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Bhansali RS, Ellin F, Relander T, Cao M, Li W, Long Q, Ganesan N, Stuver RN, Horwitz SM, Wudhikarn K, Hwang SR, Bennani NN, Chavez JC, Sokol L, Saeed H, Duan F, Porcu P, Pullarkat P, Mehta-Shah N, Zain J, Ruiz M, Brammer JE, Prakash R, Padmanabhan Iyer S, Olszewski AJ, Major A, Riedell PA, Smith SM, Goldin C, Haverkos BM, Hu B, Zhuang TZ, Allen PB, Toama W, Janakiram M, Jagadeesh D, Brooks TR, Hariharan N, Goodman AM, Hartmann G, Ghione P, Fayyaz F, Rhodes JM, Chong EA, Gerson JN, Landsburg DJ, Nasta SD, Schuster SJ, Svoboda J, Jerkeman M, Barta SK. The CNS Relapse in T-Cell Lymphoma Index Predicts CNS Relapse in Patients with T- and NK-Cell Lymphomas. Blood Adv 2024:bloodadvances.2024012800. [PMID: 38739715 DOI: 10.1182/bloodadvances.2024012800] [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: 01/29/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 05/16/2024] Open
Abstract
Little is known about risk factors for central nervous system (CNS) relapse in mature T- and NK-cell neoplasms (MTNKN). We aimed to describe the clinical epidemiology of CNS relapse in patients with MTNKN and developed the CNS relapse In T-cell lymphoma Index (CITI) to predict patients at highest risk of CNS relapse. We reviewed data from 135 patients with MTNKN and CNS relapse from 19 North American institutions. After exclusion of leukemic and most cutaneous forms of MTNKN, patients were pooled with non-CNS relapse control patients from a single institution to create a CNS relapse-enriched training set. Using a complete case analysis (N=182), of whom 91 had CNS relapse, we applied a LASSO Cox regression model to select weighted clinicopathologic variables for the CITI score, which we validated in an external cohort from the Swedish Lymphoma Registry (N=566). CNS relapse was most frequently observed in patients with PTCL, NOS (25%). Median time to CNS relapse and median overall survival after CNS relapse was 8.0 months and 4.7 months, respectively. We calculated unique CITI risk scores for individual training set patients and stratified them into risk terciles. Validation set patients with low-risk (N=158) and high-risk (N=188) CITI scores had a 10-year cumulative risk of CNS relapse of 2.2% and 13.4%, respectively (HR 5.24, 95%CI 1.50-18.26, P=0.018). We developed an open-access web-based CITI calculator (https://redcap.link/citicalc) to provide an easy tool for clinical practice. The CITI score is a validated model to predict patients with MTNKN at highest risk of developing CNS relapse.
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Affiliation(s)
| | - Fredrik Ellin
- Department of Internal Medicine, Kalmar County Hospital, Sweden
| | | | - Miao Cao
- Lymphoma Program, Abramson Cancer Center, United States
| | - Wenrui Li
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Qi Long
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Nivetha Ganesan
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Robert N Stuver
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Steven M Horwitz
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | | | | | | | | | - Lubomir Sokol
- Moffitt Cancer Center, Tampa, Florida, United States
| | - Hayder Saeed
- Moffitt Cancer Center, Tampa, Florida, United States
| | - Frank Duan
- Christiana Care, Newark, Delaware, United States
| | - Pierluigi Porcu
- Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania, United States
| | | | - Neha Mehta-Shah
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States
| | | | - Miguel Ruiz
- The Ohio State University James Comprehensive Cancer Center, United States
| | - Jonathan E Brammer
- The Ohio State University James Comprehensive Cancer Center, United States
| | - Rishab Prakash
- The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | | | - Adam J Olszewski
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Ajay Major
- University of Colorado School of Medicine, Denver, Colorado, United States
| | | | | | - Caroline Goldin
- Ochsner MD Anderson Cancer Center, Jefferson, Louisiana, United States
| | | | - Bei Hu
- Atrium Health Levine Cancer Institute, Charlotte, North Carolina, United States
| | | | | | - Wael Toama
- University of Minnesota, Minneapolis, Minnesota, United States
| | | | | | | | | | | | - Gabrielle Hartmann
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
| | - Paola Ghione
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Fatima Fayyaz
- Regional Cancer Care Associates, Marmora, New Jersey, United States
| | - Joanna M Rhodes
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, United States
| | - Elise A Chong
- Lymphoma Program, Abramson Cancer Center, United States
| | | | | | | | - Stephen J Schuster
- University of PennsLymphoma Program, Abramson Cancer Centerylvania, United States
| | - Jakub Svoboda
- Lymphoma Program, Abramson Cancer Center, United States
| | - Mats Jerkeman
- Skane University Hospital and Lund University, Lund, Sweden
| | - Stefan K Barta
- University of PeLymphoma Program, Abramson Cancer Centernnsylvania, United States
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Qiao X, Sil A, Sangtarash S, Smith SM, Wu C, Robertson CM, Nichols RJ, Higgins SJ, Sadeghi H, Vezzoli A. Nuclear Magnetic Resonance Chemical Shift as a Probe for Single-Molecule Charge Transport. Angew Chem Int Ed Engl 2024; 63:e202402413. [PMID: 38478719 DOI: 10.1002/anie.202402413] [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: 02/02/2024] [Indexed: 04/05/2024]
Abstract
Existing modelling tools, developed to aid the design of efficient molecular wires and to better understand their charge-transport behaviour and mechanism, have limitations in accuracy and computational cost. Further research is required to develop faster and more precise methods that can yield information on how charge transport properties are impacted by changes in the chemical structure of a molecular wire. In this study, we report a clear semilogarithmic correlation between charge transport efficiency and nuclear magnetic resonance chemical shifts in multiple series of molecular wires, also accounting for the presence of chemical substituents. The NMR data was used to inform a simple tight-binding model that accurately captures the experimental single-molecule conductance values, especially useful in this case as more sophisticated density functional theory calculations fail due to inherent limitations. Our study demonstrates the potential of NMR spectroscopy as a valuable tool for characterising, rationalising, and gaining additional insights on the charge transport properties of single-molecule junctions.
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Affiliation(s)
- X Qiao
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, United Kingdom
| | - A Sil
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, United Kingdom
| | - S Sangtarash
- Device Modelling Group, School of Engineering, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - S M Smith
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, United Kingdom
| | - C Wu
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, United Kingdom
- Institute of Optoelectronic Materials and Devices, Faculty of Materials Metallurgy and Chemistry, Jiangxi University of Science and Technology, Ganzhou, 341000, China
| | - C M Robertson
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, United Kingdom
| | - R J Nichols
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, United Kingdom
| | - S J Higgins
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, United Kingdom
| | - H Sadeghi
- Device Modelling Group, School of Engineering, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - A Vezzoli
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, United Kingdom
- Stephenson Institute for Renewable Energy, University of Liverpool, Peach Street, Liverpool, L69 7ZF, United Kingdom
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3
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Tumuluru S, Godfrey JK, Cooper A, Yu J, Chen X, MacNabb BW, Venkataraman G, Zha Y, Pelzer B, Song J, Duns G, Sworder BJ, Bolen C, Penuel E, Postovalova E, Kotlov N, Bagaev A, Fowler N, Smith SM, Alizadeh AA, Steidl C, Kline J. Integrative genomic analysis identifies unique immune environments associated with immunotherapy response in diffuse large B cell lymphoma. bioRxiv 2024:2024.01.17.576100. [PMID: 38328071 PMCID: PMC10849512 DOI: 10.1101/2024.01.17.576100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Most diffuse large B-cell lymphoma (DLBCL) patients treated with bispecific antibodies (BsAb) or chimeric antigen receptor (CAR) T cells fail to achieve durable treatment responses, underscoring the need for a deeper understanding of mechanisms that regulate the immune environment and response to treatment. Here, an integrative, multi-omic approach was employed to characterize DLBCL immune environments, which effectively segregated DLBCLs into four quadrants - termed DLBCL-immune quadrants (IQ) - defined by cell-of-origin and immune-related gene set expression scores. Recurrent genomic alterations were enriched in each IQ, suggesting that lymphoma cell-intrinsic alterations contribute to orchestrating unique DLBCL immune environments. In relapsed/refractory DLBCL patients, DLBCL-IQ assignment correlated significantly with clinical benefit with the CD20 x CD3 BsAb, mosunetuzumab, but not with CD19-directed CAR T cells. DLBCL-IQ provides a new framework to conceptualize the DLBCL immune landscape and uncovers the differential impact of the endogenous immune environment on outcomes to BsAb and CAR T cell treatment.
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Chen X, Yu J, Venkataraman G, Smith SM, Chen M, Cooper A, Tumuluru S, Brody JD, Godfrey J, Kline J. T-cell States, Repertoire, and Function in Classical Hodgkin Lymphoma Revealed through Single-Cell Analyses. Cancer Immunol Res 2024; 12:296-307. [PMID: 38240659 DOI: 10.1158/2326-6066.cir-23-0547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/13/2023] [Accepted: 01/18/2024] [Indexed: 03/06/2024]
Abstract
The classical Hodgkin lymphoma (cHL) environment is comprised of a dense and complex immune cell infiltrate interspersed with rare malignant Hodgkin-Reed-Sternberg (HRS) cells. HRS cells are actively surveilled by endogenous T cells, but data linking phenotypic and functional T-cell states with clonality at the single-cell level in cHL is lacking. To address this knowledge gap, we performed paired single-cell RNA and T-cell receptor sequencing on 14 cHL and 5 reactive lymphoid tissue specimens. Conventional CD4+ T cells dominated the cHL landscape. However, recurrent clonal expansion within effector and exhausted CD8+ T-cell and regulatory T-cell clusters was uniquely observed in cHL specimens. Multiplex flow cytometric analysis revealed that most lymphoma-resident T cells produced effector cytokines upon ex vivo restimulation, arguing against a profound dysfunctional T-cell state in cHL. Our results raise new questions about the nature of T cells that mediate the antilymphoma response following programmed cell death protein 1 (PD-1) blockade therapy in cHL.
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Affiliation(s)
- Xiufen Chen
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Jovian Yu
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | | | - Sonali M Smith
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Mengjie Chen
- Department of Medicine, Section of Genetic Medicine, University of Chicago, Chicago, Illinois
- Department of Human Genetics, University of Chicago, Chicago, Illinois
- Committee on Cancer Biology, University of Chicago, Chicago, Illinois
| | - Alan Cooper
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Sravya Tumuluru
- Committee on Cancer Biology, University of Chicago, Chicago, Illinois
| | - Joshua D Brody
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James Godfrey
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Justin Kline
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
- Committee on Cancer Biology, University of Chicago, Chicago, Illinois
- Committee on Immunology, University of Chicago, Chicago, Illinois
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Rojek AE, Kline JP, Feinberg N, Appelbaum DE, Pu Y, Derman BA, Jakubowiak A, Kosuri S, Liu H, Nawas MT, Smith SM, Bishop MR, Riedell PA. Optimization of Metabolic Tumor Volume as a Prognostic Marker in CAR T-Cell Therapy for Aggressive Large B-cell NHL. Clin Lymphoma Myeloma Leuk 2024; 24:83-93. [PMID: 37827881 DOI: 10.1016/j.clml.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND CD19-targeted chimeric antigen receptor (CAR) T-cell therapy has become a standard of care in relapsed/refractory (R/R) aggressive large B-cell non-Hodgkin lymphomas (B-NHL) though the majority of recipients do not receive durable disease benefit, prompting the need to better define risk factors for relapse/progression. OBJECTIVES We performed a single-center, retrospective analysis of patients treated with commercial CAR T-cell therapy to evaluate the impact of tumor burden, as measured by whole-body metabolic tumor volume (MTV) from 18F fluorodeoxyglucose PET imaging, on treatment outcomes. STUDY DESIGN Sixty-one patients treated with CAR T-cell therapy for R/R B-NHL between May 2016 and November 2021 were included. RESULTS Using a receiver operating characteristic curve-based MTV optimization cutoff of 450 mL, 1-year progression-free survival (PFS) was 22% for high MTV versus 54% for low MTV (P < .01), and 1-year overall survival (OS) was 37% and 73%, respectively (P = .01). In a subset of 46 patients, residual MTV of less than 106 mL at the day 30 (D30) disease assessment was associated with significantly improved outcomes (1-year OS 85% vs. 13%, P < .01). Incorporation of pretreatment MTV to the International Prognostic Index (IPI) scoring system significantly distinguished 2-year PFS and OS outcomes by 3 risk groups. CONCLUSIONS Our findings suggest that both pretreatment and D30 MTV are predictive of outcomes among R/R B-NHL patients treated with CAR T-cell therapy. These data indicate that efforts to reduce pretreatment tumor burden may improve longitudinal clinical outcomes. Furthermore, D30 postinfusion MTV quantification may aid clinicians in optimally identifying patients at high-risk for progression, and in whom closer disease monitoring should be considered. MTV also adds prognostic value to patients with high-risk IPI and holds promise for incorporation in novel risk scoring systems which can identify patients prior to CAR T-cell therapy at highest risk of adverse outcomes.
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Affiliation(s)
- Alexandra E Rojek
- Department of Medicine, Section of Hematology-Oncology, University of Chicago, Chicago, IL
| | - Justin P Kline
- Department of Medicine, Section of Hematology-Oncology, University of Chicago, Chicago, IL; David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Nicholas Feinberg
- Department of Radiology, Section of Nuclear Medicine, University of Chicago, Chicago, IL
| | - Daniel E Appelbaum
- Department of Radiology, Section of Nuclear Medicine, University of Chicago, Chicago, IL
| | - Yonglin Pu
- Department of Radiology, Section of Nuclear Medicine, University of Chicago, Chicago, IL
| | - Benjamin A Derman
- Department of Medicine, Section of Hematology-Oncology, University of Chicago, Chicago, IL; David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Andrzej Jakubowiak
- Department of Medicine, Section of Hematology-Oncology, University of Chicago, Chicago, IL; David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Satyajit Kosuri
- Department of Medicine, Section of Hematology-Oncology, University of Chicago, Chicago, IL; David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Hongtao Liu
- Department of Medicine, Section of Hematology-Oncology, University of Chicago, Chicago, IL; David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Mariam T Nawas
- Department of Medicine, Section of Hematology-Oncology, University of Chicago, Chicago, IL; David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Sonali M Smith
- Department of Medicine, Section of Hematology-Oncology, University of Chicago, Chicago, IL
| | - Michael R Bishop
- Department of Medicine, Section of Hematology-Oncology, University of Chicago, Chicago, IL; David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Peter A Riedell
- Department of Medicine, Section of Hematology-Oncology, University of Chicago, Chicago, IL; David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL.
