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Cramer P, von Tresckow J, Fink AM, Robrecht S, Giza A, Tausch E, Müller L, Knauf W, Zingerle M, Al-Sawaf O, Langerbeins P, Fischer K, Kreuzer KA, Kneba M, Wendtner CM, Stilgenbauer S, Eichhorst B, Hallek M. Bendamustine, followed by obinutuzumab and idelalisib in chronic lymphocytic leukemia (CLL2-BCG): Final analysis of a multicenter, open-label phase-II-trial. Am J Hematol 2024; 99:1192-1195. [PMID: 38578022 DOI: 10.1002/ajh.27304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/03/2024] [Accepted: 03/11/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Paula Cramer
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Julia von Tresckow
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Adam Giza
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Eugen Tausch
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Lothar Müller
- Practice for Hematology and Oncology UnterEms, Leer, Germany
| | - Wolfgang Knauf
- Practice for Hematology and Oncology Bethanien, Frankfurt/Main, Germany
| | - Matthias Zingerle
- Practice for Hematology and Oncology Pasing and Fürstenfeldbruck, Munich, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Karl-Anton Kreuzer
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Michael Kneba
- Department of Internal Medicine II, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | - Clemens-Martin Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Munich Clinic Schwabing, Munich, Germany
| | | | - Barbara Eichhorst
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
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Langerbeins P, Giza A, Robrecht S, Cramer P, von Tresckow J, Al-Sawaf O, Fink AM, Fürstenau M, Kater A, van der Spek E, Niemann CU, da Cunha-Bang C, Tausch E, Schneider C, Stilgenbauer S, Fischer K, Hallek M, Eichhorst B. Infections in patients with chronic lymphocytic leukemia treated with time limited targeted drug combinations. Am J Hematol 2024. [PMID: 38757754 DOI: 10.1002/ajh.27367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/16/2024] [Accepted: 04/26/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Petra Langerbeins
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Adam Giza
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Paula Cramer
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Julia von Tresckow
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Anna Maria Fink
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Moritz Fürstenau
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Arnon Kater
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Ellen van der Spek
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, Netherlands
| | | | | | - Eugen Tausch
- Department of Internal Medicine III, Division of CLL, University Hospital Ulm, Ulm, Germany
| | - Christof Schneider
- Department of Internal Medicine III, Division of CLL, University Hospital Ulm, Ulm, Germany
| | - Stephan Stilgenbauer
- Department of Internal Medicine III, Division of CLL, University Hospital Ulm, Ulm, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Fürstenau M, Giza A, Weiss J, Kleinert F, Robrecht S, Franzen F, Stumpf J, Langerbeins P, Al-Sawaf O, Simon F, Fink AM, Schneider C, Tausch E, Schetelig J, Dreger P, Böttcher S, Fischer K, Kreuzer KA, Ritgen M, Schilhabel A, Brüggemann M, Stilgenbauer S, Eichhorst B, Hallek M, Cramer P. Acalabrutinib, venetoclax and obinutuzumab in relapsed CLL: Final efficacy and ctDNA analysis of the CLL2-BAAG trial. Blood 2024:blood.2023022730. [PMID: 38620072 DOI: 10.1182/blood.2023022730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/17/2024] Open
Abstract
The phase 2 CLL2-BAAG trial tested the measurable residual disease (MRD)-guided triple combination of acalabrutinib, venetoclax and obinutuzumab after an optional bendamustine debulking in 45 patients with relapsed/refractory CLL (one patient was excluded from the analysis due to a violation of exclusion criteria). MRD was measured by flow cytometry (FCM, undetectable MRD <10-4) in peripheral blood (PB) and circulating tumor DNA (ctDNA) by digital droplet PCR (ddPCR) of variable-diversity-joining (VDJ) rearrangements and CLL-related mutations in plasma. MRD recurrence was defined as detectable ctDNA and/or MRD ≥10-4 after achieving both uMRD/undetectable ctDNA. The median number of previous treatments was 1 (range 1-4), 18 patients (40%) had received a BTK inhibitor (BTKi) and/or venetoclax prior to inclusion, 14/44 (31.8%) had TP53 aberrations, 34 (75.6%) had unmutated IGHV. With a median observation time of 36.3 months and all patients off treatment for a median of 21.9 months, uMRD <10-4 in PB was achieved in 42/45 patients (93.3%) at any time point, including 17/18 (94.4%) previously exposed to venetoclax/BTKi and 13/14 (92.9%) with TP53 aberrations. The estimated three-year progression-free and overall survival rates were 85.0% and 93.8%. Overall 585 paired FCM/ctDNA samples were analyzed and 18 MRD recurrences (5 with and 13 without clinical progression) occurred after the end of treatment. Twelve were first detected by ctDNA, three by FCM and three synchronously. Patients with earlier detection by ctDNA appeared to have genetically higher risk disease. In conclusion, time-limited MRD-guided acalabrutinib, venetoclax and obinutuzumab achieved deep remissions in almost all patients with relapsed/refractory CLL. The addition of ctDNA-based analyses to FCM MRD assessment seems to improve early detection of relapses. ClinicalTrials.gov Identifier: NCT03787264.
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Affiliation(s)
- Moritz Fürstenau
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group, University of Cologne, Cologne, Germany, Cologne, Germany
| | - Adam Giza
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD); University of Cologne, Faculty of Medicine and University Hos, Cologne, Germany
| | | | | | | | - Fabian Franzen
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group, University of Cologne,, Cologne, Germany
| | - Janina Stumpf
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group, University of Cologne,, Koeln, Germany
| | | | - Othman Al-Sawaf
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Florian Simon
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group, University of Cologne,, Cologne, Germany
| | | | | | | | - Johannes Schetelig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany, Dresden, Germany
| | | | | | | | | | - Matthias Ritgen
- Department of Internal Medicine II, University of Schleswig-Holstein, Kiel, Germany
| | - Anke Schilhabel
- 2nd Department of Internal Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | | | | | - Paula Cramer
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD); University of Cologne, Faculty of Medicine and University Hos, Cologne, Germany
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Langerbeins P, Giza A, Robrecht S, Cramer P, von Tresckow J, Al-Sawaf O, Fink AM, Fürstenau M, Kutsch N, Simon F, Goede V, Hoechstetter MA, Niemann CU, da Cunha-Bang C, Kater AP, Dubois J, Gregor M, Staber PB, Tausch E, Schneider C, Stilgenbauer S, Eichhorst B, Fischer K, Hallek MJ. Reassessing the Chronic Lymphocytic Leukemia International Prognostic Index in the era of targeted therapies. Blood 2024:blood.2023022564. [PMID: 38620092 DOI: 10.1182/blood.2023022564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
We evaluated the prognostic value of the Chronic Lymphocytic Leukemia International Prognostic Index (CLL-IPI) using a pooled dataset of CLL-patients treated first-line with targeted drugs (N=991) or chemoimmunotherapy (N=1,256). With a median observation time of 40.5 months, the 3-year progression-free survival (PFS)-rates for targeted drug-treated patients varied by CLL-IPI risk group: 96.5% (low), 87.6% (intermediate), 82.4% (high), and 78.7% (very high). Differences between consecutive CLL-IPI risk groups were observed for intermediate vs. low (HR=3.296, 95%-CI 1.576-6.894, p=0.002), for high vs. intermediate (HR=1.365, 95%-CI 1.003-1.858, p=0.048), but not for very high vs. high. CLL-IPI factors β2-microglobulin, IGHV mutational status, and TP53 status each retained prognostic value for PFS. The 3-year overall survival (OS)-rates by CLL-IPI risk group were 100%, 96%, 93.9%, and 89.4% with no differences between consecutive risk groups. Age, Binet stage, β2-microglobulin, and TP53 status each retained prognostic value for OS. In chemoimmunotherapy patients (median observation time 66.9 months), 3-year PFS-rates for CLL-IPI risk groups were 78.1%, 51.4%, 40.1%, and 16.5%. Corresponding 3-year OS-rates were 97.4%, 93.1%, 81.8%, and 57.3%. In a matched-pair analysis, PFS-differences in targeted therapies (N=812) versus chemoimmunotherapy (N=812) across all risk groups, and OS-differences in all but low-risk patients were demonstrated. The CLL-IPI maintains its prognostic value in predicting PFS outcomes with targeted drugs. With the caveat of a short observation time its impact in predicting survival appears diminished. Targeted therapies showed enhanced outcomes over chemoimmunotherapy, highlighting their effectiveness across various risk groups. Our findings support ongoing assessment of prognostic tools in CLL treatment evolution. CLL2-BIG (NCT02345863), CLL2-BAG (NCT02401503), CLL2-BIO (NCT02689141), CLL2-BCG (NCT02445131), CLL2-GIVe (NCT02758665), CLL13 (NCT02950051), CLL14-trial (NCT02242942), CLL1 (NCT00262782), CLL8 (NCT00281918), and CLL11 (NCT01010061).
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Affiliation(s)
| | - Adam Giza
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD); University of Cologne, Faculty of Medicine and University Hos, Cologne, Germany
| | | | - Paula Cramer
- Department I of Internal Medicine and German CLL Study Group; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD); University of Cologne, Faculty of Medicine and University Hos, Cologne, Germany
| | | | - Othman Al-Sawaf
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Moritz Fürstenau
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group, University of Cologne, Cologne, Germany, Cologne, Germany
| | | | - Florian Simon
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group, University of Cologne,, Cologne, Germany
| | | | - Manuela A Hoechstetter
- Interdisciplinary Oncology Center (IOZ) Munich, Hematology and Oncology, Munich, Germany
| | | | | | - Arnon P Kater
- Department of Hematology, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands, Amsterdam, Netherlands
| | - Julie Dubois
- Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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von Tresckow J, Heyl N, Robrecht S, Giza A, Aldaoud A, Schlag R, Klausmann M, Linde H, Stein W, Schwarzer A, Fischer K, Cramer P, Eichhorst B, Hallek M, Fink AM. Treatment with idelalisib in patients with chronic lymphocytic leukemia - real world data from the registry of the German CLL Study Group. Ann Hematol 2023; 102:3083-3090. [PMID: 37358640 PMCID: PMC10567876 DOI: 10.1007/s00277-023-05314-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
Idelalisib in combination with rituximab is an efficacious treatment for patients suffering from chronic lymphocytic leukemia (CLL) with known limitations due to toxicities. However, the benefit after prior Bruton tyrosine kinase inhibitor (BTKi) therapy remains unclear. For this analysis, 81 patients included in a non-interventional registry study of the German CLL study group (registered at www.clinicaltrials.gov as # NCT02863692) meeting the predefined criteria of a confirmed diagnosis of CLL and being treated with idelalisib containing regimens outside clinical trials were considered. 11 patients were treatment naïve (13.6%) and 70 patients (86.4%) pretreated. Patients had median of one prior therapy line (range 0-11). Median treatment duration with idelalisib was 5.1 months (range 0-55.0 months). Of 58 patients with documented treatment outcome, 39 responded to idelalisib containing therapy (67.2%). Patients treated with the BTKi ibrutinib as last prior treatment prior to idelalisib responded in 71.4% compared to a response rate of 61.9% in patients without prior ibrutinib. Median event free survival (EFS) was 15.9 months with a 16 versus 14 months EFS in patients with ibrutinib as last prior treatment or not, respectively. Median overall survival was 46.6 months. In conclusion, treatment with idelalisib appears to have a valuable impact in patients being refractory to prior ibrutinib therapy even though there are limitations in our analysis due to the low number of patients included.
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Affiliation(s)
- Julia von Tresckow
- Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Nikola Heyl
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Adam Giza
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ali Aldaoud
- Praxis für Hämatologie und Onkologie, Leipzig, Germany
| | - Rudolf Schlag
- Hämatologisch-Onkologische Schwerpunktpraxis, Würzburg, Germany
| | | | - Hartmut Linde
- MVZ für Blut und Krebserkrankungen, Potsdam, Germany
| | | | | | - Kirsten Fischer
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Paula Cramer
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Maria Fink
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Leone M, Ceriani M, Cramer P, Frenkel L. Mi Reloj Interno (My endogenous clock): an evidence-based mobile-app to improve sleep and circadian rhythms. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.146] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Simon F, Giza A, Robrecht S, Fink AM, Cramer P, von Tresckow J, Fürstenau M, Goede V, Tausch E, Schneider C, Stilgenbauer S, Wendtner CM, Eichhorst B, Fischer K, Hallek M, Al-Sawaf O. Pooled analysis of first-line treatment with targeted agents in patients with chronic lymphocytic leukemia aged 80 years and older. Leuk Lymphoma 2022; 63:3299-3306. [PMID: 36120898 DOI: 10.1080/10428194.2022.2123223] [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: 01/29/2023]
Abstract
Patients aged 80 years and older make up a fifth of patients with CLL but are underrepresented in clinical trials. We analyzed the outcomes of these patients treated with targeted agents in the front-line setting in six trials of the German CLL Study Group. Targeted agents included venetoclax, ibrutinib, and idelalisib, mainly used in combination with anti-CD20 antibodies. Among 716 patients, 33 matched the selection criteria (5%). Of those, the majority had relevant comorbidity, organ dysfunctions, and/or high-/very high-risk disease. The overall response rate was 73%. The median progression-free survival was 49.2 months compared with those not reached in younger patients. There were 11 documented deaths of which two were deemed related to therapy. Additional results including 40 patients treated with BTK-inhibitors from the GCLLSG registry suggest that treatment with targeted agents is feasible and effective. Dedicated studies are warranted for this particular subgroup of patients.
