCL. Herein, we review these novel immune-based treatment strategies, their superiority over prior systemic options, and the ongoing need for further research and clinical trial enrollment.
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Affiliation(s)
- Ari Pelcovits
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
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8
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David KA, Sundaram S, Kim SH, Vaca R, Lin Y, Singer S, Malecek MK, Carter J, Zayac A, Kim MS, Reddy N, Ney D, Habib A, Strouse C, Graber J, Bachanova V, Salman S, Vendiola JA, Hossain N, Tsang M, Major A, Bond DA, Agrawal P, Mier-Hicks A, Torka P, Rajakumar P, Venugopal P, Berg S, Glantz M, Goldlust SA, Folstad M, Kumar P, Ollila TA, Cai J, Spurgeon S, Sieg A, Cleveland J, Chang J, Epperla N, Karmali R, Naik S, Martin P, Smith SM, Rubenstein J, Kahl B, Evens AM. Older patients with primary central nervous system lymphoma: Survival and prognostication across 20 U.S. cancer centers. Am J Hematol 2023; 98:900-912. [PMID: 36965007 PMCID: PMC10979647 DOI: 10.1002/ajh.26919] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 02/27/2023] [Accepted: 03/21/2023] [Indexed: 03/27/2023]
Abstract
There is a paucity of large-scale data delineating outcomes and prognostication of older patients with primary central nervous system lymphoma (PCNSL). We retrospectively analyzed 539 newly-diagnosed PCNSL patients ages ≥60 years across 20 U.S. academic centers. The median age was 70 years (range 60-88); at least one geriatric syndrome was present in 46%; the median Cumulative Index Ratings Scale-Geriatrics (CIRS-G) score was 6 (range, 0-27); and 36% had impairment in activities of daily living (ADL). The most common induction regimens were high-dose methotrexate (HD-MTX) ± rituximab; methotrexate, temozolomide, rituximab (MTR); and rituximab, methotrexate, procarbazine, vincristine (R-MPV). Overall, 70% of patients achieved remission, with 14% undergoing consolidative autologous stem cell transplant (ASCT) and 24% receiving maintenance. With 58-month median follow-up, median progression-free survival (PFS) and overall survival (OS) were 17 months (95% CI 13-22 months) and 43 months (95% CI 31-56 months), respectively. Three-year PFS and OS were highest with MTR (55% and 74%, respectively). With single-agent methotrexate ± rituximab, 3-year PFS and OS were 30% (p = .0002) and 47% (p = .0072). On multivariate analysis, increasing age at diagnosis and Cooperative Oncology Group (ECOG) performance status (PS) was associated with inferior PFS; age, hypoalbuminemia, higher CIRS-G score, and ECOG PS adversely affected OS. Among patients receiving maintenance, 3-year PFS was 65% versus 45% without maintenance (p = 0.02), with 3-year OS of 84% versus 61%, respectively (p = .0003). Altogether, outcomes in older PCNSL patients appeared optimized with HD-MTX combination induction regimens and maintenance therapy. Furthermore, several prognostic factors, including geriatric measures, were associated with inferior outcomes.
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Affiliation(s)
- Kevin A. David
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | | | - Seo-Hyun Kim
- Rush University Medical Center, Chicago, Illinois, USA
| | - Ryan Vaca
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Yong Lin
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Samuel Singer
- John Theurer Cancer Center, Hackensack, New Jersey, USA
| | | | - Jordan Carter
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Adam Zayac
- Brown University, Providence, Rhode Island, USA
| | - Myung Sun Kim
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Douglas Ney
- University of Colorado, Aurora, Colorado, USA
| | - Alma Habib
- University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | | | - Sidra Salman
- Loyola University Medical Center, Maywood, Illinois, USA
| | | | | | - Mazie Tsang
- University of California, San Francisco, California, USA
| | - Ajay Major
- University of Chicago, Chicago, Illinois, USA
| | - David A. Bond
- Division of Hematology, Ohio State University, Columbus, Ohio, USA
| | | | | | - Pallawi Torka
- Roswell Park Cancer Institute, Buffalo, New York, USA
| | | | | | - Stephanie Berg
- Loyola University Medical Center, Maywood, Illinois, USA
| | | | | | | | - Pallavi Kumar
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | | | - Johnny Cai
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Alex Sieg
- University of Iowa, Iowa City, Iowa, USA
| | | | - Julie Chang
- University of Wisconsin, Madison, Wisconsin, USA
| | | | | | - Seema Naik
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Peter Martin
- Weill Cornell Medical College, New York City, New York, USA
| | | | | | - Brad Kahl
- Washington University in St. Louis, St. Louis, Missouri, USA
| | - Andrew M. Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
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Gallo Marin B, Ollila TA, Robbins A, Brooks BE, Firoz EF, Massoud CM. Drug-induced hypersensitivity syndrome and eosinophils in skin biopsy in a patient with pancytopenia. Am J Hematol 2023; 98:697-699. [PMID: 36151897 PMCID: PMC10033331 DOI: 10.1002/ajh.26742] [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: 08/08/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Benjamin Gallo Marin
- Division of Hematology and Oncology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
- Brown Dermatology and Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Thomas A. Ollila
- Division of Hematology and Oncology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Allison Robbins
- Brown Dermatology and Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Blake Elizabeth Brooks
- Brown Dermatology and Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Elnaz F. Firoz
- Brown Dermatology and Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Cathy M. Massoud
- Brown Dermatology and Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
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10
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Agrawal P, David KA, Chen Z, Sundaram S, Kim SH, Vaca R, Lin Y, Singer S, Malecek MK, Carter J, Zayac A, Kim MS, Reddy N, Ney D, Habib A, Strouse C, Graber J, Bachanova V, Salman S, Vendiola JA, Hossain N, Tsang M, Major A, Gandhi MK, Keane C, Bond DA, Folstad M, Chang J, Mier-Hicks A, Torka P, Rajakumar P, Venugopal P, Berg S, Glantz M, Goldlust SA, Matnani R, Kumar P, Ollila TA, Cai J, Spurgeon SE, Sieg AG, Cleveland J, Epperla N, Karmali R, Naik S, Smith SM, Rubenstein JL, Kahl BS, Chadburn A, Evens AM, Martin P. EBV-positive PCNSL in older patients: incidence, characteristics, tumor pathology, and outcomes across a large multicenter cohort. Leuk Lymphoma 2023:1-9. [PMID: 36960939 DOI: 10.1080/10428194.2023.2191152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
