Pub Date : 2025-02-03DOI: 10.1016/j.clml.2025.01.017
Omar Elghawy, Julia Wang, Olivia J Leung, Nishwant Swami, Veronica Carvajal, Guang Yang, Daniel J Landsburg, Jakub Svoboda, Sunita D Nasta, Elise A Chong, Stephen J Schuster, Colin J Thomas, Jordan S Carter, Adam Bagg, Stefan K Barta
Background: The understanding of T-cell lymphoma (TCL) pathobiology has grown substantially due to gene expression profiling and high-throughput next-generation sequencing (NGS). However, real-world data on mutational profiles of mature T-cell lymphomas (TCLs) are limited, and their impact on clinical decision making has not been reported.
Methods: A single-institution study of biopsies from patients with histopathologically confirmed T-cell lymphomas and available NGS data between January 1, 2021, to July 1, 2023, was performed. Reported variants were classified as disease-associated or pathogenic variants (DAV), or variants of unknown significance (VUS). Individual physicians were surveyed via email regarding the impact of NGS results on next steps in patient care.
Results: About 94% of patients (n = 93) had ≥ 1 variants identified; at least 1 pathogenic variant or likely pathogenic variant was identified in 71% of patients (n = 70). Variants were detected in 90 unique genes with 41% (37/90) having disease-associated variants (DAV). The genes with mutations most frequently resulting in disease-associated variants in this study were TET2, RHOA, DNMT3A and TP53, IDH2, and PLCG1. NGS results were integral to clinical management in 19% of patients per physician survey.
Conclusion: This work gives insight into the real-world utility of NGS regarding clinical decision making for patients with T-cell lymphoma. Given the impact of NGS on prognostication, evaluation of therapeutic options, as well as cessation of potentially unhelpful treatments, these findings support the role of NGS as an important part in the management of T-cell lymphomas.
{"title":"Clinical Impact of Next-Generation Sequencing of T-Cell Lymphomas: A Single Institution Experience.","authors":"Omar Elghawy, Julia Wang, Olivia J Leung, Nishwant Swami, Veronica Carvajal, Guang Yang, Daniel J Landsburg, Jakub Svoboda, Sunita D Nasta, Elise A Chong, Stephen J Schuster, Colin J Thomas, Jordan S Carter, Adam Bagg, Stefan K Barta","doi":"10.1016/j.clml.2025.01.017","DOIUrl":"https://doi.org/10.1016/j.clml.2025.01.017","url":null,"abstract":"<p><strong>Background: </strong>The understanding of T-cell lymphoma (TCL) pathobiology has grown substantially due to gene expression profiling and high-throughput next-generation sequencing (NGS). However, real-world data on mutational profiles of mature T-cell lymphomas (TCLs) are limited, and their impact on clinical decision making has not been reported.</p><p><strong>Methods: </strong>A single-institution study of biopsies from patients with histopathologically confirmed T-cell lymphomas and available NGS data between January 1, 2021, to July 1, 2023, was performed. Reported variants were classified as disease-associated or pathogenic variants (DAV), or variants of unknown significance (VUS). Individual physicians were surveyed via email regarding the impact of NGS results on next steps in patient care.</p><p><strong>Results: </strong>About 94% of patients (n = 93) had ≥ 1 variants identified; at least 1 pathogenic variant or likely pathogenic variant was identified in 71% of patients (n = 70). Variants were detected in 90 unique genes with 41% (37/90) having disease-associated variants (DAV). The genes with mutations most frequently resulting in disease-associated variants in this study were TET2, RHOA, DNMT3A and TP53, IDH2, and PLCG1. NGS results were integral to clinical management in 19% of patients per physician survey.</p><p><strong>Conclusion: </strong>This work gives insight into the real-world utility of NGS regarding clinical decision making for patients with T-cell lymphoma. Given the impact of NGS on prognostication, evaluation of therapeutic options, as well as cessation of potentially unhelpful treatments, these findings support the role of NGS as an important part in the management of T-cell lymphomas.</p>","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-02DOI: 10.1016/j.clml.2025.01.016
Bruce Hough, Maher Albitar
{"title":"mRNA Expression in DLBCL Patients who are CD20 Dim With an Eye Towards More Thoughtful Design of R/R Trials, Possibly Incorporating BCMA Bite Therapy.","authors":"Bruce Hough, Maher Albitar","doi":"10.1016/j.clml.2025.01.016","DOIUrl":"https://doi.org/10.1016/j.clml.2025.01.016","url":null,"abstract":"","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.clml.2024.08.007
Efstathios Kastritis , Meral Beksac , Sorina Nicoleta Badelita , Eirini Katodritou , Jelena Bila , Emmanouil Spanoudakis , Guldane Cengiz Seval , Zorica Cvetkovic , Olivera Markovic , Selami Koçak Toprak , Dimitra Dalampira , Daniel Coriu , Zoi Bezirgiannidou , Mario Pirsic , Toni Valkovic , Iulia Ursuleac , Aleksandra Sretenovic , Angeliki Sevastoudi , Josip Batinic , Sinziana Barbu , Meletios A. Dimopoulos
Background
Bortezomib, dexamethasone and cyclophosphamide (VCd) remains a popular regimen, due to its activity and low toxicity, while bortezomib, lenalidomide and dexamethasone (VRd) is widely used in US and Europe; both are combined with anti-CD38 monoclonal antibodies but VCd and VRd have not been compared directly in adequately powered prospective trials.
