1
|
Tam CS, Opat S, D'Sa S, Jurczak W, Lee HP, Cull G, Owen RG, Marlton P, Wahlin BE, García-Sanz R, McCarthy H, Mulligan S, Tedeschi A, Castillo JJ, Czyż J, Fernández De Larrea C, Belada D, Libby E, Matous J, Motta M, Siddiqi T, Tani M, Trněný M, Minnema MC, Buske C, Leblond V, Treon SP, Trotman J, Wu B, Yu Y, Shen Z, Chan WY, Schneider J, Allewelt H, Cohen A, Dimopoulos MA. Biomarker analysis of the ASPEN study comparing zanubrutinib with ibrutinib for patients with Waldenström macroglobulinemia. Blood Adv 2024; 8:1639-1650. [PMID: 38315878 PMCID: PMC11006814 DOI: 10.1182/bloodadvances.2023010906] [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: 06/06/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 02/07/2024] Open
Abstract
ABSTRACT The phase 3 ASPEN trial (NCT03053440) compared Bruton tyrosine kinase inhibitors (BTKis), zanubrutinib and ibrutinib, in patients with Waldenström macroglobulinemia (WM). Post-hoc biomarker analysis was performed using next-generation sequencing on pretreatment bone marrow samples from 98 patients treated with zanubrutinib and 92 patients treated with ibrutinib with mutated (MUT) MYD88 and 20 patients with wild-type (WT) MYD88 treated with zanubrutinib. Of 329 mutations in 52 genes, mutations in CXCR4 (25.7%), TP53 (24.8%), ARID1A (15.7%), and TERT (9.0%) were most common. TP53MUT, ARID1AMUT, and TERTMUT were associated with higher rates of CXCR4MUT (P < .05). Patients with CXCR4MUT (frameshift or nonsense [NS] mutations) had lower very good partial response (VGPR) and complete response rates (CR; 17.0% vs 37.2%, P = .020) and longer time to response (11.1 vs 8.4 months) than patients with CXCR4WT treated with BTKis. CXCR4NS was associated with inferior progression-free survival (PFS; hazard ratio [HR], 3.39; P = .017) in patients treated with ibrutinib but not in those treated with zanubrutinib (HR, 0.67; P = .598), but VGPR + CR rates were similar between treatment groups (14.3% vs 15.4%). Compared with ibrutinib, patients with CXCR4NS treated with zanubrutinib had a favorable major response rate (MRR; 85.7% vs 53.8%; P = .09) and PFS (HR, 0.30; P = .093). In patients with TP53MUT, significantly lower MRRs were observed for patients treated with ibrutinib (63.6% vs 85.7%; P = .04) but not for those treated with zanubrutinib (80.8% vs 81.9%; P = .978). In TP53MUT, compared with ibrutinib, patients treated with zanubrutinib had higher VGPR and CR (34.6% vs 13.6%; P < .05), numerically improved MRR (80.8% vs 63.6%; P = .11), and longer PFS (not reached vs 44.2 months; HR, 0.66; P = .37). Collectively, patients with WM with CXCR4MUT or TP53MUT had worse prognosis compared with patients with WT alleles, and zanubrutinib led to better clinical outcomes.
Collapse
Affiliation(s)
- Constantine S. Tam
- Department of Haematology, Alfred Hospital and Centre for Blood Diseases, Monash University, Melbourne, VIC, Australia
| | - Stephen Opat
- Department of Haematology, Monash Health and Monash University, Clayton, VIC, Australia
| | - Shirley D'Sa
- Centre for Waldenström’s Macroglobulinemia and Associated Disorders, University College London Hospital Foundation Trust, London, United Kingdom
| | - Wojciech Jurczak
- Department of Clinical Oncology, Maria Sklodowska-Curie National Institute of Oncology, Krakow, Poland
| | - Hui-Peng Lee
- Department of Haematology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Gavin Cull
- Department of Haematology, Sir Charles Gairdner Hospital, University of Western Australia, Perth, WA, Australia
| | - Roger G. Owen
- Haematological Malignancy Diagnostic Service, St James University Hospital, Leeds, United Kingdom
| | - Paula Marlton
- Department of Haematology, Princess Alexandra Hospital and University of Queensland, Brisbane, QLD, Australia
| | - Björn E. Wahlin
- Department of Hematology, Karolinska Universitetssjukhuset and Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Ramón García-Sanz
- Department of Hematology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Helen McCarthy
- Department of Haematology, Royal Bournemouth and Christchurch Hospital, Bournemouth, United Kingdom
| | - Stephen Mulligan
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Alessandra Tedeschi
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Jorge J. Castillo
- Bing Center for Waldenstrom Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Jarosław Czyż
- Department of Hematology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | | | - David Belada
- Department of Internal Medicine – Haematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - Edward Libby
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Marina Motta
- Department of Hematology, AO Spedali Civili di Brescia, Lombardia, Italy
| | - Tanya Siddiqi
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Monica Tani
- U.O. Ematologia, Dipartimento Oncologia e Ematologia, Ospedale Civile Santa Maria delle Croci, AUSL Ravenna, Italy
| | - Marek Trněný
- Všeobecná fakultní nemocnice v Praze, Prague, Czechia
| | - Monique C. Minnema
- Department of Hematology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Christian Buske
- Comprehensive Cancer Center Ulm, Universitätsklinikum Ulm, Ulm, Baden-Württemberg, Germany
| | - Véronique Leblond
- Service d'Hématologie Clinique, Sorbonne University, Pitié Salpêtrière Hospital, Paris, France
| | - Steven P. Treon
- Bing Center for Waldenstrom Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Judith Trotman
- Department of Hematology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Binghao Wu
- BeiGene USA, Inc, San Mateo, CA
- BeiGene Co, Ltd, Shanghai, China
| | - Yiling Yu
- BeiGene USA, Inc, San Mateo, CA
- BeiGene Co, Ltd, Shanghai, China
| | - Zhirong Shen
- BeiGene USA, Inc, San Mateo, CA
- BeiGene Co, Ltd, Shanghai, China
| | - Wai Y. Chan
- BeiGene USA, Inc, San Mateo, CA
- BeiGene Co, Ltd, Shanghai, China
| | | | | | - Aileen Cohen
- BeiGene USA, Inc, San Mateo, CA
- BeiGene Co, Ltd, Shanghai, China
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
2
|
Flowers CR, Matasar MJ, Herrera AF, Hertzberg M, Assouline S, Demeter J, McMillan A, Mehta A, Opat S, Trnňný M, Musick L, Hirata J, Yang A, Sehn LH. Polatuzumab vedotin plus bendamustine and rituximab or obinutuzumab in relapsed/refractory follicular lymphoma: a phase Ib/II study. Haematologica 2024; 109:1194-1205. [PMID: 37767550 PMCID: PMC10985435 DOI: 10.3324/haematol.2023.283557] [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: 05/25/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Follicular lymphoma (FL) is the most common type of indolent non-Hodgkin lymphoma. Despite treatment advances that have improved outcomes for patients with relapsed or refractory (R/R) FL, many patients still die from progressive disease or treatment-related toxicities. In the phase Ib/II GO29365 study (clinicaltrials.gov 02257567), the safety and efficacy of polatuzumab vedotin plus bendamustine and rituximab (Pola-BR) versus bendamustine and rituximab (BR) alone, and polatuzumab vedotin plus bendamustine and obinutuzumab (Pola-BG) as a single-arm cohort were evaluated in patients with R/R FL. Following the phase Ib safety run-in, patients were randomized 1:1 to receive Pola-BR or BR alone in the phase II stage; a separate non-randomized Pola-BG cohort was examined in the phase Ib/II expansion stage. Primary endpoints included safety and tolerability (phase Ib) and positron emission tomography complete response (PET-CR) rate by independent review committee (phase II). Overall, 112 patients were enrolled (phase Ib safety run-in: Pola-BR, N=6; phase II randomized cohort: Pola-BR, N=39; BR, N=41; phase Ib/II expansion cohort: Pola-BG, N=26). PET-CR rates were 66.7% (phase Ib safety run-in, Pola-BR); 69.2% (phase II randomized, Pola-BR); 63.4% (phase II randomized, BR); and 65.4% (phase Ib/II expansion Pola-BG). There was a higher occurrence of cytopenias with Pola-BR and Pola-BG than with BR; serious adverse events were more frequent with Pola-BR (61.4%) and Pola-BG (46.2%) than with BR (29.3%). Overall, this analysis does not demonstrate a benefit of adding Pola to BR or BG regimens for patients with R/R FL.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Andrew McMillan
- Center for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham
| | | | - Stephen Opat
- Clinical Haematology, Monash Health and Monash University, Clayton
| | - Marek Trnňný
- Charles University General Hospital, Prague, Czech Republic
| | | | | | - Annie Yang
- Genentech, Inc., South San Francisco, CA
| | - Laurie H Sehn
- BC Cancer Centre for Lymphoid Cancer and The University of British Columbia, Vancouver, BC
| |
Collapse
|
3
|
Shaw B, Chung E, Wellard C, Yoo E, Bennett R, Birks C, Johnston A, Cheah CY, Hamad N, Simpson J, Barraclough A, Ku M, Viiala N, Ratnasingam S, Armytage T, Cochrane T, Chong G, Lee D, Manos K, Keane C, Wallwork S, Opat S, Hawkes EA. Poor outcomes for trial-ineligible patients receiving polatuzumab for relapsed/refractory diffuse large B-cell lymphoma in routine care: An Australian Lymphoma and Related Diseases Registry project. EJHaem 2024; 5:325-332. [PMID: 38633125 PMCID: PMC11020125 DOI: 10.1002/jha2.870] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 04/19/2024]
Abstract
Polatuzumab vedotin (Pola) is an approved therapy in combination with rituximab and bendamustine for relapsed or refractory diffuse large B-cell lymphoma (RR-DLBCL) based on positive results of the landmark phase II randomised G029365 trial. However, trial results for many approved novel therapies in RR-DLBCL have not been replicated in routine care cohorts, as RR-DLBCL patient populations are heterogeneous and trial eligibility is increasingly restrictive. We evaluated outcomes from pola ± bendamustine and rituximab in patients with RR-DLBCL enrolled in a compassionate access program with no alternative treatment options identified via the Australasian Lymphoma and Related Diseases Registry according to their eligibility for the original phase II published study. Of 58 eligible patients, 74% met the criteria deeming them ineligible for the G029365 original study at the time of pola's commencement. Median progression-free survival and overall survival in our cohort were 2.3 and 3.5 months, respectively. In contrast to the landmark trial cohort, more of our patients ceased therapy prior to completion, the majority due to progressive disease and only 8/58 received any subsequent treatment. Dismal outcomes in this Australian real-world population demonstrate trial eligibility is challenging to meet, and newer treatments can be difficult to deliver in routine care. Clinically applicable results from therapeutic studies require trial cohorts to reflect representative clinical populations wherever possible, and more research is required to address the benefit of novel agents in the increasing majority who are ineligible for modern studies.
Collapse
Affiliation(s)
- Briony Shaw
- Department of HaematologyMonash HealthClaytonAustralia
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
| | - Eliza Chung
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
| | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
| | - Edward Yoo
- Department of HaematologySir Charles Gairdner HospitalPerthAustralia
| | - Rory Bennett
- Department of HaematologyPeter MacCallum Cancer CentreMelbourneAustralia
| | | | - Anna Johnston
- Department of Clinical HaematologyRoyal Hobart HospitalHobartAustralia
| | - Chan Y Cheah
- Department of HaematologySir Charles Gairdner HospitalPerthAustralia
- Medical School, University of Western AustraliaNedlandsAustralia
| | - Nada Hamad
- Department of HaematologySt Vincent's HospitalSydneyAustralia
- School of Clinical Medicine, Faculty of Medicine and HealthUNSW SydneyAustralia
- School of MedicineUniversity of Notre Dame AustraliaSydneyAustralia
| | - Jock Simpson
- Department of HaematologyPort Macquarie Base HospitalPort MacquarieAustralia
| | | | - Matthew Ku
- Department of HaematologySt Vincent's HospitalMelbourneAustralia
- Faculty of MedicineUniversity of MelbourneMelbourneAustralia
| | - Nicholas Viiala
- Department of HaematologyLiverpool HospitalSydneyAustralia
- South West Sydney Clinical Campus, School of Clinical Medicine, Faculty of Medicine and HealthUNSW SydneyAustralia
| | - Sumita Ratnasingam
- Department of Clinical HaematologyUniversity Hospital GeelongGeelongAustralia
| | | | - Tara Cochrane
- Department of HaematologyGold Coast University HospitalGold CoastAustralia
- Griffith UniversityGold CoastAustralia
| | - Geoffrey Chong
- Department of Medical OncologyGrampians HealthBallaratAustralia
| | - Denise Lee
- Department of HaematologyEastern HealthMelbourneAustralia
| | - Kate Manos
- Department of HaematologyFlinders Medical CentreAdelaideAustralia
| | - Colm Keane
- Department of HaematologyPrincess Alexandra HospitalBrisbaneAustralia
| | | | - Stephen Opat
- Department of HaematologyMonash HealthClaytonAustralia
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
| | - Eliza A. Hawkes
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
- Department of Medical Oncology and Clinical HaematologyOlivia Newton‐John Cancer Research Institute at Austin HealthHeidelbergAustralia
| |
Collapse
|
4
|
Fedele PL, Opat S. Chronic Lymphocytic Leukemia-Time to Care for the Survivors. J Clin Oncol 2024:JCO2302738. [PMID: 38489567 DOI: 10.1200/jco.23.02738] [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: 12/19/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 03/17/2024] Open
Affiliation(s)
- Pasquale L Fedele
- Lymphoma Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Stephen Opat
- Lymphoma Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| |
Collapse
|
5
|
Barraclough A, Agrawal S, Talaulikar D, Chong G, Yoo E, Cheah CY, Franco N, Nguyen B, Mutsando H, Tahir F, Trotman J, Huang J, Keane C, Lincoln M, Cochrane T, Johnston AM, Dickinson M, Opat S, McQuilten ZK, Wood EM, St George G, Hawkes EA. Impact and utility of follicular lymphoma GELF criteria in routine care: an Australasian Lymphoma Alliance study. Haematologica 2024. [PMID: 38450504 DOI: 10.3324/haematol.2023.284538] [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: 10/23/2023] [Indexed: 03/08/2024] Open
Abstract
Follicular Lymphoma (FL) treatment initiation is largely determined by tumor burden and symptoms. In the pre-rituximab era, the Group d'Etude des Lymphomes Folliculaires (GELF) developed widely adopted criteria to identify high tumor burden FL patients to harmonize clinical trial populations. The utilization of GELF criteria (GELFc) in routine therapeutic decision-making is poorly described. This multicenter retrospective study evaluated patterns of GELFc at presentation and GELFc utilization in therapeutic decision-making in newly diagnosed, advanced stage rituximab-era FL. Associations between GELFc, treatment given, and patient survival were analyzed in 300 eligible cases identified between 2002-2019. 163 (54%) had ≥1 GELFc at diagnosis. The presence or cumulative number of GELFc did not predict PFS in patients undergoing watch-and-wait (WW) or those receiving systemic treatment. Of interest, in patients with ≥1 GELFc, 16/163 (10%) underwent initial watch-and-wait (comprising 22% of the watchand- wait cohort). In those receiving systemic therapy +/- radiotherapy, 74/215 (34%) met no GELFc. Our data suggest clinicians are using adjunctive measures to make decisions regarding treatment initiation in a significant proportion of patients. By restricting FL clinical trial eligibility only to those meeting GELFc, reported outcomes may not be applicable to a significant proportion of patients treated in routine care settings.
