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Aoki T, Jiang A, Xu A, Yin Y, Gamboa A, Milne K, Takata K, Miyata-Takata T, Chung S, Rai S, Wu S, Warren M, Strong C, Goodyear T, Morris K, Chong LC, Hav M, Colombo AR, Telenius A, Boyle M, Ben-Neriah S, Power M, Gerrie AS, Weng AP, Karsan A, Roth A, Farinha P, Scott DW, Savage KJ, Nelson BH, Merchant A, Steidl C. Spatially Resolved Tumor Microenvironment Predicts Treatment Outcomes in Relapsed/Refractory Hodgkin Lymphoma. J Clin Oncol 2024; 42:1077-1087. [PMID: 38113419 PMCID: PMC10950131 DOI: 10.1200/jco.23.01115] [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: 05/23/2023] [Revised: 09/12/2023] [Accepted: 10/04/2023] [Indexed: 12/21/2023] Open
Abstract
PURPOSE About a third of patients with relapsed or refractory classic Hodgkin lymphoma (r/r CHL) succumb to their disease after high-dose chemotherapy followed by autologous stem-cell transplantation (HDC/ASCT). Here, we aimed to describe spatially resolved tumor microenvironment (TME) ecosystems to establish novel biomarkers associated with treatment failure in r/r CHL. PATIENTS AND METHODS We performed imaging mass cytometry (IMC) on 71 paired primary diagnostic and relapse biopsies using a marker panel specific to CHL biology. For each cell type in the TME, we calculated a spatial score measuring the distance of nearest neighbor cells to the malignant Hodgkin Reed Sternberg cells within the close interaction range. Spatial scores were used as features in prognostic model development for post-ASCT outcomes. RESULTS Highly multiplexed IMC data revealed shared TME patterns in paired diagnostic and early r/r CHL samples, whereas TME patterns were more divergent in pairs of diagnostic and late relapse samples. Integrated analysis of IMC and single-cell RNA sequencing data identified unique architecture defined by CXCR5+ Hodgkin and Reed Sternberg (HRS) cells and their strong spatial relationship with CXCL13+ macrophages in the TME. We developed a prognostic assay (RHL4S) using four spatially resolved parameters, CXCR5+ HRS cells, PD1+CD4+ T cells, CD68+ tumor-associated macrophages, and CXCR5+ B cells, which effectively separated patients into high-risk versus low-risk groups with significantly different post-ASCT outcomes. The RHL4S assay was validated in an independent r/r CHL cohort using a multicolor immunofluorescence assay. CONCLUSION We identified the interaction of CXCR5+ HRS cells with ligand-expressing CXCL13+ macrophages as a prominent crosstalk axis in relapsed CHL. Harnessing this TME biology, we developed a novel prognostic model applicable to r/r CHL biopsies, RHL4S, opening new avenues for spatial biomarker development.
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Affiliation(s)
- Tomohiro Aoki
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Princess Margaret Cancer Centre—University Health Network, Toronto, Ontario, Canada
| | - Aixiang Jiang
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Yifan Yin
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | | | - Katy Milne
- Deeley Research Centre, BC Cancer, Victoria, British Columbia, Canada
| | - Katsuyoshi Takata
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Division of Molecular and Cellular Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | | | - Shanee Chung
- Leukemia/Bone Marrow Transplant Program of BC, BC Cancer, Vancouver, British Columbia, Canada
| | - Shinya Rai
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Shaocheng Wu
- Department of Molecular Oncology, BC Cancer, Vancouver, BC, Canada
| | - Mary Warren
- Deeley Research Centre, BC Cancer, Victoria, British Columbia, Canada
| | - Celia Strong
- Deeley Research Centre, BC Cancer, Victoria, British Columbia, Canada
| | - Talia Goodyear
- Deeley Research Centre, BC Cancer, Victoria, British Columbia, Canada
| | - Kayleigh Morris
- Deeley Research Centre, BC Cancer, Victoria, British Columbia, Canada
| | - Lauren C. Chong
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | | | | | - Adele Telenius
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Merrill Boyle
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Susana Ben-Neriah
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Maryse Power
- Leukemia/Bone Marrow Transplant Program of BC, BC Cancer, Vancouver, British Columbia, Canada
| | - Alina S. Gerrie
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Andrew P. Weng
- Terry Fox Laboratory, BC Cancer, Vancouver, British Columbia, Canada
| | - Aly Karsan
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Andrew Roth
- Department of Molecular Oncology, BC Cancer, Vancouver, BC, Canada
| | - Pedro Farinha
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David W. Scott
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Kerry J. Savage
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Brad H. Nelson
- Deeley Research Centre, BC Cancer, Victoria, British Columbia, Canada
| | | | - Christian Steidl
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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2
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Kim JL, Gerrie AS, Savage KJ, Villa D, Scott D, Craig JW, Farinha P, Skinnider B, Slack G, Connors JM, Sehn LH, Venner C, Freeman CL. Frontline therapy with bendamustine rituximab (BR) and rituximab cyclophosphamide vincristine prednisone (RCVP) confers similar long-term outcomes in patients with treatment naïve Waldenström macroglobulinemia in a real-world setting: a population-based analysis. Leuk Lymphoma 2024; 65:346-352. [PMID: 38156444 DOI: 10.1080/10428194.2023.2290466] [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: 09/21/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023]
Abstract
We report on outcomes of 111 patients with treatment naïve Waldenström macroglobulinemia (TN WM) treated with frontline bendamustine-rituximab (BR) (n = 57) or rituximab-cyclophosphamide-vincristine-prednisone (RCVP) (n = 54). Median follow-up was 60.7 months (range 1.9-231.6). Median progression-free survival (PFS) was 60.5 months (95% CI 47.6-73.4) for BR and 79.0 months (95% CI 31.3-126.8) for RCVP (p = .96). Median overall survival (OS) was not reached for BR and 153.4 months (95% CI 114.5-192.4) for RCVP (p = .37). While overall and major response rates did not differ between treatment groups, BR had numerically higher rate of very good partial response or better response (51% vs. 37%, p = .30) and complete response (26% vs. 13%, p = .13). RCVP confers comparable outcomes to BR in a real-world population of TN WM patients and remains an effective regimen, particularly when tolerance or frailty is an issue, or in resource-limited settings.
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Affiliation(s)
| | - Alina S Gerrie
- BC Cancer Agency, Centre for Lymphoid Cancer and Department of Medical Oncology, Vancouver, Canada
| | - Kerry Joane Savage
- BC Cancer Agency, Centre for Lymphoid Cancer and Department of Medical Oncology, Vancouver, Canada
| | - Diego Villa
- BC Cancer Agency, Centre for Lymphoid Cancer and Department of Medical Oncology, Vancouver, Canada
| | - David Scott
- BC Cancer Agency, Centre for Lymphoid Cancer and Department of Medical Oncology, Vancouver, Canada
| | - Jeffrey W Craig
- BC Cancer Agency, Centre for Lymphoid Cancer and Department of Pathology, Vancouver, Canada
| | - Pedro Farinha
- BC Cancer Agency, Centre for Lymphoid Cancer and Department of Pathology, Vancouver, Canada
| | - Brian Skinnider
- BC Cancer Agency, Centre for Lymphoid Cancer and Department of Pathology, Vancouver, Canada
| | - Graham Slack
- BC Cancer Agency, Centre for Lymphoid Cancer and Department of Pathology, Vancouver, Canada
| | - Joseph M Connors
- BC Cancer Agency, Centre for Lymphoid Cancer and Department of Medical Oncology, Vancouver, Canada
| | - Laurie H Sehn
- BC Cancer Agency, Centre for Lymphoid Cancer and Department of Medical Oncology, Vancouver, Canada
| | - Christopher Venner
- BC Cancer Agency, Centre for Lymphoid Cancer and Department of Medical Oncology, Vancouver, Canada
| | - Ciara L Freeman
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
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3
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Di Ciaccio PR, Polizzotto MN, Cwynarski K, Gerrie AS, Burton C, Bower M, Kuruvilla J, Montoto S, McKay P, Fox CP, Milliken S, Jiamsakul A, Osborne W, Collins GP, Manos K, Linton KM, Iyengar S, Kassam S, Limei MP, Kliman D, Wong Doo N, Watson AM, Fedele P, Yannakou CK, Hunt S, Ku M, Sehn LH, Smith A, Renshaw H, Maxwell A, Liu Q, Dhairyawan R, Ferguson G, Pickard K, Painter D, Thakrar N, Song KW, Hamad N. The influence of immunodeficiency, disease features, and patient characteristics on survival in plasmablastic lymphoma. Blood 2024; 143:152-165. [PMID: 37832030 DOI: 10.1182/blood.2023021348] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/23/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
ABSTRACT Plasmablastic lymphoma (PBL) is a rare and aggressive non-Hodgkin lymphoma associated with immunodeficiency, characterized by uncertain treatment approaches and an unfavorable prognosis. We conducted a multicenter, international, retrospective cohort study, aiming to characterize the clinical features, risk factors, and outcomes of patients with PBL. Data were collected from 22 institutions across 4 countries regarding patients diagnosed with PBL between 1 January 1999 and 31 December 2020. Survival risk factors were analyzed using both univariate and multivariate regression models. Overall survival (OS) was calculated using Kaplan-Meier statistics. First-line treatment regimens were stratified into standard- and higher-intensity regimens, and based on whether they incorporated a proteasome inhibitor (PI). A total of 281 patients (median age, 55 years) were included. Immunodeficiency of any kind was identified in 144 patients (51%), and 99 patients (35%) had HIV-positive results. The 5-year OS for the entire cohort was 36% (95% confidence interval, 30%-42%). In multivariate analysis, inferior OS was associated with Epstein-Barr virus-negative lymphoma, poor performance status, advanced stage, and bone marrow involvement. In an independent univariate analysis, the international prognostic index was associated with OS outcomes. Neither immunosuppression nor HIV infection, specifically, influenced OS. Among patients treated with curative intent (n = 234), the overall response rate was 72%. Neither the intensity of the treatment regimen nor the inclusion of PIs in first-line therapy was associated with OS. In this large retrospective study of patients with PBL, we identified novel risk factors for survival. PBL remains a challenging disease with poor long-term outcomes.
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Affiliation(s)
- Pietro R Di Ciaccio
- Department of Haematology, The Canberra Hospital, Garran, ACT, Australia
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Mark N Polizzotto
- Department of Haematology, The Canberra Hospital, Garran, ACT, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Kate Cwynarski
- Department of Haematology, University College Hospital, London, United Kingdom
| | - Alina S Gerrie
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Burton
- Department of Haematology, St James University Hospital, Leeds, United Kingdom
| | - Mark Bower
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - John Kuruvilla
- Division of Oncology and Haematology, Princess Margaret Cancer Centre, The Princess Margaret Hospital, Toronto, ON, Canada
| | - Silvia Montoto
- Department of Haemato-oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Pam McKay
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Christopher P Fox
- University Hospitals NHS Trust, Nottingham, United Kingdom
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Samuel Milliken
- Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Awachana Jiamsakul
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Wendy Osborne
- Department of Haematology, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | - Graham P Collins
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Kate Manos
- Department of Haematology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Kim M Linton
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
- Manchester Cancer Research Centre, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Sunil Iyengar
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - David Kliman
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Nicole Wong Doo
- Department of Haematology, Concord Repatriation General Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Anne-Marie Watson
- Department of Haematology, Liverpool Hospital, Sydney, NSW, Australia
| | - Pasquale Fedele
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Haematology Department, Monash Health, Clayton, VIC, Australia
| | - Costas K Yannakou
- Department of Molecular Oncology and Cancer Immunology, Epworth Freemasons Hospital, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Stewart Hunt
- Department of Haematology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Matthew Ku
- Department of Haematology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Laurie H Sehn
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, BC, Canada
| | - Alexandra Smith
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Hanna Renshaw
- Department of Haematology, University College Hospital, London, United Kingdom
| | - Alice Maxwell
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Qin Liu
- Division of Oncology and Haematology, Princess Margaret Cancer Centre, The Princess Margaret Hospital, Toronto, ON, Canada
| | - Rageshri Dhairyawan
- Department of Infection and Immunity, Barts Health NHS Trust, London, United Kingdom
| | - Graeme Ferguson
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Keir Pickard
- Department of Haematology, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | - Daniel Painter
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Nisha Thakrar
- Department of Haematology, University College Hospital, London, United Kingdom
| | - Kevin W Song
- Leukemia/Bone Marrow Transplant Program of British Columbia and Division of Hematology, BC Cancer, University of British Columbia, Vancouver, BC, Canada
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
- School of Medicine, University of Notre Dame, Perth, WA, Australia
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4
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Grants JM, May C, Bridgers J, Huang S, Gillis S, Meissner B, Boyle M, Ben-Neriah S, Hung S, Duns G, Hilton L, Gerrie AS, Marra M, Kridel R, Sabatini PJB, Steidl C, Scott DW, Karsan A. Chronic Lymphocytic Leukemia IGHV Somatic Hypermutation Detection by Targeted Capture Next-Generation Sequencing. Clin Chem 2024; 70:273-284. [PMID: 38175592 DOI: 10.1093/clinchem/hvad147] [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: 03/14/2023] [Accepted: 06/13/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Somatic hypermutation (SHM) status of the immunoglobulin heavy variable (IGHV) gene plays a crucial role in determining the prognosis and treatment of patients with chronic lymphocytic leukemia (CLL). A common approach for determining SHM status is multiplex polymerase chain reaction and Sanger sequencing of the immunoglobin heavy locus; however, this technique is low throughput, is vulnerable to failure, and does not allow multiplexing with other diagnostic assays. METHODS Here we designed and validated a DNA targeted capture approach to detect immunoglobulin heavy variable somatic hypermutation (IGHV SHM) status as a submodule of a larger next-generation sequencing (NGS) panel that also includes probes for ATM, BIRC3, CHD2, KLHL6, MYD88, NOTCH1, NOTCH2, POT1, SF3B1, TP53, and XPO1. The assay takes as input FASTQ files and outputs a report containing IGHV SHM status and V allele usage following European Research Initiative on CLL guidelines. RESULTS We validated the approach on 35 CLL patient samples, 34 of which were characterized using Sanger sequencing. The NGS panel identified the IGHV SHM status of 34 of 35 CLL patients. We showed 100% sensitivity and specificity among the 33 CLL samples with both NGS and Sanger sequencing calls. Furthermore, we demonstrated that this panel can be combined with additional targeted capture panels to detect prognostically important CLL single nucleotide variants, insertions/deletions, and copy number variants (TP53 copy number loss). CONCLUSIONS A targeted capture approach to IGHV SHM detection can be integrated into broader sequencing panels, allowing broad CLL prognostication in a single molecular assay.
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Affiliation(s)
- Jennifer M Grants
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Christina May
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Josh Bridgers
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Shujun Huang
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Sierra Gillis
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Barbara Meissner
- Centre for Lymphoid Cancer, BC Cancer Centre, Vancouver, BC, Canada
| | - Merrill Boyle
- Centre for Lymphoid Cancer, BC Cancer Centre, Vancouver, BC, Canada
| | | | - Stacy Hung
- Centre for Lymphoid Cancer, BC Cancer Centre, Vancouver, BC, Canada
| | - Gerben Duns
- Centre for Lymphoid Cancer, BC Cancer Centre, Vancouver, BC, Canada
| | - Laura Hilton
- Centre for Lymphoid Cancer, BC Cancer Centre, Vancouver, BC, Canada
| | - Alina S Gerrie
- Centre for Lymphoid Cancer, BC Cancer Centre, Vancouver, BC, Canada
| | - Marco Marra
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Robert Kridel
- Princess Margaret Cancer Centre, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter J B Sabatini
- Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Christian Steidl
- Centre for Lymphoid Cancer, BC Cancer Centre, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David W Scott
- Centre for Lymphoid Cancer, BC Cancer Centre, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Aly Karsan
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
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5
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Gerson JN, Handorf E, Villa D, Gerrie AS, Chapani P, Li S, Medeiros LJ, Wang M, Cohen JB, Churnetski M, Hill BT, Sawalha Y, Hernandez-Ilizaliturri FJ, Kothari S, Vose JM, Bast M, Fenske T, Rao Gari SN, Maddocks KJ, Bond D, Bachanova V, Kolla B, Chavez J, Shah B, Lansigan F, Burns T, Donovan AM, Wagner-Johnston N, Messmer M, Mehta A, Anderson JK, Reddy N, Kovach AE, Landsburg DJ, Glenn M, Inwards DJ, Ristow K, Karmali R, Kaplan JB, Caimi PF, Rajguru S, Evens A, Klein A, Umyarova E, Pulluri B, Amengual JE, Lue JK, Diefenbach C, Fisher RI, Barta SK. Outcomes of patients with blastoid and pleomorphic variant mantle cell lymphoma. Blood Adv 2023; 7:7393-7401. [PMID: 37874912 PMCID: PMC10758713 DOI: 10.1182/bloodadvances.2023010757] [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: 05/16/2023] [Revised: 08/17/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023] Open
Abstract
Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma; data indicate that blastoid and pleomorphic variants have a poor prognosis. We report characteristics and outcomes of patients with blastoid/pleomorphic variants of MCL. We retrospectively studied adults with newly diagnosed MCL treated from 2000 to 2015. Primary objectives were to describe progression-free survival (PFS) and overall survival (OS). Secondary objectives included characterization of patient characteristics and treatments. Of the 1029 patients with MCL studied, a total of 207 neoplasms were blastoid or pleomorphic variants. Median follow-up period was 82 months (range, 0.1-174 months); median PFS was 38 months (95% confidence interval [CI], 28-66) and OS was 68 months (95% CI, 45-96). Factors associated with PFS were receipt of consolidative autologous hematopoietic transplantation (auto-HCT; hazard ratio [HR], 0.52; 95% CI, 0.31-0.80; P < .05), MCL International Prognostic Index (MIPI) intermediate (HR, 2.3; 95% CI, 1.2-4.3; P < .02) and high (HR, 3.8; 95% CI, 2.0-7.4; P < .01) scores, and complete response to induction (HR, 0.29 (95% CI, 0.17-0.51). Receipt of auto-HCT was not associated with OS (HR, 0.69; 95% CI, 0.41-1.16; P = .16) but was associated with MIPI intermediate (HR, 5.7; 95% CI, 2.5-13.2; P < .01) and high (HR, 10.8; 95% CI, 4.7-24.9; P < .01) scores. We report outcomes in a large cohort of patients with blastoid/pleomorphic variant MCL. For eligible patients, receipt of auto-HCT after induction was associated with improved PFS but not OS. Higher MIPI score and auto-HCT ineligibility were associated with worse survival.
