Publications by authors named "Alvaro Alencar"

Background: Preliminary data suggest promising activity of loncastuximab tesirine in follicular lymphoma, and synergistic activity between rituximab-induced cytotoxicity and loncastuximab tesirine. In this study, we evaluated loncastuximab tesirine combined with rituximab for second-line and later treatment of follicular lymphoma.

Methods: We did a single-arm, investigator-initiated, phase 2 trial at Sylvester Comprehensive Cancer Center in Miami, FL, USA.

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The B cell receptor (BCR) signalling pathway has an integral role in the pathogenesis of many B cell malignancies, including chronic lymphocytic leukaemia, mantle cell lymphoma, diffuse large B cell lymphoma and Waldenström macroglobulinaemia. Bruton tyrosine kinase (BTK) is a key node mediating signal transduction downstream of the BCR. The advent of BTK inhibitors has revolutionized the treatment landscape of B cell malignancies, with these agents often replacing highly intensive and toxic chemoimmunotherapy regimens as the standard of care.

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Clinical bleeding events are reported here from 773 patients with B-cell malignancies receiving pirtobrutinib monotherapy from the phase 1/2 BRUIN study (ClinicalTrials.gov identifier: NCT03740529), either in the presence or absence of antithrombotic therapy (antithrombotic exposed [AT-E],  = 216; antithrombotic nonexposed [AT-NE],  = 557). Among the AT-E cohort, 51.

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Article Synopsis
  • Bruton tyrosine kinase inhibitors (BTKi) have significantly improved treatment for B-cell malignancies, but many patients stop using them due to side effects, with cardiac issues being the most common reason for discontinuation.* -
  • The BRUIN study tested pirtobrutinib, a new non-covalent BTKi, on 127 patients who were intolerant to previous BTKi treatments, finding that many experienced fewer or no cardiac issues while showing a high overall response rate.* -
  • Results indicated pirtobrutinib had a median time on treatment of 15.3 months, with notable side effects like fatigue and neutropenia; overall, it proved to be a safe and effective alternative for
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  • Richter transformation is a serious form of aggressive lymphoma found in about 10% of chronic lymphocytic leukemia patients, with no approved treatments and a grim outlook.
  • Pirtobrutinib, showing good results for patients with B-cell malignancies who have relapsed or are resistant to conventional therapies, is being studied for its safety and effectiveness in treating Richter transformation.
  • The study included 82 adult patients who received pirtobrutinib daily, tracking overall response rates and safety, with results indicating the drug was well tolerated and active in this difficult subset of cancer patients.
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Increasing use of covalent and noncovalent inhibitors of Bruton's tyrosine kinase (BTK) has elucidated a series of acquired drug-resistant BTK mutations in patients with B cell malignancies. Here we identify inhibitor resistance mutations in BTK with distinct enzymatic activities, including some that impair BTK enzymatic activity while imparting novel protein-protein interactions that sustain B cell receptor (BCR) signaling. Furthermore, we describe a clinical-stage BTK and IKZF1/3 degrader, NX-2127, that can bind and proteasomally degrade each mutant BTK proteoform, resulting in potent blockade of BCR signaling.

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We previously reported high rates of undetectable minimal residual disease <10-4 (uMRD4) with ibrutinib plus fludarabine, cyclophosphamide, and rituximab (iFCR) followed by 2-year ibrutinib maintenance (I-M) in treatment-naïve chronic lymphocytic leukemia (CLL). Here, we report updated data from this phase 2 study with a median follow-up of 63 months. Of 85 patients enrolled, including 5 (6%) with deletion 17p or TP53 mutation, 91% completed iFCR and 2-year I-M.

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Article Synopsis
  • Patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) often struggle after failing treatment with covalent BTK inhibitors, prompting the need for new options like pirtobrutinib, a selective noncovalent BTK inhibitor designed to resume BTK inhibition.* -
  • In a phase 1-2 trial involving 317 patients, 73.3% responded positively to pirtobrutinib, with a notable 82.2% response rate when including those showing partial responses with lymphocytosis; the median progression-free survival was reported at 19.6 months.* -
  • Common side effects from pirtobrutinib treatment included infections (71%),
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  • Pirtobrutinib is a new, selective Bruton tyrosine kinase inhibitor (BTKi) that shows promise for patients with mantle-cell lymphoma (MCL) who have previously been treated with covalent BTK inhibitors due to a generally poor prognosis.
  • In a phase I/II trial, the drug demonstrated an overall response rate of 57.8% with a median duration of response lasting 21.6 months, indicating effectiveness in this challenging patient group.
  • The treatment was well tolerated, with only a small percentage of patients discontinuing therapy due to adverse events such as fatigue and diarrhea, suggesting it may be a viable option for patients with previously recurRent MCL.
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Jehovah's Witnesses cannot accept blood products based upon religious beliefs, and when they present with acute leukemia, the ideal treatment strategy can be controversial. We present six cases of Jehovah's Witnesses with acute lymphoblastic leukemia and show that complete remission can be achieved without using anthracycline in 83% (5/6) of patients. We also report, for the first time in this population, that the use of agents with novel mechanisms of action, such as blinatumomab and nelarabine, is associated with minimal myelosuppression and can produce durable responses, with 2 of 6 patients still alive in CR3 at 4.

