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Gupta A, Riedel RF, Shah C, Borinstein SC, Isakoff MS, Chugh R, Rosenblum JM, Murphy ES, Campbell SR, Albert CM, Zahler S, Thomas SM, Trucco M. Consensus recommendations in the management of Ewing sarcoma from the National Ewing Sarcoma Tumor Board. Cancer 2023; 129:3363-3371. [PMID: 37403815 DOI: 10.1002/cncr.34942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/01/2023] [Accepted: 05/17/2023] [Indexed: 07/06/2023]
Abstract
Ewing sarcoma (ES) is a malignant tumor of bone and soft tissue that most often occurs in adolescents and young adults. Despite an international coordinated approach, several nuances, discrepancies, and debates remain in defining the standard of care for treating ES. In this review, the authors leverage the expertise assembled by formation of the National Ewing Sarcoma Tumor Board, a multi-institution, multidisciplinary virtual tumor board that meets monthly to discuss complicated and challenging cases of ES. This report is focused on select topics that apply to the management of patients with newly diagnosed ES. The specific topics covered include indications for bone marrow aspirate and biopsy for initial evaluation compared with fluorodeoxyglucose-positron emission tomography, the role of interval compressed chemotherapy in patients aged 18 years and older, the role of adding ifosfamide/etoposide to vincristine/doxorubicin/cyclophosphamide for patients with metastatic disease, the data on and role of high-dose chemotherapy with autologous stem cell transplantation, maintenance therapy, and whole-lung irradiation. The data referenced are often limited to subgroup analyses and/or compiled from multiple sources. Although not intended to replace the clinical judgement of treating physicians, the guidelines are intended to provide clarity and recommendations for the upfront management of patients with ES. PLAIN LANGUAGE SUMMARY: Ewing sarcoma is a malignant tumor of bone and soft tissue that most often occurs in adolescents and young adults. For this review, the authors used the experience of the National Ewing Sarcoma Tumor Board, a multi-institution, multidisciplinary virtual tumor board that meets monthly to discuss complicated and challenging cases of Ewing sarcoma. Although not intended to replace the clinical judgement of treating physicians, the guidelines will focus on the development of consensus statements for the upfront management of patients with Ewing sarcoma.
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Affiliation(s)
- Ajay Gupta
- Division of Pediatric Oncology, Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Richard F Riedel
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Scott C Borinstein
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael S Isakoff
- Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Rashmi Chugh
- Department of Medicine, Division of Hematology and Oncology, Rogel Cancer Center, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Jeremy M Rosenblum
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, New York, USA
| | - Erin S Murphy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shauna R Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Catherine M Albert
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Stacey Zahler
- Department of Hematology/Oncology/Bone Marrow Transplantation, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Stefanie M Thomas
- Department of Hematology/Oncology/Bone Marrow Transplantation, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Matteo Trucco
- Department of Hematology/Oncology/Bone Marrow Transplantation, Cleveland Clinic Children's, Cleveland, Ohio, USA
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Wahlig BD, Broida SE, Rose PS, Robinson SI, Siontis BL, Houdek MT. Is Bone Marrow Aspiration and Biopsy of Clinical Importance in the Initial Staging of Extraskeletal Ewing Sarcoma? Clin Orthop Relat Res 2023; 481:2177-2182. [PMID: 37053072 PMCID: PMC10566934 DOI: 10.1097/corr.0000000000002661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/08/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Extraskeletal Ewing sarcoma are rare tumors within the Ewing sarcoma family. Initial staging studies for extraskeletal Ewing sarcoma historically have included imaging and bone marrow aspiration and biopsy (BMAB). However, recent studies on Ewing sarcoma of bone have questioned the utility of BMAB in the initial staging of patients, but no studies of which we are aware have evaluated the role of BMAB in extraskeletal Ewing sarcoma. We suspected that BMAB was of low diagnostic yield in patients with extraskeletal Ewing sarcoma and exposed patients to potential morbidity without an impact on their clinical course. QUESTION/PURPOSE Is BMAB a useful test in the staging of extraskeletal Ewing sarcoma? METHODS Between January 1996 and December 2021, our institution evaluated 109 patients with a listed diagnosis of extraskeletal Ewing sarcoma. Those patients were retrospectively reviewed for this study. Of those, we considered patients with biopsy-confirmed diagnosis of extraskeletal Ewing sarcoma. Biopsy was performed based on institutional protocols, with all diagnoses assigned by a board-certified pathologist. Based on that criteria, 96% (105 of 109) were eligible. An additional 18% (20 of 109) were excluded because records of their initial diagnostic and staging workup were not available. This left 78% (85 of 109) for analysis. Of those, 52% (44 of 85) were male. The average age was 32 ± 16 years. Primary tumor locations included extremities in 26% (22 of 85), paraspinal in 20% (17 of 85), chest in 19% (16 of 85), retroperitoneum in 13% (11 of 85), intraabdominal in 12% (10 of 85), intrapelvic in 7% (6 of 85), and head or neck in 4% (3 of 85). Initial diagnostic and staging information, including the use of PET-CT, bone scan, CT chest, and BMAB, was collected. Metastatic disease at the time of presentation or during follow-up was noted. The utility of BMAB was determined by the rate of positive tests in those undergoing BMAB during the initial staging process. Descriptive statistical analysis was sufficient to address the study question, and therefore no comparative statistics were performed. RESULTS BMAB was obtained during the initial staging process in 64% (54 of 85) of patients. This BMAB was negative in all 54 patients, including those with known metastatic disease. CONCLUSION Diagnosing metastatic disease in extraskeletal Ewing sarcoma is important as the presence of metastases at diagnosis adversely affects prognosis. The routine use of BMAB in the staging process of extraskeletal Ewing sarcoma is of low diagnostic yield. BMAB is unlikely to diagnose metastatic involvement even in patients with known metastases to bone. We do not have enough data to suggest whether other modalities, such as PET-CT, might be more useful. Similar studies should be pursued to determine the utility of the remainder of staging modalities in patients with extraskeletal Ewing sarcoma to elucidate the most efficient and effective staging protocol. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Brian D. Wahlig
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Samuel E. Broida
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Peter S. Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Sánchez-molina S, Figuerola-bou E, Sánchez-margalet V, de la Cruz-merino L, Mora J, de Álava Casado E, García-domínguez DJ, Hontecillas-prieto L. Ewing Sarcoma Meets Epigenetics, Immunology and Nanomedicine: Moving Forward into Novel Therapeutic Strategies. Cancers (Basel) 2022; 14:5473. [PMID: 36358891 PMCID: PMC9658520 DOI: 10.3390/cancers14215473] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/25/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Simple Summary Ewing Sarcoma treatment is traditionally based on chemotherapy, surgery, and radiotherapy. Although these standard of care regimens are efficient at early disease stages, many patients fail to respond appropriately, which has prompted the search for more efficacious and specific treatments. A deeper understanding of the basic molecular mechanisms underlying the biology of both tumor cells and the tumor microenvironment, as well as advances in drug delivery, has led to the development of different approaches to improve the treatment in Ewing Sarcoma patients. Thus, epigenetic, and immunotherapy-based drugs, along with nanotechnology delivery strategies, represent novel preclinical and clinical studies in the treatment of Ewing Sarcoma. In this review, we provide a comprehensive overview of these emerging therapeutic strategies and summarize the potential of the latest preclinical and clinical trials in Ewing Sarcoma research. Finally, we underline the value and future directions of these new treatments. Abstract Ewing Sarcoma (EWS) is an aggressive bone and soft tissue tumor that mainly affects children, adolescents, and young adults. The standard therapy, including chemotherapy, surgery, and radiotherapy, has substantially improved the survival of EWS patients with localized disease. Unfortunately, this multimodal treatment remains elusive in clinics for those patients with recurrent or metastatic disease who have an unfavorable prognosis. Consistently, there is an urgent need to find new strategies for patients that fail to respond to standard therapies. In this regard, in the last decade, treatments targeting epigenetic dependencies in tumor cells and the immune system have emerged into the clinical scenario. Additionally, recent advances in nanomedicine provide novel delivery drug systems, which may address challenges such as side effects and toxicity. Therefore, therapeutic strategies stemming from epigenetics, immunology, and nanomedicine yield promising alternatives for treating these patients. In this review, we highlight the most relevant EWS preclinical and clinical studies in epigenetics, immunotherapy, and nanotherapy conducted in the last five years.
