1
|
Ghorashian S, Lucchini G, Richardson R, Nguyen K, Terris C, Guvenel A, Oporto-Espuelas M, Yeung J, Pinner D, Chu J, Williams L, Ko KY, Walding C, Watts K, Inglott S, Thomas R, Connor C, Adams S, Gravett E, Gilmour K, Lal A, Kunaseelan S, Popova B, Lopes A, Ngai Y, Hackshaw A, Kokalaki E, Carulla MB, Mullanfiroze K, Lazareva A, Pavasovic V, Rao A, Bartram J, Vora A, Chiesa R, Silva J, Rao K, Bonney D, Wynn R, Pule M, Hough R, Amrolia PJ. CD19/CD22 targeting with cotransduced CAR T cells to prevent antigen-negative relapse after CAR T-cell therapy for B-cell ALL. Blood 2024; 143:118-123. [PMID: 37647647 DOI: 10.1182/blood.2023020621] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023] Open
Abstract
ABSTRACT CD19-negative relapse is a leading cause of treatment failure after chimeric antigen receptor (CAR) T-cell therapy for acute lymphoblastic leukemia. We investigated a CAR T-cell product targeting CD19 and CD22 generated by lentiviral cotransduction with vectors encoding our previously described fast-off rate CD19 CAR (AUTO1) combined with a novel CD22 CAR capable of effective signaling at low antigen density. Twelve patients with advanced B-cell acute lymphoblastic leukemia were treated (CARPALL [Immunotherapy with CD19/22 CAR Redirected T Cells for High Risk/Relapsed Paediatric CD19+ and/or CD22+ Acute Lymphoblastic Leukaemia] study, NCT02443831), a third of whom had failed prior licensed CAR therapy. Toxicity was similar to that of AUTO1 alone, with no cases of severe cytokine release syndrome. Of 12 patients, 10 (83%) achieved a measurable residual disease (MRD)-negative complete remission at 2 months after infusion. Of 10 responding patients, 5 had emergence of MRD (n = 2) or relapse (n = 3) with CD19- and CD22-expressing disease associated with loss of CAR T-cell persistence. With a median follow-up of 8.7 months, there were no cases of relapse due to antigen-negative escape. Overall survival was 75% (95% confidence interval [CI], 41%-91%) at 6 and 12 months. The 6- and 12-month event-free survival rates were 75% (95% CI, 41%-91%) and 60% (95% CI, 23%-84%), respectively. These data suggest dual targeting with cotransduction may prevent antigen-negative relapse after CAR T-cell therapy.
Collapse
Affiliation(s)
- Sara Ghorashian
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
- Department of Developmental Biology and Cancer, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Giovanna Lucchini
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Rachel Richardson
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Kyvi Nguyen
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Craig Terris
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Aleks Guvenel
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Macarena Oporto-Espuelas
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jenny Yeung
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Danielle Pinner
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Jan Chu
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Lindsey Williams
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Ka-Yuk Ko
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Chloe Walding
- Department of Haematology, University College London Hospital Trust, London, United Kingdom
| | - Kelly Watts
- Department of Blood and Marrow Transplant, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Sarah Inglott
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Rebecca Thomas
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Christopher Connor
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Stuart Adams
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Emma Gravett
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Kimberly Gilmour
- Cell Therapy and Immunology Laboratory, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Alka Lal
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | | | - Bilyana Popova
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Andre Lopes
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Yenting Ngai
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | | | - Milena Balasch Carulla
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Khushnuma Mullanfiroze
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Arina Lazareva
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Vesna Pavasovic
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Anupama Rao
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Jack Bartram
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Ajay Vora
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Robert Chiesa
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Juliana Silva
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Kanchan Rao
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Denise Bonney
- Department of Blood and Marrow Transplant, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Robert Wynn
- Department of Blood and Marrow Transplant, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | | | - Rachael Hough
