1
|
Ren J, Liao X, Lewis JM, Chang J, Qu R, Carlson KR, Foss F, Girardi M. Generation and optimization of off-the-shelf immunotherapeutics targeting TCR-Vβ2+ T cell malignancy. Nat Commun 2024; 15:519. [PMID: 38225288 PMCID: PMC10789731 DOI: 10.1038/s41467-024-44786-2] [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: 03/11/2023] [Accepted: 01/05/2024] [Indexed: 01/17/2024] Open
Abstract
Current treatments for T cell malignancies encounter issues of disease relapse and off-target toxicity. Using T cell receptor (TCR)Vβ2 as a model, here we demonstrate the rapid generation of an off-the-shelf allogeneic chimeric antigen receptor (CAR)-T platform targeting the clone-specific TCR Vβ chain for malignant T cell killing while limiting normal cell destruction. Healthy donor T cells undergo CRISPR-induced TRAC, B2M and CIITA knockout to eliminate T cell-dependent graft-versus-host and host-versus-graft reactivity. Second generation 4-1BB/CD3zeta CAR containing high affinity humanized anti-Vβ scFv is expressed efficiently on donor T cells via both lentivirus and adeno-associated virus transduction with limited detectable pre-existing immunoreactivity. Our optimized CAR-T cells demonstrate specific and persistent killing of Vβ2+ Jurkat cells and Vβ2+ patient derived malignant T cells, in vitro and in vivo, without affecting normal T cells. In parallel, we generate humanized anti-Vβ2 antibody with enhanced antibody-dependent cellular cytotoxicity (ADCC) by Fc-engineering for NK cell ADCC therapy.
Collapse
Affiliation(s)
- Jingjing Ren
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.
| | - Xiaofeng Liao
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.
| | - Julia M Lewis
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Jungsoo Chang
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Rihao Qu
- The Computational Biology and Bioinformatics Program, Yale School of Medicine, New Haven, CT, USA
| | - Kacie R Carlson
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Francine Foss
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.
| |
Collapse
|
2
|
Goyal A, O'Leary D, Foss F. Allogeneic stem cell transplant for treatment of mycosis fungoides and Sezary syndrome: a systematic review and meta-analysis. Bone Marrow Transplant 2024; 59:41-51. [PMID: 37853164 DOI: 10.1038/s41409-023-02122-0] [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: 06/25/2023] [Revised: 09/08/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
Allogeneic hematopoietic stem cell transplant (allo-HSCT) has been noted to be a potential curative treatment in cases of advanced-stage mycosis fungoides (MF) or Sezary syndrome (SS). To assess outcomes of allo-HSCT for MF/SS we performed a systematic review and meta-analysis including 15 manuscripts and 557 patients, published from 2010-2023. Meta-analysis revealed 1-year and 3+year overall survival (OS) of 51% (95% CI 39-64%) and 40% (32-49%). Progression-free survival at 1 year and 3+years were 42% (31-53%) and 33% (25-42%). Non-relapse mortality was 18% (13-23%). Relapse occurred in of 47% (40-53%) with a median time to relapse of 7.9 months (range 1.6-24 months). Rates of acute and chronic graft-versus-host disease (GVHD) were 45% (35-55%) and 40% (33-48%). Reduced-intensity conditioning (RIC) was associated with superior OS compared to myeloablative conditioning (MAC) (58% vs. 30%, p < 0.001). Of patients with relapse after allo-HSCT, 46% treated with donor lymphocyte infusion (DLI) achieved complete remission. These data support use of allo-HSCT for treatment of advanced-stage MF/SS and suggest superiority of RIC over MAC. Rates of GVHD were comparable to allo-HSCT in general. The improved OS for RIC and high rate of CR with DLI underscore the importance of the graft-versus-lymphoma effect in allo-HSCT for MF/SS.
Collapse
Affiliation(s)
- Amrita Goyal
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA.
| | - Daniel O'Leary
- Division of Hematology, Oncology, and Bone Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Francine Foss
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
3
|
Goyal A, Foss F. Allogeneic transplantation and cellular therapies in cutaneous T-cell lymphoma. Expert Rev Anticancer Ther 2024; 24:41-58. [PMID: 38224371 DOI: 10.1080/14737140.2024.2305356] [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: 07/21/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Mycosis fungoides (MF) and Sezary syndrome (SS) are the most common types of cutaneous T-cell lymphoma. Although many available treatments offer temporary disease control, allogeneic hematopoietic stem cell transplant (allo-HSCT) is the only curative treatment option for advanced stage MF and SS. CAR T-cell therapy is a promising new avenue for treatment. AREAS COVERED In this review, we discuss the evidence supporting the use of allo-HSCT for the treatment of MF/SS, including disease status at the time of transplant, conditioning regimen, total body irradiation (TBI), and donor lymphocyte infusion (DLI). We also address the potential role for CAR T-cell therapy in CTCL. EXPERT OPINION Allo-HSCT is an effective treatment for patients with advanced MF and SS. However, significant research is required to determine optimal treatment protocols. Data support the use of reduced-intensity conditioning regimens and suggests that the use of TBI for debulking of skin disease may result in more durable remissions. Donor lymphocyte infusions (DLI) appear to be particularly effective in inducing complete remission in MF/SS patients with relapsed or residual disease. Challenges with CAR-T therapies in T-cell lymphoma include T-cell fratricide due to shared antigens on malignant and nonmalignant T-cells, penetrance into the skin compartment, and CAR-T cell persistence.
Collapse
Affiliation(s)
- Amrita Goyal
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Francine Foss
- Department of Hematology/Oncology, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
4
|
Tang H, Matsumoto N, Foss F, Xu M, Ahmed A. Clinicopathologic Features of Cutaneous T-Cell Lymphomas With Extracutaneous Metastasis: A Case Series. Clin Lymphoma Myeloma Leuk 2023; 23:e405-e410. [PMID: 37659965 DOI: 10.1016/j.clml.2023.08.006] [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] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/29/2023] [Accepted: 08/06/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND In advanced stages, Cutaneous T-cell lymphomas (CTCL) can metastasize to extracutaneous regions. CTCL with metastasis exhibits unique clinicopathologic characteristics. PATIENTS AND METHODS This study collected 35 cases of primary CTCL with extracutaneous metastasis from a single institution over a period of 20 years. Clinicopathologic features including demographics, CD30 expression, large cell transformation, metastatic sites, T-cell receptor clonality studies and survival data were analyzed. RESULTS The study identified various CTCL entities including mycosis fungoides (MF), Sezary syndrome (SS), cutaneous anaplastic large cell lymphoma (C-ALCL), and primary cutaneous peripheral T-cell lymphoma, not otherwise specified (pcPTCL-NOS). Limited data showed that metastasis can be independent of large cell transformation and/or CD30 expression. Lymph nodes were the most common site of metastasis, followed by the bone marrow. Oropharyngeal metastasis is likely to accompany visceral organ or brain metastasis (P = .049). MF had a longer interval to metastasis than SS (P = .038). Patients with lymph node only metastasis have better survival than patients with metastasis to other sites (P = .012). CONCLUSION To the best of our knowledge, there are limited studies analyzing the clinicopathologic features of different CTCL entities with metastasis as a single population. This research provides valuable insights into the unique characteristics of metastatic CTCL.
Collapse
Affiliation(s)
- Haiming Tang
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Nana Matsumoto
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Francine Foss
- Department of Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
| | - Mina Xu
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Aadil Ahmed
- Department of Pathology, Rush University Medical Center, Chicago, IL.
| |
Collapse
|
5
|
VanOudenhove J, Liu Y, Nelakanti R, Kim D, Busarello E, Ovalle NT, Qi Z, Mamillapalli P, Siddon A, Bai Z, Axtmayer A, Corso C, Kothari S, Foss F, Isufi I, Tebaldi T, Gowda L, Fan R, Seropian S, Halene S. Impact of Memory T Cells on SARS-COV-2 Vaccine Response in Hematopoietic Stem Cell Transplant. bioRxiv 2023:2023.10.26.564259. [PMID: 37961434 PMCID: PMC10634862 DOI: 10.1101/2023.10.26.564259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
During the COVID-19 pandemic, hematopoietic stem cell transplant (HSCT) recipients faced an elevated mortality rate from SARS-CoV-2 infection, ranging between 10-40%. The SARS-CoV-2 mRNA vaccines are important tools in preventing severe disease, yet their efficacy in the post-transplant setting remains unclear, especially in patients subjected to myeloablative chemotherapy and immunosuppression. We evaluated the humoral and adaptive immune responses to the SARS-CoV-2 mRNA vaccination series in 42 HSCT recipients and 5 healthy controls. Peripheral blood mononuclear nuclear cells and serum were prospectively collected before and after each dose of the SARS-CoV-2 vaccine. Post-vaccination responses were assessed by measuring anti-spike IgG and nucleocapsid titers, and antigen specific T cell activity, before and after vaccination. In order to examine mechanisms behind a lack of response, pre-and post-vaccine samples were selected based on humoral and cellular responses for single-cell RNA sequencing with TCR and BCR sequencing. Our observations revealed that while all participants eventually mounted a humoral response, transplant recipients had defects in memory T cell populations that were associated with an absence of T cell response, some of which could be detected pre-vaccination.
Collapse
|
6
|
Avery J, Kim SR, Cheng W, Foss F, Girardi M. FISH Panel for Leukemic Cutaneous T-Cell Lymphoma: Extended Patient Cohort Correlation with Blood Involvement and Clinical Outcomes. JID Innov 2023; 3:100212. [PMID: 37674691 PMCID: PMC10477749 DOI: 10.1016/j.xjidi.2023.100212] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 09/08/2023] Open
Abstract
The genomic basis of cutaneous T-cell lymphoma has been characterized by gene copy number alterations and genomic sequencing, but there are few clinical tests that are being widely used to inform the diagnosis and prognosis of leukemic cutaneous T-cell lymphoma that may arise as a progression from mycosis fungoides or de novo as Sézary syndrome. An 11-gene FISH panel of TP53, RB1, DNMT3A, FAS, ZEB1, ARID1A, ATM, and CDKN2A deletions and MYC, signal transducer and activator of transcription gene (STAT)3/5B, and CARD11 amplifications was previously found to encapsulate >95% of gene copy number variations in leukemic cutaneous T-cell lymphoma. Through a retrospective analysis of patients with leukemic cutaneous T-cell lymphoma seen at the Yale Cancer Center from 2014 to 2020, we gathered the relevant genes as they became available and correlated them to factors with prognostic relevance as a proof of concept to show the potential utility in further developing a limited gene panel for prognosis. In this study, we show that the abnormal FISH results show an association with clinically relevant factors (blood stage, CD4:8 ratio, and percentage blood involvement) and have a nonsignificant statistical trend (>90%) toward correlation with overall survival. In addition, the previous cost-effective panels were signal transducer and activator of transcription (STAT)3/5B, MYC, TP53, and ARID1A. We now suggest adding RB1 and ZEB1 on the basis of our findings.