Collapse
Affiliation(s)
- Allison Barraclough
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Victoria, Australia; Fiona Stanley Hospital, Western Australia
| | - Shivam Agrawal
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Victoria, Australia; Prince of Wales Hospital, New South Wales
| | - Dipti Talaulikar
- Canberra Health Services, Australian Capital Territory, Australia; College of Health and Medicine, Australian National University, Australian Capital Territory
| | - Geoffrey Chong
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Victoria, Australia; Ballarat Regional Integrated Cancer Centre, Ballarat Health Services, Victoria
| | - Edward Yoo
- Fiona Stanley Hospital, Western Australia, Australia; Sir Charles Gairdner Hospital, Western Australia
| | - Chan Y Cheah
- Sir Charles Gairdner Hospital, Western Australia, Australia; Medical School, University of Western Australia, Western Australia
| | - Nunzio Franco
- Canberra Health Services, Australian Capital Territory, Australia; College of Health and Medicine, Australian National University, Australian Capital Territory
| | | | - Howard Mutsando
- Toowoomba Hospital, Queensland, Australia; University of Queensland Rural Clinical School, Queensland
| | - Fatima Tahir
- Concord Repatriation General Hospital, University of Sydney, New South Wales
| | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, New South Wales
| | - Jing Huang
- School of Clinical Sciences at Monash Health, Monash University, Victoria
| | | | | | - Tara Cochrane
- Gold Coast University Hospital, Queensland, Australia; School of Medicine, Griffith University, Queensland
| | | | - Michael Dickinson
- Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Victoria
| | - Stephen Opat
- School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria
| | - Zoe K McQuilten
- School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria
| | - Erica M Wood
- School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria
| | - Gayathri St George
- School of Public Health and Preventive Medicine, Monash University, Victoria
| | - Eliza A Hawkes
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria.
| |
Collapse
|
6
|
Dimopoulos MA, Opat S, Treon SP, Tam CS. Reply to Y. Song et al. J Clin Oncol 2024; 42:482-484. [PMID: 38048515 DOI: 10.1200/jco.23.02162] [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: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 12/06/2023] Open
Affiliation(s)
- Meletios A Dimopoulos
- Meletios A. Dimopoulos, MD, National and Kapodistrian University of Athens, Athens, Greece; Stephen Opat, MBBS, Monash Health & Monash University, Clayton, Victoria, Australia; Steven P. Treon, MD, PhD, Dana-Farber Cancer Institute, Boston, MA; and Constantine S. Tam, MD, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Stephen Opat
- Meletios A. Dimopoulos, MD, National and Kapodistrian University of Athens, Athens, Greece; Stephen Opat, MBBS, Monash Health & Monash University, Clayton, Victoria, Australia; Steven P. Treon, MD, PhD, Dana-Farber Cancer Institute, Boston, MA; and Constantine S. Tam, MD, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Steven P Treon
- Meletios A. Dimopoulos, MD, National and Kapodistrian University of Athens, Athens, Greece; Stephen Opat, MBBS, Monash Health & Monash University, Clayton, Victoria, Australia; Steven P. Treon, MD, PhD, Dana-Farber Cancer Institute, Boston, MA; and Constantine S. Tam, MD, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Constantine S Tam
- Meletios A. Dimopoulos, MD, National and Kapodistrian University of Athens, Athens, Greece; Stephen Opat, MBBS, Monash Health & Monash University, Clayton, Victoria, Australia; Steven P. Treon, MD, PhD, Dana-Farber Cancer Institute, Boston, MA; and Constantine S. Tam, MD, The Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Mo A, Wood E, Shortt J, Charlton A, Evers D, Hoeks M, Pritchard E, Daly J, Hodgson C, Opat S, Bowen D, Reynolds J, Thi Phung Thao L, Stanworth SJ, McQuilten Z. Rethinking the transfusion pathway in myelodysplastic syndromes: Study protocol for a novel randomized feasibility n-of-1 trial of weekly-interval red cell transfusion in myelodysplastic syndromes. Transfusion 2024; 64:236-247. [PMID: 38214417 DOI: 10.1111/trf.17706] [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] [Received: 07/29/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Anemia in myelodysplastic syndromes (MDS) is associated with poorer health-related quality of life (HRQoL) and physical function, and is frequently treated with transfusions. The current common practice of transfusing multiple red blood cells (RBC) units every 2-4 weeks may result in peaks/troughs in hemoglobin (Hb) level, yet maintaining a stable Hb may better improve HRQoL. We describe a study protocol aiming to investigate the feasibility of weekly low-dose RBC transfusion in MDS patients, including assessing HRQoL and physical function outcomes. STUDY DESIGN AND METHODS In this n-of-1 pilot study, patients receive two treatment arms, with randomly allocated treatment sequence: arm A (patient's usual transfusion schedule) and arm B (weekly transfusion, individualized per patient). To facilitate timely delivery of weekly transfusion, extended-matched RBCs are provided, with transfusion based upon the previous week's Hb/pre-transfusion testing results to eliminate delays of awaiting contemporaneous cross-matching. Primary outcome is the feasibility of delivering weekly transfusion. Secondary outcomes include HRQoL, functional activity measurements, RBC usage, and alloimmunization rates. A qualitative substudy explores patient and staff experiences. RESULTS The trial is open in Australia, Netherlands, and UK. The first patient was recruited in 2020. Inter-country differences in providing RBCs are observed, including patient genotyping versus serological phenotyping to select compatible units. DISCUSSION This pilot trial evaluates a novel personalized transfusion approach of weekly matched RBC transfusion and challenges the dogma of current routine pre-transfusion matching practice. Findings on study feasibility, HRQoL, and physical functional outcomes and the qualitative substudy will inform the design of a larger definitive trial powered for clinical outcomes.
Collapse
Affiliation(s)
- Allison Mo
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia
- Department of Haematology, Monash Health, Clayton, Australia
- Austin Pathology & Department of Haematology, Austin Health, Heidelberg, Australia
| | - Erica Wood
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia
- Department of Haematology, Monash Health, Clayton, Australia
| | - Jake Shortt
- Department of Haematology, Monash Health, Clayton, Australia
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Andrew Charlton
- Department of Haematology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
| | - Dorothea Evers
- Department of Haematology, Radboudumc, Nijmegen, The Netherlands
| | - Marlijn Hoeks
- Department of Haematology, Radboudumc, Nijmegen, The Netherlands
| | - Elizabeth Pritchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - James Daly
- Australian Red Cross Lifeblood, Melbourne, Australia
| | - Carol Hodgson
- The Australian and New Zealand Intensive Care-Research Centre, Monash University, Melbourne, Australia
- The Alfred, Melbourne, Australia
- The George Institute for Global Health, Sydney, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Australia
| | - Stephen Opat
- Department of Haematology, Monash Health, Clayton, Australia
| | - David Bowen
- Department of Health Sciences, University of York, York, UK
| | - John Reynolds
- Department of Clinical Haematology, The Alfred, Melbourne, Australia
- Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Australia
| | - Le Thi Phung Thao
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia
| | - Simon J Stanworth
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Zoe McQuilten
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia
- Department of Haematology, Monash Health, Clayton, Australia
| |
Collapse
|
8
|
Blennerhassett R, Hamad N, Grech L, Kwok A, Choi T, Forsyth C, Jagger J, Opat S, Harris S, Chan BA, Nguyen M, Bain N, Day D, Segelov E. Attitudes towards COVID-19 vaccination in adults with haematological malignancies. Acta Haematol 2024:000536548. [PMID: 38290477 DOI: 10.1159/000536548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/29/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Despite people with haematological malignancies being particularly vulnerable to severe COVID-19 infection and complications, vaccine hesitancy may be a barrier to optimal vaccination. This study explored attitudes towards COVID-19 vaccination in people with haematological malignancies. METHODS People with haematological malignancies at nine Australian health services were surveyed between June and October, 2021. Sociodemographic and clinical characteristics were collected. Attitudes towards COVID-19 vaccination were explored using the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale, and the Disease Influenced Vaccine Acceptance Scale-Six. Open-ended comments were qualitatively analysed. RESULTS A total of 869 people with haematological malignancies (mean age 64.2 years, 43.6% female) participated. Most participants (85.3%) reported that they had received at least one COVID-19 vaccine dose. Participants who were younger, spoke English as a non-dominant language, and had a shorter time since diagnosis were less likely to be vaccinated. Those who were female or spoke English as their non-dominant language reported greater vaccine side-effects concerns. Younger participants reported greater concerns about the vaccine impacting their treatment. CONCLUSION People with haematological malignancies reported high vaccine uptake, however, targeted education for specific participant groups may address vaccine hesitancy concerns, given the need for COVID-19 vaccine boosters.
Collapse
|
9
|
Odutola MK, van Leeuwen MT, Bruinsma F, Turner J, Hertzberg M, Seymour JF, Prince HM, Trotman J, Verner E, Roncolato F, Opat S, Lindeman R, Tiley C, Milliken ST, Underhill CR, Benke G, Giles GG, Vajdic CM. A Population-Based Family Case-Control Study of Sun Exposure and Follicular Lymphoma Risk. Cancer Epidemiol Biomarkers Prev 2024; 33:106-116. [PMID: 37831120 PMCID: PMC10774741 DOI: 10.1158/1055-9965.epi-23-0578] [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: 05/20/2023] [Revised: 08/08/2023] [Accepted: 10/11/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Epidemiologic evidence suggests an inverse association between sun exposure and follicular lymphoma risk. METHODS We conducted an Australian population-based family case-control study based on 666 cases and 459 controls (288 related, 171 unrelated). Participants completed a lifetime residence and work calendar and recalled outdoor hours on weekdays, weekends, and holidays in the warmer and cooler months at ages 10, 20, 30, and 40 years, and clothing types worn in the warmer months. We used a group-based trajectory modeling approach to identify outdoor hour trajectories over time and examined associations with follicular lymphoma risk using logistic regression. RESULTS We observed an inverse association between follicular lymphoma risk and several measures of high lifetime sun exposure, particularly intermittent exposure (weekends, holidays). Associations included reduced risk with increasing time outdoors on holidays in the warmer months [highest category OR = 0.56; 95% confidence interval (CI), 0.42-0.76; Ptrend < 0.01], high outdoor hours on weekends in the warmer months (highest category OR = 0.71; 95% CI, 0.52-0.96), and increasing time outdoors in the warmer and cooler months combined (highest category OR = 0.66; 95% CI, 0.50-0.91; Ptrend 0.01). Risk was reduced for high outdoor hour maintainers in the warmer months across the decade years (OR = 0.71; 95% CI, 0.53-0.96). CONCLUSIONS High total and intermittent sun exposure, particularly in the warmer months, may be protective against the development of follicular lymphoma. IMPACT Although sun exposure is not recommended as a cancer control policy, confirming this association may provide insights regarding the future control of this intractable malignancy.
Collapse
Affiliation(s)
- Michael K. Odutola
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Marina T. van Leeuwen
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Bruinsma
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer Turner
- Anatomical Pathology, Douglass Hanly Moir Pathology, Macquarie Park, Sydney, Australia
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital and University of New South Wales, Sydney, New South Wales, Australia
| | - John F. Seymour
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - H. Miles Prince
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Judith Trotman
- Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Emma Verner
- Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | | | - Stephen Opat
- Clinical Haematology, Monash Health, Clayton, Victoria, Australia
| | - Robert Lindeman
- New South Wales Health Pathology, Sydney, New South Wales, Australia
| | | | | | - Craig R. Underhill
- Border Medical Oncology Research Unit, Albury, New South Wales, Australia
| | - Geza Benke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Graham G. Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Claire M. Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
10
|
Opat S, Tedeschi A, Hu B, Linton KM, McKay P, Leitch S, Coleman M, Zinzani PL, Jin J, Sun M, Sobieraj-Teague M, Browett P, Ke X, Thieblemont C, Ardeshna K, Bijou F, Walker P, Hawkes EA, Ho SJ, Zhou K, Liang Z, Xu J, Tankersley C, Delarue R, Co M, Trotman J. Safety and efficacy of zanubrutinib in relapsed/refractory marginal zone lymphoma: final analysis of the MAGNOLIA study. Blood Adv 2023; 7:6801-6811. [PMID: 37682792 PMCID: PMC10679804 DOI: 10.1182/bloodadvances.2023010668] [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: 05/08/2023] [Revised: 07/07/2023] [Accepted: 07/24/2023] [Indexed: 09/10/2023] Open
Abstract
The primary analysis of MAGNOLIA, an open-label, single-arm, multicenter, phase 2 study, demonstrated that the next-generation Bruton tyrosine kinase (BTK) inhibitor zanubrutinib provided a high overall response rate (ORR) in patients with relapsed/refractory marginal zone lymphoma (R/R MZL), with a favorable safety/tolerability profile. Presented here, is the final analysis of MAGNOLIA, performed to characterize the durability of response and longer-term safety and tolerability. Zanubrutinib (160 mg twice daily) was evaluated in 68 patients with R/R MZL who had received at least 1 anti-CD20-directed regimen. The primary end point was independent review committee (IRC)-assessed ORR. Secondary end points included investigator-assessed ORR, duration of response (DOR), progression-free survival (PFS), overall survival (OS), health-related quality of life, safety, and tolerability. With a median follow-up of 27.4 months, the IRC-assessed ORR was 68.2% (95% confidence interval [CI], 55.6-79.1), with a 24-month DOR event-free rate of 72.9% (95% CI, 54.4-84.9). PFS and OS at 24 months were 70.9% (95% CI, 57.2-81.0) and 85.9% (95% CI, 74.7-92.4), respectively. The zanubrutinib safety profile was consistent with the primary analysis, with no new safety signals observed. Atrial fibrillation/flutter (n = 2 [2.9%]) and hypertension (n = 3 [4.4%]) were uncommon. Neutropenia (n = 8 [11.8%]) was the most common grade ≥3 adverse event. In this final analysis of MAGNOLIA, zanubrutinib demonstrated sustained clinical responses beyond 2 years, with 73% of responders alive and progression free. Zanubrutinib continued to demonstrate a favorable safety/tolerability profile with the additional time on treatment. This trial was registered at www.clinicaltrials.gov as #NCT03846427.
Collapse
Affiliation(s)
- Stephen Opat
- Monash Health and Monash University, Clayton, VIC, Australia
| | | | - Bei Hu
- Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Kim M. Linton
- Division of Cancer Sciences, Manchester Cancer Research Centre, Manchester, United Kingdom
| | - Pamela McKay
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia “Seràgnoli,” and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
| | - Jie Jin
- The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Mingyuan Sun
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | | | | | - Xiaoyan Ke
- Peking University Third Hospital, Beijing, China
| | - Catherine Thieblemont
- Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Louis, Hemato-oncology, Paris University Diderot, Paris, France
| | - Kirit Ardeshna
- University College London Hospitals/University College London Biomedical Research Centre, London, UK
| | | | - Patricia Walker
- Peninsula Private Hospital, Ramsay Health Care, Frankston, VIC, Australia
| | - Eliza A. Hawkes
- Olivia Newton-John Cancer Research Centre, Austin Health, Heidelberg, VIC, Australia
| | | | | | | | | | | | | | | | - Judith Trotman
- Concord Repatriation General Hospital and University of Sydney, Concord, NSW, Australia
| |
Collapse
|
11
|
Dimopoulos MA, Opat S, D'Sa S, Jurczak W, Lee HP, Cull G, Owen RG, Marlton P, Wahlin BE, Garcia-Sanz R, McCarthy H, Mulligan S, Tedeschi A, Castillo JJ, Czyz J, Fernández de Larrea C, Belada D, Libby E, Matous J, Motta M, Siddiqi T, Tani M, Trněný M, Minnema MC, Buske C, Leblond V, Treon SP, Trotman J, Chan WY, Schneider J, Allewelt H, Patel S, Cohen A, Tam CS. Zanubrutinib Versus Ibrutinib in Symptomatic Waldenström Macroglobulinemia: Final Analysis From the Randomized Phase III ASPEN Study. J Clin Oncol 2023; 41:5099-5106. [PMID: 37478390 PMCID: PMC10666987 DOI: 10.1200/jco.22.02830] [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: 12/15/2022] [Revised: 03/28/2023] [Accepted: 05/08/2023] [Indexed: 07/23/2023] Open
Abstract
The phase III ASPEN study demonstrated the comparable efficacy and improved safety of zanubrutinib versus ibrutinib in patients with Waldenström macroglobulinemia (WM). Here, we report long-term follow-up outcomes from ASPEN. The primary end point was the sum of very good partial response (VGPR) + complete response (CR) rates; secondary and exploratory end points were also reported. Cohort 1 comprised 201 patients (myeloid differentiation primary response 88-mutant WM: 102 receiving zanubrutinib; 99 receiving ibrutinib); cohort 2 comprised 28 patients (myeloid differentiation primary response 88 wild-type WM: 28 zanubrutinib; 26 efficacy evaluable). At 44.4-month median follow-up, VGPR + CR rates were 36.3% with zanubrutinib versus 25.3% with ibrutinib in cohort 1 and 30.8% with one CR in cohort 2. In patients with CXC motif chemokine receptor 4 mutation, VGPR + CR rates were 21.2% with zanubrutinib versus 10.0% with ibrutinib (cohort 1). Median progression-free survival and overall survival were not reached. Any-grade adverse events (AEs) of diarrhea (34.7% v 22.8%), muscle spasms (28.6% v 11.9%), hypertension (25.5% v 14.9%), atrial fibrillation/flutter (23.5% v 7.9%), and pneumonia (18.4% v 5.0%) were more common with ibrutinib versus zanubrutinib; neutropenia (20.4% v 34.7%) was less common with ibrutinib versus zanubrutinib (cohort 1). Zanubrutinib was associated with lower risk of AE-related treatment discontinuation. Overall, these findings confirm the long-term response quality and tolerability associated with zanubrutinib.
Collapse
Affiliation(s)
| | - Stephen Opat
- Monash Health & Monash University, Clayton, VIC, Australia
| | - Shirley D'Sa
- Centre for Waldenström's Macroglobulinemia & Associated Disorders, University College London Hospital Foundation Trust, London, United Kingdom
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Institute of Oncology, Krakow, Poland
| | - Hui-Peng Lee
- Flinders Medical Centre, Adelaide, SA, Australia
| | - Gavin Cull
- Sir Charles Gairdner Hospital, University of Western Australia, Perth, WA, Australia
| | - Roger G Owen
- St James University Hospital, Leeds, United Kingdom
| | - Paula Marlton
- Princess Alexandra Hospital and University of Queensland, Brisbane, QLD, Australia
| | - Björn E Wahlin
- Karolinska Universitetssjukhuset & Karolinska Institutet, Stockholm, Sweden
| | | | - Helen McCarthy
- Royal Bournemouth & Christchurch Hospital, Bournemouth, United Kingdom
| | | | | | | | - Jaroslaw Czyz
- Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | | | | | | | | | | | | | - Monica Tani
- Ospedale Civile Santa Maria delle Croci, AUSL Ravenna, Ravenna, Italy
| | - Marek Trněný
- Všeobecná fakultní nemocnice v Praze, Prague, Czechia
| | | | - Christian Buske
- Institute of Experimental Cancer Research -CCC Ulm-Universitätsklinikum Ulm, Ulm, Baden-Württemberg, Germany
| | | | | | - Judith Trotman
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| | | | | | | | | | | | - Constantine S Tam
- Monash Health & Monash University, Clayton, VIC, Australia
- The Alfred Hospital, Melbourne, VIC, Australia
| |
Collapse
|
12
|
Salvaris R, Mulligan S, Puig A, McGeachie M, Opat S. Australian data on the utilisation and duration on treatment of ibrutinib with a proton pump inhibitor in patients with relapsed or refractory chronic lymphocytic leukaemia. Intern Med J 2023; 53:2115-2118. [PMID: 37950615 DOI: 10.1111/imj.16267] [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] [Received: 03/22/2023] [Accepted: 08/20/2023] [Indexed: 11/13/2023]
Abstract
In Australia, over half of patients with relapsed/refractory chronic lymphocytic leukaemia treated with ibrutinib use concomitant proton pump inhibitors (PPIs). High gastric pH reduces the bioavailability of some Bruton tyrosine kinase inhibitors. There was no difference in duration on ibrutinib with or without concomitant PPI (unadjusted P = 0.61; adjusted hazard ratio: 1.23, 95% confidence interval: 0.75-2.02, P = 0.411). PPI use does not affect ibrutinib treatment persistence.