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Affiliation(s)
- James N. Gerson
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Handorf
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Diego Villa
- BC Cancer Centre for Lymphoid Cancer, Vancouver, CA
| | | | - Parv Chapani
- BC Cancer Centre for Lymphoid Cancer, Vancouver, CA
| | | | | | | | - Jonathon B. Cohen
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Michael Churnetski
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | | | | | | | | | | | - Martin Bast
- University of Nebraska Cancer Center, Omaha, NE
| | - Timothy Fenske
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | | | - David Bond
- Division of Hematology, Ohio State University, Columbus, OH
| | - Veronika Bachanova
- Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN
| | - Bhaskar Kolla
- Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN
| | | | | | | | - Timothy Burns
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | - Marcus Messmer
- Hematologic Malignancies Division, Johns Hopkins University, Baltimore, MD
| | | | | | | | | | - Daniel J. Landsburg
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Kay Ristow
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Reem Karmali
- Division of Hematology and Oncology, Northwestern University, Evanston, IL
| | - Jason B. Kaplan
- Division of Hematology and Oncology, Northwestern University, Evanston, IL
| | - Paolo F. Caimi
- Division of Hematology and Oncology, Case Western Reserve University, Cleveland, OH
| | - Saurabh Rajguru
- Division of Hematology, Medical Oncology and Palliative Care, University of Wisconsin, Madison, WI
| | - Andrew Evens
- Division of Hematology/Oncology, Tufts University, Boston, MA
| | - Andreas Klein
- Division of Hematology/Oncology, Tufts University, Boston, MA
| | - Elvira Umyarova
- Division of Hematology and Oncology, University of Vermont, Burlington, VT
| | - Bhargavi Pulluri
- Division of Hematology and Oncology, University of Vermont, Burlington, VT
| | | | - Jennifer K. Lue
- Division of Hematology and Oncology, Columbia University, New York, NY
| | | | - Richard I. Fisher
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Stefan K. Barta
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
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6
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Owen C, Eisinga S, Banerji V, Johnson N, Gerrie AS, Aw A, Chen C, Robinson S. Canadian evidence-based guideline for treatment of relapsed/refractory chronic lymphocytic leukemia. Leuk Res 2023; 133:107372. [PMID: 37633157 DOI: 10.1016/j.leukres.2023.107372] [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: 06/30/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023]
Abstract
Following the recent publication of Canadian evidence-based guidelines for frontline treatment of chronic lymphocytic leukemia (CLL), the same group of clinicians developed guidelines for CLL in the relapsed/refractory (R/R) setting. The treatment of R/R CLL has changed significantly in the past few years, with many novel therapeutics available to hematologists across the country. These guidelines aim to standardize the management of CLL in the relapsed/refractory setting, using the best evidence currently available.
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Affiliation(s)
- Carolyn Owen
- Division of Hematology and Hematological Malignancies, Foothills Medical Centre, Calgary AB T2N 4N2, Canada.
| | | | - Versha Banerji
- Department of Hematology and Medical Oncology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Nathalie Johnson
- Department of Medicine, Jewish General Hospital, Montreal QC H3T 1E2, Canada
| | - Alina S Gerrie
- Division of Medical Oncology, Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC V5Z 4E6, Canada
| | - Andrew Aw
- Division of Hematology, The Ottawa Hospital, Ottawa, Ontario K1Y 4E9, Canada
| | - Christine Chen
- Department of Medical Oncology, University of Toronto, and Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada
| | - Sue Robinson
- Division of Hematology, Dalhousie University, and GEII Health Sciences Centre, Halifax NS B3H 2Y9, Canada
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7
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Hilton LK, Ngu HS, Collinge B, Dreval K, Ben-Neriah S, Rushton CK, Wong JC, Cruz M, Roth A, Boyle M, Meissner B, Slack GW, Farinha P, Craig JW, Gerrie AS, Freeman CL, Villa D, Rodrigo JA, Song K, Crump M, Shepherd L, Hay AE, Kuruvilla J, Savage KJ, Kridel R, Karsan A, Marra MA, Sehn LH, Steidl C, Morin RD, Scott DW. Relapse Timing Is Associated With Distinct Evolutionary Dynamics in Diffuse Large B-Cell Lymphoma. J Clin Oncol 2023; 41:4164-4177. [PMID: 37319384 PMCID: PMC10852398 DOI: 10.1200/jco.23.00570] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/17/2023] [Accepted: 05/08/2023] [Indexed: 06/17/2023] Open
Abstract
PURPOSE Diffuse large B-cell lymphoma (DLBCL) is cured in more than 60% of patients, but outcomes remain poor for patients experiencing disease progression or relapse (refractory or relapsed DLBCL [rrDLBCL]), particularly if these events occur early. Although previous studies examining cohorts of rrDLBCL have identified features that are enriched at relapse, few have directly compared serial biopsies to uncover biological and evolutionary dynamics driving rrDLBCL. Here, we sought to confirm the relationship between relapse timing and outcomes after second-line (immuno)chemotherapy and determine the evolutionary dynamics that underpin that relationship. PATIENTS AND METHODS Outcomes were examined in a population-based cohort of 221 patients with DLBCL who experienced progression/relapse after frontline treatment and were treated with second-line (immuno)chemotherapy with an intention-to-treat with autologous stem-cell transplantation (ASCT). Serial DLBCL biopsies from a partially overlapping cohort of 129 patients underwent molecular characterization, including whole-genome or whole-exome sequencing in 73 patients. RESULTS Outcomes to second-line therapy and ASCT are superior for late relapse (>2 years postdiagnosis) versus primary refractory (<9 months) or early relapse (9-24 months). Diagnostic and relapse biopsies were mostly concordant for cell-of-origin classification and genetics-based subgroup. Despite this concordance, the number of mutations exclusive to each biopsy increased with time since diagnosis, and late relapses shared few mutations with their diagnostic counterpart, demonstrating a branching evolution pattern. In patients with highly divergent tumors, many of the same genes acquired new mutations independently in each tumor, suggesting that the earliest mutations in a shared precursor cell constrain tumor evolution toward the same genetics-based subgroups at both diagnosis and relapse. CONCLUSION These results suggest that late relapses commonly represent genetically distinct and chemotherapy-naïve disease and have implications for optimal patient management.
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Affiliation(s)
- Laura K. Hilton
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Henry S. Ngu
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Brett Collinge
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kostiantyn Dreval
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Susana Ben-Neriah
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Christopher K. Rushton
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jasper C.H. Wong
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Manuela Cruz
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Andrew Roth
- Department of Molecular Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Merrill Boyle
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Barbara Meissner
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Graham W. Slack
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pedro Farinha
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey W. Craig
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alina S. Gerrie
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ciara L. Freeman
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Diego Villa
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Judith A. Rodrigo
- Department of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Leukemia/BMT Program of BC, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Kevin Song
- Department of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Leukemia/BMT Program of BC, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Michael Crump
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Lois Shepherd
- Canadian Cancer Trials Group, Queens University, Kingston, Ontario, Canada
- Department of Medicine, Queens University, Kingston, Ontario, Canada
| | - Annette E. Hay
- Canadian Cancer Trials Group, Queens University, Kingston, Ontario, Canada
- Department of Medicine, Queens University, Kingston, Ontario, Canada
| | - John Kuruvilla
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Kerry J. Savage
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Kridel
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Aly Karsan
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Marco A. Marra
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurie H. Sehn
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian Steidl
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan D. Morin
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - David W. Scott
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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8
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Villa D, Jiang A, Visco C, Crosbie N, McCulloch R, Buege MJ, Kumar A, Bond DA, Paludo J, Maurer MJ, Thanarajasingam G, Lewis KL, Cheah CY, Baech J, El-Galaly TC, Kugathasan L, Scott DW, Gerrie AS, Lewis D. Time to progression of disease and outcomes with second-line BTK inhibitors in relapsed/refractory mantle cell lymphoma. Blood Adv 2023; 7:4576-4585. [PMID: 37307169 PMCID: PMC10425680 DOI: 10.1182/bloodadvances.2023009804] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023] Open
Abstract
Time to progression of disease (POD) after first-line (1L) therapy is prognostic in mantle cell lymphoma (MCL), although studies have included a broad range of 1L, second-line (2L), and subsequent lines of therapy. The purpose of this study was to evaluate the factors predicting outcomes in patients with relapsed/refractory (R/R) MCL exclusively initiating 2L Bruton's tyrosine kinase inhibitors (BTKis) after 1L rituximab-containing therapy. Patients were accrued from 8 international centers (7 main, 1 validation cohort). Multivariable models evaluating the association between time to POD and clinical/pathologic factors were constructed and converted into nomograms and prognostic indexes predicting outcomes in this population. A total of 360 patients were included, including 160 in the main cohort and 200 in the validation cohort. Time to POD, Ki67 ≥ 30%, and MCL International Prognostic Index (MIPI) were associated with progression-free survival (PFS2) and overall survival (OS2) from the start of 2L BTKis. C-indexes were consistently ≥0.68 in both cohorts. Web/application-based calculators based on nomograms and prognostic indexes to estimate PFS2 and OS2 were constructed. The 2L BTKi MIPI identifies 3 groups with distinct 2-year PFS2, including high risk (14%), intermediate risk (50%), and low risk (64%). Time to POD, Ki67, and MIPI are associated with survival outcomes in patients with R/R MCL receiving 2L BTKis. Simple clinical models incorporating these variables may assist in planning for alternative therapies such as chimeric antigen receptor T-cell therapy, allogeneic stem cell transplantation, or novel agents with alternative mechanisms of action.
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Affiliation(s)
- Diego Villa
- British Columbia Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - Aixiang Jiang
- British Columbia Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - Carlo Visco
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Nicola Crosbie
- Haematology, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Rory McCulloch
- Department of Haematology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom
| | - Michael J. Buege
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
- University of Illinois Chicago College of Pharmacy, Chicago, IL
| | - Anita Kumar
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David A. Bond
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Matthew J. Maurer
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | | | - Katharine L. Lewis
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - Chan Y. Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - Joachim Baech
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Haematology, Aalborg, Denmark
| | - Tarec C. El-Galaly
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Haematology, Aalborg, Denmark
| | | | - David W. Scott
- British Columbia Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - Alina S. Gerrie
- British Columbia Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - David Lewis
- Haematology, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
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9
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Khelifi RS, Huang SJ, Savage KJ, Villa D, Scott DW, Ramadan K, Connors JM, Sehn LH, Toze CL, Gerrie AS. Population-level impact of ibrutinib for chronic lymphocytic leukemia in British Columbia, Canada. Leuk Lymphoma 2023:1-10. [PMID: 37086469 DOI: 10.1080/10428194.2023.2199340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
Abstract
Ibrutinib has dramatically changed the treatment landscape for chronic lymphocytic leukemia (CLL) since its availability in British Columbia (BC), Canada in 2014. We analyzed patterns of use and real-world survival outcomes in 370 patients who received ibrutinib for first-line (1 L, n = 35) and relapsed/refractory (R/R, n = 335) CLL between 2014-2018 in BC. Dose reductions and interruptions were frequent in 32% and 27%, respectively. With a median follow-up of 27.6 months, 35% of patients discontinued ibrutinib, primarily for adverse events (AEs) rather than progressive disease. Over the course of treatment, 87% of patients experienced at least one adverse event. The 2-year overall survival (OS) and event-free survival (EFS) were excellent at 83.9% and 76.1%, respectively, with medians not reached. However, patients who discontinued ibrutinib had a median OS of 32.5 months and median EFS of only 3.8 months from time of discontinuation, highlighting the need to minimize toxicity in the real-world.
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Affiliation(s)
- Rania S Khelifi
- Department of Experimental Medicine, University of British Columbia, Vancouver, Canada
| | - Steven J Huang
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Vancouver General Hospital, BC Cancer, University of British Columbia, Vancouver, Canada
| | - Kerry J Savage
- Centre for Lymphoid Cancer, BC Cancer, Division of Medical Oncology, University of British Columbia, Vancouver, Canada
| | - Diego Villa
- Centre for Lymphoid Cancer, BC Cancer, Division of Medical Oncology, University of British Columbia, Vancouver, Canada
| | - David W Scott
- Centre for Lymphoid Cancer, BC Cancer, Division of Medical Oncology, University of British Columbia, Vancouver, Canada
| | - Khaled Ramadan
- St. Paul's Hospital, Division of Hematology, University of British Columbia, Vancouver, Canada
| | - Joseph M Connors
- Centre for Lymphoid Cancer, BC Cancer, Division of Medical Oncology, University of British Columbia, Vancouver, Canada
| | - Laurie H Sehn
- Centre for Lymphoid Cancer, BC Cancer, Division of Medical Oncology, University of British Columbia, Vancouver, Canada
| | - Cynthia L Toze
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Vancouver General Hospital, BC Cancer, University of British Columbia, Vancouver, Canada
| | - Alina S Gerrie
- Department of Experimental Medicine, University of British Columbia, Vancouver, Canada
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Vancouver General Hospital, BC Cancer, University of British Columbia, Vancouver, Canada
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10
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Hilton LK, Ngu HS, Collinge B, Dreval K, Ben-Neriah S, Rushton CK, Wong JC, Cruz M, Roth A, Boyle M, Meissner B, Slack GW, Farinha P, Craig JW, Gerrie AS, Freeman CL, Villa D, Crump M, Shepherd L, Hay AE, Kuruvilla J, Savage KJ, Kridel R, Karsan A, Marra MA, Sehn LH, Steidl C, Morin RD, Scott DW. Relapse timing is associated with distinct evolutionary dynamics in DLBCL. medRxiv 2023:2023.03.06.23286584. [PMID: 36945587 PMCID: PMC10029038 DOI: 10.1101/2023.03.06.23286584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is cured in over 60% of patients, but outcomes are poor for patients with relapsed or refractory disease (rrDLBCL). Here, we performed whole genome/exome sequencing (WGS/WES) on tumors from 73 serially-biopsied patients with rrDLBCL. Based on the observation that outcomes to salvage therapy/autologous stem cell transplantation are related to time-to-relapse, we stratified patients into groups according to relapse timing to explore the relationship to genetic divergence and sensitivity to salvage immunochemotherapy. The degree of mutational divergence increased with time between biopsies, yet tumor pairs were mostly concordant for cell-of-origin, oncogene rearrangement status and genetics-based subgroup. In patients with highly divergent tumors, several genes acquired exclusive mutations independently in each tumor, which, along with concordance of genetics-based subgroups, suggests that the earliest mutations in a shared precursor cell constrain tumor evolution. These results suggest that late relapses commonly represent genetically distinct and chemotherapy-naïve disease.
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Affiliation(s)
- Laura K. Hilton
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Henry S. Ngu
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Brett Collinge
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kostiantyn Dreval
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Susana Ben-Neriah
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Christopher K. Rushton
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Jasper C.H. Wong
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Manuela Cruz
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Andrew Roth
- Department of Molecular Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Merrill Boyle
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Barbara Meissner
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Graham W. Slack
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Pedro Farinha
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey W. Craig
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alina S. Gerrie
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ciara L. Freeman
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Diego Villa
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michael Crump
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Lois Shepherd
- Canadian Cancer Trials Group, Queens University, Kingston, ON, Canada
- Department of Medicine, Queens University, Kingston, ON, Canada
| | - Annette E. Hay
- Canadian Cancer Trials Group, Queens University, Kingston, ON, Canada
- Department of Medicine, Queens University, Kingston, ON, Canada
| | - John Kuruvilla
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Kerry J. Savage
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert Kridel
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Aly Karsan
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Marco A. Marra
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Laurie H. Sehn
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christian Steidl
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ryan D. Morin
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, BC, Canada
| | - David W. Scott
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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11
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Thomas N, Dreval K, Gerhard DS, Hilton LK, Abramson JS, Ambinder RF, Barta S, Bartlett NL, Bethony J, Bhatia K, Bowen J, Bryan AC, Cesarman E, Casper C, Chadburn A, Cruz M, Dittmer DP, Dyer MA, Farinha P, Gastier-Foster JM, Gerrie AS, Grande BM, Greiner T, Griner NB, Gross TG, Harris NL, Irvin JD, Jaffe ES, Henry D, Huppi R, Leal FE, Lee MS, Martin JP, Martin MR, Mbulaiteye SM, Mitsuyasu R, Morris V, Mullighan CG, Mungall AJ, Mungall K, Mutyaba I, Nokta M, Namirembe C, Noy A, Ogwang MD, Omoding A, Orem J, Ott G, Petrello H, Pittaluga S, Phelan JD, Ramos JC, Ratner L, Reynolds SJ, Rubinstein PG, Sissolak G, Slack G, Soudi S, Swerdlow SH, Traverse-Glehen A, Wilson WH, Wong J, Yarchoan R, ZenKlusen JC, Marra MA, Staudt LM, Scott DW, Morin RD. Genetic subgroups inform on pathobiology in adult and pediatric Burkitt lymphoma. Blood 2023; 141:904-916. [PMID: 36201743 PMCID: PMC10023728 DOI: 10.1182/blood.2022016534] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/20/2022] Open
Abstract
Burkitt lymphoma (BL) accounts for most pediatric non-Hodgkin lymphomas, being less common but significantly more lethal when diagnosed in adults. Much of the knowledge of the genetics of BL thus far has originated from the study of pediatric BL (pBL), leaving its relationship to adult BL (aBL) and other adult lymphomas not fully explored. We sought to more thoroughly identify the somatic changes that underlie lymphomagenesis in aBL and any molecular features that associate with clinical disparities within and between pBL and aBL. Through comprehensive whole-genome sequencing of 230 BL and 295 diffuse large B-cell lymphoma (DLBCL) tumors, we identified additional significantly mutated genes, including more genetic features that associate with tumor Epstein-Barr virus status, and unraveled new distinct subgroupings within BL and DLBCL with 3 predominantly comprising BLs: DGG-BL (DDX3X, GNA13, and GNAI2), IC-BL (ID3 and CCND3), and Q53-BL (quiet TP53). Each BL subgroup is characterized by combinations of common driver and noncoding mutations caused by aberrant somatic hypermutation. The largest subgroups of BL cases, IC-BL and DGG-BL, are further characterized by distinct biological and gene expression differences. IC-BL and DGG-BL and their prototypical genetic features (ID3 and TP53) had significant associations with patient outcomes that were different among aBL and pBL cohorts. These findings highlight shared pathogenesis between aBL and pBL, and establish genetic subtypes within BL that serve to delineate tumors with distinct molecular features, providing a new framework for epidemiologic, diagnostic, and therapeutic strategies.