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Affiliation(s)
- Florian Simon
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Adam Giza
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Paula Cramer
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Julia von Tresckow
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Moritz Fürstenau
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Valentin Goede
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,Department of Oncogeriatrics, Center for Geriatric Medicine, St. Marien-Hospital, Cologne, Germany
| | - Eugen Tausch
- Division of CLL, Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Christof Schneider
- Division of CLL, Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Stephan Stilgenbauer
- Division of CLL, Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Clemens-Martin Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, German CLL Study Group, Munich Clinic Schwabing, Munich, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Cologne, Düsseldorf, German CLL Study Group, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,The Francis Crick Institute, London, United Kingdom.,UCL Cancer Institute, University College London, London, United Kingdom
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8
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Yahya G, Menges P, Amponsah PS, Ngandiri DA, Schulz D, Wallek A, Kulak N, Mann M, Cramer P, Savage V, Räschle M, Storchova Z. Sublinear scaling of the cellular proteome with ploidy. Nat Commun 2022; 13:6182. [PMID: 36261409 PMCID: PMC9581932 DOI: 10.1038/s41467-022-33904-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 10/05/2022] [Indexed: 12/24/2022] Open
Abstract
Ploidy changes are frequent in nature and contribute to evolution, functional specialization and tumorigenesis. Analysis of model organisms of different ploidies revealed that increased ploidy leads to an increase in cell and nuclear volume, reduced proliferation, metabolic changes, lower fitness, and increased genomic instability, but the underlying mechanisms remain poorly understood. To investigate how gene expression changes with cellular ploidy, we analyzed isogenic series of budding yeasts from 1N to 4N. We show that mRNA and protein abundance scales allometrically with ploidy, with tetraploid cells showing only threefold increase in protein abundance compared to haploids. This ploidy-dependent sublinear scaling occurs via decreased rRNA and ribosomal protein abundance and reduced translation. We demonstrate that the activity of Tor1 is reduced with increasing ploidy, which leads to diminished rRNA gene repression via a Tor1-Sch9-Tup1 signaling pathway. mTORC1 and S6K activity are also reduced in human tetraploid cells and the concomitant increase of the Tup1 homolog Tle1 downregulates the rDNA transcription. Our results suggest that the mTORC1-Sch9/S6K-Tup1/TLE1 pathway ensures proteome remodeling in response to increased ploidy.
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Affiliation(s)
- G. Yahya
- grid.7645.00000 0001 2155 0333Department of Molecular Genetics, TU Kaiserslautern, Paul-Ehrlich Str. 24, 67663 Kaiserslautern, Germany ,grid.31451.320000 0001 2158 2757Department of Microbiology and Immunology, School of Pharmacy, Zagazig University, Zagazig, Egypt
| | - P. Menges
- grid.7645.00000 0001 2155 0333Department of Molecular Genetics, TU Kaiserslautern, Paul-Ehrlich Str. 24, 67663 Kaiserslautern, Germany
| | - P. S. Amponsah
- grid.7645.00000 0001 2155 0333Department of Molecular Genetics, TU Kaiserslautern, Paul-Ehrlich Str. 24, 67663 Kaiserslautern, Germany
| | - D. A. Ngandiri
- grid.7645.00000 0001 2155 0333Department of Molecular Genetics, TU Kaiserslautern, Paul-Ehrlich Str. 24, 67663 Kaiserslautern, Germany
| | - D. Schulz
- grid.7400.30000 0004 1937 0650Institute of Molecular Biology, University of Zurich, Zurich, Switzerland
| | - A. Wallek
- grid.418615.f0000 0004 0491 845XMax Planck Institute of Biochemistry, 82152 Martinsried, Germany
| | - N. Kulak
- grid.418615.f0000 0004 0491 845XMax Planck Institute of Biochemistry, 82152 Martinsried, Germany
| | - M. Mann
- grid.418615.f0000 0004 0491 845XMax Planck Institute of Biochemistry, 82152 Martinsried, Germany
| | - P. Cramer
- Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - V. Savage
- grid.19006.3e0000 0000 9632 6718Department of Biomathematics, University of California at Los Angeles, Los Angeles, CA 90095 USA
| | - M. Räschle
- grid.7645.00000 0001 2155 0333Department of Molecular Genetics, TU Kaiserslautern, Paul-Ehrlich Str. 24, 67663 Kaiserslautern, Germany
| | - Z. Storchova
- grid.7645.00000 0001 2155 0333Department of Molecular Genetics, TU Kaiserslautern, Paul-Ehrlich Str. 24, 67663 Kaiserslautern, Germany
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9
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Schilhabel A, Walter PJ, Cramer P, von Tresckow J, Kohlscheen S, Szczepanowski M, Laqua A, Fischer K, Eichhorst B, Böttcher S, Schneider C, Tausch E, Brüggemann M, Kneba M, Hallek M, Ritgen M. CD20 Expression as a Possible Novel Prognostic Marker in CLL: Application of EuroFlow Standardization Technique and Normalization Procedures in Flow Cytometric Expression Analysis. Cancers (Basel) 2022; 14:cancers14194917. [PMID: 36230840 PMCID: PMC9562902 DOI: 10.3390/cancers14194917] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/16/2022] [Accepted: 09/30/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Up to 50% of patients with chronic lymphocytic leukemia relapse within four years after anti-CD20-directed treatment with a need for a subsequent treatment, which can potentially include anti-CD20 agents again. To retrospectively study the influence of CD20 expression in CLL patients receiving anti-CD20 directed therapy on therapy response, we designed and evaluated a bead-based normalization approach for the analysis of CD20 expression levels to reduce variation of flow cytometric measurements due to technical issues. Normalization significantly reduced the variability of median fluorescence intensities of fluorochrome-conjugated beads without artificially rendering the instruments’ performances, and longitudinal biological variations of marker expression based on MFI values could be robustly assessed. In a cross-trial comparison, strong MRD response correlated with the CD20 expression level before therapy started in patients receiving Ofatumumab, but not in patients receiving Obinutuzumab. Abstract Background: CD20 expression is a controversial issue regarding response prediction to anti-CD20 therapy in chronic lymphocytic leukemia (CLL). Methods: Median fluorescence intensities (MFIs) of standard fluorescence beads from the daily calibration of flow cytometers according to EuroFlow protocols were used to establish a normalization approach to study CD20 expression on CLL cells. CD20 MFI was retrospectively assessed prior to and during treatment from flow cytometric measurements of peripheral blood in patients with different depths of molecular response in the four phase-II CLL2-BXX trials (BIG; BAG; BIO; BCG; N = 194) administering either Obinutuzumab or Ofatumumab in combination with targeted agents. Results: No significant difference was observed between the normalized and measured MFIs of CD19 and CD20 on CLL cells. During treatment, CD20 expression levels on CLL cells did not significantly differ between the four investigated different treatment schemes, but a strong molecular response to Ofatumumab seemed to correlate with higher CD20 expression prior to therapy. Conclusions: Standardized staining and instrument monitoring enable a robust assessment of longitudinal biological variations of marker expression based on MFI values. Obinutuzumab showed a higher proportion of patients with a strong MRD response independent from initial CD20 expression, whereas high pre-therapeutic CD20 expression levels seem to correlate with a profound response to Ofatumumab.
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Affiliation(s)
- Anke Schilhabel
- Laboratory for Specialized Hematological Diagnostics, Medical Department II, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Peter Jonas Walter
- Laboratory for Specialized Hematological Diagnostics, Medical Department II, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Paula Cramer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, 50924 Cologne, Germany
| | - Julia von Tresckow
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Saskia Kohlscheen
- Laboratory for Specialized Hematological Diagnostics, Medical Department II, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Monika Szczepanowski
- Laboratory for Specialized Hematological Diagnostics, Medical Department II, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Anna Laqua
- Laboratory for Specialized Hematological Diagnostics, Medical Department II, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, 50924 Cologne, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, 50924 Cologne, Germany
| | - Sebastian Böttcher
- Hematology, Oncology, Palliative Care, Clinic for Internal Medicine III, Rostock University Medical School, 18057 Rostock, Germany
| | | | - Eugen Tausch
- Department III of Internal Medicine, Ulm University, 89081 Ulm, Germany
| | - Monika Brüggemann
- Laboratory for Specialized Hematological Diagnostics, Medical Department II, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Michael Kneba
- Laboratory for Specialized Hematological Diagnostics, Medical Department II, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, 50924 Cologne, Germany
| | - Matthias Ritgen
- Laboratory for Specialized Hematological Diagnostics, Medical Department II, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
- Correspondence:
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Fürstenau M, Weiss J, Giza A, Franzen F, Robrecht S, Fink AM, Fischer K, Schneider C, Tausch E, Stilgenbauer S, Ritgen M, Schilhabel A, Brüggemann M, Eichhorst B, Hallek M, Cramer P. Circulating Tumor DNA-Based MRD Assessment in Patients with CLL Treated with Obinutuzumab, Acalabrutinib, and Venetoclax. Clin Cancer Res 2022; 28:4203-4211. [PMID: 35594173 DOI: 10.1158/1078-0432.ccr-22-0433] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/08/2022] [Revised: 04/12/2022] [Accepted: 05/17/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE With the advent of highly efficacious time-limited combination treatments of targeted agents in chronic lymphocytic leukemia (CLL), minimal residual disease (MRD) assessment has gained importance as a measure for therapeutic success and as a surrogate for progression-free survival. The currently most widely used method is multicolor flow cytometry, which detects circulating CLL cells in the peripheral blood. However, it seems to be less sensitive for the detection of MRD in the lymph node compartment. PATIENTS AND METHODS To evaluate whether a cell-free approach can overcome this limitation, we performed serial assessments of circulating tumor DNA (ctDNA) in patients with CLL treated with obinutuzumab, acalabrutinib, and venetoclax in the phase II CLL2-BAAG trial. Patient-specific variability, diversity, joining (VDJ) rearrangements as well as somatic driver mutations were tracked before, during and after treatment by digital droplet PCR in blood plasma. Furthermore, these were systematically compared to matched flow cytometry data. RESULTS In the 381 sample pairs, ctDNA and flow cytometry yielded highly concordant results. However, clone-specific ctDNA was detected in 44 of 152 samples (29%) that were assessed as undetectable MRD (uMRD) by flow cytometry (defined as less than one CLL cell in 10,000 normal leukocytes). 29 ctDNA-negative samples showed detectable MRD >10-4 by flow cytometry. Also, somatic driver mutations were detected with a similar sensitivity compared with patient-specific VDJ rearrangements in plasma. In patients with predominantly nodal residual disease, ctDNA compared favorably with 4-color flow cytometry and seemed to more accurately reflect the entire disease burden across compartments. CONCLUSIONS On the basis of these findings, ctDNA-based MRD assessment appears to be a promising method to complement cell-based MRD approaches like flow cytometry that focus on circulating CLL cells in the peripheral blood.
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MESH Headings
- Antibodies, Monoclonal, Humanized
- Benzamides
- Bridged Bicyclo Compounds, Heterocyclic
- Circulating Tumor DNA/genetics
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/drug therapy
- Neoplasm, Residual/genetics
- Pyrazines
- Sulfonamides
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Affiliation(s)
- Moritz Fürstenau
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jonathan Weiss
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Adam Giza
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Fabian Franzen
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christof Schneider
- Division of CLL, Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Eugen Tausch
- Division of CLL, Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Stephan Stilgenbauer
- Division of CLL, Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Matthias Ritgen
- Department of Internal Medicine II, Faculty of Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Anke Schilhabel
- Department of Internal Medicine II, Faculty of Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Monika Brüggemann
- Department of Internal Medicine II, Faculty of Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Paula Cramer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Dusseldorf, German CLL Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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11
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Cramer P, Fürstenau M, Robrecht S, Giza A, Zhang C, Fink AM, Fischer K, Langerbeins P, Al-Sawaf O, Tausch E, Schneider C, Schetelig J, Dreger P, Böttcher S, Kreuzer KA, Schilhabel A, Ritgen M, Brüggemann M, Kneba M, Stilgenbauer S, Eichhorst B, Hallek M. Obinutuzumab, acalabrutinib, and venetoclax, after an optional debulking with bendamustine in relapsed or refractory chronic lymphocytic leukaemia (CLL2-BAAG): a multicentre, open-label, phase 2 trial. Lancet Haematol 2022; 9:e745-e755. [PMID: 35988545 DOI: 10.1016/s2352-3026(22)00211-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although BTK inhibitors provide long-term disease-control in patients with chronic lymphocytic leukaemia, they need to be combined with BCL2 inhibitors or antibodies to achieve deep responses with undetectable minimal residual disease (uMRD), which allows for time-limited treatment. This trial aims to evaluate the triple combination of obinutuzumab, acalabrutinib, and venetoclax after an optional debulking with bendamustine. METHODS This multicentre, open-label, investigator-initiated, phase 2 study evaluates a sequential treatment consisting of a debulking with two cycles of bendamustine for patients with a higher tumour load (70 mg/m2 intravenously on days 1 and 2, repeated after 28 days), followed by an induction and a maintenance with obinutuzumab (1000 mg intravenously on days 1-2, 8, and 15 of the first induction cycle, every 4 weeks in induction cycles 2-6 and every 12 weeks in the maintenance phase), acalabrutinib (100 mg orally twice daily continuously from induction cycle 2 day 1 onwards) and venetoclax (starting in induction cycle 3 with 20 mg per day with a weekly dose ramp-up over 5 weeks to the target dose of 400 mg per day). Eligible patients were aged 18 years or older with an ECOG performance score 0-2 and had relapsed or refractory chronic lymphocytic leukaemia requiring treatment according to the 2018 International Workshop on Chronic Lymphocytic Leukemia criteria. The primary endpoint was uMRD (<10-4) in peripheral blood at the end of induction treatment assessed centrally at the final restaging, 12 weeks after the start of the last induction cycle. As per protocol, all patients with more than two induction cycles were included in the analyses. This study is registered with ClinicalTrials.gov, number NCT03787264, and is ongoing. FINDINGS Between Jan 14, 2019, and June 25, 2020, 45 evaluable patients with relapsed or refractory chronic lymphocytic leukaemia were enrolled; 13 (29%) were female, 32 (71%) were male, 21 (47%) had already received a targeted agent, and 14 (32%) had del(17)(p13.1) or TP53 mutation. Ethnicity-race data was not collected. At data cutoff (Feb 25, 2021), all patients had completed the induction treatment. 34 patients (76%; 95% CI 61-87, p=0·26) had uMRD in peripheral blood after 6 months of triple therapy. Until data cutoff, 32 (71%) patients started maintenance and nine (28%) were able to stop with uMRD. After a median observation time of 13·8 months (IQR 10·4-18·4), there were two (4%) Richter transformations, but no progressions and no deaths observed. The most common adverse events of grade 3 and 4 during the entire treatment were thrombocytopenia and neutropenia (12 [27%] of 45 patients each), tumour lysis syndrome and infections (five [11%] of 45 patients each, grade 3 adverse events only), infusion-associated reactions (four [9%] of 45 patients) and anaemia (four [9%] of 45 patients). INTERPRETATION With 76% of patients achieving uMRD in peripheral blood, this trial did not reach the prespecified activity threshold. Triple therapy with obinutuzumab, acalabrutinib, and venetoclax after an optional debulking with bendamustine regimen requires further evaluation in larger trials to define its value compared with double treatment with a BTK or BCL2 inhibitor combined with obinutuzumab or a combination of the two oral targeted drugs. Until these trials show a clear benefit, the use of the triple combination in routine practice cannot be recommended. FUNDING Acerta, AstraZeneca, F Hoffmann-La Roche, and AbbVie.
