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Peres, Lauren C.

https://orcid.org/0000-0002-6620-8600

Mayo Clinic

Moffitt Cancer Center

Citations 20

Racial and Ethnic Differences in Outcomes of Multiple Myeloma Patients Treated with Idecabtagene Vicleucel or Ciltacabtagene Autoleucel
Peres, Lauren C. , Richards, Alicia, Sidana, Surbhi , Oswald, Laura B. , Afrough, Aimaz , Shune, Leyla , Midha, Shonali , Castaneda, Omar, Ferreri, Christopher J. , Blue, Brandon , Ouchveridze, Evguenia, Bansal, Radhika , Smith, Kinaya, Avila, Gabriel De, Purvey, Sneha , Hosoya, Hitomi , Mikkilineni, Lekha , Gaballa, Mahmoud , Forsberg, Peter A. , Freeman, Ciara L. , Htut, Myo , Asoori, Sireesha, Kalariya, Nilesh, Atanackovic, Djordje , Dhakal, Binod , Khouri, Jack , Alsina, Melissa , Anderson, Larry D. , Martin, Thomas , Voorhees, Peter M. , Patel, Krina K. , Hansen, Doris K., Sborov, Douglas W. , Davis, James A. , Sidana, Surbhi , Anderson, Larry D , Davis, James A , Hosoya, Hitomi , Dima, Danai , Puglianini, Omar Castañeda , Davis, James A, Pasvolsky, Oren , Dillard, Christen , Herr, Megan M. , Kocoglu, Mehmet H. , Atrash, Shebli , Ouchveridze, Evguenia, McGuirk, Joseph P. , Wagner, Charlotte B , Costello, Patrick , Lieberman-Cribbin, Alex , Kaur, Gurbakhash , Janakiram, Murali , Dhakal, Binod , Raza, Shahzad , Reshef, Ran , Locke, Frederick L. , Nadeem, Omar , Anwer, Faiz , Richard, Shambavi , Lin, Yi , Hansen, Doris K.

Blood | December 6, 2024 | Volume: 144 | Issue: Supplement 1 | Pages: 3785-3785

10.1182/blood-2024-210078 Get It

*Authors contributed equally. Introduction. Two chimeric antigen receptor (CAR) T-cell therapies have been FDA approved for patients with relapsed/refractory multiple myeloma (RRMM): idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel). Prior work from our consortium identified racial and ethnic differences in safety and response to ide-cel among patients treated in the standard of care (SOC) setting; despite these differences, survival was similar across race and ethnicity. Here, we extend this work to investigate racial and ethnic differences in safety, efficacy, and outcomes in a larger cohort of patients treated with SOC ide-cel with longer follow-up and patients treated with SOC cilta-cel. Methods. Data for RRMM patients who underwent leukapheresis by 12/31/2022 and were treated with SOC ide-cel or cilta-cel were pooled across 19 institutions in the U.S. Multiple Myeloma Immunotherapy Consortium. We compared Non-Hispanic White, Non-Hispanic Black, and Hispanic (any race) patients, excluding other racial and ethnic groups due to small sample sizes that precluded sub-group investigations. Separately for each CAR T-cell therapy, racial and ethnic differences in baseline patient characteristics, safety, and treatment responses were examined using chi-square and Kruskal-Wallis rank sum tests. Kaplan-Meier survival curves and log-rank tests were used to examine progression-free survival (PFS) and overall survival (OS) by race and ethnicity. Results. Among 332 RRMM patients treated with ide-cel, Non-Hispanic Black and Hispanic patients comprised 17% and 10% of the cohort, respectively. Hispanic patients were younger at infusion compared to Non-Hispanic Black and Non-Hispanic White patients (55.5 vs. 63 vs. 66 years, p<0.001). Non-Hispanic Black patients had a higher disease burden (≥ 50% bone marrow plasma cell percentage) compared to Non-Hispanic White and Hispanic patients (35% vs. 20% vs. 19%, p=0.05), while a higher proportion of Non-Hispanic White patients had high-risk cytogenetics compared to Non-Hispanic Black and Hispanic patients (37% vs. 23% vs. 10%, p=0.003). Non-Hispanic Black patients were more likely to develop severe (≥ grade 3) cytopenia at day 30 (p<0.001) and day 90 (p=0.01) post-infusion, and these differences were particularly driven by higher rates of severe neutropenia among Non-Hispanic Black patients at these time points. Non-Hispanic White patients were more likely to achieve a best response of partial response (PR) or better (82%) compared to Non-Hispanic Black (75%) and Hispanic patients (63%, p=0.02). No other racial and ethnic differences in baseline patient characteristics (including cytopenias), safety, PFS, and OS were observed (p>0.05). Among 222 RRMM patients treated with cilta-cel, Non-Hispanic Black and Hispanic patients comprised 12% and 9% of the cohort, respectively. At baseline, Non-Hispanic Black and Hispanic patients were more likely to have anemia (p=0.01), and Non-Hispanic Black patients were more likely to have thrombocytopenia (p=0.02) and neutropenia (p=0.06) compared to Non-Hispanic White patients. No other differences in baseline patient characteristics were observed by race and ethnicity. While not statistically significant, a higher rate of severe (≥ grade 3) cytopenia at day 90 post-infusion was observed among Non-Hispanic Black and Hispanic patients compared to Non-Hispanic White patients (33% vs. 44% vs. 21%, p=0.07), similar to the ide-cel cohort. This finding was primarily driven by higher rates of severe neutropenia among Non-Hispanic Black patients and higher rates of anemia among Hispanic patients. No other racial and ethnic differences in safety, responses to cilta-cel, PFS, or OS were not observed in the cilta-cel cohort (p>0.05). Conclusion. In a large cohort of RRMM patients treated with SOC ide-cel or cilta-cel, we observed a higher rate of cytopenias post-infusion and inferior ide-cel responses among racial and ethnic minority patients compared to Non-Hispanic White patients. Despite these differences, survival was similar across race and ethnicity, suggesting that both available CAR T-cell therapies for RRMM patients can be utilized across all populations. Future studies that include larger patient cohorts of racially and ethnically diverse patients should be conducted to confirm these findings and additionally evaluate long-term outcomes.
Post-CAR-T Driving Restrictions after Week 4 Appear Unnecessary: Data from the United States Myeloma Immunotherapy Consortium
Richards, Alicia, Khouri, Jack , Cicero, Kara I. , Shune, Leyla , Ouchveridze, Evguenia, Afrough, Aimaz , Zanwar, Saurabh , Ferreri, Christopher J. , Mikkilineni, Lekha , Purvey, Sneha , Peres, Lauren C. , Freeman, Ciara L. , Midha, Shonali , Forsberg, Peter A. , Sborov, Douglas W. , Dhakal, Binod , Voorhees, Peter M. , Anderson, Larry D. , Martin, Thomas , Sidana, Surbhi , Patel, Krina K. , Cowan, Andrew J. , Davis, James A. , Sidana, Surbhi , Anderson, Larry D , Davis, James A , Banerjee, Rahul , Janakiram, Murali , Dima, Danai , Kocoglu, Mehmet H. , Ouchveridze, Evguenia, Jain, Tania , Pasvolsky, Oren , Beitinjaneh, Amer , Davis, James A, Wagner, Charlotte B , Herr, Megan M. , Richard, Shambavi , Reshef, Ran , Dhakal, Binod , Bachanová, Veronika , McGuirk, Joseph P. , Lin, Yi , Hansen, Doris K. , Kaur, Gurbakhash