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Affiliation(s)
- Nicole Thomas
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Kostiantyn Dreval
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Daniela S. Gerhard
- Office of Cancer Genomics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Laura K. Hilton
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Jeremy S. Abramson
- Center for Lymphoma, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Richard F. Ambinder
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stefan Barta
- University of Pennsylvania Hospital, Philadelphia, PA
| | - Nancy L. Bartlett
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey Bethony
- Department of Microbiology, Immunology, and Tropical Medicine, George Washington University, Washington, DC
| | | | - Jay Bowen
- Biopathology Center, Nationwide Children's Hospital, Columbus, OH
| | - Anthony C. Bryan
- Biopathology Center, Nationwide Children's Hospital, Columbus, OH
| | - Ethel Cesarman
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, Cornell University, New York, NY
| | - Corey Casper
- Infectious Disease Research Institute, Seattle, WA
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Manuela Cruz
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Dirk P. Dittmer
- Lineberger Comprehensive Cancer Center and Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Maureen A. Dyer
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD
| | - Pedro Farinha
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Julie M. Gastier-Foster
- Biopathology Center, Nationwide Children's Hospital, Columbus, OH
- Departments of Pathology and Pediatrics, The Ohio State University, Columbus, OH
| | - Alina S. Gerrie
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | | | - Timothy Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Nicholas B. Griner
- Office of Cancer Genomics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Thomas G. Gross
- Center for Global Health, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Nancy L. Harris
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - John D. Irvin
- Foundation for Burkitt Lymphoma Research, Geneva, Switzerland
| | - Elaine S. Jaffe
- Laboratory of Pathology, Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - David Henry
- University of Pennsylvania Hospital, Philadelphia, PA
| | - Rebecca Huppi
- Office of HIV/AIDS Malignancies, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Fabio E. Leal
- Programa de Oncovirologia, Instituto Nacional de Cancer Jose de Alencar, Rio de Janeiro, Brazil
| | - Michael S. Lee
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Sam M. Mbulaiteye
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Ronald Mitsuyasu
- Center for Clinical AIDS Research and Education, University of California Los Angeles, Los Angeles, CA
| | - Vivian Morris
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | | | - Andrew J. Mungall
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Karen Mungall
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | | | - Mostafa Nokta
- Office of HIV/AIDS Malignancies, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Ariela Noy
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | | | | | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus and Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - Hilary Petrello
- Biopathology Center, Nationwide Children's Hospital, Columbus, OH
| | - Stefania Pittaluga
- Laboratory of Pathology, Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - James D. Phelan
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Juan Carlos Ramos
- Department of Medicine, Division of Hematology, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Lee Ratner
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Steven J. Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Paul G. Rubinstein
- Section of Hematology/Oncology, John H. Stroger Jr Hospital of Cook County, Chicago, IL
| | - Gerhard Sissolak
- Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa
| | - Graham Slack
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Shaghayegh Soudi
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Steven H. Swerdlow
- Division of Hematopathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Alexandra Traverse-Glehen
- Hospices Civils de Lyon, Université Lyon 1, Service d'Anatomie Pathologique, Hopital Lyon Sud France
| | - Wyndham H. Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Jasper Wong
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Robert Yarchoan
- Office of HIV/AIDS Malignancies, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jean C. ZenKlusen
- The Cancer Genome Atlas, Center for Cancer Genomics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Marco A. Marra
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Louis M. Staudt
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - David W. Scott
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Ryan D. Morin
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
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12
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Mathews AS, Paul A, Yu IS, McGahan C, Bhang E, Villa D, Gelmon K, Avina-Zubieta A, Gerrie AS, Lee U, Chia S, Woods RR, Loree JM. The clinical impact of COVID-19 on patients with cancer in British Columbia: An observational study. Heliyon 2022; 8:e12140. [PMID: 36506364 PMCID: PMC9726656 DOI: 10.1016/j.heliyon.2022.e12140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/09/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
Objective We evaluated survival outcomes for patients with cancer and COVID-19 in this population-based study. Methods A total of 631 patients who tested positive for severe acute respiratory syndrome coronavirus 2 and were seen at BC Cancer between 03/03/2020 and 01/21/2021 were included, of whom 506 had a diagnosis of cancer and PCR-confirmed positive test for coronavirus disease 2019. Patient clinical characteristics were retrospectively reviewed and the influence of demographic data, cancer diagnosis, comorbidities, and anticancer treatment(s) on survival following severe acute respiratory syndrome coronavirus 2 infection were analyzed. Results Age ≥65 years (Hazard Ratio [HR] 4.77, 95% Confidence Interval [CI] 2.72-8.35, P < 0.0001), those with Eastern Cooperative Oncology Group Performance Status ≥2 (HR 8.36, 95% CI 2.89-24.16, P < 0.0001), hypertension (HR 3.17, 95% CI 1.77-5.66, P < 0.0001), and metastatic/advanced stage (HR 3.70, 95% CI 1.77-7.73, P < 0.0001) were associated with worse coronavirus disease 2019 specific survival outcomes following severe acute respiratory syndrome coronavirus 2 infection. Patients with lung cancer had the highest 30-day COVID-19 specific mortality (25.0%), followed by genitourinary (18.1%), gastrointestinal (16.0%), and other cancer types (<10.0%). Patients with the highest 30-day coronavirus disease 2019 specific mortality according to treatment type were those on chemotherapy (23.0%), rituximab (22.2%), and immunotherapy (16.7%) while patients on hormonal treatments (2.2%) had better survival outcomes (P = 0.041) compared to those on other anticancer treatments. Conclusion This study provides further evidence that patients with cancer are at increased risk of mortality from coronavirus disease 2019 and emphasizes the need for vaccination.
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Affiliation(s)
- Angela S. Mathews
- BC Cancer Agency, 600 W 10th Ave, Vancouver, BC V5Z 4E6, Canada
- University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Ashley Paul
- BC Cancer Agency, 600 W 10th Ave, Vancouver, BC V5Z 4E6, Canada
- University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Irene S. Yu
- BC Cancer Agency, 600 W 10th Ave, Vancouver, BC V5Z 4E6, Canada
- University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Colleen McGahan
- BC Cancer Agency, 600 W 10th Ave, Vancouver, BC V5Z 4E6, Canada
| | - Eric Bhang
- BC Cancer Agency, 600 W 10th Ave, Vancouver, BC V5Z 4E6, Canada
- University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Diego Villa
- BC Cancer Agency, 600 W 10th Ave, Vancouver, BC V5Z 4E6, Canada
- University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Karen Gelmon
- BC Cancer Agency, 600 W 10th Ave, Vancouver, BC V5Z 4E6, Canada
- University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Antonio Avina-Zubieta
- University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada
| | - Alina S. Gerrie
- BC Cancer Agency, 600 W 10th Ave, Vancouver, BC V5Z 4E6, Canada
- University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Ursula Lee
- BC Cancer Agency, 600 W 10th Ave, Vancouver, BC V5Z 4E6, Canada
- University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Stephen Chia
- BC Cancer Agency, 600 W 10th Ave, Vancouver, BC V5Z 4E6, Canada
- University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Ryan R. Woods
- BC Cancer Agency, 600 W 10th Ave, Vancouver, BC V5Z 4E6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Jonathan M. Loree
- BC Cancer Agency, 600 W 10th Ave, Vancouver, BC V5Z 4E6, Canada
- University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Corresponding author.
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13
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Jessa R, Chien N, Villa D, Freeman CL, Slack GW, Savage KJ, Scott DW, Sehn LH, Song KW, Gerrie AS. Clinicopathological characteristics and long-term outcomes of plasmablastic lymphoma in British Columbia. Br J Haematol 2022; 199:230-238. [PMID: 35961783 DOI: 10.1111/bjh.18399] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022]
Abstract
Plasmablastic lymphoma (PBL) is an aggressive and rare subtype of non-Hodgkin lymphoma with no standard-of-care therapy. We reviewed all patients diagnosed with histologically confirmed PBL in British Columbia, Canada between 1997 and 2019. Overall, 42 patients were identified, including 15 (36%) positive for HIV and nine (21%) on chronic immunosuppression. Curative-intent treatment consisting primarily of cyclophosphamide, doxorubicin, vincristine and prednisone was administered to 31 patients, of which 74% achieved response, however 61% relapsed after a median of 7.5 months. At a median follow-up of eight years for the whole cohort, five-year progression-free survival (PFS) and overall survival (OS) were 18% [95% confidence interval (CI): 6%, 30%] and 22% (95% CI: 8%, 36%) with median eight and 15 months respectively. There were no differences in relapse rate (p = 0.962), PFS (p = 0.228) or OS (p = 0.340) according to immune status. For those treated with curative intent, five-year PFS and OS were 24% (95% CI: 8%, 40%) and 31% (95% CI: 13%, 49%) with median 18 and 27 months respectively. In this population-based cohort of PBL patients spanning 20 years, survival outcomes were poor. Ultimately, further research is needed to develop more effective treatment strategies and to improve survival for patients.
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Affiliation(s)
- Rehan Jessa
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole Chien
- Leukemia/Bone Marrow Transplant Program of BC and Division of Hematology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Diego Villa
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ciara L Freeman
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida, USA
| | - Graham W Slack
- Department of Pathology and Laboratory Medicine, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerry J Savage
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - David W Scott
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurie H Sehn
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin W Song
- Leukemia/Bone Marrow Transplant Program of BC and Division of Hematology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alina S Gerrie
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
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14
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Chahal M, Hayden A, Savage KJ, Villa D, Scott DW, Gerrie AS, Lo A, Chan M, Pickles T, Connors JM, Sehn LH, Freeman CL. Outcomes after initial refusal of curative treatment in patients with classic Hodgkin lymphoma. Leuk Lymphoma 2022; 63:2739-2742. [DOI: 10.1080/10428194.2022.2087071] [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: 10/17/2022]
Affiliation(s)
- Manik Chahal
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer and the University of British Columbia, Vancouver, Canada
| | | | - Kerry J. Savage
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer and the University of British Columbia, Vancouver, Canada
| | - Diego Villa
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer and the University of British Columbia, Vancouver, Canada
| | - David W. Scott
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer and the University of British Columbia, Vancouver, Canada
| | - Alina S. Gerrie
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer and the University of British Columbia, Vancouver, Canada
| | - Andrea Lo
- Division of Radiation Oncology, BC Cancer, Vancouver, Canada
| | - Matthew Chan
- Division of Radiation Oncology, BC Cancer, Vancouver, Canada
| | - Tom Pickles
- Division of Radiation Oncology, BC Cancer, Vancouver, Canada
| | - Joseph M. Connors
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer and the University of British Columbia, Vancouver, Canada
| | - Laurie Helen Sehn
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer and the University of British Columbia, Vancouver, Canada
| | - Ciara L. Freeman
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer and the University of British Columbia, Vancouver, Canada
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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15
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Zhu K, Jamroz A, Huang S, Villa D, Freeman CL, Scott DW, Slack G, Sehn LH, Connors JM, Toze CL, Savage KJ, Gerrie AS. Outcomes of Hodgkin variant Richter transformation in chronic lymphocytic leukaemia and small lymphocytic lymphoma in British Columbia. Br J Haematol 2022; 198:684-692. [PMID: 35567407 DOI: 10.1111/bjh.18241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Abstract
Hodgkin variant Richter transformation (HvRT) is a rare and challenging complication of chronic lymphocytic leukaemia (CLL) for which information on prognostic factors and treatment approaches remain limited. We analysed characteristics and survival outcomes of a population-based cohort of 32 patients with HvRT identified in British Columbia over a 40-year period. Median interval from CLL diagnosis to HvRT was 5.6 years (range, 0-33.6), with five cases diagnosed concurrently. Most patients (80%) had treatment for CLL prior to HvRT. Median age at HvRT was 71 years (range, 51-86) and the majority of patients had high-risk disease, including stage 3-4 in 87% and International Prognostic Score (IPS) ≥ 4 in 65%. Two-year progression-free (PFS) and overall survival (OS) from HvRT were 47% (95% CI: 29%-64%) and 57% (95% CI: 38%-72%), respectively. OS from HvRT was significantly worse in those with anaemia (p = 0.02), elevated lactate dehydrogenase (p = 0.04), high IPS (p = 0.04), and worse performance status (p = 0.001). For those treated with curative-intent ABVD/ABVD-like therapy, 2-year PFS and OS were 70% (95% CI: 45%-85%) and 74% (95% CI: 49%-89%), respectively. In this real-world population-based cohort, HvRT was associated with poor clinical outcomes overall; however, those able to tolerate curative-intent therapy had similar survival to older patients with de novo HL.
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Affiliation(s)
- Kai Zhu
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Jamroz
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Steven Huang
- Leukemia/Bone Marrow Transplant Program of BC and Division of Hematology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Diego Villa
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ciara L Freeman
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Centre, Tampa, Florida, USA
| | - David W Scott
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graham Slack
- Department of Pathology and Laboratory Medicine, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurie H Sehn
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph M Connors
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cynthia L Toze
- Leukemia/Bone Marrow Transplant Program of BC and Division of Hematology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerry J Savage
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alina S Gerrie
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Urban R, Chow R, Pickles T, Chan M, Livergant J, Gerrie AS, Freeman C, Sehn L, Scott DW, Villa D, Farinha P, Gondara L, Savage KJ, Lo AC. The impact of surveillance imaging after curative-intent radiotherapy for limited-stage follicular lymphoma. Br J Haematol 2021; 195:802-805. [PMID: 34734418 DOI: 10.1111/bjh.17684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ryan Urban
- Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Ryan Chow
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tom Pickles
- Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Matthew Chan
- Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Jonathan Livergant
- Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Alina S Gerrie
- Department of Medical Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Lymphoid Cancer Research, BC Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Ciara Freeman
- Department of Medical Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Lymphoid Cancer Research, BC Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Laurie Sehn
- Department of Medical Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Lymphoid Cancer Research, BC Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - David W Scott
- Department of Medical Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Lymphoid Cancer Research, BC Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Diego Villa
- Department of Medical Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Lymphoid Cancer Research, BC Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Pedro Farinha
- Department of Pathology, BC Cancer - Vancouver, Vancouver, BC, Canada
| | - Lovedeep Gondara
- Department of Population Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada
| | - Kerry J Savage
- Department of Medical Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Lymphoid Cancer Research, BC Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Andrea C Lo
- Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada.,Department of Lymphoid Cancer Research, BC Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
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17
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Nowik CM, Gerrie AS, Wong J. Conservative Management of Presumed Fetal Anemia Secondary to Maternal Chemotherapy for Acute Myeloid Leukemia. AJP Rep 2021; 11:e137-e141. [PMID: 34925954 PMCID: PMC8674095 DOI: 10.1055/s-0041-1740561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/08/2021] [Indexed: 12/02/2022] Open
Abstract
Acute myeloid leukemia occurs rarely during pregnancy. When it is diagnosed remote from term, treatment in the form of daunorubicin plus cytarabine induction with consolidative cytarabine is typically undertaken after the first trimester. There is little data to guide fetal monitoring, in particular, whether and how often middle cerebral artery peak systolic velocity (MCA PSV) should be measured to screen for fetal anemia. Cytarabine may be particularly myelosuppressive to the fetus, but information pertaining to the management of this complication is also lacking in published literature. To our knowledge, we present the first case of presumed severe fetal anemia related to in utero exposure to chemotherapy that was managed conservatively with close sonographic monitoring, including serial measurement of MCA PSV. This case suggests that in the absence of hydrops fetalis or other signs of fetal decompensation, expectant management with ultrasound twice weekly, including MCA PSV, is appropriate. Ultrasounds may be decreased to weekly when MCA PSV does not suggest fetal anemia. Screening for fetal anemia can provide helpful information to guide the timing of chemotherapy administration and delivery. Key Points Chemotherapy for acute myeloid leukemia can cause fetal anemia.Fetal MCA PSV can be used to safely and effectively screen for fetal anemia.Observation of fetal anemia due to chemotherapy is reasonable, in the absence of hydrops.Monitoring of fetal MCA PSV can help guide timing of chemotherapy and delivery.