Collapse
Affiliation(s)
- Jonathan Avery
- Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Sa Rang Kim
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Wei Cheng
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Francine Foss
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
7
|
Hodak E, Geskin L, Guenova E, Ortiz-Romero PL, Willemze R, Zheng J, Cowan R, Foss F, Mangas C, Querfeld C. Correction to: Real-Life Barriers to Diagnosis of Early Mycosis Fungoides: An International Expert Panel Discussion. Am J Clin Dermatol 2023; 24:493. [PMID: 36914911 PMCID: PMC10195702 DOI: 10.1007/s40257-023-00766-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Emmilia Hodak
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Tel Aviv University, 39 Jabotinsky Street, Petah Tiqva, 49100, Tel Aviv, Israel.
| | - Larisa Geskin
- Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Emmanuella Guenova
- University Hospital Lausanne (CHUV) and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Pablo L Ortiz-Romero
- Department of Dermatology, Hospital 12 de Octubre, Institute i+12, CIBERONC, Medical School, University Complutense, Madrid, Spain
| | - Rein Willemze
- Leiden University Medical Center, Leiden, The Netherlands
| | - Jie Zheng
- Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Richard Cowan
- Christie Hospital, The Christie School of Oncology, Manchester, UK
| | - Francine Foss
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Cristina Mangas
- Dermatology Department and Institute of Oncology of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Christiane Querfeld
- Division of Dermatology and Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| |
Collapse
|
8
|
Ramu M, Rosenberg E, Kartz S, Foss F, Lolis EJ. Engineering of the high-affinity chemokine CXCL13 to screen CXCR5 antagonists to treat cancer and autoimmune diseases. Biophys J 2023; 122:474a. [PMID: 36784440 DOI: 10.1016/j.bpj.2022.11.2542] [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: 02/12/2023] Open
Affiliation(s)
- Manjula Ramu
- Department of Pharmacology, Yale School of Medicine, New Haven, CT, USA
| | - Eric Rosenberg
- Department of Pharmacology, Yale School of Medicine, New Haven, CT, USA
| | - Sam Kartz
- Department of Pharmacology, Yale School of Medicine, New Haven, CT, USA
| | - Francine Foss
- Department of Pharmacology, Yale School of Medicine, New Haven, CT, USA
| | - Elias J Lolis
- Department of Pharmacology, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
9
|
Hodak E, Geskin L, Guenova E, Ortiz-Romero PL, Willemze R, Zheng J, Cowan R, Foss F, Mangas C, Querfeld C. Real-Life Barriers to Diagnosis of Early Mycosis Fungoides: An International Expert Panel Discussion. Am J Clin Dermatol 2023; 24:5-14. [PMID: 36399227 PMCID: PMC9673193 DOI: 10.1007/s40257-022-00732-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/19/2022]
Abstract
Mycosis fungoides (MF) is a rare, primary cutaneous T-cell lymphoma that is challenging to diagnose due to its heterogeneous clinical presentation and complex histology. The subtlety of the initial clinical appearance of MF can result in diagnostic delays and hesitancy to refer suspected cases to specialist clinics. An unmet need remains for greater awareness and education. Therefore, an international expert panel of dermatologists, oncologists, hematologists, and dermatopathologists convened to discuss and identify barriers to early and accurate MF diagnosis that could guide clinicians toward making a correct diagnosis. Confirmation of MF requires accurate assessment of symptoms and clinical signs, and subsequent correlation with dermatopathological findings. This review summarizes the expert panel's guidance, based on the literature and real-life experience, for dermatologists to help include MF in their list of differential diagnoses, along with simple clinical and histopathologic checklists that may help clinicians to suspect and identify potential MF lesions and reduce diagnostic delays.
Collapse
Affiliation(s)
- Emmilia Hodak
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Tel Aviv University, 39 Jabotinsky Street, Petah Tiqva, 49100, Tel Aviv, Israel.
| | - Larisa Geskin
- Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Emmanuella Guenova
- University Hospital Lausanne (CHUV) and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Pablo L Ortiz-Romero
- Department of Dermatology, Hospital 12 de Octubre, Institute i+12, CIBERONC, Medical School, University Complutense, Madrid, Spain
| | - Rein Willemze
- Leiden University Medical Center, Leiden, The Netherlands
| | - Jie Zheng
- Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Richard Cowan
- Christie Hospital, The Christie School of Oncology, Manchester, UK
| | - Francine Foss
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Cristina Mangas
- Dermatology Department and Institute of Oncology of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Christiane Querfeld
- Division of Dermatology and Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| |
Collapse
|
10
|
Avery J, Chandhok N, Rainey C, Torres R, Huntington S, Isufi I, Seropian S, Xu ML, Foss F. Peripheral Blood Involvement at Staging in Patients With Aggressive Peripheral T-Cell Lymphoma. Clin Lymphoma Myeloma Leuk 2022; 22:680-689. [PMID: 35568635 DOI: 10.1016/j.clml.2022.04.019] [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] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Peripheral T-Cell Lymphomas (PTCL) are a rare subgroup of lymphomas with a poor outcome.Traditional prognostic measures rely heavily on disease stage, and with the advent of targeted treatment, further stratificationcriteria are needed to guide treatment. To date, the impact of blood involvement at diagnosis on outcomes has not been assessed. MATERIALS AND METHODS We retrospectively reviewed blood involvement by flow cytometry at diagnosis in 102 consecutivelytreated patients who had flow cytometry data available at diagnosis. Of these, 78 patients with nodal subtypes were identified andstudied in this analysis. RESULTS Of 78 patients with nodal subtypes of PTCL who had flow data available at the time ofdiagnosis, circulating populations of malignant T cells matching those in the biopsied lymph nodes were found in 21 patients bymultiparameter flow cytometry. A positive flow cytometry was highly correlated with bone marrow involvement. The patientswith a negative flow cytometry had a trend toward a longer median PFS compared to those with a positive flow but there was noimpact on overall survival. CONCLUSIONS Circulating malignant tumor cells can be found in the peripheral blood in a subset ofpatients with aggressive nodal T-cell lymphomas, including peripheral t-cell lymphoma not otherwise specified andangioimmunoblastic T-cell lymphomas, and blood involvement is correlated with bone marrow involvement.
Collapse
Affiliation(s)
| | | | - Chanelle Rainey
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Richard Torres
- Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Scott Huntington
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Iris Isufi
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Stuart Seropian
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Mina L Xu
- Department of Hematopathology, Yale University School ofMedicine, New Haven, CT, USA
| | - Francine Foss
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
| |
Collapse
|
11
|
Olsen EA, Whittaker S, Willemze R, Pinter-Brown L, Foss F, Geskin L, Schwartz L, Horwitz S, Guitart J, Zic J, Kim YH, Wood GS, Duvic M, Ai W, Girardi M, Gru A, Guenova E, Hodak E, Hoppe R, Kempf W, Kim E, Lechowicz MJ, Ortiz-Romero P, Papadavid E, Quaglino P, Pittelkow M, Prince HM, Sanches JA, Sugaya M, Vermeer M, Zain J, Knobler R, Stadler R, Bagot M, Scarisbrick J. Primary cutaneous lymphoma: recommendations for clinical trial design and staging update from the ISCL, USCLC, and EORTC. Blood 2022; 140:419-437. [PMID: 34758074 PMCID: PMC9353153 DOI: 10.1182/blood.2021012057] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [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: 04/09/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
The number of patients with primary cutaneous lymphoma (PCL) relative to other non-Hodgkin lymphomas (NHLs) is small and the number of subtypes large. Although clinical trial guidelines have been published for mycosis fungoides/Sézary syndrome, the most common type of PCL, none exist for the other PCLs. In addition, staging of the PCLs has been evolving based on new data on potential prognostic factors, diagnosis, and assessment methods of both skin and extracutaneous disease and a desire to align the latter with the Lugano guidelines for all NHLs. The International Society for Cutaneous Lymphomas (ISCL), the United States Cutaneous LymphomaConsortium (USCLC), and the Cutaneous Lymphoma Task Force of the European Organization for the Research and Treatment of Cancer (EORTC) now propose updated staging and guidelines for the study design, assessment, endpoints, and response criteria in clinical trials for all the PCLs in alignment with that of the Lugano guidelines. These recommendations provide standardized methodology that should facilitate planning and regulatory approval of new treatments for these lymphomas worldwide, encourage cooperative investigator-initiated trials, and help to assess the comparative efficacy of therapeutic agents tested across sites and studies.
Collapse
Affiliation(s)
- Elise A Olsen
- Department of Dermatology and Department of Medicine, Division of Hematologic Malignancies, Duke University Medical Center, Durham, NC
| | - Sean Whittaker
- School of Basic and Medical Biosciences, Kings College London and St. Johns Institute of Dermatology, London, United Kingdom
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lauren Pinter-Brown
- Departments of Medicine and Dermatology, Chao Family Comprehensive Cancer Center, University of California-Irvine, Irvine, CA
| | - Francine Foss
- Hematology and Stem Cell Transplantation, Yale University School of Medicine, New Haven, CT
| | - Larisa Geskin
- Department of Dermatology, Columbia University Medical Center, New York, NY
| | - Lawrence Schwartz
- Department of Radiology, Columbia University Medical Center, New York, NY
| | - Steven Horwitz
- Department of Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Joan Guitart
- Departments of Dermatology and Pathology, Northwestern University, Chicago, IL
| | - John Zic
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN
| | - Youn H Kim
- Department of Dermatology, Stanford University School of Medicine and Stanford Cancer Institute, Stanford, CA
| | - Gary S Wood
- Department of Dermatology, University of Wisconsin-Madison, Madison, WI
| | - Madeleine Duvic
- University of Texas MD Anderson Cancer Center, Dermatology Unit, Houston, TX
| | - Wei Ai
- Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco, CA
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, CT
| | - Alejandro Gru
- Divisions of Dermatopathology and Hematopathology, Department of Pathology, Emily Couric Clinical Cancer Center, University of Virginia, Charlottesville, VA
| | - Emmanuella Guenova
- Department of Dermatology, Lausanne University Hospital, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Emmilia Hodak
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Richard Hoppe
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Werner Kempf
- Department of Dermatology, University Hospital Zurich and Kempf and Pfaltz Histologische Diagnostik, Zurich, Switzerland
| | - Ellen Kim
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mary Jo Lechowicz
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA
| | - Pablo Ortiz-Romero
- Department of Dermatology, Hospital Universitario 12 de Octubre, i+12 Institute, CIBERONC, Medical School, Universidad Complutense, Madrid, Spain
| | - Evangelia Papadavid
- Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin Medical School, Turin, Italy
| | - Mark Pittelkow
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ
| | - H Miles Prince
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Jose Antonio Sanches
- Department of Dermatology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Makoto Sugaya
- Department of Dermatology, International University of Health and Welfare, Chiba, Japan
| | - Maarten Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jasmine Zain
- Department of Hematology and Hematopoetic Stem Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Robert Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Rudolf Stadler
- University Clinic for Dermatology, Johannes Wesling Medical Centre, University of Bochum, Minden, Germany
| | - Martine Bagot
- Department of Dermatology, Université de Paris, AP-HP, Hôpital Saint-Louis, Paris, France; and
| | - Julia Scarisbrick
- Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| |
Collapse
|
12
|
Xu S, Lewis J, King A, Umlauf S, Carlson K, Foss F, Girardi M. 831 Proteasome inhibitor functional profiling in CTCL. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.845] [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: 11/25/2022]
|
13
|
Horwitz SM, Ansell S, Ai WZ, Barnes J, Barta SK, Brammer J, Clemens MW, Dogan A, Foss F, Ghione P, Goodman AM, Guitart J, Halwani A, Haverkos BM, Hoppe RT, Jacobsen E, Jagadeesh D, Jones A, Kallam A, Kim YH, Kumar K, Mehta-Shah N, Olsen EA, Rajguru SA, Rozati S, Said J, Shaver A, Shea L, Shinohara MM, Sokol L, Torres-Cabala C, Wilcox R, Wu P, Zain J, Dwyer M, Sundar H. T-Cell Lymphomas, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20:285-308. [PMID: 35276674 DOI: 10.6004/jnccn.2022.0015] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Peripheral T-cell lymphomas (PTCLs) are a heterogeneous group of lymphoproliferative disorders arising from mature T cells, accounting for about 10% of non-Hodgkin lymphomas. PTCL-not otherwise specified is the most common subtype, followed by angioimmunoblastic T-cell lymphoma, anaplastic large cell lymphoma, anaplastic lymphoma kinase-positive, anaplastic large cell lymphoma, anaplastic lymphoma kinase-negative, and enteropathy-associated T-cell lymphoma. This discussion section focuses on the diagnosis and treatment of PTCLs as outlined in the NCCN Guidelines for T-Cell Lymphomas.