The objective of this multicenter retrospective study was to examine the incidence, patient characteristics, pathology, and outcomes associated with Epstein-Barr virus (EBV)-related CNS lymphoma (CNSL) in older patients. Among 309 CNSL patients aged ≥60, 11.7% had EBV + tumors of which 72.2% were solid organ transplant (SOT)-related post-transplant lymphoproliferative disorders (PTLD). Younger age, SOT or autoimmune disease, and immunosuppressive treatment correlated highly with EBV-positivity. EBV + tumors were associated with absent C-MYC and BCL6 expression. EBV + PTLD was more likely to be associated with the absence of CD5 expression. EBV + non-PTLD had better median OS (not reached) compared to EBV + PTLD (10.8 months) and EBV-negative patients (43 months). Multivariable Cox regression analysis showed that age, performance status, and PTLD were negative predictors of OS. EBV status and immunosuppressive treatment were not correlated with OS. Our findings merit further investigation of EBV + PCNSL tumors and EBV-directed therapies.
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Affiliation(s)
- Prashasti Agrawal
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Kevin A David
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Zhengming Chen
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | | | - Seo-Hyun Kim
- Department of Internal Medicine, Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Ryan Vaca
- Department of Medicine, Penn State University College of Medicine, Hershey, PA, USA
| | - Yong Lin
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Mary-Kate Malecek
- Department of Medicine, Division of Hematology & Oncology, Washington University School of Medicine, University City, MO, USA
| | - Jordan Carter
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Adam Zayac
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Myung Sun Kim
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Nishitha Reddy
- Department of Medicine, Division of Hematology & Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas Ney
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Alma Habib
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | | | - Jerome Graber
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Veronika Bachanova
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Sidra Salman
- Department of Medicine and Cancer Biology, Loyola University, Chicago, IL, USA
| | - Jean A Vendiola
- Department of Medicine and Cancer Biology, Loyola University, Chicago, IL, USA
| | - Nasheed Hossain
- Department of Medicine and Cancer Biology, Loyola University, Chicago, IL, USA
| | - Mazie Tsang
- Department of Hematology/Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Ajay Major
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | | | - Colm Keane
- Princess Alexandria Hospital, Brisbane, Australia
| | - David A Bond
- Department of Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Matthew Folstad
- Department of Medicine, Division of Hematology, Oncology and Palliative Care, University of Wisconsin, Madison, WI, USA
| | - Julie Chang
- Department of Medicine, Division of Hematology, Oncology and Palliative Care, University of Wisconsin, Madison, WI, USA
| | | | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Priya Rajakumar
- Department of Internal Medicine, Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Parameswaran Venugopal
- Department of Internal Medicine, Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Stephanie Berg
- Department of Medicine and Cancer Biology, Loyola University, Chicago, IL, USA
| | - Michael Glantz
- Department of Medicine, Penn State University College of Medicine, Hershey, PA, USA
| | | | - Rahul Matnani
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Pallavi Kumar
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Johnny Cai
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Stephen E Spurgeon
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Alex G Sieg
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Joseph Cleveland
- Department of Hematology/Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Narendranath Epperla
- Department of Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Reem Karmali
- Division of Hematology Oncology, Northwestern University, Chicago, IL, USA
| | - Seema Naik
- Department of Medicine, Penn State University College of Medicine, Hershey, PA, USA
| | - Sonali M Smith
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - James L Rubenstein
- Department of Hematology/Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Brad S Kahl
- Department of Medicine, Division of Hematology & Oncology, Washington University School of Medicine, University City, MO, USA
| | - Amy Chadburn
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Peter Martin
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
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11
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Ollila TA, Kishkovich TP, Olszewski AJ, Patel NR, Jackson C, Roussel B, Niroula R, Treaba DO. Testicular Relapse of Primary Diffuse Large B-cell Lymphoma of the Central Nervous System - a Rare Occurrence. R I Med J (2013) 2023; 106:8-12. [PMID: 36848533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Among diffuse large b-cell lymphoma (DLBCL) subtypes, primary testicular lymphoma (PTL) has one of the highest risks of central nervous system (CNS) relapse. The converse, primary CNS lymphoma (PCNSL) relapse outside the CNS is rare. Molecular analysis has illustrated a genetic similarity between PTL and PCNSL. Here we present a case of a 64-year-old man with testicular relapse of PCNSL 20 months after a complete response to high dose methotrexate-based chemotherapy. His tumor demonstrated a molecular profile similar to both PCNSL and PTL on next generation sequencing, and molecular analysis confirmed common clonal origin of his CNS and testicular lesions. We review prior cases of testicular relapse of PCNSL, which lacked molecular investigations, and discuss the implications of the genomic findings in our patient, including future treatment options.