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Affiliation(s)
- Christina M Nowik
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alina S Gerrie
- Division of Hematology and Medical Oncology, University of British Columbia, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Jonathan Wong
- Division of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada
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18
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Tesch ME, Alghawas M, Gerrie AS. Using blood wisely in oncology patients: An institutional analysis of the Choosing Wisely Canada restrictive transfusion strategy guidelines. J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10 Background: Numerous studies support the safety of single-unit red red blood cell (RBC) transfusions and restrictive pre-transfusion hemoglobin (Hg) thresholds (≤ 70-80 g/L) among diverse populations of hospitalized patients, including those with malignancies on myelosuppressive systemic therapy. Using Blood Wisely is a national Choosing Wisely Canada (CWC) initiative that challenges hospitals to benchmark themselves on evidence-informed restrictive transfusion strategies, with the aim to decrease inappropriate RBC transfusions in Canada. We assessed transfusion practices among oncology inpatients at BC Cancer Vancouver Centre as part of this initiative and performed an exploratory analysis among outpatients. Methods: BC Cancer Vancouver RBC transfusion records were obtained for the period of October 2019-September 2020. The percentage of single-unit transfusions and transfusions for Hg ≤ 80 g/L were measured, to assess adherence to CWC targets of ≥ 65% and ≥ 80%, respectively, for these metrics. Univariate analyses were used to compare treatment variables and transfusion outcomes. Results: During the 1-year audit period, 120 inpatient and 586 outpatient RBC transfusions occurred. For inpatient transfusions, 40.8% (n = 49) were single-unit and 79.2% (n = 95) were for Hg ≤ 80 g/L. For outpatient transfusions, 11.8% (n = 69) were single-unit and 65.7% (n = 304) were for Hg ≤ 80 g/L. Outpatients and patients with solid malignancies were more likely to receive multiple-unit transfusions, compared to inpatients (p < 0.001) and patients with hematological malignancies (p < 0.001), respectively. Patients with solid malignancies and those on active treatment were more likely to be transfused when Hg was > 80 g/L, compared to patients with hematological malignancies (p = 0.004) and those off treatment (p = 0.003), respectively. Multiple RBC units were more likely to transfused when the interval from pre-transfusion bloodwork to receipt of transfusion was > 3 days (p = 0.029). Conclusions: A high rate of inappropriate RBC transfusions are being ordered for oncology patients at our institution, in discordance with CWC restrictive transfusion strategy guidelines. Quality improvement interventions are planned to adopt best practices in transfusion medicine in this high-use population.[Table: see text]
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Affiliation(s)
| | | | - Alina S. Gerrie
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
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19
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Chahal M, Jiang A, Hayden A, Savage KJ, Villa D, Scott DW, Gerrie AS, Lo A, Chan M, Pickles T, Connors JM, Sehn LH, Freeman CL. Outcomes after initial refusal of curative treatment in patients with Hodgkin’s lymphoma in British Columbia. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e19518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19518 Background: Classical Hodgkin lymphoma (cHL) is considered a highly curable cancer. With standard combination chemotherapy regimens, long-term survival exceeds 95% for limited-stage and 85% for advanced-stage patients. Despite these excellent outcomes some patients delay or decline conventional treatment for cHL. We retrospectively assessed the impact of initial treatment refusal on outcomes of patients with cHL in British Columbia (BC). Methods: Using the BC Cancer Lymphoid Cancer Database, we identified all patients aged 18-70 diagnosed between 1st Jan 1999- 31st Dec 2020 that had documented treatment refusal at initial presentation (‘refusers’ defined as not receiving or delaying treatment > 16 weeks). We identified a control cohort (min. 3 controls/refuser) treated within 8 weeks of diagnosis, matched for age, stage, diagnosis date within 3 years, and blinded for outcome. All patients had centrally reviewed biopsies and were treated with ABVD or ABVD-like regimens +/- radiotherapy if appropriate. Patient and disease characteristics at baseline and at time of treatment were analyzed with Chi-squared test and one-way ANOVA test. The Kaplan-Meier method was used to assess progression-free survival (PFS) and overall survival (OS), and statistical significance between groups was determined using the log-rank test. Results: We identified a cohort of 15 patients who initially refused treatment and 47 matched controls. The control cohort was well-matched, with no statistically significant differences in baseline characteristics (age, sex, Ann Arbor stage, B symptoms, International Prognostic Score (IPS) score, ECOG PS, and disease bulk) between groups. The most common reason for initial treatment refusal was to pursue alternative therapy (73%). 13 of 15 refusers eventually accepted treatment (mean time to treatment 76 weeks [range 26-214] vs. 5 weeks [range 1-8] for controls, p < 0.001). At time of treatment, the proportion of refusers with advanced-stage disease increased from 20% to 62% (p = 0.03) and had an associated alteration of treatment plan, and 62% of patients developed higher risk disease with increased IPS score (p = 0.02). At median follow-up of 5 years (0.4-21 years) for all living patients, estimated 5-year PFS was 65% vs 84%, and 5-year OS was 93% vs 98% for refusers and controls respectively. With extended follow up, 13% of refusers (1 late death at 8 years) compared to only 4% of controls died of cHL specifically. Conclusions: This study highlights the impact of treatment refusal in this highly curable malignancy. Initial refusal of treatment is associated with progression of stage, worsening prognostic score, escalation to more prolonged treatment than required at diagnosis, and increased risk of death from cHL. This analysis may help to provide guidance to counselling physicians, as well as inform patients who may be considering alternatives to standard of care for cHL.
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Affiliation(s)
| | | | | | - Kerry J. Savage
- Division of Medical Oncology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Diego Villa
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - David W. Scott
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Alina S. Gerrie
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Andrea Lo
- BC Cancer Agency, Vancouver, BC, Canada
| | - Matthew Chan
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | - Joseph M. Connors
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Laurie Helen Sehn
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Ciara L Freeman
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
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20
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Olszewski AJ, Jakobsen LH, Collins GP, Cwynarski K, Bachanova V, Blum KA, Boughan KM, Bower M, Dalla Pria A, Danilov A, David KA, Diefenbach C, Ellin F, Epperla N, Farooq U, Feldman TA, Gerrie AS, Jagadeesh D, Kamdar M, Karmali R, Kassam S, Kenkre VP, Khan N, Kim SH, Klein AK, Lossos IS, Lunning MA, Martin P, Martinez-Calle N, Montoto S, Naik S, Palmisiano N, Peace D, Phillips EH, Phillips TJ, Portell CA, Reddy N, Santarsieri A, Sarraf Yazdy M, Smeland KB, Smith SE, Smith SD, Sundaram S, Zayac AS, Zhang XY, Zhu C, Cheah CY, El-Galaly TC, Evens AM. Burkitt Lymphoma International Prognostic Index. J Clin Oncol 2021; 39:1129-1138. [PMID: 33502927 PMCID: PMC9851706 DOI: 10.1200/jco.20.03288] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Burkitt lymphoma (BL) has unique biology and clinical course but lacks a standardized prognostic model. We developed and validated a novel prognostic index specific for BL to aid risk stratification, interpretation of clinical trials, and targeted development of novel treatment approaches. METHODS We derived the BL International Prognostic Index (BL-IPI) from a real-world data set of adult patients with BL treated with immunochemotherapy in the United States between 2009 and 2018, identifying candidate variables that showed the strongest prognostic association with progression-free survival (PFS). The index was validated in an external data set of patients treated in Europe, Canada, and Australia between 2004 and 2019. RESULTS In the derivation cohort of 633 patients with BL, age ≥ 40 years, performance status ≥ 2, serum lactate dehydrogenase > 3× upper limit of normal, and CNS involvement were selected as equally weighted factors with an independent prognostic value. The resulting BL-IPI identified groups with low (zero risk factors, 18% of patients), intermediate (one factor, 36% of patients), and high risk (≥ 2 factors, 46% of patients) with 3-year PFS estimates of 92%, 72%, and 53%, respectively, and 3-year overall survival estimates of 96%, 76%, and 59%, respectively. The index discriminated outcomes regardless of HIV status, stage, or first-line chemotherapy regimen. Patient characteristics, relative size of the BL-IPI groupings, and outcome discrimination were consistent in the validation cohort of 457 patients, with 3-year PFS estimates of 96%, 82%, and 63% for low-, intermediate-, and high-risk BL-IPI, respectively. CONCLUSION The BL-IPI provides robust discrimination of survival in adult BL, suitable for use as prognostication and stratification in trials. The high-risk group has suboptimal outcomes with standard therapy and should be considered for innovative treatment approaches.
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Affiliation(s)
- Adam J. Olszewski
- Lifespan Cancer Institute, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Lasse H. Jakobsen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Graham P. Collins
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Kate Cwynarski
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | | | - Kirsten M. Boughan
- Adult Hematologic Malignancies and Stem Cell Transplant Section, University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Mark Bower
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Alessia Dalla Pria
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Alexey Danilov
- Toni Stephenson Lymphoma Center, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Kevin A. David
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Fredrik Ellin
- Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund, Sweden
| | | | - Umar Farooq
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Tatyana A. Feldman
- John Theurer Cancer Center, Hackensack Meridian Health School of Medicine, Hackensack, NJ
| | - Alina S. Gerrie
- BC Cancer Centre for Lymphoid Cancer and The University of British Columbia, Vancouver, British Columbia, Canada
| | - Deepa Jagadeesh
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | | | - Reem Karmali
- Division of Hematology Oncology, Northwestern University, Chicago, IL
| | | | | | - Nadia Khan
- Fox Chase Cancer Center, Philadelphia, PA
| | - Seo-Hyun Kim
- Division of Hematology Oncology, Rush University Medical Center, Chicago, IL
| | - Andreas K. Klein
- Division of Hematology and Oncology, Tufts Medical Center, Boston, MA
| | - Izidore S. Lossos
- Division of Hematology, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | | | - Peter Martin
- Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY
| | | | - Silvia Montoto
- Department of Haemato-oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Seema Naik
- Penn State Cancer Institute, Penn State Hershey Medical Center, Hershey, PA
| | - Neil Palmisiano
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - David Peace
- Division of Hematology/Oncology, Department of Medicine, University of Illinois College of Medicine, Chicago, IL
| | | | | | - Craig A. Portell
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | | | - Anna Santarsieri
- Department of Haematology, Cambridge University Hospitals NHSFT, Cambridge, United Kingdom
| | | | - Knut B. Smeland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Stephen D. Smith
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Suchitra Sundaram
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Adam S. Zayac
- Lifespan Cancer Institute, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Xiao-Yin Zhang
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Catherine Zhu
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Chan Y. Cheah
- Linear Clinical Research and Sir Charles Gairdner Hospital, Perth, Australia
| | - Tarec C. El-Galaly
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Andrew M. Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,Andrew M. Evens, DO, MSc, Rutgers Cancer Institute of New Jersey, 195 Little Albany St, New Brunswick, NJ 08901; e-mail:
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Cheng PTM, Villa D, Gerrie AS, Freeman CL, Slack GW, Scott DW, Connors JM, Sehn LH, Savage KJ. Outcome of elderly patients with classical Hodgkin lymphoma (HL) in British Columbia. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.8031] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8031 Background: Outcomes in elderly patients (pts) with Hodgkin lymphoma (HL) have traditionally been poor. We evaluated the survival of elderly pts (>60 years [y]) with classical HL in British Columbia (BC). Methods: All pts aged >60 y newly diagnosed with classical HL from 1961 to 2019 were identified in the BC Cancer Lymphoid Cancer Database. Limited stage was defined as non-bulky (<10 cm) stage 1A/IB or 2A (before 2000 1B = advanced stage), with the remainder considered advanced stage. Results: Following exclusions (HIV positive n=4, incomplete data n=21, prior or concurrent other lymphoproliferative disease n=67), 713 pts were identified. With a median follow up of 6.0 y (0.1 - 24.0 y) in living pts, there has been an improvement in 5 y DSS/OS (both p<.001) by decade comparison: 1960s (n=52) 25%/17%; 1970s (n=75) 38%/31%; 1980s (n=90) 51%/43%; 1990s (n=115) 53%/42%; 2000s (n=180) 66%/57%; 2010s (n=201) 63%/53%. To account for advances in diagnosis, staging, supportive care, and therapy in the modern era, we evaluated the outcome of pts diagnosed since 01/1995. A total of 368 pts were treated with curative intent (Table). Most pts received multi-agent chemotherapy (n=359, 98%: ABVD[like] n=351, alkylator-based n=7, CHOP n=1), 8 pts had radiotherapy (RT) alone, and 1 pt had surgery (primary CNS HL). The 5 y DSS, PFS, and OS were 74%, 57%, and 62%, respectively. Increasing age was associated with inferior outcomes (5 y DSS/PFS/OS): 61-70 y (81%/70%/74%), 71-80 y (69%/47%/52%), and >80 y (59%/27%/31%) (DSS p=.011; PFS p<.0001; OS p<.0001). Of 318 pts that received bleomycin, 60 (19%) developed pulmonary toxicity, including 22 cases that occurred after cycles 1 and 2. Overall, 24/368 pts (7%) died of acute treatment toxicity (pulmonary [bleomycin n=10, radiation n=1], infection n=10, cardiac n=3). There was no association between age and developing bleomycin (p=.80) or lethal treatment toxicities (p=.74). Conclusions: The outcome of elderly pts with HL has improved in recent decades. However, treatment related toxicity remains a concern and use of multi-agent chemotherapy, particularly bleomycin-containing regimens, should be undertaken with caution. [Table: see text]
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Affiliation(s)
| | - Diego Villa
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Alina S. Gerrie
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Ciara L Freeman
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Graham W Slack
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - David W. Scott
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Joseph M. Connors
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Laurie Helen Sehn
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Kerry J. Savage
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
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22
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Jakobsen LH, Ellin F, Smeland KB, Wästerlid T, Christensen JH, Jørgensen JM, Josefsson PL, Øvlisen AK, Holte H, Blaker YN, Grauslund JH, Bjørn J, Molin D, Lagerlöf I, Smedby KE, Colvin K, Thanarajasingam G, Maurer MJ, Habermann TM, Song KW, Zhu KY, Gerrie AS, Cheah CY, El-Galaly TC. Minimal relapse risk and early normalization of survival for patients with Burkitt lymphoma treated with intensive immunochemotherapy: an international study of 264 real-world patients. Br J Haematol 2020; 189:661-671. [PMID: 32017050 DOI: 10.1111/bjh.16425] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/28/2019] [Indexed: 11/27/2022]
Abstract
Non-endemic Burkitt lymphoma (BL) is a rare germinal centre B-cell-derived malignancy with the genetic hallmark of MYC gene translocation and with rapid tumour growth as a distinct clinical feature. To investigate treatment outcomes, loss of lifetime and relapse risk in adult BL patients treated with intensive immunochemotherapy, retrospective clinic-based and population-based lymphoma registries from six countries were used to identify 264 real-world patients. The median age was 47 years and the majority had advanced-stage disease and elevated LDH. Treatment protocols were R-CODOX-M/IVAC (47%), R-hyper-CVAD (16%), DA-EPOCH-R (11%), R-BFM/GMALL (25%) and other (2%) leading to an overall response rate of 89%. The two-year overall survival and event-free survival were 84% and 80% respectively. For patients in complete remission/unconfirmed, the two-year relapse risk was 6% but diminished to 0·6% for patients reaching 12 months of post-remission event-free survival (pEFS12). The loss of lifetime for pEFS12 patients was 0·4 (95% CI: -0·7 to 2) months. In conclusion, real-world outcomes of adult BL are excellent following intensive immunochemotherapy. For pEFS12 patients, the relapse risk was low and life expectancy similar to that of a general population, which is important information for developing meaningful follow-up strategies with increased focus on survivorship and less focus on routine disease surveillance.
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Affiliation(s)
- Lasse H Jakobsen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Fredrik Ellin
- Department of Clinical Sciences Lund, Oncology, Lund University, Lund, Sweden
| | - Knut B Smeland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Tove Wästerlid
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | | | - Judit M Jørgensen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Andreas K Øvlisen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Harald Holte
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- KG Jebsen Centre for B-cell malignancies, Oslo, Norway
| | - Yngvild N Blaker
- KG Jebsen Centre for B-cell malignancies, Oslo, Norway
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | | | - Jon Bjørn
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Daniel Molin
- Experimental and Clinical Oncology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Ingemar Lagerlöf
- Division of Drug Research, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Karin E Smedby
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Katherine Colvin
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | | | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Kevin W Song
- Leukemia/BMT Program of BC, Centre for Lymphoid Cancer, BC Cancer, Vancouver, Canada
| | - Katie Y Zhu
- Leukemia/BMT Program of BC, Centre for Lymphoid Cancer, BC Cancer, Vancouver, Canada
| | - Alina S Gerrie
- Leukemia/BMT Program of BC, Centre for Lymphoid Cancer, BC Cancer, Vancouver, Canada
| | - Chan Y Cheah
- Department of Hematology, Sir Charles Gairdner Hospital, Nedlands, Australia
- Department of Hematology, Pathwest Laboratory Medicine WA, Nedlands, Australia
- Medical School, University of Western Australia, Crawley, Australia
| | - Tarec C El-Galaly
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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23
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Huang SJ, Gerrie AS, Young S, Tucker T, Bruyere H, Hrynchak M, Galbraith P, Al Tourah AJ, Dueck G, Noble MC, Ramadan KM, Tsang P, Hardy E, Sehn L, Toze CL. Comparison of real-world treatment patterns in chronic lymphocytic leukemia management before and after availability of ibrutinib in the province of British Columbia, Canada. Leuk Res 2020; 91:106335. [PMID: 32114372 DOI: 10.1016/j.leukres.2020.106335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/12/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
We performed a retrospective study comparing treatment patterns and overall survival (OS) in chronic lymphocytic leukemia (CLL) patients with the advent of ibrutinib to provide current real-world data. METHODS Using a provincial population-based database, we analyzed CLL patients who received upfront treatment in British Columbia before ibrutinib availability (1984-2014), during ibrutinib access for: relapse only (2014-2015) and for upfront treatment of patients (with 17p deletion or unfit for chemotherapy) (2015-2016). Analysis included up to third-line treatment. RESULTS Of 1729 patients meeting inclusion criteria (median age, 66 years; 1466, period 1; 140, period 2; 123, period 3), FR was the most common first-line therapy (35.8 %, 54.3 % and 40.7 %, periods 1-3, respectively) and 18.7 % received ibrutinib upfront in period 3. The most common therapies in relapse were chemoimmunotherapy (36.1 % and 55.6 %, periods 1 and 2, second-line; 29.2 %, period 1, third-line) and ibrutinib (69.8 %, period 3, second-line; 46.4 % and 70.3 %, periods 2 and 3, third-line). OS improved for patients treated in periods 2-3 over period 1 (median OS not reached vs. 11.9 years, p < 0.001; no difference in OS for periods 2-3, p = 0.385). CONCLUSION Ibrutinib has replaced chemoimmunotherapy as the preferred therapy in relapse. Overall survival has improved over time with access to ibrutinib.