- Department of Haematology, University College London Hospital Trust, London, United Kingdom
| | - Persis J Amrolia
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| |
Collapse
|
2
|
Rajeev A, Gravett E, Koshy G, Devalia K. The outcomes of constrained total hip arthroplasty for recurrent dislocation of hip hemiarthroplasty. Injury 2023; 54:110970. [PMID: 37595486 DOI: 10.1016/j.injury.2023.110970] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION The incidence of hemiarthroplasty dislocation for fracture neck of femurs ranges between 1 and 15% and the one-year mortality is 49- 70%. Revision of hemiarthroplasty to total hip replacement using a constrained liner has shown to improve the morbidity and mortality rates. The aim of the study was to assess whether conversion of dislocated hemiarthroplasty to total hip replacement improve functional and one year mortality. METHODS A retrospective analysis of the number of patients who had recurrent dislocations of hemiarthroplasty for fracture neck of femurs were carried out. The data were obtained from NHFD (National Hip Fracture Database) and internal hospital computer systems (Medway, Theatre notes and PACS) between Dec 2008 and Dec 2020. Patient demographics including age, sex, Abbreviated Mental Test Score (AMTS), functional assessment, mortality at one and two years were documented. The risk factors which led to dislocations such as Parkinsons disease, Cerebrovascular accidents, Musculo-neuropathies and Alzheimer`s disease was also noted. RESULTS A total of 3994 patients were admitted during the study period of which 1735 (43.4%) patients had hemiarthroplasty. Fifty-six (3.23%) patients had dislocation of hemiarthroplasty. The mean age was 81.4 years (range - 61 to 95). There were 40 (71.4%) females and 16 males (28.6%). The average AMTS score was 5.3. All 56 patients had closed manipulative reduction under anaesthesia within in 12 h of admission. Thirty-one patients (55.4%) went on to have recurrent dislocations of which 18 patients (58.4%) had total hip replacement using captive cup, 6 patients (19.4%) had open reduction,3 patients (9.7%) had excision arthroplasty procedure and four patients (12.5%) had no intervention, Eighteen patients who had total hip replacement with constrained captive for followed up to a minimum of two years (range2- 12 years). There were no intraoperative complications, dislocation or periprosthetic fractures in the follow up period. There was no mortality at the end of two years of follow up in this group, two-year mortality for the patients with alternative management for dislocated hemiarthroplasty was 76.67. CONCLUSION Treatment of recurrent hemiarthroplasty dislocation by revising to a total hip replacement with a constrained liner gives good functional and mortality outcomes.
Collapse
Affiliation(s)
- Aysha Rajeev
- Department of Trauma and Orthopaedics, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead, Tyne and Wear, NE9 6SX, United Kingdom.
| | - Emma Gravett
- Department of Trauma and Orthopaedics, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead, Tyne and Wear, NE9 6SX, United Kingdom
| | - George Koshy
- Department of Trauma and Orthopaedics, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead, Tyne and Wear, NE9 6SX, United Kingdom
| | - Kailash Devalia
- Department of Trauma and Orthopaedics, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead, Tyne and Wear, NE9 6SX, United Kingdom
| |
Collapse
|
3
|
Ayesha R, Gravett E, Craig J, Anto J. 796 Post Operative Drop in Haemoglobin Is Associated with Increased Morbidity and Mortality in Fracture Neck of Femurs. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.473] [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: 11/07/2022]
Abstract
Abstract
Aim
Post-operative anaemia in hip fracture patients is associated with increased risk of blood transfusion, poorer outcomes, increased morbidity, and mortality. Our aim is measure the drop in haemoglobin(Hb) post-operatively in hip fracture surgery and its impact on length of stay, morbidity and 30-day mortality.
Method
A retrospective study of neck-of-femur patients looking at pre-op and discharge haemoglobin levels, taking into consideration conditions that could affect Hb, and adverse effects peri-operatively.Data collected from Medway, Clinic letters, ICE and NHFD database.
Results
257 patients were included in the study. Mean age was 82(range 43–100). Pre-operatively 60(23%) had normal Hb, 34(13%) had borderline, and 163(64%) had severe anaemia. 131(51%) had hemi-arthroplasty, 61(24%) had DHS, 45(18%) had IM nail and 20(7%) had THR.Normal Hb found in 62 patients (24%), 33(13%) had borderline and 162(63%) had severe anaemia at discharge.30 patients (11.7%) had post-op transfusions and 7 were prescribed oral iron. Readmission rate was 4.3%(11 patents) of which 8(73%) had severe anaemia.Average length of stay in patients with severe anaemia was 21 days.Overall 30-day mortality was 17%(43 patients); in patients with severe anaemia, mortality was 50%(21 patients).
