1
|
Kittai AS, Allan JN, James D, Bridge H, Miranda M, Yong AS, Fam F, Roos J, Shetty V, Skarbnik AP, Davids MS. An indirect comparison of acalabrutinib with and without obinutuzumab versus zanubrutinib in treatment-naive CLL. Blood Adv 2024:bloodadvances.2023012142. [PMID: 38598745 DOI: 10.1182/bloodadvances.2023012142] [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: 11/15/2023] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/12/2024] Open
Abstract
The efficacy and safety of acalabrutinib plus obinutuzumab and acalabrutinib monotherapy versus zanubrutinib in patients with treatment-naive chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) without del(17p) were compared using an unanchored matching-adjusted indirect comparison. Individual patient-level data (IPD) from ELEVATE-TN (acalabrutinib plus obinutuzumab, n = 162; acalabrutinib monotherapy, n = 163) were weighted to match published aggregate baseline data from SEQUOIA cohort 1, which excluded patients with del(17p) (zanubrutinib, n = 241), using variables that were prognostic/predictive of investigator-assessed progression-free survival (INV-PFS) in an exploratory Cox regression analysis of ELEVATE-TN. Post-matching, INV-PFS was longer with acalabrutinib plus obinutuzumab (hazard ratio [HR]: 0.41; 95% CI: 0.23-0.74) and comparable with acalabrutinib monotherapy (HR: 0.91; 95% CI: 0.53-1.56) versus zanubrutinib. Acalabrutinib monotherapy had significantly lower odds of any grade hypertension versus zanubrutinib (OR: 0.44, 95% CI: 0.20-0.99), while acalabrutinib plus obinutuzumab had significantly higher odds of neutropenia (odds ratio [OR]: 2.19; 95% CI: 1.33-3.60) and arthralgia (OR: 2.33; 95% CI: 1.37-3.96) versus zanubrutinib. No other significant differences in safety were observed. In summary, compared with zanubrutinib, acalabrutinib plus obinutuzumab had longer INV-PFS with increased odds of neutropenia and arthralgia, whereas acalabrutinib monotherapy had similar INV-PFS with lower odds of any grade hypertension.
Collapse
Affiliation(s)
- Adam S Kittai
- The Ohio State University, Columbus, Ohio, United States
| | - John N Allan
- Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York, United States
| | - Dan James
- Polaris Biostatistics Ltd, Edinburgh, United Kingdom
| | | | | | - Alan Sm Yong
- AstraZeneca, Gaithersburg, Maryland, United States
| | - Fady Fam
- AstraZeneca, Cambridge, United Kingdom
| | - Jack Roos
- AstraZeneca, Gaithersburg, Maryland, United States
| | | | | | - Matthew S Davids
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| |
Collapse
|
2
|
Bajwa A, Habib A, Kittai AS. Treatment of Richter's Transformation with Novel Therapies. Curr Hematol Malig Rep 2024; 19:45-55. [PMID: 38194201 PMCID: PMC10894755 DOI: 10.1007/s11899-023-00721-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW This review presents recently published clinical trial data and ongoing investigations regarding the treatment of Richter's transformation (RT). RECENT FINDINGS Recently, numerous approaches have been investigated for the treatment of RT including: traditional chemoimmunotherapy regimens combined with targeted agents such as BTKi and BCL2i; immunotherapy combined with targeted agents; non-covalent BTKis; bispecific T cell engagers; and CART therapy. In addition, various novel targeted agents are currently being studied for the treatment of RT in phase 1 and 2 clinical trials. Standard of care treatment with chemoimmunotherapy for RT has limited efficacy in achieving durable remissions. Here, we review recent data on the use of combination treatments and targeted agents in RT. Although some progress has been made in the investigation to optimize treatment of RT, further study is needed to evaluate long term outcomes of recently published trials and test efficacy of upcoming novel agents.
Collapse
Affiliation(s)
- Amneet Bajwa
- The Ohio State University, 2121 Kenney Road, Columbus, OH, 43210, USA
| | - Alma Habib
- The Ohio State University, 2121 Kenney Road, Columbus, OH, 43210, USA
| | - Adam S Kittai
- The Ohio State University, 2121 Kenney Road, Columbus, OH, 43210, USA.
| |
Collapse
|
3
|
Kittai AS, Hang Y, Bhat SA, Clark A, Grever M, Rhodes JM, Roberts M, Rogers KA, Teschemaker A, Munoz-Sagastibelza M, Woyach JA, Barrientos JC. Racial disparities in chronic lymphocytic leukemia/small lymphocytic lymphoma accounting for small molecule inhibitors: A real-world cohort analysis. Am J Hematol 2024; 99:780-784. [PMID: 38357757 DOI: 10.1002/ajh.27241] [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: 11/26/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/16/2024]
Abstract
Kaplan-Meier curve depicting overall survival from CLL treatment start by race. For patients with CLL, no overall survival difference was observed between races in this real-world US database.
Collapse
Affiliation(s)
- Adam S Kittai
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Ying Hang
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Seema A Bhat
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Abi Clark
- US Medical Affairs, AstraZeneca Pharmaceuticals, Gaithersburg, Maryland, USA
| | - Michael Grever
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Joanna M Rhodes
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Melyssa Roberts
- US Medical Affairs, AstraZeneca Pharmaceuticals, Gaithersburg, Maryland, USA
| | - Kerry A Rogers
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Anna Teschemaker
- Global Evidence Generation, AstraZeneca Pharmaceuticals, Gaithersburg, Maryland, USA
| | | | - Jennifer A Woyach
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Jacqueline C Barrientos
- Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
- Mount Sinai Comprehensive Cancer Center, Miami, Florida, USA
| |
Collapse
|
4
|
Denlinger N, Song NJ, Zhang X, Jeon H, Peterson C, Wang Y, Reynolds K, Bolz R, Miao J, Song C, Wu D, Chan WK, Bezerra ED, Epperla N, Voorhees TJ, Brammer JE, Kittai AS, Bond DA, Sawalha Y, Sigmund AM, Reneau JC, Rubinstein MP, Hanel W, Christian B, Baiocchi RA, Maddocks KJ, Alinari L, Vasu S, de Lima M, Chung D, Jaglowski SM, Li Z, Huang X, Yang Y. Post-infusion PD-1+CD8+CAR-T cells identify patients responsive to CD19-CAR-T therapy in non-Hodgkin's lymphoma. Blood Adv 2024:bloodadvances.2023012073. [PMID: 38607381 DOI: 10.1182/bloodadvances.2023012073] [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: 10/30/2023] [Revised: 03/01/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
Chimeric antigen receptor T cell therapy (CAR-T) has revolutionized treatment for relapsed/refractory (r/r) B-cell non-Hodgkin's lymphoma (NHL). Robust biomarkers and a complete understanding of CAR-T cell function in the post-infusion phase remain limited. Here we used a 37-color spectral flow cytometry panel to perform high dimensional single cell analysis of post-infusion samples in 26 patients treated with CD28 co-stimulatory domain containing commercial CAR-T (CD28-CAR-T) for NHL and focused on computationally gated CD8+ CAR-T cells. We found that the presence of post-infusion PD-1+ CD8+ CAR-T cells at the Day 14 timepoint highly correlated with the ability to achieve complete response (CR) by 6 months. Further analysis identified multiple subtypes of CD8+ PD-1+ CAR-T cells including PD-1+ TCF1+ stem-like CAR-T cells and PD-1+ TIM3+ effector-like CAR-T cells that correlated with improved clinical outcomes such as response and progression free survival. Additionally, we identified a subset of PD-1+ CD8+ CAR+ T cells with effector-like function that was increased in patients who achieved a CR and was associated with Grade 3 or higher immune effector cell-associated neurotoxicity syndrome. Here we identified robust biomarkers of response to CD28-CAR-T and highlight the importance of PD-1 positivity in CD8+ CAR-T cells post-infusion in achieving CR.