Blood | December 6, 2024 | Volume: 144 | Issue: Supplement 1 | Pages: 3765-3765

10.1182/blood-2024-199609 Get It

Background: The FDA package inserts for all approved chimeric antigen receptor T-cell (CAR-T) therapies state that patients should universally refrain from driving for 8 weeks following infusion. However, there are no clear data to support this recommendation, particularly in multiple myeloma (MM) which all CAR-T therapies use 4-1BB as opposed to CD28 costimulatory domains. Specifically, no seizures were reported in the KarMMa, KarMMa-3, CARTITUDE-1, or CARTITUDE-4 trials. Because patients typically return to their referring oncologists after Day (D) +28 following CAR-T infusion, an additional month of driving restrictions can create confusion for referring oncologists, impose significant burdens for patients and caregivers, and potentially even affect the choice of MM therapy for patients living in remote areas. Methods: We conducted a two-part study within the US MM Immunotherapy Consortium. Firstly, we analyzed data from commercial idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel) recipients (leukapheresis cutoff December 31, 2023) to identify the prevalence of CRS, ICANS, or death between Weeks 5-8 (D+29 to D+56) following CAR-T (Day 0). Patients with index hospital stays lasting over 4 weeks and patients with <8 weeks of post-CAR-T follow-up were excluded. Secondly, we surveyed Consortium members about the prevalence of impaired driving risk (defined as “anything that could impair a patient's ability to drive safely, e.g. seizures, altered mental status, blindness, etc.”) and used 1-5 Likert scales to gauge the perceived importance of driving restrictions (assuming no FDA guidance existed) during Weeks 0-4 vs 5-8. This anonymous IRB-exempted survey was distributed via email to 63 CAR-T-prescribing physicians within the Consortium. Results: Of 553 analyzed patients, 41% (n=224) had received cilta-cel and 59% (n=329) ide-cel. The median age was 64 (IQR 58-70), 42% (n=231) were female, 78% White (n=434), 13% (n=72) Black, and 9% (n=51) Hispanic. ECOG PS at infusion was ≥2 in 11% (n=63) of patients, and 5% (n=28) had had previous CNS co-morbidities such as prior strokes. One patient (0.2%) developed Grade 2 CRS during Weeks 5-8 (onset D+47, resolution one day later); no patients had de novo ICANS after D+28. There were 16 cases of non-ICANS neurotoxicity (including 2 cases of Parkinsonism) diagnosed a median of 24 days after CAR-T (range: 17-147 days), of which 3 cases (all non-Parkinsonian) were first diagnosed during Weeks 5-8. There were 10 deaths (2%) during Weeks 5-8, one due to infection and the remainder from progressive MM. The survey was completed by 45 oncologists (71% response rate), 41 of whom had managed both >5 ide-cel and >5 cilta-cel recipients. Regarding impaired driving during Weeks 0-4, 20% of physicians felt this was never a risk, 36% a risk for 1-2% of patients, 29% a risk for 3-10% of patients, and 16% a risk for >10% of patients. The distribution was significantly different (p < 0.01) for Weeks 5-8: 49% never a risk, 36% a risk for 1-2% of patients, 16% a risk for 3-10% of patients, while no respondents felt this remained a risk for >10% of patients. For Weeks 0-4, 73% agreed that patients should be advised not to drive while 9% disagreed. In contrast, for Weeks 5-8, 14% of physicians agreed with driving restrictions while 78% disagreed (p < 0.01 compared to Weeks 0-4). Discussion: Our two-part study demonstrates that driving restrictions following Week 4 after CAR-T therapy in MM may not be required. The incidence of de novo CRS or any-type neurotoxicity being diagnosed during Weeks 5-8 was <1%, and - if such toxicities developed - patients and physicians could be expected to set appropriate restrictions at that juncture. While 73% of CAR-T-prescribing oncologists agreed that patients should refrain from driving during Weeks 0-4, 78% disagreed with this recommendation during Weeks 5-8. These findings complement other real-world studies (Wesson, Dima, et al, TCT 2024; Ahmed et al, Blood Advances 2024) reporting the rarity of CRS and ICANS after the first month in both MM and lymphoma. Our study is limited by a lack of patient-reported data, which was done intentionally to avoid asking patients about activities undertaken against medical advice. Nevertheless, we believe that narrowing universal driving restrictions to Weeks 0-4 following CAR-T therapy would constitute an evidence-based modification to the package inserts for ide-cel and cilta-cel.
Comparative Safety and Efficacy of Ciltacabtagene Autoleucel and Idecabtagene Vicleucel CAR T-Cell Therapies in Relapsed or Refractory Multiple Myeloma
Hansen, Doris K., Peres, Lauren C. , Richards, Alicia, Shune, Leyla , Afrough, Aimaz , Midha, Shonali , Dhakal, Binod , Ferreri, Christopher, Davis, James A. , Ouchveridze, Evguenia, Bansal, Radhika , Smith, Kinaya, Avila, Gabriel De, Purvey, Sneha , Hosoya, Hitomi , Mikkilineni, Lekha , Oswald, Laura B. , Gaballa, Mahmoud , Forsberg, Peter A. , Htut, Myo , Asoori, Sireesha, Kalariya, Nilesh, Hashmi, Hamza , Sborov, Douglas W. , Khouri, Jack , Atanackovic, Djordje , Alsina, Melissa , Freeman, Ciara L. , Voorhees, Peter M. , Anderson, Larry D. , Martin, Thomas , Lin, Yi, Patel, Krina K. , Sidana, Surbhi , Sidana, Surbhi , Anderson, Larry D , Davis, James A , Hosoya, Hitomi , Hansen, Doris K. , Dima, Danai , Dhakal, Binod , Kocoglu, Mehmet H. , Atrash, Shebli , Puglianini, Omar Castañeda , Ouchveridze, Evguenia, McGuirk, Joseph P. , Wagner, Charlotte B , Costello, Patrick , Lieberman-Cribbin, Alex , Kaur, Gurbakhash , Pasvolsky, Oren , Herr, Megan M. , Janakiram, Murali , Reshef, Ran , Nadeem, Omar , Anwer, Faiz , Raza, Shahzad , Locke, Frederick L. , Richard, Shambavi

