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Yang J, Yang L, Tordon B, Bucher O, Nugent Z, Landego I, Bourrier N, Uminski K, Brown K, Squires M, Marshall AJ, Katyal S, Mahmud S, Decker K, Geirnaert M, Dawe DE, Gibson SB, Johnston JB, Banerji V. Clinical Outcomes in a Large Canadian Centralized CLL Clinic Based on Treatment and Molecular Factors over a Decade. Curr Oncol 2023; 30:6411-6431. [PMID: 37504332 PMCID: PMC10378068 DOI: 10.3390/curroncol30070472] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
FISH cytogenetics, TP53 sequencing, and IGHV mutational status are increasingly used as prognostic and predictive markers in chronic lymphocytic leukemia (CLL), particularly as components of the CLL International Prognostic Index (CLL-IPI) and in directing therapy with novel agents. However, testing outside of clinical trials is not routinely available in Canada. As a centralized CLL clinic at CancerCare Manitoba, we are the first Canadian province to evaluate clinical outcomes and survivorship over a long period of time, incorporating the impact of molecular testing and the CLL-IPI score. We performed a retrospective analysis on 1315 patients diagnosed between 1960 and 2018, followed over a 12-year period, where 411 patients had molecular testing and 233 patients had a known CLL-IPI score at the time of treatment. Overall, 40.3% (n = 530) of patients received treatment, and 47.5% (n = 252) of patients received multiple lines of therapy. High-risk FISH and CLL-IPI (4-10) were associated with higher mortality (HR 2.03, p = 0.001; HR 2.64, p = 0.002), consistent with other studies. Over time, there was an increase in the use of targeted agents in treated patients. The use of Bruton's tyrosine kinase inhibitors improved survival in patients with unmutated IGHV and/or TP53 aberrations (HR 2.20, p = 0.001). The major cause of death in patients who received treatment was treatment/disease-related (32%, n = 42) and secondary malignancies (57%, n = 53) in those who were treatment-naïve. Our data demonstrate the importance of molecular testing in determining survivorship in CLL and underpinning the likely immune differences in outcomes for those treated for CLL.
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Affiliation(s)
- Jiayu Yang
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Lin Yang
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Bryan Tordon
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Oliver Bucher
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Zoann Nugent
- Department of Biochemistry and Medical Genetics Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Ivan Landego
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Nicole Bourrier
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Kelsey Uminski
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Kevin Brown
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Mandy Squires
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Aaron J Marshall
- Department of Immunology, Max Rady College of Medicine, University of Manitoba, Rady Faculty of Health Sciences, Winnipeg, MB R3E 0T5, Canada
| | - Sachin Katyal
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
- Department of Pharmacology and Therapeutics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Salah Mahmud
- Department of Community Health Sciences, Max Rady College of Medicine Community Health Sciences, Winnipeg, MB R3E 0W2, Canada
| | - Kathleen Decker
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
- Department of Community Health Sciences, Max Rady College of Medicine Community Health Sciences, Winnipeg, MB R3E 0W2, Canada
| | - Marc Geirnaert
- Department of Pharmacy, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - David E Dawe
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Spencer B Gibson
- Department of Biochemistry and Medical Genetics Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - James B Johnston
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Versha Banerji
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Department of Biochemistry and Medical Genetics Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
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Wu X, Thisdelle J, Hou S, Fajardo-Despaigne JE, Gibson SB, Johnston JB, Dawe DE, Banerji V, Marshall AJ. Elevated expression of interleukin 16 in chronic lymphocytic leukemia is associated with disease burden and abnormal immune microenvironment. Leuk Res 2023; 131:107315. [PMID: 37263073 DOI: 10.1016/j.leukres.2023.107315] [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: 01/18/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
Interleukin-16 (IL-16) is a novel biomarker that has been implicated in many cancers as well as inflammatory diseases. In this study, we examined plasma levels of 30 cytokines and chemokines in chronic lymphocytic leukemia (CLL) and monoclonal B cell lymphocytosis (MBL) patients, and examined their association with disease stage, CLL biomarkers and T cell subsets. Interleukin 16 (IL-16) was identified as a relatively uncharacterized cytokine significantly elevated in CLL patients compared to healthy controls and MBL patients. Plasma levels of IL-16 were significantly elevated by Rai stage 0, increased by Rai stage 3-4, correlated strongly with lymphocyte count and were decreased after Ibrutinib treatment. CLL cells expressed IL-16 mRNA and spontaneously secreted IL-16 in vitro. CLL cells express IL-16 mRNA at significantly higher levels in lymphoid tissues than blood, and we observed that IL-16 release was increased in co-cultures of CLL and autologous CD4 + T cells. Elevated plasma IL-16 levels were associated with abnormalities in the immune microenvironment including multiple inflammatory cytokines and chemokines and expansion of type 1 follicular helper T cells. Taken together, our results identify IL-16 as a novel biomarker in CLL with potential functional roles in cellular interactions between CLL cells and T cells.
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Affiliation(s)
- Xun Wu
- Department of Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jordan Thisdelle
- Department of Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sen Hou
- Department of Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Spencer B Gibson
- Department of Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Department of Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba Research Institute, Winnipeg, MB, Canada
| | - James B Johnston
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba Research Institute, Winnipeg, MB, Canada
| | - David E Dawe
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba Research Institute, Winnipeg, MB, Canada
| | - Versha Banerji
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba Research Institute, Winnipeg, MB, Canada
| | - Aaron J Marshall
- Department of Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Department of Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba Research Institute, Winnipeg, MB, Canada
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3
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Choquette T, Henson ES, Yang X, Johnston JB, Gibson SB. A novel method to investigate drug resistance in the chronic lymphocytic leukemia (CLL) microenvironment: Analysis of CLL Cellular Environment and Response (ACCER). Leuk Lymphoma 2023; 64:822-834. [PMID: 36803637 DOI: 10.1080/10428194.2023.2171729] [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: 02/22/2023]
Abstract
Microenvironments such as lymph nodes allow chronic lymphocytic leukemia (CLL) cells to survive and become drug resistant. There are limited methods to study the to study the contribution of the stromal microenvironment. We have adapted a solid tumor microenvironment cell culture system that provides elements of the CLL microenvironment called Analysis of CLL Cellular Environment and Response (ACCER). We optimized the cell number for patient's primary CLL cells and HS-5 human bone marrow stromal cell line that will give sufficient cell number and viability with the ACCER. We then determined the amount of collagen type 1 to give the best extracellular matrix to seed CLL cells to the membrane. Finally, we determined that ACCER provide CLL cell protection against cell death following treatment with fludarabine and ibrutinib compared to co-culture conditions. This describes novel microenvironment model to investigate factors that promote drug resistance in CLL.
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Affiliation(s)
- Tricia Choquette
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth S Henson
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Xiaoyan Yang
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - James B Johnston
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Spencer B Gibson
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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Ravandi F, Kreitman RJ, Tiacci E, Andritsos L, Banerji V, Barrientos JC, Bhat SA, Blachly JS, Broccoli A, Call T, Chihara D, Dearden C, Demeter J, Dietrich S, Else M, Epperla N, Falini B, Forconi F, Gladstone DE, Gozzetti A, Iyengar S, Johnston JB, Jorgensen J, Juliusson G, Lauria F, Lozanski G, Parikh SA, Park JH, Polliack A, Quest G, Robak T, Rogers KA, Saven A, Seymour JF, Tadmor T, Tallman MS, Tam CS, Thompson PA, Troussard X, Zent CS, Zenz T, Zinzani PL, Wörmann B, Rai K, Grever M. Consensus opinion from an international group of experts on measurable residual disease in hairy cell leukemia. Blood Cancer J 2022; 12:165. [PMID: 36509740 PMCID: PMC9744664 DOI: 10.1038/s41408-022-00760-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/14/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
A significant body of literature has been generated related to the detection of measurable residual disease (MRD) at the time of achieving complete remission (CR) in patients with hairy cell leukemia (HCL). However, due to the indolent nature of the disease as well as reports suggesting long-term survival in patients treated with a single course of a nucleoside analog albeit without evidence of cure, the merits of detection of MRD and attempts to eradicate it have been debated. Studies utilizing novel strategies in the relapse setting have demonstrated the utility of achieving CR with undetectable MRD (uMRD) in prolonging the duration of remission. Several assays including immunohistochemical analysis of bone marrow specimens, multi-parameter flow cytometry and molecular assays to detect the mutant BRAF V600E gene or the consensus primer for the immunoglobulin heavy chain gene (IGH) rearrangement have been utilized with few comparative studies. Here we provide a consensus report on the available data, the potential merits of MRD assessment in the front-line and relapse settings and recommendations on future role of MRD assessment in HCL.
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Affiliation(s)
- Farhad Ravandi
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Robert J Kreitman
- Laboratory of Molecular Biology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Enrico Tiacci
- Institute of Hematology, Department of Medicine and Surgery, University and Hospital of Perugia, Perugia, Italy
| | - Leslie Andritsos
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Versha Banerji
- Department of Internal Medicine & Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Jacqueline C Barrientos
- Feinstein Institutes for Medical Research and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Seema A Bhat
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - James S Blachly
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Alessandro Broccoli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli"; and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
| | - Timothy Call
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Dai Chihara
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Judit Demeter
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Sasha Dietrich
- Department of Hematology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Monica Else
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Narendranath Epperla
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Brunangelo Falini
- Institute of Hematology, Department of Medicine and Surgery, University and Hospital of Perugia, Perugia, Italy
| | - Francesco Forconi
- School of Cancer Sciences, Cancer Research UK Southampton Centre, Faculty of Medicine, University of Southampton, Southampton, UK
- Haematology Department, Cancer Care Directorate, University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Alessandro Gozzetti
- Dept. of Medicine, Surgery and Neurosciences, University of Siena, Policlinico S. Maria alle Scotte-, Siena, Italy
| | | | - James B Johnston
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jeffrey Jorgensen
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Gerard Lozanski
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA
| | | | - Jae H Park
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Kerry A Rogers
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Alan Saven
- Division of Hematology and Oncology, Scripps Clinic, La Jolla, CA, USA
| | - John F Seymour
- Haematology Department, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Tamar Tadmor
- Hematology Unit, Bnai Zion Medical Center; and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Martin S Tallman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Constantine S Tam
- Department of Haematology, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Philip A Thompson
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xavier Troussard
- Department of Hematology, Centre Hospitalier Universitaire Cote de Nacre, Caen, France
| | - Clive S Zent
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Thorsten Zenz
- Dept. of Medical Oncology and Haematology, University Hospital Zürich and University of Zurich (UZH), Zurich, Switzerland
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli"; and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
| | | | - Kanti Rai
- Feinstein Institutes for Medical Research and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Michael Grever
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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Andritsos LA, Anghelina M, Neal J, Blachly JS, Mathur P, Lele O, Dearden C, Iyengar S, Cross M, Zent CS, Rogers KA, Epperla N, Lozanski G, Oakes CC, Kraut E, Ruppert AS, Zhao Q, Bhat SA, Forconi F, Banerji V, Handunnetti S, Tam CS, Seymour JF, Else M, Kreitman RJ, Saven A, Call T, Parikh SA, Ravandi F, Johnston JB, Tiacci E, Troussard X, Tallman MS, Dietrich S, Tadmor T, Gozzetti A, Zinzani PL, Robak T, Quest G, Demeter J, Rai K, Fernandez SA, Grever M. Development of a distributed international patient data registry for hairy cell leukemia. Leuk Lymphoma 2022; 63:3021-3031. [PMID: 36070610 PMCID: PMC9990910 DOI: 10.1080/10428194.2022.2109157] [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: 06/13/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 01/11/2023]
Abstract
Hairy cell leukemia (HCL) is a rare lymphoproliferative disorder, comprising only 2% of all leukemias. The Hairy Cell Leukemia Foundation (HCLF) has developed a patient data registry to enable investigators to better study the clinical features, treatment outcomes, and complications of patients with HCL. This system utilizes a centralized registry architecture. Patients are enrolled at HCL Centers of Excellence (COE) or via a web-based portal. All data are de-identified, which reduces regulatory burden and increases opportunities for data access and re-use. To date, 579 patients have been enrolled in the registry. Efforts are underway to engage additional COE's to expand access to patients across the globe. This international PDR will enable researchers to study outcomes in HCL in ways not previously possible due to the rarity of the disease and will serve as a platform for future prospective research.
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Affiliation(s)
- Leslie A Andritsos
- Division of Hematology Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Mirela Anghelina
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Jasmine Neal
- Department of Internal Medicine, Division of Hematology, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - James S Blachly
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Puneet Mathur
- Department of Research Information Technology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Omkar Lele
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | | | | | | | - Clive S Zent
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Kerry A Rogers
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Narendranath Epperla
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Christopher C Oakes
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Eric Kraut
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Amy S Ruppert
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Qiuhong Zhao
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Seema A Bhat
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Francesco Forconi
- Cancer Sciences and Haematology Department, University of Southampton Hospital Trust, Southampton, UK
| | - Versha Banerji
- Department of Internal Medicine & Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Research Institute in Oncology and Hematology, Winnipeg, Canada
| | - Sasanka Handunnetti
- Haematology Department, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Constantine S Tam
- Haematology Department, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - John F Seymour
- Haematology Department, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Monica Else
- The Institute of Cancer Research, London, UK
| | - Robert J Kreitman
- Laboratory of Molecular Biology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Alan Saven
- Division of Hematology and Oncology, Scripps Clinic, La Jolla, CA, USA
| | - Timothy Call
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Farhad Ravandi
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James B Johnston
- Department of Internal Medicine & Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Research Institute in Oncology and Hematology, Winnipeg, Canada
| | - Enrico Tiacci
- Department of Medicine and Surgery, Institute of Hematology, University and Hospital of Perugia, Perugia, Italy
| | - Xavier Troussard
- Department of Hematology, Centre Hospitalier Universitaire Cote de Nacre, Caen, France
| | - Martin S Tallman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sascha Dietrich
- Department of Hematology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Tamar Tadmor
- Hematology Division, Bnai Zion Medical Center and The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Alessandro Gozzetti
- Department of Medicine, University of Siena Policlinico S Maria alle Scotte, Siena, Italy
| | - Pier Luigi Zinzani
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università degli Studi, IRCCS Azienda Ospedaliero-Universitaria di Bologna and Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Graeme Quest
- Pathology and Molecular Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Canada
| | - Judit Demeter
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Kanti Rai
- Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Soledad A Fernandez
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Michael Grever
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
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Righolt CH, Zhang G, Gibson SB, Johnston JB, Banerji V, Mahmud SM. Patterns and predictors of referral to the specialized chronic lymphocytic leukemia clinic in Manitoba, Canada. Cancer Epidemiol 2022; 81:102279. [PMID: 36279643 DOI: 10.1016/j.canep.2022.102279] [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] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/26/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Better CLL patient survival has been reported for specialized CLL clinics/hematologists (compared to other CLL patients). It is possible that improved survival is driven by a better prognosis of referred patients. METHODS We used logistic regression to calculate the odds ratios (ORs) and 95 % confidence intervals 95 %CIs) of the association between patient characteristics and CLL referral of all persons diagnosed in 2005-2016 with a pathologically-confirmed CLL or SLL. RESULTS Two-thirds of 1293 patients were referred to the CLL clinic. Referred patients were younger (16 % vs 44 % were 80 +) and in better health (47 % vs 56 % with a chronic diseases) than non-referred patients. Referral increased over time: in 2005-2010, about 60 % of patients were referred; in 2011-2016, this increased to 76 %. Gender did not affect referral (the OR for females is 1.0, 95 %CI 0.8-1.2), but age played a major role; CLL patients diagnosed at age 80 + were less likely to be referred than patients diagnosed < 60, 0.2 (0.1-0.3). CONCLUSION Because referral to Manitoba's specialized CLL clinic is associated with age and the patient's overall health before referral, one should be careful in interpreting differences in outcomes between CLL patients based on referral status alone.