Collapse
Affiliation(s)
| | - No-Joon Song
- The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Xiaoli Zhang
- The Ohio State University, Columbus, United States
| | | | | | - Yi Wang
- The Ohio State University, Columbus, Ohio, United States
| | - Kelsi Reynolds
- The Ohio State University, Columbuis, Ohio, United States
| | - Robert Bolz
- The Ohio State University, Columbus, Ohio, United States
| | - Jessica Miao
- The Ohio State University, Columbus, Ohio, United States
| | - Chunhua Song
- Division of Hematology, Internal Medicine, Ohio State University, Columbus, Ohio, United States
| | - Dayong Wu
- The Ohio State University, Columbus, Ohio, United States
| | | | | | | | | | | | - Adam S Kittai
- The Ohio State University, Columbus, Ohio, United States
| | - David A Bond
- The Ohio State University, Columbus, Ohio, United States
| | - Yazeed Sawalha
- The Ohio State University, Columbus, Ohio, United States
| | - Audrey M Sigmund
- Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - John C Reneau
- The Ohio State University, Columbus, Ohio, United States
| | - Mark P Rubinstein
- The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Walter Hanel
- The Ohio State University, Columbus, Ohio, United States
| | - Beth Christian
- The Ohio State University, Columbus, Ohio, United States
| | | | | | - Lapo Alinari
- The Ohio State University, Columbus, Ohio, United States
| | - Sumithira Vasu
- The Ohio State University, Columbus, Ohio, United States
| | - Marcos de Lima
- The Ohio State University, Columbus, Ohio, United States
| | - Dongjun Chung
- The Ohio State University, Columbus, Ohio, United States
| | | | - Zihai Li
- The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Xiaopei Huang
- The Ohio State University, Columbus, Ohio, United States
| | - Yiping Yang
- The Ohio State University, Columbus, Ohio, United States
| |
Collapse
|
5
|
Avenarius MR, Huang Y, Kittai AS, Bhat SA, Rogers KA, Grever MR, Woyach JA, Miller CR. Comparison of karyotype scoring guidelines for evaluating karyotype complexity in chronic lymphocytic leukemia. Leukemia 2024; 38:676-678. [PMID: 38374409 DOI: 10.1038/s41375-024-02177-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Affiliation(s)
| | - Ying Huang
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Adam S Kittai
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Seema A Bhat
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Kerry A Rogers
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Michael R Grever
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Jennifer A Woyach
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Cecelia R Miller
- Department of Pathology, The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
6
|
Teierle SM, Huang Y, Kittai AS, Bhat SA, Grever M, Rogers KA, Zhao W, Jones D, Byrd JC, Avenarius MR, Heerema NA, Woyach JA, Miller CR. Characteristics and outcomes of patients with CLL and CDKN2A/B deletion by fluorescence in situ hybridization. Blood Adv 2023; 7:7239-7242. [PMID: 37851900 PMCID: PMC10698542 DOI: 10.1182/bloodadvances.2023010753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/14/2023] [Accepted: 10/07/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Samantha M. Teierle
- Division of Hematology, Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Ying Huang
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Adam S. Kittai
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Seema A. Bhat
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Michael Grever
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Kerry A. Rogers
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Weiqiang Zhao
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Daniel Jones
- Department of Pathology, The Ohio State University, Columbus, OH
| | - John C. Byrd
- Department of Internal Medicine, The University of Cincinnati, Cincinnati, OH
| | | | - Nyla A. Heerema
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Jennifer A. Woyach
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | | |
Collapse
|
7
|
Kittai AS, Skarbnik A, Miranda M, Yong ASM, Roos J, Hettle R, Palazuelos-Munoz S, Shetty V, Ghia P. A matching-adjusted indirect comparison of acalabrutinib versus zanubrutinib in relapsed or refractory chronic lymphocytic leukemia. Am J Hematol 2023; 98:E387-E390. [PMID: 37811799 DOI: 10.1002/ajh.27110] [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: 05/26/2023] [Revised: 09/01/2023] [Accepted: 09/09/2023] [Indexed: 10/10/2023]
Abstract
Video Abstract
Collapse
Affiliation(s)
- Adam S Kittai
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Alan Skarbnik
- Novant Health Cancer Institute, Lymphoma and Chronic Lymphocytic Leukemia Program, Charlotte, North Carolina, USA
| | | | | | - Jack Roos
- AstraZeneca, Gaithersburg, Maryland, USA
| | - Robert Hettle
- AstraZeneca, Cambridge Biomedical Campus, Cambridge, UK
| | | | | | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| |
Collapse
|
8
|
Epperla N, Feng L, Shah NN, Fitzgerald L, Shah H, Stephens DM, Lee CJ, Ollila T, Shouse G, Danilov AV, David KA, Torka P, Hashmi H, Hess B, Barta SK, Romancik JT, Cohen JB, Annunzio K, Kittai AS, Reneau J, Zurko J, Nizamuddin IA, Winter JN, Gordon LI, Ma S, Patel R, Nastoupil L, Ahmed S, Karmali R. Outcomes of patients with secondary central nervous system lymphoma following CAR T-cell therapy: a multicenter cohort study. J Hematol Oncol 2023; 16:111. [PMID: 37946255 PMCID: PMC10633964 DOI: 10.1186/s13045-023-01508-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
Chimeric antigen receptor T-cell therapy (CAR-T) has been successful in treating relapsed/refractory B-cell lymphomas. However, its role in the treatment of diseases involving the central nervous system (CNS) is not well studied. We performed a multicenter retrospective cohort study to evaluate the outcomes of patients with secondary CNS lymphoma (SCNSL) who received CAR-T. Eligibility required active CNSL at the time of apheresis. The objectives included evaluation of overall survival (OS), progression-free survival (PFS), identification of predictors of complete response (CR) post-CAR-T, and assessment of risk factors for cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Sixty-one patients were included in the analysis. The overall response rate was 68% with a CR rate of 57%. In the multivariable analysis, patients who experienced any grade CRS had higher odds of achieving CR (OR = 3.9, 95% CI = 1.01-15.39, p = 0.047). The median PFS was 3.3 months (95% CI = 2.6-6.0 months) with 6- and 12-month PFS rates of 35% and 16%, respectively. The median OS was 7.6 months (95% CI = 5.0-13.5 months) with 6- and 12-month OS rates of 59% and 41%, respectively. Any grade CRS and ICANS were 70% (n = 43) and 57% (n = 34), respectively with grade ≥ 3 CRS and ICANS rates of 16% and 44%. Factors associated with increased risk of CRS and ICANS included receiving axi-cel or having leptomeningeal ± parenchymal + CNS involvement, respectively. Despite achieving high response rates, most patients experience early relapse or death following CAR-T in SCNSL. The current study provides a benchmark for future trials exploring novel therapeutic options in SCNSL.