Aim
We compared the outcomes of 1216 patients treated with VCd (N = 690) or VRd (N = 526) in a real-world setting.
Results
Patients treated with VCd had more often severe renal dysfunction, ISS-3 disease, hypercalcemia, elevated LDH, anemia, thrombocytopenia, poor performance while VRd-treated were older and received less often autologous transplant but more frequently maintenance but the duration of induction was similar. VRd was associated with substantially higher overall response and CR/VGPR rates to induction(P < .001) and improved PFS and OS in univariate analysis, especially among patients with standard risk disease, without renal dysfunction and in the elderly; however, in multivariate analysis there was no significant difference in either PFS or OS. In patients strictly matched 1:1 for major prognostic variables (188 in each group, total N = 376), the superiority of VRd in terms of responses rates and depth of response was confirmed, but without significant PFS or OS difference.
Conclusion
VRd is a more active induction regimen than VCd, although use of maintenance with lenalidomide may dilute the PFS or OS benefit. VCd induction remains an option in special circumstances. With the implementation of monoclonal antibodies, VCd backbone can be considered for patients without access to or who do not tolerate VRd.
{"title":"VCd versus VRd in Newly Diagnosed Multiple Myeloma: Matched Real-World Analysis from the Balkan Myeloma Study Group (BMSG)","authors":"Efstathios Kastritis , Meral Beksac , Sorina Nicoleta Badelita , Eirini Katodritou , Jelena Bila , Emmanouil Spanoudakis , Guldane Cengiz Seval , Zorica Cvetkovic , Olivera Markovic , Selami Koçak Toprak , Dimitra Dalampira , Daniel Coriu , Zoi Bezirgiannidou , Mario Pirsic , Toni Valkovic , Iulia Ursuleac , Aleksandra Sretenovic , Angeliki Sevastoudi , Josip Batinic , Sinziana Barbu , Meletios A. Dimopoulos","doi":"10.1016/j.clml.2024.08.007","DOIUrl":"10.1016/j.clml.2024.08.007","url":null,"abstract":"<div><h3>Background</h3><div>Bortezomib, dexamethasone and cyclophosphamide (VCd) remains a popular regimen, due to its activity and low toxicity, while bortezomib, lenalidomide and dexamethasone (VRd) is widely used in US and Europe; both are combined with anti-CD38 monoclonal antibodies but VCd and VRd have not been compared directly in adequately powered prospective trials.</div></div><div><h3>Aim</h3><div>We compared the outcomes of 1216 patients treated with VCd (<em>N</em> = 690) or VRd (<em>N</em> = 526) in a real-world setting.</div></div><div><h3>Results</h3><div>Patients treated with VCd had more often severe renal dysfunction, ISS-3 disease, hypercalcemia, elevated LDH, anemia, thrombocytopenia, poor performance while VRd-treated were older and received less often autologous transplant but more frequently maintenance but the duration of induction was similar. VRd was associated with substantially higher overall response and CR/VGPR rates to induction(<em>P</em> < .001) and improved PFS and OS in univariate analysis, especially among patients with standard risk disease, without renal dysfunction and in the elderly; however, in multivariate analysis there was no significant difference in either PFS or OS. In patients strictly matched 1:1 for major prognostic variables (188 in each group, total <em>N</em> = 376), the superiority of VRd in terms of responses rates and depth of response was confirmed, but without significant PFS or OS difference.</div></div><div><h3>Conclusion</h3><div>VRd is a more active induction regimen than VCd, although use of maintenance with lenalidomide may dilute the PFS or OS benefit. VCd induction remains an option in special circumstances. With the implementation of monoclonal antibodies, VCd backbone can be considered for patients without access to or who do not tolerate VRd.</div></div>","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":"25 2","pages":"Pages e71-e81"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.clml.2025.01.023
Mohammad Ma'koseh, Zaid Abdel Rahman, Abeer Yaseen, Ahmad Mesmar, Husam Abu-Jazar, Salwa Saadeh, Duaa Mufarrej, Rozan Alfar, Waleed Da'na, Khalid Halahleh, Hasan Hashem, Akram Al-Ibraheem, Kamal Al-Rabi, Hikmat Abdel-Razeq
Introduction: Peripheral blood (PB) grafts are increasingly used in haploidentical hematopoietic stem cell transplantation (haplo-HSCT) with post-transplant cyclophosphamide (PT-Cy). The optimal timing for initiation of immunosuppression (IS) with calcineurin inhibitors (CNI) and mycophenolate mofetil (MMF) in PB haplo-HSCT is unclear. This study evaluates the outcomes of early initiation of IS prior to PT-Cy.
