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Mei MG, Herrera AF. Can we cure relapsed/refractory Hodgkin lymphoma without a stem cell transplant? Haematologica 2023. [PMID: 37021531 PMCID: PMC10388258 DOI: 10.3324/haematol.2023.282731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Indexed: 04/07/2023] Open
Abstract
Not available.
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Affiliation(s)
- Matthew G Mei
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Alex F Herrera
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA.
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2
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Mei MG, Masucci L, Jain MD. Cellular therapy: Great promise, but at what cost? Mol Ther 2023; 31:5-6. [PMID: 36455550 PMCID: PMC9840137 DOI: 10.1016/j.ymthe.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Matthew G Mei
- Department of Hematology and Hematopoetic Cell Transplantation, City of Hope, Duarte, CA, USA.
| | - Lisa Masucci
- Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Michael D Jain
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
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3
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Zurko J, Ramdial J, Shadman M, Ahmed S, Szabo A, Iovino L, Tomas AA, Sauter C, Perales MA, Shah NN, Acharya UH, Jacobson C, Soiffer RJ, Wang T, Komanduri KV, Jaglowski S, Kittai AS, Denlinger N, Iqbal M, Kharfan-Dabaja MA, Ayala E, Chavez J, Jain M, Locke FL, Samara Y, Budde LE, Mei MG, Pia AD, Feldman T, Ahmed N, Jacobs R, Ghosh N, Dholaria B, Oluwole OO, Hess B, Hassan A, Kenkre VP, Reagan P, Awan F, Nieto Y, Hamadani M, Herrera AF. Allogeneic transplant following CAR T-cell therapy for large B-cell lymphoma. Haematologica 2023; 108:98-109. [PMID: 35833303 PMCID: PMC9827150 DOI: 10.3324/haematol.2022.281242] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/06/2022] [Indexed: 02/04/2023] Open
Abstract
Allogeneic hematopoietic cell transplantation (alloHCT) can potentially salvage large B-cell lymphoma (LBCL) patients experiencing treatment failure after chimeric antigen receptor T-cell therapy (CAR T). Nonetheless, data on the efficacy and toxicities of alloHCT after receipt of CAR T are limited. We report a multicenter retrospective study assessing the safety, toxicities, and outcomes of alloHCT in LBCL patients following CAR T failure. Eighty-eight patients with relapsed, refractory LBCL received an alloHCT following anti-CD19 CAR T failure. The median number of lines of therapy between CAR T infusion and alloHCT was one (range, 0-7). Low intensity conditioning was used in 77% (n=68) and peripheral blood was the most common graft source (86%, n=76). The most common donor types were matched unrelated donor (39%), followed by haploidentical (30%) and matched related donor (26%). Median follow-up of survivors was 15 months (range, 1-72). One-year overall survival, progression-free survival, and graft-versus-host disease-free relapse-free survival were 59%, 45%, and 39% respectively. One-year non-relapse mortality and progression/relapse were 22% and 33% respectively. On multivariate analysis, <2 lines of intervening therapy between CAR T and alloHCT and complete response at time of alloHCT were associated with better outcomes. In conclusion, alloHCT after CAR T failure can provide durable remissions in a subset of patients.
