Prognostic relevance of circulating lymphoma cells at diagnosis in newly diagnosed follicular lymphoma patients.

Follicular lymphoma (FL) is the most common indolent B-cell non-Hodgkin lymphoma. Circulating lymphoma (CL) cells can be seen at diagnosis in some FL patients, however, previous studies evaluating this have shown mixed results. Therefore, we sought to evaluate the impact of CL at diagnosis on outcomes in patients with newly diagnosed FL using data from a single center. Patients were divided into CL+ and CL- based on immunophenotyping via peripheral blood (PB) flow cytometry. CL was defined as detectable clonally restricted B-cells that matched the actual or expected B-cell immunophenotype of FL. The primary endpoint was progression-free survival (PFS) after first-line treatment and secondary endpoints included overall response rate (ORR), overall survival (OS), diagnosis to treatment interval (DTI), progression of disease within 2 years of diagnosis (POD24), and cumulative incidence of transformation between the two groups. Among the 541 patients with FL, 204 had PB flow cytometry performed at diagnosis, and after excluding patients not meeting the eligibility criteria, 147 cases remained with 24 (16%) CL+ at diagnosis. Patients in the CL+ group were younger (53 vs. 58 years, p = 0.02), had more extranodal involvement (83% vs. 44%, p < 0.01), follicular lymphoma international prognostic index 3-5 (55% vs. 31%, p = 0.01), and a higher proportion received first-line immunochemotherapy (75% vs. 43%, p = 0.01) compared to the CL-group. The median PFS was not significantly different between CL+ (6.27 years, 95% CI = 3.61-NR) and CL- (6.61 years, 95% CI = 5.10-9.82) cohorts regardless of the first-line treatment or level of absolute PB CL cells. There was no significant difference in ORR, median OS, DTI, POD24, and cumulative incidence of transformation between the two groups. In our study, we found that the presence of CL cells at diagnosis in FL in the contemporary era did not impact outcomes and survival.

Brentuximab Vedotin Plus Ibrutinib in Relapsed and Refractory Hodgkin Lymphoma.

INTRODUCTION: Brentuximab vedotin (BV) is an antibody-drug conjugate that delivers monomethyl auristatin E (MMAE) to CD30+ cells and is safe and effective in relapsed/refractory (r/r) Hodgkin lymphoma (HL). Although most patients respond to BV, only a minority will obtain a complete response (CR), and almost all patients eventually progress. Ibrutinib is a Bruton's tyrosine kinase (BTK) inhibitor highly active in multiple subtypes of non-Hodgkin lymphoma; limited data exist regarding its use in HL. It irreversibly inhibits interleukin-2-inducible kinase (ITK) with Th1 based immune responses. As we previously observed preclinical synergy between ibrutinib and BV, we hypothesized ibrutinib may enhance the antitumor activity of BV in HL. We designed and conducted a phase II trial of ibrutinib plus BV in patients with R/R HL, and herein report the final primary analysis of safety and efficacy. METHODS: This was a multicenter phase II trial with a lead-in cohort in patients with r/r HL. Eligibility criteria included age ≥ 15 years with r/r HL after at least one prior line of therapy. Treatment consisted of 1.8 mg/kg BV intravenously every 3 weeks and ibrutinib 560 mg PO daily (420 mg PO daily in the lead-in cohort). Prior BV was allowed if patients were not refractory. The primary endpoint was the CR rate according to Lugano 2014. Secondary endpoints included toxicities, overall response rate (ORR), and duration of response (DOR). RESULTS: The 39 patients were enrolled onto the study, of which 67% were male; the median age was 33 (range: 17-71). 38% had extranodal disease at baseline, 51% had advanced stage disease, 51% were refractory to the prior therapy, and 21% had prior BV. Of 36 patients who were evaluable for response, the CR rate was 33% and ORR 64%; median DOR was 25.5 months. Thirteen patients proceeded to autologous transplant and 3 patients proceeded to allogeneic transplant for consolidation after response. The most common adverse events were nausea (67%), peripheral neuropathy (62%), diarrhea (59%), fatigue (46%), thrombocytopenia (46%), headache (41%), rash (41%), elevated ALT (38%), anemia (36%), vomiting (36%), abdominal pain (33%), fever (33%), and hypertension (33%). Six patients experienced unacceptable toxicity, defined as Gr 3/4 non-hematologic toxicity or non-resolving Gr 3/4 hematologic toxicity including one patient who died of multiorgan failure from suspected COVID-19 infection during cycle 1. DISCUSSION: The combination of BV and ibrutinib was active in r/r HL; however, given significant toxicity, it cannot be recommended for future development.