Methods: Medical records of adult patients with hematologic malignancies who received PB haplo-HSCT with PT-Cy between 2017 and 2022 were retrospectively reviewed. IS with CNI and MMF were started on day 0 and 1 postinfusion. Statistical analyses for survival outcomes were performed using the Kaplan-Meier method, and cumulative incidence (CI) models were used to account for competing risks for relapse, and nonrelapse mortality (NRM).
Results: A total of 51 patients were included, with a median age of 37 years (range: 19-63) and a median follow-up of 44 months (range: 37.8-53 months). Neutrophil and platelet engraftment were achieved in 98% and 96% of patients, respectively. CRS occurred in 35.3% of patients, predominantly grade I, with only 1 patient developing grade II CRS. At 3 years, overall survival (OS) and progression free survival (PFS) were 51.8% and 50.2%, respectively, and GVHD-relapse free survival (GFRS) was 43.1%. The CI of relapse and NRM at 3 years were 28.2% and 21.6%, respectively.
Conclusion: Early initiation of IS in PB haplo-HSCT was associated with high rates of engraftment, low rates of CRS, and favorable long-term survival outcomes. Prospective studies are needed to validate these findings and refine IS timing.
{"title":"Outcomes of Peripheral Blood Haploidentical Stem Cell Transplantation With Post-Transplant Cyclophosphamide and Earlier Initiation of Immunosuppression.","authors":"Mohammad Ma'koseh, Zaid Abdel Rahman, Abeer Yaseen, Ahmad Mesmar, Husam Abu-Jazar, Salwa Saadeh, Duaa Mufarrej, Rozan Alfar, Waleed Da'na, Khalid Halahleh, Hasan Hashem, Akram Al-Ibraheem, Kamal Al-Rabi, Hikmat Abdel-Razeq","doi":"10.1016/j.clml.2025.01.023","DOIUrl":"https://doi.org/10.1016/j.clml.2025.01.023","url":null,"abstract":"<p><strong>Introduction: </strong>Peripheral blood (PB) grafts are increasingly used in haploidentical hematopoietic stem cell transplantation (haplo-HSCT) with post-transplant cyclophosphamide (PT-Cy). The optimal timing for initiation of immunosuppression (IS) with calcineurin inhibitors (CNI) and mycophenolate mofetil (MMF) in PB haplo-HSCT is unclear. This study evaluates the outcomes of early initiation of IS prior to PT-Cy.</p><p><strong>Methods: </strong>Medical records of adult patients with hematologic malignancies who received PB haplo-HSCT with PT-Cy between 2017 and 2022 were retrospectively reviewed. IS with CNI and MMF were started on day 0 and 1 postinfusion. Statistical analyses for survival outcomes were performed using the Kaplan-Meier method, and cumulative incidence (CI) models were used to account for competing risks for relapse, and nonrelapse mortality (NRM).</p><p><strong>Results: </strong>A total of 51 patients were included, with a median age of 37 years (range: 19-63) and a median follow-up of 44 months (range: 37.8-53 months). Neutrophil and platelet engraftment were achieved in 98% and 96% of patients, respectively. CRS occurred in 35.3% of patients, predominantly grade I, with only 1 patient developing grade II CRS. At 3 years, overall survival (OS) and progression free survival (PFS) were 51.8% and 50.2%, respectively, and GVHD-relapse free survival (GFRS) was 43.1%. The CI of relapse and NRM at 3 years were 28.2% and 21.6%, respectively.</p><p><strong>Conclusion: </strong>Early initiation of IS in PB haplo-HSCT was associated with high rates of engraftment, low rates of CRS, and favorable long-term survival outcomes. Prospective studies are needed to validate these findings and refine IS timing.</p>","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.clml.2024.05.019
Aseel Alsouqi , Jennifer A. Woyach