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Affiliation(s)
- Joanna Zurko
- University of Wisconsin Carbone Comprehensive Cancer Center, University of Wisconsin, Madison, WI
| | - Jeremy Ramdial
- The University of Texas MD Anderson Cancer Center, Department of Stem Cell Transplantation, Division of Cancer Medicine, Houston, TX
| | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA
| | - Sairah Ahmed
- The University of Texas MD Anderson Cancer Center, Department of Stem Cell Transplantation, Division of Cancer Medicine, Houston, TX
| | - Aniko Szabo
- University of Wisconsin Carbone Comprehensive Cancer Center, University of Wisconsin, Madison, WI
| | - Lorenzo Iovino
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA
| | | | - Craig Sauter
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Nirav N Shah
- University of Wisconsin Carbone Comprehensive Cancer Center, University of Wisconsin, Madison, WI
| | - Utkarsh H Acharya
- Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, MA
| | - Caron Jacobson
- Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, MA
| | - Robert J Soiffer
- Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, MA
| | - Trent Wang
- Sylvester Comprehensive Cancer Center, Division of Transplantation and Cellular Therapy, Miami, FL
| | - Krishna V Komanduri
- Sylvester Comprehensive Cancer Center, Division of Transplantation and Cellular Therapy, Miami, FL
| | - Samantha Jaglowski
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Adam S Kittai
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Nathan Denlinger
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Madiha Iqbal
- Mayo Clinic, Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Jacksonville, FL
| | - Mohamed A Kharfan-Dabaja
- Mayo Clinic, Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Jacksonville, FL
| | - Ernesto Ayala
- Mayo Clinic, Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Jacksonville, FL
| | - Julio Chavez
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Michael Jain
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Yazeed Samara
- City of Hope, Department of Hematology and Hematopoietic Cell Transplantation, Duarte, CA
| | - Lihua E Budde
- City of Hope, Department of Hematology and Hematopoietic Cell Transplantation, Duarte, CA
| | - Matthew G Mei
- City of Hope, Department of Hematology and Hematopoietic Cell Transplantation, Duarte, CA
| | - Alexandra Della Pia
- John Theurer Cancer Center at Hackensack Meridian Health, NJ, USA; Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ
| | - Tatyana Feldman
- John Theurer Cancer Center at Hackensack Meridian Health, NJ
| | - Nausheen Ahmed
- University of Kansas Medical Center, Division of Hematologic Malignancies and Cellular Therapeutics, Westwood, KS
| | - Ryan Jacobs
- Levine Cancer Institute/Atrium Health, Charlotte, NC
| | | | | | - Olalekan O Oluwole
- Vanderbilt-Ingram Cancer Center, Division of Hematology and Oncology, Nashville, TN
| | - Brian Hess
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Ayesha Hassan
- University of Wisconsin Carbone Comprehensive Cancer Center, University of Wisconsin, Madison, WI
| | - Vaishalee P Kenkre
- University of Wisconsin Carbone Comprehensive Cancer Center, University of Wisconsin, Madison, WI
| | - Patrick Reagan
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Farrukh Awan
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX
| | - Yago Nieto
- The University of Texas MD Anderson Cancer Center, Department of Stem Cell Transplantation, Division of Cancer Medicine, Houston, TX
| | - Mehdi Hamadani
- Medical College of Wisconsin, BMT and Cellular Therapy Program, Division of Hematology and Oncology, Milwaukee, WI
| | - Alex F Herrera
- City of Hope, Department of Hematology and Hematopoietic Cell Transplantation, Duarte, CA.
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Kambhampati S, Saumoy M, Schneider Y, Pak S, Budde LE, Mei MG, Siddiqi T, Popplewell LL, Wen YP, Zain J, Forman SJ, Kwak LW, Rosen ST, Danilov AV, Herrera AF, Thiruvengadam NR. Cost-effectiveness of polatuzumab vedotin combined with chemoimmunotherapy in untreated diffuse large B-cell lymphoma. Blood 2022; 140:2697-2708. [PMID: 35700381 PMCID: PMC10653095 DOI: 10.1182/blood.2022016624] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 12/30/2022] Open
Abstract
In patients with treatment-naive diffuse large B-cell lymphoma (DLBCL), the POLARIX study (A Study Comparing the Efficacy and Safety of Polatuzumab Vedotin With Rituximab-Cyclophosphamide, Doxorubicin, and Prednisone [R-CHP] Versus Rituximab-Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone [R-CHOP] in Participants With Diffuse Large B-Cell Lymphoma) reported a 6.5% improvement in the 2-year progression-free survival (PFS), with no difference in overall survival (OS) or safety using polatuzumab vedotin, rituximab, cyclophosphamide, doxorubicin, and prednisone (pola-R-CHP) compared with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). We evaluated the cost-effectiveness of pola-R-CHP for DLBCL. We modeled a hypothetical cohort of US adults (mean age, 65 years) with treatment-naive DLBCL by developing a Markov model (lifetime horizon) to model the cost-effectiveness of pola-R-CHP and R-CHOP using a range of plausible long-term outcomes. Progression rates and OS were estimated from POLARIX. Outcome measures were reported in incremental cost-effectiveness ratios, with a willingness-to-pay (WTP) threshold of $150 000 per quality-adjusted life-year (QALY). Assuming a 5-year PFS of 69.6% with pola-R-CHP and 62.7% with R-CHOP, pola-R-CHP was cost-effective at a WTP of $150 000 (incremental cost-effectiveness ratio, $84 308/QALY). pola-R-CHP was no longer cost-effective if its 5-year PFS was 66.1% or lower. One-way sensitivity analysis revealed that pola-R-CHP is cost-effective up to a cost of $276 312 at a WTP of $150 000. pola-R-CHP was the cost-effective strategy in 56.6% of the 10 000 Monte Carlo iterations at a WTP of $150 000. If the absolute benefit in PFS is maintained over time, pola-R-CHP is cost-effective compared with R-CHOP at a WTP of $150 000/QALY. However, its cost-effectiveness is highly dependent on its long-term outcomes and costs of chimeric antigen receptor T-cell therapy. Routine usage of pola-R-CHP would add significantly to health care expenditures. Price reductions or identification of subgroups that have maximal benefit would improve cost-effectiveness.