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Affiliation(s)
- Steven J Huang
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Canada
| | - Alina S Gerrie
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Canada; British Columbia Cancer - Vancouver, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean Young
- Pathology and Laboratory Medicine, British Columbia Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tracy Tucker
- Pathology and Laboratory Medicine, British Columbia Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Helene Bruyere
- Division of Pathology and Laboratory Medicine, Cytogenetics Laboratory, Vancouver General Hospital, University of British Columbia, Canada
| | - Monica Hrynchak
- Molecular Cytogenetic Laboratory, Royal Columbian Hospital, University of British Columbia, New Westminster, British Columbia, Canada
| | - Paul Galbraith
- British Columbia Cancer - Abbotsford, University of British Columbia, Abbotsford, British Columbia, Canada
| | - Abdulwahab J Al Tourah
- British Columbia Cancer - Surrey, University of British Columbia, Surrey, British Columbia, Canada
| | - Gregory Dueck
- British Columbia Cancer - Kelowna, University of British Columbia, Kelowna, British Columbia, Canada
| | - Michael C Noble
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Khaled M Ramadan
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Tsang
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Canada; Richmond Hospital, Richmond, British Columbia, Canada
| | - Edward Hardy
- Tom McMurty & Peter Baerg Cancer Centre, Vernon Jubilee Hospital, Vernon, British Columbia, Canada
| | - Laurie Sehn
- British Columbia Cancer - Vancouver, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cynthia L Toze
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Canada; British Columbia Cancer - Vancouver, University of British Columbia, Vancouver, British Columbia, Canada.
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Hoofd C, Huang SJ, Gusscott S, Lam S, Wong R, Johnston A, Ben-Neriah S, Steidl C, Scott DW, Bruyere H, Gillan TL, Toze CL, Gerrie AS, Weng AP. Ultrasensitive Detection of NOTCH1 c.7544_7545delCT Mutations in Chronic Lymphocytic Leukemia by Droplet Digital PCR Reveals High Frequency of Subclonal Mutations and Predicts Clinical Outcome in Cases with Trisomy 12. J Mol Diagn 2020; 22:571-578. [PMID: 32036086 DOI: 10.1016/j.jmoldx.2020.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/25/2019] [Accepted: 01/14/2020] [Indexed: 01/07/2023] Open
Abstract
NOTCH1 is recurrently mutated in chronic lymphocytic leukemia (CLL), most commonly as a 2-bp frameshift deletion (c.7541_7542delCT). This mutated allele encodes a truncated form of the receptor (p.P2514Rfs∗4) lacking the C-terminal proline, glutamic acid, serine, and threonine (PEST) degradation domain that increases NOTCH1 signaling duration. NOTCH1 mutation has been associated with poor clinical outcomes in CLL. We validated a highly sensitive and quantitative droplet digital PCR assay for the NOTCH1 delCT mutation, which was anticipated to perform well compared with Sanger sequencing and allele-specific PCR. Performance characteristics of this assay were tested on 126 samples from an unselected CLL cohort and a separate cohort of 85 samples from patients with trisomy 12 CLL. The delCT mutation was detected at allele frequencies as low as 0.024%; 25% of unselected cases and 55% of trisomy 12 cases were positive at the 0.024% detection threshold. Mutational burdens ≥1% were significantly associated with shorter overall survival (OS) in patients with trisomy 12+ disease in multivariate analysis (median OS, 9.1 versus 13 years, with hazard ratio of 2.34; P = 0.031). Mutational burdens <1% correlated with shorter OS in univariate, but not multivariate, analyses. These results suggest that droplet digital PCR testing for NOTCH1 delCT mutation may aid in risk stratification and/or disease monitoring in certain subsets of patients with CLL.
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Affiliation(s)
- Catherine Hoofd
- Terry Fox Laboratory, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Steven J Huang
- Leukemia/Bone Marrow Transplant Program of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Samuel Gusscott
- Terry Fox Laboratory, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Sonya Lam
- Terry Fox Laboratory, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Rachel Wong
- Terry Fox Laboratory, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Alexa Johnston
- Terry Fox Laboratory, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Susana Ben-Neriah
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Christian Steidl
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - David W Scott
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Helene Bruyere
- Division of Hematology and the Cytogenetics Laboratory, Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Tanya L Gillan
- Division of Hematology and the Cytogenetics Laboratory, Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Cynthia L Toze
- Leukemia/Bone Marrow Transplant Program of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Alina S Gerrie
- Leukemia/Bone Marrow Transplant Program of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Andrew P Weng
- Terry Fox Laboratory, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Pathology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
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25
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Hayden AR, Lee DG, Villa D, Gerrie AS, Scott DW, Slack GW, Sehn LH, Connors JM, Savage KJ. Validation of a simplified international prognostic score (IPS-3) in patients with advanced-stage classic Hodgkin lymphoma. Br J Haematol 2019; 189:122-127. [PMID: 31822034 DOI: 10.1111/bjh.16293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/24/2019] [Indexed: 01/06/2023]
Abstract
A novel prognostic score (IPS-3), comprised of only three of the seven IPS-7 indicators (age ≥45, stage IV, haemoglobin <105 g/l), was recently proposed as a simplified model for advanced-stage classic Hodgkin lymphoma (cHL). We aimed to validate this model in advanced-stage cHL patients treated with doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) in British Columbia. The estimated five-year freedom from progression (FFP) for scores of 0, 1, 2 and 3 were very similar to the original report at 84%, 76%, 72% and 68% respectively. The IPS-3 score is highly reproducible in this independent dataset and its simplicity makes it appealing for everyday clinical practice.
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Affiliation(s)
- Anna R Hayden
- Department of Medical Oncology, British Columbia Cancer, Centre for Lymphoid Cancer, Vancouver, Canada
| | - Derrick G Lee
- Department of Math, Statistics, and Computer Science, St. Francis Xavier University, Antigonish, NS, Canada.,Cancer Control Research, BC Cancer, Vancouver, Canada
| | - Diego Villa
- Department of Medical Oncology, British Columbia Cancer, Centre for Lymphoid Cancer, Vancouver, Canada
| | - Alina S Gerrie
- Department of Medical Oncology, British Columbia Cancer, Centre for Lymphoid Cancer, Vancouver, Canada
| | - David W Scott
- Department of Medical Oncology, British Columbia Cancer, Centre for Lymphoid Cancer, Vancouver, Canada
| | - Graham W Slack
- Department of Pathology, British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, Canada
| | - Laurie H Sehn
- Department of Medical Oncology, British Columbia Cancer, Centre for Lymphoid Cancer, Vancouver, Canada
| | - Joseph M Connors
- Department of Medical Oncology, British Columbia Cancer, Centre for Lymphoid Cancer, Vancouver, Canada
| | - Kerry J Savage
- Department of Medical Oncology, British Columbia Cancer, Centre for Lymphoid Cancer, Vancouver, Canada
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26
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Huang SJ, Chan J, Bruyère H, Allan LL, Gerrie AS, Toze CL. Chronic lymphocytic leukemia patients with HLA-B27 referred for allogeneic hematopoietic stem cell transplantation do not have worse outcomes: Results of a population-based case series analysis in British Columbia, Canada. Leuk Res 2019; 84:106193. [PMID: 31325731 DOI: 10.1016/j.leukres.2019.106193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 12/22/2022]
Abstract
Human leukocyte antigen B27 (HLA-B27), associated with spondyloarthritis, was suggested to be protective against chronic lymphocytic leukemia (CLL). It is hypothesized that HLA-B27 patients may have worse outcome in part related to their other comorbidities. OBJECTIVES We sought to compare the clinical characteristics and outcomes of CLL and small lymphocytic lymphoma (SLL) patients referred for allogeneic hematopoietic stem cell transplantation (allo-HSCT) based on their HLA-B27 status. METHODS This retrospective population-based case series analyzed CLL/SLL patients who were HLA-typed for potential allo-HSCT in British Columbia, Canada. RESULTS of 279 CLL/SLL patients referred for potential allo-HSCT, 34 patients were HLA-B27 positive. For HLA-B27 patients, median age at CLL diagnosis was 53.5 years (range, 27-67) and 71% were male. Seven patients had 11q deletion and nine patients had 17p deletion detected prior to first CLL therapy or at relapse. Eleven HLA-B27 patients received allo-HSCT. Two patients developed acute myeloid leukemia. One patient with ankylosing spondylitis had Richter's transformation prior to any CLL therapy. Spondyloarthritis-related disorders were diagnosed in 12 HLA-B27 patients but there was no temporal correlation with development of CLL. Overall survival (OS) and treatment-free survival (TFS) were not significantly different between HLA-B27 patients with or without spondyloarthritis-related disorders. There were no significant differences in clinical characteristics at CLL diagnosis or OS/TFS between HLA-B27 positive and negative patients referred for allo-HSCT. CONCLUSIONS HLA-B27 positivity does not appear to influence outcome for CLL/SLL patients referred for allo-HSCT. Further studies are needed to evaluate the clinical significance of HLA-B27 in a general CLL population.
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Affiliation(s)
- Steven J Huang
- Division of Hematology and Leukemia/BMT Program of British Columbia, Vancouver General Hospital, University of British Columbia, Canada
| | - Jonathan Chan
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Helene Bruyère
- Division of Pathology and Laboratory Medicine, Cytogenetics Laboratory, Vancouver General Hospital, University of British Columbia, Canada
| | - Lenka L Allan
- Division of Pathology and Laboratory Medicine, Immunology Laboratory, Vancouver General Hospital, University of British Columbia, Canada
| | - Alina S Gerrie
- Division of Hematology and Leukemia/BMT Program of British Columbia, Vancouver General Hospital, University of British Columbia, Canada; British Columbia Cancer Agency, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cynthia L Toze
- Division of Hematology and Leukemia/BMT Program of British Columbia, Vancouver General Hospital, University of British Columbia, Canada; British Columbia Cancer Agency, University of British Columbia, Vancouver, British Columbia, Canada.
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Healy S, Ennishi D, Bashashati A, Saberi S, Hother C, Mottok A, Chan FC, Chong L, Kridel R, Boyle M, Meissner B, Aoki T, Takata K, Woolcock BW, Vigano E, Abraham L, Gold M, Telenius A, Farinha P, Slack G, Ben-Neriah S, Lai D, Zhang AW, Salehi S, Shulha HP, Chiu DS, Mostafavi S, Gerrie AS, Villa D, Sehn LH, Savage KJJ, Mungall AJJ, Weng AP, Bally M, Morin RD, Freue GVC, Connors JM, Marra MA, Shah SP, Gascoyne1 RD, Scott DW, Steidl C, Steidl U. Abstract 3480: TMEM30A loss-of-function mutations drive lymphomagenesis and confer therapeutically exploitable vulnerability in B-cell lymphoma. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-3480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma subtype worldwide, accounting for 40% of all non-Hodgkin lymphomas. DLBCL presents as an aggressive disease requiring immediate treatment. Although significant improvement in outcome has been achieved, ~40% of patients still experience treatment failure. Here, we characterized the recurrent genetic alterations and transcriptomic signatures in diagnostic biopsies from a population registry-based cohort of 347 patients with de novo DLBCL uniformly treated with R-CHOP. This analysis revealed bi-allelic loss of function mutations of TMEM30A that were associated with favorable treatment outcome. TMEM30A is a chaperone protein, involved in maintaining the asymmetric distribution of phosphatidylethanolamine and phosphatidylserine, an integral component of the plasma membrane and “eat-me” signal recognized by macrophages. Using TMEM30A knockout systems by CRISPR genome editing techniques, we have functionally characterized this loss-of-function mutation in representative human and mouse DLBCL cell line models. We have discovered that TMEM30A loss is associated with increased B-cell signaling following antigen stimulation, including a two-fold increase in the diffusion rate of B-cell receptor (BCR) clustering, using high resolution Single Particle Tracking (SPT) technology. In addition, we have measured three-fold increase in chemotherapeutic drug accumulation in both knockout cell lines and randomly selected patient biopsies with TMEM30A biallelic loss. This observation was validated in a xenograft mouse model, which presented improved survival and limited tumor growth following vincristine treatment in mice injected with TMEM30A null DLBCL cell lines compared with native cell lines. This phenotype explains the improved prognosis observed in DLBCL patients following R-CHOP treatment. Furthermore, we have observed over two fold higher numbers of tumor-associated macrophages in B-cell lymphoma syngeneic mouse models with Tmem30a loss-of-function, prior to any form of treatment, suggesting the existence of “hot” and primed tumors. Our data highlight a multi-faceted role for TMEM30A and plasma membrane physiology in B-cell lymphomagenesis, and characterize intrinsic and extrinsic vulnerabilities of cancer cells that can be therapeutically exploited. Characterization of these mechanisms will address a missing link in the cancer field as related insights in lymphoma will outline therapeutic approaches that can be extended to cancer therapy in general.
Citation Format: Shannon Healy, Daisuke Ennishi, Ali Bashashati, Saeed Saberi, Christoffer Hother, Anja Mottok, Fong Chun Chan, Lauren Chong, Robert Kridel, Merrill Boyle, Barbara Meissner, Tomohiro Aoki, Katsuyoshi Takata, Bruce W. Woolcock, Elena Vigano, Libin Abraham, Michael Gold, Adele Telenius, Pedro Farinha, Graham Slack, Susana Ben-Neriah, Daniel Lai, Allen W. Zhang, Sohrab Salehi, Hennady P. Shulha, Derek S. Chiu, Sara Mostafavi, Alina S. Gerrie, Diego Villa, Laurie H. Sehn, Kerry J. J. Savage, Andrew J. J. Mungall, Andrew P. Weng, Marcel Bally, Ryan D. Morin, Gabriela V. Cohen Freue, Joseph M. Connors, Marco A. Marra, Sohrab P. Shah, Randy D. Gascoyne1, David W. Scott, Christian Steidl, Ulrich Steidl. TMEM30A loss-of-function mutations drive lymphomagenesis and confer therapeutically exploitable vulnerability in B-cell lymphoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3480.
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Affiliation(s)
- Shannon Healy
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | | | - Saeed Saberi
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Anja Mottok
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Fong Chun Chan
- 2University of British Columbia, Vancouver, British Columbia, Canada
| | - Lauren Chong
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Robert Kridel
- 3University Health Network, Toronto, Ontario, Canada
| | - Merrill Boyle
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Tomohiro Aoki
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | | | - Elena Vigano
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Libin Abraham
- 2University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Gold
- 2University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Pedro Farinha
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Graham Slack
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Daniel Lai
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Sohrab Salehi
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Derek S. Chiu
- 2University of British Columbia, Vancouver, British Columbia, Canada
| | - Sara Mostafavi
- 2University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Diego Villa
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | | | | | | | - Marcel Bally
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Ryan D. Morin
- 4Simon Fraser University, Vancouver, British Columbia, Canada
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Biccler JL, Savage KJ, Brown PD, Jørgensen J, Larsen TS, Poulsen CB, Stoltenberg D, Sehn LH, Scott DW, Gerrie AS, Jakobsen LH, Bøgsted M, El-Galaly TC, Villa D. Risk of death, relapse or progression, and loss of life expectancy at different progression-free survival milestones in primary central nervous system lymphoma. Leuk Lymphoma 2019; 60:2516-2523. [DOI: 10.1080/10428194.2019.1594219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Jorne L. Biccler
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kerry J. Savage
- BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - Peter D.N. Brown
- Department of Haematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Judit Jørgensen
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas S. Larsen
- Department of Haematology, Odense University Hospital, Odense, Denmark
| | | | - Danny Stoltenberg
- Department of Haematology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Laurie H. Sehn
- BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - David W. Scott
- BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - Alina S. Gerrie
- BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - Lasse H. Jakobsen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Martin Bøgsted
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Tarec C. El-Galaly
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Diego Villa
- BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
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Gerson JN, Handorf E, Villa D, Gerrie AS, Chapani P, Li S, Medeiros LJ, Wang MI, Cohen JB, Calzada O, Churnetski MC, Hill BT, Sawalha Y, Hernandez-Ilizaliturri FJ, Kothari S, Vose JM, Bast MA, Fenske TS, Narayana Rao Gari S, Maddocks KJ, Bond D, Bachanova V, Kolla B, Chavez J, Shah B, Lansigan F, Burns TF, Donovan AM, Wagner-Johnston N, Messmer M, Mehta A, Anderson JK, Reddy N, Kovach AE, Landsburg DJ, Glenn M, Inwards DJ, Karmali R, Kaplan JB, Caimi PF, Rajguru S, Evens A, Klein A, Umyarova E, Pulluri B, Amengual JE, Lue JK, Diefenbach C, Fisher RI, Barta SK. Survival Outcomes of Younger Patients With Mantle Cell Lymphoma Treated in the Rituximab Era. J Clin Oncol 2019; 37:471-480. [PMID: 30615550 DOI: 10.1200/jco.18.00690] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Mantle cell lymphoma (MCL) is a B-cell lymphoma characterized by cyclin D1 expression. Autologous hematopoietic cell transplantation (AHCT) consolidation after induction chemotherapy is often used for eligible patients; however, the benefit remains uncertain in the rituximab era. Herein we retrospectively assessed the impact of AHCT consolidation on survival in a large cohort of transplantation-eligible patients age 65 years or younger. PATIENTS AND METHODS We retrospectively studied transplantation-eligible adults age 65 years or younger with newly diagnosed MCL treated between 2000 and 2015. The primary objective was to assess for improved progression-free survival (PFS) with AHCT consolidation and secondarily to assess for improved overall survival (OS). Cox multivariable regression analysis and propensity score-weighted (PSW) analysis were performed. RESULTS Data were collected from 25 medical centers for 1,254 patients; 1,029 met inclusion criteria. Median follow-up for the cohort was 76 months. Median PFS and OS were 62 and 139 months, respectively. On unadjusted analysis, AHCT was associated with improved PFS (75 v 44 months with v without AHCT, respectively; P < .01) and OS (147 v 115 months with v without AHCT, respectively; P < .05). On multivariable regression analysis, AHCT was associated with improved PFS (hazard ratio [HR], 0.54; 95% CI, 0.44 to 0.66; P < .01) and a trend toward improved OS (HR, 0.77; 95% CI, 0.59 to 1.01; P = .06). After PSW analysis, AHCT remained associated with improved PFS (HR, 0.70; 95% CI, 0.59 to 0.84; P < .05) but not improved OS (HR, 0.87; 95% CI, 0.69 to 1.1; P = .2). CONCLUSION In this large cohort of younger, transplantation-eligible patients with MCL, AHCT consolidation after induction was associated with significantly improved PFS but not OS after PSW analysis. Within the limitations of a retrospective analysis, our findings suggest that in younger, fit patients, AHCT consolidation may improve PFS.