Collapse
Affiliation(s)
- Ross Salvaris
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
- Monash University, Melbourne, Victoria, Australia
| | | | - Andrea Puig
- Janssen-Cilag Pty Ltd, Sydney, New South Wales, Australia
| | | | | |
Collapse
|
13
|
Tam CS, Muñoz JL, Seymour JF, Opat S. Correction: Zanubrutinib: past, present, and future. Blood Cancer J 2023; 13:154. [PMID: 37783709 PMCID: PMC10545724 DOI: 10.1038/s41408-023-00926-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Affiliation(s)
| | | | - John F Seymour
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital & University of Melbourne, Melbourne, VIC, Australia
| | - Stephen Opat
- Monash Health and Monash University, Clayton, VIC, Australia
| |
Collapse
|
14
|
Odutola MK, van Leeuwen MT, Bruinsma FJ, Benke G, Turner MC, Trotman J, Turner J, Seymour JF, Prince HM, Milliken ST, Tiley C, Hertzberg M, Roncolato F, Opat S, Lindeman R, Verner E, Underhill CR, Cardis E, Giles G, Vajdic CM. Occupational exposure to extremely low-frequency magnetic fields and follicular lymphoma risk: a family case-control study. Occup Environ Med 2023; 80:599-602. [PMID: 37722828 PMCID: PMC10591762 DOI: 10.1136/oemed-2023-108949] [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] [Received: 04/13/2023] [Accepted: 08/30/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVES We aimed to examine the relationship between occupational exposure to extremely low-frequency magnetic fields (ELF-MFs) and follicular lymphoma (FL) risk. METHODS We conducted a family case-control study between 2011 and 2016 in Australia and included 681 cases. Controls were either a family member of cases (related (n=294), unrelated (n=179)) or were unrelated recruited for a similarly designed Australian multiple myeloma study (n=711). We obtained detailed job histories using lifetime work calendars. We assigned exposure to ELF-MFs using an enhanced job exposure matrix, with a lag period of 10 years. We examined associations with FL risk using logistic regression accounting for relatedness between cases and controls. We performed sensitivity analyses including by control type, by sex, complete case analyses, ELF-MF exposure percentiles in addition to quartiles, ELF-MF exposure in the maximum exposed job, a shorter lag period (1 year) and the cumulative exposure in the most recent time period (1-9 years). RESULTS We observed no association with the average intensity, duration or lifetime cumulative exposure to occupational ELF-MF exposure in the primary or sensitivity analyses. CONCLUSIONS Our findings do not support an association between occupational ELF-MF exposure and FL risk. Although the inclusion of family members as part of the larger control group may have biased our risk estimates towards the null, findings were similar in sensitivity analyses restricted to cases and unrelated controls. Further research incorporating enhanced exposure assessment to ELF-MF is warranted to inform occupational safety regulations and any potential role in lymphomagenesis.
Collapse
Affiliation(s)
- Michael K Odutola
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Marina T van Leeuwen
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona J Bruinsma
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Geza Benke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michelle C Turner
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Department of Global Health, Pompeu Fabra University (UPF), Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Judith Trotman
- Concord Repatriation General Hospital and University of Sydney, Concord, New South Wales, Australia
| | - Jennifer Turner
- Anatomical Pathology, Douglass Hanly Moir Pathology, Sydney, New South Wales, Australia
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, New South Wales, Australia
| | - John F Seymour
- Royal Melbourne Hospital, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia
| | - H Miles Prince
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Samuel T Milliken
- Haematology Department, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Campbell Tiley
- Cancer Day Unit, Gosford Hospital, Gosford, New South Wales, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital and University of New South Wales, Sydney, New South Wales, Australia
| | - Fernando Roncolato
- Clinical Haematology, St. George Hospital, Kogarah, New South Wales, Australia
| | - Stephen Opat
- Clinical Haematology, Monash Health, Clayton, Victoria, Australia
| | - Robert Lindeman
- Clinical Operations, New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Emma Verner
- Concord Repatriation General Hospital and University of Sydney, Concord, New South Wales, Australia
| | - Craig R Underhill
- Border Medical Oncology Research Unit, Albury, New South Wales, Australia
| | - Elisabeth Cardis
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Department of Global Health, Pompeu Fabra University (UPF), Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Graham Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
15
|
Abstract
In recent years, Bruton tyrosine kinase (BTK) inhibitors have provided significant advances in the treatment of patients with B-cell malignancies. Ibrutinib was the first BTK inhibitor to be approved, and it changed the standard-of-care treatment for diseases such as chronic lymphocytic leukemia, mantle cell lymphoma, marginal zone lymphoma, and Waldenström macroglobulinemia, improving efficacy outcomes and safety compared to chemotherapy. In this article, we review the development of zanubrutinib, a next-generation BTK inhibitor, from molecular design to patient-related outcomes. We start this journey by providing insights into the discovery of BTK and the physiologic, genetic, and molecular characterization of patients lacking this kinase, together with the brief treatment landscape in the era of chemo-immunotherapies. Zanubrutinib was originally developed by applying a structure-activity strategy to enhance the specificity as well as enzymatic and pharmacokinetic properties. Preclinical studies confirmed greater specificity and better bioavailability of zanubrutinib compared with that of ibrutinib, which supported the initiation of clinical trials in humans. Preliminary clinical results indicated activity in B-cell malignancies together with an improved safety profile, in line with less off-target effects described in the preclinical studies. The clinical program of zanubrutinib has since expanded significantly, with ongoing studies in a wide range of hemato-oncological diseases and in combination with many other therapies. Zanubrutinib currently is approved for various B-cell malignancies in multiple countries. This story highlights the importance of multidisciplinary collaborative research, from bench to bedside, and provides an example of how the commitment to finding improved treatment options should always run parallel to patient care.
Collapse
Affiliation(s)
| | | | - John F Seymour
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital & University of Melbourne, Melbourne, VIC, Australia
| | - Stephen Opat
- Monash Health and Monash University, Clayton, VIC, Australia
| |
Collapse
|
16
|
Anderson MA, Bennett R, Badoux X, Best G, Chia N, Cochrane T, Cull G, Crassini K, Harrup R, Jackson S, Kuss B, Lasica M, Lew TE, Marlton P, Opat S, Palfreyman E, Polizzotto MN, Ratnasingam S, Seymour JF, Soosapilla A, Talaulikar D, Tam CS, Weinkove R, Wight J, Mulligan SP. Chronic lymphocytic leukaemia Australasian consensus practice statement. Intern Med J 2023; 53:1678-1691. [PMID: 37743239 DOI: 10.1111/imj.16207] [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: 11/30/2022] [Accepted: 07/30/2023] [Indexed: 09/26/2023]
Abstract
Chronic lymphocytic leukaemia (CLL) is the most common haematological malignancy in Australia and New Zealand (ANZ). Considerable changes to diagnostic and management algorithms have occurred within the last decade. The availability of next-generation sequencing and measurable residual disease assessment by flow cytometry allow for advanced prognostication and response assessments. Novel therapies, including inhibitors of Bruton's tyrosine kinase (BTKi) and B-cell lymphoma 2 (BCL2) inhibitors, have transformed the treatment landscape for both treatment-naïve and relapsed/refractory disease, particularly for patients with high-risk genetic aberrations. Recommendations regarding appropriate supportive management continue to evolve, and special considerations are required for patients with CLL with respect to the global SARS-CoV-2 pandemic. The unique funding and treatment environments in Australasia highlight the need for specific local guidance with respect to the investigation and management of CLL. This consensus practice statement was developed by a broadly representative group of ANZ experts in CLL with endorsement by peak haematology bodies, with a view to providing this standardised guidance.
Collapse
Affiliation(s)
- Mary A Anderson
- Department of Clinical Haematology, The Royal Melbourne Hospital and The Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Division of Blood Cells and Blood Cancer, The Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rory Bennett
- Department of Clinical Haematology, The Royal Melbourne Hospital and The Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Xavier Badoux
- St George Hospital, Sydney, New South Wales, Australia
| | - Giles Best
- Flinders University and Medical Centre, Adelaide, South Australia, Australia
| | - Nicole Chia
- Genomic Diagnostics, Healius Pathology, Brisbane, Queensland, Australia
| | - Tara Cochrane
- Gold Coast University Hospital, Griffith University, Gold Coast, Queensland, Australia
| | - Gavin Cull
- Sir Charles Gairdner Hospital, PathWest Laboratory Medicine and University of Western Australia, Perth, Western Australia, Australia
| | - Kyle Crassini
- Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Rosemary Harrup
- Cancer and Blood Services Royal Hobart Hospital, Hobart, Tasmania, Australia
- Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
| | - Sharon Jackson
- Te Whatu Ora health New Zealand Counties Manukau, Auckland, New Zealand
| | - Bryone Kuss
- Flinders University and Medical Centre, Adelaide, South Australia, Australia
| | - Masa Lasica
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Thomas E Lew
- Department of Clinical Haematology, The Royal Melbourne Hospital and The Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Division of Blood Cells and Blood Cancer, The Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paula Marlton
- Department of Haematology, Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Stephen Opat
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Emma Palfreyman
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Mark N Polizzotto
- Department of Clinical Haematology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
- Clinical Hub for Interventional Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sumita Ratnasingam
- St John of God Hospital Geelong, Geelong, Victoria, Australia
- University Hospital Geelong, Geelong, Victoria, Australia
- School of Medicine, Geelong Clinical School, Deakin University, Geelong, Victoria, Australia
| | - John F Seymour
- Department of Clinical Haematology, The Royal Melbourne Hospital and The Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Asha Soosapilla
- Flow Cytometry, Healius Pathology, Sydney, New South Wales, Australia
| | - Dipti Talaulikar
- Department of Diagnostic Genomics, ACT Pathology, Canberra Health Services, Canberra, Australian Capital Territory, Australia
- Department of Haematology, ACT Pathology, Canberra Health Services, Canberra, Australian Capital Territory, Australia
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Constantine S Tam
- Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Robert Weinkove
- Te Rerenga Ora Blood & Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast & Hutt Valley, Wellington, New Zealand
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Joel Wight
- Department of Haematology and Bone Marrow Transplantation, Townsville University Hospital, Townsville, Queensland, Australia
- James Cook University, School of Medicine, Townsville, Queensland, Australia
| | - Stephen P Mulligan
- Royal North Shore Hospital, Sydney, New South Wales, Australia
- Healius Pathology, Sydney, New South Wales, Australia
| |
Collapse
|
17
|
Song Y, Zhou K, Zou D, Li D, Hu J, Yang H, Zhang H, Ji J, Xu W, Jin J, Lv F, Feng R, Gao S, Zhou D, Tam CS, Simpson D, Wang M, Phillips TJ, Opat S, Fang C, Sun S, Zhu J. Long-term outcomes of second-line versus later-line zanubrutinib treatment in patients with relapsed/refractory mantle cell lymphoma: An updated pooled analysis. Cancer Med 2023; 12:18643-18653. [PMID: 37705497 PMCID: PMC10557885 DOI: 10.1002/cam4.6473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/24/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND We previously reported results of a pooled analysis of two zanubrutinib studies in relapsed or refractory (R/R) MCL showing better survival outcomes when zanubrutinib is used in second-line versus later-line. Here, we present an updated pooled analysis with a longer follow-up of 35.2 months. METHODS Data were pooled from two studies-BGB-3111-AU-003 (NCT02343120) and BGB-3111-206 (NCT03206970) of zanubrutinib in R/R MCL. The patients were divided into two groups based on the treatment line of zanubrutinib: the second-line and the later-line group. The inverse propensity score weighting method was used to balance the baseline covariates between the groups. The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), PFS, and OS rates, objective response rate (ORR), duration of response (DOR), and safety. RESULTS Among 112 pooled patients, 41 (36.6%) patients received zanubrutinib as second-line and 71 (63.4%) patients as later-line therapy. After weighting, OS was significantly improved in the second-line versus later-line group (HR, 0.459 [95% CI: 0.215, 0.98]; p = 0.044) with median OS not estimable in both groups. The PFS was similar between the two groups (HR, 0.78 [95% CI: 0.443, 1.373]; p = 0.389) but with numerically longer median PFS in the second-line versus later-line group (27.8 vs. 22.1 months). ORR was numerically higher in the second-line versus later-line (88.6% vs. 85.7%), and DOR was similar between the two groups (25.2 vs. 25.1 months). Zanubrutinib showed a similar safety profile in both groups. CONCLUSION Zanubrutinib in second-line treatment was associated with significantly improved OS compared with later-line treatment of R/R MCL.
Collapse
Affiliation(s)
- Yuqin Song
- Peking University Cancer Hospital and InstituteBeijingChina
| | - Keshu Zhou
- Affiliated Cancer Hospital of Zhengzhou UniversityHenan Cancer HospitalZhengzhouChina
| | - Dehui Zou
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
| | - Dengju Li
- Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Jianda Hu
- Fujian Medical University Union HospitalFuzhouChina
| | - Haiyan Yang
- The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of SciencesHangzhouChina
| | - Huilai Zhang
- Tianjin Medical University Cancer Institute and HospitalTianjinChina
| | - Jie Ji
- West China Hospital of Sichuan UniversityChengduChina
| | - Wei Xu
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province HospitalNanjingChina
| | - Jie Jin
- The First Affiliated HospitalZhejiang University College of MedicineHangzhouChina
| | - Fangfang Lv
- Fudan University Shanghai Cancer CenterShanghaiChina
| | - Ru Feng
- Nanfang Hospital of Southern Medical UniversityGuangzhouChina
| | - Sujun Gao
- The First Hospital of Jilin UniversityChangchunChina
| | - Daobin Zhou
- Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Constantine S. Tam
- Peter MacCallum Cancer Centre, St. Vincent's HospitalUniversity of MelbourneMelbourneVictoriaAustralia
| | | | - Michael Wang
- The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Stephen Opat
- Monash Health, Monash UniversityClaytonVictoriaAustralia
| | | | | | - Jun Zhu
- Peking University Cancer Hospital and InstituteBeijingChina
| |
Collapse
|
18
|
Shaw B, Parker C, Opat S, Shortt J, Poon P. Hematologic Malignancy: Who Cares in the End? A Retrospective Cohort Study of Markers of Quality End-of-Life Care. J Natl Compr Canc Netw 2023; 21:813-820.e1. [PMID: 37549908 DOI: 10.6004/jnccn.2023.7033] [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: 01/31/2023] [Accepted: 04/25/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Early palliative care is increasingly used in solid organ malignancy but is less established in patients with hematologic malignancy. Disease-related factors increase the demand for hospitalization, treatment, and supportive care in patients with hematologic malignancy. The terminal phase of illness in patients with hematologic malignancy can be difficult to predict, resulting in complexities in establishing a standard for quality end-of-life care. METHODS This is a retrospective single-center cohort study of adult patients with hematologic malignancy who died between October 2019 and July 2022. Patients were identified, and disease characteristics, therapy, and outcomes were extracted from medical records. Descriptive statistics are reported and univariate analyses were performed across a range of factors to assess for associations. RESULTS A total of 229 patients were identified, with a median age of 77 years and 35% female. In the final 30 days of life, 65% presented to the emergency department, 22% had an ICU admission, 22% had an invasive procedure, 48% received cytotoxic therapy, 61% received a RBC transfusion, and 46% received a platelet transfusion. Use of intensive chemotherapy was particularly associated with hospitalization and ICU admission. A total of 74% referred to palliative care, with a median time from referral to death of 13 days. Of these patients, one-third were referred within the last 5 days of life. In terms of place of death, 54% died in the acute hospital setting and 30% in hospice, with a median hospice length of stay of 4 days. CONCLUSIONS These findings highlight the need for further research into quality indicators for end of life in hematologic malignancy and earlier integration of specialist supportive and palliative care in both inpatient and outpatient settings.