Conclusions
Most patients (63%) had severe anaemia at discharge. There was a significant drop of Hb post-operatively especially THR and hemi-arthroplasty. Our study demonstrates pre-surgical anaemia in hip fracture patients is associated with increased hospital morbidity and mortality.Identification of anaemia at admission and discharge provides an opportunity for treatment to avoid transfusions and improve patient outcomes.
Collapse
Affiliation(s)
- R Ayesha
- Queen Elizabeth Hospital , Gateshead , United Kingdom
| | - E Gravett
- Queen Elizabeth Hospital , Gateshead , United Kingdom
| | - J Craig
- Queen Elizabeth Hospital , Gateshead , United Kingdom
| | - J Anto
- Queen Elizabeth Hospital , Gateshead , United Kingdom
| |
Collapse
|
4
|
Adams SP, Gravett E, Kent N, Kricke S, Ifederu A, Scoto M, Samsuddin S, Muntoni F. Screening of Neonatal UK Dried Blood Spots Using a Duplex SMN1 Screening Assay. Int J Neonatal Screen 2021; 7:ijns7040069. [PMID: 34842601 PMCID: PMC8629004 DOI: 10.3390/ijns7040069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022] Open
Abstract
Spinal muscular atrophy (SMA) is an autosomal inherited neuromuscular genetic disease caused, in 95% of cases, by homozygous deletions involving the SMN1 gene exon 7. It remains the leading cause of death in children under 2 years of age. New treatments have been developed and adopted for use in many countries, including the UK. Success of these treatments depends on early diagnosis and intervention in newborn babies, and many countries have implemented a newborn screening (NBS) or pilot NBS program to detect SMN1 exon 7 deletions on dried blood spots. In the UK, there is no current NBS program for SMA, and no pilot studies have commenced. For consideration of adoption of NBS for a new condition, numerous criteria must be satisfied, including critical assessment of a working methodology. This study uses a commercially available real-time PCR assay to simultaneously detect two different DNA segments (SMN1 exon 7 and control gene RPP30) using DNA extracted from a dried blood spot. This study was carried out in a routine clinical laboratory to determine the specificity, sensitivity, and feasibility of SMA screening in a UK NBS lab setting. Just under 5000 normal DBSs were used alongside 43 known SMA positive DBSs. Study results demonstrate that NBS for SMA using real-time PCR is feasible within the current UK NBS Laboratory infrastructure using the proposed algorithm.
Collapse
Affiliation(s)
- Stuart P. Adams
- SIHMDS-Haematology, Camelia Botnar Labs, Great Ormond Street Hospital for Children, London WC1N 3JH, UK; (E.G.); (N.K.); (S.K.)
- Infection, Immunity and Inflammation Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Correspondence: ; Tel.: +44-207-405-9200-x5400
| | - Emma Gravett
- SIHMDS-Haematology, Camelia Botnar Labs, Great Ormond Street Hospital for Children, London WC1N 3JH, UK; (E.G.); (N.K.); (S.K.)
| | - Natalie Kent
- SIHMDS-Haematology, Camelia Botnar Labs, Great Ormond Street Hospital for Children, London WC1N 3JH, UK; (E.G.); (N.K.); (S.K.)
| | - Susanne Kricke
- SIHMDS-Haematology, Camelia Botnar Labs, Great Ormond Street Hospital for Children, London WC1N 3JH, UK; (E.G.); (N.K.); (S.K.)
| | - Adeboye Ifederu
- Newborn Screening Unit, Camelia Botnar Labs, Great Ormond Street Hospital for Children, London WC1N 3JH, UK;
| | - Mariacristina Scoto
- Developmental Neurosciences Research & Teaching Department, Molecular Neurosciences, Dubowitz Neuromuscular Unit, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK; (M.S.); (S.S.); (F.M.)
- The Dubowitz Neuromuscular Centre, Great Ormond Street Hospital, London WC1N 1EH, UK
| | - Salma Samsuddin
- Developmental Neurosciences Research & Teaching Department, Molecular Neurosciences, Dubowitz Neuromuscular Unit, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK; (M.S.); (S.S.); (F.M.)
| | - Francesco Muntoni
- Developmental Neurosciences Research & Teaching Department, Molecular Neurosciences, Dubowitz Neuromuscular Unit, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK; (M.S.); (S.S.); (F.M.)
| |
Collapse
|