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MESH Headings
- Antibodies, Monoclonal, Humanized
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Bendamustine Hydrochloride/adverse effects
- Benzamides
- Bridged Bicyclo Compounds, Heterocyclic
- Cytoreduction Surgical Procedures
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Neoplasm, Residual
- Proto-Oncogene Proteins c-bcl-2
- Pyrazines
- Sulfonamides
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Affiliation(s)
- Paula Cramer
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.
| | - Moritz Fürstenau
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Adam Giza
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Can Zhang
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Eugen Tausch
- Department of Internal Medicine III, Division of CLL, University Hospital Ulm, Ulm, Germany
| | - Christof Schneider
- Department of Internal Medicine III, Division of CLL, University Hospital Ulm, Ulm, Germany
| | - Johannes Schetelig
- Department I of Internal Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Peter Dreger
- Department V of Internal Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Böttcher
- Clinic for Internal Medicine III (Hematology, Oncology, Palliative Care), Rostock University Medical School, Rostock, Germany
| | - Karl-Anton Kreuzer
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Anke Schilhabel
- Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | - Matthias Ritgen
- Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | - Monika Brüggemann
- Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | - Michael Kneba
- Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | - Stephan Stilgenbauer
- Department of Internal Medicine III, Division of CLL, University Hospital Ulm, Ulm, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
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Datta S, Cramer P, Sung J, Wright D, Charalel R. Abstract No. 591 Systematic review of use of patient-reported outcome measures in interventional radiology. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.573] [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: 11/16/2022] Open
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13
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Cramer P, Fürstenau M, Giza A, Robrecht S, Tausch E, Schneider C, Wendtner CM, Hoechstetter M, Schetelig J, Böttcher S, Dreger P, Fink AM, Langerbeins P, Al-Sawaf O, Fischer K, Stilgenbauer S, Eichhorst B, Hallek M. P641: RETREATMENT WITH VENETOCLAX AFTER VENETOCLAX, OBINUTUZUMAB +/- IBRUTINIB: POOLED ANALYSIS OF 13 PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) TREATED IN GCLLSG TRIALS. Hemasphere 2022. [DOI: 10.1097/01.hs9.0000845448.71709.3a] [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] Open
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14
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Cramer P, Mensah C, De Sancho M, Malhotra A, Winokur R, Kesselman A. Abstract No. 607 Hypercoagulable states in stented thrombotic iliac vein compression syndrome with comparison of re-intervention and anticoagulation regimens. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.589] [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: 11/24/2022] Open
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15
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Gambichler T, Hessam S, Cramer P, Abu Rached N, Bechara G. Complete blood collection‐based systemic inflammation biomarkers for patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2022; 36:1593-1596. [DOI: 10.1111/jdv.18175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/05/2022] [Indexed: 11/27/2022]
Affiliation(s)
- T. Gambichler
- Department of Dermatology, Venereology and Allergology, Ruhr‐University Bochum Bochum Germany
| | - S. Hessam
- Department of Dermatology, Venereology and Allergology, Ruhr‐University Bochum Bochum Germany
| | - P. Cramer
- Department of Dermatology, Venereology and Allergology, Ruhr‐University Bochum Bochum Germany
| | - N. Abu Rached
- Department of Dermatology, Venereology and Allergology, Ruhr‐University Bochum Bochum Germany
| | - G. Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr‐University Bochum Bochum Germany
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Cramer P, Fürstenau M, Robrecht S, Giza A, Fink AM, Fischer K, Langerbeins P, Al Sawaf O, Tausch E, Schneider C, Schetelig J, Dreger P, Böttcher S, Kreuzer KA, Schilhabel A, Brüggemann M, Kneba M, Wendtner CM, Stilgenbauer S, Eichhorst B, Hallek M. BENDAMUSTINE, FOLLOWED BY OBINUTUZUMAB, ACALABRUTINIB AND VENETOCLAX IN PATIENTS (PTS) WITH RELAPSED/REFRACTORY CHRONIC LYMPHOCYTIC LEUKEMIA (CLL): CLL2‐BAAG TRIAL OF THE GCLLSG. Hematol Oncol 2021. [DOI: 10.1002/hon.34_2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- P Cramer
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - M Fürstenau
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - S Robrecht
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - A Giza
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - A. M Fink
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - K Fischer
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - P Langerbeins
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - O Al Sawaf
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - E Tausch
- University Hospital Ulm Department III of Internal Medicine Ulm Germany
| | - C Schneider
- University Hospital Ulm Department III of Internal Medicine Ulm Germany
| | - J Schetelig
- University Hospital Carl Gustav Carus Department I of Internal Medicine Dresden Germany
| | - P Dreger
- University Hospital Heidelberg Department V of Internal Medicine Heidelberg Germany
| | - S Böttcher
- University Hospital Rostock Department III of Internal Medicine Rostock Germany
| | - K. A Kreuzer
- Klinikum Schwabing Department of Hematology, Oncology, Immunology, Palliative Care Infectious Diseases and Tropical Medicine Munich Germany
| | - A Schilhabel
- University of Schleswig‐Holstein Campus Kiel, Department II of Internal Medicine, Kiel Germany
| | - M Brüggemann
- University of Schleswig‐Holstein Campus Kiel, Department II of Internal Medicine, Kiel Germany
| | - M Kneba
- University of Schleswig‐Holstein Campus Kiel, Department II of Internal Medicine, Kiel Germany
| | - C. M Wendtner
- Klinikum Schwabing Department of Hematology, Oncology, Immunology, Palliative Care Infectious Diseases and Tropical Medicine Munich Germany
| | - S Stilgenbauer
- University Hospital Ulm Department III of Internal Medicine Ulm Germany
| | - B Eichhorst
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
| | - M Hallek
- University of Cologne Faculty of Medicine and University Hospital of Cologne Department I of Internal Medicine and German CLL Study Group Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne Germany
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17
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Cramer P, Tresckow JV, Robrecht S, Bahlo J, Fürstenau M, Langerbeins P, Pflug N, Al-Sawaf O, Heinz WJ, Vehling-Kaiser U, Dürig J, Tausch E, Hensel M, Sasse S, Fink AM, Fischer K, Kreuzer KA, Böttcher S, Ritgen M, Kneba M, Wendtner CM, Stilgenbauer S, Eichhorst B, Hallek M. Bendamustine, followed by ofatumumab and ibrutinib in chronic lymphocytic leukemia (CLL2-BIO): primary endpoint analysis of a multicenter, open-label phase-II trial. Haematologica 2021; 106:543-554. [PMID: 32107341 PMCID: PMC7849583 DOI: 10.3324/haematol.2019.223693] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 04/09/2019] [Accepted: 02/25/2020] [Indexed: 12/12/2022] Open
Abstract
The introduction of targeted agents has revolutionized the treatment of chronic lymphocytic leukemia but only few patients achieve a complete remission and minimal residual disease negativity with ibrutinib monotherapy. This multicenter, investigator-initiated, phase II study is evaluating sequential treatment with two cycles of bendamustine debulking for patients with a higher tumor load, followed by ofatumumab and ibrutinib induction and maintenance treatment. An all-comer population, irrespective of prior treatment, physical fitness and genetic factors, was included. The primary endpoint was the investigator-assessed overall response rate at the end of induction treatment. Of 66 patients enrolled, one patient with early treatment discontinuation was excluded from the efficacy analysis as predefined by the protocol. Thirty-nine patients (60%) were treatment-naïve and 26 patients (40%) had relapsed/refractory chronic lymphocytic leukemia, 21 patients (32%) had a del(17p) and/or TP53 mutation and 45 patients (69%) had unmutated IGHV status. At the end of the induction, 60 of 65 patients (92%) responded and nine (14%) achieved minimal residual disease negativity (<10-4) in peripheral blood. No unexpected or cumulative toxicities occurred. The most common grade 3 or 4 adverse events, according to the Common Toxicity Criteria, were neutropenia, anemia, infusion-related reactions, and diarrhea. This sequential treatment of bendamustine debulking, followed by ofatumumab and ibrutinib was well tolerated without unexpected safety signals and showed a good efficacy with an overall response rate of 92%. Ongoing maintenance treatment aims at deeper responses with minimal residual disease negativity. However, ibrutinib should still be used as a single agent outside clinical trials. Clinicaltrials.gov number: NCT02689141.
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Affiliation(s)
- Paula Cramer
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Julia V Tresckow
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Sandra Robrecht
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Jasmin Bahlo
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Moritz Fürstenau
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Petra Langerbeins
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Natali Pflug
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Othman Al-Sawaf
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Werner J Heinz
- University of Würzburg, Medical Center, Medical Clinic II, Würzburg, Germany
| | | | - Jan Dürig
- University Hospital Essen, Department for Hematology, West German Cancer Center, Essen, Germany
| | - Eugen Tausch
- Department III of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | | | - Stephanie Sasse
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Anna-Maria Fink
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Kirsten Fischer
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Karl-Anton Kreuzer
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Sebastian Böttcher
- Department III of Internal Medicine, Rostock University Medical Center, Rostock, Germany
| | - Matthias Ritgen
- Department of Internal Medicine II, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | - Michael Kneba
- Department of Internal Medicine II, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | | | | | - Barbara Eichhorst
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Michael Hallek
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
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18
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Abstract
Two major advances were made in the treatment of chronic lymphocytic leukaemia (CLL): the addition of the antibody rituximab to chemotherapy two decades ago and the introduction of the targeted agents during the last few years. Four targeted drugs with different mechanisms of action were added to the armamentarium of CLL treatment: the anti-CD20 antibody obinutuzumab, the two kinase inhibitors ibrutinib and idelalisib, which target the Bruton tyrosine kinase (BTK) and Phosphatidylinositiol-3-Kinase (PI3K) respectively in the B-cell receptor signalling pathway, as well as the Bcl2-antagonist venetoclax.Recently, the combination of venetoclax/obinutuzumab was approved for the first-line treatment of all CLL patients based on a phase-III trial in elderly unfit patients. This combination was shown to be clearly superior to chlorambucil/obinutuzumab and should become the preferred first-line treatment for the so called "slow-go" patients. Other options for these elderly, unfit patients are continuous ibrutinib or chlorambucil/obinutuzumab. Although data from phase-III studies are not yet available, venetoclax/obintuzumab may also be offered to younger, fit patients. Established therapeutic options for these so called "go go" patients are ibrutinib, fludarabin/cyclophosphamide/rituximab or bendemustine/rituximab (if > 65 years). Patients with the high-risk parameters deletion 17p or TP53mutation are known to poorly respond to chemo(immuno)therapy and should receive either ibrutinib or venetoclax/obinutuzumab.Thus, a choice has to be made between a continuous monotherapy with ibrutinib or a time-limited combination with either venetoclax/obinutuzumab (12 months) or chemoimmunotherapy (usually 6 months). In addition to disease-related factors (e. g. presence of deletion 17p/TP53 mutation, IgHV mutational status, prior therapies), comorbidities, co-medication and the specific side effects of the CLL therapies (myelosuppression, infections and secondary malignancies for chemoimmunotherapy; cardiac toxicity, bleeding and autoimmune disease for ibrutinib; tumour-lysis syndromes and infections for venetoclax) the patient's expectations need to be considered.
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Affiliation(s)
- Paula Cramer
- Uniklink Köln, Klinik I für Innere Medizin, Deutsche CLL Studiengruppe; Kerpener Str. 62, 50937 Köln
| | - Julia von Tresckow
- Uniklink Köln, Klinik I für Innere Medizin, Deutsche CLL Studiengruppe; Kerpener Str. 62, 50937 Köln
| | - Barbara Eichhorst
- Uniklink Köln, Klinik I für Innere Medizin, Deutsche CLL Studiengruppe; Kerpener Str. 62, 50937 Köln
| | - Michael Hallek
- Uniklink Köln, Klinik I für Innere Medizin, Deutsche CLL Studiengruppe; Kerpener Str. 62, 50937 Köln
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19
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Fraser GAM, Chanan-Khan A, Demirkan F, Santucci Silva R, Grosicki S, Janssens A, Mayer J, Bartlett NL, Dilhuydy MS, Loscertales J, Avigdor A, Rule S, Samoilova O, Pavlovsky MA, Goy A, Mato A, Hallek M, Salman M, Tamegnon M, Sun S, Connor A, Nottage K, Schuier N, Balasubramanian S, Howes A, Cramer P. Final 5-year findings from the phase 3 HELIOS study of ibrutinib plus bendamustine and rituximab in patients with relapsed/refractory chronic lymphocytic leukemia/small lymphocytic lymphoma. Leuk Lymphoma 2020; 61:3188-3197. [PMID: 32762271 PMCID: PMC9094431 DOI: 10.1080/10428194.2020.1795159] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report final analysis outcomes from the phase 3 HELIOS study (NCT01611090). Patients with relapsed/refractory chronic lymphocytic leukemia/small lymphocytic lymphoma without deletion 17p (n = 578) were randomized 1:1 to 420 mg daily ibrutinib or placebo plus ≤6 cycles of bendamustine plus rituximab (BR), followed by ibrutinib or placebo alone. Median follow-up was 63.7 months. Median investigator-assessed progression-free survival was longer with ibrutinib plus BR (65.1 months) than placebo plus BR (14.3 months; hazard ratio [HR] 0.229 [95% confidence interval (CI) 0.183–0.286]; p < .0001). Despite crossover of 63.3% of patients from the placebo plus BR arm to ibrutinib treatment upon disease progression, ibrutinib plus BR versus placebo plus BR demonstrated an overall survival benefit (HR 0.611 [95% CI 0.455–0.822]; p = 0010; median not reached in either arm). Long-term follow-up data confirm the survival benefit of ibrutinib plus BR over BR alone. Safety profiles were consistent with those known for ibrutinib and BR.