Inhibitors of Bruton's tyrosine kinase (BTK) are among the most widely used therapies for chronic lymphocytic leukemia (CLL) and established a new expectation for efficacy and safety in the treatment of this disease. Currently there are 3 covalent inhibitors of BTK approved for the treatment of CLL: ibrutinib, acalabrutinib, and zanubrutinib. The first-in-class covalent BTK inhibitor is ibrutinib, which as monotherapy has excellent efficacy in the front-line setting with a 7-year progression free survival (PFS) of 59%. Ibrutinib-based therapies have also demonstrated superiority over standard chemoimmunotherapy in the front-line and the relapsed/refractory setting. Acalabrutinib is a second-generation BTK inhibitor that has higher selectivity to BTK. Acalabrutinib has efficacy in both frontline and relapsed CLL and is associated with a decreased incidence of atrial fibrillation and hypertension when compared to ibrutinib. Like acalabrutinib, zanubrutinib was designed to be more selective for BTK than ibrutinib and to maximize BTK inhibition in tissues. Zanubrutinib has demonstrated clinical efficacy in first line and relapsed/refractory setting. These agents are indicated as monotherapy, with dosing until disease progression or intolerable toxicity, and are mainly differentiated by safety profile, although efficacy differences may exist as well. Combination with CD20 monoclonal antibodies and/or BCL2 inhibitors are alternative options for use. Here we will review efficacy and safety considerations with these agents.
{"title":"SOHO State of the Art Updates and Next Questions | Covalent Bruton's Tyrosine Kinase Inhibitors in Chronic Lymphocytic Leukemia","authors":"Aseel Alsouqi , Jennifer A. Woyach","doi":"10.1016/j.clml.2024.05.019","DOIUrl":"10.1016/j.clml.2024.05.019","url":null,"abstract":"<div><div><span><span><span>Inhibitors of Bruton's tyrosine kinase (BTK) are among the most widely used therapies for </span>chronic lymphocytic leukemia (CLL) and established a new expectation for efficacy and safety in the treatment of this disease. Currently there are 3 covalent inhibitors of BTK approved for the treatment of CLL: </span>ibrutinib, </span>acalabrutinib<span><span>, and zanubrutinib<span>. The first-in-class covalent BTK inhibitor<span><span> is ibrutinib, which as </span>monotherapy<span> has excellent efficacy in the front-line setting with a 7-year progression free survival (PFS) of 59%. Ibrutinib-based therapies have also demonstrated superiority over standard </span></span></span></span>chemoimmunotherapy<span><span><span><span> in the front-line and the relapsed/refractory setting. Acalabrutinib is a second-generation BTK inhibitor that has higher selectivity to BTK. Acalabrutinib has efficacy in both frontline and relapsed CLL and is associated with a decreased incidence of </span>atrial fibrillation<span> and hypertension when compared to ibrutinib. Like acalabrutinib, </span></span>zanubrutinib<span> was designed to be more selective for BTK than ibrutinib and to maximize BTK inhibition in tissues. Zanubrutinib has demonstrated clinical efficacy in first line and relapsed/refractory setting. These agents are indicated as monotherapy, with dosing until </span></span>disease progression<span><span> or intolerable toxicity, and are mainly differentiated by safety profile, although efficacy differences may exist as well. Combination with CD20 </span>monoclonal antibodies<span> and/or BCL2 inhibitors are alternative options for use. Here we will review efficacy and safety considerations with these agents.</span></span></span></span></div></div>","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":"25 2","pages":"Pages 89-95"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.clml.2024.07.017
Mark A. Fiala , Mengmeng Ji , Yi-Hsuan Shih , John Huber , Mei Wang , Kimberly J. Johnson , Hamlet Gasoyan , Rong Wang , Graham A. Colditz , Shi-Yi Wang , Su-Hsin Chang
Purpose
Continuous Medicaid coverage prior to a cancer diagnosis has been associated with earlier detection and better outcomes, for patients with solid tumors. In this study, we aimed to determine if this was observed among patients with multiple myeloma, a hematologic cancer where there are no routine screening tests and most are diagnosed through acute medical events.
