1
|
Kuhnl A, Roddie C, Kirkwood AA, Chaganti S, Norman J, Lugthart S, Osborne W, Gibb A, Gonzalez Arias C, Latif A, Uttenthal B, Seymour F, Jones C, Springell D, Brady JL, Illidge T, Stevens A, Alexander E, Hawley L, O'Rourke N, Bedi C, Prestwich R, Frew J, Burns D, O'Reilly M, Sanderson R, Sivabalasingham S, Mikhaeel NG. Outcome and feasibility of radiotherapy bridging in large B-cell lymphoma patients receiving CD19 CAR T in the UK. Br J Haematol 2024. [PMID: 38594876 DOI: 10.1111/bjh.19453] [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: 02/06/2024] [Revised: 03/07/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
Radiotherapy (RT) has potential synergistic effects with chimeric antigen receptor (CAR) T but is not widely used as bridging therapy due to logistical challenges and lack of standardised protocols. We analysed RT bridging in a multicentre national cohort of large B-cell lymphoma patients approved for 3L axicabtagene ciloleucel or tisagenlecleucel across 12 UK centres. Of 763 approved patients, 722 were leukapheresed, 717 had data available on bridging therapy. 169/717 (24%) received RT bridging, 129 as single modality and 40 as combined modality treatment (CMT). Of 169 patients, 65.7% had advanced stage, 36.9% bulky disease, 86.5% elevated LDH, 41.7% international prognostic index (IPI) ≥3 and 15.2% double/triple hit at the time of approval. Use of RT bridging varied from 11% to 32% between centres and increased over time. Vein-to-vein time and infusion rate did not differ between bridging modalities. RT-bridged patients had favourable outcomes with 1-year progression-free survival (PFS) of 56% for single modality and 47% for CMT (1-year PFS 43% for systemic bridging). This is the largest cohort of LBCL patients receiving RT bridging prior to CAR T reported to date. Our results show that RT bridging can be safely and effectively used even in advanced stage and high-risk disease, with low dropout rates and excellent outcomes.
Collapse
Affiliation(s)
- A Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - C Roddie
- University College London Hospitals, London, UK
- UCL Cancer Institute, University College London, London, UK
| | - A A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, UCL, London, UK
| | - S Chaganti
- Queen Elizabeth Hospital, Birmingham, UK
| | - J Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - S Lugthart
- University Hospitals Bristol and Weston, Bristol, UK
| | - W Osborne
- Freeman Hospital, Newcastle, UK
- Newcastle University, Newcastle, UK
| | - A Gibb
- Department of Medical Oncology, The Christie Hospital, Manchester, UK
| | | | - A Latif
- Queen Elizabeth University Hospital, Glasgow, UK
| | - B Uttenthal
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | | | - C Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - D Springell
- University College London Hospitals, London, UK
| | - J L Brady
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - T Illidge
- Cancer Sciences, University of Manchester Christie NHS Trust, Manchester NIHR BRC, Manchester, UK
| | - A Stevens
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - L Hawley
- University Hospitals Bristol and Weston, Bristol, UK
| | - N O'Rourke
- Queen Elizabeth University Hospital, Glasgow, UK
| | - C Bedi
- Western General Hospital, Edinburgh, UK
| | | | - J Frew
- Freeman Hospital, Newcastle, UK
| | - D Burns
- Queen Elizabeth Hospital, Birmingham, UK
| | - M O'Reilly
- University College London Hospitals, London, UK
| | - R Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | | | - N G Mikhaeel
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
2
|
Kuhnl A, Kirkwood AA, Roddie C, Menne T, Tholouli E, Bloor A, Besley C, Chaganti S, Osborne W, Norman J, Gibb A, Sharplin K, Cuadrado M, Correia de Farias M, Cheok K, Neill L, Latif AL, González Arias C, Uttenthal B, Jones C, Johnson R, McMillan A, Sanderson R, Townsend W. CAR T in patients with large B-cell lymphoma not fit for autologous transplant. Br J Haematol 2023. [PMID: 37082780 DOI: 10.1111/bjh.18810] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023]
Abstract
Large B-cell lymphoma (LBCL) patients with comorbidities and/or advanced age are increasingly considered for treatment with CD19 CAR T, but data on the clinical benefit of CAR T in the less fit patient population are still limited. We analysed outcomes of consecutive patients approved for treatment with axicabtagene ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel) by the UK National CAR T Clinical Panel, according to fitness for autologous stem cell transplant (ASCT). 81/404 (20%) of approved patients were deemed unfit for ASCT. Unfit patients were more likely to receive tisa-cel versus axi-cel (52% vs. 48%) compared to 20% versus 80% in ASCT-fit patients; p < 0.0001. The drop-out rate from approval to infusion was significantly higher in the ASCT-unfit group (34.6% vs. 23.5%; p = 0.042). Among infused patients, response rate, progression-free and overall survival were similar in both cohorts. CAR T was well-tolerated in ASCT-unfit patients with an incidence of grade ≥3 cytokine release syndrome and neurotoxicity of 2% and 11%, respectively. Results from this multicentre real-world cohort demonstrate that CD19 CAR T can be safely delivered in carefully selected older patients and patients with comorbidities who are not deemed suitable for transplant.
