1
|
Eyre TA, Barrington SF, Okosun J, Abamba C, Pearce RM, Lee J, Carpenter B, Crawley CR, Bloor AJC, Gilleece M, Nicholson E, Shah N, Orchard K, Malladi R, Townsend WM. Impact of positron emission tomography - computed tomography status on progression-free survival for relapsed follicular lymphoma patients undergoing autologous stem cell transplantation. Haematologica 2023; 108:785-796. [PMID: 35586966 PMCID: PMC9973492 DOI: 10.3324/haematol.2021.280287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/28/2022] [Indexed: 11/09/2022] Open
Abstract
The optimum management approach for patients with relapsed or refractory follicular lymphoma remains uncertain. Autologous stem cell transplantation (autoSCT) is considered a standard option in suitable, younger patients with relapsed follicular lymphoma. AutoSCT is associated with very durable remissions in a minority of subjects, but also with significant, well-established toxicities. Although positron emission tomography (PET) status prior to autoSCT is an established prognostic factor in diffuse large B-cell lymphoma and Hodgkin lymphoma, no data exist in follicular lymphoma. We describe survival outcomes according to pre-transplant PET status, classified by the Lugano criteria into complete metabolic remission (CMR) versus non-CMR, in 172 patients with relapsed or refractory follicular lymphoma within a national, multicenter, retrospective British Society of Blood and Marrow Transplantation and Cellular Therapy registry study. The median number of lines of therapy prior to SCT was three (range, 1-6). The median follow-up after SCT was 27 months (range, 3-70). The median progression-free survival for all patients after autoSCT was 28 months (interquartile range, 23- 36). There was no interaction between age at transplantation, sex, number of months since last relapse, Karnofsky performance status or comorbidity index and achieving CMR prior to autoSCT. Superior progression-free survival was observed in 115 (67%) patients obtaining CMR versus 57 (33%) non-CMR patients (3-year progression-free survival 50% vs. 22%, P=0.011) and by pre-SCT Deauville score (continuous variable 1-5, hazard ratio [HR]=1.32, P=0.049). PET status was independently associated with progression-free status (non-CMR HR=2.02, P=0.003), overall survival (non-CMR HR=3.08, P=0.010) and risk of relapse (non-CMR HR=1.64, P=0.046) after autoSCT by multivariable analysis. Our data suggest that pre- SCT PET status is of clear prognostic value and may help to improve the selection of patients for autoSCT.
Collapse
Affiliation(s)
- Toby A Eyre
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford.
| | - Sally F Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London
| | - Jessica Okosun
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London
| | - Clementina Abamba
- BSBMTCT data registry, 5th Floor Tabard House, Talbot Yard, Guy's Hospital, Great Maze Pond, London
| | - Rachel M Pearce
- BSBMTCT data registry, 5th Floor Tabard House, Talbot Yard, Guy's Hospital, Great Maze Pond, London
| | - Julia Lee
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London
| | - Ben Carpenter
- Department of Haematology, University College London Hospitals 235 Euston Road, London
| | - Charles R Crawley
- Department of Haematology and Bone Marrow Transplantation, Addenbrookes Hospital, Cambridge
| | - Adrian J C Bloor
- Department of Haematology, The Christie Hospital NHS Trust, Manchester
| | - Maria Gilleece
- Department of Haematology and Bone Marrow Transplantation, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Emma Nicholson
- Department of Haematology and Bone Marrow Transplantation, Royal Marsden Hospital, London
| | - Nimish Shah
- Department of Haematology, Norfolk and Norwich University Hospitals, Norwich
| | - Kim Orchard
- Department of Haematology and Bone Marrow Transplantation, Southampton University Hospitals, Southampton
| | - Ram Malladi
- Department of Haematology and Bone Marrow Transplantation, Addenbrookes Hospital, Cambridge
| | - William M Townsend
- Department of Haematology, University College London Hospitals 235 Euston Road, London
| |
Collapse
|
2
|
Affiliation(s)
- Adrian J C Bloor
- The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Fiona L Dignan
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Julia Lee
- British Society of Blood and Marrow Transplantation and Cellular Therapy, London, UK
| | - Kim H Orchard
- University Hospital Southampton, University of Southampton, Southampton, UK
| |
Collapse
|
3
|
Affiliation(s)
| | - Adrian J. C. Bloor
- Department of Haematology; The Christie NHS Foundation Trust; Manchester UK
- University of Manchester; Manchester UK
- Manchester Academic Health Science Centre; Manchester UK
| |
Collapse
|
4
|