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Affiliation(s)
- Thomas A Ollila
- Alpert Medical School of Brown University, Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI
| | - Thomas P Kishkovich
- Division of Obstetrics and Gynecology, Brigham and Women's Hospital/Massachusetts General Hospital, Boston, MA
| | - Adam J Olszewski
- Alpert Medical School of Brown University; Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI
| | - Nimesh R Patel
- Alpert Medical School of Brown University; Department of Pathology, Rhode Island Hospital, Providence, RI
| | - Cynthia Jackson
- Alpert Medical School of Brown University; Department of Pathology, Rhode Island Hospital, Providence, RI
| | - Breton Roussel
- Alpert Medical School of Brown University; Division of Gastroenterology, Rhode Island Hospital, Providence, RI
| | - Rabin Niroula
- Alpert Medical School of Brown University; Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI
| | - Diana O Treaba
- Alpert Medical School of Brown University; Department of Pathology, Rhode Island Hospital, Providence, RI
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12
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Ollila TA, Masel RH, Reagan JL, Lu S, Rogers RD, Paiva KJ, Taher R, Burguera-Couce E, Zayac AS, Yakirevich I, Niroula R, Barth P, Olszewski AJ. Seroconversion and outcomes after initial and booster COVID-19 vaccination in adults with hematologic malignancies. Cancer 2022; 128:3319-3329. [PMID: 35811461 PMCID: PMC9349722 DOI: 10.1002/cncr.34354] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/04/2022] [Accepted: 05/25/2022] [Indexed: 12/15/2022]
Abstract
Background Patients with hematologic malignancies have impaired humoral immunity secondary to their malignancy and its treatment, placing them at risk of severe coronavirus disease‐19 (COVID‐19) infection and reduced response to vaccination. Methods The authors retrospectively analyzed serologic responses to initial and booster COVID‐19 vaccination in 378 patients with hematologic malignancy and subsequently tracked COVID‐19–related outcomes. Results Seroconversion occurred in 181 patients (48%) after initial vaccination; patients who had active malignancy or those who were recently treated with a B‐cell–depleting monoclonal antibody had the lowest rates of seroconversion. For initial nonresponders to vaccination, seroconversion after a booster dose occurred in 48 of 85 patients (56%). The seroconversion rate after the booster was similar for patients on (53%) and off (58%) active therapy (p = .82). Thirty‐three patients (8.8%) developed a COVID‐19 infection, and there were three COVID‐19–related deaths (0.8%). Although no significant association was observed between postvaccination seroconversion and the incidence of COVID‐19 infection, no patient with seroconversion died from COVID‐19, and no patient who received tixagevimab/cilgavimab (N = 25) was diagnosed with a COVID‐19 infection. Conclusions Booster vaccinations can promote seroconversion in a significant proportion of patients who are seronegative after the initial vaccination course regardless of the specific vaccine or on/off treatment status at the time of revaccination. Although postvaccination seroconversion may not be associated with a decrease in any (including asymptomatic) COVID‐19 infection, the authors' experience suggested that effective vaccination (including a booster), supplemented by passive immunization using tixagevimab/cilgavimab in case of lack of seroconversion, effectively eliminated the risk of COVID‐19 death in the otherwise high‐risk population. Lay summary Patients with hematologic malignancy, especially lymphoma, have an impaired response to coronavirus disease 2019 (COVID‐19) vaccination. In this single‐institution review, less than one half of the patients studied made detectable antibodies. For those who did not make detectable antibodies after initial vaccination, over one half (65%) were able to produce antibodies after booster vaccination. By the end of February 2022, 33 of the original 378 patients had a documented COVID‐19 infection. The only deaths from COVID‐19 were in those who had undetectable antibodies, and no patient who received prophylactic antibody therapy developed a COVID‐19 infection.
Hematologic malignancies and their treatments impaired humoral immunity from coronavirus disease 2019 vaccination, and booster vaccine overcame a lack of initial response in 58% of patients, including 63% those on active therapy. The findings indicated that booster vaccinations should be strongly encouraged; however, even with boosters, many remain unprotected, which should inform infection prevention and treatment strategies.
