H. Zhong, C. Chen, S. Cheng, G. Cai, P. Sun, P. Liu, P. Xu, M. Cai, H. Yang, J. Xiong, Y. Wang, Y. Huang, J. Zhao, H. Yang, J. Chen, L. Wang, S. Luminari, E. Zucca, F. Cavalli, Z. Li, W. Zhao
<p>H. Zhong, C. Chen, S. Cheng, G. Cai, P. Sun, P. Liu Z. Li, and W. Zhao equally contributing authors.</p><p><b>Introduction:</b> Natural killer/T-cell lymphoma (NKTCL) is highly aggressive and characterized by Epstein-Barr virus (EBV) infection and overexpression of immune checkpoints. The therapeutic options were limited for patients unsuitable for chemotherapy. Immune checkpoint inhibitors have been shown effective in refractory and relapsed NKTCL. This study aims to investigate the efficacy and safety of programmed death 1 (PD-1) antibody pembrolizumab concurrent with radiotherapy as a first-line treatment in newly diagnosed early-stage frail NKTCL patients.</p><p><b>Methods:</b> This is a multicenter phase II study. Eligible patients met the following criteria: (1) age ≥ 18 years; (2) newly diagnosed NKTCL with Ann Arbor stage I-II disease; (3) presence of at least one risk factor (age > 60 years, elevated serum lactate dehydrogenase, Ann Arbor stage II or primary tumor invasion); (4) unsuitable for systemic chemotherapy. All patients received induction treatment with pembrolizumab (200 mg intravenously on day 1 in each 21-day cycle for 6 cycles) concurrently with radiotherapy (a total dose of 50–54 Gy). The patients achieved complete remission (CR), partial remission (PR), or stable disease (SD) have been given pembrolizumab 200 mg every 21 days as a maintenance up to 2 years. The primary endpoint was 2-year progression-free survival (PFS) rate. The main secondary endpoints included CR rate (CRR), overall response rate (ORR), adverse events and plasma EBV DNA change.</p><p><b>Results:</b> From August 2020 to January 2025, a total of 30 patients with median age of 62 (20–74) years were enrolled in Shanghai Ruijin Hospital and Guangzhou Sun Yat Sen University Cancer Center. All patients were intermediate (60%, <i>n</i> = 18) and high (40%, <i>n</i> = 12) risk according to nomogram-revised risk index. Until February 2025, 62.5% CRR (95% CI: 40.6%–81.2%) and 91.7% ORR (95% CI: 73.0%–99.0%) have been achieved in twenty-four evaluable patients after induction treatment. With median follow-up time of 10.2 months (not yet mature for the analysis of the primary endpoint), the best CRR and ORR were 83.3% (95% CI: 62.6%–95.3%) and 91.7% (95% CI: 73.0%%–99.0%), respectively (Figure). The responses improved with the increase of cycles. The most common adverse events were lymphocytopenia, leukopenia, oral mucositis, radiodermatitis and dry mouth. Grade 3/4 adverse events were low, including lymphocytopenia (16.6%) and oral mucositis (13.3%). The treatment was well-tolerated. Among patients who were EBV DNA positive before treatment, 70% achieved EBV DNA negativity following induction therapy.</p><p><b>Conclusion:</b> Pembrolizumab concurrent with radiotherapy was effective and safe in newly diagnosed early-stage frail NKTCL patients, even in those with intermediate or high risk. Immune checkpoint inhibitors could be applied as first-line alternative
{"title":"A PHASE II TRIAL OF PEMBROLIZUMAB CONCURRENT WITH RADIOTHERAPY FOR FRAIL PATIENTS WITH NEWLY DIAGNOSED EARLY-STAGE NATURAL KILLER/T-CELL LYMPHOMA (IELSG50)","authors":"H. Zhong, C. Chen, S. Cheng, G. Cai, P. Sun, P. Liu, P. Xu, M. Cai, H. Yang, J. Xiong, Y. Wang, Y. Huang, J. Zhao, H. Yang, J. Chen, L. Wang, S. Luminari, E. Zucca, F. Cavalli, Z. Li, W. Zhao","doi":"10.1002/hon.70093_62","DOIUrl":"https://doi.org/10.1002/hon.70093_62","url":null,"abstract":"<p>H. Zhong, C. Chen, S. Cheng, G. Cai, P. Sun, P. Liu Z. Li, and W. Zhao equally contributing authors.</p><p><b>Introduction:</b> Natural killer/T-cell lymphoma (NKTCL) is highly aggressive and characterized by Epstein-Barr virus (EBV) infection and overexpression of immune checkpoints. The therapeutic options were limited for patients unsuitable for chemotherapy. Immune checkpoint inhibitors have been shown effective in refractory and relapsed NKTCL. This study aims to investigate the efficacy and safety of programmed death 1 (PD-1) antibody pembrolizumab concurrent with radiotherapy as a first-line treatment in newly diagnosed early-stage frail NKTCL patients.</p><p><b>Methods:</b> This is a multicenter phase II study. Eligible patients met the following criteria: (1) age ≥ 18 years; (2) newly diagnosed NKTCL with Ann Arbor stage I-II disease; (3) presence of at least one risk factor (age > 60 years, elevated serum lactate dehydrogenase, Ann Arbor stage II or primary tumor invasion); (4) unsuitable for systemic chemotherapy. All patients received induction treatment with pembrolizumab (200 mg intravenously on day 1 in each 21-day cycle for 6 cycles) concurrently with radiotherapy (a total dose of 50–54 Gy). The patients achieved complete remission (CR), partial remission (PR), or stable disease (SD) have been given pembrolizumab 200 mg every 21 days as a maintenance up to 2 years. The primary endpoint was 2-year progression-free survival (PFS) rate. The main secondary endpoints included CR rate (CRR), overall response rate (ORR), adverse events and plasma EBV DNA change.</p><p><b>Results:</b> From August 2020 to January 2025, a total of 30 patients with median age of 62 (20–74) years were enrolled in Shanghai Ruijin Hospital and Guangzhou Sun Yat Sen University Cancer Center. All patients were intermediate (60%, <i>n</i> = 18) and high (40%, <i>n</i> = 12) risk according to nomogram-revised risk index. Until February 2025, 62.5% CRR (95% CI: 40.6%–81.2%) and 91.7% ORR (95% CI: 73.0%–99.0%) have been achieved in twenty-four evaluable patients after induction treatment. With median follow-up time of 10.2 months (not yet mature for the analysis of the primary endpoint), the best CRR and ORR were 83.3% (95% CI: 62.6%–95.3%) and 91.7% (95% CI: 73.0%%–99.0%), respectively (Figure). The responses improved with the increase of cycles. The most common adverse events were lymphocytopenia, leukopenia, oral mucositis, radiodermatitis and dry mouth. Grade 3/4 adverse events were low, including lymphocytopenia (16.6%) and oral mucositis (13.3%). The treatment was well-tolerated. Among patients who were EBV DNA positive before treatment, 70% achieved EBV DNA negativity following induction therapy.</p><p><b>Conclusion:</b> Pembrolizumab concurrent with radiotherapy was effective and safe in newly diagnosed early-stage frail NKTCL patients, even in those with intermediate or high risk. Immune checkpoint inhibitors could be applied as first-line alternative ","PeriodicalId":12882,"journal":{"name":"Hematological Oncology","volume":"43 S3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hon.70093_62","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144299614","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}
Y. Li, L. Jin, Y. Duan, W. Liu, J. Zhou, F. Li, X. Yang, Y. Jia, K. Yang, Y. Liu, Y. Dai, L. Yang, A. Liu, P. Wu, R. Liu, L. Jiang, X. Yuan, J. Jiang, S. Zhuang, J. Wang, Z. Xu, H. Gao, Q. Zheng, Y. Zhang
<p>Y. Li, L. Jin, Q. Zheng, and Y. Zhang equally contributing authors.</p><p><b>Introduction:</b> T-cell lymphoblastic lymphoma (T-LBL) is a highly aggressive malignancy with a high incidence among children and adolescents. Despite its prevalence, research on fusion genes in T-LBL, particularly their distribution and prognostic implications, remains limited. This study aimed to elucidate the frequency of fusion genes in Chinese pediatric T-LBL patients and explore their potential impact on prognosis, thereby providing new insights for clinical management.</p><p><b>Methods:</b> We collected data from 552 pediatric T-LBL patients (aged ≤ 16 years) treated at multiple centers of the China Network of Childhood Lymphoma (CNCL), with fusion gene testing results available for 180 patients. Sequencing-based methods were used to detect fusion genes, and statistical analysis was performed to investigate their associations with patient clinical outcomes.</p><p><b>Results:</b> Among the 180 patients analyzed, 105 (58.3%) were found to harbor fusion genes, with a total of 40 distinct fusion genes identified. The higher percentage of fusion genes were <i>SIL</i>::<i>TAL1</i> (<i>n</i> = 40, 22.2%), <i>MLL</i> fusions (<i>n</i> = 20, 11.1%), <i>TCR</i> partner-related fusions (<i>n</i> = 11, 6.1%), <i>ABL1</i> fusions (<i>n</i> = 9, 5%), <i>NOTCH1</i> fusions (<i>n</i> = 7, 3.9%), and <i>SET</i>::<i>CAN</i> (<i>n</i> = 7, 3.9%) (Figure 1a). These findings highlight the genetic heterogeneity of T-LBL in pediatric patients.</p><p>Prognostic analysis revealed that patients with <i>NOTCH1</i> fusions had significantly poorer event-free survival (EFS) and overall survival (OS) compared to those without <i>NOTCH1</i> fusions (EFS, <i>p</i> < 0.0001; OS, <i>p</i> = 0.00013, Figure 1b,c). The identified <i>NOTCH1</i> fusion types included <i>IKZF2</i>::<i>NOTCH1</i> (<i>n</i> = 4, 57%), <i>MIR142</i>::<i>NOTCH1</i> (<i>n</i> = 2, 29%) and <i>IKZF1</i>::<i>NOTCH1</i> (<i>n</i> = 1, 14%), all of which are associated with poor outcomes. We further analyzed the relationship between <i>NOTCH1</i> mutations and <i>NOTCH1</i> fusions, and there was no obvious evidence of co-occurrence or mutual exclusivity between these genetic events. Notably, although <i>NOTCH1</i> mutations are generally associated with favorable outcomes in pediatric T-LBL patients, the cooccurrence of <i>NOTCH1</i> fusions appeared to diminish this benefit, showing a trend toward poorer prognosis (<i>p</i> = 0.056). These findings indicate that <i>NOTCH1</i> fusions may serve as potential biomarkers for adverse prognosis in pediatric patients with T-LBL. Additionally, <i>SIL::TAL1</i> and <i>MLL</i> fusions were observed but showed no prognostic significance in this cohort, warranting further study in larger cohorts.</p><p><b>Conclusion:</b> Our study provides the comprehensive overview of fusion gene distribution in Chinese pediatric T-LBL patients and highlights the significant prognostic impact of