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Affiliation(s)
| | | | - Diego Villa
- 2 BC Cancer, Vancouver, British Columbia, Canada
| | | | - Parv Chapani
- 2 BC Cancer, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Julie M Vose
- 7 University of Nebraska Cancer Center, Omaha, NE
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Martha Glenn
- 17 Huntsman Cancer Institute, Salt Lake City, UT
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Owen C, Gerrie AS, Banerji V, Assouline S, Chen C, Robinson KS, Lye E, Fraser G. Canadian evidence-based guideline for the first-line treatment of chronic lymphocytic leukemia. Curr Oncol 2018; 25:e461-e474. [PMID: 30464698 PMCID: PMC6209557 DOI: 10.3747/co.25.4092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 01/26/2023] Open
Abstract
Chronic lymphocytic leukemia (cll) is the most common adult leukemia in North America. In Canada, no unified national guideline exists for the front-line treatment of cll; provincial guidelines vary and are largely based on funding. A group of clinical experts from across Canada developed a national evidence-based treatment guideline to provide health care professionals with clear guidance on the first-line management of cll. Consensus recommendations based on available evidence are presented for the first-line treatment of cll.
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Affiliation(s)
- C Owen
- Division of Hematology and Hematological Malignancies, Foothills Medical Centre, Calgary, AB
| | - A S Gerrie
- Division of Medical Oncology, University of British Columbia and BC Cancer, Vancouver, BC
| | - V Banerji
- Department of Hematology and Medical Oncology, Cancer Care Manitoba, Winnipeg, MB
| | - S Assouline
- Department of Medical Oncology, McGill University and Jewish General Hospital, Montreal, QC
| | - C Chen
- Department of Medical Oncology, University of Toronto, and Princess Margaret Cancer Centre, Toronto, ON
| | - K S Robinson
- Division of Hematology, Dalhousie University, and qeii Health Sciences Centre, Halifax, NS
| | - E Lye
- Lymphoma Canada, Mississauga, ON
| | - G Fraser
- Department of Oncology, McMaster University, and Juravinski Cancer Centre, Hamilton, ON
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Limvorapitak W, Barnett MJ, Hogge DE, Forrest DL, Nevill TJ, Narayanan S, Power MM, Nantel SH, Broady R, Song KW, Toze CL, Mourad YA, Sutherland HJ, Gerrie AS, White J, Sanford DS. Outcomes of Intermediate Risk Karyotype Acute Myeloid Leukemia in First Remission Undergoing Autologous Stem Cell Transplantation Compared With Allogeneic Stem Cell Transplantation and Chemotherapy Consolidation: A Retrospective, Propensity-score Adjusted Analysis. Clin Lymphoma Myeloma Leuk 2018; 18:e481-e491. [PMID: 30100330 DOI: 10.1016/j.clml.2018.07.290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/07/2018] [Accepted: 07/11/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Optimal post-remission therapy (PRT) for intermediate risk acute myeloid leukemia remains an area of ongoing research. We aimed to retrospectively compare outcomes following autologous stem cell transplantation (autoSCT) with allogeneic SCT (alloSCT) and consolidation chemotherapy (CMT) in patients with intermediate-risk karyotype AML in first complete remission. PATIENTS AND METHODS We compared overall survival (OS) and leukemia-free survival (LFS) using propensity score (PS)-adjusted analysis of patients receiving PRT with autoSCT, matched sibling (MSD) alloSCT, unrelated/mismatch (UD/MM) alloSCT, and CMT. We included patients diagnosed between 1984 and 2003 (period of autoSCT at our center) in CR1 following induction CMT and received at least 2 consolidative cycles. RESULTS We identified 190 patients (62 MSD-alloSCT, 18 UD/MM-alloSCT, 30 autoSCT, and 80 CMT). Baseline characteristics were used for PS calculation and were well-balanced after weight adjustment. The median follow-up for patients surviving beyond 1 year was 8.7 years. We excluded 55 patients based on PS calculation. Adjusted multivariate hazard ratio (HR), 95% confidence interval (CI) and P-value for OS, considering CMT as reference, were: MSD-alloSCT (HR, 0.4; 95% CI, 0.2-0.8; P = .009), UD/MM-alloSCT (HR, 1.5; 95% CI, 0.6-3.9; P = .363), and autoSCT (HR, 1.2; 95% CI, 0.5-3.1; P = .666), respectively. Adjusted multivariate HR, 95% CI and P-value for LFS were MSD-alloSCT (HR, 0.3; 95% CI, 0.2-0.6; P < .001), UD/MM-alloSCT (HR, 1.1; 95% CI, 0.4-2.7; P = .854), and autoSCT (HR, 0.8; 95% CI, 0.3-2.2; P = .697), respectively. CONCLUSION Patients with intermediate risk-karyotype acute myeloid leukemia who underwent MSD-alloSCT in first complete remission had the best outcomes. There were no survival differences between autoSCT, UD/MM-alloSCT, and CMT. Further study incorporating molecular changes and minimal residual disease status is warranted to select appropriate patients for autoSCT.
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Affiliation(s)
- Wasithep Limvorapitak
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Michael J Barnett
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Donna E Hogge
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Donna L Forrest
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas J Nevill
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sujaatha Narayanan
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Maryse M Power
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stephen H Nantel
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Raewyn Broady
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kevin W Song
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Cynthia L Toze
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Yasser Abou Mourad
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Heather J Sutherland
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alina S Gerrie
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer White
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David S Sanford
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Villa D, Sehn LH, Aquino-Parsons C, Tonseth P, Scott DW, Gerrie AS, Wilson D, Bénard F, Gascoyne RD, Slack GW, Farinha P, Morris J, Pickles T, Connors JM, Savage KJ. Interim PET-directed therapy in limited-stage Hodgkin lymphoma initially treated with ABVD. Haematologica 2018; 103:e590-e593. [PMID: 30002124 DOI: 10.3324/haematol.2018.196782] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Diego Villa
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology
| | - Laurie H Sehn
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology
| | | | | | - David W Scott
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology
| | - Alina S Gerrie
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology
| | | | | | - Randy D Gascoyne
- Department of Pathology and Laboratory Medicine, BC Cancer and the University of British Columbia, Vancouver, BC, Canada
| | - Graham W Slack
- Department of Pathology and Laboratory Medicine, BC Cancer and the University of British Columbia, Vancouver, BC, Canada
| | - Pedro Farinha
- Department of Pathology and Laboratory Medicine, BC Cancer and the University of British Columbia, Vancouver, BC, Canada
| | | | | | - Joseph M Connors
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology
| | - Kerry J Savage
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology
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33
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Zhu KY, Song KW, Connors JM, Leitch H, Barnett MJ, Ramadan K, Slack GW, Abou Mourad Y, Forrest DL, Hogge DE, Nantel SH, Narayanan S, Nevill TJ, Power MM, Sanford DS, Sutherland HJ, Tucker T, Toze CL, Sehn LH, Broady R, Gerrie AS. Excellent real-world outcomes of adults with Burkitt lymphoma treated with CODOX-M/IVAC plus or minus rituximab. Br J Haematol 2018; 181:782-790. [DOI: 10.1111/bjh.15262] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/01/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Katie Y. Zhu
- Faculty of Medicine; University of British Columbia; Vancouver BC Canada
| | - Kevin W. Song
- Hematology; Leukemia/BMT Program of BC; BC Cancer; University of British Columbia; Vancouver BC Canada
| | | | - Heather Leitch
- Division of Hematology; St. Paul's Hospital; University of British Columbia; Vancouver BC Canada
| | - Michael J. Barnett
- Hematology; Leukemia/BMT Program of BC; BC Cancer; University of British Columbia; Vancouver BC Canada
| | - Khaled Ramadan
- Division of Hematology; St. Paul's Hospital; University of British Columbia; Vancouver BC Canada
| | - Graham W. Slack
- Department of Pathology and Laboratory Medicine; BC Cancer; University of British Columbia; Vancouver BC Canada
| | - Yasser Abou Mourad
- Hematology; Leukemia/BMT Program of BC; BC Cancer; University of British Columbia; Vancouver BC Canada
| | - Donna L. Forrest
- Hematology; Leukemia/BMT Program of BC; BC Cancer; University of British Columbia; Vancouver BC Canada
| | - Donna E. Hogge
- Hematology; Leukemia/BMT Program of BC; BC Cancer; University of British Columbia; Vancouver BC Canada
| | - Stephen H. Nantel
- Hematology; Leukemia/BMT Program of BC; BC Cancer; University of British Columbia; Vancouver BC Canada
| | - Sujaatha Narayanan
- Hematology; Leukemia/BMT Program of BC; BC Cancer; University of British Columbia; Vancouver BC Canada
| | - Thomas J. Nevill
- Hematology; Leukemia/BMT Program of BC; BC Cancer; University of British Columbia; Vancouver BC Canada
| | - Maryse M. Power
- Hematology; Leukemia/BMT Program of BC; BC Cancer; University of British Columbia; Vancouver BC Canada
| | - David S. Sanford
- Hematology; Leukemia/BMT Program of BC; BC Cancer; University of British Columbia; Vancouver BC Canada
| | - Heather J. Sutherland
- Hematology; Leukemia/BMT Program of BC; BC Cancer; University of British Columbia; Vancouver BC Canada
| | - Tracy Tucker
- Genetics Laboratory; BC Cancer; University of British Columbia; Vancouver BC Canada
| | - Cynthia L. Toze
- Hematology; Leukemia/BMT Program of BC; BC Cancer; University of British Columbia; Vancouver BC Canada
| | - Laurie H. Sehn
- Centre for Lymphoid Cancer; BC Cancer; Vancouver BC Canada
| | - Raewyn Broady
- Hematology; Leukemia/BMT Program of BC; BC Cancer; University of British Columbia; Vancouver BC Canada
| | - Alina S. Gerrie
- Hematology; Leukemia/BMT Program of BC; BC Cancer; University of British Columbia; Vancouver BC Canada
- Centre for Lymphoid Cancer; BC Cancer; Vancouver BC Canada
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34
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Lee LJ, Toze CL, Huang SJT, Gillan TL, Connors JM, Sehn LH, Bruyere H, Leitch H, Ramadan KM, Gerrie AS. Improved survival outcomes with the addition of rituximab to initial therapy for chronic lymphocytic leukemia: a comparative effectiveness analysis in the province of British Columbia, Canada. Leuk Lymphoma 2017; 59:1356-1363. [PMID: 29032719 DOI: 10.1080/10428194.2017.1387904] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chemoimmunotherapy with rituximab improves survival in clinical trials in upfront chronic lymphocytic leukemia (CLL) treatment. This study compared clinical outcomes with and without rituximab added to first-line chemotherapy in a provincial cohort of CLL patients. Between 1973 and 2014, 1345 patients received CLL treatment: 48% with rituximab, 52% chemotherapy alone. Median overall survival (OS) and treatment-free survival (TFS) were significantly longer with rituximab: OS 8.9 vs. 6.2 years, p < .0001; TFS 3.6 vs. 2.1 years, p < .0001. Addition of rituximab to chemotherapy was a strong independent predictor of mortality with a 32% mortality reduction after controlling for co-variates (age, sex, stage, and treatment with purine analogs). This large population-based study complements clinical trial and registry data demonstrating the benefit of adding rituximab to first-line CLL therapy and adds further evidence of the efficacy of rituximab-based chemoimmunotherapy in a real-world setting.
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Affiliation(s)
- Lauren J Lee
- a Department of Medicine, Division of Hematology , University of British Columbia , Vancouver , Canada
| | - Cynthia L Toze
- b Leukemia/BMT Program of BC, Vancouver General Hospital, BC Cancer Agency and University of British Columbia , Vancouver , Canada
| | - Steven J T Huang
- b Leukemia/BMT Program of BC, Vancouver General Hospital, BC Cancer Agency and University of British Columbia , Vancouver , Canada
| | - Tanya L Gillan
- c Department of Laboratory Medicine, Medical Genetics Laboratory , Eastern Health , St. John's , Canada
| | - Joseph M Connors
- d Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia , Vancouver , Canada
| | - Laurie H Sehn
- d Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia , Vancouver , Canada
| | - Helene Bruyere
- e Department of Pathology and Laboratory Medicine , Vancouver General Hospital, University of British Columbia , Vancouver , Canada
| | - Heather Leitch
- f Division of Hematology , St. Paul's Hospital, University of British Columbia , Vancouver , Canada
| | - Khaled M Ramadan
- f Division of Hematology , St. Paul's Hospital, University of British Columbia , Vancouver , Canada
| | - Alina S Gerrie
- b Leukemia/BMT Program of BC, Vancouver General Hospital, BC Cancer Agency and University of British Columbia , Vancouver , Canada.,d Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia , Vancouver , Canada
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35
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Chan FC, Mottok A, Gerrie AS, Power M, Nijland M, Diepstra A, van den Berg A, Kamper P, d'Amore F, d'Amore AL, Hamilton-Dutoit S, Savage KJ, Shah SP, Connors JM, Gascoyne RD, Scott DW, Steidl C. Prognostic Model to Predict Post-Autologous Stem-Cell Transplantation Outcomes in Classical Hodgkin Lymphoma. J Clin Oncol 2017; 35:3722-3733. [PMID: 28898161 DOI: 10.1200/jco.2017.72.7925] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Purpose Our aim was to capture the biology of classical Hodgkin lymphoma (cHL) at the time of relapse and discover novel and robust biomarkers that predict outcomes after autologous stem-cell transplantation (ASCT). Materials and Methods We performed digital gene expression profiling on a cohort of 245 formalin-fixed, paraffin-embedded tumor specimens from 174 patients with cHL, including 71 with biopsies taken at both primary diagnosis and relapse, to investigate temporal gene expression differences and associations with post-ASCT outcomes. Relapse biopsies from a training cohort of 65 patients were used to build a gene expression-based prognostic model of post-ASCT outcomes (RHL30), and two independent cohorts were used for validation. Results Gene expression profiling revealed that 24% of patients exhibited poorly correlated expression patterns between their biopsies taken at initial diagnosis and relapse, indicating biologic divergence. Comparative analysis of the prognostic power of gene expression measurements in primary versus relapse specimens demonstrated that the biology captured at the time of relapse contained superior properties for post-ASCT outcome prediction. We developed RHL30, using relapse specimens, which identified a subset of high-risk patients with inferior post-ASCT outcomes in two independent external validation cohorts. The prognostic power of RHL30 was independent of reported clinical prognostic markers (both at initial diagnosis and at relapse) and microenvironmental components as assessed by immunohistochemistry. Conclusion We have developed and validated a novel clinically applicable prognostic assay that at the time of first relapse identifies patients with unfavorable post-ASCT outcomes. Moving forward, it will be critical to evaluate the clinical use of RHL30 in the context of positron emission tomography-guided response assessment and the evolving cHL treatment landscape.