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Cooper A, Tumuluru S, Kissick K, Venkataraman G, Song JY, Lytle A, Duns G, Yu J, Kotlov N, Bagaev A, Hodkinson B, Srinivasan S, Smith SM, Scott DW, Steidl C, Godfrey JK, Kline J. CD5 Gene Signature Identifies Diffuse Large B-Cell Lymphomas Sensitive to Bruton's Tyrosine Kinase Inhibition. J Clin Oncol 2024; 42:467-480. [PMID: 38079587 DOI: 10.1200/jco.23.01574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/29/2023] [Accepted: 09/13/2023] [Indexed: 01/31/2024] Open
Abstract
PURPOSE A genetic classifier termed LymphGen accurately identifies diffuse large B-cell lymphoma (DLBCL) subtypes vulnerable to Bruton's tyrosine kinase inhibitors (BTKis), but is challenging to implement in the clinic and fails to capture all DLBCLs that benefit from BTKi-based therapy. Here, we developed a novel CD5 gene expression signature as a biomarker of response to BTKi-based therapy in DLBCL. METHODS CD5 immunohistochemistry (IHC) was performed on 404 DLBCLs to identify CD5 IHC+ and CD5 IHC- cases, which were subsequently characterized at the molecular level through mutational and transcriptional analyses. A 60-gene CD5 gene expression signature (CD5sig) was constructed using genes differentially expressed between CD5 IHC+ and CD5 IHC- non-germinal center B-cell-like (non-GCB DLBCL) DLBCLs. This CD5sig was applied to external DLBCL data sets, including pretreatment biopsies from patients enrolled in the PHOENIX study (n = 584) to define the extent to which the CD5sig could identify non-GCB DLBCLs that benefited from the addition of ibrutinib to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). RESULTS CD5 expression was observed in 12% of non-GCB DLBCLs. CD5+ DLBCLs displayed transcriptional features of B-cell receptor (BCR) activation and were enriched for BCR-activating mutations known to correlate with BTKi sensitivity. However, most CD5+ DLBCLs lacked canonical BCR-activating mutations or were LymphGen-unclassifiable (LymphGen-Other). The CD5sig recapitulated these findings in multiple independent data sets, indicating its utility in identifying DLBCLs with genetic and nongenetic bases for BCR dependence. Supporting this notion, CD5sig+ DLBCLs derived a selective survival advantage from the addition of ibrutinib to R-CHOP in the PHOENIX study, independent of LymphGen classification. CONCLUSION CD5sig is a useful biomarker to identify DLBCLs vulnerable to BTKi-based therapies and complements current biomarker approaches by identifying DLBCLs with genetic and nongenetic bases for BTKi sensitivity.
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Affiliation(s)
- Alan Cooper
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Sravya Tumuluru
- Committee on Cancer Biology, University of Chicago, Chicago, IL
| | - Kyle Kissick
- Department of Pathology, University of Chicago, Chicago, IL
| | | | - Joo Y Song
- Department of Pathology, City of Hope, Duarte, CA
| | - Andrew Lytle
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC
| | - Gerben Duns
- Lymphoid Cancer Research, BC Cancer Agency, Vancouver, BC, Canada
| | - Jovian Yu
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | | | | | - Brendan Hodkinson
- Oncology Translational Research, Janssen Research & Development, Spring House, PA
| | - Srimathi Srinivasan
- Oncology Translational Research, Janssen Research & Development, Lower Gwynedd Township, PA
| | - Sonali M Smith
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - David W Scott
- Lymphoid Cancer Research, BC Cancer Agency, Vancouver, BC, Canada
| | - Christian Steidl
- Lymphoid Cancer Research, BC Cancer Agency, Vancouver, BC, Canada
| | - James K Godfrey
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Justin Kline
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
- Committee on Cancer Biology, University of Chicago, Chicago, IL
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7
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Vose JM, Fu K, Wang L, Mansoor A, Stewart D, Cheng H, Smith L, Yuan J, Qureishi HN, Link BK, Cessna MH, Barr PM, Kahl BS, Mckinney MS, Khan N, Advani RH, Martin P, Goy AH, Phillips TJ, Mehta A, Kamdar M, Crump M, Pro B, Flowers CR, Jacobson CA, Smith SM, Stephens DM, Bachanova V, Jin Z, Wu S, Hernandez-Ilizaliturri F, Torka P, Anampa-Guzmán A, Kashef F, Li X, Sharma S, Greiner TC, Armitage JO, Lunning M, Weisenburger DD, Bociek RG, Iqbal J, Yu G, Bi C. Integrative analysis of clinicopathological features defines novel prognostic models for mantle cell lymphoma in the immunochemotherapy era: a report from The North American Mantle Cell Lymphoma Consortium. J Hematol Oncol 2023; 16:122. [PMID: 38104096 PMCID: PMC10725579 DOI: 10.1186/s13045-023-01520-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Patients with mantle cell lymphoma (MCL) exhibit a wide variation in clinical presentation and outcome. However, the commonly used prognostic models are outdated and inadequate to address the needs of the current multidisciplinary management of this disease. This study aims to investigate the clinical and pathological features of MCL in the immunochemotherapy era and improve the prognostic models for a more accurate prediction of patient outcomes. METHODS The North American Mantle Cell Lymphoma Project is a multi-institutional collaboration of 23 institutions across North America to evaluate and refine prognosticators for front-line therapy. A total of 586 MCL cases diagnosed between 2000 and 2012 are included in this study. A comprehensive retrospective analysis was performed on the clinicopathological features, treatment approaches, and outcomes of these cases. The establishment of novel prognostic models was based on in-depth examination of baseline parameters, and subsequent validation in an independent cohort of MCL cases. RESULTS In front-line strategies, the use of hematopoietic stem cell transplantation was the most significant parameter affecting outcomes, for both overall survival (OS, p < 0.0001) and progression-free survival (PFS, p < 0.0001). P53 positive expression was the most significant pathological parameter correlating with inferior outcomes (p < 0.0001 for OS and p = 0.0021 for PFS). Based on the baseline risk factor profile, we developed a set of prognostic models incorporating clinical, laboratory, and pathological parameters that are specifically tailored for various applications. These models, when tested in the validation cohort, exhibited strong predictive power for survival and showed a stratification resembling the training cohort. CONCLUSIONS The outcome of patients with MCL has markedly improved over the past two decades, and further enhancement is anticipated with the evolution of clinical management. The innovative prognostic models developed in this study would serve as a valuable tool to guide the selection of more suitable treatment strategies for patients with MCL.
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Affiliation(s)
- Julie M Vose
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine Fred and Pamela Buffett Cancer Center, 505 S 45Th St, Omaha, NE, 68105, USA
| | - Kai Fu
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lu Wang
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Yantai University, Yantai, China
| | - Adnan Mansoor
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
| | - Douglas Stewart
- Departments of Oncology and Medicine, University of Calgary, Calgary, Canada
| | - Hongxia Cheng
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Lynette Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ji Yuan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Hina Naushad Qureishi
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Brian K Link
- Department of Internal Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Melissa H Cessna
- Department of Pathology, Intermountain Medical Center, Murray, UT, USA
| | - Paul M Barr
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Brad S Kahl
- Department of Medicine, Oncology Division, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Matthew S Mckinney
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Nadia Khan
- Department of Hematology/Oncology, Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Ranjana H Advani
- Division of Oncology, Stanford Cancer Institute, Stanford, CA, USA
| | - Peter Martin
- Division of Hematology and Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Andre H Goy
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | - Tycel J Phillips
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Amitkumar Mehta
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Manali Kamdar
- Division of Hematology, University of Colorado, Denver, CO, USA
| | - Michael Crump
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
| | - Barbara Pro
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Christopher R Flowers
- Division of Cancer Medicine, Department of Lymphoma-Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Caron A Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Sonali M Smith
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Deborah M Stephens
- Huntsman Cancer Institute at University of Utah, Salt Lake City, UT, USA
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Zhaohui Jin
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Shishou Wu
- Department of Pathology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, No.20 Yuhuangding East Road, Yantai, 264000, China
| | | | - Pallawi Torka
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Anampa-Guzmán
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Farshid Kashef
- Department of Pathology, University at Buffalo, Buffalo, NY, USA
| | - Xing Li
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Sunandini Sharma
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Timothy C Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - James O Armitage
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine Fred and Pamela Buffett Cancer Center, 505 S 45Th St, Omaha, NE, 68105, USA
| | - Matthew Lunning
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine Fred and Pamela Buffett Cancer Center, 505 S 45Th St, Omaha, NE, 68105, USA
| | - Dennis D Weisenburger
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Robert G Bociek
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine Fred and Pamela Buffett Cancer Center, 505 S 45Th St, Omaha, NE, 68105, USA
| | - Javeed Iqbal
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Guohua Yu
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA.
- Department of Pathology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, No.20 Yuhuangding East Road, Yantai, 264000, China.
| | - Chengfeng Bi
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine Fred and Pamela Buffett Cancer Center, 505 S 45Th St, Omaha, NE, 68105, USA.
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8
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Cardwell K, Clyne B, Broderick N, Tyner B, Masukume G, Larkin L, McManus L, Carrigan M, Sharp M, Smith SM, Harrington P, Connolly M, Ryan M, O'Neill M. Lessons learnt from the COVID-19 pandemic in selected countries to inform strengthening of public health systems: a qualitative study. Public Health 2023; 225:343-352. [PMID: 37979311 DOI: 10.1016/j.puhe.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/11/2023] [Accepted: 10/10/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has prompted governments internationally to consider strengthening their public health systems. To support the work of Ireland's Public Health Reform Expert Advisory Group, the Health Information and Quality Authority, an independent governmental agency, was asked to describe the lessons learnt regarding the public health response to COVID-19 internationally and the applicability of this response for future pandemic preparedness. METHODS Semi-structured interviews with key public health representatives from nine countries were conducted. Interviews were conducted in March and April 2022 remotely via Zoom and were recorded. Notes were taken by two researchers, and a thematic analysis undertaken. RESULTS Lessons learnt from the COVID-19 pandemic related to three main themes: 1) setting policy; 2) delivering public health interventions; and 3) providing effective communication. Real-time surveillance, evidence synthesis, and cross-sectoral collaboration were reported as essential for policy setting; it was noted that having these functions established prior to the pandemic would lead to a more efficient implementation in a health emergency. Delivering public health interventions such as testing, contact tracing, and vaccination were key to limiting and or mitigating the spread of the SARS-CoV-2 virus. However, a number of challenges were highlighted such as staff capacity and burnout, delays in vaccination procurement, and reduced delivery of regular healthcare services. Clear, consistent, and regular communication of the scientific evidence was key to engaging citizens with mitigation strategies. However, these communication strategies had to compete with an infodemic of information being circulated, particularly through social media. CONCLUSIONS Overall, functions relating to policy setting, public health interventions, and communication are key to pandemic response. Ideally, these should be established in the preparedness phase so that they can be rapidly scaled-up during a pandemic.
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Affiliation(s)
- K Cardwell
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - B Clyne
- Department of Public Health & Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - N Broderick
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - B Tyner
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - G Masukume
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - L Larkin
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - L McManus
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Carrigan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Sharp
- Department of Public Health & Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - S M Smith
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | - P Harrington
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Connolly
- School of Medicine, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
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9
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Scheele J, Smith SM, Wahab RJ, Bais B, Steegers-Theunissen RPM, Gaillard R, Harmsen van der Vliet-Torij HW. Current preconception care practice in the Netherlands - An evaluation study among birth care professionals. Midwifery 2023; 127:103855. [PMID: 37890235 DOI: 10.1016/j.midw.2023.103855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To evaluate the current practice of preconception care in the Netherlands and the perceptions of birth care professionals concerning preconception care. METHODS We have developed a digital questionnaire and conducted a cross-sectional study by distributing the questionnaire among 102 organisations: 90 primary care midwifery practices and obstetric departments of 12 hospitals in the Southwest region of the Netherlands between December 2020 and March 2021. One birth care professional per organization was asked to complete the questionnaire. Descriptive statistics were used to present the results. FINDINGS Respondents of eighty-three organisations (81.4 %) filled in the questionnaire, of whom 74 respondents were independent primary care midwives and 9 respondents were obstetricians. Preconception care mostly consisted of an individual consultation in which personalized health and lifestyle advice was given. Among the respondents, 44.4 % reported that the organization had a preconception care protocol. The way in which the consultation was carried out, as well as the health and lifestyle related questions asked, differed between respondents. More than 85 % of the respondents inquire about the following possible risk factors for complications: maternal illnesses, obstetric history, folic acid supplement intake, alcohol intake, smoking, substance abuse, hereditary disease, prescription medication, dietary habits, overweight, and birth defects in the family. The respondents acknowledged that preconception care should be offered to all couples who wish to become pregnant, as opposed to offering preconception care only to those with an increased risk of complications. Still, respondents do not receive many questions regarding the preconception period or requests for preconception care consultations. KEY CONCLUSION Birth care professionals acknowledge the need for preconception care for all couples. In the Netherlands, preconception care consists mostly of an individual consultation with recommendations for health and lifestyle advice. However, the identification of risk factors varies between birth care professionals and less than half of the respondents indicate that they have a protocol available in their practice. Furthermore, the demand of parents-to-be for preconception care is low. More research, that includes more obstetricians, is necessary to investigate if there is a difference between the care provided by primary care midwives and obstetricians. IMPLICATIONS FOR PRACTICE To increase the awareness and uptake of preconception care, it would be prudent to emphasize its importance to parents-to-be and professionals, and actively promote the use of widespread, standardized protocols for birth care professionals.
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Affiliation(s)
- J Scheele
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK Rotterdam, the Netherlands.
| | - S M Smith
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Rotterdam the Netherlands
| | - R J Wahab
- The Generation R Study Group, Erasmus MC, University Medical Center, 3000 CA Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - B Bais
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Rotterdam the Netherlands
| | - R P M Steegers-Theunissen
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Rotterdam the Netherlands
| | - R Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center, 3000 CA Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - H W Harmsen van der Vliet-Torij
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK Rotterdam, the Netherlands; Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Rotterdam the Netherlands
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10
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Yamshon S, Chen GZ, Gribbin C, Christos P, Shah B, Schuster SJ, Smith SM, Svoboda J, Furman RR, Leonard JP, Martin P, Ruan J. Nine-year follow-up of lenalidomide plus rituximab as initial treatment for mantle cell lymphoma. Blood Adv 2023; 7:6579-6588. [PMID: 37682791 PMCID: PMC10641095 DOI: 10.1182/bloodadvances.2023010606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
Although chemoimmunotherapy is the current standard of care for initial treatment of mantle cell lymphoma (MCL), newer data suggest that there may be a role for a chemotherapy-free approach. We report the 9-year follow-up results of a multicenter, phase 2 study of lenalidomide plus rituximab (LR) as the initial treatment of MCL. The LR doublet is used as induction and maintenance until progression, with optional discontinuation after 3 years. We previously reported an overall response rate of 92% in evaluable patients, with 64% achieving a complete response. At a median follow-up of 103 months, 17 of 36 evaluable patients (47%) remain in remission. The 9-year progression-free survival and overall survival were 51% and 66%, respectively. During maintenance, hematologic adverse events included asymptomatic grade 3 or 4 cytopenia (42% neutropenia, 5% thrombocytopenia, and 3% anemia) and mostly grade 1 to 2 infections managed in the outpatient setting (50% upper respiratory infections, 21% urinary tract infections, 16% sinusitis, 16% cellulitis, and 13% pneumonia, with 5% requiring hospitalization). More patients developed grade 1 and 2 neuropathy during maintenance therapy (29%) than during induction therapy (8%). Twenty-one percent of patients developed secondary malignancies, including 5% with invasive malignancies, whereas the remainder were noninvasive skin cancers treated with local skin-directed therapy. Two patients permanently discontinued therapy because of concerns of immunosuppression during the COVID-19 pandemic. With long-term follow-up, LR continues to demonstrate prolonged, durable responses with manageable safety as initial induction therapy. This trial was registered at www.clinicaltrials.gov as #NCT01472562.
