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    Faculty & Disclosures
    Dr Nilanjan Ghosh

    Atrium Health Levine Cancer Institute, Atrium Health, Charlotte, NC, USA

    Nilanjan Ghosh, MD, PhD, is the chair of hematology and chief of the lymphoma division at Atrium Health Levine Cancer Institute, Charlotte, NC, USA. He also serves as a clinical professor of medicine at the Wake Forest School of Medicine, Winston-Salem, and is a member of the Wake Forest Comprehensive Cancer Center. read more

    He received his medical degree at K.J. Somaiya Medical College and Research Center at the University of Mumbai, India, and his doctoral degree in biochemistry and molecular biology at the University of South Florida, Tampa, FL. He completed his residency in internal medicine at Long Island Jewish Medical Center, Queens, NY, and a fellowship in haematology and oncology at Johns Hopkins University, Baltimore, MD. 

    Dr Ghosh’s research interests include lymphoma, chronic lymphocytic leukaemia, chimeric antigen receptor T-cell therapy, stem cell transplant, development of novel therapies and overcoming disparities in healthcare. He has published numerous research papers in prestigious journals such as the New England Journal of Medicine, Lancet, Lancet Oncology, Journal of Clinical Oncology and JAMA Oncology. 

    Dr Ghosh has served as a principal investigator and on steering committees for multiple clinical trials in the field of lymphoma. He is the recipient of several awards, including from the American Society of Clinical Oncology and the Leukemia Lymphoma Society.

    Dr Nilanjan Ghosh discloses: Advisory board or panel fees from Roche NHL Solutions Panel. Consultancy fees from AbbVie, Adaptive Biotech (relationship terminated), ADC Therapeutics, AstraZeneca, BeiGene, Bristol Myers Squibb, Genmab, Gilead Sciences, Incyte, Janssen, Kite Pharma, Lava Therapeutics (relationship terminated), Loxo Oncology, Novartis, Pharmacyclics, Roche/Genentech, Seagen and TG Therapeutics (relationship terminated). Grants/research support from AbbVie, Bristol Myers Squibb, Gilead Sciences, MorphoSys, Pharmacyclics, Roche/Genentech and TG Therapeutics. Speakers bureau fees from AstraZeneca, Bristol Myers Squibb, Epizyme, Janssen, Kite Pharma and Pharmacyclics (all relationships terminated).
    Dr Peter Riedell

    The David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL, USA

    Peter Riedell, MD, is an assistant professor of medicine and also serves as the director of clinical research for the Hematopoietic Cellular Therapy Program, and associate director of the David and Etta Jonas Center for Cellular Therapy at the University of Chicago, Chicago, IL, USA.read more

    Dr Riedell specializes in the care of adults with lymphomas and chronic lymphocytic leukaemia. In particular, he has a special interest in the use of chimeric antigen receptor T-cell therapy in the treatment of these conditions. 

    As an active clinical researcher, Dr Riedell serves as the principal investigator on several national and international clinical trials evaluating the role of targeted therapies, stem cell transplantation and cellular therapy in the treatment of lymphoma. He has been heavily involved in the development and implementation of therapies that harness a patient’s own immune system to fight cancer. His research aims to better characterize and enhance the safety and effectiveness of cellular therapy in order to improve patient outcomes.

    Dr Riedell holds roles on several national committees related to lymphoma and cellular therapy, and he is active in both patient and physician education. He also serves on the editorial board for peer-reviewed journals and is a member of the American Society of Hematology, the American Society of Clinical Oncology and the American Society of Transplantation and Cellular Therapy.

    Dr Peter Riedell discloses: Advisory board or panel fees from ADC Therapeutics, BeiGene, Bristol Myers Squibb, Genmab, Intellia Therapeutics, Janssen, Kite Pharma/Gilead, Nektar Therapeutics, Novartis and Nurix Therapeutics. Consultancy fees from Abbvie, Bristol Myers Squibb, CVS Caremark, Pharmacyclics, Sana Biotechnology. Grants/research support from Calibr, Celgene/Bristol Myers Squibb, CRISPR Therapeutics, Fate Therapeutics, Kite Pharma, MorphoSys, Nkarta, Novartis, Tessa Therapeutics, Roche and Xencor. Speakers bureau fees from Kite Pharma (relationship terminated). 
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    Utilizing prognostic factors in FL to identify high-risk patients and guide treatment decisions
    CAR T-cell therapies in R/R FL: Latest evidence, treatment sequencing and patient selection
    Managing the practicalities of CAR T-cell therapies: Focus on safety and the multidisciplinary team
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    New horizons in R/R follicular lymphoma: Focus on risk stratification and managing the practicalities of CAR T-cell therapy

