Publications by authors named "Neha Mehta-Shah"

Peripheral T-cell lymphomas (PTCLs) are a heterogenous yet aggressive group of lymphomas that arise from mature T- or NK-cell precursors. Nodal PTCLs include anaplastic large-cell lymphoma, PTCL not otherwise specified, and follicular helper T-cell lymphomas. Recent advances in understanding these heterogenous diseases have prompted investigation of novel agents to improve on treatment.

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Background: Peripheral T-cell lymphomas are aggressive non-Hodgkin lymphomas with few treatment options for relapsed or refractory disease. Valemetostat tosylate (valemetostat) is a potent, novel, dual inhibitor of EZH2 and EZH1. We investigated the clinical activity and safety of valemetostat in patients with relapsed or refractory peripheral T-cell lymphoma, and its safety in patients with relapsed or refractory adult T-cell leukaemia/lymphoma.

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Post-transplant lymphoproliferative disorders (PTLDs) remain a feared complication of transplantation, with significant morbidity and mortality. The oncogenic Epstein-Barr virus (EBV) is a key pathogenic driver in 50%-80% of cases. Numerous prognostic indices, comprising multiple clinical, epidemiological and tumor characteristics, including EBV tumor positivity, do not consistently associate with worse patient survival, suggesting a potential role for EBV genome variants in determining outcome.

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Patients with cutaneous T cell lymphoma (CTCL) experience high morbidity and mortality due to skin infections and sepsis, but the causative immune defect is unclear. We previously identified high levels of LAIR2, a decoy protein for the inhibitory receptor LAIR1, in advanced CTCL. Mice do not have a LAIR2 homolog, so we used knock-out (KO) mice to model LAIR2 overexpression.

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PI3K-δ inhibitors have shown impressive activity in lymphoid malignancies but have been hampered by autoimmune and infectious toxicities, leading to market withdrawals. We previously demonstrated activity of the PI3K-δγ inhibitor duvelisib in T cell lymphomas (TCLs) that was associated with inflammatory adverse events. As reported here, we conducted a phase 1b/2a study of duvelisib in combination with either romidepsin (n = 66) or bortezomib (n = 32) in patients with relapsed/refractory TCL and found that the addition of romidepsin, but not bortezomib, appeared to increase efficacy while attenuating PI3K inhibitor-driven toxicity.

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Article Synopsis
  • Personalized cancer vaccines targeting neoantigens show promise for treating follicular lymphoma (FL) by using advanced sequencing technologies to identify unique tumor mutations.
  • In a study involving 58 tumor samples from 57 FL patients, researchers predicted and filtered high-quality neoantigens, finding an average of 52 mutations per patient with multiple high-quality neoantigens identified.
  • A pilot clinical trial using these personalized neoantigen vaccines combined with PD-1 blockade has been initiated, showing early signs of feasibility, safety, and potential therapeutic benefits for patients with relapsed or refractory FL.
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Gamma Delta (γδ) T-cell lymphomas are uncommon and aggressive neoplasms originating from the γδ receptor-bearing lymphocytes. The most frequent entities include primary hepatosplenic γδ T-cell lymphomas, primary cutaneous γδ lymphoma, and monomorphic epitheliotropic T-cell lymphoma. F-18 fluorodeoxyglucose (FDG) PET/CT is an important modality in the staging of Hodgkin's and various non-Hodgkin's lymphoma.

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Peripheral T-cell lymphomas (PTCLs) are a heterogeneous group of mature T-cell neoplasms that represent ∼10% of all non-Hodgkin lymphoma. Outcomes for the majority of patients with PTCL are poor, and treatment approaches have been relatively uniform using cyclophosphamide, doxorubicin, vincristine, and prednisone-based therapy. For example, large registry studies consistently demonstrate 5-year overall survival of ∼30% to 40%.

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Article Synopsis
  • * The study, which took place at 49 centers in Australia, China, South Korea, and the USA, included 104 patients who met eligibility criteria and received the medication at a daily dose of 150 mg until disease progression.
  • * Results showed that 88 patients were included in the primary analysis, with a median follow-up of 13.3 months, highlighting the drug's potential effectiveness in treating this challenging cancer type.
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Although a rare subset of non-Hodgkin lymphomas, peripheral T-cell lymphomas (PTCL) account for a disproportionate proportion of patient mortality. Conventional therapies are derived from experience treating aggressive B-cell lymphomas and center around CHOP-based chemotherapy. However, due to the unique biology and diverse subtypes of PTCL, most patients fail to durably respond to this approach and 5-year survival is only 20% to 30%.