Postinfusion PD-1+ CD8+ CAR T cells identify patients responsive to CD19 CAR T-cell therapy in non-Hodgkin lymphoma.

ABSTRACT: Chimeric antigen receptor (CAR) T-cell therapy has revolutionized treatment for relapsed/refractory B-cell non-Hodgkin lymphoma (NHL). Robust biomarkers and a complete understanding of CAR T-cell function in the postinfusion phase remain limited. Here, we used a 37-color spectral flow cytometry panel to perform high dimensional single-cell analysis of postinfusion samples in 26 patients treated with CD28 costimulatory domain containing commercial CAR T cells for NHL and focused on computationally gated CD8+ CAR T cells. We found that the presence of postinfusion Programmed cell death protein 1 (PD-1)+ CD8+ CAR T cells at the day 14 time point highly correlated with the ability to achieve complete response (CR) by 6 months. Further analysis identified multiple subtypes of CD8+ PD-1+ CAR T cells, including PD-1+ T cell factor 1 (TCF1)+ stem-like CAR T cells and PD-1+ T-cell immunoglobulin and mucin-domain containing-3 (TIM3)+ effector-like CAR T cells that correlated with improved clinical outcomes such as response and progression-free survival. Additionally, we identified a subset of PD-1+ CD8+ CAR+ T cells with effector-like function that was increased in patients who achieved a CR and was associated with grade 3 or higher immune effector cell-associated neurotoxicity syndrome. Here, we identified robust biomarkers of response to CD28 CAR T cells and highlight the importance of PD-1 positivity in CD8+ CAR T cells after infusion in achieving CR.

Anti-CD19 Chimeric Antigen Receptor T-Cell Therapy for Richter Transformation: An International, Multicenter, Retrospective Study.

PURPOSE: Outcomes for Richter transformation (RT) are poor with current therapies. The efficacy and safety of anti-CD19 chimeric antigen receptor T-cell therapy (CAR-T) for RT are not established. METHODS: We performed an international multicenter retrospective study of patients with RT who received CAR-T. Patient, disease, and treatment characteristics were summarized using descriptive statistics, and modeling analyses were used to determine association with progression-free survival (PFS) and overall survival (OS). PFS and OS were estimated from the date of CAR-T infusion. RESULTS: Sixty-nine patients were identified. The median age at CAR-T infusion was 64 years (range, 27-80). Patients had a median of four (range, 1-15) previous lines of therapy for CLL and/or RT, including previous Bruton tyrosine kinase inhibitor and/or BCL2 inhibitor therapy in 58 (84%) patients. The CAR-T product administered was axicabtagene ciloleucel in 44 patients (64%), tisagenlecleucel in 17 patients (25%), lisocabtagene maraleucel in seven patients (10%), and brexucabtagene autoleucel in one patient (1%). Eleven patients (16%) and 25 patients (37%) experienced grade ≥3 cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome, respectively. The overall response rate was 63%, with 46% attaining a complete response (CR). After a median follow-up of 24 months, the median PFS was 4.7 months (95% CI, 2.0 to 6.9); the 2-year PFS was 29% (95% CI, 18 to 41). The median OS was 8.5 months (95% CI, 5.1 to 25.4); the 2-year OS was 38% (95% CI, 26 to 50). The median duration of response was 27.6 months (95% CI, 14.5 to not reached) for patients achieving CR. CONCLUSION: CAR-T demonstrates clinical efficacy for patients with RT.

