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Singh C, Jandial A, Jain A, Lad D, Khadwal A, Basher R, Bal A, Malhotra P, Prakash G. Challenges in Administering Salvage Therapy and Outcomes of Relapsed/Refractory Diffuse Large B-Cell Lymphoma Patients: A LMIC Real-World Study. Indian J Hematol Blood Transfus 2024; 40:231-236. [PMID: 38708153 PMCID: PMC11065853 DOI: 10.1007/s12288-023-01693-8] [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: 05/20/2023] [Accepted: 08/10/2023] [Indexed: 05/07/2024] Open
Abstract
Standard therapy for patients with Relapsed/Refractory Diffuse Large B-Cell Lymphoma (RR DLBCL) involves salvage chemotherapy followed by autologous hematopoietic stem cell transplant. However, information regarding the number of patients receiving salvage therapy and associated factors is not available from low/middle income countries (LMICs). All patients treated at our center with RR DLBCL from 2016 to 2021 were included in the study. Univariate and multivariate analyses was performed to find factors associated with the lack of receipt of salvage chemotherapy. Eighty-five patients were included in the study. Most patients had primary refractory disease (69.4%). Only 26 patients received standard salvage therapy, while the others (N = 59) received metronomic/palliative oral therapy. On univariate analysis, patients with an annual income below India's Gross National Income per capita (p = 0.014), an education level below Class XII (p = 0.025), Stage III/IV disease at relapse (p = 0.018) and CNS relapse (p = 0.027) were more likely to receive palliative therapy. Conversely, patients with a late relapse were more likely to receive salvage therapy (p = 0.001). On multivariate analysis, patients with Stage III/IV relapse (p = 0.030) and an education level less than Class XII (p = 0.012) were more likely to receive palliative therapy, while patients with a late relapse (p = 0.001) were more likely to receive salvage therapy. Patients who received salvage therapy had a longer Median OS than those who received palliative therapy (p < 0.001). Timing of relapse, stage at relapse and educational status of the patient are significant factors affecting access to effective therapy for patients with RR DLBCL in LMICs.
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Affiliation(s)
- Charanpreet Singh
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya Jandial
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arihant Jain
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepesh Lad
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajender Basher
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Avivi I, Perry C, Segman Y, Amit O, Bar-On Y, Katz OB, Gold R, Ribakovsky E, Avigdor A, Vainstein V, Goldschmidt N, Ringelstein-Harlev S, Horowitz NA, Gutwein O, Gurion R, Itchaki G, Abadi U, Nemets A, Sofer O, Vezker M, Tadmor T, Dally N, Filanovsky K, Leiba M, Sarid N, Benyamini N, Luttwak E, Herishanu Y, Ram R. Polatuzumab-based regimen or CAR T cell for patients with refractory/relapsed DLBCL-a matched cohort analysis. Ann Hematol 2022; 101:755-762. [PMID: 35083525 DOI: 10.1007/s00277-021-04749-9] [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: 10/25/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022]
Abstract
Polatuzumab (Pola)-based regimens and chimeric antigen receptor T (CAR T) cells provide superior outcome compared to conventional chemoimmunotherapy in patients with relapsed/refractory diffuse large B cell lymphoma (R/R DLBCL). Choosing between these strategies remains controversial. The efficacy of CAR T versus Pola-rituximab(R) /Pola-bendamustine(B)-R in R/R DLBCL patients after failing ≥2 lines of treatment was compared in a retrospective, 'real-world' study. Propensity score matching, for age, lymphoma category (de-novo/transformed), number of prior lines, Eastern Cooperative Oncology Group performance status and lactate dehydrogenase level, was applied to control for differences in patients' characteristics. Response rate, progression-free survival (PFS) and overall survival (OS) were analyzed. A total of 82 patients, treated with CAR T (n=41) or Pola-based regimens (n=41), were included. No treatment-related deaths occurred with CAR T vs. 3 (7.3%) with Pola. The overall and complete response rates were 83% and 58% with CAR T vs. 66% and 44% with Pola-based-regimens (p=0.077 and p=0.18, respectively). At a median follow-up of 9 months (range 1-19.2) and 16 months (range 0.7-25.3) for the CAR T and Pola arm respectively, the median PFS has not been reached for CAR T vs. 5.6 months for Pola (95% CI 3.6-7.6, p=0.014). Median OS has not been reached for CAR T vs. 10.8 months (95% CI 2.2-19.4) for Pola (p=0.026). To conclude, in a real-world setting, treatment with CAR T achieved superior PFS and OS compared to Pola-based regimens in patients with R/R DLBCL.