Collapse
Affiliation(s)
| | | | - Weiyun Z Ai
- 3UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Stefan K Barta
- 5Abramson Cancer Center at the University of Pennsylvania
| | - Jonathan Brammer
- 6The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | - Joan Guitart
- 11Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Ahmad Halwani
- 12Huntsman Cancer Institute at the University of Utah
| | | | | | | | - Deepa Jagadeesh
- 16Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Allison Jones
- 17St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Kiran Kumar
- 19UT Southwestern Simmons Comprehensive Cancer Center
| | - Neha Mehta-Shah
- 20Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Sima Rozati
- 23The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | - Michi M Shinohara
- 27Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Ryan Wilcox
- 29University of Michigan Rogel Cancer Center
| | - Peggy Wu
- 30UC Davis Comprehensive Cancer Center
| | | | | | | |
Collapse
|
14
|
Sethi T, Montanari F, Foss F. Safety considerations with the current treatments for peripheral T-cell lymphoma. Expert Opin Drug Saf 2022; 21:653-660. [PMID: 35129014 DOI: 10.1080/14740338.2022.2036120] [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: 11/04/2022]
Abstract
INTRODUCTION Peripheral T-Cell Lymphomas (PTCL) constitute a heterogeneous group of aggressive T - and natural killer (NK)-cell disorders and are associated with a poor prognosis. Frontline treatments often consist of anthracycline-based combination chemotherapy with the exception of NK-T cell lymphomas, where such combinations are ineffective due to the presence of P-glycoprotein which leads to multidrug resistance. Infectious and immune mediated side effects might be more pronounced in or unique to T-cell lymphomas due to the selection of agents which target multiple T-cell subtypes and also an immunocompromised state induced by the lymphomas themselves. AREAS COVERED This review provides a comprehensive overview of safety considerations of treatment regimens used for peripheral T-cell lymphomas. We cover regimens used in both frontline and relapsed settings including combination chemotherapy, single agent chemotherapies and immunotherapies. EXPERT OPINION Treatment of T-cell lymphomas often requires sequencing of several therapies due to lower efficacy of available treatment regimens in curing the disease compared to that seen in B-cell non-Hodgkin lymphomas. In addition, certain complications are more common in T-cell lymphomas due to their unique immunobiology. An understanding of these salient aspects is important for all providers who treat patients with this challenging disease group.
Collapse
Affiliation(s)
- Tarsheen Sethi
- Hematology and Stem Cell Therapy, Yale University School of Medicine, New Haven
| | - Francesca Montanari
- Hematology and Stem Cell Therapy, Yale University School of Medicine, New Haven
| | - Francine Foss
- Hematology and Stem Cell Therapy, Yale University School of Medicine, New Haven
| |
Collapse
|
15
|
Murthy HS, Ahn KW, Estrada-Merly N, Alkhateeb HB, Bal S, Kharfan-Dabaja MA, Dholaria B, Foss F, Gowda L, Jagadeesh D, Sauter C, Abid MB, Aljurf M, Awan FT, Bacher U, Badawy SM, Battiwalla M, Bredeson C, Cerny J, Chhabra S, Deol A, Diaz MA, Farhadfar N, Freytes C, Gajewski J, Gandhi MJ, Ganguly S, Grunwald MR, Halter J, Hashmi S, Hildebrandt GC, Inamoto Y, Jimenez-Jimenez AM, Kalaycio M, Kamble R, Krem MM, Lazarus HM, Lazaryan A, Maakaron J, Munshi PN, Munker R, Nazha A, Nishihori T, OIuwole OO, Ortí G, Pan DC, Patel SS, Pawarode A, Rizzieri D, Saba NS, Savani B, Seo S, Ustun C, van der Poel M, Verdonck LF, Wagner JL, Wirk B, Oran B, Nakamura R, Scott B, Saber W. Outcomes of Allogeneic Hematopoietic Cell Transplantation in T-cell Prolymphocytic Leukemia: A Contemporary Analysis from the Center for International Blood and Marrow Transplant Research. Transplant Cell Ther 2022; 28:187.e1-187.e10. [PMID: 35081472 PMCID: PMC8977261 DOI: 10.1016/j.jtct.2022.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
T cell prolymphocytic leukemia (T-PLL) is a rare, aggressive malignancy with limited treatment options and poor long-term survival. Previous studies of allogeneic hematopoietic cell transplantation (alloHCT) for T-PLL are limited by small numbers, and descriptions of patient and transplantation characteristics and outcomes after alloHCT are sparse. In this study, we evaluated outcomes of alloHCT in patients with T-PLL and attempted to identify predictors of post-transplantation relapse and survival. We conducted an analysis of data using the Center for International Blood and Marrow Transplant Research database on 266 patients with T-PLL who underwent alloHCT between 2008 and 2018. The 4-year rates of overall survival (OS), disease-free survival (DFS), relapse, and treatment-related mortality (TRM) were 30.0% (95% confidence interval [CI], 23.8% to 36.5%), 25.7% (95% CI, 20% to 32%), 41.9% (95% CI, 35.5% to 48.4%), and 32.4% (95% CI, 26.4% to 38.6%), respectively. In multivariable analyses, 3 variables were associated with inferior OS: receipt of a myeloablative conditioning (MAC) regimen (hazard ratio [HR], 2.18; P < .0001), age >60 years (HR, 1.61; P = .0053), and suboptimal performance status, defined by Karnofsky Performance Status (KPS) <90 (HR, 1.53; P = .0073). Receipt of an MAC regimen also was associated with increased TRM (HR, 3.31; P < .0001), an elevated cumulative incidence of grade II-IV acute graft-versus-host disease (HR, 2.94; P = .0011), and inferior DFS (HR, 1.86; P = .0004). Conditioning intensity was not associated with relapse; however, stable disease/progression was correlated with increased risk of relapse (HR, 2.13; P = .0072). Both in vivo T cell depletion (TCD) as part of conditioning and KPS <90 were associated with worse TRM and inferior DFS. Receipt of total body irradiation had no significant effect on OS, DFS, or TRM. Our data show that reduced-intensity conditioning without in vivo TCD (ie, without antithymocyte globulin or alemtuzumab) before alloHCT was associated with long-term DFS in patients with T-PLL who were age ≤60 years or who had a KPS >90 or chemosensitive disease.
Collapse
|
16
|
Ribrag V, Davar D, Garralda E, Curigliano G, Zain J, Mehta A, Minchom A, Sanborn R, Foss F, Oberoi H, Forero-Torres A, Ansell S. 558TiP Phase I study of effector-function enhanced monoclonal antibody (mAb), SEA-TGT, in advanced malignancies. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1080] [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: 11/15/2022] Open
|
17
|
Kwan JM, Henry ML, Cook K, Higgins A, Cuomo J, Foss F, Baldassarre LA. Adverse cardiovascular events in patients treated with mogamulizumab. Am Heart J Plus 2021; 9:100049. [PMID: 38559371 PMCID: PMC10978139 DOI: 10.1016/j.ahjo.2021.100049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/17/2021] [Accepted: 09/02/2021] [Indexed: 04/04/2024]
Abstract
Study objectives Mogamulizumab is an important treatment for T-cell leukemia and lymphoma. Adverse cardiovascular events (ACE) after mogamulizumab therapy have not been investigated. The aim of the study is to investigate ACE occurrence after mogamulizumab therapy. Methods The International World Health Organization database, VigiBase, was analyzed from January 2013 to August 2019 for all adverse events, including ACE, that occurred after mogamulizumab treatment. ACE was defined as: cardiac death, myocardial infarction, heart failure, myocarditis, arrhythmia, vasculitis, thrombosis, palpitations and new hypertension. Results ACE after mogamulizumab therapy affected 28 out of 650 unique patients (4.3%). Heart failure (42.8%) and ventricular arrhythmias (17.85%) were most common. ACE accounted for 10% of all fatal adverse outcomes, and 25% of all ACE were fatal. Time to fatal outcome was significantly shorter for patients with ACE compared to non-cardiovascular events, with a mean of 7.7 days (SD 6.91) vs 73 days (SD 90.7), p = 0.017, respectively. There was an increased total number of adverse cardiovascular events in patients greater than 65 and in Asian countries. Conclusions Cardiovascular toxicity with mogamulizumab is a possible early occurring adverse outcome associated with high mortality.
Collapse
Affiliation(s)
- Jennifer M. Kwan
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Mariana L. Henry
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Kirstin Cook
- Department of Neurosurgery, University of California, Los Angeles School of Medicine, Los Angeles, CA, United States of America
| | - Angela Higgins
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Jason Cuomo
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Francine Foss
- Section of Hematology, Yale University School of Medicine, New Haven, CT, United States of America
| | - Lauren A. Baldassarre
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| |
Collapse
|
18
|
Abstract
INTRODUCTION The most common types of CTCL are mycosis fungoides (MF) and Sézary syndrome (SS). In both MF and SS, complete responses to treatment are uncommon. Recent developments and understanding of the biology of MF/SS have led to novel agents which may offer prolonged responses with less toxicity compared to conventional chemotherapy approaches. AREAS COVERED In this review, we discuss the efficacy and safety of new nonchemotherapy treatment options including antibody agents, small molecule inhibitors, fusion proteins, and CAR T-cell therapy. We also reflect on older immunomodulatory treatments including retinoids and histone deacetylase inhibitors. EXPERT OPINION Patients with MF/SS who require systemic therapy often progress through multiple agents sequentially, thus the need for additional novel agents in the treatment armamentarium. Antibody-based therapies such as alemtuzumab are highly effective in the blood compartment of disease, while brentuximab vedotin has shown higher activity in skin and lymph nodes. Checkpoint inhibitors may play a role in treating MF/SS but may induce hyperprogression, and engineered T cells and bispecific antibodies recruiting immune effectors are being developed and may show promise in the future.
Collapse
Affiliation(s)
- Suzanne Xu
- Yale University School of Medicine, New Haven, United States
| | - Francine Foss
- Hematology and Stem Cell Transplantation, Yale University School of Medicine, New Haven, United States
| |
Collapse
|
19
|
Cowan RA, Scarisbrick JJ, Zinzani PL, Nicolay JP, Sokol L, Pinter-Brown L, Quaglino P, Iversen L, Dummer R, Musiek A, Foss F, Ito T, Rosen JP, Medley MC. Efficacy and safety of mogamulizumab by patient baseline blood tumour burden: a post hoc analysis of the MAVORIC trial. J Eur Acad Dermatol Venereol 2021; 35:2225-2238. [PMID: 34273208 PMCID: PMC9290719 DOI: 10.1111/jdv.17523] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/02/2021] [Indexed: 12/21/2022]
Abstract
Background Mogamulizumab was compared with vorinostat in the phase 3 MAVORIC trial (NCT01728805) in 372 patients with relapsed/refractory mycosis fungoides (MF) or Sézary syndrome (SS) who had failed ≥1 prior systemic therapy. Mogamulizumab significantly prolonged progression‐free survival (PFS), with a superior objective response rate (ORR) vs. vorinostat. Objectives This post hoc analysis was performed to evaluate the effect of baseline blood tumour burden on patient response to mogamulizumab. Methods PFS, ORR, time to next treatment (TTNT), skin response (modified Severity‐Weighted Assessment Tool [mSWAT]) and safety were assessed in patients stratified by blood classification (B0 [n = 126], B1 [n = 62], or B2 [n = 184], indicating increasing blood involvement). Results Investigator‐assessed PFS was longer for mogamulizumab versus vorinostat across all blood classes, significantly so for B1 and B2 patients. ORR was higher with mogamulizumab than with vorinostat in all blood classification groups and more markedly so with escalating B class (B0: 15.6% vs. 6.5%, P = 0.0549; B1: 25.8% vs. 6.5%, P = 0.2758; B2: 37.4% vs. 3.2%, P < 0.0001). TTNT was significantly longer for patients treated with mogamulizumab versus vorinostat with B1 (12.63 vs. 3.07 months; HR 0.32 [95% CI 0.16–0.67]; P = 0.0018) and B2 (13.07 vs. 3.53 months; HR 0.30 [95% CI 0.21–0.43]; P < 0.0001) blood involvement. In the mogamulizumab arm, 81 patients (43.5%) had ≥50% change in the mSWAT vs. 41 patients (22.0%) with vorinostat; mSWAT improvements with mogamulizumab occurred most often in B1 and B2 patients. Rapid, sustained reductions were seen in CD4+CD26‐ cell counts and CD4:CD8 ratios in mogamulizumab patients for all B classes. Treatment‐emergent adverse events were less frequent overall with mogamulizumab and similar in frequency regardless of B class. Conclusions This post hoc analysis indicates greater clinical benefit with mogamulizumab vs. vorinostat in patients with MF and SS classified as having B1 and B2 blood involvement.