Materials and methods
This is an analysis of the Merative MarketScan Multistate Medicaid Database, a claims-based dataset. In total, 1105 patients < 65 years old were included in the analyses. Among them, 66% had continuous enrollment (at least 6 months enrollment prior to myeloma), and 34% had discontinuous enrollment (2-6 months enrollment prior to myeloma). Multivariable Cox regression was used to estimate the association between continuous enrollment status and receipt of myeloma treatment within 1 year of index date.
Results
Only 54% of all Medicaid enrollees received myeloma therapy and only 12% received stem cell transplant within the 1st year. Those with continuous enrollment were less likely to receive any treatment (adjusted hazard ratio [aHR] 0.59; 95% confidence interval [CI] 0.59-0.70; P < .001) and to receive stem cell transplant (aHR 0.51; 95% CI 0.32-0.81; P = .005).
Conclusion
Patients with continuous Medicaid coverage prior to diagnosis were less likely to receive myeloma therapy. Future studies should examine whether myeloma patients with continuous Medicaid enrollment have more chronic financial instability and/or higher medical needs and, thus, have higher barriers to care.
{"title":"Treatment Access among Younger Medicaid Beneficiaries with Multiple Myeloma","authors":"Mark A. Fiala , Mengmeng Ji , Yi-Hsuan Shih , John Huber , Mei Wang , Kimberly J. Johnson , Hamlet Gasoyan , Rong Wang , Graham A. Colditz , Shi-Yi Wang , Su-Hsin Chang","doi":"10.1016/j.clml.2024.07.017","DOIUrl":"10.1016/j.clml.2024.07.017","url":null,"abstract":"<div><h3>Purpose</h3><div>Continuous Medicaid coverage prior to a cancer diagnosis has been associated with earlier detection and better outcomes, for patients with solid tumors. In this study, we aimed to determine if this was observed among patients with multiple myeloma, a hematologic cancer where there are no routine screening tests and most are diagnosed through acute medical events.</div></div><div><h3>Materials and methods</h3><div>This is an analysis of the Merative MarketScan Multistate Medicaid Database, a claims-based dataset. In total, 1105 patients < 65 years old were included in the analyses. Among them, 66% had continuous enrollment (at least 6 months enrollment prior to myeloma), and 34% had discontinuous enrollment (2-6 months enrollment prior to myeloma). Multivariable Cox regression was used to estimate the association between continuous enrollment status and receipt of myeloma treatment within 1 year of index date.</div></div><div><h3>Results</h3><div>Only 54% of all Medicaid enrollees received myeloma therapy and only 12% received stem cell transplant within the 1<sup>st</sup> year. Those with continuous enrollment were less likely to receive any treatment (adjusted hazard ratio [aHR] 0.59; 95% confidence interval [CI] 0.59-0.70; <em>P</em> < .001) and to receive stem cell transplant (aHR 0.51; 95% CI 0.32-0.81; <em>P</em> = .005).</div></div><div><h3>Conclusion</h3><div>Patients with continuous Medicaid coverage prior to diagnosis were less likely to receive myeloma therapy. Future studies should examine whether myeloma patients with continuous Medicaid enrollment have more chronic financial instability and/or higher medical needs and, thus, have higher barriers to care.</div></div>","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":"25 2","pages":"Pages 109-115"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.clml.2024.07.019
Izel Okcu , Yucai Wang , Allison M. Bock , Jihao Zhou , Muhamad Alhaj Moustafa , Han W. Tun , Allison C. Rosenthal , Patrick B. Johnston , Firas Baidoun , Arushi Khurana , Brian F. Kabat , Rebecca L. King , Thomas M. Habermann , Grzegorz S. Nowakowski
Background
Primary mediastinal large B-cell lymphoma (PMBCL) is an uncommon type of aggressive B-cell non-Hodgkin lymphoma. PMBCL shares some clinical and biologic features with nodular sclerosis classic Hodgkin lymphoma (cHL). Central nervous system (CNS) relapse is exceedingly rare in cHL. Therefore, it may be expected that CNS relapse in PMBCL is also uncommon. Herein, we examined the incidence of CNS relapse in patients with PMBCL treated with standard chemoimmunotherapy.