Blood | December 5, 2024 | Volume: 144 | Issue: Supplement 1 | Pages: 936-936

10.1182/blood-2024-194390 Get It

Introduction. Ciltacabtagene autoleucel (cilta-cel) and idecabtagene vicleucel (ide-cel), two anti-B-cell maturation antigen (BCMA) CAR T therapies, have demonstrated remarkable responses and improved survival among patients with relapsed/refractory multiple myeloma (RRMM) in the clinical trials and standard of care (SOC) setting. Here, we compare safety, efficacy, and survival for patients treated with SOC ide-cel and cilta-cel. Methods. Data were from a retrospective chart review of RRMM patients leukapheresed by 12/31/2022 with the intent to receive SOC ide- or cilta-cel at 19 institutions in the US Multiple Myeloma Immunotherapy Consortium. An inverse probability of treatment weighting (IPTW) approach was used to compare outcomes by therapy type (cilta- vs. ide-cel), balancing on age, sex, race and ethnicity, performance status, extramedullary disease, high-risk cytogenetics, prior BCMA therapy, bone marrow plasma cells, penta-refractory status, lymphodepleting chemotherapy, baseline ferritin, low cell dose, and bridging therapy response. Logistic regression and Cox proportional hazard models were used to examine the association of treatment type with safety, efficacy, and survival accordingly, while adjusting for IPTW weights. We employed propensity score matching utilizing the same covariates to identify the association of treatment type with progression-free survival (PFS) within relevant patient sub-groups. Results. A total of 641 patients were leukapheresed by 12/31/2022 with ide-cel (n=386) and cilta-cel (n=255). 586 patients were infused (n=350 for ide-cel; n=236 for cilta-cel) with a median follow-up of 13.0 and 12.6 months, respectively. After IPTW, patient characteristics were well-balanced. Patients treated with cilta-cel were more likely to have grade ≥ 3 cytokine release syndrome (CRS) (OR=5.52, 95% CI=1.76-17.30, p=0.004), infections (OR=2.07, 95% CI=1.44-2.97, p<0.001), and delayed neurotoxicity (NT) (OR=20.97, 95% CI=4.75-92.42, p<0.001) compared to patients treated with ide-cel. In the cilta-cel cohort, 24 patients (10%) experienced delayed NT compared to 2 patients (1%) in the ide-cel cohort. Although not statistically significant, patients treated with cilta-cel were more likely to have any second primary malignancies (SPMs) (OR=1.87, 95% CI=0.94-3.71, p=0.08) and any SPMs excluding non-melanoma skin cancers (OR=1.78, 95% CI=0.78-4.10, p=0.2) but no association was observed for odds of hematologic SPMs (OR=0.98, 95% CI=0.26-3.61). No association was observed for therapy type with any or severe immune effector cell-associated neurotoxicity syndrome, any CRS, severe cytopenias, and non-relapse mortality. Compared to ide-cel, cilta-cel was associated with better treatment responses of ≥ complete response (OR=2.38, 95% CI=1.61-3.51, p<0.001) and ≥ partial response (OR=1.74, 95% CI=0.99-3.05, p=0.06). Patients treated with cilta-cel had a longer PFS and overall survival (OS) than ide-cel (HR=0.47, 95% CI=0.35-0.62, p<0.001 and HR=0.63, 95% CI=0.42-0.93, p=0.02, respectively), and these findings were similar in the intention to treat cohort (PFS: HR=0.44, 95% CI=0.34-0.55, p<0.001; OS: HR=0.55, 95% CI=0.41-0.73, p<0.001, respectively). We observed consistent findings when repeating the analyses restricting the ide-cel cohort to patients infused during the same time-period as FDA approval for cilta-cel (≥ March 2022), restricting to patients with data on all covariates, and restricting to sites that contributed data for both products. In a propensity matched population, (n=380; n=190 for cilta-cel and n=190 for ide-cel), patients treated with cilta-cel had superior PFS compared to those treated with ide-cel in most subgroups with respect to age and disease characteristics including extramedullary disease, high-risk cytogenetics, and elevated baseline ferritin (p<0.05). Conclusion. Our results suggest superior efficacy of cilta-cel with a higher incidence of certain toxicities compared to ide-cel in the SOC setting. This study provides valuable information for patient counseling and guiding the selection of CAR T-cell therapy for specific patient populations. Further validation through similar large-scale real-world experiences or prospective studies is needed to confirm our results and enhance applicability in the clinical setting. *DH, LP, & DD are co-first authors * YL, KP, & SS are co-last authors
