1
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Spyrou N, Akahoshi Y, Kowalyk S, Morales G, Beheshti R, Aguayo-Hiraldo P, Al Malki MM, Ayuk F, Bader P, Baez J, Capellini A, Choe H, DeFilipp Z, Eder M, Eng G, Etra A, Gleich S, Grupp SA, Hexner E, Hoepting M, Hogan WJ, Kasikis S, Katsivelos N, Khan A, Kitko CL, Kraus S, Kwon D, Merli P, Portelli J, Qayed M, Reshef R, Schechter T, Vasova I, Wölfl M, Wudhikarn K, Young R, Holler E, Chen YB, Nakamura R, Levine JE, Ferrara JLM. A Day 14 Endpoint for Acute GVHD Clinical Trials. Transplant Cell Ther 2024; 30:421-432. [PMID: 38320730 PMCID: PMC11009039 DOI: 10.1016/j.jtct.2024.01.079] [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: 10/03/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 02/19/2024]
Abstract
The overall response rate (ORR) 28 days after treatment has been adopted as the primary endpoint for clinical trials of acute graft versus host disease (GVHD). However, physicians often need to modify immunosuppression earlier than day (D) 28, and non-relapse mortality (NRM) does not always correlate with ORR at D28. We studied 1144 patients that received systemic treatment for GVHD in the Mount Sinai Acute GVHD International Consortium (MAGIC) and divided them into a training set (n=764) and a validation set (n=380). We used a recursive partitioning algorithm to create a Mount Sinai model that classifies patients into favorable or unfavorable groups that predicted 12 month NRM according to overall GVHD grade at both onset and D14. In the Mount Sinai model grade II GVHD at D14 was unfavorable for grade III/IV GVHD at onset and predicted NRM as well as the D28 standard response model. The MAGIC algorithm probability (MAP) is a validated score that combines the serum concentrations of suppression of tumorigenicity 2 (ST2) and regenerating islet-derived 3-alpha (REG3α) to predict NRM. Inclusion of the D14 MAP biomarker score with the D14 Mount Sinai model created three distinct groups (good, intermediate, poor) with strikingly different NRM (8%, 35%, 76% respectively). This D14 MAGIC model displayed better AUC, sensitivity, positive and negative predictive value, and net benefit in decision curve analysis compared to the D28 standard response model. We conclude that this D14 MAGIC model could be useful in therapeutic decisions and may offer an improved endpoint for clinical trials of acute GVHD treatment.
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Affiliation(s)
- Nikolaos Spyrou
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yu Akahoshi
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven Kowalyk
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - George Morales
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rahnuma Beheshti
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Paibel Aguayo-Hiraldo
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Monzr M Al Malki
- Hematology/Hematopoietic Cell Transplant, City of Hope National Medical Center, Duarte, CA
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt, Germany
| | - Janna Baez
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexandra Capellini
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hannah Choe
- Division of Hematology, The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA
| | - Matthias Eder
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Gilbert Eng
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Aaron Etra
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sigrun Gleich
- Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany
| | - Stephan A Grupp
- Division of Oncology, Children's Hospital of Philadelphia, and Perelman School of Medicine, Philadelphia, PA
| | - Elizabeth Hexner
- Blood and Marrow Transplantation Program, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Matthias Hoepting
- Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany
| | | | - Stelios Kasikis
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nikolaos Katsivelos
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alina Khan
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Carrie L Kitko
- Pediatric Stem Cell Transplant Program, Vanderbilt University Medical Center, Nashville TN
| | - Sabrina Kraus
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Deukwoo Kwon
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Pietro Merli
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Rome, Italy
| | - Joseph Portelli
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Ran Reshef
- Blood and Marrow Transplantation Program, Columbia University Medical Center, New York, NY
| | - Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Ingrid Vasova
- Dept. of Internal Medicine 5, Hematology/Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Matthias Wölfl
- Pediatric Blood and Marrow Transplantation Program, Children's Hospital, University of Würzburg, Würzburg, Germany
| | - Kitsada Wudhikarn
- Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Rachel Young
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ernst Holler
- Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany
| | - Yi-Bin Chen
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA
| | - Ryotaro Nakamura
- Hematology/Hematopoietic Cell Transplant, City of Hope National Medical Center, Duarte, CA
| | - John E Levine
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James L M Ferrara
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
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2
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Qayed M, Kapoor U, Gillespie S, Westbrook A, Aguayo-Hiraldo P, Ayuk FA, Aziz M, Baez J, Choe H, DeFilipp Z, Etra A, Grupp SA, Hexner E, Holler E, Hogan WJ, Kowalyk S, Merli P, Morales G, Nakamura R, Pulsipher MA, Schechter T, Shah J, Spyrou N, Srinagesh HK, Wölfl M, Yanik G, Young R, Kitko CL, Ferrara JLM, Levine JE. A Validated Risk Stratification That Incorporates MAGIC Biomarkers Predicts Long-Term Outcomes in Pediatric Patients with Acute GVHD. Transplant Cell Ther 2024:S2666-6367(24)00294-X. [PMID: 38548227 DOI: 10.1016/j.jtct.2024.03.022] [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: 01/29/2024] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024]
Abstract
Acute graft versus host disease (GVHD) is a common and serious complication of allogeneic hematopoietic cell transplantation (HCT) in children but overall clinical grade at onset only modestly predicts response to treatment and survival outcomes. Two tools to assess risk at initiation of treatment were recently developed. The Minnesota risk system stratifies children for risk of nonrelapse mortality (NRM) according to the pattern of GVHD target organ severity. The Mount Sinai Acute GVHD International Consortium (MAGIC) algorithm of 2 serum biomarkers (ST2 and REG3α) predicts NRM in adult patients but has not been validated in a pediatric population. We aimed to develop and validate a system that stratifies children at the onset of GVHD for risk of 6-month NRM. We determined the MAGIC algorithm probabilities (MAPs) and Minnesota risk for a multicenter cohort of 315 pediatric patients who developed GVHD requiring treatment with systemic corticosteroids. MAPs created 3 risk groups with distinct outcomes at the start of treatment and were more accurate than Minnesota risk stratification for prediction of NRM (area under the receiver operating curve (AUC), .79 versus .62, P = .001). A novel model that combined Minnesota risk and biomarker scores created from a training cohort was more accurate than either biomarkers or clinical systems in a validation cohort (AUC .87) and stratified patients into 2 groups with highly different 6-month NRM (5% versus 38%, P < .001). In summary, we validated the MAP as a prognostic biomarker in pediatric patients with GVHD, and a novel risk stratification that combines Minnesota risk and biomarker risk performed best. Biomarker-based risk stratification can be used in clinical trials to develop more tailored approaches for children who require treatment for GVHD.
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Affiliation(s)
- Muna Qayed
- Emory University School of Medicine, Atlanta, Georgia; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.
| | - Urvi Kapoor
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott Gillespie
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Adrianna Westbrook
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Paibel Aguayo-Hiraldo
- Division of Hematology, Oncology, and BMT, Children's Hospital Los Angeles, Los Angeles, California
| | - Francis A Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mina Aziz
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Janna Baez
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hannah Choe
- Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Aaron Etra
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephan A Grupp
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth Hexner
- Blood and Marrow Transplantation Program, Abramson Cancer Center and the Division of Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ernst Holler
- Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany
| | | | - Steven Kowalyk
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pietro Merli
- Ospedale Pediatrico Bambino Gesú, IRCCS, Rome, Italy
| | - George Morales
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ryotaro Nakamura
- Hematology/Hematopoietic Cell Transplant, City of Hope National Medical Center, Duarte, California
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and BMT, Children's Hospital Los Angeles, Los Angeles, California; Division of Hematology and Oncology, Intermountain Primary Children's Hospital, Huntsman Cancer Institute at the Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah
| | - Tal Schechter
- Division of Hematology/Oncology/BMT, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jay Shah
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nikolaos Spyrou
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hrishikesh K Srinagesh
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthias Wölfl
- Pediatric Blood and Marrow Transplantation Program, Children's Hospital, University of Würzburg, Würzburg, Germany
| | - Gregory Yanik
- Pediatric Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, Michigan
| | - Rachel Young
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Carrie L Kitko
- Pediatric Blood and Marrow Transplant Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James L M Ferrara
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John E Levine
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
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3
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Bagley SJ, Binder ZA, Lamrani L, Marinari E, Desai AS, Nasrallah MP, Maloney E, Brem S, Lustig RA, Kurtz G, Alonso-Basanta M, Bonté PE, Goudot C, Richer W, Piaggio E, Kothari S, Guyonnet L, Guerin CL, Waterfall JJ, Mohan S, Hwang WT, Tang OY, Logun M, Bhattacharyya M, Markowitz K, Delman D, Marshall A, Wherry EJ, Amigorena S, Beatty GL, Brogdon JL, Hexner E, Migliorini D, Alanio C, O'Rourke DM. Repeated peripheral infusions of anti-EGFRvIII CAR T cells in combination with pembrolizumab show no efficacy in glioblastoma: a phase 1 trial. Nat Cancer 2024; 5:517-531. [PMID: 38216766 DOI: 10.1038/s43018-023-00709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024]
Abstract
We previously showed that chimeric antigen receptor (CAR) T-cell therapy targeting epidermal growth factor receptor variant III (EGFRvIII) produces upregulation of programmed death-ligand 1 (PD-L1) in the tumor microenvironment (TME). Here we conducted a phase 1 trial (NCT03726515) of CAR T-EGFRvIII cells administered concomitantly with the anti-PD1 (aPD1) monoclonal antibody pembrolizumab in patients with newly diagnosed, EGFRvIII+ glioblastoma (GBM) (n = 7). The primary outcome was safety, and no dose-limiting toxicity was observed. Secondary outcomes included median progression-free survival (5.2 months; 90% confidence interval (CI), 2.9-6.0 months) and median overall survival (11.8 months; 90% CI, 9.2-14.2 months). In exploratory analyses, comparison of the TME in tumors harvested before versus after CAR + aPD1 administration demonstrated substantial evolution of the infiltrating myeloid and T cells, with more exhausted, regulatory, and interferon (IFN)-stimulated T cells at relapse. Our study suggests that the combination of CAR T cells and PD-1 inhibition in GBM is safe and biologically active but, given the lack of efficacy, also indicates a need to consider alternative strategies.
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Affiliation(s)
- Stephen J Bagley
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Zev A Binder
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- GBM Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Lamia Lamrani
- Clinical Immunology Laboratory, Institut Curie, Paris, France
- INSERM U932, PSL University, Immunity and Cancer, Institut Curie Research Center, Paris, France
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Eliana Marinari
- Agora Cancer Research Center, Lausanne, Switzerland
- Center for Translational Research in Onco-Hematology, University of Geneva, Geneva, Switzerland
- Swiss Cancer Center Léman, Lausanne and Geneva, Geneva, Switzerland
- Department of Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Arati S Desai
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - MacLean P Nasrallah
- GBM Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Eileen Maloney
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Brem
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- GBM Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert A Lustig
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Goldie Kurtz
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle Alonso-Basanta
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Pierre-Emmanuel Bonté
- INSERM U932, PSL University, Immunity and Cancer, Institut Curie Research Center, Paris, France
| | - Christel Goudot
- INSERM U932, PSL University, Immunity and Cancer, Institut Curie Research Center, Paris, France
| | - Wilfrid Richer
- INSERM U932, PSL University, Immunity and Cancer, Institut Curie Research Center, Paris, France
- Department of Translational Research, PSL Research University, Institut Curie Research Center, Paris, France
| | - Eliane Piaggio
- INSERM U932, PSL University, Immunity and Cancer, Institut Curie Research Center, Paris, France
| | - Shawn Kothari
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Lea Guyonnet
- Cytometry Platform, CurieCoreTech, Institut Curie, Paris, France
| | - Coralie L Guerin
- Cytometry Platform, CurieCoreTech, Institut Curie, Paris, France
| | - Joshua J Waterfall
- Department of Translational Research, PSL Research University, Institut Curie Research Center, Paris, France
- INSERM U830, PSL University, Institut Curie Research Cente, Paris, France
| | - Suyash Mohan
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Wei-Ting Hwang
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Oliver Y Tang
- GBM Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Meghan Logun
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- GBM Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Meghna Bhattacharyya
- GBM Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Kelly Markowitz
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Devora Delman
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Amy Marshall
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - E John Wherry
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Institute for Immunology and Immune Health, Cambridge, MA, USA
| | - Sebastian Amigorena
- INSERM U932, PSL University, Immunity and Cancer, Institut Curie Research Center, Paris, France
| | - Gregory L Beatty
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- GBM Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Elizabeth Hexner
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Denis Migliorini
- Agora Cancer Research Center, Lausanne, Switzerland
- Center for Translational Research in Onco-Hematology, University of Geneva, Geneva, Switzerland
- Swiss Cancer Center Léman, Lausanne and Geneva, Geneva, Switzerland
- Department of Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Cecile Alanio
- Clinical Immunology Laboratory, Institut Curie, Paris, France.
- INSERM U932, PSL University, Immunity and Cancer, Institut Curie Research Center, Paris, France.