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Park K, Kim H, Koh KN, Im HJ, Cho YU, Jang S, Seo EJ, Park CJ. Bone Marrow Findings in Patients With Ewing Sarcoma/Primitive Neuroectodermal Tumor. Ann Lab Med 2021; 41:499-501. [PMID: 33824240 PMCID: PMC8041597 DOI: 10.3343/alm.2021.41.5.499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/07/2020] [Accepted: 03/05/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Kuenyoul Park
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Hyeri Kim
- Department of Pediatrics, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Kyung-Nam Koh
- Department of Pediatrics, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Ho Joon Im
- Department of Pediatrics, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Young-Uk Cho
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Seongsoo Jang
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Eul-Ju Seo
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Chan-Jeoung Park
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
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Sano H, Mochizuki K, Kobayashi S, Ohara Y, Takahashi N, Kudo S, Ikeda K, Ohto H, Kikuta A. T-cell replete haploidentical stem cell transplantation with low dose anti-thymocyte globulin for relapsed/refractory Ewing sarcoma family tumors. Cancer Rep (Hoboken) 2021; 5:e1519. [PMID: 34291886 PMCID: PMC9327660 DOI: 10.1002/cnr2.1519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background Despite intensive multimodal therapies, the prognosis of relapsed/ refractory Ewing sarcoma family tumors (RR‐ESFTs) is dismal. Some case reports using allogeneic stem cell transplantation (allo SCT) for RR‐ESFTs have been reported, however, the efficacy of allo SCT is yet to be established. Aim The purpose of this study was to evaluate the response and toxicity of T‐cell replete haploidentical SCT (TCR‐haplo‐SCT) in RR‐ESFTs. Methods and results In this study, we retrospectively analyzed six patients with RR‐ESFTs who received TCR‐haplo‐SCT. Four patients had relapsed and two patients had refractory Ewing sarcoma. Before the TCR‐haplo‐SCT, all patients received a reduced intensity‐conditioning regimen containing fludarabine, melphalan, and low‐dose rabbit anti‐thymocyte globulin (2.5 mg/kg), as well as graft‐versus‐host disease (GVHD) prophylaxis, which consisted of tacrolimus, methotrexate, and prednisolone. Primary neutrophil engraftment was achieved in all the patients. Four patients developed acute GVHD (aGVHD) (grade I, 1; grade II, 1; grade III, 2), and two patients developed chronic GVHD (cGVHD). Among the four that developed aGVHD, three survived for 14, 116, and 129 months without relapse, while one died due to a transplant‐related complication. In contrast, the two patients who did not develop aGVHD experienced relapse early after TCR‐haplo‐SCT. Conclusions In this study, three of the six patients with RR‐ESFTs survived for more than one year without relapse, and the treatment toxicity was considered acceptable even for patients who underwent high‐intensity pretreatment. TCR‐haplo‐SCT could be a potential therapeutic option for patients with RR‐ESFTs.
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Affiliation(s)
- Hideki Sano
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Kazuhiro Mochizuki
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Shogo Kobayashi
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yoshihiro Ohara
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Nobuhisa Takahashi
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Shingo Kudo
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Kazuhiko Ikeda
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hitoshi Ohto
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Atsushi Kikuta
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
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Umeda K, Miyamura T, Yamada K, Sano H, Hosono A, Sumi M, Okita H, Kamio T, Maeda N, Fujisaki H, Jyoko R, Watanabe A, Hosoya Y, Hasegawa D, Takenaka S, Nakagawa S, Chin M, Ozaki T. Prognostic and therapeutic factors influencing the clinical outcome of metastatic Ewing sarcoma family of tumors: A retrospective report from the Japan Ewing Sarcoma Study Group. Pediatr Blood Cancer 2021; 68:e28844. [PMID: 33340261 DOI: 10.1002/pbc.28844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The prognosis of patients with metastatic Ewing sarcoma family of tumors (ESFT) remains poor. PROCEDURE We retrospectively analyzed 57 patients diagnosed with metastatic ESFT between 2000 and 2018 to identify prognostic and therapeutic factors affecting the clinical outcome. RESULTS The 3-year overall survival (OS) rate of the entire cohort was 46.8% (95% confidence interval [CI], 33.0-59.4%). Treatment-related death was not observed. Multivariate analysis identified stem cell transplantation (SCT), response to first-line chemotherapy, and bone metastasis as independent risk factors for OS. Objective response rate to first-line chemotherapy was 65.1% in the 43 evaluable patients. There was no significant difference in the response to different types of first-line chemotherapy. Among patients with lung metastasis alone, the 3-year OS rate was higher in 13 patients who received local treatment than in four who did not, although the difference was not significant. CONCLUSIONS One possible reason for the high OS rates was the absence of treatment-related mortality even in patients receiving SCT, which could be attributed to advances in the management of post-SCT complications. Novel first-line chemotherapy strategies need to be established to improve the disease status prior to SCT in a higher proportion of patients.