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Affiliation(s)
- Samuel Yamshon
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Gui Zhen Chen
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Caitlin Gribbin
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Paul Christos
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | | | | | | | - Jakub Svoboda
- University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | - Richard R. Furman
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - John P. Leonard
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Peter Martin
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Jia Ruan
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
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11
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Smith SM, Pasqualucci L. Introduction to series: Diffuse large B-cell lymphoma. Semin Hematol 2023; 60:251-254. [PMID: 38326145 DOI: 10.1053/j.seminhematol.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
- Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, IL.
| | - Laura Pasqualucci
- Institute for Cancer Genetics, Department of Pathology and Cell Biology, and the Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
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12
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Burack WR, Li H, Adlowitz D, Spence JM, Rimsza LM, Shadman M, Spier CM, Kaminski MS, Leonard JP, Leblanc ML, Smith SM, Friedberg JW. Subclonal TP53 mutations are frequent and predict resistance to radioimmunotherapy in follicular lymphoma. Blood Adv 2023; 7:5082-5090. [PMID: 37379264 PMCID: PMC10471938 DOI: 10.1182/bloodadvances.2022009467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/12/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Abstract
Although TP53 is commonly mutated in transformed follicular lymphoma, mutations are reported in <5% of pretreatment follicular lymphoma (FL) specimens. We assayed archival follicular B-cell non-Hodgkin lymphoma specimens from a completed clinical trial, Southwest Oncology Group S0016, a phase 3 randomized intergroup trial of CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone) chemotherapy plus R-CHOP (rituximab-CHOP) compared with CHOP chemotherapy plus 131-iodine tositumomab (radioimmunotherapy [RIT]-CHOP). Subclonal TP53 mutations (median allele frequency 0.02) were found in 25% of diagnostic FL specimens and in 27% of a separate validation cohort. In the R-CHOP arm, pathogenic TP53 mutations were not associated with progression-free survival (PFS) (10-year PFS 43% vs 44%). In contrast, among patients with no detectable pathogenic TP53 mutation, RIT-CHOP was associated with a longer PFS than with R-CHOP (10-year PFS 67% vs 44%; hazard ratio = 0.49; P = .008). No relationship was detected between PFS and the extent of activation-induced cytidine deaminase (AICDA)-mediated heterogeneity. In summary, subclonal TP53 mutations are common in FL and are a distinct phenomenon from AICDA-mediated genetic heterogeneity. The absence of a detectable subclonal mutation in TP53 defined a population that particularly benefited from RIT.
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Affiliation(s)
- W. Richard Burack
- Department of Pathology, University of Rochester Medical Center, Rochester, NY
| | - Hongli Li
- Clinical Research Division, Fred Hutchison Cancer Research Center, Seattle, WA
| | - Diana Adlowitz
- Department of Pathology, University of Rochester Medical Center, Rochester, NY
| | - Janice M. Spence
- Department of Pathology, University of Rochester Medical Center, Rochester, NY
| | - Lisa M. Rimsza
- Department of Laboratory Medicine and Pathology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Mazyar Shadman
- Clinical Research Division, Fred Hutchison Cancer Research Center, Seattle, WA
| | | | - Mark S. Kaminski
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - John P. Leonard
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Michael L. Leblanc
- Clinical Research Division, Fred Hutchison Cancer Research Center, Seattle, WA
| | - Sonali M. Smith
- Department of Medicine, University of Chicago School of Medicine, Chicago, IL
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13
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Smith SM. When more is just more, not better: a recurring lesson. Haematologica 2023; 108:2265-2266. [PMID: 37675570 PMCID: PMC10483362 DOI: 10.3324/haematol.2023.283786] [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: 09/01/2023] [Indexed: 09/08/2023] Open
Affiliation(s)
- Sonali M Smith
- Section of Hematology / Oncology, Department of Medicine, University of Chicago, Chicago, IL.
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14
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Hawkes EA, Trotman J, Casulo C, Smith SM, LaCasce A. Author gender representation of journal reviews and editorials on lymphoma (2017-22). Lancet 2023; 402:523-525. [PMID: 37573074 DOI: 10.1016/s0140-6736(23)01428-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 08/14/2023]
Affiliation(s)
- Eliza A Hawkes
- Olivia Newton-John Cancer Research & Wellness Centre, Austin Health, Melbourne, VIC 3084, Australia; Monash University School of Public Health & Preventive Medicine, Melbourne, VIC, Australia.
| | - Judith Trotman
- Concord Repatriation Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - Carla Casulo
- Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Sonali M Smith
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, IL, USA
| | - Ann LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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15
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Barraclough A, Hawkes E, Sehn LH, Smith SM. Diffuse large B-cell lymphoma. Hematol Oncol 2023. [PMID: 37435781 DOI: 10.1002/hon.3202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/29/2023] [Accepted: 06/07/2023] [Indexed: 07/13/2023]
Abstract
Large B-cell lymphoma, the prototype of aggressive non-Hodgkin lymphomas, is both the most common lymphoma and accounts for the highest global burden of lymphoma-related deaths. For nearly 4 decades, the goal of treatment has been "cure", first based on CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), and subsequently with rituximab plus CHOP. However, there is significant clinical, pathologic, and biologic heterogeneity, and not all patients are cured. Understanding and incorporating this biologic heterogeneity into treatment decisions unfortunately is not yet standard of care. Despite this gap, we now have significant advances in frontline, relapsed, and refractory settings. The POLARIX trial shows, for the first time, improved progression-free survival in a prospective randomized phase 3 setting. In the relapsed and refractory settings, there are now many approved agents/regimens, and several bispecific antibodies poised to join the arsenal of options. While chimeric antigen receptor T-cell therapy is discussed in detail elsewhere, it has quickly become an excellent option in the second-line setting and beyond. Unfortunately, special populations such as older adults continue to have poor outcomes and be underrepresented in trials, although a new generation of trials aim to address this disparity. This brief review will highlight the key issues and advances that offer improved outcomes to an increasing portion of patients.
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Affiliation(s)
- Allison Barraclough
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- University of Melbourne, Medical School, Melbourne, Victoria, Australia
| | - Eliza Hawkes
- Olivia Newton John Cancer Research Centre, Austin Health, Melbourne, Victoria, Australia
- Monash University School of Public Health & Preventive Medicine, Melbourne, Victoria, Australia
| | - Laurie H Sehn
- BC Cancer Centre for Lymphoid Cancer, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonali M Smith
- The University of Chicago Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois, USA
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16
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David KA, Sundaram S, Kim SH, Vaca R, Lin Y, Singer S, Malecek MK, Carter J, Zayac A, Kim MS, Reddy N, Ney D, Habib A, Strouse C, Graber J, Bachanova V, Salman S, Vendiola JA, Hossain N, Tsang M, Major A, Bond DA, Agrawal P, Mier-Hicks A, Torka P, Rajakumar P, Venugopal P, Berg S, Glantz M, Goldlust SA, Folstad M, Kumar P, Ollila TA, Cai J, Spurgeon S, Sieg A, Cleveland J, Chang J, Epperla N, Karmali R, Naik S, Martin P, Smith SM, Rubenstein J, Kahl B, Evens AM. Older patients with primary central nervous system lymphoma: Survival and prognostication across 20 U.S. cancer centers. Am J Hematol 2023; 98:900-912. [PMID: 36965007 PMCID: PMC10979647 DOI: 10.1002/ajh.26919] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/21/2023] [Indexed: 03/27/2023]
Abstract
There is a paucity of large-scale data delineating outcomes and prognostication of older patients with primary central nervous system lymphoma (PCNSL). We retrospectively analyzed 539 newly-diagnosed PCNSL patients ages ≥60 years across 20 U.S. academic centers. The median age was 70 years (range 60-88); at least one geriatric syndrome was present in 46%; the median Cumulative Index Ratings Scale-Geriatrics (CIRS-G) score was 6 (range, 0-27); and 36% had impairment in activities of daily living (ADL). The most common induction regimens were high-dose methotrexate (HD-MTX) ± rituximab; methotrexate, temozolomide, rituximab (MTR); and rituximab, methotrexate, procarbazine, vincristine (R-MPV). Overall, 70% of patients achieved remission, with 14% undergoing consolidative autologous stem cell transplant (ASCT) and 24% receiving maintenance. With 58-month median follow-up, median progression-free survival (PFS) and overall survival (OS) were 17 months (95% CI 13-22 months) and 43 months (95% CI 31-56 months), respectively. Three-year PFS and OS were highest with MTR (55% and 74%, respectively). With single-agent methotrexate ± rituximab, 3-year PFS and OS were 30% (p = .0002) and 47% (p = .0072). On multivariate analysis, increasing age at diagnosis and Cooperative Oncology Group (ECOG) performance status (PS) was associated with inferior PFS; age, hypoalbuminemia, higher CIRS-G score, and ECOG PS adversely affected OS. Among patients receiving maintenance, 3-year PFS was 65% versus 45% without maintenance (p = 0.02), with 3-year OS of 84% versus 61%, respectively (p = .0003). Altogether, outcomes in older PCNSL patients appeared optimized with HD-MTX combination induction regimens and maintenance therapy. Furthermore, several prognostic factors, including geriatric measures, were associated with inferior outcomes.
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Affiliation(s)
- Kevin A. David
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | | | - Seo-Hyun Kim
- Rush University Medical Center, Chicago, Illinois, USA
| | - Ryan Vaca
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Yong Lin
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Samuel Singer
- John Theurer Cancer Center, Hackensack, New Jersey, USA
| | | | - Jordan Carter
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Adam Zayac
- Brown University, Providence, Rhode Island, USA
| | - Myung Sun Kim
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Douglas Ney
- University of Colorado, Aurora, Colorado, USA
| | - Alma Habib
- University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | | | - Sidra Salman
- Loyola University Medical Center, Maywood, Illinois, USA
| | | | | | - Mazie Tsang
- University of California, San Francisco, California, USA
| | - Ajay Major
- University of Chicago, Chicago, Illinois, USA
| | - David A. Bond
- Division of Hematology, Ohio State University, Columbus, Ohio, USA
| | | | | | - Pallawi Torka
- Roswell Park Cancer Institute, Buffalo, New York, USA
| | | | | | - Stephanie Berg
- Loyola University Medical Center, Maywood, Illinois, USA
| | | | | | | | - Pallavi Kumar
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | | | - Johnny Cai
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Alex Sieg
- University of Iowa, Iowa City, Iowa, USA
| | | | - Julie Chang
- University of Wisconsin, Madison, Wisconsin, USA
| | | | | | - Seema Naik
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Peter Martin
- Weill Cornell Medical College, New York City, New York, USA
| | | | | | - Brad Kahl
- Washington University in St. Louis, St. Louis, Missouri, USA
| | - Andrew M. Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
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17
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Godfrey J, Chen X, Sunseri N, Cooper A, Yu J, Varlamova A, Zarubin D, Popov Y, Jacobson C, Postovalova E, Xiang Z, Nomie K, Bagaev A, Venkataraman G, Zha Y, Tumuluru S, Smith SM, Kline JP. TIGIT is a key inhibitory checkpoint receptor in lymphoma. J Immunother Cancer 2023; 11:e006582. [PMID: 37364933 PMCID: PMC10410806 DOI: 10.1136/jitc-2022-006582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND PD-1 checkpoint blockade therapy (CBT) has greatly benefited patients with select solid tumors and lymphomas but has limited efficacy against diffuse large B-cell lymphoma (DLBCL). Because numerous inhibitory checkpoint receptors have been implicated in driving tumor-specific T cell dysfunction, we hypothesized that combinatorial CBT would enhance the activity of anti-PD-1-based therapy in DLBCL. T cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain (TIGIT) is a coinhibitory receptor expressed on dysfunctional tumor-infiltrating T cells, and TIGIT blockade has demonstrated encouraging activity in combination with PD-1 blockade in murine tumor models and in clinical studies. However, the degree to which TIGIT mediates T cell dysfunction in DLBCL has not been fully explored. RESULTS Here, we demonstrate that TIGIT is broadly expressed on lymphoma-infiltrating T cells (LITs) across a variety of human lymphomas and is frequently coexpressed with PD-1. TIGIT expression is particularly common on LITs in DLBCL, where TIGIT+ LITs often form distinct cellular communities and exhibit significant contact with malignant B cells. TIGIT+/PD-1+ LITs from human DLBCL and murine lymphomas exhibit hypofunctional cytokine production on ex vivo restimulation. In mice with established, syngeneic A20 B-cell lymphomas, TIGIT or PD-1 mono-blockade leads to modest delays in tumor outgrowth, whereas PD-1 and TIGIT co-blockade results in complete rejection of A20 lymphomas in most mice and significantly prolongs survival compared with mice treated with monoblockade therapy. CONCLUSIONS These results provide rationale for clinical investigation of TIGIT and PD-1 blockade in lymphomas, including DLBCL.
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Affiliation(s)
- James Godfrey
- Hematology, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Xiufen Chen
- Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, USA
| | - Nicole Sunseri
- Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, USA
| | - Alan Cooper
- Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, USA
| | - Jovian Yu
- Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, USA
| | | | | | | | | | | | | | | | | | | | - Yuanyuan Zha
- Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, USA
| | - Sravya Tumuluru
- Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, USA
| | - Sonali M Smith
- Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, USA
| | - Justin P Kline
- Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, USA
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18
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Chavez JC, Foss FM, William BM, Brammer JE, Smith SM, Prica A, Zain JM, Tuscano JM, Shah H, Mehta-Shah N, Geethakumari PR, Wang BX, Zantinge S, Wang L, Zhang L, Boutrin A, Zhao W, Cheng L, Standifer N, Hewitt L, Enowtambong E, Shao W, Sharma S, Carlesso G, Moscow JA, Siu LL. Targeting the Inducible T-cell Costimulator (ICOS) in Patients with Relapsed/Refractory T-follicular Helper Phenotype Peripheral T-cell and Angioimmunoblastic T-cell Lymphoma. Clin Cancer Res 2023; 29:1869-1878. [PMID: 36826995 PMCID: PMC10716864 DOI: 10.1158/1078-0432.ccr-22-2955] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/26/2022] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Proliferation of T-follicular helper (TFH) CD4+ T cells is a postulated pathogenic mechanism for T-cell non-Hodgkin lymphomas (T-NHL). The inducible T-cell costimulator (ICOS) is highly expressed by TFH, representing a potential target. MEDI-570 is a monoclonal antibody against ICOS, which eliminates ICOS+ cells in preclinical models. PATIENTS AND METHODS We report the safety, pharmacokinetics (PK), pharmacodynamics (PD), and clinical activity of MEDI-570 in T-NHL. NCI-9930 is a phase I, first-in-human study of MEDI-570 in relapsed/refractory malignant T-NHL known to express ICOS. MEDI-570 was administered intravenously every 3 weeks for up to 12 cycles. Primary endpoints were safety, dose-limiting toxicities (DLT), and recommended phase II dose (RP2D). Secondary and exploratory endpoints included efficacy parameters and various correlative studies. This study is supported by the National Cancer Institute (NCT02520791). RESULTS Twenty-three patients were enrolled and received MEDI-570 at five dose levels (0.01-3 mg/kg). Sixteen (70%) had angioimmunoblastic T-cell lymphoma (AITL); median age was 67 years (29-86) and the median prior lines of therapies was 3 (1-16). Most common grade 3 or 4 adverse events were decreased CD4+ T cells (57%), lymphopenia (22%), anemia (13%), and infusion-related reactions (9%). No DLTs were observed. The RP2D was determined at 3 mg/kg. Analysis of T-cell subsets showed reductions in CD4+ICOS+ T cells reflecting its effects on TFH cells. The response rate in AITL was 44%. CONCLUSIONS MEDI-570 was well tolerated and showed promising clinical activity in refractory AITL. MEDI-570 resulted in sustained reduction of ICOS+ T lymphocytes.