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA.
| | - Donald M O'Rourke
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- GBM Translational Center of Excellence, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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4
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Spyrou N, Akahoshi Y, Ayuk F, Holler E, Choe H, Etra A, Hogan WJ, Rösler W, Hexner E, DeFilipp Z, Reshef R, Chanswangphuwana C, Qayed M, Kraus S, Eder M, Javorniczky NR, Grupp SA, Kitko CL, Merli P, Aguayo-Hiraldo P, Wölfl M, Baez J, Beheshti R, Eng G, Gleich S, Katsivelos N, Khan A, Kowalyk S, Morales G, Young R, Nakamura R, Chen YB, Levine JE, Ferrara JLM. The utility of biomarkers in acute GVHD prognostication. Blood Adv 2023; 7:5152-5155. [PMID: 37142257 PMCID: PMC10480526 DOI: 10.1182/bloodadvances.2023009929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/06/2023] Open
Affiliation(s)
- Nikolaos Spyrou
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yu Akahoshi
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ernst Holler
- Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany
| | - Hannah Choe
- Division of Hematology, The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Aaron Etra
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Wolf Rösler
- Department of Internal Medicine 5, Hematology/Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Elizabeth Hexner
- Blood and Marrow Transplantation Program, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA
| | - Ran Reshef
- Blood and Marrow Transplantation Program, Columbia University Medical Center, New York, NY
| | - Chantiya Chanswangphuwana
- Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Sabrina Kraus
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Matthias Eder
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Nora Rebeka Javorniczky
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, Albert Ludwigs University, Freiburg, Germany
| | - Stephan A. Grupp
- Division of Oncology, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, PA
| | - Carrie L. Kitko
- Pediatric Stem Cell Transplant Program, Vanderbilt University Medical Center, Nashville, TN
| | - Pietro Merli
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Rome, Italy
| | - Paibel Aguayo-Hiraldo
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Matthias Wölfl
- Pediatric Blood and Marrow Transplantation Program, Children's Hospital, University of Würzburg, Würzburg, Germany
| | - Janna Baez
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rahnuma Beheshti
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gilbert Eng
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sigrun Gleich
- Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany
| | - Nikolaos Katsivelos
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alina Khan
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven Kowalyk
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - George Morales
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rachel Young
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ryotaro Nakamura
- Hematology/Hematopoietic Cell Transplant, City of Hope National Medical Center, Duarte, CA
| | - Yi-Bin Chen
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA
| | - John E. Levine
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James L. M. Ferrara
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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5
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Al Malki MM, London K, Baez J, Akahoshi Y, Hogan WJ, Etra A, Choe H, Hexner E, Langston A, Abhyankar S, Ponce DM, DeFilipp Z, Kitko CL, Adekola K, Reshef R, Ayuk F, Capellini A, Chanswangphuwana C, Eder M, Eng G, Gandhi I, Grupp S, Gleich S, Holler E, Javorniczky NR, Kasikis S, Kowalyk S, Morales G, Özbek U, Rösler W, Spyrou N, Yanik G, Young R, Chen YB, Nakamura R, Ferrara JLM, Levine JE. Phase 2 study of natalizumab plus standard corticosteroid treatment for high-risk acute graft-versus-host disease. Blood Adv 2023; 7:5189-5198. [PMID: 37235690 PMCID: PMC10505783 DOI: 10.1182/bloodadvances.2023009853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 05/28/2023] Open
Abstract
Graft-versus-host disease (GVHD) of the gastrointestinal (GI) tract is the main cause of nonrelapse mortality (NRM) after allogeneic hematopoietic cell transplantation. Ann Arbor (AA) scores derived from serum biomarkers at onset of GVHD quantify GI crypt damage; AA2/3 scores correlate with resistance to treatment and higher NRM. We conducted a multicenter, phase 2 study using natalizumab, a humanized monoclonal antibody that blocks T-cell trafficking to the GI tract through the α4 subunit of α4β7 integrin, combined with corticosteroids as primary treatment for patients with new onset AA2/3 GVHD. Seventy-five patients who were evaluable were enrolled and treated; 81% received natalizumab within 2 days of starting corticosteroids. Therapy was well tolerated with no treatment emergent adverse events in >10% of patients. Outcomes for patients treated with natalizumab plus corticosteroids were compared with 150 well-matched controls from the MAGIC database whose primary treatment was corticosteroids alone. There were no significant differences in overall or complete response between patients treated with natalizumab plus corticosteroids and those treated with corticosteroids alone (60% vs 58%; P = .67% and 48% vs 48%; P = 1.0, respectively) including relevant subgroups. There were also no significant differences in NRM or overall survival at 12 months in patients treated with natalizumab plus corticosteroids compared with controls treated with corticosteroids alone (38% vs 39%; P = .80% and 46% vs 54%; P = .48, respectively). In this multicenter biomarker-based phase 2 study, natalizumab combined with corticosteroids failed to improve outcome of patients with newly diagnosed high-risk GVHD. This trial was registered at www.clinicaltrials.gov as # NCT02133924.
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Affiliation(s)
- Monzr M. Al Malki
- Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Kaitlyn London
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Janna Baez
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yu Akahoshi
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Aaron Etra
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hannah Choe
- Division of Hematology, James Cancer Center, The Ohio State University, Columbus, OH
| | - Elizabeth Hexner
- Blood and Marrow Transplantation Program, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Sunil Abhyankar
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Doris M. Ponce
- Division of Hematology/Oncology, Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering, New York, NY
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA
| | - Carrie L. Kitko
- Pediatric Stem Cell Transplant Program, Vanderbilt University Medical Center, Nashville, TN
| | - Kehinde Adekola
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Ran Reshef
- Blood and Marrow Transplantation, Columbia University Medical Center, New York, NY
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Capellini
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Chantiya Chanswangphuwana
- Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Matthias Eder
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Gilbert Eng
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Isha Gandhi
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stephan Grupp
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sigrun Gleich
- Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany
| | - Ernst Holler
- Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany
| | - Nora Rebeka Javorniczky
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, Albert Ludwigs University, Freiburg, Germany
| | - Stelios Kasikis
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven Kowalyk
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - George Morales
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Umut Özbek
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Wolf Rösler
- Department of Internal Medicine 5, University Hospital Erlangen, Erlangen, Germany
| | - Nikolaos Spyrou
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gregory Yanik
- Blood and Marrow Transplant Program, Michigan Medicine, Ann Arbor, MI
| | - Rachel Young
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yi-Bin Chen
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA
| | - Ryotaro Nakamura
- Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - James L. M. Ferrara
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John E. Levine
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Freyer CW, Hughes ME, Carulli A, Bagg A, Hexner E. Pemigatinib for the treatment of myeloid/lymphoid neoplasms with FGFR1 rearrangement. Expert Rev Anticancer Ther 2023; 23:351-359. [PMID: 36927350 DOI: 10.1080/14737140.2023.2192930] [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] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Myeloid/lymphoid neoplasms with fibroblast growth factor receptor-1 (FGFR1) rearrangements (MLNFGFR1) are rare entities with aggressive features and poor prognosis. Presentation is heterogeneous, ranging from myeloproliferative neoplasms (with or without eosinophilia) to T-cell lymphoma and acute leukemia. Historical treatments have been guided by the presenting phenotype with induction chemotherapy frequently used. Pemigatinib is a FGFR1-3 tyrosine kinase inhibitor that has demonstrated high complete hematologic and cytogenetic response rates in MLNFGFR1. AREAS COVERED We discuss the pathogenesis, presentation, and historical treatments for MLNFGFR1, in addition to clinical data using pemigatinib and other targeted therapies. Discussion of the mechanism of action and adverse events are also included. EXPERT OPINION Pemigatinib represents a significant advance in the management of MLNFGFR1. High rates of complete hematologic and cytogenetic response have been observed. While direct comparative data are unavailable, outcomes appear favorable compared to conventional approaches. Long term efficacy and tolerability are not yet known, and allogeneic hematopoietic stem cell transplant (alloHSCT) has been and continues to be the treatment with the highest chance of long term disease free survival in responding patients. Combinations of pemigatinib and chemotherapy, particularly for more aggressive phenotypes, warrant future investigation as does the use of pemigatinib maintenance following alloHSCT.
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Affiliation(s)
- Craig W Freyer
- Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Department of Medicine, Division of Hematology/Oncology, Perelman School of Medicine and the Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
| | - Mitchell E Hughes
- Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Lymphoma Program, Hematology/Oncology Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alison Carulli
- Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Hexner
- Department of Medicine, Division of Hematology/Oncology, Perelman School of Medicine and the Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
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Etra A, Capellini A, Alousi A, Al Malki MM, Choe H, DeFilipp Z, Hogan WJ, Kitko CL, Ayuk F, Baez J, Gandhi I, Kasikis S, Gleich S, Hexner E, Hoepting M, Kapoor U, Kowalyk S, Kwon D, Langston A, Mielcarek M, Morales G, Özbek U, Qayed M, Reshef R, Rösler W, Spyrou N, Young R, Chen YB, Ferrara JLM, Levine JE. Effective treatment of low-risk acute GVHD with itacitinib monotherapy. Blood 2023; 141:481-489. [PMID: 36095841 PMCID: PMC9936304 DOI: 10.1182/blood.2022017442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/16/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 02/07/2023] Open
Abstract
The standard primary treatment for acute graft-versus-host disease (GVHD) requires prolonged, high-dose systemic corticosteroids (SCSs) that delay reconstitution of the immune system. We used validated clinical and biomarker staging criteria to identify a group of patients with low-risk (LR) GVHD that is very likely to respond to SCS. We hypothesized that itacitinib, a selective JAK1 inhibitor, would effectively treat LR GVHD without SCS. We treated 70 patients with LR GVHD in a multicenter, phase 2 trial (NCT03846479) with 28 days of itacitinib 200 mg/d (responders could receive a second 28-day cycle), and we compared their outcomes to those of 140 contemporaneous, matched control patients treated with SCSs. More patients responded to itacitinib within 7 days (81% vs 66%, P = .02), and response rates at day 28 were very high for both groups (89% vs 86%, P = .67), with few symptomatic flares (11% vs 12%, P = .88). Fewer itacitinib-treated patients developed a serious infection within 90 days (27% vs 42%, P = .04) due to fewer viral and fungal infections. Grade ≥3 cytopenias were similar between groups except for less severe leukopenia with itacitinib (16% vs 31%, P = .02). No other grade ≥3 adverse events occurred in >10% of itacitinib-treated patients. There were no significant differences between groups at 1 year for nonrelapse mortality (4% vs 11%, P = .21), relapse (18% vs 21%, P = .64), chronic GVHD (28% vs 33%, P = .33), or survival (88% vs 80%, P = .11). Itacitinib monotherapy seems to be a safe and effective alternative to SCS treatment for LR GVHD and deserves further investigation.
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Affiliation(s)
- Aaron Etra
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexandra Capellini
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amin Alousi
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Monzr M. Al Malki
- Hematology/Hematopoietic Cell Transplant, City of Hope National Medical Center, Duarte, CA
| | - Hannah Choe
- Division of Hematology, James Cancer Center, The Ohio State University, Columbus, OH
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA
| | | | - Carrie L. Kitko
- Pediatric Stem Cell Transplant Program, Vanderbilt University Medical Center, Nashville, TN
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Janna Baez
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Isha Gandhi
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stelios Kasikis
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sigrun Gleich
- Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany
| | - Elizabeth Hexner
- Blood and Marrow Transplantation Program, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Matthias Hoepting
- Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany
| | - Urvi Kapoor
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven Kowalyk
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Deukwoo Kwon
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Marco Mielcarek
- Adult Blood and Marrow Transplant Program, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - George Morales
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Umut Özbek
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Ran Reshef
- Blood and Marrow Transplantation Program, Columbia University Medical Center, New York, NY
| | - Wolf Rösler
- Med. Klinik III/Poliklinik, Universitatsklinik Erlangen, Erlangen, Germany
| | - Nikolaos Spyrou
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rachel Young
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yi-Bin Chen
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA
| | - James L. M. Ferrara
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John E. Levine
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Akahoshi Y, Spyrou N, Hogan WJ, Ayuk F, DeFilipp Z, Weber D, Choe H, Hexner E, Rösler W, Etra A, Sandhu KS, Yanik GA, Chanswangphuwana C, Kitko CL, Reshef R, Kraus S, Wölfl M, Eder M, Bertrand H, Qayed M, Merli P, Grupp SA, Aguayo-Hiraldo DP, Schechter T, Ullrich E, Baez J, Kowalyk S, Morales G, Young MR, Nakamura R, Levine JE, Ferrara J, Chen DYB. De Novo Late Acute Gvhd: Incidence, Outcomes, and Impact of Biomarkers Compared to Classic Acute Gvhd. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00101-x] [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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Herman D, Zhang R, Humaira S, Shaheen D, Hexner E. Development of Scalable, Electronic Health Record (EHR)-based Screening for Undiagnosed Systemic Mastocytosis: PREDICT-SM. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.574] [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: 02/05/2023]
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Gerds AT, Gotlib J, Ali H, Bose P, Dunbar A, Elshoury A, George TI, Gundabolu K, Hexner E, Hobbs GS, Jain T, Jamieson C, Kaesberg PR, Kuykendall AT, Madanat Y, McMahon B, Mohan SR, Nadiminti KV, Oh S, Pardanani A, Podoltsev N, Rein L, Salit R, Stein BL, Talpaz M, Vachhani P, Wadleigh M, Wall S, Ward DC, Bergman MA, Hochstetler C. Myeloproliferative Neoplasms, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20:1033-1062. [PMID: 36075392 DOI: 10.6004/jnccn.2022.0046] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The classic Philadelphia chromosome-negative myeloproliferative neoplasms (MPN) consist of myelofibrosis, polycythemia vera, and essential thrombocythemia and are a heterogeneous group of clonal blood disorders characterized by an overproduction of blood cells. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for MPN were developed as a result of meetings convened by a multidisciplinary panel with expertise in MPN, with the goal of providing recommendations for the management of MPN in adults. The Guidelines include recommendations for the diagnostic workup, risk stratification, treatment, and supportive care strategies for the management of myelofibrosis, polycythemia vera, and essential thrombocythemia. Assessment of symptoms at baseline and monitoring of symptom status during the course of treatment is recommended for all patients. This article focuses on the recommendations as outlined in the NCCN Guidelines for the diagnosis of MPN and the risk stratification, management, and supportive care relevant to MF.