Patients and Methods
This retrospective single center analysis included 154 patients with newly diagnosed PMBCL seen at Mayo Clinic. The CNS relapse rate was calculated using a competing risk model, with death considered as a competing risk.
Results
With a median follow-up of 39 months, 3 patients experienced CNS relapse, all associated with systemic relapse. The cumulative incidence of CNS relapse for the entire cohort was 1.43% (95% CI, 0.3%-4.6%) at 1 year and 2.21% (95% CI, 0.6%-5.8%) at both 2 and 5 years. For those who did not receive CNS prophylaxis (n = 131), the incidence was 0.85% (95% CI, 0.1%-4.2%) at 1 year and 1.80% (95% CI, 0.3%-5.8%) at both 2 and 5 years. All 3 patients who experienced CNS relapse had R-CHOP as frontline therapy; 2 patients did not receive any CNS prophylaxis, while 1 patient received intrathecal CNS prophylaxis.
Conclusion
The risk of CNS relapse in PMBCL appears to be very low after treatment with standard chemoimmunotherapy, suggesting routine CNS prophylaxis is not necessary.
{"title":"Incidence of Central Nervous System Relapse in Primary Mediastinal Large B-Cell Lymphoma: Implications for Central Nervous System Prophylaxis","authors":"Izel Okcu , Yucai Wang , Allison M. Bock , Jihao Zhou , Muhamad Alhaj Moustafa , Han W. Tun , Allison C. Rosenthal , Patrick B. Johnston , Firas Baidoun , Arushi Khurana , Brian F. Kabat , Rebecca L. King , Thomas M. Habermann , Grzegorz S. Nowakowski","doi":"10.1016/j.clml.2024.07.019","DOIUrl":"10.1016/j.clml.2024.07.019","url":null,"abstract":"<div><h3>Background</h3><div>Primary mediastinal large B-cell lymphoma (PMBCL) is an uncommon type of aggressive B-cell non-Hodgkin lymphoma. PMBCL shares some clinical and biologic features with nodular sclerosis classic Hodgkin lymphoma (cHL). Central nervous system (CNS) relapse is exceedingly rare in cHL. Therefore, it may be expected that CNS relapse in PMBCL is also uncommon. Herein, we examined the incidence of CNS relapse in patients with PMBCL treated with standard chemoimmunotherapy.</div></div><div><h3>Patients and Methods</h3><div>This retrospective single center analysis included 154 patients with newly diagnosed PMBCL seen at Mayo Clinic. The CNS relapse rate was calculated using a competing risk model, with death considered as a competing risk.</div></div><div><h3>Results</h3><div>With a median follow-up of 39 months, 3 patients experienced CNS relapse, all associated with systemic relapse. The cumulative incidence of CNS relapse for the entire cohort was 1.43% (95% CI, 0.3%-4.6%) at 1 year and 2.21% (95% CI, 0.6%-5.8%) at both 2 and 5 years. For those who did not receive CNS prophylaxis (n = 131), the incidence was 0.85% (95% CI, 0.1%-4.2%) at 1 year and 1.80% (95% CI, 0.3%-5.8%) at both 2 and 5 years. All 3 patients who experienced CNS relapse had R-CHOP as frontline therapy; 2 patients did not receive any CNS prophylaxis, while 1 patient received intrathecal CNS prophylaxis.</div></div><div><h3>Conclusion</h3><div>The risk of CNS relapse in PMBCL appears to be very low after treatment with standard chemoimmunotherapy, suggesting routine CNS prophylaxis is not necessary.</div></div>","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":"25 2","pages":"Pages 116-123"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.clml.2024.09.007
Anveshika Soni , Sujay Rainchwar , Reema Singh , Dikshat Gopal Gupta , Nakul Tikare , Rohan Halder , Roy J. Palatty , Vipul Sharad Sheth , Narendra Agrawal , Dinesh Bhurani , Tribikram Panda
Introduction
High risk myeloma is heterogeneous with significant variation in risk stratifications. Real world outcomes differ from controlled clinical trials and affected by socioeconomical determinants.
Material and methods
This retrospective study was performed in a North Indian teriarty care cancer hospital. Out of 384,76(19.7%) high risk myeloma patients (median age 58 years) were analyzed.
