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DiNardo CDD, Roboz GJ, Watts JM, Madanat YF, Prince GT, Baratam P, de Botton S, Stein AS, Foran JM, Arellano ML, Sallman DA, Hossain M, Marchione DM, Bai X, Patel PA, Kapsalis SM, Garcia-Manero G, Fathi AT. Final phase I substudy results of ivosidenib in patients with mutant IDH1 relapsed/refractory myelodysplastic syndrome. Blood Adv 2024:bloodadvances.2023012302. [PMID: 38640348 DOI: 10.1182/bloodadvances.2023012302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/28/2024] [Accepted: 04/09/2024] [Indexed: 04/21/2024] Open
Abstract
Ivosidenib is a first-in-class mutant isocitrate dehydrogenase 1 (mIDH1) inhibitor and has shown efficacy and tolerability in patients with advanced mIDH1 hematologic malignancies, leading to approval in front-line and relapsed/refractory (R/R) mIDH1 AML populations. We report final data from a phase I single-arm substudy (NCT02074839) of patients with R/R mIDH1 MDS following failure of standard-of-care therapies. Oral ivosidenib was taken once daily on days 1-28 in 28-day cycles. Primary objectives were to determine safety, tolerability, and clinical activity. The primary efficacy endpoint was the complete remission + partial remission (CR+PR) rate. Nineteen patients were enrolled; 18 were included in the efficacy analysis. Treatment-related adverse events occurred in eight (42.1%) patients, including a grade 1 QT interval prolongation in one (5.3%) patient and grade 2 differentiation syndrome in two (10.5%) patients. Rates of CR+PR and objective response (CR +PR+marrow CR) were 38.9% (95% confidence interval [CI]: 17.3, 64.3) and 83.3% (95% CI: 58.6, 96.4), respectively. Kaplan-Meier estimates showed a 68.6% probability of patients in CR achieving a remission duration of >=5 years, and a median OS of 35.7 months. Of note, 71.4% and 75.0% baseline red blood cell (RBC) and platelet transfusion-dependent patients, respectively, became transfusion independent (TI; no transfusion >=56 days); 81.8% and 100% of baseline RBC and platelet TI patients, respectively, remained TI. One (5.3%) patient proceeded to a hematopoietic stem cell transplant by data cut-off. In conclusion, ivosidenib is clinically active, with durable remissions and a manageable safety profile observed in patients with mIDH1 R/R MDS.
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Affiliation(s)
| | - Gail J Roboz
- Weill Medical College of Cornell University, New York, New York, United States
| | - Justin M Watts
- University of Miami, Sylvester Comprehensive Cancer Center, Miami, Florida, United States
| | - Yazan F Madanat
- UT Southwestern Medical Center, Dallas, Texas, United States
| | | | - Praneeth Baratam
- Medical University of South Carolina, Charleston, South Carolina, United States
| | | | - Anthony S Stein
- City of Hope National Medical Center, Duarte, California, United States
| | - James M Foran
- Mayo Clinic Florida, Jacksonville, Florida, United States
| | - Martha L Arellano
- Winship Cancer Institute of Emory University, Atlanta, Georgia, United States
| | - David A Sallman
- Moffitt Cancer Center and Research Institute, Tampa, Florida, United States
| | | | | | - Xiaofei Bai
- Servier Pharmaceuticals, LLC, Boston, Massachusetts, United States
| | | | | | | | - Amir T Fathi
- Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, United States
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2
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Pemmaraju N, Cuglievan B, Lasky J, Kheradpour A, Hijiya N, Stein AS, Meshinchi S, Mullen CA, Angelucci E, Vinti L, Mughal TI, Pawlowska AB. Efficacy and manageable safety of tagraxofusp in blastic plasmacytoid dendritic cell neoplasm: a case series of pediatric and adolescent/young adult patients. EJHaem 2024; 5:61-69. [PMID: 38406504 PMCID: PMC10887247 DOI: 10.1002/jha2.856] [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] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 02/27/2024]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) predominantly occurs in adults ≥60 years old; 10-20% of cases are pediatric or adolescent/young adult (AYA) patients. Tagraxofusp (TAG, Elzonris®) is the only approved treatment for BPDCN; in the United States it is approved for patients aged ≥2 years. Data on treating pediatric and AYA BPDCN patients are limited. We present a case series of pediatric and AYA patients with BPDCN treated with TAG. Eight patients (five newly diagnosed; three relapsed/refractory [R/R]), aged 2-21 years, received 12 mcg/kg TAG. Seven patients were female; most had skin (n = 6) and/or bone marrow (n = 4) involvement. No new safety signals were identified. Grade 3 adverse events were headache (n = 1) and transaminitis (n = 2). Three patients with newly diagnosed BPDCN achieved complete response, one achieved partial response, and one had stable disease (SD). One patient with R/R BPDCN achieved a minor response; one had SD. Seven patients (88%) were bridged to stem cell transplant: 80% of newly diagnosed patients and 100% of R/R patients. Five patients remained alive at last follow-up. These cases highlight the efficacy and safety of TAG in pediatric and AYA patients for whom there is no other approved BPDCN therapy.
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Affiliation(s)
- Naveen Pemmaraju
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Branko Cuglievan
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Albert Kheradpour
- Department of Pediatric Hematology and OncologyLoma Linda University Children's HospitalLoma LindaCaliforniaUSA
| | - Nobuko Hijiya
- Division of Pediatric Oncology, Hematology, and Stem Cell TransplantationColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Anthony S. Stein
- Department of Hematology and Hematopoietic Cell TransplantationCity of Hope National Medical CenterDuarteCaliforniaUSA
| | - Soheil Meshinchi
- Department of PediatricsUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Craig A. Mullen
- Division of Pediatric Hematology/OncologyDepartment of PediatricsGolisano Children's HospitalUniversity of RochesterRochesterNew YorkUSA
| | - Emanuele Angelucci
- Hematology and Cellular Therapy Unit, IRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Luciana Vinti
- Department of Paediatric Haematology/Oncology, Cell and Gene TherapyBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Tariq I. Mughal
- Division of Hematology‐OncologyTufts University Medical SchoolBostonMassachusettsUSA
- Consultant to Stemline Therapeutics IncNew YorkNew YorkUSA
| | - Anna B. Pawlowska
- Department of PediatricsCity of Hope National Medical CenterDuarteCaliforniaUSA
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3
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Aldoss I, Afkhami M, Yang D, Gu Z, Mokhtari S, Shahani S, Pourhassan H, Agrawal V, Koller P, Arslan S, Tomasian V, Al Malki MM, Artz A, Salhotra A, Ali H, Aribi A, Sandhu KS, Ball B, Otoukesh S, Amanam I, Becker PS, Stewart FM, Curtin P, Smith E, Telatar M, Stein AS, Marcucci G, Forman SJ, Nakamura R, Pullarkat V. High response rates and transition to transplant after novel targeted and cellular therapies in adults with relapsed/refractory acute lymphoblastic leukemia with Philadelphia-like fusions. Am J Hematol 2023; 98:848-856. [PMID: 36880203 DOI: 10.1002/ajh.26908] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/16/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
Philadelphia (Ph)-like acute lymphoblastic leukemia (ALL) is associated with a poor response to standard chemotherapy. However, outcomes with novel antibody and cellular therapies in relapsed/refractory (r/r) Ph-like ALL are largely unknown. We conducted a single-center retrospective analysis of adult patients (n = 96) with r/r B-ALL and fusions associated with Ph-like who received novel salvage therapies. Patients were treated with 149 individual novel regimens (blinatumomab = 83, inotuzumab ozogamicin [InO] = 36, and CD19CAR T cells = 30). The median age at first novel salvage therapy was 36 years (range; 18-71). Ph-like fusions were IGH::CRLF2 (n = 48), P2RY8::CRLF2 (n = 26), JAK2 (n = 9), ABL-class (n = 8), EPOR::IGH (n = 4) and ETV6::NTRK2 (n = 1). CD19CAR T cells were administered later in the course of therapy compared to blinatumomab and InO (p < .001) and more frequently in recipients who relapsed after allogeneic hematopoietic cell transplantation (alloHCT) (p = .002). Blinatumomab was administered at an older age compared to InO and CAR T-cells (p = .004). The complete remission (CR)/CR with incomplete hematologic recovery (CRi) rates were 63%, 72%, and 90% following blinatumomab, InO and CD19CAR, respectively, among which 50%, 50%, and 44% of responders underwent consolidation with alloHCT, respectively. In multivariable analysis, the type of novel therapy (p = .044) and pretreatment marrow blasts (p = .006) predicted the CR/CRi rate, while the Ph-like fusion subtype (p = .016), pretreatment marrow blasts (p = .022) and post-response consolidation with alloHCT (p < .001) influenced event-free survival. In conclusion, novel therapies are effective in inducing high remission rates in patients with r/r Ph-like ALL and successfully transitioning the responders to alloHCT.
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Affiliation(s)
- Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Michelle Afkhami
- Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - Dongyun Yang
- Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, California, USA
| | - Zhaohui Gu
- Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, California, USA
| | - Sally Mokhtari
- Department of Clinical and Translational Project Development, City of Hope National Medical Center, Duarte, California, USA
| | - Shilpa Shahani
- Department of Pediatrics, City of Hope National Medical Center, Duarte, California, USA
| | - Hoda Pourhassan
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Vaibhav Agrawal
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Paul Koller
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Shukaib Arslan
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Vanina Tomasian
- Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Andrew Artz
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Ahmed Aribi
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Karamjeet S Sandhu
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Brian Ball
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Salman Otoukesh
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Idoroenyi Amanam
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Pamela S Becker
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Forrest M Stewart
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Peter Curtin
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Eileen Smith
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Milhan Telatar
- Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - Anthony S Stein
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
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4
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La Rosa C, Chiuppesi F, Park Y, Zhou Q, Yang D, Gendzekhadze K, Ly M, Li J, Kaltcheva T, Ortega Francisco S, Gutierrez MA, Ali H, Otoukesh S, Amanam I, Salhotra A, Pullarkat VA, Aldoss I, Rosenzweig M, Aribi AM, Stein AS, Marcucci G, Dadwal SS, Nakamura R, Forman SJ, Al Malki MM, Diamond DJ. Functional SARS-CoV-2-specific T cells of donor origin in allogeneic stem cell transplant recipients of a T-cell-replete infusion: A prospective observational study. Front Immunol 2023; 14:1114131. [PMID: 36936918 PMCID: PMC10020189 DOI: 10.3389/fimmu.2023.1114131] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
In the current post-pandemic era, recipients of an allogeneic hematopoietic stem cell transplant (HCT) deserve special attention. In these vulnerable patients, vaccine effectiveness is reduced by post-transplant immune-suppressive therapy; consequently, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) is often associated with elevated morbidity and mortality. Characterizing SARS-CoV-2 adaptive immunity transfer from immune donors to HCT recipients in the context of immunosuppression will help identify optimal timing and vaccination strategies that can provide adequate protection to HCT recipients against infection with evolving SARS-CoV-2 variants. We performed a prospective observational study (NCT04666025 at ClinicalTrials.gov) to longitudinally monitor the transfer of SARS-CoV-2-specific antiviral immunity from HCT donors, who were either vaccinated or had a history of COVID-19, to their recipients via T-cell replete graft. Levels, function, and quality of SARS-CoV-2-specific immune responses were longitudinally analyzed up to 6 months post-HCT in 14 matched unrelated donor/recipients and four haploidentical donor/recipient pairs. A markedly skewed donor-derived SARS-CoV-2 CD4 T-cell response was measurable in 15 (83%) recipients. It showed a polarized Th1 functional profile, with the prevalence of central memory phenotype subsets. SARS-CoV-2-specific IFN-γ was detectable throughout the observation period, including early post-transplant (day +30). Functionally experienced SARS-CoV-2 Th1-type T cells promptly expanded in two recipients at the time of post-HCT vaccination and in two others who were infected and survived post-transplant COVID-19 infection. Our data suggest that donor-derived SARS-CoV-2 T-cell responses are functional in immunosuppressed recipients and may play a critical role in post-HCT vaccine response and protection from the fatal disease. Clinical trial registration clinicaltrials.gov, identifier NCT04666025.
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Affiliation(s)
- Corinna La Rosa
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Flavia Chiuppesi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Yoonsuh Park
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Qiao Zhou
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Dongyun Yang
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Ketevan Gendzekhadze
- Histocompatibility Laboratory, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Minh Ly
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Jing Li
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Teodora Kaltcheva
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Sandra Ortega Francisco
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Miguel-Angel Gutierrez
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Salman Otoukesh
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Idoroenyi Amanam
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Vinod A. Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Michael Rosenzweig
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Ahmed M. Aribi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Anthony S. Stein
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | | | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Stephen J. Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Monzr M. Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Don J. Diamond
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
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5
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Queudeville M, Stein AS, Locatelli F, Ebinger M, Handgretinger R, Gökbuget N, Gore L, Zeng Y, Gokani P, Zugmaier G, Kantarjian HM. Low leukemia burden improves blinatumomab efficacy in patients with relapsed/refractory B-cell acute lymphoblastic leukemia. Cancer 2023; 129:1384-1393. [PMID: 36829303 DOI: 10.1002/cncr.34667] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 06/27/2022] [Revised: 10/02/2022] [Accepted: 10/25/2022] [Indexed: 02/26/2023]
Abstract
BACKGROUND A lower baseline bone marrow blast percentage (bBMB%) is associated with better outcomes in patients with B-cell acute lymphoblastic leukemia (B-ALL) receiving blinatumomab. The objective of this analysis was to investigate the association between bBMB% and treatment outcomes in relapsed/refractory (R/R) B-ALL. METHODS Data from five trials of blinatumomab for R/R B-ALL were pooled for analyses. Patients were placed in one of three groups: group 1, ≥50% bBMBs; group 2, ≥25% to <50% bBMBs; group 3, ≥5% to <25% bBMBs. Response and survival outcomes were compared between groups. RESULTS Data from 683 patients (166 pediatric, 517 adult) were analyzed. Collectively, patients in groups 2 and 3 had significantly higher odds of achieving a complete remission (CR) (odds ratio [OR], 3.50 [95% confidence interval (CI), 2.23-5.48] and 3.93 [95% CI, 2.50-6.18], respectively; p < .001) and minimal/measurable residual disease response (OR, 2.61 and 3.37, respectively; p < .001) when compared with group 1 (reference). Groups 2 and 3 had a 37% and 46% reduction in the risk of death (hazard ratio [HR], 0.63 and 0.54, respectively; p < .001) and a 41% and 43% reduction in the risk of an event (relapse or death) (HR, 0.59 and 0.57, respectively; p < .001) compared with group 1. No significant differences in response or survival outcomes were observed between groups 2 and 3. Seven of nine patients whose bBMB% was lowered to <50% with dexamethasone achieved CR with blinatumomab. CONCLUSION Any bBMB% <50% was associated with improved efficacy following blinatumomab treatment for R/R B-ALL.