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Affiliation(s)
- Aaron T Gerds
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Haris Ali
- City of Hope National Medical Center
| | | | | | | | | | | | | | | | - Tania Jain
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | | | | | - Stephen Oh
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Rachel Salit
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Brady L Stein
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Sarah Wall
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Dawn C Ward
- UCLA Jonsson Comprehensive Cancer Center; and
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11
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DeZern AE, Eapen M, Wu J, Talano JA, Solh M, Dávila Saldaña BJ, Karanes C, Horwitz ME, Mallhi K, Arai S, Farhadfar N, Hexner E, Westervelt P, Antin JH, Deeg HJ, Leifer E, Brodsky RA, Logan BR, Horowitz MM, Jones RJ, Pulsipher MA. Haploidentical bone marrow transplantation in patients with relapsed or refractory severe aplastic anaemia in the USA (BMT CTN 1502): a multicentre, single-arm, phase 2 trial. Lancet Haematol 2022; 9:e660-e669. [PMID: 35907408 PMCID: PMC9444987 DOI: 10.1016/s2352-3026(22)00206-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 04/14/2022] [Revised: 05/30/2022] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Relapsed severe aplastic anaemia is a marrow failure disorder with high morbidity and mortality. It is often treated with bone marrow transplantation at relapse post-immunosuppressive therapy, but under-represented minorities often cannot find a suitably matched donor. This study aimed to understand the 1-year overall survival in patients with relapsed or refractory severe aplastic anaemia after haploidentical bone marrow transplantation. METHODS We report the outcomes of BMT CTN 1502, a single-arm, phase 2 clinical trial done at academic bone marrow transplantation centres in the USA. Included patients were children and adults (75 years or younger) with severe aplastic anaemia that was refractory (fulfilment of severe aplastic anaemia disease criteria at least 3 months after initial immunosuppressive therapy) or relapsed (initial improvement of cytopenias after first-line immunosuppressive therapy but then a later return to fulfilment of severe aplastic anaemia disease criteria), adequate performance status (Eastern Cooperative Oncology Group score 0 or 1, Karnofsky or Lansky score ≥60%), and the presence of an eligible related haploidentical donor. The regimen used reduced-intensity conditioning (rabbit anti-thymocyte globulin 4·5 mg/kg in total, cyclophosphamide 14·5 mg/kg daily for 2 days, fludarabine 30 mg/m2 daily for 5 days, total body irradiation 200 cGy in a single fraction), related HLA-haploidentical donors, and post-transplantation cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis. Additionally, for GVHD prophylaxis, mycophenolate mofetil was given orally at a dose of 15 mg/kg three times a day up to 1 g three times a day (maximum dose 3000 mg per day) from day 5 to day 35, and tacrolimus was given orally or intravenously from day 5 to day 180 as per institutional standards to maintain a serum concentration of 10-15 ng/mL. The primary endpoint was overall survival 1 year after bone marrow transplantation. All patients treated per protocol were analysed. This study is complete and is registered with ClinicalTrials.gov, NCT02918292. FINDINGS Between May 1, 2017, and Aug 30, 2020, 32 patients with relapsed or refractory severe aplastic anaemia were enrolled from 14 centres, and 31 underwent bone marrow transplantation. The median age was 24·9 years (IQR 10·4-51·3), and median follow-up was 24·3 months (IQR 12·1-29·2). Of the 31 patients who received a transplant, 19 (61%) were male and 12 (39%) female. 13 (42%) patients were site-reported as non-White, and 19 (61%) were from under-represented racial and ethnic groups; there were four (13%) patients who were Asian, seven (23%) Black, one (3%) Hawaiian/Pacific Islander, and one (3%) more than one race, with seven (23%) patients reporting Hispanic ethnicity. 24 (77%) of 31 patients were alive with engraftment at 1 year, and one (3%) patient alive with autologous recovery. The 1-year overall survival was 81% (95% CI 62-91). The most common grade 3-5 adverse events (seen in seven or more patients) included seven (23%) patients with abnormal liver tests, 15 (48%) patients with cardiovascular changes (including sinus tachycardia, heart failure, pericarditis), ten (32%) patients with gastrointestinal issues, seven (23%) patients with nutritional disorders, and eight (26%) patients with respiratory disorders. Six (19%) deaths, due to disease and unsuccessful bone marrow transplantation, were reported after transplantation. INTERPRETATION Haploidentical bone marrow transplantation using this approach results in excellent overall survival with minimal GVHD in patients who have not responded to immunosuppressive therapy, and can expand access to bone marrow transplantation across all populations. In clinical practice, this could now be considered a standard approach for salvage treatment of severe aplastic anaemia. Attention to obtaining high cell doses (>2·5 × 108 nucleated marrow cells per kg of recipient ideal bodyweight) from bone marrow harvests is crucial to the success of this approach. FUNDING US National Heart, Lung, and Blood Institute and US National Cancer Institute.
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Affiliation(s)
- Amy E DeZern
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
| | - Mary Eapen
- Division of Hematologic Malignancies, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Juan Wu
- The EMMES Company, Rockville, MD, USA
| | - Julie-An Talano
- Division of Hematologic Malignancies, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Melhem Solh
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | | | | | | | | | - Sally Arai
- Blood and Marrow Transplantation and Cellular Therapy Division, Stanford University, Stanford, CA, USA
| | - Nosha Farhadfar
- UF Health Bone Marrow Transplant, University of Florida, Gainesville, FL, USA
| | - Elizabeth Hexner
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | | | - H Joachim Deeg
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Eric Leifer
- Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Robert A Brodsky
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Brent R Logan
- Division of Hematologic Malignancies, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mary M Horowitz
- Division of Hematologic Malignancies, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Richard J Jones
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
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Shah P, Shlanksy-Goldberg R, Martin L, Nadolski G, Hexner E, Shamimi-Noori S, Hwang WT, Matlawski T, Cervini A, Shea J, Nelson L, Lacey S, Plesa G, Lledo L, Dengel K, Marshall A, Leskowitz R, Kandalaft L, Figini M, Canevari S, Coukos G, Powell D. 431 First-in-human phase I clinical trial evaluating intraperitoneal administration of MOv19-BBz CAR T cells in patients with alpha folate receptor-expressing recurrent high grade serous ovarian cancer. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundMost women with epithelial ovarian cancer develop uniformly incurable disease recurrence. Chimeric antigen receptor (CAR) T cells pair the MHC-independent tumor-recognition capabilities of monoclonal antibodies with the cytotoxicity of effector T cells. The success of CAR T cell therapy in solid tumors has been hindered by (1) difficulty identifying highly expressed, tumor-specific, cell surface target antigens; (2) limited trafficking and infiltration; and (3) suboptimal cytotoxic activity. Alpha folate receptor (FRα) is a transmembrane protein involved in cellular folate transport; expression has been reported in 80% of ovarian cancer, with limited physiologic expression on epithelial cells including bronchial, renal, and intestinal tissue. We hypothesize that intraperitoneal administration of alpha folate receptor (FRα) directed CAR T cells with dual 4-1BB and TCRzeta signaling domains will circumvent the above challenges and be safe, feasible, and elicit anti-tumor responses.MethodsWe initiated a first-in-human phase I clinical trial to evaluate the feasibility, safety and preliminary efficacy of intraperitoneal administration of FRα directed CAR T cells with and without antecedent lymphodepleting chemotherapy (LDC) in women with recurrent high grade serous ovarian cancer. The lentivirally-transduced CAR is composed of a MOv19 anti-FRα-specific single chain variable fragment fused to 4-1BB and TCRzeta signaling domains. Eligible patients have persistent or recurrent high grade serous epithelial ovarian, fallopian tube, or primary peritoneal carcinoma that is not platinum refractory and expresses ≥2+ FRα staining in ≥70% of tumor cells. Subjects must have an ECOG performance status 0–1, measurable disease, adequate hematologic and organ function, and must have progressed on at least two prior chemotherapy regimens for advanced disease. Patients undergo biopsy pre-infusion and Day +14 after infusion. After same-day placement of an intraperitoneal catheter by Interventional Radiology, CAR T cells are administered via a single infusion on three dose cohorts: Cohort 1 (starting cohort), 1–3x107/m2 cells without LDC; Cohort 2, 1–3x107/m2 CAR T cells after LDC; Cohort 3, 1–3x108/m2 cells after LDC. Catheter is removed after infusion. A 3+3 dose escalation design to determine maximum tolerated dose (MTD) yields approximately 9 to 18 subjects. The primary objective is safety and feasibility, and secondary objectives are anti-tumor response (endpoints: overall response rate based on RECIST v 1.1 and irRECIST when feasible, progression-free survival and overall survival). Correlative endpoints include CAR T cell engraftment and persistence in peripheral blood and body fluids examined via quantitative PCR of CAR T DNA, and bioactivity of CAR T cells. Enrollment is ongoing.Trial RegistrationThis trial is registered at ClinicalTrials.gov (NCT03585764).Ethics ApprovalThis study was approved by the Institutional Review Board at the University of Pennsylvania (IRB 830111). All subjects provided written informed consent prior to any study-related procedures.
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13
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Tian Y, Meng L, Wang Y, Li B, Yu H, Zhou Y, Bui T, Abraham C, Li A, Zhang Y, Wang J, Zhao C, Mineishi S, Gallucci S, Porter D, Hexner E, Zheng H, Zhang Y, Hu S, Zhang Y. Graft-versus-host disease depletes plasmacytoid dendritic cell progenitors to impair tolerance induction. J Clin Invest 2021; 131:136774. [PMID: 33090973 DOI: 10.1172/jci136774] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 01/27/2020] [Accepted: 10/14/2020] [Indexed: 12/31/2022] Open
Abstract
Graft-versus-host disease (GVHD) causes failed reconstitution of donor plasmacytoid dendritic cells (pDCs) that are critical for immune protection and tolerance. We used both murine and human systems to uncover the mechanisms whereby GVHD induces donor pDC defects. GVHD depleted Flt3-expressing donor multipotent progenitors (MPPs) that sustained pDCs, leading to impaired generation of pDCs. MPP loss was associated with decreased amounts of MPP-producing hematopoietic stem cells (HSCs) and oxidative stress-induced death of proliferating MPPs. Additionally, alloreactive T cells produced GM-CSF to inhibit MPP expression of Tcf4, the transcription factor essential for pDC development, subverting MPP production of pDCs. GM-CSF did not affect the maturation of pDC precursors. Notably, enhanced recovery of donor pDCs upon adoptive transfer early after allogeneic HSC transplantation repressed GVHD and restored the de novo generation of donor pDCs in recipient mice. pDCs suppressed the proliferation and expansion of activated autologous T cells via a type I IFN signaling-dependent mechanism. They also produced PD-L1 and LILRB4 to inhibit T cell production of IFN-γ. We thus demonstrate that GVHD impairs the reconstitution of tolerogenic donor pDCs by depleting DC progenitors rather than by preventing pDC maturation. MPPs are an important target to effectively bolster pDC reconstitution for controlling GVHD.
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Affiliation(s)
- Yuanyuan Tian
- Shanghai Institute of Immunology, Institutes of Medical Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Fels Institute for Cancer Research and Molecular Biology, Temple University, Philadelphia, Pennsylvania, USA
| | - Lijun Meng
- Fels Institute for Cancer Research and Molecular Biology, Temple University, Philadelphia, Pennsylvania, USA.,Department of Hematology, Children Hospital, Soochow University, Suzhou, China
| | - Ying Wang
- Fels Institute for Cancer Research and Molecular Biology, Temple University, Philadelphia, Pennsylvania, USA.,Department of Microbiology and Immunology, Temple University, Philadelphia, Pennsylvania, USA
| | - Bohan Li
- Department of Hematology, Children Hospital, Soochow University, Suzhou, China
| | - Hongshuang Yu
- Fels Institute for Cancer Research and Molecular Biology, Temple University, Philadelphia, Pennsylvania, USA
| | - Yan Zhou
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Tien Bui
- Fels Institute for Cancer Research and Molecular Biology, Temple University, Philadelphia, Pennsylvania, USA
| | - Ciril Abraham
- Fels Institute for Cancer Research and Molecular Biology, Temple University, Philadelphia, Pennsylvania, USA
| | - Alicia Li
- Fels Institute for Cancer Research and Molecular Biology, Temple University, Philadelphia, Pennsylvania, USA
| | - Yongping Zhang
- Department of Hematology, Children Hospital, Soochow University, Suzhou, China
| | - Jian Wang
- Department of Hematology, Children Hospital, Soochow University, Suzhou, China
| | - Chenchen Zhao
- Penn State Cancer Institute, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Shin Mineishi
- Penn State Cancer Institute, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Stefania Gallucci
- Department of Microbiology and Immunology, Temple University, Philadelphia, Pennsylvania, USA
| | - David Porter
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth Hexner
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hong Zheng
- Penn State Cancer Institute, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Yanyun Zhang
- Shanghai Institute of Immunology, Institutes of Medical Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaoyan Hu
- Department of Hematology, Children Hospital, Soochow University, Suzhou, China
| | - Yi Zhang
- Fels Institute for Cancer Research and Molecular Biology, Temple University, Philadelphia, Pennsylvania, USA.,Department of Microbiology and Immunology, Temple University, Philadelphia, Pennsylvania, USA
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14
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Verschraegen CF, Hashibe M, O'Connell A, Neill U, Rodriguez R, Pirl WF, Gray T, Yusufov M, Hexner E, Mankoff DA, Noel C, Romney M, Korczak J, Matthews L, Jedidi I, Jackson R. NCI Awardee Skills Development Consortium (NASDC): Applicant profiles. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11030] [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] [Indexed: 11/20/2022] Open
Abstract
11030 Background: In 2020, the NCI funded a new educational consortium, NASDC (NCI Awardee Skills Development Consortium, RFA-CA-19-010 and -011), through four institutionally granted UE5 awards to deliver a specific course each and a U24 award as a Coordinating Center. The goal is to teach current early-career faculty NCI grantees skills in areas critical for successful independent academic cancer research careers. Courses focus on leadership and socioemotional skills, health disparities, immuno-oncology, and cell and gene therapy. Teaching will initially be virtual, given the COVID pandemic. Methods: A steering committee and four working groups were established to build the consortium infrastructure, including the NASDC (osu.edu) website. Clientele are early-career faculty PD/PI of a current NCI-funded grant (K01, K07, K08, K22, K23, K25, R00, R21, DP1, DP2, DP5, R01, R23, R29, R37, R56, RF1, RL1, U01), of whom 454 were directly contacted. Blast emails and social media were also used. We are reporting the characteristics of 154 applicants, who completed the RedCap application online. Results: 85% of the applicants are within the first 5 years of a faculty appointment, 87% at the assistant professor rank, and 65% on tenure track. 40% hold an M.D. degree and 72% a Ph.D. 81% are US citizens, 52% females, and 45/33/16/2/4%-11% are White/Asian/Black/Native Americans/Other–Hispanics/Latino. 76% work at NCI-designated comprehensive cancer centers. Mean protected research time is 80%. Non-mutually exclusive fields of research interest are therapeutics (46%), basic science (37%), disparities (34%) prevention (32%), public health (28%), and pediatrics (10%). 66% have received a K-award grant, 13% each an R21 or R00, and 3% an R01. Additionally, 35% had a second NCI grant as PI, 10% a third grant, and 60% had non-NCI grants. Reasons for applying included (1) not quite ready to lead a research team (42%), (2) need for stronger career mentoring (37%), and (3) not being fully confident in research skills (21%). Conclusions: Applicants to the new NCI educational consortium (NASDC) have a successful start to their academic career with a third having obtained more than one NCI award. Most applicants work at NCI-designated comprehensive cancer centers. As cancer research continues to evolve and has the potential to address critical health care needs of the nation, NASDC will strive to equip scientists to be leaders, teach advances in technology, and impart confidence in research skills.
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Affiliation(s)
| | - Mia Hashibe
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Ushma Neill
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - William F. Pirl
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL
| | | | | | | | | | | | - Madeline Romney
- University of Utah-Huntsman Cancer Institute, Salt Lake City, UT
| | | | | | - Iness Jedidi
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
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15
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Vasu S, Bejanyan N, Devine SM, Hexner E, Logan B, Luznik L, Ragon B, Sandler A, Krakow EF, Fitzgerald M, Tracey L, Champlin R. BMT CTN 1803: Haploidentical Natural Killer Cells (K-NK002) to Prevent Post-Transplant Relapse in AML and MDS (NK-REALM). Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00556-x] [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: 10/22/2022]
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16
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Cenin DA, Manjunath SH, Freyer CW, Timlin C, Hughes ME, Radcliff JA, Carulli A, Babushok DV, Frey NV, Gill SI, Hexner E, Loren AW, Luger SM, Maity A, Martin ME, Pratz KW, Perl AE, Porter DL, Stadtmauer EA, Plastaras JP, McCurdy SR. Characterizing the Incidence of Pneumonitis in Haploidentical Vs. HLA-Matched Allogeneic Hematopoietic Stem Cell Transplants Receiving Total Body Irradiation. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00591-1] [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: 10/22/2022]
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17
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Gerds AT, Gotlib J, Bose P, Deininger MW, Dunbar A, Elshoury A, George TI, Gojo I, Gundabolu K, Hexner E, Hobbs G, Jain T, Jamieson C, Kuykendall AT, McMahon B, Mohan SR, Oehler V, Oh S, Pardanani A, Podoltsev N, Ranheim E, Rein L, Salit R, Snyder DS, Stein BL, Talpaz M, Thota S, Vachhani P, Wadleigh M, Walsh K, Ward DC, Bergman MA, Sundar H. Myeloid/Lymphoid Neoplasms with Eosinophilia and TK Fusion Genes, Version 3.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:1248-1269. [PMID: 32886902 DOI: 10.6004/jnccn.2020.0042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Eosinophilic disorders and related syndromes represent a heterogeneous group of neoplastic and nonneoplastic conditions, characterized by more eosinophils in the peripheral blood, and may involve eosinophil-induced organ damage. In the WHO classification of myeloid and lymphoid neoplasms, eosinophilic disorders characterized by dysregulated tyrosine kinase (TK) fusion genes are recognized as a new category termed, myeloid/lymphoid neoplasms with eosinophilia and rearrangement of PDGFRA, PDGFRB or FGFR1 or with PCM1-JAK2. In addition to these aforementioned TK fusion genes, rearrangements involving FLT3 and ABL1 genes have also been described. These new NCCN Guidelines include recommendations for the diagnosis, staging, and treatment of any one of the myeloid/lymphoid neoplasms with eosinophilia (MLN-Eo) and a TK fusion gene included in the 2017 WHO Classification, as well as MLN-Eo and a FLT3 or ABL1 rearrangement.
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Affiliation(s)
- Aaron T Gerds
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | | | - Ivana Gojo
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | - Tania Jain
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Vivian Oehler
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Stephen Oh
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Rachel Salit
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Brady L Stein
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | - Katherine Walsh
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Dawn C Ward
- UCLA Jonsson Comprehensive Cancer Center; and
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18
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Hartmann K, Gotlib J, Akin C, Hermine O, Awan FT, Hexner E, Mauro MJ, Menssen HD, Redhu S, Knoll S, Sotlar K, George TI, Horny HP, Valent P, Reiter A, Kluin-Nelemans HC. Midostaurin improves quality of life and mediator-related symptoms in advanced systemic mastocytosis. J Allergy Clin Immunol 2020; 146:356-366.e4. [DOI: 10.1016/j.jaci.2020.03.044] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 02/17/2020] [Accepted: 03/11/2020] [Indexed: 12/18/2022]
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19
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Gladney W, Hexner E, Salas-McKee J, Fesnak A, Jadlowsky J, Plesa G, Leskowitz R, Chew A, Dai A, Gohil M, Xu J, Siegel D, Lacey S, Davis M, June C. Pre-clinical development of multiplex-CRISPR-edited cell and gene therapy products. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.026] [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: 10/24/2022]
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20
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Vasu S, Bejanyan N, Devine SM, Hexner E, Krakow E, Logan B, Luznik L, Ragon B, Barrett E, Shan J, Champlin RE. BMT CTN 1803: Trial to Investigate If Haploidentical Natural Killer Cells (CSTD002) Prevent Post-Transplant Relapse in AML and MDS (NK-REALM). Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.174] [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: 10/25/2022]
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21
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Srinagesh HK, Ozbek U, Kapoor U, Ayuk F, Aziz M, Ben-David K, Choe H, DeFilipp Z, Etra A, Grupp SA, Hartwell MJ, Hexner E, Hogan WJ, Karol AB, Kasikis S, Kitko CL, Kowalyk S, Major-Monfried H, Lin JY, Mielke S, Merli P, Morales G, Ordemann R, Pulsipher MA, Qayed M, Reddy P, Reshef R, Roesler W, Sandhu KS, Schechter T, Shah J, Sigel K, Weber D, Wölfl M, Wudhikarn K, Young R, Levine JE, Ferrara J. The MAGIC Algorithm Probability (MAP) Is a Validated Response Biomarker of Treatment for Acute Graft-Versus-Host Disease. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.123] [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: 11/28/2022]
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22
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Yacoub A, Mascarenhas J, Kosiorek H, Prchal JT, Berenzon D, Baer MR, Ritchie E, Silver RT, Kessler C, Winton E, Finazzi MC, Rambaldi A, Vannucchi AM, Leibowitz D, Rondelli D, Arcasoy MO, Catchatourian R, Vadakara J, Rosti V, Hexner E, Kremyanskaya M, Sandy L, Tripodi J, Najfeld V, Farnoud N, Papaemmanuil E, Salama M, Singer-Weinberg R, Rampal R, Goldberg JD, Barbui T, Mesa R, Dueck AC, Hoffman R. Pegylated interferon alfa-2a for polycythemia vera or essential thrombocythemia resistant or intolerant to hydroxyurea. Blood 2019; 134:1498-1509. [PMID: 31515250 PMCID: PMC6839950 DOI: 10.1182/blood.2019000428] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [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: 03/04/2019] [Accepted: 07/31/2019] [Indexed: 12/22/2022] Open
Abstract
Prior studies have reported high response rates with recombinant interferon-α (rIFN-α) therapy in patients with essential thrombocythemia (ET) and polycythemia vera (PV). To further define the role of rIFN-α, we investigated the outcomes of pegylated-rIFN-α2a (PEG) therapy in ET and PV patients previously treated with hydroxyurea (HU). The Myeloproliferative Disorders Research Consortium (MPD-RC)-111 study was an investigator-initiated, international, multicenter, phase 2 trial evaluating the ability of PEG therapy to induce complete (CR) and partial (PR) hematologic responses in patients with high-risk ET or PV who were either refractory or intolerant to HU. The study included 65 patients with ET and 50 patients with PV. The overall response rates (ORRs; CR/PR) at 12 months were 69.2% (43.1% and 26.2%) in ET patients and 60% (22% and 38%) in PV patients. CR rates were higher in CALR-mutated ET patients (56.5% vs 28.0%; P = .01), compared with those in subjects lacking a CALR mutation. The median absolute reduction in JAK2V617F variant allele fraction was -6% (range, -84% to 47%) in patients achieving a CR vs +4% (range, -18% to 56%) in patients with PR or nonresponse (NR). Therapy was associated with a significant rate of adverse events (AEs); most were manageable, and PEG discontinuation related to AEs occurred in only 13.9% of subjects. We conclude that PEG is an effective therapy for patients with ET or PV who were previously refractory and/or intolerant of HU. This trial was registered at www.clinicaltrials.gov as #NCT01259856.
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Affiliation(s)
- Abdulraheem Yacoub
- Division of Hematologic Malignancies and Cellular Therapeutics, The University of Kansas Cancer Center, Westwood, KS
| | - John Mascarenhas
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Josef T Prchal
- Division of Hematology, University of Utah School of Medicine and
- Huntsman Cancer Center, Salt Lake City, UT
| | - Dmitry Berenzon
- Comprehensive Cancer Center, Wake Forest University Medical Center, Wake Forest Health, Winston-Salem, NC
| | - Maria R Baer
- Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD
| | - Ellen Ritchie
- Division of Hematology and Oncology, Department of Medicine, Richard T. Silver Myeloproliferative Neoplasms Center, Weill Cornell Medical College, New York, NY
| | - Richard T Silver
- Division of Hematology and Oncology, Department of Medicine, Richard T. Silver Myeloproliferative Neoplasms Center, Weill Cornell Medical College, New York, NY
| | - Craig Kessler
- Georgetown University Medical Center, Washington, DC
| | - Elliott Winton
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Maria Chiara Finazzi
- Department of Hematology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandro Rambaldi
- Department of Hematology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
- Department of Oncology, University of Milan, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandro M Vannucchi
- Center for Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, and
- Denothe Excellence Center, University of Florence, Florence, Italy
| | - David Leibowitz
- Department of Oncology, Palo Alto Medical Foundation, Sutter Health, Palo Alto, CA
| | - Damiano Rondelli
- Division of Hematology and Oncology, University of Illinois, Chicago, IL
| | - Murat O Arcasoy
- Division of Hematology, Duke University School of Medicine, Durham, NC
| | | | | | - Vittorio Rosti
- Laboratory of Biochemistry, Biotechnology, and Advanced Diagnosis, Center for the Study of Myelofibrosis, Istituto Di Ricovero e Cura a Carattere Scientifico, Foundation Policlinico San Matteo, Pavia, Italy
| | - Elizabeth Hexner
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Marina Kremyanskaya
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lonette Sandy
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joseph Tripodi
- Department of Pathology and
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vesna Najfeld
- Department of Pathology and
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Noushin Farnoud
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elli Papaemmanuil
- Computational Oncology
- Center for Hematological Malignancies, and
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Raajit Rampal
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Judith D Goldberg
- Department of Population Health and
- Department of Environmental Medicine, New York University School of Medicine, New York, NY
| | | | - Ruben Mesa
- UT Health San Antonio Cancer Center, San Antonio, TX
| | | | - Ronald Hoffman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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23
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Mascarenhas J, Kosiorek H, Prchal J, Yacoub A, Berenzon D, Baer MR, Ritchie E, Silver RT, Kessler C, Winton E, Finazzi MC, Rambaldi A, Vannucchi AM, Leibowitz D, Rondelli D, Arcasoy MO, Catchatourian R, Vadakara J, Rosti V, Hexner E, Kremyanskaya M, Sandy L, Tripodi J, Najfeld V, Farnoud N, Salama ME, Weinberg RS, Rampal R, Goldberg JD, Mesa R, Dueck AC, Hoffman R. A prospective evaluation of pegylated interferon alfa-2a therapy in patients with polycythemia vera and essential thrombocythemia with a prior splanchnic vein thrombosis. Leukemia 2019; 33:2974-2978. [PMID: 31363161 PMCID: PMC6884668 DOI: 10.1038/s41375-019-0524-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/11/2019] [Accepted: 05/17/2019] [Indexed: 12/15/2022]
Affiliation(s)
- J Mascarenhas
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | - J Prchal
- Division of Hematology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - A Yacoub
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - D Berenzon
- Comprehensive Cancer Center, Wake Forest University Medical Center, Wake Forest Health, Winston-Salem, NC, USA
| | - M R Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - E Ritchie
- Weill Cornell Medical College, New York, NY, USA
| | - R T Silver
- Weill Cornell Medical College, New York, NY, USA
| | - C Kessler
- Georgetown University Medical Center, Washington, DC, USA
| | - E Winton
- Winship Cancer Institute Emory University School of Medicine, Atlanta, GA, USA
| | - M C Finazzi
- Hematology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - A Rambaldi
- Hematology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.,Department of Oncology, University of Milan, Milan, Italy
| | - A M Vannucchi
- CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Florence, Italy
| | - D Leibowitz
- Oncology Department, Palo Alto Medical Foundation Sutter Health, Sunnyvale, CA, USA
| | - D Rondelli
- Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - M O Arcasoy
- Duke University School of Medicine, Durham, NC, USA
| | - R Catchatourian
- Oncology Department, John H Stroger Jr. Hospital of Cook County Chicago, Chicago, IL, USA
| | - J Vadakara
- Geisinger Medical Center, Danville, PA, USA
| | - V Rosti
- Center for the Study of Myelofibrosis, Laboratory of Biochemistry, Biotechnology, and Advanced Diagnosis, IRCCS Policlinico San Matteo Foundation, 19, viale Golgi, 27100, Pavia, Italy
| | - E Hexner
- University of Pennsylvania Abramson Cancer Center, Philadelphia, PA, USA
| | - M Kremyanskaya
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - L Sandy
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Tripodi
- Department of Pathology and Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - V Najfeld
- Department of Pathology and Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N Farnoud
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - M E Salama
- Mayo Medical Laboratories, Rochester, MN, USA
| | | | - R Rampal
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - J D Goldberg
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - R Mesa
- UT Health San Antonio Cancer Center, San Antonio, TX, USA
| | | | - R Hoffman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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24
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Mascarenhas J, Baer MR, Kessler C, Hexner E, Tremblay D, Price L, Sandy L, Weinberg R, Pahl H, Silverman LR, Goldberg JD, Kosiorek H, Dueck AC, Hoffman R. Phase II trial of Lestaurtinib, a JAK2 inhibitor, in patients with myelofibrosis. Leuk Lymphoma 2019; 60:1343-1345. [PMID: 30668266 DOI: 10.1080/10428194.2018.1532509] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- John Mascarenhas
- a Icahn School of Medicine at Mount Sinai , Tisch Cancer Institute , New York , NY , USA
| | - Maria R Baer
- b Greenebaum Cancer Center , University of Maryland , Baltimore , MD , USA
| | - Craig Kessler
- c Lombardi Comprehensive Cancer Center , Georgetown University Medical Center , Washinton , DC , USA
| | - Elizabeth Hexner
- d Abramson Cancer Center , University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA
| | - Douglas Tremblay
- a Icahn School of Medicine at Mount Sinai , Tisch Cancer Institute , New York , NY , USA
| | - Leah Price
- e Department of Population Health , New York University , New York , NY , USA
| | - Lonette Sandy
- a Icahn School of Medicine at Mount Sinai , Tisch Cancer Institute , New York , NY , USA
| | - Rona Weinberg
- f New York Blood Center, Myeloproliferative Disorders Laboratory , New York , NY , USA
| | - Heike Pahl
- g Section of Molecular Hematology, Department of Hematology/Oncology , University Medical Center Freiburg , Freiburg , Germany
| | - Lewis R Silverman
- a Icahn School of Medicine at Mount Sinai , Tisch Cancer Institute , New York , NY , USA
| | - Judith D Goldberg
- e Department of Population Health , New York University , New York , NY , USA
| | - Heidi Kosiorek
- h Division of Biostatistics , Mayo Clinic Arizona , Scottsdale , AZ , USA
| | - Amylou C Dueck
- h Division of Biostatistics , Mayo Clinic Arizona , Scottsdale , AZ , USA
| | - Ronald Hoffman
- a Icahn School of Medicine at Mount Sinai , Tisch Cancer Institute , New York , NY , USA
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Holtan SG, DeFor TE, Panoskaltsis-Mortari A, Khera N, Levine JE, Flowers MED, Lee SJ, Inamoto Y, Chen GL, Mayer S, Arora M, Palmer J, Cutler CS, Arai S, Lazaryan A, Newell LF, Jagasia MH, Pusic I, Wood WA, Renteria AS, Yanik G, Hogan WJ, Hexner E, Ayuk F, Holler E, Bunworasate U, Efebera YA, Ferrara JLM, Pidala J, Howard A, Wu J, Bolaños-Meade J, Ho V, Alousi A, Blazar BR, Weisdorf DJ, MacMillan ML. Amphiregulin modifies the Minnesota Acute Graft-versus-Host Disease Risk Score: results from BMT CTN 0302/0802. Blood Adv 2018; 2:1882-1888. [PMID: 30087106 PMCID: PMC6093743 DOI: 10.1182/bloodadvances.2018017343] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 02/12/2018] [Accepted: 06/26/2018] [Indexed: 01/07/2023] Open
Abstract
Amphiregulin (AREG) is an epidermal growth factor receptor ligand that can restore integrity to damaged intestinal mucosa in murine models of acute graft-versus-host disease (aGVHD). We previously reported that circulating AREG is elevated in late-onset aGVHD (occurring after 100 days posttransplant), but its clinical relevance in the context of aGVHD risk is unknown. We measured AREG in 251 aGVHD onset blood samples from Blood and Marrow Clinical Trials Network (BMT CTN) primary treatment trials and determined their association with GVHD severity, day 28 complete or partial response (CR/PR) to first-line therapy, overall survival (OS), and nonrelapse mortality (NRM). Every doubling of plasma AREG was associated with a 33% decrease in the odds of day 28 CR/PR (odds ratio [OR], 0.67; P < .01). An AREG threshold of 33 pg/mL or greater divided patients with Minnesota standard-risk (SR) aGVHD into a distinct group with a significantly lower likelihood of: day 28 CR/PR (72% vs 85%; P = .02); greater 2-year NRM (42% vs 15%; P < .01); and inferior OS (40% vs 66%; P < .01). High AREG ≥ 33 pg/mL also stratified patients with Minnesota high-risk (HR) aGVHD: day 28 CR/PR (54% vs 83%; P = .03) and 2-year NRM (53% vs 11%; P < .01), with a trend toward inferior 2-year OS (37% vs 60%; P = .09). High-circulating AREG (≥33 pg/mL) reclassifies patients into HR subgroups and thereby further refines the Minnesota aGVHD clinical risk score.
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Affiliation(s)
- Shernan G Holtan
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
| | - Todd E DeFor
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
| | | | | | - John E Levine
- Blood and Marrow Transplantation Program, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Yoshihiro Inamoto
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - George L Chen
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | - Sebastian Mayer
- Department of Medicine, Weill Cornell Medical Center, New York, NY
| | - Mukta Arora
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
| | | | - Corey S Cutler
- Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Sally Arai
- Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
| | - Aleksandr Lazaryan
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
| | - Laura F Newell
- Center for Hematologic Malignancies, Oregon Health and Science University, Portland, OR
| | - Madan H Jagasia
- Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Iskra Pusic
- Medical Oncology, Washington University Medical Center, St. Louis, MO
| | - William A Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Anne S Renteria
- Blood and Marrow Transplantation Program, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gregory Yanik
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI
| | - William J Hogan
- Blood and Marrow Transplantation Program, Mayo Clinic, Rochester, MN
| | - Elizabeth Hexner
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center, Hamburg-Eppendorf, Germany
| | - Ernst Holler
- Blood and Marrow Transplantation Program, University of Regensburg, Regensburg, Germany
| | - Udomsak Bunworasate
- Blood and Marrow Transplantation Program, Chulalongkorn University, Bangkok, Thailand
| | - Yvonne A Efebera
- Blood and Marrow Transplantation Program, The Ohio State University, Columbus, OH
| | - James L M Ferrara
- Blood and Marrow Transplantation Program, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joseph Pidala
- Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Alan Howard
- National Marrow Donor Program, Minneapolis, MN
| | - Juan Wu
- The EMMES Corporation, Rockville, MD
| | - Javier Bolaños-Meade
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and
| | - Vincent Ho
- Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
| | | | - Bruce R Blazar
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
| | - Daniel J Weisdorf
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
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Aynardi J, Manur R, Hess PR, Chekol S, Morrissette JJD, Babushok D, Hexner E, Rogers HJ, Hsi ED, Margolskee E, Orazi A, Hasserjian R, Bagg A. JAK2
V617F-positive acute myeloid leukaemia (AML): a comparison between de novo
AML and secondary AML transformed from an underlying myeloproliferative neoplasm. A study from the Bone Marrow Pathology Group. Br J Haematol 2018; 182:78-85. [DOI: 10.1111/bjh.15276] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 03/13/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Jason Aynardi
- Department of Pathology and Laboratory Medicine; University of Pennsylvania; Philadelphia PA USA
| | - Rashmi Manur
- Department of Pathology and Laboratory Medicine; University of Pennsylvania; Philadelphia PA USA
| | - Paul R. Hess
- Department of Pathology and Laboratory Medicine; University of Pennsylvania; Philadelphia PA USA
| | - Seble Chekol
- Department of Pathology and Laboratory Medicine; University of Pennsylvania; Philadelphia PA USA
| | | | - Daria Babushok
- Department of Medicine; Division of Hematology and Oncology; University of Pennsylvania; Philadelphia PA USA
| | - Elizabeth Hexner
- Department of Medicine; Division of Hematology and Oncology; University of Pennsylvania; Philadelphia PA USA
| | - Heesun J. Rogers
- Department of Laboratory Medicine; Cleveland Clinic; Cleveland OH USA
| | - Eric D. Hsi
- Department of Laboratory Medicine; Cleveland Clinic; Cleveland OH USA
| | - Elizabeth Margolskee
- Department of Pathology and Laboratory Medicine; Weill Cornell Medicine; New York NY USA
| | - Attilio Orazi
- Department of Pathology and Laboratory Medicine; Weill Cornell Medicine; New York NY USA
| | - Robert Hasserjian
- Department of Pathology; Massachusetts General Hospital; Boston MA USA
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine; University of Pennsylvania; Philadelphia PA USA
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27
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DeMichele AM, Clark AS, Holmes R, Volpe M, Medrano C, Troxel A, Fox K, Domchek S, Matro J, Bradbury A, Shih N, Feldman M, Hexner E, Bromberg J. Abstract P2-08-03: Targeting inflammatory pathways: A phase 2 trial of the JAK-inhibitor ruxolitinib in combination with exemestane for aromatase inhibitor-resistant, estrogen receptor-positive breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-08-03] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In vitro mechanisms link IL-6 to poor outcome in breast cancer via inflammatory pathways, activated JAK/STAT tumor signaling and upregulation of aromatase, leading to an aggressive tumor phenotype. Epidemiological data from our group and others support these mechanisms in women with ER-positive (+) disease. We therefore hypothesized that the JAK inhibitor, ruxolitinib (RUX, INCB018424; Incyte), would enhance activity of exemestane (EXE) in women with ER+ breast cancer who relapsed after non-steroidal aromatase inhibitor therapy, particularly among carriers of a germ-line polymorphism in IL-6, conferring elevated levels of IL-6 in the tumor microenvironment.
Methods: The “JAKEE trial” is a phase II trial to determine the safety and efficacy of RUX + EXE in postmenopausal women with relapsed, ER+ advanced breast cancer. Eligible patients were required to have progressed on a non-steroidal AI and either measureable or bone-only disease. CRP, a putative biomarker of tumor microenvironment inflammation, was measured at baseline and serially during treatment. Using a Simon 2-stage design, we treated 15 patients with RUX at 25 mg BID and EXE at 25mg daily on a continuous 28-day schedule. First stage results were previously presented (AACR, 2014). Accrual proceeded to second stage after no patient met the pre-defined stopping rule of grade (G) 3/4 toxicity requiring discontinuation from the study within the first treatment cycle. Due to the substantial rate of anemia requiring dose reductions, however, RUX dose was reduced to 15 mg BID in second stage.
Results: A total of 25 patients were enrolled; 24/25 had progressed on AI in metastatic setting; 1 relapsed on adjuvant AI. RUX+EXE was well-tolerated overall, with only 2 G4 events (creatinine elevation, hepatic failure); both were due to disease progression. 16% had G3 fatigue, anemia or hypertension; 12% had G3 neutropenia or depression. Other lower grade toxicities in >20% included musculoskeletal pain, increased ALT, and headache. Overall, patients stayed on therapy for a median of 3 cycles (range 2 – 21). There were no CR or PR, but 6/25 (24%) had prolonged disease control (SD> 6 months). Median CRP at study entry was 6.4 (range 0.3-38.9), with 8/25 (32%) having CRP>10. Achieving SD>6 months was not associated with baseline CRP (CRP>10 in 32% with vs. 33% without SD>6 months, p(exact)=1.0). A novel pharmacodynamic assay to assess STAT3 phosphorylation in peripheral blood mononuclear cells after RUX exposure demonstrated differential effects in patients with response.
Conclusions: Targeting JAK/STAT signaling in AI-resistant breast cancer with RUX+EXE was safe and well-tolerated. 24% of patients had prolonged SD, but baseline CRP level did not predict response. Correlative studies to determine whether host and/or tumor biomarkers predict response to therapy, including germline IL-6 genotype, immune profiles, p-STAT3 and estradiol levels, are currently underway.
Citation Format: DeMichele AM, Clark AS, Holmes R, Volpe M, Medrano C, Troxel A, Fox K, Domchek S, Matro J, Bradbury A, Shih N, Feldman M, Hexner E, Bromberg J. Targeting inflammatory pathways: A phase 2 trial of the JAK-inhibitor ruxolitinib in combination with exemestane for aromatase inhibitor-resistant, estrogen receptor-positive breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-08-03.
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Affiliation(s)
- AM DeMichele
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - AS Clark
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - R Holmes
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Volpe
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - C Medrano
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Troxel
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - K Fox
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Domchek
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Matro
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Bradbury
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - N Shih
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Feldman
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - E Hexner
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Bromberg
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
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Lewen M, Gresh R, Queenan M, Paessler M, Pillai V, Hexner E, Frank D, Bagg A, Aplenc R, Caywood E, Wertheim G. Pediatric chronic myeloid leukemia with inv(3)(q21q26.2) and T lymphoblastic transformation: a case report. Biomark Res 2016; 4:14. [PMID: 27453784 PMCID: PMC4957483 DOI: 10.1186/s40364-016-0069-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 04/18/2016] [Accepted: 07/07/2016] [Indexed: 12/11/2022] Open
Abstract
Background Chronic myeloid leukemia (CML) comprises ~3 % of pediatric leukemia. Although therapy with tyrosine kinase inhibitors (TKIs) is highly effective for CML, multiple factors have been identified as predictive of treatment failure. Chromosomal abnormalities involving the MECOM locus at 3q26 portend therapy resistant disease in adults, yet have never been described in pediatric patients and have not been associated with T lymphoblastic progression. Case presentation We present a case of an 11-year-old boy with CML possessing the unique combination of T lymphoblastic transformation and a subclone harboring inv(3)(q21q26.2) at diagnosis. This is the first reported case of pediatric CML with inv(3)(q21q26.2) and the first case of T lymphoblastic progression associated with this karyotype. The patient was treated with single agent TKI therapy with robust initial response. Marrow histology at one month showed restoration of trilineage hematopoiesis and BCR-ABL RT-PCR at three months showed a 1.4 log reduction in transcript levels. Conclusions The karyotypic abnormality of inv(3)(q21q26.2) in CML is not restricted to adult patients. Moreover, while chromosome 3 abnormalities are markers of TKI resistance in adults, our patient showed a robust early response to single agent TKI therapy. This finding suggests pediatric CML with inv(3)(q21q26.2) may have distinct features and more favorable treatment responses than those described in adults.
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Affiliation(s)
- Margaret Lewen
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts USA
| | - Renee Gresh
- Nemours Center for Cancer and Blood Disorders, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware USA
| | - Maria Queenan
- Department of Pathology and Laboratory Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware USA
| | - Michele Paessler
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania USA ; Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania USA
| | - Vinodh Pillai
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania USA ; Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania USA
| | - Elizabeth Hexner
- Department of Medicine, Division of Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania USA
| | - Dale Frank
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania USA
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania USA
| | - Richard Aplenc
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania USA
| | - Emi Caywood
- Nemours Center for Cancer and Blood Disorders, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware USA
| | - Gerald Wertheim
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania USA ; Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania USA
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29
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Gotlib J, Kluin-Nelemans HC, George TI, Akin C, Sotlar K, Hermine O, Awan FT, Hexner E, Mauro MJ, Sternberg DW, Villeneuve M, Huntsman Labed A, Stanek EJ, Hartmann K, Horny HP, Valent P, Reiter A. Efficacy and Safety of Midostaurin in Advanced Systemic Mastocytosis. N Engl J Med 2016; 374:2530-41. [PMID: 27355533 DOI: 10.1056/nejmoa1513098] [Citation(s) in RCA: 315] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Advanced systemic mastocytosis comprises rare hematologic neoplasms that are associated with a poor prognosis and lack effective treatment options. The multikinase inhibitor midostaurin inhibits KIT D816V, a primary driver of disease pathogenesis. METHODS We conducted an open-label study of oral midostaurin at a dose of 100 mg twice daily in 116 patients, of whom 89 with mastocytosis-related organ damage were eligible for inclusion in the primary efficacy population; 16 had aggressive systemic mastocytosis, 57 had systemic mastocytosis with an associated hematologic neoplasm, and 16 had mast-cell leukemia. The primary outcome was the best overall response. RESULTS The overall response rate was 60% (95% confidence interval [CI], 49 to 70); 45% of the patients had a major response, which was defined as complete resolution of at least one type of mastocytosis-related organ damage. Response rates were similar regardless of the subtype of advanced systemic mastocytosis, KIT mutation status, or exposure to previous therapy. The median best percentage changes in bone marrow mast-cell burden and serum tryptase level were -59% and -58%, respectively. The median overall survival was 28.7 months, and the median progression-free survival was 14.1 months. Among the 16 patients with mast-cell leukemia, the median overall survival was 9.4 months (95% CI, 7.5 to not estimated). Dose reduction owing to toxic effects occurred in 56% of the patients; re-escalation to the starting dose was feasible in 32% of those patients. The most frequent adverse events were low-grade nausea, vomiting, and diarrhea. New or worsening grade 3 or 4 neutropenia, anemia, and thrombocytopenia occurred in 24%, 41%, and 29% of the patients, respectively, mostly in those with preexisting cytopenias. CONCLUSIONS In this open-label study, midostaurin showed efficacy in patients with advanced systemic mastocytosis, including the highly fatal variant mast-cell leukemia. (Funded by Novartis Pharmaceuticals and others; ClinicalTrials.gov number, NCT00782067.).
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Affiliation(s)
- Jason Gotlib
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Hanneke C Kluin-Nelemans
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Tracy I George
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Cem Akin
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Karl Sotlar
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Olivier Hermine
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Farrukh T Awan
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Elizabeth Hexner
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Michael J Mauro
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - David W Sternberg
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Matthieu Villeneuve
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Alice Huntsman Labed
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Eric J Stanek
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Karin Hartmann
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Hans-Peter Horny
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Peter Valent
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Andreas Reiter
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
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Kumar AJ, Vassilev P, Loren AW, Luger SM, Reshef R, Gill S, Smith J, Goldstein SC, Hexner E, Stadtmauer EA, Porter D, Frey NV. Time to unrelated donor leukocyte infusion is longer, but incidence of GVHD and overall survival are similar for recipients of unrelated DLI compared to matched sibling DLI. Am J Hematol 2016; 91:426-9. [PMID: 26820493 DOI: 10.1002/ajh.24308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 01/14/2016] [Indexed: 02/07/2023]
Abstract
Donor leukocyte infusion (DLI) is used to treat relapsed leukemia after allogeneic hematopoietic stem cell transplant (HCT). Data comparing outcomes after unrelated DLI (uDLI) to matched sibling DLI (msDLI) are scant. We performed a retrospective analysis to assess differences in time to administer uDLI versus msDLI, and impact on outcomes. Fifty three patients with relapsed acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), or myelodysplastic syndrome (MDS) after allogeneic HCT received uDLI (n = 18) or msDLI (n = 35) from 2000 to 2011. Median time from relapse to uDLI request was 15 days (range 0-66). Median time from relapse to uDLI was 56 days versus 40 days for msDLI patients (p = 0.034). 35% of msDLI and 44% of uDLI patients developed acute GVHD (p = 0.50). There was no significant difference in Grade C/D GVHD among uDLI and msDLI (28% and 21%, p = 0.58) or median OS after DLI between uDLI and msDLI (95 versus 75 days, p = 0.76). For patients with relapsed acute leukemia and MDS after allogeneic HCT, time from relapse to uDLI was longer than to msDLI, but incidence of GVHD and overall survival were similar. Access to uDLI does not appear to be a barrier to DLI administration. Outcomes unfortunately remain poor regardless of donor source.
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Affiliation(s)
- Anita J. Kumar
- Division of Hematology/Oncology; Tufts Medical Center; Boston Massachusetts
| | | | - Alison W. Loren
- Division of Hematology/Oncology; Abramson Cancer Center of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Selina M. Luger
- Division of Hematology/Oncology; Abramson Cancer Center of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Ran Reshef
- Columbia Center for Translational Immunology and Division of Hematology/Oncology; Columbia University Medical Center; New York New York
| | - Saar Gill
- Division of Hematology/Oncology; Abramson Cancer Center of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Jacqueline Smith
- Division of Hematology/Oncology; Abramson Cancer Center of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Steven C. Goldstein
- Department of Hematology/Oncology, University of Michigan; Ann Arbor Michigan
| | - Elizabeth Hexner
- Division of Hematology/Oncology; Abramson Cancer Center of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Edward A. Stadtmauer
- Division of Hematology/Oncology; Abramson Cancer Center of the University of Pennsylvania; Philadelphia Pennsylvania
| | - David Porter
- Division of Hematology/Oncology; Abramson Cancer Center of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Noelle V. Frey
- Division of Hematology/Oncology; Abramson Cancer Center of the University of Pennsylvania; Philadelphia Pennsylvania
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Tong Q, He S, Xie F, Mochizuki K, Liu Y, Mochizuki I, Meng L, Sun H, Zhang Y, Guo Y, Hexner E, Zhang Y. Ezh2 regulates transcriptional and posttranslational expression of T-bet and promotes Th1 cell responses mediating aplastic anemia in mice. J Immunol 2014; 192:5012-22. [PMID: 24760151 DOI: 10.4049/jimmunol.1302943] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Acquired aplastic anemia (AA) is a potentially fatal bone marrow (BM) failure syndrome. IFN-γ-producing Th1 CD4(+) T cells mediate the immune destruction of hematopoietic cells, and they are central to the pathogenesis. However, the molecular events that control the development of BM-destructive Th1 cells remain largely unknown. Ezh2 is a chromatin-modifying enzyme that regulates multiple cellular processes primarily by silencing gene expression. We recently reported that Ezh2 is crucial for inflammatory T cell responses after allogeneic BM transplantation. To elucidate whether Ezh2 mediates pathogenic Th1 responses in AA and the mechanism of Ezh2 action in regulating Th1 cells, we studied the effects of Ezh2 inhibition in CD4(+) T cells using a mouse model of human AA. Conditionally deleting Ezh2 in mature T cells dramatically reduced the production of BM-destructive Th1 cells in vivo, decreased BM-infiltrating Th1 cells, and rescued mice from BM failure. Ezh2 inhibition resulted in significant decrease in the expression of Tbx21 and Stat4, which encode transcription factors T-bet and STAT4, respectively. Introduction of T-bet but not STAT4 into Ezh2-deficient T cells fully rescued their differentiation into Th1 cells mediating AA. Ezh2 bound to the Tbx21 promoter in Th1 cells and directly activated Tbx21 transcription. Unexpectedly, Ezh2 was also required to prevent proteasome-mediated degradation of T-bet protein in Th1 cells. Our results demonstrate that Ezh2 promotes the generation of BM-destructive Th1 cells through a mechanism of transcriptional and posttranscriptional regulation of T-bet. These results also highlight the therapeutic potential of Ezh2 inhibition in reducing AA and other autoimmune diseases.
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Affiliation(s)
- Qing Tong
- International Joint Cancer Institute, Second Military Medical University, Shanghai 200433, China; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109
| | - Shan He
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109; Department of Microbiology and Immunology, Fels Institute for Cancer Research and Molecular Biology, Temple University, Philadelphia, PA 19140
| | - Fang Xie
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109
| | - Kazuhiro Mochizuki
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109
| | - Yongnian Liu
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109; Department of Microbiology and Immunology, Fels Institute for Cancer Research and Molecular Biology, Temple University, Philadelphia, PA 19140
| | - Izumi Mochizuki
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109
| | - Lijun Meng
- Department of Microbiology and Immunology, Fels Institute for Cancer Research and Molecular Biology, Temple University, Philadelphia, PA 19140; Institute of Health Sciences, Shanghai Institutes for Biological Sciences Chinese Academy of Sciences, Shanghai 200433, China; and
| | - Hongxing Sun
- Institute of Health Sciences, Shanghai Institutes for Biological Sciences Chinese Academy of Sciences, Shanghai 200433, China; and
| | - Yanyun Zhang
- Institute of Health Sciences, Shanghai Institutes for Biological Sciences Chinese Academy of Sciences, Shanghai 200433, China; and
| | - Yajun Guo
- International Joint Cancer Institute, Second Military Medical University, Shanghai 200433, China
| | - Elizabeth Hexner
- Department of Medicine and Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | - Yi Zhang
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109; Department of Microbiology and Immunology, Fels Institute for Cancer Research and Molecular Biology, Temple University, Philadelphia, PA 19140;
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Abstract
PURPOSE OF REVIEW Allogeneic hematopoietic stem cell transplantation (HSCT) is the only potentially curative therapy for myelofibrosis. Despite improved outcomes, morbidity and mortality of HSCT remain high. Here we examine recent data on patient selection, timing, and outcomes of HSCT in myelofibrosis. RECENT FINDINGS While there is a general effort to restrict HSCT to transplant-eligible intermediate-2 and high-risk patients, this group has comparatively worse HSCT outcomes, largely driven by their high transplant-related mortality (TRM). When adjusted for age, reduced intensity conditioning (RIC) has shown superior outcomes compared with myeloablative conditioning (MAC), making RIC-HSCT a viable option for older patients. Emerging concepts include the use of ruxolitinib pretransplant, optimizing MAC to decrease toxicity, and use of posttransplant JAK2-mutant allele burden to guide prophylactic immunotherapy to prevent relapse. The recognition of prognostic significance of somatic mutations in the ASXL1, EZH2, SRSF2, and IDH1/2 genes, and the improved assessment of risk of leukemic transformation have added a new dimension to risk stratification. SUMMARY Improving our understanding of molecular genetics and leukemic transformation holds promise for more precise patient selection for HSCT. Although RIC-HSCT may reduce TRM, further studies are needed to optimize conditioning regimens and to define the optimal timing of HSCT.
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Affiliation(s)
- Daria Babushok
- Division of Hematology and Oncology and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Hexner E, Roboz G, Hoffman R, Luger S, Mascarenhas J, Carroll M, Clementi R, Bensen-Kennedy D, Moliterno A. Open-label study of oral CEP-701 (lestaurtinib) in patients with polycythaemia vera or essential thrombocythaemia withJAK2-V617F mutation. Br J Haematol 2013; 164:83-93. [DOI: 10.1111/bjh.12607] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 08/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Gail Roboz
- Weill Cornell Medical College; New York NY USA
| | - Ron Hoffman
- Mount Sinai School of Medicine; Tisch Cancer Institute; New York NY USA
| | | | - John Mascarenhas
- Mount Sinai School of Medicine; Tisch Cancer Institute; New York NY USA
| | | | - Regina Clementi
- Teva Branded Pharmaceutical Products R&D, Inc.; Frazer PA USA
| | - Debra Bensen-Kennedy
- Cephalon, Inc., now a wholly owned subsidiary of Teva Branded Pharmaceutical Products R&D, Inc.; Frazer PA USA
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Mesa RA, Kiladjian JJ, Verstovsek S, Al-Ali HK, Gotlib J, Gisslinger H, Levy R, Siulnik A, Gupta V, Khan M, DiPersio JF, McQuitty M, Catalano JV, Hunter DS, Knoops L, Deininger M, Cervantes F, Miller C, Vannucchi AM, Silver RT, Barbui T, Talpaz M, Barosi G, Winton EF, Mendeson E, Harvey JH, Arcasoy MO, Hexner E, Lyons RM, Paquette R, Raza A, Sun W, Sandor V, Kantarjian HM, Harrison C. Comparison of placebo and best available therapy for the treatment of myelofibrosis in the phase 3 COMFORT studies. Haematologica 2013; 99:292-8. [PMID: 23911705 DOI: 10.3324/haematol.2013.087650] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Prior to Janus kinase inhibitors, available therapies for myelofibrosis were generally supportive and did not improve survival. This analysis compares efficacy outcomes of patients with myelofibrosis in the control arms (placebo [n=154] and best available therapy [n=73]) from the two phase 3 COntrolled MyeloFibrosis study with ORal JAK inhibitor Treatment (COMFORT) studies. Spleen volume was assessed by magnetic resonance imaging/computed tomography at baseline and every 12 weeks through week 72; spleen length was assessed by palpation at each study visit. Health-related quality of life and symptoms were assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 Items at baseline and in weeks 4, 8, 12, 16 and 24 in COMFORT-I and in weeks 8, 16, 24 and 48 in COMFORT-II. The demographic and baseline characteristics were similar between the control arms of the two studies. One patient who received placebo and no patients who received best available therapy had a ≥35% reduction in spleen volume from baseline at week 24. At 24 weeks, neither placebo nor best available therapy had produced clinically meaningful changes in global quality of life or symptom scales. Non-hematologic adverse events were mostly grade 1/2; the most frequently reported adverse events in each group were abdominal pain, fatigue, peripheral edema and diarrhea. These data suggest that non-Janus kinase inhibitor therapies provide little improvement in splenomegaly, symptoms or quality of life as compared with placebo. Both COMFORT-I (NCT00952289) and COMFORT-II (NCT00934544) studies have been appropriately registered with clinicaltrials.gov.
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Wertheim GBW, Hexner E, Bagg A. Molecular-based classification of acute myeloid leukemia and its role in directing rational therapy: personalized medicine for profoundly promiscuous proliferations. Mol Diagn Ther 2013. [PMID: 23184342 DOI: 10.1007/s40291-012-0009-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Acute myeloid leukemia (AML) is not a single pathologic entity but represents a heterogeneous group of malignancies. This heterogeneity is exemplified by the variable clinical outcomes that are observed in patients with AML, and it is largely the result of diverse mutations within the leukemic cells. These mutations range from relatively large genetic alterations, such as gains, losses, and translocations of chromosomes, to single nucleotide changes. Detection of many of these mutations is required for accurate diagnosis, prognosis, and treatment of patients with AML. As such, many testing modalities have been developed and are currently employed in clinical laboratories to ascertain mutational status at prognostically and therapeutically critical loci. The assays include those that specifically identify large chromosomal alterations, such as conventional metaphase analysis and fluorescence in situ hybridization, and methods that are geared more toward analysis of small mutations, such as PCR with allele-specific oligonucleotide primers. Furthermore, newer tests, including array analysis and next-generation sequencing, which can simultaneously probe numerous molecular aberrancies within tumor cells, are likely to become commonplace in AML diagnostics. Each testing method clearly has advantages and disadvantages, an understanding of which should influence the choice of test in various clinical circumstances. To aid such understanding, this review discusses both genetic mutations in AML and the clinical tests-including their pros and cons-that may be used to probe these abnormalities. Additionally, we highlight the significance of genetic testing by describing cases in which results of genetic testing significantly influence clinical management of patients with AML.
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Affiliation(s)
- Gerald B W Wertheim
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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Verstovsek S, Mesa RA, Gotlib J, Levy RS, Gupta V, DiPersio JF, Catalano JV, Deininger M, Miller C, Silver RT, Talpaz M, Winton EF, Harvey JH, Arcasoy MO, Hexner E, Lyons RM, Paquette R, Raza A, Vaddi K, Erickson-Viitanen S, Sun W, Sandor V, Kantarjian HM. The clinical benefit of ruxolitinib across patient subgroups: analysis of a placebo-controlled, Phase III study in patients with myelofibrosis. Br J Haematol 2013; 161:508-16. [PMID: 23480528 DOI: 10.1111/bjh.12274] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 01/17/2013] [Indexed: 12/15/2022]
Abstract
Myelofibrosis (MF) patients can present with a wide spectrum of disease characteristics. We analysed the consistency of ruxolitinib efficacy across patient subgroups in the COntrolled MyeloFibrosis Study With ORal JAK Inhibitor Treatment (COMFORT-I,) a double-blind trial, where patients with intermediate-2 or high-risk MF were randomized to twice-daily oral ruxolitinib (n = 155) or placebo (n = 154). Subgroups analysed included MF subtype (primary, post-polycythaemia vera, post-essential thrombocythaemia), age (≤65, > 65 years), International Prognostic Scoring System risk group, baseline Eastern Cooperative Oncology Group performance status (0, 1, ≥2), JAK2 V617F mutation (positive, negative), baseline haemoglobin level (≥100, <100 g/l), baseline platelet count (100-200 × 10(9)/l, >200 × 10(9)/l), baseline palpable spleen size (≤10, >10 cm), and baseline quartile of spleen volume and Total Symptom Score (TSS; Q1 = lowest, Q4 = highest). Mean percentage change from baseline to week 24 in spleen volume and TSS were calculated for ruxolitinib and placebo in each subgroup. Overall survival was estimated by Kaplan-Meier method according to original randomization group. In ruxolitinib-treated patients, reductions in spleen volume and TSS and evidence of improved survival relative to placebo across subgroups were consistent with those seen in the COMFORT-I population, confirming that ruxolitinib is an effective therapy for the spectrum of MF patients studied in COMFORT-I.
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Affiliation(s)
- Srdan Verstovsek
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Mascarenhas J, Heaney ML, Najfeld V, Hexner E, Abdel-Wahab O, Rampal R, Ravandi F, Petersen B, Roboz G, Feldman E, Podoltsev N, Douer D, Levine R, Tallman M, Hoffman R. Proposed criteria for response assessment in patients treated in clinical trials for myeloproliferative neoplasms in blast phase (MPN-BP): formal recommendations from the post-myeloproliferative neoplasm acute myeloid leukemia consortium. Leuk Res 2012; 36:1500-4. [PMID: 22938832 PMCID: PMC4114151 DOI: 10.1016/j.leukres.2012.08.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [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: 07/07/2012] [Revised: 08/03/2012] [Accepted: 08/09/2012] [Indexed: 11/26/2022]
Abstract
Leukemic transformation (LT) of a myeloproliferative neoplasm (MPN) is associated with a dismal prognosis and no medical therapies have shown a survival improvement in patients with MPN in blast phase (MPN-BP). Effective therapies for the treatment of MPN-BP are a serious unmet need. Consensus response criteria do not exist for the treatment of patients with MPN-BP and this is necessary for the uniformed reporting of treatment response in clinical trials. We have identified relevant MPN and MPN-BP features in order to define treatment response categories that reflect hematological, clinical, pathological, cytogenetic and molecular changes after therapeutic intervention. We plan to validate these proposed response criteria within multi-centered clinical trials.
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Affiliation(s)
- John Mascarenhas
- Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY, USA.
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Verstovsek S, Mesa RA, Gotlib J, Levy RS, Gupta V, DiPersio JF, Catalano JV, Deininger M, Miller C, Silver RT, Talpaz M, Winton EF, Harvey JH, Arcasoy MO, Hexner E, Lyons RM, Paquette R, Raza A, Vaddi K, Erickson-Viitanen S, Koumenis IL, Sun W, Sandor V, Kantarjian HM. A double-blind, placebo-controlled trial of ruxolitinib for myelofibrosis. N Engl J Med 2012; 366:799-807. [PMID: 22375971 PMCID: PMC4822164 DOI: 10.1056/nejmoa1110557] [Citation(s) in RCA: 1486] [Impact Index Per Article: 123.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Ruxolitinib, a selective inhibitor of Janus kinase (JAK) 1 and 2, has clinically significant activity in myelofibrosis. METHODS In this double-blind trial, we randomly assigned patients with intermediate-2 or high-risk myelofibrosis to twice-daily oral ruxolitinib (155 patients) or placebo (154 patients). The primary end point was the proportion of patients with a reduction in spleen volume of 35% or more at 24 weeks, assessed by means of magnetic resonance imaging. Secondary end points included the durability of response, changes in symptom burden (assessed by the total symptom score), and overall survival. RESULTS The primary end point was reached in 41.9% of patients in the ruxolitinib group as compared with 0.7% in the placebo group (P<0.001). A reduction in spleen volume was maintained in patients who received ruxolitinib; 67.0% of the patients with a response had the response for 48 weeks or more. There was an improvement of 50% or more in the total symptom score at 24 weeks in 45.9% of patients who received ruxolitinib as compared with 5.3% of patients who received placebo (P<0.001). Thirteen deaths occurred in the ruxolitinib group as compared with 24 deaths in the placebo group (hazard ratio, 0.50; 95% confidence interval, 0.25 to 0.98; P=0.04). The rate of discontinuation of the study drug because of adverse events was 11.0% in the ruxolitinib group and 10.6% in the placebo group. Among patients who received ruxolitinib, anemia and thrombocytopenia were the most common adverse events, but they rarely led to discontinuation of the drug (in one patient for each event). Two patients had transformation to acute myeloid leukemia; both were in the ruxolitinib group. CONCLUSIONS Ruxolitinib, as compared with placebo, provided significant clinical benefits in patients with myelofibrosis by reducing spleen size, ameliorating debilitating myelofibrosis-related symptoms, and improving overall survival. These benefits came at the cost of more frequent anemia and thrombocytopenia in the early part of the treatment period. (Funded by Incyte; COMFORT-I ClinicalTrials.gov number, NCT00952289.).
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Affiliation(s)
- Srdan Verstovsek
- Leukemia Department, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Nguyen J, Tetzlaff MT, Zhang PJ, Xu X, Hexner E, Rosenbach M. Fluorescent in situ hybridization of a skin biopsy: an adjunctive tool to support a diagnosis of graft-versus-host disease. J Am Acad Dermatol 2011; 64:e113-4. [PMID: 21571154 DOI: 10.1016/j.jaad.2010.09.716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 09/10/2010] [Accepted: 09/12/2010] [Indexed: 11/18/2022]
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Abstract
The myeloid malignancies include the myeloproliferative neoplasms (MPN) including chronic myeloid leukemia (CML), and acute myeloid leukemia (AML). A growing body of evidence documents that these diseases are caused by genetic mutations that constitutively activate tyrosine kinases. They include the BCR/ABL in CML, the V617F JAK2 in Philadelphia chromosome-negative MPN, and the Flt3 ITD and TKD mutations in AML. Trials of the ABL kinase inhibitor, imatinib, have revolutionized the treatment of CML, and there are ongoing studies with other kinase inhibitors in MPN and AML. Here we review results of recent studies with first-generation JAK2 inhibitors in the treatment of MPN and second-generation ABL and Flt3 inhibitors in CML and AML, respectively. It is becoming apparent that although these kinase mutations have similar effects in vitro, each of the diseases has unique features that alter the use of kinase inhibitors in the clinic.
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Affiliation(s)
- Emma Scott
- University of Pennsylvania, Philadelphia, 19104, USA
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41
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Kato K, Cui S, Kuick R, Mineishi S, Hexner E, Ferrara JLM, Emerson SG, Zhang Y. Identification of stem cell transcriptional programs normally expressed in embryonic and neural stem cells in alloreactive CD8+ T cells mediating graft-versus-host disease. Biol Blood Marrow Transplant 2010; 16:751-71. [PMID: 20116439 DOI: 10.1016/j.bbmt.2010.01.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 01/20/2010] [Indexed: 02/01/2023]
Abstract
A hallmark of graft-versus-host-disease (GVHD), a life-threatening complication after allogeneic hematopoietic stem cell transplantation, is the cytopathic injury of host tissues mediated by persistent alloreactive effector T cells (T(E)). However, the mechanisms that regulate the persistence of alloreactive T(E) during GVHD remain largely unknown. Using mouse GVHD models, we demonstrate that alloreactive CD8(+) T(E) rapidly diminished in vivo when adoptively transferred into irradiated secondary congenic recipient mice. In contrast, although alloreactive CD8(+) T(E) underwent massive apoptosis upon chronic exposure to alloantigens, they proliferated in vivo in secondary allogeneic recipients, persisted, and caused severe GVHD. Thus, the continuous proliferation of alloreactive CD8(+) T(E), which is mediated by alloantigenic stimuli rather than homeostatic factors, is critical to maintaining their persistence. Gene expression profile analysis revealed that although alloreactive CD8(+) T(E) increased the expression of genes associated with cell death, they activated a group of stem cell genes normally expressed in embryonic and neural stem cells. Most of these stem cell genes are associated with cell cycle regulation, DNA replication, chromatin modification, and transcription. One of these genes, Ezh2, which encodes a chromatin modifying enzyme, was abundantly expressed in CD8(+) T(E). Silencing Ezh2 significantly reduced the proliferation of alloantigen-activated CD8(+) T cells. Thus, these findings identify that a group of stem cell genes could play important roles in sustaining terminally differentiated alloreactive CD8(+) T(E) and may be therapeutic targets for controlling GVHD.