Collapse
Affiliation(s)
- Narendranath Epperla
- Division of Hematology, Department of Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, 43210, USA.
| | - Lei Feng
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nirav N Shah
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Harsh Shah
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Catherine J Lee
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Fred Hutchinson Cancer Center, University of Washington Medical Center, Seattle, WA, USA
| | - Thomas Ollila
- Lifespan Cancer Institute, Brown University, Providence, RI, USA
| | | | | | - Kevin A David
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pallawi Torka
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Hamza Hashmi
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Brian Hess
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Stefan K Barta
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Kaitlin Annunzio
- Division of Hematology, Department of Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, 43210, USA
| | - Adam S Kittai
- Division of Hematology, Department of Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, 43210, USA
| | - John Reneau
- Division of Hematology, Department of Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, 43210, USA
| | - Joanna Zurko
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Imran A Nizamuddin
- Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Jane N Winter
- Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Leo I Gordon
- Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Shuo Ma
- Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Romil Patel
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sairah Ahmed
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Reem Karmali
- Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| |
Collapse
|
9
|
Gordon MJ, Bond DA, Kittai AS, Amirmokhtari N, Steinbrunner A, Huffman A, Orellana-Noia V, Shouse G, Cohen JB, Phillips T, Danilov AV. TRES, a validated three-factor comorbidity score, is associated with survival in older patients with mantle cell lymphoma. Haematologica 2023; 108:3110-3114. [PMID: 37226703 PMCID: PMC10620592 DOI: 10.3324/haematol.2023.283074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/06/2023] [Indexed: 05/26/2023] Open
Affiliation(s)
- Max J Gordon
- University of Texas M.D. Anderson Cancer Center, Houston, TX.
| | - David A Bond
- Ohio State University, James Cancer Center, Columbus, OH
| | - Adam S Kittai
- Ohio State University, James Cancer Center, Columbus, OH
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Avenarius MR, Huang Y, Hyak J, Byrd JC, Bhat SA, Grever M, Kittai AS, Rogers KA, Jones D, Zhao W, Heerema NA, Abruzzo LV, Woyach J, Miller CR. Refining prognosis in chronic lymphocytic leukemia with normal Fluorescence in situ hybridization results. Hematol Oncol 2023; 41:771-775. [PMID: 37010242 DOI: 10.1002/hon.3134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Fluorescence in situ hybridization (FISH) to detect the recurrent cytogenetics abnormalities deletion 13q, trisomy 12, deletion 11q, and deletion 17p is important for prognostication in chronic lymphocytic leukemia (CLL). A subset of patients are negative for each of these abnormalities (normal 12/13/11/17 FISH), and outcomes are heterogenous within this group. To elucidate variables important for prognostication in this subgroup we conducted a retrospective analysis of 280 treatment-naïve CLL patients with normal standard CLL FISH results. In a multivariable model, advanced Rai stage (p = 0.04, hazard ratio [HR] 1.24 (95% confidence interval [CI] 1.01-1.53)), unmutated immunoglobulin heavy chain gene (IGHV) (p < 0.0001, HR 5.59 (95% CI 3.63-8.62)) and IGH rearrangement by FISH (p = 0.02, HR 2.56 (95% CI 1.20-5.48)) were significantly associated with shorter time to first treatment. In a multivariable model for overall survival, increasing age at 5-year increments (p < 0.0001, HR 1.55 (95% CI 1.25-1.93)), unmutated IGHV (p = 0.01, HR 5.28 (95% CI 1.52-18.35)) and gain of REL (p = 0.01, HR 4.08 (5% CI 1.45-11.49)) were significantly associated with shorter survival. Our study identifies variables important for refining prognosis for CLL patients with normal standard CLL FISH results.
Collapse
Affiliation(s)
- Matthew R Avenarius
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Ying Huang
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jonathan Hyak
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - John C Byrd
- Department of Internal Medicine, The University of Cincinnati, Cincinnati, Ohio, USA
| | - Seema A Bhat
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Michael Grever
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Adam S Kittai
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Kerry A Rogers
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Dan Jones
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Weiqiang Zhao
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Nyla A Heerema
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Lynne V Abruzzo
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer Woyach
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Cecelia R Miller
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
11
|
Quartermaine C, Ghazi SM, Yasin A, Awan FT, Fradley M, Wiczer T, Kalathoor S, Ferdousi M, Krishan S, Habib A, Shaaban A, Kola-Kehinde O, Kittai AS, Rogers KA, Grever M, Ruz P, Bhat S, Dickerson T, Byrd JC, Woyach J, Addison D. Cardiovascular Toxicities of BTK Inhibitors in Chronic Lymphocytic Leukemia: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2023; 5:570-590. [PMID: 37969643 PMCID: PMC10635896 DOI: 10.1016/j.jaccao.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 11/17/2023] Open
Abstract
Over the past decade, the treatment landscape of chronic lymphocytic leukemia (CLL) has dramatically changed, shifting from cytotoxic chemotherapy to targeted therapies. Bruton's tyrosine kinase (BTK) inhibitors have revolutionized the treatment of CLL and are increasingly applied in many other malignancies. However, ibrutinib, the first BTK inhibitor approved, is associated with serious toxicities, including atrial fibrillation in up to 38% of patients, ventricular arrhythmias, and other cardiovascular toxicities. Emerging data suggest several newer BTK inhibitors (eg, acalabrutinib, zanubrutinib) are still associated with cardiotoxic risks. This review examines the current state of evidence, including incidence rates, risk factors, mechanisms, and management strategies of cardiovascular toxicities with BTK inhibitors and other CLL therapies. We specifically focus on atrial fibrillation, ventricular arrhythmias/sudden death, hypertension, heart failure, bleeding, and stroke. We also touch on other emerging BTK therapies (eg, pirtobrutinib). Finally, we highlight key unanswered questions and future directions of research.
Collapse
Affiliation(s)
- Cooper Quartermaine
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Sanam M Ghazi
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Aneeq Yasin
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Farrukh T Awan
- Division of Hematology, UT-Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Fradley
- Cardio-Oncology Program, Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tracy Wiczer
- Department of Pharmacy, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Sujay Kalathoor
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Mussammat Ferdousi
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Satyam Krishan
- Department of Medicine, University of Oklahoma Medical Center, Oklahoma City, Oklahoma, USA
| | - Alma Habib
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Adnan Shaaban
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Onaopepo Kola-Kehinde
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Adam S Kittai
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Kerry A Rogers
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Michael Grever
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Patrick Ruz
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Seema Bhat
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Tyler Dickerson
- Department of Pharmacy, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - John C Byrd
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jennifer Woyach
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio, USA
- Division of Cancer Prevention and Control, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
12
|
Shouse G, Kaempf A, Gordon MJ, Artz A, Yashar D, Sigmund AM, Smilnak G, Bair SM, Mian A, Fitzgerald LA, Bajwa A, Jaglowski S, Bailey N, Shadman M, Patel K, Stephens DM, Kamdar M, Hill BT, Gauthier J, Karmali R, Nastoupil LJ, Kittai AS, Danilov AV. A validated composite comorbidity index predicts outcomes of CAR T-cell therapy in patients with diffuse large B-cell lymphoma. Blood Adv 2023; 7:3516-3529. [PMID: 36735393 PMCID: PMC10362276 DOI: 10.1182/bloodadvances.2022009309] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 11/07/2022] [Revised: 12/23/2022] [Accepted: 01/15/2023] [Indexed: 02/04/2023] Open
Abstract
Chimeric antigen receptor T-cell therapy (CART) has extended survival of patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL). However, limited durability of response and prevalent toxicities remain problematic. Identifying patients who are at high risk of disease progression, toxicity, and death would inform treatment decisions. Although the cumulative illness rating scale (CIRS) has been shown to correlate with survival in B-cell malignancies, no prognostic score has been independently validated in CART recipients. We retrospectively identified 577 patients with relapsed/refractory DLBCL indicated for CART at 9 academic centers to form a learning cohort (LC). Random survival forest modeling of overall survival (OS) and progression-free survival (PFS) was performed to determine the most influential CIRS organ systems and severity grades. The presence of a severe comorbidity (CIRS score ≥ 3) in the respiratory, upper gastrointestinal, hepatic, or renal system, herein termed "Severe4," had the greatest impact on post-CART survival. Controlling for other prognostic factors (number of prior therapies, Eastern Cooperative Oncology Group performance status, BCL6 translocation, and molecular subtype), Severe4 was strongly associated with shorter PFS and OS in the LC and in an independent single-center validation cohort (VC). Severe4 was also a significant predictor of grade ≥3 cytokine release syndrome in the LC, while maintaining this trend in the VC. Thus, our results indicate that adverse outcomes for patients with DLBCL meant to receive CART can be predicted using a simplified CIRS-derived comorbidity index.