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Affiliation(s)
- Katsutsugu Umeda
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takako Miyamura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenji Yamada
- Department of Orthopedic Surgery, Okazaki City Hospital, Okazaki, Japan
| | - Hideki Sano
- Department of Pediatric Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ako Hosono
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Minako Sumi
- Department of Radiation Oncology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Hajime Okita
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Takuya Kamio
- Department of Pediatrics, Hirosaki University Hospital, Hirosaki, Japan
| | - Naoko Maeda
- Department of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Hiroyuki Fujisaki
- Department of Pediatric Hematology/Oncology, Osaka City General Hospital, Osaka, Japan
| | - Ryoji Jyoko
- Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Atsuko Watanabe
- Division of Pediatric Oncology, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Yosuke Hosoya
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Daiichiro Hasegawa
- Department of Hematology and Oncology, Children's Cancer Center, Kobe Children's Hospital, Kobe, Japan
| | - Satoshi Takenaka
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shunsuke Nakagawa
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Motoaki Chin
- Department of Pediatrics and Child Health, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Toshifumi Ozaki
- Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Campbell KM, Shulman DS, Grier HE, DuBois SG. Role of bone marrow biopsy for staging new patients with Ewing sarcoma: A systematic review. Pediatr Blood Cancer 2021; 68:e28807. [PMID: 33219750 DOI: 10.1002/pbc.28807] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/19/2020] [Accepted: 10/28/2020] [Indexed: 12/12/2022]
Abstract
The incidence of bone marrow metastasis (BMM) in newly diagnosed Ewing sarcoma (ES) is variable across studies. An optimal staging strategy for detecting BMM is not defined. While bone marrow (BM) biopsy and/or aspirate (BMBA) have been the gold standard, [F-18]fluorodeoxyglucose positron emission tomography (FDG-PET) to detect BMM may decrease reliance on BMBA. We conducted a systematic review to assess incidence of BMM and the role of FDG-PET. We observed a pooled incidence of BMM by BMBA of 4.8% in all newly diagnosed ES patients and 17.5% among patients with metastatic disease. Only 1.2% of patients had BMM as their sole metastatic site. FDG-PET detection of BMM compared to BMBA demonstrated pooled 100% sensitivity and 96% specificity, positive predictive value of 75%, and negative predictive value of 100%. In the era of FDG-PET imaging, omission of BMBA may be considered in patients with otherwise localized disease after initial staging studies.
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Affiliation(s)
- Kevin M Campbell
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts
| | - David S Shulman
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts
| | - Holcombe E Grier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts
| | - Steven G DuBois
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts
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Pawlowska AB, Sun V, Calvert GT, Karras NA, Sato JK, Anderson CP, Cheng JC, DiMundo JF, Femino JD, Lu J, Yang D, Dagis A, Miser JS, Rosenthal J. Long-Term Follow-up of High-Dose Chemotherapy with Autologous Stem Cell Transplantation in Children and Young Adults with Metastatic or Relapsed Ewing Sarcoma: A Single-Institution Experience. Transplant Cell Ther 2020; 27:72.e1-72.e7. [PMID: 33007495 DOI: 10.1016/j.bbmt.2020.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/06/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
Forty-seven patients with metastatic disease at diagnosis or recurrent Ewing sarcoma (EWS) received high-dose chemotherapy (HDC) followed by tandem (n = 20, from February 13, 1997, to October 24, 2002) or single (n = 27, from October 1, 2004, to September 5, 2018) autologous hematopoietic stem cell transplantation (ASCT). To our knowledge, this is the largest single-institution study with sustained long-term follow-up exceeding 10 years. All patients who underwent single ASCT received a novel conditioning regimen with busulfan, melphalan, and topotecan. The overall survival (OS) and disease-free survival (DFS) were 46% and 37% at 10 years and 42% and 37% at 15 years, respectively. Disease status at transplant and the time to disease relapse prior to ASCT were identified as important prognostic factors in OS, DFS, and risk of relapse. At 10 years, patients who underwent transplantation in first complete response (1CR) had an excellent outcome (OS 78%), patients in 1CR/second complete response (2CR)/first partial response (1PR) had an OS of 66%, and patients at third or more complete response, second or more partial response, or advanced disease had an OS of 26%. Ten-year OS for patients without a history of relapse, with late relapse (≥2 years from diagnosis), or with early relapse (<2 years from diagnosis) was 75%, 50%, and 18%, respectively. Selected patients in 1CR, 2CR, 1PR, and with late relapse had excellent, sustained 10- and 15-year OS and DFS.
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Affiliation(s)
| | - Victoria Sun
- Department of Pediatrics, City of Hope, Duarte, California
| | - George T Calvert
- Department of Orthopedic Oncology, Norton Cancer Institute, Louisville, Kentucky
| | | | - Judith K Sato
- Department of Pediatrics, City of Hope, Duarte, California
| | | | - Jerry C Cheng
- Southern California Permanente Medical Group, Los Angeles, California
| | | | | | - J'Rick Lu
- Department of Pediatrics, City of Hope, Duarte, California
| | - Dongyun Yang
- Department of Computational and Quantitative Medicine, City of Hope, Duarte, California
| | - Andrew Dagis
- Department of Computational and Quantitative Medicine, City of Hope, Duarte, California
| | - James S Miser
- Department of Pediatrics, City of Hope, Duarte, California
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Schober SJ, Thiede M, Gassmann H, Prexler C, Xue B, Schirmer D, Wohlleber D, Stein S, Grünewald TGP, Busch DH, Richter GHS, Burdach SEG, Thiel U. MHC Class I-Restricted TCR-Transgenic CD4 + T Cells Against STEAP1 Mediate Local Tumor Control of Ewing Sarcoma In Vivo. Cells 2020; 9:cells9071581. [PMID: 32610710 PMCID: PMC7408051 DOI: 10.3390/cells9071581] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 12/16/2022] Open
Abstract
In this study we report the functional comparison of T cell receptor (TCR)-engineered major histocompatibility complex (MHC) class I-restricted CD4+ versus CD8+ T cells targeting a peptide from six transmembrane epithelial antigen of the prostate 1 (STEAP1) in the context of HLA-A*02:01. STEAP1 is a tumor-associated antigen, which is overexpressed in many cancers, including Ewing sarcoma (EwS). Based on previous observations, we postulated strong antitumor potential of tumor-redirected CD4+ T cells transduced with an HLA class I-restricted TCR against a STEAP1-derived peptide. We compared CD4+ T cell populations to their CD8+ counterparts in vitro using impedance-based xCELLigence and cytokine/granzyme release assays. We further compared antitumor activity of STEAP130-TCR transgenic (tg) CD4+ versus CD8+ T cells in tumor-bearing xenografted Rag2-/-gc-/- mice. TCR tgCD4+ T cells showed increased cytotoxic features over time with similar functional avidity compared to tgCD8+ cells after 5-6 weeks of culture. In vivo, local tumor control was equal. Assessing metastatic organotropism of intraveniously (i.v.) injected tumors, only tgCD8+ cells were associated with reduced metastases. In this analysis, EwS-redirected tgCD4+ T cells contribute to local tumor control, but fail to control metastatic outgrowth in a model of xenografted EwS.