Thomson KJ, Morris EC, Milligan D, Parker AN, Hunter AE, Cook G, Bloor AJC, Clark F, Kazmi M, Linch DC, Chakraverty R, Peggs KS, Mackinnon S. T-cell-depleted reduced-intensity transplantation followed by donor leukocyte infusions to promote graft-versus-lymphoma activity results in excellent long-term survival in patients with multiply relapsed follicular lymphoma. J Clin Oncol 2010; 28:3695-700. [PMID: 20606089 DOI: 10.1200/jco.2009.26.9100] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Follicular lymphoma (FL) is an indolent disorder that is treatable but considered incurable with chemotherapy alone. The curative potential of allogeneic transplantation using conventional myeloablative conditioning has been demonstrated, but this approach is precluded in the majority of patients with FL because of excessive toxicity. Thus, reduced-intensity conditioning regimens are being explored. PATIENTS AND METHODS This study reports the outcome of 82 consecutive patients with FL who underwent transplantation using fludarabine, melphalan, and alemtuzumab for in vivo T-cell depletion. Patients were heavily pretreated, having received a median of four lines of prior therapy, and 26% had experienced treatment failure with previous autologous transplantation. Median patient age was 45 years, and 52% of patients received stem cells from unrelated donors. RESULTS With a median follow-up time of 43 months, the nonrelapse mortality was 15% at 4 years (8% for sibling and 22% for unrelated donor transplantations), acute grade 2 or 3 graft-versus-host disease (GVHD) occurred in 13%, and the incidence of extensive chronic GVHD was only 18%. Although relapse risk was 26%, this was significantly reduced where mixed chimerism had been converted to full donor chimerism by the use of donor lymphocyte infusion (DLI; P = .03). In addition, 10 (77%) of 13 patients given DLI for relapse after transplantation experienced remission, with nine of these responses being sustained. Current progression-free survival at 4 years was 76% for the whole cohort (90% for those with sibling donors and 64% for those with unrelated donors). CONCLUSION The excellent long-term survival with associated low rates of GVHD and the frequency and durability of DLI responses make this an extremely encouraging strategy for the treatment and potential cure of FL.
Collapse
Affiliation(s)
- Kirsty J Thomson
- Department of Haematology, University College Hospital, London, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Bloor AJC, Thomson K, Chowdhry N, Verfuerth S, Ings SJ, Chakraverty R, Linch DC, Goldstone AH, Peggs KS, Mackinnon S. High response rate to donor lymphocyte infusion after allogeneic stem cell transplantation for indolent non-Hodgkin lymphoma. Biol Blood Marrow Transplant 2008; 14:50-8. [PMID: 18158961 DOI: 10.1016/j.bbmt.2007.04.013] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Accepted: 04/18/2007] [Indexed: 11/24/2022]
Abstract
The role of donor lymphocyte infusion (DLI) in the management of lymphoid malignancies after allogeneic stem cell transplantation (SCT) has not been clearly characterized. There is emerging evidence pointing to the effectiveness of this approach, particularly in patients with low-grade disease, although to date this has been reported only in small numbers of patients, and thus the utility of this treatment remains uncertain. A total of 28 patients with low-grade lymphoid malignancies previously treated with allogeneic SCT received a total of 68 infusions of donor lymphocytes. The diagnoses were indolent non-Hodgkin lymphoma (NHL; n = 23) and transformed NHL (n = 5), and the indications for DLI were progressive disease with or without mixed chimerism (MC) (n = 17) and persistent MC alone (n = 11). Escalating doses of cells were administered in the absence of graft-versus-host disease (GVHD) or continued disease progression, until stable full donor chimerism or disease response were achieved. The cumulative response rates after DLI to treat progressive disease and persistent MC were 76.5% and 91.6%, respectively. The major toxicity resulting from the use of donor lymphocytes was GVHD. The cumulative incidence of acute grade II-IV disease was 15%, and that of extensive chronic disease was 31%; there were no deaths resulting from GVHD. Seven patients had graft-versus-lymphoma responses without significant GVHD. These data support the existence of a clinically significant graft-versus-tumor effect in indolent NHL and suggest that this is an effective treatment for progressive disease after allogeneic SCT.
Collapse
Affiliation(s)
- Adrian J C Bloor
- Department of Haematology, Royal Free and University College London School of Medicine, London, United Kingdom.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Bloor AJC, Mackinnon S. Cerebral tuberculosis post stem cell transplant. Eur J Haematol 2006; 77:456. [PMID: 16856918 DOI: 10.1111/j.1600-0609.2006.00718.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
MESH Headings
- Adult
- Antitubercular Agents/administration & dosage
- Fatal Outcome
- Humans
- Immunocompromised Host
- Leukemia, Myeloid, Acute/cerebrospinal fluid
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/microbiology
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/therapy
- Male
- Stem Cell Transplantation/adverse effects
- Transplantation, Homologous
- Tuberculoma, Intracranial/cerebrospinal fluid
- Tuberculoma, Intracranial/drug therapy
- Tuberculoma, Intracranial/etiology
- Tuberculoma, Intracranial/pathology
Collapse
Affiliation(s)
- Adrian J C Bloor
- Department of Haematology, University College London, London, UK.