Collapse
Affiliation(s)
- Geoffrey Shouse
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Andy Kaempf
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Max J. Gordon
- Department of Lymphoma, MD Anderson Cancer Center, Houston, TX
| | - Andy Artz
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - David Yashar
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Audrey M. Sigmund
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Gordon Smilnak
- Division of Hematology/Oncology, Northwestern University, Chicago, IL
| | - Steven M. Bair
- University of Colorado Cancer Center, University of Colorado, Aurora, CO
| | - Agrima Mian
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | | | - Amneet Bajwa
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Samantha Jaglowski
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Neil Bailey
- Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute, Seattle, WA
| | - Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Krish Patel
- Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute, Seattle, WA
| | | | - Manali Kamdar
- University of Colorado Cancer Center, University of Colorado, Aurora, CO
| | - Brian T. Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Jordan Gauthier
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Reem Karmali
- Division of Hematology/Oncology, Northwestern University, Chicago, IL
| | | | - Adam S. Kittai
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Alexey V. Danilov
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| |
Collapse
|
13
|
Zurko J, Nizamuddin I, Epperla N, David K, Cohen JB, Moyo TK, Ollila T, Hess B, Roy I, Ferdman R, Liu J, Chowdhury SM, Romancik J, Bhansali RS, Harris EI, Sorrell M, Masel R, Kittai AS, Denlinger N, Sigmund AM, Fitzgerald L, Galvez C, Ma S, Winter J, Pro B, Gordon LI, Danilov A, Stephens D, Shah NN, Kenkre V, Barta SK, Torka P, Shouse G, Karmali R. Peri-CAR-T practice patterns and survival predictors for all CAR-T patients and post-CAR-T failure in aggressive B-NHL. Blood Adv 2023; 7:2657-2669. [PMID: 36094847 PMCID: PMC10333741 DOI: 10.1182/bloodadvances.2022008240] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 06/01/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/20/2022] Open
Abstract
Most patients receiving chimeric antigen receptor T-cell therapy (CAR-T) for aggressive B-cell non-Hodgkin lymphoma (B-NHL) do not experience a durable remission. Several novel agents are approved to treat relapsed, refractory aggressive B-NHL; however, it remains unclear how to sequence these therapies pre- and post-CAR-T. We conducted a multicenter retrospective analysis to describe peri-CAR-T practice patterns and survival predictors for patients receiving CD19-directed CAR-T. Patients (n = 514) from 13 centers treated with CAR-T for B-NHL between 2015-2021 were included in the study. Survival curves were constructed using Kaplan-Meier method. Multivariate Cox regression analysis was used to determine the impact of the variables on survival outcomes. For all patients receiving CAR-T, a greater number of lines of therapy pre-CAR-T apheresis and bridging therapy were predictive of inferior progression-free survival (PFS) and overall survival (OS). The median PFS and OS from the time of CAR-T cell infusion were 7.6 and 25.6 months, respectively. From the time of progression post-CAR-T, the median OS was 5.5 months. The median PFS of treatments administered in the first-line post-CAR-T failure was 2.8 months. Patients with refractory disease on day 30 had inferior OS and were less likely to receive subsequent treatment(s) than other patients with CAR-T failure. Allogeneic hematopoietic cell transplantation for selected patients at any time following CAR-T failure led to durable responses in over half of patients at 1 year. These data provide a benchmark for future clinical trials in patients with post-CAR-T cell progression, which remains an unmet clinical need.
Collapse
Affiliation(s)
- Joanna Zurko
- Department of Medicine, Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Imran Nizamuddin
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Narendranath Epperla
- Department of Internal Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Kevin David
- Department of Medicine, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Jonathon B. Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | | | - Thomas Ollila
- Department of Medicine, Lifespan Cancer Institute, Brown University, Providence, RI
| | - Brian Hess
- Department of Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Ishan Roy
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert Ferdman
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Jieqi Liu
- Department of Medicine, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Sayan Mullick Chowdhury
- Department of Internal Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Jason Romancik
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Rahul S. Bhansali
- Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Elyse I. Harris
- Department of Medicine, Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Mckenzie Sorrell
- Department of Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Rebecca Masel
- Department of Medicine, Lifespan Cancer Institute, Brown University, Providence, RI
| | - Adam S. Kittai
- Department of Internal Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Nathan Denlinger
- Department of Internal Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Audrey M. Sigmund
- Department of Internal Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Lindsey Fitzgerald
- Department of Internal Medicine, Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | - Carlos Galvez
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shuo Ma
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jane Winter
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Barbara Pro
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leo I. Gordon
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alexey Danilov
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Deborah Stephens
- Department of Internal Medicine, Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | - Nirav N. Shah
- Department of Medicine, MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI
| | - Vaishalee Kenkre
- Department of Medicine, Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Stefan K. Barta
- Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Pallawi Torka
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Geoffrey Shouse
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Reem Karmali
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
14
|
Kumar PS, Wiczer T, Rosen L, Pollauf AJ, Zheng A, Palettas M, Azali L, Bhat SA, Byrd JC, Grever MR, Rogers KA, Woyach JA, Kittai AS. Correction: Evaluation of bleeding events in patients receiving acalabrutinib therapy. Leukemia 2023:10.1038/s41375-023-01927-8. [PMID: 37231141 DOI: 10.1038/s41375-023-01927-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Pooja S Kumar
- The Ohio State University, Department of Pharmacy, Columbus, OH, USA
| | - Tracy Wiczer
- The Ohio State University, Department of Pharmacy, Columbus, OH, USA
| | - Lindsay Rosen
- The Ohio State University, Department of Pharmacy, Columbus, OH, USA
| | | | - Amy Zheng
- The Ohio State College of Pharmacy, Columbus, OH, USA
| | - Marilly Palettas
- The Ohio State University, Department of Biomedical Informatics, Center for Biostatistics, Columbus, OH, USA
| | - Leylah Azali
- Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Seema A Bhat
- The Ohio State University, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA
| | - John C Byrd
- University of Cincinnati, Department of Internal Medicine, Cincinnati, OH, USA
| | - Michael R Grever
- The Ohio State University, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA
| | - Kerry A Rogers
- The Ohio State University, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA
| | - Jennifer A Woyach
- The Ohio State University, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA
| | - Adam S Kittai
- The Ohio State University, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA.