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Affiliation(s)
- Sebastian J. Schober
- Department of Pediatrics, Children’s Cancer Research Center, Kinderklinik München Schwabing, School of Medicine, Technical University of Munich, 80804 Munich, Germany; (M.T.); (H.G.); (C.P.); (B.X.); (D.S.); (G.H.S.R.); (S.E.G.B.)
- Correspondence: (S.J.S.); (U.T.)
| | - Melanie Thiede
- Department of Pediatrics, Children’s Cancer Research Center, Kinderklinik München Schwabing, School of Medicine, Technical University of Munich, 80804 Munich, Germany; (M.T.); (H.G.); (C.P.); (B.X.); (D.S.); (G.H.S.R.); (S.E.G.B.)
| | - Hendrik Gassmann
- Department of Pediatrics, Children’s Cancer Research Center, Kinderklinik München Schwabing, School of Medicine, Technical University of Munich, 80804 Munich, Germany; (M.T.); (H.G.); (C.P.); (B.X.); (D.S.); (G.H.S.R.); (S.E.G.B.)
| | - Carolin Prexler
- Department of Pediatrics, Children’s Cancer Research Center, Kinderklinik München Schwabing, School of Medicine, Technical University of Munich, 80804 Munich, Germany; (M.T.); (H.G.); (C.P.); (B.X.); (D.S.); (G.H.S.R.); (S.E.G.B.)
| | - Busheng Xue
- Department of Pediatrics, Children’s Cancer Research Center, Kinderklinik München Schwabing, School of Medicine, Technical University of Munich, 80804 Munich, Germany; (M.T.); (H.G.); (C.P.); (B.X.); (D.S.); (G.H.S.R.); (S.E.G.B.)
| | - David Schirmer
- Department of Pediatrics, Children’s Cancer Research Center, Kinderklinik München Schwabing, School of Medicine, Technical University of Munich, 80804 Munich, Germany; (M.T.); (H.G.); (C.P.); (B.X.); (D.S.); (G.H.S.R.); (S.E.G.B.)
| | - Dirk Wohlleber
- Institute of Molecular Immunology/Experimental Oncology, Klinikum rechts der Isar, Technical University of Munich, 81674 Munich, Germany;
| | - Stefanie Stein
- Max-Eder Research Group for Pediatric Sarcoma Biology, Institute of Pathology of the LMU, 80337 Munich, Germany; (S.S.); (T.G.P.G.)
| | - Thomas G. P. Grünewald
- Max-Eder Research Group for Pediatric Sarcoma Biology, Institute of Pathology of the LMU, 80337 Munich, Germany; (S.S.); (T.G.P.G.)
- Division of Translational Pediatric Sarcoma Research, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Institute of Pathology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Dirk H. Busch
- Institute for Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, 81674 Munich, Germany;
| | - Guenther H. S. Richter
- Department of Pediatrics, Children’s Cancer Research Center, Kinderklinik München Schwabing, School of Medicine, Technical University of Munich, 80804 Munich, Germany; (M.T.); (H.G.); (C.P.); (B.X.); (D.S.); (G.H.S.R.); (S.E.G.B.)
- Division of Oncology and Hematology, Department of Pediatrics, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Stefan E. G. Burdach
- Department of Pediatrics, Children’s Cancer Research Center, Kinderklinik München Schwabing, School of Medicine, Technical University of Munich, 80804 Munich, Germany; (M.T.); (H.G.); (C.P.); (B.X.); (D.S.); (G.H.S.R.); (S.E.G.B.)
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), partner site Munich, 80336 Munich, Germany
| | - Uwe Thiel
- Department of Pediatrics, Children’s Cancer Research Center, Kinderklinik München Schwabing, School of Medicine, Technical University of Munich, 80804 Munich, Germany; (M.T.); (H.G.); (C.P.); (B.X.); (D.S.); (G.H.S.R.); (S.E.G.B.)
- Correspondence: (S.J.S.); (U.T.)
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10
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Cesari M, Righi A, Colangeli M, Gambarotti M, Spinnato P, Ferraro A, Longhi A, Abate ME, Palmerini E, Paioli A, Ferrari C, Donati DM, Picci P, Ferrari S. Bone marrow biopsy in the initial staging of Ewing sarcoma: Experience from a single institution. Pediatr Blood Cancer 2019; 66:e27653. [PMID: 30724024 DOI: 10.1002/pbc.27653] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/08/2019] [Accepted: 01/22/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ewing sarcoma (ES) is the second most common bone tumor in adolescents and children. Staging workup for ES includes imaging and bone marrow biopsy (BMB). The effective role of BMB is now under discussion. PROCEDURE A monoinstitutional retrospective analysis reviewed clinical charts, imaging, and histology of patients with diagnosis of ES treated at the Rizzoli Institute between 1998 and 2017. RESULTS The cohort included 504 cases of ES of bone; 137 (27%) had metastases at diagnosis, while the remaining 367 had localized disease. Twelve patients had a positive BMB (2.4%). Eleven had distant metastases detected at initial workup staging with imaging assessment: six patients presented with bone metastases, five with both bone and lung metastases. Only one patient with ES of the foot (second metatarsus) was found to have bone marrow involvement with negative imaging evaluation (0.3%). CONCLUSIONS On the basis of our data, we suggest reconsidering the effective role of BMB in initial staging workup for patients with ES with no signs of metastases by modern imaging techniques. In metastatic disease, the assessment of the bone marrow status may remain useful to identify a group of patients at very high risk who could benefit from different treatment strategies.