Collapse
Affiliation(s)
- Briony Shaw
- Department of Clinical Haematology, Monash Health, Clayton, Victoria, Australia
- Department of Supportive and Palliative Care, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Catriona Parker
- Department of Supportive and Palliative Care, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Stephen Opat
- Department of Clinical Haematology, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Jake Shortt
- Department of Clinical Haematology, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Peter Poon
- Department of Supportive and Palliative Care, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
19
|
Tam CS, Trotman J, Opat S, Stern JC, Allewelt H, By K, Novotny W, Huang J, Tedeschi A. Zanubrutinib for the treatment of relapsed/refractory hairy cell leukemia. Blood Adv 2023; 7:2884-2887. [PMID: 36753605 PMCID: PMC10300288 DOI: 10.1182/bloodadvances.2022008990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 02/10/2023] Open
Affiliation(s)
| | - Judith Trotman
- Concord Repatriation General Hospital, Concord, NSW, Australia
- The University of Sydney, Concord, NSW, Australia
| | - Stephen Opat
- Monash Health, Clayton, VIC, Australia
- Monash University, Clayton, VIC, Australia
| | | | | | | | | | | | | |
Collapse
|
20
|
Tey A, Schwarer J, Raffa R, Shi E, Paul E, Opat S, Dendle C, Shortt J. High risk of infection in 'real-world' patients receiving ibrutinib, idelalisib or venetoclax for mature B-cell leukaemia/lymphoma. Eur J Haematol 2023; 110:540-547. [PMID: 36656100 PMCID: PMC10952205 DOI: 10.1111/ejh.13928] [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] [Received: 11/20/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The infection risk in patients receiving ibrutinib, idelalisib or venetoclax for chronic lymphocytic leukaemia (CLL) or B-cell lymphoma treated outside of clinical trials is incompletely defined. We sought to identify the severe infection rate and associated risk factors in a 'real-world' cohort. METHODS We conducted a retrospective cohort study of adult patients with CLL or lymphoma treated with ibrutinib, idelalisib or venetoclax. RESULTS Of 67 patients identified (ibrutinib n = 53, idelalisib n = 8 and venetoclax n = 6), 32 (48%) experienced severe infection. Severe infection occurred at a rate of 65 infections per 100 person-years, with a median of 17.8 months of therapy. Median time to first infection (IQR) was 5.4 months (1.4-15.9). Poor baseline Eastern Cooperative Oncology Group (ECOG) performance status and high Charlson Comorbidity Index (CCI) score associated with increased risk of severe infection [hazard ratios (95% CI) 1.57 (1.07-2.31, p = .018) and 1.3 (1.05-1.62, p = .016) respectively]. CONCLUSION The severe infection rate for patients receiving ibrutinib, idelalisib or venetoclax for lymphoma and CLL exceeded those reported in clinical trials. Patients with poor ECOG or high CCI should be closely monitored for early signs of infection and prevention strategies actively pursued. Further prospective research is required to define optimal antimicrobial prophylaxis recommendations.
Collapse
MESH Headings
- Adult
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Retrospective Studies
- Lymphoma, B-Cell/drug therapy
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
Collapse
Affiliation(s)
- Amanda Tey
- Pharmacy DepartmentMonash HealthClaytonVictoriaAustralia
| | - James Schwarer
- Monash Infectious DiseasesMonash HealthClaytonVictoriaAustralia
| | - Robert Raffa
- Pharmacy DepartmentMonash HealthClaytonVictoriaAustralia
| | - Emily Shi
- Pharmacy DepartmentMonash HealthClaytonVictoriaAustralia
| | - Eldho Paul
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive MedicineMonash UniversityClaytonVictoriaAustralia
| | - Stephen Opat
- Department of Medicine, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVictoriaAustralia
- Monash HaematologyMonash HealthClaytonVictoriaAustralia
| | - Claire Dendle
- Monash Infectious DiseasesMonash HealthClaytonVictoriaAustralia
- Department of Medicine, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVictoriaAustralia
| | - Jake Shortt
- Department of Medicine, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVictoriaAustralia
- Monash HaematologyMonash HealthClaytonVictoriaAustralia
| |
Collapse
|
21
|
Tam C, Munoz J, Cull G, Opat S, Allewelt H, Zhang X, Stern JC, Hilger J, By K, Cohen A, Tedeschi A. Zanubrutinib, Alone and in Combination With Tislelizumab, for the Treatment of Richter Transformation of Chronic Lymphocytic Leukemia. Hemasphere 2023; 7:e870. [PMID: 36999005 PMCID: PMC10043571 DOI: 10.1097/hs9.0000000000000870] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/13/2023] [Indexed: 04/01/2023] Open
Affiliation(s)
- Constantine Tam
- Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Javier Munoz
- Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Gavin Cull
- Sir Charles Gairdner Hospital, Perth, WA, Australia
- University of Western Australia, Perth, WA, Australia
| | - Stephen Opat
- Monash Health, Clayton, VIC, Australia
- Monash University, Clayton, VIC, Australia
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Nguyen J, Wellard C, Chung E, Cheah CY, Dickinson M, Doo NW, Keane C, Talaulikar D, Berkahn L, Morgan S, Hamad N, Cochrane T, Johnston AM, Forsyth C, Opat S, Barraclough A, Mutsando H, Ratnasingam S, Giri P, Wood EM, McQuilten ZK, Hawkes EA. Clinical characteristics of Australian treatment-naïve patients with classical Hodgkin lymphoma from the lymphoma and related diseases registry. Eur J Haematol 2023; 110:386-395. [PMID: 36539351 DOI: 10.1111/ejh.13915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/03/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
Comprehensive clinical characteristics of Australian patients with classical Hodgkin Lymphoma (cHL) have not previously been systematically collected and described. We report real-world data of 498 eligible patients from the first 5 years of the Lymphoma and Related Diseases Registry (LaRDR), including baseline characteristics, histologic subtype, and treatment patterns in first-line therapy. Patient demographics and distribution of histopathological subtypes of cHL are similar to reported international cohorts. Doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) was the most common therapy for both early and advanced-stage disease, and 48% of patients with the early-stage disease received radiotherapy. Treatment patterns are consistent with international guidelines. In comorbid patients ≥60 years of age with advanced-stage disease, there is greater variation in treatment. In patients with a recorded response, the objective response rate (ORR) was 96% in early-stage disease, and 88% in advanced-stage disease. Early progression-free survival data suggest Australian patients with cHL have good outcomes, similar to other international studies.
Collapse
Affiliation(s)
| | - Cameron Wellard
- Monash University School of Public Health & Preventive Medicine, Melbourne, Victoria, Australia
| | - Eliza Chung
- Monash University School of Public Health & Preventive Medicine, Melbourne, Victoria, Australia
| | - Chan Y Cheah
- Sir Charles Gairdner Hospital and Medical School, University of Western Australia, Western Australia, Australia
| | - Michael Dickinson
- Peter MacCallum Cancer Centre; Royal Melbourne Hospital, and the Sir Peter MacCallum Department of Oncology at the University of Melbourne, Melbourne, Victoria, Australia
| | - Nicole Wong Doo
- Concord Repatriation General Hospital; Concord Clinical School, University of Sydney, Concord, New South Wales, Australia
| | - Colm Keane
- Princess Alexandra Hospital, Queensland, Australia
| | - Dipti Talaulikar
- Canberra Health Services, The Australian National University, Australian Capital Territory, Australia
| | | | | | - Nada Hamad
- St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Tara Cochrane
- Gold Coast University Hospital, Griffith University, Southport, Queensland, Australia
| | | | | | | | | | | | | | | | - Erica M Wood
- Monash University School of Public Health & Preventive Medicine, Melbourne, Victoria, Australia
| | - Zoe K McQuilten
- Monash University School of Public Health & Preventive Medicine, Melbourne, Victoria, Australia
| | - Eliza A Hawkes
- Monash University School of Public Health & Preventive Medicine, Melbourne, Victoria, Australia.,Olivia Newton John Cancer Research Institute at Austin Health, Victoria, Australia
| | | |
Collapse
|
23
|
Baggio D, Wellard C, Chung E, Talaulikar D, Keane C, Opat S, Giri P, Minson A, Cheah CY, Armytage T, Lee D, Chong G, Johnston A, Cochrane T, Waters N, Hamad N, Wood EM, Hawkes EA. Australian experience with ibrutinib in patients with relapsed/refractory mantle cell lymphoma: a study from the Lymphoma and Related Diseases Registry. Leuk Lymphoma 2023; 64:621-627. [PMID: 38376128 DOI: 10.1080/10428194.2022.2157676] [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: 10/01/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
Bruton's tyrosine kinase inhibitors (BTKi) have an established role in the management of patients with relapsed/refractory mantle cell lymphoma (MCL). However, scant data exist on outcomes of patients ineligible for clinical trials testing these therapies. We describe a contemporary cohort of relapsed/refractory MCL patients from the Australasian Lymphoma and Related Diseases Registry treated with ibrutinib December 2014 until July 2018, to determine the proportion potentially eligible for original trials, reasons for ineligibility and survival outcomes. Of 44 patients, 41% met one or more exclusion criteria from previous phase II/III MCL BTKi studies. Median progression-free and overall survival were 13.7 months (95% CI 6.2-28.1) and 15.6 months (95% CI 10.8-29.6) respectively and were shorter in patients excluded from clinical trials based on ECOG ≥2. Ibrutinib has demonstrable clinical effectiveness in a population enriched for unfit and trial-ineligible patients, and a need for more inclusive enrollment criteria in future BTKi studies is highlighted.
Collapse
Affiliation(s)
- Diva Baggio
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Australia
| | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Eliza Chung
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dipti Talaulikar
- Canberra Health, Australian Capital Territory, Canberra, Australia
| | - Colm Keane
- Princess Alexandra Hospital, Woolloongabba, Australia
| | - Stephen Opat
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Monash Health, Clayton, Australia
| | | | - Adrian Minson
- Peter MacCallum Cancer Centre, Melbourne, Australia
- The Royal Melbourne Hospital, Parkville, Australia
| | | | | | | | - Geoffrey Chong
- Ballarat Regional Integrated Cancer Centre, Ballarat, Australia
| | | | - Tara Cochrane
- Gold Coast University Hospital, Southport, Australia
| | - Neil Waters
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nada Hamad
- St Vincent's Health, Darlinghurst, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Eliza A Hawkes
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
24
|
Mulligan SP, Opat S, Cheah CY, Kuss B, Hertzberg M, Marlton P, Poplar S, Puig A, McGeachie M, Weinkove R, Tam CS. Real-world experience of Australian and New Zealand patients with chronic lymphocytic leukemia and mantle cell lymphoma accessing ibrutinib through a Named Patient Program. Leuk Lymphoma 2023; 64:312-318. [PMID: 36423351 DOI: 10.1080/10428194.2022.2148220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ibrutinib is a small molecule inhibitor of Bruton's tyrosine kinase indicated for the treatment of relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), and mantle cell lymphoma (MCL). The Named Patient Program in Australia and New Zealand (ANZ NPP) provided access to ibrutinib treatment to 1126 R/R CLL/SLL and 330 R/R MCL patients, prior to Pharmaceutical Benefits Scheme listing. This study aimed to assess the duration of treatment for the ANZ NPP patients, as an indicator of efficacy and tolerability of ibrutinib in the real world. Based on the NPP data, ibrutinib provided a median of 47 months clinical benefit for participants with CLL/SLL and 14 months clinical benefit for those with MCL; outcomes that are consistent with the clinical trial results and further support the well-established efficacy and safety profile of ibrutinib in the real world.
Collapse
Affiliation(s)
- Stephen P Mulligan
- Department of Haematology, Royal North Shore Hospital, Sydney, Australia
| | - Stephen Opat
- Monash Health, Monash University, Melbourne, Australia
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia.,Department of Haematology, Pathwest Laboratory Medicine, Perth, Australia.,School of Medicine, University of Western Australia, Perth, Australia
| | - Bryone Kuss
- Flinders Medical Centre and Finders University, Bedford Park, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, Australia
| | - Paula Marlton
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland School of Medicine, Brisbane, Australia
| | - Sarah Poplar
- Northland Cancer and Blood Services, Northland District Health Board, Whangarei, New Zealand
| | - Andrea Puig
- Real-world Evidence, Janssen-Cilag Pty Ltd, Sydney, Australia
| | - Marija McGeachie
- Medical and Scientific Affairs, Janssen-Cilag Pty Ltd, Sydney, Australia
| | - Robert Weinkove
- Te Rerenga Ora Blood & Cancer Centre, Wellington Hospital, Wellington, New Zealand.,Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | | |
Collapse
|
25
|
Tariq B, Ou YC, Stern JC, Mundra V, Wong Doo N, Walker P, Lewis KL, Lin C, Novotny W, Sahasranaman S, Opat S. A phase 1, open-label, randomized drug-drug interaction study of zanubrutinib with moderate or strong CYP3A inhibitors in patients with B-cell malignancies. Leuk Lymphoma 2023; 64:329-338. [PMID: 36480811 DOI: 10.1080/10428194.2022.2150820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BTK inhibitor exposure increases significantly when coadministered with CYP3A inhibitors, which may lead to dose-related toxicities. This study explored the pharmacokinetics, efficacy, and safety of zanubrutinib when coadministered with moderate or strong CYP3A inhibitors in 26 patients with relapsed or refractory B-cell malignancies. Coadministration of zanubrutinib (80 mg BID) with moderate CYP3A inhibitors fluconazole and diltiazem or zanubrutinib (80 mg QD) with strong CYP3A inhibitor voriconazole resulted in comparable exposures to zanubrutinib (320 mg QD) with AUC0-24h geometric least squares mean ratios approaching 1 (0.94, 0.81, and 0.83, for fluconazole, diltiazem, and voriconazole, respectively). The most common treatment-emergent adverse events were contusion (26.9%), back pain (19.2%), constipation and neutropenia (15.4% each), and rash, diarrhea, and fall (11.5% each). This study supports current United States Prescribing Information dose recommendations for the coadministration of reduced-dose zanubrutinib with moderate or strong CYP3A inhibitors and confirms the favorable efficacy and safety profile of zanubrutinib.
Collapse
Affiliation(s)
- Bilal Tariq
- Clinical Pharmacology, BeiGene USA, Inc, Fulton, MD, USA
| | - Ying C Ou
- Clinical Pharmacology, BeiGene USA, Inc, San Mateo, CA, USA
| | | | - Vaibhav Mundra
- Clinical Pharmacology, BeiGene USA, Inc, San Mateo, CA, USA
| | - Nicole Wong Doo
- Department of Hematology, Concord Repatriation General Hospital, Concord, Australia.,Concord Clinical School, University of Sydney, Sydney, Australia
| | - Patricia Walker
- Department of Hematology, Peninsula Health and Peninsula Private Hospitals, Frankston, Australia
| | - Katharine L Lewis
- Department of Haematology, Sir Charles Gairdner Hospital and Linear Clinical Research, Nedlands, Australia
| | - Chester Lin
- Biostatistics, BeiGene, Ltd, Emeryville, CA, USA
| | - William Novotny
- Clinical Development, Hematology, BeiGene USA, Inc, San Mateo, CA, USA
| | | | - Stephen Opat
- Clinical Hematology, Monash Health and Monash University, Clayton, Australia
| |
Collapse
|
26
|
Shaw B, Shortt J, Low M, Rogers B, Kaplan Z, Fedele P, Gregory G, Vilcassim S, Gilbertson M, Grigoriadis G, Opat S. Low mortality in vaccinated immunocompromised haematology patients infected with
SARS‐CoV
‐2. Intern Med J 2022; 52:2172-2175. [PMID: 36436197 DOI: 10.1111/imj.15954] [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: 08/03/2022] [Accepted: 10/04/2022] [Indexed: 11/29/2022]
Abstract
Coronavirus disease 2019 (COVID-19) infection in patients with haematological neoplasms has been associated with increased mortality; however, many studies in this patient group were reported early in the pandemic. The authors evaluated outcomes of COVID-19 infection in patients with haematological conditions following widespread vaccination, newer viral variants and increasingly effective antiviral therapies. A 4% mortality rate was found and contemporary risk factors for hospitalisation including older age, nonvaccination or partial COVID-19 vaccination status and infection with non-Omicron strain were identified.
Collapse
Affiliation(s)
- Briony Shaw
- Department of Clinical Haematology Monash Health Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
| | - Jake Shortt
- Department of Clinical Haematology Monash Health Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
| | - Michael Low
- Department of Clinical Haematology Monash Health Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
| | - Benjamin Rogers
- Department of Clinical Haematology Monash Health Melbourne Victoria Australia
- Department of Infectious Diseases Monash Health Melbourne Victoria Australia
| | - Zane Kaplan
- Department of Clinical Haematology Monash Health Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
| | - Pasquale Fedele
- Department of Clinical Haematology Monash Health Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
| | - Gareth Gregory
- Department of Clinical Haematology Monash Health Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
| | - Shahla Vilcassim
- Department of Clinical Haematology Monash Health Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
| | - Michael Gilbertson
- Department of Clinical Haematology Monash Health Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
| | - George Grigoriadis
- Department of Clinical Haematology Monash Health Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
| | - Stephen Opat
- Department of Clinical Haematology Monash Health Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
| |
Collapse
|
27
|
Segelov E, Body A, Lal L, Abdulla H, Turville S, Naing Z, Opat S, Leahy M, Balendra J, Hamad N, Mccuaig R, Rao S, Lineburg K, Smith C, MacIntyre C, Milch V, Busija L, Ahern E. 1611P Clinical determinants of SARS-CoV-2 vaccine response in adults with cancer. Ann Oncol 2022. [PMCID: PMC9472460 DOI: 10.1016/j.annonc.2022.07.1704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
28
|
Tam CS, Brown JR, Kahl BS, Ghia P, Giannopoulos K, Jurczak W, Šimkovič M, Shadman M, Österborg A, Laurenti L, Walker P, Opat S, Chan H, Ciepluch H, Greil R, Tani M, Trněný M, Brander DM, Flinn IW, Grosicki S, Verner E, Tedeschi A, Li J, Tian T, Zhou L, Marimpietri C, Paik JC, Cohen A, Huang J, Robak T, Hillmen P. Zanubrutinib versus bendamustine and rituximab in untreated chronic lymphocytic leukaemia and small lymphocytic lymphoma (SEQUOIA): a randomised, controlled, phase 3 trial. Lancet Oncol 2022; 23:1031-1043. [PMID: 35810754 DOI: 10.1016/s1470-2045(22)00293-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [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: 01/31/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Zanubrutinib is a next-generation, selective Bruton tyrosine kinase inhibitor with efficacy in relapsed chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL). We compared zanubrutinib with bendamustine-rituximab to determine its effectiveness as frontline therapy in patients with CLL or SLL. METHODS We conducted an open-label, multicentre, phase 3 study at 153 academic or community hospitals in 14 countries and regions. Eligible patients had untreated CLL or SLL requiring treatment as per International Workshop on CLL criteria; were aged 65 years or older, or 18 years or older and had comorbidities; and had an Eastern Cooperative Oncology Group performance status score of 0-2. A central interactive web response system randomly assigned patients without del(17)(p13·1) to zanubrutinib (group A) or bendamustine-rituximab (group B) by sequential block method (permutated blocks with a random block size of four). Patients with del(17)(p13·1) were enrolled in group C and received zanubrutinib. Zanubrutinib was administered orally at 160 mg twice per day (28-day cycles); bendamustine at 90 mg/m2 of body surface area on days 1 and 2 for six cycles plus rituximab at 375 mg/m2 of body surface area the day before or on day 1 of cycle 1, and 500 mg/m2 of body surface area on day 1 of cycles 2-6, were administered intravenously. The primary endpoint was progression-free survival per independent review committee in the intention-to-treat population in groups A and B, with minimum two-sided α of 0·05 for superiority. Safety was analysed in all patients who received at least one dose of study treatment. The study is registered with ClinicalTrials.gov, NCT03336333, and is closed to recruitment. FINDINGS Between Oct 31, 2017, and July 22, 2019, 590 patients were enrolled; patients without del(17)(p13·1) were randomly assigned to zanubrutinib (group A; n=241) or bendamustine-rituximab (group B; n=238). At median follow-up of 26·2 months (IQR 23·7-29·6), median progression-free survival per independent review committee was not reached in either group (group A 95% CI not estimable [NE] to NE; group B 28·1 months to NE). Progression-free survival was significantly improved in group A versus group B (HR 0·42 [95% CI 0·28 to 0·63]; two-sided p<0·0001). The most common grade 3 or worse adverse event was neutropenia (27 [11%] of 240 patients in group A, 116 [51%] of 227 in group B, and 17 [15%] of 111 patients in group C). Serious adverse events occurred in 88 (37%) of 240 patients in group A, 113 (50%) of 227 patients in group B, and 45 (41%) of 111 patients in group C. Adverse events leading to death occurred in 11 (5%) of 240 patients in group A, 12 (5%) of 227 patients in group B, and three (3%) of 111 patients in group C, most commonly due to COVID-19 (four [2%] of 240 patients in group A), diarrhoea, and aspiration pneumonia (two each [1%] of 227 patients in group B). INTERPRETATION Zanubrutinib significantly improved progression-free survival versus bendamustine-rituximab, with an acceptable safety profile consistent with previous studies. These data support zanubrutinib as a potential new treatment option for untreated CLL and SLL. FUNDING BeiGene.