| |
Collapse
|
15
|
Buck B, Chum AP, Patel M, Carter R, Nawaz H, Yildiz V, Ruz P, Wiczer T, Rogers KA, Awan FT, Bhat S, Guha A, Kittai AS, Simonetti OP, Raman SV, Wallace G, Sanchez R, Bonsu JM, Gambril J, Haddad D, Mann J, Wei L, Kola-Kehinde O, Byrd JC, Woyach JA, Addison D. Cardiovascular Magnetic Resonance Imaging in Patients With Ibrutinib-Associated Cardiotoxicity. JAMA Oncol 2023; 9:552-555. [PMID: 36729480 PMCID: PMC9896369 DOI: 10.1001/jamaoncol.2022.6869] [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: 05/12/2022] [Accepted: 09/14/2022] [Indexed: 02/03/2023]
Abstract
Importance Ibrutinib has been associated with serious cardiotoxic arrhythmias. In preclinical models, these events are paralleled or proceeded by diffuse myocardial injury (inflammation and fibrosis). Yet whether this is seen in patients or has implications for future cardiotoxic risk is unknown. Objective To assess the incidence and outcomes of myocardial injury among patients with ibrutinib-related cardiotoxicity. Design, Setting, and Participants This cohort study included consecutive patients treated with ibrutinib from 2012 to 2019, phenotyped using cardiovascular magnetic resonance (CMR) from a large US Comprehensive Cancer Center registry. Exposures Ibrutinib treatment for cancer control. Main Outcomes and Measures The primary outcome was the presence of late gadolinium enhancement (LGE) fibrosis. The secondary outcome was the occurrence of major adverse cardiac events (MACE), defined as atrial fibrillation, heart failure, symptomatic ventricular arrhythmias, and sudden death of probable or definite ibrutinib association after CMR. We also assessed parametric-mapping subclinical fibrosis (native-T1, extracellular volume fraction) and inflammation/edema (max-T2) measures. Cardiovascular magnetic resonance measures were compared with those obtained in similar consecutive patients with cancer without ibrutinib treatment (pretreatment controls). Observed measures were also compared with similar-aged broad population rates (general-population controls) and a broader pool of cardiovascular disease (CVD) risk-matched cancer controls. Multivariable regression was used to assess the association between CMR measures and MACE. Results Overall, 49 patients treated with ibrutinib were identified, including 33 imaged after treatment initiation (mean [SD] age, 65 [10] years, 9 [27%] with hypertension, and 23 [69.7%] with index-arrhythmias); median duration of ibrutinib-use was 14 months. The mean (SD) pretreatment native T1 was 977.0 (73.0) ms, max-T2 56.5 (4.0) ms, and 4 (13.3%) had LGE. Posttreatment initiation, mean (SD) native T1 was 1033.7 (48.2) ms, max-T2 61.5 (4.8) ms, and 17 (54.8%) had LGE (P < .001, P = .01, and P < .001, respectively, pre- vs post-ibrutinib treatment). Native T12SDs was elevated in 9 (28.6%), and max-T22SDs in 21 (63.0%), respectively. Cardiovascular magnetic resonance measures were highest in those with suspected toxic effects (P = .01 and P = .01, respectively). There was no association between traditional CVD-risk or cancer-treatment status and abnormal CMR measures. Among those without traditional CVD, 16 (58.6%) had LGE vs 38 (13.3%) in matched-controls (relative-risk, 4.8; P < .001). Over a median follow-up of 19 months, 13 (39.4%) experienced MACE. In multivariable models inclusive of traditional CVD risk factors, LGE (hazard ratio [HR], 4.9; P = .04), and native-T12SDs (HR, 3.3; P = .05) associated with higher risks of MACE. Conclusions and Relevance In this cohort study, myocardial injury was common in ibrutinib users, and its presence was associated with higher cardiotoxic risk.
Collapse
Affiliation(s)
- Benjamin Buck
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - Aaron P. Chum
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - Mitkumar Patel
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - Rebecca Carter
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), Ohio State University College of Medicine, Columbus
| | - Haseeb Nawaz
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
- Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Vedat Yildiz
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus
| | - Patrick Ruz
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - Tracy Wiczer
- Department of Pharmacy, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus
| | - Kerry A. Rogers
- Division of Hematology, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus
| | - Farrukh T. Awan
- Division of Hematology, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus
- Division of Hematology/Oncology, University of Texas-Southwestern Medical Center, Dallas
| | - Seema Bhat
- Division of Hematology, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus
| | - Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio
| | - Adam S. Kittai
- Division of Hematology, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus
| | - Orlando P. Simonetti
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
- Department of Biomedical Engineering, The Ohio State University, Columbus
| | - Subha V. Raman
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
- Division of Cardiology, Indiana University School of Medicine, Indianapolis
| | - Grant Wallace
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - Reynaldo Sanchez
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - Janice M. Bonsu
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - John Gambril
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - Devin Haddad
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - James Mann
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora
| | - Lai Wei
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus
| | - Onaopepo Kola-Kehinde
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - John C. Byrd
- Division of Hematology, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus
| | - Jennifer A. Woyach
- Division of Hematology, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus
| |
Collapse
|
16
|
Zurko J, Ramdial J, Shadman M, Ahmed S, Szabo A, Iovino L, Tomas AA, Sauter C, Perales MA, Shah NN, Acharya UH, Jacobson C, Soiffer RJ, Wang T, Komanduri KV, Jaglowski S, Kittai AS, Denlinger N, Iqbal M, Kharfan-Dabaja MA, Ayala E, Chavez J, Jain M, Locke FL, Samara Y, Budde LE, Mei MG, Pia AD, Feldman T, Ahmed N, Jacobs R, Ghosh N, Dholaria B, Oluwole OO, Hess B, Hassan A, Kenkre VP, Reagan P, Awan F, Nieto Y, Hamadani M, Herrera AF. Allogeneic transplant following CAR T-cell therapy for large B-cell lymphoma. Haematologica 2023; 108:98-109. [PMID: 35833303 PMCID: PMC9827150 DOI: 10.3324/haematol.2022.281242] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/06/2022] [Indexed: 02/04/2023] Open
Abstract
Allogeneic hematopoietic cell transplantation (alloHCT) can potentially salvage large B-cell lymphoma (LBCL) patients experiencing treatment failure after chimeric antigen receptor T-cell therapy (CAR T). Nonetheless, data on the efficacy and toxicities of alloHCT after receipt of CAR T are limited. We report a multicenter retrospective study assessing the safety, toxicities, and outcomes of alloHCT in LBCL patients following CAR T failure. Eighty-eight patients with relapsed, refractory LBCL received an alloHCT following anti-CD19 CAR T failure. The median number of lines of therapy between CAR T infusion and alloHCT was one (range, 0-7). Low intensity conditioning was used in 77% (n=68) and peripheral blood was the most common graft source (86%, n=76). The most common donor types were matched unrelated donor (39%), followed by haploidentical (30%) and matched related donor (26%). Median follow-up of survivors was 15 months (range, 1-72). One-year overall survival, progression-free survival, and graft-versus-host disease-free relapse-free survival were 59%, 45%, and 39% respectively. One-year non-relapse mortality and progression/relapse were 22% and 33% respectively. On multivariate analysis, <2 lines of intervening therapy between CAR T and alloHCT and complete response at time of alloHCT were associated with better outcomes. In conclusion, alloHCT after CAR T failure can provide durable remissions in a subset of patients.
Collapse
Affiliation(s)
- Joanna Zurko
- University of Wisconsin Carbone Comprehensive Cancer Center, University of Wisconsin, Madison, WI
| | - Jeremy Ramdial
- The University of Texas MD Anderson Cancer Center, Department of Stem Cell Transplantation, Division of Cancer Medicine, Houston, TX
| | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA
| | - Sairah Ahmed
- The University of Texas MD Anderson Cancer Center, Department of Stem Cell Transplantation, Division of Cancer Medicine, Houston, TX
| | - Aniko Szabo
- University of Wisconsin Carbone Comprehensive Cancer Center, University of Wisconsin, Madison, WI
| | - Lorenzo Iovino
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA
| | | | - Craig Sauter
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Nirav N Shah
- University of Wisconsin Carbone Comprehensive Cancer Center, University of Wisconsin, Madison, WI
| | - Utkarsh H Acharya
- Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, MA
| | - Caron Jacobson
- Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, MA
| | - Robert J Soiffer
- Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, MA
| | - Trent Wang
- Sylvester Comprehensive Cancer Center, Division of Transplantation and Cellular Therapy, Miami, FL
| | - Krishna V Komanduri
- Sylvester Comprehensive Cancer Center, Division of Transplantation and Cellular Therapy, Miami, FL
| | - Samantha Jaglowski
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Adam S Kittai
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Nathan Denlinger
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Madiha Iqbal
- Mayo Clinic, Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Jacksonville, FL
| | - Mohamed A Kharfan-Dabaja
- Mayo Clinic, Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Jacksonville, FL
| | - Ernesto Ayala
- Mayo Clinic, Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Jacksonville, FL
| | - Julio Chavez
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Michael Jain
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Yazeed Samara
- City of Hope, Department of Hematology and Hematopoietic Cell Transplantation, Duarte, CA
| | - Lihua E Budde
- City of Hope, Department of Hematology and Hematopoietic Cell Transplantation, Duarte, CA
| | - Matthew G Mei
- City of Hope, Department of Hematology and Hematopoietic Cell Transplantation, Duarte, CA
| | - Alexandra Della Pia
- John Theurer Cancer Center at Hackensack Meridian Health, NJ, USA; Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ
| | - Tatyana Feldman
- John Theurer Cancer Center at Hackensack Meridian Health, NJ
| | - Nausheen Ahmed
- University of Kansas Medical Center, Division of Hematologic Malignancies and Cellular Therapeutics, Westwood, KS
| | - Ryan Jacobs
- Levine Cancer Institute/Atrium Health, Charlotte, NC
| | | | | | - Olalekan O Oluwole
- Vanderbilt-Ingram Cancer Center, Division of Hematology and Oncology, Nashville, TN
| | - Brian Hess
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Ayesha Hassan
- University of Wisconsin Carbone Comprehensive Cancer Center, University of Wisconsin, Madison, WI
| | - Vaishalee P Kenkre
- University of Wisconsin Carbone Comprehensive Cancer Center, University of Wisconsin, Madison, WI
| | - Patrick Reagan
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Farrukh Awan
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX
| | - Yago Nieto
- The University of Texas MD Anderson Cancer Center, Department of Stem Cell Transplantation, Division of Cancer Medicine, Houston, TX
| | - Mehdi Hamadani
- Medical College of Wisconsin, BMT and Cellular Therapy Program, Division of Hematology and Oncology, Milwaukee, WI
| | - Alex F Herrera
- City of Hope, Department of Hematology and Hematopoietic Cell Transplantation, Duarte, CA.