Safety and efficacy of standard-of-care ciltacabtagene autoleucel for relapsed/refractory multiple myeloma
Sidana, Surbhi , Patel, Krina K. , Peres, Lauren C. , Bansal, Radhika , Kocoglu, Mehmet H. , Shune, Leyla , Atrash, Shebli , Smith, Kinaya, Midha, Shonali , Ferreri, Christopher J. , Dhakal, Binod , Wagner, Charlotte B , Hosoya, Hitomi , Mikkilineni, Lekha , Atanackovic, Djordje , Mann, Hashim , Kalariya, Nilesh, Hovanky, Vanna, DeAvila, Gabriel, Freeman, Ciara L. , Alsina, Melissa , Wong, Sandy W. , Htut, Myo , Sborov, Douglas W. , Khouri, Jack , Janakiram, Murali , Lin, Yi, Dima, Danai , Wagner, Charlotte , Atanackovic, Djordje , Chhabra, Saurabh , Parrondo, Ricardo D , Mann, Hashim , Freeman, Ciara L , Herr, Megan M. , McGuirk, Joseph , Sborov, Douglas W , Khouri, Jack , Sidana, Surbhi , Kocoglu, Mehmet H , Patel, Krina , Atrash, Shebli , Hosoya, Hitomi , Janakiram, Murali , Dhakal, Binod , Dima, Danai , Costello, Patrick , Reshef, Ran , Chhabra, Saurabh , Nadeem, Omar , Locke, Frederick L. , McGuirk, Joseph P. , Martin, Thomas , Hansen, Doris K.

Blood | October 4, 2024 | Volume: 145 | Issue: 1 | Pages: 85-97

10.1182/blood.2024025945 Get It

Abstract Ciltacabtagene autoleucel (cilta-cel) was approved in 2022 for patients with relapsed/refractory multiple myeloma (RRMM). We report outcomes with cilta-cel in the standard-of-care setting. Patients with RRMM who underwent leukapheresis for cilta-cel manufacturing between 1 March 2022 and 31 December 2022 at 16 US academic medical centers were included. Overall, 255 patients underwent leukapheresis and 236 (92.5%) received cilta-cel, of which 54% would not have met CARTITUDE-1 eligibility criteria. In treated patients (N = 236), cytokine release syndrome was seen in 75% (grade ≥3, 5%), immune effector cell–associated neurotoxicity syndrome in 14% (grade ≥3, 4%), and delayed neurotoxicity in 10%. Overall and complete response rates were as follows: all patients who received cilta-cel (N = 236), 89% and 70%; patients receiving conforming cilta-cel (n = 191), 94% and 74%; and conforming cilta-cel with fludarabine/cyclophosphamide lymphodepletion (n = 152), 95% and 76%, respectively. Nonrelapse mortality was 10%, most commonly from infection. After a median follow-up of 13 months from cilta-cel, the median progression-free survival (PFS) was not reached, with 12-month estimate being 68% (95% confidence interval, 62-74). High ferritin levels, high-risk cytogenetics, and extramedullary disease were independently associated with inferior PFS, with a signal for prior B-cell maturation antigen–targeted therapy (P = .08). Second primary malignancies excluding nonmelanoma skin cancers were seen in 5.5% and myeloid malignancies/acute leukemia in 1.7%. We observed a favorable efficacy profile of standard-of-care cilta-cel in RRMM, despite more than half the patients not meeting the CARTITUDE-1 eligibility criteria.
Assessment of BRCA1 and BRCA2 Germline Variant Data From Patients With Breast Cancer in a Real-World Data Registry
Nepomuceno, Thales C. , Lyra, Paulo C. , Zhu, Jianbin , Yi, Fanchao, MARTIN, R , Lupu, Daniel S. , Peterson, Luke F., Peres, Lauren C. , Berry, Anna B. , Iversen, Edwin S. , Iversen, Ed , Martin, Rachael H , Lupu, Daniel , Berry, Anna , Couch, Fergus J. , Mo, Qianxing , Monteiro, Alvaro N , Morais Lyra, Paulo Cilas , Peterson, Luke, Couch, Fergus J. , Monteiro, Álvaro N.A.