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Affiliation(s)
| | - Asher Chanan-Khan
- Division of Hematology, Mayo Clinic Cancer Center, Jacksonville, FL, USA
| | - Fatih Demirkan
- Division of Hematology, Dokuz Eylul University, Izmir, Turkey
| | | | - Sebastian Grosicki
- Department of Hematology and Cancer Prevention, School of Public Health, Silesian Medical University, Katowice, Poland
| | - Ann Janssens
- Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Jiri Mayer
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Jihlavska, Brno, Czech Republic
| | - Nancy L Bartlett
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Javier Loscertales
- Hematology Department, Hospital Universitario La Princesa, IIS-IP, Madrid, Spain
| | - Abraham Avigdor
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, University of Tel-Aviv, Tel-Aviv, Israel
| | - Simon Rule
- Department of Haematology, University of Plymouth Medical School, Plymouth, UK
| | - Olga Samoilova
- Nizhny Novogorod Regional Clinical Hospital, Nizhny Novogorod, Russia
| | | | - Andre Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - Michael Hallek
- Department I of Internal Medicine and German CLL Study Group, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | | | | | - Steven Sun
- Janssen Research & Development, Raritan, NJ, USA
| | - Anne Connor
- Janssen Research & Development, Spring House, PA, USA
| | | | | | | | - Angela Howes
- Janssen Research & Development, High Wycombe, UK
| | - Paula Cramer
- Department I of Internal Medicine and German CLL Study Group, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
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20
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Fürstenau M, Hopfinger G, Robrecht S, Fink AM, Al-Sawaf O, Langerbeins P, Cramer P, Tresckow JV, Maurer C, Kutsch N, Hoechstetter M, Dreyling M, Lange E, Kneba M, Stilgenbauer S, Döhner H, Hensel M, Kiehl MG, Jaeger U, Wendtner CM, Goede V, Fischer K, von Bergwelt-Baildon M, Eichhorst B, Hallek M, Theurich S. Influence of obesity and gender on treatment outcomes in patients with chronic lymphocytic leukemia (CLL) undergoing rituximab-based chemoimmunotherapy. Leukemia 2019; 34:1177-1181. [PMID: 31728057 DOI: 10.1038/s41375-019-0630-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/14/2019] [Accepted: 11/03/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Moritz Fürstenau
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany.
| | - Georg Hopfinger
- Department of Internal Medicine I, Bone Marrow Transplantation, Medical University of Vienna, Vienna, Austria
| | - Sandra Robrecht
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Paula Cramer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Julia Von Tresckow
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Christian Maurer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Nadine Kutsch
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Manuela Hoechstetter
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, München Klinik Schwabing, Munich, Germany
| | - Martin Dreyling
- Department of Medicine III, University Hospital, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
| | | | - Michael Kneba
- Department II of Internal Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Stephan Stilgenbauer
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany.,Department of Hematology, Oncology and Rheumatology and José Carreras Center for Immuno and Gene Therapy, Saarland University Medical School, Homburg/Saar, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | | | - Michael G Kiehl
- Department of Internal Medicine, Frankfurt (Oder) General Hospital, Frankfurt/Oder, Germany
| | - Ulrich Jaeger
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology and Comprehensive Cancer Center (CCC), Medical University of Vienna, Vienna, Austria
| | - Clemens-Martin Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, München Klinik Schwabing, Munich, Germany
| | - Valentin Goede
- Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | | | - Barbara Eichhorst
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Sebastian Theurich
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany. .,Department of Medicine III, University Hospital, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany. .,Gene Center, Cancer- and Immunometabolism Research Group, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany.
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21
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Kipps TJ, Fraser G, Coutre SE, Brown JR, Barrientos JC, Barr PM, Byrd JC, O’Brien SM, Dilhuydy MS, Hillmen P, Jaeger U, Moreno C, Cramer P, Stilgenbauer S, Chanan-Khan AA, Mahler M, Salman M, Eckert K, Solman IG, Balasubramanian S, Cheng M, Londhe A, Ninomoto J, Howes A, James DF, Hallek M. Long-Term Studies Assessing Outcomes of Ibrutinib Therapy in Patients With Del(11q) Chronic Lymphocytic Leukemia. Clinical Lymphoma Myeloma and Leukemia 2019; 19:715-722.e6. [DOI: 10.1016/j.clml.2019.07.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 12/21/2022]
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22
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Al‐Sawaf O, Bazeos A, Robrecht S, Bahlo J, Gower C, Fink A, Tresckow J, Cramer P, Langerbeins P, Kutsch N, Humphrey K, Fingerle‐Rowson G, Stilgenbauer S, Wendtner C, Fischer K, Eichhorst B, Hallek M, Goede V. Mode of progression after first line treatment correlates with outcome of chronic lymphocytic leukemia (CLL). Am J Hematol 2019; 94:1002-1006. [PMID: 31222797 DOI: 10.1002/ajh.25561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 01/24/2023]
Abstract
In CLL, progressive disease (PD) following remission after first line treatment can present with varying phenotypes. We hypothesized that the mode of PD correlates with clinical outcomes. Data from three phase III trials of the German CLL Study Group (GCLLSG) (CLL8, CLL10, CLL11) including a total of 2159 patients receiving first line (immuno)-chemotherapy (FCR, FC, CLB, CLB-R, CLB-Ob) were analyzed. Patients were categorized as "ALC" if PD was due to increasing absolute lymphocyte count, or as "Ly" if due to lymphadenopathy. A group of 241 patients progressed with ALC, and 727 progressed with Ly, including 329 who progressed on both modalities. In fit patients, median TTNT after PD in the Ly group was 12.3 months vs 17.0 months in the ALC group (HR 1.299 [1.036-1.628]; P = .024). Median OS after PD was 45.1 months in the Ly group and 42.4 months in the ALC group (HR=1.023 [0.753-1.389]; P = .885). For unfit patients, median TTNT in the Ly group was 11.7 months vs 21.4 months in the ALC group (HR 1.357 [1.051-1.753]; P = .019). Median OS was 42.8 months in the Ly group and not reached in the ALC group (HR 1.851 [1.280-2.677]; P = .001). Patients in the Ly group more frequently showed impairment of quality of life (QoL). This analysis demonstrates that patients with progressive lymphadenopathy have a significantly shorter TTNT, OS and less favorable QoL. Our findings might help physicians to better estimate the clinical course of a progressing CLL patient.
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Affiliation(s)
- Othman Al‐Sawaf
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | | | - Sandra Robrecht
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | - Jasmin Bahlo
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | | | - Anna‐Maria Fink
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | - Julia Tresckow
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | - Paula Cramer
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | - Petra Langerbeins
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | - Nadine Kutsch
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | | | | | | | - Clemens‐Martin Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, German CLL Study GroupHospital Munich‐Schwabing Munich Germany
| | - Kirsten Fischer
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | - Barbara Eichhorst
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | - Michael Hallek
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | - Valentin Goede
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
- Oncogeriatric Unit, Department of Geriatric MedicineSt. Marien Hospital Cologne Germany
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23
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Kreuzer KA, Furman RR, Stilgenbauer S, Dubowy RL, Kim Y, Munugalavadla V, Lilienweiss E, Reinhardt HC, Cramer P, Eichhorst B, Hillmen P, O'Brien SM, Pettitt AR, Hallek M. The impact of complex karyotype on the overall survival of patients with relapsed chronic lymphocytic leukemia treated with idelalisib plus rituximab. Leukemia 2019; 34:296-300. [PMID: 31427720 PMCID: PMC7214265 DOI: 10.1038/s41375-019-0533-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 10/16/2018] [Revised: 06/19/2019] [Accepted: 06/26/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Karl-Anton Kreuzer
- Department I of Internal Medicine, University of Cologne, Cologne, Germany.
| | | | - Stephan Stilgenbauer
- Department III of Internal Medicine, Ulm University Medical Center, Ulm, Germany
| | | | | | | | - Esther Lilienweiss
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Hans Christian Reinhardt
- Department I of Internal Medicine, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Paula Cramer
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | | | - Susan M O'Brien
- University of California-Irvine, Irvine Chao Family Comprehensive Cancer Center, Orange, CA, USA
| | | | - Michael Hallek
- Department I of Internal Medicine, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
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24
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Langerbeins P, Bahlo J, Rhein C, Gerwin H, Cramer P, Fürstenau M, Al-Sawaf O, von Tresckow J, Fink A, Kreuzer K, Vehling-Kaiser U, Tausch E, Müller L, Eckart M, Schlag R, Freier W, Gaska T, Balser C, Reiser M, Stauch M, Wendtner C, Fischer K, Stilgenbauer S, Eichhorst B, Hallek M. IBRUTINIB VERSUS PLACEBO IN PATIENTS WITH ASYMPTOMATIC, TREATMENT-NAÏVE EARLY STAGE CLL: PRIMARY ENDPOINT RESULTS OF THE PHASE 3 DOUBLE-BLIND RANDOMIZED CLL12 TRIAL. Hematol Oncol 2019. [DOI: 10.1002/hon.7_2629] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- P. Langerbeins
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - J. Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - C. Rhein
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - H. Gerwin
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - P. Cramer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - M. Fürstenau
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - O. Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - J. von Tresckow
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - A.M. Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - K. Kreuzer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | | | - E. Tausch
- Internal Medicine III; University Hospital; Ulm Germany
| | - L. Müller
- Hämatologie und Onkologie; Studienzentrum UnterEms; Leer Germany
| | - M. Eckart
- Hämatologie und Onkologie; Onkologische Schwerpunktpraxis; Erlangen Germany
| | - R. Schlag
- Hämatologie und Onkologie; Gemeinschaftspraxis; Würzburg Germany
| | - W. Freier
- Hämatologie und Onkologie; Medicinum; Hildesheim Germany
| | - T. Gaska
- Klinik für Hämatologie und Onkologie; Brüderkrankenhaus St. Josef; Paderborn Germany
| | - C. Balser
- Hämatologie und Onkologie; Internistische Praxis; Marburg Germany
| | - M. Reiser
- PIOH; Praxis Internistischer Onkologie und Hämatologie; Köln Germany
| | - M. Stauch
- Hämatologie; Onkologie, Gerinnung; Ambulantes Zentrum Kronach Germany
| | - C. Wendtner
- Department I of Internal Medicine, Munich Clinic Schwabing; Academic Teaching Hospital of University of Munich; Munich Germany
| | - K. Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - S. Stilgenbauer
- Internal Medicine I; University of Saarland; Homburg Germany
| | - B. Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - M. Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
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25
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Sharman JP, Coutre SE, Furman RR, Cheson BD, Pagel JM, Hillmen P, Barrientos JC, Zelenetz AD, Kipps TJ, Flinn IW, Ghia P, Eradat H, Ervin T, Lamanna N, Coiffier B, Pettitt AR, Ma S, Tausch E, Cramer P, Huang J, Mitra S, Hallek M, O’Brien SM, Stilgenbauer S. Final Results of a Randomized, Phase III Study of Rituximab With or Without Idelalisib Followed by Open-Label Idelalisib in Patients With Relapsed Chronic Lymphocytic Leukemia. J Clin Oncol 2019; 37:1391-1402. [PMID: 30995176 PMCID: PMC10448866 DOI: 10.1200/jco.18.01460] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [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] [Accepted: 03/06/2019] [Indexed: 01/19/2023] Open
Abstract
PURPOSE A randomized, double-blind, phase III study of idelalisib (IDELA) plus rituximab versus placebo plus rituximab in patients with relapsed chronic lymphocytic leukemia (CLL) was terminated early because of superior efficacy of the IDELA-plus-rituximab (IDELA/R) arm. Patients in either arm could then enroll in an extension study to receive IDELA monotherapy. Here, we report the long-term efficacy and safety data for IDELA-treated patients across the primary and extension studies. PATIENTS AND METHODS Patients were randomly assigned to receive rituximab in combination with either IDELA 150 mg twice daily (IDELA/R; n = 110) or placebo (placebo/R; n = 110). Key end points were progression-free survival (PFS), overall response rate (ORR), overall survival (OS), and safety. RESULTS The long-term efficacy and safety of treatment with IDELA was assessed in 110 patients who received at least one dose of IDELA in the primary study, 75 of whom enrolled in the extension study. The IDELA/R-to-IDELA group had a median PFS of 20.3 months (95% CI, 17.3 to 26.3 months) after a median follow-up time of 18 months (range, 0.3 to 67.6 months). The ORR was 85.5% (94 of 110 patients; n = 1 complete response). The median OS was 40.6 months (95% CI, 28.5 to 57.3 months) and 34.6 months (95% CI, 16.0 months to not reached) for patients randomly assigned to the IDELA/R and placebo/R groups, respectively. Prolonged exposure to IDELA increased the incidence of all-grade, grade 2, and grade 3 or greater diarrhea (46.4%, 17.3%, and 16.4%, respectively), all-grade and grade 3 or greater colitis (10.9% and 8.2%, respectively) and all-grade and grade 3 or greater pneumonitis (10.0% and 6.4%, respectively) but did not increase the incidence of elevated hepatic aminotransferases. CONCLUSION IDELA improved PFS and OS compared with rituximab alone in patients with relapsed CLL. Long-term IDELA was effective and had an expected safety profile. No new IDELA-related adverse events were identified with longer exposure.