| |
Collapse
|
17
|
Kittai AS, Huang Y, Beckwith KA, Bhat SA, Bond DA, Byrd JC, Goldstein D, Grever MR, Miller C, Rogers KA, Yano M, Woyach JA. Patient characteristics that predict Richter's transformation in patients with chronic lymphocytic leukemia treated with ibrutinib. Am J Hematol 2023; 98:56-65. [PMID: 36216791 DOI: 10.1002/ajh.26755] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/23/2022] [Accepted: 10/03/2022] [Indexed: 02/04/2023]
Abstract
Chronic lymphocytic leukemia (CLL) transformation to aggressive lymphoma, known as Richter's Transformation (RT), has a dismal prognosis. There are limited data evaluating risk of RT in patients treated with ibrutinib. We performed a retrospective analysis to determine prognostic variables associated with development of RT and overall survival (OS) at progression after treatment with ibrutinib. We identified 559 patients with CLL treated with ibrutinib from 2010-2019. After a median follow-up of 44.5 months from ibrutinib start, 179 patients progressed and were included in our analysis. After a median follow-up of 20.8 months from progression, 54 out of 179 patients developed RT. Progression on treatment (hazard ratio [HR] 4.01 [1.60-10.00], p = .003), higher LDH (HR 1.80 for 2-fold increase [1.33-2.43], p = .0001), and lymphadenopathy without lymphocytosis (HR 2.88 [1.15-7.20], p = .02) were independent prognostic variables for the development of RT at progression. Progression with lymphadenopathy without lymphocytosis continued to be an independent prognostic variable of worse OS post-progression. In a subset analysis of 50 patients who obtained a PET-CT at progression, the median SUVmax for patients who would develop RT was 15.2 (n = 30, range: 4.0-46.3) versus those patients who did not develop RT with a SUVmax of 7.7 (n = 20, range: 2.3-27.2) (p = .0030). Median OS from date of RT was 4.0 months, suggesting that prognosis for RT remains poor. A lymph node biopsy to rule out RT should be considered in patients who received ibrutinib who progress on treatment, have an elevated LDH, or progress with lymphadenopathy without lymphocytosis.
Collapse
Affiliation(s)
- Adam S Kittai
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Ying Huang
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Kyle A Beckwith
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Seema A Bhat
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - David A Bond
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - John C Byrd
- Department of Internal Medicine, The University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel Goldstein
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Michael R Grever
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Cecelia Miller
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Kerry A Rogers
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Max Yano
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer A Woyach
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
18
|
Steinman B, Plaza JA, Kittai AS. Glabellar and auricular leukemia cutis in CLL. EJHaem 2022; 3:1398-1399. [PMID: 36467811 PMCID: PMC9713035 DOI: 10.1002/jha2.538] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 06/17/2023]
Affiliation(s)
| | - Jose A. Plaza
- Department of Pathology and DermatologyThe Ohio State UniversityColumbusOhioUSA
| | - Adam S. Kittai
- Department of Internal MedicineDivision of HematologyThe James Comprehensive Cancer CenterThe Ohio State UniversityColumbusOhioUSA
| |
Collapse
|
19
|
Hyak JM, Huang Y, Rogers KA, Bhat SA, Grever MR, Byrd JC, Kittai AS, Jones D, Miller CR, Woyach JA. Combined BCL2 and BTK inhibition in CLL demonstrates efficacy after monotherapy with both classes. Blood Adv 2022; 6:5124-5127. [PMID: 35834733 PMCID: PMC9631640 DOI: 10.1182/bloodadvances.2022007708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/29/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jonathan M. Hyak
- Department of Medicine and Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ying Huang
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH; and
| | - Kerry A. Rogers
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH; and
| | - Seema A. Bhat
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH; and
| | - Michael R. Grever
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH; and
| | - John C. Byrd
- Department of Internal Medicine, The University of Cincinnati, Cincinnati, OH
| | - Adam S. Kittai
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH; and
| | - Dan Jones
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH; and
| | - Cecelia R. Miller
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH; and
| | - Jennifer A. Woyach
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH; and
| |
Collapse
|
20
|
Sigmund AM, Huang Y, Ruppert AS, Maddocks K, Rogers KA, Jaglowski S, Bhat SA, Kittai AS, Grever MR, Byrd JC, Woyach JA. Depth of response and progression-free survival in chronic lymphocytic leukemia patients treated with ibrutinib. Leukemia 2022; 36:2129-2131. [PMID: 35842461 DOI: 10.1038/s41375-022-01640-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/29/2022] [Accepted: 06/28/2022] [Indexed: 01/16/2023]
Affiliation(s)
- Audrey M Sigmund
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Ying Huang
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Amy S Ruppert
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Kami Maddocks
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Kerry A Rogers
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | | | - Seema A Bhat
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Adam S Kittai
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Michael R Grever
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - John C Byrd
- Division of Hematology, The Ohio State University, Columbus, OH, USA.,Department of Internal Medicine, The University of Cincinnati, Cincinnati, OH, USA
| | - Jennifer A Woyach
- Division of Hematology, The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
21
|
Abstract
PURPOSE OF REVIEW Richter's transformation (RT) occurs when chronic (CLL) transforms into an aggressive lymphoma. Despite improvements in the treatment of CLL, prognosis for RT remains poor. Here, we review current literature of RT, with a focus on novel treatment options. RECENT FINDINGS Efforts are underway to improve outcomes for patients with RT. While small molecule inhibitors have limited efficacy as monotherapy, recent developments combining them with chemo-immunotherapy show promise. Studies exploring the use of cellular therapies including chimeric antigen receptor T-cells and bispecific antibodies are ongoing. The current treatment paradigm for RT is to enroll these patients on a clinical trial when available, together with consultation for a consolidative allogeneic stem cell transplant. Trials investigating novel combinations and cellular therapy are ongoing. Determining predictive variables of transformation is imperative to design studies that allow for early identification and intervention for patients with RT.