{"title":"FREQUENCY OF FUSION GENES AND THEIR CLINICAL IMPACTS IN CHINESE PEDIATRIC PATIENTS WITH T-CELL LYMPHOBLASTIC LYMPHOMA","authors":"Y. Li, L. Jin, Y. Duan, W. Liu, J. Zhou, F. Li, X. Yang, Y. Jia, K. Yang, Y. Liu, Y. Dai, L. Yang, A. Liu, P. Wu, R. Liu, L. Jiang, X. Yuan, J. Jiang, S. Zhuang, J. Wang, Z. Xu, H. Gao, Q. Zheng, Y. Zhang","doi":"10.1002/hon.70093_36","DOIUrl":"https://doi.org/10.1002/hon.70093_36","url":null,"abstract":"<p>Y. Li, L. Jin, Q. Zheng, and Y. Zhang equally contributing authors.</p><p><b>Introduction:</b> T-cell lymphoblastic lymphoma (T-LBL) is a highly aggressive malignancy with a high incidence among children and adolescents. Despite its prevalence, research on fusion genes in T-LBL, particularly their distribution and prognostic implications, remains limited. This study aimed to elucidate the frequency of fusion genes in Chinese pediatric T-LBL patients and explore their potential impact on prognosis, thereby providing new insights for clinical management.</p><p><b>Methods:</b> We collected data from 552 pediatric T-LBL patients (aged ≤ 16 years) treated at multiple centers of the China Network of Childhood Lymphoma (CNCL), with fusion gene testing results available for 180 patients. Sequencing-based methods were used to detect fusion genes, and statistical analysis was performed to investigate their associations with patient clinical outcomes.</p><p><b>Results:</b> Among the 180 patients analyzed, 105 (58.3%) were found to harbor fusion genes, with a total of 40 distinct fusion genes identified. The higher percentage of fusion genes were <i>SIL</i>::<i>TAL1</i> (<i>n</i> = 40, 22.2%), <i>MLL</i> fusions (<i>n</i> = 20, 11.1%), <i>TCR</i> partner-related fusions (<i>n</i> = 11, 6.1%), <i>ABL1</i> fusions (<i>n</i> = 9, 5%), <i>NOTCH1</i> fusions (<i>n</i> = 7, 3.9%), and <i>SET</i>::<i>CAN</i> (<i>n</i> = 7, 3.9%) (Figure 1a). These findings highlight the genetic heterogeneity of T-LBL in pediatric patients.</p><p>Prognostic analysis revealed that patients with <i>NOTCH1</i> fusions had significantly poorer event-free survival (EFS) and overall survival (OS) compared to those without <i>NOTCH1</i> fusions (EFS, <i>p</i> < 0.0001; OS, <i>p</i> = 0.00013, Figure 1b,c). The identified <i>NOTCH1</i> fusion types included <i>IKZF2</i>::<i>NOTCH1</i> (<i>n</i> = 4, 57%), <i>MIR142</i>::<i>NOTCH1</i> (<i>n</i> = 2, 29%) and <i>IKZF1</i>::<i>NOTCH1</i> (<i>n</i> = 1, 14%), all of which are associated with poor outcomes. We further analyzed the relationship between <i>NOTCH1</i> mutations and <i>NOTCH1</i> fusions, and there was no obvious evidence of co-occurrence or mutual exclusivity between these genetic events. Notably, although <i>NOTCH1</i> mutations are generally associated with favorable outcomes in pediatric T-LBL patients, the cooccurrence of <i>NOTCH1</i> fusions appeared to diminish this benefit, showing a trend toward poorer prognosis (<i>p</i> = 0.056). These findings indicate that <i>NOTCH1</i> fusions may serve as potential biomarkers for adverse prognosis in pediatric patients with T-LBL. Additionally, <i>SIL::TAL1</i> and <i>MLL</i> fusions were observed but showed no prognostic significance in this cohort, warranting further study in larger cohorts.</p><p><b>Conclusion:</b> Our study provides the comprehensive overview of fusion gene distribution in Chinese pediatric T-LBL patients and highlights the significant prognostic impact of ","PeriodicalId":12882,"journal":{"name":"Hematological Oncology","volume":"43 S3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hon.70093_36","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144299696","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}
C. S. Tam, P. Ghia, M. Shadman, T. Munir, S. S. Opat, P. A. Walker, M. Lasica, I. W. Flinn, T. Tian, S. Agresti, J. Hirata, J. R. Brown
<p><b>Introduction:</b> Zanubrutinib is a next-generation Bruton tyrosine kinase inhibitor that is approved for five indications, including CLL/SLL. Initial results from the SEQUOIA study (NCT03336333), at a median follow-up of 26.2 months, demonstrated superior progression-free survival (PFS) by independent review with zanubrutinib versus bendamustine + rituximab (arms A and B) in patients with treatment-naive CLL/SLL without del(17p) as well as high overall response rate (ORR) and PFS benefit in patients with del(17p) (arm C). Additionally, the 5-year follow-up in arm A demonstrated durable PFS benefit, with estimated 54- and 60-month PFS rates of 80% and 76%, respectively. Here we report updated results in SEQUOIA arm C, in patients with del(17p), after approximately 5 years of follow-up (data cutoff: Apr 30, 2024).</p><p><b>Methods:</b> Arm C is a nonrandomized cohort of SEQUOIA patients with del(17p) that received zanubrutinib monotherapy. Investigator-assessed PFS, overall survival (OS), ORR, and safety/tolerability were evaluated. Adverse events (AEs) were recorded until disease progression or start of next-line therapy.</p><p><b>Results:</b> Between Feb 2018 and Mar 2019, 111 treatment-naive patients with del(17p) were enrolled to receive zanubrutinib. The median age was 71 years (range, 42–87 years), 79 (71%) were male, 67 (60%) were IGHV unmutated, and 47 (42%) had both del(17p) and <i>TP53</i> mutation. At a median follow-up of 65.8 months (range, 5–75 months), median PFS was not reached. The estimated 60-month PFS rate was 72.2% (62.4%–79.8%) (Figure), or 73.0% (63.3%–80.6%) when adjusted for COVID-19. Median OS was also not reached. The estimated 60-month OS rate was 85.1% (76.9%–90.6%), or 87.0% (79.0%–92.1%) when adjusted for COVID-19. The ORR was 97.3%, and the complete response/complete response with incomplete hematologic recovery rate was 18.2%. Zanubrutinib treatment was ongoing in 62.2% of patients. The most common causes for treatment discontinuation were AEs and progressive disease (in 17.1% and 15.3%, respectively). Key AEs of interest (AEI) included any-grade infection (82%), bleeding (60%), neutropenia (19%), hypertension (18%), anemia (9%), thrombocytopenia (8%), and atrial fibrillation/flutter (7%). Grade ≥ 3 AEI included infection (33%), neutropenia (16%), hypertension (8%), bleeding (6%), atrial fibrillation/flutter (5%), and thrombocytopenia (2%).</p><p><b>Conclusions:</b> With this 5-year follow-up in SEQUOIA, the efficacy of zanubrutinib in treatment-naive higher-risk patients with del(17p) was maintained, and patients continue to demonstrate PFS benefits consistent with the randomized cohort of patients without del(17p) (arm A). Additionally, with longer-term follow-up, no new safety signals were identified. This update, in the largest cohort of uniformly treated patients with del(17p), suggests that zanubrutinib remains a valuable frontline treatment option for patients with or without del(17p) CLL/SLL.</p><p><b