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Affiliation(s)
- Manon Queudeville
- Department of General Pediatrics, Hematology and Oncology, Children's University Hospital Tübingen, Tübingen, Germany
| | - Anthony S Stein
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California, USA
| | - Franco Locatelli
- Department of Paediatric Haematology and Oncology, IRCCS Ospedale Pediatrico Bambino Gesù, Catholic University of the Sacred Heart, Rome, Italy
| | - Martin Ebinger
- Department of General Pediatrics, Hematology and Oncology, Children's University Hospital Tübingen, Tübingen, Germany
| | - Rupert Handgretinger
- Department of General Pediatrics, Hematology and Oncology, Children's University Hospital Tübingen, Tübingen, Germany
| | - Nicola Gökbuget
- Department of Medicine, University Hospital, Goethe University, Frankfurt, Germany
| | - Lia Gore
- Section of Pediatric Hematology/Oncology/Bone Marrow Transplant-Cellular Therapeutics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Yi Zeng
- Oncology TA, Amgen Inc., Thousand Oaks, California, USA
| | - Priya Gokani
- International Biostatistics, Amgen Ltd, Cambridge, UK
| | | | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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6
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Blackmon A, Afkhami M, Al Malki MM, Desai A, Yang D, Otoukesh S, Arslan S, Amanam I, Ball B, Koller P, Salhotra A, Aribi A, Aldoss I, Artz AS, Ali H, Stein AS, Marcucci G, Forman SJ, Nakamura R. Outcomes of Patients with Acute Myeloid Leukemia Undergoing Allogeneic Hematopoietic Cell Transplantation with Measurable Residual Disease and the Impact of Conditioning Regimen and Graft-Versus-Host Disease Prophylaxis Intensity: A Single Center Retrospective Analysis. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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7
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Koller P, Shan H, Platt D, Agrawal V, Aldoss I, Ali H, Amanam I, Aribi A, Arslan S, Ball B, Blackmon A, Becker PS, Curtin P, Otoukesh S, Pourhassan H, Pullarkat V, Salhotra A, Sandhu KS, Spielberger R, Stewart F, Smith E, Stein AS, Dale W, Marcucci G, Al-Malki M, Forman SJ, Nakamura R, Artz AS. Allogeneic Hematopoietic Cell Transplantation (HCT) in Patients 75 Years and Older: Another Age Barrier Crossed? Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00637-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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8
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Agrawal V, Salhotra A, Song J, Gu Z, Stein AS, Marcucci G, Forman SJ, Pullarkat V, Aldoss I. The feasibility of additional CD19-targeted cellular therapy in relapsed/refractory B-ALL with re-emergence of CD19 antigen after prior CD19-negative relapse. Am J Hematol 2023; 98:E38-E40. [PMID: 36413124 DOI: 10.1002/ajh.26787] [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] [Received: 10/24/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Vaibhav Agrawal
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA.,Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA.,Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - Joo Song
- Department of Computational and Quantitative Medicine, Beckman Research Institute at City of Hope, Duarte, California, USA
| | - Zhaohui Gu
- Department of Computational and Quantitative Medicine, Beckman Research Institute at City of Hope, Duarte, California, USA.,Department of Systems Biology, Beckman Research Institute at City of Hope, Duarte, California, USA
| | - Anthony S Stein
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA.,Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA.,Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA.,Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA.,Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA.,Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
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Desai A, Yang D, Ball B, Koller P, Blackmon A, Agrawal V, Pourhassan H, Samara Y, Amanam I, Arslan S, Otoukesh S, Sandhu KS, Aldoss I, Ali H, Salhotra A, Al Malki MM, Artz AS, Becker PS, Stein AS, Marcucci G, Forman SJ, Curtin P, Nakamura R, Pullarkat V. Outcomes of MDS Patients with and without Spliceosome Mutations Undergoing Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00196-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Othman T, Koller P, Tsai NC, Pourhassan H, Agrawal V, Otoukesh S, Amanam I, Ngo D, Chen J, Al Malki MM, Salhotra A, Ali H, Aribi A, Sandhu KS, Arslan S, Ball B, Stewart F, Curtin P, Artz AS, Snyder DS, Marcucci G, Forman SJ, Stein AS, Nakamura R, Pullarkat V, Aldoss I, Mei M. Myeloablative Vs Reduced-Intensity Allogeneic Hematopoietic Cell Transplantation in Philadelphia-Chromosome Positive Acute Lymphoblastic Leukemia. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00202-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Agrawal V, Pourhassan H, Tsai NC, Ngo D, Koller P, Malki MMA, Salhotra A, Ali H, Aribi A, Sandhu KS, Arslan S, Ball B, Otoukesh S, Amanam I, Artz A, Singh D, Becker PS, Stewart FM, Smith EP, Curtin P, Stein AS, Marcucci G, Forman SJ, Nakamura R, Pullarkat V, Aldoss I. Post-Transplantation Sinusoidal Obstruction Syndrome in Adult Patients with B Cell Acute Lymphoblastic Leukemia Treated with Pretransplantation Inotuzumab. Transplant Cell Ther 2023; 29:314-320. [PMID: 36682470 DOI: 10.1016/j.jtct.2023.01.017] [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: 12/05/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023]
Abstract
Sinusoidal obstruction syndrome (SOS) is a potentially life-threatening complication that can be observed after allogeneic hematopoietic cell transplantation (HCT). Inotuzumab ozogamicin is an anti-CD22 monoclonal antibody-drug conjugate that has demonstrated high efficacy in relapsed/refractory (R/R) acute lymphoblastic leukemia (ALL) but is associated with an increased risk of SOS in HCT recipients. Here we aimed to examine the incidence and outcomes of SOS in 47 adult patients with R/R ALL who received inotuzumab therapy and subsequently underwent HCT at our institution. All patients received prophylactic therapy with ursodiol, and continuous low-dose heparin also was administered to patients receiving myeloablative conditioning (MAC). SOS occurred in 12 patients (26%) post-HCT, at a median onset of 11 days (range, 3 to 41 days). SOS was graded as very severe in 50% (n = 6), severe in 25% (n = 3), and mild in 25% (n = 3). All patients diagnosed with SOS received treatment with defibrotide for a median of 21 days (range, 3 to 34 days), with resolution of SOS occurring in 8 patients (67%). Mortality from SOS was 33% (n = 4) and occurred at a median of 10 days from diagnosis (range, 3 to 31 days) in patients graded as very severe (n = 3) or severe (n = 1). There were no significant differences between patients who developed SOS and those who did not develop SOS in the median time from the last dose of inotuzumab to transplantation (46 days versus 53 days; P = .37), use of an MAC regimen (42% versus 49%; P = .75), number of lines of therapy prior to inotuzumab (P = .79), median number of administered cycles of inotuzumab (2 versus 2; P = .14), or receipt of inotuzumab as the last therapy prior to HCT (67% versus 66%; P = 1.0). Sirolimus-based graft-versus-host disease (GVHD) prophylaxis was used more frequently in the SOS group (75% versus 29%; P < .01), but there was no between-group difference in the peak sirolimus level (P = .81) or the median time to peak sirolimus level (7 days versus 3.5 days; P = .39). In univariable analysis, only the use of sirolimus-based GVHD prophylaxis was significantly associated with an increased risk of SOS (hazard ratio [HR], 7.50; 95% confidence interval [CI], 1.7 to 33.6; P < .01). In the SOS group, the 100-day mortality rate was 33% (n = 4), and median overall survival (OS) post-HCT was 4.3 months (range, 0.2 to 57.2 months). In the group without SOS, the 100-day mortality rate was 14% (n = 5) and the median OS post-HCT was 10.7 months (range, .52 to 39.6 months). In this study cohort, SOS was prevalent in HCT recipients who had been treated with inotuzumab prior to transplantation, and sirolimus-based GVHD prophylaxis was a risk factor for SOS in inotuzumab recipients.
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Affiliation(s)
- Vaibhav Agrawal
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Hoda Pourhassan
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Ni-Chun Tsai
- Department of Computational and Quantitative Medicine, Beckman Research Institute at City of Hope, Duarte, California
| | - Dat Ngo
- Department of Pharmacy, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Paul Koller
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Ahmed Aribi
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Karamjeet S Sandhu
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Shukaib Arslan
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Brian Ball
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Salman Otoukesh
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Idoroenyi Amanam
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Andrew Artz
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Dupinder Singh
- Department of Gastroenterology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Pamela S Becker
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Forrest M Stewart
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Eileen P Smith
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Peter Curtin
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Anthony S Stein
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Comprehensive Cancer Center, Duarte, California.
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12
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Pemmaraju N, Sweet KL, Stein AS, Wang ES, Rizzieri DA, Vasu S, Rosenblat TL, Brooks CL, Habboubi N, Mughal TI, Kantarjian H, Konopleva M, Lane AA. Long-Term Benefits of Tagraxofusp for Patients With Blastic Plasmacytoid Dendritic Cell Neoplasm. J Clin Oncol 2022; 40:3032-3036. [PMID: 35820082 PMCID: PMC9462530 DOI: 10.1200/jco.22.00034] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically on the based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an aggressive myeloid malignancy. We report long-term results, including data from the continued access phase, of the largest prospective BPDCN trial evaluating the CD123-targeted therapy tagraxofusp (TAG) in adults with treatment-naive and relapsed/refractory BPDCN. The primary outcome was complete response (CR) + clinical CR (CRc: CR with residual skin abnormality not indicative of active disease). Eighty-four (65 treatment-naive and 19 relapsed/refractory) of 89 patients received TAG 12 μg/kg once daily; the median follow-up was 34.0 months. For treatment-naive patients, the overall response rate was 75%; 57% achieved CR + CRc. The median time to remission was 39 (range, 14-131) days, and the median CR + CRc duration was 24.9 (95% CI, 3.8 to not reached) months. Nineteen patients (51%) with CR + CRc were bridged to stem-cell transplant, with a median CR + CRc duration of 22.2 (range, 1.5-57.4) months. Most common adverse events were increased alanine (64%) or aspartate (60%) aminotransferase and hypoalbuminemia (51%); most occurred in cycle 1 and were transient. Capillary leak syndrome occurred in 21% of patients (grade ≥ 3: 7%). In first-line patients with BPDCN, TAG monotherapy resulted in high and durable responses, allowing many to bridge to stem-cell transplant. TAG was generally well-tolerated with a predictable and manageable safety profile.
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Affiliation(s)
| | | | | | - Eunice S Wang
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | - Sumithira Vasu
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Todd L Rosenblat
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | | | | | - Tariq I Mughal
- Stemline Therapeutics, New York, NY.,Tufts University School of Medicine, Boston, MA
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13
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Stein AS, Al Malki MM, Yang D, Palmer JM, Tsai NC, Aldoss I, Ali H, Aribi A, Artz A, Dandapani S, Farol L, Hui S, Liu A, Nakamura R, Pullarkat V, Radany E, Rosenthal J, Salhotra A, Sanchez JF, Spielberger R, Marcucci G, Forman SJ, Wong J. Total Marrow and Lymphoid Irradiation with Post-Transplantation Cyclophosphamide for Patients with AML in Remission. Transplant Cell Ther 2022; 28:368.e1-368.e7. [PMID: 35398328 PMCID: PMC9253081 DOI: 10.1016/j.jtct.2022.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/17/2022]
Abstract
Graft-versus-host disease (GVHD) has remained the main cause of post-transplantation mortality and morbidity after allogeneic hematopoietic cell transplantation (alloHCT), adding significant economic burden and affecting quality of life. It would be desirable to reduce the rate of GVHD among patients in complete remission (CR) without increasing the risk of relapse. In this study, we have tested a novel conditioning regimen of total marrow and lymphoid irradiation (TMLI) at 2000 cGy, together with post-transplantation cyclophosphamide (PTCy) for patients with acute myeloid leukemia in first or second CR, to attenuate the risk of chronic GVHD by using PTCy, while using escalated targeted radiation conditioning before allografting to offset the possible increased risk of relapse. The primary objective was to evaluate the safety/feasibility of combining a TMLI transplantation conditioning regimen with a PTCy-based GVHD prophylaxis strategy, through the assessment of adverse events in terms of type, frequency, severity, attribution, time course, duration, and complications, including acute GVHD, infection, and delayed neutrophil/platelet engraftment. Secondary objectives included estimation of non-relapse mortality (NRM), overall survival (OS), relapse-free survival, acute and chronic GVHD, and GVHD-relapse-free survival (GRFS). A patient safety lead-in was first conducted to ensure there were no unexpected toxicities and was expanded on the basis of lack of dose-limiting toxicities. The patient safety lead-in segment followed 3 + 3 dose expansion/(de-)escalation rules based on observed toxicity through day 30; the starting dose of TMLI was 2000 cGy, and a de-escalation to 1800 cGy was considered. After the safety lead-in segment, an expansion cohort of up to 12 additional patients was to be studied. TMLI was administered on days -4 to 0, delivered in 200 cGy fractions twice daily. The radiation dose delivered to the liver and brain was kept at 1200 cGy. Cyclophosphamide was given on days 3 and 4 after alloHCT, 50 mg/kg each day for GVHD prevention; tacrolimus was given until day 90 and then tapered. Among 18 patients with a median age of 40 years (range 19-56), the highest grade toxicities were grade 2 Bearman bladder toxicity and stomatitis. No grade 3 or 4 Bearman toxicities or toxicity-related deaths were observed. The cumulative incidence of acute GVHD grade 2 to 4 and moderate-to-severe chronic GVHD were 11.1% and 11.9%, respectively. At a median follow up of 24.5 months, two-year estimates of OS and relapse-free survival were 86.7% and 83.3%, respectively. Disease relapse at 2 years was 16.7%. The estimates of NRM at 2 years was 0%. The GVHD/GRFS rate at 2 years was 59.3% (95% confidence interval, 28.8-80.3). This chemotherapy-free conditioning regimen, together with PTCy and tacrolimus, is safe, with no NRM. Preliminary results suggest an improved GRFS rate.
