Publications by authors named "John Pagel"

Article Synopsis
  • The SIERRA trial aimed to improve outcomes for older patients with relapsed or refractory acute myeloid leukemia (RR AML) by comparing a new treatment, I-apamistamab, against standard care before bone marrow transplant.
  • The study involved 153 patients, with results showing a significantly higher durable complete remission (dCR) rate of 17.1% for the I-apamistamab group compared to 0% for the conventional care group.
  • Although the overall survival rates were similar between the two groups, the I-apamistamab regimen exhibited more promise for achieving long-lasting remission with similar levels of severe side effects.
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  • * Research involving younger patients with untreated AML (age ≤60) showed that class III obesity significantly increases early death rates and worsens overall survival compared to normal weight individuals.
  • * These results emphasize the need for more in-depth studies on the impacts of class III obesity in AML patients to better understand their unique risks and outcomes.
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  • - The text discusses the relationship between obesity and outcomes in acute myeloid leukemia (AML), particularly focusing on how different obesity classes (I, II, and III) impact patient outcomes.
  • - A study involving younger AML patients (age ≤60) showed that class III obesity significantly increased the risk of early death and negatively affected overall survival compared to those with normal weight.
  • - The findings underscore the need for more research on the effects of class III obesity in AML patients to better understand their unique health risks.
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  • - Venetoclax is commonly used after treatment with covalent Bruton tyrosine kinase inhibitors (cBTKi) for chronic lymphocytic leukemia (CLL), but there is limited data on its effectiveness in this context.
  • - Pirtobrutinib, a newer reversible BTKi, was compared to venetoclax in a study involving CLL patients who were previously treated with cBTKi, focusing on metrics like progression-free survival and overall survival.
  • - Results showed that while pirtobrutinib and venetoclax had similar PFS and OS, pirtobrutinib had a higher overall response rate and fewer severe adverse events, indicating it could be a viable option for treating relapsed C
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Purpose: Hematopoietic cell transplantation (HCT) has curative potential for myeloid malignancies, though many patients cannot tolerate myeloablative conditioning with high-dose chemotherapy alone or with total-body irradiation (TBI). Here we report long-term outcomes from a phase I/II study using iodine-131 (131I)-anti-CD45 antibody BC8 combined with nonmyeloablative conditioning prior to HLA-haploidentical HCT in adults with high-risk relapsed/ refractory acute myeloid or lymphoid leukemia (AML or ALL), or myelodysplastic syndrome (MDS; ClinicalTrials.gov, NCT00589316).

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Prior experience indicated that use of higher doses of cytarabine during induction for acute myeloid leukemia (AML) with a histone deacetylase inhibitor resulted in high response rates. S1203 was a randomized multicenter trial for previously untreated patients aged 18-60 with AML which compared daunorubicin and cytarabine (DA), idarubicin with higher dose cytarabine (IA) and IA with vorinostat (IA + V). The primary endpoint was event free survival (EFS).

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Purpose: Older patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL) may be considered ineligible for curative-intent therapy including high-dose chemotherapy with autologous stem-cell transplantation (HDT-ASCT). Here, we report outcomes of a preplanned subgroup analysis of patients ≥65 years in ZUMA-7.

Patients And Methods: Patients with LBCL refractory to or relapsed ≤12 months after first-line chemoimmunotherapy were randomized 1:1 to axicabtagene ciloleucel [axi-cel; autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy] or standard of care (SOC; 2-3 cycles of chemoimmunotherapy followed by HDT-ASCT).

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This retrospective study using the nationwide de-identified Flatiron Health electronic health record-derived database was designed to evaluate clinical outcomes among patients with chronic lymphocytic leukemia (CLL) who previously received both a covalent Bruton's tyrosine kinase inhibitor (cBTKi) and B-cell lymphoma 2 inhibitor (BCL2i) in a real-world setting. Outcomes for the immediate next line of therapy following the latter of the cBTKi or BCL2i treatment included: real-world response rate of 34.4% (using methods most consistent with clinical trials); median duration of real-world response of 13.

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Purpose: This study describes the treatment patterns and outcomes of patients with CLL/SLL in a de-identified real-world oncology electronic health records database.

Methods: Adult patients with CLL/SLL were eligible if they had received cBTKi therapy, both a cBTKi and a BCL2i, or all 4 drug classes (cBTKi, BCL2i, rituximab, and chemotherapy) at any time during the first 5 lines of therapy. Time-to-event outcomes were evaluated using Kaplan Meier method.

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Acute Promyelocytic Leukemia (APL) is characterized by the t(15;17) chromosomal translocation resulting in a PML-RARA fusion protein. The all-trans-retinoic acid (ATRA) and Arsenic Trioxide (ATO) only regimens have demonstrated success in treating low- and intermediate-risk patients. However, induction with ATRA/ATO only regimens have been showing increased incidence of differentiation syndrome (DS), a potentially lethal complication, traditionally treated with dexamethasone.

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  • Researchers evaluated zandelisib, a new PI3Kδ inhibitor, for treating relapsed or refractory B-cell malignancies, assessing its safety and effectiveness through continuous versus intermittent dosing, both alone and with rituximab.
  • The study was a phase 1b trial conducted across ten centers in Switzerland and the USA, targeting patients aged 18 and older who had prior treatments but no previous exposure to PI3Kδ inhibitors.
  • Primary goals included determining safety, maximum tolerated doses, and the drug's effectiveness in fighting cancer, with results being analyzed based on the initial treatment plan.
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Purpose: Brexucabtagene autoleucel (KTE-X19) autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy is approved for the treatment of relapsed/refractory mantle cell lymphoma (MCL). Outcomes after a 3-year follow-up in the pivotal ZUMA-2 study of KTE-X19 in relapsed/refractory MCL are reported, including for subgroups by prior therapy (bendamustine and type of Bruton tyrosine kinase inhibitor [BTKi]) or high-risk characteristics.