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    Learning Objectives

    After watching this activity, participants should be better able to:

    • Apply prognostic and risk stratification strategies that predict treatment response and outcomes and help guide treatment decisions in FL
    • Describe the latest efficacy data for CAR T-cell therapies, their positioning in the treatment sequence for R/R FL, and key considerations for patient selection
    • Discuss the practical management of CAR T-cell-related toxicities and the importance of a multidisciplinary approach to care
    Overview

    In this activity, haemato-oncologists with expertise in follicular lymphoma (FL) and chimeric antigen receptor (CAR) T-cell therapy respond to questions from the community oncology, haemato-oncology and CAR T-cell therapy communities on utilizing prognostic factors in FL, evidence for the use of CAR T-cell therapies in relapsed or refractory FL, and how to manage the practicalities of CAR T-cell therapies in the clinic, with a focus on safety.

    This activity is jointly provided by USF Health and touchIME.

    Target Audience

    Haematologists, haemato-oncologists (including CAR T-cell therapy specialists) and oncologists (including community oncologists) involved in the management of follicular lymphoma.

    Disclosures

    USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty

    Dr Nilanjan Ghosh discloses: Advisory board or panel fees from Roche NHL Solutions Panel. Consultancy fees from AbbVie, Adaptive Biotech (relationship terminated), ADC Therapeutics, AstraZeneca, BeiGene, Bristol Myers Squibb, Genmab, Gilead Sciences, Incyte, Janssen, Kite Pharma, Lava Therapeutics (relationship terminated), Loxo Oncology, Novartis, Pharmacyclics, Roche/Genentech, Seagen and TG Therapeutics (relationship terminated). Grants/research support from AbbVie, Bristol Myers Squibb, Gilead Sciences, MorphoSys, Pharmacyclics, Roche/Genentech and TG Therapeutics. Speakers bureau fees from AstraZeneca, Bristol Myers Squibb, Epizyme, Janssen, Kite Pharma and Pharmacyclics (all relationships terminated).

    Dr Peter Riedell discloses: Advisory board or panel fees from ADC Therapeutics, BeiGene, Bristol Myers Squibb, Genmab, Intellia Therapeutics, Janssen, Kite Pharma/Gilead, Nektar Therapeutics, Novartis and Nurix Therapeutics. Consultancy fees from Abbvie, Bristol Myers Squibb, CVS Caremark, Pharmacyclics, Sana Biotechnology. Grants/research support from Calibr, Celgene/Bristol Myers Squibb, CRISPR Therapeutics, Fate Therapeutics, Kite Pharma, MorphoSys, Nkarta, Novartis, Tessa Therapeutics, Roche and Xencor. Speakers bureau fees from Kite Pharma (relationship terminated).

    Content Reviewer

    Carolina Leon BSN, MSN, ARNP-BC has no financial interests/relationships or affiliations in relation to this activity.
    Touch Medical Contributor

    Sola Neunie has no financial interests/relationships or affiliations in relation to this activity.

    USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

    In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

    If you have questions regarding credit please contact cpdsupport@usf.edu.

    Accreditations

    Physicians

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

    USF Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

    Advanced Practice Providers

    Physician Assistants may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

    The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

    Date of original release: 09 January 2024. Date credits expire: 09 January 2025.

    If you have any questions regarding credit please contact cpdsupport@usf.edu.

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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    Topics covered in this activity

    Haematological Malignancies
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    This activity is funded by:

    An independent medical education grant from Bristol Myers Squibb.
    This activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 09 January 2024. Date credits expire: 09 January 2025.

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    touchIN CONVERSATION
    New horizons in R/R follicular lymphoma: Focus on risk stratification and managing the practicalities of CAR T-cell therapy
    1.0 CE/CME credit
    Question 1/4
    Which of the following tools are used to stratify patients with FL according to their risk of early relapse following treatment in the first-line setting?

    FL, follicular lymphoma; FLIPI, Follicular Lymphoma International Prognostic Index; GELF, Groupe d’Étude des Lymphomes Folliculaires; POD24, progression of disease within 24 months; PRIMA-PI, Primary Rituximab and Maintenance Study Prognostic Index.

    Upon diagnosis of FL and prior to treatment initiation, the FLIPI-1, m7-FLIPI and PRIMA-PI tools help stratify patients according to their risk of early relapse following treatment and provide an indication of their prognosis. GELF is used to estimate disease burden; it may also support decisions about treatment initiation. POD24 is commonly used to predict outcomes at relapse and may help guide subsequent therapy choices.