Collapse
Affiliation(s)
- A Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - A A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - C Roddie
- Department of Haematology, University College London Hospitals, London, UK
- UCL Cancer Institute, University College London, London, UK
| | - T Menne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - E Tholouli
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Bloor
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - C Besley
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - S Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - W Osborne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - J Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Gibb
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - K Sharplin
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - M Cuadrado
- Department of Haematology, King's College Hospital, London, UK
| | | | - K Cheok
- Department of Haematology, University College London Hospitals, London, UK
| | - L Neill
- Department of Haematology, University College London Hospitals, London, UK
| | - A L Latif
- Department of Haematology, Queen Elizabeth II Hospital, Glasgow, UK
| | | | - B Uttenthal
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | - C Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - R Johnson
- Department of Haematology, St. James's Hospital, Leeds, UK
| | - A McMillan
- Department of Haematology, Nottingham University Hospitals, Nottingham, UK
| | - R Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | - W Townsend
- Department of Haematology, University College London Hospitals, London, UK
| |
Collapse
|
3
|
Choquet S, Uttenthal B, Chaganti S, Comoli P, Trappe R, Friedetzky A, Xing B, Li X, Polak T, Gamelin L, Terwey JH, Dierickx D. P1457: DEMOGRAPHICS AND TREATMENT OUTCOMES IN PATIENTS WITH EBV+ PTLD TREATED WITH OFF-THE-SHELF EBV-SPECIFIC CTL (TABELECLEUCEL) UNDER AN ONGOING EXPANDED ACCESS PROGRAM IN EUROPE: FIRST ANALYSES. Hemasphere 2022. [PMCID: PMC9429700 DOI: 10.1097/01.hs9.0000848684.24968.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
4
|
Carr R, Davies A, Uttenthal B, Lamb M, Fidalgo J, Carpenter B. A UK POPULATION‐BASED STUDY OF NON‐HODGKIN LYMPHOMA IN TEENAGERS AND YOUNG ADULTS (TYA) ‐ INCIDENCE, TREATMENT AND OUTCOMES. Hematol Oncol 2021. [DOI: 10.1002/hon.39_2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- R Carr
- Guy's & St Thomas' Hospital Haematology London UK
| | - A Davies
- Southampton NCRI/CR UK Experimental Cancer Medicines Centre Haematology Southampton UK
| | - B Uttenthal
- Addenbrookes Hospital Paediatric Oncology Cambridge UK
| | - M Lamb
- Department of Health Sciences University of York Haematological Malignancy Research Network York UK
| | - J Fidalgo
- Guy's & St Thomas' Hospital Haematology London UK
| | - B Carpenter
- University College Hospital Haematology London UK
| |
Collapse
|
5
|
Follows G, Santarsieri A, Sturgess K, Menne T, Osborne W, Creasey T, Ardeshna K, Behan S, Booth S, Collins G, Cwynarski K, Iyengar S, Jones S, Martinez-Calle N, McKay P, Nagumantry S, O'Mahony D, Rudge J, Shah N, Stafford G, Sternberg A, Uttenthal B, McMillan A. MODIFICATION OF ESCALATED BEACOPP WITH DACARBAZINE / PROCARBAZINE SUBSTITUTION REDUCES RED CELL TRANSFUSION REQUIREMENTS AND MAY SHORTEN TIME TO MENSTRUAL PERIOD RECOVERY. Hematol Oncol 2019. [DOI: 10.1002/hon.168_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- G. Follows
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - A. Santarsieri
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - K. Sturgess
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - T. Menne
- Haematology; Freeman Hospital; Newcastle upon Tyne United Kingdom
| | - W. Osborne
- Haematology; Freeman Hospital; Newcastle upon Tyne United Kingdom
| | - T. Creasey
- Haematology; Freeman Hospital; Newcastle upon Tyne United Kingdom
| | - K.M. Ardeshna
- Haematology; University College London Hospital; London United Kingdom
| | - S. Behan
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - S. Booth
- Haematology; Royal Berkshire NHS Foundation Trust; Reading United Kingdom
| | - G. Collins
- Haematology; Oxford University Hospitals NHSFT; Oxford United Kingdom
| | - K. Cwynarski
- Haematology; University College London Hospital; London United Kingdom
| | - S. Iyengar
- Haematology; The Royal Marsden; London United Kingdom
| | - S. Jones
- Haematology; Sherwood Forest Hospitals; Sutton in Ashfield United Kingdom
| | - N. Martinez-Calle
- Haematology; Nottingham University Hospital NHS Trust; Nottingham United Kingdom