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Affiliation(s)
- Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Rebecca H Masel
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - John L Reagan
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Shaolei Lu
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ralph D Rogers
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Infectious Disease, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Kimberly J Paiva
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Rashida Taher
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ella Burguera-Couce
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adam S Zayac
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Inna Yakirevich
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Rabin Niroula
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Peter Barth
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
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13
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Orellana-Noia VM, Reed DR, McCook AA, Sen JM, Barlow CM, Malecek MK, Watkins M, Kahl BS, Spinner MA, Advani R, Voorhees TJ, Snow A, Grover NS, Ayers A, Romancik J, Liu Y, Huntington SF, Chavez JC, Saeed H, Lazaryan A, Raghunathan V, Spurgeon SE, Ollila TA, Del Prete C, Olszewski A, Ayers EC, Landsburg DJ, Echalier B, Lee J, Kamdar M, Caimi PF, Fu T, Liu J, David KA, Alharthy H, Law J, Karmali R, Shah H, Stephens DM, Major A, Rojek AE, Smith SM, Yellala A, Kallam A, Nakhoda S, Khan N, Sohail MA, Hill BT, Barrett-Campbell O, Lansigan F, Switchenko J, Cohen J, Portell CA. Single-route CNS prophylaxis for aggressive non-Hodgkin lymphomas: real-world outcomes from 21 US academic institutions. Blood 2022; 139:413-423. [PMID: 34570876 PMCID: PMC8777199 DOI: 10.1182/blood.2021012888] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [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: 06/14/2021] [Accepted: 09/05/2021] [Indexed: 01/22/2023] Open
Abstract
Prophylaxis is commonly used to prevent central nervous sy stem (CNS) relapse in diffuse large B-cell lymphoma (DLBCL), with no clear standard of care. We retrospectively evaluated 1162 adult patients across 21 US academic centers with DLBCL or similar histologies who received single-route CNS prophylaxis as part of frontline therapy between 2013 and 2019. Prophylaxis was administered intrathecally(IT) in 894 (77%) and using systemic high-dose methotrexate (HD-MTX) in 236 (20%); 32 patients (3%) switched route due to toxicity and were assessed separately. By CNS-International Prognostic Index (IPI), 18% were considered low-risk, 51% moderate, and 30% high. Double-hit lymphoma (DHL) was confirmed in 243 of 866 evaluable patients (21%). Sixty-four patients (5.7%) had CNS relapse after median 7.1 months from diagnosis, including 15 of 64 (23%) within the first 6 months. There was no significant difference in CNS relapse between IT and HD-MTX recipients (5.4% vs 6.8%, P = .4), including after propensity score matching to account for differences between respective recipient groups. Weighting by CNS-IPI, expected vs observed CNS relapse rates were nearly identical (5.8% vs 5.7%). Testicular involvement was associated with high risk of CNS relapse (11.3%) despite most having lower CNS-IPI scores. DHL did not significantly predict for CNS relapse after single-route prophylaxis, including with adjustment for treatment regimen and other factors. This large study of CNS prophylaxis recipients with DLBCL found no significant difference in CNS relapse rates between routes of administration. Relapse rates among high-risk subgroups remain elevated, and reconsideration of prophylaxis strategies in DLBCL is of critical need.
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Affiliation(s)
- Victor Manuel Orellana-Noia
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Daniel R Reed
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
- Comprehensive Cancer Center of Wake Forest University, Section on Hematology and Oncology, Winston-Salem, NC
| | - Ashley Alesia McCook
- Winship Cancer Institute, Department of Biostatistics, Emory University, Atlanta, GA
| | | | - Christian M Barlow
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Mary-Kate Malecek
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Marcus Watkins
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Brad S Kahl
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Michael A Spinner
- Division of Oncology, Stanford University Medical Center, Stanford, CA
| | - Ranjana Advani
- Division of Oncology, Stanford University Medical Center, Stanford, CA
| | - Timothy J Voorhees
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
- Division of Hematology, Ohio State University, Columbus, OH
| | - Anson Snow
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Natalie Sophia Grover
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Amy Ayers
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Jason Romancik
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Yuxin Liu
- Division of Hematology, Yale University, New Haven, CT
| | | | - Julio C Chavez
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Hayder Saeed
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | | | - Vikram Raghunathan
- Division of Hematology and Oncology, Oregon Health Sciences University, Portland, OR
- Division of Medical Oncology, University of Washington, Seattle, WA
| | - Stephen E Spurgeon
- Division of Hematology and Oncology, Oregon Health Sciences University, Portland, OR
| | - Thomas A Ollila
- Division of Hematology/Oncology, Brown University, Providence, RI
| | | | - Adam Olszewski
- Division of Hematology/Oncology, Brown University, Providence, RI
| | - Emily C Ayers
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Daniel J Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | - Jun Lee
- Division of Hematology, University of Colorado, Denver, CO
| | - Manali Kamdar
- Division of Hematology, University of Colorado, Denver, CO
| | - Paolo F Caimi
- Adult Hematologic Malignancies and Stem Cell Transplant Section, University Hospitals Seidman Cancer Center, Cleveland, OH
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Timothy Fu
- Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Jieqi Liu
- Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Kevin A David
- Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Hanan Alharthy
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD
| | - Jennie Law
- Division of Hematology and Oncology, University of Maryland Greenbaum Comprehensive Cancer Center, Baltimore, MD
| | - Reem Karmali
- Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Harsh Shah
- University of Utah/Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Ajay Major
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | | | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Amulya Yellala
- Department of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Avyakta Kallam
- Department of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE
| | | | - Nadia Khan
- Fox Chase Cancer Center, Philadelphia, PA; and
| | - Mohammad Ahsan Sohail
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Frederick Lansigan