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Affiliation(s)
| | | | - Basem M. William
- The Ohio State University Comprehensive Cancer Center, Columbus, OĤ
| | | | | | - Anca Prica
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Harsh Shah
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | | | - Ben X Wang
- Tumor Immunotherapy Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Stephanie Zantinge
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lisa Wang
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ling Zhang
- Department of Hematopathology, Moffitt Cancer Center, Tampa, FL
| | - Anmarie Boutrin
- US Imaging Hub, Clinical Pharmacology and Safety Sciences, AstraZeneca, Gaithersburg, MD
| | - Weiguang Zhao
- US Imaging Hub, Clinical Pharmacology and Safety Sciences, AstraZeneca, Gaithersburg, MD
| | - Lily Cheng
- Oncology Safety/Pathology, Clinical Pharmacology and Safety Sciences, AstraZeneca, Gaithersburg, MD
| | - Nathan Standifer
- Integrated Bioanalysis, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, South San Francisco, CA*
| | - Lisa Hewitt
- Integrated Bioanalysis, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Gaithersburg, MD
| | - Enowmpey Enowtambong
- Integrated Bioanalysis, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Gaithersburg, MD
| | - Weiping Shao
- Integrated Bioanalysis, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Gaithersburg, MD
| | - Shringi Sharma
- Quantitative Clinical Pharmacology, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, South San Francisco, CA
| | - Gianluca Carlesso
- Early Oncology Discovery, Early Oncology R&D, AstraZeneca, Gaithersburg, MD
| | - Jeffrey A. Moscow
- Investigational Drug Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | - Lillian L. Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Tumor Immunotherapy Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
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19
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Godfrey J, Liu H, Yu J, Tallarico M, Curran E, Artz A, Riedell PA, Stock W, Karrison T, Fitzpatrick C, Venkataraman G, Cooper A, Smith SM, Bishop MR, Kline J. Pembrolizumab for the treatment of disease relapse after allogeneic hematopoietic stem cell transplantation. Blood Adv 2023; 7:963-970. [PMID: 35973200 PMCID: PMC10027501 DOI: 10.1182/bloodadvances.2022008403] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 11/20/2022] Open
Abstract
A failed graft-versus-tumor (GVT) effect is a common mechanism of relapse after allogeneic hematopoietic cell transplantation (alloHCT). Although targeting the PD-1/PD-L1 axis may restore GVT effects, PD-1 blockade exacerbates graft-versus-host disease (GVHD) in murine models, and severe GVHD can occur in patients treated with anti-PD-1 therapy after alloHCT. Therefore, we developed a prospective study to assess the safety and efficacy of pembrolizumab in patients relapsing after alloHCT. Eligible patients received pembrolizumab (200 mg every 3 weeks) for up to 2 years. Twelve patients were enrolled (8 patients with acute myeloid leukemia, 1 patient with myelodysplastic syndrome, 1 patient with classical Hodgkin lymphoma, and 2 patients with diffuse large B-cell lymphoma [DLBCL]). All participants received reduced-intensity preparative regimens with in vivo T-cell depletion. The median time from alloHCT to enrollment was 587 days (range, 101-4211). Three participants (25%) experienced grade 3 to 4 immune-related adverse events (irAE) (pneumonitis, 2 patients; hyperthyroidism, 1 patient), all occurring after 1 to 2 cycles, and resolving after pembrolizumab discontinuation and corticosteroid treatment. irAEs of any grade occurred in 5 patients (42%). No treatment-emergent GVHD was observed. Overall and complete response (CR) rates were 22% (2/9). Both patients achieving CRs had PD-L1 gene-amplified lymphomas and diffuse PD-L1 expression on pretreatment biopsies. An acquired EZH2 mutation was identified at relapse in a patient with DLBCL who achieved an initial CR to pembrolizumab, which was associated with downregulated HLA expression on malignant B cells, implicating EZH2 mutations as a potential immune escape mechanism after PD-1-blockade therapy. In conclusion, after alloHCT, treatment with pembrolizumab is feasible and associated with objective responses in relapsed lymphoid malignancies but can induce severe irAEs, requiring vigilant monitoring. This trial was registered at www.clinicaltrials.gov as #NCT02981914.
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Affiliation(s)
- James Godfrey
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Hongtao Liu
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
- David and Etta Jones Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Jovian Yu
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | | | - Emily Curran
- Division of Hematology/Oncology, College of Medicine, University of Cincinnati, Cincinnati, IL
| | - Andrew Artz
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Peter A Riedell
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
- David and Etta Jones Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Wendy Stock
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
- David and Etta Jones Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Theodore Karrison
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | | | | | - Alan Cooper
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Sonali M Smith
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Michael R Bishop
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
- David and Etta Jones Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Justin Kline
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
- David and Etta Jones Center for Cellular Therapy, University of Chicago, Chicago, IL
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20
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Agrawal P, David KA, Chen Z, Sundaram S, Kim SH, Vaca R, Lin Y, Singer S, Malecek MK, Carter J, Zayac A, Kim MS, Reddy N, Ney D, Habib A, Strouse C, Graber J, Bachanova V, Salman S, Vendiola JA, Hossain N, Tsang M, Major A, Gandhi MK, Keane C, Bond DA, Folstad M, Chang J, Mier-Hicks A, Torka P, Rajakumar P, Venugopal P, Berg S, Glantz M, Goldlust SA, Matnani R, Kumar P, Ollila TA, Cai J, Spurgeon SE, Sieg AG, Cleveland J, Epperla N, Karmali R, Naik S, Smith SM, Rubenstein JL, Kahl BS, Chadburn A, Evens AM, Martin P. EBV-positive PCNSL in older patients: incidence, characteristics, tumor pathology, and outcomes across a large multicenter cohort. Leuk Lymphoma 2023:1-9. [PMID: 36960939 DOI: 10.1080/10428194.2023.2191152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
The objective of this multicenter retrospective study was to examine the incidence, patient characteristics, pathology, and outcomes associated with Epstein-Barr virus (EBV)-related CNS lymphoma (CNSL) in older patients. Among 309 CNSL patients aged ≥60, 11.7% had EBV + tumors of which 72.2% were solid organ transplant (SOT)-related post-transplant lymphoproliferative disorders (PTLD). Younger age, SOT or autoimmune disease, and immunosuppressive treatment correlated highly with EBV-positivity. EBV + tumors were associated with absent C-MYC and BCL6 expression. EBV + PTLD was more likely to be associated with the absence of CD5 expression. EBV + non-PTLD had better median OS (not reached) compared to EBV + PTLD (10.8 months) and EBV-negative patients (43 months). Multivariable Cox regression analysis showed that age, performance status, and PTLD were negative predictors of OS. EBV status and immunosuppressive treatment were not correlated with OS. Our findings merit further investigation of EBV + PCNSL tumors and EBV-directed therapies.
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Affiliation(s)
- Prashasti Agrawal
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Kevin A David
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Zhengming Chen
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | | | - Seo-Hyun Kim
- Department of Internal Medicine, Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Ryan Vaca
- Department of Medicine, Penn State University College of Medicine, Hershey, PA, USA
| | - Yong Lin
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Mary-Kate Malecek
- Department of Medicine, Division of Hematology & Oncology, Washington University School of Medicine, University City, MO, USA
| | - Jordan Carter
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Adam Zayac
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Myung Sun Kim
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Nishitha Reddy
- Department of Medicine, Division of Hematology & Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas Ney
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Alma Habib
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | | | - Jerome Graber
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Veronika Bachanova
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Sidra Salman
- Department of Medicine and Cancer Biology, Loyola University, Chicago, IL, USA
| | - Jean A Vendiola
- Department of Medicine and Cancer Biology, Loyola University, Chicago, IL, USA
| | - Nasheed Hossain
- Department of Medicine and Cancer Biology, Loyola University, Chicago, IL, USA
| | - Mazie Tsang
- Department of Hematology/Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Ajay Major
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | | | - Colm Keane
- Princess Alexandria Hospital, Brisbane, Australia
| | - David A Bond
- Department of Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Matthew Folstad
- Department of Medicine, Division of Hematology, Oncology and Palliative Care, University of Wisconsin, Madison, WI, USA
| | - Julie Chang
- Department of Medicine, Division of Hematology, Oncology and Palliative Care, University of Wisconsin, Madison, WI, USA
| | | | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Priya Rajakumar
- Department of Internal Medicine, Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Parameswaran Venugopal
- Department of Internal Medicine, Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Stephanie Berg
- Department of Medicine and Cancer Biology, Loyola University, Chicago, IL, USA
| | - Michael Glantz
- Department of Medicine, Penn State University College of Medicine, Hershey, PA, USA
| | | | - Rahul Matnani
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Pallavi Kumar
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Johnny Cai
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Stephen E Spurgeon
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Alex G Sieg
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Joseph Cleveland
- Department of Hematology/Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Narendranath Epperla
- Department of Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Reem Karmali
- Division of Hematology Oncology, Northwestern University, Chicago, IL, USA
| | - Seema Naik
- Department of Medicine, Penn State University College of Medicine, Hershey, PA, USA
| | - Sonali M Smith
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - James L Rubenstein
- Department of Hematology/Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Brad S Kahl
- Department of Medicine, Division of Hematology & Oncology, Washington University School of Medicine, University City, MO, USA
| | - Amy Chadburn
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Peter Martin
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
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21
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Zack EH, Smith SM, Angielczyk KD. From Fairies to Giants: Untangling the Effect of Body Size, Phylogeny, and Ecology on Vertebral Bone Microstructure of Xenarthran Mammals. Integr Org Biol 2023; 5:obad002. [PMID: 36844392 PMCID: PMC9949600 DOI: 10.1093/iob/obad002] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/02/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
Trabecular bone is a spongy bone tissue that serves as a scaffolding-like support inside many skeletal elements. Previous research found allometric variation in some aspects of trabecular bone architecture (TBA) and bone microstructure, whereas others scale isometrically. However, most of these studies examined very wide size and phylogenetic ranges or focused exclusively on primates or lab mice. We examined the impact of body size on TBA across a smaller size range in the mammalian clade Xenarthra (sloths, armadillos, and anteaters). We µCT-scanned the last six presacral vertebrae of 23 xenarthran specimens (body mass 120 g-35 kg). We collected ten gross-morphology measurements and seven TBA metrics and analyzed them using phylogenetic and nonphylogenetic methods. Most metrics had similar allometries to previous work. However, because ecology and phylogeny align closely in Xenarthra, the phylogenetic methods likely removed some covariance due to ecology; clarifying the impact of ecology on TBA in xenarthrans requires further work. Regressions for Folivora had high P-values and low R-squared values, indicating that the extant sloth sample either is too limited to determine patterns or that the unique way sloths load their vertebral columns causes unusually high TBA variation. The southern three-banded armadillo sits far below the regression lines, which may be related to its ability to roll into a ball. Body size, phylogeny, and ecology impact xenarthran TBA, but parsing these effects is highly complex.
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Affiliation(s)
| | - S M Smith
- Negaunee Integrative Research Center, Field Museum of Natural History, Chicago, IL 60605, USA
| | - K D Angielczyk
- Negaunee Integrative Research Center, Field Museum of Natural History, Chicago, IL 60605, USA
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22
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Major A, Wright R, Hlubocky FJ, Smith SM, Prochaska MT. Longitudinal assessment of quality of life in indolent non-Hodgkin lymphomas managed with active surveillance. Leuk Lymphoma 2022; 63:3331-3339. [PMID: 36120910 PMCID: PMC9877126 DOI: 10.1080/10428194.2022.2123225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/12/2022] [Accepted: 09/04/2022] [Indexed: 01/28/2023]
Abstract
There are limited data describing the impact of active surveillance on longitudinal health-related quality of life (HRQoL) in patients with indolent non-Hodgkin lymphomas (NHL). A cohort of untreated indolent NHL patients completed FACT-LYM questionnaires at 6, 12, 18, 24, and 36 months after diagnosis. Longitudinal FACT-LYM scores were analyzed by ANOVA and generalized linear mixed models. Indolent NHL scores were compared to norm general population scores. A total of 52 patients were identified, of which 46 (88%) remained on active surveillance at 36 months. There was no significant change in any of the FACT-LYM scores over 36 months. As compared to the general population, indolent NHL patients had higher, clinically meaningful scores in physical, functional, and social well-being, but not emotional well-being. Patients with indolent NHL on active surveillance have globally preserved HRQoL for up to 3 years after diagnosis. Emotional well-being continues to be an unmet need during active surveillance.
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Affiliation(s)
- Ajay Major
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL
| | - Rachel Wright
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL
| | - Fay J. Hlubocky
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL
| | - Sonali M. Smith
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL
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23
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Lukas RV, Chmura SJ, Parney IF, Mammoser A, Smith SM, Li J. Neuro-oncology at the American Society for Clinical Oncology 2022 Annual Meeting. Neurooncol Pract 2022; 9:552-558. [PMID: 36388417 PMCID: PMC9665054 DOI: 10.1093/nop/npac071] [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] [Indexed: 09/12/2023] Open
Abstract
In the following brief report, we highlight the advances in the neuro-oncology space from the ASCO 2022 Annual Meeting. We put into context the phase 2 and 3 trials and how these may alter the standard of care going forward. In addition, we highlight some other earlier work that will lead to future and potentially practice-changing trials.
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Affiliation(s)
- Rimas V Lukas
- Department of Neurology, Northwestern University, Chicago, Illinois, USA
- Lou and Jean Malnati Brain Tumor Institute, Northwestern University, Chicago, Illinois, USA
| | - Steven J Chmura
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois, USA
| | - Ian F Parney
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron Mammoser
- Department of Neurosurgery, Louisiana State University, New Orleans, Louisiana, USA
| | - Sonali M Smith
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, Illinois, USA
| | - Jing Li
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
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24
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Stephens DM, Li H, Constine LS, Fitzgerald TJ, Leonard JP, Kahl BS, Song JY, LeBlanc ML, Smith SM, Persky DO, Friedberg JW. Extranodal presentation in limited-stage diffuse large Bcell lymphoma as a prognostic marker in three SWOG trials S0014, S0313 and S1001. Haematologica 2022; 107:2732-2736. [PMID: 35833300 PMCID: PMC9614528 DOI: 10.3324/haematol.2022.281004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/07/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Hongli Li
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester, Rochester
| | | | - John P Leonard
- Division of Hematology and Medical Oncology, Weill Cornell Medical Center, New York
| | - Brad S Kahl
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Joo Y Song
- Department of Pathology, City of Hope, Duarte, CA
| | - Michael L LeBlanc
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle
| | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Daniel O Persky
- Division of Hematology/Oncology, University of Arizona, Tucson, AZ
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25
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Murphy AW, Moran D, Smith SM, Wallace E, Glynn LG, Hanley K, Kelly ME. Supporting Medical Students Towards Future Careers in General Practice: A Quantitative Study of Irish Medical Schools. Ir Med J 2022; 115:10. [PMID: 36917466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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26
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Campo E, Jaffe ES, Cook JR, Quintanilla-Martinez L, Swerdlow SH, Anderson KC, Brousset P, Cerroni L, de Leval L, Dirnhofer S, Dogan A, Feldman AL, Fend F, Friedberg JW, Gaulard P, Ghia P, Horwitz SM, King RL, Salles G, San-Miguel J, Seymour JF, Treon SP, Vose JM, Zucca E, Advani R, Ansell S, Au WY, Barrionuevo C, Bergsagel L, Chan WC, Cohen JI, d'Amore F, Davies A, Falini B, Ghobrial IM, Goodlad JR, Gribben JG, Hsi ED, Kahl BS, Kim WS, Kumar S, LaCasce AS, Laurent C, Lenz G, Leonard JP, Link MP, Lopez-Guillermo A, Mateos MV, Macintyre E, Melnick AM, Morschhauser F, Nakamura S, Narbaitz M, Pavlovsky A, Pileri SA, Piris M, Pro B, Rajkumar V, Rosen ST, Sander B, Sehn L, Shipp MA, Smith SM, Staudt LM, Thieblemont C, Tousseyn T, Wilson WH, Yoshino T, Zinzani PL, Dreyling M, Scott DW, Winter JN, Zelenetz AD. The International Consensus Classification of Mature Lymphoid Neoplasms: a report from the Clinical Advisory Committee. Blood 2022; 140:1229-1253. [PMID: 35653592 PMCID: PMC9479027 DOI: 10.1182/blood.2022015851] [Citation(s) in RCA: 457] [Impact Index Per Article: 228.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/18/2022] [Indexed: 11/20/2022] Open
Abstract
Since the publication of the Revised European-American Classification of Lymphoid Neoplasms in 1994, subsequent updates of the classification of lymphoid neoplasms have been generated through iterative international efforts to achieve broad consensus among hematopathologists, geneticists, molecular scientists, and clinicians. Significant progress has recently been made in the characterization of malignancies of the immune system, with many new insights provided by genomic studies. They have led to this proposal. We have followed the same process that was successfully used for the third and fourth editions of the World Health Organization Classification of Hematologic Neoplasms. The definition, recommended studies, and criteria for the diagnosis of many entities have been extensively refined. Some categories considered provisional have now been upgraded to definite entities. Terminology for some diseases has been revised to adapt nomenclature to the current knowledge of their biology, but these modifications have been restricted to well-justified situations. Major findings from recent genomic studies have impacted the conceptual framework and diagnostic criteria for many disease entities. These changes will have an impact on optimal clinical management. The conclusions of this work are summarized in this report as the proposed International Consensus Classification of mature lymphoid, histiocytic, and dendritic cell tumors.