Pharmacogenomic overlap between antidepressant treatment response in major depression & antidepressant associated treatment emergent mania in bipolar disorder.

There is increasing interest in individualizing treatment selection for more than 25 regulatory approved treatments for major depressive disorder (MDD). Despite an inconclusive efficacy evidence base, antidepressants (ADs) are prescribed for the depressive phase of bipolar disorder (BD) with oftentimes, an inadequate treatment response and or clinical concern for mood destabilization. This study explored the relationship between antidepressant response in MDD and antidepressant-associated treatment emergent mania (TEM) in BD. We conducted a genome-wide association study (GWAS) and polygenic score analysis of TEM and tested its association in a subset of BD-type I patients treated with SSRIs or SNRIs. Our results did not identify any genome-wide significant variants although, we found that a higher polygenic score (PGS) for antidepressant response in MDD was associated with higher odds of TEM in BD. Future studies with larger transdiagnostic depressed cohorts treated with antidepressants are encouraged to identify a neurobiological mechanism associated with a spectrum of depression improvement from response to emergent mania.

The great catastrophe: causes of the Permo-Triassic marine mass extinction.

The marine losses during the Permo-Triassic mass extinction were the worst ever experienced. All groups were badly affected, especially amongst the benthos (e.g. brachiopods, corals, bryozoans, foraminifers, ostracods). Planktonic populations underwent a fundamental change with eukaryotic algae being replaced by nitrogen-fixing bacteria, green-sulphur bacteria, sulphate-reducing bacteria and prasinophytes. Detailed studies of boundary sections, especially those in South China, have resolved the crisis to a ∼55 kyr interval straddling the Permo-Triassic boundary. Many of the losses occur at the beginning and end of this interval painting a picture of a two-phase extinction. Improved knowledge of the extinction has been supported by numerous geochemical studies that allow diverse proposed extinction mechanisms to be studied. A transition from oxygenated to anoxic-euxinic conditions is seen in most sections globally, although the intensity and timing shows regional variability. Decreased ocean ventilation coincides with rapidly rising temperatures and many extinction scenarios attribute the losses to both anoxia and high temperatures. Other kill mechanisms include ocean acidification for which there is conflicting support from geochemical proxies and, even less likely, siltation (burial under a massive influx of terrigenous sediment) which lacks substantive sedimentological evidence. The ultimate driver of the catastrophic changes at the end of the Permian was likely Siberian Trap eruptions and their associated carbon dioxide emissions with consequences such as warming, ocean stagnation and acidification. Volcanic winter episodes stemming from Siberian volcanism have also been linked to the crisis, but the short-term nature of these episodes (

30-year Cardiovascular Disease Risk for Young Adults with Serious Mental Illness.

Objective: To estimate 30-year CVD risk and modifiable risk factors in young adults with serious mental illness (SMI) versus those without, and assess variations in CVD risk by race, ethnicity, and sex. Method: In this cross-sectional study, we estimated and compared the Framingham 30-year CVD risk score and individual modifiable CVD risk factors in young adult (20-39 years) primary care patients with and without SMI at two US healthcare systems (January 2016-Septemeber 2018). Interaction terms assessed whether the SMI-risk association differed across demographic groups. Results: Covariate-adjusted 30-year CVD risk was significantly higher for those with (n=4228) versus those without (n=155,363) SMI (RR 1.28, 95% CI [1.26, 1.30]). Patients with SMI had higher rates of hypertension (OR 2.02 [1.7, 2.39]), diabetes (OR 3.14 [2.59, 3.82]), obesity (OR 1.93 [1.8, 2.07]), and smoking (OR 4.94 [4.6, 5.36]). The increased 30-year CVD risk associated with SMI varied significantly by race and sex: there was an 8% higher risk in Black compared to White patients (RR 1.08, [1.04, 1.12]) and a 9% lower risk in men compared to women (RR 0.91 [0.88, 0.94]). Conclusions: Young adults with SMI are at increased 30-year risk of CVD, and further disparities exist for Black individuals and women.