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Affiliation(s)
- Marilena Cesari
- Chemotherapy Section, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Alberto Righi
- Department of Surgical Pathology, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Marco Colangeli
- Department of Orthopaedic Surgery, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Marco Gambarotti
- Department of Surgical Pathology, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Paolo Spinnato
- Department of Radiology, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Andrea Ferraro
- Department of Orthopaedic Surgery, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Alessandra Longhi
- Chemotherapy Section, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | | | - Emanuela Palmerini
- Chemotherapy Section, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Anna Paioli
- Chemotherapy Section, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Cristina Ferrari
- Laboratory of Experimental Oncology, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Davide Maria Donati
- Department of Orthopaedic Surgery, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Piero Picci
- Laboratory of Experimental Oncology, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Stefano Ferrari
- Chemotherapy Section, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
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11
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Tamura A, Yamamoto N, Nino N, Ichikawa T, Nakatani N, Nakamura S, Saito A, Kozaki A, Kishimoto K, Ishida T, Yoshida M, Akasaka Y, Hasegawa D, Kosaka Y. Pazopanib maintenance therapy after tandem high-dose chemotherapy for disseminated Ewing sarcoma. Int Cancer Conf J 2019; 8:95-100. [PMID: 31218182 DOI: 10.1007/s13691-019-00362-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 02/11/2019] [Indexed: 10/27/2022] Open
Abstract
The dismal prognosis of patients with disseminated Ewing sarcoma necessitates the development of novel treatment strategies. Pazopanib is an oral multi-targeted tyrosine kinase inhibitor that is active against advanced soft tissue sarcoma. However, the clinical activity and feasibility of pazopanib for treating Ewing sarcoma remain poorly understood. Moreover, clinical information on the use of tandem high-dose chemotherapy for Ewing sarcoma is limited. A 14-year-old boy with Ewing sarcoma was transferred to our hospital for treatment. Magnetic resonance imaging, computed tomography scans, and bone scintigraphy revealed multiple lesions in the pubis, ilium, ischium, femur, rib, cranial bone, thoracic vertebrae, sacrum, obturator muscle, adductor magnus muscle, testicular cord, and lungs. Bone scintigraphy after intensive chemotherapies confirmed that multiple abnormal accumulations were still present in the cranial bone and pubis. Subsequently, the patient received tandem high-dose chemotherapy including topotecan, and radiotherapy. Abnormal accumulations have disappeared in bone scintigraphy. Subsequently, pazopanib maintenance therapy was initiated. Despite the presence of innumerable lesions at diagnosis, the patient has been in near-complete remission for the past 1 year with pazopanib administration. This confirms that adding pazopanib maintenance therapy after tandem high-dose chemotherapy is a therapeutic option for cases with disseminated Ewing sarcoma.
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Affiliation(s)
- Akihiro Tamura
- 1Department of Hematology and Oncology, Kobe Children's Hospital, Minatojima-Minamimachi 1-6-7, Chuo-ku, Kobe, 650-0047 Japan
| | - Nobuyuki Yamamoto
- 1Department of Hematology and Oncology, Kobe Children's Hospital, Minatojima-Minamimachi 1-6-7, Chuo-ku, Kobe, 650-0047 Japan
| | - Nanako Nino
- 1Department of Hematology and Oncology, Kobe Children's Hospital, Minatojima-Minamimachi 1-6-7, Chuo-ku, Kobe, 650-0047 Japan
| | - Takayuki Ichikawa
- 1Department of Hematology and Oncology, Kobe Children's Hospital, Minatojima-Minamimachi 1-6-7, Chuo-ku, Kobe, 650-0047 Japan
| | - Naoko Nakatani
- 1Department of Hematology and Oncology, Kobe Children's Hospital, Minatojima-Minamimachi 1-6-7, Chuo-ku, Kobe, 650-0047 Japan
| | - Sayaka Nakamura
- 1Department of Hematology and Oncology, Kobe Children's Hospital, Minatojima-Minamimachi 1-6-7, Chuo-ku, Kobe, 650-0047 Japan
| | - Atsuro Saito
- 1Department of Hematology and Oncology, Kobe Children's Hospital, Minatojima-Minamimachi 1-6-7, Chuo-ku, Kobe, 650-0047 Japan
| | - Aiko Kozaki
- 1Department of Hematology and Oncology, Kobe Children's Hospital, Minatojima-Minamimachi 1-6-7, Chuo-ku, Kobe, 650-0047 Japan
| | - Kenji Kishimoto
- 1Department of Hematology and Oncology, Kobe Children's Hospital, Minatojima-Minamimachi 1-6-7, Chuo-ku, Kobe, 650-0047 Japan
| | - Toshiaki Ishida
- 1Department of Hematology and Oncology, Kobe Children's Hospital, Minatojima-Minamimachi 1-6-7, Chuo-ku, Kobe, 650-0047 Japan
| | - Makiko Yoshida
- 2Department of Diagnostic Pathology, Kobe Children's Hospital, Kobe, Japan
| | - Yoshinobu Akasaka
- 3Department of Diagnostic Radiology, Kobe Children's Hospital, Kobe, Japan
| | - Daiichiro Hasegawa
- 1Department of Hematology and Oncology, Kobe Children's Hospital, Minatojima-Minamimachi 1-6-7, Chuo-ku, Kobe, 650-0047 Japan
| | - Yoshiyuki Kosaka
- 1Department of Hematology and Oncology, Kobe Children's Hospital, Minatojima-Minamimachi 1-6-7, Chuo-ku, Kobe, 650-0047 Japan
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12
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Medford A, Brunner A, Nardi V, Hasserjian R, Carlson J, Choy E. Therapy-Related Erythroleukemia in a Man With Metastatic Ewing Sarcoma: A Clinical Role for Advanced Molecular Diagnostics. JCO Precis Oncol 2018; 2:1-6. [PMID: 35135116 DOI: 10.1200/po.17.00217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Schober SJ, von Luettichau I, Wawer A, Steinhauser M, Salat C, Schwinger W, Ussowicz M, Antunovic P, Castagna L, Kolb HJ, Burdach SEG, Thiel U. Donor lymphocyte infusions in adolescents and young adults for control of advanced pediatric sarcoma. Oncotarget 2018; 9:22741-22748. [PMID: 29854312 PMCID: PMC5978262 DOI: 10.18632/oncotarget.25228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/06/2018] [Indexed: 01/22/2023] Open
Abstract
Background Allogeneic stem cell transplantation (allo-SCT) and donor lymphocyte infusions (DLI) may induce a graft-versus-tumor effect in pediatric sarcoma patients. Here, we describe general feasibility, toxicity and efficacy of DLI after allo-SCT. Results 4 of 8 patients responded. ES#4 had stable disease (SD) for 9 months after DLI and RMS#4 partial response for 8 months with combined hyperthermia/chemotherapy. In ES#4, DLI led to SD for 6 months and reverted residual disease before allo-SCT into complete remission. After DLI, ES#4 and RMS#4 developed acute GvHD (°III-°IV), ES#4 also developed chronic GvHD. 5 patients including ES#4 lived longer than expected. Median survival after allo-SCT was 2.3 years, post-relapse survival (PRS) was 13 months. Off note, HLA-mismatched DLI were associated with a trend towards increased survival after allo-SCT and increased PRS compared to HLA-matched DLI (23 versus 3 months). Materials and Methods We studied eight adolescents and young adults (AYAs) with advanced Ewing sarcoma (ES#1-4) and rhabdomyosarcoma (RMS#1-4) who received DLI. Escalating doses ranged from 2.5 × 104 to 1 × 108 CD3+ cells/kg body weight. AYAs were evaluated for response to DLI, graft-versus-host disease (GvHD) and survival. Conclusions DLI after allo-SCT may control advanced pediatric sarcoma in AYAs with controllable toxicity.