Collapse
Affiliation(s)
- R A Cowan
- Christie Hospital Foundation NHS Trust, University of Manchester, Manchester, UK
| | | | - P L Zinzani
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia.,Istituto di Ematologia 'Seràgnoli', Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università degli Studi, Bologna, Italia
| | - J P Nicolay
- University Medical Centre Mannheim, Mannheim, Germany
| | - L Sokol
- Moffitt Cancer Center, Tampa, FL, USA
| | - L Pinter-Brown
- Chao Family Comprehensive Cancer Center, University of California-Irvine, Orange, CA, USA
| | | | - L Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - R Dummer
- Universitäts Spital Zürich, Zürich, Switzerland
| | - A Musiek
- Division of Dermatology, Washington University in Saint Louis, St. Louis, Missouri, USA
| | - F Foss
- Hematology and Stem Cell Transplantation, Yale School of Medicine, New Haven, Connecticut, USA
| | - T Ito
- Kyowa Kirin Pharmaceutical Development, Inc., Princeton, NJ, USA
| | - J-P Rosen
- Kyowa Kirin International, Buckinghamshire, UK
| | - M C Medley
- Kyowa Kirin International, Buckinghamshire, UK
| |
Collapse
|
20
|
Perreault S, Schiffer M, Clinchy-Jarmoszko V, Bocchetta N, Barbarotta L, Abdelghany O, Foss F, Huntington S, Seropian S, Isufi I. Mitigating the risk of COVID-19 exposure by transitioning from clinic-based to home-based immune globulin infusion. Am J Health Syst Pharm 2021; 78:1112-1117. [PMID: 33617630 PMCID: PMC7929449 DOI: 10.1093/ajhp/zxab072] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Intravenous immune globulin (IVIG) therapy is used in patients with hypogammaglobulinemia to lower the risk of infections. IVIG and subcutaneous IVIG (SCIG) therapy have been to shown to be safe and effective when administered as clinic-based infusions. Concern from both patients and providers for increased transmission of the coronavirus disease 2019 (COVID-19) virus to immunosuppressed patients with scheduled medical visits and procedures made it necessary for us to reassess our process of how we manage patient care in general and chronic clinic infusions in particular. Here we describe our experience of transitioning patients from clinic-based to home based IVIG and/or SCIG infusions to decrease the risk of COVID-19 exposure. METHODS Criteria were developed to identify high-risk immunosuppressed patients who would be appropriate candidates for potential conversion to home based IVIG infusions. Data were collected via chart review, and cost analysis was performed using Medicare Part B reimbursement data. A patient outcome questionnaire was developed for administration through follow-up phone calls. RESULTS From March to May 2020, 45 patients met criteria for home-based infusion, with 27 patients (60%) agreeing to home-based infusion. Posttransition patient outcomes assessment, conducted in 26 patients (96%), demonstrated good patient understanding of the home-based infusion process. No infusion-related complications were reported, and 24 patients (92%) had no concerns about receiving future IVIG and/or SCIG doses at home. No patient tested positive for COVID-19 during the study period. Clinic infusion visits decreased by 26.6 visits per month, resulting in a total of 106 hours of additional available infusion chair time per month and associated cost savings of $12,877. CONCLUSION Transition of clinic based to home based IVIG/SCIG infusion can be successfully done to decrease potential exposure during a pandemic in a high-risk immunosuppressed population, with no impact on patient satisfaction, adherence, or efficacy. The home-based infusion initiative was associated with a reduction in costs to patients and an increase in available chair time in the infusion clinic.
Collapse
Affiliation(s)
- Sarah Perreault
- Department of Pharmacy, Yale New Haven Health, New Haven, CT, USA
| | - Molly Schiffer
- Department of Pharmacy, Yale New Haven Health, New Haven, CT, USA
| | | | - Nicole Bocchetta
- Department of Nursing, Yale New Haven Health, New Haven, CT, USA
| | - Lisa Barbarotta
- Department of Nursing, Yale New Haven Health, New Haven, CT, USA
| | - Osama Abdelghany
- Department of Pharmacy, Yale New Haven Health, New Haven, CT, USA
| | - Francine Foss
- Department of Hematology, Yale School of Medicine, New Haven, CT, and Yale New Haven Health, New Haven, CT, USA
| | - Scott Huntington
- Department of Hematology, Yale School of Medicine, New Haven, CT, and Yale New Haven Health, New Haven, CT, USA
| | - Stuart Seropian
- Department of Hematology, Yale School of Medicine, New Haven, CT, and Yale New Haven Health, New Haven, CT, USA
| | - Iris Isufi
- Department of Hematology, Yale School of Medicine, New Haven, CT, and Yale New Haven Health, New Haven, CT, USA
| |
Collapse
|
21
|
Sethi TK, Montanari F, Foss F, Reddy N. How we treat advanced stage cutaneous T-cell lymphoma - mycosis fungoides and Sézary syndrome. Br J Haematol 2021; 195:352-364. [PMID: 33987825 DOI: 10.1111/bjh.17458] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
T-cell lymphomas (TCLs) constitute a rare subset of non-Hodgkin lymphomas, with mycosis fungoides/Sézary syndrome (MF/SS) being the most common subtype of cutaneous TCLs (CTCLs). Considered an incurable but treatable disease, MF/SS management presents several challenges including diagnostic delays, debilitating effect on patients' quality of life, need for several lines of therapies, multidisciplinary care and cumulative drug toxicities limiting duration of use. The present review intends to provide an overview of the recent advances in our understanding of the biology of CTCL and how these are being leveraged to provide additional treatment options for management of advanced and recurrent disease. In addition, the discussion of the different modalities of treatment is summarised to further outline the importance of multidisciplinary care and early referral to CTCL centres.
Collapse
Affiliation(s)
- Tarsheen K Sethi
- Division of Hematology, Yale University School of Medicine, New Haven, CT, USA
| | - Francesca Montanari
- Division of Hematology, Yale University School of Medicine, New Haven, CT, USA
| | - Francine Foss
- Division of Hematology, Yale University School of Medicine, New Haven, CT, USA
| | - Nishitha Reddy
- Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
22
|
King A, Mirza F, Lewis J, Yumeen S, Kim S, Carlson K, Foss F, Girardi M. 672 JAK inhibitor functional profiling in CTCL. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.702] [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: 10/21/2022]
|
23
|
Zhao J, Merl M, Foss F. Tolinapant. X-linked inhibitor of apoptosis protein (XIAP) antagonist, Cellular inhibitor of apoptosis protein-1 (cIAP) antagonist, Treatment of advanced solid tumors and lymphomas. DRUG FUTURE 2021. [DOI: 10.1358/dof.2021.46.6.3250243] [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: 10/21/2022]
|
24
|
Perreault S, Schiffer M, Zhao J, McManus D, Foss F, Gowda L, Isufi I, Seropian S, Topal JE. 577. Incidence and Outcomes of Positive Outpatient Surveillance Blood Cultures in Hematopoietic Stem Cell Transplant (HSCT) Patients with Graft Versus Host Disease (GvHD) On High Dose ≥ 0.5 mg/kg/day (HD) and Low Dose < 0.5mg/kg/day (LD) Steroid Therapy. Open Forum Infect Dis 2020. [PMCID: PMC7776791 DOI: 10.1093/ofid/ofaa439.771] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Treatment of GvHD with steroids increases the risk of infection in HSCT patients due to additive immunosuppression and may delay the diagnosis of infection due to lack of symptoms. Outpatient surveillance blood cultures in HSCT with GvHD being treated with HD steroids has demonstrated a blood culture positivity rate of 3.5%. Currently, the utility of surveillance cultures in patients receiving LD steroid therapy is unknown. Our practice includes weekly outpatient surveillance cultures for all GvHD patients treated with steroids regardless of the dose. The primary endpoint of this study was to assess the incidence of positive surveillance blood cultures in GvHD patients receiving HD or LD steroids. Secondary endpoints included number of patients treated, hospitalization, 30 day mortality due to infection, and organisms isolated.
Methods
This was a single-center, retrospective review of GvHD patients at Yale New Haven Hospital between January 2013 and May 2019. Patients were excluded if: lack of signs or symptoms of GvHD, treatment with steroids for any indication other than GvHD, and active GvHD without central line. Cultures from patients receiving antibiotics for concurrent infection were also excluded.
Results
A total of 71 patients met criteria with 901 blood cultures. On HD, eight patients (14%) had 12 positive cultures (4%), and on LD, 16 patients (25%) had 22 positive cultures (4%) (p=0.15). Treatment occurred in six patients (75%) with four (24%) requiring hospitalization on HD, and 12 patients (75%) with 10 (83%) requiring hospitalization on LD (p=0.45). The median duration of steroid therapy was 93 and 236 days with a median dose of steroids of 1mg/kg/day and 0.15mg/kg/day, respectively. The number of positive cultures/1000 steroid days was 1.2 on HD and 0.5 on LD (RR 2.2). 30 day mortality was only noted in one patient (8%) on LD. The most common organism in both groups was Coagulase-negative staphylococci with all six cultures on HD classified as contaminants and 6/10 cultures requiring treatment on LD.
Conclusion
Although the relative risk of positive surveillance blood cultures in HD patients compared to LD was twofold higher, there were clinically significant infections identified in the LD group.
Disclosures
All Authors: No reported disclosures
Collapse
|
25
|
Schiffer M, Perreault S, McManus D, Foss F, Gowda L, Isufi I, Seropian S, Topal JE. 574. De-escalation of Broad Spectrum Antibiotics during Cytokine Release Syndrome with Haploidentical Hematopoietic Stem Cell Transplantation. Open Forum Infect Dis 2020. [PMCID: PMC7776323 DOI: 10.1093/ofid/ofaa439.768] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Fever is a common component of cytokine release syndrome (CRS) occurring in 90% of patients undergoing haploidentical hematopoietic stem cell transplantation (Haplo-HSCT). Fevers typically occur between the stem cell infusion (Day 0) and initiation of post-transplant cyclophosphamide and are often confused with febrile neutropenia (FN). Due to longer time to engraftment in Haplo-HSCT, CRS/FN exposes patients to prolonged courses of empiric broad spectrum antibiotic (BSA) therapy increasing the risk for multi-drug resistant organisms. Recently, at Yale New Haven Health, our practice has changed to now recommend antibiotic de-escalation to prophylaxis after 7 days of BSA if no infection is identified. The objective of this study was to assess the incidence of breakthrough infections with the de-escalation of BSA in CRS/FN. Secondary endpoints include rate of FN, rate of de-escalation, rate of recurrent fevers, duration of BSA, and positive blood culture data. Methods The patient population included those undergoing Haplo-HSCT between July 2016 and February 2020 and who developed CRS/FN between Day 0 and Day +5. Patients were excluded if they had prolonged hospitalization due to non-infectious complications or engraftment failure. Bacteremia was defined using NHSN definitions. Results Of the 53 Haplo-HSCTs assessed, 43 experienced CRS/FN. Thirty-five Haplo-HSCT (81%) with CRS/FN had negative cultures and 23 (66%) of these were de-escalated back to antibacterial prophylaxis. The median duration of BSA in the de-escalated group was 7 days (range 5–13) compared to 16.5 days range (13–21) in the non-de-escalated group (p< 0.001). Among those de-escalated, 7 (30%) had recurrent fever occurring at a median of 4 days (range 2–14) and were placed back on BSA. Two Haplo-HSCT (9%) that had fever after de-escalation developed a breakthrough bacteremia. No Haplo-HSCT after de-escalation had fever or re-admission for bacteremia 30 days after engraftment. Four Haplo-HSCT (9%) with CRS/FN had positive blood cultures; however, three (7%) were still able to be de-escalated from BSA to narrower agents based on susceptibilities. Conclusion De-escalation of BSA in FN/CRS in Haplo-HSCT patients reduced unnecessary, prolonged antibiotic exposure with a low incidence of breakthrough infections. Disclosures All Authors: No reported disclosures
Collapse
|
26
|
Patel KK, Isufi I, Kothari S, Foss F, Huntington S. Cost-effectiveness of polatuzumab vedotin in relapsed or refractory diffuse large B-cell lymphoma. Leuk Lymphoma 2020; 61:3387-3394. [PMID: 32835553 DOI: 10.1080/10428194.2020.1808208] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A recent phase II trial showed that use of polatuzumab vedotin in combination with bendamustine plus rituximab (Pola-BR) in transplant-ineligible patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) resulted in longer progression-free survival and overall survival compared to bendamustine plus rituximab (BR) alone. In this study, we constructed a Markov model to assess the cost-effectiveness of Pola-BR versus BR in transplant-ineligible R/R DLBCL. We calculated the incremental cost-effectiveness ratio (ICER) of each treatment strategy from a US payer perspective, using a lifetime horizon and a willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY). Use of Pola-BR was associated with an incremental cost of $92,641 compared to BR alone ($200,905 vs $108,265, respectively), an incremental effectiveness of 1.76 QALYs (2.35 vs 0.59 QALYs, respectively), and an ICER of $52,519/QALY. These data suggest that use of Pola-BR for R/R DLBCL is likely to be cost-effective compared to BR alone.