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Affiliation(s)
- Irit Avivi
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chava Perry
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yafit Segman
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Odelia Amit
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaeli Bar-On
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofrat Beyer Katz
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Gold
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elena Ribakovsky
- Hematology Division, Chaim Sheba Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Abraham Avigdor
- Hematology Division, Chaim Sheba Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Vladimir Vainstein
- Hematology Division, Hadassah Medical Center and the Hebrew Faculty of Medicine, Jerusalem University, Jerusalem, Israel
| | - Neta Goldschmidt
- Hematology Division, Hadassah Medical Center and the Hebrew Faculty of Medicine, Jerusalem University, Jerusalem, Israel
| | | | | | - Odit Gutwein
- Department of Hematology, Assaf Harofeh Medical Center, Tzrifin, Israel
| | - Ronit Gurion
- Institute of Hematology, Rabin Medical Center, Petch Tikva, Israel
| | - Gilad Itchaki
- Institute of Hematology, Rabin Medical Center, Petch Tikva, Israel
| | - Uri Abadi
- Department of Hematology, Meir Medical Center, Kfar Saba, Israel
| | - Anatoly Nemets
- Department of Hematology, Barzilai Medical Center, Ashkelon, Israel
| | - Orit Sofer
- Institute of Hematology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Miri Vezker
- Department of Hematology, Soroka University Medical Center, Negev, Beer Sheva, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Najib Dally
- Hematology Unit, Ziv Medical Center, Zefat, Israel
| | | | - Merav Leiba
- Hematology Institute, Assuta Medical Center, Ashdod, Israel
| | - Nadav Sarid
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Benyamini
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Luttwak
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Herishanu
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Ram
- Hematology Division, Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Casasnovas RO, Follows G, Zijlstra JM, Vermaat JSP, Kalakonda N, Choquet S, Neste EVD, Hill B, Thieblemont C, Cavallo F, la Cruz FD, Kuruvilla J, Hamad N, Jaeger U, Caimi PF, Gurion R, Warzocha K, Bakhshi S, Sancho JM, Schuster M, Egyed M, Offner F, Vassilakopoulos TP, Samal P, Ku M, Ma X, Chamoun K, Shah J, Canales M, Maerevoet M, Shacham S, Kauffman MG, Goy A. Comparison of the Effectiveness and Safety of the Oral Selective Inhibitor of Nuclear Export, Selinexor, in Diffuse Large B Cell Lymphoma Subtypes. Clin Lymphoma Myeloma Leuk 2021; 22:24-33. [PMID: 34493477 DOI: 10.1016/j.clml.2021.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/11/2021] [Accepted: 07/16/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The SADAL study evaluated oral selinexor in patients with relapsed and/or refractory diffuse large B-cell lymphoma (DLBCL) after at least 2 prior lines of systemic therapy. In this post-hoc analysis, we analyzed the outcomes of the SADAL study by DLBCL subtype to determine the effects of DLBCL subtypes on efficacy and tolerability of selinexor. PATIENTS AND METHODS Data from 134 patients in SADAL were analyzed by DLBCL subtypes for overall response rate (ORR), overall survival (OS), duration of treatment response, progression-free survival, and adverse events rate. RESULTS ORR in the entire cohort was 29.1%, and similar in patients with germinal center (GCB) versus non-GCB DLBCL (31.7% vs. 24.2%, P = 0.45); transformed DLBCL showed a trend towards higher ORR than de novo DLBCL: 38.7% vs. 26.2% (P = 0.23). Despite similar prior treatment regimens and baseline characteristics, patients with DLBCL and normal C-MYC/BCL-2 protein expression levels had a significantly higher ORR (46.2% vs.14.8%, P = 0.012) and significantly longer OS (medians 13.7 vs. 5.1 months, hazard ratio 0.43 [95% CI, 0.23-0.77], P = 0.004) as compared with those whose DLBCL had C-MYC and BCL-2 overexpression. Among patients who had normal expression levels of either C-MYC or BCL-2 and baseline hemoglobin levels ≥ 10g/dL, ORR was 51.5% (n = 47), with median OS of 15.5 months and median PFS of 4.6 months. Similar rates of adverse events were noted in all subgroups. CONCLUSIONS Overall, single agent oral selinexor showed strong responses in patients with limited treatment alternatives regardless of germinal center B-cell type or disease origin.
