American Society of Hematology (ASH) 2022 Involvement: The Lymphoma Epidemiological Outcomes (LEO) Cohort

At Weill Cornell Medicine (WCM) and NewYork-Presbyterian, we are proud to partner with the Lymphoma Epidemiological Outcomes (LEO) Cohort for a variety of research projects aimed to change the way we understand and manage lymphoma, a broad category which encompasses nearly 80 different distinct disease types. The LEO Cohort is the largest, most diverse study of lymphoma patients in the world to-date, comprised of participants from eight large U.S. academic centers.

At the 2022 American Society for Hematology (ASH) annual meeting, several studies involving the WCM Lymphoma Program, which included results and analyses from the LEO Cohort, were selected to be presented.

Weill Cornell Lymphoma Program Chief, Dr. Peter Martin, shares his gratitude for the patients who have participated in this research, as they’ve played an integral role in helping move the field forward and expanding our knowledge of this disease.

I would like to thank our amazing patients who are participating in the Lymphoma Epidemiology of Outcomes (LEO) cohort study, the largest, most diverse cohort study of lymphoma patients anywhere. Your dedication, along with fellow participants at eight institutions around the country, has resulted in multiple abstracts being presented at the 2022 Annual Meeting of the American Society of Hematology. These include studies in follicular lymphoma, diffuse large B-cell lymphoma, and marginal zone lymphoma. With dozens of additional studies already reported or underway, the LEO cohort is poised to change the way we understand and manage lymphoma over the decade to come.

Peter Martin, MD

Learn more about research presented at the ASH 2022 Conference from the LEO Cohort data:

Abstract #1591: Patterns of Care and Clinical Outcomes in Peripheral T-Cell Lymphomas: The Lymphoma Epidemiology of Outcomes (LEO) and Molecular Epidemiology Resource (LEO-MER) Prospective Cohort Study

Dr. Jia Ruan presented on this multi-center prospective cohort study analyzing the patterns of care and clinical outcomes of patients diagnosed with peripheral T-cell lymphoma (PTCL), a rare and heterogenous group of non-Hodgkin lymphoma. This research included 718 PTCL patients enrolled in the National Cancer Institute (NCI) supported Molecular Epidemiology Resource (MER) and the Lymphoma Epidemiology of Outcomes (LEO) cohort from 2002-2020. The study showed increased demographic diversity with time, and an increased use of novel agents such as brentuximab vedotin in the initial treatment setting. CHOP-based induction chemotherapy was the most common treatment in the LEO-MER cohort, despite being suboptimal particularly for patients with PTCL subtypes other than the anaplastic large cell lymphoma, including PTCL not otherwise specified (NOS) subtype and angioimmunoblastic T-cell lymphoma. These results warrant further research to develop therapies with targeted agents tailored to these different subtypes of PTCL.

Abstract #4207: Predictive Value of Staging PET/CT to Detect Bone Marrow Involvement in Marginal Zone Lymphoma (MZL): An Analysis from LEO MZL Working Group

This study led used prospectively collected data from the LEO Cohort to assess the predictive value of using PET/CT scans to detect bone marrow involvement and survival implications in marginal zone lymphoma (MZL) patients. The team looked at 311 MZL patients enrolled in the LEO Cohort who had data on bone marrow involvement and both biopsy and PET/CT results. The initial results, with short-term follow-up, showed low sensitivity to assessing bone marrow involvement using PET/CT data across all MZL subtypes. Additionally, splenic MZL demonstrated low negative predictive values for this assessment. These results highlight the limitations for MZL patients in current staging criteria.

Abstract #2957: Outcomes and Prognostic Factors of Transformed Follicular Lymphoma: An Analysis from the LEO Consortium

In this abstract, the team evaluated histological transformation (HT) in follicular lymphoma (FL) patients by examining prognostic factors for and outcomes following HT in patients enrolled in the LEO Cohort. HT from FL to an aggressive cancer is rare but when it does occur, is associated with unfavorable outcomes. This observational cohort study looked at patients diagnosed between 2002-2019 with FL who progressed through HT to an aggressive lymphoma, totaling 306 patients. The results confirmed previous reports of negative prognostic indicators being early HT, prior immunochemotherapy treatment, and anthracycline exposure, while also extending this observation to any systemic treatment. Patients who had HT and were older than 70 years old had worse overall survival rates. This study found that HT continues to be an unmet need concerning high lymphoma-related mortality and further research is needed to create a more refined prognostic model, to better understand these factors and the influence of patterns of care on outcomes.

Abstract #850: Evaluating the Impact of Lab-Based Eligibility Criteria By Race/Ethnicity in Frontline Clinical Trials for Diffuse Large B-Cell Lymphoma (DLBCL): A LEO Cohort Analysis

Data has shown that patients treated with immunochemotherapy who are ineligible for frontline clinical trials based on lab results have worse clinical outcomes and increased death rates from lymphoma progression. In this study, the team wanted to address this question of limiting eligibility for frontline clinical trials based on lab results. They did this by investigating the LEO Cohort where they analyzed 2330 newly diagnosed diffuse large B-cell lymphoma (DLBCL) patients between 2015-2020 who had 3 or more lab-based values for comparison. These patients were prospectively followed, and all received the same treatment course. Their results found that patients who were deemed ineligible for frontline clinical trials had significantly inferior overall survival, consistent with the previously determined association between ineligibility and poor outcomes. This larger, more diverse study confirmed previous assumptions, and found that specifically for Hispanic/non-white patients, there are some criteria that disproportionately limit eligibility. Further research is needed to evaluate the impact of each lab-based criteria on eligibility in different racial/ethnic populations and to determine how to tailor eligibility criteria to be more inclusive of the most excluded populations.