Methods: Patients with relapsed/refractory MCL (one to five prior therapies, including prior BTKi exposure) received a single infusion of KTE-X19 (2 × 10 CAR T cells/kg).

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  • Some doctors are debating whether to change treatment for Hodgkin Lymphoma patients who still have cancer after two cycles of ABVD therapy.
  • Researchers looked at data from 15 hospitals to see how many patients with positive PET scans switched their treatment between 2015 and 2019.
  • They found that not many patients changed their treatment, and results showed that those who did aren’t always getting better, so better ways to treat these patients are needed.
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  • Preclinical studies showed that combining an anti-PD-1 inhibitor with a CDK9 inhibitor can boost cancer-fighting effects while minimizing side effects, indicating a potential new treatment strategy.
  • The phase 1 KEYNOTE-155 trial tested this combination on patients with difficult-to-treat cancers like chronic lymphocytic leukemia, diffuse large B-cell lymphoma, and multiple myeloma, focusing on safety and effectiveness.
  • Out of 72 patients, the combination treatment was generally well tolerated, with observed response rates of 29.4% for chronic lymphocytic leukemia and 21.1% for diffuse large B-cell lymphoma, but no responses in multiple myeloma, highlighting a need for further research on this combination therapy
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Background: The prognosis of patients with early relapsed or refractory large B-cell lymphoma after the receipt of first-line chemoimmunotherapy is poor.

Methods: In this international, phase 3 trial, we randomly assigned, in a 1:1 ratio, patients with large B-cell lymphoma that was refractory to or had relapsed no more than 12 months after first-line chemoimmunotherapy to receive axicabtagene ciloleucel (axi-cel, an autologous anti-CD19 chimeric antigen receptor T-cell therapy) or standard care (two or three cycles of investigator-selected, protocol-defined chemoimmunotherapy, followed by high-dose chemotherapy with autologous stem-cell transplantation in patients with a response to the chemoimmunotherapy). The primary end point was event-free survival according to blinded central review.

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The management of chronic lymphocytic leukemia (CLL) has undergone unprecedented changes over the last decade. Modern targeted therapies are incorporated into clinical practice. Unfortunately, patients have begun to develop resistance or intolerance to multiple classes.

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  • Patients with chronic lymphocytic leukaemia that progress to Richter transformation (a form of diffuse large B-cell lymphoma) face limited treatment options, prompting this study on the safety and effectiveness of acalabrutinib, a Bruton's tyrosine kinase inhibitor.
  • The phase 1-2 trial involved 25 patients receiving acalabrutinib (200 mg twice daily) and focused on assessing safety, overall response rates, and progression-free survival, with participants from various countries.
  • Key findings showed that after a median treatment time of 2.6 months, only 2 out of 25 patients remained on acalabrutinib, with common side effects including diarrhea (48%), headache (44%), and anemia
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Purpose: CAPTIVATE (NCT02910583), a randomized phase II study, evaluates minimal residual disease (MRD)-guided treatment discontinuation following completion of first-line ibrutinib plus venetoclax treatment in patients with chronic lymphocytic leukemia (CLL).

Methods: Previously untreated CLL patients age < 70 years received three cycles of ibrutinib and then 12 cycles of combined ibrutinib plus venetoclax. Patients in the MRD cohort who met the stringent random assignment criteria for confirmed undetectable MRD (Confirmed uMRD) were randomly assigned 1:1 to double-blind placebo or ibrutinib; patients without Confirmed uMRD (uMRD Not Confirmed) were randomly assigned 1:1 to open-label ibrutinib or ibrutinib plus venetoclax.

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Article Synopsis
  • The study examines the cardiovascular (CV) toxicities associated with the BTK inhibitor acalabrutinib in patients with chronic lymphocytic leukemia (CLL), particularly in comparison to ibrutinib, which has notable CV side effects.
  • A total of 762 patients undergoing acalabrutinib treatment reported a low incidence of cardiac adverse events (AEs), with only 17% experiencing any grade of cardiac issues, primarily atrial fibrillation or flutter.
  • Most patients with these AEs had existing CV risk factors, and hypertension was noted in 9% of participants, but no severe cases led to treatment discontinuation or sudden cardiac deaths.
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  • Umbralisib is a dual inhibitor of PI3Kδ and CK1ε, showing activity in treating various relapsed/refractory non-Hodgkin lymphomas in a study involving 371 adult patients with a median age of 67 years.
  • Most patients experienced treatment-emergent adverse events (AEs), with diarrhea, nausea, and fatigue being the most common; however, serious AEs were less frequent, affecting about 25% of participants.
  • Despite some patients discontinuing treatment due to AEs, the study indicates umbralisib has a favorable long-term tolerance and low levels of immune-related toxicities, suggesting it could benefit a wide range of
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Purpose: Standard cytotoxic induction chemotherapy for acute myeloid leukemia (AML) results in prolonged neutropenia and risk of infection. Romyelocel-L is a universal, allogeneic myeloid progenitor cell product being studied to reduce infection during induction chemotherapy.

Patients And Methods: One hundred sixty-three patients with de novo AML (age ≥ 55 years) receiving induction chemotherapy were randomly assigned on day 0 (d0), of whom 120 were evaluable.

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