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Affiliation(s)
| | | | - Josee M Zijlstra
- Amsterdam University Medical Center, Vrije Universiteit, Cancer Center, Amsterdam, The Netherlands
| | | | | | | | | | | | - Catherine Thieblemont
- AP-HP, Hopital Saint-Louis, Hémato-oncology, DMU DHI, Paris, France; Université de Paris, Paris, France
| | - Federica Cavallo
- Department of Molecular Biotechnologies and Health Sciences, Division of Hematology, University of Turin, Turin, Italy
| | | | | | - Nada Hamad
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | | | | | - Ronit Gurion
- Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Sameer Bakhshi
- Dr. B. R. A. Institute Rotary Cancer Hospital, New Delhi, India
| | | | | | | | | | - Theodoros P Vassilakopoulos
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Priyanka Samal
- Institute of Medical Sciences & SUM Hospital, Odisha, India
| | - Matthew Ku
- St.Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Xiwen Ma
- Karyopharm Therapeutics, Newton, MA
| | | | | | | | | | | | | | - Andre Goy
- Hackensack University Medical Center, Hackensack, NJ
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Kim DY, Nam J, Chung JS, Kim SW, Shin HJ. Role of Roflumilast Combined with ESHAP Chemotherapy in Relapsed/Refractory Patients with Diffuse Large B-Cell Lymphoma. Cancer Res Treat 2021; 54:301-313. [PMID: 33940789 PMCID: PMC8756117 DOI: 10.4143/crt.2020.1371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/26/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose There are unmet needs associated with the current treatment strategies for relapsed/refractory diffuse large B-cell lymphoma (DLBCL) due to the poor treatment outcomes of these strategies. Roflumilast, a selective phosphodiesterase-4 inhibitor used for treating chronic obstructive pulmonary disease, is effective against B-cell malignancy via phosphoinositide 3-kinase (PI3K)–activity suppression. We analyzed the effects of roflumilast combined with ESHAP (etoposide, cisplatin, methylprednisolone, and cytarabine) chemotherapy in experimental and clinical settings. Materials and Methods An in vitro study using lymphoma cell lines and a pilot study on relapsed/refractory DLBCL patients were conducted to investigate the effects and mechanism of the combination of roflumilast and chemotherapy. The complete response (CR), overall response rate (ORR), and 1-year progression-free survival (PFS) were analyzed. Results We found that roflumilast is efficient when combined with other chemotherapy drugs, especially cytarabine. Synergistic effects between these two drugs influence the translation of mammalian target of rapamycin and myeloid cell leukemia 1, resulting in apoptosis and inhibition of B-cell lymphoma proliferation. In clinical setting, the roflumilast group showed better rates of CR (46.2% vs. 34.6%), ORR (76.9% vs. 53.8%), and 1-year PFS (50.0% vs. 25.9%) compared with the control group, though not statistically significant. The roflumilast group showed a higher incidence of asthenia and gastrointestinal adverse events. However, grade 3 or 4 adverse events were similar in both groups. Conclusion We found that roflumilast, when combined with ESHAP chemotherapy, for relapsed/refractory DLBCL was clinically active and well tolerated. This combined treatment was able to suppress PI3K activity, which is correlated with the degree of clinical response.