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MESH Headings
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Disease Progression
- Double-Blind Method
- Drug Administration Schedule
- Europe
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Progression-Free Survival
- Purines/administration & dosage
- Purines/adverse effects
- Quinazolinones/administration & dosage
- Quinazolinones/adverse effects
- Recurrence
- Rituximab/administration & dosage
- Rituximab/adverse effects
- Time Factors
- United States
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Affiliation(s)
- Jeff P. Sharman
- Willamette Valley Cancer Institute and Research Center, US Oncology Research, Springfield, OR
| | | | | | | | | | - Peter Hillmen
- St James’s University Hospital, Leeds, United Kingdom
| | | | | | - Thomas J. Kipps
- University of California, San Diego, Moores Cancer Center, La Jolla, CA
| | - Ian W. Flinn
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and Istituto Di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Herbert Eradat
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | | | - Nicole Lamanna
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | | | | | - Shuo Ma
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | | | - Paula Cramer
- University Hospital of Cologne, Cologne, Germany
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26
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Lavezzi SM, de Jong J, Neyens M, Cramer P, Demirkan F, Fraser G, Bartlett N, Dilhuydy MS, Loscertales J, Avigdor A, Rule S, Samoilova O, Goy A, Ganguly S, Salman M, Howes A, Mahler M, De Nicolao G, Poggesi I. Systemic Exposure of Rituximab Increased by Ibrutinib: Pharmacokinetic Results and Modeling Based on the HELIOS Trial. Pharm Res 2019; 36:93. [PMID: 31044267 DOI: 10.1007/s11095-019-2605-8] [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] [Received: 11/06/2018] [Accepted: 03/06/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION In the HELIOS trial, bendamustine/rituximab (BR) plus ibrutinib (BR-I) improved disease outcomes versus BR plus placebo in previously treated chronic lymphocytic leukemia/small lymphocytic lymphoma. Here, we describe the pharmacokinetic (PK) observations, along with modeling to further explore the interaction between ibrutinib and rituximab. METHODS 578 subjects were randomized to ibrutinib or placebo with BR (6 cycles). Ibrutinib PK samples and tumor measurements were obtained from all subjects; a subset was evaluated for bendamustine and rituximab PK. Population rituximab PK was assessed using nonlinear mixed-effects modeling. RESULTS Dose-normalized plasma concentration-time bendamustine data were comparable between the arms. Systemic rituximab exposure was higher with BR-I versus BR; mean trough serum concentrations were 2- to 3-fold higher in the first three cycles and 1.2- to 1.7-fold higher subsequently. No relevant safety differences were observed. In the modeling, including treatment arm as a categorical covariate and tumor burden as a continuous time-varying covariate on overall rituximab clearance significantly improved fitting of the data. CONCLUSIONS BR-I led to higher dose-normalized systemic rituximab exposure versus BR and more rapid steady-state achievement. The modeling data suggest that rituximab disposition is, at least in part, target mediated. Determining the clinical significance of these findings requires further assessments. TRIAL REGISTRATION This study is registered at https://clinicaltrials.gov/ct2/show/NCT01611090 .
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Affiliation(s)
- Silvia Maria Lavezzi
- Department of Electrical, Computer and Biomedical Engineering, Università degli Studi di Pavia, Pavia, Italy.,Quantitative Clinical Development, PAREXEL International, Dublin 8, Ireland
| | | | | | - Paula Cramer
- German CLL Study Group, University Hospital of Cologne, Cologne, Germany
| | | | - Graeme Fraser
- Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Nancy Bartlett
- Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri, USA
| | | | | | - Abraham Avigdor
- Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | | | - Olga Samoilova
- Nizhny Novgorod Regional Clinical Hospital, Nizhny Novgorod, Russia
| | - Andre Goy
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey, USA
| | | | | | | | | | - Giuseppe De Nicolao
- Department of Electrical, Computer and Biomedical Engineering, Università degli Studi di Pavia, Pavia, Italy
| | - Italo Poggesi
- Global Clinical Pharmacology, Quantitative Sciences, Janssen-Cilag SpA, Via Michelangelo Buonarroti 23, 20093, Cologno Monzese, MI, Italy.
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27
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Fraser G, Cramer P, Demirkan F, Silva RS, Grosicki S, Pristupa A, Janssens A, Mayer J, Bartlett NL, Dilhuydy MS, Pylypenko H, Loscertales J, Avigdor A, Rule S, Villa D, Samoilova O, Panagiotidis P, Goy A, Pavlovsky MA, Karlsson C, Hallek M, Mahler M, Salman M, Sun S, Phelps C, Balasubramanian S, Howes A, Chanan-Khan A. Updated results from the phase 3 HELIOS study of ibrutinib, bendamustine, and rituximab in relapsed chronic lymphocytic leukemia/small lymphocytic lymphoma. Leukemia 2019; 33:969-980. [PMID: 30315239 PMCID: PMC6484712 DOI: 10.1038/s41375-018-0276-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [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: 02/12/2018] [Revised: 05/09/2018] [Accepted: 08/28/2018] [Indexed: 12/21/2022]
Abstract
We report follow-up results from the randomized, placebo-controlled, phase 3 HELIOS trial of ibrutinib+bendamustine and rituximab (BR) for previously treated chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) without deletion 17p. Overall, 578 patients were randomized 1:1 to either ibrutinib (420 mg daily) or placebo, in combination with 6 cycles of BR, followed by ibrutinib or placebo alone. Median follow-up was 34.8 months (range: 0.1-45.8). Investigator-assessed median progression-free survival (PFS) was not reached for ibrutinib+BR, versus 14.3 months for placebo+BR (hazard ratio [HR] [95% CI], 0.206 [0.159-0.265]; P < 0.0001); 36-month PFS rates were 68.0% versus 13.9%, respectively. The results are consistent with the primary analysis findings (HR = 0.203, as assessed by independent review committee, with 17-month median follow-up). Median overall survival was not reached in either arm; HR (95% CI) for ibrutinib+BR versus placebo: 0.652 (0.454-0.935; P = 0.019). Minimal residual disease (MRD)-negative response rates were 26.3% for ibrutinib+BR and 6.2% for placebo+BR (P < 0.0001). Incidence of treatment-emergent adverse events (including grades 3-4) were generally consistent with the initial HELIOS report. These long-term data support improved survival outcomes and deepening responses with ibrutinib+BR compared with BR in relapsed CLL/SLL.
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Affiliation(s)
- G Fraser
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada.
| | - P Cramer
- Department of Internal Medicine, Center of Integrated Oncology and German CLL Study Group, University of Cologne, Cologne, Germany
| | - F Demirkan
- Division of Hematology, Dokuz Eylul University, Izmir, Turkey
| | - R Santucci Silva
- IEP São Lucas/Hemomed Oncologia e Hematologia, São Paulo, Brazil
| | - S Grosicki
- Department of Cancer Prevention, Faculty of Public Health, Silesian Medical University, Katowice, Poland
| | - A Pristupa
- Regional Clinical Hospital, Ryazan, Russia
| | - A Janssens
- Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - J Mayer
- Department of Internal Medicine, Hematology and Oncology, Masaryk University Hospital Brno, Jihlavska, Brno, Czech Republic
| | - N L Bartlett
- Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA
| | | | - H Pylypenko
- Department of Hematology, Cherkassy Regional Oncological Center, Cherkassy, Ukraine
| | - J Loscertales
- Hematology Department, Hospital Universitario La Princesa, IIS-IP, Madrid, Spain
| | - A Avigdor
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, University of Tel-Aviv, Tel-Aviv, Israel
| | - S Rule
- Department of Haematology, Plymouth University Medical School, Plymouth, UK
| | - D Villa
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - O Samoilova
- Nizhny Novogorod Regional Clinical Hospital, Nizhny Novogorod, Russia
| | - P Panagiotidis
- 1st Department of Propedeutic Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Goy
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | - M A Pavlovsky
- Department of Hematology, Fundaleu, Buenos Aires, Argentina
| | - C Karlsson
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - M Hallek
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - M Mahler
- Janssen Research & Development, Raritan, NJ, USA
| | - M Salman
- Janssen Research & Development, Raritan, NJ, USA
| | - S Sun
- Janssen Research & Development, Raritan, NJ, USA
| | - C Phelps
- Janssen Research & Development, Raritan, NJ, USA
| | | | - A Howes
- Janssen Research & Development, High Wycombe, UK
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28
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Zhang Z, Cramer P, Maldow D, McBride A, Park L, Krauthamer A, Rosenkrantz A. Abstract No. 485 Looking ahead to move ahead: recruiting female and male medical students to close the gender gap in interventional radiology. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.566] [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: 11/26/2022] Open
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29
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Al-Sawaf O, Herling CD, Holtick U, Scheid C, Cramer P, Sasse S, von Tresckow B, Tuchscherer A, Fischer K, Eichhorst B, Hallek M, Frenzel LP. Venetoclax plus rituximab or obinutuzumab after allogeneic hematopoietic stem cell transplantation in chronic lymphocytic leukemia. Haematologica 2019; 104:e224-e226. [PMID: 30792201 DOI: 10.3324/haematol.2018.212837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Othman Al-Sawaf
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Carmen Diana Herling
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Udo Holtick
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Christoph Scheid
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Paula Cramer
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Stephanie Sasse
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Bastian von Tresckow
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Armin Tuchscherer
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Kirsten Fischer
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Barbara Eichhorst
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Michael Hallek
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Lukas P Frenzel
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, Germany
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30
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Alsahafi M, Cramer P, Chatur N, Donnellan F. The impact of inpatient capsule endoscopy on the need for therapeutic interventions in patients with obscure gastrointestinal bleeding. Saudi J Gastroenterol 2019; 26:53-60. [PMID: 31997779 PMCID: PMC7045773 DOI: 10.4103/sjg.sjg_415_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND/AIM There are limited data evaluating the impact of inpatient video capsule endoscopy (VCE) on the need for therapeutic interventions in hospitalized patients with obscure gastrointestinal bleeding (OGIB). The objective of this study was to determine the impact of inpatient VCE on the need for therapeutic interventions and rehospitalization for recurrent bleeding. PATIENTS AND METHODS Hospitalized patients who underwent VCE for OGIB indication were retrospectively included. Clinical data were collected including therapeutic interventions performed after VCE. Specific therapeutic interventions were defined as the medical, endoscopic, or surgical treatment directly targeting the cause of OGIB. Patients were followed up to determine the rate of rehospitalization. RESULTS A total of 48 inpatient VCE were identified, of which 43 VCE were performed for OGIB indication and were included for analysis. The completion rate and the diagnostic yield were 78.5% and 55.8%, respectively. Subsequent specific therapeutic interventions were performed in 65.2% and 5.8% of patients with positive and negative VCE, respectively (P < 0.001). After a median follow up of 30 months (minimum 12, maximum 58), rehospitalization for recurrent bleeding occurred in 30.4% and 17% of patients with positive and negative VCE, respectively. Patients with angiodysplasia on VCE were significantly more likely to be readmitted (P = 0.02). Throughout the course of the follow-up, only 2 (11.7%) patients with negative VCE underwent specific therapeutic interventions. CONCLUSION Inpatient VCE is an effective tool to identify patients who need specific therapeutic interventions. Patients with negative VCE are unlikely to be readmitted or require specific therapeutic interventions in the index admission.
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Affiliation(s)
- Majid Alsahafi
- Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada,Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,Address for correspondence: Dr. Majid Alsahafi, Department of Medicine, King Abdulaziz University, Building 10, second Floor, P.O. Box 80215, Jeddah - 21589, Saudi Arabia. E-mail:
| | - Paula Cramer
- Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nazira Chatur
- Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fergal Donnellan
- Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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31
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Burger JA, Cramer P, Barr PM, Dilhuydy M, Mato A, Byrd JC, Chang S, Graef T, Lin T, Tedeschi A. Ibrutinib provides favourable survival outcomes in patients with comorbidities
versus
established therapies. Br J Haematol 2019; 186:175-180. [DOI: 10.1111/bjh.15784] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jan A. Burger
- University of Texas MD Anderson Cancer Center Houston TX USA
| | - Paula Cramer
- German CLL Study Group University of Cologne Cologne Germany
| | - Paul M. Barr
- University of Rochester Cancer Center Rochester NY USA
| | | | - Anthony Mato
- Memorial Sloan Kettering Cancer Center New York City NYUSA
| | | | - Stephen Chang
- Pharmacyclics LLC, an AbbVie Company Sunnyvale CA USA
| | | | - Tony Lin
- Pharmacyclics LLC, an AbbVie Company Sunnyvale CA USA
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32
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Brown JR, Moslehi J, Ewer MS, O'Brien SM, Ghia P, Cymbalista F, Shanafelt TD, Fraser G, Rule S, Coutre SE, Dilhuydy MS, Cramer P, Jaeger U, Dreyling M, Byrd JC, Treon S, Liu EY, Chang S, Bista A, Vempati R, Boornazian L, Valentino R, Reddy V, Mahler M, Yang H, Graef T, Burger JA. Incidence of and risk factors for major haemorrhage in patients treated with ibrutinib: An integrated analysis. Br J Haematol 2018; 184:558-569. [PMID: 30506764 PMCID: PMC6587776 DOI: 10.1111/bjh.15690] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/15/2018] [Indexed: 01/16/2023]
Abstract
Ibrutinib, a Bruton tyrosine kinase inhibitor, is approved for treatment of various B‐cell malignancies. In ibrutinib clinical studies, low‐grade haemorrhage was common, whereas major haemorrhage (MH) was infrequent. We analysed the incidence of and risk factors for MH from 15 ibrutinib clinical studies (N = 1768), including 4 randomised controlled trials (RCTs). Rates of any‐grade bleeding were similar for single‐agent ibrutinib and ibrutinib combinations (39% and 40%). Low‐grade bleeding was more common in ibrutinib‐treated than comparator‐treated patients (35% and 15%), and early low‐grade bleeding was not associated with MH. The proportion of MH in RCTs was higher with ibrutinib than comparators (4.4% vs. 2.8%), but after adjusting for longer exposure with ibrutinib (median 13 months vs. 6 months), the incidence of MH was similar (3.2 vs. 3.1 per 1000 person‐months). MH led to treatment discontinuation in 1% of all ibrutinib‐treated patients. Use of anticoagulants and/or antiplatelets (AC/AP) during the study was common (~50% of patients) and had an increased exposure‐adjusted relative risk for MH in both the total ibrutinib‐treated population (1.9; 95% confidence interval, 1.2–3.0) and RCT comparator‐treated patients (2.4; 95% confidence interval, 1.0–5.6), indicating that ibrutinib may not alter the effect of AC/AP on the risk of MH in B‐cell malignancies.