Result and conclusion
Most common HRCA was 1 q gain 36(47.4%) followed by del17p 32(42.1%). 61/76(80.2%) received bortezomib based triplets and 15(19.74%) daratumumab based quadruplets induction, 31(40.79%) received ASCT. Median duration of follow up was 19.5 months. The 2 year OS and PFS was 73.8%, 52.6% respectively. Estimated 3 year OS was 74.7% in ASCT cohort versus 52.9% (P = .0067) without. Estimated 3-year PFS in the ASCT cohort was 72.1% versus 30.3% (P = .0026) without. Estimated 3-year OS for single hit and multi hit ultra HRMM was 67.7% and 61.9% (P = .642) whereas PFS was 58.2% and 35.2% (P = .486) respectively. In multivariate analysis ASCT correlated with better OS (HR 0.3, P = .041) and PFS (HR 0.35, P = .012). Absence of baseline renal impairment correlated with better OS (HR 4.12, P = .004) only. Early aggressive therapy with prompt ASCT translates to a better survival in high risk myeloma. Emphasis on real world clinical outcome is the need of the hour for addressing practical issues and improving global myeloma outcome.
{"title":"Real World Outcome of High-Risk Multiple Myeloma: An Indian Tertiary Care Centre Experience","authors":"Anveshika Soni , Sujay Rainchwar , Reema Singh , Dikshat Gopal Gupta , Nakul Tikare , Rohan Halder , Roy J. Palatty , Vipul Sharad Sheth , Narendra Agrawal , Dinesh Bhurani , Tribikram Panda","doi":"10.1016/j.clml.2024.09.007","DOIUrl":"10.1016/j.clml.2024.09.007","url":null,"abstract":"<div><h3>Introduction</h3><div>High risk myeloma is heterogeneous with significant variation in risk stratifications. Real world outcomes differ from controlled clinical trials and affected by socioeconomical determinants.</div></div><div><h3>Material and methods</h3><div>This retrospective study was performed in a North Indian teriarty care cancer hospital. Out of 384,76(19.7%) high risk myeloma patients (median age 58 years) were analyzed.</div></div><div><h3>Result and conclusion</h3><div>Most common HRCA was 1 q gain 36(47.4%) followed by del17p 32(42.1%). 61/76(80.2%) received bortezomib based triplets and 15(19.74%) daratumumab based quadruplets induction, 31(40.79%) received ASCT. Median duration of follow up was 19.5 months. The 2 year OS and PFS was 73.8%, 52.6% respectively. Estimated 3 year OS was 74.7% in ASCT cohort versus 52.9% (<em>P</em> = .0067) without. Estimated 3-year PFS in the ASCT cohort was 72.1% versus 30.3% (<em>P</em> = .0026) without. Estimated 3-year OS for single hit and multi hit ultra HRMM was 67.7% and 61.9% (<em>P</em> = .642) whereas PFS was 58.2% and 35.2% (<em>P</em> = .486) respectively. In multivariate analysis ASCT correlated with better OS (HR 0.3, <em>P</em> = .041) and PFS (HR 0.35, <em>P</em> = .012). Absence of baseline renal impairment correlated with better OS (HR 4.12, <em>P</em> = .004) only. Early aggressive therapy with prompt ASCT translates to a better survival in high risk myeloma. Emphasis on real world clinical outcome is the need of the hour for addressing practical issues and improving global myeloma outcome.</div></div>","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":"25 2","pages":"Pages e110-e119"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.clml.2024.09.010
Somya Khare, Staci Williamson, Brittany O'Barr, Levanto Schachter, Andy Chen, Brandon Hayes-Lattin, Jessica Leonard, Amrita Desai, Peter Ferreira-Gandolfo, Kevin Christmas, Denise Lackey, Richard T Maziarz, Eneida R. Nemecek
Background
Chimeric antigen receptor T-cell (CAR-T) therapies are available for patients with Non-Hodgkin Lymphoma (NHL); however, their use has been limited in accessibility due to nondisease factors.
Patients & Methods
We conducted a retrospective study evaluating the influence of sociodemographic factors on access and outcomes after CAR-T therapy for adult patients with B-cell NHL in our institution treated between 2016 and 2023.