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Affiliation(s)
- Do Young Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Biochemical Research Institution, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jehyun Nam
- Department of Biological Sciences, Pusan National University, Busan, Korea
| | - Joo-Seop Chung
- Division of Hematology-Oncology, Department of Internal Medicine, Biochemical Research Institution, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Sang-Woo Kim
- Department of Biological Sciences, Pusan National University, Busan, Korea
| | - Ho-Jin Shin
- Division of Hematology-Oncology, Department of Internal Medicine, Biochemical Research Institution, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Wang L, Zhao Z, Luo Y, Yu H, Wu S, Ren X, Zheng C, Huang X. Classifying 2-year recurrence in patients with dlbcl using clinical variables with imbalanced data and machine learning methods. Comput Methods Programs Biomed 2020; 196:105567. [PMID: 32544778 DOI: 10.1016/j.cmpb.2020.105567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Treatments are limited for patients with relapsed/refractory Diffuse large B-cell lymphoma (DLBCL), and their survival rate is low. Prediction of the recurrence hazard for each patient could provide a reference regarding chemotherapy regimens for clinicians to extend patients' period of long-term remission. As current strategies cannot satisfy such need, we have established predictive models to classify patients with DLBCL with complete remission who had recurrences in 2 years from ones who did not. METHODS We assessed 518 patients with DLBCL and measured 52 variables of each patient. They were treated between January 2011 and July 2016. 17 variables were first selected by variable selection methods (including Lasso, Adaptive Lasso, and Elastic net). Then, we set classifiers and probability models for imbalanced data by combining the SMOTE sampling, cost-sensitive, and ensemble learning (consisting of AdaBoost, voting strategy, and Stacking) methods with the machine learning methods (Support Vector Machine, BackPropagation Artificial Neural Network, Random Forest), respectively. Last, assessed their performance. RESULTS The disease stage and other 5 variables are significant indicators for recurrence. The SVM with AdaBoost ensemble learning method modeling by SMOTE data performs the best (Sensitivity=97.3%, AUC=96%, RMSE=19.6%, G-mean=96%) in all classifiers. The SVM with AdaBoost method(AUC=98.7%, RMSE=17.7%, MXE=12.7%, Cal mean=3.2%, BS0=2.5%, BS1=4%, BSALL=3.1%) and random forest (AUC=99.5%, RMSE=19.8%, MXE=16.2%, Cal mean=9.1%, BS0=4.8%, BS1=2.9%, BSALL=3.9%) both modeling by SMOTE sampling data perform well in probability models. CONCLUSIONS This predictive model has high accuracy for almost all DLBCL patients and the six indicators can be recurrence signals.
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Affiliation(s)
- Lei Wang
- Department of Health Statistics, Public Health department of Shanxi Medical University, Shan Xi Provincial Key Laboratory of Major Diseases Risk Assessment, China.
| | - ZhiQiang Zhao
- Hematology department of Shanxi cancer hospital, China.
| | - YanHong Luo
- Department of Health Statistics, Public Health department of Shanxi Medical University, Shan Xi Provincial Key Laboratory of Major Diseases Risk Assessment, China.
| | - HongMei Yu
- Department of Health Statistics, Public Health department of Shanxi Medical University, Shan Xi Provincial Key Laboratory of Major Diseases Risk Assessment, China.
| | - ShuQing Wu
- Department of Health Statistics, Public Health department of Shanxi Medical University, Shan Xi Provincial Key Laboratory of Major Diseases Risk Assessment, China.
| | - XiaoLu Ren
- Radiology department of Shanxi cancer hospital, China.
| | - ChuChu Zheng
- Department of Health Statistics, Public Health department of Shanxi Medical University, Shan Xi Provincial Key Laboratory of Major Diseases Risk Assessment, China.
| | - XueQian Huang
- Department of Health Statistics, Public Health department of Shanxi Medical University, Shan Xi Provincial Key Laboratory of Major Diseases Risk Assessment, China.
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