Collapse
Affiliation(s)
- Constantine S Tam
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; University of Melbourne, Parkville, VIC, Australia; St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Royal Melbourne Hospital, Parkville, VIC, Australia.
| | | | - Brad S Kahl
- Washington University School of Medicine, St Louis, MO, USA
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | - Krzysztof Giannopoulos
- Experimental Hematooncology Department, Medical University of Lublin, Lublin, Poland; Hematology Department, St John's Cancer Centre, Lublin, Poland
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland
| | - Martin Šimkovič
- Fourth Department of Internal Medicine-Haematology, University Hospital, Hradec Kralove, Czech Republic; Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Anders Österborg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Luca Laurenti
- Fondazione Policlinico Universitario A Gemelli UCSC, Rome, Italy
| | | | - Stephen Opat
- Monash Health, Clayton, VIC, Australia; Monash University, Clayton, VIC, Australia
| | - Henry Chan
- North Shore Hospital, Auckland, New Zealand
| | | | - Richard Greil
- Third Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria
| | - Monica Tani
- Hematology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Marek Trněný
- First Department of Medicine, First Faculty of Medicine, Charles University, General Hospital, Prague, Czech Republic
| | - Danielle M Brander
- Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA
| | - Ian W Flinn
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN, USA
| | - Sebastian Grosicki
- Department of Hematology and Cancer Prevention, Health Sciences Faculty, Medical University of Silesia, Katowice, Poland
| | - Emma Verner
- Concord Repatriation General Hospital, Concord, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | | | - Jianyong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Tam CS, Gregory GP, Ku M, Fleming S, Handunnetti SM, Lee D, Walker P, Perkins A, Lew TE, Sirdesai S, Chua CC, Gilbertson M, Lasica M, Anderson MA, Renwick W, Grigg A, Patil S, Opat S, Friebe A, Cooke R, De Boer J, Spencer A, Ritchie D, Agarwal R, Blombery P. Recommendation for TP53 mutation testing in newly diagnosed mantle cell lymphoma: a statement from working groups sponsored by the Victorian Comprehensive Cancer Centre. Intern Med J 2022; 52:1286-1287. [PMID: 35879233 DOI: 10.1111/imj.15851] [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: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Constantine S Tam
- Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,VCCC Alliance, Melbourne, Victoria, Australia
| | - Gareth P Gregory
- Monash University, Melbourne, Victoria, Australia.,Monash Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Matthew Ku
- Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Shaun Fleming
- Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Sasanka M Handunnetti
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Denise Lee
- Department of Haematology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Patricia Walker
- Alfred Hospital, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Peninsula Health, Melbourne, Victoria, Australia.,Peninsula Private Hospital, Melbourne, Victoria, Australia
| | - Andrew Perkins
- Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Thomas E Lew
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Shreerang Sirdesai
- Department of Haematology, University Hospital Geelong, Geelong, Victoria, Australia
| | - Chong Chyn Chua
- Alfred Hospital, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Northern Health, Melbourne, Victoria, Australia
| | - Michael Gilbertson
- Monash University, Melbourne, Victoria, Australia.,Monash Haematology, Monash Health, Melbourne, Victoria, Australia.,Department of Haematology and Oncology, Western Health, Melbourne, Victoria, Australia
| | - Masa Lasica
- Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Mary Ann Anderson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - William Renwick
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Haematology and Oncology, Western Health, Melbourne, Victoria, Australia
| | - Andrew Grigg
- Department of Clinical Haematology, Austin Hospital, Melbourne, Victoria, Australia
| | - Sush Patil
- Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Stephen Opat
- Monash University, Melbourne, Victoria, Australia.,Monash Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Adam Friebe
- Department of Haematology, University Hospital Geelong, Geelong, Victoria, Australia
| | - Rachel Cooke
- Department of Clinical Haematology, Northern Health, Melbourne, Victoria, Australia
| | | | - Andrew Spencer
- Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - David Ritchie
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rishu Agarwal
- Department of Clinical Haematology, Austin Hospital, Melbourne, Victoria, Australia
| | - Piers Blombery
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
30
|
Segelov E, Body A, Luong V, Lopez VA, Lal L, Abdulla H, Turville S, Niang Z, Opat S, McCuaig R, Lineburg K, Rao S, Smith C, MacIntyre R, Ahern E. Abstract CT259: Comprehensive humoral and cellular immune assessments to SARS-CoV-2 (wild type, delta and omicron) following two- and three-dose vaccination schedule in a large adult cancer population: SerOzNET study: placeholder abstract. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct259] [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
Background: Defining cancer and treatment-related factors which influence protection against COVID-19 following vaccination are important given the worse outcomes following infection in this group. Sophisticated and detailed studies which go beyond a single measure are required particularly with correlation to multiple disease and treatment factors. This study cohort is unique due to (a) very low prior COVID-19 infection at time of sampling (July-Nov 2021), (b) vaccines studied were BNT162b2 (Pf) given 3 weeks apart or ChAdOx1 (AZ) spaced 12 weeks (dose 1, 2) (c) most participants then received a third dose 2 months later (heterologous for AZ).
Methods: SerOzNET (ACTRN12621001004853) enrols Australian blood and solid cancer patients prior to vaccination, with serial blood analyses and qualitative measures. We measured neutralizing antibodies (nAb) against SARS-CoV-2 wild type (wt) and variants of concern delta and omicron, quantitative S-protein IgG antibody level (Abbott), and T-cell correlates (interferon-g, tumour necrosis factor-a, interleukins 2/4/5/13) and epigenetic profiling at baseline and 3-4 weeks post dose 1, 2 +/- 3.
Results: 379 participants were included, median age 58 years (IQR 47-66) and 60% female. 30% participants had hematological malignancies with the remainder solid organ cancers. 90% patients were on current systemic cancer treatment (most commonly chemotherapy in 41%, chemoimmunotherapy or immunotherapy in 20%). In 331 patients where treatment intent was recorded, 47% was palliative. Only one patient had known prior COVID-19 infection. Of the initial 94 participants who received Pf vaccination, median (IQR) neutralizing antibody titre 4 weeks following dose 2 was 80 (40-160) for SARS-CoV-2 wt and 40 (0-80) for delta variant.
Conclusion: Neutralizing antibody titres in this Australian cancer population following Pf vaccination appear lower than those reported elsewhere such as CAPTURE study (Fendler et al, 2021), possibly related to shorter interdose interval. Preliminary data highlights low nAb titres as expected in haematology patients but also in some cases with treatment not traditionally associated with immunosuppression such as hormonal therapy. These results will be updated in February 2022 with third dose, AZ and omicron variant data.
Citation Format: Eva Segelov, Amy Body, Vi Luong, Veronica Aedo Lopez, Luxi Lal, Hesham Abdulla, Stuart Turville, Zin Niang, Stephen Opat, Robert McCuaig, Katie Lineburg, Sudha Rao, Corey Smith, Raina MacIntyre, Elizabeth Ahern. Comprehensive humoral and cellular immune assessments to SARS-CoV-2 (wild type, delta and omicron) following two- and three-dose vaccination schedule in a large adult cancer population: SerOzNET study: placeholder abstract [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT259.
Collapse
Affiliation(s)
- Eva Segelov
- 1Monash University and Monash Health, Clayton, Australia
| | - Amy Body
- 1Monash University and Monash Health, Clayton, Australia
| | - Vi Luong
- 2Monash Health, Clayton, Australia
| | | | - Luxi Lal
- 2Monash Health, Clayton, Australia
| | | | | | - Zin Niang
- 3University of New South Wales, Sydney, Australia
| | - Stephen Opat
- 1Monash University and Monash Health, Clayton, Australia
| | - Robert McCuaig
- 4Queensland Institute of Medical Research Berghofer, Brisbane, Australia
| | - Katie Lineburg
- 4Queensland Institute of Medical Research Berghofer, Brisbane, Australia
| | - Sudha Rao
- 4Queensland Institute of Medical Research Berghofer, Brisbane, Australia
| | - Corey Smith
- 4Queensland Institute of Medical Research Berghofer, Brisbane, Australia
| | | | | |
Collapse
|
31
|
Segelov E, Body A, Turville S, Smith C, Lineburg K, Rao S, McCuaig R, Opat S, Niang Z, Lal L, Luong V, Abdulla H, Lopez VA, Padhye B, Bolanos NF, Anazodo A, MacIntyre R, Downie P, O'Brien T, Ahern E. Abstract CT567: Comprehensive measures of COVID-19 vaccine efficacy in adolescent cancer patients: Results from SerOzNET. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct567] [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
The authors did not submit an updated abstract. The original abstract should be considered final.
Citation Format: Eva Segelov, Amy Body, Stuart Turville, Corey Smith, Katie Lineburg, Sudha Rao, Robert McCuaig, Stephen Opat, Zin Niang, Luxi Lal, Vi Luong, Hesham Abdulla, Veronica Aedo Lopez, Bhavna Padhye, Noemi Fuentes Bolanos, Antoinette Anazodo, Raina MacIntyre, Peter Downie, Tracey O'Brien, Elizabeth Ahern. Comprehensive measures of COVID-19 vaccine efficacy in adolescent cancer patients: Results from SerOzNET [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT567.
Collapse
Affiliation(s)
- Eva Segelov
- 1Monash University and Monash Health, Clayton, Australia
| | - Amy Body
- 2Monash University, Clayton, Australia
| | | | - Corey Smith
- 4Queensland Institute of Medical Research Berghofer, Brisbane, Australia
| | - Katie Lineburg
- 4Queensland Institute of Medical Research Berghofer, Brisbane, Australia
| | - Sudha Rao
- 4Queensland Institute of Medical Research Berghofer, Brisbane, Australia
| | - Robert McCuaig
- 4Queensland Institute of Medical Research Berghofer, Brisbane, Australia
| | | | - Zin Niang
- 3University of New South Wales, Sydney, Australia
| | - Luxi Lal
- 5Monash Health, Clayton, Australia
| | - Vi Luong
- 5Monash Health, Clayton, Australia
| | | | | | - Bhavna Padhye
- 6The Children's Hospital Westmead, Sydney, Australia
| | | | | | | | | | | | | |
Collapse
|
32
|
Mulligan SP, Opat S, Marlton P, Kuss B, Gerungan P, Puig A, McGeachie M, Tam CS. Ibrutinib use, treatment duration, and concomitant medications in Australian patients with relapsed or refractory chronic lymphocytic leukaemia. Br J Haematol 2022; 198:790-793. [PMID: 35702012 DOI: 10.1111/bjh.18306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Paula Marlton
- Princess Alexandra Hospital and University of Queensland, Brisbane, Australia
| | - Bryone Kuss
- Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
| | - Poppy Gerungan
- Real World Evidence, Janssen-Cilag Pty Ltd, Sydney, New South Wales, Australia
| | - Andrea Puig
- Real World Evidence, Janssen-Cilag Pty Ltd, Sydney, New South Wales, Australia
| | - Marija McGeachie
- Medical and Scientific Affairs, Janssen-Cilag Pty Ltd, Sydney, New South Wales, Australia
| | - Constantine S Tam
- The Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
33
|
Segelov E, Body A, Luong VTT, Aedo Lopez V, Lal L, Abdulla H, Turville S, Naing Z, Opat S, McCuaig R, Rao S, Lineburg K, Smith C, MacIntyre C, Ahern ES. Humoral and cellular immune response to Sars-CoV-2 wild-type and variants of concern following 3-dose vaccination in a large cohort of adults with cancer: The SerOzNET study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.17_suppl.lba12065] [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
LBA12065 Background: COVID-19 infection has poor outcomes for patients (pts) with cancer. Understanding vaccine response as a correlate of protection from severe infection is essential to advise pts regarding protective behaviours and optimal vaccine schedule. This Australian cohort is unique due to low rates of COVID-19 exposure at study entry (July-November 2021). and use of a 3 dose schedule. Pts initially received 2 doses of either BNT162b2 (Pf) at a 3 week interval, or ChadOx1-S (AZ) at a 6 week interval, all then received a 3rd dose, either mRNA-1273 (Mod) or Pf after 2-4 months, and finally a 4th dose at an interval of a further 3 months, for a subset. Methods: SerOzNET (ACTRN12621001004853) has enrolled pts with solid and haematological (haem) cancers prior to initial vaccination. Serial blood samples were processed for serum, PBMC and PMN at timepoints: 0, then 3-4 weeks post dose 1 then 2 then 3 then 4 (where administered). We report here neutralizing antibodies (nAb) against wild type (wt) and delta and omicron variants of concern (VOC); quantitative S-protein IgG antibody (Abbott); T-cell correlates measured by levels of interferon-g (IFN g), tumour necrosis factor-a, interleukins (IL-) 2/4/5/13; and epigenetic profiling of T cells. Results: The cohort consists of 401 pts with median age 58 (range 18-85); 59% female; 128 (32%) haem cancers. 377 (94%) are on current or recent (< 12 months) systemic therapy: 162 (43%) chemotherapy, 62 (16%) immunotherapy, 40 (10%) combined chemo/immunotherapy, 113 (29%) hormonal or targeted therapy. 42 (10%) received anti-CD20 therapy < 12 months, 6 (1.4%) had allogeneic stem cell transplant. NAb levels against wt are available for 256 pts post dose 1, 245 pts post dose 2 and 159 pts post dose 3 (will be updated). Response rates post dose were respectively 27%, 77% and 88%. Pts with haem cancer were less likely to respond to vaccination at any time compared to pts with solid cancer (p < 0.001, chi-squared test). After 3 doses, 3.8% of pts with solid cancer and 27.8% with haem cancer lacked NAb. NAb results to VOC delta are available for 92 pts post dose 2: 25/92 (27%) were negative, compared with a non-response rate to wt of 15% at same time in same pts. IFN-γ-Spike response was detectable in 18/31 (58%) and 24/30 (80%) pts post dose 1 and 2 respectively. 101 pts to date have received a 4th dose; data will be available at the meeting, as will epigenetic profiles and detailed clinicopathological correlations. Conclusions: This interim analysis shows that a significant proportion of pts with haem cancers (27.8%) lack protective Sars-CoV-2 antibodies following 3 vaccinations, whereas only 3.8% of solid cancer pts lack detectable response. Results from other B and T cell parameters may also be important in identifying pts less well protected by vaccination. Follow up is ongoing, response rate post 4th dose will be presented at the meeting. Clinical trial information: ACTRN12621001004853.