{"title":"SEQUOIA 5-YEAR FOLLOW-UP IN ARM C: FRONTLINE ZANUBRUTINIB IN PATIENTS WITH DEL(17P) AND TREATMENT-NAIVE CHRONIC LYMPHOCYTIC LEUKEMIA/SMALL LYMPHOCYTIC LYMPHOMA (CLL/SLL)","authors":"C. S. Tam, P. Ghia, M. Shadman, T. Munir, S. S. Opat, P. A. Walker, M. Lasica, I. W. Flinn, T. Tian, S. Agresti, J. Hirata, J. R. Brown","doi":"10.1002/hon.70093_72","DOIUrl":"https://doi.org/10.1002/hon.70093_72","url":null,"abstract":"<p><b>Introduction:</b> Zanubrutinib is a next-generation Bruton tyrosine kinase inhibitor that is approved for five indications, including CLL/SLL. Initial results from the SEQUOIA study (NCT03336333), at a median follow-up of 26.2 months, demonstrated superior progression-free survival (PFS) by independent review with zanubrutinib versus bendamustine + rituximab (arms A and B) in patients with treatment-naive CLL/SLL without del(17p) as well as high overall response rate (ORR) and PFS benefit in patients with del(17p) (arm C). Additionally, the 5-year follow-up in arm A demonstrated durable PFS benefit, with estimated 54- and 60-month PFS rates of 80% and 76%, respectively. Here we report updated results in SEQUOIA arm C, in patients with del(17p), after approximately 5 years of follow-up (data cutoff: Apr 30, 2024).</p><p><b>Methods:</b> Arm C is a nonrandomized cohort of SEQUOIA patients with del(17p) that received zanubrutinib monotherapy. Investigator-assessed PFS, overall survival (OS), ORR, and safety/tolerability were evaluated. Adverse events (AEs) were recorded until disease progression or start of next-line therapy.</p><p><b>Results:</b> Between Feb 2018 and Mar 2019, 111 treatment-naive patients with del(17p) were enrolled to receive zanubrutinib. The median age was 71 years (range, 42–87 years), 79 (71%) were male, 67 (60%) were IGHV unmutated, and 47 (42%) had both del(17p) and <i>TP53</i> mutation. At a median follow-up of 65.8 months (range, 5–75 months), median PFS was not reached. The estimated 60-month PFS rate was 72.2% (62.4%–79.8%) (Figure), or 73.0% (63.3%–80.6%) when adjusted for COVID-19. Median OS was also not reached. The estimated 60-month OS rate was 85.1% (76.9%–90.6%), or 87.0% (79.0%–92.1%) when adjusted for COVID-19. The ORR was 97.3%, and the complete response/complete response with incomplete hematologic recovery rate was 18.2%. Zanubrutinib treatment was ongoing in 62.2% of patients. The most common causes for treatment discontinuation were AEs and progressive disease (in 17.1% and 15.3%, respectively). Key AEs of interest (AEI) included any-grade infection (82%), bleeding (60%), neutropenia (19%), hypertension (18%), anemia (9%), thrombocytopenia (8%), and atrial fibrillation/flutter (7%). Grade ≥ 3 AEI included infection (33%), neutropenia (16%), hypertension (8%), bleeding (6%), atrial fibrillation/flutter (5%), and thrombocytopenia (2%).</p><p><b>Conclusions:</b> With this 5-year follow-up in SEQUOIA, the efficacy of zanubrutinib in treatment-naive higher-risk patients with del(17p) was maintained, and patients continue to demonstrate PFS benefits consistent with the randomized cohort of patients without del(17p) (arm A). Additionally, with longer-term follow-up, no new safety signals were identified. This update, in the largest cohort of uniformly treated patients with del(17p), suggests that zanubrutinib remains a valuable frontline treatment option for patients with or without del(17p) CLL/SLL.</p><p><b","PeriodicalId":12882,"journal":{"name":"Hematological Oncology","volume":"43 S3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hon.70093_72","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144299720","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}
J. M. Kahn, J. M. Unger, H. Li, S. M. Castellino, H. Dillon, T. Hernandez, S. C. Rutherford, A. Punnett, M. LeBlanc, J. Y. Song, S. M. Smith, A. M. Evens, K. M. Kelly, J. W. Friedberg, A. Herrera
<p>J. M. Unger, H. Li, S. M. Castellino, H. Dillon, T. Hernandez, S. C. Rutherford, A. Punnett, M. LeBlanc, J. Y. Song, S. M. Smith, A. M. Evens, K. M. Kelly, J. W. Friedberg, and A. Herrera equally contributing author.</p><p><b>Background</b>: The phase 3 randomized trial S1826 showed that among patients with advanced-stage classic Hodgkin lymphoma (cHL), nivolumab plus doxorubicin, vinblastine, and dacarbazine (N+AVD) resulted in longer progression-free survival (PFS) compared to brentuximab vedotin plus AVD (BV+AVD). We assessed whether the treatment benefits of N+AVD applied to potentially socioeconomically vulnerable populations.</p><p><b>Methods:</b> S1826 was a multicenter trial for patients ≥ 12 years old with stage III or IV newly diagnosed cHL. The trial was stopped early at its pre-specified second interim analysis due to efficacy of the N+AVD arm (hazard ratio [HR] for progression or death, 0.48; 95% confidence interval [CI], 0.27–0.87, <i>p</i> = 0.001). We assessed whether there was any evidence of differential benefit of N+AVD with respect to PFS according to categories of race/ethnicity (Black race and/or Hispanic ethnicity vs. others), rural versus urban residence, area-level socioeconomic deprivation (Area Deprivation Index [ADI] above median, yes vs. no), and insurance status (Medicaid or no insurance vs. others) using interaction tests. Analyses were conducted using Cox regression adjusting for the study-specified stratification variables including age (12 –17 vs. 18–60 vs. > 60 years), the international prognostic score (IPS; 0–3 vs. 4–7), and intent to use radiation (yes vs. no). An overall Type I error rate of alpha = 0.10 was used; multiplicity was accounted for by specifying each individual test at the two-sided alpha = 0.025 level using Bonferroni. If no interaction was found, the marginal association of socioeconomic variables and PFS using multivariable Cox regression was examined.</p><p><b>Results:</b> Of N = 970 eligible patients, 90% were < 60 years, and 56% were male; 11.8% were Black, 12.7% were Hispanic, and 32% had IPS 4–7. Among socioeconomic variables, the combined Black and/or Hispanic patients comprised 24.5%, 13.3% were from rural areas, 50% lived in areas above the median ADI level, and 23.2% had Medicaid or no insurance. In survival analyses, there was no statistically significant evidence that the effect of treatment on PFS differed between levels of the socioeconomic variables (Table). For instance, the PFS HR was 0.52 for Black and/or Hispanic patients and 0.41 for other patients (interaction <i>p</i>-value = 0.60). Across all patients, there was no statistically significant association of Black and/or Hispanic race/ethnicity (HR = 1.10, 95% CI: 0.72–1.69, <i>p</i> = 0.65), rural geography (HR = 1.11, 95% CI: 0.67–1.85, <i>p</i> = 0.67), high ADI (HR = 1.30, 95% CI: 0.89–1.88, <i>p</i> = 0.17), or Medicaid/no insurance (HR = 1.01, 95% CI: 0.63–1.60, <i>p</i> = 0.98) with PFS.</p><p><b>Conclusion:
J. M.昂格，H.李，S. M.卡斯特利诺，H.狄龙，T.埃尔南德斯，S. C.卢瑟福，A.庞尼特，M. LeBlanc， J. Y.宋，S. M.史密斯，A. M.埃文斯，K. M.凯利，J. W.弗里德伯格和A.埃雷拉都是同样贡献的作者。背景：3期随机试验S1826显示，在晚期经典霍奇金淋巴瘤（cHL）患者中，纳武单抗联合阿霉素、长春花碱和达卡巴嗪（N+AVD）比布伦妥昔单抗联合AVD （BV+AVD）可获得更长的无进展生存期（PFS）。我们评估了N+AVD的治疗益处是否适用于潜在的社会经济弱势群体。方法：S1826是一项针对≥12岁的III期或IV期新诊断cHL患者的多中心试验。由于N+AVD组的疗效，该试验在预先指定的第二次中期分析中提前停止(进展或死亡的风险比[HR]为0.48；95%可信区间[CI]， 0.27-0.87, p = 0.001)。根据种族/民族（黑人和/或西班牙裔与其他种族）、农村与城市居住、区域层面的社会经济剥夺（区域剥夺指数高于中位数，是与否）和保险状况（医疗补助或无保险与其他），我们使用相互作用测试评估了是否有任何证据表明N+AVD对PFS有不同的益处。使用Cox回归对研究指定的分层变量进行分析，包括年龄(12 -17岁vs. 18-60岁vs. >；60岁)，国际预后评分(IPS；0-3 vs. 4-7)，以及使用辐射的意图（是vs.否）。总体I型错误率为alpha = 0.10；多重性是通过使用Bonferroni在双侧alpha = 0.025水平上指定每个个体检验来解释的。如果没有发现相互作用，则使用多变量Cox回归检查社会经济变量与PFS的边际关联。结果：在970例符合条件的患者中，90%为<；60岁，男性占56%；11.8%为黑人，12.7%为西班牙裔，32%为IPS 4-7。在社会经济变量中，黑人和/或西班牙裔患者占24.5%，13.3%来自农村地区，50%生活在高于ADI中位数水平的地区，23.2%有医疗补助或没有保险。在生存分析中，没有统计学上显著的证据表明治疗对PFS的影响在不同的社会经济变量水平之间存在差异（表）。例如，黑人和/或西班牙裔患者的PFS HR为0.52，其他患者为0.41（相互作用p值= 0.60）。在所有患者中，黑人和/或西班牙裔人种/民族（HR = 1.10, 95% CI: 0.72-1.69, p = 0.65）、农村地理（HR = 1.11, 95% CI: 0.67 - 1.85, p = 0.67）、高ADI （HR = 1.30, 95% CI: 0.89-1.88, p = 0.17）或医疗补助/无保险（HR = 1.01, 95% CI: 0.63-1.60, p = 0.98）与PFS没有统计学意义的关联。结论：在S1826纳入的晚期cHL患者中，我们没有发现证据表明，与BV+AVD相比，N+AVD的PFS获益会因社会不利因素而显著减弱。这表明N+AVD广泛适用于不同社会经济背景的患者。总体生存分析正在进行中。科研经费声明：美国国立卫生研究院国家癌症研究所U10CA180888、U10CA180819；部分由BMS实现；埃米特,托尼斯蒂芬森白血病淋巴瘤学会（LLS）学者奖；拉里&；丹尼斯·梅森临床学者职业发展奖；V基金会劳埃德家庭临床研究者基金；LLS临床研究学者奖。关键词：癌症健康差异无潜在利益冲突来源