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Affiliation(s)
- Jennifer R Brown
- Chronic Lymphocytic Leukemia Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Michael S Ewer
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan M O'Brien
- Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA, USA
| | - Paolo Ghia
- Strategic Research Program on CLL, Università Vita-Salute San Raffaele Milano and IRCCS Istituto Scientifico San Raffaele, Milan, Italy
| | | | | | - Graeme Fraser
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Simon Rule
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | | | | | - Paula Cramer
- German CLL Study Group, University of Cologne, Cologne, Germany
| | | | | | - John C Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Emily Y Liu
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | - Stephen Chang
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | - Amulya Bista
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | - Rama Vempati
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | | | | | - Vijay Reddy
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | | | - Huiying Yang
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | - Thorsten Graef
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | - Jan A Burger
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Al-Sawaf O, Bahlo J, Robrecht S, Fischer K, Herling CD, Hoechstetter M, Fink AM, von Tresckow J, Langerbeins P, Cramer P, Stilgenbauer S, Wendtner CM, Eichhorst B, Hallek M, Goede V. Outcome of patients aged 80 years or older treated for chronic lymphocytic leukaemia. Br J Haematol 2018; 183:727-735. [PMID: 30460980 DOI: 10.1111/bjh.15604] [Citation(s) in RCA: 6] [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: 05/18/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022]
Abstract
Clinical management of chronic lymphocytic leukaemia (CLL) in patients aged ≥80 years is based on limited evidence due to the lack of published information. Therefore, we analysed CLL patients aged ≥80 years using data from seven phase III clinical trials of the German CLL Study Group. Among 3552 participants, 152 were ≥80 years old at initiation of first-line study treatment. Median age was 82 years (range 80-90). Concomitant diseases were present in 99% of the patients, with a median cumulative illness rating scale score of 8 (0-18). Chemoimmunotherapy with chlorambucil-obinutuzumab (CLB-OB) or chlorambucil-rituximab (CLB-R) was administered to 61 (40%) and 56 (37%) patients. The remaining patients received CLB (n = 19) or fludarabine (F, n = 10), F/cyclophosphamide (FC, n = 1), FC/rituximab (FCR, n = 2) or bendamustine/rituximab (BR, n = 3). Rates of grade 3 or 4 neutropenia and infections were 35% and 13%. Overall response rate was 77% with 13% complete remissions. Median progression-free survival and treatment-free survival were 17·2 and 32·3 months, respectively. Median overall survival was 48·3 months; adverse events (22%) and progressive CLL (16·4%) were the most frequent causes of death. These findings suggest that anti-leukaemic treatment including chemoimmunotherapy is feasible and efficacious in ≥80-year-old CLL patients. However, this group of patients lives for a shorter time than age-matched controls of the general population.
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Affiliation(s)
- Othman Al-Sawaf
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Carmen D Herling
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Manuela Hoechstetter
- Department of Haematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, German CLL Study Group, Hospital Munich-Schwabing, Munich, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Julia von Tresckow
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Paula Cramer
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | | | - Clemens M Wendtner
- Department of Haematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, German CLL Study Group, Hospital Munich-Schwabing, Munich, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany.,Cologne Cluster of Excellence in Cellular Stress Responses in Aging-associated Disease (CECAD), University of Cologne, Cologne, Germany
| | - Valentin Goede
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany.,Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital, Cologne, Germany
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34
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Pflug N, Cramer P, Robrecht S, Bahlo J, Westermann A, Fink AM, Schrader A, Mayer P, Oberbeck S, Seiler T, Zenz T, Dürig J, Kreuzer KA, Stilgenbauer S, Eichhorst B, Hallek M, Herling M, Hopfinger G. New lessons learned in T-PLL: results from a prospective phase-II trial with fludarabine-mitoxantrone-cyclophosphamide-alemtuzumab induction followed by alemtuzumab maintenance. Leuk Lymphoma 2018; 60:649-657. [PMID: 30234404 DOI: 10.1080/10428194.2018.1488253] [Citation(s) in RCA: 8] [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: 10/28/2022]
Abstract
Clinical trials in T-cell prolymphocytic leukemia (T-PLL) are scarce. Based on a precursor study testing fludarabine, mitoxantrone, and cyclophosphamide followed by alemtuzumab (FMC-A), we aimed to improve this regimen by upfront combining subcutaneous (s.c.) alemtuzumab with FMC for four cycles followed by an alemtuzumab-maintenance (FMCA + A). This prospective multicenter phase-II trial assessed response, survival, and toxicity of that regimen administered to pretreated (n = 4) and treatment-naïve (n = 12) T-PLL patients. The best overall response rate after FMCA was 68.8% (n = 11) including five CRs (31.3%) and six PRs (37.5%). Six patients entered the alemtuzumab-maintenance. Median overall and progression-free survival was 16.7 and 11.2 months, respectively. Hematologic toxicities were the most frequent grade 3/4 side effects. A reduced incidence of CMV-reactivations was attributed to the prophylactic administration of valganciclovir. Overall, FMCA + A did not improve the efficacy of the FMC-A-regimen or of single i.v. alemtuzumab. It suggests that a chemotherapy backbone prevents efficient alemtuzumab dosing and confirms that intravenous alemtuzumab is to be preferred over its s.c. route in T-PLL. ClinicalTrials.gov identifier: NCT01186640.
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Affiliation(s)
- Natali Pflug
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Paula Cramer
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Sandra Robrecht
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Jasmin Bahlo
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Anne Westermann
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Anna-Maria Fink
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Alexandra Schrader
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Petra Mayer
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Sebastian Oberbeck
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Till Seiler
- b Medizinische Klinik und Poliklinik III , LMU University of Munich , Munich , Germany
| | - Thorsten Zenz
- c National Center for Tumor Diseases Heidelberg , Heidelberg , Germany
| | - Jan Dürig
- d Klinik für Hämatologie , University of Essen , Essen , Germany
| | - Karl-Anton Kreuzer
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | | | - Barbara Eichhorst
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Michael Hallek
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Marco Herling
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Georg Hopfinger
- f AKH Wien , Universitätsklinik für Innere Medizin I , Vienna , Austria
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Cramer P, von Tresckow J, Bahlo J, Robrecht S, Langerbeins P, Al-Sawaf O, Engelke A, Fink AM, Fischer K, Tausch E, Seiler T, Fischer von Weikersthal L, Hebart H, Kreuzer KA, Böttcher S, Ritgen M, Kneba M, Wendtner CM, Stilgenbauer S, Eichhorst B, Hallek M. Bendamustine followed by obinutuzumab and venetoclax in chronic lymphocytic leukaemia (CLL2-BAG): primary endpoint analysis of a multicentre, open-label, phase 2 trial. Lancet Oncol 2018; 19:1215-1228. [DOI: 10.1016/s1470-2045(18)30414-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 12/21/2022]
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36
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O'Brien S, Hillmen P, Coutre S, Barr PM, Fraser G, Tedeschi A, Burger JA, Dilhuydy MS, Hess G, Moreno C, Cramer P, Liu E, Chang S, Vermeulen J, Styles L, Howes A, James DF, Patel K, Graef T, Valentino R. Safety Analysis of Four Randomized Controlled Studies of Ibrutinib in Patients With Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma or Mantle Cell Lymphoma. Clin Lymphoma Myeloma Leuk 2018; 18:648-657.e15. [PMID: 30061088 DOI: 10.1016/j.clml.2018.06.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/16/2018] [Accepted: 06/19/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Multiple studies have demonstrated the efficacy and safety of ibrutinib for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and mantle cell lymphoma (MCL). This first-in-class inhibitor of Bruton's tyrosine kinase has become a standard treatment for patients with CLL and MCL. PATIENTS AND METHODS We conducted an integrated safety analysis to characterize the frequency, severity, natural history, and outcomes of adverse events (AEs) with ibrutinib versus comparators. Data were pooled from 4 completed randomized controlled studies that had included 756 ibrutinib-treated and 749 comparator-treated patients with CLL/SLL or relapsed/refractory MCL. Safety analyses included reporting of AEs using crude and exposure-adjusted incidence rates. RESULTS The median treatment duration was 13.3 months (maximum, 28.2 months) for ibrutinib and 5.8 months (maximum, 27.3 months) for comparators. When adjusted for exposure, diarrhea, atrial fibrillation, and hypertension were the only common grade ≥ 3 AEs more often reported with ibrutinib than with the comparators. Dose reductions (7% vs. 14%) and discontinuation (12% vs. 16%) because of AEs occurred less often with ibrutinib, and deaths due to AEs occurred at similar rates (6% vs. 7%). When adjusted for exposure, the corresponding data were all lower with ibrutinib than with the comparators (0.06 vs. 0.22, 0.11 vs. 0.22, and 0.06 vs. 0.09 patient-exposure-years, respectively). The prevalence of common grade 3/4 AEs with ibrutinib generally decreased over time, with the exception of hypertension. CONCLUSION These results from an integrated analysis support a favorable benefit/risk profile of ibrutinib in patients with CLL/SLL and MCL.
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Affiliation(s)
- Susan O'Brien
- Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange, CA.
| | - Peter Hillmen
- The Leeds Teaching Hospitals, St. James University Hospital, Leeds, United Kingdom
| | - Steven Coutre
- Stanford University School of Medicine, Stanford, CA
| | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester Cancer Center, Rochester, NY
| | - Graeme Fraser
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | - Jan A Burger
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Georg Hess
- Universitats Medizin Mainz, Mainz, Germany
| | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Paula Cramer
- University of Cologne, German CLL Study Group, Cologne, Germany
| | - Emily Liu
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | | | | | - Lori Styles
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
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37
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Julia VT, Cramer P, Bahlo J, Robrecht S, Al-Sawaf O, Langerbeins P, Fürstenau M, Engelke A, Fink AM, Fischer K, Kreuzer KA, Ritgen M, Boettcher S, Wendtner CM, Stilgenbauer S, Eichhorst B, Hallek MJ. Comparison of different phase II studies using sequential combinations of targeted agents for treating chronic lymphocytic leukemia. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Von Tresckow Julia
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Paula Cramer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Colgne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Colgne, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Moritz Fürstenau
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Anja Engelke
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Karl A Kreuzer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Matthias Ritgen
- 2nd Department of Internal Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sebastian Boettcher
- Clinic III, Hematology, Oncology and Palliative Medicine, University of Rostock, Rostock, Germany
| | - Clemens Martin Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | | | - Barbara Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Michael J. Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, CECAD Cluster of Excellence at the University of Cologne, Clinical Research Unit (KFO) 286, German CLL Study Group, University of Cologne, Cologne, Germany
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Alsahafi MA, Cramer P, Chatur N, Donnellan F. A274 THE EFFECT OF PRUCALOPRIDE ON SMALL BOWEL TRANSIT TIME FOR INPATIENTS UNDERGOING SMALL BOWEL CAPSULE ENDOSCOPY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.275] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M A Alsahafi
- Vancouver General Hospital, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - P Cramer
- Vancouver General Hospital, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - N Chatur
- Vancouver General Hospital, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - F Donnellan
- Vancouver General Hospital, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
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39
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Cramer P, von Tresckow J, Bahlo J, Engelke A, Langerbeins P, Fink AM, Fischer K, Wendtner CM, Kreuzer KA, Stilgenbauer S, Böttcher S, Eichhorst B, Hallek M. CLL2-BXX Phase II trials: sequential, targeted treatment for eradication of minimal residual disease in chronic lymphocytic leukemia. Future Oncol 2018; 14:499-513. [PMID: 29465308 DOI: 10.2217/fon-2017-0442] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Four Phase II trials (clinical trials numbers: NCT02345863, NCT02401503, NCT02445131 and NCT02689141) evaluate a different combination of targeted agents in an all-comer population of approximately 60 patients with chronic lymphocytic leukemia irrespective of prior treatment, physical fitness and genetic risk factors. Patients with a higher tumor load start with a debulking treatment with bendamustine. The subsequent induction and maintenance treatment with an anti-CD20 antibody (obinutuzumab or ofatumumab) and a targeted oral agent (ibrutinib, idelalisib or venetoclax) are continued until achievement of a complete response and minimal residual disease negativity. CONCLUSION This strategy represents a new era of chronic lymphocytic leukemia therapy where chemotherapy is increasingly replaced by targeted agents and treatment duration is tailored to the patient's individual tumor load and response.
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Affiliation(s)
- Paula Cramer
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Julia von Tresckow
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Anja Engelke
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Clemens-Martin Wendtner
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany.,Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases & Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | - Karl-Anton Kreuzer
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | | | - Sebastian Böttcher
- Department III of Internal Medicine, University Hospital Rostock, Rostock, Germany.,Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
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40
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Herling CD, Abedpour N, Weiss J, Schmitt A, Jachimowicz RD, Merkel O, Cartolano M, Oberbeck S, Mayer P, Berg V, Thomalla D, Kutsch N, Stiefelhagen M, Cramer P, Wendtner CM, Persigehl T, Saleh A, Altmüller J, Nürnberg P, Pallasch C, Achter V, Lang U, Eichhorst B, Castiglione R, Schäfer SC, Büttner R, Kreuzer KA, Reinhardt HC, Hallek M, Frenzel LP, Peifer M. Clonal dynamics towards the development of venetoclax resistance in chronic lymphocytic leukemia. Nat Commun 2018; 9:727. [PMID: 29463802 PMCID: PMC5820258 DOI: 10.1038/s41467-018-03170-7] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [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: 05/12/2017] [Accepted: 01/24/2018] [Indexed: 12/20/2022] Open
Abstract
Deciphering the evolution of cancer cells under therapeutic pressure is a crucial step to understand the mechanisms that lead to treatment resistance. To this end, we analyzed whole-exome sequencing data of eight chronic lymphocytic leukemia (CLL) patients that developed resistance upon BCL2-inhibition by venetoclax. Here, we report recurrent mutations in BTG1 (2 patients) and homozygous deletions affecting CDKN2A/B (3 patients) that developed during treatment, as well as a mutation in BRAF and a high-level focal amplification of CD274 (PD-L1) that might pinpoint molecular aberrations offering structures for further therapeutic interventions. BCL2-inhibitor venetoclax is used to treat relapsed/refractory chronic lymphocytic leukemia (CLL). Here, the authors show the clonal dynamics towards venetoclax resistance by performing whole-exome sequencing of 8 CLL patients undergoing venetoclax treatment.