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Affiliation(s)
- Sebastian J Schober
- Department of Pediatrics and Children's Cancer Research Center, TUM School of Medicine, Technical University of Munich, Kinderklinik München Schwabing, 80804 Munich, Germany
| | - Irene von Luettichau
- Department of Pediatrics and Children's Cancer Research Center, TUM School of Medicine, Technical University of Munich, Kinderklinik München Schwabing, 80804 Munich, Germany
| | - Angela Wawer
- Department of Pediatrics and Children's Cancer Research Center, TUM School of Medicine, Technical University of Munich, Kinderklinik München Schwabing, 80804 Munich, Germany
| | - Maximilian Steinhauser
- Department of Pediatrics and Children's Cancer Research Center, TUM School of Medicine, Technical University of Munich, Kinderklinik München Schwabing, 80804 Munich, Germany
| | - Christoph Salat
- Medical Center for Hematology and Oncology Munich MVZ, 80639 Munich, Germany
| | - Wolfgang Schwinger
- Department of Pediatrics, Medical University of Graz, A-8036 Graz, Austria
| | - Marek Ussowicz
- Department of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Petar Antunovic
- Department of Hematology and Regional Tumor Registry, University Hospital Linköping, 581 85 Linköping, Sweden
| | - Luca Castagna
- Department of Oncology and Hematology, IRCCS Humanitas Cancer Center, Humanitas University, 20089, Milan, Italy
| | - Hans-Jochem Kolb
- Department of Pediatrics and Children's Cancer Research Center, TUM School of Medicine, Technical University of Munich, Kinderklinik München Schwabing, 80804 Munich, Germany
| | - Stefan E G Burdach
- Department of Pediatrics and Children's Cancer Research Center, TUM School of Medicine, Technical University of Munich, Kinderklinik München Schwabing, 80804 Munich, Germany.,CCC München-Comprehensive Cancer Center, DKTK German Cancer Consortium Munich, 80336 Munich, Germany
| | - Uwe Thiel
- Department of Pediatrics and Children's Cancer Research Center, TUM School of Medicine, Technical University of Munich, Kinderklinik München Schwabing, 80804 Munich, Germany
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14
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Rifatbegovic F, Frech C, Abbasi MR, Taschner-Mandl S, Weiss T, Schmidt WM, Schmidt I, Ladenstein R, Ambros IM, Ambros PF. Neuroblastoma cells undergo transcriptomic alterations upon dissemination into the bone marrow and subsequent tumor progression. Int J Cancer 2017; 142:297-307. [PMID: 28921546 PMCID: PMC5725737 DOI: 10.1002/ijc.31053] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/28/2017] [Accepted: 08/02/2017] [Indexed: 12/12/2022]
Abstract
Neuroblastoma is the most common extracranial solid tumor in childhood. The vast majority of metastatic (M) stage patients present with disseminated tumor cells (DTCs) in the bone marrow (BM) at diagnosis and relapse. Although these cells represent a major obstacle in the treatment of neuroblastoma patients, insights into their expression profile remained elusive. The present RNA‐Seq study of stage 4/M primary tumors, enriched BM‐derived diagnostic and relapse DTCs, as well as the corresponding BM‐derived mononuclear cells (MNCs) from 53 patients revealed 322 differentially expressed genes in DTCs as compared to the tumors (q < 0.001, |log2FC|>2). Particularly, the levels of transcripts encoded by mitochondrial DNA were elevated in DTCs, whereas, for example, genes involved in angiogenesis were downregulated. Furthermore, 224 genes were highly expressed in DTCs and only slightly, if at all, in MNCs (q < 8 × 10−75 log2FC > 6). Interestingly, we found the transcriptome of relapse DTCs largely resembling those of diagnostic DTCs with only 113 differentially expressed genes under relaxed cut‐offs (q < 0.01, |log2FC|>0.5). Notably, relapse DTCs showed a positional enrichment of 31 downregulated genes on chromosome 19, including five tumor suppressor genes: SIRT6, BBC3/PUMA, STK11, CADM4 and GLTSCR2. This first RNA‐Seq analysis of neuroblastoma DTCs revealed their unique expression profile in comparison to the tumors and MNCs, and less pronounced differences between diagnostic and relapse DTCs. The latter preferentially affected downregulation of genes encoded by chromosome 19. As these alterations might be associated with treatment failure and disease relapse, further functional studies on DTCs should be considered. What's new? More than 90% of patients diagnosed with stage 4 metastatic (4/M) neuroblastoma present with disseminated tumor cells (DTCs) in the bone marrow (BM). Despite treatment, a substantial fraction of these patients experience disease relapse. Here, sequencing analysis of tumor tissue, BM‐derived mononuclear cells (MNCs), and DTCs from stage 4/M neuroblastoma patients indicates that numerous genes are differentially expressed in DTCs but are not or are only slightly altered in tumors and MNCs. Moreover, DTCs exhibited significant downregulation of tumor suppressor genes specifically on chromosome 19. Further studies are needed to determine whether DTC transcriptomic alterations are associated with neuroblastoma relapse.