{"title":"THE ASSOCIATION OF SOCIAL DISADVANTAGE WITH OUTCOMES IN PATIENTS WITH ADVANCED-STAGE, CLASSIC HODGKIN LYMPHOMA ENROLLED IN THE PHASE 3 INTERGROUP TRIAL S1826","authors":"J. M. Kahn, J. M. Unger, H. Li, S. M. Castellino, H. Dillon, T. Hernandez, S. C. Rutherford, A. Punnett, M. LeBlanc, J. Y. Song, S. M. Smith, A. M. Evens, K. M. Kelly, J. W. Friedberg, A. Herrera","doi":"10.1002/hon.70094_368","DOIUrl":"https://doi.org/10.1002/hon.70094_368","url":null,"abstract":"<p>J. M. Unger, H. Li, S. M. Castellino, H. Dillon, T. Hernandez, S. C. Rutherford, A. Punnett, M. LeBlanc, J. Y. Song, S. M. Smith, A. M. Evens, K. M. Kelly, J. W. Friedberg, and A. Herrera equally contributing author.</p><p><b>Background</b>: The phase 3 randomized trial S1826 showed that among patients with advanced-stage classic Hodgkin lymphoma (cHL), nivolumab plus doxorubicin, vinblastine, and dacarbazine (N+AVD) resulted in longer progression-free survival (PFS) compared to brentuximab vedotin plus AVD (BV+AVD). We assessed whether the treatment benefits of N+AVD applied to potentially socioeconomically vulnerable populations.</p><p><b>Methods:</b> S1826 was a multicenter trial for patients ≥ 12 years old with stage III or IV newly diagnosed cHL. The trial was stopped early at its pre-specified second interim analysis due to efficacy of the N+AVD arm (hazard ratio [HR] for progression or death, 0.48; 95% confidence interval [CI], 0.27–0.87, <i>p</i> = 0.001). We assessed whether there was any evidence of differential benefit of N+AVD with respect to PFS according to categories of race/ethnicity (Black race and/or Hispanic ethnicity vs. others), rural versus urban residence, area-level socioeconomic deprivation (Area Deprivation Index [ADI] above median, yes vs. no), and insurance status (Medicaid or no insurance vs. others) using interaction tests. Analyses were conducted using Cox regression adjusting for the study-specified stratification variables including age (12 –17 vs. 18–60 vs. > 60 years), the international prognostic score (IPS; 0–3 vs. 4–7), and intent to use radiation (yes vs. no). An overall Type I error rate of alpha = 0.10 was used; multiplicity was accounted for by specifying each individual test at the two-sided alpha = 0.025 level using Bonferroni. If no interaction was found, the marginal association of socioeconomic variables and PFS using multivariable Cox regression was examined.</p><p><b>Results:</b> Of N = 970 eligible patients, 90% were < 60 years, and 56% were male; 11.8% were Black, 12.7% were Hispanic, and 32% had IPS 4–7. Among socioeconomic variables, the combined Black and/or Hispanic patients comprised 24.5%, 13.3% were from rural areas, 50% lived in areas above the median ADI level, and 23.2% had Medicaid or no insurance. In survival analyses, there was no statistically significant evidence that the effect of treatment on PFS differed between levels of the socioeconomic variables (Table). For instance, the PFS HR was 0.52 for Black and/or Hispanic patients and 0.41 for other patients (interaction <i>p</i>-value = 0.60). Across all patients, there was no statistically significant association of Black and/or Hispanic race/ethnicity (HR = 1.10, 95% CI: 0.72–1.69, <i>p</i> = 0.65), rural geography (HR = 1.11, 95% CI: 0.67–1.85, <i>p</i> = 0.67), high ADI (HR = 1.30, 95% CI: 0.89–1.88, <i>p</i> = 0.17), or Medicaid/no insurance (HR = 1.01, 95% CI: 0.63–1.60, <i>p</i> = 0.98) with PFS.</p><p><b>Conclusion:","PeriodicalId":12882,"journal":{"name":"Hematological Oncology","volume":"43 S3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hon.70094_368","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144299664","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}
E. Pettersson, K. Vemuri, M. Berglund, J. Collin, M. Herre, R. Amini, D. Molin, A. Olsson, G. Enblad
<p><b>Introduction:</b> Neutrophil extracellular traps (NETs) are complexes of decondensed chromatin and granule proteins that can be released from activated neutrophils during infections or in inflammatory conditions, including cancer. Accumulation of NETs in tissues and blood can contribute to increased inflammation, thrombosis and organ damage. In several types of solid cancers, NETs have been shown to facilitate metastasis and tumour growth, leading to a worse prognosis. However, little is known about the role of NETs in malignant lymphomas.</p><p><b>Methods:</b> The concentration of NETs was analysed in plasma samples taken at diagnosis from patients with diffuse large B-cell lymphoma (DLBCL, <i>n</i> = 227) and classical Hodgkin lymphoma (cHL, <i>n</i> = 117) in the Uppsala Umeå Comprehensive Cancer Consortium (U-CAN) biobank. Plasma from blood donors (<i>n</i> = 54) were used as healthy controls. NETs were measured using a commercial enzyme-linked immunosorbent assay (ELISA) targeting complexes of citrullinated histones and extracellular DNA, a biomarker with high specificity for NETs. Clinical data, including blood counts at diagnosis and treatment outcome, was extracted from patient records and analysed in relation to the plasma concentrations of NETs.</p><p><b>Results:</b> Higher concentrations of NETs were seen in plasma from DLBCL patients (range 0.62 to 200 ng/ml) compared to cHL patients (<i>p</i> < 0.01, range 0.58 to 62 ng/ml) and healthy controls (<i>p</i> < 0.001, range 1.0 to 37 ng/ml). The level of NETs in cHL was not significantly higher than in control samples. In both DLBCL and cHL, a poorer overall survival was seen in patients with concentrations of NETs above median (7.4 and 5.6 ng/ml respectively, <i>p</i> < 0.05). There was no significant correlation between progression free survival and NETs. In cHL, there was a positive correlation between elevated levels of NETs and age above 45 years (<i>p</i> < 0.05), but no correlation to age was shown in DLBCL. The NET levels did not significantly differ between the sexes. A trend, although not significant, could be seen with increased NET levels in higher stages of both DLBCL and cHL. The plasma concentration of NETs in both lymphoma diseases showed a positive correlation with the neutrophil count in blood (<i>p</i> < 0.05), as well as erythrocyte sedimentation rate (ESR) above 50 mmHg (<i>p</i> < 0.01) at diagnosis.</p><p><b>Conclusions:</b> In line with previous studies on NETs in cancer, we show that high levels of NETs in plasma correlates with worse survival for both DLBCL and cHL patients. However, plasma concentrations were only significantly increased in DLBCL compared to healthy controls, with no correlation to age or sex. Based on the results, NETs could be a possible prognostic marker to further investigate in malignant lymphoma. In both DLBCL and cHL, higher levels of NETs were seen in patients with elevated neutrophil count and high ESR, a sign of
{"title":"INVESTIGATING NEUTROPHIL EXTRACELLULAR TRAPS AS A POSSIBLE PROGNOSTIC MARKER IN DIFFUSE LARGE B-CELL LYMPHOMA AND CLASSICAL HODGKIN LYMPHOMA","authors":"E. Pettersson, K. Vemuri, M. Berglund, J. Collin, M. Herre, R. Amini, D. Molin, A. Olsson, G. Enblad","doi":"10.1002/hon.70094_205","DOIUrl":"https://doi.org/10.1002/hon.70094_205","url":null,"abstract":"<p><b>Introduction:</b> Neutrophil extracellular traps (NETs) are complexes of decondensed chromatin and granule proteins that can be released from activated neutrophils during infections or in inflammatory conditions, including cancer. Accumulation of NETs in tissues and blood can contribute to increased inflammation, thrombosis and organ damage. In several types of solid cancers, NETs have been shown to facilitate metastasis and tumour growth, leading to a worse prognosis. However, little is known about the role of NETs in malignant lymphomas.</p><p><b>Methods:</b> The concentration of NETs was analysed in plasma samples taken at diagnosis from patients with diffuse large B-cell lymphoma (DLBCL, <i>n</i> = 227) and classical Hodgkin lymphoma (cHL, <i>n</i> = 117) in the Uppsala Umeå Comprehensive Cancer Consortium (U-CAN) biobank. Plasma from blood donors (<i>n</i> = 54) were used as healthy controls. NETs were measured using a commercial enzyme-linked immunosorbent assay (ELISA) targeting complexes of citrullinated histones and extracellular DNA, a biomarker with high specificity for NETs. Clinical data, including blood counts at diagnosis and treatment outcome, was extracted from patient records and analysed in relation to the plasma concentrations of NETs.</p><p><b>Results:</b> Higher concentrations of NETs were seen in plasma from DLBCL patients (range 0.62 to 200 ng/ml) compared to cHL patients (<i>p</i> < 0.01, range 0.58 to 62 ng/ml) and healthy controls (<i>p</i> < 0.001, range 1.0 to 37 ng/ml). The level of NETs in cHL was not significantly higher than in control samples. In both DLBCL and cHL, a poorer overall survival was seen in patients with concentrations of NETs above median (7.4 and 5.6 ng/ml respectively, <i>p</i> < 0.05). There was no significant correlation between progression free survival and NETs. In cHL, there was a positive correlation between elevated levels of NETs and age above 45 years (<i>p</i> < 0.05), but no correlation to age was shown in DLBCL. The NET levels did not significantly differ between the sexes. A trend, although not significant, could be seen with increased NET levels in higher stages of both DLBCL and cHL. The plasma concentration of NETs in both lymphoma diseases showed a positive correlation with the neutrophil count in blood (<i>p</i> < 0.05), as well as erythrocyte sedimentation rate (ESR) above 50 mmHg (<i>p</i> < 0.01) at diagnosis.</p><p><b>Conclusions:</b> In line with previous studies on NETs in cancer, we show that high levels of NETs in plasma correlates with worse survival for both DLBCL and cHL patients. However, plasma concentrations were only significantly increased in DLBCL compared to healthy controls, with no correlation to age or sex. Based on the results, NETs could be a possible prognostic marker to further investigate in malignant lymphoma. In both DLBCL and cHL, higher levels of NETs were seen in patients with elevated neutrophil count and high ESR, a sign of","PeriodicalId":12882,"journal":{"name":"Hematological Oncology","volume":"43 S3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hon.70094_205","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144299850","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}