Collapse
Affiliation(s)
- Audrey M Sigmund
- Division of Hematology, Department of Internal Medicine, The Ohio State University, 11th Floor Lincoln Tower and 1140D Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA
| | - Adam S Kittai
- Division of Hematology, Department of Internal Medicine, The Ohio State University, 11th Floor Lincoln Tower and 1140D Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA.
| |
Collapse
|
22
|
Sigmund AM, Denlinger N, Huang Y, Bond D, Voorhees T, Bajwa A, Elder P, Brammer JE, Saad A, Penza S, Vasu S, de Lima M, Jaglowski S, Kittai AS. Assessment of Salvage Regimens Post CAR-T Cell Therapy for Patients with Diffuse Large B-Cell Lymphoma. Transplant Cell Ther 2022; 28:342.e1-342.e5. [PMID: 35248778 DOI: 10.1016/j.jtct.2022.02.021] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Anti-CD19 chimeric antigen receptor T-cell therapy (CAR19) represents a critical treatment modality for patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). However, the majority of patients will subsequently experience disease progression following CAR19 and there is limited data assessing the best salvage regimen for these patients. OBJECTIVE To evaluate outcomes in DLBCL patients with progressive disease post CAR19 and to assess variables that predict response to salvage therapy. STUDY DESIGN We performed a retrospective analysis of all patients with DLBCL who received CAR19 at our institution from January 2018 to February 2021. Demographics, disease characteristics, best response to CAR19, date of relapse or progression, and first salvage therapy and response to salvage were also collected. We analyzed patients according to whether they responded to CAR19 (responders) or did not (non-responders). Salvage regimens were classified into 6 groups for analysis. Primary endpoints included overall survival (OS) and progression free survival (PFS), calculated using the Kaplan Meier method. Cox models were fit to evaluate the effect of prognostic factors. RESULTS Of the 120 patients who received CAR19 during the analysis period, 69 patients achieved a CR/PR to CAR19 (responders), 44 patients achieved SD/PD to CAR19, and 7 died before assessment (51 non-responders). 30 responders relapsed and 26 received salvage therapy, while 24 non-responders received salvage. The primary salvage regimens that were utilized included lenalidomide-based regimens (n=17, 34%), BTKi (n=10, 20%), checkpoint inhibitor based (n=7, 14%), chemo-immunotherapy (n=5, 10%), allo (n=5, 10%), and other (n=6, 12%). There was no significant difference in OS based on salvage regimen (p=0.4545). Responders who received salvage had significantly longer OS compared to non-responders (median OS not reached vs. 10.9 months; p=0.0187), and response to CAR19 and elevated lactate dehydrogenase (LDH) level at time of salvage treatment were the only two statistically significant prognostic factors after accounting for other variables. CONCLUSION Outcomes for responders to CAR19 are significantly better with salvage therapy as compared to non-responders to CAR19. There was no significant difference in outcomes seen based on salvage regimen in our study. Future research is needed to assess the best salvage regimen post CAR19 failure.
Collapse
Affiliation(s)
- Audrey M Sigmund
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Nathan Denlinger
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Ying Huang
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - David Bond
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Timothy Voorhees
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Amneet Bajwa
- Division of Hospital Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Patrick Elder
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Jonathan E Brammer
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Ayman Saad
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Sam Penza
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Sumithira Vasu
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Marcos de Lima
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Samantha Jaglowski
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Adam S Kittai
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio.
| |
Collapse
|
23
|
Bajwa A, Huang Y, Li R, Denlinger N, Brammer J, Penza S, Saad A, Jaglowski S, Kittai AS. Prognostic value of early imaging following CAR-T cell therapy in diffuse large B-cell lymphoma. Leuk Lymphoma 2022; 63:1492-1495. [PMID: 35109749 DOI: 10.1080/10428194.2022.2032039] [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: 10/19/2022]
Affiliation(s)
- Amneet Bajwa
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Ying Huang
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Rui Li
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Nathan Denlinger
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Jonathan Brammer
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Sam Penza
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Ayman Saad
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | | | - Adam S Kittai
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
24
|
Kittai AS, Danilova OV, Lam V, Liu T, Bruss N, Best S, Fan G, Danilov AV. NEDD8-activating enzyme inhibition induces cell cycle arrest and anaphase catastrophe in malignant T-cells. Oncotarget 2021; 12:2068-2074. [PMID: 34611480 PMCID: PMC8487718 DOI: 10.18632/oncotarget.28063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/18/2021] [Indexed: 11/25/2022] Open
Abstract
Peripheral T-cell lymphoma (PTCL) is characterized by poor outcomes. We and others have shown that targeting the NEDD8-activating enzyme (NAE) with an investigational inhibitor pevonedistat deregulates cell cycle and mitosis in lymphoma and leukemia. Here, we report that PTCL is characterized by increased rate of chromosomal instability. NAE inhibition promotes cell cycle arrest and induces multipolar anaphases in T-cell lymphoma cell lines, resulting in apoptosis, also observed in primary malignant PTCL cells treated with pevonedistat. We identified p27Kip1 as a mediator of anaphase catastrophe in these cells. Targeting neddylation with pevonedistat may be a promising approach to treatment of PTCL.
Collapse
Affiliation(s)
- Adam S Kittai
- The Ohio State University, Columbus, OH 43210, USA.,These authors contributed equally to this work
| | - Olga V Danilova
- City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA.,These authors contributed equally to this work
| | - Vi Lam
- City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Tingting Liu
- City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Nur Bruss
- Oregon Health and Science University, Portland, OR 97239, USA
| | - Scott Best
- Oregon Health and Science University, Portland, OR 97239, USA
| | - Guang Fan
- Oregon Health and Science University, Portland, OR 97239, USA
| | | |
Collapse
|
25
|
Kittai AS, Best S, Thurlow B, Lam V, Hashiguchi T, Goodyear S, Persky DO, Okada C, Park B, Spurgeon SE, Danilov AV. Entospletinib and obinutuzumab in patients with relapsed/refractory chronic lymphocytic leukemia and B-cell malignancies. Haematologica 2021; 106:2022-2025. [PMID: 33504141 PMCID: PMC8252925 DOI: 10.3324/haematol.2020.270298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Adam S Kittai
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Scott Best
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Bria Thurlow
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Vi Lam
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Taylor Hashiguchi
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Shaun Goodyear
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | | | - Craig Okada
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Byung Park
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Stephen E Spurgeon
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Alexey V Danilov
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR; City of Hope Comprehensive Cancer Center, Duarte, CA.
| |
Collapse
|
26
|
Miller CR, Huang Y, Ruppert AS, Labanowska J, Jaglowski SM, Maddocks KJ, Rogers KA, Bhat S, Kittai AS, Grever M, Lapalombella R, Abruzzo LV, Heerema NA, Byrd JC, Hertlein EK, Woyach JA. Significance of chromosome 2p gain in ibrutinib-treated chronic lymphocytic leukemia patients. Leukemia 2021; 35:3287-3290. [PMID: 33820961 DOI: 10.1038/s41375-021-01237-x] [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: 10/22/2020] [Revised: 02/04/2021] [Accepted: 03/22/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Cecelia R Miller
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ying Huang
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Amy S Ruppert
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jadwiga Labanowska
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Samantha M Jaglowski
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Kami J Maddocks
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Kerry A Rogers
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Seema Bhat
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Adam S Kittai
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Michael Grever
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Rosa Lapalombella
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Lynne V Abruzzo
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Nyla A Heerema
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - John C Byrd
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Erin K Hertlein
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jennifer A Woyach
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
27
|
Kawakami M, Mustachio LM, Chen Y, Chen Z, Liu X, Wei CH, Roszik J, Kittai AS, Danilov AV, Zhang X, Fang B, Wang J, Heymach JV, Tyutyunyk-Massey L, Freemantle SJ, Kurie JM, Liu X, Dmitrovsky E. A Novel CDK2/9 Inhibitor CYC065 Causes Anaphase Catastrophe and Represses Proliferation, Tumorigenesis, and Metastasis in Aneuploid Cancers. Mol Cancer Ther 2020; 20:477-489. [PMID: 33277443 DOI: 10.1158/1535-7163.mct-19-0987] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 06/18/2020] [Accepted: 11/30/2020] [Indexed: 12/16/2022]
Abstract
Cyclin-dependent kinase 2 (CDK2) antagonism inhibits clustering of excessive centrosomes at mitosis, causing multipolar cell division and apoptotic death. This is called anaphase catastrophe. To establish induced anaphase catastrophe as a clinically tractable antineoplastic mechanism, induced anaphase catastrophe was explored in different aneuploid cancers after treatment with CYC065 (Cyclacel), a CDK2/9 inhibitor. Antineoplastic activity was studied in preclinical models. CYC065 treatment augmented anaphase catastrophe in diverse cancers including lymphoma, lung, colon, and pancreatic cancers, despite KRAS oncoprotein expression. Anaphase catastrophe was a broadly active antineoplastic mechanism. Reverse phase protein arrays (RPPAs) revealed that along with known CDK2/9 targets, focal adhesion kinase and Src phosphorylation that regulate metastasis were each repressed by CYC065 treatment. Intriguingly, CYC065 treatment decreased lung cancer metastases in in vivo murine models. CYC065 treatment also significantly reduced the rate of lung cancer growth in syngeneic murine and patient-derived xenograft (PDX) models independent of KRAS oncoprotein expression. Immunohistochemistry analysis of CYC065-treated lung cancer PDX models confirmed repression of proteins highlighted by RPPAs, implicating them as indicators of CYC065 antitumor response. Phospho-histone H3 staining detected anaphase catastrophe in CYC065-treated PDXs. Thus, induced anaphase catastrophe after CYC065 treatment can combat aneuploid cancers despite KRAS oncoprotein expression. These findings should guide future trials of this novel CDK2/9 inhibitor in the cancer clinic.