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Affiliation(s)
- Carmen D Herling
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany
| | - Nima Abedpour
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, 50931 Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany
| | - Jonathan Weiss
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany
| | - Anna Schmitt
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
| | - Ron Daniel Jachimowicz
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
| | - Olaf Merkel
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
| | - Maria Cartolano
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, 50931 Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany
| | - Sebastian Oberbeck
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany.,Laboratory of Lymphocyte Signaling and Oncoproteom, University of Cologne, 50931 Cologne, Germany
| | - Petra Mayer
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany.,Laboratory of Lymphocyte Signaling and Oncoproteom, University of Cologne, 50931 Cologne, Germany
| | - Valeska Berg
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
| | - Daniel Thomalla
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
| | - Nadine Kutsch
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany
| | - Marius Stiefelhagen
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany
| | - Paula Cramer
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany
| | - Clemens-Martin Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, 80804 Munich, Germany
| | - Thorsten Persigehl
- Department of Radiology, Cologne University Hospital, 50937 Cologne, Germany
| | - Andreas Saleh
- Department of Diagnostic and Interventional Radiology and Pediatric Radiology, Städtisches Klinikum München Schwabing, 80804 Munich, Germany
| | - Janine Altmüller
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany.,Cologne Center for Genomics (CCG), University of Cologne, 50931 Cologne, Germany
| | - Peter Nürnberg
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany.,Cologne Center for Genomics (CCG), University of Cologne, 50931 Cologne, Germany
| | - Christian Pallasch
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
| | - Viktor Achter
- Computing Center, University of Cologne, 50931 Cologne, Germany
| | - Ulrich Lang
- Computing Center, University of Cologne, 50931 Cologne, Germany.,Department of Informatics, University of Cologne, 50931 Cologne, Germany
| | - Barbara Eichhorst
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany
| | | | - Stephan C Schäfer
- Department of Pathology, University of Cologne, 50937, Cologne, Germany
| | - Reinhard Büttner
- Department of Pathology, University of Cologne, 50937, Cologne, Germany
| | - Karl-Anton Kreuzer
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany
| | - Hans Christian Reinhardt
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
| | - Michael Hallek
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
| | - Lukas P Frenzel
- Department of Internal Medicine I, Center of Integrated Oncology Cologne-Bonn, University of Cologne, 50937 Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
| | - Martin Peifer
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, 50931 Cologne, Germany. .,Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany.
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Cramer P, Fraser G, Santucci-Silva R, Grosicki S, Dilhuydy MS, Janssens A, Loscertales J, Rule S, Goy A, Traina S, Chan EKH, Diels J, Sengupta N, Mahler M, Salman M, Howes A, Chanan-Khan A. Improvement of fatigue, physical functioning, and well-being among patients with severe impairment at baseline receiving ibrutinib in combination with bendamustine and rituximab for relapsed chronic lymphocytic leukemia/small lymphocytic lymphoma in the HELIOS study. Leuk Lymphoma 2018; 59:2075-2084. [DOI: 10.1080/10428194.2017.1416364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Paula Cramer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Graeme Fraser
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | | | | | - Ann Janssens
- Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Javier Loscertales
- Hematology Department, Hospital Universitario La Princesa, IIS-IP, Madrid, Spain
| | - Simon Rule
- Plymouth University Medical School, Plymouth, UK
| | - Andre Goy
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | | | | | - Joris Diels
- Janssen EU HEMAR Statistics & Modelling, Beerse, Belgium
| | | | | | | | - Angela Howes
- Janssen Research & Development, High Wycombe, UK
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Kovacs G, Robrecht S, Fink AM, Bahlo J, Cramer P, von Tresckow J, Maurer C, Langerbeins P, Fingerle-Rowson G, Ritgen M, Kneba M, Döhner H, Stilgenbauer S, Klapper W, Wendtner CM, Fischer K, Hallek M, Eichhorst B, Böttcher S. Minimal Residual Disease Assessment Improves Prediction of Outcome in Patients With Chronic Lymphocytic Leukemia (CLL) Who Achieve Partial Response: Comprehensive Analysis of Two Phase III Studies of the German CLL Study Group. J Clin Oncol 2017; 34:3758-3765. [PMID: 27573660 DOI: 10.1200/jco.2016.67.1305] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose To determine the value of minimal residual disease (MRD) assessments, together with the evaluation of clinical response in chronic lymphocytic leukemia according to the 2008 International Workshop on Chronic Lymphocytic Leukemia criteria. Patients and Methods Progression-free survival (PFS) and overall survival of 554 patients from two randomized trials of the German CLL Study Group (CLL8: fludarabine and cyclophosphamide [FC] v FC plus rituximab; CLL10: FC plus rituximab v bendamustine plus rituximab) were analyzed according to MRD assessed in peripheral blood at a threshold of 10-4 and clinical response. The prognostic value of different parameters defining a partial response (PR) was further investigated. Results Patients with MRD-negative complete remission (CR), MRD-negative PR, MRD-positive CR, and MRD-positive PR experienced a median PFS from a landmark at end of treatment of 61 months, 54 months, 35 months, and 21 months, respectively. PFS did not differ significantly between MRD-negative CR and MRD-negative PR; however, PFS was longer for MRD-negative PR than for MRD-positive CR ( P = .048) and for MRD-positive CR compared with MRD-positive PR ( P = .002). Compared with MRD-negative CR, only patients with MRD-positive PR had a significantly shorter overall survival (not reached v 72 months; P = .001), whereas there was no detectable difference for patients with MRD-negative PR or MRD-positive CR ( P = 0.612 and P = 0.853, respectively). Patients with MRD-negative PR who presented with residual splenomegaly had only a similar PFS (63 months) compared with patients with MRD-negative CR (61 months; P = .354), whereas patients with MRD-negative PR with lymphadenopathy showed a shorter PFS (31 months; P < .001). Conclusion MRD quantification allows for improved PFS prediction in both patients who achive PR and CR, which thus supports its application in all responders. In contrast to residual lymphadenopathy, persisting splenomegaly does not impact outcome in patients with MRD-negative PR.
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Affiliation(s)
- Gabor Kovacs
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Sandra Robrecht
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Anna Maria Fink
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Jasmin Bahlo
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Paula Cramer
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Julia von Tresckow
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Christian Maurer
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Petra Langerbeins
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Günter Fingerle-Rowson
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Matthias Ritgen
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Michael Kneba
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Hartmut Döhner
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Stephan Stilgenbauer
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Wolfram Klapper
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Clemens-Martin Wendtner
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Kirsten Fischer
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Michael Hallek
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Barbara Eichhorst
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Sebastian Böttcher
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
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Kohler R, Mooney RA, Mills DJ, Landick R, Cramer P. Architecture of a transcribing-translating expressome. Science 2017; 356:194-197. [PMID: 28408604 DOI: 10.1126/science.aal3059] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 03/15/2017] [Indexed: 11/02/2022]
Abstract
DNA transcription is functionally coupled to messenger RNA (mRNA) translation in bacteria, but how this is achieved remains unclear. Here we show that RNA polymerase (RNAP) and the ribosome of Escherichia coli can form a defined transcribing and translating "expressome" complex. The cryo-electron microscopic structure of the expressome reveals continuous protection of ~30 nucleotides of mRNA extending from the RNAP active center to the ribosome decoding center. The RNAP-ribosome interface includes the RNAP subunit α carboxyl-terminal domain, which is required for RNAP-ribosome interaction in vitro and for pronounced cell growth defects upon translation inhibition in vivo, consistent with its function in transcription-translation coupling. The expressome structure can only form during transcription elongation and explains how translation can prevent transcriptional pausing, backtracking, and termination.
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Affiliation(s)
- R Kohler
- Max Planck Institute for Biophysical Chemistry, Department of Molecular Biology, Am Fassberg 11, 37077 Göttingen, Germany
| | - R A Mooney
- Department of Biochemistry, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - D J Mills
- Max Planck Institute for Biophysics, Department of Structural Biology, Max-von-Laue-Straße 3, 60438 Frankfurt am Main, Germany
| | - R Landick
- Department of Biochemistry, University of Wisconsin-Madison, Madison, WI 53706, USA.
| | - P Cramer
- Max Planck Institute for Biophysical Chemistry, Department of Molecular Biology, Am Fassberg 11, 37077 Göttingen, Germany.
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Schilbach S, Hantsche M, Tegunov D, Dienemann C, Wigge C, Urlaub H, Cramer P. Structures of transcription pre-initiation complex with TFIIH and Mediator. Nature 2017; 551:204-209. [PMID: 29088706 PMCID: PMC6078178 DOI: 10.1038/nature24282] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [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: 07/09/2017] [Accepted: 09/14/2017] [Indexed: 12/18/2022]
Abstract
For the initiation of transcription, RNA polymerase II (Pol II) assembles with general transcription factors on promoter DNA to form the pre-initiation complex (PIC). Here we report cryo-electron microscopy structures of the Saccharomyces cerevisiae PIC and PIC-core Mediator complex at nominal resolutions of 4.7 Å and 5.8 Å, respectively. The structures reveal transcription factor IIH (TFIIH), and suggest how the core and kinase TFIIH modules function in the opening of promoter DNA and the phosphorylation of Pol II, respectively. The TFIIH core subunit Ssl2 (a homologue of human XPB) is positioned on downstream DNA by the 'E-bridge' helix in TFIIE, consistent with TFIIE-stimulated DNA opening. The TFIIH kinase module subunit Tfb3 (MAT1 in human) anchors the kinase Kin28 (CDK7), which is mobile in the PIC but preferentially located between the Mediator hook and shoulder in the PIC-core Mediator complex. Open spaces between the Mediator head and middle modules may allow access of the kinase to its substrate, the C-terminal domain of Pol II.
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Affiliation(s)
- S Schilbach
- Max Planck Institute for Biophysical Chemistry, Department of Molecular Biology, Am Fassberg 11, 37077 Göttingen, Germany
| | - M Hantsche
- Max Planck Institute for Biophysical Chemistry, Department of Molecular Biology, Am Fassberg 11, 37077 Göttingen, Germany
| | - D Tegunov
- Max Planck Institute for Biophysical Chemistry, Department of Molecular Biology, Am Fassberg 11, 37077 Göttingen, Germany
| | - C Dienemann
- Max Planck Institute for Biophysical Chemistry, Department of Molecular Biology, Am Fassberg 11, 37077 Göttingen, Germany
| | - C Wigge
- Max Planck Institute for Biophysical Chemistry, Department of Molecular Biology, Am Fassberg 11, 37077 Göttingen, Germany
| | - H Urlaub
- Max Planck Institute for Biophysical Chemistry, Department of Molecular Biology, Am Fassberg 11, 37077 Göttingen, Germany
- University Medical Center Göttingen, Institute of Clinical Chemistry, Bioanalytics Group, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - P Cramer
- Max Planck Institute for Biophysical Chemistry, Department of Molecular Biology, Am Fassberg 11, 37077 Göttingen, Germany
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Brown JR, Moslehi J, O'Brien S, Ghia P, Hillmen P, Cymbalista F, Shanafelt TD, Fraser G, Rule S, Kipps TJ, Coutre S, Dilhuydy MS, Cramer P, Tedeschi A, Jaeger U, Dreyling M, Byrd JC, Howes A, Todd M, Vermeulen J, James DF, Clow F, Styles L, Valentino R, Wildgust M, Mahler M, Burger JA. Characterization of atrial fibrillation adverse events reported in ibrutinib randomized controlled registration trials. Haematologica 2017; 102:1796-1805. [PMID: 28751558 PMCID: PMC5622864 DOI: 10.3324/haematol.2017.171041] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [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] [Received: 04/17/2017] [Accepted: 07/18/2017] [Indexed: 12/22/2022] Open
Abstract
The first-in-class Bruton's tyrosine kinase inhibitor ibrutinib has proven clinical benefit in B-cell malignancies; however, atrial fibrillation (AF) has been reported in 6-16% of ibrutinib patients. We pooled data from 1505 chronic lymphocytic leukemia and mantle cell lymphoma patients enrolled in four large, randomized, controlled studies to characterize AF with ibrutinib and its management. AF incidence was 6.5% [95% Confidence Interval (CI): 4.8, 8.5] for ibrutinib at 16.6-months versus 1.6% (95%CI: 0.8, 2.8) for comparator and 10.4% (95%CI: 8.4, 12.9) at the 36-month follow up; estimated cumulative incidence: 13.8% (95%CI: 11.2, 16.8). Ibrutinib treatment, prior history of AF and age 65 years or over were independent risk factors for AF. Multiple AF events were more common with ibrutinib (44.9%; comparator, 16.7%) among patients with AF. Most (85.7%) patients with AF did not discontinue ibrutinib, and more than half received common anticoagulant/antiplatelet medications on study. Low-grade bleeds were more frequent with ibrutinib, but serious bleeds were uncommon (ibrutinib, 2.9%; comparator, 2.0%). Although the AF rate among older non-trial patients with comorbidities is likely underestimated by this dataset, these results suggest that AF among clinical trial patients is generally manageable without ibrutinib discontinuation (clinicaltrials.gov identifier: 01578707, 01722487, 01611090, 01646021).
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Affiliation(s)
| | - Javid Moslehi
- Division of Cardiovascular Medicine and Cardio-Oncology Program Vanderbilt School of Medicine, Nashville, TN, USA
| | - Susan O'Brien
- Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange, CA, USA
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele, Milano, Italy
| | - Peter Hillmen
- CA Leeds Teaching Hospitals, St. James Institute of Oncology, Leeds, UK
| | | | | | - Graeme Fraser
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Simon Rule
- Department of Haematology, Plymouth University Medical School, Plymouth, UK
| | | | - Steven Coutre
- Stanford University School of Medicine and Stanford Cancer Institute, Stanford, CA, USA
| | | | - Paula Cramer
- Department I of Internal Medicine and German CLL Study Group, University of Cologne, Germany
| | | | | | - Martin Dreyling
- Department of Medicine III, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Germany
| | - John C Byrd
- Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Angela Howes
- Janssen Research & Development, High Wycombe, UK
| | - Michael Todd
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | | | | | | | | | | | - Mark Wildgust
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | | | - Jan A Burger
- Leukemia Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Kipps TJ, Fraser G, Coutre S, Brown JR, Barrientos JC, Barr PM, Byrd JC, O'Brien SM, Dilhuydy MS, Devereux S, Jaeger U, Moreno C, Cramer P, Stilgenbauer S, Chanan-Khan AA, Mahler M, Salman M, Cheng M, Londhe A, Ninomoto J, Howes A, James D, Hallek M. Abstract CT158: Unmutated IGHV is not an adverse predictor of outcome to therapy with ibrutinib in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-ct158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients (pts) with CLL/SLL who use unmutated IGHV (u-CLL) have a less favorable outcome with standard chemotherapy than pts who use mutated IGHV (m-CLL). Ibrutinib (ibr) inhibits B-cell receptor signaling through Bruton’s tyrosine kinase and has robust clinical activity against CLL. This integrated analysis of 3 phase 3 studies examined the impact of IGHV status on ibr- and comparator (comp)-treated pts.