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Affiliation(s)
- Fong Chun Chan
- Fong Chun Chan, Anja Mottok, Alina S. Gerrie, Maryse Power, Kerry J. Savage, Sohrab P. Shah, Joseph M. Connors, Randy D. Gascoyne, David W. Scott, and Christian Steidl, British Columbia Cancer Agency; Fong Chun Chan, Anja Mottok, Sohrab P. Shah, and Christian Steidl, University of British Columbia, Canada; Marcel Nijland, Arjan Diepstra, and Anke van den Berg, University Medical Center Groningen, Groningen, the Netherlands; and Peter Kamper, Francesco d'Amore, Alexander Lindholm d'Amore, and Stephen Hamilton-Dutoit, Aarhus University Hospital, Aarhus, Denmark
| | - Anja Mottok
- Fong Chun Chan, Anja Mottok, Alina S. Gerrie, Maryse Power, Kerry J. Savage, Sohrab P. Shah, Joseph M. Connors, Randy D. Gascoyne, David W. Scott, and Christian Steidl, British Columbia Cancer Agency; Fong Chun Chan, Anja Mottok, Sohrab P. Shah, and Christian Steidl, University of British Columbia, Canada; Marcel Nijland, Arjan Diepstra, and Anke van den Berg, University Medical Center Groningen, Groningen, the Netherlands; and Peter Kamper, Francesco d'Amore, Alexander Lindholm d'Amore, and Stephen Hamilton-Dutoit, Aarhus University Hospital, Aarhus, Denmark
| | - Alina S Gerrie
- Fong Chun Chan, Anja Mottok, Alina S. Gerrie, Maryse Power, Kerry J. Savage, Sohrab P. Shah, Joseph M. Connors, Randy D. Gascoyne, David W. Scott, and Christian Steidl, British Columbia Cancer Agency; Fong Chun Chan, Anja Mottok, Sohrab P. Shah, and Christian Steidl, University of British Columbia, Canada; Marcel Nijland, Arjan Diepstra, and Anke van den Berg, University Medical Center Groningen, Groningen, the Netherlands; and Peter Kamper, Francesco d'Amore, Alexander Lindholm d'Amore, and Stephen Hamilton-Dutoit, Aarhus University Hospital, Aarhus, Denmark
| | - Maryse Power
- Fong Chun Chan, Anja Mottok, Alina S. Gerrie, Maryse Power, Kerry J. Savage, Sohrab P. Shah, Joseph M. Connors, Randy D. Gascoyne, David W. Scott, and Christian Steidl, British Columbia Cancer Agency; Fong Chun Chan, Anja Mottok, Sohrab P. Shah, and Christian Steidl, University of British Columbia, Canada; Marcel Nijland, Arjan Diepstra, and Anke van den Berg, University Medical Center Groningen, Groningen, the Netherlands; and Peter Kamper, Francesco d'Amore, Alexander Lindholm d'Amore, and Stephen Hamilton-Dutoit, Aarhus University Hospital, Aarhus, Denmark
| | - Marcel Nijland
- Fong Chun Chan, Anja Mottok, Alina S. Gerrie, Maryse Power, Kerry J. Savage, Sohrab P. Shah, Joseph M. Connors, Randy D. Gascoyne, David W. Scott, and Christian Steidl, British Columbia Cancer Agency; Fong Chun Chan, Anja Mottok, Sohrab P. Shah, and Christian Steidl, University of British Columbia, Canada; Marcel Nijland, Arjan Diepstra, and Anke van den Berg, University Medical Center Groningen, Groningen, the Netherlands; and Peter Kamper, Francesco d'Amore, Alexander Lindholm d'Amore, and Stephen Hamilton-Dutoit, Aarhus University Hospital, Aarhus, Denmark
| | - Arjan Diepstra
- Fong Chun Chan, Anja Mottok, Alina S. Gerrie, Maryse Power, Kerry J. Savage, Sohrab P. Shah, Joseph M. Connors, Randy D. Gascoyne, David W. Scott, and Christian Steidl, British Columbia Cancer Agency; Fong Chun Chan, Anja Mottok, Sohrab P. Shah, and Christian Steidl, University of British Columbia, Canada; Marcel Nijland, Arjan Diepstra, and Anke van den Berg, University Medical Center Groningen, Groningen, the Netherlands; and Peter Kamper, Francesco d'Amore, Alexander Lindholm d'Amore, and Stephen Hamilton-Dutoit, Aarhus University Hospital, Aarhus, Denmark
| | - Anke van den Berg
- Fong Chun Chan, Anja Mottok, Alina S. Gerrie, Maryse Power, Kerry J. Savage, Sohrab P. Shah, Joseph M. Connors, Randy D. Gascoyne, David W. Scott, and Christian Steidl, British Columbia Cancer Agency; Fong Chun Chan, Anja Mottok, Sohrab P. Shah, and Christian Steidl, University of British Columbia, Canada; Marcel Nijland, Arjan Diepstra, and Anke van den Berg, University Medical Center Groningen, Groningen, the Netherlands; and Peter Kamper, Francesco d'Amore, Alexander Lindholm d'Amore, and Stephen Hamilton-Dutoit, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Kamper
- Fong Chun Chan, Anja Mottok, Alina S. Gerrie, Maryse Power, Kerry J. Savage, Sohrab P. Shah, Joseph M. Connors, Randy D. Gascoyne, David W. Scott, and Christian Steidl, British Columbia Cancer Agency; Fong Chun Chan, Anja Mottok, Sohrab P. Shah, and Christian Steidl, University of British Columbia, Canada; Marcel Nijland, Arjan Diepstra, and Anke van den Berg, University Medical Center Groningen, Groningen, the Netherlands; and Peter Kamper, Francesco d'Amore, Alexander Lindholm d'Amore, and Stephen Hamilton-Dutoit, Aarhus University Hospital, Aarhus, Denmark
| | - Francesco d'Amore
- Fong Chun Chan, Anja Mottok, Alina S. Gerrie, Maryse Power, Kerry J. Savage, Sohrab P. Shah, Joseph M. Connors, Randy D. Gascoyne, David W. Scott, and Christian Steidl, British Columbia Cancer Agency; Fong Chun Chan, Anja Mottok, Sohrab P. Shah, and Christian Steidl, University of British Columbia, Canada; Marcel Nijland, Arjan Diepstra, and Anke van den Berg, University Medical Center Groningen, Groningen, the Netherlands; and Peter Kamper, Francesco d'Amore, Alexander Lindholm d'Amore, and Stephen Hamilton-Dutoit, Aarhus University Hospital, Aarhus, Denmark
| | - Alexander Lindholm d'Amore
- Fong Chun Chan, Anja Mottok, Alina S. Gerrie, Maryse Power, Kerry J. Savage, Sohrab P. Shah, Joseph M. Connors, Randy D. Gascoyne, David W. Scott, and Christian Steidl, British Columbia Cancer Agency; Fong Chun Chan, Anja Mottok, Sohrab P. Shah, and Christian Steidl, University of British Columbia, Canada; Marcel Nijland, Arjan Diepstra, and Anke van den Berg, University Medical Center Groningen, Groningen, the Netherlands; and Peter Kamper, Francesco d'Amore, Alexander Lindholm d'Amore, and Stephen Hamilton-Dutoit, Aarhus University Hospital, Aarhus, Denmark
| | - Stephen Hamilton-Dutoit
- Fong Chun Chan, Anja Mottok, Alina S. Gerrie, Maryse Power, Kerry J. Savage, Sohrab P. Shah, Joseph M. Connors, Randy D. Gascoyne, David W. Scott, and Christian Steidl, British Columbia Cancer Agency; Fong Chun Chan, Anja Mottok, Sohrab P. Shah, and Christian Steidl, University of British Columbia, Canada; Marcel Nijland, Arjan Diepstra, and Anke van den Berg, University Medical Center Groningen, Groningen, the Netherlands; and Peter Kamper, Francesco d'Amore, Alexander Lindholm d'Amore, and Stephen Hamilton-Dutoit, Aarhus University Hospital, Aarhus, Denmark
| | - Kerry J Savage
- Fong Chun Chan, Anja Mottok, Alina S. Gerrie, Maryse Power, Kerry J. Savage, Sohrab P. Shah, Joseph M. Connors, Randy D. Gascoyne, David W. Scott, and Christian Steidl, British Columbia Cancer Agency; Fong Chun Chan, Anja Mottok, Sohrab P. Shah, and Christian Steidl, University of British Columbia, Canada; Marcel Nijland, Arjan Diepstra, and Anke van den Berg, University Medical Center Groningen, Groningen, the Netherlands; and Peter Kamper, Francesco d'Amore, Alexander Lindholm d'Amore, and Stephen Hamilton-Dutoit, Aarhus University Hospital, Aarhus, Denmark
| | - Sohrab P Shah
- Fong Chun Chan, Anja Mottok, Alina S. Gerrie, Maryse Power, Kerry J. Savage, Sohrab P. Shah, Joseph M. Connors, Randy D. Gascoyne, David W. Scott, and Christian Steidl, British Columbia Cancer Agency; Fong Chun Chan, Anja Mottok, Sohrab P. Shah, and Christian Steidl, University of British Columbia, Canada; Marcel Nijland, Arjan Diepstra, and Anke van den Berg, University Medical Center Groningen, Groningen, the Netherlands; and Peter Kamper, Francesco d'Amore, Alexander Lindholm d'Amore, and Stephen Hamilton-Dutoit, Aarhus University Hospital, Aarhus, Denmark
| | - Joseph M Connors
- Fong Chun Chan, Anja Mottok, Alina S. Gerrie, Maryse Power, Kerry J. Savage, Sohrab P. Shah, Joseph M. Connors, Randy D. Gascoyne, David W. Scott, and Christian Steidl, British Columbia Cancer Agency; Fong Chun Chan, Anja Mottok, Sohrab P. Shah, and Christian Steidl, University of British Columbia, Canada; Marcel Nijland, Arjan Diepstra, and Anke van den Berg, University Medical Center Groningen, Groningen, the Netherlands; and Peter Kamper, Francesco d'Amore, Alexander Lindholm d'Amore, and Stephen Hamilton-Dutoit, Aarhus University Hospital, Aarhus, Denmark
| | - Randy D Gascoyne
- Fong Chun Chan, Anja Mottok, Alina S. Gerrie, Maryse Power, Kerry J. Savage, Sohrab P. Shah, Joseph M. Connors, Randy D. Gascoyne, David W. Scott, and Christian Steidl, British Columbia Cancer Agency; Fong Chun Chan, Anja Mottok, Sohrab P. Shah, and Christian Steidl, University of British Columbia, Canada; Marcel Nijland, Arjan Diepstra, and Anke van den Berg, University Medical Center Groningen, Groningen, the Netherlands; and Peter Kamper, Francesco d'Amore, Alexander Lindholm d'Amore, and Stephen Hamilton-Dutoit, Aarhus University Hospital, Aarhus, Denmark
| | - David W Scott
- Fong Chun Chan, Anja Mottok, Alina S. Gerrie, Maryse Power, Kerry J. Savage, Sohrab P. Shah, Joseph M. Connors, Randy D. Gascoyne, David W. Scott, and Christian Steidl, British Columbia Cancer Agency; Fong Chun Chan, Anja Mottok, Sohrab P. Shah, and Christian Steidl, University of British Columbia, Canada; Marcel Nijland, Arjan Diepstra, and Anke van den Berg, University Medical Center Groningen, Groningen, the Netherlands; and Peter Kamper, Francesco d'Amore, Alexander Lindholm d'Amore, and Stephen Hamilton-Dutoit, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Steidl
- Fong Chun Chan, Anja Mottok, Alina S. Gerrie, Maryse Power, Kerry J. Savage, Sohrab P. Shah, Joseph M. Connors, Randy D. Gascoyne, David W. Scott, and Christian Steidl, British Columbia Cancer Agency; Fong Chun Chan, Anja Mottok, Sohrab P. Shah, and Christian Steidl, University of British Columbia, Canada; Marcel Nijland, Arjan Diepstra, and Anke van den Berg, University Medical Center Groningen, Groningen, the Netherlands; and Peter Kamper, Francesco d'Amore, Alexander Lindholm d'Amore, and Stephen Hamilton-Dutoit, Aarhus University Hospital, Aarhus, Denmark
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Goy J, Gillan TL, Bruyere H, Huang SJT, Hrynchak M, Karsan A, Ramadan K, Connors J, Toze CL, Gerrie AS. Chronic Lymphocytic Leukemia Patients With Deletion 11q Have a Short Time to Requirement of First-Line Therapy, But Long Overall Survival: Results of a Population-Based Cohort in British Columbia, Canada. Clin Lymphoma Myeloma Leuk 2017; 17:382-389. [PMID: 28559149 DOI: 10.1016/j.clml.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/26/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) patients with 11q22.3 deletion (11q-) have an aggressive clinical course, and thus selection of first-line therapy in this group is important. This study aimed to improve our understanding of real-world practice patterns and outcomes of CLL patients with 11q- in a population-based setting. PATIENTS AND METHODS The British Columbia CLL Database was used to identify patients with 11q-. Overall survival (OS) and treatment-free survival (TFS) were assessed after adjustment for prognostic factors. RESULTS Of 1044 patients in the database, 125 had 11q- (12%). Sixty-nine patients had 11q- identified before therapy initiation and had a median OS and TFS of 14.7 (95% confidence interval [CI], 11.3-18.1) and 2.5 (95% CI, 1.5-3.6) years. Patient with copresence of 11q- and deletion 17p had a markedly worse prognosis, with median OS of 4.9 versus 14.7 years (P < .001). Most treated patients (33 of 52) received fludarabine with or without rituximab (FR). Patients treated with FR had a median OS of 12.8 years (standard error, 1.0), which was not statistically different from those treated with alkylator-containing therapy (P = .35). CONCLUSION Although median TFS of 11q- patients in this cohort was short at 2.5 years, OS remains long at 14.7 years, even when most patients received initial treatment without alkylators.
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Affiliation(s)
- Jennifer Goy
- Leukemia/Bone Marrow Transplant Program of BC, British Columbia Cancer Agency, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Tanya L Gillan
- Pathology and Laboratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Helene Bruyere
- Pathology and Laboratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven J T Huang
- Leukemia/Bone Marrow Transplant Program of BC, British Columbia Cancer Agency, University of British Columbia, Vancouver, British Columbia, Canada; Pathology and Laboratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Monica Hrynchak
- Molecular Cytogenetic Laboratory, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Aly Karsan
- Cancer Genetics Laboratory, Pathology and Laboratory Medicine, British Columbia Cancer Agency, University of British Columbia, Vancouver, British Columbia, Canada
| | - Khaled Ramadan
- Division of Hematology, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph Connors
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Cynthia L Toze
- Leukemia/Bone Marrow Transplant Program of BC, British Columbia Cancer Agency, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alina S Gerrie
- Leukemia/Bone Marrow Transplant Program of BC, British Columbia Cancer Agency, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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Huang SJ, Bergin K, Smith AC, Gerrie AS, Bruyere H, Dalal CB, Sugioka DK, Hrynchak M, Ramadan KM, Karsan A, Gillan TL, Toze CL. Clonal evolution as detected by interphase fluorescence in situ hybridization is associated with worse overall survival in a population-based analysis of patients with chronic lymphocytic leukemia in British Columbia, Canada. Cancer Genet 2017; 210:1-8. [PMID: 28212806 DOI: 10.1016/j.cancergen.2016.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/20/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
Abstract
This study evaluates prognostic markers as predictors of clonal evolution (CE) and assesses the impact of CE on overall survival (OS) in a population-based cohort of 159 consecutive eligible patients with chronic lymphocytic leukemia (CLL) obtained from the British Columbia Provincial CLL Database. CE was detected by interphase fluorescence in situ hybridization (FISH) in 34/159 patients (21%) with 65% of CE patients acquiring deletion 17p or 11q. CD38 positive status (≥30%) on flow cytometry predicted 2.7 times increased risk of high-risk CE (acquisition of deletion 17p or 11q) on multivariate analysis. Prior CLL therapy was not a significant predictor of CE. CE was associated with 4.1 times greater risk of death when analyzed as a time-dependent variable for OS after adjusting for age, lymphocyte count, and FISH timing. High-risk CE was associated with worse OS while acquisition of low/intermediate-risk abnormalities (trisomy 12, deletion 13q, and IGH translocation) had no difference in OS. Our study demonstrates the negative impact of CE detected by FISH on OS in this population-based cohort. These data provide support for repeating FISH testing during CLL follow-up as patients with high-risk CE have reduced survival and may require closer observation.
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Affiliation(s)
- Steven J Huang
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; Pathology and Laboratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Krystal Bergin
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Adam C Smith
- Cancer Genetics Laboratory, Pathology and Laboratory Medicine, British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada; The Pelé Research Institute, Hospital Pequeno Prinicipe, Brazil
| | - Alina S Gerrie
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; Leukemia/BMT Program of BC, Vancouver General Hospital and British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada
| | - Helene Bruyere
- Pathology and Laboratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Chinmay B Dalal
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Monica Hrynchak
- Cytogenetics Laboratory, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Khaled M Ramadan
- Division of Hematology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Aly Karsan
- Cancer Genetics Laboratory, Pathology and Laboratory Medicine, British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada
| | - Tanya L Gillan
- Pathology and Laboratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Cynthia L Toze
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; Leukemia/BMT Program of BC, Vancouver General Hospital and British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada.