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Affiliation(s)
- Elias Campo
- Haematopathology Section, Hospital Clínic of Barcelona, Institut d'Investigaciones Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Barcelona, Spain
| | - Elaine S Jaffe
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - James R Cook
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Steven H Swerdlow
- Department of Pathology, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Pierre Brousset
- Department of Pathology, Institut Universitaire du Cancer de Toulouse-Oncopole, and Laboratoire d'Excellence Toulouse Cancer, Toulouse, France
| | - Lorenzo Cerroni
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ahmet Dogan
- Laboratory of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Falko Fend
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | | | - Philippe Gaulard
- Department of Pathology, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
- Mondor Institute for Biomedical Research, INSERM U955, Faculty of Medicine, University of Paris-Est Créteil, Créteil, France
| | - Paolo Ghia
- Strategic Research Program on Chronic Lymphocytic Leukemia, Division of Experimental Oncology, IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Steven M Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rebecca L King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Gilles Salles
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jesus San-Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, CIBERONC, Pamplona, Spain
| | - John F Seymour
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Julie M Vose
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, University of Nebraska, Omaha, NE
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, and Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Ranjana Advani
- Stanford Cancer Center, Blood and Marrow Transplant Program, Stanford University, Stanford, CA
| | - Stephen Ansell
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Wing-Yan Au
- Blood-Med Clinic, Hong Kong, People's Republic of China
| | - Carlos Barrionuevo
- Department of Pathology, Instituto Nacional de Enfermedades Neoplásicas, Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Leif Bergsagel
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ
| | - Wing C Chan
- Department of Pathology, City of Hope National Medical Center, Duarte, CA
| | - Jeffrey I Cohen
- Medical Virology Section, Laboratory of Infectious Diseases, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Francesco d'Amore
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Andrew Davies
- Cancer Research UK Centre, Centre for Cancer Immunology, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| | - Brunangelo Falini
- Institute of Hematology and Center for Hemato-Oncology Research, Hospital of Perugia, University of Perugia , Perugia, Italy
| | - Irene M Ghobrial
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Harvard University, Boston, MA
| | - John R Goodlad
- National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - John G Gribben
- Department of Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Eric D Hsi
- Department of Pathology, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Brad S Kahl
- Oncology Division, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Won-Seog Kim
- Hematology and Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Shaji Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Camille Laurent
- Department of Pathology, Institut Universitaire du Cancer de Toulouse-Oncopole, and Laboratoire d'Excellence Toulouse Cancer, Toulouse, France
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - John P Leonard
- Weill Department of Medicine, Weill Medical College, Cornell University, New York, NY
| | - Michael P Link
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Armando Lopez-Guillermo
- Department of Hematology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Maria Victoria Mateos
- Department of Hematology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cancer, Universidad de Salamanca, Salamanca, Spain
| | - Elizabeth Macintyre
- Laboratoire d'Onco-Hématologie, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris Cité and Institut Necker-Enfants Malades, Paris, France
| | - Ari M Melnick
- Division of Hematology and Oncology, Weill Medical College, Cornell University, New York, NY
| | - Franck Morschhauser
- Department of Hematology, Centre Hospitalier Universitaire de Lille, University Lille, Lille, France
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Marina Narbaitz
- Department of Pathology, Instituto de Investigaciones Hematológicas, Academia Nacional de Medicina and Fundacion para combatir la leucemia (FUNDALEU), Buenos Aires, Argentina
| | - Astrid Pavlovsky
- Fundación para Combatir la Leucemia (FUNDALEU), Centro de Hematología Pavlovsky, Buenos Aires, Argentina
| | - Stefano A Pileri
- Haematopathology Division, IRCCS, Istituto Europeo di Oncologia, Milan, Italy
| | - Miguel Piris
- Jiménez Díaz Foundation University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Barbara Pro
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Vincent Rajkumar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Steven T Rosen
- Beckman Research Institute, and Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Birgitta Sander
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Laurie Sehn
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Louis M Staudt
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Catherine Thieblemont
- Service Hémato-Oncologie, AP-HP, Hôpital Saint-Louis, Paris, France
- DMU-DHI, Université de Paris-Paris Diderot, Paris, France
| | - Thomas Tousseyn
- Department of Pathology, Universitair Ziekenhuis Leuven Hospitals, Leuven, Belgium
| | - Wyndham H Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Tadashi Yoshino
- Department of Pathology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Pier-Luigi Zinzani
- Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seragnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Martin Dreyling
- Department of Medicine III, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - David W Scott
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Jane N Winter
- Feinberg School of Medicine, Northwestern University, Chicago, IL; and
| | - Andrew D Zelenetz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Medical College, Cornell University, New York, NY
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27
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Major A, Kline J, Karrison TG, Fishkin PAS, Kimball AS, Petrich AM, Nattam S, Rao K, Sleckman BG, Cohen K, Besien KV, Rapoport AP, Smith SM. Phase I/II clinical trial of temsirolimus and lenalidomide in patients with relapsed and refractory lymphomas. Haematologica 2022; 107:1608-1618. [PMID: 34320785 PMCID: PMC9244831 DOI: 10.3324/haematol.2021.278853] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/22/2021] [Indexed: 12/01/2022] Open
Abstract
The PI3K/Akt/mTOR (PAM) axis is constitutively activated in multiple lymphoma subtypes and is a promising therapeutic target. The mTOR inhibitor temsirolimus (TEM) and the immunomodulatory agent lenalidomide (LEN) have overlapping effects within the PAM axis with synergistic potential. This multicenter phase I/II study evaluated combination therapy with TEM/LEN in patients with relapsed and refractory lymphomas. Primary endpoints of the phase II study were rates of complete (CR) and overall response (ORR). There were 18 patients in the phase I dose-finding study, and TEM 25 mg weekly and LEN 20 mg on day 1 through day 21 every 28 days was established as the recommended phase II dose. An additional 93 patients were enrolled in the phase II component with three cohorts: diffuse large B-cell lymphoma (DLBCL, n=39), follicular lymphoma (FL, n=15), and an exploratory cohort of other lymphoma histologies with classical Hodgkin lymphoma (cHL) comprising the majority (n=39 total, n=20 with cHL). Patients were heavily pretreated with a median of four (range, 1-14) prior therapies and one-third with relapse following autologous stem cell transplantation (ASCT); patients with cHL had a median of six prior therapies. The FL cohort was closed prematurely due to slow accrual. ORR were 26% (13% CR) and 64% (18% CR) for the DLBCL and exploratory cohorts, respectively. ORR for cHL patients in the exploratory cohort, most of whom had relapsed after both brentuximab vedotin and ASCT, was 80% (35% CR). Eight cHL patients (40%) proceeded to allogeneic transplantation after TEM/LEN therapy. Grade ≥3 hematologic adverse events (AE) were common. Three grade 5 AE occurred. Combination therapy with TEM/LEN was feasible and demonstrated encouraging activity in heavily-pretreated lymphomas, particularly in relapsed/refractory cHL (clinicaltrials gov. Identifier: NCT01076543).
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Affiliation(s)
| | | | | | | | - Amy S Kimball
- University of Maryland School of Medicine and Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA; Amgen Inc., Thousand Oaks, CA
| | - Adam M Petrich
- Northwestern University, Chicago, IL, USA; Daiichi-Sankyo, Basking Ridge, NJ
| | | | - Krishna Rao
- Southern Illinois University, Springfield, IL
| | | | | | | | - Aaron P Rapoport
- University of Maryland School of Medicine and Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD
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28
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Bennani NN, Tun AM, Carson KR, Geiger JL, Maeda LS, Savage KJ, Rose J, Pinter-Brown L, Lunning MA, Abramson JS, Bartlett NL, Vose JM, Evens AM, Smith SM, Horwitz SM, Ansell SM, Advani RH. Characteristics and Outcome of Extranodal NK/T-cell Lymphoma in North America: A Retrospective Multi-Institutional Experience. Clin Lymphoma Myeloma Leuk 2022; 22:e300-e309. [PMID: 34848181 DOI: 10.1016/j.clml.2021.10.018] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Extranodal natural killer/T-cell lymphoma (ENKTL) is rare and clinical data from non-Asian countries are lacking. It is unclear whether outcomes and disease natural history is similar to reported Asian series. We assessed characteristics and outcomes of patients with ENKTL from major North American centers. PATIENTS AND METHODS We retrospectively identified patients with newly-diagnosed CD56 + ENKTL and studied disease characteristics and clinical outcomes. RESULTS One hundred and twenty-one patients with ENKTL diagnosed between June 1990 and November 2012 were identified. Eighty-three patients (69%) had stage I/II disease and were treated with combined modality therapy (CMT) (n = 53), chemotherapy alone (CT) (n = 14) or radiotherapy alone (RT) (n = 16). Thirty-eight patients (31%) had stage III/IV disease and were treated with CMT (n = 12), CT (n = 23), or RT (n = 3). The median follow-up for the entire cohort was 51 months. Patients with stage I/II disease, compared to those with stage III/IV disease, had superior 2-year progression free survival (PFS) 43% vs 19% (P = .03) and overall survival (OS) 59% vs. 29% (P= .004). Outcomes were similar for stage I/II patients who received CMT vs. RT alone with 2-year PFS (53% vs. 47%; P= .91) and OS (67% vs. 67%; P= .58). No significant differences in outcomes were noted based on race/ethnicity. CONCLUSIONS This series represents a large experience of ENKTL treated at several major North American academic centers. Our data are consistent with Asian studies: (1) majority of patients present with early-stage disease; (2) overall poor outcome regardless of race/ethnicity; (3) CMT likely yields favorable outcomes for suitable candidates with early-stage disease.
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Affiliation(s)
| | - Aung M Tun
- Division of Hematology, Mayo Clinic, Rochester, MN; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Kansas City, KS
| | - Kenneth R Carson
- Research Service, St Louis Veterans Affairs Medical Center, St. Louis, MO; Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | | | | | - Kerry J Savage
- Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC
| | - Jim Rose
- Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC
| | | | - Matthew A Lunning
- Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Jeremy S Abramson
- Divisions of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Nancy L Bartlett
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Julie M Vose
- Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | | | - Sonali M Smith
- Divisions of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Steven M Horwitz
- Division of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
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29
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Siddiqui F, Perez Silos V, Karube K, Yasin Goksu S, Nandakumar S, Saygin C, Onajin O, Prabu SS, Gurbuxani S, Arber DA, Tjota M, Segal J, Smith SM, Murga-Zamalloa CA, Venkataraman G. B-cell lymphoma-2 (BCL2) downregulation is a useful feature -supporting a neoplastic phenotype in mature T-cell lymphomas. Hum Pathol 2022; 125:48-58. [PMID: 35452696 DOI: 10.1016/j.humpath.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022]
Abstract
Normal T-cells express high levels of BCL2 protein, data regarding BCL2 expression status and its diagnostic utility in T-cell lymphoma is scarce. We evaluated BCL2 expression in a series of mature T-cell lymphoproliferations including indolent and more recently recognized entities (follicular helper T-cell (TFH) lymphomas). Sixty-six neoplastic biopsies (60 patients) representing mature nodal, extranodal and leukemia T-cell neoplasms were collected from three institutes (2 US and 1 Japan) and were compared with reactive T-cells in 8 benign tissues/blood and 9 T-cell rich B-cell proliferations. BCL2 immunostaining was performed and scored based on intensity weighted H-score (0-300). Next generation sequencing (5 cases), BCL2 gene sequencing, and real time-PCR (3 cases) were conducted. Association of H-score with overall survival (using proportional hazards modeling) was assessed in non-leukemic T-cell lymphoproliferations (TCL). Most TCLs showed significantly downregulated median BCL2 H-score (125, range 18-300) with the exception of T-cell prolymphocytic leukemia (T-PLL) and hepatosplenic T-cell lymphoma (HSTL) both of which showed uniform strong retention of BCL2 as did the 8 reactive tissues (median H-score 280; p=0.000). Notably all TFH lymphoma CD4 neoplastic T-cells, subcutaneous panniculitis-like T-cell lymphoma (SPTCL) CD8 adipocyte-rimming T-cells and T-cell large lymphocyte leukemia (T-LGLL) with pathogenic STAT5B and TP53 mutation showed BCL2 downregulation. No BCL2 mutations were observed by NGS or sequencing with decreased BCL2 mRNA transcripts by real-time PCR. BCL2 downregulation is pervasive among many T-cell lymphoproliferations and unrelated to any mutations. There is utility for BCL2 immunostaining in some challenging situations as discussed in manuscript.
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MESH Headings
- Down-Regulation
- Humans
- Leukemia
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/pathology
- Lymphoma, T-Cell/genetics
- Lymphoma, T-Cell/metabolism
- Lymphoma, T-Cell/pathology
- Lymphoma, T-Cell, Peripheral/metabolism
- Lymphoma, T-Cell, Peripheral/pathology
- Phenotype
- Proto-Oncogene Proteins c-bcl-2/genetics
- Proto-Oncogene Proteins c-bcl-2/metabolism
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Affiliation(s)
- Faiza Siddiqui
- The University of Chicago Medicine, Departments of Pathology, Section of Hematopathology, USA
| | | | - Kennosuke Karube
- Department of Pathology and Cell Biology, University of the Ryukyus, Okinawa, Japan
| | | | | | - Caner Saygin
- The University of Chicago Medicine, Departments of Medicine, Section of Hematology/Oncology, USA
| | - Oluwakemi Onajin
- The University of Chicago Medicine, Departments of Dermatology, USA
| | | | - Sandeep Gurbuxani
- The University of Chicago Medicine, Departments of Pathology, Section of Hematopathology, USA
| | - Daniel A Arber
- The University of Chicago Medicine, Departments of Pathology, Section of Hematopathology, USA
| | - Melissa Tjota
- The University of Chicago Medicine, Departments of Pathology, Section of Hematopathology, USA
| | - Jeremy Segal
- The University of Chicago Medicine, Departments of Pathology, Section of Hematopathology, USA
| | - Sonali M Smith
- The University of Chicago Medicine, Departments of Medicine, Section of Hematology/Oncology, USA
| | | | - Girish Venkataraman
- The University of Chicago Medicine, Departments of Pathology, Section of Hematopathology, USA.
