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  • 1
    In: Blood, American Society of Hematology, Vol. 124, No. 21 ( 2014-12-06), p. 395-395
    Abstract: Background: In diffuse large B-cell lymphoma (DLBCL), a MYC-rearrangement (MYC-R) is present in approximately 10% of cases and has been associated with an inferior outcome following R-CHOP chemotherapy. In a previous report that retrospectively analyzed the prognostic impact of a MYC-R on survival following DA-EPOCH-R, patients with a MYC-R had a similar outcome to MYC negative cases (4 year EFS of 83% versus 76% respectively: p=0.46 Ann Oncol 2011 (22) Suppl 4 # 71). We set out to prospectively validate these results in a multicenter study. Methods: Patients were newly diagnosed with DLBCL or B-cell lymphoma unclassifiable (BCL-U) with features intermediate between DLBCL and Burkitt lymphoma (BL). Only cases that harbored a MYC translocation by fluorescent in-situ hybridization (FISH) or conventional cytogenetic testing were included in this report. Treatment consisted of 6 cycles of DA-EPOCH-R. R esults: 52 patients were included in this preliminary analysis. Characteristics were median (range) age 61 (29-80) years; male sex 37 (71%); stage III or IV disease 38 (73%); IPI score 0-2 in 35% versus 3-5 in 65%; HIV positive 4 (7%). Histologic diagnosis was DLBCL in 45 (86%) and BCL-U in 7 (14%). All cases had a MYC-rearrangement. BCL2 was rearranged in 14/31 (45%) and overexpressed by IHC in 24/43 (56%) cases tested. There were 3 deaths secondary to infectious complications and otherwise toxicities were similar to previous reports of the regimen. At a median follow-up time of 14 months, progression-free survival (PFS), time to progression (TTP) and overall survival (OS) were 79%, 86% and 77% respectively for all patients. PFS was 87% and 64% in cases that were FISH positive (double-hit) and IHC positive for BCL2 respectively. Conclusions: Albeit short follow-up, DA-EPOCH-R in MYC-R DLBCL demonstrates promising activity in a multicenter prospective setting. Further analysis of this data is planned with central pathology review of cases and longer follow-up. The principal arm of this study testing the regimen in BL remains open to accrual (NCT01092182). Figure 1 Figure 1. Disclosures LaCasce: Seattle Genetics, Inc.: Research Funding.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2014
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 2
    In: Blood, American Society of Hematology, Vol. 112, No. 11 ( 2008-11-16), p. 3590-3590
    Abstract: Gray zone lymphomas (GZL) are diseases with transitional morphology and immunophenotypic features between Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Their pathological and clinical characteristics are not well studied and the best treatment strategy (using HL or DLBCL regimens) has not been defined. Small previous series of HL-like ALCL, which would include GZL, suggest they have a poor outcome with HL treatments. We present GZL’s treated on studies of DA-EPOCH-R at the National Cancer Institute and describe their clinical and histological features and outcome. Overall, 14 patients with GZL were identified. Characteristics included median (range) age 30 (12–51) years; male sex 10 (71%); stage III/IV 2 (14%) and; elevated LDH 7 (50%). These cases could be divided into three Gray zone groups: classical HL (cHL) and primary mediastinal B-cell lymphoma (PMBL) in 9 (64%) patients; cHL and DLBCL in 2 (14%) and; lymphocyte predominant HL (LPHL) and T-cell histiocyte-rich large cell lymphoma (TCRBCL) in 2 (14%). Pathological characteristics are shown below. All but one case was CD 10 negative. Markers of cHL included CD15 in 33–50% and CD30 in 66–100% of cases. Morphologically, Reed-Sternberg like cells were typically seen in GZL with cHL features. Thirteen newly diagnosed patients received DA-EPOCH-R. Of 11 patients evaluable for response (2TE), 10 (91%) achieved CR and 1 PR. At a median follow-up time of 4 years, OS and PFS are is 86% and 57%, respectively. Of 9 patients with GZL between cHL and PMBL, 4 (44%) also required radiation therapy compared to only 3/31 (10%) patients with PMBL to achieve durable remissions. Gray zone lymphomas represent a biological and clinical continuum between HL and B-cell lymphomas. Clinically, they appear to be more resistant to treatment than either HL or DLBCL and may require aggressive treatment strategies including radiation. Accrual continues. Gray Zone Total 14 CD 20 CD 15 CD 30 cHL- PMBL 9 8 (89%) 7 (50%) 9 (100%) cHL-DLBCL 2 2 (100%) 1 (50%) 2(100%) LPHL-TCRBCL 3 3 (100%) 1 (33%) 2 (66%)
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2008
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 3
    In: Blood, American Society of Hematology, Vol. 122, No. 21 ( 2013-11-15), p. 3029-3029