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Affiliation(s)
- Anthony S Stein
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California; Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California.
| | - Monzr M Al Malki
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California; Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Dongyun Yang
- Department of Computational and Quantitative Sciences, Beckman Research Institute, City of Hope, Duarte, California
| | - Joycelynne M Palmer
- Department of Computational and Quantitative Sciences, Beckman Research Institute, City of Hope, Duarte, California
| | - Ni-Chun Tsai
- Department of Computational and Quantitative Sciences, Beckman Research Institute, City of Hope, Duarte, California
| | - Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California; Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Haris Ali
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California; Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Ahmed Aribi
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California; Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Andrew Artz
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California; Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Savita Dandapani
- Department of Radiation Oncology, City of Hope, Duarte, California
| | - Len Farol
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Southern California Kaiser Permanente Bone Marrow Transplant Program, Pasadena, California
| | - Susanta Hui
- Department of Radiation Oncology, City of Hope, Duarte, California
| | - An Liu
- Department of Radiation Oncology, City of Hope, Duarte, California
| | - Ryotaro Nakamura
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California; Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Vinod Pullarkat
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California; Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Eric Radany
- Department of Radiation Oncology, City of Hope, Duarte, California
| | | | - Amandeep Salhotra
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California; Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - James F Sanchez
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Ricardo Spielberger
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Southern California Kaiser Permanente Bone Marrow Transplant Program, Pasadena, California
| | - Guido Marcucci
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California; Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Stephen J Forman
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Jeffrey Wong
- Department of Radiation Oncology, City of Hope, Duarte, California.
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Ngo D, Otoukesh S, Stein AS, Forman S, Pullarkat V, Aldoss I. The safety of concurrent intrathecal chemotherapy during blinatumomab in adults with acute lymphoblastic leukemia. Leuk Lymphoma 2022; 63:2754-2756. [DOI: 10.1080/10428194.2022.2090555] [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: 10/18/2022]
Affiliation(s)
- Dat Ngo
- Department of Pharmacy, City of Hope, Duarte, CA, USA
| | - Salman Otoukesh
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Anthony S. Stein
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Stephen Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
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Aldoss I, Khaled SK, Blanchard MS, Wang X, Wagner JR, Clark M, Simpson J, Paul J, Stein AS, Pullarkat V, Salhotra A, Al Malki MM, Thomas S, Budde LE, Marcucci G, Brown CE, Forman SJ. Favorable Activity of CD19-Targeted Chimeric Antigen Receptor (CD19CAR) T Cell Therapy in Adults with Relapsed/ Refractory (R/R) ALL Including Extramedullary Disease (EMD) and Ph-like Genotype, Using Naive/Memory (Tn/ Mem) Derived T Cells. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Qiao J, Liang C, Zhao D, Nguyen LXT, Chen F, Suo S, Hoang DH, Pellicano F, Rodriguez IR, Elhajmoussa Y, Ghoda L, Yoshimura A, Stein AS, Ali H, Koller P, Perrotti D, Copland M, Han A, Zhang BA, Marcucci G. Spred1 deficit promotes treatment resistance and transformation of chronic phase CML. Leukemia 2022; 36:492-506. [PMID: 34564700 PMCID: PMC9134843 DOI: 10.1038/s41375-021-01423-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 11/09/2022]
Abstract
Spred1 is highly expressed in normal hematopoietic stem cells (HSCs). Lack of Spred1 function has been associated with aberrant hematopoiesis and acute leukemias. In chronic myelogenous leukemia (CML), Spred1 is reduced in patients with accelerated phase (AP) or blast crisis (BC) CML, thereby suggesting that deficit of this protein may contribute to disease transformation. In fact, Spred1 knockout (KO) in SCLtTA/BCR-ABL CML mice either globally, or restricted to hematopoietic cells (i.e., HSCs) or to endothelial cells (ECs), led to transformation of chronic phase (CP) CML into AP/BC CML. Upon BCR-ABL induction, all three Spred1 KO CML models showed AP/BC features. However, compared with global Spred1 KO, the AP/BC phenotypes of HSC-Spred1 KO and EC-Spred1 KO CML models were attenuated, suggesting a concurrent contribution of Spred1 deficit in multiple compartments of the leukemic bone marrow niche to the CML transformation. Spred1 KO, regardless if occurred in HSCs or in ECs, increased miR-126 in LSKs (Lin-Sca-1+c-Kit+), a population enriched in leukemic stem cells (LSCs), resulting in expansion of LSCs, likely through hyperactivation of the MAPK/ERK pathway that augmented Bcl-2 expression and stability. This ultimately led to enhancement of Bcl-2-dependent oxidative phosphorylation that supported homeostasis, survival and activity of LSCs and drove AP/BC transformation.
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MESH Headings
- Adaptor Proteins, Signal Transducing/genetics
- Adaptor Proteins, Signal Transducing/metabolism
- Adaptor Proteins, Signal Transducing/physiology
- Animals
- Cell Transformation, Neoplastic/drug effects
- Cell Transformation, Neoplastic/metabolism
- Cell Transformation, Neoplastic/pathology
- Drug Resistance, Neoplasm
- Gene Expression Regulation, Leukemic
- Hematopoietic Stem Cells/drug effects
- Hematopoietic Stem Cells/metabolism
- Hematopoietic Stem Cells/pathology
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Neoplastic Stem Cells/drug effects
- Neoplastic Stem Cells/metabolism
- Neoplastic Stem Cells/pathology
- Protein Kinase Inhibitors/pharmacology
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Affiliation(s)
- Junjing Qiao
- Department of Pathology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
- Phase I Clinical Research Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, P. R. China
| | - Chen Liang
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, P. R. China
| | - Dandan Zhao
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Le Xuan Truong Nguyen
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Fang Chen
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Shanshan Suo
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P. R. China
| | - Dinh Hoa Hoang
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Francesca Pellicano
- Paul O' Gorman Leukemia Research Centre, College of Medical, Veterinary and Life Sciences, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Ivan Rodriguez Rodriguez
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Yasmin Elhajmoussa
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Lucy Ghoda
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Akihiko Yoshimura
- Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo, Japan
| | - Anthony S Stein
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Haris Ali
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Paul Koller
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | | | - Mhairi Copland
- Paul O' Gorman Leukemia Research Centre, College of Medical, Veterinary and Life Sciences, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Anjia Han
- Department of Pathology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China.
| | - Bin Amber Zhang
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA.
| | - Guido Marcucci
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA.
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17
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Aldoss I, Otoukesh S, Zhang J, Mokhtari S, Ngo D, Mojtahedzadeh M, Al Malki MM, Salhotra A, Ali H, Aribi A, Sandhu KS, Arslan S, Koller P, Ball B, Stewart F, Curtin P, Artz A, Nakamura R, Marcucci G, Forman SJ, Stein AS, Pullarkat V. Extramedullary disease relapse and progression after blinatumomab therapy for treatment of acute lymphoblastic leukemia. Cancer 2021; 128:529-535. [PMID: 34633671 DOI: 10.1002/cncr.33967] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 07/16/2021] [Revised: 08/20/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Blinatumomab has demonstrated encouraging activity in relapsed/refractory (r/r) and minimal residual disease-positive (MRD+) acute lymphoblastic leukemia (ALL). Extramedullary disease (EMD) relapse or relapse with CD19- disease has been observed after blinatumomab therapy in patients with r/r or MRD+ ALL. However, the pathophysiology and risk factors of treatment failure are not fully understood. METHODS This study retrospectively reviewed the outcomes of adult patients with B-cell ALL treated with blinatumomab (n = 132) for either r/r (n = 103) or MRD+ disease (n = 29) at the authors' center (2013-2021) and analyzed factors associated with treatment response and EMD failure. RESULTS The overall response rate was 64%. A lower marrow blast burden before blinatumomab (P = .049) and no history of previous EMD (P = .019) were significantly associated with a higher response. Among the patients who responded to blinatumomab, 56% underwent consolidation with allogeneic transplantation. Blinatumomab failure was observed in 89 patients; 43% of these patients (n = 38) either progressed or relapsed at extramedullary sites. A history of extramedullary involvement (53% vs 24%; P = .005) and retention of CD19 expression at the time of relapse/progression (97% vs 74%; P = .012) were associated with a higher risk for extramedullary failure. Central nervous system (CNS) failure after blinatumomab was encountered in 39% of the patients with EMD. CONCLUSIONS A history of EMD predicted an inferior response to blinatumomab therapy with a higher risk for relapse/progression at extramedullary sites (particularly CNS). Consolidation with allogenic transplantation in patients who primarily responded to blinatumomab did not abrogate the risk of extramedullary relapse. The incorporation of extramedullary assessment and the intensification of CNS prophylaxis may help in addressing extramedullary failure. LAY SUMMARY Extramedullary failure is common during blinatumomab therapy for relapsed/refractory acute lymphoblastic leukemia. A history of extramedullary disease predicts an inferior response to blinatumomab therapy and a higher risk for relapse/progression at extramedullary sites. Most extramedullary failure cases retain CD19 expression.
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Affiliation(s)
- Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Salman Otoukesh
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Jianying Zhang
- Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, California
| | - Sally Mokhtari
- Department of Clinical and Translational Project Development, City of Hope National Medical Center, Duarte, California
| | - Dat Ngo
- Department of Pharmacy, City of Hope National Medical Center, Duarte, California
| | - Mona Mojtahedzadeh
- Department of Clinical Supportive Care, City of Hope National Medical Center, Duarte, California
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Ahmed Aribi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Karamjeet S Sandhu
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Shukaib Arslan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Paul Koller
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Brian Ball
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Forrest Stewart
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Peter Curtin
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Andrew Artz
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Anthony S Stein
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
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18
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Wang H, Sun J, Zhang B, Zhao D, Tong H, Wu H, Li X, Luo Y, Dong D, Yao Y, McDonald T, Stein AS, Al Malki MM, Pichiorri F, Carlesso N, Kuo Y, Marcucci G, Li L, Jin J. Targeting miR-126 disrupts maintenance of myelodysplastic syndrome stem and progenitor cells. Clin Transl Med 2021; 11:e610. [PMID: 34709739 PMCID: PMC8516361 DOI: 10.1002/ctm2.610] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/23/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Myelodysplastic syndrome (MDS) arises from a rare population of aberrant hematopoietic stem and progenitor cells (HSPCs). These cells are relatively quiescent and therefore treatment resistant. Understanding mechanisms underlying their maintenance is critical for effective MDS treatment. METHODS We evaluated microRNA-126 (miR-126) levels in MDS patients' sample and in a NUP98-HOXD13 (NHD13) murine MDS model along with their normal controls and defined its role in MDS HSPCs' maintenance by inhibiting miR-126 expression in vitro and in vivo. Identification of miR-126 effectors was conducted using biotinylated miR-126 pulldown coupled with transcriptome analysis. We also tested the therapeutic activity of our anti-miR-126 oligodeoxynucleotide (miRisten) in human MDS xenografts and murine MDS models. RESULTS miR-126 levels were higher in bone marrow mononuclear cells from MDS patients and NHD13 mice relative to their respective normal controls (P < 0.001). Genetic deletion of miR-126 in NHD13 mice decreased quiescence and self-renewal capacity of MDS HSPCs, and alleviated MDS symptoms of NHD13 mice. Ex vivo exposure to miRisten increased cell cycling, reduced colony-forming capacity, and enhanced apoptosis in human MDS HSPCs, but spared normal human HSPCs. In vivo miRisten administration partially reversed pancytopenia in NHD13 mice and blocked the leukemic transformation (combination group vs DAC group, P < 0.0001). Mechanistically, we identified the non-coding RNA PTTG3P as a novel miR-126 target. Lower PTTG3P levels were associated with a shorter overall survival in MDS patients. CONCLUSIONS MiR-126 plays crucial roles in MDS HSPC maintenance. Therapeutic targeting of miR-126 is a potentially novel approach in MDS.
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Affiliation(s)
- Huafeng Wang
- Department of Hematologythe First Affiliated HospitalSchool of Medicine, Zhejiang UniversityHangzhouZhejiangPR China
- Hematological Malignancies Translational ScienceGehr Family Center for Leukemia ResearchCity of Hope Medical Center and Beckman Research InstituteDuarteCaliforniaUSA
- Zhejiang Provincial Key Lab of Hematopoietic MalignancyZhejiang UniversityHangzhouZhejiangPR China
- Zhejiang Laboratory for Systems & Precision MedicineZhejiang University Medical CenterHangzhouZhejiangPR China
| | - Jie Sun
- Department of Hematologythe First Affiliated HospitalSchool of Medicine, Zhejiang UniversityHangzhouZhejiangPR China
- Hematological Malignancies Translational ScienceGehr Family Center for Leukemia ResearchCity of Hope Medical Center and Beckman Research InstituteDuarteCaliforniaUSA
- Zhejiang Provincial Key Lab of Hematopoietic MalignancyZhejiang UniversityHangzhouZhejiangPR China
| | - Bin Zhang
- Hematological Malignancies Translational ScienceGehr Family Center for Leukemia ResearchCity of Hope Medical Center and Beckman Research InstituteDuarteCaliforniaUSA
| | - Dandan Zhao
- Hematological Malignancies Translational ScienceGehr Family Center for Leukemia ResearchCity of Hope Medical Center and Beckman Research InstituteDuarteCaliforniaUSA
| | - Hongyan Tong
- Department of Hematologythe First Affiliated HospitalSchool of Medicine, Zhejiang UniversityHangzhouZhejiangPR China
- Zhejiang Provincial Key Lab of Hematopoietic MalignancyZhejiang UniversityHangzhouZhejiangPR China
| | - Herman Wu
- Hematological Malignancies Translational ScienceGehr Family Center for Leukemia ResearchCity of Hope Medical Center and Beckman Research InstituteDuarteCaliforniaUSA
| | - Xia Li
- Department of Hematologythe First Affiliated HospitalSchool of Medicine, Zhejiang UniversityHangzhouZhejiangPR China
| | - Yingwan Luo
- Department of Hematologythe First Affiliated HospitalSchool of Medicine, Zhejiang UniversityHangzhouZhejiangPR China
| | - Dan Dong
- Hematological Malignancies Translational ScienceGehr Family Center for Leukemia ResearchCity of Hope Medical Center and Beckman Research InstituteDuarteCaliforniaUSA
| | - Yiyi Yao
- Department of Hematologythe First Affiliated HospitalSchool of Medicine, Zhejiang UniversityHangzhouZhejiangPR China
- Zhejiang Provincial Key Lab of Hematopoietic MalignancyZhejiang UniversityHangzhouZhejiangPR China
| | - Tinisha McDonald
- Hematological Malignancies Translational ScienceGehr Family Center for Leukemia ResearchCity of Hope Medical Center and Beckman Research InstituteDuarteCaliforniaUSA
| | - Anthony S. Stein
- Hematological Malignancies Translational ScienceGehr Family Center for Leukemia ResearchCity of Hope Medical Center and Beckman Research InstituteDuarteCaliforniaUSA
| | - Monzr M. Al Malki
- Hematological Malignancies Translational ScienceGehr Family Center for Leukemia ResearchCity of Hope Medical Center and Beckman Research InstituteDuarteCaliforniaUSA
| | - Flavia Pichiorri
- Hematological Malignancies Translational ScienceGehr Family Center for Leukemia ResearchCity of Hope Medical Center and Beckman Research InstituteDuarteCaliforniaUSA
| | - Nadia Carlesso
- Hematological Malignancies Translational ScienceGehr Family Center for Leukemia ResearchCity of Hope Medical Center and Beckman Research InstituteDuarteCaliforniaUSA
| | - Ya‐Huei Kuo
- Hematological Malignancies Translational ScienceGehr Family Center for Leukemia ResearchCity of Hope Medical Center and Beckman Research InstituteDuarteCaliforniaUSA
| | - Guido Marcucci
- Hematological Malignancies Translational ScienceGehr Family Center for Leukemia ResearchCity of Hope Medical Center and Beckman Research InstituteDuarteCaliforniaUSA
| | - Ling Li
- Hematological Malignancies Translational ScienceGehr Family Center for Leukemia ResearchCity of Hope Medical Center and Beckman Research InstituteDuarteCaliforniaUSA
| | - Jie Jin
- Department of Hematologythe First Affiliated HospitalSchool of Medicine, Zhejiang UniversityHangzhouZhejiangPR China
- Zhejiang Provincial Key Lab of Hematopoietic MalignancyZhejiang UniversityHangzhouZhejiangPR China
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19
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Ali H, Salhotra A, Stein AS, Nakamura R, Marcucci G, Forman SJ, Pullarkat V, Aldoss I. Efficacy of blinatumomab for MRD relapse in ALL post allogenic HCT. Leuk Res 2021; 104:106579. [PMID: 33831656 DOI: 10.1016/j.leukres.2021.106579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Haris Ali
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
| | - Amandeep Salhotra
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
| | - Anthony S Stein
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
| | - Ryotaro Nakamura
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
| | - Guido Marcucci
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
| | - Stephen J Forman
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
| | - Vinod Pullarkat
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
| | - Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States.