A. D. Dreyfuss, N. Ganesan, B. S. Imber, M. LaRiviere, D. Isrow, J. Plastaras, J. Svoboda, J. Yahalom, C. H. Moskowitz, A. Moskowitz
<p><b>Background:</b> Chemotherapy (chemo) followed by stem cell transplant (SCT) is standard of care for relapsed/refractory (RR) Hodgkin Lymphoma (HL). In a phase II study, we evaluated pembrolizumab (pembro) with involved site radiation therapy (ISRT) as an alternative salvage approach for localized favorable relapse.</p><p><b>Methods:</b> Patients with RR stage IA/IIA, non-bulky (< 10cm) HL after one line of therapy had a PETCT simulation followed by pembro 200 mg IV q 21d for 4 cycles and PETCT simulation 3 wks later. Patients then received ISRT per response as follows: (1) 20 Gy for complete metabolic response (CMR) defined by Deauville Score (DS) 1–3; (2) 30 Gy for partial metabolic response (PMR) or stable disease (SD) (DS 4–5) and negative biopsy; or (3) 36–40 Gy for PMR/SD and positive biopsy. Patients who progressed (PD) were taken off study. PETCT response was documented 4–6 weeks after ISRT. The primary endpoint was CMR rate after pembro-RT. Secondary endpoints were response to single agent pembro, 2-year progression free survival (PFS), and toxicity.</p><p><b>Results:</b> 22 of planned 22 patients enrolled with median age of 36 (range 22–66) and 10 (45%) males. 3 (14%) had stage I, 18 (82%) stage II, and 1 had an unspecified limited stage at initial diagnosis. Frontline therapy was chemotherapy alone in 19 (86%) and combined modality in 3 (14%). 21 (95%) received adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD), 17 (81%) with < 6 cycles. 14 (64%) had relapsed and 8 (36%) had refractory disease.</p><p>7 (32%) had CMR after pembro, 3 (14%) had PMR/SD with negative biopsy, 6 (27%) had PMR with positive biopsy, 1 (5%) had PMR without biopsy, and 5 (23%) had PD. 17 patients proceeded to ISRT, of whom 7 (41%) with CMR received 20 Gy, 3 (18%) with PMR/SD and negative biopsy received 30 Gy, and 7 (41%) with PMR/SD and positive/no biopsy received 36–40 Gy. Of the 14 with post-RT PET, 12 (86% of these patients, 67% overall) achieved CMR. After median follow up of 34 months (6–79), 2-year PFS was 65% (95% CI: 47–91).</p><p>Five patients progressed on pembro and three relapsed after a median of 12 months (range 7–70) from completion of pembro-RT. Among the patients with PD during or after pembro-RT, three are currently in remission, one is currently undergoing therapy, and the status for the others are unknown. Subsequent treatments included pembro plus gemcitabine/vinorelbine/liposomal doxorubicin followed by ASCT (<i>n</i> = 2), brentuximab vedotin (BV) plus nivolumab followed by ASCT (<i>n</i> = 1) and 2 doses of BV followed by additional RT (<i>n</i> = 1).</p><p>Immune-related toxicities were 3 (14%) grade 1 rash, and 3 (14%) grade 2 hypo/hyperthyroidism. Grade > 2 toxicities were 1 (5%) grade 3 headache, 1 (5%) grade 3 urinary tract infection, 1 (5%) grade 3 encephalopathy, and 1 (5%) grade 4 lipase elevation.</p><p><b>Conclusion:</b> Pembro-RT yielded excellent CMR rates and minimal toxicity. These data suggest pembro-R
{"title":"PEMBROLIZUMAB AND RADIATION THERAPY ALONE AS AN ALTERNATIVE TO TRANSPLANT FOR LOCALIZED FAILURE AFTER CHEMOTHERAPY IN HODGKIN LYMPHOMA: A MULTICENTER PHASE II STUDY","authors":"A. D. Dreyfuss, N. Ganesan, B. S. Imber, M. LaRiviere, D. Isrow, J. Plastaras, J. Svoboda, J. Yahalom, C. H. Moskowitz, A. Moskowitz","doi":"10.1002/hon.70093_129","DOIUrl":"https://doi.org/10.1002/hon.70093_129","url":null,"abstract":"<p><b>Background:</b> Chemotherapy (chemo) followed by stem cell transplant (SCT) is standard of care for relapsed/refractory (RR) Hodgkin Lymphoma (HL). In a phase II study, we evaluated pembrolizumab (pembro) with involved site radiation therapy (ISRT) as an alternative salvage approach for localized favorable relapse.</p><p><b>Methods:</b> Patients with RR stage IA/IIA, non-bulky (< 10cm) HL after one line of therapy had a PETCT simulation followed by pembro 200 mg IV q 21d for 4 cycles and PETCT simulation 3 wks later. Patients then received ISRT per response as follows: (1) 20 Gy for complete metabolic response (CMR) defined by Deauville Score (DS) 1–3; (2) 30 Gy for partial metabolic response (PMR) or stable disease (SD) (DS 4–5) and negative biopsy; or (3) 36–40 Gy for PMR/SD and positive biopsy. Patients who progressed (PD) were taken off study. PETCT response was documented 4–6 weeks after ISRT. The primary endpoint was CMR rate after pembro-RT. Secondary endpoints were response to single agent pembro, 2-year progression free survival (PFS), and toxicity.</p><p><b>Results:</b> 22 of planned 22 patients enrolled with median age of 36 (range 22–66) and 10 (45%) males. 3 (14%) had stage I, 18 (82%) stage II, and 1 had an unspecified limited stage at initial diagnosis. Frontline therapy was chemotherapy alone in 19 (86%) and combined modality in 3 (14%). 21 (95%) received adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD), 17 (81%) with < 6 cycles. 14 (64%) had relapsed and 8 (36%) had refractory disease.</p><p>7 (32%) had CMR after pembro, 3 (14%) had PMR/SD with negative biopsy, 6 (27%) had PMR with positive biopsy, 1 (5%) had PMR without biopsy, and 5 (23%) had PD. 17 patients proceeded to ISRT, of whom 7 (41%) with CMR received 20 Gy, 3 (18%) with PMR/SD and negative biopsy received 30 Gy, and 7 (41%) with PMR/SD and positive/no biopsy received 36–40 Gy. Of the 14 with post-RT PET, 12 (86% of these patients, 67% overall) achieved CMR. After median follow up of 34 months (6–79), 2-year PFS was 65% (95% CI: 47–91).</p><p>Five patients progressed on pembro and three relapsed after a median of 12 months (range 7–70) from completion of pembro-RT. Among the patients with PD during or after pembro-RT, three are currently in remission, one is currently undergoing therapy, and the status for the others are unknown. Subsequent treatments included pembro plus gemcitabine/vinorelbine/liposomal doxorubicin followed by ASCT (<i>n</i> = 2), brentuximab vedotin (BV) plus nivolumab followed by ASCT (<i>n</i> = 1) and 2 doses of BV followed by additional RT (<i>n</i> = 1).</p><p>Immune-related toxicities were 3 (14%) grade 1 rash, and 3 (14%) grade 2 hypo/hyperthyroidism. Grade > 2 toxicities were 1 (5%) grade 3 headache, 1 (5%) grade 3 urinary tract infection, 1 (5%) grade 3 encephalopathy, and 1 (5%) grade 4 lipase elevation.</p><p><b>Conclusion:</b> Pembro-RT yielded excellent CMR rates and minimal toxicity. These data suggest pembro-R","PeriodicalId":12882,"journal":{"name":"Hematological Oncology","volume":"43 S3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hon.70093_129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144299797","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}
K. D. Hofer, S. Scheinost, L. Ben-Taarit, J. Hüllein, T. Walther, K. Putzker, L. Sellner, M. W. Kühn, T. Kindler, F. Nguyen-Khac, M. Crespo Maull, F. Bosch, A. Theocharides, M. G. Manz, J. Bourquin, B. Bornhauser, S. Dietrich, J. Lewis, W. Huber, J. Lu, T. Zenz
K. D. Hofer and S. Scheinost equally contributing author.
Ex vivo drug screening may leverage the cellular response to drugs for disease understanding, identification of new targets and improved treatment. Precise stratification of patients with hematologic malignancies based on molecular profiling can improve treatment selection and outcome.
Here, we perform a large-scale drug screen across a range of hematologic malignancies to link drug response to diseases and subgroups, identify pathway dependencies and define determinants of drug response. We analyze sequential samples to assess the dynamics of drug response phenotypes over time and compare ex vivo results to clinical outcomes.
For 722 patient samples from 17 blood cancers we assessed drug response to 63 different compounds. The analysis of 143,640 data points shows that drug response is strongly linked to disease entities. We link functional pathway dependencies to individual blood cancers and genetic subgroups. In CLL, trisomy(12) confers susceptibility to inhibition of MEK/ERK and PI3K-AKT-mTOR pathways. DDX3X mutations are associated with increased sensitivity to BTK and SYK inhibition. Longitudinal assessment shows stable drug response over time in untreated patients. Patients receiving BCR signaling inhibitors acquire sensitivities to BET and dual MCL-1/BCL-2 inhibition.