Collapse
Affiliation(s)
- Kishan K Patel
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Iris Isufi
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Shalin Kothari
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Francine Foss
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Scott Huntington
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT, USA
| |
Collapse
|
27
|
Isufi I, Seropian S, Gowda L, Wilson LD, Roberts K, Girardi M, Perreault S, Foss F. Outcomes for allogeneic stem cell transplantation in refractory mycosis fungoides and primary cutaneous gamma Delta T cell lymphomas. Leuk Lymphoma 2020; 61:2955-2961. [DOI: 10.1080/10428194.2020.1790555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Iris Isufi
- Hematology and Bone Marrow Transplantation, Yale University School of Medicine, New Haven, CT, USA
| | - Stuart Seropian
- Hematology and Bone Marrow Transplantation, Yale University School of Medicine, New Haven, CT, USA
| | - Lohith Gowda
- Hematology and Bone Marrow Transplantation, Yale University School of Medicine, New Haven, CT, USA
| | - Lynn D. Wilson
- Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Kenneth Roberts
- Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Michael Girardi
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah Perreault
- Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
| | - Francine Foss
- Hematology and Bone Marrow Transplantation, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
28
|
Hornick N, Wang A, Lim Y, Gehlhausen J, Siegel J, Wang J, Foss F, Lim I, Zubek A, Milstone L, Galan A, King B, Damsky W. Development or worsening of sarcoidosis associated with IL-17 blockade for psoriasis. J Eur Acad Dermatol Venereol 2020; 34:e583-e585. [PMID: 32277505 DOI: 10.1111/jdv.16451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- N Hornick
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - A Wang
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Y Lim
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - J Gehlhausen
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - J Siegel
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - J Wang
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - F Foss
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.,Department of Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - I Lim
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - A Zubek
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - L Milstone
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - A Galan
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.,Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - B King
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - W Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
29
|
Wang A, Hornick N, Lim Y, Gehlhausen J, Siegel J, Wang J, Foss F, Lim I, Zubek A, Milstone L, Galan A, King B, Damsky W. Interleukin-17 blockade downregulates NOD2 in skin and may promote paradoxical sarcoidosis. J Eur Acad Dermatol Venereol 2020; 34:e497-e499. [PMID: 32249470 DOI: 10.1111/jdv.16416] [Citation(s) in RCA: 4] [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] [Received: 03/15/2020] [Accepted: 03/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- A Wang
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - N Hornick
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Y Lim
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - J Gehlhausen
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - J Siegel
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - J Wang
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - F Foss
- Department of Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - I Lim
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - A Zubek
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - L Milstone
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - A Galan
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.,Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - B King
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - W Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
30
|
Zic JA, Ai W, Akilov OE, Carter JB, Duvic M, Foss F, Girardi M, Gru AA, Kim E, Musiek A, Olsen EA, Schieke SM, Shinohara M, Zain JM, Geskin LJ. United States Cutaneous Lymphoma Consortium recommendations for treatment of cutaneous lymphomas during the COVID-19 pandemic. J Am Acad Dermatol 2020; 83:703-704. [PMID: 32305443 PMCID: PMC7161526 DOI: 10.1016/j.jaad.2020.04.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/11/2020] [Accepted: 04/12/2020] [Indexed: 11/16/2022]
Affiliation(s)
- John A Zic
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Weiyun Ai
- Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
| | - Oleg E Akilov
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joi B Carter
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Madeleine Duvic
- Department of Dermatology, MD Anderson Cancer Center, Houston, Texas
| | - Francine Foss
- Division of Hematology/Oncology, Yale-New Haven Medical Center, New Haven, Connecticut
| | - Michael Girardi
- Department of Dermatology, Yale-New Haven Medical Center, New Haven, Connecticut
| | - Alejandro A Gru
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Ellen Kim
- Department of Dermatology, University of Pennsylvania Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania
| | - Amy Musiek
- Division of Dermatology, Washington University in Saint Louis, St Louis, Missouri
| | - Elise A Olsen
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Stefan M Schieke
- Department of Dermatology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michi Shinohara
- Department of Dermatology, University of Washington Medical Center, Seattle, Washington
| | - Jasmine M Zain
- Division of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Larisa J Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York.
| |
Collapse
|
31
|
Khodadoust MS, Rook AH, Porcu P, Foss F, Moskowitz AJ, Shustov A, Shanbhag S, Sokol L, Fling SP, Ramchurren N, Pierce R, Davis A, Shine R, Li S, Fong S, Kim J, Yang Y, Blumenschein WM, Yearley JH, Das B, Patidar R, Datta V, Cantu E, McCutcheon JN, Karlovich C, Williams PM, Subrahmanyam PB, Maecker HT, Horwitz SM, Sharon E, Kohrt HE, Cheever MA, Kim YH. Pembrolizumab in Relapsed and Refractory Mycosis Fungoides and Sézary Syndrome: A Multicenter Phase II Study. J Clin Oncol 2020; 38:20-28. [PMID: 31532724 PMCID: PMC6943974 DOI: 10.1200/jco.19.01056] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [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] [Accepted: 07/31/2019] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To assess the efficacy of pembrolizumab in patients with advanced relapsed or refractory mycosis fungoides (MF) or Sézary syndrome (SS). PATIENTS AND METHODS CITN-10 is a single-arm, multicenter phase II trial of 24 patients with advanced MF or SS. Patients were treated with pembrolizumab 2 mg/kg every 3 weeks for up to 24 months. The primary end point was overall response rate by consensus global response criteria. RESULTS Patients had advanced-stage disease (23 of 24 with stage IIB to IV MF/SS) and were heavily pretreated with a median of four prior systemic therapies. The overall response rate was 38% with two complete responses and seven partial responses. Of the nine responding patients, six had 90% or more improvement in skin disease by modified Severity Weighted Assessment Tool, and eight had ongoing responses at last follow-up. The median duration of response was not reached, with a median response follow-up time of 58 weeks. Immune-related adverse events led to treatment discontinuation in four patients. A transient worsening of erythroderma and pruritus occurred in 53% of patients with SS. This cutaneous flare reaction did not result in treatment discontinuation for any patient. The flare reaction correlated with high PD-1 expression on Sézary cells but did not associate with subsequent clinical responses or lack of response. Treatment responses did not correlate with expression of PD-L1, total mutation burden, or an interferon-γ gene expression signature. CONCLUSION Pembrolizumab demonstrated significant antitumor activity with durable responses and a favorable safety profile in patients with advanced MF/SS.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Asa Davis
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | | | - Yi Yang
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | - Biswajit Das
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Rajesh Patidar
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | - Erin Cantu
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | - Chris Karlovich
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Hollebecque A, Assouline S, Samaniego F, You B, Foss F, Prica A, Gordon SW, Webster M, Dyer MJS, El-Sharkawi D, Shapiro GI, Nabell L, Blagden SP, Lister J, Ulahannan SV, Sun Y, Chan D, Ferraldeschi R, Mita M. Abstract A072: Preliminary results of ASTX660, a novel non-peptidomimetic cIAP1/2 and XIAP antagonist, in 107 patients with solid tumors or lymphoma. Mol Cancer Ther 2019. [DOI: 10.1158/1535-7163.targ-19-a072] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: ASTX660 is an oral, novel nonpeptidomimetic, small-molecule antagonist of cellular/X-linked inhibitors of apoptosis proteins (cIAP1/2 and XIAP). ASTX660 is currently being evaluated in a first-in-human phase 1–2 study in patients (pts) with advanced solid tumors or lymphoma (ClinicalTrials.gov NCT02503423). In the ongoing phase 2, ASTX660 has demonstrated preliminary evidence of clinical activity in the relapsed/refractory peripheral T-cell lymphoma (PTCL) and cutaneous T-cell lymphoma (CTCL) cohorts (Mehta et al, presented at the EHA Conference 2019, abs PS1073). Here, we report overall efficacy and safety data from the solid tumors (head and neck squamous cell carcinoma [HNSCC]; cervical carcinoma and other solid tumors) and lymphoma (diffuse large B-cell lymphoma [DLBCL], PTCL, CTCL,) phase 2 cohorts. Methods: Pts received treatment with ASTX660 orally at the RP2D 180mg/day on days 1 to 7, and 15 to 22 in a 28-day cycle. In the first stage 14 evaluable pts were enrolled in each of the 6 phase 2 cohorts with the option to expand the cohort if activity was observed. The primary endpoint was response rate as assessed by the investigator according to the Lugano criteria (DLBCL and PTCL), Global Assessment (CTCL), or RECIST 1.1 (solid tumors). Adverse events (AEs) were assessed per CTCAE V4.03. Results: As of June 4, 2019, a total of 107 pts have received ASTX660 in the solid tumors and lymphoma phase 2 cohorts (HNSCC n=14; DLBCL n=16; PTCL n=26; CTCL n=23; cervical carcinoma n=14; other solid tumors n= 14). Median age (range) was 61 (23-84) years and median number (range) of prior anticancer regimens was 3 (0-12). Among all pts, the most common related AEs of any grade (≥ 10%) were rash (35%), lipase elevation (34%), amylase elevation (29%), diarrhea (14%), fatigue (14%), AST elevation (13%), nausea (13%), and anemia (11%). Related AEs ≥ Grade 3 occurring in ≥ 5% of pts were rash (18%), lipase elevation (16%) and amylase elevation (9%). As of 4 June 2019, 86 pts (80%) discontinued study treatment: 64 (60%) due to progressive disease, 13 (12%) due to AE, 4 (4%) due to death, 4 (4%) due to withdrawal by participant and 1 (1%) for investigator’s decision. At the time of analysis, the ORR was 36% in the PTCL cohort and 15% in the CTCL cohort. One PR was reported in a pt with metastatic melanoma after 12 cycles of treatment. No objective responses were reported in the HNSCC, DLBCL or cervical cohorts. Accrual in the PTCL and CTCL continues; updated efficacy and safety data will be presented at the meeting. Conclusion: In the phase 2 part of the study ASTX660 monotherapy has demonstrated a manageable safety profile and encouraging activity in PTCL and CTCL warranting cohort expansion. Future plans include evaluation of ASXT660 both as mono- or combination therapy in selected malignancies.
Citation Format: Antoine Hollebecque, Sarit Assouline, Felipe Samaniego, Benoit You, Francine Foss, Anca Prica, Sarah W. Gordon, Marc Webster, Martin JS. Dyer, Dima El-Sharkawi, Geoffrey I. Shapiro, Lisa Nabell, Sarah P. Blagden, John Lister, Susanna V. Ulahannan, Yijun Sun, Danna Chan, Roberta Ferraldeschi, Monica Mita. Preliminary results of ASTX660, a novel non-peptidomimetic cIAP1/2 and XIAP antagonist, in 107 patients with solid tumors or lymphoma [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr A072. doi:10.1158/1535-7163.TARG-19-A072
Collapse
Affiliation(s)
| | | | | | | | | | - Anca Prica
- 6Princess Margaret Cancer Centre, Toronto, ON
| | | | | | - Martin JS. Dyer
- 9Ernest and Helen Scott Haematological Research Institute University of Leicester, Leicester
| | | | | | - Lisa Nabell
- 12University of Alabama at Birmingham, Birmingham, AL
| | - Sarah P. Blagden
- 13Churchill Hospital, Oxford University Hospital NHS Trust, Oxford
| | - John Lister
- 14Allegheny Health Network Cancer Institute, Pittsburgh, PA
| | - Susanna V. Ulahannan
- 15Stephenson Cancer Center, OUHSC and Sarah Cannon Research Institute, Oklahoma City, OK
| | - Yijun Sun
- 16Astex Pharmaceuticals, Inc., Pleasanton, CA
| | - Danna Chan
- 16Astex Pharmaceuticals, Inc., Pleasanton, CA
| | | | | |
Collapse
|
33
|
Perreault S, McManus D, Pulk R, Topal JE, Foss F, Isufi I, Seropian S, Bar N. 2694. Incidence of Pneumocytis jiroveci (PJP) Infection with 3-Month Prophylaxis of Aerosolized Pentamidine (AP) in Autologous Hematopoietic Stem Cell Transplantation (HSCT). Open Forum Infect Dis 2019. [PMCID: PMC6809600 DOI: 10.1093/ofid/ofz360.2371] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
HSCT patients are at an increased risk of developing PJP after transplant due to treatment induced immunosuppression. Given the risk of cytopenias with co-trimoxazole, AP is utilized as an alternative for PJP prophylaxis. A prior study revealed a 0% (0/19 patients) incidence when AP prophylaxis was given for one year post autologous HSCT. Current guidelines recommend a duration of 3 – 6 months for PJP prophylaxis in autologous HSCT. The primary endpoint of this study was to assess the incidence of PJP infection within one year post autologous HSCT in patients who received 3 months of AP. Secondary endpoint was a cost comparison of 3 months compared with 6 months of AP.