Collapse
Affiliation(s)
- Masanori Kawakami
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Lisa Maria Mustachio
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yulong Chen
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zibo Chen
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Xiuxia Liu
- Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Cheng-Hsin Wei
- Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Jason Roszik
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam S Kittai
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Alexey V Danilov
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Xiaoshan Zhang
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bingliang Fang
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Wang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Jonathan M Kurie
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xi Liu
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Ethan Dmitrovsky
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. .,Frederick National Laboratory for Cancer Research, Frederick, Maryland.,Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
28
|
Raghunathan V, Fan G, Kittai AS, Okada C, Danilov AV, Spurgeon SE. A novel somatic PLCG2 variant associated with resistance to BTK and SYK inhibition in chronic lymphocytic leukemia. Eur J Haematol 2020; 106:294-297. [PMID: 33089525 DOI: 10.1111/ejh.13538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/14/2020] [Accepted: 10/17/2020] [Indexed: 11/27/2022]
Abstract
The treatment of chronic lymphocytic leukemia (CLL) has been transformed by the use of targeted small molecules inhibiting components of the B cell receptor (BCR) signaling pathway (Haematologica, 103, 2018 and e204; Curr Hematol Malig Rep, 14, 2019, 302). Chief among these is ibrutinib, an irreversible inhibitor of Bruton tyrosine kinase (BTK), which produces deep, durable responses in CLL with good tolerability (Haematologica, 103, 2018 and e204). Though prolonged exposure to the drug can exert selective pressure on CLL cells and allow for the emergence of drug-resistant clones, primary ibrutinib treatment failure is rare (Expert Rev Hematol, 11 and 2018, 185; N Engl J Med, 370, 2014 and 2352; N Engl J Med, 373, 2015 and 25, 2425; Blood, 128, 2016 and 2199). Activating mutations in the gene PLCG2, which encodes a downstream target of BTK, appear to enable constitutive BCR signaling and have been associated with ibrutinib resistance (Int J Cancer, 146 and 2020, 85; J Clin Oncol, 35, 2017 and 1437; Blood, 126, 2015 and 61). In recent years, novel investigational agents have targeted other components of the BCR pathway. Among these is entospletinib, an orally bioavailable, selective inhibitor of splenic tyrosine kinase (SYK) (Blood, 126, 2015 and 1744), which lies upstream of the enzyme phospholipase C-gamma-2 (PLCG2). Here, we describe a patient who was found to harbor a novel somatic variant of PLCG2 and experienced a lack of treatment response to both ibrutinib and entospletinib.
Collapse
Affiliation(s)
- Vikram Raghunathan
- Division of Hematology and Oncology, Oregon Health & Science University, Portland, OR, USA
| | - Guang Fan
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Adam S Kittai
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Craig Okada
- Division of Hematology and Oncology, Oregon Health & Science University, Portland, OR, USA
| | - Alexey V Danilov
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Stephen E Spurgeon
- Division of Hematology and Oncology, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
29
|
Kittai AS, Huang Y, Gordon M, Denlinger N, Mian A, Fitzgerald L, Bishop J, Nagle S, Stephens DM, Jaglowski S, Hill B, Danilov AV. Comorbidities Predict Inferior Survival in Patients Receiving Chimeric Antigen Receptor T Cell Therapy for Diffuse Large B Cell Lymphoma: A Multicenter Analysis. Transplant Cell Ther 2020; 27:46-52. [PMID: 33002640 DOI: 10.1016/j.bbmt.2020.09.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/02/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022]
Abstract
Chimeric antigen receptor T cell (CAR-T) therapy is approved for treatment of relapsed/refractory (R/R) diffuse large B cell lymphoma (DLBCL). Here we evaluate whether comorbidities, calculated using the Cumulative Illness Rating Scale (CIRS), predict survival for these patients. A retrospective chart review was performed at 4 academic institutions. All patients who underwent leukapheresis for commercial CAR-T therapy for R/R DLBCL were included. CIRS scores were calculated at the time of leukapheresis. High comorbidity was defined as either CIRS ≥7 or the presence of severe impairment (CIRS 3/4 in ≥1 system; CIRS-3+). Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method, and differences in curves were detected by the log-rank test. A total of 130 patients were analyzed, 56.9% with CIRS ≥7 and 56.2% with CIRS-3+. After a median follow-up of 13 months, the median PFS was 6.7 months, and the median OS was not reached. On univariable analysis, Eastern Cooperative Oncology Group (ECOG) performance status (PS) was associated with inferior PFS (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.03-2.05; P = .03) and OS (HR, 1.76; 95% CI, 1.17-2.64; P = .007). Higher CIRS (CIRS ≥7 or CIRS-3+) was associated with inferior OS (HR, 2.12; 95%, CI, 1.06-4.22; P = .03) and a nonsignificant trend in worse PFS (HR, 1.45; 95% CI, .87-2.44; P = .16). In multivariable analyses, CIRS ≥7 or CIRS-3+ and ECOG PS maintained independent prognostic significance. Comorbidities as determined by CIRS and ECOG PS predict inferior survival in patients receiving CAR-T therapy for R/R DLBCL.
Collapse
Affiliation(s)
- Adam S Kittai
- Division of Hematology, The Ohio State University, Columbus, Ohio.
| | - Ying Huang
- Division of Hematology, The Ohio State University, Columbus, Ohio
| | - Max Gordon
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Nathan Denlinger
- Division of Hematology, The Ohio State University, Columbus, Ohio
| | - Agrima Mian
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, Ohio
| | | | - Jennifer Bishop
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Sarah Nagle
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | | | | | - Brian Hill
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, Ohio
| | | |
Collapse
|
30
|
|
31
|
Kittai AS, Blank J, Graff JN. Gonadotropin-Releasing Hormone Antagonists in Prostate Cancer. Oncology (Williston Park) 2018; 32:599-606. [PMID: 30632129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Androgen deprivation therapy (ADT) comes in several forms, such as surgical castration or medical castration using gonadotropin-releasing hormone (GnRH) agonist or GnRH antagonist therapy. ADT is a critical treatment for high-risk and metastatic prostate cancer. There are important differences between GnRH agonists and antagonists. Here we review the mechanism of action between GnRH agonists and antagonists and the studies that led to the approval of degarelix. We also comment on the potential risks and benefits of degarelix, particularly when it comes to cardiovascular health. Finally, we describe an oral GnRH antagonist, which is not currently used in prostate cancer, but is included for completeness.
Collapse
|