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30
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Brem EA, Li H, Beaven AW, Caimi PF, Cerchietti L, Alizadeh A, Olin R, Henry NL, Dillon H, Little RF, Laubach C, LeBlanc M, Friedberg JW, Smith SM. SWOG 1918: A phase II/III randomized study of R-miniCHOP with or without oral azacitidine (CC-486) in participants age 75 years or older with newly diagnosed aggressive non-Hodgkin lymphomas - Aiming to improve therapy, outcomes, and validate a prospective frailty tool. J Geriatr Oncol 2022; 13:258-264. [PMID: 34686472 PMCID: PMC9879719 DOI: 10.1016/j.jgo.2021.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/08/2021] [Indexed: 01/28/2023]
Abstract
Diffuse large B cell lymphoma (DLBCL) is an aggressive but potentially curable malignancy; however, cure is highly dependent on the ability to deliver intensive, anthracycline-based chemoimmunotherapy. Nearly one third of cases of DLBCL occur in patients over age 75 years, and advanced age is an important adverse feature in prognostic models. Despite this incidence in older patients, there is no clear accepted standard of care due to under-representation of this group in large randomized clinical trials. Furthermore, insufficient assessments of baseline frailty and prediction of toxicity hamper clinical decision-making. Here, we present an ongoing randomized study of R-miniCHOP chemoimmunotherapy with or without oral azacitidine (CC-486, Onureg) for patients age 75 and older with newly diagnosed DLBCL and associated aggressive lymphomas. The incorporation of an oral hypomethylating agent is based on increased tumor methylation as a biologic feature of older patients with DLBCL and a desire to minimize the injection burden for this population. This is the first randomized study in this population conducted in North America by the National Clinical Trials Network (NCTN) and will enroll up to 422 patients including 40 patients in a safety run-in phase. This study incorporates an objective assessment of baseline frailty (the FIL Tool) and a serial comprehensive geriatric assessment (CGA). Key correlative tests will include circulating tumor DNA (ctDNA) assays at pre-specified timepoints to explore if ctDNA quantity and methylation patterns correlate with response. S1918 has the potential to impact future trial design and to change the standard of care for patients 75 years and older with aggressive lymphoma given its randomized design, prospective incorporation of geriatric assessments, and exploration of ctDNA correlatives. Trial registration: The trial is registered with ClinicalTrial.gov Identifier NCT04799275.
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Affiliation(s)
| | - Hongli Li
- SWOG Statistics and Data Management Center, Seattle, WA,Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Anne W. Beaven
- Lineberger Comprehensive Cancer Center University of North Carolina, Chapel Hill, NC
| | - Paolo F. Caimi
- Case Western Reserve University School of Medicine, Case Comprehensive Cancer Center, Cleveland, OH
| | | | - Ash Alizadeh
- Stanford University Medical Center, Stanford, CA
| | - Rebecca Olin
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | | | | | - Richard F. Little
- National Cancer Institute, Cancer Therapy Evaluation Program (CTEP), Bethesda, MD
| | | | - Michael LeBlanc
- SWOG Statistics and Data Management Center, Seattle, WA,Fred Hutchinson Cancer Research Center, Seattle, WA
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31
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Martin P, Bartlett NL, Chavez JC, Reagan JL, Smith SM, LaCasce AS, Jones J, Drew J, Wu C, Mulvey E, Revuelta MV, Cerchietti L, Leonard JP. Phase 1 study of oral azacitidine (CC-486) plus R-CHOP in previously untreated intermediate- to high-risk DLBCL. Blood 2022; 139:1147-1159. [PMID: 34428285 PMCID: PMC9211445 DOI: 10.1182/blood.2021011679] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/30/2021] [Indexed: 11/20/2022] Open
Abstract
Resistance to standard immunochemotherapy remains an unmet challenge in diffuse large B-cell lymphoma (DLBCL), and aberrant DNA methylation may contribute to chemoresistance. Promising early-phase results were reported with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) plus subcutaneous azacitidine, a hypomethylating agent. In this phase 1 study, we evaluated CC-486 (oral azacitidine) plus 6 cycles of R-CHOP in patients with previously untreated intermediate- to high-risk DLBCL or grade 3B/transformed follicular lymphoma. CC-486 doses of 100, 150, 200, or 300 mg given 7 days before cycle 1 and on days 8-21 of cycles 1-5 were evaluated; additional patients were enrolled in the expansion phase to examine preliminary efficacy. The primary objectives were to determine the safety and the maximum tolerated dose (MTD) of CC-486 in combination with R-CHOP. The most common grade 3/4 toxicities were hematologic, including neutropenia (62.7%) and febrile neutropenia (25.4%); grade 3/4 nonhematologic toxicities were uncommon (<7%). The MTD was not established; 2 patients had dose-limiting toxicities (1 with grade 4 febrile neutropenia; 1 with grade 4 prolonged neutropenia). The recommended phase 2 dose was established as 300 mg. The overall response rate was 94.9%, with 52 patients (88.1%) achieving complete responses. With a median follow-up of 28.9 months, estimated 1- and 2-year progression-free survival rates were 84.1% and 78.6%, respectively. Overall, epigenetic priming with CC-486 before R-CHOP can be delivered with acceptable safety to patients with previously untreated intermediate- to high-risk DLBCL or grade 3B/transformed follicular lymphoma. ClinicalTrials.gov: NCT02343536.
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Affiliation(s)
| | | | | | - John L Reagan
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Sonali M Smith
- University of Chicago Comprehensive Cancer Center, Chicago, IL
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32
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Orellana-Noia VM, Reed DR, McCook AA, Sen JM, Barlow CM, Malecek MK, Watkins M, Kahl BS, Spinner MA, Advani R, Voorhees TJ, Snow A, Grover NS, Ayers A, Romancik J, Liu Y, Huntington SF, Chavez JC, Saeed H, Lazaryan A, Raghunathan V, Spurgeon SE, Ollila TA, Del Prete C, Olszewski A, Ayers EC, Landsburg DJ, Echalier B, Lee J, Kamdar M, Caimi PF, Fu T, Liu J, David KA, Alharthy H, Law J, Karmali R, Shah H, Stephens DM, Major A, Rojek AE, Smith SM, Yellala A, Kallam A, Nakhoda S, Khan N, Sohail MA, Hill BT, Barrett-Campbell O, Lansigan F, Switchenko J, Cohen J, Portell CA. Single-route CNS prophylaxis for aggressive non-Hodgkin lymphomas: real-world outcomes from 21 US academic institutions. Blood 2022; 139:413-423. [PMID: 34570876 PMCID: PMC8777199 DOI: 10.1182/blood.2021012888] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/05/2021] [Indexed: 01/22/2023] Open
Abstract
Prophylaxis is commonly used to prevent central nervous sy stem (CNS) relapse in diffuse large B-cell lymphoma (DLBCL), with no clear standard of care. We retrospectively evaluated 1162 adult patients across 21 US academic centers with DLBCL or similar histologies who received single-route CNS prophylaxis as part of frontline therapy between 2013 and 2019. Prophylaxis was administered intrathecally(IT) in 894 (77%) and using systemic high-dose methotrexate (HD-MTX) in 236 (20%); 32 patients (3%) switched route due to toxicity and were assessed separately. By CNS-International Prognostic Index (IPI), 18% were considered low-risk, 51% moderate, and 30% high. Double-hit lymphoma (DHL) was confirmed in 243 of 866 evaluable patients (21%). Sixty-four patients (5.7%) had CNS relapse after median 7.1 months from diagnosis, including 15 of 64 (23%) within the first 6 months. There was no significant difference in CNS relapse between IT and HD-MTX recipients (5.4% vs 6.8%, P = .4), including after propensity score matching to account for differences between respective recipient groups. Weighting by CNS-IPI, expected vs observed CNS relapse rates were nearly identical (5.8% vs 5.7%). Testicular involvement was associated with high risk of CNS relapse (11.3%) despite most having lower CNS-IPI scores. DHL did not significantly predict for CNS relapse after single-route prophylaxis, including with adjustment for treatment regimen and other factors. This large study of CNS prophylaxis recipients with DLBCL found no significant difference in CNS relapse rates between routes of administration. Relapse rates among high-risk subgroups remain elevated, and reconsideration of prophylaxis strategies in DLBCL is of critical need.
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Affiliation(s)
- Victor Manuel Orellana-Noia
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Daniel R Reed
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
- Comprehensive Cancer Center of Wake Forest University, Section on Hematology and Oncology, Winston-Salem, NC
| | - Ashley Alesia McCook
- Winship Cancer Institute, Department of Biostatistics, Emory University, Atlanta, GA
| | | | - Christian M Barlow
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Mary-Kate Malecek
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Marcus Watkins
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Brad S Kahl
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Michael A Spinner
- Division of Oncology, Stanford University Medical Center, Stanford, CA
| | - Ranjana Advani
- Division of Oncology, Stanford University Medical Center, Stanford, CA
| | - Timothy J Voorhees
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
- Division of Hematology, Ohio State University, Columbus, OH
| | - Anson Snow
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Natalie Sophia Grover
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Amy Ayers
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Jason Romancik
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Yuxin Liu
- Division of Hematology, Yale University, New Haven, CT
| | | | - Julio C Chavez
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Hayder Saeed
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | | | - Vikram Raghunathan
- Division of Hematology and Oncology, Oregon Health Sciences University, Portland, OR
- Division of Medical Oncology, University of Washington, Seattle, WA
| | - Stephen E Spurgeon
- Division of Hematology and Oncology, Oregon Health Sciences University, Portland, OR
| | - Thomas A Ollila
- Division of Hematology/Oncology, Brown University, Providence, RI
| | | | - Adam Olszewski
- Division of Hematology/Oncology, Brown University, Providence, RI
| | - Emily C Ayers
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Daniel J Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | - Jun Lee
- Division of Hematology, University of Colorado, Denver, CO
| | - Manali Kamdar
- Division of Hematology, University of Colorado, Denver, CO
| | - Paolo F Caimi
- Adult Hematologic Malignancies and Stem Cell Transplant Section, University Hospitals Seidman Cancer Center, Cleveland, OH
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Timothy Fu
- Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Jieqi Liu
- Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Kevin A David
- Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Hanan Alharthy
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD
| | - Jennie Law
- Division of Hematology and Oncology, University of Maryland Greenbaum Comprehensive Cancer Center, Baltimore, MD
| | - Reem Karmali
- Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Harsh Shah
- University of Utah/Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Ajay Major
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | | | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Amulya Yellala
- Department of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Avyakta Kallam
- Department of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE
| | | | - Nadia Khan
- Fox Chase Cancer Center, Philadelphia, PA; and
| | - Mohammad Ahsan Sohail
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Frederick Lansigan
- Division of Hematology and Oncology, Dartmouth Geisel School of Medicine, Hanover, NH
| | - Jeffrey Switchenko
- Winship Cancer Institute, Department of Biostatistics, Emory University, Atlanta, GA
| | - Jonathon Cohen
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Craig A Portell
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
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Smith SM, Salles G. Indolent lymphomas: introduction to a series highlighting progress and ongoing challenges. Haematologica 2022; 107:4-6. [PMID: 34985229 PMCID: PMC8719072 DOI: 10.3324/haematol.2021.280218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 10/19/2021] [Indexed: 12/11/2022] Open
Affiliation(s)
- Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, IL.
| | - Gilles Salles
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Major A, Smith SM. DA-R-EPOCH vs R-CHOP in DLBCL: How do we choose? Clin Adv Hematol Oncol 2021; 19:698-709. [PMID: 34807015 PMCID: PMC9036549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The emerging molecular and prognostic characterization of diffuse large B-cell lymphoma (DLBCL) has challenged the rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) treatment paradigm in recent years, with the identification of several DLBCL subtypes associated with significantly inferior survival after standard R-CHOP therapy. Efforts to improve upon the R-CHOP backbone have included dose intensification as well as the addition of new agents; the infusional dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-R-EPOCH) regimen has been identified as a potential replacement for R-CHOP in high-risk DLBCL. In this review, we provide a historical perspective on the R-CHOP and DA-R-EPOCH regimens and summarize the clinical trial literature regarding the efficacy of each regimen in various risk groups of DLBCL. Further, we propose clinical management scenarios in which DA-R-EPOCH may be preferred, including some for patient populations in which the use of R-CHOP vs DA-R-EPOCH is controversial.
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Affiliation(s)
- Ajay Major
- Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | - Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
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Riedell PA, Hamadani M, Ahn KW, Litovich C, Murthy GSG, Locke FL, Brunstein CG, Merryman RW, Stiff PJ, Pawarode A, Nishihori T, Kharfan-Dabaja MA, Herrera AF, Sauter CS, Smith SM. Outcomes and Utilization Trends of Front-Line Autologous Hematopoietic Cell Transplantation for Mantle Cell Lymphoma. Transplant Cell Ther 2021; 27:911.e1-911.e7. [PMID: 34450333 PMCID: PMC8556305 DOI: 10.1016/j.jtct.2021.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Although autologous hematopoietic cell transplantation (auto-HCT) has become a common practice for eligible patients in the front-line setting with mantle cell lymphoma (MCL), there are limited data regarding trends in auto-HCT utilization and associated outcomes. This study used the Center for International Blood and Marrow Transplant Research (CIBMTR) database to evaluate survival outcomes and auto-HCT utilization in adults age ≥18 years who underwent auto-HCT within 12 months of diagnosis of MCL between January 2000 and December 2018. The 19-year period from 2000 to 2018 was divided into 4 separate intervals-2000 to 2004, 2005 to 2009, 2010 to 2014, and 2015 to 2018-and encompassed 5082 patients. To evaluate transplantation utilization patterns, we combined MCL incidence derived from the SEER 21 database with CIBMTR- reported auto-HCT activity within 12 months of diagnosis of MCL. Primary outcomes included overall survival (OS) along with the auto-HCT utilization rate. The cumulative incidence of nonrelapse mortality at 1 year decreased from 7% in the earliest cohort (2000 to 2004) to 2% in the latest cohort (2015 to 2018). Mirroring this trend, OS outcomes improved continually with time, with a 3-year OS of 72% in the earliest cohort improving to 86% in the latest cohort. In addition, we noted an increase in auto-HCT utilization from 2001 to 2018, particularly in patients age ≤65 years. This large retrospective analysis highlights trends in auto-HCT utilization and outcomes in patients with MCL and emphasizes the need to optimize pretransplantation and post-transplantation treatment strategies to enhance survival outcomes.
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Affiliation(s)
- Peter A Riedell
- Division of Hematology and Oncology, University of Chicago Medicine, Chicago, Illinois
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Kwang W Ahn
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Carlos Litovich
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Frederick L Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Claudio G Brunstein
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Reid W Merryman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Masachusetts
| | - Patrick J Stiff
- Division of Hematology-Oncology, Department of Medicine, Loyola University Stritch School of Medicine, Maywood, Illinois
| | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, Michigan
| | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Craig S Sauter
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sonali M Smith
- Division of Hematology and Oncology, University of Chicago Medicine, Chicago, Illinois
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36
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Sharp M, Forde Z, McGeown C, O'Murchu E, Smith SM, O'Neill M, Ryan M, Clyne B. Media coverage of evidence outputs during the COVID-19 pandemic: findings from one national agency. Eur J Public Health 2021. [PMCID: PMC8574242 DOI: 10.1093/eurpub/ckab164.740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The COVID-19 Evidence Synthesis Team within the Health Information and Quality Authority (HIQA) in Ireland produced a range of evidence-based reports on a broad range of public health topics related to COVID-19. These evidence outputs (EO) arose directly from questions posed by policy makers and clinicians supporting Ireland's National Public Health Emergency Team (NPHET). Findings from these EOs informed the national response to the COVID-19 pandemic in Ireland and influenced international public health guidance. How research findings are presented through domestic news can influence behaviour and risk perceptions.
Methods
We investigated traditional media coverage of nine COVID-19 EOs and associated press releases, published (April to July 2020) by HIQA. NVivo was used for conceptual content analysis of manifest content. ‘Core messages' from each evidence output were proposed and 488 sources from national and regional broadcast, print, and online media were coded at the phrase level. The presence of political and public health actors in coverage were also coded.