Methods: Pooled data from 3 studies of ibr (420 mg/d) in CLL/SLL pts (RESONATE: relapsed/refractory [R/R] pts, ibr vs ≤ 24 weeks ofatumumab; RESONATE-2: treatment-naïve [TN] pts ≥ 65 yrs of age [no del17p], ibr vs ≤ 12 cycles chlorambucil; HELIOS: R/R pts [no del17p], ≤ 6 cycles bendamustine-rituximab with ibr vs placebo) were analyzed by IGHV status. Analyses included Kaplan-Meier method (overall survival [OS]; progression-free survival [PFS]); log-rank test (group comparisons); and Cox multivariate analysis (prognostic factors; Table).
Results: For 491 ibr- (366 u-CLL, 125 m-CLL) and 494 comp-treated (351 u-CLL, 143 m-CLL) pts with IGHV data, baseline characteristics were similar for u-CLL vs m-CLL, except for the proportions of pts who were TN (17 vs 31%), had bulky disease (60 vs 37%), or had CLL cells with del11q (32 vs 16%). Median follow up was 21.4 mos for ibr and 20.6 mos for comp. PFS and OS were similar for u-CLL and m-CLL ibr-treated pts; u-CLL had poorer outcomes than m-CLL in comp-treated pts, which remained after adjustment for prognostic factors (Table). Ibr treatment was more effective than comp regardless of IGHV status. Incidence of adverse events (AEs) was similar between groups. For ibr vs comp pts (u-CLL/m-CLL): serious AEs: 49% (50%/47%) vs 36.5% (37%/35%); AEs that led to discontinuation: 12% (11%/15%) vs 13% (13%/14%); death within 30 days of last dose: 5% (6%/3%) vs 5% (6%/2%).
Conclusions: U-CLL was an adverse predictor of outcome for comp-treated, but not for ibr-treated pts.
Table.Efficacy Outcomes in Ibr- and Comparator-Treated Patients by IGHV Mutation StatusIbrutinib (N=491)Comparator (N =494)u-CLL (n=717)m-CLL (n=268)u-CLL(n=366): m-CLL(n=125)u-CLL(n=351): m-CLL(n=143)Ibr(n=366): Comp(n=351)Ibr (n=125): Comp (n=143)PFS24-month rate HR78%:81%10%:32%78%:10%81%:32%0.93a1.99a0.12b0.21bp = 0.78p < 0.0001p < 0.0001p <0.0001Adjusted HRc1.02a1.94a0.11b0.17bp = 0.93p < 0.0001p < 0.0001p < 0.0001OS24-month rate HR88%:89%78%:87%88%:78%89%:87%0.95a1.96a0.49b0.85b,ep = 0.86p = 0.02p < 0.01p = 0.66Adjusted HRc1.21a2.10a0.49bNAp =0.57p = 0.01p < 0.001Response ratesu-CLLm-CLLu-CLLm-CLLIbrCompIbrCompORR, %d8990475189479051p = 0.96p = 0.36p < 0.0001p < 0.0001CR, %d221546224156p = 0.10p = 0.44p < 0.0001p = 0.01CI, confidence interval; CR, complete response; HR, hazard ratio; ORR, overall response rate; NA, not applicable. aHR < 1 favors unmutated. bHR < 1 favors ibrutinib. cMultivariate Cox model adjusted for age, sex, current Rai stage, baseline ECOG performance status score, del11q, del17p, number of prior therapies, and cytopenias. dp value is from a Cochran-Mantel-Haenszel chi-square test. eInsufficient number of events prevents meaningful analysis, only 13 and 16 events observed in ibr and comp groups, respectively, and 46 (32%) pts in comp arm crossed over to ibr arm; interpret results with caution.
Citation Format: Thomas J. Kipps, Graeme Fraser, Steven Coutre, Jennifer R. Brown, Jacqueline C. Barrientos, Paul M. Barr, John C. Byrd, Susan M. O'Brien, Marie-Sarah Dilhuydy, Stephen Devereux, Ulrich Jaeger, Carol Moreno, Paula Cramer, Stephan Stilgenbauer, Asher A. Chanan-Khan, Michelle Mahler, Mariya Salman, Mei Cheng, Anil Londhe, Joi Ninomoto, Angela Howes, Danelle James, Michael Hallek. Unmutated IGHV is not an adverse predictor of outcome to therapy with ibrutinib in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr CT158. doi:10.1158/1538-7445.AM2017-CT158
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Affiliation(s)
| | - Graeme Fraser
- 2Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Steven Coutre
- 3Stanford Cancer Center, Stanford University School of Medicine, Stanford, CA
| | | | | | - Paul M. Barr
- 6Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
| | - John C. Byrd
- 7Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Stephen Devereux
- 10Kings College Hospital, NHS Foundation Trust, London, United Kingdom
| | - Ulrich Jaeger
- 11Division of Hematology and Hemostaseology, Medical University of Vienna, Wien, Austria
| | - Carol Moreno
- 12Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Paula Cramer
- 13Department of Internal Medicine and German CLL Study Group, University of Cologne, Cologne, Germany
| | - Stephan Stilgenbauer
- 14Department of Internal Medicine, Division of Hematology, University of Ulm, Ulm, Germany
| | | | | | | | - Mei Cheng
- 17Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - Anil Londhe
- 16Janssen Research and Development, Raritan, NJ
| | - Joi Ninomoto
- 17Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - Angela Howes
- 18Janssen Research and Development, High Wycombe, United Kingdom
| | - Danelle James
- 17Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - Michael Hallek
- 13Department of Internal Medicine and German CLL Study Group, University of Cologne, Cologne, Germany
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Kipps T, Fraser G, Coutre S, Brown J, Barrientos J, Barr P, Byrd J, O'Brien S, Dilhuydy M, Hillmen P, Jaeger U, Moreno C, Cramer P, Stilgenbauer S, Chanan-Khan A, Mahler M, Salman M, Cheng M, Londhe A, Ninomoto J, Howes A, James D, Hallek M. INTEGRATED ANALYSIS: OUTCOMES OF IBRUTINIB-TREATED PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA/SMALL LYMPHOCYTIC LEUKEMIA (CLL/SLL) WITH HIGH-RISK PROGNOSTIC FACTORS. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_99] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- T.J. Kipps
- Department of Medicine; UC San Diego Moores Cancer Center; La Jolla USA
| | - G. Fraser
- Department of Oncology, Juravinski Cancer Centre; McMaster University; Hamilton Canada
| | - S.E. Coutre
- Division of Hematology, Stanford Cancer Center; Stanford University School of Medicine; Stanford USA
| | - J.R. Brown
- Division of Hematologic Malignancies; Dana-Farber Cancer Institute; Boston USA
| | - J.C. Barrientos
- Division of Hematology and Medical Oncology, Department of Medicine, CLL Research and Treatment Program; Northwell Health Cancer Institute; Hempstead USA
| | - P.M. Barr
- Department of Medicine, Hematology/Oncology, James P. Wilmot Cancer Center; University of Rochester; Rochester USA
| | - J.C. Byrd
- Division of Hematology, Department of Internal Medicine; The Ohio State University Comprehensive Cancer Center; Columbus USA
| | - S.M. O'Brien
- Chao Family Comprehensive Cancer Center; University of California; Irvine, Orange USA
| | - M. Dilhuydy
- Department of Hematology; CHU Hopitauz de Bordeaux; Pessac France
| | - P. Hillmen
- Department of Haematology; The Leeds Teaching Hospitals, St. James Institute of Oncology; Leeds UK
| | - U. Jaeger
- Division of Hematology and Hemostaseology; Medical University of Vienna; Wien Austria
| | - C. Moreno
- Hematology Department; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - P. Cramer
- Department of Internal Medicine and Center of Integrated Onology Cologne Bonn; University of Cologne; Cologne Germany
| | - S. Stilgenbauer
- Department of Internal Medicine, Division of Hematology; University of Ulm; Ulm Germany
| | - A.A. Chanan-Khan
- Department of Hematology/Oncology; Mayo Clinic Cancer Center; Jacksonville USA
| | - M. Mahler
- Global Medical Affairs Lead; Janssen Research & Development, LLC; Raritan USA
| | - M. Salman
- Janssen Research & Development, LLC; Raritan USA
| | - M. Cheng
- Biometrics; Pharmacyclics LLC, an AbbVie Company; Sunnyvale USA
| | - A. Londhe
- Biostatistics; Janssen Research & Development, LLC; Raritan USA
| | - J. Ninomoto
- Clinical Science; Pharmacyclics LLC, an AbbVie Company; Sunnyvale USA
| | - A. Howes
- Clinical Leader; Janssen Research & Development; Wycombe UK
| | - D.F. James
- Clinical Research; Pharmacyclics LLC, an AbbVie Company; Sunnyvale USA
| | - M. Hallek
- Department of Internal Medicine and Center of Integrated Onology Cologne Bonn; University of Cologne; Cologne Germany
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Cramer P, von Tresckow J, Bahlo J, Robrecht S, Al-Sawaf O, Langerbeins P, Engelke A, Fink A, Fischer K, Seiler T, von Weikersthal L, Hebart H, Kreuzer K, Ritgen M, Kneba M, Wendtner C, Stilgenbauer S, Eichhorst B, Hallek M. BENDAMUSTINE (B), FOLLOWED BY OBINUTUZUMAB (G) AND VENETOCLAX (A) IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL): CLL2-BAG TRIAL OF THE GERMAN CLL STUDY GROUP (GCLLSG). Hematol Oncol 2017. [DOI: 10.1002/hon.2437_5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- P. Cramer
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - J. von Tresckow
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - J. Bahlo
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - S. Robrecht
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - O. Al-Sawaf
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - P. Langerbeins
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - A. Engelke
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - A.M. Fink
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - K. Fischer
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - T. Seiler
- Department III of Internal Medicine; University Hospital Munich, Ludwig-Maximilians University, Campus Großhadern; Munich Germany
| | | | - H. Hebart
- Center for Internal Medicine; Stauferklinikum Schwäbisch Gmünd; Mutlangen Germany
| | - K.A. Kreuzer
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - M. Ritgen
- Department II of Internal Medicine; University of Schleswig-Holstein; Campus Kiel, Kiel Germany
| | - M. Kneba
- Department II of Internal Medicine; University of Schleswig-Holstein; Campus Kiel, Kiel Germany
| | - C.M. Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing; Munich Germany
| | - S. Stilgenbauer
- Department III of Internal Medicine; University Hospital Ulm; Ulm Germany
| | - B. Eichhorst
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - M. Hallek
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
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Al-Sawaf O, Bahlo J, Fischer K, Herling C, Bergmann M, Fink A, von Tresckow J, Langerbeins P, Cramer P, Stilgenbauer S, Wendtner C, Eichhorst B, Hallek M, Goede V. CHARACTERISTICS, TREATMENT, AND OUTCOMES OF ≥ 80 YEAR OLD PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) ENROLLED TO PROSPECTIVE TRIALS OF THE GERMAN CLL STUDY GROUP. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- O. Al-Sawaf
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - J. Bahlo
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - K. Fischer
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - C. Herling
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - M. Bergmann
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine; Klinikum Schwabing; Munich Germany
| | - A.M. Fink
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - J. von Tresckow
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - P. Langerbeins
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - P. Cramer
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - S. Stilgenbauer
- Department III of Internal Medicine; University Hospital Ulm; Ulm Germany
| | - C.M. Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine; Klinikum Schwabing; Munich Germany
| | - B. Eichhorst
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - M. Hallek
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - V. Goede
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
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Cramer P, Demirkan F, Fraser G, Pristupa A, Bartlett N, Dilhuydy M, Loscertales J, Avigdor A, Rule S, Samoilova O, Goy A, Ganguly S, Poggesi I, Lavezzi S, De Nicolao G, de Jong J, Neyens M, Salman M, Howes A, Mahler M. IBRUTINIB INCREASES THE SYSTEMIC EXPOSURE OF RITUXIMAB: PHARMACOKINETIC RESULTS FROM THE HELIOS TRIAL. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- P. Cramer
- Department I of Internal Medicine and German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - F. Demirkan
- Hematology; Dokuz Eylul University; Izmir Turkey
| | - G. Fraser
- Oncology; McMaster University, Juravinski Cancer Centre; Hamilton Canada
| | - A. Pristupa
- Hematology; Ryazan Regional Clinical Hospital; Ryazan Russian Federation
| | - N. Bartlett
- Medicine; Washington University School of Medicine, Siteman Cancer Center; St. Louis USA
| | - M. Dilhuydy
- Hematology and Cell Therapy, Hôpital Haut-Lévèque; Bordeaux France
| | - J. Loscertales
- Hematology; Hospital Universitario de La Princesa, IIS-IP; Madrid Spain
| | - A. Avigdor
- Hematology and Bone-Marrow Transplantation, Chaim Sheba Medical Center; Tel Hashomer Israel
| | - S. Rule
- Haematology; Derriford Hospital; Plymouth UK
| | - O. Samoilova
- Hematology; Nizhny Novgorod Regional Clinical Hospital; Nizhny Novgorod Russian Federation
| | - A. Goy
- Lymphoma; John Theurer Cancer Center at Hackensack University Medical Center; Hackensack USA
| | - S. Ganguly
- Hematologic Malignancies and Cellular Therapeutics; University of Kansas Medical Center; Kansas City USA
| | - I. Poggesi
- Clinical Pharmacology, Janssen R&D; Cologno Monzese Italy
| | - S.M. Lavezzi
- Electrical, Computer, and Biomedical Engineering, University of Pavia; Pavia Italy
| | - G. De Nicolao
- Electrical, Computer, and Biomedical Engineering, University of Pavia; Pavia Italy
| | - J. de Jong
- Clinical Pharmacology, Janssen R&D; San Diego USA
| | - M. Neyens
- Clinical Pharmacology-Pharmacometrics, Janssen R&D; Beerse Belgium
| | - M. Salman
- Clinical Oncology, Janssen R&D; Raritan USA
| | - A. Howes
- Clinical Oncology, Janssen R&D; High Wycombe UK
| | - M. Mahler
- Clinical Oncology, Janssen R&D; Raritan USA
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