    Abbreviations

    FL, follicular lymphoma; FLIPI, Follicular Lymphoma International Prognostic Index; GELF, Groupe d’Étude des Lymphomes Folliculaires; POD24, progression of disease within 24 months; PRIMA-PI, Primary Rituximab and Maintenance Study Prognostic Index.

    Reference

    Gupta G, et al. Am J Blood Res. 2022;12:105–24.

    Question 2/4
    Your 58-year-old female patient with grade 2 FL has recently shown disease progression despite second-line treatment with lenalidomide plus rituximab therapy. According to the 2023 NCCN guidelines for FL, which of these treatment options might you consider next?

    Axi-cel, axicabtagene ciloleucel; FL, follicular lymphoma; NCCN, National Comprehensive Cancer Network; tisa-cel, tisagenlecleucel.

    The patient has relapsed on prior lenalidomide and rituximab. According to the 2023 NCCN guidelines, the BsAb, mosunetuzumab, and the CAR T-cell therapies, axi-cel and tisa-cel, are possible third-line treatment options in FL, in addition to small molecule inhibitors or second-line therapies not previously used. Chlorambucil ± rituximab is recommended in the first or second line for elderly or infirm patients.

    Abbreviations

    Axi-cel, axicabtagene ciloleucel; BsAb, bispecific antibody; CAR, chimeric antigen receptor; FL, follicular lymphoma; NCCN, National Comprehensive Cancer Network; tisa-cel, tisagenlecleucel.

    Reference

    NCCN. B-cell lymphomas. V6.2023. Available at: www.nccn.org (accessed 28 November 2023).

    Question 3/4
    You are considering offering CAR T-cell therapy to a patient with R/R FL. Which of the following criteria would support your decision in favour of CAR T-cell therapy?

    CAR, chimeric antigen receptor; ECOG PS, Eastern Cooperative Oncology Group performance status; FLIPI-H, Follicular Lymphoma International Prognostic Index – high risk; POD24, progression of disease within 24 months; R/R FL, relapsed or refractory follicular lymphoma.

    Axi-cel and tisa-cel are approved to treat R/R FL after two or more lines of prior therapy.1,2 There is no upper age limit on who can receive CAR T-cell therapy3 and available evidence suggests it can be safely administered to older patients.4 In clinical practice, performance status, somewhat correlated with age, is more likely than chronological age to determine physician choice; poor performance status (ECOG PS >2) constitutes an exclusion criterion for receiving CAR T-cell therapy.3

    Abbreviations

    Axi-cel, axicabtagene ciloleucel; CAR, chimeric antigen receptor; ECOG PS, Eastern Cooperative Oncology Group performance status; R/R FL, relapsed or refractory follicular lymphoma; tisa-cel, tisagenlecleucel.

    References

    1. FDA. Axicabtagene ciloleucel PI. Available at: www.fda.gov/media/108377/download?attachment (accessed 28 November 2023).
    2. FDA. Tisagenlecleucel PI. Available at: www.fda.gov/media/107296/download (accessed 28 November 2023).
    3. Hayden PJ, et al. Curr Res Transl Med. 2019;67:79–88.
    4. Maakaron JE, William BM. Drugs Aging. 2023;40:685–9.
    Question 4/4
    You have a patient with R/R FL who has been experiencing recurrent mild infections following treatment with tisa-cel. After routine monitoring of immunoglobulin levels, you find that their IgG is 290 mg/dL. What will you do next?

    G-CSF, granulocyte colony-stimulating factor; IgG, immunoglobulin G; IVIG, intravenous immunoglobulin; R/R FL, relapsed or refractory follicular lymphoma; tisa-cel, tisagenlecleucel.

    It is recommended that patients with hypogammaglobulinaemia following tisa-cel receive IVIG replacement therapy until serum IgG levels normalize,1 as well as antibiotic prophylaxis.2 Tocilizumab and corticosteroids are used to manage CRS.1 G-CSF support is used to manage prolonged cytopenias.1 Vaccination with live vaccines is not recommended following treatment with tisa-cel, until the immune system has recovered.2

    Abbreviations

    CRS, cytokine release syndrome; G-CSF, granulocyte colony-stimulating factor; IgG, immunoglobulin G; IVIG, intravenous immunoglobulin; tisa-cel, tisagenlecleucel.

    References

    1. Thompson JA, et al. J Natl Compr Canc Netw. 2022;20:387–405.
    2. FDA. Tisagenlecleucel PI. Available at: www.fda.gov/media/107296/download (accessed 28 November 2023).
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    This activity is funded by:

    An independent medical education grant from Bristol Myers Squibb.
    This activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 09 January 2024. Date credits expire: 09 January 2025.

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