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MESH Headings
- Aged, 80 and over
- Female
- Humans
- Canada
- Chronic Disease
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Manitoba/epidemiology
- Referral and Consultation/statistics & numerical data
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Affiliation(s)
- Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, 337-750 McDermot Avenue, Winnipeg, MB, Canada R3E 0T5
| | - Geng Zhang
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, 337-750 McDermot Avenue, Winnipeg, MB, Canada R3E 0T5
| | - Spencer B Gibson
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Hematology and Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - James B Johnston
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Hematology and Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Versha Banerji
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Hematology and Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, 337-750 McDermot Avenue, Winnipeg, MB, Canada R3E 0T5.
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Bourrier N, Landego I, Bucher O, Squires M, Streu E, Hibbert I, Whiteside T, Gibson SB, Geirnaert M, Johnston JB, Dawe DE, Banerji V. Real world risk of infusion reactions and effectiveness of front-line obinutuzumab plus chlorambucil compared with other frontline treatments for chronic lymphocytic leukemia. BMC Cancer 2022; 22:148. [PMID: 35123433 PMCID: PMC8818183 DOI: 10.1186/s12885-022-09256-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in North America. Previous studies have shown improved progression free survival (PFS) and response rates in unfit patients treated with obinutuzumab compared to other regimens. The aim of this study was to evaluate the obinutuzumab-chlorambucil regimen in the context of historical treatments and first-dose infusion reactions at CancerCare Manitoba (CCMB). Methods A retrospective chart review was conducted for patients treated with obinutuzumab from January 1, 2014 to December 31, 2017 at CCMB. A minimum data set was extracted for patients treated with other front-line therapies. Descriptive statistics were used to evaluate patient demographics, toxicity, duration and dosing of obinutuzumab treatment. Kaplan–Meier curves were used to evaluate time-to-next-treatment (TTNT), overall survival (OS) and PFS for patients treated with obinutuzumab. A multivariable logistic regression model was used to investigate associations between infusion related reactions (IRRs) and age at treatment, pre-treatment lymphocyte count, cumulative illness rating scale (CIRS) and receipt of prior chemotherapy. Results Forty seven percent of patients receiving frontline therapy received chlorambucil and obinutuzumab. Sixty-seven patients were treated with obinutuzumab and consisted of 36 males (53.7%) and 31 females (46.3%) with 29 patients (43.3%) over age 75 years. Rates of grade 3 and 4 obinutuzumab IRRs were lower (6%) compared to the CLL11 clinical trial (20%) due to local practices including slower infusion rates and using chlorambucil before starting obinutuzumab treatment. Many patients had difficulty tolerating the full dosage of chlorambucil. Only 26 patients (38.8%) had their dose of chlorambucil escalated to the full dose of 0.5 mg/kg. In addition, only 18 patients (26.9%) received all doses of obinutuzumab and all 12 doses of chlorambucil. Conclusions In summary, first dose infusion reactions with obinutuzumab can be markedly reduced by using chlorambucil to decrease the lymphocyte count before obinutuzumab and by using a very slow initial obinutuzumab infusion rate. Modifications in chlorambucil dosing and obinutuzumab administration can improve tolerance without significant loss in efficacy. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09256-2.
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Wu X, Fajardo-Despaigne JE, Zhang C, Neppalli V, Banerji V, Johnston JB, Gibson SB, Marshall AJ. Altered T Follicular Helper Cell Subsets and Function in Chronic Lymphocytic Leukemia. Front Oncol 2021; 11:674492. [PMID: 33996605 PMCID: PMC8113764 DOI: 10.3389/fonc.2021.674492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Follicular helper T cells (TFH) have specialized properties in promoting normal B cell activation but their role in chronic lymphocytic leukemia (CLL) is unknown. We find that TFH cells are elevated in CLL patients and are phenotypically abnormal, expressing higher levels of PD-1, TIGIT, CD40L, IFNγ and IL-21, and exhibiting abnormal composition of TFH1, TFH2 and TFH17 subsets. Frequencies of CD4-positive T cells expressing TFH1 markers and IL-21 were positively correlated with patient lymphocyte counts and RAI stage, suggesting that accumulation of abnormal TFH cells is concomitant with expansion of the leukemic B cell clone. Treatment with ibrutinib led to normalization of TFH frequencies and phenotype. TFH cells identified in CLL bone marrow display elevated expression of several functional markers compared to blood TFH cells. CLL T cell-B cell co-culture experiments revealed a correlation of patient TFH frequencies with functional ability of their CD4-positive T cells to promote CLL proliferation. Conversely, CLL cells can preferentially activate the TFH cell subset in co-culture. Together our results indicate that CLL development is associated with expansion of abnormal TFH populations that produce elevated levels of cytokines and costimulatory molecules which may help support CLL proliferation.
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Affiliation(s)
- Xun Wu
- Department of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - J Ernesto Fajardo-Despaigne
- Department of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Christine Zhang
- Department of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Vishala Neppalli
- Hematopathology Laboratory, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Versha Banerji
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James B Johnston
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Spencer B Gibson
- Department of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Aaron J Marshall
- Department of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Biochemistry and Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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9
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Slager SL, Lanasa MC, Marti GE, Achenbach SJ, Camp NJ, Abbasi F, Kay NE, Vachon CM, Cerhan JR, Johnston JB, Call TG, Rabe KG, Kleinstern G, Boddicker NJ, Norman AD, Parikh SA, Leis JF, Banerji V, Brander DM, Glenn M, Ferrajoli A, Curtin K, Braggio E, Shanafelt TD, McMaster ML, Weinberg JB, Hanson CA, Caporaso NE. Natural history of monoclonal B-cell lymphocytosis among relatives in CLL families. Blood 2021; 137:2046-2056. [PMID: 33512457 PMCID: PMC8057266 DOI: 10.1182/blood.2020006322] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 04/20/2020] [Accepted: 11/14/2020] [Indexed: 12/21/2022] Open
Abstract
Chronic lymphocytic lymphoma (CLL) has one of the highest familial risks among cancers. Monoclonal B-cell lymphocytosis (MBL), the precursor to CLL, has a higher prevalence (13%-18%) in families with 2 or more members with CLL compared with the general population (5%-12%). Although, the rate of progression to CLL for high-count MBLs (clonal B-cell count ≥500/µL) is ∼1% to 5%/y, no low-count MBLs have been reported to progress to date. We report the incidence and natural history of MBL in relatives from CLL families. In 310 CLL families, we screened 1045 relatives for MBL using highly sensitive flow cytometry and prospectively followed 449 of them. MBL incidence was directly age- and sex-adjusted to the 2010 US population. CLL cumulative incidence was estimated using Kaplan-Meier survival curves. At baseline, the prevalence of MBL was 22% (235/1045 relatives). After a median follow-up of 8.1 years among 449 relatives, 12 individuals progressed to CLL with a 5-year cumulative incidence of 1.8%. When considering just the 139 relatives with low-count MBL, the 5-year cumulative incidence increased to 5.7%. Finally, 264 had no MBL at baseline, of whom 60 individuals subsequently developed MBL (2 high-count and 58 low-count MBLs) with an age- and sex-adjusted incidence of 3.5% after a median of 6 years of follow-up. In a screening cohort of relatives from CLL families, we reported progression from normal-count to low-count MBL to high-count MBL to CLL, demonstrating that low-count MBL precedes progression to CLL. We estimated a 1.1% annual rate of progression from low-count MBL, which is in excess of that in the general population.
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Affiliation(s)
- Susan L Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Mark C Lanasa
- Department of Medicine, Duke University, Duke Cancer Institute, Durham, NC
| | - Gerald E Marti
- Lymphoid Malignancies Section, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Sara J Achenbach
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Nicola J Camp
- Department of Internal Medicine, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - Fatima Abbasi
- Center for Biologics Research and Evaluation, Food and Drug Administration, Silver Springs, MD
| | - Neil E Kay
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Celine M Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - James B Johnston
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Timothy G Call
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Kari G Rabe
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | - Aaron D Norman
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Sameer A Parikh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jose F Leis
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ
| | - Versha Banerji
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Biochemistry and Medical Genetics, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Danielle M Brander
- Department of Medicine, Duke University, Duke Cancer Institute, Durham, NC
| | - Martha Glenn
- Department of Internal Medicine, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - Alessandra Ferrajoli
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karen Curtin
- Department of Internal Medicine, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - Esteban Braggio
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ
| | - Tait D Shanafelt
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Mary L McMaster
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - J Brice Weinberg
- Department of Medicine, Duke University, Duke Cancer Institute, Durham, NC
- Department of Immunology, Duke University Medical Center, Durham, NC
- Durham Veterans Affairs Medical Center, Durham, NC; and
| | - Curtis A Hanson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Neil E Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
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10
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Chowdhury SR, Peltier C, Hou S, Singh A, Johnston JB, Gibson SB, Marshall AJ, Banerji V. Ex Vivo Mitochondrial Respiration Parallels Biochemical Response to Ibrutinib in CLL Cells. Cancers (Basel) 2021; 13:cancers13020354. [PMID: 33477957 PMCID: PMC7835851 DOI: 10.3390/cancers13020354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/05/2021] [Accepted: 01/14/2021] [Indexed: 11/16/2022] Open
Abstract
Mitochondrial respiration is becoming more commonly used as a preclinical tool and potential biomarker for chronic lymphocytic leukemia (CLL) and activated B-cell receptor (BCR) signaling. However, respiration parameters have not been evaluated with respect to dose of ibrutinib given in clinical practice or the effect of progression on ibrutinib treatment on respiration of CLL cells. We evaluated the impact of low and standard dose ibrutinib on CLL cells from patients treated in vivo on mitochondrial respiration using Oroboros oxygraph. Cytokines CCL3 and CCL4 were evaluated using the Mesoscale. Western blot analysis was used to evaluate the BCR and apoptotic pathways. We observed no difference in the mitochondrial respiration rates or levels of plasma chemokine (C-C motif) ligands 3 and 4 (CCL3/CCL4), β-2 microglobulin (β-2 M) and lactate dehydrogenase (LDH) between low and standard doses of ibrutinib. This may confirm why clinical observations of the safety and efficacy of low dose ibrutinib are observed in practice. Of interest, we also observed that the mitochondrial respiration of CLL cells paralleled the increase in β-2 M and LDH at progression. Our study further supports mitochondrial respiration as a biomarker for response and progression on ibrutinib in CLL cells and a valuable pre-clinical tool.
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Affiliation(s)
- Subir Roy Chowdhury
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (C.P.); (A.S.); (J.B.J.); (S.B.G.); (A.J.M.)
| | - Cheryl Peltier
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (C.P.); (A.S.); (J.B.J.); (S.B.G.); (A.J.M.)
| | - Sen Hou
- Department of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada;
| | - Amandeep Singh
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (C.P.); (A.S.); (J.B.J.); (S.B.G.); (A.J.M.)
| | - James B. Johnston
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (C.P.); (A.S.); (J.B.J.); (S.B.G.); (A.J.M.)
| | - Spencer B. Gibson
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (C.P.); (A.S.); (J.B.J.); (S.B.G.); (A.J.M.)
- Department of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada;
- Biochemistry and Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3N4, Canada
| | - Aaron J. Marshall
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (C.P.); (A.S.); (J.B.J.); (S.B.G.); (A.J.M.)
- Department of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada;
- Biochemistry and Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3N4, Canada
- Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Versha Banerji
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (C.P.); (A.S.); (J.B.J.); (S.B.G.); (A.J.M.)
- Biochemistry and Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3N4, Canada
- Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Correspondence: ; Tel.: +204-787-1884; Fax: +204-787-0196
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11
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Chanas-Larue A, Villalpando-Rodriguez GE, Henson ES, Johnston JB, Gibson SB. Antihistamines are synergistic with Bruton's tyrosine kinase inhibiter ibrutinib mediated by lysosome disruption in chronic lymphocytic leukemia (CLL) cells. Leuk Res 2020; 96:106423. [PMID: 32712432 DOI: 10.1016/j.leukres.2020.106423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 02/03/2020] [Revised: 06/30/2020] [Accepted: 07/12/2020] [Indexed: 12/14/2022]
Abstract
Lysosomes in chronic lymphocytic leukemia (CLL) cells have previously been identified as a promising target for therapeutic intervention in combination with targeted therapies. Recent studies have shown that antihistamines can induce lysosomal membrane permeabilization (LMP) in a variety of cell lines. Furthermore, our previous data indicates that lysosomotropic agents can cause synergistic cell death in vitro when combined with some tyrosine kinase inhibitors (TKI). In the current study, we have shown that three over-the-counter antihistamines, clemastine, desloratadine, and loratadine, preferentially induce cell death via LMP in CLL cells, as compared to normal lymphocytes. We treated primary CLL cells with antihistamines and found clemastine was the most effective at inducing LMP and cell death. More importantly, the antihistamines induced synergistic cytotoxicity when combined with the tyrosine kinase inhibitor, ibrutinib, but not with chemotherapy. Moreover, the synergy between clemastine and ibrutinib was associated with the induction of reactive oxygen species (ROS), loss of mitochondrial membrane potential and decreased Mcl-1 expression leading to apoptosis. This study proposes a potential novel treatment strategy for CLL, repurposing FDA-approved allergy medications in combination with the targeted therapy ibrutinib to enhance drug efficacy.