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To optimise management of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection identifying high-risk patients and maintaining treatment dose intensity is an important issue in patients with aggressive lymphomas. In the present study, we report on the presentation, management, and outcome of an international series of 91 patients with primary central nervous system lymphoma and SARS-CoV-2 infection. SARS-CoV-2 was diagnosed before/during first-line treatment in 64 patients, during follow-up in 21, and during salvage therapy in six.

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Article Synopsis
  • Covalent Bruton's tyrosine kinase (BTK) inhibitors have significantly improved treatment for B-cell cancers, such as chronic lymphocytic leukemia (CLL), but patients can develop resistance due to mutations at the BTK binding site and other mechanisms.
  • This study analyzed genomic data from CLL patients treated with the noncovalent BTK inhibitor pirtobrutinib and identified several mutations in BTK and phospholipase C gamma 2 (PLCγ2) that contribute to resistance.
  • The findings highlight new mechanisms of resistance that allow CLL to escape treatment effects, affecting both noncovalent and certain covalent BTK inhibitors, indicating a need for further research in overcoming these challenges.
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Chimeric antigen receptor T-cells (CAR-T cells) are a new modality of oncological treatment which has demonstrated impressive response in refractory or relapsed diseases, such as acute lymphoblastic leukemia (ALL), lymphomas, and myeloma but is also associated with unique and potentially life-threatening toxicities. The most common adverse events (AEs) include cytokine release syndrome (CRS), neurological toxicities, such as the immune effector cell-associated neurotoxicity syndrome (ICANS), cytopenias, infections, and hypogammaglobulinemia. These may be severe and require admission of the patient to an intensive care unit.

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The treatment and evolution of B-cell non-Hodgkin lymphoma (B-NHL) has undergone important changes in the last years with the emergence of targeted therapies, such as monoclonal antibodies, small molecules, antibody-drug conjugates, and bispecific antibodies. Nevertheless, a significant portion of patients remains refractory or relapsed (R/R) to the new therapeutic modalities, representing thus an unmet medical need. The use of CAR-T cells for the treatment of B-NHL patients has shown to be a promising therapy with impressive results in patients with R/R disease.

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We present long-term combined results of two clinical trials implementing R-MACLO-IVAM induction followed by thalidomide or rituximab maintenance in 44 patients with untreated mantle cell lymphoma (MCL). The first 22 patients (UM-MCL1 ClinicalTrials.gov identifier NCT00450801) received maintenance with thalidomide (200 mg daily until relapse/intolerable toxicity) and a subsequent cohort of 22 patients (UM-MCL2 ClinicalTrials.

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Article Synopsis
  • Covalent BTK inhibitors are effective for B-cell malignancies, but patients often stop using them due to resistance or side effects, prompting the evaluation of pirtobrutinib, a new reversible BTK inhibitor.
  • In a phase 1/2 trial with 323 patients, pirtobrutinib showed no dose-limiting toxicities and the recommended dose was established at 200 mg daily, with some reported side effects like fatigue and diarrhea.
  • Among patients with chronic lymphocytic leukemia or small lymphocytic lymphoma who previously used other BTK inhibitors, pirtobrutinib demonstrated a 62% overall response rate, indicating significant efficacy even in those who previously experienced treatment resistance or intolerance.*
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  • In response to the COVID-19 outbreak in March 2020, a diverse team was formed in South Florida to rapidly develop testing capabilities for SARS-CoV-2 using various detection methods.
  • * The team faced challenges with reagent shortages but successfully collaborated with scientists and diagnostic labs to establish authorized testing protocols and drive-through facilities.
  • * Over a swift three-week period, they organized a workforce to process samples and launched a smart test ordering system, increasing testing capacity significantly to serve hundreds of healthcare workers and patients daily.
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Background: Langerhans cell tumors are rare clonal disorders characterized by neoplastic proliferation of dendritic cells that can be further classified into the subtypes Langerhans cell histiocytosis and Langerhans cell sarcoma, which are rare neoplasms exhibiting aggressive features and a poor prognosis. In addition to illustrating the refractoriness and poor outcomes of multisystem Langerhans cell histiocytosis in adults, specific events in this case highlight important characteristics of disease biology that warrant detailed discussion and exposition to a wider audience.

Case Presentation: We describe the case of a 42-year-old Caucasian man with Langerhans cell histiocytosis diagnosed from a lesion on the left arm that presented with constitutional symptoms, early satiety, and weight loss.

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  • Follicular lymphoma (FL) is a common type of lymphoma in the U.S. and Europe, and its diagnosis and grading have not changed much according to the latest WHO classification updates.
  • FL exhibits a wide range of biological and histopathological variations, making some cases hard to identify due to their unique features or being rare variants.
  • This text discusses several unusual FL cases to increase awareness of the diverse histopathological characteristics, including FL variants with Castleman-like changes and those involving specific mutations or virus-related features.
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