Methods
A single-center, retrospective study of adult autologous HSCT patients at Yale New Haven Hospital between February 2013 and December 2017 was performed. Patients were excluded if: <18 years of age, received < or >3 months of AP, changed to alternative PJP prophylactic agent or received no PJP prophylaxis, received tandem HSCT, deceased prior to one year post-transplant from a non PJP-related infection, HIV positive, or lost to follow-up. Pentamidine was given as a 300 mg inhalation monthly for 3 months starting Day +15 after autologous HSCT.
Results
A total of 288 patients were analyzed, no PJP infections occurred within one year post HSCT. Additionally, 187 (65%) patients received treatment post HSCT with 135/215 (63%) receiving maintenance immunomodulatory drugs for myeloma and 40/288 (14%) patients developing relapsed disease. 43% of the chemotherapy regimens for relapsed disease included high dose corticosteroids. The cost difference of using 3 months vs. 6 months of AP is $790, reflecting the cost of drug and its administration. Applying our incidence of 0%, potential cost savings of 3 months vs. 6 months of AP would be $330,000 over 5 years or $66,000 per year.
Conclusion
Three months of AP for PJP prophylaxis in autologous HSCT patients is safe and effective as well as cost-effective compared with a 6 month regimen.
Disclosures
All authors: No reported disclosures.
Collapse
Affiliation(s)
| | | | | | | | | | - Iris Isufi
- Yale New Haven Hospital, New Haven, Connecticut
| | | | - Noffar Bar
- Yale School of Medicine, Yale New Haven Hospital, Connecticut
| |
Collapse
|
34
|
Wang M, Kibbi N, Ring N, Siddon A, Foss F, Totonchy M. DUSP22-IRF4 rearrangement in AIDS-associated ALK-negative anaplastic large cell lymphoma. BMJ Case Rep 2019; 12:12/9/e230641. [PMID: 31570354 DOI: 10.1136/bcr-2019-230641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Patients with AIDS have increased risk of developing lymphomas, such as anaplastic large cell lymphoma (ALCL), which generally carry a poor prognosis. The DUSP-IRF4 genetic rearrangement in ALCL confers a favourable prognosis in HIV-negative patients; it is unknown how this interacts clinically with HIV/AIDS. A man aged 53 years presented with subcutaneous nodules on the scalp and axillae, and diffuse lymphadenopathy. Biopsy of subcutaneous nodule and lymph node showed large atypical anaplastic lymphocytes which were CD30+ and anaplastic lymphoma kinase-negative, consistent with primary systemic ALCL. In addition, he was found to be HIV-positive and diagnosed with AIDS. Genetic testing of the tissue revealed a DUSP22-IRF4 rearrangement. Complete remission was achieved with HyperCVAD and subsequent brentuximab vedotin monotherapy. We report a case of AIDS-associated primary systemic ALCL with a DUSP22-IRF4 rearrangement. AIDS-associated ALCL is an aggressive lymphoma, with a poor prognosis. However, the presence of the genetic rearrangement, previously unseen in this disease, drastically altered the disease course. This case highlights the value of genetic testing and identifies DUSP22-IRF4-associated ALCL in the setting of HIV-associated lymphoproliferative disorders.
Collapse
Affiliation(s)
- Mike Wang
- Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nour Kibbi
- Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nan Ring
- Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Alexa Siddon
- Laboratory Medicine and Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Francine Foss
- Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA.,Hematology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mariam Totonchy
- Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
35
|
Affiliation(s)
- Salma Afifi
- Hematology Section, Smilow Cancer Center, New Haven, CT, USA
| | - Sara Mohamed
- Hematology Section, Smilow Cancer Center, New Haven, CT, USA
| | - Jennifer Zhao
- Hematology Section, Smilow Cancer Center, New Haven, CT, USA
| | - Francine Foss
- Hematology and Bone Marrow Transplantation, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
36
|
Samaniego F, Hollebecque A, Foss F, Lister J, Mita M, Wagner-Johnston N, Dyer M, You B, Prica A, Hernandez-Llizaliturri F, Ferraldeschi R, Chan D, Zhang J, Mehta A. PRELIMINARY RESULTS OF ASTX660, A NOVEL NON-PEPTIDOMIMETIC cIAP1/2 AND XIAP ANTAGONIST, IN RELAPSED/REFRACTORY PERIPHERAL T-CELL LYMPHOMA AND CUTANEOUS T CELL LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.211_2631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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)
- F. Samaniego
- Lymphoma & Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - A. Hollebecque
- Early Drug Development (DITEP) Gastro-Intestinal Oncology; Institute Gustave Roussy; Villejuif France
| | - F. Foss
- Internal Medicine; Hematology, Yale Cancer Center; New Haven United States
| | - J. Lister
- Division of Hematology and Cellular Therapy; Allegheny Health Network Cancer Institute; Pittsburgh United States
| | - M. Mita
- Experimental Therapeutics; Samuel Oschin Comprehensive Cancer Institute Cedars-Sinai Medical Center; Los Angeles United States
| | | | - M. Dyer
- Ernest and Helen Scott Haematological Research Institute; University of Leicester; Leicester United Kingdom
| | - B. You
- Medical Oncology; Centre Hospitalier Lyon Sud; Pierre Benite France
| | - A. Prica
- Hematology; Princess Margaret Cancer Centre Mount Sinai Hospital; Toronto Ontario Canada
| | | | - R. Ferraldeschi
- Clinical Development; Astex Pharmaceuticals, Inc.; Pleasanton United States
| | - D. Chan
- Clinical Development; Astex Pharmaceuticals, Inc.; Pleasanton United States
| | - J. Zhang
- Clinical Development; Astex Pharmaceuticals, Inc.; Pleasanton United States
| | - A. Mehta
- Hematology and Oncology; University of Alabama at Birmingham; Birmingham United States
| |
Collapse
|
37
|
Witzig T, Sokol L, Kim W, Foss F, Jacobsen E, de la Cruz Vincente F, Caballero D, Advani R, Roncero Vidal J, Marin-Niebla A, Rodriguez Izquierdo A, de Ona Navarrete R, Terol M, Domingo-Domenech E, Rodriguez M, Piris M, Bolognese J, Janes M, Burrows F, Kessler L, Mishra V, Curry R, Kurman M, Scholz C, Gualberto A. TIPIFARNIB IN RELAPSED OR REFRACTORY ANGIOIMMUNOBLASTIC T-CELL LYMPHOMA (AITL) AND CXCL12+ PERIPHERAL T-CELL LYMPHOMA (PTCL): PRELIMINARY RESULTS FROM A PHASE 2 STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.32_2629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- T. Witzig
- Laboratory Medicine and Pathology; Mayo Clinic; Rochester United States
| | - L. Sokol
- Hematology; H. Lee Moffitt Cancer Center & Research Institute; Tampa FL United States
| | - W. Kim
- Hematology - Oncology; Samsung Medical Center; Seoul Republic of Korea
| | - F. Foss
- Medical Oncology; Yale University School of Medicine; New Haven United States
| | - E. Jacobsen
- Medical Oncology; Dana-Farber Cancer Institute; Boston United States
| | | | - D. Caballero
- Hematology - Oncology; Hospital Universitario de Salamanca; Salamanca Spain
| | - R. Advani
- Medicine - Med/Oncology; Stanford University Medical Center; Palo Alto United States
| | | | - A. Marin-Niebla
- Hematology - Oncology; Vall D'Hebron Institute of Oncology; Barcelona Spain
| | | | | | - M.J. Terol
- Hematology; Hospital Clinico Universitario de Valencia; València Spain
| | | | | | - M.A. Piris
- Pathology; Fundación Jiménez Díaz; Madrid Spain
| | | | - M.R. Janes
- Biology; Wellspring Biosciences, Inc.; San Diego United States
| | - F. Burrows
- Research; Kura Oncology, Inc.; San Diego United States
| | - L. Kessler
- Development; Kura Oncology, Inc.; San Diego United States
| | - V. Mishra
- Development; Kura Oncology, Inc.; San Diego United States
| | - R. Curry
- Development; Kura Oncology, Inc.; Cambridge United States
| | - M. Kurman
- Development; Kura Oncology, Inc.; Cambridge United States
| | - C. Scholz
- Development; Kura Oncology, Inc.; Cambridge United States
| | - A. Gualberto
- Development; Kura Oncology, Inc.; Cambridge United States
| |
Collapse
|
38
|
Shallis RM, Gleeson S, Chokr N, Fangyong L, Wei W, Azar M, Schulz W, Summers D, Hendrickson J, Foss F, Isufi I, Kim TK, Pillai M, Snyder E, Seropian S, Gowda L. Restrictive Transfusions in the Era of Pathogen-Inactivated Platelets: A Single Center Experience. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.591] [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: 10/27/2022]
|
39
|
Perreault S, McManus D, Bar N, Foss F, Gowda L, Isufi I, Seropian S, Malinis M, Topal JE. The impact of a multimodal approach to vancomycin discontinuation in hematopoietic stem cell transplant recipients (HSCT) with febrile neutropenia (FN). Transpl Infect Dis 2019; 21:e13059. [PMID: 30737868 DOI: 10.1111/tid.13059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/11/2019] [Accepted: 01/29/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Current guidelines recommend adding vancomycin to empiric treatment of FN in patients who meet specific criteria. After 48 hours, the guidelines recommend discontinuing vancomycin if resistant Gram-positive organisms are not identified. Based on these recommendations, a vancomycin stewardship team defined criteria for discontinuation of vancomycin at 48 hours and increased surveillance of vancomycin usage through a multimodal approach. The purpose of this retrospective analysis is to assess the impact of this multimodal approach on the discontinuation of empiric vancomycin at 48 hours in FN. METHODS This retrospective analysis included a pre- and post-intervention cohort of 200 HSCT recipients with FN from 2015 to 2018. Criteria for continued vancomycin use beyond 48 hours included culture-documented resistant Gram-positive infection, positive Methicillin-Resistant S aureus (MRSA) nasal swab with evidence of pneumonia, or hemodynamic instability with concern for sepsis. The following patient characteristics were collected: previous MRSA infection, MRSA nasal swab collection and results, culture results, duration of vancomycin use, rationale for continuation of vancomycin beyond 48 hours, and re-initiation of vancomycin. RESULTS In the post-intervention cohort, vancomycin discontinuation at 48 hours increased from 31% (95% CI 21.94-40.05) to 70% (95% CI 61.02-78.97; P < 0.0001). An additional 23% of vancomycin orders were discontinued at 72 hours. Off criteria vancomycin use decreased from 33% in pre to 1% in the post-implementation cohort. CONCLUSION Establishing define criteria for vancomycin use in FN patients with a multimodal approach of physicians from hematology and infectious diseases, clinical pharmacists and the antibiotic stewardship team significantly improved vancomycin discontinuation.