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Hapgood G, Pickles T, Sehn LH, Villa D, Klasa R, Scott DW, Gerrie AS, Gascoyne RD, Slack GW, Parsons C, Morris JW, Connors JM, Savage KJ. Outcome of primary cutaneous anaplastic large cell lymphoma: a 20-year British Columbia Cancer Agency experience. Br J Haematol 2016; 176:234-240. [DOI: 10.1111/bjh.14404] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/22/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Greg Hapgood
- Department of Medical Oncology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Tom Pickles
- Department of Radiation Oncology; British Columbia Cancer Agency; Vancouver BC Canada
| | - Laurie H. Sehn
- Department of Medical Oncology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Diego Villa
- Department of Medical Oncology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Richard Klasa
- Department of Medical Oncology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - David W. Scott
- Department of Medical Oncology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Alina S. Gerrie
- Department of Medical Oncology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Randy D. Gascoyne
- Department of Pathology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Graham W. Slack
- Department of Pathology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Christina Parsons
- Department of Radiation Oncology; British Columbia Cancer Agency; Vancouver BC Canada
| | - James W. Morris
- Department of Radiation Oncology; British Columbia Cancer Agency; Vancouver BC Canada
| | - Joseph M. Connors
- Department of Medical Oncology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Kerry J. Savage
- Department of Medical Oncology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
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Kridel R, Telio D, Villa D, Sehn LH, Gerrie AS, Shenkier T, Klasa R, Slack GW, Tan K, Gascoyne RD, Connors JM, Savage KJ. Diffuse large B-cell lymphoma with testicular involvement: outcome and risk of CNS relapse in the rituximab era. Br J Haematol 2016; 176:210-221. [DOI: 10.1111/bjh.14392] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/31/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Robert Kridel
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - David Telio
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Diego Villa
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Laurie H. Sehn
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Alina S. Gerrie
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Tamara Shenkier
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Richard Klasa
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Graham W. Slack
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Pathology; British Columbia Cancer Agency; Vancouver BC Canada
| | - King Tan
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Randy D. Gascoyne
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Pathology; British Columbia Cancer Agency; Vancouver BC Canada
| | - Joseph M. Connors
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Kerry J. Savage
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
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Kansara R, Villa D, Gerrie AS, Klasa R, Shenkier T, Scott DW, Slack GW, Gascoyne RD, Connors JM, Sehn LH, Savage KJ. Site of central nervous system (CNS) relapse in patients with diffuse large B-cell lymphoma (DLBCL) by the CNS-IPI risk model. Br J Haematol 2016; 179:508-510. [PMID: 27443424 DOI: 10.1111/bjh.14229] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Roopesh Kansara
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Diego Villa
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Alina S Gerrie
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.,Leukemia/Bone Marrow Transplant Program of British Columbia, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Richard Klasa
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Tamara Shenkier
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - David W Scott
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Graham W Slack
- Centre for Lymphoid Cancer and Department of Pathology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Randy D Gascoyne
- Centre for Lymphoid Cancer and Department of Pathology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Joseph M Connors
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Laurie H Sehn
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Kerry J Savage
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
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Hapgood G, Zheng Y, Sehn LH, Villa D, Klasa R, Gerrie AS, Shenkier T, Scott DW, Gascoyne RD, Slack GW, Parsons C, Morris J, Pickles T, Connors JM, Savage KJ. Evaluation of the Risk of Relapse in Classical Hodgkin Lymphoma at Event-Free Survival Time Points and Survival Comparison With the General Population in British Columbia. J Clin Oncol 2016; 34:2493-500. [DOI: 10.1200/jco.2015.65.4194] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Studies in classical Hodgkin lymphoma (cHL) typically measure the time to events from diagnosis. We evaluated the risk of relapse at event-free survival time points in cHL and compared the risk of death to expected mortality rates in British Columbia (BC). Methods The BC Cancer Agency Lymphoid Cancer Database was screened to identify all patients age 16 to 69 years diagnosed with cHL between 1989 and 2012 treated with the chemotherapy regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine (or equivalent). We compared the observed mortality to the general population using age-, sex-, and calendar period–generated expected mortality rates from BC life-tables. Relative survival was calculated using a conditional approach and expressed as a standardized mortality ratio of observed-to-expected deaths. Results One thousand four hundred two patients were identified; 749 patients were male (53%), the median age was 32 years, and 68% had advanced-stage disease. The median follow-up time was 8.4 years. Seventy-two percent of relapses occurred within the first 2 years of diagnosis. For all patients, the 5-year risk of relapse from diagnosis was 18.1% but diminished to 5.6% for patients remaining event free at 2 years. For advanced-stage patients who were event free at 2 years, the 5-year risk of relapse was only 7.6%, and for those who were event free at 3 years, it was comparable to that of limited-stage patients (4.1% v 2.5%, respectively; P = .07). Furthermore, international prognostic score ≥ 4 and bulky disease were no longer prognostic in patients who were event free at 1 year. Although the relative survival improved as patients remained in remission, it did not normalize compared with the general population. Conclusion Patients with cHL who are event free at 2 years have an excellent outcome regardless of baseline prognostic factors. All patients with cHL had an enduring increased risk of death compared with the general population.
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Affiliation(s)
- Greg Hapgood
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Yvonne Zheng
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Laurie H. Sehn
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Diego Villa
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Richard Klasa
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Alina S. Gerrie
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Tamara Shenkier
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - David W. Scott
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Randy D. Gascoyne
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Graham W. Slack
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Christina Parsons
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - James Morris
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Tom Pickles
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Joseph M. Connors
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Kerry J. Savage
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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Kansara R, Connors JM, Savage KJ, Gerrie AS, Scott DW, Slack GW, Gascoyne RD, Sehn LH, Villa D. Maintenance rituximab following induction R-CHOP chemotherapy in patients with composite or discordant, indolent and aggressive, B-cell non-Hodgkin lymphomas. Haematologica 2016; 101:e411-e414. [PMID: 27479818 DOI: 10.3324/haematol.2016.144550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Roopesh Kansara
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Joseph M Connors
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Kerry J Savage
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Alina S Gerrie
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada Leukemia/Bone Marrow Transplant Program of British Columbia, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - David W Scott
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Graham W Slack
- Centre for Lymphoid Cancer and Department of Pathology and Laboratory Medicine, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Randy D Gascoyne
- Centre for Lymphoid Cancer and Department of Pathology and Laboratory Medicine, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Laurie H Sehn
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Diego Villa
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
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43
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Srour L, Zheng YY, Gerrie AS, Savage KJ, Scott DW, Villa D, Slack GW, Gascoyne RD, Connors JM, Sehn LH. EFS24 as a predictor of outcome in a population-based cohort of patients with DLBCL in British Columbia (BC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Line Srour
- British Columbia Cancer Agency, Vancouver, BC, Vancouver, BC, Canada
| | | | | | - Kerry J. Savage
- British Columbia Cancer Agency Center for Lymphoid Cancer, Vancouver, BC, Canada
| | | | - Diego Villa
- British Columbia Cancer Agency, Vancouver, BC, Canada
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44
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Kansara R, Shenkier TN, Connors JM, Sehn LH, Savage KJ, Gerrie AS, Villa D. Rituximab with high-dose methotrexate in primary central nervous system lymphoma. Am J Hematol 2015; 90:1149-54. [PMID: 26414492 DOI: 10.1002/ajh.24204] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/02/2015] [Accepted: 09/23/2015] [Indexed: 11/11/2022]
Abstract
The addition of rituximab (R) to chemotherapy improves outcomes in patients with systemic B-cell non-Hodgkin lymphomas, but the impact in patients with primary central nervous system lymphoma (PCNSL) receiving high-dose methotrexate (HDMTX) is unknown. Patients diagnosed with PCNSL at the British Columbia Cancer Agency (BCCA) between 2000 and 2013 were treated with ≥1 cycle of HDMTX 8 g/m(2) every 2 weeks, to best response or 10 cycles. After 2006, rituximab 375 mg/m(2) was given every 2 weeks with HDMTX for a total of 4 doses. 49 (66%) patients received HDMTX alone and 25 (34%) HDMTX+R, with a median of 5 (range 1-10) HDMTX cycles, and no difference between groups. The median follow-up was 5 years: 8.8 years (range 3.15-13.5 years) HDMTX and 1.9 years (range 0.5-7 years) HDMTX+R. The 5-year PFS was 17%, with no difference between groups (HR: 0.75, 95% CI: 0.41-1.35; P = 0.33). The 5-year OS was 38%, with no difference between the groups OS (HR: 0.73, 95% CI: 0.35-1.52; P = 0.39). In this retrospective study comparing two subgroups of patients treated in different eras, the addition of R to HDMTX did not appear to improve outcomes in PCNSL, possibly consistent with its known poor CNS penetration. It is possible that with a larger sample size, longer follow-up, or different rituximab dosing/schedule, the addition of rituximab may lead to a statistically significant improvement in outcomes. Prospective randomized trials currently in progress will more definitively estimate the impact of the addition of rituximab to HDMTX-based chemotherapy for PCNSL.
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Affiliation(s)
- Roopesh Kansara
- Centre for Lymphoid Cancer and Department of Medical Oncology; British Columbia Cancer Agency; Vancouver British Columbia Canada
| | - Tamara N. Shenkier
- Centre for Lymphoid Cancer and Department of Medical Oncology; British Columbia Cancer Agency; Vancouver British Columbia Canada
| | - Joseph M. Connors
- Centre for Lymphoid Cancer and Department of Medical Oncology; British Columbia Cancer Agency; Vancouver British Columbia Canada
| | - Laurie H. Sehn
- Centre for Lymphoid Cancer and Department of Medical Oncology; British Columbia Cancer Agency; Vancouver British Columbia Canada
| | - Kerry J. Savage
- Centre for Lymphoid Cancer and Department of Medical Oncology; British Columbia Cancer Agency; Vancouver British Columbia Canada
| | - Alina S. Gerrie
- Centre for Lymphoid Cancer and Department of Medical Oncology; British Columbia Cancer Agency; Vancouver British Columbia Canada
- Leukemia/Bone Marrow Transplantation Program of BC; Vancouver British Columbia Canada
| | - Diego Villa
- Centre for Lymphoid Cancer and Department of Medical Oncology; British Columbia Cancer Agency; Vancouver British Columbia Canada
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45
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Brooks EG, Connors JM, Sehn LH, Gascoyne RD, Savage KJ, Shenkier TN, Klasa R, Gerrie AS, Skinnider B, Slack GW, Villa D. Impact of time from diagnosis to initiation of curative-intent chemotherapy on clinical outcomes in patients with classical Hodgkin lymphoma. Leuk Lymphoma 2015; 57:872-9. [DOI: 10.3109/10428194.2015.1086919] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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46
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Huang SJT, Gillan TL, Gerrie AS, Hrynchak M, Karsan A, Ramadan K, Smith AC, Toze CL, Bruyere H. Influence of clone and deletion size on outcome in chronic lymphocytic leukemia patients with an isolated deletion 13q in a population-based analysis in British Columbia, Canada. Genes Chromosomes Cancer 2015; 55:16-24. [PMID: 26391112 DOI: 10.1002/gcc.22294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 08/05/2015] [Indexed: 01/22/2023] Open
Abstract
Deletion of the long arm of chromosome 13 (del(13q)) as the sole abnormality in chronic lymphocytic leukemia (CLL) portends a good prognosis; however, there is great outcome heterogeneity within this subgroup. The percentage of cells with a del(13q) (clone size) and the extent of the deletion are two factors that may affect outcome in CLL patients with isolated del(13q). We analyzed 248 CLL patients from the BC Provincial CLL database identified as having isolated del(13q) detected pretreatment by interphase fluorescence in situ hybridization to determine what impact clone and deletion size had on overall survival (OS) and treatment free survival (TFS). Patients with 60% or more of nuclei with a del(13q) had shorter TFS and shorter OS. A large deletion, encompassing the RB1 gene locus, was detected in half of the 90 cases with available specimens for testing, and there was no significant difference in OS and TFS between RB1-deleted and RB1-not-deleted cases. Further study in a larger sample size is required to determine the clinical interest of RB1 locus testing; however, clone size of del(13q) does predict TFS and OS and may better refine prognosis in this clinically heterogeneous population.
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Affiliation(s)
- Steven J T Huang
- Leukemia/BMT Program of BC, Vancouver General Hospital and British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada.,Pathology and Laboratory Medicine, Vancouver General Hospital University of British Columbia, Vancouver, BC, Canada
| | - Tanya L Gillan
- Pathology and Laboratory Medicine, Vancouver General Hospital University of British Columbia, Vancouver, BC, Canada
| | - Alina S Gerrie
- Leukemia/BMT Program of BC, Vancouver General Hospital and British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada
| | - Monica Hrynchak
- Department of Laboratory Medicine Molecular Cytogenetic Laboratory, Royal Columbian Hospital, University of British Columbia, New Westminster, BC, Canada
| | - Aly Karsan
- Pathology and Laboratory Medicine, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Khaled Ramadan
- Division of Hematology, St. Paul's Hospital University of British Columbia, Vancouver, BC, Canada
| | - Adam C Smith
- Instituto De Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil and the Dept. Of Pathology, University of British Columbia, Vancouver, Canada
| | - Cynthia L Toze
- Leukemia/BMT Program of BC, Vancouver General Hospital and British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada
| | - Helene Bruyere
- Pathology and Laboratory Medicine, Vancouver General Hospital University of British Columbia, Vancouver, BC, Canada
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47
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Sun H, Savage KJ, Karsan A, Slack GW, Gascoyne RD, Toze CL, Sehn LH, Abou Mourad Y, Barnett MJ, Broady RC, Connors JM, Forrest DL, Gerrie AS, Hogge DE, Narayanan S, Nevill TJ, Nantel SH, Power MM, Sutherland HJ, Villa D, Shepherd JD, Song KW. Outcome of Patients With Non-Hodgkin Lymphomas With Concurrent MYC and BCL2 Rearrangements Treated With CODOX-M/IVAC With Rituximab Followed by Hematopoietic Stem Cell Transplantation. Clinical Lymphoma Myeloma and Leukemia 2015; 15:341-8. [DOI: 10.1016/j.clml.2014.12.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 12/26/2014] [Accepted: 12/29/2014] [Indexed: 12/25/2022]
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48
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Nair AP, Barnett MJ, Broady RC, Hogge DE, Song KW, Toze CL, Nantel SH, Power MM, Sutherland HJ, Nevill TJ, Abou Mourad Y, Narayanan S, Gerrie AS, Forrest DL. Allogeneic Hematopoietic Stem Cell Transplantation Is an Effective Salvage Therapy for Patients with Chronic Myeloid Leukemia Presenting with Advanced Disease or Failing Treatment with Tyrosine Kinase Inhibitors. Biol Blood Marrow Transplant 2015; 21:1437-44. [PMID: 25865648 DOI: 10.1016/j.bbmt.2015.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 01/09/2015] [Accepted: 04/03/2015] [Indexed: 01/01/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) remains the only known curative therapy for chronic myeloid leukemia (CML); however, it is rarely utilized given the excellent long-term results with tyrosine kinase inhibitor (TKI) treatment. The purpose of this study is to examine HSCT outcomes for patients with CML who failed TKI therapy or presented in advanced phase and to identify predictors of survival, relapse, and nonrelapse mortality (NRM). Fifty-one patients with CML underwent HSCT for advanced disease at diagnosis (n = 15), TKI resistance as defined by the European LeukemiaNet guidelines (n = 30), TKI intolerance (n = 2), or physician preference (n = 4). At a median follow-up of 71.9 months, the 8-year overall survival (OS), event-free survival (EFS), relapse, and NRM were 68%, 46%, 41%, and 23%, respectively. In univariate analysis, predictors of OS included first chronic phase (CP1) disease status at HSCT (P = .0005), European Society for Blood and Marrow Transplantation score 1 to 4 (P = .04), and complete molecular response (CMR) to HSCT (P < .0001). Donor (female) to patient (male) gender combination (P = .02) and CMR to HSCT (P < .0001) predicted lower relapse. In multivariate analysis, CMR to HSCT remained an independent predictor of OS (odds ratio [OR], 43), EFS (OR, 56) and relapse (OR, 29). This report indicates that the outlook is excellent for those patients who remain in CP1 at the time of HSCT and achieve a CMR after HSCT. However, only approximately 50% of those in advanced phase at HSCT are long-term survivors. This highlights the ongoing need to try to identify patients earlier, before disease progression, who are destined to fail this treatment to optimize transplantation outcomes.
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Affiliation(s)
- Anish P Nair
- Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael J Barnett
- Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Raewyn C Broady
- Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna E Hogge
- Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin W Song
- Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Cynthia L Toze
- Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen H Nantel
- Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Maryse M Power
- Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather J Sutherland
- Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas J Nevill
- Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Yasser Abou Mourad
- Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Sujaatha Narayanan
- Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Alina S Gerrie
- Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna L Forrest
- Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency, and University of British Columbia, Vancouver, British Columbia, Canada.
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49
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Xing KH, Kahlon A, Skinnider BF, Connors JM, Gascoyne RD, Sehn LH, Savage KJ, Slack GW, Shenkier TN, Klasa R, Gerrie AS, Villa D. Outcomes in splenic marginal zone lymphoma: analysis of 107 patients treated in British Columbia. Br J Haematol 2015; 169:520-7. [PMID: 25854936 DOI: 10.1111/bjh.13320] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/01/2015] [Indexed: 11/28/2022]
Abstract
Splenic marginal zone lymphoma (SMZL) accounts for less than 2% of all non-Hodgkin lymphomas. We identified 107 cases diagnosed with SMZL between 1985 and 2012 from the British Columbia Cancer Agency Centre for Lymphoid Cancer and Lymphoma Pathology Databases. Patient characteristics were: median age 67 years (range 30-88), male 40%, stage IV 98%, splenomegaly 93%, bone marrow involvement 96%, peripheral blood involvement 87%. As initial treatment, 52 underwent splenectomy (10 with chemotherapy), 38 chemotherapy alone (21 chemoimmunotherapy containing rituximab, 1 rituximab alone), two antivirals for hepatitis C, and 15 were only observed. The 10-year overall survival for first-line splenectomy versus chemotherapy was 61% and 42%, respectively [Hazard Ratio (HR) 0·48, 95% confidence interval (CI) 0·26-0·88, P = 0·017]. The 10-year failure-free survival (FFS) after first-line splenectomy vs chemotherapy was 39% and 14%, respectively (HR 0·48, 95% CI 0·28-0·80, P = 0·004). Among the 38 patients who received first-line chemotherapy, FFS was similar between those receiving rituximab (n = 22) and those who did not (n = 16) (HR 0·64, 95% CI 0·31-1·34, P = 0·238). Fifteen patients transformed to aggressive lymphoma with median time to transformation of 3·5 years (range 6 months to 12 years) and the 10-year transformation rate was 18%. In conclusion, splenectomy remains a reasonable treatment for patients with SMZL.
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Affiliation(s)
- Katharine H Xing
- Department of Medical Oncology, British Columbia Cancer Agency - Vancouver Island Centre, Victoria, BC, Canada
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Affiliation(s)
- Cynthia L Toze
- Leukemia/Bone Marrow Transplant Program of British Columbia, Canada; Division of Hematology, Vancouver General Hospital and British Columbia Cancer Agency, Canada; University of British Columbia, Canada.
| | - Alina S Gerrie
- Leukemia/Bone Marrow Transplant Program of British Columbia, Canada; Lymphoma Tumour Group, Divisions of Hematology and Medical Oncology, British Columbia Cancer Agency, Canada; University of British Columbia, Canada
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