- Division of Hematology and Oncology, Dartmouth Geisel School of Medicine, Hanover, NH
| | - Jeffrey Switchenko
- Winship Cancer Institute, Department of Biostatistics, Emory University, Atlanta, GA
| | - Jonathon Cohen
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Craig A Portell
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
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14
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Ollila TA, Lu S, Masel R, Zayac A, Paiva K, Rogers RD, Olszewski AJ. Antibody Response to COVID-19 Vaccination in Adults With Hematologic Malignant Disease. JAMA Oncol 2021; 7:1714-1716. [PMID: 34379085 DOI: 10.1001/jamaoncol.2021.4381] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island
| | - Shaolei Lu
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, Rhode Island
| | - Rebecca Masel
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adam Zayac
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island
| | - Kimberly Paiva
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, Rhode Island
| | - Ralph D Rogers
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.,Division of Infectious Disease, Rhode Island Hospital, Providence, Rhode Island
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island
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15
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Ollila TA, Olszewski AJ. Chemotherapy-Free Management of Follicular and Marginal Zone Lymphoma. Cancer Manag Res 2021; 13:3935-3952. [PMID: 34017197 PMCID: PMC8131013 DOI: 10.2147/cmar.s267258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
Many patients with follicular (FL) or marginal zone lymphoma (MZL) are not eligible to receive immunochemotherapy due to advanced age or comorbidities. Recent innovations in the treatment of these indolent lymphomas provide options for multiple lines of chemotherapy-free management. More research is needed to determine which older patients are best served by a chemotherapy-free approach in the context of geriatric vulnerabilities. In the first line, regardless of disease burden, rituximab monotherapy can provide high rates of disease control with minimal toxicity, while judicious use of brief maintenance extends the duration of response. Radioimmunotherapy using ibritumomab tiuxetan is an effective and safe post-rituximab consolidation for older patients who have <25% bone marrow involvement. The combination of rituximab and lenalidomide, although “chemotherapy-free”, does not improve tolerability over immunochemotherapy. However, studies support lower doses and shorter duration of lenalidomide exposure as a means to improve safety without materially compromising efficacy for older individuals. Extranodal MZL can often be effectively controlled with low-dose radiation therapy, and splenic MZL has excellent outcomes with rituximab monotherapy. For many patients with relapsed FL/MZL, simple retreatment with anti-CD20 antibodies will prove sufficient. Other currently available options for relapsed/refractory disease include ibritumomab tiuxetan, lenalidomide with rituximab, umbralisib as a potentially less toxic PI3K inhibitor, ibrutinib (for MZL), and tazemetostat (for FL, especially with EZH2 mutation). Emerging data with novel forms of immunotherapy (antibody-drug conjugates like polatuzumab vedotin or loncastuximab tesirine; T-cell-engaging bispecific antibodies like mosunetuzumab or epcoritamab; and chimeric antigen receptor CAR T-cells like axicabtagene ciloleucel) suggest that immune-directed approaches can produce very high and potentially durable responses in FL/MZL with limited toxicities, further obviating the need for chemotherapy.
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Affiliation(s)
- Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
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16
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Ollila TA, Kurt H, Waroich J, Vatkevich J, Sturtevant A, Patel N, Treaba DO, Dubielecka PM, Olszewski AJ. Abstract PO-38: Genomic subtypes correlate with the risk of central nervous system (CNS) recurrence in diffuse large B-cell lymphoma (DLBCL). Blood Cancer Discov 2020. [DOI: 10.1158/2643-3249.lymphoma20-po-38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Clinicopathologic features are poor at predicting the risk of CNS relapse after initial treatment in DLBCL, or at guiding CNS prophylactic therapy. However, mutational profiles may correlate with primary extranodal disease, including primary CNS lymphoma (Ollila T, Curr Treat Options Oncol 2018). We hypothesized that specific genomic profiles in DLBCL would also correlate with CNS relapse or with systemic-only (non-CNS) relapse. We examined 26 DLBCLs with CNS-only (n=13) or systemic-only relapse (n=13) using a 592 gene next-generation sequencing (NGS) assay (Illumina NextSeq, average coverage depth >750x; Caris Life Sciences) performed on formalin-fixed tissue. We also determined cell of origin (COO) by IHC; MYC/BCL2/BCL6 rearrangements by FISH, and karyotype by cytogenetics. We used the novel LymphGen genomic DLBCL classifier (Wright GW, Cancer Cell 2020) to group tumors into the MCD, ST2, EZB, BN2, and A53 subtypes. We then constructed a simplified hierarchical classifier (hc) usable with common clinical multigene NGS panels to identify 3 relevant subtypes: (1) hc-MCD subtype (defined as MYD88L265P or >2 mutations in CD79B, PIM1, ETV6, BTG1, TBL1XR1, or PRDM1), (2) hc-TP53 subtype characterized by TP53 mutations +/- complex karyotype, and (3) hc-GCB subtype with ≥2 mutations in BCL2, CREBBP, EZH2, KMT2D, TNFRSF14, GNA13, MEF2B, or PTEN. We compared prevalence of these subtypes between our groups and a reference dataset of unselected DLBCL tumors combining data from Chapuy (Nat Medicine 2018; n=135; dbGaP phs000450) and Reddy (Cell 2018; n=1001; EGA: EGAS00001002606). There was no difference between DLBCL with CNS-only or systemic recurrence in any standard clinicopathologic characteristics, including COO, FISH, or karyotype. The LymphGen MCD subtype was significantly more frequent in DLBCL with CNS-only relapse compared with reference datasets (39% vs. 7%, P=.001), but not in DLBCL with systemic relapse (P=.05). Conversely, the ST2 subtype was more frequent in DLBCL with systemic relapse (23% vs. 3%, P=.010) and completely absent in CNS relapse (0%). The A53 or EZB subtypes did not significantly differ between any groups. The simplified NGS classifier identified 96% of LymphGen MCD cases and 100% of A53 cases. The hc-MCD subtype was also significantly associated with CNS relapse (46% vs. 18%, P=.018) but not with systemic relapse (P=.26), whereas hc-TP53 and hc-GCB subtypes did not differ from the reference dataset (P=.15 and P=.70, respectively). Our data demonstrate that the MCD DLBCL subtype is specifically associated with the risk of CNS relapse. Full molecular classification of DLBCL is not yet incorporated into current clinical practice, as it requires integration of single nucleotide, structural chromosomal variants, and copy alterations. We show that a meaningful molecular predictor signature for the MCD subtype can be obtained from clinically validated multigene NGS assays. If validated, this signature may prove useful for selecting patients for CNS-directed prophylactic therapy.