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20
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Jeyakumar N, Aldoss I, Yang D, Mokhtari S, Gendzekhadze K, Khaled S, O'Donnell M, Palmer J, Song JY, Marcucci G, Stein AS, Forman SJ, Pullarkat VA, Chen W, Wu X, Nakamura R. Cytokine gene polymorphisms are associated with response to blinatumomab in B-cell acute lymphoblastic leukemia. Eur J Haematol 2021; 106:851-858. [PMID: 33721333 DOI: 10.1111/ejh.13622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/16/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/28/2022]
Abstract
Blinatumomab is a bispecific T cell-engaging antibody approved for treatment of relapsed/refractory (r/r) ALL, with 40%-50% complete response (CR)/CR with incomplete count recovery (CRi). Cytokine release syndrome (CRS) as a major adverse effect after blinatumomab therapy. Here, we evaluated the possible association between single-nucleotide polymorphisms (SNPs) in cytokine genes, disease response, and CRS in r/r ALL patients who received blinatumomab between 2012 and 2017 at our center (n = 66), using patients' archived DNA samples. With a median duration of 9.5 months (range: 1-37), 37 patients (56.1%) achieved CR/CRi, 54 (81.8%) experienced CRS (G1: n = 35, G2: n = 14, G3: n = 5), and 9 (13.6%) developed neurotoxicity. By multivariable analysis, after adjusting for high disease burden, one SNP on IL2 (rs2069762), odds ratio (OR) = 0.074 (95% CI: NE-0.43, P = .01) and one SNP on IL17A (rs4711998), OR = 0.28 (95% CI: 0.078-0.92, P = .034) were independently associated with CR/CRi. None of the analyzed SNPs were associated with CRS. To our knowledge, this is the first study demonstrating a possible association between treatment response to blinatumomab and SNPs. Our hypothesis-generated data suggest a potential role for IL-17 and IL-2 in blinatumomab response and justify a larger confirmatory study, which may lead to personalized blinatumomab immunotherapy for B-ALL.
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Affiliation(s)
- Nikeshan Jeyakumar
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Ibrahim Aldoss
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Dongyun Yang
- Department of Computational Quantitative Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Sally Mokhtari
- Department of Clinical Translational Project Development, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Samer Khaled
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Margaret O'Donnell
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Joycelynne Palmer
- Department of Computational Quantitative Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Joo Y Song
- Department of Molecular and Cellular Biology/Integrative Genomics Core, City of Hope National Medical Center, Duarte, CA, USA
| | - Guido Marcucci
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Anthony S Stein
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Stephen J Forman
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Vinod A Pullarkat
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Wei Chen
- Department of Molecular and Cellular Biology/Integrative Genomics Core, City of Hope National Medical Center, Duarte, CA, USA
| | - Xiwei Wu
- Department of Molecular and Cellular Biology/Integrative Genomics Core, City of Hope National Medical Center, Duarte, CA, USA
| | - Ryotaro Nakamura
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
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21
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Topp MS, Stein AS, Gökbuget N, Horst HA, Boissel N, Martinelli G, Kantarjian H, Brüggemann M, Chen Y, Zugmaier G. Blinatumomab as first salvage versus second or later salvage in adults with relapsed/refractory B-cell precursor acute lymphoblastic leukemia: Results of a pooled analysis. Cancer Med 2021; 10:2601-2610. [PMID: 33734596 PMCID: PMC8026950 DOI: 10.1002/cam4.3731] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/08/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background Blinatumomab is a BiTE® immuno‐oncology therapy indicated for the treatment of patients with relapsed or refractory (r/r) B‐cell precursor (BCP) acute lymphoblastic leukemia (ALL).
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Affiliation(s)
- Max S Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Anthony S Stein
- Gehr Leukemia Center, City of Hope Medical Center, Duarte, CA, USA
| | - Nicola Gökbuget
- Medizinische Klinik III (Hämatologie/Onkologie/Rheumatologie/Infektiologie, Universitätsklinikum, Frankfurt, Germany
| | - Heinz-August Horst
- Klinik für Innere Medizin II, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Nicolas Boissel
- Unité d'Hématologie Adolescents et Jeunes Adultes, Hôpital Saint-Louis, Paris, France
| | - Giovanni Martinelli
- Scientific Directorate, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Monika Brüggemann
- Sektion für Hämatologische Spezialdiagnostik Klinik für Innere Medizin II, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Yuqi Chen
- Global Biostatistical Science, Amgen Inc, Thousand Oaks, California, USA
| | - Gerhard Zugmaier
- Global Development, Amgen Research (Munich) GmbH, Munich, Germany
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22
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Arslan S, Zhang J, Dhakal P, Moran J, Naidoo N, Lombardi J, Pullarkat V, Stein AS, Marcucci G, Yaghmour G, Bhatt VR, Fathi AT, Aldoss I. Outcomes of therapy with venetoclax combined with a hypomethylating agent in favorable-risk acute myeloid leukemia. Am J Hematol 2021; 96:E59-E63. [PMID: 33227142 DOI: 10.1002/ajh.26057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Shukaib Arslan
- Department of Hematology and Hematopoietic Cell Transplantation City of Hope Duarte California USA
| | - Jianying Zhang
- Department of Information Sciences City of Hope Medical Center Duarte California USA
| | - Prajwal Dhakal
- Department of Hematology and Oncology University of Nebraska Medical Center Omaha Nebraska USA
| | - Jenna Moran
- Division of Hematology/Oncology Massachusetts General Hospital Boston Massachusetts USA
| | - Nuthana Naidoo
- Jane Anne Nohl Division of Hematology and Center for the study of Blood disease University of Southern California Los Angeles California USA
| | - Jennifer Lombardi
- Division of Hematology/Oncology Massachusetts General Hospital Boston Massachusetts USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation City of Hope Duarte California USA
| | - Anthony S. Stein
- Department of Hematology and Hematopoietic Cell Transplantation City of Hope Duarte California USA
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation City of Hope Duarte California USA
| | - George Yaghmour
- Jane Anne Nohl Division of Hematology and Center for the study of Blood disease University of Southern California Los Angeles California USA
| | - Vijaya R. Bhatt
- Department of Hematology and Oncology University of Nebraska Medical Center Omaha Nebraska USA
| | - Amir T. Fathi
- Division of Hematology/Oncology Massachusetts General Hospital Boston Massachusetts USA
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation City of Hope Duarte California USA
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23
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Abstract
Venetoclax in combination with hypomethylating agents (HMAs) or low-dose cytarabine (LDAC) has demonstrated exceptional activity in elderly and unfit patients with newly diagnosed acute myeloid leukemia (AML). Notably, the safety profile of venetoclax-based induction regimens was favorable, with a low rate of early treatment-related mortality, even in frail study participants. Thus, the introduction of venetoclax has transformed the landscape of AML therapy in elderly patients. Given these promising results, venetoclax in combination with other agents is now being studied as a frontline therapy in younger patients with AML, as well as in relapsed/refractory AML patients. Here, we review clinical data for venetoclax-based therapy in AML, both from prospective as well as retrospective studies, and highlight ongoing novel studies of venetoclax-containing regimens and discuss future research directions.
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Affiliation(s)
- Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Vinod Pullarkat
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Anthony S Stein
- Gehr Family Center for Leukemia Research, City of Hope, 1500 Duarte Road, Duarte, CA 91010, USA
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24
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Zhao Y, Aldoss I, Qu C, Crawford JC, Gu Z, Allen EK, Zamora AE, Alexander TB, Wang J, Goto H, Imamura T, Akahane K, Marcucci G, Stein AS, Bhatia R, Thomas PG, Forman SJ, Mullighan CG, Roberts KG. Tumor-intrinsic and -extrinsic determinants of response to blinatumomab in adults with B-ALL. Blood 2021; 137:471-484. [PMID: 32881995 PMCID: PMC7845009 DOI: 10.1182/blood.2020006287] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/20/2020] [Indexed: 12/16/2022] Open
Abstract
Blinatumomab, a bispecific antibody that directs CD3+ T cells to CD19+ tumor cells, shows variable efficacy in B-progenitor acute lymphoblastic leukemia (B-ALL). To determine tumor-intrinsic and -extrinsic determinants of response, we studied 44 adults with relapsed or refractory B-ALL (including 2 minimal residual disease positive) treated with blinatumomab using bulk tumor and single-cell sequencing. The overall response rate in patients with hematological disease was 55%, with a high response rate in those with CRLF2-rearranged Philadelphia chromosome-like ALL (12 [75%] of 16). Pretreatment samples of responders exhibited a tumor-intrinsic transcriptomic signature of heightened immune response. Multiple mechanisms resulted in loss of CD19 expression, including CD19 mutations, CD19-mutant allele-specific expression, low CD19 RNA expression, and mutations in CD19 signaling complex member CD81. Patients with low hypodiploid ALL were prone to CD19- relapse resulting from aneuploidy-mediated loss of the nonmutated CD19 allele. Increased expression of a CD19 isoform with intraexonic splicing of exon 2, CD19 ex2part, at baseline or during therapy was associated with treatment failure. These analyses demonstrate both tumor-intrinsic and -extrinsic factors influence blinatumomab response. We show that CD19 mutations are commonly detected in CD19- relapse during blinatumomab treatment. Identification of the CD19 ex2part splice variant represents a new biomarker predictive of blinatumomab therapy failure.
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MESH Headings
- Adolescent
- Adult
- Aged
- Amino Acid Sequence
- Aneuploidy
- Antibodies, Bispecific/immunology
- Antibodies, Bispecific/pharmacology
- Antibodies, Bispecific/therapeutic use
- Antigens, CD19/biosynthesis
- Antigens, CD19/genetics
- Antigens, CD19/immunology
- Antigens, Neoplasm/biosynthesis
- Antigens, Neoplasm/genetics
- Antigens, Neoplasm/immunology
- Antineoplastic Agents, Immunological/immunology
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Agents, Immunological/therapeutic use
- B-Lymphocytes/drug effects
- B-Lymphocytes/immunology
- Cytotoxicity, Immunologic/drug effects
- Drug Resistance, Neoplasm/physiology
- Female
- Gene Expression Profiling
- Humans
- Male
- Middle Aged
- Mutation
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Protein Isoforms/antagonists & inhibitors
- Protein Isoforms/genetics
- RNA, Messenger/biosynthesis
- RNA, Messenger/genetics
- RNA, Neoplasm/biosynthesis
- RNA, Neoplasm/genetics
- Recurrence
- Retrospective Studies
- Salvage Therapy
- Sequence Alignment
- Sequence Homology, Amino Acid
- Single-Cell Analysis
- T-Lymphocyte Subsets/drug effects
- T-Lymphocyte Subsets/immunology
- Young Adult
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Affiliation(s)
- Yaqi Zhao
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Medical Center, Duarte, CA
| | - Chunxu Qu
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN
| | | | - Zhaohui Gu
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN
| | - Emma K Allen
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN
| | - Anthony E Zamora
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN
| | | | - Jeremy Wang
- Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Hiroaki Goto
- Division of Hemato-Oncology/Regenerative Medicine, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Toshihiko Imamura
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koshi Akahane
- Department of Pediatrics, School of Medicine, University of Yamanashi, Chuo, Japan; and
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Medical Center, Duarte, CA
| | - Anthony S Stein
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Medical Center, Duarte, CA
| | - Ravi Bhatia
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Paul G Thomas
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Medical Center, Duarte, CA
| | | | - Kathryn G Roberts
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN
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Topp MS, Gökbuget N, Zugmaier G, Stein AS, Dombret H, Chen Y, Ribera JM, Bargou RC, Horst HA, Kantarjian HM. Long-term survival of patients with relapsed/refractory acute lymphoblastic leukemia treated with blinatumomab. Cancer 2020; 127:554-559. [PMID: 33141929 PMCID: PMC7894150 DOI: 10.1002/cncr.33298] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 07/01/2020] [Revised: 09/11/2020] [Accepted: 10/01/2020] [Indexed: 12/19/2022]
Abstract
Background Blinatumomab is a CD19 BiTE (bispecific T‐cell engager) immuno‐oncology therapy that mediates the lysis of cells expressing CD19. Methods A pooled analysis of long‐term follow‐up data from 2 phase 2 studies that evaluated blinatumomab in heavily pretreated adults with Philadelphia chromosome–negative, relapsed/refractory B‐cell precursor acute lymphoblastic leukemia was conducted. Results A total of 259 patients were included in the analysis. The median overall survival (OS) among all patients, regardless of response, was 7.5 months (95% confidence interval [CI], 5.5‐8.5 months); the median follow‐up time for OS was 36.0 months (range, 0.3‐60.8 months). The median relapse‐free survival (RFS) among patients who achieved a complete remission (CR) or complete remission with partial hematologic recovery (CRh) in the first 2 cycles (n = 123) was 7.7 months (95% CI, 6.2‐10.0 months); the median follow‐up time for RFS was 35.0 months (range, 9.5‐59.5 months). OS and RFS plateaued with 3‐year rates of 17.7% and 23.4%, respectively. The cumulative incidence function of the time to relapse, with death not due to relapse considered a competing risk, for patients who achieved a CR/CRh within 2 cycles of treatment also plateaued with a 3‐year relapse rate of 59.3%. For patients who achieved a CR/CRh with blinatumomab followed by allogeneic hematopoietic stem cell transplantation while in continuous CR, the median OS was 18.1 months (95% CI, 10.3‐30.0 months) with a 3‐year survival rate of 37.2%. Conclusions These data suggest that long‐term survival is possible after blinatumomab therapy. Lay Summary Immuno‐oncology therapies such as blinatumomab activate the patient's own immune system to kill cancer cells. This study combined follow‐up data from 2 blinatumomab‐related clinical trials to evaluate long‐term survival in patients with relapsed and/or refractory B‐cell precursor acute lymphoblastic leukemia at high risk for unfavorable outcomes. Among patients who achieved a deep response with blinatumomab, one‐third lived 3 years or longer. These findings suggest that long‐term survival is possible after treatment with blinatumomab.