We have generated an accessible resource of ex vivo drug profiling across different hematologic malignancies that can be leveraged for functional analyses and biomarker-stratified treatment strategies.
Researchfunding declaration: Jacques and Gloria Gossweiler Foundation, Swiss Academy of Medical Sciences, University Hospital Zurich
Keywords: bioinformatics; computational and systems biology; tumor biology and heterogeneity
No potential sources of conflict of interest.
K. D. Hofer和S. Scheinost是同样有贡献的作者。体外药物筛选可以利用细胞对药物的反应来了解疾病，确定新的靶点和改善治疗。基于分子谱的血液恶性肿瘤患者的精确分层可以改善治疗选择和结果。在这里，我们在一系列血液恶性肿瘤中进行了大规模的药物筛选，以将药物反应与疾病和亚群联系起来，确定途径依赖性并定义药物反应的决定因素。我们分析了连续的样本，以评估药物反应表型随时间的动态，并将离体结果与临床结果进行比较。对于来自17种血癌的722例患者样本，我们评估了对63种不同化合物的药物反应。对143,640个数据点的分析表明，药物反应与疾病实体密切相关。我们将功能通路依赖与个体血癌和遗传亚群联系起来。在CLL中，三体（12）对MEK/ERK和PI3K-AKT-mTOR通路的抑制具有易感性。DDX3X突变与BTK和SYK抑制敏感性增加有关。纵向评估显示，未经治疗的患者随着时间的推移，药物反应稳定。接受BCR信号抑制剂治疗的患者对BET和MCL-1/BCL-2双重抑制具有敏感性。我们已经创建了一个可访问的跨不同血液恶性肿瘤的体外药物分析资源，可以用于功能分析和生物标志物分层治疗策略。研究经费声明：Jacques and Gloria Gossweiler基金会，瑞士医学科学院，苏黎世大学医院计算与系统生物学；肿瘤生物学和异质性无潜在的利益冲突来源。
{"title":"SYSTEMATIC INVESTIGATION OF DISEASE- AND GENOTYPE-SPECIFIC VULNERABILITIES IN PRIMARY BLOOD CANCER USING HIGH-THROUGHPUT EX VIVO DRUG SCREENING","authors":"K. D. Hofer, S. Scheinost, L. Ben-Taarit, J. Hüllein, T. Walther, K. Putzker, L. Sellner, M. W. Kühn, T. Kindler, F. Nguyen-Khac, M. Crespo Maull, F. Bosch, A. Theocharides, M. G. Manz, J. Bourquin, B. Bornhauser, S. Dietrich, J. Lewis, W. Huber, J. Lu, T. Zenz","doi":"10.1002/hon.70093_114","DOIUrl":"https://doi.org/10.1002/hon.70093_114","url":null,"abstract":"<p>K. D. Hofer and S. Scheinost equally contributing author.</p><p>Ex vivo drug screening may leverage the cellular response to drugs for disease understanding, identification of new targets and improved treatment. Precise stratification of patients with hematologic malignancies based on molecular profiling can improve treatment selection and outcome.</p><p>Here, we perform a large-scale drug screen across a range of hematologic malignancies to link drug response to diseases and subgroups, identify pathway dependencies and define determinants of drug response. We analyze sequential samples to assess the dynamics of drug response phenotypes over time and compare ex vivo results to clinical outcomes.</p><p>For 722 patient samples from 17 blood cancers we assessed drug response to 63 different compounds. The analysis of 143,640 data points shows that drug response is strongly linked to disease entities. We link functional pathway dependencies to individual blood cancers and genetic subgroups. In CLL, trisomy(12) confers susceptibility to inhibition of MEK/ERK and PI3K-AKT-mTOR pathways. DDX3X mutations are associated with increased sensitivity to BTK and SYK inhibition. Longitudinal assessment shows stable drug response over time in untreated patients. Patients receiving BCR signaling inhibitors acquire sensitivities to BET and dual MCL-1/BCL-2 inhibition.</p><p>We have generated an accessible resource of ex vivo drug profiling across different hematologic malignancies that can be leveraged for functional analyses and biomarker-stratified treatment strategies.</p><p><b>Research</b> <b>funding declaration:</b> Jacques and Gloria Gossweiler Foundation, Swiss Academy of Medical Sciences, University Hospital Zurich</p><p><b>Keywords:</b> bioinformatics; computational and systems biology; tumor biology and heterogeneity</p><p><b>No potential sources of conflict of interest.</b></p>","PeriodicalId":12882,"journal":{"name":"Hematological Oncology","volume":"43 S3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hon.70093_114","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144299758","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}
C. D'Angelo, C. Enke, J. Vose, R. G. Bociek, S. Ananth, E. Lyden, F. Yu, M. Schissel, M. Lunning
<p><b>Introduction:</b> Low dose radiation therapy (RT), 4 Gray administered over 2 fractions (BOOM-BOOM), has demonstrated efficacy and low toxicity in B-cell lymphoma. Pre-clinical experiments demonstrate that BOOM-BOOM RT prior to CAR T-cell therapy successfully enhances CAR T-cell efficacy, suggesting engagement of immunotherapeutic mechanisms. We hypothesized that BOOM-BOOM radiation would be safe and effective as bridging therapy prior to liso-cel infusion.</p><p><b>Methods:</b> We performed an investigator-initiated study of BOOM-BOOM bridging RT prior to liso-cel. Eligible patients included adults with relapsed/refractory aggressive B-cell non-Hodgkin lymphoma at the University of Nebraska Medical Center. Subjects received BOOM-BOOM RT to disease sites 7–10 days prior to liso-cel. No other bridging therapy beyond steroids was allowed. The primary endpoint was feasibility, defined as the percentage of subjects enrolled who received BOOM-BOOM RT and liso-cel.</p><p><b>Results:</b> The trial has completed recruitment, and this is the first analysis of feasibility and efficacy for the whole cohort. The median follow-up is 146 days. Thirty-two subjects were enrolled and 30 subjects received BOOM-BOOM RT and liso-cel (30/32, 94%), meeting the prespecified feasibility threshold of > 70%. The median age was 70 (range 23–84), 22 (69%) subjects were male. Three subjects were diagnosed with high-grade B-cell lymphoma, 1 with grey zone lymphoma, 1 with Richter’s transformation, and 27 with DLBCL. Fourteen subjects (18/32, 56%) had a LDH above the upper limit of normal. Twenty-nine subjects (29/32, 91%) received liso-cel as second line therapy. Twenty-one subjects (21/32, 66%) had extranodal disease, 20/32 (63%) were advanced stage, and 16/32 (50%) were refractory to frontline therapy.</p><p>Twenty-nine subjects receiving per-protocol therapy were evaluable for response using Lugano criteria for PET/CT. Responses to BOOM-BOOM and liso-cel were observed in 25/29 (86%) subjects, and the complete response (CR) rate was 24/29 (83%). Two subjects had stable disease, and 2 subjects experienced progressive disease as best response. Progression-free survival (PFS) and overall survival (OS) curves are depicted in Figure 1. A landmark analysis by response at D30 for PFS and OS is depicted in Figure 1C/D and demonstrates a 200-day PFS and OS rate for patients obtaining a CR of 75% (95% CI: 46%–90%) and 89% (95% CI: 62%–97%), respectively.</p><p>Thirty subjects were evaluable for safety. CRS was observed in 15 subjects and was G1–2 in 14 and G5 in one. Immune effector cell-associated neurotoxicity was observed in 8 subjects and G3–4 in 5/8. Two subjects died, 1 due to intestinal perforation and 1 due to septic shock prior to D100.</p><p><b>Conclusion:</b> The combination of BOOM-BOOM RT and liso-cel met our primary endpoint of feasibility and produced a high CR rate of 83%. These data suggest that the use of low-dose RT as bridging therapy is safe, feasible, a
{"title":"BOOM-BOOM RADIATION PRIOR TO LISOCABTAGENE MARALEUCEL IS FEASIBLE AND CONTRIBUTES TO HIGH COMPLETE RESPONSE RATES FOR AGGRESSIVE B-CELL NON-HODGKIN LYMPHOMA","authors":"C. D'Angelo, C. Enke, J. Vose, R. G. Bociek, S. Ananth, E. Lyden, F. Yu, M. Schissel, M. Lunning","doi":"10.1002/hon.70093_111","DOIUrl":"https://doi.org/10.1002/hon.70093_111","url":null,"abstract":"<p><b>Introduction:</b> Low dose radiation therapy (RT), 4 Gray administered over 2 fractions (BOOM-BOOM), has demonstrated efficacy and low toxicity in B-cell lymphoma. Pre-clinical experiments demonstrate that BOOM-BOOM RT prior to CAR T-cell therapy successfully enhances CAR T-cell efficacy, suggesting engagement of immunotherapeutic mechanisms. We hypothesized that BOOM-BOOM radiation would be safe and effective as bridging therapy prior to liso-cel infusion.</p><p><b>Methods:</b> We performed an investigator-initiated study of BOOM-BOOM bridging RT prior to liso-cel. Eligible patients included adults with relapsed/refractory aggressive B-cell non-Hodgkin lymphoma at the University of Nebraska Medical Center. Subjects received BOOM-BOOM RT to disease sites 7–10 days prior to liso-cel. No other bridging therapy beyond steroids was allowed. The primary endpoint was feasibility, defined as the percentage of subjects enrolled who received BOOM-BOOM RT and liso-cel.