Results
Coverage largely did not distort or misrepresent the results of the EOs, however, there was variability in terms of what content was reported on and to what extent different stakeholders were involved in the contextualization of the findings of the EOs. Coverage appeared to focus more on ‘human-interest' stories as opposed to more technical reports (e.g. focusing on viral load, antibodies, testing, etc.). Selective reporting and the variability in the use of quotes from governmental and public health stakeholders changed and contextualized results in different manners than perhaps originally intended in the press release.
Conclusions
Our findings provide a case-study of European media coverage of evidence reports produced by a national agency. Results highlighted several strengths and weaknesses of current communication efforts.
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Affiliation(s)
- M Sharp
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Z Forde
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - C McGeown
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - E O'Murchu
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - SM Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - B Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
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Clyne B, Byrne P, Smith SM, O'Neill M, Ryan M. Evaluating rapid review provision to inform policy during the COVID-19 pandemic. Eur J Public Health 2021. [PMCID: PMC8574241 DOI: 10.1093/eurpub/ckab164.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Evidence based decision making is central to population health, particularly during a pandemic. Few studies examine the production and use of evidence in decision-making during crisis management. This study describes and evaluates the provision of rapid evidence products by a single agency to support national decision making.
Methods
Semi-structured interviews were conducted with a convenience sample of evidence providers (who gathered and disseminated the required evidence) and service users (policy makers). Interviews were transcribed verbatim and analysed using thematic analysis. Quantitative data of work activity were summarised descriptively.
Results
Three themes were generated from the data: the work, the use and the future, with a fourth theme cross-cutting across these: the team. The work followed clear protocols and was centrally managed. The scope and changing nature of the evidence were highlighted as issues. The service providers reported a strong sense of team work and ‘being in this together', however, the majority of the participants felt that the workload was huge and exhausting and not sustainable long-term. Overall the service users thought the rapid evidence synthesis was indispensable to the decision-making process and had trust and confidence in the work, largely based on existing working relationships with the team. While they recognised that the evidence synthesis support would be an essential component of the continued pandemic response, they did query the sustainability of the process and reflected on the amount of work the team performed.
Conclusions
This evaluation, drawing on qualitative data, has highlighted that, across the services users and evidence providers, the support provided by HIQA was generally perceived as positive. From the service users' perspective, having access to the team was indispensable to the decision making process. However, the sustainability of the work load was identified as a major challenge.
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Affiliation(s)
- B Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - P Byrne
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - SM Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
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Cardwell K, O'Murchu E, Byrne P, Broderick N, O'Neill S, Smith SM, Harrington P, O'Neill M, Ryan M. COVID-19 - Interventions and lifestyle factors that prevent infection or minimise progression to severe disease. Eur J Public Health 2021. [PMCID: PMC8574924 DOI: 10.1093/eurpub/ckab164.739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
This evidence summary synthesised the evidence relating to pharmacological and non-pharmacological interventions in the community to prevent COVID-19/progression to severe disease. An additional aim was to identify potentially modifiable lifestyle factors associated with reduced risk of infection/progression to severe disease.
Methods
A systematic search of published peer-reviewed articles and non-peer-reviewed pre-prints was undertaken from 1 January 2020 to 19 April 2021; no language restrictions were applied. All potentially eligible papers were exported to Covidence. Titles/abstracts and full texts were single screened for relevance. Data extraction and quality appraisal of included studies was completed by a single reviewer and checked by a second.
Results
In total, 50 studies, three randomised controlled trials (RCTs), one non-RCT and 46 cohort studies were included. The four included controlled trials tested variations of the pharmacological intervention, ivermectin. While these controlled trials reported a protective effect for ivermectin use, these trials were of poor quality and had serious risk of bias. Across 46 cohort studies, the modifiable lifestyle risk factors identified were obesity, smoking, vitamin D status, physical activity, alcohol consumption and processed meat consumption. These studies reported mixed results in terms of the association between modifiable lifestyle risk factors and poor COVID-19 outcomes.
Conclusions
At the time of writing there is no high quality evidence of benefit to support pharmacological interventions to prevent COVID-19. Although there were mixed results for the risk factors identified, maintenance of healthy weight, smoking cessation, engaging in physical activity and moderation of alcohol and processed meat consumption are likely to be beneficial to health and should continue to be encouraged.
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Affiliation(s)
- K Cardwell
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E O'Murchu
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - P Byrne
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - N Broderick
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - S O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - SM Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P Harrington
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
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Bennani NN, Tun AM, Carson KR, Geiger JL, Maeda LS, Savage KJ, Rose J, Pinter-Brown L, Lunning MA, Abramson JS, Bartlett NL, Vose JM, Evens AM, Smith SM, Horwitz SM, Ansell SM, Advani RH. Characteristics and Outcome of Extranodal NK/T-Cell Lymphoma in North America: A Retrospective Multi-Institutional Experience. Clin Lymphoma Myeloma Leuk 2021; 22:e250-e260. [PMID: 34794912 DOI: 10.1016/j.clml.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Extranodal natural killer/T-cell lymphoma (ENKTL) is rare and clinicaldata from non-Asian countries are lacking. It is unclear whether outcomes and diseasenatural history is similar to reported Asian series. We assessed characteristics and outcomes of patients with ENKTL from major North American centers. PATIENTS AND METHODS We retrospectively identified patients with newly-diagnosedCD56 + ENKTL and studied disease characteristics and clinical outcomes. RESULTS 121 patients with ENKTL diagnosed between June 1990 and November 2012 were identified. Eighty-three patients (69%) had stage I/II disease and were treatedwith combined modality therapy (CMT) (n=53), chemotherapy alone (CT) (n=14) orradiotherapy alone (RT) (n=16). Thirty-eight patients (31%) had stage III/IV diseaseand were treated with CMT (n=12), CT (n=23), or RT (n=3). The median follow-up forthe entire cohort was 51 months. Patients with stage I/II disease, compared to thosewith stage III/IV disease, had superior 2-year progression free survival (PFS) 43% vs19% (p=0.03) and overall survival (OS) 59% vs 29% (p=0.004). Outcomes were similarfor stage I/II patients who received CMT vs RT alone with 2-year PFS (53% vs 47%;p=0.91) and OS (67% vs 67%; p=0.58). No significant differences in outcomes werenoted based on race/ethnicity. CONCLUSIONS This series represents a large experience of ENKTL treated at several major North American academic centers. OUR DATA ARE CONSISTENT WITH ASIAN STUDIES 1) majority of patients present with early-stage disease; 2) overall poor outcome regardless of race/ethnicity; 3) CMT likely yields favorable outcomes for suitable candidates with early-stage disease.
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Affiliation(s)
| | - Aung M Tun
- Division of Hematology, Mayo Clinic, Rochester, MN; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Kansas City, KS
| | - Kenneth R Carson
- Research Service, St Louis Veterans Affairs Medical Center, St Louis, MO; Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | | | - Lauren S Maeda
- Division of Oncology, Stanford Cancer Institute, Stanford, CA
| | - Kerry J Savage
- Department of Medical Oncology, Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Jim Rose
- Department of Medical Oncology, Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | | | - Matthew A Lunning
- Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Jeremy S Abramson
- Divisions of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Nancy L Bartlett
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Julie M Vose
- Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | | | - Sonali M Smith
- Divisions of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Steven M Horwitz
- Division of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
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40
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Smith SM. Evolving strategies for the management of transformed lymphoma. Clin Adv Hematol Oncol 2021; 19:624-626. [PMID: 34637426] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Sonali M Smith
- Section of Hematology/Oncology, UChicago Medicine, Chicago, Illinois
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41
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Riedell PA, Hamadani M, Ahn KW, Litovich C, Brunstein CG, Cashen AF, Cohen JB, Epperla N, Hill BT, Im A, Inwards DJ, Lister J, McCarty JM, Ravi Kiran Pingali S, Shadman M, Shaughnessy P, Solh M, Stiff PJ, Vose JM, Kharfan-Dabaja MA, Herrera AF, Sauter CS, Smith SM. Effect of time to relapse on overall survival in patients with mantle cell lymphoma following autologous haematopoietic cell transplantation. Br J Haematol 2021; 195:757-763. [PMID: 34581433 DOI: 10.1111/bjh.17865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/24/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/28/2022]
Abstract
In young and fit patients with mantle cell lymphoma (MCL), intensive induction therapy followed by a consolidative autologous haematopoietic cell transplant (autoHCT) is the standard of care in the front-line setting. Recently, time-to-event analysis has emerged as an important risk assessment tool in lymphoma, though its impact in MCL is not well defined. We utilized the Center for International Blood and Marrow Transplant Research database to evaluate the effect of post-autoHCT time to relapse on overall survival (OS) over time in 461 patients who underwent autoHCT within 12 months of MCL diagnosis. On multivariate analysis, the impact of relapse on OS was greatest at the six-month [hazard ratio (HR) = 7·68], 12-month (HR = 6·68), and 18-month (HR = 5·81) landmark timepoints. Using a dynamic landmark model we demonstrate that adjusted OS at five years following each landmark timepoint improved with time for relapsing and non-relapsing patients. Furthermore, early relapse (<18 months) following autoHCT defines a high-risk group with inferior post-relapse OS. This retrospective analysis highlights the impact of time to relapse on OS in MCL patients undergoing up-front autoHCT and emphasizes the need to consider novel therapeutic approaches for patients suffering early relapse.
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Affiliation(s)
- Peter A Riedell
- Division of Hematology and Oncology, University of Chicago Medicine, Chicago, IL, USA
| | - Mehdi Hamadani
- Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA.,BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kwang W Ahn
- Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carlos Litovich
- Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Claudio G Brunstein
- Department of Medicine, Adult Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
| | - Amanda F Cashen
- Division of Oncology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Narendranath Epperla
- Division of Hematology, Department of Medicine, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Annie Im
- Division of Hematology/Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | | | - John Lister
- Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - John M McCarty
- Bone Marrow Transplant Program, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Medical Oncology Division, University of Washington, Seattle, WA, USA
| | - Paul Shaughnessy
- Sarah Cannon Transplant and Cellular Therapy Program Methodist Hospital, San Antonio, TX, USA
| | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA, USA
| | - Patrick J Stiff
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Julie M Vose
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Craig S Sauter
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, IL, USA
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Munshi PN, Hamadani M, Kumar A, Dreger P, Friedberg JW, Dreyling M, Kahl B, Jerkeman M, Kharfan-Dabaja MA, Locke FL, Shadman M, Hill BT, Ahmed S, Herrera AF, Sauter CS, Bachanova V, Ghosh N, Lunning M, Kenkre VP, Aljurf M, Wang M, Maddocks KJ, Leonard JP, Kamdar M, Phillips T, Cashen AF, Inwards DJ, Sureda A, Cohen JB, Smith SM, Carlo-Stella C, Savani B, Robinson SP, Fenske TS. American Society of Transplantation and Cellular Therapy, Center of International Blood and Marrow Transplant Research, and European Society for Blood and Marrow Transplantation Clinical Practice Recommendations for Transplantation and Cellular Therapies in Mantle Cell Lymphoma. Transplant Cell Ther 2021; 27:720-728. [PMID: 34452722 PMCID: PMC8447221 DOI: 10.1016/j.jtct.2021.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 11/18/2022]
Abstract
Autologous (auto-) and allogeneic (allo-) hematopoietic cell transplantation (HCT) are accepted treatment modalities in contemporary treatment algorithms for mantle cell lymphoma (MCL). Chimeric antigen receptor (CAR) T cell therapy recently received approval for MCL; however, its exact place and sequence in relation to HCT remain unclear. The American Society of Transplantation and Cellular Therapy, Center of International Blood and Marrow Transplant Research, and the European Society for Blood and Marrow Transplantation jointly convened an expert panel to formulate consensus recommendations for role, timing, and sequencing of auto-HCT, allo-HCT, and CAR T cell therapy for patients with newly diagnosed and relapsed/refractory (R/R) MCL. The RAND-modified Delphi method was used to generate consensus statements. Seventeen consensus statements were generated, with a few key statements as follows: in the first line setting, auto-HCT consolidation represents standard of care in eligible patients, whereas there is no clear role of allo-HCT or CAR T cell therapy outside of clinical trials. In the R/R setting, the preferential option is CAR T cell therapy, especially in patients with MCL failing or intolerant to at least one Bruton's tyrosine kinase inhibitor, while allo-HCT is recommended if CAR T cell therapy fails or is infeasible. Several recommendations were based on expert opinion, where the panel developed consensus statements for important real-world clinical scenarios to guide clinical practice. In the absence of contemporary evidence-based data, the panel found RAND-modified Delphi methodology effective in providing a formal framework for developing consensus recommendations for the timing and sequence of cellular therapies for MCL.
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Affiliation(s)
- Pashna N Munshi
- Department of Blood and Marrow Transplantation, MedStar Georgetown University Hospital, Washington, DC
| | - Mehdi Hamadani
- Center for International Blood & Marrow Transplant Research and the BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Ambuj Kumar
- Department of Internal Medicine, Office of Research, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Peter Dreger
- Department of Medicine, University of Heidelberg, Germany
| | | | - Martin Dreyling
- Department of Medicine III, LMU Hospital Munich, Munich, Germany
| | - Brad Kahl
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Mats Jerkeman
- Department of Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapies Program, Mayo Clinic, Jacksonville, Florida
| | - Frederick L Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Mazyar Shadman
- Blood and Marrow Transplantation Program, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sairah Ahmed
- Department of Lymphoma, Myeloma and Stem Cell Transplantation & Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California
| | - Craig S Sauter
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Nilanjan Ghosh
- Levine Cancer Institute, Atrium Health, Charlotte, Nnorth Carolina
| | - Matthew Lunning
- Divsion of Hematology and Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Vaishalee P Kenkre
- Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mahmoud Aljurf
- Blood and Marrow Transplantation Program, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Michael Wang
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kami J Maddocks
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - John P Leonard
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Manali Kamdar
- Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado Cancer Center, Denver, Colorado
| | - Tycel Phillips
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Amanda F Cashen
- Division of Oncology, Section of Stem Cell Transplantation, Washington University School of Medicine, St Louis, Missouri
| | | | - Anna Sureda
- Clinical Hematology Department, Catalan Institute of Oncology, Institut d'Investigació Biomèdica de Bellvitge IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | | | - Sonali M Smith
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Carmello Carlo-Stella
- Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital, Milan, Italy
| | - Bipin Savani
- Blood and Marrow Transplantation Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephen P Robinson
- University Hospital Bristol NHS Foundation Trust, London, United Kingdom
| | - Timothy S Fenske
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Munshi PN, Hamadani M, Kumar A, Dreger P, Friedberg JW, Dreyling M, Kahl B, Jerkeman M, Kharfan-Dabaja MA, Locke FL, Shadman M, Hill BT, Ahmed S, Herrera AF, Sauter CS, Bachanova V, Ghosh N, Lunning M, Kenkre VP, Aljurf M, Wang M, Maddocks KJ, Leonard JP, Kamdar M, Phillips T, Cashen AF, Inwards DJ, Sureda A, Cohen JB, Smith SM, Carlo-Stella C, Savani B, Robinson SP, Fenske TS. ASTCT, CIBMTR, and EBMT clinical practice recommendations for transplant and cellular therapies in mantle cell lymphoma. Bone Marrow Transplant 2021; 56:2911-2921. [PMID: 34413469 PMCID: PMC8639670 DOI: 10.1038/s41409-021-01288-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/08/2021] [Accepted: 03/25/2021] [Indexed: 11/09/2022]
Abstract
Autologous (auto-) or allogeneic (allo-) hematopoietic cell transplantation (HCT) are accepted treatment modalities for mantle cell lymphoma (MCL). Recently, chimeric antigen receptor (CAR) T-cell therapy received approval for MCL; however, its exact place and sequence in relation to HCT is unclear. The ASTCT, CIBMTR, and the EBMT, jointly convened an expert panel to formulate consensus recommendations for role, timing, and sequencing of auto-, allo-HCT, and CAR T-cell therapy for patients with newly diagnosed and relapsed/refractory (R/R) MCL. The RAND-modified Delphi method was used to generate consensus statements. Seventeen consensus statements were generated; in the first-line setting auto-HCT consolidation represents standard-of-care in eligible patients, whereas there is no clear role of allo-HCT or CAR T-cell therapy, outside of a clinical trial. In the R/R setting, the preferential option is CAR T-cell therapy especially in MCL failing or intolerant to at least one Bruton's tyrosine kinase inhibitor, while allo-HCT is recommended if CAR T-cell therapy has failed or is not feasible. In the absence of contemporary evidence-based data, the panel found RAND-modified Delphi methodology effective in providing a formal framework for developing consensus recommendations for the timing and sequence of cellular therapies for MCL.