Citation Format: Thomas A. Ollila, Habibe Kurt, Jozal Waroich, John Vatkevich, Ashlee Sturtevant, Nimesh Patel, Diana O. Treaba, Patrycja M. Dubielecka, Adam J. Olszewski. Genomic subtypes correlate with the risk of central nervous system (CNS) recurrence in diffuse large B-cell lymphoma (DLBCL) [abstract]. In: Proceedings of the AACR Virtual Meeting: Advances in Malignant Lymphoma; 2020 Aug 17-19. Philadelphia (PA): AACR; Blood Cancer Discov 2020;1(3_Suppl):Abstract nr PO-38.
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Affiliation(s)
- Thomas A. Ollila
- 1Warren Alpert Medical School of Brown University, Providence, RI,
| | - Habibe Kurt
- 2Molecular Pathology, Rhode Island Hospital, Providence, RI,
| | | | | | | | - Nimesh Patel
- 2Molecular Pathology, Rhode Island Hospital, Providence, RI,
| | - Diana O. Treaba
- 1Warren Alpert Medical School of Brown University, Providence, RI,
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17
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Olszewski AJ, Chorzalska A, Kurt H, Ollila TA, Treaba DO, Hsu A, Zayac A, Reagan JL, Sahin I, Rafelson W, Egan PC, Robison J, Vatkevich J, Mullins CD, Petersen M, Dubielecka PM. Abstract PO-27: Clonotypic cell-free DNA (cfDNA) in the cerebrospinal fluid (CSF) of patients with aggressive lymphomas. Blood Cancer Discov 2020. [DOI: 10.1158/2643-3249.lymphoma20-po-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Current methods for detection of CNS involvement in lymphoma (CSF cytology, flow cytometry) have very limited sensitivity, particularly in cases of parenchymal brain involvement. Early detection is critical to institute CNS-directed therapy and avert dismal outcomes of overt CNS recurrence. Clonotype-specific cfDNA can be detected in the plasma of patients with lymphoma using next-generation sequencing (NGS), and cfDNA-based minimal residual disease (MRD) assay can predict impending recurrence (Roschewski, Lancet Oncol 2015). cfDNA has not been systematically evaluated in the CSF, yet it may hold promise as a sensitive and specific method to detect CNS invasion. To evaluate the ability of an NGS-MRD assay in CSF to detect CNS invasion, we examined CSF and plasma samples from patients with aggressive lymphomas who either had overt CNS disease or who were without known CNS invasion, but at high clinical risk. Genomic DNA from primary tumors was analyzed for tumor-specific clonotype using NGS of rearranged IGK, IGH (VJ or DJ), or IGL loci (Adaptive Biotechnologies; Carlson, Nat Commun 2013). Tumor-specific clonotypes from each case were selected for subsequent tracking by NGS-MRD in CSF and plasma samples. Clonotype copy numbers are expressed per mL for acellular CSF, and clonotype frequency per all B cells. NGS identified median 3 (range, 2-7) dominant immunoglobulin sequences in each primary lymphoma (N=16), with median dominant clonotype frequency 50.3% (range, 26.8-9.28%). In the CSF, the NGS-MRD assay detected the dominant clonotype in 9 out of 16 samples, including all (N=4) with overt CNS invasion (sensitivity=100%), of which 2 had parenchymal disease only with negative CSF cytology, flow cytometry, or IGH PCR. Median detectable cfDNA clonotype in the CSF was 1,077 copies per mL (range, 2-5,620), with median clonotype frequency of 28.4% (range, 0.1-98.5%). cfDNA copy counts were significantly higher in cases with positive CSF cytology than those with parenchymal or clinically occult disease (P=.0016). We observed no significant correlation between the red blood cell count in the CSF and the cfDNA clonotype concentration (P=0.73) or frequency (P=0.62), suggesting that the presence of cfDNA in the CSF was not due to contamination by blood plasma. There was also no evident correlation between cfDNA in plasma and CSF. Within median 11 months of follow-up, 1 of 4 patients (25%) with a positive CSF NGS-MRD assay and no CNS disease developed a fatal CNS recurrence. Our results suggest that NGS-MRD assay for cfDNA in the CSF can identify intraparenchymal or leptomeningeal CNS invasion with high sensitivity, including cases not identifiable by traditional methods. Prognostic significance of detecting lymphoma-specific cfDNA in the CSF of high-risk patients without overt CNS disease will be explored in a larger sample. Pretreatment NGS-MRD assay could be prospectively tested to predict the risk of CNS recurrence and potentially enable more accurate selection of patients for CNS prophylaxis therapy.