</p><p><b>Results:</b> The trial has completed recruitment, and this is the first analysis of feasibility and efficacy for the whole cohort. The median follow-up is 146 days. Thirty-two subjects were enrolled and 30 subjects received BOOM-BOOM RT and liso-cel (30/32, 94%), meeting the prespecified feasibility threshold of > 70%. The median age was 70 (range 23–84), 22 (69%) subjects were male. Three subjects were diagnosed with high-grade B-cell lymphoma, 1 with grey zone lymphoma, 1 with Richter’s transformation, and 27 with DLBCL. Fourteen subjects (18/32, 56%) had a LDH above the upper limit of normal. Twenty-nine subjects (29/32, 91%) received liso-cel as second line therapy. Twenty-one subjects (21/32, 66%) had extranodal disease, 20/32 (63%) were advanced stage, and 16/32 (50%) were refractory to frontline therapy.</p><p>Twenty-nine subjects receiving per-protocol therapy were evaluable for response using Lugano criteria for PET/CT. Responses to BOOM-BOOM and liso-cel were observed in 25/29 (86%) subjects, and the complete response (CR) rate was 24/29 (83%). Two subjects had stable disease, and 2 subjects experienced progressive disease as best response. Progression-free survival (PFS) and overall survival (OS) curves are depicted in Figure 1. A landmark analysis by response at D30 for PFS and OS is depicted in Figure 1C/D and demonstrates a 200-day PFS and OS rate for patients obtaining a CR of 75% (95% CI: 46%–90%) and 89% (95% CI: 62%–97%), respectively.</p><p>Thirty subjects were evaluable for safety. CRS was observed in 15 subjects and was G1–2 in 14 and G5 in one. Immune effector cell-associated neurotoxicity was observed in 8 subjects and G3–4 in 5/8. Two subjects died, 1 due to intestinal perforation and 1 due to septic shock prior to D100.</p><p><b>Conclusion:</b> The combination of BOOM-BOOM RT and liso-cel met our primary endpoint of feasibility and produced a high CR rate of 83%. These data suggest that the use of low-dose RT as bridging therapy is safe, feasible, a","PeriodicalId":12882,"journal":{"name":"Hematological Oncology","volume":"43 S3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hon.70093_111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144299760","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}
B. Chen, A. Q. Xu, M. S. Hung, A. Toboso-Navasa, I. Rodriguez-Hernandez, P. Chakravarty, D. P. Calado
<p>B. Chen and A. Q. Xu equally contributing author.</p><p><b>Introduction:</b> Constitutive MYC overexpression is a hallmark of germinal center (GC) B-cell-derived lymphomas. Stabilizing mutations in MYC, such as T58A, are frequently found in highly aggressive subtypes, including Burkitt’s lymphoma and Double-Hit lymphomas. Under physiological conditions, MYC is transiently upregulated in positively selected GC B-cells within the light zone (LZ) following T-cell help (TCH). However, the precise mechanisms by which aberrant MYC expression drives GC B-cell lymphomagenesis remain unclear. Here, we propose that aberrant MYC levels diminish GC B-cell dependence on TCH, thereby promoting lymphomagenesis.</p><p><b>Methods:</b> We generated novel mouse models in which either wildtype MYC (MYC<sup>WT</sup>) or MYC stabilizing mutant (MYC<sup>T58A</sup>) was overexpressed in GC B-cells using the Cɣ1-Cre system. To assess the phenotypic and functional consequences, we performed flow cytometry and immunohistochemistry. To investigate MYC-driven alterations in GC dynamics and metabolism, we conducted CITE-seq analysis on MYC<sup>WT</sup>, MYC<sup>T58A</sup>, and control GC B-cells. Additionally, we modulated TCH and its downstream mTOR signaling pathway in GC B-cells using CD40L blockade and rapamycin treatment.</p><p><b>Results:</b> MYC<sup>WT</sup> overexpression induced GC B-cell hyperplasia and promoted the expansion of a dark zone (DZ)-like phenotype. This was accompanied by increased cell cycle entry and progression in the LZ, albeit with a concurrent rise in apoptosis. CITE-seq analysis revealed that MYC<sup>WT</sup> overexpression led to a reduction in activation signatures in positively selected LZ GC B-cells, suggesting that these cells become less dependent on TCH. Functionally, MYC<sup>WT</sup> overexpression conferred an advantage under conditions of limited TCH. However, MYC<sup>WT</sup>-overexpressing GC B-cells remained sensitive to sustained CD40L blockade or mTOR inhibition, indicating that MYC<sup>WT</sup> activity is still regulated by TCH in a premalignant state.</p><p>In contrast, MYC<sup>T58A</sup> overexpression did not induce short-term GC hyperplasia but instead prolonged GC B-cell retention and exacerbated lymphomagenesis. CITE-seq analysis revealed that MYC<sup>T58A</sup> GC B-cells not only exhibited a consistent reduction in activation signatures but also enriched for an intermediate LZ/DZ "Grey Zone" phenotype characterized by a metabolic profile resembling lymphoma. Functionally, MYC<sup>T58A</sup> overexpression conferred GC B-cells with the ability to survive even under inhibition of key TCH-dependent signaling pathways, most notably mTOR signaling.</p><p><b>Conclusion:</b> These findings suggest thatMYC overexpression, particularly MYC<sup>T58A</sup>, reprograms GC B-cells to bypass TCH dependency, supporting their transition toward a lymphomagenic state. This work provides mechanistic insights into how MYC mutations drive
{"title":"STABILIZED MYCT58A BYPASSES T-CELL HELP TO FUEL GERMINAL CENTER B-CELL LYMPHOMAGENESIS","authors":"B. Chen, A. Q. Xu, M. S. Hung, A. Toboso-Navasa, I. Rodriguez-Hernandez, P. Chakravarty, D. P. Calado","doi":"10.1002/hon.70094_171","DOIUrl":"https://doi.org/10.1002/hon.70094_171","url":null,"abstract":"<p>B. Chen and A. Q. Xu equally contributing author.</p><p><b>Introduction:</b> Constitutive MYC overexpression is a hallmark of germinal center (GC) B-cell-derived lymphomas. Stabilizing mutations in MYC, such as T58A, are frequently found in highly aggressive subtypes, including Burkitt’s lymphoma and Double-Hit lymphomas. Under physiological conditions, MYC is transiently upregulated in positively selected GC B-cells within the light zone (LZ) following T-cell help (TCH). However, the precise mechanisms by which aberrant MYC expression drives GC B-cell lymphomagenesis remain unclear. Here, we propose that aberrant MYC levels diminish GC B-cell dependence on TCH, thereby promoting lymphomagenesis.</p><p><b>Methods:</b> We generated novel mouse models in which either wildtype MYC (MYC<sup>WT</sup>) or MYC stabilizing mutant (MYC<sup>T58A</sup>) was overexpressed in GC B-cells using the Cɣ1-Cre system. To assess the phenotypic and functional consequences, we performed flow cytometry and immunohistochemistry. To investigate MYC-driven alterations in GC dynamics and metabolism, we conducted CITE-seq analysis on MYC<sup>WT</sup>, MYC<sup>T58A</sup>, and control GC B-cells. Additionally, we modulated TCH and its downstream mTOR signaling pathway in GC B-cells using CD40L blockade and rapamycin treatment.</p><p><b>Results:</b> MYC<sup>WT</sup> overexpression induced GC B-cell hyperplasia and promoted the expansion of a dark zone (DZ)-like phenotype. This was accompanied by increased cell cycle entry and progression in the LZ, albeit with a concurrent rise in apoptosis. CITE-seq analysis revealed that MYC<sup>WT</sup> overexpression led to a reduction in activation signatures in positively selected LZ GC B-cells, suggesting that these cells become less dependent on TCH. Functionally, MYC<sup>WT</sup> overexpression conferred an advantage under conditions of limited TCH. However, MYC<sup>WT</sup>-overexpressing GC B-cells remained sensitive to sustained CD40L blockade or mTOR inhibition, indicating that MYC<sup>WT</sup> activity is still regulated by TCH in a premalignant state.</p><p>In contrast, MYC<sup>T58A</sup> overexpression did not induce short-term GC hyperplasia but instead prolonged GC B-cell retention and exacerbated lymphomagenesis. CITE-seq analysis revealed that MYC<sup>T58A</sup> GC B-cells not only exhibited a consistent reduction in activation signatures but also enriched for an intermediate LZ/DZ \"Grey Zone\" phenotype characterized by a metabolic profile resembling lymphoma. Functionally, MYC<sup>T58A</sup> overexpression conferred GC B-cells with the ability to survive even under inhibition of key TCH-dependent signaling pathways, most notably mTOR signaling.</p><p><b>Conclusion:</b> These findings suggest thatMYC overexpression, particularly MYC<sup>T58A</sup>, reprograms GC B-cells to bypass TCH dependency, supporting their transition toward a lymphomagenic state. This work provides mechanistic insights into how MYC mutations drive ","PeriodicalId":12882,"journal":{"name":"Hematological Oncology","volume":"43 S3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hon.70094_171","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144299858","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}