JCO Clinical Cancer Informatics | May 3, 2024 | Volume: No volume available | Issue: 8 | Pages: No page available

10.1200/cci.23.00251 Get It

PURPOSE The emergence of large real-world clinical databases and tools to mine electronic medical records has allowed for an unprecedented look at large data sets with clinical and epidemiologic correlates. In clinical cancer genetics, real-world databases allow for the investigation of prevalence and effectiveness of prevention strategies and targeted treatments and for the identification of barriers to better outcomes. However, real-world data sets have inherent biases and problems (eg, selection bias, incomplete data, measurement error) that may hamper adequate analysis and affect statistical power. METHODS Here, we leverage a real-world clinical data set from a large health network for patients with breast cancer tested for variants in BRCA1 and BRCA2 (N = 12,423). We conducted data cleaning and harmonization, cross-referenced with publicly available databases, performed variant reassessment and functional assays, and used functional data to inform a variant's clinical significance applying American College of Medical Geneticists and the Association of Molecular Pathology guidelines. RESULTS In the cohort, White and Black patients were over-represented, whereas non-White Hispanic and Asian patients were under-represented. Incorrect or missing variant designations were the most significant contributor to data loss. While manual curation corrected many incorrect designations, a sizable fraction of patient carriers remained with incorrect or missing variant designations. Despite the large number of patients with clinical significance not reported, original reported clinical significance assessments were accurate. Reassessment of variants in which clinical significance was not reported led to a marked improvement in data quality. CONCLUSION We identify the most common issues with BRCA1 and BRCA2 testing data entry and suggest approaches to minimize data loss and keep interpretation of clinical significance of variants up to date.
Real-World Impact of Bridging Therapy on Outcomes of Ide-cel for Myeloma in the U.S. Myeloma Immunotherapy Consortium
Afrough, Aimaz , Hashmi, Hamza , Hansen, Doris K. , Peres, Lauren C. , Dima, Danai , Freeman, Ciara L. , Puglianini, Omar Castañeda , Voorhees, Peter M. , Shune, Leyla , Simmons, Gary , Sborov, Douglas W. , Kaur, Gurbakash, Sannareddy, Aishwarya , Ferreri, Christopher J. , Gaballa, Mahmoud , Janakiram, Murali , Midha, Shonali , Wagner, Charlotte B , Patel, Krina K. , Khouri, Jack , Castaneda Puglianini, Omar , Dima, Danai , Wagner, Charlotte , Janakiram, Murali , Hansen, Doris K

No container title available | December 7, 2023 | Volume: No volume available | Issue: No issue available | Pages: No page available

10.21203/rs.3.rs-3477431/v1 Get It

Abstract In a retrospective analysis at 11 US medical centers, bridging therapy (BT) impact after receiving idecabtagene vicleucel was assessed in 214 patients. 79% received BT, including 12% Selinexor-containing, 45% alkylator-based, 15% proteasome inhibitor combinations, and 18% immunomodulatory drugs +/- monoclonal antibody combinations (IMiD +/- mAb combos). BT recipients had worse performance status, higher stage disease, ferritin and CRP pre-infusion. The overall response rate to BT was 12%, with no difference among BT subgroups. Safety profiles were similar, but Selinexor had a higher grade ≥2 ICANS incidence. Median progression-free survival (PFS) was 6.7 months in BT vs. 11.5 months in no-BT (p=0.007). Median PFS was longest with IMiD +/- mAb combos (12 months), comparable to no-BT, and significantly longer than other BT subgroups (p=0.01). Alkylator-based BT had inferior PFS compared to IMiD +/- mAb combos (p=0.03). Median overall survival (OS) for the BT was 13.8 months vs. not reached in no-BT (p=0.002). Alkylator-based BT had shorter OS compared to others (11.97 months vs. NR; p=0.001). Stepwise Cox regression showed alkylator-based BT and response
Racial and ethnic differences in clinical outcomes among patients with multiple myeloma treated with CAR T-cell therapy
Peres, Lauren C. , Oswald, Laura B. , Dillard, Christen , Avila, Gabriel De, Nishihori, Taiga , Blue, Brandon , Freeman, Ciara L. , Alsina, Melissa , Puglianini, Omar Castañeda , Shune, Leyla , Sborov, Douglas W. , Wagner, Charlotte B , Hashmi, Hamza , Davis, James A. , Badros, Ashraf , Simmons, Gary , Kalariya, Nilesh, Ferreri, Christopher J. , Anderson, Larry D. , Afrough, Aimaz , Liu, Lawrence , Voorhees, Peter M. , Khouri, Jack , Sidana, Surbhi , Patel, Krina K. , Dillard, Christen M , Castaneda Puglianini, Omar , Sborov, Douglas W , Wagner, Charlotte , Dima, Danai , Hashmi, Hamza , Davis, James A , Kocoglu, Mehmet H , Badros, Ashraf Z , Ferreri, Christopher , Anderson, Larry D , Kaur, Gurbakhash , Liu, Lawrence , Voorhees, Peter , Khouri, Jack , McGuirk, Joseph , Sidana, Surbhi , Patel, Krina , Nishihori, Taiga , Locke, Frederick L. , Dima, Danai , Kocoglu, Mehmet H. , Atrash, Shebli , Kaur, Gurbakhash , Lin, Yi , Nadeem, Omar , McGuirk, Joseph P. , Hansen, Doris K.