Patients achieving remission after blinatumomab can have a durable response. The survival plateau indicates a high probability of a cure in those patients responding to blinatumomab and alive after 3 years.
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Affiliation(s)
- Max S Topp
- Universitätsklinikum Würzburg, Würzburg, Germany
| | | | | | - Anthony S Stein
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
| | - Hervé Dombret
- Saint Louis Hospital, University of Paris, Paris, France
| | - Yuqi Chen
- Amgen, Inc, Thousand Oaks, California
| | - Josep-Maria Ribera
- Catalan Institute of Oncology-Germans Trias I Pujol Hospital, Josep Carreras Leukemia Research Institute, Badalona, Spain
| | - Ralf C Bargou
- Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany
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26
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DiNardo CD, Stein AS, Stein EM, Fathi AT, Frankfurt O, Schuh AC, Döhner H, Martinelli G, Patel PA, Raffoux E, Tan P, Zeidan AM, de Botton S, Kantarjian HM, Stone RM, Frattini MG, Lersch F, Gong J, Gianolio DA, Zhang V, Franovic A, Fan B, Goldwasser M, Daigle S, Choe S, Wu B, Winkler T, Vyas P. Mutant Isocitrate Dehydrogenase 1 Inhibitor Ivosidenib in Combination With Azacitidine for Newly Diagnosed Acute Myeloid Leukemia. J Clin Oncol 2020; 39:57-65. [PMID: 33119479 PMCID: PMC7771719 DOI: 10.1200/jco.20.01632] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Ivosidenib is an oral inhibitor of the mutant isocitrate dehydrogenase 1 (IDH1) enzyme, approved for treatment of IDH1-mutant (mIDH1) acute myeloid leukemia (AML). Preclinical work suggested that addition of azacitidine to ivosidenib enhances mIDH1 inhibition-related differentiation and apoptosis. PATIENTS AND METHODS This was an open-label, multicenter, phase Ib trial comprising dose-finding and expansion stages to evaluate safety and efficacy of combining oral ivosidenib 500 mg once daily continuously with subcutaneous azacitidine 75 mg/m2 on days 1-7 in 28-day cycles in patients with newly diagnosed mIDH1 AML ineligible for intensive induction chemotherapy (ClinicalTrials.gov identifier: NCT02677922). RESULTS Twenty-three patients received ivosidenib plus azacitidine (median age, 76 years; range, 61-88 years). Treatment-related grade ≥ 3 adverse events occurring in > 10% of patients were neutropenia (22%), anemia (13%), thrombocytopenia (13%), and electrocardiogram QT prolongation (13%). Adverse events of special interest included all-grade IDH differentiation syndrome (17%), all-grade electrocardiogram QT prolongation (26%), and grade ≥ 3 leukocytosis (9%). Median treatment duration was 15.1 months (range, 0.3-32.2 months); 10 patients remained on treatment as of February 19, 2019. The overall response rate was 78.3% (18/23 patients; 95% CI, 56.3% to 92.5%), and the complete remission rate was 60.9% (14/23 patients; 95% CI, 38.5% to 80.3%). With median follow-up of 16 months, median duration of response in responders had not been reached. The 12-month survival estimate was 82.0% (95% CI, 58.8% to 92.8%). mIDH1 clearance in bone marrow mononuclear cells by BEAMing (beads, emulsion, amplification, magnetics) digital polymerase chain reaction was seen in 10/14 patients (71.4%) achieving complete remission. CONCLUSION Ivosidenib plus azacitidine was well tolerated, with an expected safety profile consistent with monotherapy with each agent. Responses were deep and durable, with most complete responders achieving mIDH1 mutation clearance.
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Affiliation(s)
| | | | - Eytan M Stein
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amir T Fathi
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | - Andre C Schuh
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Giovanni Martinelli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Prapti A Patel
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Peter Tan
- Royal Perth Hospital, Perth, Western Australia, Australia
| | | | | | | | | | | | | | | | | | | | | | - Bin Fan
- Agios Pharmaceuticals, Cambridge, MA
| | | | | | - Sung Choe
- Agios Pharmaceuticals, Cambridge, MA
| | - Bin Wu
- Agios Pharmaceuticals, Cambridge, MA
| | | | - Paresh Vyas
- University of Oxford, Oxford, United Kingdom
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27
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Aldoss I, Zhang J, Mei M, Al Malki MM, Arslan S, Ngo D, Aribi A, Ali H, Sandhu K, Salhotra A, Koller P, Khaled S, Artz A, Snyder D, Nakamura R, Forman SJ, Stein AS, Marcucci G, Pullarkat V. Venetoclax and hypomethylating agents in FLT3-mutated acute myeloid leukemia. Am J Hematol 2020; 95:1193-1199. [PMID: 32628327 DOI: 10.1002/ajh.25929] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 01/10/2023]
Abstract
FMS-like tyrosine kinase 3 (FLT3) mutations are prevalent in acute myeloid leukemia (AML), and their presence confers adverse risk. FLT3-mutated (FLT3m) AML is a challenging leukemia to manage, particularly in older and unfit patients as well as patients with relapsed/refractory (r/r) disease. We retrospectively analyzed the outcomes of 50 FLT3m AML patients (17 treatment-naïve, 33 r/r) treated with venetoclax (VEN) and hypomethylating agents (HMA). The overall CR/CRi rate with VEN-HMA was 60% (94% in treatment-naïve AML and 42% in r/r AML). Early (60-days) treatment related mortality was 2%. The r/r AML setting was an independent predictor of lower complete response (OR: 0.08; 95%CI: 0.00-0.60, P = .03). Cytogenetics-molecular risk, concurrent mutations, the type of FLT3 mutation (ITD vs TKD), the ITD allelic ratio, the type of HMA, age, prior exposure to HMA and receipt of prior allogeneic transplant did not independently impact response or leukemia-free survival (LFS). Concurrent IDH mutations were associated with lower CR/CRi (P = .01), while ASXL1 or TET2 mutations showed a non-significant association toward higher CR/CRi (P = .07, for both). However, none of the concurrent mutations were an independent predictor for response when adjusted to AML setting. In conclusion, VEN-HMA is associated with encouraging efficacy in FLT3m AML among both newly diagnosed unfit and r/r patients.
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Affiliation(s)
- Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Jianying Zhang
- Department of Information Sciences, City of Hope Medical Center, Duarte, California, USA
| | - Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Shukaib Arslan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Dat Ngo
- Department of Pharmacy, City of Hope Medical Center, Duarte, California, USA
| | - Ahmed Aribi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Karamjeet Sandhu
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Paul Koller
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Samer Khaled
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Andrew Artz
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - David Snyder
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Anthony S Stein
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
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28
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Othman TA, Zhang J, Mei M, Stein AS, Forman SJ, Marcucci G, Pullarkat V, Aldoss I. Retreatment with venetoclax and hypomethylating agents among AML patients who have relapsed after initial response and subsequent interruption of therapy. Leuk Lymphoma 2020; 61:3532-3533. [DOI: 10.1080/10428194.2020.1808213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Tamer A. Othman
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Jianying Zhang
- Department of Information Sciences, City of Hope Medical Center, Duarte, CA, USA
| | - Matthew Mei
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Anthony S. Stein
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Stephen J. Forman
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Guido Marcucci
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Vinod Pullarkat
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
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29
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Otoukesh S, Zhang J, Nakamura R, Stein AS, Forman SJ, Marcucci G, Pullarkat V, Aldoss I. The efficacy of venetoclax and hypomethylating agents in acute myeloid leukemia with extramedullary involvement. Leuk Lymphoma 2020; 61:2020-2023. [PMID: 32191144 DOI: 10.1080/10428194.2020.1742908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Salman Otoukesh
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Jianying Zhang
- Department of Information Sciences, City of Hope Medical Center, Duarte, CA, USA
| | - Ryotaro Nakamura
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Anthony S Stein
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Stephen J Forman
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Guido Marcucci
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Vinod Pullarkat
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
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30
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Al Malki MM, Tsai NC, Palmer J, Mokhtari S, Cao T, Ali H, Salhotra A, Arslan S, Aldoss I, Karras N, Zain J, Khaled SK, Stein AS, Snyder DS, Marcucci G, Forman SJ, Nademanee A, Nakamura R. A Phase II Trial of Post-Transplant Cyclophosphamide As Graft-Versus-Host Disease Prophylaxis in HLA-Mismatched Unrelated Donor Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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31
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Rambaldi A, Ribera JM, Kantarjian HM, Dombret H, Ottmann OG, Stein AS, Tuglus CA, Zhao X, Kim C, Martinelli G. Blinatumomab compared with standard of care for the treatment of adult patients with relapsed/refractory Philadelphia chromosome-positive B-precursor acute lymphoblastic leukemia. Cancer 2019; 126:304-310. [PMID: 31626339 PMCID: PMC7003760 DOI: 10.1002/cncr.32558] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 02/28/2019] [Revised: 06/24/2019] [Accepted: 07/11/2019] [Indexed: 12/24/2022]
Abstract
Background A single‐arm, phase 2 trial demonstrated the efficacy and safety of blinatumomab, a bispecific T‐cell–engaging antibody construct, in patients with relapsed/refractory (r/r) Philadelphia chromosome–positive (Ph+) acute lymphoblastic leukemia (ALL), a rare hematologic malignancy with limited treatment options. This study compared outcomes with blinatumomab with those of a historical control treated with the standard of care (SOC). Methods The blinatumomab trial enrolled adult patients with Ph+ ALL who were r/r to at least 1 second‐generation tyrosine kinase inhibitor (n = 45). Propensity score analysis (PSA) was used to compare outcomes with blinatumomab with those of an external cohort of similar patients receiving SOC chemotherapy (n = 55). The PSA mitigated confounding variables between studies by adjusting for imbalances in the age at diagnosis and start of treatment, sex, duration from diagnosis to most recent treatment, prior allogeneic hematopoietic stem cell transplantation, prior salvage therapy, and number of salvage therapies. Bayesian data augmentation was applied to improve power to 80% with data from a phase 3 blinatumomab study in r/r Philadelphia chromosome–negative ALL. Results In the PSA, the rate of complete remission or complete remission with partial hematologic recovery was 36% for blinatumomab and 25% for SOC, and this resulted in an odds ratio of 1.54 (95% confidence interval [CI], 0.61‐3.89) or 1.70 (95% credible interval [CrI], 0.94‐2.94) with Bayesian data augmentation. Overall survival favored blinatumomab over SOC, with a hazard ratio of 0.81 (95% CI, 0.57‐1.14) or 0.77 (95% CrI, 0.61‐0.96) with Bayesian data augmentation. Conclusions These results further support blinatumomab as a treatment option for patients with r/r Ph+ ALL. A single‐arm, phase 2 trial has demonstrated the efficacy and safety of blinatumomab, a bispecific T‐cell–engaging antibody construct, in patients with relapsed/refractory (r/r) Philadelphia chromosome–positive (Ph+) acute lymphoblastic leukemia (ALL), a rare hematologic malignancy with limited treatment options. Using propensity score analysis, this study demonstrates that efficacy outcomes (complete remission and overall survival) from the phase 2 trial with blinatumomab compare favorably with those for a cohort of similar patients with r/r Ph+ ALL treated with standard‐of‐care chemotherapy.