Collapse
Affiliation(s)
| | - Amy Body
- Monash Health, Clayton, Australia
| | | | | | - Luxi Lal
- Monash Health, Clayton, Australia
| | | | | | - Zin Naing
- NSW Department of Health, Sydney, Australia
| | - Stephen Opat
- Monash Health, Monash University, Clayton, Victoria, Australia
| | - Robert McCuaig
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Sudha Rao
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Katie Lineburg
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Corey Smith
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Chandini MacIntyre
- The Kirby Institute, University of New South Wales, Australia, Sydney, Australia
| | | |
Collapse
|
34
|
Tam CS, Allan JN, Siddiqi T, Kipps TJ, Jacobs R, Opat S, Barr PM, Tedeschi A, Trentin L, Bannerji R, Jackson S, Kuss BJ, Moreno C, Szafer-Glusman E, Russell K, Zhou C, Ninomoto J, Dean JP, Wierda WG, Ghia P. Fixed-duration ibrutinib plus venetoclax for first-line treatment of CLL: primary analysis of the CAPTIVATE FD cohort. Blood 2022; 139:3278-3289. [PMID: 35196370 PMCID: PMC11022982 DOI: 10.1182/blood.2021014488] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [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: 10/20/2021] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
CAPTIVATE (NCT02910583) is an international phase 2 study in patients aged ≤70 years with previously untreated chronic lymphocytic leukemia (CLL). Results from the cohort investigating fixed-duration (FD) treatment with ibrutinib plus venetoclax are reported. Patients received 3 cycles of ibrutinib lead-in then 12 cycles of ibrutinib plus venetoclax (oral ibrutinib [420 mg/d]; oral venetoclax [5-week ramp-up to 400 mg/d]). The primary endpoint was complete response (CR) rate. Hypothesis testing was performed for patients without del(17p) with prespecified analyses in all treated patients. Secondary endpoints included undetectable minimal residual disease (uMRD) rates, progression-free survival (PFS), overall survival (OS), and safety. Of the 159 patients enrolled and treated, 136 were without del(17p). The median time on study was 27.9 months, and 92% of patients completed all planned treatment. The primary endpoint was met, with a CR rate of 56% (95% confidence interval [CI], 48-64) in patients without del(17p), significantly higher than the prespecified 37% minimum rate (P < .0001). In the all-treated population, CR rate was 55% (95% CI, 48-63); best uMRD rates were 77% (peripheral blood [PB]) and 60% (bone marrow [BM]); 24-month PFS and OS rates were 95% and 98%, respectively. At baseline, 21% of patients were in the high tumor burden category for tumor lysis syndrome (TLS) risk; after ibrutinib lead-in, only 1% remained in this category. The most common grade ≥3 adverse events (AEs) were neutropenia (33%) and hypertension (6%). First-line ibrutinib plus venetoclax represents the first all-oral, once-daily, chemotherapy-free FD regimen for patients with CLL. FD ibrutinib plus venetoclax achieved deep, durable responses and promising PFS, including in patients with high-risk features.
Collapse
Affiliation(s)
- Constantine S. Tam
- Peter MacCallum Cancer Center, Melbourne, VIC, Australia
- St. Vincent's Hospital, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Thomas J. Kipps
- Moores Cancer Center, University of California San Diego, San Diego, CA
| | | | | | - Paul M. Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | | | - Rajat Bannerji
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Bryone J. Kuss
- Flinders University and Medical Center, Bedford Park, SA, Australia
| | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | - Cathy Zhou
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - Joi Ninomoto
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | | | - William G. Wierda
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paolo Ghia
- Università Vita-Salute San Raffaele, Milan, Italy
- IRCCS Ospedale San Raffaele, Milan, Italy
| |
Collapse
|
35
|
Tam CSL, Garcia-Sanz R, Opat S, D'Sa S, Jurczak W, Lee HP, Cull G, Owen RG, Marlton P, Wahlin BE, Tedeschi A, Castillo JJ, Siddiqi T, Buske C, Leblond V, Chan WY, Schneider J, Cohen A, Huang J, Dimopoulos MA. ASPEN: Long-term follow-up results of a phase 3 randomized trial of zanubrutinib (ZANU) versus ibrutinib (IBR) in patients with Waldenström macroglobulinemia (WM). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7521] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7521 Background: ASPEN is a randomized, open-label, phase 3 study comparing ZANU, a potent and selective Bruton tyrosine kinase inhibitor (BTKi), with the first-generation BTKi IBR in patients with WM. We present data with a median follow-up of 43 months. Methods: Patients with MYD88 mutations were assigned to cohort 1 and randomized 1:1 to receive ZANU 160 mg twice daily or IBR 420 mg once daily. Randomization was stratified by CXCR4 mutational status and lines of prior therapy (0 vs 1-3 vs > 3). Patients without MYD88 mutations were assigned to cohort 2 and received ZANU 160 mg twice daily. The primary endpoint was proportion of patients achieving complete response or very good partial response (CR+VGPR). Results: A total of 201 patients (ZANU arm, n = 102; IBR arm, n = 99) were enrolled in cohort 1 and 28 patients were enrolled in cohort 2. A larger proportion of patients in the ZANU arm of cohort 1 vs IBR had CXCR4 mutations by next-generation sequencing (32% vs 20%, or 33 of 98 vs 20 of 92 with data available) and were aged > 75 years (33% vs 22%). Median duration of treatment was 42 months (ZANU) and 41 months (IBR), with 67% and 58% remaining on treatment, respectively. The CR+VGPR rate by investigator was 36% with ZANU vs 22% with IBR ( p= 0.02) in cohort 1, and 31% in cohort 2. One patient achieved CR (cohort 2). In patients with wild type or mutant CXCR4 from cohort 1, CR+VGPR rates with ZANU vs IBR were 45% vs 28% ( p= 0.04) and 21% vs 5% ( p= 0.15) , respectively. Median progression-free survival and overall survival were not yet reached. Rates of atrial fibrillation, diarrhea, hypertension, localized infection, hemorrhage, muscle spasms, pneumonia, and adverse events leading to discontinuation or death were lower with ZANU vs IBR (Table). Exposure-adjusted incidence rates of atrial fibrillation/flutter and hypertension were lower with ZANU vs IBR (0.2 vs 0.8 and 0.5 vs 1.0 persons per 100 person-months, respectively; p< 0.05). Rate of neutropenia was higher and rate of grade ≥3 infection was lower with ZANU vs IBR. Safety outcomes of ZANU were similar between cohorts 1 and 2. Conclusions: ASPEN is the largest phase 3 trial with head-to-head BTKi comparison in WM. At a median follow-up of 43 months, ZANU was associated with higher CR+VGPR rate and demonstrated clinically meaningful advantages in long-term safety and tolerability vs IBR. Clinical trial information: NCT03053440. [Table: see text]
Collapse
Affiliation(s)
| | | | - Stephen Opat
- Monash Health, Monash University, Clayton, Victoria, Australia
| | - Shirley D'Sa
- Centre for Waldenström’s Macroglobulinemia and Associated Disorders, University College London Hospital Foundation Trust, London, United Kingdom
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland
| | - Hui-Peng Lee
- Flinders Medical Centre, Adelaide, SA, Australia
| | - Gavin Cull
- Sir Charles Gairdner Hospital and University of Western Australia, Perth, Australia
| | - Roger G. Owen
- HMDS Laboratory, St. James’ Institute of Oncology, Leeds, United Kingdom
| | - Paula Marlton
- Princess Alexandra Hospital, University of Queensland Brisbane, Brisbane, Australia
| | - Bjorn E. Wahlin
- Karolinska Universitetssjukhuset and Karolinska Institutet, Stockholm, Sweden
| | | | - Jorge J. Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - Christian Buske
- CCC Ulm-Universitätsklinikum Ulm, Baden-Württemberg, Germany
| | | | | | | | | | | | | |
Collapse
|
36
|
Wierda WG, Barr PM, Siddiqi T, Allan JN, Kipps TJ, Trentin L, Jacobs R, Jackson S, Tedeschi A, Opat S, Bannerji R, Kuss BJ, Moreno C, Croner LJ, Szafer-Glusman E, Zhou C, Szoke A, Dean JP, Ghia P, Tam CSL. Fixed-duration (FD) ibrutinib (I) + venetoclax (V) for first-line (1L) treatment (tx) of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL): Three-year follow-up from the FD cohort of the phase 2 CAPTIVATE study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7519] [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
7519 Background: CAPTIVATE (PCYC-1142) is a multicenter phase 2 study of 1L I+V in CLL. The primary analysis (PA) evaluating FD tx with I+V was previously presented (Ghia et al., ASCO 2021). Here we present 3-y follow-up results from the FD cohort. Methods: Patients (pts) aged ≤70 y with previously untreated CLL/SLL received 3 cycles of I then 12 cycles of I+V (I 420 mg/d orally; V ramp-up to 400 mg/d orally). Responses were investigator assessed per iwCLL 2008 criteria. Undetectable minimal residual disease (uMRD; <10-4) was measured by 8-color flow cytometry. Serious AEs (SAEs) deemed related to I reported >30 d after last dose of study drug were collected. Results: 159 pts were enrolled (median age 60 y), including pts with high-risk features of del(17p)/ TP53 mutation (17%), unmutated IGHV (uIGHV; 56%), and complex karyotype (19%). 147 (92%) and 149 (94%) pts completed tx with I and V, respectively. With 1 y of additional follow-up since PA, median time on study was 39 mo (range 1-41). ORR was 96% and was consistent (96%-97%) in pts with high-risk features (Table).The primary endpoint of complete response (CR) including CR with incomplete bone marrow recovery (CRi) rate in pts without del(17p) (n=136) increased nominally from 56% (95% CI, 48-64) to 58% (95% CI 50-66); in all pts, CR rate increased from 55% (95% CI 48-63) to 57% (95% CI 50-65). In pts achieving CR, 93% had durable responses lasting ≥12 mo post-tx. Of pts with uMRD in peripheral blood at 3 mo post-tx, 66/85 (78%) evaluable pts maintained uMRD through 12-mo post-tx. At 36 mo, PFS was 88% (95% CI 82‒92) and OS was 98% (95% CI 94‒99); similar rates were seen in pts with high-risk features (Table). All pts are off tx; no new SAEs of any kind have occurred since the PA. Available data on relevant mutations in BTK, PLCɣ2, or BCL-2 at time of PD will be presented. As of January 2022, 12 pts were retreated with single-agent I after PD (tx duration range 3-29 mo); of evaluated pts, 7/9 had partial responses and 2/9 had stable disease. Conclusions: Fixed duration I+V continues to provide deep, durable responses and clinically meaningful PFS, including in pts with high-risk disease features, representing an all-oral, once-daily, chemotherapy-free FD regimen for previously untreated pts with CLL/SLL. With an additional 1 y of follow-up, no OS events or SAEs occurred. Manageable safety profile is unchanged as previously reported. To date, successful single-agent I retreatment responses are observed. Clinical trial information: NCT02910583. [Table: see text]
Collapse
Affiliation(s)
- William G. Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul M. Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | - Ryan Jacobs
- Department of Hematology, Lymphoma Division, Assistant Professor of Medicine, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | | | | | - Stephen Opat
- Monash Health, Monash University, Clayton, Victoria, Australia
| | - Rajat Bannerji
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Bryone J. Kuss
- Flinders University and Medical Center, Bedford Park, South Australia, Australia
| | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | - Cathy Zhou
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA
| | - Anita Szoke
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA
| | - James P. Dean
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | | |
Collapse
|
37
|
Tatarczuch M, Waltham M, Shortt J, Hawkes E, Ho SJ, Trotman J, Brasacchio D, Co M, Li J, Ramakrishnan V, Dunne K, Opat S, Gregory G. P1261: ALLG LABORATORY SCIENCE STUDY LS21: MOLECULAR CORRELATES OF RESPONSE IN RELAPSED/REFRACTORY MARGINAL ZONE LYMPHOMA (RRMZL) PATIENTS TREATED WITH ZANUBRUTINIB IN THE MAGNOLIA TRIAL. Hemasphere 2022. [PMCID: PMC9430053 DOI: 10.1097/01.hs9.0000847908.60002.1c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
38
|
Shadman M, Giannopoulos K, Jurczak W, Šimkovič M, Österborg A, Laurenti L, Walker P, Opat S, Chan H, Ciepluch H, Greil R, Tani M, Trněný M, Brander DM, Flinn IW, Grosicki S, Verner E, Brown JR, Kahl BS, Ghia P, Li J, Tian T, Zhou L, Marimpietri C, Paik JC, Cohen A, Huang J, Robak T, Hillmen P, Tam CS. Sequoia: Results of a Phase 3 Randomized Study of Zanubrutinib (Zanu) Versus Bendamustine + Rituximab (BR) in Patients (Pts) with Treatment-Naïve (TN) Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL). Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00785-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
39
|
Body A, Ahern E, Lal L, Gillett K, Abdulla H, Opat S, O'Brien T, Downie P, Turville S, Munier CML, Smith C, MacIntyre CR, Segelov E. Protocol for SARS-CoV-2 post-vaccine surveillance study in Australian adults and children with cancer: an observational study of safety and serological and immunological response to SARS-CoV-2 vaccination (SerOzNET). BMC Infect Dis 2022; 22:70. [PMID: 35057745 PMCID: PMC8771167 DOI: 10.1186/s12879-021-07019-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer is associated with excess morbidity and mortality from coronavirus disease 2019 (COVID-19) following infection by the novel pandemic coronavirus SARS-CoV-2. Vaccinations against SARS-CoV-2 have been rapidly developed and proved highly effective in reducing the incidence of severe COVID-19 in clinical trials of healthy populations. However, patients with cancer were excluded from pivotal clinical trials. Early data suggest that vaccine response is less robust in patients with immunosuppressive conditions or treatments, while toxicity and acceptability of COVID-19 vaccines in the cancer population is unknown. Unanswered questions remain about the impact of various cancer characteristics (such as treatment modality and degree of immunosuppression) on serological response to and safety of COVID-19 vaccinations. Furthermore, as the virus and disease manifestations evolve, ongoing data is required to address the impact of new variants. METHODS SerOzNET is a prospective observational study of adults and children with cancer undergoing routine SARS-CoV-2 vaccination in Australia. Peripheral blood will be collected and processed at five timepoints (one pre-vaccination and four post-vaccination) for analysis of serologic responses to vaccine and exploration of T-cell immune correlates. Cohorts include: solid organ cancer (SOC) or haematological malignancy (HM) patients currently receiving (1) chemotherapy, (2) immune checkpoint inhibitors (3) hormonal or targeted therapy; (4) patients who completed chemotherapy within 6-12 months of vaccination; (5) HM patients with conditions associated with hypogammaglobulinaemia or immunocompromise; (6) SOC or HM patients with allergy to PEG or polysorbate 80. Data from healthy controls already enrolled on several parallel studies with comparable time points will be used for comparison. For children, patients with current or prior cancer who have not received recent systemic therapy will act as controls. Standardised scales for quality-of-life assessment, patient-reported toxicity and vaccine hesitancy will be obtained. DISCUSSION The SerOzNET study was commenced in June 2021 to prospectively study immune correlates of vaccination in specific cancer cohorts. The high proportion of the Australian population naïve to COVID-19 infection and vaccination at study commencement has allowed a unique window of opportunity to study vaccine-related immunity. Quality of life and patient-reported adverse events have not yet been reported in detail post-vaccination for cancer patients. Trial registration This trial is registered on the Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001004853. Submitted for registration 25 June 2021. Registered 30 July 2021 (Retrospectively registered). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382281&isReview=true.
Collapse
Affiliation(s)
- Amy Body
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia.
- Monash University, Clayton, Melbourne, VIC, 3168, Australia.
| | - Elizabeth Ahern
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
- Monash University, Clayton, Melbourne, VIC, 3168, Australia
| | - Luxi Lal
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
- Monash University, Clayton, Melbourne, VIC, 3168, Australia
| | - Karen Gillett
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
| | - Hesham Abdulla
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
| | - Stephen Opat
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
- Monash University, Clayton, Melbourne, VIC, 3168, Australia
| | - Tracey O'Brien
- Kids Cancer Centre, Sydney Children's Hospital', Randwick, NSW, 2031, Australia
- School of Women's & Children's Health, Faculty of Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Peter Downie
- Children's Cancer Centre, Monash Children's Hospital, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
| | - Stuart Turville
- Immunovirology and Pathogenesis Program, The Kirby Institute, University of New South Wales, Kensington, Sydney NSW, 2052, Australia
| | - C Mee Ling Munier
- Immunovirology and Pathogenesis Program, The Kirby Institute, University of New South Wales, Kensington, Sydney NSW, 2052, Australia
| | - Corey Smith
- QIMR Berghofer Centre for Immunotherapy and Vaccine Development and Translational and Human Immunology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - C Raina MacIntyre
- The Kirby Institute, University of New South Wales, Kensington, Sydney NSW, 2052, Australia
| | - Eva Segelov
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
- Monash University, Clayton, Melbourne, VIC, 3168, Australia
| |
Collapse
|
40
|
Wong J, Gruber E, Maher B, Waltham M, Sabouri-Thompson Z, Jong I, Luong Q, Levy S, Kumar B, Brasacchio D, Jia W, So J, Skinner H, Lewis A, Hogg SJ, Vervoort S, DiCorleto C, Uhe M, Gamgee J, Opat S, Gregory GP, Polekhina G, Reynolds J, Hawkes EA, Kailainathan G, Gasiorowski R, Kats LM, Shortt J. Integrated clinical and genomic evaluation of guadecitabine (SGI-110) in peripheral T-cell lymphoma. Leukemia 2022; 36:1654-1665. [PMID: 35459873 PMCID: PMC9162925 DOI: 10.1038/s41375-022-01571-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 01/03/2023]
Abstract
Peripheral T-cell lymphoma (PTCL) is a rare, heterogenous malignancy with dismal outcomes at relapse. Hypomethylating agents (HMA) have an emerging role in PTCL, supported by shared mutations with myelodysplasia (MDS). Response rates to azacitidine in PTCL of follicular helper cell origin are promising. Guadecitabine is a decitabine analogue with efficacy in MDS. In this phase II, single-arm trial, PTCL patients received guadecitabine on days 1-5 of 28-day cycles. Primary end points were overall response rate (ORR) and safety. Translational sub-studies included cell free plasma DNA sequencing and functional genomic screening using an epigenetically-targeted CRISPR/Cas9 library to identify response predictors. Among 20 predominantly relapsed/refractory patients, the ORR was 40% (10% complete responses). Most frequent grade 3-4 adverse events were neutropenia and thrombocytopenia. At 10 months median follow-up, median progression free survival (PFS) and overall survival (OS) were 2.9 and 10.4 months respectively. RHOAG17V mutations associated with improved PFS (median 5.47 vs. 1.35 months; Wilcoxon p = 0.02, Log-Rank p = 0.06). 4/7 patients with TP53 variants responded. Deletion of the histone methyltransferase SETD2 sensitised to HMA but TET2 deletion did not. Guadecitabine conveyed an acceptable ORR and toxicity profile; decitabine analogues may provide a backbone for future combinatorial regimens co-targeting histone methyltransferases.