| | | |
Collapse
|
7
|
Bloor AJC, Smith GA, Jaswon M, Parker NE, Ouwehand WH, Liesner R. Acquired thrombasthenia due to GPIIbIIIa platelet autoantibodies in a 4-yr-old child. Eur J Haematol 2006; 76:89-90. [PMID: 16343278 DOI: 10.1111/j.1600-0609.2005.00574.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
8
|
Abstract
Basic helix-loop-helix (bHLH) transcription factors play a pivotal role in the regulation of tumorigenesis, and also in a wide range of other developmental processes in diverse species from yeast to humans. Here we demonstrate for the first time that Ret finger protein (RFP), a member of the TRIM family of proteins initially identified as a recombined transforming gene from a human lymphoma, is a novel interaction partner for four different bHLH proteins (SCL, E47, MyoD and mASH-1), but does not interact with GATA-1 or PU.1. Interaction with SCL required the B-box and first coiled-coil region of RFP together with the bHLH domain of SCL. RFP was able to repress transcriptional activation by E47, MyoD and mASH-1, but not by members of several other transcription factor families. Transcriptional repression by RFP was trichostatin A sensitive and did not involve an Id-like mechanism or ubiquitination with subsequent degradation of bHLH proteins. Instead, our results suggest that bHLH transcription factors are regulated by a previously undescribed interaction with RFP, which functions to recruit HDAC and/or Polycomb proteins and thus repress target genes of bHLH proteins. These results reveal an unexpected link between the bHLH and TRIM protein families.
Collapse
Affiliation(s)
- Adrian J C Bloor
- Department of Haematology, Cambridge Institute for Medical Research, Cambridge University, Hills Road, Cambridge CB2 2XY, UK
| | | | | | | | | |
Collapse
|
9
|
Sinclair AM, Bench AJ, Bloor AJC, Li J, Göttgens B, Stanley ML, Miller J, Piltz S, Hunter S, Nacheva EP, Sanchez MJ, Green AR. Rescue of the lethal scl(-/-) phenotype by the human SCL locus. Blood 2002; 99:3931-8. [PMID: 12010791 DOI: 10.1182/blood.v99.11.3931] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The stem cell leukemia (SCL) gene encodes a basic helix-loop-helix transcription factor with a critical role in the development of both blood and endothelium. Loss-of-function studies have shown that SCL is essential for the formation of hematopoietic stem cells, for subsequent erythroid development and for yolk sac angiogenesis. SCL exhibits a highly conserved pattern of expression from mammals to teleost fish. Several murine SCL enhancers have been identified, each of which directs reporter gene expression in vivo to a subdomain of the normal SCL expression pattern. However, regulatory elements necessary for SCL expression in erythroid cells remain to be identified and the size of the chromosomal domain needed to support appropriate SCL transcription is unknown. Here we demonstrate that a 130-kilobase (kb) yeast artificial chromosome (YAC) containing the human SCL locus completely rescued the embryonic lethal phenotype of scl(-/-) mice. Rescued YAC(+) scl(-/-) mice were born in appropriate Mendelian ratios, were healthy and fertile, and exhibited no detectable abnormality of yolk sac, fetal liver, or adult hematopoiesis. The human SCL protein can therefore substitute for its murine homologue. In addition, our results demonstrate that the human SCL YAC contains the chromosomal domain necessary to direct expression to the erythroid lineage and to all other tissues in which SCL performs a nonredundant essential function.
Collapse
Affiliation(s)
- Angus M Sinclair
- University of Cambridge, Department of Haematology, Cambridge Institute for Medical Research, Hills Road, Cambridge, CB2 2XY, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Bloor AJC, Sánchez MJ, Green AR, Göttgens B. The role of the stem cell leukemia (SCL) gene in hematopoietic and endothelial lineage specification. J Hematother Stem Cell Res 2002; 11:195-206. [PMID: 11983093 DOI: 10.1089/152581602753658402] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Anatomical observations made at the beginning of the twentieth century revealed an intimate association between the ontogeny of blood and endothelium and led to the hypothesis of a common cell of origin termed the hemangioblast. However, the precise nature of the cellular intermediates involved in the development of both lineages from uncommitted precursors to mature cell types is still the subject of ongoing studies, as are the molecular mechanisms driving this process. There is clear evidence that lineage-restricted transcription factors play a central role in the genesis of mature lineage committed cells from multipotent progenitors. Amongst these, the basic helix-loop-helix (bHLH) family is of key importance for cell fate determination in the development of the hematopoietic system and beyond. This article will review the current evidence for the common origin of blood and endothelium, focusing on the function of the bHLH protein encoded by the stem cell leukemia (SCL) gene, and its role as a pivotal regulator of hematopoiesis and vasculogenesis.
Collapse
Affiliation(s)
- Adrian J C Bloor
- Cambridge University Department of Haematology, Cambridge Institute for Medical Research, Hills Road, Cambridge, CB2 2XY, UK
| | | | | | | |
Collapse
|