Citation Format: Adam J. Olszewski, Anna Chorzalska, Habibe Kurt, Thomas A. Ollila, Diana O. Treaba, Andrew Hsu, Adam Zayac, John L. Reagan, Ilyas Sahin, William Rafelson, Pamela C. Egan, Jordan Robison, John Vatkevich, Chelsea D. Mullins, Max Petersen, Patrycja M. Dubielecka. Clonotypic cell-free DNA (cfDNA) in the cerebrospinal fluid (CSF) of patients with aggressive lymphomas [abstract]. In: Proceedings of the AACR Virtual Meeting: Advances in Malignant Lymphoma; 2020 Aug 17-19. Philadelphia (PA): AACR; Blood Cancer Discov 2020;1(3_Suppl):Abstract nr PO-27.
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Affiliation(s)
| | | | - Habibe Kurt
- 1Alpert Medical School of Brown University, Providence, RI,
| | | | | | | | | | - John L. Reagan
- 1Alpert Medical School of Brown University, Providence, RI,
| | - Ilyas Sahin
- 1Alpert Medical School of Brown University, Providence, RI,
| | | | - Pamela C. Egan
- 1Alpert Medical School of Brown University, Providence, RI,
| | | | | | | | - Max Petersen
- 1Alpert Medical School of Brown University, Providence, RI,
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Zayac AS, Hilliard RW, Olszewski AJ, Pelcovits A, Reagan JL, Hsu A, Riley D, Austin M, Ollila TA. Enforcing the "4T": An In-Line Calculator for HIT Antibody Ordering in the Electronic Medical Record. R I Med J (2013) 2020; 103:78-83. [PMID: 33003686] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Heparin-induced thrombocytopenia (HIT) remains a difficult clinical diagnosis, even with the under-utilized standardized scoring systems, like the '4T' score, to aid in clinical decision-making. Our quality improvement study sought to assess the use of '4T' score, improve the use of HIT antibody (HITA) testing and improvement management of possible HIT by implementing an in-line calculator with guidance within our electronic medical record (EMR) at our institution. We retrospectively reviewed patient charts between October 2017 and October 2018, assessing practices before and after implementation of the '4T' in-line calculator in April 2018. HITA were ordered inappropriately (for 4T <4) in 141 (67%) of 210 instances (75 before and 66 after). We found no statistically significant difference in positive predictive value (PPV) or 4T documentation in provider notes after its implementation. We were able to identify problematic areas in HIT management, such as the ordering of non-heparin anticoagulants, and implement additional changes addressing these problems.
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Affiliation(s)
- Adam S Zayac
- The Warren Alpert Medical School of Brown University, Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI
| | - Ross W Hilliard
- The Warren Alpert Medical School of Brown University, Division of General Internal Medicine, Rhode Island Hospital, Providence, RI
| | - Adam J Olszewski
- The Warren Alpert Medical School of Brown University, Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI
| | - Aryeh Pelcovits
- The Warren Alpert Medical School of Brown University, Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI
| | - John L Reagan
- The Warren Alpert Medical School of Brown University, Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI
| | - Andrew Hsu
- The Warren Alpert Medical School of Brown University, Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI
| | - David Riley
- The Warren Alpert Medical School of Brown University, Division of General Internal Medicine, Rhode Island Hospital, Providence, RI
| | - Matthew Austin
- The Warren Alpert Medical School of Brown University, Division of General Internal Medicine, Rhode Island Hospital, Providence, RI
| | - Thomas A Ollila
- The Warren Alpert Medical School of Brown University, Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI
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Bakow BR, Elco CP, LeGolvan M, Dizon D, Ollila TA. Molecular Profiles of Brain and Pulmonary Metastatic Disease in Cancer of Unknown Primary. Oncologist 2020; 25:555-559. [PMID: 32310333 DOI: 10.1634/theoncologist.2019-0798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/03/2020] [Indexed: 11/17/2022] Open
Abstract
Cancers of unknown primary (CUP) are histologically confirmed malignancies but for which further investigation cannot identify a primary site. Improvements in histopathologic modalities for diagnosis have lessened the frequency of CUPs to 3%-5% of all malignancies compared with historical estimates of 5%-10%. Despite this, there is an ongoing debate as to whether CUPs are malignancies where the primary is not found or if they are otherwise a fully separate entity. Improvements in molecular analysis holds promise for improved identification and treatment of CUPs with mixed preliminary results. Here we present a woman with CUP and metastases in her brain and lung. We performed genomic profiling to compare the molecular makeup of each site in order to establish treatment targets. KEY POINTS: Cancer of unknown primary remains a diagnostic and therapeutic challenge. Molecular analysis may provide improvements in diagnosis and novel treatment options. Different sites of metastatic disease have subtle variations in molecular profile. Sequencing of different sites may offer therapeutic options that are either already approved or available in clinical trial.