| | - P. McKay
- Haematology; Beatson West of Scotland Cancer Centre; Glasgow United Kingdom
| | - S.K. Nagumantry
- Haematology; Peterborough City Hospital; Peterborough United Kingdom
| | - D. O'Mahony
- Haematology; Cork University Hospital; Wilton Republic of Ireland
| | - J.F. Rudge
- Department of Earth Sciences; University of Cambridge.; Cambridge United Kingdom
| | - N. Shah
- Haematology; Norfolk and Norwich University Hospitals; Norwich United Kingdom
| | - G. Stafford
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - A. Sternberg
- Haematology; Great Western Hospital NHS Foundation Trust; Swindon United Kingdom
| | - B. Uttenthal
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - A. McMillan
- Haematology; Nottingham University Hospital NHS Trust; Nottingham United Kingdom
| |
Collapse
|
6
|
Russell J, Collins A, Fowler A, Karanth M, Saha C, Shyamsundar V, Docherty S, Kirkwood A, Maw K, Cooke L, Hodson A, Shah N, Sadullah S, Grigoropoulos N, Uttenthal B, Follows G. Advanced Hodgkin lymphoma in the east of England cancer network: A 10-year comparative analysis of outcomes for ABVD and escalated-BEACOPP treated patients aged 16 to 59. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- J. Russell
- Clinical Haematology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - A. Collins
- Clinical Haematology; Norfolk and Norwich University Hospital; Norwich UK
| | - A. Fowler
- Clinical Haematology; Peterborough City Hospital; Peterborough UK
| | - M. Karanth
- Clinical Haematology; West Suffolk Hospital; Bury Saint Edmunds UK
| | - C. Saha
- Clinical Haematology; Norfolk and Norwich University Hospital; Norwich UK
| | - V. Shyamsundar
- Clinical Haematology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - S. Docherty
- Clinical Haematology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - A. Kirkwood
- Cancer Research UK and UCL Cancer Trials Centre; University College London; London UK
| | - K. Maw
- Clinical Haematology; James Paget University Hospital; Great Yarmouth UK
| | - L. Cooke
- Clinical Haematology; Queen Elizabeth Hospital; King's Lynn UK
| | - A. Hodson
- Clinical Haematology; Ipswich Hospital; Ipswich UK
| | - N. Shah
- Clinical Haematology; Norfolk and Norwich University Hospital; Norwich UK
| | - S. Sadullah
- Clinical Haematology; James Paget University Hospital; Great Yarmouth UK
| | - N. Grigoropoulos
- Clinical Haematology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - B. Uttenthal
- Clinical Haematology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - G. Follows
- Clinical Haematology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| |
Collapse
|
7
|
Swayne R, Enoch D, Aliyu S, Crawley C, Krishnamurthy P, Craig J, Follows G, Uttenthal B, Babar J, Sander CR. P266 Outcomes from the introduction of fungal biomarkers to the neutropenic fever pathway in a tertiary haematology department. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
8
|
Goulding C, Uttenthal B, Foroni L, Duke V, Traore A, Kottaridis P, Hoffbrand AV, Patch D, McNamara C. The JAK2(V617F) tyrosine kinase mutation identifies clinically latent myeloproliferative disorders in patients presenting with hepatic or portal vein thrombosis. Int J Lab Hematol 2009; 30:415-9. [PMID: 19046316 DOI: 10.1111/j.1751-553x.2007.00973.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Clinically latent myeloproliferative disorders (MPDs) are important causes of what would otherwise be considered idiopathic hepatic (HVT) or portal vein thrombosis (PVT). They may be difficult to diagnose initially because the peripheral blood count may be normal at the time of thrombosis. A strong association between an activating mutation of the gene encoding one of the Janus kinase family of tyrosine kinases (JAK2(V617F)) and the Philadelphia chromosome-negative MPDs has been identified. We have studied 19 patients with unexplained HVT or PVT and tested for JAK2(V617F). Fourteen (74%) of the 19 patients were heterozygous for JAK2(V617F) but did not meet diagnostic criteria for a MPD at the time of presentation with thrombosis. Prolonged follow-up established the presence of an overt MPD in 13 of the 14 patients after a median duration of 38 months. We recommend testing for JAK2(V617F) in all patients with unexplained HVT or PVT, to identify latent MPDs and prevent potential complications.
Collapse
Affiliation(s)
- C Goulding
- Department of Gastroenterology, The Royal Free Hospital, London, UK
| | | | | | | | | | | | | | | | | |
Collapse
|