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Affiliation(s)
- Fikret Rifatbegovic
- Department of Tumor Biology, Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Christian Frech
- Department of Tumor Biology, Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - M Reza Abbasi
- Department of Tumor Biology, Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Sabine Taschner-Mandl
- Department of Tumor Biology, Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Tamara Weiss
- Department of Tumor Biology, Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Wolfgang M Schmidt
- Neuromuscular Research Department, Medical University of Vienna, Vienna, Austria
| | - Iris Schmidt
- Neuromuscular Research Department, Medical University of Vienna, Vienna, Austria
| | - Ruth Ladenstein
- Department of Tumor Biology, Children's Cancer Research Institute (CCRI), Vienna, Austria.,Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Inge M Ambros
- Department of Tumor Biology, Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Peter F Ambros
- Department of Tumor Biology, Children's Cancer Research Institute (CCRI), Vienna, Austria.,Department of Pediatrics, Medical University of Vienna, Vienna, Austria
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15
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von Heyking K, Calzada-Wack J, Göllner S, Neff F, Schmidt O, Hensel T, Schirmer D, Fasan A, Esposito I, Müller-Tidow C, Sorensen PH, Burdach S, Richter GHS. The endochondral bone protein CHM1 sustains an undifferentiated, invasive phenotype, promoting lung metastasis in Ewing sarcoma. Mol Oncol 2017; 11:1288-1301. [PMID: 28319320 PMCID: PMC5579336 DOI: 10.1002/1878-0261.12057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/24/2017] [Accepted: 03/08/2017] [Indexed: 12/11/2022] Open
Abstract
Ewing sarcomas (ES) are highly malignant, osteolytic bone or soft tissue tumors, which are characterized by EWS–ETS translocations and early metastasis to lung and bone. In this study, we investigated the role of the BRICHOS chaperone domain‐containing endochondral bone protein chondromodulin I (CHM1) in ES pathogenesis. CHM1 is significantly overexpressed in ES, and chromosome immunoprecipitation (ChIP) data demonstrate CHM1 to be directly bound by an EWS–ETS translocation, EWS‐FLI1. Using RNA interference, we observed that CHM1 promoted chondrogenic differentiation capacity of ES cells but decreased the expression of osteolytic genes such as HIF1A,IL6,JAG1, and VEGF. This was in line with the induction of the number of tartrate‐resistant acid phosphatase (TRAP+)‐stained osteoclasts in an orthotopic model of local tumor growth after CHM1 knockdown, indicating that CHM1‐mediated inhibition of osteomimicry might play a role in homing, colonization, and invasion into bone tissues. We further demonstrate that CHM1 enhanced the invasive potential of ES cells in vitro. This invasiveness was in part mediated via CHM1‐regulated matrix metallopeptidase 9 expression and correlated with the observation that, in an xenograft mouse model, CHM1 was essential for the establishment of lung metastases. This finding is in line with the observed increase in CHM1 expression in patient specimens with ES lung metastases. Our results suggest that CHM1 seems to have pleiotropic functions in ES, which need to be further investigated, but appears to be essential for the invasive and metastatic capacities of ES.
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Affiliation(s)
- Kristina von Heyking
- Laboratory for Functional Genomics and Transplantation Biology, Children's Cancer Research Center and Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center Munich (CCCM), German Translational Cancer Research Consortium (DKTK), Munich, Germany
| | - Julia Calzada-Wack
- Institute of Pathology, Helmholtz Zentrum München - German Research Centre for Environmental Health (GmbH), Neuherberg, Germany
| | - Stefanie Göllner
- Department of Medicine IV, Hematology and Oncology, University Hospital Halle, Germany
| | - Frauke Neff
- Institute of Pathology, Helmholtz Zentrum München - German Research Centre for Environmental Health (GmbH), Neuherberg, Germany
| | - Oxana Schmidt
- Laboratory for Functional Genomics and Transplantation Biology, Children's Cancer Research Center and Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center Munich (CCCM), German Translational Cancer Research Consortium (DKTK), Munich, Germany
| | - Tim Hensel
- Laboratory for Functional Genomics and Transplantation Biology, Children's Cancer Research Center and Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center Munich (CCCM), German Translational Cancer Research Consortium (DKTK), Munich, Germany
| | - David Schirmer
- Laboratory for Functional Genomics and Transplantation Biology, Children's Cancer Research Center and Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center Munich (CCCM), German Translational Cancer Research Consortium (DKTK), Munich, Germany
| | - Annette Fasan
- Laboratory for Functional Genomics and Transplantation Biology, Children's Cancer Research Center and Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center Munich (CCCM), German Translational Cancer Research Consortium (DKTK), Munich, Germany
| | | | - Carsten Müller-Tidow
- Department of Medicine IV, Hematology and Oncology, University Hospital Halle, Germany.,Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Germany
| | - Poul H Sorensen
- Department of Molecular Oncology, British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | - Stefan Burdach
- Laboratory for Functional Genomics and Transplantation Biology, Children's Cancer Research Center and Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center Munich (CCCM), German Translational Cancer Research Consortium (DKTK), Munich, Germany
| | - Günther H S Richter
- Laboratory for Functional Genomics and Transplantation Biology, Children's Cancer Research Center and Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center Munich (CCCM), German Translational Cancer Research Consortium (DKTK), Munich, Germany
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16
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Thiel U, Schober SJ, Einspieler I, Kirschner A, Thiede M, Schirmer D, Gall K, Blaeschke F, Schmidt O, Jabar S, Ranft A, Alba Rubío R, Dirksen U, Grunewald TGP, Sorensen PH, Richter GHS, von Lüttichau IT, Busch DH, Burdach SEG. Ewing sarcoma partial regression without GvHD by chondromodulin-I/HLA-A*02:01-specific allorestricted T cell receptor transgenic T cells. Oncoimmunology 2017. [PMID: 28638739 DOI: 10.1080/2162402x.2017.1312239] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Chondromodulin-I (CHM1) sustains malignancy in Ewing sarcoma (ES). Refractory ES carries a dismal prognosis and patients with bone marrow (BM) metastases do not survive irrespective of therapy. We assessed HLA-A*02:01/CHM1-specific allorestricted T cell receptor (TCR) wild-type and transgenic cytotoxic (CD8+) T cells against ES. Patients and Methods: Three refractory HLA-A2+ ES patients were treated with HLA-A*02:01/peptide-specific allorepertoire-derived (i.e., allorestricted) CD8+ T cells. Patient #1 received up to 4.8 × 105/kg body weight HLA-A*02:01- allorestricted donor-derived wild-type CD8+ T cells. Patient #2 received up to 8.2 × 106/kg HLA-A*02:01- donor-derived and patient #3 up to 6 × 106/kg autologous allorestricted TCR transgenic CD8+ T cells. All patients were treated with the same TCR complementary determining region 3 allorecognition sequence for CHM1 peptide 319 (CHM1319). Results: HLA-A*02:01/CHM1319-specific allorestricted CD8+ T cells showed specific in vitro lysis of all patient-derived ES cell lines. Therapy was well tolerated and did not cause graft versus host disease (GvHD). Patients #1 and #3 showed slow progression, whereas patient #2, while having BM involvement, showed partial metastatic regression associated with T cell homing to involved lesions. CHM1319 TCR transgenic T cells could be tracked in his BM for weeks. Conclusions: CHM1319-TCR transgenic T cells home to affected BM and may cause partial disease regression. HLA-A*02:01/antigen-specific allorestricted T cells proliferate in vivo without causing GvHD.