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Affiliation(s)
- Brianna R Bakow
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Division of Internal Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Christopher P Elco
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Division of Pathology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Mark LeGolvan
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Division of Pathology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Don Dizon
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Division of Hematology and Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Thomas A Ollila
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Division of Hematology and Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
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Di M, Ollila TA, Olszewski AJ. Exposure to ibritumomab tiuxetan and incidence of treatment-related myeloid neoplasms among older patients with B-cell lymphoma: a population-based study. Leukemia 2020; 34:2794-2797. [PMID: 32203140 DOI: 10.1038/s41375-020-0798-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Mengyang Di
- Department of Medicine, Rhode Island Hospital, Providence, RI, USA.,The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Thomas A Ollila
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Adam J Olszewski
- The Warren Alpert Medical School of Brown University, Providence, RI, USA. .,Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA.
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Ollila TA, Reagan JL, Olszewski AJ. Clinical features and survival of patients with T-cell/histiocyte-rich large B-cell lymphoma: analysis of the National Cancer Data Base. Leuk Lymphoma 2019; 60:3426-3433. [PMID: 31287335 DOI: 10.1080/10428194.2019.1639166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Using data from the National Cancer Data Base, 2010-2015, we examined characteristics and outcomes of T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL, N = 622) relative to unspecified diffuse large B-cell lymphoma (DLBCL-NOS, N = 91,588) and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL, N = 2240). Socio-demographic characteristics of patients with THRLBCL resembled more NLPHL than DLBCL-NOS. Five-year overall survival in THRLBCL was 66% (95% confidence interval [CI], 60-71%). Adjusting for clinical and socio-economic covariates, THRLBCL was associated with better survival than DLBCL-NOS (adjusted hazard ratio, 0.80; 95%CI, 0.67-0.94). This association was similar in academic and community hospitals and consistent in a model stratified by the revised International Prognostic Index. Prognostic factors in THRLBCL included age, comorbidity index, and extranodal primary site, but not stage. Adjusted odds of prior NLPHL were 18.2 higher for THRLBCL (95%CI, 7.2-45.7) than DLBCL-NOS. These large-scale epidemiologic data support the relationship between THRLBCL and NLPHL, and suggest improved prognosis with modern rituximab-based immunochemotherapy.
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Affiliation(s)
- Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI, USA
| | - John L Reagan
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI, USA
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Abstract
Cutaneous T-cell lymphoma (CTCL) poses unique treatment challenges, given its range of presentations and numerous systemic therapy options. These options often lack comparative evidence or are characterized by low response rates and short remission duration in relapsed/refractory disease. The approval of mogamulizumab, a humanized, glycoengineered IgG1κ monoclonal antibody targeting the chemokine receptor type 4 (CCR4) chemokine receptor, brings a novel tool into the spectrum of treatment options for advanced CTCL and adult T-cell leukemia/lymphoma (ATLL). CCR4 is expressed in almost all cases of ATLL, and in a majority of CTCLs, particularly when blood involvement is present. In a Phase III randomized trial, mogamulizumab was associated with 28% overall response rate among patients with relapsed CTCL, median progression-free survival of 7.7 months, and median duration of remission of 14.1 months. Responses are more frequent among patients with Sézary syndrome and within the blood compartment. Common adverse effects include rash and infusion reactions, which are usually low grade. Sentinel reports indicate that exposure to mogamulizumab may result in severe or refractory graft vs host disease after allogeneic bone marrow transplantation, highlighting the need for vigilance and expert management. Further research may establish incremental efficacy of combining mogamulizumab with cytotoxic or immunomodulatory agents in CTCL, ATLL, and possibly other lymphomas and even solid tumors.
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Affiliation(s)
- Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA, .,Department of Medicine, Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA,
| | - Ilyas Sahin
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA, .,Department of Medicine, Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA,
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA, .,Department of Medicine, Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA,
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Affiliation(s)
- Thomas A Ollila
- a Department of Medicine, Alpert Medical School of Brown University , Providence , RI, USA.,b Division of Hematology and Oncology , Rhode Island Hospital , Providence , RI, USA
| | - Adam J Olszewski
- a Department of Medicine, Alpert Medical School of Brown University , Providence , RI, USA.,b Division of Hematology and Oncology , Rhode Island Hospital , Providence , RI, USA
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Ollila TA, Olszewski AJ, Butera JN, Quesenberry MI, Quesenberry PJ, Reagan JL. Marrow Hypocellularity, But Not Residual Blast Count or Receipt of Reinduction Chemotherapy, Is Prognostic on Day-14 Assessment in Acute Myeloid Leukemia Patients With Morphologic Residual Disease. Clinical Lymphoma Myeloma and Leukemia 2018; 18:204-209. [DOI: 10.1016/j.clml.2018.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/24/2018] [Indexed: 11/28/2022]
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