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Affiliation(s)
| | - Josep-Maria Ribera
- Clinical Hematology Service, Catalan Institute of Oncology, University Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Hagop M Kantarjian
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hervé Dombret
- Department of Hematology, Hopital Saint-Louis, Paris Diderot University, Paris, France
| | - Oliver G Ottmann
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Anthony S Stein
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
| | | | | | | | - Giovanni Martinelli
- Scientific Institute of Romagna for the Study and Treatment of Cancer, Meldola, Italy
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32
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Aldoss I, Yang D, Pillai R, Sanchez JF, Mei M, Aribi A, Ali H, Sandhu K, Al Malki MM, Salhotra A, Khaled S, Sun W, O'Donnell M, Snyder D, Nakamura R, Stein AS, Forman SJ, Marcucci G, Pullarkat V. Association of leukemia genetics with response to venetoclax and hypomethylating agents in relapsed/refractory acute myeloid leukemia. Am J Hematol 2019; 94:E253-E255. [PMID: 31259427 DOI: 10.1002/ajh.25567] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Dongyun Yang
- Department of Information SciencesCity of Hope Medical Center Duarte California
| | - Raju Pillai
- Department of PathologyCity of Hope Medical Center Duarte California
| | - James F. Sanchez
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Matthew Mei
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Ahmed Aribi
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Haris Ali
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Karamjeet Sandhu
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Monzr M. Al Malki
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Amandeep Salhotra
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Samer Khaled
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Weili Sun
- Department of PediatricsCity of Hope Medical Center Duarte California
| | - Margaret O'Donnell
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - David Snyder
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Ryotaro Nakamura
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Anthony S. Stein
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Stephen J. Forman
- Department of PathologyCity of Hope Medical Center Duarte California
| | - Guido Marcucci
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Vinod Pullarkat
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
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33
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Srideshikan SM, Brooks J, Zuro D, Kumar B, Sanchez J, Echavarria Parra L, Orellana M, Vishwasrao P, Nair I, Chea J, Poku K, Bowles N, Miller A, Ebner T, Molnar J, Rosenthal J, Vallera DA, Wong JYC, Stein AS, Colcher D, Shively JE, Yazaki PJ, Hui SK. ImmunoPET, [ 64Cu]Cu-DOTA-Anti-CD33 PET-CT, Imaging of an AML Xenograft Model. Clin Cancer Res 2019; 25:7463-7474. [PMID: 31548348 DOI: 10.1158/1078-0432.ccr-19-1106] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/13/2019] [Accepted: 09/11/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Acute myeloid leukemia (AML) is a highly aggressive form of leukemia, which results in poor survival outcomes. Currently, diagnosis and prognosis are based on invasive single-point bone marrow biopsies (iliac crest). There is currently no AML-specific noninvasive imaging method to detect disease, including in extramedullary organs, representing an unmet clinical need. About 85% to 90% of human myeloid leukemia cells express CD33 cell surface receptors, highlighting CD33 as an ideal candidate for AML immunoPET. EXPERIMENTAL DESIGN We evaluated whether [64Cu]Cu-DOTA-anti-CD33 murine mAb can be used for immunoPET imaging of AML in a preclinical model. MicroCT was adjusted to detect spatial/anatomical details of PET activity. For translational purposes, a humanized anti-CD33 antibody was produced; we confirmed its ability to detect disease and its distribution. We reconfirmed/validated CD33 antibody-specific targeting with an antibody-drug conjugate (ADC) and radioimmunotherapy (RIT). RESULTS [64Cu]Cu-DOTA-anti-CD33-based PET-CT imaging detected CD33+ AML in mice with high sensitivity (95.65%) and specificity (100%). The CD33+ PET activity was significantly higher in specific skeletal niches [femur (P < 0.00001), tibia (P = 0.0001), humerus (P = 0.0014), and lumber spine (P < 0.00001)] in AML-bearing mice (over nonleukemic control mice). Interestingly, the hybrid PET-CT imaging showed high disease activity in the epiphysis/metaphysis of the femur, indicating regional spatial heterogeneity. Anti-CD33 therapy using newly developed humanized anti-CD33 mAb as an ADC (P = 0.02) and [225Ac]Ac-anti-CD33-RIT (P < 0.00001) significantly reduced disease burden over that of respective controls. CONCLUSIONS We have successfully developed a novel anti-CD33 immunoPET-CT-based noninvasive modality for AML and its spatial distribution, indicating a preferential skeletal niche.
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MESH Headings
- Animals
- Antibodies, Monoclonal, Humanized/pharmacokinetics
- Cell Line, Tumor
- Copper Radioisotopes/chemistry
- Disease Models, Animal
- Heterocyclic Compounds, 1-Ring/chemistry
- Immunoconjugates/pharmacokinetics
- Leukemia, Myeloid, Acute/diagnostic imaging
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/pathology
- Mice
- Mice, Inbred NOD
- Mice, SCID
- Positron Emission Tomography Computed Tomography/methods
- Radiopharmaceuticals/pharmacokinetics
- Sialic Acid Binding Ig-like Lectin 3/antagonists & inhibitors
- Sialic Acid Binding Ig-like Lectin 3/immunology
- Tissue Distribution
- Xenograft Model Antitumor Assays
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Affiliation(s)
| | - Jamison Brooks
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Darren Zuro
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Bijender Kumar
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - James Sanchez
- Beckman Research Institute of City of Hope, Duarte, California
| | | | - Marvin Orellana
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Paresh Vishwasrao
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Indu Nair
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Junie Chea
- Department of Molecular Imaging & Therapy, Beckman Research Institute of City of Hope, Duarte, California
| | - Kofi Poku
- Department of Molecular Imaging & Therapy, Beckman Research Institute of City of Hope, Duarte, California
| | - Nicole Bowles
- Department of Molecular Imaging & Therapy, Beckman Research Institute of City of Hope, Duarte, California
| | - Aaron Miller
- Department of Molecular Imaging & Therapy, Beckman Research Institute of City of Hope, Duarte, California
| | - Todd Ebner
- Department of Molecular Imaging & Therapy, Beckman Research Institute of City of Hope, Duarte, California
| | - Justin Molnar
- Department of Molecular Imaging & Therapy, Beckman Research Institute of City of Hope, Duarte, California
| | - Joseph Rosenthal
- Department of Pediatrics, City of Hope National Medical Center, Duarte, California
| | - Daniel A Vallera
- Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota, Minneapolis, Minnesota
| | - Jeffrey Y C Wong
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Anthony S Stein
- Department of Hematology/HCT, City of Hope National Medical Center, Duarte, California
| | - David Colcher
- Department of Molecular Imaging & Therapy, Beckman Research Institute of City of Hope, Duarte, California
| | - John E Shively
- Department of Molecular Imaging & Therapy, Beckman Research Institute of City of Hope, Duarte, California
| | - Paul J Yazaki
- Department of Molecular Imaging & Therapy, Beckman Research Institute of City of Hope, Duarte, California
| | - Susanta K Hui
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California.
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DiNardo CD, Stein AS, Stein EM, Fathi AT, Frankfurt O, Schuh AC, Döhner H, Martinelli G, Raffoux E, Tan P, Zeidan A, de Botton S, Kantarjian HM, Stone RM, Lam D, Wang X, Gong J, Kapsalis SM, Hickman D, Zhang V, Winkler T, Daigle S, Vyas P. Mutant IDH1 Inhibitor Ivosidenib (IVO; AG-120) in Combination with Azacitidine (AZA) for Newly Diagnosed Acute Myeloid Leukemia (ND AML). Clinical Lymphoma Myeloma and Leukemia 2019. [DOI: 10.1016/j.clml.2019.07.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aldoss I, Zhang J, Pillai R, Shouse G, Sanchez JF, Mei M, Nakamura R, Stein AS, Forman SJ, Marcucci G, Pullarkat V. Venetoclax and hypomethylating agents in TP53-mutated acute myeloid leukaemia. Br J Haematol 2019; 187:e45-e48. [PMID: 31441045 DOI: 10.1111/bjh.16166] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Jianying Zhang
- Department of Computational and Quantitative Medicine, City of Hope, Duarte, CA, USA
| | - Raju Pillai
- Department of Pathology, City of Hope, Duarte, CA, USA
| | - Geoffrey Shouse
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - James F Sanchez
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Anthony S Stein
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
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Jabbour EJ, Gökbuget N, Kantarjian HM, Thomas X, Larson RA, Yoon SS, Ghobadi A, Topp MS, Tran Q, Franklin JL, Forman SJ, Stein AS. Transplantation in adults with relapsed/refractory acute lymphoblastic leukemia who are treated with blinatumomab from a phase 3 study. Cancer 2019; 125:4181-4192. [PMID: 31433496 DOI: 10.1002/cncr.32335] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [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: 01/28/2019] [Revised: 04/23/2019] [Accepted: 05/20/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Blinatumomab, a bispecific T-cell-engaging (BiTE®) immuno-oncology therapy, demonstrated superior overall survival versus standard-of-care chemotherapy (SOC) in adults with relapsed/refractory B-cell precursor acute lymphoblastic leukemia (R/R ALL) in the phase 3 TOWER study. Herein, the authors reported clinical features and outcomes for those patients who underwent allogeneic hematopoietic stem cell transplantation (HSCT) after treatment with blinatumomab. METHODS In the TOWER study, adults with R/R ALL were randomized 2:1 to receive blinatumomab or SOC. Study treatment consisted of 2 cycles of induction with blinatumomab or SOC followed by consolidation and maintenance therapy. At any time after the first cycle, patients who were eligible for HSCT could proceed to HSCT. RESULTS Of the 97 patients who underwent HSCT during the study, baseline characteristics generally were comparable and donor types were similar between the patients treated with blinatumomab (65 patients) and those receiving SOC (32 patients). There was no evidence to suggest that the survival benefit of HSCT differed between the patients treated with blinatumomab and those receiving SOC (P = .68). On the basis of descriptive statistics, a survival benefit of HSCT versus no HSCT was not observed in patients who achieved complete remission with full, partial, or incomplete hematologic recovery with blinatumomab (odds ratio, 1.17; 95% CI, 0.54-2.53). The best outcomes were achieved in patients with no prior salvage therapy and with minimal residual disease response to blinatumomab regardless of on-study HSCT status. CONCLUSIONS Survival was found to be driven by response to study treatment and by salvage status regardless of on-study HSCT status. These data should be interpreted with caution because the current study was not designed to prospectively assess survival outcomes associated with HSCT after blinatumomab. LAY SUMMARY Evidence before this study: Blinatumomab is associated with superior morphologic and molecular response rates and superior overall outcome when compared with standard of care chemotherapy in adults with relapsed/refractory B-cell precursor acute lymphoblastic leukemia. Added value of this study: The best outcomes with blinatumomab were observed in patients who achieved minimal residual disease remission in first salvage treatment regardless of subsequent allogeneic stem cell transplantation (HSCT). Implications of all the available evidence: Patients achieving CR/CRh/CRi following blinatumomab can have a durable response with or without HSCT.
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Affiliation(s)
- Elias J Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nicola Gökbuget
- Department of Medicine, Goethe University Hospital, Frankfurt, Germany
| | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xavier Thomas
- Department of Hematology, Lyon-Sud Hospital, Pierre-Benite, France
| | - Richard A Larson
- Department of Hematology and Oncology, University of Chicago, Chicago, Illinois
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Armin Ghobadi
- Division of Hematology and Oncology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Max S Topp
- Department of Haematology, Wurzburg University, Wurzburg, Germany
| | - Qui Tran
- Amgen Inc, Thousand Oaks, California
| | | | - Stephen J Forman
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
| | - Anthony S Stein
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
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Wang H, Zhao D, Nguyen LX, Wu H, Li L, Dong D, Troadec E, Zhu Y, Hoang DH, Stein AS, Al Malki M, Aldoss I, Lin A, Ghoda LY, McDonald T, Pichiorri F, Carlesso N, Kuo YH, Zhang B, Jin J, Marcucci G. Targeting cell membrane HDM2: A novel therapeutic approach for acute myeloid leukemia. Leukemia 2019; 34:75-86. [PMID: 31337857 DOI: 10.1038/s41375-019-0522-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 12/14/2022]
Abstract
The E3 ligase human double minute 2 (HDM2) regulates the activity of the tumor suppressor protein p53. A p53-independent HDM2 expression has been reported on the membrane of cancer cells but not on that of normal cells. Herein, we first showed that membrane HDM2 (mHDM2) is exclusively expressed on human and mouse AML blasts, including leukemia stem cell (LSC)-enriched subpopulations, but not on normal hematopoietic stem cells (HSCs). Higher mHDM2 levels in AML blasts were associated with leukemia-initiating capacity, quiescence, and chemoresistance. We also showed that a synthetic peptide PNC-27 binds to mHDM2 and enhances the interaction of mHDM2 and E-cadherin on the cell membrane; in turn, E-cadherin ubiquitination and degradation lead to membrane damage and cell death of AML blasts by necrobiosis. PNC-27 treatment in vivo resulted in a significant killing of both AML "bulk" blasts and LSCs, as demonstrated respectively in primary and secondary transplant experiments, using both human and murine AML models. Notably, PNC-27 spares normal HSC activity, as demonstrated in primary and secondary BM transplant experiments of wild-type mice. We concluded that mHDM2 represents a novel and unique therapeutic target, and targeting mHDM2 using PNC-27 selectively kills AML cells, including LSCs, with minimal off-target hematopoietic toxicity.
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Affiliation(s)
- Huafeng Wang
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China.,Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA.,Zhejiang Provincial Key Lab of Hematopoietic Malignancy, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Dandan Zhao
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Le Xuan Nguyen
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA.,Department of Medical Biotechnology, Biotechnology Center of Ho Chi Minh City, Ho Chi Minh, Vietnam
| | - Herman Wu
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Ling Li
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Dan Dong
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA.,Department of Pathophysiology, College of Basic Medical Science, China Medical University, Shenyang, PR China
| | - Estelle Troadec
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Yinghui Zhu
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Dinh Hoa Hoang
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Anthony S Stein
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Monzr Al Malki
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Ibrahim Aldoss
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Allen Lin
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Lucy Y Ghoda
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Tinisha McDonald
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Flavia Pichiorri
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Nadia Carlesso
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Ya-Huei Kuo
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Bin Zhang
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA.
| | - Jie Jin
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China. .,Zhejiang Provincial Key Lab of Hematopoietic Malignancy, Zhejiang University, Hangzhou, Zhejiang, PR China.
| | - Guido Marcucci
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA.
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Cortes JE, Jonas BA, Graef T, Luan Y, Stein AS. Clinical Experience With Ibrutinib Alone or in Combination With Either Cytarabine or Azacitidine in Patients With Acute Myeloid Leukemia. Clin Lymphoma Myeloma Leuk 2019; 19:509-515.e1. [PMID: 31227358 DOI: 10.1016/j.clml.2019.05.008] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/30/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Preclinical studies have suggested a role for Bruton tyrosine kinase (BTK) as a potential therapeutic target in acute myeloid leukemia (AML), and anti-AML activity in vivo has been demonstrated with BTK inhibitors. PATIENTS AND METHODS In this open-label phase 2a study, patients with AML were treated with ibrutinib 560 mg per day alone (cohort 1; n = 7), or ibrutinib in combination with either cytarabine 20 mg administered subcutaneously twice daily for 10 days of a 28-day cycle (cohort 2; n = 21) or azacitidine 75 mg/m2 administered intravenously once daily on days 1 to 7 of a 28-day cycle (cohort 3; n = 8). Best overall response (primary end point), overall survival, and safety were summarized. RESULTS A total of 36 patients were enrolled and received treatment; median duration of ibrutinib treatment was 5.4 weeks, and median time on study was 16 months. Of 24 patients evaluable for response, 1 partial remission (cohort 3) and 1 complete remission (cohort 2) were observed; the remaining responses were treatment failures. Median overall survival was 4.0 months in cohort 1, 2.2 months in cohort 2, 2.8 months in cohort 3, and 2.4 months for the overall population. No unexpected safety signals were identified. Grade 3 or higher adverse events that occurred in ≥ 10% of patients included AML progression, febrile neutropenia, pneumonia, anemia, thrombocytopenia, fatigue, asthenia, and respiratory failure. CONCLUSION Ibrutinib alone or in combination with cytarabine or azacitidine demonstrated an acceptable safety profile. However, limited efficacy with ibrutinib was observed in patients with AML.