Marcadores de estrés oxidativo en el trastorno bipolar: un metaanálisis / Oxidative stress markers in bipolar disorder: a meta-analysis

Fundamento: Se considera que el estrés oxidativo media los procesos neuropatológicos de una serie de enfermedades neuropsiquiátricas y los datos recientes indican que puede participar en la fisiopatología del trastorno bipolar (TB). En el presente estudio condujimos un metaanálisis de los estudios que evaluaban los marcadores de estrés oxidativo en individuos con TB, en comparación con individuos de control sanos. Métodos: Se efectuó una búsqueda en la base de datos MEDLINE para identificar los estudios que evaluaron los marcadores periféricos de estrés oxidativo en el trastorno. Los datos se sometieron a metaanálisis usando un modelo de efectos aleatorios para examinar los tamaños del efecto de los resultados combinados. También se llevó a cabo una evaluación del sesgo (prueba de Egger) y una evaluación de la heterogeneidad (I2). Resultados: En el TB se identificó un aumento significativo de las sustancias reactivas al ácido tiobarbitúrico (SRATB) (p = 0,001), al igual que de la actividad del óxido nítrico (p = 0,02), con un mayor tamaño del efecto para SRATB y un tamaño moderado del efecto para el aumento de la actividad de NO. No se observaron tamaños significativos del efecto para las enzimas antioxidantes superóxido dismutasa, catalasa y glutatión peroxidasa (todas las p > 0,05). Limitaciones: en la interpretación de estos resultados se requiere precaución: a) la prueba de Egger fue positiva para SOD, lo que indica que los resultados para esta enzima podrían haber estado influidos por un sesgo de publicación, y b) analizamos los valores absolutos de cada enzima antioxidante por separado y los estudios publicados señalan que un desequilibrio entre estas enzimas es una mejor indicación de la presencia de estrés oxidativo. Conclusiones: El presente metaanálisis indica que en el TB aumentan los marcadores de estrés oxidativo y que éste podría desempeñar un papel en la fisiopatología del trastorno (AU)

Background: Oxidative stress is thought to mediate  neuropathological processes of a number of  neuropsychiatric disorders and recent data suggest  that oxidative stress may be involved in the  pathophysiology of bipolar disorder (BD). In the  present investigation, we conducted a meta-analysis of  studies that evaluated markers of oxidative stress in  individuals with BD, as compared to healthy controls. Methods: A MEDLINE search was conducted to  identify studies that measured peripheral markers of  oxidative stress in bipolar disorder. Data were  subjected to meta-analysis using a random effects  model to examine the effect sizes of the pooled results.  Bias assessment (Egger’s test) and assessment of  heterogeneity (I2 ) were also carried out. Results: Thiobarbituric acidic reactive substances  (TBARS) (p = 0.001) as well as NO activity (p = 0.02)  were significantly increased in BD with a large effect  size for TBARS and a moderate effect size for  increase in NO. No significant effect sizes were  observed for the antioxidant enzymes superoxide dismutase, catalase and glutathione peroxidase (all  p > 0.05). Limitations: some caution is warranted in  interpreting these results: a) Egger’s test was positive  for SOD, suggesting that SOD results may have been  influenced by a publication bias, and b) we analyzed  the absolute values of each antioxidant enzyme  separately and the literature suggests that an  imbalance between the antioxidant enzymes is a  better indication of the presence of oxidative stress. Conclusions: The present meta-analysis suggests  that oxidative stress markers are increased in BD and  that oxidative stress may play a role in the  pathophysiology of BD (AU)