Blood Advances | October 19, 2023 | Volume: 8 | Issue: 1 | Pages: 251-259

10.1182/bloodadvances.2023010894 Get It

Abstract Idecabtagene vicleucel (ide-cel) was the first chimeric antigen receptor T-cell therapy to gain US Food and Drug Administration approval for patients with relapsed/refractory multiple myeloma (RRMM). The clinical outcomes of standard of care (SOC) ide-cel in racially and ethnically diverse populations have been understudied. This study pooled data from 207 patients with RRMM (28% patients of racial and ethnic minority groups) treated with SOC ide-cel across 11 institutions to examine racial and ethnic differences in the incidence of toxicities and adverse events, response to ide-cel, and survival. This study included 22 (11%) Hispanic, 36 (17%) non-Hispanic Black, and 149 (72%) non-Hispanic White patients with RRMM. Compared with Hispanic and non-Hispanic White patients, non-Hispanic Black patients had higher median levels of C-reactive protein (1.0, 0.8, and 3.5 mg/dL, respectively; P = .02) and baseline ferritin (362.0 vs 307.0 vs 680.5, respectively; P = .08) and were more likely to develop cytokine release syndrome (77%, 85%, and 97%, respectively; P = .04). Although best overall response rate was lower among Hispanic patients (59%) than among non-Hispanic Black (86%) and White patients (86%; P = .01), there were no racial and ethnic differences in progression-free or overall survival. We provide, to our knowledge, the first and largest investigation of clinical outcomes of SOC ide-cel by race and ethnicity. Despite differences in safety and response to ide-cel, our findings encourage the use of ide-cel in all patients with RRMM. These findings should be confirmed in larger samples of diverse patients with RRMM, with longer follow-up time.
Safety and efficacy of standard of care (SOC) ciltacabtagene autoleucel (Cilta-cel) for relapsed/refractory multiple myeloma (RRMM).
Patel, Krina K. , Peres, Lauren C. , Shune, Leyla , Simmons, Gary , Ferreri, Christopher J. , Midha, Shonali , Alsina, Melissa , Voorhees, Peter M. , Htut, Myo, Sborov, Douglas W. , Khouri, Jack , Hansen, Doris K. , Kocoglu, Mehmet H. , Atrash, Shebli , Parrondo, Ricardo D , Chhabra, Saurabh , Costello, Patrick , Htut, Myo , Janakiram, Murali , Lin, Yi , Sidana, Surbhi

Journal of Clinical Oncology | June 4, 2023 | Volume: 41 | Issue: 16_suppl | Pages: 8012-8012