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Affiliation(s)
| | - Brian A Jonas
- UC Davis Comprehensive Cancer Center, Sacramento, CA
| | | | - Ying Luan
- Pharmacyclics LLC, An AbbVie Company, Sunnyvale, CA
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Pemmaraju N, Lane AA, Sweet KL, Stein AS, Vasu S, Blum W, Rizzieri DA, Wang ES, Duvic M, Sloan JM, Spence S, Shemesh S, Brooks CL, Balser J, Bergstein I, Lancet JE, Kantarjian HM, Konopleva M. Tagraxofusp in Blastic Plasmacytoid Dendritic-Cell Neoplasm. N Engl J Med 2019; 380:1628-1637. [PMID: 31018069 DOI: 10.1056/nejmoa1815105] [Citation(s) in RCA: 238] [Impact Index Per Article: 47.6] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND Blastic plasmacytoid dendritic-cell neoplasm (BPDCN) is an aggressive hematologic cancer that is caused by transformed plasmacytoid dendritic cells that overexpress interleukin-3 receptor subunit alpha (IL3RA or CD123). Tagraxofusp (SL-401) is a CD123-directed cytotoxin consisting of human interleukin-3 fused to truncated diphtheria toxin. METHODS In this open-label, multicohort study, we assigned 47 patients with untreated or relapsed BPDCN to receive an intravenous infusion of tagraxofusp at a dose of 7 μg or 12 μg per kilogram of body weight on days 1 to 5 of each 21-day cycle. Treatment continued until disease progression or unacceptable toxic effects. The primary outcome was the combined rate of complete response and clinical complete response among patients who had not received previous treatment for BPDCN. A secondary outcome was the duration of response. RESULTS Of the 47 patients, 32 were receiving tagraxofusp as first-line treatment and 15 had received previous treatment. The median age of the patients was 70 years (range, 22 to 84). Among the 29 previously untreated patients who received tagraxofusp at a dose of 12 μg per kilogram, the primary outcome occurred in 21 (72%), and the overall response rate was 90%; of these patients, 45% went on to undergo stem-cell transplantation. Survival rates at 18 and 24 months were 59% and 52%, respectively. Among the 15 previously treated patients, the response rate was 67%, and the median overall survival was 8.5 months. The most common adverse events were increased levels of alanine aminotransferase (64%) and aspartate aminotransferase (60%), hypoalbuminemia (55%), peripheral edema (51%), and thrombocytopenia (49%). Capillary leak syndrome was reported in 19% of the patients and was associated with one death in each of the dose subgroups. CONCLUSIONS In adult patients with untreated or relapsed BPDCN, the use of tagraxofusp led to clinical responses. Serious adverse events included capillary leak syndrome; hepatic dysfunction and thrombocytopenia were common. (Funded by Stemline Therapeutics and the Leukemia and Lymphoma Society Therapy Acceleration Program; ClinicalTrials.gov number, NCT02113982.).
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Affiliation(s)
- Naveen Pemmaraju
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Andrew A Lane
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Kendra L Sweet
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Anthony S Stein
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Sumithira Vasu
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - William Blum
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - David A Rizzieri
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Eunice S Wang
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Madeleine Duvic
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - J Mark Sloan
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Sharon Spence
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Shay Shemesh
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Christopher L Brooks
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - John Balser
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Ivan Bergstein
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Jeffrey E Lancet
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Hagop M Kantarjian
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Marina Konopleva
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
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Stein AS, Kantarjian H, Gökbuget N, Bargou R, Litzow MR, Rambaldi A, Ribera JM, Zhang A, Zimmerman Z, Zugmaier G, Topp MS. Blinatumomab for Acute Lymphoblastic Leukemia Relapse after Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:1498-1504. [PMID: 31002989 DOI: 10.1016/j.bbmt.2019.04.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 12/14/2018] [Revised: 03/25/2019] [Accepted: 04/10/2019] [Indexed: 12/24/2022]
Abstract
Patients with relapsed/refractory (R/R) acute lymphoblastic leukemia (ALL) following allogeneic hematopoietic stem cell transplantation (alloHSCT) have a poor prognosis, and alternative therapies are needed for this patient population. Blinatumomab, a bispecific T cell engager immunotherapy, was evaluated in an open-label, single-arm, phase II study of adults with R/R Philadelphia chromosome-negative B cell precursor ALL and resulted in a rate of complete remission (CR) or CR with partial hematologic recovery of peripheral blood counts (CRh) of 43% within 2 treatment cycles. We conducted an exploratory analysis to determine the efficacy and safety of blinatumomab in 64 patients who had relapsed following alloHSCT before enrollment in the phase II study. Forty-five percent of the patients (29 of 64) achieved a CR/CRh within the first 2 cycles of treatment, 22 of whom had a minimal residual disease (MRD) response (including 19 with a complete MRD response). After 1 year and 3 years of follow-up, the median relapse-free survival was 7.4 months for patients who achieved CR/CRh in the first 2 cycles, and the median overall survival was 8.5 months; overall survival rate (Kaplan-Meier estimate) was 36% at 1 year and 18% at 3 years. Grade 3 and 4 adverse events were reported in 20 patients (31%) and 28 patients (44%), respectively, with grade 3 and 4 neurologic events in 8 and 2 patients, respectively, and grade 3 cytokine release syndrome in 2 patients. Eight patients had fatal adverse events, including 5 due to infections. Seven patients had grade ≤ 3 graft-versus-host disease during the study, none of which resulted in the discontinuation of blinatumomab or hospitalization. Our data suggest that blinatumomab is an effective salvage therapy in this patient population.
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Affiliation(s)
- Anthony S Stein
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California.
| | - Hagop Kantarjian
- The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Nicola Gökbuget
- Department of Medicine II, Goethe University, Frankfurt, Germany
| | - Ralf Bargou
- Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany
| | | | - Alessandro Rambaldi
- Department of Oncology and Hemato-Oncology, University of Milan and Azienda Pope John XXIII Hospital, Bergamo, Italy
| | - Josep-Maria Ribera
- Catalan Institute of Oncology-Hospital Germans Trias i Pujol, Jose Carreras Leukemia Research Institute, Badalona, Spain
| | | | | | | | - Max S Topp
- Medical Clinic and Polyclinic II, University Hospital Würzburg, Würzburg, Germany
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Pollyea DA, Tallman MS, de Botton S, Kantarjian HM, Collins R, Stein AS, Frattini MG, Xu Q, Tosolini A, See WL, MacBeth KJ, Agresta SV, Attar EC, DiNardo CD, Stein EM. Enasidenib, an inhibitor of mutant IDH2 proteins, induces durable remissions in older patients with newly diagnosed acute myeloid leukemia. Leukemia 2019; 33:2575-2584. [DOI: 10.1038/s41375-019-0472-2] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 12/20/2022]
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Gupta R, Jamal F, Yang D, Ali H, Aldoss I, Malki MMA, Mei M, Salhotra A, Dobrin S, Tran M, Venkataraman K, Palmer J, Stein AS, Sandhu KS, Khaled SK, Aribi A, Marcucci G, Forman SJ, Snyder DS, Nakamura R, Pullarkat V. Pulmonary Arterial Hypertension (PAH) Is Associated with Increased Non-Relapse Mortality after Allogeneic Hematopoietic Cell Transplantation (allo HCT) for Myelofibrosis. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Salhotra A, Yang D, Mokhtari S, Mei M, Aribi A, Ali H, Al Malki MM, Sandhu KS, Khaled SK, Budde LE, O'Donnell M, Snyder DS, Forman SJ, Marcucci G, Pullarkat V, Nakamura R, Stein AS, Aldoss I. A Retrospective Study of Blinatumomab Based Salvage Regimen As a Bridge to Allogeneic Hematopoietic Cell Transplantation (HCT) for Patients with Relapsed and Refractory ALL. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Aldoss I, Khaled SK, Budde E, Stein AS. Cytokine Release Syndrome With the Novel Treatments of Acute Lymphoblastic Leukemia: Pathophysiology, Prevention, and Treatment. Curr Oncol Rep 2019; 21:4. [PMID: 30666425 DOI: 10.1007/s11912-019-0753-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW T cell-based therapies (blinatumomab and CAR T cell therapy) have produced unprecedented responses in relapsed and refractory (r/r) acute lymphoblastic leukemia (ALL) but is accompanied with significant toxicities, of which one of the most common and serious is cytokine release syndrome (CRS). Here we will review the pathophysiology, prevention, and treatment of CRS. RECENT FINDINGS Efforts have been initiated to define and grade cytokine release syndrome (CRS), to identify patients at risk, to describe biomarkers that predict onset and severity, to understand the pathophysiology, and to prevent and treat severe cases to reduce T cell immunotherapy-related morbidity and mortality. Optimizing the timing of T cell-based therapies in ALL, identifying new biomarkers, and investigating novel anti-cytokine agents that have anti-CRS activity are likely to be fruitful avenues of study.
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Affiliation(s)
- Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, City of Hope, 1500 Duarte Rd, Duarte, CA, 91010, USA
| | - Samer K Khaled
- Gehr Family Center for Leukemia Research, City of Hope, 1500 Duarte Rd, Duarte, CA, 91010, USA
| | - Elizabeth Budde
- Gehr Family Center for Leukemia Research, City of Hope, 1500 Duarte Rd, Duarte, CA, 91010, USA
| | - Anthony S Stein
- Gehr Family Center for Leukemia Research, City of Hope, 1500 Duarte Rd, Duarte, CA, 91010, USA.
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Stein AS, Schiller G, Benjamin R, Jia C, Zhang A, Zhu M, Zimmerman Z, Topp MS. Neurologic adverse events in patients with relapsed/refractory acute lymphoblastic leukemia treated with blinatumomab: management and mitigating factors. Ann Hematol 2018; 98:159-167. [PMID: 30238148 PMCID: PMC6334725 DOI: 10.1007/s00277-018-3497-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/09/2018] [Indexed: 12/20/2022]
Abstract
Neurologic events (NEs) have been reported during treatment with blinatumomab, a bispecific T cell engager (BiTE®) construct. We evaluated the occurrence, severity, and management of NEs; the relationship between NEs and blinatumomab dose; and the potential clinical risk factors in an open-label, single-arm, phase 2 study (N = 189). Patients had Philadelphia chromosome–negative, relapsed/refractory acute lymphoblastic leukemia (ALL) and ≥ 10% bone marrow blasts. The relationship between blinatumomab exposure and NE incidence and severity was assessed. Clinical risk factors for NEs were assessed in a post hoc multivariate analysis. Overall, 98 patients (52%) experienced NEs: most frequently, dizziness, tremor, confusional state, and encephalopathy. NEs occurred predominantly during cycle 1 (median onset, 9 days) and were usually grades 1 or 2. Grade ≥ 3 NEs (13–17% incidence), serious NEs (16–19% incidence), and recurring NEs were managed with infusion interruptions or dexamethasone treatment. The incidence of NEs increased with increasing blinatumomab exposure at a given dose, but exposure appeared unrelated to NE severity. NEs were more frequent in patients ≥ 65 years than < 65 years (72 vs 49%). In a multivariate analysis, race other than white (hazard ratio [HR], 2.11; P = 0.009), > 2 prior salvage therapies (HR, 2.48; P = 0.006), and prior NEs (HR, 1.65; P = 0.020) were risk factors for time to first on-study NE. Although the mechanism underlying NEs associated with blinatumomab treatment in patients with relapsed/refractory ALL remains unclear, NEs tended to occur early during treatment and were often resolved by interrupting treatment and with dexamethasone. Additional research is warranted to investigate the risk factors for NEs.
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Affiliation(s)
- Anthony S Stein
- Department of Hematology/Hematopoietic Cell Transplantation, Gehr Leukemia Center, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010-3000, USA.
| | - Gary Schiller
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ramsis Benjamin
- Department of Hematology/Hematopoietic Cell Transplantation, Gehr Leukemia Center, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010-3000, USA
| | | | | | - Min Zhu
- Amgen Inc., Thousand Oaks, CA, USA
| | | | - Max S Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
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DiNardo CD, Stein EM, de Botton S, Roboz GJ, Altman JK, Mims AS, Swords R, Collins RH, Mannis GN, Pollyea DA, Donnellan W, Fathi AT, Pigneux A, Erba HP, Prince GT, Stein AS, Uy GL, Foran JM, Traer E, Stuart RK, Arellano ML, Slack JL, Sekeres MA, Willekens C, Choe S, Wang H, Zhang V, Yen KE, Kapsalis SM, Yang H, Dai D, Fan B, Goldwasser M, Liu H, Agresta S, Wu B, Attar EC, Tallman MS, Stone RM, Kantarjian HM. Durable Remissions with Ivosidenib in IDH1-Mutated Relapsed or Refractory AML. N Engl J Med 2018; 378:2386-2398. [PMID: 29860938 DOI: 10.1056/nejmoa1716984] [Citation(s) in RCA: 927] [Impact Index Per Article: 154.5] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mutations in the gene encoding isocitrate dehydrogenase 1 ( IDH1) occur in 6 to 10% of patients with acute myeloid leukemia (AML). Ivosidenib (AG-120) is an oral, targeted, small-molecule inhibitor of mutant IDH1. METHODS We conducted a phase 1 dose-escalation and dose-expansion study of ivosidenib monotherapy in IDH1-mutated AML. Safety and efficacy were assessed in all treated patients. The primary efficacy population included patients with relapsed or refractory AML receiving 500 mg of ivosidenib daily with at least 6 months of follow-up. RESULTS Overall, 258 patients received ivosidenib and had safety outcomes assessed. Among patients with relapsed or refractory AML (179 patients), treatment-related adverse events of grade 3 or higher that occurred in at least 3 patients were prolongation of the QT interval (in 7.8% of the patients), the IDH differentiation syndrome (in 3.9%), anemia (in 2.2%), thrombocytopenia or a decrease in the platelet count (in 3.4%), and leukocytosis (in 1.7%). In the primary efficacy population (125 patients), the rate of complete remission or complete remission with partial hematologic recovery was 30.4% (95% confidence interval [CI], 22.5 to 39.3), the rate of complete remission was 21.6% (95% CI, 14.7 to 29.8), and the overall response rate was 41.6% (95% CI, 32.9 to 50.8). The median durations of these responses were 8.2 months (95% CI, 5.5 to 12.0), 9.3 months (95% CI, 5.6 to 18.3), and 6.5 months (95% CI, 4.6 to 9.3), respectively. Transfusion independence was attained in 29 of 84 patients (35%), and patients who had a response had fewer infections and febrile neutropenia episodes than those who did not have a response. Among 34 patients who had a complete remission or complete remission with partial hematologic recovery, 7 (21%) had no residual detectable IDH1 mutations on digital polymerase-chain-reaction assay. No preexisting co-occurring single gene mutation predicted clinical response or resistance to treatment. CONCLUSIONS In patients with advanced IDH1-mutated relapsed or refractory AML, ivosidenib at a dose of 500 mg daily was associated with a low frequency of grade 3 or higher treatment-related adverse events and with transfusion independence, durable remissions, and molecular remissions in some patients with complete remission. (Funded by Agios Pharmaceuticals; ClinicalTrials.gov number, NCT02074839 .).