    Abstract: Background While several studies have now demonstrated that patients with MYC-rearranged DLBCL have a worse outcome following treatment with CHOP -with or without rituximab - recent reports suggest that concurrent expression of MYC and BCL2 protein by immunohistochemistry (IHC), independent of a MYC rearrangement, is associated with an inferior clinical outcome following R-CHOP (Johnson et al. JCO 2012 Oct 1; 30 (28): 3452-9). We previously reported that DLBCL patients with a MYC rearrangement have a similar outcome to MYC negative cases (4 year EFS of 83% versus 76% respectively: p=0.46) following dose-adjusted (DA)-EPOCH-R (Dunleavy et al. Ann Oncol 2011 (22) Suppl 4 # 71). Methods To assess the prognostic role of MYC and BCL2 protein expression, we performed immunohistochemistry for MYC and BCL2 in patients with newly diagnosed DLBCL who received DA-EPOCH-R or short-course (SC)-EPOCH-RR (if HIV infected). Primary mediastinal B-cell lymphoma (PMBL) cases were excluded as they have a different biology. Tumors were scored positive for MYC if ≥ 40% of cells stained positive. For BCL2, the staining intensity was compared with that in control T cells present in the tumor samples – tumor cells were considered positive if they stained the same or more intensely than T cells. We used the Hans algorithm, as previously described, to predict cell of origin as germinal center B-cell like (GCB) or non-GCB type and correlated this with outcome. Results Of 66 patients enrolled on study, characteristics were median (range) age: 48 (18-76) years; male sex 47 (71%); IPI score low versus intermediate/high 18 (27%) versus 48 (73%); HIV positive 22 (33%). IHC was positive for MYC in 28/48 (58%) cases and positive for BCL2 in 24/51 (47%). 36/51 (71%) and 15/51 (29%) of cases were of GCB and non-GCB origin respectively. At a median follow-up time of greater than 10 years, progression-free survival (PFS) and overall survival (OS) were 67.5% and 75% for all patients. We compared survival in the 4 groups: MYC+/BCL2+, MYC+/BCL2-, MYC-/BCL2+ and MYC-/BCL2-. PFS and OS were not significantly inferior in any group (global p value=0.5 (PFS) and 0.8 (OS)). Cell of origin did however predict outcome and at 10 years follow-up, PFS was 78% (GCB) versus 43% (non-GCB) (p=0.016) and OS 80% (GCB) versus 65% (non-GCB) (p=0.24). There was a significant association between MYC+/BCL2+ cases and non-GCB subtype (p=0.01) but as 42% were of GCB origin, MYC+/BCL2+ status alone did not predict a poor outcome. Conclusions In DLBCL patients treated with DA-EPOCH-R and SC-EPOCH-RR, concurrent expression of MYC and BCL2 protein did not correspond with a worse clinical outcome. However, cell of origin (GCB versus non-GCB) was predictive of outcome. MYC+/BCL2+ cases segregate with the non-GCB subtype. The overall survival of PMBL cases was 97% at 5 years follow-up. We are currently prospectively studying the DA-EPOCH-R regimen in MYC-rearranged DLBCL in a multicenter study (NCT01092182). Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2013
    detail.hit.zdb_id: 1468538-3
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  • 4
    In: Blood, American Society of Hematology, Vol. 122, No. 21 ( 2013-11-15), p. 3760-3760
    Abstract: Forty-three newly diagnosed MCL patients were treated with single agent Bortezomib followed by DA-EPOCH-R (Dunleavy et al, ASH 2012). To understand the genomic and epigenomic basis of differences in patient outcomes, particularly disease free survival (DFS), we carried out high-resolution genome-wide methylation analysis using enhanced RRBS (ERRBS) and correlated cytosine methylation to gene expression (GE) and patient outcomes. For ERRBS, genomic DNA was extracted from CD19+ selected cells from lymph node biopsies or peripheral blood prior to therapy. Library fragment lengths of 150-250 bp and 250-400 bp were prepared and gel isolated per Akalin et al (PLOS Genetics, 2012) and sequencing was performed on an Illumina Hi-seq 2000. 24 out of 24 patient samples passed quality control with methylation assayed at 〉 3.3 million CpG dinucleotides per sample on average 80x coverage per cytosine. Patients were divided into two groups based on 2 year DFS. There were 39,373 differentially methylated (DM) loci (25% difference in methylation, q 〈 0.01) correlating to 3,968 genes between these two groups. The hyper and hypomethylated loci were annotated with hg19 to find gene associations. The annotated analysis represented 74% and 26% hypermethylated loci located in gene body and promoter regions respectively. Similarly, 70% and 30% of hypomethylated loci were located in gene body and promoter regions. Genomic Regions Enrichment of Annotations Tool (GREAT), a next-generation software aimed at the interpretation of genome-wide cis-regulatory data sets, was used to understand the functional significance of identified DM cytosines. Pathway analysis by GREAT for the DM genes showed significant (p 〈 0.05) enrichment for Wnt and Cadherin signaling pathways. 