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Affiliation(s)
- Swetha Kambhampati
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Monica Saumoy
- Center for Digestive Health, Penn Medicine Princeton Medical Center, Plainsboro, NJ
| | | | - Stacy Pak
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Lihua Elizabeth Budde
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Matthew G. Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Tanya Siddiqi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Leslie L. Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Yi-Ping Wen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Jasmine Zain
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Stephen J. Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Larry W. Kwak
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Steven T. Rosen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Alexey V. Danilov
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Alex F. Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
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Kambhampati S, Saumoy M, Schneider Y, Serrao S, Solaimani P, Budde LE, Mei MG, Popplewell LL, Siddiqi T, Zain J, Forman SJ, Kwak LW, Rosen ST, Danilov AV, Herrera AF, Thiruvengadam NR. Cost-effectiveness of second-line axicabtagene ciloleucel in relapsed refractory diffuse large B-cell lymphoma. Blood 2022; 140:2024-2036. [PMID: 35914220 PMCID: PMC9837443 DOI: 10.1182/blood.2022016747] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 04/22/2022] [Accepted: 07/06/2022] [Indexed: 01/21/2023] Open
Abstract
The ZUMA-7 (Efficacy of Axicabtagene Ciloleucel Compared to Standard of Care Therapy in Subjects With Relapsed/Refractory Diffuse Large B Cell Lymphoma) study showed that axicabtagene ciloleucel (axi-cel) improved event-free survival (EFS) compared with standard of care (SOC) salvage chemoimmunotherapy followed by autologous stem cell transplant in primary refractory/early relapsed diffuse large B-cell lymphoma (DLBCL); this led to its recent US Food and Drug Administration approval in this setting. We modeled a hypothetical cohort of US adults (mean age, 65 years) with primary refractory/early relapsed DLBCL by developing a Markov model (lifetime horizon) to model the cost-effectiveness of second-line axi-cel compared with SOC using a range of plausible long-term outcomes. EFS and OS were estimated from ZUMA-7. Outcome measures were reported in incremental cost-effectiveness ratios, with a willingness-to-pay (WTP) threshold of $150 000 per quality-adjusted life-year (QALY). Assuming a 5-year EFS of 35% with second-line axi-cel and 10% with SOC, axi-cel was cost-effective at a WTP of $150 000 per QALY ($93 547 per QALY). axi-cel was no longer cost-effective if its 5-year EFS was ≤26.4% or if it cost more than $972 061 at a WTP of $150 000. Second-line axi-cel was the cost-effective strategy in 73% of the 10 000 Monte Carlo iterations at a WTP of $150 000. If the absolute benefit in EFS is maintained over time, second-line axi-cel for aggressive relapsed/refractory DLBCL is cost-effective compared with SOC at a WTP of $150 000 per QALY. However, its cost-effectiveness is highly dependent on long-term outcomes. Routine use of second-line chimeric antigen receptor T-cell therapy would add significantly to health care expenditures in the United States (more than $1 billion each year), even when used in a high-risk subpopulation. Further reductions in the cost of chimeric antigen receptor T-cell therapy are needed to be affordable in many regions of the world.