10.1200/jco.2023.41.16_suppl.8012 Get It

8012 Background: Cilta-cel was FDA approved in 2022 for the treatment of RRMM. We evaluated the outcomes of patients treated with intended SOC cilta-cel. Methods: 12 US academic medical centers contributed data to this retrospective study. As of 12/31/2022, 177 patients were leukapheresed and 139 received cilta-cel. Results: The table describes the study population compared to the CARTITUDE-1 trial. More patients in our study had extramedullary disease (EMD, 35%) and high-risk cytogenetics (41%). 55% of the patients would not have met eligibility criteria for CARTITUDE-1. Common reasons for ineligibility were cytopenias (19%), prior BCMA therapy (14%), organ dysfunction (12%), oligosecretory disease (13%), and plasma cell leukemia (8%). 83% of the patients received bridging chemotherapy (overall response rate, ORR: 28%). Lymphodepletion included fludarabine (Flu) + cyclophosphamide (Cy): 81%, bendamustine: 11%, Cy: 4%, and cladribine + Cy: 4%. Median CAR-T cells infused were 0.6 million/kg (range: 0.1-0.9), and 19% of patients were treated on an expanded access protocol (EAP). Median follow-up was 2.3 months (range: 0-8). Cytokine release syndrome (CRS) was seen in 81% (≥ grade 3: 7%) and immune effector cell-associated neurotoxicity syndrome (ICANS) in 22% (≥ grade 3: 8%) of patients. Tocilizumab, steroids, and anakinra were used in 61%, 44%, and 10% of patients, respectively. Delayed neurotoxicity (NT) was seen in 9% (cranial nerve palsy: 8, Parkinsonism: 2, others: 3). Grade ≥ 3 cytopenias at day ≥ 30 were seen in 75% of patients. Infections were seen in 32% of patients. Day 30 (N=115) and best response rates (N=118) were: ≥ partial response (PR), 75/80%; ≥ very good PR, 44/62%; and ≥ complete response (CR), 26/40%, respectively. In the non-EAP FluCy population (N=88), best ORR/≥CR were 89/49%. 17 patients died by data cut-off, 4 due to disease progression and 13 (9%) due to non-relapse mortality (NRM) (grade 5 CRS: 3, infection: 6, CRS/infection: 1, grade 5 ICANS: 1, delayed NT: 2). Conclusions: Patients treated with intended SOC cilta-cel had a favorable ORR (80%) despite a larger proportion of patients having high-risk features relative to trial patients and limited follow-up. Response rates were higher in patients receiving conforming products with FluCy conditioning (89%). Delayed NT and NRM were seen in 9% of patients. Results will be updated with continued follow-up. D.K.H., K.K.P, M.J., Y.L. & S.S. contributed equally. [Table: see text]
Evaluation of vitamin D biosynthesis and pathway target genes reveals UGT2A1/2 and EGFR polymorphisms associated with epithelial ovarian cancer in African American Women
Grant, Delores J. , Alberg, Anthony J. , Barnholtz‐Sloan, Jill S. , Bondy, Melissa L. , Funkhouser, Ellen, Moorman, Patricia G. , Peres, Lauren C. , Peters, Edward , Schwartz, Ann G. , Terry, Paul , Wang, Xin‐Qun, Hoyo, Cathrine , Sandler, Dale P. , Taylor, Jack A. , Edwards, Todd L., Beeghly‐Fadiel, Alicia, Wentzensen, Nicolas , Pearce, Celeste Leigh , Wu, Anna H. , Whittemore, Alice S. , McGuire, Valerie , Sieh, Weiva , Rothstein, Joseph H. , Ness, Roberta B., Moysich, Kirsten B. , Rossing, Mary Anne, Sellers, Thomas A. , Monteiro, Álvaro N.A. , Levine, Douglas A. , Haiman, Christopher A. , Menon, Usha , Ramus, Susan J. , Gayther, Simon A. , Terry, Kathryn L. , Goode, Ellen L. , Cannioto, Rikki , Odunsi, Kunle , Etter, John Lewis , Huang, Ruea‐Yea , Bernardini, Marcus Q. , Tone, Alicia , May, Taymaa, Goodman, Marc T. , Thompson, Pamela J., Carney, Michael E. , Tworoger, Shelley S. , Lambrechts, Diether , Vergote, Ignace , Nieuwenhuysen, Els Van , Salvensen, Helga B., Massuger, Leon F.A.G. , Bruegl, Amanda , Moffitt, Melissa , Le, Nhu D. , Brooks‐Wilson, Angela , Kelemen, Linda E. , Song, Honglin , Eccles, Diana , DeFazio, Anna , Kennedy, Catherine J. , Schildkraut, Joellen M. , Lambrechts, Diether , Barnholtz-Sloan, Jill S , Moysich, Kirsten , Permuth, Jennifer B , Cramer, Daniel W , Fazio, Anna de , Lambrechts, Diether , Ramus, Susan J , Sandler, Dale P , Tworoger, Shelley S , Eccles, Diana , Menon, Usha , Monteiro, Alvaro N , Brooks-Wilson, Angela R , Kennedy, Catherine J , Lambrechts, Diether , Sieh, Weiva , Taylor, Jack A , Goodman, Marc T , Manichaikul, Ani , Bandera, Elisa V. , Coté, Michele L. , Keku, Temitope O , Berchuck, Andrew , O’Brien, Katie M. , Edwards, Digna R. Velez , Beeghly‐Fadiel, Alicia , Modugno, Francesmary , Doherty, Jennifer A. , Permuth, Jennifer B. , Setiawan, Veronica Wendy , Marchand, Loı̈c Le , Wilkens, Lynne R. , Karlan, Beth Y. , Gentry‐Maharaj, Aleksandra , Cramer, Daniel W. , Larson, Melissa C. , Kaufmann, Scott H. , Poole, Elizabeth M. , Vanderstichele, Adriaan , Anton‐Culver, Hoda , Ziogas, Argyrios , Brenton, James D. , Bjørge, Line , Kiemeney, Lambertus A. , Pejovic, Tanja B. , Cook, Linda S. , Pharoah, Paul D.P. , Campbell, Ian