Collapse
Affiliation(s)
- Sarah Perreault
- Department of Pharmacy Services, Yale-New Haven Hospital, New Haven, Connecticut
| | - Dayna McManus
- Department of Pharmacy Services, Yale-New Haven Hospital, New Haven, Connecticut
| | - Noffar Bar
- Department of Internal Medicine, Section of Hematology, Yale-New Haven Hospital, New Haven, Connecticut
| | - Francine Foss
- Department of Internal Medicine, Section of Hematology, Yale-New Haven Hospital, New Haven, Connecticut
| | - Lohith Gowda
- Department of Internal Medicine, Section of Hematology, Yale-New Haven Hospital, New Haven, Connecticut
| | - Iris Isufi
- Department of Internal Medicine, Section of Hematology, Yale-New Haven Hospital, New Haven, Connecticut
| | - Stuart Seropian
- Department of Internal Medicine, Section of Hematology, Yale-New Haven Hospital, New Haven, Connecticut
| | - Maricar Malinis
- Department of Internal Medicine, Section of Infectious Diseases, Yale-New Haven Hospital, New Haven, Connecticut
| | - Jeffrey E Topal
- Department of Pharmacy Services, Yale-New Haven Hospital, New Haven, Connecticut.,Department of Internal Medicine, Section of Infectious Diseases, Yale-New Haven Hospital, New Haven, Connecticut
| |
Collapse
|
40
|
O'Connor OA, Özcan M, Jacobsen ED, Roncero JM, Trotman J, Demeter J, Masszi T, Pereira J, Ramchandren R, Beaven A, Caballero D, Horwitz SM, Lennard A, Turgut M, Hamerschlak N, d'Amore FA, Foss F, Kim WS, Leonard JP, Zinzani PL, Chiattone CS, Hsi ED, Trümper L, Liu H, Sheldon-Waniga E, Ullmann CD, Venkatakrishnan K, Leonard EJ, Shustov AR. Randomized Phase III Study of Alisertib or Investigator's Choice (Selected Single Agent) in Patients With Relapsed or Refractory Peripheral T-Cell Lymphoma. J Clin Oncol 2019; 37:613-623. [PMID: 30707661 PMCID: PMC6494247 DOI: 10.1200/jco.18.00899] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of this open-label, first-in-setting, randomized phase III trial was to evaluate the efficacy of alisertib, an investigational Aurora A kinase inhibitor, in patients with relapsed/refractory peripheral T-cell lymphoma (PTCL). PATIENTS AND METHODS Adult patients with relapsed/refractory PTCL—one or more prior therapy—were randomly assigned 1:1 to receive oral alisertib 50 mg two times per day (days 1 to 7; 21-day cycle) or investigator-selected single-agent comparator, including intravenous pralatrexate 30 mg/m2 (once per week for 6 weeks; 7-week cycle), or intravenous gemcitabine 1,000 mg/m2 or intravenous romidepsin 14 mg/m2 (days 1, 8, and 15; 28-day cycle). Tumor tissue (disease subtype) and imaging were assessed by independent central review. Primary outcomes were overall response rate and progression-free survival (PFS). Two interim analyses and one final analysis were planned. RESULTS Between May 2012 and October 2014, 271 patients were randomly assigned (alisertib, n = 138; comparator, n = 133). Enrollment was stopped early on the recommendation of the independent data monitoring committee as a result of the low probability of alisertib achieving PFS superiority with full enrollment. Centrally assessed overall response rate was 33% for alisertib and 45% for the comparator arm (odds ratio, 0.60; 95% CI, 0.33 to 1.08). Median PFS was 115 days for alisertib and 104 days for the comparator arm (hazard ratio, 0.87; 95% CI, 0.637 to 1.178). The most common adverse events were anemia (53% of alisertib-treated patients v 34% of comparator-treated patients) and neutropenia (47% v 31%, respectively). A lower percentage of patients who received alisertib (9%) compared with the comparator (14%) experienced events that led to study drug discontinuation. Of 26 on-study deaths, five were considered treatment related (alisertib, n = 3 of 11; comparator, n = 2 of 15). Two-year overall survival was 35% for each arm. CONCLUSION In patients with relapsed/refractory PTCL, alisertib was not statistically significantly superior to the comparator arm.
Collapse
Affiliation(s)
| | - Muhit Özcan
- 2 Ankara University Medical School, Ankara, Turkey
| | | | | | - Judith Trotman
- 5 Concord Repatriation General Hospital, Concord, New South Wales, Australia.,6 University of Sydney, New South Wales, Australia
| | - Judit Demeter
- 7 Semmelweis Egyetem Általános Orvostudományi Kar, Budapest, Hungary
| | - Tamás Masszi
- 8 St. István and St. László Hospital, Budapest, Hungary.,9 Semmelweis University, Budapest, Hungary
| | - Juliana Pereira
- 10 Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Anne Beaven
- 12 Duke University Health System, Durham, NC
| | | | | | - Anne Lennard
- 15 Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
| | | | | | | | - Francine Foss
- 19 Smilow Cancer Hospital at Yale New Haven, New Haven, CT
| | - Won-Seog Kim
- 20 Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | | | - Lorenz Trümper
- 25 University Medical Center Göttingen, Göttingen, Germany
| | - Hua Liu
- 26 Millennium Pharmaceuticals, Cambridge, MA
| | | | | | | | | | - Andrei R Shustov
- 27 University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | | |
Collapse
|
41
|
Ahmad H, Perreault S, McManus D, Foss F, Isufi I, Seropian S, Topal J. 2487. Vaccination Rates in Post-Transplant Hematopoietic Stem Cell Transplant (HSCT) Patients: Where Do We Stand? Open Forum Infect Dis 2018. [PMCID: PMC6255683 DOI: 10.1093/ofid/ofy210.2140] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
Collapse
Affiliation(s)
- Hiba Ahmad
- Pharmacy, Yale New Haven Hospital, New Haven, Connecticut
| | | | - Dayna McManus
- Department of Pharmacy, Yale New Haven Hospital, New Haven, Connecticut
| | - Francine Foss
- Section of Hematology, Yale School of Medicine, New Haven, Connecticut
| | - Iris Isufi
- Section of Hematology, Yale School of Medicine, New Haven, Connecticut
| | - Stuart Seropian
- Section of Hematology, Yale School of Medicine, New Haven, Connecticut
| | - Jeffrey Topal
- Department of Pharmacy, Yale New Haven Hospital, New Haven, Connecticut
- Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
42
|
Davids MS, von Keudell G, Portell CA, Cohen JB, Fisher DC, Foss F, Roberts AW, Seymour JF, Humerickhouse RA, Tam CS. Revised Dose Ramp-Up to Mitigate the Risk of Tumor Lysis Syndrome When Initiating Venetoclax in Patients With Mantle Cell Lymphoma. J Clin Oncol 2018; 36:JCO1800359. [PMID: 30359156 DOI: 10.1200/jco.18.00359] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Matthew S Davids
- Matthew S. Davids, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Gottfried von Keudell, Yale School of Medicine, New Haven, CT; Craig A. Portell, University of Virginia Health System, Charlottesville, VA; Jonathon B. Cohen, Winship Cancer Institute of Emory University, Atlanta, GA; David C. Fisher, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Francine Foss, Yale School of Medicine, New Haven, CT; Andrew W. Roberts, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia; John F. Seymour, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Victoria, Australia; Rod A. Humerickhouse, AbbVie, Chicago, IL; and Constantine S. Tam, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, St Vincent's Hospital, and University of Melbourne, Melbourne, Victoria, Australia
| | - Gottfried von Keudell
- Matthew S. Davids, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Gottfried von Keudell, Yale School of Medicine, New Haven, CT; Craig A. Portell, University of Virginia Health System, Charlottesville, VA; Jonathon B. Cohen, Winship Cancer Institute of Emory University, Atlanta, GA; David C. Fisher, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Francine Foss, Yale School of Medicine, New Haven, CT; Andrew W. Roberts, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia; John F. Seymour, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Victoria, Australia; Rod A. Humerickhouse, AbbVie, Chicago, IL; and Constantine S. Tam, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, St Vincent's Hospital, and University of Melbourne, Melbourne, Victoria, Australia
| | - Craig A Portell
- Matthew S. Davids, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Gottfried von Keudell, Yale School of Medicine, New Haven, CT; Craig A. Portell, University of Virginia Health System, Charlottesville, VA; Jonathon B. Cohen, Winship Cancer Institute of Emory University, Atlanta, GA; David C. Fisher, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Francine Foss, Yale School of Medicine, New Haven, CT; Andrew W. Roberts, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia; John F. Seymour, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Victoria, Australia; Rod A. Humerickhouse, AbbVie, Chicago, IL; and Constantine S. Tam, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, St Vincent's Hospital, and University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathon B Cohen
- Matthew S. Davids, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Gottfried von Keudell, Yale School of Medicine, New Haven, CT; Craig A. Portell, University of Virginia Health System, Charlottesville, VA; Jonathon B. Cohen, Winship Cancer Institute of Emory University, Atlanta, GA; David C. Fisher, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Francine Foss, Yale School of Medicine, New Haven, CT; Andrew W. Roberts, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia; John F. Seymour, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Victoria, Australia; Rod A. Humerickhouse, AbbVie, Chicago, IL; and Constantine S. Tam, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, St Vincent's Hospital, and University of Melbourne, Melbourne, Victoria, Australia
| | - David C Fisher
- Matthew S. Davids, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Gottfried von Keudell, Yale School of Medicine, New Haven, CT; Craig A. Portell, University of Virginia Health System, Charlottesville, VA; Jonathon B. Cohen, Winship Cancer Institute of Emory University, Atlanta, GA; David C. Fisher, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Francine Foss, Yale School of Medicine, New Haven, CT; Andrew W. Roberts, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia; John F. Seymour, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Victoria, Australia; Rod A. Humerickhouse, AbbVie, Chicago, IL; and Constantine S. Tam, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, St Vincent's Hospital, and University of Melbourne, Melbourne, Victoria, Australia
| | - Francine Foss
- Matthew S. Davids, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Gottfried von Keudell, Yale School of Medicine, New Haven, CT; Craig A. Portell, University of Virginia Health System, Charlottesville, VA; Jonathon B. Cohen, Winship Cancer Institute of Emory University, Atlanta, GA; David C. Fisher, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Francine Foss, Yale School of Medicine, New Haven, CT; Andrew W. Roberts, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia; John F. Seymour, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Victoria, Australia; Rod A. Humerickhouse, AbbVie, Chicago, IL; and Constantine S. Tam, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, St Vincent's Hospital, and University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew W Roberts
- Matthew S. Davids, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Gottfried von Keudell, Yale School of Medicine, New Haven, CT; Craig A. Portell, University of Virginia Health System, Charlottesville, VA; Jonathon B. Cohen, Winship Cancer Institute of Emory University, Atlanta, GA; David C. Fisher, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Francine Foss, Yale School of Medicine, New Haven, CT; Andrew W. Roberts, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia; John F. Seymour, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Victoria, Australia; Rod A. Humerickhouse, AbbVie, Chicago, IL; and Constantine S. Tam, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, St Vincent's Hospital, and University of Melbourne, Melbourne, Victoria, Australia
| | - John F Seymour
- Matthew S. Davids, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Gottfried von Keudell, Yale School of Medicine, New Haven, CT; Craig A. Portell, University of Virginia Health System, Charlottesville, VA; Jonathon B. Cohen, Winship Cancer Institute of Emory University, Atlanta, GA; David C. Fisher, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Francine Foss, Yale School of Medicine, New Haven, CT; Andrew W. Roberts, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia; John F. Seymour, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Victoria, Australia; Rod A. Humerickhouse, AbbVie, Chicago, IL; and Constantine S. Tam, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, St Vincent's Hospital, and University of Melbourne, Melbourne, Victoria, Australia
| | - Rod A Humerickhouse
- Matthew S. Davids, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Gottfried von Keudell, Yale School of Medicine, New Haven, CT; Craig A. Portell, University of Virginia Health System, Charlottesville, VA; Jonathon B. Cohen, Winship Cancer Institute of Emory University, Atlanta, GA; David C. Fisher, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Francine Foss, Yale School of Medicine, New Haven, CT; Andrew W. Roberts, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia; John F. Seymour, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Victoria, Australia; Rod A. Humerickhouse, AbbVie, Chicago, IL; and Constantine S. Tam, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, St Vincent's Hospital, and University of Melbourne, Melbourne, Victoria, Australia
| | - Constantine S Tam
- Matthew S. Davids, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Gottfried von Keudell, Yale School of Medicine, New Haven, CT; Craig A. Portell, University of Virginia Health System, Charlottesville, VA; Jonathon B. Cohen, Winship Cancer Institute of Emory University, Atlanta, GA; David C. Fisher, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Francine Foss, Yale School of Medicine, New Haven, CT; Andrew W. Roberts, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia; John F. Seymour, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Victoria, Australia; Rod A. Humerickhouse, AbbVie, Chicago, IL; and Constantine S. Tam, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, St Vincent's Hospital, and University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
43
|
Khodadoust MS, Rook AH, Porcu P, Foss F, Moskowitz A, Shustov AR, Shanbhag S, Sokol L, Fling SP, Li S, Fong S, Kim J, Yang Y, Yearley J, Subrahmanyam P, Maecker H, Horwitz SM, Sharon E, Cheever MA, Kim YH. Pembrolizumab in mycosis fungoides and Sézary syndrome: Updated results of the CITN multicenter Phase 2 study. Eur J Cancer 2018. [DOI: 10.1016/j.ejca.2018.07.304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
44
|
Kim TK, DeVeaux M, Stahl M, Perreault S, Isufi I, Cooper D, Foss F, Shlomchik W, Zelterman D, Zeidan AM, Seropian S. Long-term follow-up of a single institution pilot study of sirolimus, tacrolimus, and short course methotrexate for graft versus host disease prophylaxis in mismatched unrelated donor allogeneic stem cell transplantation. Ann Hematol 2018; 98:237-240. [PMID: 30027436 DOI: 10.1007/s00277-018-3427-1] [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] [Received: 03/13/2018] [Accepted: 06/30/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Tae Kon Kim
- Section of Hematology/Department of Internal Medicine and Yale Cancer Center, Smilow Cancer Hospital at Yale-New Haven, Yale University School of Medicine, New Haven, USA
| | | | - Maximilian Stahl
- Section of Hematology/Department of Internal Medicine and Yale Cancer Center, Smilow Cancer Hospital at Yale-New Haven, Yale University School of Medicine, New Haven, USA
| | | | - Iris Isufi
- Section of Hematology/Department of Internal Medicine and Yale Cancer Center, Smilow Cancer Hospital at Yale-New Haven, Yale University School of Medicine, New Haven, USA
| | - Dennis Cooper
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - Francine Foss
- Section of Hematology/Department of Internal Medicine and Yale Cancer Center, Smilow Cancer Hospital at Yale-New Haven, Yale University School of Medicine, New Haven, USA
| | - Warren Shlomchik
- University of Pittsburgh School of Medicine, Division of Hematology and Oncology, Department of Medicine, UPMC Hillman Cancer Center, Pittsburgh, USA
| | | | - Amer M Zeidan
- Section of Hematology/Department of Internal Medicine and Yale Cancer Center, Smilow Cancer Hospital at Yale-New Haven, Yale University School of Medicine, New Haven, USA
| | - Stuart Seropian
- Section of Hematology/Department of Internal Medicine and Yale Cancer Center, Smilow Cancer Hospital at Yale-New Haven, Yale University School of Medicine, New Haven, USA.