67% of the DM genes had DNA binding transcription factor activity with tumor suppressors BCOR, HIC1, TP73 from hypomethylated genes and oncogenes GATA3 and MAFB from hypermethylated genes. Simultaneously, Cox proportional hazard models evaluating time-to-progression based on RNA expression using Affymetrix U133 Plus 2 arrays identified 1,933 genes as significantly (p 〈 0.05) associated with DFS. The top canonical pathways enriched by these genes included Protein Kinase A Signaling, PI3K/AKT Signaling, and Protein Ubiquitination Pathway. Top molecular functions of prognostic loci by GEP were cell growth and proliferation. Our analysis has shown that high expression of CDC25A, NFKB2, GLI3, FOXO3, and USP9X were likely associated with increased hazard risk in MCL patient after Bortezomib + DA-EPOCH-R treatment. The gene sets identified by the two platforms were distinct, with only 343 genes in common between DM and DE genes. Based on these findings, we conclude that genomic methylation analysis by next-generation sequencing can identify functionally important cis-regulatory cytosines associated with prognosis in MCL. Prognostic gene sets identified by methylation and gene expression were distinct with transcriptional regulation being the major function of DM genes while cell growth and proliferation being the major function of DE genes. We are developing an integrated prognostic platform for patient outcomes following Bortezomib + DA-EPOCH-R combining genomic methylation and gene expression. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2013
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 5
    In: Blood, American Society of Hematology, Vol. 124, No. 10 ( 2014-09-04), p. 1563-1569
    Abstract: MGZL with pathologic features in between NSHL and PMBL is very rare and most frequently occurs in young patients. A prospective study of DA-EPOCH-R without mediastinal radiation in MGZL demonstrated an inferior outcome compared to patients with PMBL.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2014
    detail.hit.zdb_id: 1468538-3
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  • 6
    In: Blood, American Society of Hematology, Vol. 132, No. Supplement 1 ( 2018-11-29), p. 777-777
    Abstract: Remarkable clinical efficacy and durable responses to antibodies that block the programmed death-1 (PD-1)-programmed death-ligand 1 (PD-L1) pathway have been observed in patients with multiple cancers, including classical Hodgkin lymphomas (cHL). However, the responses in the majority of Non-Hodgkin lymphoma patients, including mantle cell lymphoma (MCL), treated with anti- PD1/PDL1 antibodies have been modest to date. It has been postulated that the immune suppressive nature of the tumor microenvironment (TME) may play a role in limiting the efficacy of checkpoint blockade strategies. As such, identification of critical molecules in TME required for driving response and resistance is key to improve lymphoma immunotherapy. We have therefore generated in vivo and ex-vivo MCL lymphoma-stroma co-culture models and capitalize this model with primary human MCL cells as well. First, we found that co-injection of murine Fc-muMCL1 cells with stromal cells significantly promote lymphoma growthas compared to Fc-muMCL1 cells injected alone. This aggressive growth was associated with less tumor infiltrating cytotoxic T-cells in the TME. Second, to identify the tolerogenic mechanism(s) that drive immunosuppression in TME, we co-cultured MCL cells with stroma cells ex-vivo and found an increased translation and transcription of PD-L1 via upregulation of c-Myc. Furthermore, co-culture of patient primary lymphoma cells with stromal cell dramatically increases PD-L1 expression in both stromal cells and lymphoma cells. Tumor infiltrating T cells also induce PD-L1 expression in stromal cells. Of note, just by knocking down c-Myc in stromal cell we were able to block co-culture-induced PD-L1 expression, highlighting a critical role for c-Myc in driving this tolerogenic process in the TME. In lieu of the above findings, next we treated murine MCL in vitro with a bromodomain inhibitor (JQ1) and observed a significant decrease in c-Myc/PD-L1 expression which was associated with increased immunogenicity of malignant B-cells leading to a better T-cell activation. More importantly, treatment of MCL-bearing mice with a combination of a bromodomain inhibitor with anti-PD1 antibody resulted in enhanced inhibition of MCL growth, increased effector memory T cells and improved function of tumor infiltrating T cells in vivo. No such effects were observed in MCL-bearing mice treated with either agent alone. Taken together, we have identified the c-Myc/PD-L1 axis in stromal cells that by creating a tolerogenic/immunosuppressive TME imposes a significant barrier to the efficacy of checkpoint blockade therapy in lymphomas. This barrier seems not to be unsurmountable since the addition of a bromodomain inhibitor augmented the efficacy of checkpoint blockade by inducing a more immunogenic TME in MCL. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2018