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Affiliation(s)
- Uwe Thiel
- Department of Pediatrics and Children's Cancer Research Center, Kinderklinik München Schwabing, Technische Universität München, Munich, Germany
| | - Sebastian J Schober
- Department of Pediatrics and Children's Cancer Research Center, Kinderklinik München Schwabing, Technische Universität München, Munich, Germany
| | - Ingo Einspieler
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Andreas Kirschner
- Department of Pediatrics and Children's Cancer Research Center, Kinderklinik München Schwabing, Technische Universität München, Munich, Germany
| | - Melanie Thiede
- Department of Pediatrics and Children's Cancer Research Center, Kinderklinik München Schwabing, Technische Universität München, Munich, Germany
| | - David Schirmer
- Department of Pediatrics and Children's Cancer Research Center, Kinderklinik München Schwabing, Technische Universität München, Munich, Germany
| | - Katja Gall
- Department of Pediatrics and Children's Cancer Research Center, Kinderklinik München Schwabing, Technische Universität München, Munich, Germany
| | - Franziska Blaeschke
- Department of Pediatrics and Children's Cancer Research Center, Kinderklinik München Schwabing, Technische Universität München, Munich, Germany
| | - Oxana Schmidt
- Department of Pediatrics and Children's Cancer Research Center, Kinderklinik München Schwabing, Technische Universität München, Munich, Germany
| | - Susanne Jabar
- Department of Pediatric Hematology and Oncology, Westfälische Wilhelms Universität, Münster, Germany
| | - Andreas Ranft
- Department of Pediatric Hematology and Oncology, Westfälische Wilhelms Universität, Münster, Germany
| | - Rebeca Alba Rubío
- Max-Eder Research Group for Pediatric Sarcoma Biology, Institute of Pathology, LMU, Munich.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Uta Dirksen
- Department of Pediatric Hematology and Oncology, Westfälische Wilhelms Universität, Münster, Germany
| | - Thomas G P Grunewald
- Max-Eder Research Group for Pediatric Sarcoma Biology, Institute of Pathology, LMU, Munich.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,CCC München Comprehensive Cancer Center and German Translational Cancer Research Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Poul H Sorensen
- Department of Pediatrics and Children's Cancer Research Center, Kinderklinik München Schwabing, Technische Universität München, Munich, Germany.,Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, BC, Canada.,Institute for Advanced Study, Technische Universität München, Munich, Germany
| | - Günther H S Richter
- Department of Pediatrics and Children's Cancer Research Center, Kinderklinik München Schwabing, Technische Universität München, Munich, Germany
| | - Irene Teichert von Lüttichau
- Department of Pediatrics and Children's Cancer Research Center, Kinderklinik München Schwabing, Technische Universität München, Munich, Germany
| | - Dirk H Busch
- Institute of Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany.,Institute for Advanced Study, Technische Universität München, Munich, Germany
| | - Stefan E G Burdach
- Department of Pediatrics and Children's Cancer Research Center, Kinderklinik München Schwabing, Technische Universität München, Munich, Germany.,CCC München Comprehensive Cancer Center and German Translational Cancer Research Consortium (DKTK), Partner Site Munich, Munich, Germany
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Kirschner A, Thiede M, Grünewald TGP, Alba Rubio R, Richter GHS, Kirchner T, Busch DH, Burdach S, Thiel U. Pappalysin-1 T cell receptor transgenic allo-restricted T cells kill Ewing sarcoma in vitro and in vivo. Oncoimmunology 2017; 6:e1273301. [PMID: 28344885 PMCID: PMC5353903 DOI: 10.1080/2162402x.2016.1273301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/09/2016] [Accepted: 12/10/2016] [Indexed: 01/06/2023] Open
Abstract
Pregnancy-associated plasma protein-A (PAPPA), also known as pappalysin, is a member of the insulin-like growth factor (IGF) family. PAPPA acts as a protease, cleaving IGF inhibitors, i.e., IGF binding proteins (IGFBPs), thereby setting free IGFs. The insulin/IGF-axis is involved in cancer in general and in Ewing sarcoma (ES) in particular. ES is a highly malignant bone tumor characterized by early metastatic spread. PAPPA is associated with various cancers. It is overexpressed and required for proliferation in ES. PAPPA also stimulates normal bone growth. We isolated HLA-A*02:01+/peptide-restricted T cells from A*02:01− healthy donors directed against PAPPA, generated by priming with A*02:01+ PAPPA peptide loaded dendritic cells. After TCR identification, retrovirally TCR transduced CD8+ T cells were assessed for their in vitro specificity and in vivo efficacy in human ES bearing Rag2−/−γc−/− mice. Engraftment in mice and tumor infiltration of TCR transgenic T cells in the mice was evaluated. The TCR transgenic T cell clone PAPPA-2G6 demonstrated specific reactivity toward HLA-A*02:01+/PAPPA+ ES cell lines. We furthermore detected circulating TCR transgenic T cells in the blood in Rag2−/−γc−/− mice and in vivo engraftment in bone marrow. Tumor growth in mice with xenografted ES was significantly reduced after treatment with PAPPA-2G6 TCR transgenic T cells in contrast to controls. Tumors of treated mice revealed tumor-infiltrating PAPPA-2G6 TCR transgenic T cells. In summary, we demonstrate that PAPPA is a first-rate target for TCR-based immunotherapy of ES.
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Affiliation(s)
- Andreas Kirschner
- Laboratory for Functional Genomics and Transplantation Biology, Department of Pediatrics and Children's Cancer Research Center, Klinikum rechts der Isar, Technische Universität München , München, Germany
| | - Melanie Thiede
- Laboratory for Functional Genomics and Transplantation Biology, Department of Pediatrics and Children's Cancer Research Center, Klinikum rechts der Isar, Technische Universität München , München, Germany
| | - Thomas G P Grünewald
- Max-Eder Research Group for Pediatric Sarcoma Biology, Institute of Pathology of the LMU Munich, München, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rebeca Alba Rubio
- Max-Eder Research Group for Pediatric Sarcoma Biology, Institute of Pathology of the LMU Munich , München, Germany
| | - Günther H S Richter
- Laboratory for Functional Genomics and Transplantation Biology, Department of Pediatrics and Children's Cancer Research Center, Klinikum rechts der Isar, Technische Universität München, München, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Kirchner
- Max-Eder Research Group for Pediatric Sarcoma Biology, Institute of Pathology of the LMU Munich, München, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Comprehensive Cancer Center (CCC) Munich, München, Germany
| | - Dirk H Busch
- Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München , München, Germany
| | - Stefan Burdach
- Laboratory for Functional Genomics and Transplantation Biology, Department of Pediatrics and Children's Cancer Research Center, Klinikum rechts der Isar, Technische Universität München, München, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Comprehensive Cancer Center (CCC) Munich, München, Germany
| | - Uwe Thiel
- Laboratory for Functional Genomics and Transplantation Biology, Department of Pediatrics and Children's Cancer Research Center, Klinikum rechts der Isar, Technische Universität München , München, Germany
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