Results
Among 154 patients treated with CAR-T, 43% were older than 65 years, 68% male, and 14% non-White (including Hispanic). Of those under 65, 66% had private insurance, while 82% over 65 had Medicare. Most patients (85%) were from in-state, 29% from areas below the national poverty level and 18% from nonmetropolitan areas. Distance to the treatment center was greater than 30, 60 or 120 miles for 52%, 40% and 29% of patients, respectively. No significant differences were found in the use of commercial versus investigational products among racial/ethnic minorities or those living >60 miles from the center. However, patients from nonmetropolitan areas and those below the national poverty level were less likely to receive commercial products. With a median follow-up of 11 months, the 1-year overall survival (OS) was 63.2% (95th CI 59.9%-66.8%). Poverty was associated with lower 1-year OS (HR 0.4, 95th CI 0.17-0.90, P = .031).
Conclusion
Our study shows that CAR-T therapy can be delivered across sociodemographic barriers and underscores the importance of considering social determinants of health to optimize access for all patients.
背景：嵌合抗原受体T细胞（CAR-T）疗法可用于非霍奇金淋巴瘤（NHL）患者；然而，由于非疾病因素，其使用的可及性受到限制：我们开展了一项回顾性研究，评估社会人口因素对2016年至2023年期间在本院接受治疗的B细胞NHL成年患者接受CAR-T疗法的机会和治疗后的结果的影响：在154名接受CAR-T治疗的患者中，43%年龄超过65岁，68%为男性，14%为非白人（包括西班牙裔）。65岁以下的患者中，66%有私人保险，而65岁以上的患者中，82%有医疗保险。大多数患者（85%）来自州内，29%来自全国贫困线以下地区，18%来自非大都市地区。距离治疗中心超过 30 英里、60 英里或 120 英里的患者分别占 52%、40% 和 29%。在少数种族/族裔或距离治疗中心超过 60 英里的患者中，使用商业产品和研究产品的比例没有明显差异。不过，来自非大都市地区和低于国家贫困线的患者使用商业产品的可能性较低。中位随访时间为11个月，1年总生存率（OS）为63.2%（95th CI 59.9%-66.8%）。贫困与较低的1年OS相关（HR 0.4，95th CI 0.17-0.90，P = .031）：我们的研究表明，CAR-T疗法可以跨越社会人口学障碍，并强调了考虑健康的社会决定因素以优化所有患者获得治疗的重要性。
{"title":"Sociodemographic Factors Influencing Access to Chimeric Antigen T-Cell Receptor Therapy for Patients With Non-Hodgkin Lymphoma","authors":"Somya Khare, Staci Williamson, Brittany O'Barr, Levanto Schachter, Andy Chen, Brandon Hayes-Lattin, Jessica Leonard, Amrita Desai, Peter Ferreira-Gandolfo, Kevin Christmas, Denise Lackey, Richard T Maziarz, Eneida R. Nemecek","doi":"10.1016/j.clml.2024.09.010","DOIUrl":"10.1016/j.clml.2024.09.010","url":null,"abstract":"<div><h3>Background</h3><div>Chimeric antigen receptor T-cell (CAR-T) therapies are available for patients with Non-Hodgkin Lymphoma (NHL); however, their use has been limited in accessibility due to nondisease factors.</div></div><div><h3>Patients & Methods</h3><div>We conducted a retrospective study evaluating the influence of sociodemographic factors on access and outcomes after CAR-T therapy for adult patients with B-cell NHL in our institution treated between 2016 and 2023.</div></div><div><h3>Results</h3><div>Among 154 patients treated with CAR-T, 43% were older than 65 years, 68% male, and 14% non-White (including Hispanic). Of those under 65, 66% had private insurance, while 82% over 65 had Medicare. Most patients (85%) were from in-state, 29% from areas below the national poverty level and 18% from nonmetropolitan areas. Distance to the treatment center was greater than 30, 60 or 120 miles for 52%, 40% and 29% of patients, respectively. No significant differences were found in the use of commercial versus investigational products among racial/ethnic minorities or those living >60 miles from the center. However, patients from nonmetropolitan areas and those below the national poverty level were less likely to receive commercial products. With a median follow-up of 11 months, the 1-year overall survival (OS) was 63.2% (95<sup>th</sup> CI 59.9%-66.8%). Poverty was associated with lower 1-year OS (HR 0.4, 95<sup>th</sup> CI 0.17-0.90, <em>P</em> = .031).</div></div><div><h3>Conclusion</h3><div>Our study shows that CAR-T therapy can be delivered across sociodemographic barriers and underscores the importance of considering social determinants of health to optimize access for all patients.</div></div>","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":"25 2","pages":"Pages e120-e125"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号