Collapse
Affiliation(s)
- Jonathan Wong
- grid.419789.a0000 0000 9295 3933Monash Haematology, Monash Health, Clayton, VIC Australia ,grid.1002.30000 0004 1936 7857Blood Cancer Therapeutics Laboratory, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC Australia
| | - Emily Gruber
- grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC Australia ,grid.1055.10000000403978434Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Belinda Maher
- grid.419789.a0000 0000 9295 3933Monash Haematology, Monash Health, Clayton, VIC Australia ,grid.1002.30000 0004 1936 7857Blood Cancer Therapeutics Laboratory, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC Australia
| | - Mark Waltham
- grid.1002.30000 0004 1936 7857Blood Cancer Therapeutics Laboratory, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC Australia
| | - Zahra Sabouri-Thompson
- grid.1002.30000 0004 1936 7857Blood Cancer Therapeutics Laboratory, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC Australia
| | - Ian Jong
- grid.419789.a0000 0000 9295 3933Monash Health Imaging, Monash Health, Clayton, VIC Australia ,grid.1002.30000 0004 1936 7857Department of Imaging, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC Australia
| | - Quinton Luong
- grid.1002.30000 0004 1936 7857Blood Cancer Therapeutics Laboratory, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC Australia
| | - Sidney Levy
- grid.419789.a0000 0000 9295 3933Monash Health Imaging, Monash Health, Clayton, VIC Australia ,grid.1002.30000 0004 1936 7857Department of Imaging, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC Australia
| | - Beena Kumar
- grid.419789.a0000 0000 9295 3933Monash Pathology, Monash Health, Clayton, VIC Australia
| | - Daniella Brasacchio
- grid.1002.30000 0004 1936 7857Blood Cancer Therapeutics Laboratory, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC Australia
| | - Wendy Jia
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Joan So
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Hugh Skinner
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Alexander Lewis
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Simon J. Hogg
- grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC Australia ,grid.1055.10000000403978434Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Stephin Vervoort
- grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC Australia ,grid.1055.10000000403978434Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Carmen DiCorleto
- grid.419789.a0000 0000 9295 3933Monash Haematology, Monash Health, Clayton, VIC Australia
| | - Micheleine Uhe
- grid.419789.a0000 0000 9295 3933Monash Haematology, Monash Health, Clayton, VIC Australia
| | - Jeanette Gamgee
- grid.419789.a0000 0000 9295 3933Monash Haematology, Monash Health, Clayton, VIC Australia
| | - Stephen Opat
- grid.419789.a0000 0000 9295 3933Monash Haematology, Monash Health, Clayton, VIC Australia ,grid.1002.30000 0004 1936 7857Blood Cancer Therapeutics Laboratory, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC Australia
| | - Gareth P. Gregory
- grid.419789.a0000 0000 9295 3933Monash Haematology, Monash Health, Clayton, VIC Australia ,grid.1002.30000 0004 1936 7857Blood Cancer Therapeutics Laboratory, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC Australia
| | - Galina Polekhina
- grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - John Reynolds
- grid.1002.30000 0004 1936 7857Biostatistics Consulting Platform, Monash University and Alfred Health, Prahran, VIC Australia
| | - Eliza A. Hawkes
- grid.482637.cOlivia Newton John Cancer Wellness and Research Centre, at Austin Health, Heidelberg, VIC Australia ,grid.1002.30000 0004 1936 7857Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Gajan Kailainathan
- grid.414685.a0000 0004 0392 3935Haematology Department, Concord Repatriation General Hospital, Concord, NSW Australia
| | - Robin Gasiorowski
- grid.414685.a0000 0004 0392 3935Haematology Department, Concord Repatriation General Hospital, Concord, NSW Australia ,grid.1013.30000 0004 1936 834XUniversity of Sydney, Sydney, NSW Australia
| | - Lev M. Kats
- grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC Australia ,grid.1055.10000000403978434Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Jake Shortt
- Monash Haematology, Monash Health, Clayton, VIC, Australia. .,Blood Cancer Therapeutics Laboratory, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia. .,Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
| |
Collapse
|
41
|
Cull G, Burger JA, Opat S, Gottlieb D, Verner E, Trotman J, Marlton P, Munoz J, Johnston P, Simpson D, Stern JC, Prathikanti R, Wu K, Novotny W, Huang J, Tam CS. Zanubrutinib for treatment-naïve and relapsed/refractory chronic lymphocytic leukaemia: long-term follow-up of the phase I/II AU-003 study. Br J Haematol 2021; 196:1209-1218. [PMID: 34915592 PMCID: PMC9300083 DOI: 10.1111/bjh.17994] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/28/2022]
Abstract
The phase I/II AU-003 study in patients with treatment-naïve (TN) or relapsed/refractory (R/R) chronic lymphocytic leukaemia/small lymphocytic lymphoma demonstrated that zanubrutinib therapy results in clinically meaningful and durable responses with acceptable safety and tolerability. We report updated safety and efficacy data for 123 patients with a median follow-up of 47·2 months. Patients received zanubrutinib 160 mg twice daily (81 patients), 320 mg once daily (40), or 160 mg once daily (two). Discontinuations due to adverse events or disease progression were uncommon. The overall response rate (ORR) was 95·9% (TN, 100%; R/R, 95%) with 18·7% achieving complete response (CR). Ongoing response at 3 years was reported in 85·7%. The ORR in patients with del(17p)/tumour protein p53 mutation was 87·5% (CR 16·7%). The 2- and 3-year progression-free survival estimates were 90% (TN, 90%; R/R, 91%) and 83% (TN, 81%; R/R, 83%) respectively. The most reported Grade ≥3 adverse events were neutropenia (15·4%), pneumonia (9·8%), hypertension (8·9%) and anaemia (6·5%). The annual incidence of atrial fibrillation, major haemorrhage, Grade ≥3 neutropenia and Grade ≥3 infection decreased over time. With a median follow-up of ~4 years, responses remain clinically meaningful and durable and long-term tolerability to zanubrutinib therapy continues.
Collapse
Affiliation(s)
- Gavin Cull
- Sir Charles Gairdner Hospital, Perth, WA, Australia.,University of Western Australia, Perth, WA, Australia
| | - Jan A Burger
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen Opat
- Monash Health, Clayton, VIC, Australia.,Monash University, Clayton, VIC, Australia
| | - David Gottlieb
- Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Sydney, NSW, Australia
| | - Emma Verner
- Concord Repatriation Hospital, Concord, NSW, Australia.,The University of Sydney, Concord, NSW, Australia
| | - Judith Trotman
- Concord Repatriation Hospital, Concord, NSW, Australia.,The University of Sydney, Concord, NSW, Australia
| | - Paula Marlton
- Princess Alexandra Hospital, Brisbane, QLD, Australia.,University of Queensland, Brisbane, QLD, Australia
| | - Javier Munoz
- Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | | | - David Simpson
- North Shore Hospital, Auckland, New Zealand.,BeiGene USA, Inc, San Mateo, CA, USA
| | | | | | - Kenneth Wu
- BeiGene USA, Inc, San Mateo, CA, USA.,BeiGene (Beijing) Co, Ltd, Beijing, China
| | | | - Jane Huang
- BeiGene USA, Inc, San Mateo, CA, USA.,BeiGene (Beijing) Co, Ltd, Beijing, China
| | - Constantine S Tam
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,St Vincent's Hospital, Fitzroy, VIC, Australia.,University of Melbourne, Parkville, VIC, Australia.,Royal Melbourne Hospital, Parkville, VIC, Australia
| |
Collapse
|
42
|
Wierda WG, Allan JN, Siddiqi T, Kipps TJ, Opat S, Tedeschi A, Badoux XC, Kuss BJ, Jackson S, Moreno C, Jacobs R, Pagel JM, Flinn I, Pak Y, Zhou C, Szafer-Glusman E, Ninomoto J, Dean JP, James DF, Ghia P, Tam CS. Ibrutinib Plus Venetoclax for First-Line Treatment of Chronic Lymphocytic Leukemia: Primary Analysis Results From the Minimal Residual Disease Cohort of the Randomized Phase II CAPTIVATE Study. J Clin Oncol 2021; 39:3853-3865. [PMID: 34618601 PMCID: PMC8713593 DOI: 10.1200/jco.21.00807] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE CAPTIVATE (NCT02910583), a randomized phase II study, evaluates minimal residual disease (MRD)-guided treatment discontinuation following completion of first-line ibrutinib plus venetoclax treatment in patients with chronic lymphocytic leukemia (CLL). METHODS Previously untreated CLL patients age < 70 years received three cycles of ibrutinib and then 12 cycles of combined ibrutinib plus venetoclax. Patients in the MRD cohort who met the stringent random assignment criteria for confirmed undetectable MRD (Confirmed uMRD) were randomly assigned 1:1 to double-blind placebo or ibrutinib; patients without Confirmed uMRD (uMRD Not Confirmed) were randomly assigned 1:1 to open-label ibrutinib or ibrutinib plus venetoclax. Primary end point was 1-year disease-free survival (DFS) rate with placebo versus ibrutinib in the Confirmed uMRD population. Secondary end points included response rates, uMRD, and safety. RESULTS One hundred sixty-four patients initiated three cycles of ibrutinib lead-in. After 12 cycles of ibrutinib plus venetoclax, best uMRD response rates were 75% (peripheral blood) and 68% (bone marrow). Patients with Confirmed uMRD were randomly assigned to receive placebo (n = 43) or ibrutinib (n = 43); patients with uMRD Not Confirmed were randomly assigned to ibrutinib (n = 31) or ibrutinib plus venetoclax (n = 32). Median follow-up was 31.3 months. One-year DFS rate was not significantly different between placebo (95%) and ibrutinib (100%; arm difference: 4.7% [95% CI, -1.6 to 10.9]; P = .15) in the Confirmed uMRD population. After ibrutinib lead-in tumor debulking, 36 of 40 patients (90%) with high tumor lysis syndrome risk at baseline shifted to medium or low tumor lysis syndrome risk categories. Adverse events were most frequent during the first 6 months of ibrutinib plus venetoclax and generally decreased over time. CONCLUSION The 1-year DFS rate of 95% in placebo-randomly assigned patients with Confirmed uMRD suggests the potential for fixed-duration treatment with this all-oral, once-daily, chemotherapy-free regimen in first-line CLL.
Collapse
Affiliation(s)
- William G Wierda
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | - Bryone J Kuss
- Flinders University and Medical Centre, Bedford Park, SA, Australia
| | | | - Carol Moreno
- Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | | | - John M Pagel
- Swedish Cancer Institute Center for Blood Disorders and Stem Cell Transplantation, Seattle, WA
| | - Ian Flinn
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | - Yvonne Pak
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - Cathy Zhou
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | | | - Joi Ninomoto
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - James P Dean
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | | | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Constantine S Tam
- Peter MacCallum Cancer Center and St Vincent's Hospital and the University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
43
|
Opat S, Tedeschi A, Linton K, McKay P, Hu B, Chan H, Jin J, Sobieraj-Teague M, Zinzani PL, Coleman M, Thieblemont C, Browett P, Ke X, Sun M, Marcus R, Portell CA, Ardeshna K, Bijou F, Walker P, Hawkes EA, Mapp S, Ho SJ, Talaulikar D, Zhou KS, Co M, Li X, Zhou W, Cappellini M, Tankersley C, Huang J, Trotman J. The MAGNOLIA Trial: Zanubrutinib, a Next-Generation Bruton Tyrosine Kinase Inhibitor, Demonstrates Safety and Efficacy in Relapsed/Refractory Marginal Zone Lymphoma. Clin Cancer Res 2021; 27:6323-6332. [PMID: 34526366 PMCID: PMC9401507 DOI: 10.1158/1078-0432.ccr-21-1704] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/29/2021] [Accepted: 09/10/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Marginal zone lymphoma (MZL) is an uncommon non-Hodgkin lymphoma with malignant cells that exhibit a consistent dependency on B-cell receptor signaling. We evaluated the efficacy and safety of zanubrutinib, a next-generation selective Bruton tyrosine kinase inhibitor, in patients with relapsed/refractory (R/R) MZL. PATIENTS AND METHODS Patients with R/R MZL were enrolled in the phase II MAGNOLIA (BGB-3111-214) study. The primary endpoint was overall response rate (ORR) as determined by an independent review committee (IRC) based on the Lugano 2014 classification. RESULTS Sixty-eight patients were enrolled. After a median follow-up of 15.7 months (range, 1.6 to 21.9 months), the IRC-assessed ORR was 68.2% and complete response (CR) was 25.8%. The ORR by investigator assessment was 74.2%, and the CR rate was 25.8%. The median duration of response (DOR) and median progression-free survival (PFS) by independent review was not reached. The IRC-assessed DOR rate at 12 months was 93.0%, and IRC-assessed PFS rate was 82.5% at both 12 and 15 months. Treatment was well tolerated with the majority of adverse events (AE) being grade 1 or 2. The most common AEs were diarrhea (22.1%), contusion (20.6%), and constipation (14.7%). Atrial fibrillation/flutter was reported in 2 patients; 1 patient had grade 3 hypertension. No patient experienced major hemorrhage. In total, 4 patients discontinued treatment due to AEs, none of which were considered treatment-related by the investigators. CONCLUSIONS Zanubrutinib demonstrated high ORR and CR rate with durable disease control and a favorable safety profile in patients with R/R MZL.
Collapse
Affiliation(s)
- Stephen Opat
- Monash Health, Monash University, Clayton, Victoria, Australia
| | | | - Kim Linton
- Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester Cancer Research Centre, Manchester, United Kingdom
| | - Pamela McKay
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Bei Hu
- Levine Cancer Institute University City, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Henry Chan
- North Shore Hospital, Auckland, New Zealand
| | - Jie Jin
- The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, Zhejiang, China
| | | | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Morton Coleman
- WCM Research Alliance, Weill Cornell Medicine, Lake Success, New York
| | - Catherine Thieblemont
- Service d'Hématologie-Oncologie, Hôpital Saint-Louis, APHP, Paris, France
- Paris University, Paris, France
| | - Peter Browett
- Auckland City Hospital, University of Auckland, Grafton, Auckland, New Zealand
| | - Xiaoyan Ke
- Peking University Third Hospital, Beijing, China
| | - Mingyuan Sun
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Robert Marcus
- Sarah Cannon Research Institute, London, United Kingdom
| | - Craig A Portell
- University of Virginia Cancer Center, Charlottesville, Virginia
| | - Kirit Ardeshna
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- UCLH NIHR Biomedical Research Centre, London, United Kingdom
| | | | - Patricia Walker
- Peninsula Private Hospital, Ramsay Health Care, Frankston, Australia
| | - Eliza A Hawkes
- Olivia Newton-John Cancer Research Institute and Austin Health, Heidelberg, Victoria, Australia
- Eastern Health, Box Hill, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Sally Mapp
- Haematology Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Shir-Jing Ho
- Haematology Clinical Services, St George Hospital, Sydney, New South Wales, Australia
| | - Dipti Talaulikar
- The Canberra Hospital, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | - Ke-Shu Zhou
- Henan Cancer Hospital, Zhengzhou, Henan, China
| | | | | | | | | | | | | | - Judith Trotman
- Concord Repatriation General Hospital, Sydney Medical School, University of Sydney, Concord, New South Wales, Australia.
| |
Collapse
|
44
|
Tam CS, Ou YC, Trotman J, Opat S. Clinical pharmacology and PK/PD translation of the second-generation Bruton's tyrosine kinase inhibitor, zanubrutinib. Expert Rev Clin Pharmacol 2021; 14:1329-1344. [PMID: 34491123 DOI: 10.1080/17512433.2021.1978288] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Introduction: Bruton's tyrosine kinase (BTK) inhibitors have revolutionized the treatment of B-cell lymphomas. Zanubrutinib was designed to achieve improved therapeutic concentrations and minimize off-target activities putatively accounting, in part, for the adverse effects seen with other BTK inhibitors.Areas covered: This drug profile covers zanubrutinib clinical pharmacology and the translation of pharmacokinetics (PK) and pharmacodynamics (PD) to clinical efficacy and safety profiles, by highlighting key differences between zanubrutinib and other BTK inhibitors. We discuss PK, sustained BTK occupancy, and potential factors affecting PK of zanubrutinib, including food effects, hepatic impairment, and drug-drug interactions. These data, along with exposure-response analyses, were used to support the recommended dose of 320 mg, either once daily or as 160 mg twice daily. Translation of PK/PD attributes into clinical effects was demonstrated in a randomized, phase 3 head-to-head study comparing it with ibrutinib in patients with Waldenström macroglobulinemia.Expert opinion: Among the approved BTK inhibitors, zanubrutinib is less prone to PK modulation by intrinsic and extrinsic factors, leading to more consistent, sustained therapeutic exposures and improved dosing convenience. Zanubrutinib PK/PD has translated into durable responses and improved safety, representing an important new treatment option for patients who benefit from BTK therapy.