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Affiliation(s)
- Aaron Chanas-Larue
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gloria E Villalpando-Rodriguez
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth S Henson
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James B Johnston
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Spencer B Gibson
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada.
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12
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Roy Chowdhury S, Bouchard EDJ, Saleh R, Nugent Z, Peltier C, Mejia E, Hou S, McFall C, Squires M, Hewitt D, Davidson L, Shen GX, Johnston JB, Doucette C, Hatch GM, Fernyhough P, Marshall A, Gibson SB, Dawe DE, Banerji V. Mitochondrial Respiration Correlates with Prognostic Markers in Chronic Lymphocytic Leukemia and Is Normalized by Ibrutinib Treatment. Cancers (Basel) 2020; 12:cancers12030650. [PMID: 32168755 PMCID: PMC7139649 DOI: 10.3390/cancers12030650] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 12/20/2022] Open
Abstract
Mitochondrial bioenergetics profiling, a measure of oxygen consumption rates, correlates with prognostic markers and can be used to assess response to therapy in chronic lymphocytic leukemia (CLL) cells. In this study, we measured mitochondrial respiration rates in primary CLL cells using respirometry to evaluate mitochondrial function. We found significant increases in mitochondrial respiration rates in CLL versus control B lymphocytes. We also observed amongst CLL patients that advanced age, female sex, zeta-chain-associated protein of 70 kD (ZAP-70+), cluster of differentiation 38 (CD38+), and elevated β2-microglobulin (β2-M) predicted increased maximal respiration rates. ZAP-70+ CLL cells exhibited significantly higher bioenergetics than B lymphocytes or ZAP-70− CLL cells and were more sensitive to the uncoupler, carbonyl cyanide-p-trifluoro-methoxyphenylhydrazone (FCCP). Univariable and multivariable linear regression analysis demonstrated that ZAP-70+ predicted increased maximal respiration. ZAP-70+ is a surrogate for B cell receptor (BCR) activation and can be targeted by ibrutinib, which is a clinically approved Bruton’s tyrosine kinase (BTK) inhibitor. Therefore, we evaluated the oxygen consumption rates (OCR) of CLL cells and plasma chemokine (C-C motif) ligands 3 and 4 (CCL3/CCL4) levels from ibrutinib-treated patients and demonstrated decreased OCR similar to control B lymphocytes, suggesting that ibrutinib treatment resets the mitochondrial bioenergetics, while diminished CCL3/CCL4 levels indicate the down regulation of the BCR signaling pathway in CLL. Our data support evaluation of mitochondrial respiration as a preclinical tool for the response assessment of CLL cells.
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Affiliation(s)
- Subir Roy Chowdhury
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Eric D. J. Bouchard
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Ryan Saleh
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Zoann Nugent
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Cheryl Peltier
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Edgard Mejia
- Departments of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada; (E.M.); (S.H.); (A.M.)
| | - Sen Hou
- Departments of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada; (E.M.); (S.H.); (A.M.)
| | - Carly McFall
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Mandy Squires
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Donna Hewitt
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Linda Davidson
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Garry X. Shen
- Departments of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada; (C.D.); (G.M.H.)
| | - James B. Johnston
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
- Departments of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Christine Doucette
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada; (C.D.); (G.M.H.)
- Departments of Physiology & Pathophysiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Grant M. Hatch
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada; (C.D.); (G.M.H.)
- St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB R2H 2A6, Canada
| | - Paul Fernyhough
- Departments of Pharmacology and Therapeutics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
- Departments of Biochemistry and Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3N4, Canada
| | - Aaron Marshall
- Departments of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada; (E.M.); (S.H.); (A.M.)
- Departments of Pharmacology and Therapeutics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
| | - Spencer B. Gibson
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
- Departments of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada; (E.M.); (S.H.); (A.M.)
- Departments of Pharmacology and Therapeutics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
| | - David E. Dawe
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
- Departments of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Versha Banerji
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
- Departments of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
- Departments of Pharmacology and Therapeutics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
- Correspondence: ; Tel.: +1-204-7871-884; Fax: +1-204-7870-196
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13
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Streu E, Wiseman MC, Johnston JB. Low-dose subcutaneous immunoglobulin is an effective treatment for autoimmune bullous skin disorders: A case report. SAGE Open Med Case Rep 2020; 8:2050313X19901071. [PMID: 32010445 PMCID: PMC6974749 DOI: 10.1177/2050313x19901071] [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] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Intravenous immunoglobulin is a recognized treatment in recalcitrant autoimmune bullous diseases. Infusions are administered monthly over 1-5 days in the hospital setting and associated with mild to severe infusion-related systemic effects, in part due to the high doses necessary to induce and achieve remission. We present a case series of four patients with bullous diseases treated successfully with low-dose subcutaneous IgG who achieved remission with maintenance therapy. Patient-administered smaller, more frequent doses of IgG into subcutaneous tissue more closely mimics the body's own antibody production and produces a more stable serum trough level. Subcutaneous IgG is a novel treatment approach in bullous diseases which can induce a state remission.
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Affiliation(s)
- Erin Streu
- Research Institute of Hematology and Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Marni C Wiseman
- Section of Dermatology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - James B Johnston
- CancerCare Manitoba, Winnipeg, MB, Canada.,Section of Haematology/Oncology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
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14
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Uminski K, Brown K, Bucher O, Hibbert I, Dhaliwal DH, Johnston JB, Geirnaert M, Dawe DE, Banerji V. Descriptive analysis of dosing and outcomes for patients with ibrutinib-treated relapsed or refractory chronic lymphocytic leukemia in a Canadian centre. ACTA ACUST UNITED AC 2019; 26:e610-e617. [PMID: 31708654 DOI: 10.3747/co.26.4957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 11/15/2022]
Abstract
Background Ibrutinib is an approved treatment for relapsed or refractory chronic lymphocytic leukemia (cll) and small lymphocytic lymphoma (sll). The effect of ibrutinib dose reduction compared with discontinuation in a population-based setting is unclear. Methods To examine the patterns of ibrutinib use in a Canadian population-based setting, we analyzed a retrospective cohort of patients with relapsed or refractory cll or sll treated with ibrutinib. Results The 64 patients diagnosed with cll or sll had a median age of 76.5 years. Most had unmutated ighv (immunoglobulin variable heavy chain). A hematologic response occurred in 39 patients regardless of the ibrutinib dose. The most common toxicities were infection, bruising or bleeding, and musculoskeletal problems, with a median time to first toxicity of 14 days. More than half the cohort experienced a dose reduction, with musculoskeletal problems, cytopenias, and infection being the leading causes; surgery was the most frequent indication for holding treatment. Only 26 of the 64 patients (40.6%) stayed on the recommended maximal dose of ibrutinib. No differences in reported toxicities or hematologic response rates were evident between the patients receiving maximal and submaximal therapy. At the end of the study period, 53 patients from the initial cohort remained on ibrutinib. Conclusions More than half the study patients received ibrutinib therapy at a submaximal dose without evidence of increased frequency of toxicities or disease progression. The rate of ibrutinib discontinuation was lower in our cohort than has been reported in other settings. Submaximal ibrutinib dosing will have to be further systematically evaluated.
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Affiliation(s)
- K Uminski
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - K Brown
- Department of Internal Medicine, Section of Hematology and Oncology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - O Bucher
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB
| | - I Hibbert
- Department of Internal Medicine, Section of Hematology and Oncology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - D H Dhaliwal
- Department of Internal Medicine, Section of Hematology and Oncology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - J B Johnston
- Department of Internal Medicine, Section of Hematology and Oncology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - M Geirnaert
- Department of Pharmacy, CancerCare Manitoba, Winnipeg, MB
| | - D E Dawe
- Department of Internal Medicine, Section of Hematology and Oncology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - V Banerji
- Department of Internal Medicine, Section of Hematology and Oncology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
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15
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Yang L, Kost SEF, Beiggi S, Zhang Y, Schmidt R, Nugent Z, Marshall A, Banerji V, Gibson SB, Johnston JB. Buccal cell telomere length is not a useful marker for comorbidities in chronic lymphocytic leukemia. Leuk Res 2019; 86:106220. [PMID: 31499418 DOI: 10.1016/j.leukres.2019.106220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/27/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Lin Yang
- Section of Hematology/Medical Oncology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Sara E F Kost
- Research Institute of Oncology and Hematology (formerly, Manitoba Institute of Cell Biology), University of Manitoba, Winnipeg, MB, Canada
| | - Sara Beiggi
- Research Institute of Oncology and Hematology (formerly, Manitoba Institute of Cell Biology), University of Manitoba, Winnipeg, MB, Canada
| | - Yunli Zhang
- Research Institute of Oncology and Hematology (formerly, Manitoba Institute of Cell Biology), University of Manitoba, Winnipeg, MB, Canada
| | - Robert Schmidt
- Research Institute of Oncology and Hematology (formerly, Manitoba Institute of Cell Biology), University of Manitoba, Winnipeg, MB, Canada
| | - Zoann Nugent
- Department of Epidemiology and Cancer Registry, Cancer Care Manitoba, Winnipeg, MB, Canada
| | - Aaron Marshall
- Department of Immunology, University of Manitoba, Winnipeg, MB, Canada
| | - Versha Banerji
- Section of Hematology/Medical Oncology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada; Research Institute of Oncology and Hematology, University of Manitoba, Winnipeg, MB, Canada; Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB, Canada
| | - Spencer B Gibson
- Research Institute of Oncology and Hematology, University of Manitoba, Winnipeg, MB, Canada; Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB, Canada
| | - James B Johnston
- Section of Hematology/Medical Oncology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada; Research Institute of Oncology and Hematology, University of Manitoba, Winnipeg, MB, Canada
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16
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Ishdorj G, Beiggi S, Nugent Z, Streu E, Banerji V, Dhaliwal D, Mahmud SM, Marshall AJ, Gibson SB, Wiseman MC, Johnston JB. Risk factors for skin cancer and solid tumors in newly diagnosed patients with chronic lymphocytic leukemia and the impact of skin surveillance on survival. Leuk Lymphoma 2019; 60:3204-3213. [DOI: 10.1080/10428194.2019.1620941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Ganchimeg Ishdorj
- CancerCare Manitoba Research Institute (formerly, Manitoba Institute of Cell Biology), University of Manitoba, Winnipeg, Canada
| | - Sara Beiggi
- CancerCare Manitoba Research Institute (formerly, Manitoba Institute of Cell Biology), University of Manitoba, Winnipeg, Canada
| | - Zoann Nugent
- CancerCare Manitoba Research Institute (formerly, Manitoba Institute of Cell Biology), University of Manitoba, Winnipeg, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Canada
| | - Erin Streu
- Department of Nursing, CancerCare Manitoba, Winnipeg, Canada
| | - Versha Banerji
- CancerCare Manitoba Research Institute (formerly, Manitoba Institute of Cell Biology), University of Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Dhali Dhaliwal
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Salah M. Mahmud
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Spencer B. Gibson
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Canada
| | - Marni C. Wiseman
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - James B. Johnston
- CancerCare Manitoba Research Institute (formerly, Manitoba Institute of Cell Biology), University of Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
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17
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Righolt CH, Zhang G, Ye X, Banerji V, Johnston JB, Gibson S, Mahmud SM. Statin Use and Chronic Lymphocytic Leukemia Incidence: A Nested Case-Control Study in Manitoba, Canada. Cancer Epidemiol Biomarkers Prev 2019; 28:1495-1501. [PMID: 31186266 DOI: 10.1158/1055-9965.epi-19-0107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/27/2019] [Accepted: 06/06/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recent studies have reported reduced risk of chronic lymphocytic leukemia (CLL) among statin users. However, the possibility that the effect of statins may differ by their chemical or pharmacodynamic properties has not been investigated. METHODS In this nested case-control study, all Manitobans ages ≥40 years when diagnosed with CLL (as a first cancer) from 1999 to 2014 (n = 1,385) were matched (on gender, age, residence, and duration of insurance coverage) to cancer-free controls (n = 6,841). Using conditional logistic regression, statin use was analyzed by individual statins and groups: hydrophilic, low-potency lipophilic (fluvastatin and lovastatin), and high-potency lipophilic statins. RESULTS Statin users constituted 27% and 28% of the CLL cases and controls, respectively. After adjusting for potential confounding by indication, patterns of healthcare utilization, and use of other drugs, CLL incidence was not associated with use of hydrophilic [odds ratio (OR) = 1.08; 95% confidence interval (CI), 0.86-1.34] or high-potency lipophilic (OR = 0.94; 95% CI, 0.79-1.11) statins. Low-potency lipophilic statins were associated with a lower risk of CLL (OR = 0.64; 95% CI, 0.45-0.92), with stronger association (OR = 0.44; 95% CI, 0.22-0.88) observed with more regular use (half to full standard dose on average). CONCLUSIONS We found an association between low-potency lipophilic statin use and reduced CLL risk, with a possible dose-response effect. IMPACT Although requiring replication in future studies, our findings suggest that the effect of statins on CLL risk may depend on their specific chemical or pharmacodynamic properties.
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Affiliation(s)
- Christiaan H Righolt
- Department of Community Health Sciences, Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geng Zhang
- Department of Community Health Sciences, Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Xibiao Ye
- Department of Community Health Sciences, Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada.,School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
| | - Versha Banerji
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Hematology and Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - James B Johnston
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Hematology and Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Spencer Gibson
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Hematology and Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Salaheddin M Mahmud
- Department of Community Health Sciences, Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
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18
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Ali AY, Guan Q, Wu X, Hou S, Banerji V, Johnston JB, Wall D, Szwajcer D, Gibson SB, Marshall AJ. Expression and function of phosphoinositide 3-kinase delta in mesenchymal stromal cells from normal and leukaemic bone marrow. Br J Haematol 2019; 185:883-887. [PMID: 30873593 DOI: 10.1111/bjh.15865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/30/2019] [Indexed: 12/01/2022]
Abstract
Within lymphoid tissues, chronic lymphocytic leukaemia (CLL) cells interact with mesenchymal stromal cells (MSC). Inhibitors of phosphoinositide 3-kinase delta (PI3Kδ) cause release of CLL cells from lymphoid tissues into blood. PI3Kδ inhibitors are thought to target only CLL and other immune cells because PI3Kδ expression is restricted to haematopoietic cells. We found that PI3Kδ is unexpectedly expressed in primary MSC derived from CLL patients and healthy donors. PI3Kδ inhibition in MSC using idelalisib or duvelisib significantly reduced their ability to support CLL migration and adhesion. These observations provide the first evidence that PI3Kδ is expressed and functional in CLL MSC.
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Affiliation(s)
- Ahmed Y Ali
- Department of Immunology, University of Manitoba, Winnipeg, Canada.,Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada
| | - Qingdong Guan
- Cellular Therapy Laboratory, CancerCare Manitoba, Winnipeg, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.,The Manitoba Centre for Advanced Cell and Tissue Therapy, The Health Science Centre, Winnipeg, Canada
| | - Xun Wu
- Department of Immunology, University of Manitoba, Winnipeg, Canada
| | - Sen Hou
- Department of Immunology, University of Manitoba, Winnipeg, Canada
| | - Versha Banerji
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - James B Johnston
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Donna Wall
- Department of Paediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, USA
| | - David Szwajcer
- Cellular Therapy Laboratory, CancerCare Manitoba, Winnipeg, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.,The Manitoba Centre for Advanced Cell and Tissue Therapy, The Health Science Centre, Winnipeg, Canada
| | - Spencer B Gibson
- Department of Immunology, University of Manitoba, Winnipeg, Canada.,Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada.,Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Canada
| | - Aaron J Marshall
- Department of Immunology, University of Manitoba, Winnipeg, Canada.,Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada.,Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Canada
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19
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Chen CI, Paul H, Snitzler S, Kakar S, Le LW, Wei EN, Lau A, Johnston JB, Gibson SB, Queau M, Spaner D, Croucher D, Sherry B, Trudel S. A phase 2 study of lenalidomide and dexamethasone in previously untreated patients with chronic lymphocytic leukemia (CLL). Leuk Lymphoma 2018; 60:980-989. [DOI: 10.1080/10428194.2018.1508669] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | - Susi Snitzler
- Princess Margaret Cancer Centre, Toronto, (ON) Canada
| | - Sumeet Kakar
- Princess Margaret Cancer Centre, Toronto, (ON) Canada
| | - Lisa W. Le
- Princess Margaret Cancer Centre, Toronto, (ON) Canada
| | - Ellen N. Wei
- Princess Margaret Cancer Centre, Toronto, (ON) Canada
| | - Anthea Lau
- Princess Margaret Cancer Centre, Toronto, (ON) Canada
| | | | | | - Michelle Queau
- Manitoba Institute of Cell Biology, Winnipeg, (MN), Canada
| | - David Spaner
- Sunnybrook Health Sciences Centre, Toronto, (ON), Canada
| | | | - Barbara Sherry
- Karches Center for Oncology Research, The Feinstein Institute for Medical Research, Manhasset, (NY) USA
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20
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Kost SEF, Saleh A, Mejia EM, Mostafizar M, Bouchard EDJ, Banerji V, Marshall AJ, Gibson SB, Katyal S, Johnston JB. Abstract 1891: Cross-resistance and synergy between idelalisib and bendamustine in chronic lymphocytic leukemia. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-1891] [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
Idelalisib (IDE) is an inhibitor of the δ isoform of PI3 kinase and has shown high activity in chronic lymphocytic leukemia (CLL) either when given alone or in combination with bendamustine (BEN) /rituximab (BR). In the present study, we have determined whether there is cross-resistance between BEN and IDE in primary CLL cells in vitro and whether synergy is observed upon combining these agents. In primary CLL cells in vitro, cross-resistance was not observed between BEN and IDE suggesting different modes of cytotoxicity. In contrast to BEN, sensitivity to IDE was not influenced by prior clinical treatment or the presence of a del 17p. Marked synergy in cytotoxicity was seen between BEN and IDE, which was paralleled by changes in γ-H2AX staining. These findings suggest that the synergistic antitumor effect was related to enhanced DNA damage by the drug combination. The degree of cytotoxic synergy varied and synergy was observed in some cases that were resistant to BEN or IDE, and those with del 17p. Synergy between BEN and IDE was also seen in the B cell lines, BJAB and I83, and in healthy donor peripheral blood mononuclear cells indicating that the phenomenon was not CLL-specific. To simulate the microenvironment, CLL cells were pre-stimulating with CD40L and IL4 prior to drug treatment. Interestingly this treatment caused the cells to become resistant to IDE, but BEN sensitivity was unaffected. However, combining BEN and IDE produced greater synergy than observed when cells were incubated without IL4/CD40. To examine the role of PI3Kδ for synergy, B cells from C57 BL/6 mice, both wild type and with non-functioning PI3Kδ protein, were exposed to BEN and/or IDE. Cells with the non-functioning PI3Kδ protein were more resistant to IDE than the wild-type cells and showed lesser synergy confirming the importance of this protein for the synergistic effect. In summary, these results confirm that IDE can be active against BEN-resistant CLL cells, while BEN may remain active against IDE-resistant samples, demonstrating different modes of anti-tumor activity. However, the unique yet inconsistent synergy seen between these two agents suggest an overlapping mechanism of action. Ongoing studies are evaluating the mechanism for this synergy.
Citation Format: Sara E. F. Kost, Ali Saleh, Edgard M. Mejia, Marina Mostafizar, Eric D. J. Bouchard, Versha Banerji, Aaron J. Marshall, Spencer B. Gibson, Sachin Katyal, James B. Johnston. Cross-resistance and synergy between idelalisib and bendamustine in chronic lymphocytic leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1891.
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Affiliation(s)
| | - Ali Saleh
- 1CancerCare Manitoba, Winnipeg, Manitoba, Canada
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21
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Abstract
Abstract
Chronic Lymphocytic Leukemia (CLL) is a B-cell derived cancer and is the most commonly diagnosed leukemia in older adults. Several survival signals contribute to the accumulation of CLL cells including constitutive activation the B-cell receptor (BCR) signaling pathway. Approved treatments for CLL are nucleoside analogs such as Fludarabine, alkylating agents including Chlorambucil and Bendamustine, and targeted therapies inhibiting BCR-associated kinases such as Ibrutinib and Idelalisib. Unfortunately, CLL remains incurable, but other weaknesses of the disease have been identified. Recent studies have shown CLL cells to be sensitive to lysosomal membrane permeabilization (LMP) and release of lysosomal contents due to altered sphingosine metabolism. Drugs that induce LMP are referred to as lysosomotropic agents and include antidepressants and antimalarials. These drugs accumulate in lysosomes and inhibit enzymes in the sphingolipid metabolic pathway, causing lysosomal membrane damage. Effectors are released from lysosomes including cathepsin proteases and reactive oxygen species (ROS), which cause dysfunction in cellular machinery and cell death via apoptosis. Our data indicates that kinase inhibitors induce synergic death when combined with lysosomotropic agents in vitro in many cancer models. A non-small cell lung cancer study showed that antihistamines acted as lysosomotropic agents, and were correlated with better patient outcomes when combined with chemotherapy. Therefore, the objective of this study is to characterize the cytotoxicity of antihistamines in B-cell cancer models and identify synergistic interactions with clinically relevant drugs used in CLL. We have shown that three commonly prescribed over-the-counter antihistamines, Desloratadine, Loratadine and Clemastine, induce cell death at concentrations that are clinically achievable in the B-cell lines BJAB and I83, as well as CLL patient derived primary lymphocytes. Each antihistamine caused synergic cell death in combination treatments with Ibrutinib and Idelalisib, but not Fludarabine, Chlorambucil or Bendamustine, which may indicate that the synergy is specific to kinase inhibitors. In addition, the treatment with antihistamines was shown to induce cell death at significantly lower concentrations in primary CLL cells compared to normal lymphocytes from age-matched donors. Both the antihistamine-induced cell death and combination treatments depend on intracellular soluble ROS, but the main effectors of the apoptotic pathways remain to be determined. Taken together, this study intends to exploit the vulnerabilities of CLL by repurposing allergy drugs in combination with kinase inhibitors already available for treating CLL patients.
Citation Format: Aaron P. Chanas-LaRue, James B. Johnston, Spencer B. Gibson. Antihistamines as synergists with targeted therapies in chronic lymphocytic leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3976.
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22
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Chen CI, Paul H, Le LW, Wei EN, Snitzler S, Wang T, Levina O, Kakar S, Lau A, Queau M, Johnston JB, Smith DA, Trudel S. A phase 2 study of ofatumumab (Arzerra ®) in combination with a pan-AKT inhibitor (afuresertib) in previously treated patients with chronic lymphocytic leukemia (CLL). Leuk Lymphoma 2018; 60:92-100. [PMID: 29916761 DOI: 10.1080/10428194.2018.1468892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AKT plays a centralized role in tumor proliferation and survival and is aberrantly activated in chronic lymphocytic leukemia (CLL). In this phase 2 trial, 30 relapsed/refractory CLL patients were treated with combination afuresertib, a novel oral AKT inhibitor, and ofatumumab for 6 months, followed by afuresertib maintenance for 12 months. We aimed to achieve deeper and more durable responses, without requiring long-term continuous treatment. Treatment was generally well tolerated but respiratory infections were common, with 18% severe requiring hospitalization. Hematologic toxicities were manageable (grade 3-4 neutropenia 39%). At a median follow-up of 13.4 months, overall responses were 50% (complete responses 3.6%). Median progression-free survival was 8.5 months and overall survival 34.8 months. Combination therapy with ofatumumab and afuresertib is active and well tolerated, but does not appear to lead to durable responses and may not provide additional benefit over single-agent ofatumumab in relapsed/refractory CLL. Novel agent combinations are currently undergoing intense investigation.
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Affiliation(s)
- Christine I Chen
- a Princess Margaret Cancer Centre/Ontario Cancer Institute , Toronto , ON , Canada
| | - Harminder Paul
- a Princess Margaret Cancer Centre/Ontario Cancer Institute , Toronto , ON , Canada
| | - Lisa W Le
- a Princess Margaret Cancer Centre/Ontario Cancer Institute , Toronto , ON , Canada
| | - Ellen N Wei
- a Princess Margaret Cancer Centre/Ontario Cancer Institute , Toronto , ON , Canada
| | - Susi Snitzler
- a Princess Margaret Cancer Centre/Ontario Cancer Institute , Toronto , ON , Canada
| | - Trina Wang
- a Princess Margaret Cancer Centre/Ontario Cancer Institute , Toronto , ON , Canada
| | - Olga Levina
- a Princess Margaret Cancer Centre/Ontario Cancer Institute , Toronto , ON , Canada
| | - Sumeet Kakar
- a Princess Margaret Cancer Centre/Ontario Cancer Institute , Toronto , ON , Canada
| | - Anthea Lau
- b Department of Biostatistics , Princess Margaret Cancer Centre , Toronto , ON , Canada
| | - Michelle Queau
- c Manitoba Institute of Cell Biology , Winnipeg , MB , Canada
| | | | | | - Suzanne Trudel
- a Princess Margaret Cancer Centre/Ontario Cancer Institute , Toronto , ON , Canada
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23
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Das S, Dielschneider R, Chanas-LaRue A, Johnston JB, Gibson SB. Antimalarial drugs trigger lysosome-mediated cell death in chronic lymphocytic leukemia (CLL) cells. Leuk Res 2018; 70:79-86. [PMID: 29902707 DOI: 10.1016/j.leukres.2018.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 01/12/2023]
Abstract
Lysosomes are the most acidic vesicles within mammalian cells and are promising targets for the treatment of breast cancer, glioblastomas and acute myeloid leukemia (AML). Our previous studies have shown that chronic lymphocytic leukemia (CLL) cells are also sensitive to lysosome disruption and cell death, by siramesine or chemotherapy. In the present study, we screened the antimalarial drugs, mefloquine, atovaquone, primaquine, and tafenoquine, for their effects on lysosome disruption and cytotoxicity in primary CLL cells. We found that mefloquine and tafenoquine could permeabilize lysosome membranes and induce cell death at doses that are clinically achievable. In contrast, these agents had less effect on normal B cells. Tafenoquine was most effective at inducing cell death, and this was associated with increased formation of reactive oxygen species (ROS) and lipid peroxidation. Addition of ROS scavengers blocked both tafenoquine- and mefloquine-induced cell death. Moreover, blocking the activity of cathepsins released from the lysosomes decreased tafenoquine-induced cell death. Taken together, lysosome disruption using antimalarial drugs is a novel approach for the treatment of CLL.
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Affiliation(s)
- Subhadip Das
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Rebecca Dielschneider
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aaron Chanas-LaRue
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James B Johnston
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Spencer B Gibson
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada.
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Kleinstern G, Camp NJ, Goldin LR, Vachon CM, Vajdic CM, de Sanjose S, Weinberg JB, Benavente Y, Casabonne D, Liebow M, Nieters A, Hjalgrim H, Melbye M, Glimelius B, Adami HO, Boffetta P, Brennan P, Maynadie M, McKay J, Cocco PL, Shanafelt TD, Call TG, Norman AD, Hanson C, Robinson D, Chaffee KG, Brooks-Wilson AR, Monnereau A, Clavel J, Glenn M, Curtin K, Conde L, Bracci PM, Morton LM, Cozen W, Severson RK, Chanock SJ, Spinelli JJ, Johnston JB, Rothman N, Skibola CF, Leis JF, Kay NE, Smedby KE, Berndt SI, Cerhan JR, Caporaso N, Slager SL. Association of polygenic risk score with the risk of chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis. Blood 2018; 131:2541-2551. [PMID: 29674426 PMCID: PMC5992865 DOI: 10.1182/blood-2017-11-814608] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 11/03/2017] [Accepted: 03/23/2018] [Indexed: 01/07/2023] Open
Abstract
Inherited loci have been found to be associated with risk of chronic lymphocytic leukemia (CLL). A combined polygenic risk score (PRS) of representative single nucleotide polymorphisms (SNPs) from these loci may improve risk prediction over individual SNPs. Herein, we evaluated the association of a PRS with CLL risk and its precursor, monoclonal B-cell lymphocytosis (MBL). We assessed its validity and discriminative ability in an independent sample and evaluated effect modification and confounding by family history (FH) of hematological cancers. For discovery, we pooled genotype data on 41 representative SNPs from 1499 CLL and 2459 controls from the InterLymph Consortium. For validation, we used data from 1267 controls from Mayo Clinic and 201 CLL, 95 MBL, and 144 controls with a FH of CLL from the Genetic Epidemiology of CLL Consortium. We used odds ratios (ORs) to estimate disease associations with PRS and c-statistics to assess discriminatory accuracy. In InterLymph, the continuous PRS was strongly associated with CLL risk (OR, 2.49; P = 4.4 × 10-94). We replicated these findings in the Genetic Epidemiology of CLL Consortium and Mayo controls (OR, 3.02; P = 7.8 × 10-30) and observed high discrimination (c-statistic = 0.78). When jointly modeled with FH, PRS retained its significance, along with FH status. Finally, we found a highly significant association of the continuous PRS with MBL risk (OR, 2.81; P = 9.8 × 10-16). In conclusion, our validated PRS was strongly associated with CLL risk, adding information beyond FH. The PRS provides a means of identifying those individuals at greater risk for CLL as well as those at increased risk of MBL, a condition that has potential clinical impact beyond CLL.
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Affiliation(s)
| | - Nicola J Camp
- Huntsman Cancer Institute and Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Lynn R Goldin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Celine M Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Silvia de Sanjose
- CIBER de Epidemiología y Salud Pública, Barcelona, Spain
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Institute d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J Brice Weinberg
- Department of Medicine and
- Department of Immunology, Duke University Medical Center, Durham, NC
- Durham Veterans Affairs Medical Center, Durham, NC
| | - Yolanda Benavente
- CIBER de Epidemiología y Salud Pública, Barcelona, Spain
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Institute d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Delphine Casabonne
- CIBER de Epidemiología y Salud Pública, Barcelona, Spain
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Institute d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mark Liebow
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Alexandra Nieters
- Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Henrik Hjalgrim
- Department of Epidemiology Research, Division of Health Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Mads Melbye
- Department of Epidemiology Research, Division of Health Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Boffetta
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - Marc Maynadie
- Registre des Hémopathies Malignes de Côte d'Or, INSERM UMR1231, Université de Bourgogne-Franche-Comté, Dijon, France
| | - James McKay
- International Agency for Research on Cancer, Lyon, France
| | - Pier Luigi Cocco
- Department of Medical Sciences and Public Health, Occupational Health Section, University of Cagliari, Monserrato, Italy
| | | | | | - Aaron D Norman
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Curtis Hanson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Dennis Robinson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Kari G Chaffee
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Angela R Brooks-Wilson
- Genome Sciences Centre, BC Cancer Agency, Vancouver, BC, Canada
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Alain Monnereau
- Registre des Hémopathies Malignes de la Gironde, Institut Bergonié, University of Bordeaux, INSERM, Team EPICENE, UMR 1219, Bordeaux, France
- Epidemiology of Childhood and Adolescent Cancers Group, INSERM, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris, France
- Université Paris Descartes, Paris, France
| | - Jacqueline Clavel
- Epidemiology of Childhood and Adolescent Cancers Group, INSERM, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris, France
- Université Paris Descartes, Paris, France
| | - Martha Glenn
- Huntsman Cancer Institute and Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Karen Curtin
- Huntsman Cancer Institute and Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Lucia Conde
- UCL Cancer Institute, London, United Kingdom
| | - Paige M Bracci
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Wendy Cozen
- Department of Preventive Medicine and
- Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Richard K Severson
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - John J Spinelli
- Cancer Control Research, BC Cancer Agency, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - James B Johnston
- Department of Medical Oncology, Cancer Care Manitoba, Winnipeg, MB, Canada
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Christine F Skibola
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Jose F Leis
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ; and
| | - Neil E Kay
- Department of Medical Sciences and Public Health, Occupational Health Section, University of Cagliari, Monserrato, Italy
| | - Karin E Smedby
- Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Neil Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Susan L Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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Abstract
Non-Hodgkin lymphomas (NHL) are a group of cancers with highly heterogeneous biology and clinical features. Statins are increasingly prescribed to prevent cardiovascular diseases. Early evidence shows a preventive effect of statins for some cancers, but their effect on NHL risk is unclear. We conducted a population-based nested case-control study involving 5,541 NHL cases and 27,315 controls matched for gender, age, place of residence and length of period of available prescription drug data. We assessed the use of statins prior to diagnosis (excluding the 12 months prior to the index date). We used conditional logistic regression models to estimate odds ratio (OR) and 95% confidence interval (CI) for use of any statin, adjusting for medical conditions, number of family physician visits for 5 years prior to index date, healthcare utilization, income and use of other medications. Over one-quarter of cases and controls were prescribed statins. Ever-use of any statin was associated with lower risk of Total NHL (OR = 0.82, 95% CI 0.76-0.89) and of certain subtypes including diffuse large B-cell lymphomas (DLBCL, OR = 0.77, 95% CI 0.65-0.92), plasma cell neoplasms (PCN, OR = 0.76, 95% CI 0.63-0.91) and other B-cell NHL (0.75, 0.59-0.95). Analysis by statin type suggested that the association was limited to high potency statin and lipophilic statin users. No clear duration or dose-response relationships were observed. Our findings provide evidence that statin use can reduce the risk of DLBCL and plasma cell lymphomas, but not other NHL types. Further studies are warranted to verify these associations and to examine the biological mechanisms.
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Affiliation(s)
- Xibiao Ye
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Geng Zhang
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Christiaan Righolt
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada
| | - James B Johnston
- Research Institute of Oncology and Hematology, Cancer Care Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Versha Banerji
- Research Institute of Oncology and Hematology, Cancer Care Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Spencer B Gibson
- Research Institute of Oncology and Hematology, Cancer Care Manitoba, Winnipeg, MB, Canada
- Department of Immunology, University of Manitoba, Winnipeg, MB, Canada
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB, Canada
| | - Salaheddin M Mahmud
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada
- College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada
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Ye X, Zhang G, Righolt C, Johnston JB, Banerji V, Gibson SB, Mahmud SM. Metformin Is Not Associated with Incidence Risk of Non-Hodgkin Lymphomas among Diabetic Patients. Cancer Epidemiol Biomarkers Prev 2018; 27:610-612. [PMID: 29511039 DOI: 10.1158/1055-9965.epi-18-0012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 01/08/2018] [Revised: 01/11/2018] [Accepted: 02/12/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Several epidemiological studies have shown a positive association between diabetes and increased risk of non-Hodgkin lymphoma (NHL), but the effect of diabetic treatment drugs such as metformin on the risk is unknown.Methods: We conducted a population-based nested case-control study involving 878 NHL cases and 4,364 controls diagnosed with diabetes. Use of metformin and other medications before diagnosis and medical condition histories were assessed using administrative databases. We used conditional logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for use of metformin, adjusting for confounders.Results: Risk of total NHLs is not associated with ever use of metformin (OR, 0.93; 95% CI, 0.79-1.10) among diabetic patients. NHL subtypes were also not associated with metformin use.Conclusions: Metformin use is not associated with overall or subtype NHL risk among diabetic patients.Impact: NHLs are etiologically heterogeneous and larger scale studies are warranted to test the potential effect of metformin by NHL subtype. Cancer Epidemiol Biomarkers Prev; 27(5); 610-2. ©2018 AACR.
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Affiliation(s)
- Xibiao Ye
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geng Zhang
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christiaan Righolt
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James B Johnston
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Versha Banerji
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Spencer B Gibson
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Canada
- Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Salaheddin M Mahmud
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
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27
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Ali AY, Wu X, Eissa N, Hou S, Ghia JE, Murooka TT, Banerji V, Johnston JB, Lin F, Gibson SB, Marshall AJ. Distinct roles for phosphoinositide 3-kinases γ and δ in malignant B cell migration. Leukemia 2018; 32:1958-1969. [PMID: 29479062 PMCID: PMC6127087 DOI: 10.1038/s41375-018-0012-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/13/2017] [Accepted: 12/15/2017] [Indexed: 12/19/2022]
Abstract
The PI 3-kinases (PI3K) are essential mediators of chemokine receptor signaling necessary for migration of chronic lymphocytic leukemia (CLL) cells and their interaction with tissue-resident stromal cells. While the PI3Kδ-specific inhibitor idelalisib shows efficacy in treatment of CLL and other B cell malignancies, the function of PI3Kγ has not been extensively studied in B cells. Here, we assess whether PI3Kγ has non-redundant functions in CLL migration and adhesion to stromal cells. We observed that pharmaceutical PI3Kγ inhibition with CZC24832 significantly impaired CLL cell migration, while dual PI3Kδ/γ inhibitor duvelisib had a greater impact than single isoform-selective inhibitors. Knockdown of PI3Kγ reduced migration of CLL cells and cell lines. Expression of the PI3Kγ subunits increased in CLL cells in response to CD40L/IL-4, whereas BCR cross-linking had no effect. Overexpression of PI3Kγ subunits enhanced cell migration in response to SDF1α/CXCL12, with the strongest effect observed within ZAP70 + CLL samples. Microscopic tracking of cell migration within chemokine gradients revealed that PI3Kγ functions in gradient sensing and impacts cell morphology and F-actin polarization. PI3Kγ inhibition also reduced CLL adhesion to stromal cells to a similar extent as idelalisib. These findings provide the first evidence that PI3Kγ has unique functions in malignant B cells.
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Affiliation(s)
- Ahmed Y Ali
- Department of Immunology, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada.,Research Institute in Oncology and Hematology, CancerCare Manitoba, 675 McDermot Ave., Winnipeg, MB, R3E 0V9, Canada
| | - Xun Wu
- Department of Immunology, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada
| | - Nour Eissa
- Department of Immunology, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada
| | - Sen Hou
- Department of Immunology, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada
| | - Jean-Eric Ghia
- Department of Immunology, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada.,Department of Internal Medicine, Section of Gastroenterology, University of Manitoba, 820 Sherbrooke St., Winnipeg, MB, R3A 1R9, Canada
| | - Thomas T Murooka
- Department of Immunology, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, 745 Bannatyne Ave., Winnipeg, MB, R3E 0J9, Canada
| | - Versha Banerji
- Research Institute in Oncology and Hematology, CancerCare Manitoba, 675 McDermot Ave., Winnipeg, MB, R3E 0V9, Canada.,Department of Biochemistry and Medical Genetics, University of Manitoba, 745 Bannatyne Ave., Winnipeg, MB, R3E 0J9, Canada
| | - James B Johnston
- Research Institute in Oncology and Hematology, CancerCare Manitoba, 675 McDermot Ave., Winnipeg, MB, R3E 0V9, Canada
| | - Francis Lin
- Department of Immunology, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada.,Department of Physics and Astronomy, University of Manitoba, Allen Building, Winnipeg, MB, R3T 2N2, Canada
| | - Spencer B Gibson
- Department of Immunology, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada.,Research Institute in Oncology and Hematology, CancerCare Manitoba, 675 McDermot Ave., Winnipeg, MB, R3E 0V9, Canada.,Department of Biochemistry and Medical Genetics, University of Manitoba, 745 Bannatyne Ave., Winnipeg, MB, R3E 0J9, Canada
| | - Aaron J Marshall
- Department of Immunology, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada. .,Research Institute in Oncology and Hematology, CancerCare Manitoba, 675 McDermot Ave., Winnipeg, MB, R3E 0V9, Canada. .,Department of Biochemistry and Medical Genetics, University of Manitoba, 745 Bannatyne Ave., Winnipeg, MB, R3E 0J9, Canada.
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28
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Ye X, Mahmud S, Skrabek P, Lix L, Johnston JB. Long-term time trends in incidence, survival and mortality of lymphomas by subtype among adults in Manitoba, Canada: a population-based study using cancer registry data. BMJ Open 2017; 7:e015106. [PMID: 28716788 PMCID: PMC5734550 DOI: 10.1136/bmjopen-2016-015106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To examine 30-year time trends in incidence, survival and mortality of lymphomas by subtype in Manitoba, Canada. METHODS Lymphoma cases diagnosed between 1984 and 2013 were classified according to the 2008 WHO classification system for lymphoid neoplasms. Death data (1984-2014) were obtained from the Manitoba Vital Statistics Agency. To examine time trends in incidence and mortality, we used joinpoint regression to estimate annual percentage change and average annual percentage change. Age-period-cohort modelling was conducted to measure the effects of age, period and cohort on incidence and mortality time trends. We estimated age-specific and standardised 5-year relative survival and used Poisson regression model to test time trends in relative survival. RESULTS Total Hodgkin lymphoma (HL) incidence in men and women was stable during the study period. Age-standardised total non-Hodgkin lymphoma (NHL) incidence increased by 4% annually until around 2000, and the trend varied by sex and NHL subtype. Total HL mortality continuously declined (by 2.5% annually in men and by 2.7% annually in women), while total NHL mortality increased (by 4.4% annually in men until 1998 and by 3.2% annually in women until 2001) and then declined (by 3.6% annually in men and by 2.5% annually in women). Age-standardised 5-year relative survival for HL improved from 72.6% in 1984-1993 to 85.8% in 2004-2013, and for NHL from 57.0% in 1984-1993 to 67.5% in 2004-2013. Survival improvement was also noted for NHL subtypes, although the extent varied, with the greatest improvement for follicular lymphoma (from 65.3% in 1984-1993 to 87.6% in 2004-2013). CONCLUSIONS Time trends were generally consistent with those reported in other jurisdictions in total HL and NHL incidence, but were unique in incidence for HL and for NHL subtypes chronic/small lymphocytic leukaemia/lymphoma, diffuse large B cell lymphoma and follicular lymphoma. Survival improvements and mortality reductions were seen for HL and NHL in both sexes.
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Affiliation(s)
- Xibiao Ye
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Salaheddin Mahmud
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pamela Skrabek
- Department of Medical Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James B Johnston
- Department of Medical Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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29
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Ishdorj G, Kost SEF, Beiggi S, Zang Y, Gibson SB, Johnston JB. A novel spliced variant of the TIN2 shelterin is present in chronic lymphocytic leukemia. Leuk Res 2017; 59:66-74. [PMID: 28575699 DOI: 10.1016/j.leukres.2017.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/02/2017] [Accepted: 05/26/2017] [Indexed: 01/24/2023]
Abstract
The shelterin proteins play important roles in telomere maintenance and genome stability. These proteins have been found to be mutated in many cancers including CLL. Herein, we demonstrate here the presence of a novel spliced isoform of TIN2S in chronic lymphocytic leukemia (CLL), related to deletion of exon 2 in the TIN2 gene. The expressions of spliced TIN2S mRNA varied widely in CLL and there was an inverse relationship between the mRNA levels of full-length TIN2S and the spliced moiety. Small amounts of spliced TIN2S were also observed in normal B cells but not in T cells. Spliced TIN2S appeared dysfunctional, as immunoprecipitation studies showed the typical association of TRF2 and TIN2 in normal lymphocytes but not in CLL cells. Moreover, whereas TRF2 localized to the nucleus in normal lymphocytes, it was present in both nuclei and cytoplasm in CLL cells. The levels of spliced TIN2S increased with age and in 3 of 8 patients increased over time. The presence of the spliced variant failed to be related to telomere length in CLL suggesting other functions for this protein. Further studies are required to determine the etiology and biological significance of this unique spliced TIN2S variant.
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Affiliation(s)
- Ganchimeg Ishdorj
- Research Institute of Oncology and Hematology (Formerly Manitoba Institute of Cell Biology), CancerCare Manitoba, Winnipeg, Manitoba, Canada.
| | - Sara E F Kost
- Research Institute of Oncology and Hematology (Formerly Manitoba Institute of Cell Biology), CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Sara Beiggi
- Research Institute of Oncology and Hematology (Formerly Manitoba Institute of Cell Biology), CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Yunli Zang
- Research Institute of Oncology and Hematology (Formerly Manitoba Institute of Cell Biology), CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Spencer B Gibson
- Research Institute of Oncology and Hematology (Formerly Manitoba Institute of Cell Biology), CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James B Johnston
- Research Institute of Oncology and Hematology (Formerly Manitoba Institute of Cell Biology), CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Grever MR, Abdel-Wahab O, Andritsos LA, Banerji V, Barrientos J, Blachly JS, Call TG, Catovsky D, Dearden C, Demeter J, Else M, Forconi F, Gozzetti A, Ho AD, Johnston JB, Jones J, Juliusson G, Kraut E, Kreitman RJ, Larratt L, Lauria F, Lozanski G, Montserrat E, Parikh SA, Park JH, Polliack A, Quest GR, Rai KR, Ravandi F, Robak T, Saven A, Seymour JF, Tadmor T, Tallman MS, Tam C, Tiacci E, Troussard X, Zent CS, Zenz T, Zinzani PL, Falini B. Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia. Blood 2017; 129:553-560. [PMID: 27903528 PMCID: PMC5290982 DOI: 10.1182/blood-2016-01-689422] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [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: 01/21/2016] [Accepted: 11/06/2016] [Indexed: 12/20/2022] Open
Abstract
Hairy cell leukemia is an uncommon hematologic malignancy characterized by pancytopenia and marked susceptibility to infection. Tremendous progress in the management of patients with this disease has resulted in high response rates and improved survival, yet relapse and an appropriate approach to re-treatment present continuing areas for research. The disease and its effective treatment are associated with immunosuppression. Because more patients are being treated with alternative programs, comparison of results will require general agreement on definitions of response, relapse, and methods of determining minimal residual disease. The development of internationally accepted, reproducible criteria is of paramount importance in evaluating and comparing clinical trials to provide optimal care. Despite the success achieved in managing these patients, continued participation in available clinical trials in the first-line and particularly in the relapse setting is highly recommended. The Hairy Cell Leukemia Foundation convened an international conference to provide common definitions and structure to guide current management. There is substantial opportunity for continued research in this disease. In addition to the importance of optimizing the prevention and management of the serious risk of infection, organized evaluations of minimal residual disease and treatment at relapse offer ample opportunities for clinical research. Finally, a scholarly evaluation of quality of life in the increasing number of survivors of this now manageable chronic illness merits further study. The development of consensus guidelines for this disease offers a framework for continued enhancement of the outcome for patients.
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Affiliation(s)
- Michael R Grever
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Omar Abdel-Wahab
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leslie A Andritsos
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Versha Banerji
- Section of Hematology/Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - Jacqueline Barrientos
- Department of Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Hofstra University, Hempstead, NY
| | - James S Blachly
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | | | - Daniel Catovsky
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Claire Dearden
- Department of Haemato-Oncology, Royal Marsden Biomedical Research Centre, London, United Kingdom
| | - Judit Demeter
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Monica Else
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Francesco Forconi
- Haematology Department, University Hospital Trust and Cancer Sciences Unit, Cancer Research UK and National Institute for Health Research Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | | | - Anthony D Ho
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - James B Johnston
- Section of Hematology/Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - Jeffrey Jones
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Gunnar Juliusson
- Department of Hematology, Skåne University Hospital and Stem Cell Center, Lund University, Lund, Sweden
| | - Eric Kraut
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Robert J Kreitman
- Laboratory of Molecular Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Loree Larratt
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Francesco Lauria
- Hematology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Emili Montserrat
- Department of Hematology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Jae H Park
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Aaron Polliack
- Department of Hematology, Hadassah University Hospital and Hebrew University Medical School, Jerusalem, Israel
| | - Graeme R Quest
- Department of Laboratory Medicine and Pathology, University Health Network, Toronto, ON, Canada
| | - Kanti R Rai
- Department of Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Hofstra University, Hempstead, NY
| | - Farhad Ravandi
- Section of Developmental Therapeutics, Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Alan Saven
- Division of Hematology and Oncology, Scripps Clinic, La Jolla, CA
| | - John F Seymour
- Haematology Department, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center, and the Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Martin S Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Constantine Tam
- Haematology Department, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Enrico Tiacci
- Institute of Hematology, Department of Medicine, University and Hospital of Perugia, Perugia, Italy
| | - Xavier Troussard
- Department of Hematology, Centre Hospitalier Universitaire Côte de Nacre, Caen, France
| | - Clive S Zent
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Thorsten Zenz
- Department of Molecular Therapy in Hematology and Oncology, National Center for Tumor Diseases and German Cancer Research Center (DKFZ), Heidelberg, Germany; and
| | - Pier Luigi Zinzani
- Institute of Hematology "Seràgnoli," University of Bologna, Bologna, Italy
| | - Brunangelo Falini
- Institute of Hematology, Department of Medicine, University and Hospital of Perugia, Perugia, Italy
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Kost SE, Bouchard ED, LaBossière É, Ye X, Queau ML, Liang WS, Banerji V, Gibson SB, Katyal S, Johnston JB. Cross-resistance and synergy with bendamustine in chronic lymphocytic leukemia. Leuk Res 2016; 50:63-71. [DOI: 10.1016/j.leukres.2016.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 10/21/2022]
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Ishdorj G, Kost SEF, Zang Y, Gibson SB, Johnston JB. Abstract 2850: Role of shelterin proteins for telomere shortening in chronic lymphocytic leukemia. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-2850] [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
Telomeres are important in maintaining the integrity of the chromosomes. A series of shelterin proteins (TRF1, TRF2, RAP1, POT1a and b, TIPP1 and TIN2), are involved in the maintenance of telomeres. In chronic lymphocytic leukemia (CLL), the telomeres are shorter than in normal B cells, with very short telomeres being associated with poor survival. In the present study, we demonstrate that the leukemia cell telomere length shortens over time were CLL are followed over year, indicating that telomere shortening in these cells is an ongoing process. When CLL cell metaphases were examined by Q-FISH, telomere length shortening was found to affect all chromosomes equally. To determine whether these telomere changes were related to alterations in the shelterin complex, protein levels of the six shelterins were determined in CLL cells and normal pooled B cells. In general, apart from TIN2, the shelterin protein levels were increased in CLL cells and TRF2 levels were higher in IgVH unmutated cells than in mutated cells. TIN2 protein levels were dramatically reduced in CLL cells as compared to normal B cells and an alternative isoform of TIN2 was observed, both in IgVH mutated and unmuted cases. TIN2 targeted RT-PCR followed by sequencing revealed a deletion of the entire exon 2, totaling 105 bp. This abnormality appeared in monoclonal B-cell lymphocytosis (MBL) indicating that this was an early event. In addition, a subgroup of patients showed an increase in the spliced form of TIN2, when followed over time, suggesting that this might provide the cell with a survival advantage. A protein translated from the spliced variant RNA is expected to be deleted for 35 amino acids at the N-terminus, which is the binding site for TRF2. As TIN2 maintains telomere structure by forming a complex of TRF1 and TRF2 with the telomere, this should not occur with the splice variant. Indicating a pathological role of spliced TIN2 in CLL, TRF2 was localized in both the nuclei and cytoplasm in CLL cells compared to localization only to the nucleus in normal B cells. To confirm the function of the spliced TIN2, we have overexpressed the both full length and spliced clones of TIN2 in HEK293 cells and are presently determining the localization of TRF2 and the ability to form a TRF2/TIN2 complex. Thus, these studies demonstrate a unique splice variant of TIN2 in CLL, which potentially may influence the formation of the shelterin complex and contribute to telomere shortening in this disease.
Citation Format: Ganchimeg Ishdorj, Sara EF Kost, Yunli Zang, Spencer B. Gibson, James B. Johnston. Role of shelterin proteins for telomere shortening in chronic lymphocytic leukemia. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2850.
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Affiliation(s)
| | - Sara EF Kost
- 1CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Yunli Zang
- 1CancerCare Manitoba, Winnipeg, Manitoba, Canada
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Kost SEF, Bouchard EDJ, LaBossière É, Ye X, Queau ML, Liang WS, Banerji V, Gibson SB, Katyal S, Johnston JB. Abstract 281: Bendamustine has the biochemical properties of an alkylating agent that synergizes with nucleoside analogues in chronic lymphocytic leukemia. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-281] [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
Bendamustine (BEN) is a promising new treatment for chronic lymphocytic leukemia (CLL) and may function as an alkylating agent (eg, chlorambucil, CLB) while sharing structural similarities to a nucleoside analogue (eg, fludarabine, FLU). Enhanced cell death has been observed with the combination of BEN and FLU in primary CLL cells in vitro, but both BEN and FLU are marrow-toxic, potentially limiting the clinical value of this combination. While the nucleoside analogue pentostatin (PEN) is active in CLL and less marrow-toxic than FLU, it is unknown whether it produces synergy when combined with BEN. PEN acts by inhibiting adenosine deaminase, resulting in the accumulation of deoxyadenosine (dADO), which is toxic to CLL cells. In the present study, we evaluated the activity of BEN against CLL cells in vitro, as compared to CLB, FLU or dADO/PEN, alone and in combination. Cell death was assessed using annexin V/7-ADD staining and the MTT assay. We observed that BEN, CLB, FLU, or dADO/PEN induced apoptosis, the extent of which was time- and concentration-dependent. In general, cross-resistance was observed to all agents, with previously treated patients or those with a del 17p being most resistant. Enhanced cell killing was seen when combining BEN or CLB with FLU or dADO/PEN, with the extent of synergy being similar for FLU or dADO/PEN. To correlate mechanism of cell death as a result of treatment with these agents, we analyzed the expression of death receptors (DR4 and DR5) and mitochondrial stress (DICO6 and DHE). An increase in DR5 (but not DR4) surface expression, loss of mitochondrial membrane potential, and increased reactive oxygen species production was observed following treatment indicating that all agents induced death through the death receptor and mitochondrial apoptotic pathways. However, using γH2AX and the alkaline comet assay, FLU produced a greater number of DNA double-strand breaks (DSB) than BEN or CLB. Thus, all these agents induce apoptosis through the mitochondrial and death receptor pathways with cross-resistance being observed in most cases. BEN is more similar to CLB in producing fewer DNA DSBs than FLU and demonstrating synergy when combined with FLU or dADO/PEN. The latter observation suggests that combining BEN with PEN might be useful clinically.
Citation Format: Sara EF Kost, Eric DJ Bouchard, Élise LaBossière, Xibiao Ye, Michelle L. Queau, William S. Liang, Versha Banerji, Spencer B. Gibson, Sachin Katyal, James B. Johnston. Bendamustine has the biochemical properties of an alkylating agent that synergizes with nucleoside analogues in chronic lymphocytic leukemia. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 281.
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Affiliation(s)
- Sara EF Kost
- 1CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Xibiao Ye
- 3Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
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Beiggi S, Banerji V, Deneka A, Griffith J, Gibson SB, Johnston JB. Comparison of outcome of patients with CLL who are referred or nonreferred to a specialized CLL clinic: a Canadian population-based study. Cancer Med 2016; 5:971-9. [PMID: 26889755 PMCID: PMC4924353 DOI: 10.1002/cam4.559] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 03/10/2015] [Revised: 08/28/2015] [Accepted: 09/01/2015] [Indexed: 02/04/2023] Open
Abstract
Chronic lymphocytic leukemia and small lymphocytic lymphoma (CLL/SLL) patients in Manitoba are either referred to the CLL Clinic at CancerCare Manitoba (CCMB) or are followed by other hematologists and general practitioners. However, it has been unclear whether referral to the CLL clinic influences patient outcome. Overall survival (OS) was assessed for all CLL/SLL patients diagnosed in Manitoba between 2007 and 2011. Of 555 patients, 281 (51%) were referred to the CLL clinic. Patients seen in this clinic had a twofold increased OS compared to patients who were managed by other hematologists and general practitioners (HR 2.375, P 0.0002) when adjusted for age, gender, presence of pre‐ or post‐CLL cancer, treatment and urban/rural location. In the nonreferred population there was a striking correlation between advancing age and decreasing OS. However, this correlation was almost eliminated in the referred population who were more likely to receive chemotherapy. Patients referred and seen in the CLL clinic have an improved OS compared to nonreferred patients and this appears to be primarily related to improved OS in the elderly. Possible explanations for this finding are discussed.
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Affiliation(s)
- Sara Beiggi
- Department of Biochemistry and Medical Genetics, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0J9, Canada.,Manitoba Institute of Cell Biology, Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada
| | - Versha Banerji
- Department of Biochemistry and Medical Genetics, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0J9, Canada.,Manitoba Institute of Cell Biology, Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada.,Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba, R3E 2N2, Canada.,Department of Hematology and Medical Oncology, Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada
| | - Angela Deneka
- Department of Epidemiology and Cancer Registry, Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada
| | - Jane Griffith
- Department of Epidemiology and Cancer Registry, Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada.,Department of Community Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0W3, Canada
| | - Spencer B Gibson
- Department of Biochemistry and Medical Genetics, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0J9, Canada.,Manitoba Institute of Cell Biology, Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada
| | - James B Johnston
- Manitoba Institute of Cell Biology, Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada.,Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba, R3E 2N2, Canada.,Department of Hematology and Medical Oncology, Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada
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Li H, Wu X, Hou S, Malek M, Kielkowska A, Noh E, Makondo KJ, Du Q, Wilkins JA, Johnston JB, Gibson SB, Lin F, Marshall AJ. Phosphatidylinositol-3,4-Bisphosphate and Its Binding Protein Lamellipodin Regulate Chemotaxis of Malignant B Lymphocytes. J I 2015; 196:586-95. [DOI: 10.4049/jimmunol.1500630] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 11/16/2015] [Indexed: 01/14/2023]
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Abstract
Significant advances in the diagnosis and treatment of hairy cell leukemia (HCL) have recently been made. Improved distinction of HCL from its mimics though clinical presentations, morphologic and immunophenotypic features, and more recently molecular biology, has highlighted marked differences in treatment response and overall prognosis between these disorders. As our understanding of the unique pathobiology of HCL has grown, exciting new avenues of treatment as well as insight into immune function have been obtained. This review provides an overview of the clinical features and diagnostic attributes of HCL, with contrast to other mature B cell lymphoproliferative disorders with overlapping features.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- B-Lymphocytes/drug effects
- B-Lymphocytes/pathology
- Diagnosis, Differential
- Fatigue/diagnosis
- Fatigue/pathology
- Female
- Humans
- Indoles/therapeutic use
- Leukemia, Hairy Cell/diagnosis
- Leukemia, Hairy Cell/drug therapy
- Leukemia, Hairy Cell/pathology
- Leukemia, Hairy Cell/surgery
- Leukemia, Prolymphocytic, B-Cell/diagnosis
- Leukemia, Prolymphocytic, B-Cell/drug therapy
- Leukemia, Prolymphocytic, B-Cell/pathology
- Leukemia, Prolymphocytic, B-Cell/surgery
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/surgery
- Male
- Mutation
- Proto-Oncogene Proteins B-raf/antagonists & inhibitors
- Proto-Oncogene Proteins B-raf/genetics
- Sex Factors
- Splenectomy
- Splenomegaly/diagnosis
- Splenomegaly/pathology
- Splenomegaly/surgery
- Sulfonamides/therapeutic use
- Vemurafenib
- Waldenstrom Macroglobulinemia/diagnosis
- Waldenstrom Macroglobulinemia/drug therapy
- Waldenstrom Macroglobulinemia/pathology
- Waldenstrom Macroglobulinemia/surgery
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Affiliation(s)
- Graeme R Quest
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
| | - James B Johnston
- Section of Hematology/Oncology, CancerCare Manitoba, University of Manitoba, Manitoba, Canada
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Ye X, Mneina A, Johnston JB, Mahmud SM. Associations between statin use and non-Hodgkin lymphoma (NHL) risk and survival: a meta-analysis. Hematol Oncol 2015; 35:206-214. [PMID: 26482323 DOI: 10.1002/hon.2265] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 05/22/2015] [Revised: 08/04/2015] [Accepted: 09/18/2015] [Indexed: 12/22/2022]
Abstract
Evidence on the effect of statin use on non-Hodgkin lymphoma (NHL) is not clear. We conducted a systematic review and meta-analysis to examine the associations between statin use and NHL risk and survival. We searched multiple literature sources up to October 2014 and identified 10 studies on the risk of diagnosis with NHL and 9 studies on survival. Random effects model was used to calculate pooled odds ratio (PORs) for risk and pooled hazard ratio (PHR) for survival. Heterogeneity among studies was examined using the Tau-squared and the I-squared (I2 ) tests. Statin use was associated with reduced risk for total NHL (POR = 0.82, 95% CI 0.69-0.99). Among statin users, there was a lower incidence risk for marginal zone lymphoma (POR = 0.54, 95% CI 0.31-0.94), but this was not observed for other types of NHL. However, statin use did not affect overall survival (PHR = 1.02, 95% CI 0.99-1.06) or event-free survival (PHR = 0.99, 95% CI 0.87-1.12) in diffuse large B-cell lymphoma. There is suggestive epidemiological evidence that statins decrease the risk of NHL, but they do not influence survival in NHL patients. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Xibiao Ye
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Centre for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada.,Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ayat Mneina
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James B Johnston
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Salaheddin M Mahmud
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Centre for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada.,Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada.,College of Pharmacy, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Johnston JB. Bridging the Gap: Fostering Competitiveness in the Canadian Biobased Industry. Ind Biotechnol (New Rochelle N Y) 2015. [DOI: 10.1089/ind.2015.29012.jbj] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- James B. Johnston
- Aquatic and Crop Resource Development Portfolio, National Research Council of Canada, Ottawa, Canada
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Kriangkum J, Motz SN, Mack T, Beiggi S, Baigorri E, Kuppusamy H, Belch AR, Johnston JB, Pilarski LM. Single-Cell Analysis and Next-Generation Immuno-Sequencing Show That Multiple Clones Persist in Patients with Chronic Lymphocytic Leukemia. PLoS One 2015; 10:e0137232. [PMID: 26353109 PMCID: PMC4564241 DOI: 10.1371/journal.pone.0137232] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/14/2015] [Indexed: 12/29/2022] Open
Abstract
The immunoglobulin heavy chain (IGH) gene rearrangement in chronic lymphocytic leukemia (CLL) provides a unique molecular signature; however, we demonstrate that 26/198 CLL patients (13%) had more than one IGH rearrangement, indicating the power of molecular technology over phenotypic analysis. Single-cell PCR analysis and next-generation immuno-sequencing identified IGH-defined clones. In 23% (18/79) of cases whose clones carried unmutated immunoglobulin heavy chain variable (IGHV) genes (U-CLL), IGH rearrangements were bialleic with one productive (P) and one non-productive (NP) allele. Two U-CLL were biclonal, each clone being monoallelic (P). In 119 IGHV-mutated (M-CLL) cases, one had biallelic rearrangements in their CLL (P/NP) and five had 2–4 distinct clones. Allelic exclusion was maintained in all B-clones analyzed. Based on single-cell PCR analysis, 5/11 partner clones (45%) reached levels of >5x109 cells/L, suggesting second CLL clones. Partner clones persisted over years. Conventional IGH characterization and next-generation sequencing of 13 CLL, 3 multiple myeloma, 2 Waldenstrom’s macroglobulinemia and 3 age-matched healthy donors consistently identified the same rearranged IGH sequences. Most multiple clones occurred in M-CLL, perhaps indicative of weak clonal dominance, thereby associating with a good prognosis. In contrast, biallelic CLL occurred primarily in U-CLL thus being associated with poor prognosis. Extending beyond intra-clonal diversity, molecular analysis of clonal evolution and apparent subclones in CLL may also reflect inter-clonal diversity.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- B-Lymphocytes/immunology
- Clone Cells/immunology
- Female
- Gene Rearrangement, B-Lymphocyte, Heavy Chain/genetics
- Gene Rearrangement, B-Lymphocyte, Heavy Chain/immunology
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Heavy Chains/immunology
- Immunoglobulin Variable Region/genetics
- Immunoglobulin Variable Region/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Prognosis
- Single-Cell Analysis
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Affiliation(s)
- Jitra Kriangkum
- Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Canada
| | - Sarah N. Motz
- Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Canada
| | - Tanner Mack
- Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Canada
| | - Sara Beiggi
- Manitoba Institute of Cell Biology, Winnipeg, Canada
| | - Eva Baigorri
- Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Canada
| | - Hemalatha Kuppusamy
- Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Canada
| | - Andrew R. Belch
- Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Canada
| | | | - Linda M. Pilarski
- Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Canada
- * E-mail:
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Johnston JB. Enhancing monoclonal antibody activity in chronic lymphocytic leukemia. Leuk Lymphoma 2015; 56:2231-2. [PMID: 26247301 DOI: 10.3109/10428194.2015.1080927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- James B Johnston
- a Department of Internal Medicine , Section of Hematology/Oncology, Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba , Winnipeg , Manitoba, Canada
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Bouchard EDJ, Mejia EM, Gehrke I, Poeppl AG, Hewitt D, Johnston JB, Gibson SB, Hatch GM, Banerji V. Abstract 3052: NAMPT inhibition induces mitochondrial dysfunction leading to apoptosis in chronic lymphocytic leukemia cells. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-3052] [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
We have previously shown that the NAD depletion following inhibition of NAMPT by the NA-mimetic FK866 leads to loss of mitochondrial membrane potential, depletion of cellular ATP, cytochrome C release and caspase activation in primary Chronic Lymphocytic Leukemia (CLL) cells in vitro, and that these events are coupled with an increased production of reactive oxygen species uncharacteristic of metabolic inhibition. In the present study we characterize the effect of NAD depletion on CLL mitochondria and the downstream mechanism of cell death.
We profiled the mitochondrial respiration of CLL cells and control B-lymphocytes, by extracellular flux analysis, over the 48 hours following FK866 treatment and found time-dependant inhibition of respiratory capacity consistent with disruption of the electron transport chain (ETC) in CLL cells. This led to suppression of basal respiration concomitant with the rise in ROS and approximately one day before loss of cellular viability. Interestingly, Zap70-positive CLL cells exhibited increased mitochondrial respiration and respiratory capacity over Zap70-negative CLL cells, but responded similarly to NAMPT inhibition. Additionally, mitochondrial respiration was not effected by NAMPT inhibition in control B-lymphocytes.
Increase autophagic flux, caspase-dependant apoptosis and mitochondrio-nuclear translocation of Apoptosis Inducing Factor (AIF) were detected by western blot. However, neither pan-caspase inhibition with Z-VAD-fmk nor inhibition of autophagy with 3-methyladenine were sufficient to prevent FK866-induced CLL cell death. We conclude that NAD depletion following inhibition of NAMPT leads to disruption of the mitochondrial ETC in CLL cells, leading to mitochondrial initiation of the intrinsic apoptosis pathway. As healthy B-lymphocytes are resistant to this NAD depletion, these downstream effects are also selective for malignant cells.
We are currently working to characterize the roles of NAD and Zap70 in the regulation and function of the CLL ETC. This will not only lead to an improved understanding of CLL metabolism, but will also inform new therapeutic strategies that will effectively employ NAMPT inhibition to treat this yet-incurable disease.
Citation Format: Eric DJ Bouchard, Edgard M. Mejia, Iris Gehrke, Armando G. Poeppl, Donna Hewitt, James B. Johnston, Spencer B. Gibson, Grant M. Hatch, Versha Banerji. NAMPT inhibition induces mitochondrial dysfunction leading to apoptosis in chronic lymphocytic leukemia cells. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3052. doi:10.1158/1538-7445.AM2015-3052
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Affiliation(s)
| | | | - Iris Gehrke
- 2CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | | | - Donna Hewitt
- 2CancerCare Manitoba, Winnipeg, Manitoba, Canada
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Yang L, Beiggi S, Zhang Y, Schmidt R, Gibson SB, Johnston JB. Abstract 4624: Clinical impact of telomere shortening in normal and leukemia cells in chronic lymphocytic leukemia. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-4624] [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
Introduction: Prognosis in CLL is heterogeneous with the elderly, males and those with multiple co-morbidities having the highest risk of poorer outcomes. Whether this reflects differences in the biology of CLL or the result of altered immunosuppression is unknown. In normal individuals, the telomeres in somatic cells shorten with age, predisposing those with shorter telomeres to death from infections, cancer and cardiovascular disease. In chronic lymphocytic leukemia (CLL), short telomere length in the leukemia cells predicts poor prognosis. The contribution of un-modifiable factors of age, sex or comorbidities to telomere shortening in CLL has not been elucidated. In the present study, we evaluated buccal cell (BC) telomere length in patients with CLL, to determine if this is predictive of survival, and can enhance the predictive value of leukemia cell telomere length.
Methods: The Manitoba CLL tumor bank contains 168 samples from newly diagnosed CLL patients between 2007-2011; with a median follow-up of 4 years. Half of these patients required chemotherapy and one-tenth have died. Genomic DNA was extracted from purified CLL cells and buccal cells (BC) collected at diagnosis. Telomere length was established by multiplex quantitative real-time PCR. Telomere/standard (t/s) ratio was calculated using the beta-globulin gene as the standard. Statistical analysis was performed using Statistical Analysis Software (SAS) and Prism software.
Results: The median adjusted telomere length was shorter in CLL cells than in BCs being 0.53 and 2.01, respectively. In BCs, telomere length significantly shortened with increasing age (p = 0.01) but was not reflective of the number of comorbidities or survival. In contrast, telomere length in CLL cells was independent of age (p = 0.44) and sex (p = 0.75). Short CLL telomere length correlated with other biological and clinical markers of poorer prognosis including un-mutated IGHV status (p<0.0001), Zap70 positivity (p = 0.05), CD38 positivity (p = 0.003), short lymphocyte doubling time (p = 0.004), higher Rai stage (p = 0.02) and an earlier time to treatment (p<0.0001). Patients with short CLL telomeres had also decreased survival at four years (p = 0.05); living 22 months less than those with normal telomeres. Adjusting for BC telomere length improved the prognostic value of CLL telomere length as an independent predictor of survival.
Conclusions: These results demonstrate that BC telomere length in CLL patients shorten with age independent of co-morbidities, secondary malignancies and the respective CLL telomere length. CLL telomere shortening is strongly associated with biochemical and clinical markers of disease progression and survival. The predictive value for overall survival is enhanced by correcting for changes in buccal cell telomere length.
Note: This abstract was not presented at the meeting.
Citation Format: Lin Yang, Sara Beiggi, Yunli Zhang, Robert Schmidt, Spencer B. Gibson, James B. Johnston. Clinical impact of telomere shortening in normal and leukemia cells in chronic lymphocytic leukemia. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4624. doi:10.1158/1538-7445.AM2015-4624
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Affiliation(s)
- Lin Yang
- 1University of Manitoba, Department of Medicine, Winnipeg, Manitoba, Canada
| | - Sara Beiggi
- 2Department of Health Science Research, Mayo Clinic, Winnipeg, MN
| | - Yunli Zhang
- 3Manitoba Institute of Cell Biology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | | | - Spencer B. Gibson
- 3Manitoba Institute of Cell Biology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - James B. Johnston
- 3Manitoba Institute of Cell Biology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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Kost SE, Bouchard ED, Liang WS, Banerji V, Gibson SB, Katyal S, Johnston JB. Abstract 2555: The mechanism of action of bendamustine alone or in combination with nucleoside analogs in chronic lymphocytic leukemia. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-2555] [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
Bendamustine (BEN) is a promising new treatment for chronic lymphocytic leukemia (CLL) and is believed to function as an alkylating agent (eg, chlorambucil, CLB) while sharing structural similarities to a nucleoside analogue (eg, fludarabine, FLU). Enhanced cell death has been observed with the combination of BEN and FLU in primary CLL cells in vitro, likely due to the inhibition of repair of BEN DNA cross-linking by FLU. However, both BEN and FLU are marrow-toxic, limiting the use of this combination in the clinic. The nucleoside analog, pentostatin (PEN), is an adenosine deaminase inhibitor that causes the accumulation of deoxyadenosine (dADO) and is less marrow-suppressive than FLU. However, the cytotoxic effectiveness of dADO/PEN in combination with BEN is not known.
Flow cytometry analysis using annexin V/7-ADD and the MTT assay were performed to determine the effectiveness of BEN treatment in primary CLL cells as compared to or in combination with CLB, FLU, or dADO/PEN at varying drug concentrations and time points. Using the MTT assay, there was a linear relationship between cytotoxicity and drug concentration, similar to that seen with CLB. In vitro treatment of CLL cells with BEN, CLB, FLU, or dADO/PEN induced apoptosis, the degree being time- and concentration-dependent. However, the sensitivity of CLL cells to BEN or CLB varied, suggesting different mechanisms of action. Enhanced cell kill was seen with the combination of BEN or CLB with FLU or dADO/PEN, with the extent of increased cytotoxicity being similar for FLU or dADO/PEN. Cell death mechanisms were analyzed via staining for surface expression of death receptors (DR4 and DR5) and mitochondrial stress (DICO6 and DHE). γ-H2AX staining was used to measure DNA double-strand breaks (DSBs) and the alkaline comet assay was used to measure both DNA DSBs and single-strand breaks (SSBs). An increase in DR4 and DR5 surface expression, loss of mitochondrial membrane potential, and increased reactive oxygen species production was observed with all agents. There was an increase in DNA SSB and DSB following FLU, as compared to BEN and CLB, while a combination of BEN and FLU further increased the number of breaks (especially SSBs) compared to FLU alone.
Thus, BEN has the properties of an alkylating agent, rather than a nucleoside analog, but has a different spectrum of antitumor activity to CLB. BEN induces apoptosis through both the death receptor and mitochondrial pathways. Increased cell kill is seen on combining BEN with dADO/PEN suggesting that this might be a useful combination in the clinic.
Citation Format: Sara E.F. Kost, Eric D.J. Bouchard, William S. Liang, Versha Banerji, Spencer B. Gibson, Sachin Katyal, James B. Johnston. The mechanism of action of bendamustine alone or in combination with nucleoside analogs in chronic lymphocytic leukemia. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2555. doi:10.1158/1538-7445.AM2015-2555
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Beauchemin C, Johnston JB, Lapierre MÈ, Aissa F, Lachaine J. Relationship between progression-free survival and overall survival in chronic lymphocytic leukemia: a literature-based analysis. ACTA ACUST UNITED AC 2015; 22:e148-56. [PMID: 26089725 DOI: 10.3747/co.22.2119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The endpoints of progression-free survival (pfs) and time-to-progression (ttp) are frequently used to evaluate the clinical benefit of anticancer drugs. However, the surrogacy of those endpoints for overall survival (os) is not validated in all cancer settings. In the present study, we used a trial-based approach to assess the relationship between median pfs or ttp and median os in chronic lymphocytic leukemia (cll). METHODS The pico (population, interventions, comparators, outcomes) method was used to conduct a systematic review of the literature. The population consisted of patients with cll; the interventions and comparators were standard therapies for cll; and the outcomes were median pfs, ttp, and os. Two independent reviewers screened titles, abstracts, and full papers for eligibility and then extracted data from selected studies. Correlation coefficients were calculated to assess the relationship between median pfs or ttp and median os. Subgroup correlation analyses were also conducted according to the characteristics of the selected studies (such as line of treatment and type of treatment under investigation). RESULTS Of the 1263 potentially relevant articles identified during the literature search, twenty-three were included. On average, median pfs or ttp was 16.0 months (standard deviation: 12.4 months) and median os was 43.5 months (standard deviation: 31.2 months). Results of the correlation analysis indicated that median pfs or ttp is highly correlated with median os (Spearman correlation coefficient: 0.813; p ≤ 0.001). A significant correlation between median pfs or ttp and median os was observed in second- and subsequent-line therapies, but not in the first-line setting. CONCLUSIONS Our study demonstrates a strong correlation between median pfs or ttp and median os in previously treated cll, which reinforce the hypothesis that pfs and ttp could be adequate surrogate endpoints for os in this cancer setting.
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Affiliation(s)
| | - J B Johnston
- Manitoba Institute of Cell Biology, Winnipeg, MB
| | | | - F Aissa
- Lundbeck Canada, Montreal, QC
| | - J Lachaine
- Faculty of Pharmacy, University of Montreal, QC
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Lafarge ST, Hou S, Pauls SD, Johnston JB, Gibson SB, Marshall AJ. Differential expression and function of CD27 in chronic lymphocytic leukemia cells expressing ZAP-70. Leuk Res 2015; 39:773-8. [PMID: 26002513 DOI: 10.1016/j.leukres.2015.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 01/29/2015] [Revised: 04/14/2015] [Accepted: 04/16/2015] [Indexed: 12/25/2022]
Abstract
Chronic lymphocytic leukemia is a malignancy driven by abberant B cell signaling and survival. Leukemic B cells accumulate in the peripheral blood and the lymphoid organs where contact with stromal cells and T cells provide critical survival signals. Clinical severity of CLL is associated with several prognostic markers including expression of the kinase ZAP-70. ZAP-70 expression enhances signaling via the B cell antigen receptor and is associated with increased cell adhesion and migration capacity. Here we report that ZAP-70-positive CLL patients display significantly higher expression of the TNF superfamily receptor and memory marker CD27 than do ZAP-70 negative patients. CD27 expression by CLL was acutely elevated upon BCR cross-linking, or upon ectopic expression of ZAP-70. CD27 expression correlated with functional capacity to adhere to stromal cells and antibody blockade of CD27 impaired CLL binding to stroma. These results provide the first evidence for differential expression of CD27 among CLL prognostic groups, suggest a role for ZAP-70 dependent signaling in CD27 induction and implicate CD27 in cell-cell interactions with the lymphoid tissue microenvironment.
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Affiliation(s)
- Sandrine T Lafarge
- University of Manitoba, Department of Immunology, Winnipeg, MB, Canada; CancerCare Manitoba, Manitoba Institute of Cell Biology, Winnipeg, MB, Canada
| | - Sen Hou
- University of Manitoba, Department of Immunology, Winnipeg, MB, Canada
| | - Samantha D Pauls
- University of Manitoba, Department of Biochemistry and Medical Genetics, Winnipeg, MB, Canada
| | - James B Johnston
- CancerCare Manitoba, Manitoba Institute of Cell Biology, Winnipeg, MB, Canada
| | - Spencer B Gibson
- University of Manitoba, Department of Immunology, Winnipeg, MB, Canada; CancerCare Manitoba, Manitoba Institute of Cell Biology, Winnipeg, MB, Canada; University of Manitoba, Department of Biochemistry and Medical Genetics, Winnipeg, MB, Canada
| | - Aaron J Marshall
- University of Manitoba, Department of Immunology, Winnipeg, MB, Canada; University of Manitoba, Department of Biochemistry and Medical Genetics, Winnipeg, MB, Canada.
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Johnston JB, Nickerson JG, Daroszewski J, Mogg TJ, Burton GW. Biologically active polymers from spontaneous carotenoid oxidation: a new frontier in carotenoid activity. PLoS One 2014; 9:e111346. [PMID: 25360750 PMCID: PMC4216090 DOI: 10.1371/journal.pone.0111346] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/01/2014] [Indexed: 12/21/2022] Open
Abstract
In animals carotenoids show biological activity unrelated to vitamin A that has been considered to arise directly from the behavior of the parent compound, particularly as an antioxidant. However, the very property that confers antioxidant activity on some carotenoids in plants also confers susceptibility to oxidative transformation. As an alternative, it has been suggested that carotenoid oxidative breakdown or metabolic products could be the actual agents of activity in animals. However, an important and neglected aspect of the behavior of the highly unsaturated carotenoids is their potential to undergo addition of oxygen to form copolymers. Recently we reported that spontaneous oxidation of ß-carotene transforms it into a product dominated by ß-carotene-oxygen copolymers. We now report that the polymeric product is biologically active. Results suggest an overall ability to prime innate immune function to more rapidly respond to subsequent microbial challenges. An underlying structural resemblance to sporopollenin, found in the outer shell of spores and pollen, may allow the polymer to modulate innate immune responses through interactions with the pattern recognition receptor system. Oxygen copolymer formation appears common to all carotenoids, is anticipated to be widespread, and the products may contribute to the health benefits of carotenoid-rich fruits and vegetables.
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Affiliation(s)
- James B. Johnston
- National Research Council of Canada, Charlottetown, Prince Edward Island, Canada
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Dielschneider RF, Xiao W, Yoon JY, Noh E, Banerji V, Li H, Marshall AJ, Johnston JB, Gibson SB. Gefitinib targets ZAP-70-expressing chronic lymphocytic leukemia cells and inhibits B-cell receptor signaling. Cell Death Dis 2014; 5:e1439. [PMID: 25275600 PMCID: PMC4649506 DOI: 10.1038/cddis.2014.391] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 07/04/2014] [Accepted: 08/06/2014] [Indexed: 01/03/2023]
Abstract
Chronic lymphocytic leukemia (CLL) can be divided into groups based on biomarkers of poor prognosis. The expression of the tyrosine kinase ZAP-70 (member of the Syk tyrosine kinase family) in CLL cells is associated with shorter overall survival in CLL patients. Currently, there is a lack of targeted therapies for patients with ZAP-70 expression in CLL cells. The tyrosine kinase inhibitor gefitinib has been shown to be effective at induce apoptosis in acute myeloid leukemia through inhibition of Syk. In this study, we sought to test the efficacy of gefitinib in primary human ZAP-70+ CLL cells. We demonstrate that gefitinib preferentially induces cell death in ZAP-70-expressing CLL cells with a median IC50 of 4.5 μM. In addition, gefitinib decreases the viability of ZAP-70+ Jurkat T leukemia cells but fails to affect T cells from CLL patients. Western blot analysis shows gefitinib reduces both basal and B-cell receptor (BCR)-stimulated phosphorylation of Syk/ZAP-70, ERK, and Akt in ZAP-70+ CLL cells. Moreover, gefitinib inhibits the pro-survival response from BCR stimulation and decreases pro-survival proteins such as Mcl-1. Finally, ZAP-70 expression sensitizes Raji cells to gefitinib treatment. These results demonstrate that gefitinib specifically targets ZAP-70+ CLL cells and inhibits the BCR cell survival pathway leading to apoptosis. This represents the likelihood of tyrosine kinase inhibitors being effective targeted treatments for ZAP-70+ CLL cells.
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Affiliation(s)
- R F Dielschneider
- 1] Department of Immunology, University of Manitoba, Winnipeg, MB, Canada [2] Manitoba Institute of Cell Biology, Winnipeg, MB, Canada
| | - W Xiao
- Manitoba Institute of Cell Biology, Winnipeg, MB, Canada
| | - J-Y Yoon
- 1] Manitoba Institute of Cell Biology, Winnipeg, MB, Canada [2] Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - E Noh
- Manitoba Institute of Cell Biology, Winnipeg, MB, Canada
| | - V Banerji
- 1] Manitoba Institute of Cell Biology, Winnipeg, MB, Canada [2] Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada [3] Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB, Canada
| | - H Li
- Department of Immunology, University of Manitoba, Winnipeg, MB, Canada
| | - A J Marshall
- Department of Immunology, University of Manitoba, Winnipeg, MB, Canada
| | - J B Johnston
- 1] Manitoba Institute of Cell Biology, Winnipeg, MB, Canada [2] Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - S B Gibson
- 1] Department of Immunology, University of Manitoba, Winnipeg, MB, Canada [2] Manitoba Institute of Cell Biology, Winnipeg, MB, Canada [3] Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada [4] Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB, Canada
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Yoon JY, Ishdorj G, Graham BA, Johnston JB, Gibson SB. Valproic acid enhances fludarabine-induced apoptosis mediated by ROS and involving decreased AKT and ATM activation in B-cell-lymphoid neoplastic cells. Apoptosis 2014; 19:191-200. [PMID: 24057147 DOI: 10.1007/s10495-013-0906-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Histone deacetylase (HDAC) inhibitors have been shown synergize with a number of cytotoxic drugs in leukemic cells. In chronic lymphocytic leukemia (CLL), the first line therapy is based on the combination of fludarabine, a nucleoside analogue, and rituximab, an anti-CD20 monoclonal antibody, and there are presently no HDAC inhibitors are used to manage CLL. In the present study, we found that the addition of valproic acid (VPA), a HDAC inhibitor, increases cell death in B-cell-neoplasm-derived cell lines, BJAB, NALM-6 and I-83. This increased apoptosis caused release of mitochondrial cytochrome c, activation of caspases, and increased reactive oxygen species (ROS). The addition of a ROS scavenger inhibited cell death induced by the VPA-fludarabine combination. In contrast, blocking the death receptor pathway failed to inhibit VPA increased fludarabine induced apoptosis. Combination of VPA and fludarabine treatment decreased both total and phosphorylated levels of AKT, an important anti-apoptotic protein, and ATM, a pivotal protein in DNA damage response. Chemical inhibition of AKT or ATM was sufficient to enhance fludarabine-induced apoptosis. We next examined patient samples from a local clinical trial where relapsed CLL patients were treated with VPA and examined the effects of VPA on AKT and ATM in vivo. After 30 days, there was a reduction in ATM levels in three out of the four patients treated, while AKT phosphorylation was reduced only in one patient. Taken together, VPA reduces ATM levels, thereby increasing ROS-dependent cell death via the mitochondrial apoptotic pathway when combined with fludarabine.
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Affiliation(s)
- Ju-Yoon Yoon
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB, Canada
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Gehrke I, Bouchard ED, Beiggi S, Poeppl AG, Johnston JB, Gibson SB, Banerji V. On-Target Effect of FK866, a Nicotinamide Phosphoribosyl Transferase Inhibitor, by Apoptosis-Mediated Death in Chronic Lymphocytic Leukemia Cells. Clin Cancer Res 2014; 20:4861-72. [DOI: 10.1158/1078-0432.ccr-14-0624] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lafarge ST, Li H, Pauls SD, Hou S, Johnston JB, Gibson SB, Marshall AJ. ZAP70 expression directly promotes chronic lymphocytic leukaemia cell adhesion to bone marrow stromal cells. Br J Haematol 2014; 168:139-42. [PMID: 25088442 DOI: 10.1111/bjh.13063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Sandrine T Lafarge
- Department of Immunology, University of Manitoba, Winnipeg, MB, Canada; Cancercare Manitoba, Manitoba Institute of Cell Biology, Winnipeg, MB, Canada
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