Cancer Medicine | April 19, 2019 | Volume: 8 | Issue: 5 | Pages: 2503-2513

10.1002/cam4.1996 Get It

AbstractAn association between genetic variants in the vitamin D receptor (VDR) gene and epithelial ovarian cancer (EOC) was previously reported in women of African ancestry (AA). We sought to examine associations between genetic variants in VDR and additional genes from vitamin D biosynthesis and pathway targets (EGFR, UGT1A, UGT2A1/2, UGT2B, CYP3A4/5, CYP2R1, CYP27B1, CYP24A1, CYP11A1, and GC). Genotyping was performed using the custom‐designed 533,631 SNP Illumina OncoArray with imputation to the 1,000 Genomes Phase 3 v5 reference set in 755 EOC cases, including 537 high‐grade serous (HGSOC), and 1,235 controls. All subjects are of African ancestry (AA). Logistic regression was performed to estimate odds ratios (OR) and 95% confidence intervals (CI). We further evaluated statistical significance of selected SNPs using the Bayesian False Discovery Probability (BFDP). A significant association with EOC was identified in the UGT2A1/2 region for the SNP rs10017134 (per allele OR = 1.4, 95% CI = 1.2‐1.7, P = 1.2 × 10−6, BFDP = 0.02); and an association with HGSOC was identified in the EGFR region for the SNP rs114972508 (per allele OR = 2.3, 95% CI = 1.6‐3.4, P = 1.6 × 10−5, BFDP = 0.29) and in the UGT2A1/2 region again for rs1017134 (per allele OR = 1.4, 95% CI = 1.2‐1.7, P = 2.3 × 10−5, BFDP = 0.23). Genetic variants in the EGFR and UGT2A1/2 may increase susceptibility of EOC in AA women. Future studies to validate these findings are warranted. Alterations in EGFR and UGT2A1/2 could perturb enzyme efficacy, proliferation in ovaries, impact and mark susceptibility to EOC.
Abstract 1307: Identification of novel epithelial ovarian cancer loci in women of African ancestry from the Ovarian Cancer Association Consortium
Peres, Lauren C. , Wang, Xin-Qun , Lawrenson, Kate , Abbott, Sarah, Schwartz, Ann G. , Wu, Anna H. , Peters, Edward , Moorman, Patricia G. , Kelemen, Linda E., Goode, Ellen L. , Gather, Simon A., Schildkraut, Joellen, Manichaikul, Ani , Abbott, Sarah, Coté, Michele L. , Bondy, Melissa L. , Barnholtz‐Sloan, Jill S. , Berchuck, Andrew , Doherty, Jennifer A. , Pharoah, Paul D.P. , Lawrenson, Kate

Cancer Research | July 31, 2017 | Volume: 77 | Issue: 13_Supplement | Pages: 1307-1307

10.1158/1538-7445.am2017-1307 Get It

Abstract Epithelial ovarian cancer (EOC) is a rare but deadly disease for which there is notably poorer survival in women of African Ancestry (AA) compared to women of European Ancestry (EA). Previous EA-based genome-wide association studies (GWAS) have identified 30 common, low penetrant EOC susceptibility alleles. Using the custom-designed 533,631 SNP Illumina OncoArray and imputation to ~12 million genetic variants in the 1000 Genomes Phase 3, we conducted a GWAS in 755 AA EOC cases, including 537 high-grade serous ovarian cancer (HGSOC) cases, and 1,235 AA controls from the Ovarian Cancer Association Consortium (OCAC). We identified novel susceptibility loci with suggestive evidence of association with EOC, based on a threshold of P<1x10-6, at three distinct loci including 10p15.1 (lead SNP rs4525119, intronic to AKR1C3, P=4.9 x 10-7, minor allele frequency [MAF]=0.33), 3p25.3 (lead SNP rs7643459, intronic to LOC101927394, P=8.4 x 10-7, MAF=0.36), and 4q13.3 (lead SNP rs4286604, 15 kb 3’ of UGT2A1, P=8.5x10-7, MAF=0.27). In analysis of HGSOC, we identified suggestive evidence of association at six distinct loci including 5q11.2 (lead SNP rs37792, 132 kb 5’ of FST, P=6.0x10-8, MAF=0.34), Xq27.2 (lead SNP rs57403204, 81 kb 3' of MAGEC1, P=1.7x10-7, MAF=0.06), 10p15.1 (lead SNP rs79079890, LOC105376360 intronic, P=3.0x10-7, MAF=0.03), 17p25.1 (lead SNP rs66459581, 5 kb 5’ of PRPSAP1, P=5.1x10-7, MAF=0.23), 15p12 (lead SNP rs116046250, GABRG3 intronic, P=8.7x10-7, MAF=0.05), and 4q21.21 (lead SNP rs192876988, 30 kb 3’ of GK2, P=9.2x10-7, MAF=0.05). These SNPs showed no evidence of association with risk in the OCAC EA GWAS including up to 23,543 EOC cases and 29,444 controls. Of the SNPs identified with suggestive evidence of association in our GWAS, two are located near genes known to regulate hormones and previously reported in relation to diseases of the ovary (AKR1C3 and FST), two have been linked to cancer (AKR1C3 and MAGEC1) and one represents testis-specific expression (GK2). Of the 30 SNPs identified previously in a EA EOC GWAS, we observed nominally significant associations (P<0.05) with consistent direction of effect for eight SNPs in AA women. Our investigation presents evidence of (1) variants for EOC shared among EA and AA women and (2) novel EOC risk loci of importance for AA women. Citation Format: Ani Manichaikul, Lauren C. Peres, Xin-Qun Wang, Kate Lawrenson, Sarah Abbott, Ann G. Schwartz, Anna H. Wu, Edward Peters, Patricia G. Moorman, Michele L. Cote, Melissa Bondy, Linda Kelemen, Ellen L. Goode, Jill Barnholtz-Sloan, Simon A. Gather, Andrew Berchuck, Jennifer A. Doherty, Paul Pharoah, Joellen Schildkraut. Identification of novel epithelial ovarian cancer loci in women of African ancestry from the Ovarian Cancer Association Consortium [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1307. doi:10.1158/1538-7445.AM2017-1307