Peter Riedell, MD, assistant professor of Medicine, Section of Hematology and Oncology, The University of Chicago Department of medicine, discusses the clinical utility of 

 mutation testing when navigating treatment options for patients with relapsed/refractory follicular lymphoma (FL).

tazemetostat (Tazverik) was approved by the FDA in 2020 for patients with relapsed/refractory EZH2-positive FL

 who have received at least 2 prior systemic therapies or who have relapsed/refractory disease with no other available satisfactory treatment options. Additionally, an associated EZH2 Mutation Test was concurrently approved by the FDA as a companion diagnostic for this population.

 mutation testing can help guide treatment decisions and optimize the selection of appropriate therapeutic interventions, Riedell begins. During treatment selection, this diagnostic tool’s predictive value may provide valuable insights into patient responses to tazemetostat in clinical practice, he expands.

Next-generation sequencing (NGS) is typically employed to identify 

mutations, Riedell continues. However, it is crucial to note that 

mutations are relatively rare, he states. Ridell explains that approximately 20% of patients harbor these mutations, though the percentage may be lower outside of a clinical trial setting. Additionally, current research indicates that tazemetostat demonstrates efficacy in patients with both 

-mutant disease, Riedell notes, although tazemetostat may provide more benefit to those expressing 

mutations. Consequently, the decision to initiate tazemetostat treatment is not solely determined by the presence or absence of this mutation, Riedell emphasizes.

Ultimately, this personalized approach can ensure that patients receive the most suitable treatment options, thereby improving their chances of a favorable response to therapy, Riedell concludes.

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Peter Riedell, MD, discusses the clinical utility of EZH2 mutation testing when navigating treatment options for patients with relapsed/refractory follicular lymphoma.
 

Dr. Riedell on the Clinical Utility of EZH2 Mutation Testing in Relapsed/Refractory FL

Peter Riedell, MD, assistant professor of Medicine, Section of Hematology and Oncology, The University of Chicago Department of medicine, discusses the use of axicabtagene ciloleucel (axi-cel; Yescarta) in high-risk large B-cell lymphoma (LBCL), as evaluated on the phase 2 ZUMA-12 trial (NCT03761056).

The ZUMA-12 trial evaluated the efficacy and safety of axi-cel as a first-line treatment in patients with high-risk LBCL.

The trial examined a high-risk patient population and utilized a dynamic risk assessment with a PET/CT scan after 2 complete cycles of therapy, Riedell says. Patients that did not achieve a complete response, determined by a Deauville score of 3 or lower, were then eligible to participate on the trial, Riedell explains. T cells were extracted from enrolled patients, and they were moved to treatment with lymphodepleting chemotherapy, followed by the CAR T-cell infusion, Riedell says.

Although the ZUMA-12 trial provided encouraging results with progression-free survival and complete response rates, additional follow-up of the study is required to understand the implications of axi-cel in these patients, Riedell continues. A randomized trial will be necessary to potentially bring axi-cel to the first-line setting, Riedell concludes.

Peter Riedell, MD, discusses the use of axicabtagene ciloleucel in high-risk large B-cell lymphoma, as evaluated on the phase 2 ZUMA-12 trial.


Dr. Riedell on the Examination of Axi-Cel Therapy in High-Risk LBCL

Peter Riedell, MD, assistant professor of medicine, University of Chicago Medicine, discusses unique data points of a landmark analysis conducted in mantle cell lymphoma (MCL).

Several unique data points were noted from the analysis, Riedell explains. For example, the data showed that when employing a multivariate analysis, the effect of relapse on overall survival (OS) varied with time, Riedell says. Additionally, the effect of relapse was the greatest at early time points after patients had undergone an autologous hematopoietic cell transplant (AHCT), Riedell explains. Moreover, patients who relapsed by the 6-, 12-, or 18-month landmark time points following AHCT had the worst outcomes overall, Riedell says.

Moreover, patients aged 60 years or older had worse OS at the various landmark time points compared with younger patients, which is consistent with other previously published data, Riedell concludes.

Peter Riedell, MD, discusses unique data points of a landmark analysis conducted in mantle cell lymphoma. 

Dr. Riedell on Unique Data Points from an Analysis in MCL 

Peter Riedell, MD, assistant professor of medicine, University of Chicago Medicine, discusses the patient population and design of a dynamic landmark analysis conducted in patients with mantle cell lymphoma (MCL). 

The analysis focused on evaluating the effect of time to relapse on OS in adult patients with MCL who were treated with up to 2 lines of rituximab (Rituxan)-based induction therapy, followed by frontline autologous stem cell transplantation (ASCT), according to Riedell. In an effort to include a homogenous population, the analysis only included patients who underwent ASCT within 1 year of their diagnosis, Riedell explains. Patients who were transplanted between 2000 and 2018 were evaluated, Riedell adds.

Primary end points included overall survival (OS) and post-relapse OS, Riedell adds. The dynamic landmark analysis was employed at 6-month intervals to evaluate the effects of relapse on OS while adjusting for pertinent patient- and disease-related variables, Riedell concludes.

Peter Riedell, MD, discusses the patient population and design of a dynamic landmark analysis conducted in patients with mantle cell lymphoma.

Dr. Riedell on an Analysis Evaluating the Effect of Time to Relapse on OS in MCL

Peter Riedell, MD, assistant professor of medicine, University of Chicago Medicine, discusses the effects of time to relapse on outcomes in mantle cell lymphoma (MCL).

Findings from an analysis examining the effect of time to relapse on overall survival (OS) in patients with MCL following frontline treatment with high-dose therapy and autologous hematopoietic cell transplantation (AHCT) demonstrated that relapse in MCL following AHCT defines a high-risk group with inferior post-relapse OS.

Other data in other non-Hodgkin lymphoma subtypes like follicular lymphoma have also shed light on how the timing of relapse affects long-term outcomes, Riedell explains.

Ultimately, these data suggest that treatment strategies should be adapted based on timing of relapse following AHCT and that these higher-risk patients should be considered for clinical trials or novel approaches, such as CAR T-cell therapy, Riedell concludes. 

Peter Riedell, MD, discusses the effects of time to relapse on outcomes in mantle cell lymphoma. 



Dr. Riedell on the Effects of Time to Relapse on Outcomes in MCL 

Peter Riedell, MD, assistant professor of medicine, University of Chicago Medicine, discusses the rationale to evaluate survival outcomes after transplant in mantle cell lymphoma (MCL).

MCL is a rare subtype of non-Hodgkin lymphoma in which survival outcomes are heterogenous, Riedell says. For most patients, the standard treatment approach includes intensive induction therapy followed by consolidative autologous stem cell transplant. However, some patients do not derive long-term benefit from this regimen, Riedell explains. 

As such, during the 2021 ASCO Annual Meeting, findings from a study evaluating the effect of time to relapse on overall survival in patients with MCL who underwent this frontline therapeutic approach were presented, Riedell concludes.

Peter Riedell, MD, discusses the rationale to evaluate survival outcomes after transplant in mantle cell lymphoma.



Peter Riedell, MD

Articles

Dr. Riedell on the Clinical Utility of EZH2 Mutation Testing in Relapsed/Refractory FL

Dr. Riedell on the Examination of Axi-Cel Therapy in High-Risk LBCL

Dr. Riedell on Unique Data Points from an Analysis in MCL

Dr. Riedell on an Analysis Evaluating the Effect of Time to Relapse on OS in MCL

Dr. Riedell on the Effects of Time to Relapse on Outcomes in MCL

Dr. Riedell on the Rationale to Evaluate Survival Outcomes After Transplant in MCL