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Affiliation(s)
- Swetha Kambhampati
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Monica Saumoy
- Center for Digestive Health, Penn Medicine Princeton Medical Center, Plainsboro, NJ
| | | | - Steve Serrao
- Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, CA
| | - Pejman Solaimani
- Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, CA
| | - Lihua Elizabeth Budde
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Matthew G. Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Leslie L. Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Tanya Siddiqi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Jasmine Zain
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Stephen J. Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Larry W. Kwak
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Steven T. Rosen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Alexey V. Danilov
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Alex F. Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
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Kambhampati S, Mei MG, Godfrey J, Siddiqi T, Salhotra A, Chen R, Smith E, Popplewell LL, Herrera AF. PD-1 Blockade After Avelumab in Relapsed/Refractory Classical Hodgkin Lymphoma. Clin Lymphoma Myeloma Leuk 2022; 22:e893-e897. [PMID: 35778267 DOI: 10.1016/j.clml.2022.06.004] [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: 03/26/2022] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Anti-PD-1 directed therapy is safe and effective in patients with relapsed/refractory (r/r) cHL and is currently being studied in the frontline setting. There are currently little data regarding the safety and efficacy of PD-1 blockade after prior PD-L1 blockade with agents such as avelumab. METHODS This is a retrospective case series evaluating r/r cHL patients treated with avelumab who subsequently received at least 1 dose of PD-1 blockade. Primary objective is efficacy as measured by overall response rate. Secondary objectives include duration of response and time to progression on PD-1 blockade as well as safety as evaluated by incidence and severity of immune-related adverse events (irAE) with PD-1 blockade. RESULTS There were 7 patients treated with PD-1 blockade after avelumab, of whom 4 were re-treated. The median follow-up was 46.8 months. At the time of PD-1 blockade initiation median age was 36.6 years, all patients had advanced stage, 1 patient had B symptoms, and 4 patients had extranodal disease. Patients received median 7 prior lines of therapy including avelumab. Median duration on anti-PD-1 treatment was 15.9 months. A response was observed in 86% of patients with median duration of response of 26.4 months and median time to progression of 22.2 months. Only 1 patient experienced an irAE (grade 2 pneumonitis). CONCLUSION Our study suggests that PD-1 blockade after PD-L1 blockade in r/r cHL appears safe and may be effective with durable responses observed in a subset of patients.
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Affiliation(s)
- Swetha Kambhampati
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Matthew G Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - James Godfrey
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Tanya Siddiqi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Robert Chen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Eileen Smith
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Leslie L Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA.
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Ansell SM, Maris MB, Lesokhin AM, Chen RW, Flinn IW, Sawas A, Minden MD, Villa D, Percival MEM, Advani AS, Foran JM, Horwitz SM, Mei MG, Zain J, Savage KJ, Querfeld C, Akilov OE, Johnson LDS, Catalano T, Petrova PS, Uger RA, Sievers EL, Milea A, Roberge K, Shou Y, O'Connor OA. Phase I Study of the CD47 Blocker TTI-621 in Patients with Relapsed or Refractory Hematologic Malignancies. Clin Cancer Res 2021; 27:2190-2199. [PMID: 33451977 DOI: 10.1158/1078-0432.ccr-20-3706] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/23/2020] [Accepted: 01/08/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE TTI-621 (SIRPα-IgG1 Fc) is a novel checkpoint inhibitor that activates antitumor activity by blocking the CD47 "don't eat me" signal. This first-in-human phase I study (NCT02663518) evaluated the safety and activity of TTI-621 in relapsed/refractory (R/R) hematologic malignancies. PATIENTS AND METHODS Patients with R/R lymphoma received escalating weekly intravenous TTI-621 to determine the maximum tolerated dose (MTD). During expansion, patients with various malignancies received weekly single-agent TTI-621 at the MTD; TTI-621 was combined with rituximab in patients with B-cell non-Hodgkin lymphoma (B-NHL) or with nivolumab in patients with Hodgkin lymphoma. The primary endpoint was the incidence/severity of adverse events (AEs). Secondary endpoint included overall response rate (ORR). RESULTS Overall, 164 patients received TTI-621: 18 in escalation and 146 in expansion (rituximab combination, n = 35 and nivolumab combination, n = 4). On the basis of transient grade 4 thrombocytopenia, the MTD was determined as 0.2 mg/kg; 0.1 mg/kg was evaluated in combination cohorts. AEs included infusion-related reactions, thrombocytopenia, chills, and fatigue. Thrombocytopenia (20%, grade ≥3) was reversible between doses and not associated with bleeding. Transient thrombocytopenia that determined the initial MTD may not have been dose limiting. The ORR for all patients was 13%. The ORR was 29% (2/7) for diffuse large B-cell lymphoma (DLBCL) and 25% (8/32) for T-cell NHL (T-NHL) with TTI-621 monotherapy and was 21% (5/24) for DLBCL with TTI-621 plus rituximab. Further dose optimization is ongoing. CONCLUSIONS TTI-621 was well-tolerated and demonstrated activity as monotherapy in patients with R/R B-NHL and T-NHL and combined with rituximab in patients with R/R B-NHL.
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Affiliation(s)
| | - Michael B Maris
- Colorado Blood Cancer Institute and Sarah Cannon Research Institute, Denver, Colorado
| | - Alexander M Lesokhin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert W Chen
- Department of Hematology and Hematopoietic Transplantation, City of Hope Medical Center, Duarte, California
| | - Ian W Flinn
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, Nashville, Tennessee
| | - Ahmed Sawas
- Center for Lymphoid Malignancies, Columbia University Medical Center, College of Physicians and Surgeons, New York, New York
| | - Mark D Minden
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Diego Villa
- Division of Medical Oncology and Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Mary-Elizabeth M Percival
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Hematology, University of Washington, Seattle, Washington
| | | | - James M Foran
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Steven M Horwitz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew G Mei
- Department of Hematology and Hematopoietic Transplantation, City of Hope Medical Center, Duarte, California
| | - Jasmine Zain
- Department of Hematology and Hematopoietic Transplantation, City of Hope Medical Center, Duarte, California
| | - Kerry J Savage
- Division of Medical Oncology and Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Christiane Querfeld
- Department of Hematology and Hematopoietic Transplantation, City of Hope Medical Center, Duarte, California
| | - Oleg E Akilov
- Cutaneous Lymphoma Program, Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Tina Catalano
- Trillium Therapeutics Inc., Mississauga, Ontario, Canada
| | | | - Robert A Uger
- Trillium Therapeutics Inc., Mississauga, Ontario, Canada
| | - Eric L Sievers
- Trillium Therapeutics Inc., Mississauga, Ontario, Canada
| | - Anca Milea
- Trillium Therapeutics Inc., Mississauga, Ontario, Canada
| | | | - Yaping Shou
- Trillium Therapeutics Inc., Mississauga, Ontario, Canada
| | - Owen A O'Connor
- University of Virginia Cancer Center, Charlottesville, Virginia
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Mei MG, Cao TM, Chen L, Song JY, Siddiqi T, Cai JL, Farol LT, Al Malki MM, Salhotra A, Aldoss I, Palmer J, Herrera AF, Zain J, Popplewell LL, Chen RW, Rosen ST, Forman SJ, Kwak L, Nademanee AP, Budde LE. Long-Term Results of High-Dose Therapy and Autologous Stem Cell Transplantation for Mantle Cell Lymphoma: Effectiveness of Maintenance Rituximab. Biol Blood Marrow Transplant 2017; 23:1861-1869. [PMID: 28733266 DOI: 10.1016/j.bbmt.2017.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/09/2017] [Indexed: 10/19/2022]
Abstract
High-dose therapy followed by autologous stem cell transplantation (ASCT) can improve outcomes for mantle cell lymphoma (MCL) but is associated with a high incidence of relapse. A retrospective study of 191 MCL patients who underwent ASCT at City of Hope was performed to examine prognostic factors for outcomes after ASCT. For all patients the 5-year overall survival (OS) was 71% (95% confidence interval [CI], 63% to 77%) and progression-free survival (PFS) was 53% (95% CI, 45% to 60%). The 5-year cumulative incidence of relapse was 41% (95% CI, 34% to 48%) with a continuous pattern of relapse events occurring at a median of 2.1 years (range, .2 to 13.4) after ASCT. In multivariate analysis, post-transplant maintenance rituximab was the factor most significantly associated with both OS (relative risk [RR], .17; 95% CI, .07 to .38) and PFS (RR, .25; 95% CI, .14 to .44). For the subset of patients who had positron emission tomography (PET) data available and were in a PET-negative first complete remission at ASCT (n = 105), maintenance rituximab was significantly associated with superior OS (RR, .17; 95% CI, .05 to .59) and PFS (RR, .20; 95% CI, .09 to .43). These results support a benefit with maintenance rituximab for all MCL patients treated with ASCT.
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Affiliation(s)
- Matthew G Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Thai M Cao
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California; Kaiser Permanente Southern California Bone Marrow Transplantation Program, Los Angeles, California
| | - Lu Chen
- Department of Information Sciences, City of Hope National Medical Center, Duarte, California
| | - Joo Y Song
- Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Tanya Siddiqi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Ji-Lian Cai
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California; Kaiser Permanente Southern California Bone Marrow Transplantation Program, Los Angeles, California
| | - Leonardo T Farol
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California; Kaiser Permanente Southern California Bone Marrow Transplantation Program, Los Angeles, California
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Joycelynne Palmer
- Department of Information Sciences, City of Hope National Medical Center, Duarte, California
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Jasmine Zain
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Leslie L Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Robert W Chen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Steven T Rosen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Larry Kwak
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Auayporn P Nademanee
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Lihua E Budde
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California.
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