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Affiliation(s)
| | - Mehdi Hamadani
- CIBMTR & BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Ambuj Kumar
- Department of Internal Medicine, Office of Research, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | | | - Martin Dreyling
- Department of Medicine III, LMU Hospital Munich, Munich, Germany
| | - Brad Kahl
- Washington University School of Medicine, St. Louis, MO, USA
| | - Mats Jerkeman
- Department of Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapies Program, Mayo Clinic, Jacksonville, FL, USA
| | - Frederick L Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sairah Ahmed
- Department of Lymphoma, Myeloma and Stem Cell Transplantation & Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Craig S Sauter
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Nilanjan Ghosh
- Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | | | - Vaishalee P Kenkre
- University of Wisconsin, Division of Hematology and Oncology, Madison, WI, USA
| | | | - Michael Wang
- Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Kami J Maddocks
- Division of Hematology, Ohio State University, Columbus, OH, USA
| | | | - Manali Kamdar
- Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado Cancer Center, Denver, CO, USA
| | - Tycel Phillips
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Amanda F Cashen
- Division of Oncology, Section of Stem Cell Transplantation, Washington University School of Medicine, St Louis, MO, USA
| | - David J Inwards
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Anna Sureda
- Clinical Hematology Department, Catalan Institute of Oncology, Institut d'Investigació Biomèdica de Bellvitge IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | | | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Carmello Carlo-Stella
- Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital, Milan, Italy
| | - Bipin Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Timothy S Fenske
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Pearse WB, Petrich AM, Gordon LI, Karmali R, Winter JN, Ma S, Kaplan JB, Behdad A, Klein A, Jovanovic B, Helenowski I, Smith SM, Evens AM, Pro B. A phase I/II trial of brentuximab vedotin plus rituximab as frontline therapy for patients with immunosuppression-associated CD30+ and/or EBV + lymphomas. Leuk Lymphoma 2021; 62:3493-3500. [PMID: 34338127 DOI: 10.1080/10428194.2021.1957867] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 10/20/2022]
Abstract
Treatment strategies for post-transplant lymphoproliferative disorders (PTLD) consist of response-adapted risk-stratified methods using immunosuppression reduction, immunotherapy, and chemotherapy. We investigated the efficacy of Brentuximab vedotin given concurrently with Rituximab (BV + R) once weekly for four weeks, followed by optional consolidation, and up to one year of maintenance. Among 20 assessable patients, BV + R therapy resulted in an overall response rate of 75% (95% CI 51 to 91, p = 0.044) with 60% achieving a complete response. Median time to best response was 28 days. Two-year progression-free survival and overall survival rates were 75 and 90%, respectively. Most common severe grade 3/4 treatment-related toxicities included neutropenia (40%), hypertension (30%), infection (25%), and peripheral neuropathy (15%). BV + R is a novel and effective therapeutic strategy that achieved rapid and durable remissions in previously untreated PTLD patients; however, this treatment platform requires further modification due to the high rates of treatment-related toxicity.Key pointsBrentuximab vedotin + Rituximab showed ORR and CR rates of 75 and 60% in patients with immunosuppression-associated lymphoid malignanciesHigh rates of treatment delay were attributed to treatment-related toxicity; further dosing optimization of this regimen is required.
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Affiliation(s)
- William B Pearse
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Adam M Petrich
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Leo I Gordon
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Reem Karmali
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane N Winter
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shuo Ma
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jason B Kaplan
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amir Behdad
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andreas Klein
- Department of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
| | - Borko Jovanovic
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Irene Helenowski
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Barbara Pro
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Landsburg DJ, Barta SK, Ramchandren R, Batlevi C, Iyer S, Kelly K, Micallef IN, Smith SM, Stevens DA, Alvarez M, Califano A, Shen Y, Bosker G, Parker J, Soikes R, Martinez E, von Roemeling R, Martell RE, Oki Y. Fimepinostat (CUDC-907) in patients with relapsed/refractory diffuse large B cell and high-grade B-cell lymphoma: report of a phase 2 trial and exploratory biomarker analyses. Br J Haematol 2021; 195:201-209. [PMID: 34341990 DOI: 10.1111/bjh.17730] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 05/20/2021] [Accepted: 07/13/2021] [Indexed: 12/28/2022]
Abstract
Fimepinostat (CUDC-907), a first-in-class oral small-molecule inhibitor of histone deacetylase and phosphatidylinositol 3-kinase, demonstrated efficacy in a phase 1 study of patients with relapsed/refractory (R/R) diffuse large and high-grade B-cell lymphomas (DLBCL/HGBL), particularly those with increased MYC protein expression and/or MYC gene rearrangement/copy number gain (MYC-altered disease). Therefore, a phase 2 study of fimepinostat was conducted in this patient population with 66 eligible patients treated. The primary end-point of overall response (OR) rate for patients with MYC-IHC ≥40% (n = 46) was 15%. Subsequently, exploratory pooled analyses were performed including patients treated on both the phase 1 and 2 studies based upon the presence of MYC-altered disease as well as a biomarker identified by Virtual Inference of Protein activity by Enriched Regulon analysis (VIPER). For these patients with MYC-altered disease (n = 63), the overall response (OR) rate was 22% with seven responding patients remaining on treatment for approximately two years or longer, and VIPER yielded a three-protein biomarker classification with positive and negative predictive values of ≥85%. Prolonged durations of response were achieved by patients with MYC-altered R/R DLBCL/HGBL treated with single-agent fimepinostat. Combination therapies and/or biomarker-based patient selection strategies may lead to higher response rates in future clinical trials.
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Affiliation(s)
| | - Stefan K Barta
- University of Pennsylvania, Philadelphia, PA, USA.,Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - Connie Batlevi
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Swaminathan Iyer
- MD Anderson Cancer Center, Houston, TX, USA.,Houston Methodist Hospital, Houston, TX, USA
| | - Kevin Kelly
- University of Southern California, Los Angeles, CA, USA
| | | | | | | | | | | | - Yao Shen
- DarwinHealth, Inc, New York, NY, USA
| | | | | | | | | | | | | | - Yasuhiro Oki
- MD Anderson Cancer Center, Houston, TX, USA.,Genentech, San Francisco, CA, USA
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Tumuluru S, Godfrey JK, Yu J, Cooper A, Leukam M, Smith SM, Chen X, Kline JP. Abstract 1821: Integrative genomic analysis of diffuse large B cell lymphoma (DLBCL) identifies recurrent oncogenic alterations associated with distinct immune-related clusters. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-1821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Genetic alterations in tumor cells shape the cancer immune landscape and influence response to checkpoint blockade therapy (CBT). Despite recent advances in defining DLBCL genomics, the impact of genetic alterations on the DLBCL immune environment is not well-characterized. Here, we aim to define unique immune landscapes in DLBCL and determine the impact of lymphoma-cell intrinsic alterations on shaping immune environments in this disease, which may have implications for CBT response
Methods: Gene set variation analysis (GSVA) was used to generate sample-wise enrichment scores for immune-related gene sets in ~500 DLBCLs. A cell-of-origin (COO) signature that classifies DLBCLs based on transcriptional similarity to activated B cells (ABC) or germinal center B cells (GCB) was included to control for COO-related genomic heterogeneity. Samples were hierarchically clustered. Paired exome sequencing was analyzed to identify mutations associated with each cluster. Cas9-mediated gene editing was used to modulate genes of interest in a murine lymphoma model (A20)
Results: GSVA revealed 4 DLBCL immune clusters - ABC hot, ABC cold, GCB hot and GCB cold. Concordant with previous work, PD-L1 gene amplifications were highly enriched in ABC hot DLBCLs, while double-hit signature DLBCLs fell within the GCB cold cluster. Mutations and oncogenic pathways associated with each cluster were identified. ABC cold DLBCLs harbored recurrent inactivating mutations in TMEM30A and PRDM1, while mutations in KLHL6 and SPEN were associated with ABC hot DLBCLs. The GBC cold cluster was enriched for mutations in TP53 and FOXO1, and inactivating SOCS1 mutations were prevalent in GCB hot DLBCLs.
MYC activation signatures characterized ABC and GCB cold clusters. A20 lymphomas with inducible c-Myc activation (A20MycER) contained fewer CD8+ T cells following tamoxifen versus control treatment, confirming our computational findings. Moreover, as SOCS1 mutations strongly associated with GCB hot DLBCLs and are prevalent in CBT-sensitive lymphomas, the extent to which Socs1-deficient lymphoma cells showed increased sensitivity to the critical T cell effector cytokine IFNγ was examined. Upon IFNγ exposure, A20Socs1-/- cells showed increased pStat1 levels, enhanced expression of PD-L1 and MHC-I, and strikingly diminished proliferation compared to A20WT cells, suggesting that enhanced JAK/STAT signaling via Socs1-/- increases IFNγ sensitivity, rendering lymphoma cells vulnerable to CBT
Conclusion: Through computational analyses in a large genomic dataset, we have defined unique immune-related DLBCL clusters and associated recurrent genomic alterations. Through ongoing studies in murine models, we aim to elucidate mechanisms by which particular oncogenic alterations in lymphoma cells shape the DLBCL immune landscape and impact CBT response
Citation Format: Sravya Tumuluru, James K. Godfrey, Jovian Yu, Alan Cooper, Michael Leukam, Sonali M. Smith, Xiufen Chen, Justin P. Kline. Integrative genomic analysis of diffuse large B cell lymphoma (DLBCL) identifies recurrent oncogenic alterations associated with distinct immune-related clusters [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1821.
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Riedell PA, Hamadani M, Ahn KW, Litovich C, Kharfan-Dabaja M, Herrera AF, Sauter CS, Smith SM. Effect of time to relapse on overall survival (OS) in mantle cell lymphoma (MCL) patients (pts) following frontline high-dose therapy and autologous hematopoietic cell transplantation (autoHCT). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7521 Background: In MCL, outcomes are heterogeneous and the clinical significance of the timing of relapse following autoHCT and its impact on OS is not well defined. Using the CIBMTR database, we evaluate the effect of post-autoHCT time to relapse on OS over time. Methods: Adult MCL pts treated with up to two lines of rituximab-based induction therapy followed by first autoHCT within 1-year of diagnosis were identified between 2000-2018. Primary outcomes included OS and post-relapse OS. A dynamic landmark analysis was performed at 6-month intervals following autoHCT to evaluate the impact of relapse on OS while adjusting for significant patient- and disease-related variables. Post-relapse OS was evaluated in pts who experienced relapse. Results: Of the 461 pts included in the analysis, the median age was 60 years (range 29-78), 57% had a KPS of ≥ 90, 83% had stage III-IV disease at diagnosis, and 76% had extranodal involvement. BEAM was the most common conditioning regimen (58%) and 23% of pts received post-autoHCT maintenance rituximab. With a median follow-up of 67 months, the 5-year progression-free survival was 45.8% with a 5-year OS of 69.6%. On multivariate analysis, age ≥60 years was associated with worse OS (HR= 1.55, 95% CI 1.08-2.24, p=0.0191) at all landmark timepoints. Additionally, the impact of relapse on OS varied with time (p=0.006) and was greatest at the 6-month (HR=7.68), 12-month (HR=6.68), and 18-month (HR=5.81) landmark timepoints. The risk of death for relapsing pts decreased with time and was mirrored by an improvement in adjusted OS for both relapsing and non-relapsing pts. In total, 9.3% of patients relapsed prior to the 18-month landmark timepoint. Relapse at the 6-month, 12-month, and 18-month landmark timepoints correlated with a poor median post-relapse OS of 9 months, 24 months, and 34 months, respectively (Table). Conversely, patients relapsing after the 18-month landmark timepoint experienced a median post-relapse OS ranging from 44-67 months. Conclusions: In MCL, early relapse (< 18-months) following autoHCT defines a high-risk group with inferior post-relapse OS. This population should be considered for clinical trials or novel therapeutic approaches including early utilization of chimeric antigen receptor T-cell therapy.[Table: see text]
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Affiliation(s)
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Kwang Woo Ahn
- Center for International Blood and Marrow Transplant Research, Milwuakee, WI
| | - Carlos Litovich
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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Smith SM, Wachter K, Burris HA, Schilsky RL, George DJ, Peterson DE, Johnson ML, Markham MJ, Mileham KF, Beg MS, Bendell JC, Dreicer R, Keedy VL, Kimple RJ, Knoll MA, LoConte N, MacKay H, Meisel JL, Moynihan TJ, Mulrooney DA, Mulvey TM, Odenike O, Pennell NA, Reeder-Hayes K, Smith C, Sullivan RJ, Uzzo R. Clinical Cancer Advances 2021: ASCO's Report on Progress Against Cancer. J Clin Oncol 2021; 39:1165-1184. [DOI: 10.1200/jco.20.03420] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
| | - Kerri Wachter
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | | | | | | | | | | | | | | | - Robert Dreicer
- University of Virginia Cancer Center, Charlottesville, VA
| | | | | | | | - Noelle LoConte
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Helen MacKay
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Katherine Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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50
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Vidaurre D, Llera A, Smith SM, Woolrich MW. Behavioural relevance of spontaneous, transient brain network interactions in fMRI. Neuroimage 2021; 229:117713. [PMID: 33421594 PMCID: PMC7994296 DOI: 10.1016/j.neuroimage.2020.117713] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 12/03/2020] [Accepted: 12/26/2020] [Indexed: 12/19/2022] Open
Abstract
How spontaneously fluctuating functional magnetic resonance imaging (fMRI) signals in different brain regions relate to behaviour has been an open question for decades. Correlations in these signals, known as functional connectivity, can be averaged over several minutes of data to provide a stable representation of the functional network architecture for an individual. However, associations between these stable features and behavioural traits have been shown to be dominated by individual differences in anatomy. Here, using kernel learning tools, we propose methods to assess and compare the relation between time-varying functional connectivity, time-averaged functional connectivity, structural brain data, and non-imaging subject behavioural traits. We applied these methods to Human Connectome Project resting-state fMRI data to show that time-varying fMRI functional connectivity, detected at time-scales of a few seconds, has associations with some behavioural traits that are not dominated by anatomy. Despite time-averaged functional connectivity accounting for the largest proportion of variability in the fMRI signal between individuals, we found that some aspects of intelligence could only be explained by time-varying functional connectivity. The finding that time-varying fMRI functional connectivity has a unique relationship to population behavioural variability suggests that it might reflect transient neuronal communication fluctuating around a stable neural architecture.
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Affiliation(s)
- D Vidaurre
- Center for Functionally Integrative Neuroscience, Department of Clinical Health, Aarhus University, 8000 Denmark; Department of Psychiatry, University of Oxford, OX37JX UK; Wellcome Trust Center for Integrative Neuroimaging, University of Oxford, OX37JX UK,.
| | - A Llera
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 Netherlands
| | - S M Smith
- Wellcome Trust Center for Integrative Neuroimaging, University of Oxford, OX37JX UK
| | - M W Woolrich
- Department of Psychiatry, University of Oxford, OX37JX UK; Wellcome Trust Center for Integrative Neuroimaging, University of Oxford, OX37JX UK
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