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  • 7
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    Online Resource
    American Society of Hematology ; 2020
    In:  Blood Vol. 136, No. 19 ( 2020-11-5), p. 2118-2124
    In: Blood, American Society of Hematology, Vol. 136, No. 19 ( 2020-11-5), p. 2118-2124
    Abstract: Lymphomas afflict all age groups of people, with certain types demonstrating a female predilection in adolescents and young adults. A proportion of lymphomas that are diagnosed in this population demographic occur in the setting of pregnancy. Most of these behave aggressively at presentation and require immediate or urgent therapy. Treatment must consider both maternal and fetal health, and management approaches are therefore influenced by gestational age at diagnosis and treatment and timing of delivery. Although there is a paucity of literature on how to treat these patients, limited retrospective reports demonstrate generally good outcomes and highlight the necessity of an experienced multidisciplinary team approach to management.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2020
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  • 8
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    Online Resource
    American Society of Hematology ; 2020
    In:  Blood Vol. 135, No. 14 ( 2020-04-2), p. 1078-1080
    In: Blood, American Society of Hematology, Vol. 135, No. 14 ( 2020-04-2), p. 1078-1080
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2020
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  • 9
    In: Blood, American Society of Hematology, Vol. 104, No. 11 ( 2004-11-16), p. 1385-1385
    Abstract: Activation of NF-kB is a possible mechanism of drug resistance in the activated B-cell (ABC) subtype of diffuse large B-cell lymphoma (DLBCL). Bortezomib is a proteasome inhibitor that inhibits NF-kB activation and has promising activity in some lymphoma subtypes. We hypothesized that bortezomib may be active in ABC DLBCL and enhance the efficacy of chemotherapy. The effect of bortezomib on NF-kB and other pathways in serial tumor samples will be examined by microarray and correlated with outcome. The study employs a sequential treatment design. Patients first receive bortezomib alone (Part A), unless they require chemotherapy due to disease, and then cross over to DA-EPOCH-bortezomib (Part B) if they do not achieve a CR. In Part A, the dose of bortezomib is 1.3 mg/m2 IV d 1, 4, 8, 11 q21days. In Part B, bortezomib is escalated over 4 dose levels, in an accelerated design, of 0.5, 1, 1.5 and 1.7 mg/m2 on d 1,4 with DA-EPOCH, q21days. Of 32 patients enrolled, there are 16 on Part A and 26 on Part B. Patient characteristics include median age (range) 54 (19–76); stage III/IV 29 (91%); median 4 (1–8) prior regimens and; 25 (83%) refractory to the last therapy. Part A response in 15 (1 TE) patients includes 1 PR, 3 SD and 11 (73%) PD. Toxicity over 35 cycles includes 2 (6%) grade 3 neutropenia; 2 and 3 grade 3/4 thrombocytopenia, respectively; and 3 grade 3 GI toxicities. Part B response in 25 (1 TE) patients includes 2 (8%) CR, 4 (16%) PR, and 20 (80%) NR. Twenty-three patients enrolled at bortezomib 1.7 mg/m2 (max dose). Toxicity over 58 cycles includes 31 (53%) grade 4 neutropenia; 13 (22%) grade 4 thrombocytopenia and; 12 (21%) fever/neutropenia. Transfusions were required with red cells on 22 (38%) and platelets on 18 (31%) cycles. Other toxicity included grade ≥ 3 sensory neurotoxicity in 2 (8%) patients and grade ≥ 2 GI toxicity on 32 (55%) cycles. Comparison of hematological toxicities of DA-EPOCH-bortezomib with fixed dose EPOCH in relapsed patients (JCO18:3633, 2000) was similar with fever/neutropenia 21% vs. 18%; grade 4 neutropenia 53% vs. 48% and; grade 3/4 thrombocytopenia 51% vs. 27%, respectively. GI toxicity appears higher with ≥ grade 2 on 55% vs. 14% of cycles. Neurotoxicity ≥ grade 2 was 8% vs. 22%, but patients on the present study received fewer cycles of treatment. Bortezomib alone is ineffective in relapsed/refractory DLBCL. Bortezomib can be safely combined with combination chemotherapy but does not appear to increase the efficacy of DA-EPOCH chemotherapy in relapsed/refractory DLBCL. However, compared to our previous study of EPOCH alone, most patients on the current study entered with chemotherapy-refractory disease. Results of microarray profiling are pending. Accrual continues.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2004
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  • 10
    In: Blood, American Society of Hematology, Vol. 128, No. 1 ( 2016-07-07), p. 82-92
    Abstract: Activation of BCR and canonical NF-κB signaling in the lymph node correlates with survival in MCL. Mutations and polymorphisms in BCR and NF-κB pathways may confer cell autonomous signaling and affect response to ibrutinib.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2016
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