| |
Collapse
|
45
|
Dehner CA, Ruff WE, Foss F, Girardi M, Kriegel MA. Skin Microbiota as Antigenic Triggers for Cutaneous T Cell Lymphoma. The Journal of Immunology 2018. [DOI: 10.4049/jimmunol.200.supp.166.24] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Background
Cutaneous T Cell lymphoma (CTCL) is a debilitating malignancy of lymphocytes that home to the skin, thereby manifesting in a variety of chronic skin lesions. CTCL is thought to arise from a combination of genetic, epigenetic and environmental factors, but specific triggers remain unknown. We propose a model in which adaptive immune responses to particular skin commensals evolve into clonal proliferation of T cells in genetically predisposed patients.
Methods and Results
10 CTCL patients with active skin lesions were sampled at 3 time points (blood, stool and lesional vs non-lesional skin). Skin swabs of SLE patients and healthy donors served as control. Dual-index V1–3 and V4 16S rRNA sequencing was performed on the MiSeq platform and revealed significantly more Firmicutes in patient skin compared to controls. In addition, single bacterial colonies were cultured from 3 subjects. Full-length 16S rRNA sequencing demonstrated unique bacterial strains in lesional compared to non-lesional cultures. Malignant cutaneous T cells from patient biopsies were extracted and cultured in vitro for antigenic challenge with patient-isolated skin commensal candidates. One patient’s T cells showed significant proliferation to lesionally enriched B. safensis, while not responding to non-lesional bacteria.
Discussion
Dissecting cancer cell-microbiota interactions revealed potential skin commensal candidates involved in the pathogenesis of CTCL. Pathobionts enriched in lesional skin might act as antigenic drivers for progression to clonality similar to processes involved in H. pylori-induced MALT lymphoma, a paradigm that may be applicable to skin lymphomagenesis.
Collapse
|
46
|
Kharfan-Dabaja MA, Kumar A, Ayala E, Hamadani M, Reimer P, Gisselbrecht C, d'Amore F, Jantunen E, Ishida T, Bazarbachi A, Foss F, Advani R, Fenske TS, Lazarus HM, Friedberg JW, Aljurf M, Sokol L, Tobinai K, Tse E, Burns LJ, Chavez JC, Reddy NM, Suzuki R, Ahmed S, Nademanee A, Mohty M, Gopal AK, Fanale MA, Pro B, Moskowitz AJ, Sureda A, Perales MA, Carpenter PA, Savani BN. Clinical Practice Recommendations on Indication and Timing of Hematopoietic Cell Transplantation in Mature T Cell and NK/T Cell Lymphomas: An International Collaborative Effort on Behalf of the Guidelines Committee of the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2017; 23:1826-1838. [PMID: 28797780 DOI: 10.1016/j.bbmt.2017.07.027] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 07/30/2017] [Indexed: 01/16/2023]
Abstract
Recognizing the significant biological and clinical heterogeneity of mature T cell and natural killer (NK)/T cell lymphomas, the American Society for Blood and Marrow Transplantation invited experts to develop clinical practice recommendations related to the role of autologous hematopoietic cell transplantation (auto-HCT) and allogeneic HCT (allo-HCT) for specific histological subtypes. We used the GRADE methodology to aid in moving from evidence to decision making and ultimately to generating final recommendations. Auto-HCT in front-line consolidation is recommended in peripheral T cell lymphoma not otherwise specified (PTCL-NOS), angioimmunoblastic T cell lymphoma (AITL), anaplastic large cell lymphoma-anaplastic lymphoma kinase (ALCL-ALK)-negative, NK/T cell (disseminated), enteropathy-associated T cell lymphoma (EATL), and hepatosplenic lymphomas. Auto-HCT in relapsed-sensitive disease is recommended for NK/T cell (localized and disseminated), EATL, subcutaneous panniculitis-like T cell, and ALCL-ALK-positive lymphomas. Auto-HCT is also recommended for PTCL-NOS, AITL, and ALCL-ALK-negative lymphomas if not performed as front-line therapy. Auto-HCT in refractory (primary or relapsed) disease is not recommended for any of the histological subtypes discussed. Allo-HCT in front-line consolidation is recommended for NK/T cell (disseminated), adult T cell leukemia/lymphoma (ATLL; acute and lymphoma type), and hepatosplenic lymphomas. Allo-HCT for relapsed-sensitive disease is recommended for PTCL-NOS, AITL, ALCL-ALK-negative, ALCL-ALK-positive, NK/T cell (localized and disseminated), ATLL (acute, lymphoma type, smoldering/chronic), mycosis fungoides/Sezary syndrome (advanced stage IIB-IVB or tumor stage/extracutaneous), EATL, subcutaneous panniculitis-like T cell, and hepatosplenic lymphoma. Allo-HCT in refractory (primary or relapsed refractory) disease is recommended for any aforementioned histological subtypes. Emerging novel therapies will likely be incorporated into the pretransplantation, peritransplantation, and post-transplantation algorithms (auto-HCT or allo-HCT) with the goals of optimizing efficacy and improving outcomes. We acknowledge that there are unique clinical scenarios not covered by these recommendations that may require individualized decisions.
Collapse
Affiliation(s)
- Mohamed A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute and Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida.
| | - Ambuj Kumar
- Program for Comparative Effectiveness Research, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Ernesto Ayala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute and Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Mehdi Hamadani
- Department of Internal Medicine, Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Peter Reimer
- Department of Hematology, Medical Oncology and Stem Cell Transplantation, Evangelisches Krankenhaus Essen-Werden, Essen, Germany
| | | | | | - Esa Jantunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Takashi Ishida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Francine Foss
- Yale University School of Medicine, New Haven, Connecticut
| | | | - Timothy S Fenske
- Department of Internal Medicine, Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hillard M Lazarus
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | | | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Lubomir Sokol
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute and Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida Tampa, Florida
| | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Eric Tse
- Department of Medicine, The University of Hong Kong, Hong Kong
| | - Linda J Burns
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Julio C Chavez
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute and Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida Tampa, Florida
| | | | - Ritsuro Suzuki
- Department of Oncology/Hematology, Shimane University Hospital, Shimane, Japan
| | - Sairah Ahmed
- University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Mohamad Mohty
- Saint-Antoine Hospital, Pierre and Marie Curie University, INSERM UMRs U938, Paris, France
| | - Ajay K Gopal
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | - Anna Sureda
- Clinical Hematology Department, Institut Català d'Oncologia, Barcelona, Spain
| | | | | | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
47
|
Cyrenne BM, Subtil A, Girardi M, Foss F. Primary cutaneous aggressive epidermotropic cytotoxic CD8 + T-cell lymphoma: long-term remission after brentuximab vedotin. Int J Dermatol 2017; 56:1448-1450. [PMID: 29047111 DOI: 10.1111/ijd.13792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/30/2017] [Accepted: 09/13/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Benoit M Cyrenne
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Antonio Subtil
- Department of Dermatology and Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Francine Foss
- Hematology and Bone Marrow Transplantation, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
48
|
Foss F, Horwitz S, Pro B, Miles Prince H, Sokol L, Balser B, Wolfson J, Coiffier B. Erratum to: Romidepsin for the treatment of relapsed/refractory peripheral T cell lymphoma: prolonged stable disease provides clinical benefits for patients in the pivotal trial. J Hematol Oncol 2017; 10:154. [PMID: 28923081 PMCID: PMC5603163 DOI: 10.1186/s13045-017-0518-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/14/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Francine Foss
- Yale Cancer Center, 333 Cedar St, TMP 3, PO Box 208028, New Haven, CT, 06520-8028, USA.
| | - Steven Horwitz
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Barbara Pro
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - H Miles Prince
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | | | | | | | | |
Collapse
|
49
|
Foss F, Pro B, Miles Prince H, Sokol L, Caballero D, Horwitz S, Coiffier B. Responses to romidepsin by line of therapy in patients with relapsed or refractory peripheral T-cell lymphoma. Cancer Med 2017; 6:36-44. [PMID: 27981793 PMCID: PMC5269566 DOI: 10.1002/cam4.939] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/21/2016] [Accepted: 09/23/2016] [Indexed: 01/23/2023] Open
Abstract
Peripheral T-cell lymphoma (PTCL) is a heterogeneous group of aggressive non-Hodgkin lymphomas typically associated with poor prognosis. Most patients with PTCL receive chemotherapy as first-line treatment, but many experience rapid relapse. For patients with relapsed/refractory PTCL, responses to treatment and long-term outcomes tend to worsen with increasing lines of therapy. Romidepsin is a potent class I histone deacetylase inhibitor approved by the US Food and Drug Administration for the treatment of PTCL in patients who have received ≥1 prior therapy. A pivotal phase 2 trial of romidepsin in patients with relapsed/refractory PTCL demonstrated an objective response rate of 25% (33/130), including 15% with confirmed/unconfirmed complete response, and a median duration of response of 28 months. In the analysis presented herein, romidepsin was shown to have similar responses and long-term outcomes in patients with 1, 2, and ≥3 prior lines of treatment, including in patients with disease refractory to the last prior therapy. Although adverse events increased with increasing lines of treatment, the rate of dose modifications and discontinuations due to adverse events was not significantly different. These data support the use of romidepsin as salvage treatment for PTCL irrespective of the number of prior therapies.
Collapse
Affiliation(s)
| | - Barbara Pro
- Thomas Jefferson UniversityPhiladelphiaPennsylvania
| | - H. Miles Prince
- Peter MacCallum Cancer CentreUniversity of MelbourneMelbourne, VictoriaAustralia
| | | | | | | | | |
Collapse
|
50
|
Weed J, Gibson J, Lewis J, Carlson K, Foss F, Choi J, Li P, Girardi M. FISH Panel for Leukemic CTCL. J Invest Dermatol 2016; 137:751-753. [PMID: 27836797 DOI: 10.1016/j.jid.2016.10.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/22/2016] [Accepted: 10/02/2016] [Indexed: 12/14/2022]
MESH Headings
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- DNA, Neoplasm/analysis
- Humans
- In Situ Hybridization, Fluorescence/methods
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/metabolism
- Mutation
- Skin Neoplasms/diagnosis
- Skin Neoplasms/genetics
- Skin Neoplasms/metabolism
Collapse
Affiliation(s)
- Jason Weed
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Juliet Gibson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Julia Lewis
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kacie Carlson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Francine Foss
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jaehyuk Choi
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Peining Li
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA.
| |
Collapse
|