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Luo L, Chen Y, Wu Z, Huang Y, Lu L, Li J, Zheng X, Nie C, Chen R, Lin W, Yang T, Hu J. Clinical characteristics, genetic alterations, and prognosis of adult T-cell leukemia/lymphoma: an 11-year multicenter retrospective study in China. Am J Cancer Res 2024; 14:1649-1661. [PMID: 38726267 PMCID: PMC11076263 DOI: 10.62347/rarp1733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/10/2024] [Indexed: 05/12/2024] Open
Abstract
Adult T-cell leukemia/lymphoma (ATLL) is an aggressive malignancy with a poor prognosis, and there is little data available from the Chinese population. This retrospective study included 115 patients diagnosed with ATLL who were treated across five hospitals in China from June 2011 to December 2022. The median age at diagnosis was 53 years. Several genes involved in T-cell receptor-induced nuclear factor κB (TCR-NF-κB) signaling were commonly mutated, including PLCG1, CIC, PRKCB, CARD11, and IRF4. Eighty-seven patients received chemotherapy. Of these, 13 received a hematopoietic stem cell transplant (HSCT) (allogeneic-HSCT, n=9; autologous-HSCT, n=4) after chemotherapy. Following initial multiagent chemotherapy using EPOCH/CHOEP and other regimens, the overall response rates were 80.6% (complete response [CR], 44.4%) and 42.8% (CR, 14.2%), respectively. The 4-year survival rates (median survival time in days) for EPOCH/CHOEP (n=43), HSCT (n=13), and CHOP-based regimens (n=31) were 12.7% (138), 30.8% (333), and 0% (66), respectively. Lymphadenopathy, EPOCH/CHOEP, and hematopoietic stem cell transplantation were independent prognostic protective factors in patients with aggressive ATLL. Chinese patients exhibit a higher incidence of aggressive-type ATLL, sharing similar genetic alterations with Japanese patients. Etoposide-based chemotherapy (EPOCH or CHOEP) remains the preferred choice for aggressive ATLL, and upfront allogeneic HSCT should be considered in all eligible patients.
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Affiliation(s)
- Luting Luo
- Fujian Medical University Union HospitalFuzhou, Fujian, China
- The Second Affiliated Hospital, Fujian Medical UniversityQuanzhou, Fujian, China
| | - Yanxin Chen
- Fujian Medical University Union HospitalFuzhou, Fujian, China
| | - Zhengjun Wu
- Fujian Medical University Union HospitalFuzhou, Fujian, China
| | - Yan Huang
- Fujian Medical University Union HospitalFuzhou, Fujian, China
| | - Lihua Lu
- Fujian Medical University Union HospitalFuzhou, Fujian, China
| | - Jiazheng Li
- Fujian Medical University Union HospitalFuzhou, Fujian, China
- The Second Affiliated Hospital, Fujian Medical UniversityQuanzhou, Fujian, China
| | - Xiaoyun Zheng
- Department of Hematology, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical UniversityFuzhou, Fujian, China
- Department of Hematology, The First Affiliated Hospital, Fujian Medical UniversityFuzhou, Fujian, China
| | - Chengjun Nie
- Department of Hematology, Ningde Hospital Affiliated to Ningde Normal UniversityNingde, Fujian, China
| | - Renli Chen
- Department of Hematology, Ningde Hospital Affiliated to Ningde Normal UniversityNingde, Fujian, China
| | - Wuqiang Lin
- Department of Hematology, The First Hospital of Putian, Teaching Hospital, Fujian Medical UniversityPutian, Fujian, China
| | - Ting Yang
- Department of Hematology, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical UniversityFuzhou, Fujian, China
- Department of Hematology, The First Affiliated Hospital, Fujian Medical UniversityFuzhou, Fujian, China
- Institute of Precision Medicine, Fujian Medical UniversityFuzhou, Fujian, China
| | - Jianda Hu
- Fujian Medical University Union HospitalFuzhou, Fujian, China
- Institute of Precision Medicine, Fujian Medical UniversityFuzhou, Fujian, China
- The Second Affiliated Hospital, Fujian Medical UniversityQuanzhou, Fujian, China
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Karsten H, Matrisch L, Cichutek S, Fiedler W, Alsdorf W, Block A. Broadening the horizon: potential applications of CAR-T cells beyond current indications. Front Immunol 2023; 14:1285406. [PMID: 38090582 PMCID: PMC10711079 DOI: 10.3389/fimmu.2023.1285406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023] Open
Abstract
Engineering immune cells to treat hematological malignancies has been a major focus of research since the first resounding successes of CAR-T-cell therapies in B-ALL. Several diseases can now be treated in highly therapy-refractory or relapsed conditions. Currently, a number of CD19- or BCMA-specific CAR-T-cell therapies are approved for acute lymphoblastic leukemia (ALL), diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma (MCL), multiple myeloma (MM), and follicular lymphoma (FL). The implementation of these therapies has significantly improved patient outcome and survival even in cases with previously very poor prognosis. In this comprehensive review, we present the current state of research, recent innovations, and the applications of CAR-T-cell therapy in a selected group of hematologic malignancies. We focus on B- and T-cell malignancies, including the entities of cutaneous and peripheral T-cell lymphoma (T-ALL, PTCL, CTCL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), chronic lymphocytic leukemia (CLL), classical Hodgkin-Lymphoma (HL), Burkitt-Lymphoma (BL), hairy cell leukemia (HCL), and Waldenström's macroglobulinemia (WM). While these diseases are highly heterogenous, we highlight several similarly used approaches (combination with established therapeutics, target depletion on healthy cells), targets used in multiple diseases (CD30, CD38, TRBC1/2), and unique features that require individualized approaches. Furthermore, we focus on current limitations of CAR-T-cell therapy in individual diseases and entities such as immunocompromising tumor microenvironment (TME), risk of on-target-off-tumor effects, and differences in the occurrence of adverse events. Finally, we present an outlook into novel innovations in CAR-T-cell engineering like the use of artificial intelligence and the future role of CAR-T cells in therapy regimens in everyday clinical practice.
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Affiliation(s)
- Hendrik Karsten
- Faculty of Medicine, University of Hamburg, Hamburg, Germany
| | - Ludwig Matrisch
- Department of Rheumatology and Clinical Immunology, University Medical Center Schleswig-Holstein, Lübeck, Germany
- Faculty of Medicine, University of Lübeck, Lübeck, Germany
| | - Sophia Cichutek
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Eppendorf, Hamburg, Germany
| | - Walter Fiedler
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Eppendorf, Hamburg, Germany
| | - Winfried Alsdorf
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Eppendorf, Hamburg, Germany
| | - Andreas Block
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Eppendorf, Hamburg, Germany
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