H. Mocikova, L. Gaherova, T. Jancarkova, A. Suri, A. Janikova, K. Steinerova, D. Belada, R. Pytlik, J. Duras, M. Trnkova, P. Blahovcova, T. Kozak, M. Trneny
<p><b>Introduction:</b> CNS relapse occurs in around 5% of patients with systemic diffuse large B-cell lymphoma (DLBCL) and its prognosis is poor. The optimal strategy for CNS prophylaxis is not established. The CLSG-CNS-01 trial compared CNS prophylaxis with high doses of intravenous (i.v.) methotrexate (MTX) and intrathecal (i.t.) MTX in systemic DLBCL.</p><p><b>Methods:</b> This randomized, multicenter, prospective phase 3 trial was registered at ClinicalTrials.gov (NCT02777736). Patients with systemic DLBCL aged between 18 and 72 years were treated with 6 cycles of R-CHOP+2xR or DA EPOCH-R+2xR. Patients with intermediate (2–3 risk factors) and high risk (4–6 risk factors) for CNS relapse were randomly assigned (1:1) to CNS prophylaxis with either 2 doses of MTX 3g/m<sup>2</sup> i.v. (arm A) or 6 doses of MTX 12 mg i.t. (arm B). Low risk patients (0–1 risk factor) for CNS relapse were not randomized and did not receive CNS prophylaxis (arm C). Primary objective was to compare cumulative incidence of CNS relapse between arms A and B. Major secondary objectives included: overall response rate (ORR), progression-free and overall survivals (PFS, OS) and treatment toxicity.</p><p><b>Results:</b> Overall 100 patients were enrolled between 2015 and 2024: 30 were randomly assigned to arm A and 31 to arm B; 39 patients did not receive prophylaxis (arm C). Median age of patients was 61 years (range 27–72) and 54% were male. CNS relapses occurred in 3 (3%) patients (arm A 1, arm B 2) during the median follow-up of 54.9 months. CNS relapse after MTX i.v. occurred later (5.2 years after the initiation of treatment). Comparison of 5year cumulative incidence of CNS relapse between randomized arms A and B did not reach statistical significance (0% vs. 8.7%, HR 1.521, <i>p</i> = 0.72). ORR was not significant among arms A, B, C (83.3% vs. 83.8% vs. 94.8%, <i>p</i> = 0.20). The 5year PFS was comparable in arms A and B (45.3% and 57.4%), HR 0.66, <i>p</i> = 0.20. CNS prophylaxis (i.v. and i.t.) significantly increased neutropenia grade ≥ 3 (12.61% vs. 18.48 % vs. 3.59 %, <i>p</i> < 0.0001) with the highest rate of infections grade ≥ 3 in arm A (4.95% vs. 0.95% vs. 0.80%, <i>p</i> = 0.0046). Other toxicities grade ≥ 3 occurred most frequently in arm A (<i>p</i> = 0.0039). Overall 29 patients died (arm A 16, arm B 10, arm C 3). Infections (arm A 5 vs. arm B 2) and unknown causes (arm A 4 vs. arm B 2) indicated the major difference between randomized arms. This observation resulted in significantly worse 5year OS in arm A versus B (47.2% vs. 72.4%, HR 0.46, <i>p</i> = 0.04).</p><p><b>Conclusions:</b> CNS prophylaxis with MTX i.v. or i.t. did not eliminate CNS relapse, but MTX i.v. delayed its occurrence. Cumulative incidence of CNS relapse did not differ significantly between i.v. and i.t. MTX prophylaxis, however, the number of randomized patients was low. MTX i.v. was significantly associated with worse OS, probably due to the toxicity.</p><p><b>Research</b> <
简介：系统性弥漫性大b细胞淋巴瘤（DLBCL）患者的中枢神经系统复发发生率约为5%，预后较差。预防中枢神经系统疾病的最佳策略尚未确定。CLSG-CNS-01试验比较了高剂量静脉注射（i.v.）甲氨蝶呤（MTX）和鞘内注射（i.t.）预防CNS的效果。MTX在系统性DLBCL中的应用。方法：该随机、多中心、前瞻性3期试验已在ClinicalTrials.gov注册（NCT02777736）。年龄在18 - 72岁之间的系统性DLBCL患者接受6个周期的R-CHOP+2xR或DA EPOCH-R+2xR治疗。具有中度（2 - 3个危险因素）和高危（4-6个危险因素）CNS复发的患者被随机（1:1）分配到CNS预防组，其中2剂MTX 3g/m2静脉注射（A组）或6剂MTX 12mg静脉注射（B组）。CNS复发的低风险患者（0-1危险因素）没有随机分组，也没有接受CNS预防治疗（C组）。主要目标是比较A组和b组CNS复发的累积发生率。次要目标包括：总缓解率（ORR）、无进展生存期和总生存期（PFS， OS）和治疗毒性。结果：2015年至2024年共入组100例患者：30例随机分配到A组，31例随机分配到B组；39例患者未接受预防治疗（C组）。患者中位年龄为61岁（27-72岁），54%为男性。在54.9个月的中位随访期间，有3例（3%）患者（a1组，b2组）出现中枢神经系统复发。甲氨喋呤静脉注射后中枢神经系统复发发生较晚（治疗开始后5.2年）。随机组A组与随机组B组5年累积中枢神经系统复发发生率比较无统计学意义（0% vs. 8.7%, HR 1.521, p = 0.72）。A、B、C组的ORR无统计学意义（83.3%比83.8%比94.8%,p = 0.20）。A组和B组5年PFS具有可比性（45.3%和57.4%），HR 0.66, p = 0.20。中枢神经系统预防（静脉注射和静脉注射）显著增加中性粒细胞减少症≥3级(12.61% vs. 18.48% vs. 3.59%, p <；0.0001)， A组感染率≥3级最高（4.95% vs. 0.95% vs. 0.80%, p = 0.0046）。其他≥3级的毒性最常见于A组（p = 0.0039）。共有29例患者死亡（A组16例，B组10例，C组3例）。感染（aa组5 vs B组2）和未知原因（aa组4 vs B组2）表明随机分组之间的主要差异。这一观察结果导致A组5年OS明显低于B组（47.2% vs. 72.4%, HR 0.46, p = 0.04）。结论：甲氨喋呤静脉滴注或静脉滴注并不能消除中枢神经系统的复发，但甲氨喋呤延缓了中枢神经系统复发的发生。CNS复发的累积发生率在静脉注射和静脉注射MTX预防之间没有显著差异，然而，随机患者的数量很低。MTX静脉注射与更差的OS显著相关，可能是由于毒性。研究经费声明：本工作得到捷克共和国卫生部AZV NU21-03-00411基金和合作项目的支持，研究领域为“肿瘤学和血液学”。关键词：化疗；侵袭性b细胞非霍奇金淋巴瘤没有潜在的利益冲突来源。
{"title":"ASSESSING THE EFFICACY AND TOXICITY OF CNS PROPHYLAXIS IN DIFFUSE LARGE B-CELL LYMPHOMA (CLSG-CNS-01): A RANDOMIZED, MULTICENTER, PROSPECTIVE PHASE 3 TRIAL","authors":"H. Mocikova, L. Gaherova, T. Jancarkova, A. Suri, A. Janikova, K. Steinerova, D. Belada, R. Pytlik, J. Duras, M. Trnkova, P. Blahovcova, T. Kozak, M. Trneny","doi":"10.1002/hon.70094_278","DOIUrl":"https://doi.org/10.1002/hon.70094_278","url":null,"abstract":"<p><b>Introduction:</b> CNS relapse occurs in around 5% of patients with systemic diffuse large B-cell lymphoma (DLBCL) and its prognosis is poor. The optimal strategy for CNS prophylaxis is not established. The CLSG-CNS-01 trial compared CNS prophylaxis with high doses of intravenous (i.v.) methotrexate (MTX) and intrathecal (i.t.) MTX in systemic DLBCL.</p><p><b>Methods:</b> This randomized, multicenter, prospective phase 3 trial was registered at ClinicalTrials.gov (NCT02777736). Patients with systemic DLBCL aged between 18 and 72 years were treated with 6 cycles of R-CHOP+2xR or DA EPOCH-R+2xR. Patients with intermediate (2–3 risk factors) and high risk (4–6 risk factors) for CNS relapse were randomly assigned (1:1) to CNS prophylaxis with either 2 doses of MTX 3g/m<sup>2</sup> i.v. (arm A) or 6 doses of MTX 12 mg i.t. (arm B). Low risk patients (0–1 risk factor) for CNS relapse were not randomized and did not receive CNS prophylaxis (arm C). Primary objective was to compare cumulative incidence of CNS relapse between arms A and B. Major secondary objectives included: overall response rate (ORR), progression-free and overall survivals (PFS, OS) and treatment toxicity.</p><p><b>Results:</b> Overall 100 patients were enrolled between 2015 and 2024: 30 were randomly assigned to arm A and 31 to arm B; 39 patients did not receive prophylaxis (arm C). Median age of patients was 61 years (range 27–72) and 54% were male. CNS relapses occurred in 3 (3%) patients (arm A 1, arm B 2) during the median follow-up of 54.9 months. CNS relapse after MTX i.v. occurred later (5.2 years after the initiation of treatment). Comparison of 5year cumulative incidence of CNS relapse between randomized arms A and B did not reach statistical significance (0% vs. 8.7%, HR 1.521, <i>p</i> = 0.72). ORR was not significant among arms A, B, C (83.3% vs. 83.8% vs. 94.8%, <i>p</i> = 0.20). The 5year PFS was comparable in arms A and B (45.3% and 57.4%), HR 0.66, <i>p</i> = 0.20. CNS prophylaxis (i.v. and i.t.) significantly increased neutropenia grade ≥ 3 (12.61% vs. 18.48 % vs. 3.59 %, <i>p</i> < 0.0001) with the highest rate of infections grade ≥ 3 in arm A (4.95% vs. 0.95% vs. 0.80%, <i>p</i> = 0.0046). Other toxicities grade ≥ 3 occurred most frequently in arm A (<i>p</i> = 0.0039). Overall 29 patients died (arm A 16, arm B 10, arm C 3). Infections (arm A 5 vs. arm B 2) and unknown causes (arm A 4 vs. arm B 2) indicated the major difference between randomized arms. This observation resulted in significantly worse 5year OS in arm A versus B (47.2% vs. 72.4%, HR 0.46, <i>p</i> = 0.04).</p><p><b>Conclusions:</b> CNS prophylaxis with MTX i.v. or i.t. did not eliminate CNS relapse, but MTX i.v. delayed its occurrence. Cumulative incidence of CNS relapse did not differ significantly between i.v. and i.t. MTX prophylaxis, however, the number of randomized patients was low. MTX i.v. was significantly associated with worse OS, probably due to the toxicity.</p><p><b>Research</b> <","PeriodicalId":12882,"journal":{"name":"Hematological Oncology","volume":"43 S3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hon.70094_278","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144299949","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}
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