Collapse
Affiliation(s)
- Constantine S Tam
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Haematology, St Vincent's Hospital, Fitzroy, VIC, Australia.,Department of Haematology, University of Melbourne, Parkville, VIC, Australia.,Department of Haematology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Ying C Ou
- Sr. Director, Clinical Pharmacology, BeiGene USA Inc., San Mateo, CA, USA
| | - Judith Trotman
- Department of Haematology, Concord Repatriation Hospital, Concord, NSW, Australia.,Department of Haematology, The University of Sydney, Concord, NSW, Australia
| | - Stephen Opat
- Director, Clinical Haematology, Monash Health, Clayton, VIC, Australia.,Director, Clinical Haematology, Monash University, Clayton, VIC, Australia
| |
Collapse
|
45
|
Tam CS, Robak T, Ghia P, Kahl BS, Walker P, Janowski W, Simpson D, Shadman M, Ganly PS, Laurenti L, Opat S, Tani M, Ciepluch H, Verner E, Šimkovič M, Österborg A, Trněný M, Tedeschi A, Paik JC, Kuwahara SB, Feng S, Ramakrishnan V, Cohen A, Huang J, Hillmen P, Brown JR. Zanubrutinib monotherapy for patients with treatment naïve chronic lymphocytic leukemia and 17p deletion. Haematologica 2021; 106:2354-2363. [PMID: 33054121 PMCID: PMC8409041 DOI: 10.3324/haematol.2020.259432] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/17/2020] [Indexed: 12/27/2022] Open
Abstract
Patients with chronic lymphocytic leukemia or small lymphocytic lymphoma whose tumors carry deletion of chromosome 17p13.1 [del(17p)] have an unfavorable prognosis and respond poorly to standard chemoimmunotherapy. Zanubrutinib is a selective next-generation Bruton tyrosine kinase inhibitor. We evaluated the safety and efficacy of zanubrutinib 160 mg twice daily in treatment-naïve patients with del(17p) disease enrolled in a dedicated, nonrandomized cohort (Arm C) of the phase 3 SEQUOIA trial. A total of 109 patients (median age, 70 years; range, 42 - 86) with centrally confirmed del(17p) were enrolled and treated. After a median of 18.2 months (range, 5.0 - 26.3), seven patients had discontinued study treatment due to progressive disease, four due to an adverse event, and one due to withdrawal of consent. The overall response rate was 94.5% with 3.7% of patients achieving complete response with or without incomplete hematologic recovery. The estimated 18-month progression-free survival rate was 88.6% (95% CI, 79.0 - 94.0) and the estimated 18-month overall survival rate was 95.1% (95% CI, 88.4 - 98.0). Most common all-grade adverse events included contusion (20.2%), upper respiratory tract infection (19.3%), neutropenia/neutrophil count decreased (17.4%), and diarrhea (16.5%). Grade ≥ 3 adverse events were reported in 53 patients (48.6%), most commonly neutropenia (12.9%) and pneumonia (3.7%). An adverse event of atrial fibrillation was reported in three patients (2.8%). Zanubrutinib was active and well tolerated in this large, prospectively enrolled treatment cohort of previously untreated patients with del(17p) chronic lymphocytic leukemia/small lymphocytic lymphoma. This trial was registered at ClinicalTrials.gov as #NCT03336333.
Collapse
Affiliation(s)
- Constantine S Tam
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia; Royal Melbourne Hospital, Parkville, Victoria, Australia; St Vincent's Hospital Melbourne, Fitzroy, Victoria.
| | | | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano
| | - Brad S Kahl
- Washington University School of Medicine, St Louis, MO
| | | | | | | | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA
| | - Peter S Ganly
- Department of Haematology, Christchurch Hospital, Christchurch
| | - Luca Laurenti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Stephen Opat
- Monash Health, Clayton, Victoria, Australia; Monash University, Clayton, Victoria
| | - Monica Tani
- Hematology Unit, Santa Maria delle Croci Hospital, Ravenna
| | | | - Emma Verner
- Concord Repatriation General Hospital, Concord, NSW, Australia; University of Sydney, Concord, NSW
| | - Martin Šimkovič
- Fourth Department of Internal Medicine - Hematology, University Hospital, Hradec Kralove, Czech Republic; Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Anders Österborg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Hematology, Karolinska University Hospital, Stockholm
| | - Marek Trněný
- First Department of Medicine, First Faculty of Medicine, Charles University, General Hospital, Prague, Czech Republic
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Batlevi CL, Salles G, Tilly H, Chaidos A, McKay P, Phillips T, Assouline S, Campbell P, Ribrag V, Damaj GL, Dickinson M, Jurczak W, Kaźmierczak M, Opat S, Radford JR, Schmitt A, Rajarethinam A, Shang G, Morschhauser F. CHARACTERISTICS OF PATIENTS ACHIEVING COMPLETE OR PARTIAL RESPONSE (CR/PR) WITH TAZEMETOSTAT (TAZ) IN WILD‐TYPE RELAPSED/REFRACTORY (R/R) FOLLICULAR LYMPHOMA (FL). Hematol Oncol 2021. [DOI: 10.1002/hon.21_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C. L. Batlevi
- Memorial Sloan Kettering Cancer Center Lymphoma Service Department of Medicine New York USA
| | - G. Salles
- Lyon‐Sud Hospital University of Lyon Hematology Pierre‐Bénite France
| | - H. Tilly
- Centre Henri Becquerel and Rouen University Department of Haematology and INSERM U1245 Rouen France
| | - A. Chaidos
- Imperial College Healthcare NHS Trust Hammersmith Hospital Department of Medicine London UK
| | - P. McKay
- Beatson West of Scotland Cancer Centre Department of Hematology Glasgow UK
| | - T. Phillips
- University of Michigan Hematology and Oncology Ann Arbor USA
| | - S. Assouline
- Division of Hematology Sir Mortimer B. Davis‐Jewish General Hospital Oncology Montreal Canada
| | - P. Campbell
- Barwon Health University Hospital Geelong Department of Clinical Haematology Geelong Australia
| | - V. Ribrag
- Gustave Roussy Hematology Villejuif France
| | - G. Laurent Damaj
- Hematology Institute University Hospital School of Medicine Hematology Caen France
| | - M. Dickinson
- Peter MacCallum Cancer Centre Royal Melbourne Hospital Department of Clinical Haematology Melbourne Australia
| | - W. Jurczak
- Maria Sklodowska‐Curie National Research Institute of Oncology Department of Hematology Kraków Poland
| | - M. Kaźmierczak
- Poznań University of Medical Sciences Department of Hematology and Bone Marrow Transplantation Poznań Poland
| | - S. Opat
- Monash University Department of Haematology Victoria Australia
| | - J. R. Radford
- University of Manchester NIHR Manchester Clinical Research Facility Manchester Academic Health Science Centre The Christie NHS Foundation Trust Department of Medical Oncology Manchester UK
| | - A. Schmitt
- Institut Bergonié Department of Hematology Bordeaux France
| | | | - G. Shang
- Epizyme, Inc. Medical Affairs Cambridge USA
| | - F. Morschhauser
- Groupe de Recherche sur les formes Injectables et les Technologies Associées CHU de Lille Université de Lille Oncology Lille France
| |
Collapse
|
47
|
Tam CSL, Allan JN, Siddiqi T, Kipps TJ, Jacobs R, Opat S, Barr PM, Tedeschi A, Trentin L, Bannerji R, Jackson S, Kuss B, Moreno C, Szafer‐Glusman E, Russell K, Zhou C, Ninomoto J, Dean JP, Ghia P, Wierda WG. CAPTIVATE PRIMARY ANALYSIS OF FIRST‐LINE TREATMENT WITH FIXED‐DURATION IBRUTINIB PLUS VENETOCLAX FOR CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)/SMALL LYMPHOCYTIC LYMPHOMA (SLL). Hematol Oncol 2021. [DOI: 10.1002/hon.32_2879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- C. S. L Tam
- Peter MacCallum Cancer Center & St. Vincent's Hospital and the University of Melbourne Haematology and Disease Group, Melbourne VIC Australia
| | - J. N Allan
- Weill Cornell Medicine, Hematology/Oncology New York USA
| | - T Siddiqi
- City of Hope National Medical Center Hematology Duarte USA
| | - T. J Kipps
- UCSD Moores Cancer Center Chronic Lymphocytic Leukemia San Diego USA
| | - R Jacobs
- Levine Cancer Institute Hematology and Medical Oncology Charlotte USA
| | - S Opat
- Monash University, Clinical Haematology Clayton VIC Australia
| | - P. M Barr
- Wilmot Cancer Institute University of Rochester Medical Center Hematology/Oncology Rochester USA
| | - A Tedeschi
- ASST Grande Ospedale Metropolitano Niguarda Haematology Milan Italy
| | - L Trentin
- Hematology and Clinical Immunology Unit Department of Medicine University of Padova, Hematology Padova Italy
| | - R Bannerji
- Rutgers Cancer Institute of New Jersey Hematology/Oncology New Brunswick USA
| | - S Jackson
- Middlemore Hospital, Haematology Auckland New Zealand
| | - B Kuss
- Flinders University and Medical Centre Haemotology and Molecular Genetics, Bedford Park SA Australia
| | - C Moreno
- Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Hematology Barcelona Spain
| | - E Szafer‐Glusman
- Pharmacyclics LLC, an AbbVie Company, Translational Medicine Sunnyvale USA
| | - K Russell
- Pharmacyclics LLC, an AbbVie Company, Clinical Program Development Sunnyvale USA
| | - C Zhou
- Pharmacyclics LLC, an AbbVie Company, Biostatistics Sunnyvale USA
| | - J Ninomoto
- Pharmacyclics LLC, an AbbVie Company, Oncology Sunnyvale USA
| | - J. P Dean
- Pharmacyclics LLC, an AbbVie Company, Oncology Sunnyvale USA
| | - P Ghia
- ivision of Experimental Oncology Università Vita‐Salute San Raffaele and IRCCS Ospedale San Raffaele, Experimental Oncology Milan Italy
| | - W. G Wierda
- University of Texas MD Anderson Cancer Center Leukemia Houston USA
| |
Collapse
|
48
|
Cheah CY, Verner E, Tam CS, Hilger J, Gao Y, Huang J, Simpson D, Opat S. PRELIMINARY SAFETY DATA FROM PATIENTS (PTS) WITH RELAPSED/REFRACTORY (R/R) B‐CELL MALIGNANCIES TREATED WITH THE NOVEL B‐CELL LYMPHOMA 2 (BCL2) INHIBITOR BGB‐11417. Hematol Oncol 2021. [DOI: 10.1002/hon.85_2881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- C. Y. Cheah
- Sir Charles Gairdner Hospital and Pathwest Laboratory Medicine Nedlands; Medical School University of Western Australia Crawley; Linear Clinical Research Department of Haematology Nedlands Australia
| | - E. Verner
- Concord Repatriation General Hospital Concord; University of Sydney Haematology Sydney Australia
| | - C. S. Tam
- Peter MacCallum Cancer Centre Melbourne; University of Melbourne Parkville; St Vincent’s Hospital Fitzroy; Royal Melbourne Hospital Haematology Parkville Australia
| | - J. Hilger
- BeiGene (Beijing) Co., Ltd. Beijing, China and BeiGene USA, Inc. Hematology San Mateo California USA
| | - Y. Gao
- BeiGene (Beijing) Co., Ltd. Beijing, China and BeiGene USA, Inc. Hematology San Mateo California USA
| | - J. Huang
- BeiGene (Beijing) Co., Ltd. Beijing, China and BeiGene USA, Inc. Hematology San Mateo California USA
| | - D. Simpson
- BeiGene (Beijing) Co., Ltd. Beijing, China and BeiGene USA, Inc. Hematology San Mateo California USA
| | - S. Opat
- Monash Health and Monash University Haematology Clayton Australia
| |
Collapse
|
49
|
Trotman J, Tedeschi A, Linton K, McKay P, Hu B, Chan H, Jin J, Sobieraj‐Teague M, Zinzani PL, Coleman M, Browett P, Ke X, Sun M, Marcus R, Portell C, Thieblemont C, Zhou K, Liberati AM, Bachy E, Cavallo F, Costello R, Iyengar S, Marasca R, Mociková H, Kim JS, Talaulikar D, Co M, Zhou W, Huang J, Opat S. SAFETY AND EFFICACY OF ZANUBRUTINIB IN PATIENTS WITH RELAPSED/REFRACTORY MARGINAL ZONE LYMPHOMA (MAGNOLIA PHASE 2 STUDY). Hematol Oncol 2021. [DOI: 10.1002/hon.19_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J. Trotman
- Concord Repatriation General Hospital University of Sydney Oncology Concord Australia
| | - A. Tedeschi
- ASST Grande Ospedale Metropolitano Niguarda Hematology Milan Italy
| | - K. Linton
- The Christie Hematology Manchester UK
| | - P. McKay
- Beatson West of Scotland Cancer Centre Oncology Glasgow UK
| | - B. Hu
- Levine Cancer Institute/Atrium Health Oncology Charlotte USA
| | - H. Chan
- North Shore Hospital Haematology Auckland New Zealand
| | - J. Jin
- The First Affiliated Hospital Zhejiang University Hematology Hangzhou China
| | | | - P. L. Zinzani
- Institute of Hematology “Seràgnoli” University of Bologna Hematology Bologna Italy
| | - M. Coleman
- Clinical Research Alliance Hematology Lake Success USA
| | - P. Browett
- Auckland City Hospital Haematology Grafton New Zealand
| | - X. Ke
- Peking University Third Hospital Hematology Beijing China
| | - M. Sun
- Institute of Hematology & Blood Diseases Hospital Chinese Academy of Medical Sciences Peking Union Medical College Hematology Tianjin China
| | - R. Marcus
- Sarah Cannon Research Institute UK Oncology London UK
| | - C. Portell
- University of Virginia Health System Hematology/Oncology Charlottesville USA
| | - C. Thieblemont
- APHP, Hôpital Saint‐Louis, Hemato‐oncology Paris University Diderot Hematology/Oncology Paris France
| | - K. Zhou
- Henan Cancer Hospital Oncology Zhengzhou China
| | - A. M. Liberati
- Azienda Ospedaliera Santa Maria Di Terni Oncology Terni Italy
| | - E. Bachy
- Centre Hospitalier Lyon Sud Pierre Bénite Hematology Rhone Italy
| | - F. Cavallo
- Azienda Ospedaliera Città della Salute e della Scienza di Torino Hematology Torino Italy
| | - Rég. Costello
- Hôpital de la Conception – APHM Hematology Marseille France
| | - S. Iyengar
- Royal Marsden Hospital Haematology London UK
| | - R. Marasca
- AOU Policlinico di Modena Hematology Modena Italy
| | - H. Mociková
- Fakultní nemocnice Královské Vinohrady Hematology Praha 10 Czech Republic
| | - J. S. Kim
- Severance Hospital Hematology Seoul Korea
| | - D. Talaulikar
- The Canberra Hospital Haematology Canberra Australia
| | - M. Co
- BeiGene (Beijing) Co., Ltd. Beijing, China and BeiGene USA, Inc Hematology San Mateo USA
| | - W. Zhou
- BeiGene (Beijing) Co., Ltd. Beijing, China and BeiGene USA, Inc Hematology San Mateo USA
| | - J. Huang
- BeiGene (Beijing) Co., Ltd. Beijing, China and BeiGene USA, Inc Hematology San Mateo USA
| | - S. Opat
- Monash Health Monash University Haematology Clayton Australia
| |
Collapse
|
50
|
Ko T, Seah C, Gilbertson M, McQuilten Z, Opat S, Dendle C. A Description of the Type, Frequency and Severity of Infections Among Sixteen Patients Treated for T-Cell Lymphoma. J Hematol 2021; 10:123-129. [PMID: 34267849 PMCID: PMC8256920 DOI: 10.14740/jh838] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/02/2021] [Indexed: 11/20/2022] Open
Abstract
Background Infections are an important cause of morbidity and mortality in T-cell lymphomas. Factors contributing to increased risk of infection include the nature of the underlying disease, as well as treatment-associated immunosuppression. Currently there are few reports describing the types of infections, including preventable infections, in this cohort of patients. The aim of the study was to identify the type, frequency and severity of infection in patients with T-cell lymphoma undergoing treatment. Methods A case series was performed on all patients with T-cell lymphoma over a 5-year period from 2011 to 2016 at a tertiary Australian hospital. Information was collected from medical record review regarding patient demographics, lymphoma treatment and outcomes, and infectious outcomes. Severe infections were recorded, defined as infection requiring hospitalization. Results Sixteen patients were identified with a diagnosis of T-cell lymphoma who received treatment at our institution. There were 42 discrete episodes of severe infections in total. Severe infections occurred in 81% of patients, with over 40% having more than one infection. The median length of hospital stay was 13 days, 33% required intensive care admission and 14% of infectious episodes resulted in death. Only 50% of infectious episodes were microbiologically proven, with the most common etiology being bacterial. The most commonly isolated organism overall was Staphylococcus aureus, with the most common source of infection being skin and soft tissue. There was one case of cytomegalovirus (CMV) infection and five cases (12%) of invasive fungal infection. The highest rates of infection occurred during progressive disease. Rates of prophylaxis were highest with antiviral agents, and comparatively lower with antibacterial and antifungal agents. Conclusion Infections are frequent, opportunistic and severe in patients with T-cell lymphoma. Our data suggests that fungal prophylaxis may be indicated with T-cell lymphoma.
Collapse
Affiliation(s)
- Tina Ko
- Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia
| | - Crystal Seah
- Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia
| | - Michael Gilbertson
- Monash Haematology, Monash Health, Victoria, Australia.,School of Clinical Sciences, Monash University, Victoria, Australia.,Monash Haematology, Monash Medical Centre, 246 Clayton Road, Clayton 3168, Australia
| | - Zoe McQuilten
- Monash Haematology, Monash Health, Victoria, Australia.,Monash Haematology, Monash Medical Centre, 246 Clayton Road, Clayton 3168, Australia.,Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Stephen Opat
- Monash Haematology, Monash Health, Victoria, Australia.,Monash Haematology, Monash Medical Centre, 246 Clayton Road, Clayton 3168, Australia.,Monash University, Victoria, Australia
| | - Claire Dendle
- Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Victoria, Australia
| |
Collapse
|