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MESH Headings
- Administration, Oral
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Cell Count
- Dose-Response Relationship, Drug
- Drug Resistance, Neoplasm
- Enzyme Inhibitors/administration & dosage
- Enzyme Inhibitors/adverse effects
- Enzyme Inhibitors/pharmacokinetics
- Female
- Follow-Up Studies
- Glycine/administration & dosage
- Glycine/adverse effects
- Glycine/analogs & derivatives
- Glycine/pharmacokinetics
- Hemoglobins/analysis
- Humans
- Isocitrate Dehydrogenase/antagonists & inhibitors
- Isocitrate Dehydrogenase/genetics
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Male
- Middle Aged
- Mutation
- Pyridines/administration & dosage
- Pyridines/adverse effects
- Pyridines/pharmacokinetics
- Recurrence
- Remission Induction
- Survival Rate
- Young Adult
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Affiliation(s)
- Courtney D DiNardo
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Eytan M Stein
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Stéphane de Botton
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Gail J Roboz
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Jessica K Altman
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Alice S Mims
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Ronan Swords
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Robert H Collins
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Gabriel N Mannis
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Daniel A Pollyea
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Will Donnellan
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Amir T Fathi
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Arnaud Pigneux
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Harry P Erba
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Gabrielle T Prince
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Anthony S Stein
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Geoffrey L Uy
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - James M Foran
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Elie Traer
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Robert K Stuart
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Martha L Arellano
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - James L Slack
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Mikkael A Sekeres
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Christophe Willekens
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Sung Choe
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Hongfang Wang
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Vickie Zhang
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Katharine E Yen
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Stephanie M Kapsalis
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Hua Yang
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - David Dai
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Bin Fan
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Meredith Goldwasser
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Hua Liu
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Sam Agresta
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Bin Wu
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Eyal C Attar
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Martin S Tallman
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Richard M Stone
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Hagop M Kantarjian
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
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47
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Aldoss I, Stiller T, Tsai NC, Song JY, Cao T, Bandara NA, Salhotra A, Khaled S, Aribi A, Al Malki MM, Mei M, Ali H, Spielberger R, O'Donnell M, Snyder D, Slavin T, Nakamura R, Stein AS, Forman SJ, Marcucci G, Pullarkat V. Therapy-related acute lymphoblastic leukemia has distinct clinical and cytogenetic features compared to de novo acute lymphoblastic leukemia, but outcomes are comparable in transplanted patients. Haematologica 2018; 103:1662-1668. [PMID: 29903756 PMCID: PMC6165794 DOI: 10.3324/haematol.2018.193599] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/08/2018] [Indexed: 01/02/2023] Open
Abstract
Therapy-related acute lymphoblastic leukemia remains poorly defined due to a lack of large data sets recognizing the defining characteristics of this entity. We reviewed all consecutive cases of adult acute lymphoblastic leukemia treated at our institution between 2000 and 2017 and identified therapy-related cases - defined as acute lymphoblastic leukemia preceded by prior exposure to cytotoxic chemotherapy and/or radiation. Of 1022 patients with acute lymphoblastic leukemia, 93 (9.1%) were classified as therapy-related. The median latency for therapy-related acute lymphoblastic leukemia onset was 6.8 years from original diagnosis, and this was shorter for patients carrying the MLL gene rearrangement compared to those with other cytogenetics. When compared to de novo acute lymphoblastic leukemia, therapy-related patients were older (P<0.01), more often female (P<0.01), and had more MLL gene rearrangement (P<0.0001) and chromosomes 5/7 aberrations (P=0.02). Although therapy-related acute lymphoblastic leukemia was associated with inferior 2-year overall survival compared to de novo cases (46.0% vs 68.1%, P=0.001), prior exposure to cytotoxic therapy (therapy-related) did not independently impact survival in multivariate analysis (HR=1.32; 95% CI: 0.97-1.80, P=0.08). There was no survival difference (2-year = 53.4% vs 58.9%, P=0.68) between the two groups in patients who received allogenic hematopoietic cell transplantation. In conclusion, therapy-related acute lymphoblastic leukemia represents a significant proportion of adult acute lymphoblastic leukemia diagnoses, and a subset of cases carry clinical and cytogenetic abnormalities similar to therapy-related myeloid neoplasms. Although survival of therapy-related acute lymphoblastic leukemia was inferior to de novo cases, allogeneic hematopoietic cell transplantation outcomes were comparable for the two entities.
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Affiliation(s)
- Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Tracey Stiller
- Department of Information Sciences, Division of Biostatistics, City of Hope, Duarte, CA, USA
| | - Ni-Chun Tsai
- Department of Information Sciences, Division of Biostatistics, City of Hope, Duarte, CA, USA
| | - Joo Y Song
- Department of Pathology, City of Hope, Duarte, CA, USA
| | - Thai Cao
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA.,Kaiser Permanente, Department of BMT, Southern California Medical Group, Los Angeles
| | - N Achini Bandara
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Samer Khaled
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Ahmed Aribi
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Ricardo Spielberger
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA.,Kaiser Permanente, Department of BMT, Southern California Medical Group, Los Angeles
| | - Margaret O'Donnell
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - David Snyder
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Thomas Slavin
- Department of Medical Oncology, Division of Clinical Genetics, City of Hope, Duarte, CA, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Anthony S Stein
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
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48
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Aldoss I, Yang D, Aribi A, Ali H, Sandhu K, Al Malki MM, Mei M, Salhotra A, Khaled S, Nakamura R, Snyder D, O'Donnell M, Stein AS, Forman SJ, Marcucci G, Pullarkat V. Efficacy of the combination of venetoclax and hypomethylating agents in relapsed/refractory acute myeloid leukemia. Haematologica 2018; 103:e404-e407. [PMID: 29545346 DOI: 10.3324/haematol.2018.188094] [Citation(s) in RCA: 189] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Dongyun Yang
- Department of Information Sciences, Division of Biostatistics, City of Hope, Duarte, CA, USA
| | - Ahmed Aribi
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Karamjeet Sandhu
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Samer Khaled
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - David Snyder
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Margaret O'Donnell
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Anthony S Stein
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
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49
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Zhang B, Nguyen LXT, Li L, Zhao D, Kumar B, Wu H, Lin A, Pellicano F, Hopcroft L, Su YL, Copland M, Holyoake TL, Kuo CJ, Bhatia R, Snyder DS, Ali H, Stein AS, Brewer C, Wang H, McDonald T, Swiderski P, Troadec E, Chen CC, Dorrance A, Pullarkat V, Yuan YC, Perrotti D, Carlesso N, Forman SJ, Kortylewski M, Kuo YH, Marcucci G. Bone marrow niche trafficking of miR-126 controls the self-renewal of leukemia stem cells in chronic myelogenous leukemia. Nat Med 2018; 24:450-462. [PMID: 29505034 PMCID: PMC5965294 DOI: 10.1038/nm.4499] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/22/2018] [Indexed: 12/16/2022]
Abstract
Leukemia stem cells (LSCs) in individuals with chronic myelogenous leukemia (CML) (hereafter referred to as CML LSCs) are responsible for initiating and maintaining clonal hematopoiesis. These cells persist in the bone marrow (BM) despite effective inhibition of BCR-ABL kinase activity by tyrosine kinase inhibitors (TKIs). Here we show that although the microRNA (miRNA) miR-126 supported the quiescence, self-renewal and engraftment capacity of CML LSCs, miR-126 levels were lower in CML LSCs than in long-term hematopoietic stem cells (LT-HSCs) from healthy individuals. Downregulation of miR-126 levels in CML LSCs was due to phosphorylation of Sprouty-related EVH1-domain-containing 1 (SPRED1) by BCR-ABL, which led to inhibition of the RAN-exportin-5-RCC1 complex that mediates miRNA maturation. Endothelial cells (ECs) in the BM supply miR-126 to CML LSCs to support quiescence and leukemia growth, as shown using mouse models of CML in which Mir126a (encoding miR-126) was conditionally knocked out in ECs and/or LSCs. Inhibition of BCR-ABL by TKI treatment caused an undesired increase in endogenous miR-126 levels, which enhanced LSC quiescence and persistence. Mir126a knockout in LSCs and/or ECs, or treatment with a miR-126 inhibitor that targets miR-126 expression in both LSCs and ECs, enhanced the in vivo anti-leukemic effects of TKI treatment and strongly diminished LSC leukemia-initiating capacity, providing a new strategy for the elimination of LSCs in individuals with CML.
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Affiliation(s)
- Bin Zhang
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Le Xuan Truong Nguyen
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA.,Department of Medical Biotechnology, Biotechnology Center of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ling Li
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Dandan Zhao
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Bijender Kumar
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Herman Wu
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Allen Lin
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Francesca Pellicano
- Paul O' Gorman Leukemia Research Centre, College of Medical, Veterinary and Life Sciences, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Lisa Hopcroft
- Paul O' Gorman Leukemia Research Centre, College of Medical, Veterinary and Life Sciences, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Yu-Lin Su
- Department of Immuno-oncology, City of Hope Medical Center, Duarte, California, USA
| | - Mhairi Copland
- Paul O' Gorman Leukemia Research Centre, College of Medical, Veterinary and Life Sciences, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Tessa L Holyoake
- Paul O' Gorman Leukemia Research Centre, College of Medical, Veterinary and Life Sciences, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Calvin J Kuo
- Stanford University School of Medicine, Stanford, California, USA
| | - Ravi Bhatia
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David S Snyder
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Haris Ali
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Anthony S Stein
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Casey Brewer
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Huafeng Wang
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA.,Department of Hematology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tinisha McDonald
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Piotr Swiderski
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Estelle Troadec
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Ching-Cheng Chen
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Adrienne Dorrance
- Division of Hematology, Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
| | - Vinod Pullarkat
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Yate-Ching Yuan
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Danilo Perrotti
- Department of Medicine, Biochemistry and Molecular Biology and the Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine Baltimore, Baltimore, Maryland, USA.,Deparment of Hematology, Hammersmith Hospital, Imperial College London, London, UK
| | - Nadia Carlesso
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Stephen J Forman
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Marcin Kortylewski
- Department of Immuno-oncology, City of Hope Medical Center, Duarte, California, USA
| | - Ya-Huei Kuo
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
| | - Guido Marcucci
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope Medical Center, Duarte, California, USA
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50
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Aldoss I, Pham A, Li SM, Gendzekhadze K, Afkhami M, Telatar M, Hong H, Padeganeh A, Bedell V, Cao T, Khaled SK, Malki MMA, Salhotra A, Ali H, Aribi A, Palmer J, Aoun P, Spielberger R, Stein AS, Snyder D, O'Donnell MR, Murata-Collins J, Senitzer D, Weisenburger D, Forman SJ, Pullarkat V, Marcucci G, Pillai R, Nakamura R. Favorable impact of allogeneic stem cell transplantation in patients with therapy-related myelodysplasia regardless of TP53 mutational status. Haematologica 2017; 102:2030-2038. [PMID: 28971906 PMCID: PMC5709102 DOI: 10.3324/haematol.2017.172544] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/20/2017] [Indexed: 01/04/2023] Open
Abstract
Therapy-related myelodysplastic syndrome is a long-term complication of cancer treatment in patients receiving cytotoxic therapy, characterized by high-risk genetics and poor outcomes. Allogeneic hematopoietic cell transplantation is the only potential cure for this disease, but the prognostic impact of pre-transplant genetics and clinical features has not yet been fully characterized. We report here the genetic and clinical characteristics and outcomes of a relatively large cohort of patients with therapy-related myelodysplastic syndrome (n=67) who underwent allogeneic transplantation, comparing these patients to similarly treated patients with de novo disease (n=199). The 5-year overall survival was not different between patients with therapy-related and de novo disease (49.9% versus 53.9%; P=0.61) despite a higher proportion of individuals with an Intermediate-2/High International Prognostic Scoring System classification (59.7% versus 43.7%; P=0.003) and high-risk karyotypes (61.2% versus 30.7%; P<0.01) among the patients with therapy-related disease. In mutational analysis, TP53 alteration was the most common abnormality in patients with therapy-related disease (n=18: 30%). Interestingly, the presence of mutations in TP53 or in any other of the high-risk genes (EZH2, ETV6, RUNX1, ASXL1: n=29: 48%) did not significantly affect either overall survival or relapse-free survival. Allogeneic stem-cell transplantation is, therefore, a curative treatment for patients with therapy-related myelodysplastic syndrome, conferring a similar long-term survival to that of patients with de novo disease despite higher-risk features. While TP53 alteration was the most common mutation in therapy-related myelodysplastic syndrome, the finding was not detrimental in our case-series.
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Affiliation(s)
- Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Anh Pham
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Sierra Min Li
- Department of Information Sciences, Division of Biostatistics, City of Hope, Duarte, CA, USA
| | | | | | | | - Hao Hong
- Department of Pathology, City of Hope, Duarte, CA, USA
| | | | | | - Thai Cao
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Samer K Khaled
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Ahmed Aribi
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Joycelynne Palmer
- Department of Information Sciences, Division of Biostatistics, City of Hope, Duarte, CA, USA
| | - Patricia Aoun
- Department of Pathology, City of Hope, Duarte, CA, USA
| | - Ricardo Spielberger
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Anthony S Stein
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - David Snyder
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Margaret R O'Donnell
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | | | | | | | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Raju Pillai
- Department of Pathology, City of Hope, Duarte, CA, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
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