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Affiliation(s)
- Koji Kato
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109-5942, USA
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42
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Neuwirth AK, Sahai I, Falcone JF, Fleming J, Bagg A, Borgna-Pignatti C, Casey R, Fabris L, Hexner E, Mathews L, Ribeiro ML, Wierenga KJ, Neufeld EJ. Thiamine-responsive megaloblastic anemia: identification of novel compound heterozygotes and mutation update. J Pediatr 2009; 155:888-892.e1. [PMID: 19643445 PMCID: PMC2858590 DOI: 10.1016/j.jpeds.2009.06.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 03/25/2009] [Accepted: 06/08/2009] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine causative mutations and clinical status of 7 previously unreported kindreds with TRMA syndrome, (thiamine-responsive megaloblastic anemia, online Mendelian inheritance in man, no. 249270), a recessive disorder of thiamine transporter Slc19A2. STUDY DESIGN Genomic DNA was purified from blood, and SLC19A2 mutations were characterized by sequencing polymerase chain reaction-amplified coding regions and intron-exon boundaries of all probands. Compound heterozygotes were further analyzed by sequencing parents, or cloning patient genomic DNA, to ascertain that mutations were in trans. RESULTS We detected 9 novel SLC19A2 mutations. Of these, 5 were missense, 3 were nonsense, and 1 was insertion. Five patients from 4 kindreds were compound heterozygotes, a finding not reported previously for this disorder, which has mostly been found in consanguineous kindreds. CONCLUSION SLC19A2 mutation sites in TRMA are heterogeneous; with no regional "hot spots." TRMA can be caused by heterozygous compound mutations; in these cases, the disorder is found in outbred populations. To the extent that heterozygous patients were ascertained at older ages, a plausible explanation is that if one or more allele(s) is not null, partial function might be preserved. Phenotypic variability may lead to underdiagnosis or diagnostic delay, as the average time between the onset of symptoms and diagnosis was 8 years in this cohort.
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Affiliation(s)
- Anke K. Neuwirth
- Division of Hematology and Oncology, Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts
| | - Inderneel Sahai
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jill F. Falcone
- Division of Hematology and Oncology, Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts
| | - Judy Fleming
- Translational Research Program, Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia
| | | | - Robin Casey
- Department of Medical Genetics, Alberta Children’s Hospital & University of Calgary, Alberta, Canada
| | - Luca Fabris
- Department of Surgical and Gastroenterological Sciences University of Padova, Italy
| | - Elizabeth Hexner
- Department of Medicine, University of Pennsylvania, Philadelphia
| | - Lulu Mathews
- Department of Pediatrics, Medical College Calicut, Kerala, India
| | | | - Klaas J. Wierenga
- Division of Genetics, Department of Pediatrics, University of Miami, Miller School of Medicine, Florida
| | - Ellis J. Neufeld
- Division of Hematology and Oncology, Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts, Dana-Farber Cancer Institute, Boston, Massachusetts
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Frey NV, Leid CE, Nowell PC, Tomczak E, Strauser HT, Kasner M, Goldstein S, Loren A, Stadtmauer E, Luger S, Hexner E, Hinkle J, Porter DL. Trisomy 8 in an allogeneic stem cell transplant recipient representative of a donor-derived constitutional abnormality. Am J Hematol 2008; 83:846-9. [PMID: 18819096 DOI: 10.1002/ajh.21268] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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] [Indexed: 11/10/2022]
Abstract
Trisomy 8 is a common cytogenetic abnormality in myeloid malignancies. It can also be present constitutionally and is associated with a wide range of phenotypes. We report a case of a 20-year-old woman with acute myelogenous leukemia associated with the 11q23/MLL translocation who underwent allogeneic hematopoietic stem cell transplantation (HSCT) from a healthy, unrelated 26-year-old female. Cytogenetics on a bone marrow biopsy and aspirate performed 71 days after transplant to evaluate pancytopenia identified trisomy 8 in 6 of 7 cells examined. The bone marrow was hypocellular but normal by morphology and flow cytometry. Fluorescent in situ hybridization (FISH) for the original 11q23/MLL translocation was negative. Chimerism analysis using multiplex polymerase chain reaction to amplify an informative short tandem repeat demonstrated 97% donor cells. These findings were confirmed by repeat bone marrow biopsies at Day 110 after transplant and 1 year after transplant. With resolution of comorbid illness, the patient's peripheral blood counts recovered and remained normal at 1 year after HSCT. FISH analysis of a cryopreserved sample of the donor graft showed trisomy 8 in 120 of 200 cells examined. This represents the first reported case of a person with constitutional trisomy 8 mosaicism serving as a stem cell donor. The case illustrates the importance of identifying donor-derived constitutional abnormalities to avoid the assumption that these cytogenetic abnormalities after HSCT are representative of malignant disease.
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Affiliation(s)
- Noelle V Frey
- Division of Hematology-Oncology and Abramson Cancer Center, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Zhang Y, Hexner E, Frank D, Emerson SG. CD4+T Cells Generated De Novo from Donor Hemopoietic Stem Cells Mediate the Evolution from Acute to Chronic Graft-versus-Host Disease. J Immunol 2007; 179:3305-14. [PMID: 17709547 DOI: 10.4049/jimmunol.179.5.3305] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Acute and chronic graft-versus-host disease (GVHD) remain the major complications limiting the efficacy of allogeneic hemopoietic stem cell transplantation. Chronic GVHD can evolve from acute GVHD, or in some cases may overlap with acute GVHD, but how acute GVHD evolves to chronic GVHD is unknown. In this study, in a classical CD8+ T cell-dependent mouse model, we found that pathogenic donor CD4+ T cells developed from engrafted hemopoietic stem cells (HSCs) in C57BL/6SJL(B6/SJL, H-2(b)) mice suffering from acute GVHD after receiving donor CD8+ T cells and HSCs from C3H.SW mice (H-2(b)). These CD4+ T cells were activated, infiltrated into GVHD target tissues, and produced high levels of IFN-gamma. These in vivo-generated CD4+ T cells caused lesions characteristic of chronic GVHD when adoptively transferred into secondary allogeneic recipients and also caused GVHD when administered into autologous C3H.SW recipients. The in vivo generation of pathogenic CD4+ T cells from engrafted donor HSCs was thymopoiesis dependent. Keratinocyte growth factor treatment improved the reconstitution of recipient thymic dendritic cells in CD8+ T cell-repleted allogeneic hemopoietic stem cell transplantation and prevented the development of pathogenic donor CD4+ T cells. These results suggest that de novo-generated donor CD4+ T cells, arising during acute graft-versus-host reactions, are key contributors to the evolution from acute to chronic GVHD. Preventing or limiting thymic damage may directly ameliorate chronic GVHD.
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Affiliation(s)
- Yi Zhang
- Department of Medicine and Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Zhu J, Garrett R, Jung Y, Zhang Y, Kim N, Wang J, Joe GJ, Hexner E, Choi Y, Taichman RS, Emerson SG. Osteoblasts support B-lymphocyte commitment and differentiation from hematopoietic stem cells. Blood 2007; 109:3706-12. [PMID: 17227831 DOI: 10.1182/blood-2006-08-041384] [Citation(s) in RCA: 267] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Early B lymphopoiesis in mammals is induced within the bone marrow (BM) microenvironment, but which cells constitute this niche is not known. Previous studies had shown that osteoblasts (OBs) support hematopoietic stem cell (HSC) proliferation and myeloid differentiation. We now find that purified primary murine OBs also support the differentiation of primitive hematopoietic stem cells through lymphoid commitment and subsequent differentiation to all stages of B-cell precursors and mature B cells. Lin(-)Sca-1(+)Rag-2(-) BM cell differentiation to B cells requires their attachment to OBs in vitro, and this developmental process is mediated via VCAM-1, SDF-1, and IL-7 signaling induced by parathyroid hormone (PTH). Addition of cytokines produced by nonosteoblastic stromal cells (c-Kit ligand, IL-6, and IL-3) shifted the cultures toward myelopoiesis. Confirming the role of OBs in B lymphopoiesis, we found that selective elimination of osteoblasts in Col2.3Delta-TK transgenic mice severely depleted pre-pro-B and pro-B cells from BM, preceding any decline in HSCs. Taken together, these results demonstrate that osteoblasts are both necessary and sufficient for murine B-cell commitment and maturation, and thereby constitute the cellular homolog of the avian bursa of Fabricius.
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Affiliation(s)
- Jiang Zhu
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania School of Medicine, 3600 Spruce Street, Philadelphia, PA 19104, USA
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Mesa RA, Verstovsek S, Cervantes F, Barosi G, Reilly JT, Dupriez B, Levine R, Le Bousse-Kerdiles MC, Wadleigh M, Campbell PJ, Silver RT, Vannucchi AM, Deeg HJ, Gisslinger H, Thomas D, Odenike O, Solberg LA, Gotlib J, Hexner E, Nimer SD, Kantarjian H, Orazi A, Vardiman JW, Thiele J, Tefferi A. Primary myelofibrosis (PMF), post polycythemia vera myelofibrosis (post-PV MF), post essential thrombocythemia myelofibrosis (post-ET MF), blast phase PMF (PMF-BP): Consensus on terminology by the international working group for myelofibrosis research and treatment (IWG-MRT). Leuk Res 2007; 31:737-40. [PMID: 17210175 DOI: 10.1016/j.leukres.2006.12.002] [Citation(s) in RCA: 205] [Impact Index Per Article: 12.1] [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: 11/30/2006] [Revised: 11/30/2006] [Accepted: 12/03/2006] [Indexed: 10/23/2022]
Abstract
The International Working Group for Myelofibrosis Research and Treatment (IWG-MRT) is comprised of hematologists, hematopathologists, and laboratory scientists and its main goal is to provide a forum for scientific exchange and collaboration. During its first general meeting in April 2006, the IWG-MRT established uniform treatment response criteria for chronic idiopathic myelofibrosis (CIMF); also known as agnogenic myeloid metaplasia (AMM), myelofibrosis with myeloid metaplasia (MMM), and many other names in the hematologic literature. This document summarizes the proceedings from the second meeting of the IWG-MRT, in November 2006, where the group discussed and agreed to standardize the nomenclature referring to CIMF: (i) the term primary myelofibrosis (PMF) was chosen over several other designations including CIMF, AMM, and MMM, (ii) myelofibrosis that develops in the setting of either polycythemia vera (PV) or essential thrombocythemia (ET) will be referred to as post-PV MF and post-ET MF, respectively, and (iii) "leukemic" transformation will be recognized as blast phase disease (PMF-BP, post-PV/ET MF in blast phase).
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Affiliation(s)
- Ruben A Mesa
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Abstract
Much attention has focused on the immune recovery of donor T cells following hematopoietic stem cell transplantation (HSCT). Termed immune reconstitution, a better understanding of the dynamics of the functional recovery of immune cells following HSCT has important implications both for fighting infections and, in the allogeneic setting, for providing antitumor activity while controlling graft-vs.-host disease (GVHD). The immune cells involved in immune reconstitution include antigen-presenting cells, B lymphocytes, natural killer cells, and, in particular, T lymphocytes, the immune cell that will be the subject of this review. In addition, T cells can play an important role in the process of engraftment of hematopoietic stem cells. The evidence for a T cell tropic effect on hematopoietic engraftment is both direct and indirect, and comes from the clinic as well as the research lab. Animal models have provided useful clues, but the molecular mechanisms that govern the interaction between donor stem cells, donor T cells, the host immune system, and the stem cell niche remain obscure. This review will describe the current published clinical and basic evidence related to T cells and stem cell engraftment, and will identify future directions for translational research in this area.
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Affiliation(s)
- Elizabeth Hexner
- Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Zhang Y, Hexner E, Frank D, Joe G, Emerson S. Alloreactive memory T cells induce chronic graft-versus-host disease. Biol Blood Marrow Transplant 2006. [DOI: 10.1016/j.bbmt.2005.11.193] [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: 11/25/2022]
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Hexner E, Danet-Desnoyers GA, Zhang Y, Secreto A, Emerson S. Revealing the effects of T cell depletion on engraftment of umbilical cord blood using the B2microglobulin−/−/NOD/SCID xenograft model. Biol Blood Marrow Transplant 2006. [DOI: 10.1016/j.bbmt.2005.11.233] [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: 10/25/2022]
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Zhang Y, Joe G, Hexner E, Zhu J, Emerson SG. Host-reactive CD8+ memory stem cells in graft-versus-host disease. Nat Med 2005; 11:1299-305. [PMID: 16288282 DOI: 10.1038/nm1326] [Citation(s) in RCA: 268] [Impact Index Per Article: 14.1] [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: 05/20/2005] [Accepted: 10/15/2005] [Indexed: 11/08/2022]
Abstract
Graft-versus-host disease (GVHD) is caused by alloreactive donor T cells that trigger host tissue injury. GVHD develops over weeks or months, but how this immune response is maintained over time is unknown. In mouse models of human GVHD, we identify a new subset of postmitotic CD44(lo)CD62L(hi)CD8(+) T cells that generate and sustain all allogeneic T-cell subsets in GVHD reactions, including central memory, effector memory and effector CD8(+) T cells, while self-renewing. These cells express Sca-1, CD122 and Bcl-2, and induce GVHD upon transfer into secondary recipients. The postmitotic CD44(lo)CD62L(hi)CD8(+) T cells persist throughout the course of GVHD, are generated in the initial phase in response to alloantigens and dendritic cells and require interleukin-15. Thus, their long life, ability to self-renew and multipotentiality define these cells as candidate memory stem cells. Memory stem cells will be important targets for understanding and influencing diverse chronic immune reactions, including GVHD.
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Affiliation(s)
- Yi Zhang
- Department of Medicine, University of Pennsylvania School of Medicine, Room 510, Maloney, 3600 Spruce Street, Philadelphia, Pennsylvania 19104, USA
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