ASCO 2021 – Lymphoma Updates

The American Society of Clinical Oncology (ASCO) is the world’s leading organization for physicians and oncology professionals caring for people with cancer. The 2021 Annual Meeting was hosted virtually, connecting oncology professionals from around the world to discuss the newest, state-of-the-art research and treatment updates.

The Weill Cornell Lymphoma Program team is always proud of our contributions to new lymphoma research presentations at the ASCO Annual Meeting. We’ve outlined some of the highlights from this year’s conference, including research updates and new discoveries from our team. Additionally, our Weill Cornell Medicine and NewYork-Presbyterian Hematology & Oncology Fellow Dr. Sam Yamshon received a prestigious ASCO Conquer Cancer Foundation 2021 Young Investigator Award to support critical lymphoma research and the transition from fellowship to faculty. 

Samuel Yamshon, MD – 2021 ASCO Young Investigator Award Recipient

Weill Cornell Lymphoma Program Chief Dr. Peter Martin presented new mantle cell lymphoma research and shared important insights about care in the community or real-world setting as part of an oral abstract session. 

Dr. John Leonard reviews an National Cancer Institute (NCI)-supported clinical trial evaluating the role of stem cell transplant in primary central nervous system (CNS) lymphoma treatment. 

Dr. Richard Furman explains exciting results from a phase 3 clinical trial comparing two different treatment options for patients with chronic lymphocytic leukemia (CLL) for the first time.

Additionally, Dr. Peter Martin breaks down mantle cell lymphoma research evaluating the role of botezomib when added to bendamustine and rituximab as induction therapy.

PET scan imaging during treatment for bulky Hodgkin lymphoma can provide critical information to shape the course of care. Dr. John Leonard breaks down this NCI-supported ALLIANCE research presented this year’s ASCO meeting. 

Initial Treatment with Lenalidomide Plus Rituximab for Mantle Cell Lymphoma (MCL): 7-Year Analysis from a Multi-Center Phase II Study

At the 2020 Annual Meeting of the American Hematology Society (ASH), the Weill Cornell Medicine mantle cell lymphoma research team presented the 7-year long-term outcome analysis of the first study of a non-chemotherapy frontline treatment regimen with lenalidomide plus rituximab as induction and maintenance therapy for mantle cell lymphoma (MCL).  

The multi-center phase 2 study, led by study chair Dr. Jia Ruan, was initiated in 2011 and previously reported early efficacy in the New England Journal of Medicine (NEJM) and 5-year follow-up results in Blood, which was highly effective with an overall response rate (ORR) of 92%, and complete response (CR) of 64%. It was also well tolerated, with durable responses, including the 5-year progression free survival (PFS) and overall survival (OS) of 64% and 77% respectively. Dr. Samuel Yamshon, a second-year hematology and medical oncology fellow at Weill Cornell Medicine and NewYork-Presbyterian Hospital led the oral presentation of the 7-year follow up analysis at this year’s ASH meeting.

The study treatment is conveniently administered in the outpatient setting, with the oral agent lenalidomide given on days 1-21 of a 28-day cycle and rituximab provided once very other cycle during maintenance. The treatment continues until progression of disease, with an option to stop therapy after 3 years of remission.

A total of 38 clinical trial participants were enrolled at four participating centers across the United States. Of the 36 evaluable patients, 19 (53%) of the patients remain in remission, including 12 (33%) beyond 7 years. Of the patients in remission, 10 remain on treatment, while 9 patients in remission opted to stop therapy after at least 3 years of study treatment due to side effects or patient preference. The median progression free survival (PFS) and duration of response have not been reached. The 7-year PFS rate was estimated at 60%, and 7-year OS rates at 73%. With long-term maintenance treatment, there were no new safety concerns, and close follow up limited toxicity for those who wished to remain on therapy.

The long-term outcome of the lenalidomide plus rituximab regimen represents a major stride in the treatment and care of MCL patients – a population of patients who harbor a rare and generally incurable disease where intensive chemotherapy regimens do not necessarily translate into cure and may not be tolerated by all. It is notable that this combination therapy offers a chemotherapy-free initial treatment approach that compares favorably in outcome to conventional chemotherapy-based regimens such as bendamustine-rituximab, VR-CAP, and R-CHOP with rituximab maintenance. The National Comprehensive Cancer Network (NCCN) has incorporated this evidence into their treatment guidelines for MCL patients. The Weill Cornell Lymphoma Program researchers concluded that the evaluation of this active regimen in larger, randomized frontline trials comparing novel agents with chemoimmunotherapy is warranted. 

704 Initial Treatment with Lenalidomide Plus Rituximab for Mantle Cell Lymphoma (MCL): 7-Year Analysis from a Multi-Center Phase II Study
Type: Oral presentation
Session: 623. Mantle Cell and Indolent B-Cell Lymphoma – CAR-T and immunotherapy clinical studies

Monday, December 7, 2020: 2:30 PM 

ASH 2020 Weill Cornell Medicine Lymphoma Program Conference Coverage
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