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Article Synopsis
  • The study utilizes ultra-deep exome sequencing to analyze the scarce malignant Hodgkin and Reed Sternberg (HRS) cells in classical Hodgkin lymphoma (cHL), enabling better detection of somatic mutations compared to traditional methods.* -
  • Researchers identified novel mutations in several genes and recurrent patterns affecting pathways related to Hippo signaling, thereby expanding the understanding of genetic factors involved in cHL.* -
  • Additionally, single-nuclei RNA sequencing confirmed the presence of somatic mutations in specific cell clusters, providing insight into the malignant characteristics of HRS cells and establishing a methodology for future genomic studies in larger cHL patient cohorts.*
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Article Synopsis
  • * In a pilot study involving 14 patients who received auto-SCT followed by a cycle of blinatumomab, the treatment was safe, with only mild side effects reported, and most patients achieved complete remission after 100 days.
  • * Follow-up results showed that 50% of patients maintained remission one year later; however, those who relapsed had a lower CD8:CD4 T-cell ratio, suggesting further research on treatment strategies
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Antibodies targeting PD-1 or 4-1BB achieve objective responses in follicular lymphoma (FL), but only in a minority of patients. We hypothesized that targeting multiple immune receptors could overcome immune resistance and increase response rates in patients with relapsed/refractory FL. We therefore conducted a phase 1b trial testing time-limited therapy with different immunotherapy doublets targeting 4-1BB (utomilumab), OX-40 (ivuxolimab), and PD-L1 (avelumab) in combination with rituximab among patients with relapsed/refractory grade 1-3A FL.

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Article Synopsis
  • Follicular lymphoma (FL) varies greatly among patients, with some needing immediate treatment due to aggressive disease while others can monitor their condition without intervention.
  • A study analyzed the genetic alterations in FL across 370 patients, discovering that higher mutation burdens were present in relapsed or transformed FL but not linked to better outcomes in newly diagnosed cases.
  • A set of 7 specific gene mutations (MAP signature) was identified that indicates a shorter progression-free survival in newly diagnosed FL, which could help better predict patient outcomes beyond existing prognostic tools.
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Patients with relapsed/refractory primary mediastinal large B-cell lymphoma (R/R PMBL) have poor responses to salvage therapy. Nivolumab and brentuximab vedotin (BV) showed promising early efficacy in patients with R/R PMBL in the phase 1/2 open-label, multicenter CheckMate 436 study; we report safety and efficacy findings from the 3-year follow-up. Patients who were eligible were aged ≥15 years with R/R PMBL previously treated with either high-dose chemotherapy plus autologous hematopoietic cell transplantation (HCT) or ≥2 prior multiagent chemotherapies, and had Eastern Cooperative Oncology Group performance status scores of 0 to 1 and CD30 expression of ≥1%.

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In the last decade, there has been increased understanding of the pathologic features and biology of peripheral T cell lymphomas (PTCLs) through development of multi omics and molecular profiling techniques. In addition, international collaborations through multi center trials as well as prospective registry studies have improved our knowledge of host and tumor genomic factors and treatment factors affecting disease outcomes. In our review today, we aim to highlight the current epidemiology, latest advances in classification, disease biology and the evolving treatment landscape for nodal PTCLs.

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There remains no one standard induction for nodal-based peripheral T-cell lymphoma (PTCL). We conducted a phase II study of lenalidomide plus CHOEP as a novel induction strategy. Patients received CHOEP at standard doses in combination with 10 mg of lenalidomide on days 1-10 of a 21-day cycle for six cycles of therapy followed by observation, high-dose therapy with autologous stem cell rescue, or maintenance lenalidomide per provider preference.

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Introduction: Mantle cell lymphoma (MCL) is a moderately aggressive lymphoma subtype, generally viewed as incurable. For younger, fit patients, the standard of care remains various high-dose cytarabine-based induction regimens followed by autologous hematopoietic cell transplant and 3 years of rituximab maintenance. Despite reasonably good outcomes, with median progression-free survival in the range of 7 to 9 years, most patients eventually relapse, indicating a need to improve the safety and tolerability of remission induction strategies.

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