Global Collaboration: Lymphoma Researchers Attend Workshop at Shanghai Institute of Hematology

In early July, several researchers from the Weill Cornell Medicine/NewYork-Presbyterian (WCM/NYP) Lymphoma Program traveled to Shanghai, China to participate in the first Lymphoma Research Workshop, jointly sponsored by WCM/NYP and Shanghai Institute of Hematology (SIH). The workshop aimed to foster clinical and translational research exchange and collaboration, with the goal of further global alliance with leading Chinese institutions.

Our own Drs. Leandro Cerchietti, Peter Martin, Ari Melnick, Kristy Richards, and Jia Ruan were in attendance. Drs. Melnick and Ruan co-organized the workshop with Drs. Saijuan Chen and Weili Zhao from SIH. SIH and its affiliated Ruijin Hospital (RJH) is a leader in human genomics and lymphoma research in China.

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Dr. Ari Melnick (Left) and Dr. Jia Ruan

Dr. Melnick began by introducing the lymphoma research missions at WCM/NYP and provided an overview of our translational program, which integrates state-of-the-art genetic, epigenetic, and proteomic approaches to study lymphoma pathogenesis and inform development of mechanism-based therapeutics.

Dr. Zhao followed with a review of the recent lymphoma program developments at Ruijin Hospital, which focuses on building a multi-disciplinary diagnosis and treatment team. RJH’s translational development has been aimed at building a lymphoma biobank, next-generation sequencing, system biology, and biomarker investigations to support clinical research.

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Dr. Peter Martin (Left) and Dr. Leandro Cerchietti

On the project level, Dr. Cerchietti discussed bench-to-bedside translation of epigenetic modifying agents, such as novel treatments that sensitize chemotherapy responses in patients with diffuse large B-cell lymphoma (DLBCL). Dr. Martin then provided a comprehensive overview of the management approach for DLBCL in the U.S., reviewing important study design and findings of DLBCL clinical trials that incorporated novel agents, including epigenetic modifiers. Dr. Richards spoke about promises and challenges in canine lymphoma research in both the disease and drug development models.

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Dr. Kristy Richards

Additionally, Dr. Pengpeng Xu from RJH presented preliminary data of a phase 1 study using an epigenetic hypomethylating agent in combination with chemotherapy for DLBCL patients. This joint clinical project developed from the two institutions’ shared translational interest and expertise in exploring therapeutic potential of epigenetic agents in lymphoma.

Drs. Ruan and Melnick concluded the workshop by thanking the hosts at the Shanghai Institute of Hematology and Ruijin Hospital for their gracious hospitality. Faculty from both institutions are impressed by the progress of the ongoing collaboration and support further development of translational and clinical projects in the future, including academic exchange and joint translational and clinical trials.

 

FDA Approves Subcutaneous Administration of Rituximab for Three Lymphoma Types

On June 22, 2017, the United States Food and Drug Administration (FDA) approved subcutaneous injection of rituximab plus hyaluronidase human for people with follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), and chronic lymphocytic leukemia (CLL). Subcutaneous administration refers to the method of delivering a drug under the skin rather than directly into a vein as performed during intravenous (IV) administration.

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Administration of rituximab under the skin tends to take less than 10 minutes, whereas the traditional IV method can last several hours. The technique also allows for fixed dosing, which can reduce preparation time and excess drug waste, and may be more cost effective than IV infusion.

The approved treatment is to be employed only after patients have received at least one cycle of intravenous rituximab.

Approval comes based on the results of a series of clinical trials demonstrating comparable safety and efficacy outcomes across subcutaneous and intravenous administration.

Dr. Sarah Rutherford Sheds Light on Double-Hit, Double-Expressor Lymphomas

Diffuse large B-cell lymphoma (DLBCL), a fast-growing cancer of abnormal B lymphocyte cells that ordinarily help to fight infection and inflammation in the body, is the most common type of lymphoma. Approximately two-thirds of DLBCL patients are cured by six cycles of the chemotherapy drug combination rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) that serves as a standard treatment, but chromosomal changes involving MYC, BCL-2, and BCL-6 have been linked to more aggressive disease that is harder to cure.

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Normally, MYC plays a role in cell growth, protein synthesis, metabolism, DNA replication, and blood vessel formation (known as angiogenesis), while BCL-2 regulates the natural death of cells when they are no longer needed in the body (known as apoptosis), and BCL-6 helps regulate genes that suppress tumor growth.

At the OncLive State of the Science Summit on Hematologic Malignancies, Dr. Sarah Rutherford provided an overview of two aggressive variations of B-cell lymphoma involving MYC and BCL-2 or BCL-6 that are characterized by resistance to chemotherapy: double-hit lymphoma and double protein-expressor lymphoma.

Double-hit lymphoma occurs due to alterations in two chromosomes involving MYC, BCL-2, and/or BCL-6, with the majority of cases involving MYC and BCL-2. This variant is fairly uncommon and has an incidence rate estimated at 5-10 percent of DLBCL cases, which can include instances in which patients’ follicular lymphoma transformed into DLBCL. Many double-hit lymphomas also tend to infiltrate sites outside the lymph nodes, such as the bone marrow and central nervous system.

According to Dr. Rutherford, outcomes for double-hit lymphomas are poor, even when intensive therapies like autologous stem cell transplant are added to treatment. Overall survival (OS) for double-hit lymphoma patients ranges between 5-24 months when treated with six cycles of R-CHOP, but dose-adjusted chemotherapy drug combination etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R) has become the standard frontline therapy for double-hit cases. DA-EPOCH-R is more intensive than the R-CHOP approach and appears to have improved outcomes, but data is still limited and new strategies are being planned to increase response rates in the double-hit patient population.

Double protein-expressor lymphomas have increased protein expression of MYC and BCL-2 or BCL-6 in the absence of the chromosomal changes seen in double-hit lymphomas. This variant is more common than double-hit lymphoma, with an incidence rate of about 30-40 percent of DLBCL cases, but it is not as difficult to cure. It is, however, more aggressive and has less favorable outcomes than classical DLBCL cases (those without changes in MYC, BCL-2, and BCL-6). The standard treatment for double protein-expressor lymphomas is six cycles of R-CHOP.

Dr. Rutherford said that the Lymphoma Program at Weill Cornell Medicine/NewYork-Presbyterian Hospital – along with other institutions, including Massachusetts General Hospital – is working hard to develop novel strategies that will improve outcomes for these patients. For example, the team currently has a multi-center investigator-initiated clinical trial open to determine the maximum tolerated dose of BCL-2 inhibitor venetoclax combined with DA-EPOCH-R. The goal is to then open a second clinical trial with an objective of evaluating the efficacy of this promising combination in the double-hit and double-expressor lymphoma population.

Watch Dr. Rutherford speak with OncLive about the discrepancy between double-hit and double protein-expressor lymphoma here: